PulmCCM - Page 20 of 43 - All the best in pulmonary & critical care
Mar 252012

“The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care,” writes Ezekiel Emanuel, Obama’s former health care advisor who’s now back at University of Pennsylvania in a big-thinker job spanning ethics, economics and medicine. In a JAMA essay with co-author Viktor Fuchs, they opine that [… read more]

Mar 242012

(Comments by first author James T. Good follow this post.) For 58 patients with refractory asthma at National Jewish, James Good et al devised a systematic, bronchoscopy-driven approach that they feel resulted in improved asthma symptoms and identification of potential phenotypes of refractory asthma among the enrolled subjects. Their methodology was highly detailed and time- and labor-intensive. It included using [… read more]

Mar 232012

An observational trial by Jim Kutsoguiannis, Cathy Alberda, Daren Heyland et al published in the December 2011 Critical Care Medicine showed no difference in 60-day survival among critically ill, mechanically ventilated patients started on parenteral nutrition (TPN) “early” (within 48 hours of ICU admission) or “late” (after 48 hours). Only 258 patients were included in the [… read more]

Mar 222012

Mazen Albeldawi and Rohit Makkar of the Cleveland Clinic bring us a free image in the New England Journal of what the bronchial tree looks like when a barium swallow test goes horribly awry. This patient had a very poor outcome, particularly unfortunate since this was an elective test. The New England Journal also ran a previous [… read more]

Mar 192012

This post was featured on KevinMD.com; an excerpt follows: An essay in JAMA by Vinay Prasad (Northwestern of Chicago), Adam Cifu (U. of Chicago) and John Ioannidis (Stanford) should be required reading for every medical student, resident, and to pass every board certification exam in any specialty. In my humble opinion. John Ioannidis became one [… read more]

Mar 182012

Sleep docs don’t come off looking so hot in this recent NPR story, which paints some of them as opportunistic plunderers of the nation’s health care dollars, over-ordering expensive sleep studies to make a buck. As reporter Jenny Gold points out, the number of sleep studies performed in the U.S. has quadrupled over the past [… read more]

Mar 152012

Diaphragmatic dysfunction can result from nerve damage, primary muscle problems, or problems with the muscle’s interaction with the chest wall. The true incidence of diaphragmatic paralysis is unknown, since many patients are asymptomatic. Treatment for diaphragmatic dysfunction usually consists of watchful waiting, addressing underlying causes, with mechanical ventilation if respiratory failure develops. Causes of Diaphragmatic [… read more]

Mar 142012

The National Lung Screening Trial (NSLT) showed a 20% reduction in death from lung cancer, but with a number needed to screen of 320 to prevent one death, a false-positive rate of 96% and each abnormal scan generating costs of ~$45,000, the risk / benefit / cost accounts are far from settled. Few insurers (e.g. [… read more]

Mar 112012

The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.

Mar 092012
Rituximab improved pulmonary alveolar proteinosis in pilot study (Eur Resp J)

Pulmonary alveolar proteinosis occurs as an idiopathic disease, or can be secondary to other conditions (HIV, silica exposure, infections, blood cancers). In the idiopathic form, autoantibodies to GM-CSF are thought to be responsible. Rituximab (a chimeric mouse-human monoclonal antibody binding CD-20) depletes human B-cells, reducing antibody production. Autoantibodies are particularly reduced after rituximab administration, leading [… read more]

Mar 082012
Obstructive sleep apnea increases risk for postop complications (CHEST)

Mayo investigators reported back in 2001 that people with obstructive sleep apnea had a higher rate of perioperative complications including hypoxia and longer lengths of stay. Since then, there have been other signals that this is a real phenomenon, but perhaps surprisingly, the evidence hasn’t exactly piled up to unequivocally prove the intuitive point. That’s [… read more]

Mar 072012

When someone with a pneumothorax lies supine — as in the 23-year old man described in this New England Journal mini-case from Saweera Sabbar and Eric James Nilles of Rashid Trauma Center in Dubai, UAE — air rises laterally and caudally, and creates displacement downward and medially of the hemidiaphragm, displaying as the “deep sulcus [… read more]

Mar 042012

It wasn’t such a crazy idea, injecting beta-agonists continuously into the veins of people with acute respiratory distress syndrome (ARDS) for a week. After all, if you spray some albuterol on alveolar epithelial cells in a dish, it upregulates their cAMP production and doubles the rate at which they clear fluid across their basement membranes. [… read more]

Mar 022012
Walk to wean: Early mobilization for ventilated patients (Review, CHEST)

Daily interruption of sedation (daily awakening or sedation holidays) works like a charm to get patients off the ventilator, faster. After proving that a decade or so ago, practice-changers John Kress and William Schweickert have turned their attention to early mobilization as the next intervention that could help mechanically ventilated patients escape the ventilator faster. [… read more]

Feb 292012
"First dibs" on patients by sleep docs increased CPAP adherence (CHEST)

In the face of criticism from insurers and the government for a perceived excessive zeal for profits, and mounting evidence that uncomplicated obstructive sleep apnea (OSA) can be diagnosed at home and managed by primary physicians, you can’t blame sleep specialists for feeling down-in-the-mouth lately. Sushmita Pamidi et al report some brighter news in the [… read more]

Feb 282012

For unclear reasons, people receiving chemotherapy for solid tumors are at particularly increased risk for deep venous thrombosis and pulmonary embolism (DVT/PE). Semuloparin is an ultra-low-molecular weight heparin with a long half life of 16-20 hours that (like enoxaparin) is renally excreted. Sanofi, makers of Lovenox, report in the February 16 New England Journal of [… read more]

Feb 272012

“Medical identity theft” — theft of your unique identifiers to perpetrate Medicare or insurance fraud — may be on the rise, according to the Federal Trade Commission. There were 12,000 cases of medical identity theft reported by patients or doctors between 2007-2009. A JAMA article by Shantanu Agrawal and Peter Budetti describes one hapless victim’s [… read more]