PulmCCM - Page 30 of 40 - All the best in pulmonary & critical care
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Jun 202011
 

Menthol doesn’t kill people — cigarettes that are tastier and easier to smoke because of menthol do. The FDA’s Tobacco Products Scientific Advisory Committee blandly concluded that removing menthol from cigarettes would improve public health, but in the current pro-economic recovery environment, there is no political will to take on Big Tobacco, Siegel, Benowitz and [... read more]

Jun 192011
 

In severe congestive heart failure, lymphatic drainage can increase 10-fold. Pastis et al hypothesize this could result in enlarged mediastinal lymph nodes. They retrospectively examined chest CT scans for 118 patients undergoing heart transplantation. Fifty-three had mediastinal LNs > 1 cm. In the 9 who had post-transplant CT scans available, mediastinal lymph nodes shrank after [... read more]

Jun 192011
 

Masclans et al followed 38 patients with ARDS in 3 ICUs for 6 months. Health-related quality of life (Nottingham Test Profile) was lower than expected at 6 months, with 40% reporting limitations in daily activities mainly due to low energy, mobility and social functioning. Mild radiographic abnormalities and restrictive physiology were usually present on HRCT [... read more]

Jun 182011
 

Actuarial survival in PAH has been predicted mainly by functional class and echocardiographic evidence of right heart failure. Observing 484 patients with WHO group I PAH for 5 years after diagnosis, Kane et al showed that using their own multivariate model (incorporating clinical data including renal function, BNP, DLCO, BP & HR, etc.) generated better [... read more]

Jun 182011
 

After 25 years of declines in coal workers’ pneumoconiosis (thanks to federal regulation of tolerable concentrations of coal dust and radiographic surveillance of miners), CWP and progressive massive fibrosis have been on the upswing since 2001, killing or disabling dozens of relatively young miners. Wade et al describe the trend in a cohort of 138 [... read more]

Jun 172011
 

Pulmonary rehabilitation, realities in clinical practice. Birnbaum S, CHEST 2011;139:1498-1502. Having trouble finding a pulmonary rehab program to refer your COPD patient into? That may be because in 2011, according to Mr. Birnbaum, Medicare paid outpatient centers $28 per rehabilitation session, per patient.

Jun 162011
 

Boutitie et al analyzed pooled anticoagulation clinic data from 2,925 people with a first deep venous thrombosis or pulmonary embolism in the UK. They found that the recurrence risk after stopping anticoagulation at 3 months was equivalent to stopping at 6 months. Proximal DVTs were more likely to recur than distal DVTs. BMJ 2011;342:d3036. FREE [... read more]

Jun 152011
 

Douma et al compared the Wells score, Geneva score, and the simplified versions of each, combined with D-dimer, on a prospective cohort of 807 patients with suspected PE (~23% of whom were found to have PE). With a negative D-dimer and a low-probability score using any rule, risk of pulmonary embolism was ~0.5%. However, only [... read more]

Jun 152011
 

No one knows, say Lee et al. They report on 27 Korean soldiers who were exposed to 5 barracks-mates with active TB; 26 eventually “converted” by tuberculin skin test/PPD or by interferon-gamma release assay. One-time TST/PPD identified 21, or 78%. IGRA every two weeks eventually diagnosed 26 (96%), but it took 14 weeks for 3 [... read more]

Jun 142011
 

Gershengorn et al retrospectively compared two MICUs at Beth Israel: one with “midlevels” (nurse practitioners and physician assistants during the day with attending coverage overnight) and one that was all house staff 24/7. There were no differences in important outcomes (mortality, MICU or hospital LOS), although the study was nonrandomized and subject to bias. CHEST [... read more]

Jun 142011
 

Salaun et al publish their experience using a simple algorithm for management of 321 consecutive patients with suspected pulmonary embolism at one center in France. The tool sought to avoid CT-angiography (and associated radiation) wherever possible, instead favoring leg ultrasounds and ventilation-perfusion scans. Only the indeterminate cases (a mere 35, or 11%) underwent CT-A. In [... read more]