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May 052012
 
Fellows: This is your brain on protocols (JAMA)

(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]

May 032012
 
Epinephrine in field no help after out-of-hospital cardiac arrest? (JAMA)

(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]

May 022012
 
Cost shifting of asthma meds to patients had little effect on adherence, outcomes (JAMA)

(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]

Apr 282012
 
Inferior vena cava filters for acute PE and DVT (ACCP Guidelines)

The content here previously has been removed at the request of the American College of Chest Physicians. For the ACCP’s Guidelines for Diagnosis and Management of DVT/PE/VTE, 9th edition, please visit the ACCP’s web site. PulmCCM is not affiliated with the ACCP.

Apr 272012
 
Watch out for staph coinfections in severe influenza pneumonia (MMWR)

The CDC announced in its Morbidity and Mortality Weekly Report (MMWR) the sad story of three members of a close-knit Maryland family who all died within days of each other from pneumonia due to seasonal influenza A (H3N2) with methicillin-resistant Staph aureus (MRSA) co-infection. Three additional family members acquired the same influenza A strain (which was [… read more]

Apr 242012
 
How to make $25,000 on each EBUS (Chest)

(image: flickrCC) Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), when performed by skilled physicians, reduces the need for mediastinoscopy and unnecessary thoracotomies with their associated morbidity, and is poised to permanently alter the landscape of lung cancer diagnosis and staging. Prior to 2008, Medicare seemed to recognize the potential value of EBUS by paying hospitals [… read more]

Apr 232012
 
Thrombolytics for acute pulmonary embolism (Guidelines)

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.

Apr 222012
 
Should you check pleural manometry during thoracentesis?

(image: Cardinal Health) Should you routinely check pleural pressures with bedside manometry during thoracentesis? David Feller-Kopman of Johns Hopkins says, of course: it’s zero risk, zero cost, only seconds of extra time, and provides potentially useful clinical information. Specifically, one can identify people with “entrapped lung” and “trapped lung”: Identifying “Entrapped Lung” by Pleural Pressures [… read more]

Apr 212012
 
Pneumothorax in the ICU (Review, Chest)

From the excellent review by Lonny Yarmus and David Feller-Kopman in the April 2012 Chest, along with the British Thoracic Society and ACCP’s consensus statements: Mechanisms of Pneumothorax in the Critically Ill Air can accumulate in the pleural space in three ways: Rupture of the visceral pleura allowing air to travel from alveoli to the [… read more]

Apr 202012
 
Texting resident fails to stop warfarin; hemopericardium ensues

Texting while doctoring is a newly hyped threat to patient safety. Multitasking and the constant flow of new distracting information in the form of alarms, interruptions, pages, etc. have always been inherent to the practice of medicine. But some are wondering if the ubiquitous temptations of personal social media-enabled smartphones and tablets in the medical [… read more]

Apr 172012
 
Most oncologists dump end-of-life talks on other MDs (Ann Intern Med)

(image: Plioz.com) Ever cared for that patient with metastatic cancer in your ICU, intubated for acute respiratory failure and surrounded by a bewildered and stressed family who cope by emotionally blaming you, the intensivist, because “He just saw his oncologist last week, and he said everything was OK!”? Forcing you to begin painful end-of-life discussions [… read more]

Apr 162012
 
NYT runs press release for new OSA treatment Provent. Does it work?

Provent is the trade name for disposable, stick-on nose plugs made by Ventus Medical that are a relatively new (second-line) treatment for obstructive sleep apnea. The bandage-like device has pinholes cut in the nostrils that let air in during inspiration, but create back pressure during exhalation, helping prevent airway collapse. The New York Times just [… read more]

Apr 142012
 
NYU's Clinical Correlations: a great internal medicine review

We have our hands full at PulmCCM Central just keeping up with the best published literature in pulmonary and critical care medicine. Somehow, the folks at NYU manage to vet the much larger volume of literature published in internal medicine, and offer it in a user-friendly review in their Clinical Correlations blog. Clinical Correlations is [… read more]

Apr 132012
 
Vitamin D supplements don't prevent COPD exacerbations in RCT (Ann Intern Med)

Vitamin D deficiency has been linked to many chronic medical conditions, including asthma and chronic obstructive pulmonary disease (COPD). In some cases, more severe vitamin D deficiency is associated with more severe chronic illness. However, it’s never been shown that vitamin D deficiency supplemenation improves or prevents illness; i.e., that vitamin D deficiency causes or exacerbates [… read more]

Apr 122012
 
Release the data on Relenza and Tamiflu, Cochrane implores Pharma (NYT)

Antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) made big bucks for Roche and GSK respectively during the H1N1 influenza pandemic: Roche reportedly sold  about $3 billion of Tamiflu in 2009. Although sales have dropped off precipitously, the drugs are still recommended by CDC for serious cases of seasonal influenza. But do Relenza and Tamiflu even [… read more]

Apr 112012
 
Lack of ICU beds has no effect on mortality ... in Canada? (Arch Intern Med)

What happens when the “Rapid Response Team” is called for an acutely deteriorating patient, but there’s no ICU bed available to send her to? In Alberta, Canada, not much, apparently. Henry Stelfox, Brenda Hemmelgarn, and Braden Manns analyzed 3,494 consecutive patients with “Code MET (medical emergency team)” rapid-response activations in Calgary between 2007 and 2009. [… read more]

Apr 062012
 

The 5-year results of the Danish Lung Cancer Screening Trial (DLCST) were reported in the April 2012 Thorax, and they show no mortality benefit from annual screening for lung cancer with chest CT. Rather, it appeared that more harmless early stage cancers were identified through screening — “overdiagnosis” of cancers that would never have advanced [… read more]

Apr 052012
 

A large proportion of primary care doctors were easily fooled by numbers that seemed to support cancer screening, but were actually irrelevant. Just as bad, they ignored data supporting screening that would genuinely save lives, in a questionnaire simulation published in the March 6 Annals of Internal Medicine. 412 primary care docs were given surveys testing [… read more]

Apr 052012
 

The Joint Commission (previously called “JCAHO”) launched its new “Tobacco Cessation Performance Measure Set” on January 1, 2012. Like most New Years’ resolutions, we all promptly ignored it. But it’s time to pay attention — your hospital might be. Wasn’t there already a smoking cessation performance measure? Yes, in 2004 hospitals were required to report the proportion [… read more]