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COPD self-care program fail; unexplained deaths at VA hospitals (RCT)

 Clinic and Consults, COPD, Policy, Ethics, Education, Randomized Controlled Trials  Comments Off on COPD self-care program fail; unexplained deaths at VA hospitals (RCT)
Jun 092012
 
COPD self-care program fail; unexplained deaths at VA hospitals (RCT)

Chronic diseases like chronic obstructive pulmonary disease (COPD) account for at least 2/3 of medical care spending in the U.S. Policy makers, payers, and many physicians recognize that the outpatient clinic-based model is poorly suited to provide support in between physician visits, when most complications or exacerbations occur. Many hospitalizations and decline in function could [… read more]

Inhaled hypertonic saline for young kids with cystic fibrosis: no benefit? (RCT)

 Cystic Fibrosis, Randomized Controlled Trials  Comments Off on Inhaled hypertonic saline for young kids with cystic fibrosis: no benefit? (RCT)
Jun 072012
 
Inhaled hypertonic saline for young kids with cystic fibrosis: no benefit? (RCT)

(image: Bennett Gamel blog) Inhaled hypertonic saline (7% NaCl) increases clearance of mucus by airway cilia, making it an attractive treatment for cystic fibrosis. Hypertonic saline has been a cornerstone of daily therapy for CF ever since a 2006 NEJM randomized trial showed that ~80 adults and kids older than 6 using hypertonic saline for [… read more]

Jun 012012
 
Bronchodilator reversibility testing in COPD: Bill for it, but don't believe it

(image: flickrCC) Why do we test chronic obstructive pulmonary disease (COPD) patients for bronchodilator responsiveness (besides getting to charging a few extra bucks for it)? If I am reading this article right, the answer is, there’s no good reason. Consider this: Bronchodilator responsiveness (BDR) or the lack thereof does not distinguish COPD from asthma. Bronchodilator [… read more]

May 252012
 
Fever reduction improves early mortality in septic shock? Take a closer look

by Scott Aberegg, MD, MPH It is rare occasion that one article allows me to review so many aspects of the epistemology of medical evidence, but alas Schortgen et al afforded me that opportunity in the May 15th issue of AJRCCM. The issues raised by this article are so numerous that I shall make subsections for each one. [… read more]

U.S. Gov’t purse strings may be tightening on GME programs

 Policy, Ethics, Education  Comments Off on U.S. Gov’t purse strings may be tightening on GME programs
May 242012
 
U.S. Gov't purse strings may be tightening on GME programs

(image: arstechnica) The Centers for Medicare and Medicaid Services fund graduate medical education (GME) in the U.S. through payroll taxes — to the tune of $9.5 billion per year. Only a portion of that actually goes to paying house staff salaries, though. The rest, academic medical centers have traditionally been free to spend more or [… read more]

May 232012
 
For some LTAC patients, pessimism is the new kindness

(image: flickrCC) Half of patients transferred to long-term acute care facilities (LTACs) on prolonged mechanical ventilation will die within a year, according to a 2010 review. Only a small minority will ever go home without needing significant caregiver assistance. For those over age 65, the prognosis is even worse. It seems rude, or even cruel, [… read more]

Where’s the respect (and $$) for critical care research?

 Critical Care, Policy, Ethics, Education  Comments Off on Where’s the respect (and $$) for critical care research?
May 172012
 
Where's the respect (and $$) for critical care research?

(image: Suburban Wino) Craig Coopersmith of Emory is an amazing guy and a prolific investigator in critical care — and it looks like he’s fed up with having his grants rejected. After some epic bean-counting, his group concludes that critical care research gets short shrift in federal research funding, compared to the huge amounts spent [… read more]

May 162012
 
Tattletales rain on private cardiologists' cash-grabbing parade

Did you know that about half of cardiologists’ $400,000+ average income comes from self-referring patients to undergo imaging studies on scanners owned in part or in whole by the physicians themselves? This type of arrangement violates the spirit but not the letter of the Stark Law, created in 1992 to address the inevitable economic and medical inequities that result when physicians are permitted [… read more]

May 132012
 
Chantix: no excess cardiovascular risk in new meta-analysis

(image: People’s Pharmacy) Sure to re-light controversy around Pfizer’s varenicline (Chantix): a new study concludes the smoking cessation drug likely carries no increased risk for cardiovascular events.  Judith Prochaska and Joan Hilton (University of California – San Francisco) report the results in the May 4 BMJ. Sonal Singh (Johns Hopkins) et al’s previous meta-analysis, reported in CMAJ [… read more]

May 122012
 
Mechanical Ventilation in ARDS: Research Update

Mechanical Ventilation in ARDS: 2014 Review (More PulmCCM Topic Updates) People with acute respiratory distress syndrome (ARDS) are by definition severely hypoxemic, and nearly all require invasive mechanical ventilation. Yet mechanical ventilation itself can further injure damaged lungs (so-called ventilator-induced lung injury); minimizing any additional damage while maintaining adequate gas exchange (“compatible with life”) is the [… read more]

May 112012
 
Acetaminophen causes childhood asthma, researcher argues

(image: flickrCC) Is acetaminophen responsible for the worldwide rise in childhood asthma over the past 30 years? Citing a mounting pile of circumstantial evidence from epidemiologic observational studies, John McBride of Akron’s Children’s Hospital in Ohio believes so, and that it’s time to officially push the worry button. The theory is that the fear of aspirin-induced [… read more]

May 102012
 
How to bill for palliative care in the ICU ... legally

Reimbursement for Palliative Care in the ICU By Intensivists To an intensivist, providing palliative care often means having multiple time-consuming and emotionally challenging interactions with families struggling to cope with the impending loss of their loved one. The emotional content of these interactions can be strongly positive, negative, or somewhere in between, but frequently it’s [… read more]

Are those your cooties? MDR-bug transmission rates in ICUs

 Critical Care, Infectious Disease and Sepsis  Comments Off on Are those your cooties? MDR-bug transmission rates in ICUs
May 092012
 
Are those your cooties? MDR-bug transmission rates in ICUs

(image: flickrCC) Foam in, foam out, gown on, gown off … ah, the tedium of practicing critical care medicine in the age of rampant, lethal, multi-drug resistant bacteria. As a reminder to keep your guard up and your gear on, here’s a yucky study from Daniel Morgan, Elizabeth Rogawski, and Anthony Harris of the University [… read more]

May 062012
 
Chronic obstructive pulmonary disease 2014 update (COPD Review)

Chronic Obstructive Pulmonary Disease (COPD) 2014 Review Epidemiology of COPD Globally, ~10% of people older than 40 have airflow limitation of GOLD stage 2 or worse (FEV1 < 80% predicted); up to 25% may have GOLD stage 1 (FEV1 ≥ 80% predicted but FEV1/FVC < 0.7). Up to 60-85% of people with COPD (mostly mild/moderate [… read more]

May 052012
 
Fellows: This is your brain on protocols

(image: flickrCC) Do protocols make trainees’ brains go soft? That’s the assertion of more than a few crusty hard-liners who miss the good old days — when you got 2-liter tidal volumes for your ARDS and liked it, dad-gum-it!! Prasad et al can’t say whether critical care fellows can actually run ventilators in the post-protocol [… read more]

Epinephrine in field no help after out-of-hospital cardiac arrest?

 Cardiovascular Disease, Critical Care  Comments Off on Epinephrine in field no help after out-of-hospital cardiac arrest?
May 032012
 
Epinephrine in field no help after out-of-hospital cardiac arrest?

(image: Hospira) Akihito Hagihara et al present suggestive data in the March 21 JAMA that giving epinephrine to people with out of hospital cardiac arrest increases their chances of making it to the hospital with a pulse, but not of making it home with decent brain function or functional status. In a prospective observational analysis [… read more]

Cost shifting of asthma meds to patients had little effect on adherence, outcomes

 Asthma, Clinic and Consults, Policy, Ethics, Education  Comments Off on Cost shifting of asthma meds to patients had little effect on adherence, outcomes
May 022012
 
Cost shifting of asthma meds to patients had little effect on adherence, outcomes

(image: flickrCC) Health insurance plans are shifting an increasing portion of costs for prescription medications onto patients. A recent study in JAMA concluded that such cost shifting decreased asthma medication use and increased hospitalization rates in U.S. children. But the effect, if real, was small. What They Did Pinar Karaca-Mandic et al looked back at [… read more]