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The price of manners: $42 million

 Clinic and Consults, Policy, Ethics, Education  Comments Off on The price of manners: $42 million
Oct 022011
 

It sounds like a doctor must have been pretty rude to Chicago’s Ms. Carolyn Bucksbaum 20+ years ago. She’s giving $42 million of her and her husband’s shopping-mall fortune to the University of Chicago, to create an institute devoted to improving medical students’ bedside mannerisms. Their beloved personal U. of C. physician, Mark Siegler, will [… read more]

Is your stage III NSCLC patient truly “downstaged” to N0? EUS helpful only if positive

 Interventional Pulmonology, Lung Cancer  Comments Off on Is your stage III NSCLC patient truly “downstaged” to N0? EUS helpful only if positive
Oct 022011
 

So you’ve referred your patient with stage III non-small cell lung cancer (N2 or N3 mediastinal nodes) to receive neoadjuvant chemoradiation therapy in the hopes of eliminating cancer from the mediastinal nodes, “downstaging” her to a resectable N0 status. How do you re-evaluate the lymph nodes to ensure resection may be curative? von Bartheld et [… read more]

I learned it from watching YOU, Mum!! U.K. kids smoke more when parents, siblings do

 Clinic and Consults, COPD, Policy, Ethics, Education  Comments Off on I learned it from watching YOU, Mum!! U.K. kids smoke more when parents, siblings do
Oct 012011
 

Combining 58 studies into a meta-analysis, Leonardi-Bee et al report that children in the U.K. are more likely to start smoking if both parents smoke (odds ratio 2.7), a brother or sister (OR 2.3), only their mother smokes (OR 2.2), or only their father (OR 1.7). If only their Aunt Haggie smokes, the effects are [… read more]

PET-CT’s diagnostic accuracy plummets in region endemic for granulomatous disease (southeast U.S.)

 Interventional Pulmonology, Lung Cancer, Radiology & Imaging  Comments Off on PET-CT’s diagnostic accuracy plummets in region endemic for granulomatous disease (southeast U.S.)
Oct 012011
 

Deppen et al report that PET-CT’s specificity for lung cancer was only 40% among 211 patients undergoing resection for presumed lung cancer at Vanderbilt in Nashville, TN, an area endemic for histoplasmosis. Twenty-two of 43 benign nodules were granulomas; most were positive on PET-CT (~60%). Ann Thorac Surg 2011;92:428-433.

Sep 302011
 

Hao et al pooled data from 10 heterogeneous randomized trials (n=3,451) comparing probiotics (various preparations) vs. placebo, with the outcome of upper respiratory tract infections. Those using probiotics had a reduction in number of URTIs and antibiotic prescriptions by ~1/3 to ~1/2. There was significant heterogeneity among the trials, which included very few people over [… read more]

Sep 292011
 

Increasing urine output should reduce the risk for contrast nephropathy, as should hustling contrast metal past vulnerable Na-K-Cl transporters using loop diuretics. However, furosemide alone increases the risk for contrast nephropathy. Some hypothesized that was due to diuretic-induced hypovolemia. Briguori et al report results of REMEDIAL-II. They randomized ~300 patients at very high risk for [… read more]

NSCLC: Use of biomarkers in prognosis, treatment

 Interventional Pulmonology, Lung Cancer, Review Articles  Comments Off on NSCLC: Use of biomarkers in prognosis, treatment
Sep 282011
 

37 Canadian oncologists got together in a consensus panel to talk about biomarkers and histologic subtypes of non-small cell lung cancer. The take-home: All NSCLC should be tested for the EGFR mutation, as tyrosine kinase inhibitors can prolong survival for eligible patients. There is insufficient evidence to recommend routine testing for other mutations (KRAS, p53, [… read more]

Montelukast improved peak flow during acute asthma exacerbations

 Asthma, Randomized Controlled Trials  Comments Off on Montelukast improved peak flow during acute asthma exacerbations
Sep 272011
 

Leukotrienes are important inflammatory mediators in both chronic asthma and acute exacerbations. Well-known for their benefits in the management of chronic asthma, leukotriene receptor antagonists haven’t been tested in acute asthma. Ramsay et al randomized 87 adults admitted to the hospital for asthma exacerbations to receive daily montelukast 10 mg or placebo for 4 weeks, [… read more]

Sep 272011
 

Perhaps the most contentious debate in critical care is whether and when to transfuse blood to patients, especially those with acute lung injury and/or septic shock. FACTT showed less fluids (which could include blood) are better for ALI/ARDS, but transfusion wasn’t controlled and its contribution to the outcomes is unknown. Practicing physicians vary widely in [… read more]

Lifetime risk of COPD is 28% in cohort study of 13M people

 COPD, Policy, Ethics, Education  Comments Off on Lifetime risk of COPD is 28% in cohort study of 13M people
Sep 262011
 

Gershon et al used Canadian health administrative databases to identify all new diagnoses of COPD in Ontario from 1996-2010, a cohort of 13 million people. Lifetime risk of COPD (by age 80) was 27.6%. Smoking status was not available/included in the analysis. These were physicians’ diagnoses of COPD (using a validated case definition); there was [… read more]

New H3N2 swine flu emerges, in isolated cases only (MMWR)

 Infectious Disease and Sepsis, Policy, Ethics, Education  Comments Off on New H3N2 swine flu emerges, in isolated cases only (MMWR)
Sep 242011
 

Two kids under 5, one in Indiana and the other in Pennsylvania, have contracted a new reassorted swine flu: H3N2. The Pennsylvania child had had direct contact with a pig at an agricultural fair; the Indiana kid had been cared for by someone who had come in contact with a pig recently. Both children recovered [… read more]

Idiopathic pulmonary fibrosis: Tyrosine kinase inhibitor BIBF 1120 appeared helpful

 Diffuse Lung Disease & Interstitial Lung Disease, Randomized Controlled Trials  Comments Off on Idiopathic pulmonary fibrosis: Tyrosine kinase inhibitor BIBF 1120 appeared helpful
Sep 222011
 

Lung fibrosis is partially mediated by tyrosine kinase pathways. BIBF 1120 is a tyrosine kinase inhibitor that targets vascular endothelial growth factor receptor (VEGFR), fibroblast growth factor receptor (FGFR) and platelet-derived growth factor receptor (PDGFR) — all receptors known to be involved in lung fibrosis. Supported by Boehringer Ingelheim, Richeldi et al randomized 432 patients with [… read more]

EBUS FNA very good at finding lymph node mets from extrathoracic malignancy

 Interventional Pulmonology, Lung Cancer  Comments Off on EBUS FNA very good at finding lymph node mets from extrathoracic malignancy
Sep 222011
 

In 161 patients with known extrathoracic malignancy and enlarged hilar/mediastinal lymph nodes, endobronchial ultrasound FNA was very helpful at identifying metastasis to the chest. EBUS found lymph node mets in 44% of the patients and a new lung cancer in 12%. Sarcoidosis was discovered in 9%. Neal et al followed-up these 161 patients for 6 months [… read more]

COPD: Exhale airway stents didn’t help (bronchoscopic lung-volume reduction EASE trial)

 COPD, Interventional Pulmonology, Randomized Controlled Trials  Comments Off on COPD: Exhale airway stents didn’t help (bronchoscopic lung-volume reduction EASE trial)
Sep 222011
 

If air trapping causes symptoms and limitation in people with emphysema, why not un-trap the air? Say, by poking holes in bronchi leading to areas of severe emphysema, and putting paclitaxel-eluting stents in place to maintain patency? The air should naturally become freed, flow out, and improve respiratory mechanics. Only, it didn’t. Shah et al [… read more]

Sep 222011
 

Observational epidemiologic data on 132 California kids who caught pertussis (of 15,000 in a cohort), presented at the American Society for Microbiology meeting last week, suggested that protection from pertussis vaccination may wane as soon as 3 years after the last dose. Kids age 8-12 were most at risk (the last dose is given at [… read more]

Effects of asthma treatment on airway remodeling

 Asthma, Clinic and Consults, Review Articles  Comments Off on Effects of asthma treatment on airway remodeling
Sep 172011
 

Surprisingly little is really known about airway remodeling in asthma, including its clinical course, or how treatment may modify it. Two examples: rather than occurring as a late sequela of unchecked inflammation, numerous recent studies show remodeling can occur in tandem with inflammation starting in early childhood. A recent NEJM article generates the hypothesis that [… read more]

Survey says: Residents are sad, especially when they’re broke

 Policy, Ethics, Education  Comments Off on Survey says: Residents are sad, especially when they’re broke
Sep 132011
 

West et al report survey and in-service exam data from 16,394 internal medicine residents nationwide, 2008-2009. Almost 15% reported that their lives “suck” or “profoundly suck” (I’m paraphrasing slightly). About half reported emotional exhaustion or feeling burned-out. Almost 30% were in a disconnected, fugue-like state. The really depressed ones did worse on their in-service exams, [… read more]

Millions of adults quit smoking since 2005 (MMWR)

 Clinic and Consults, COPD, Policy, Ethics, Education  Comments Off on Millions of adults quit smoking since 2005 (MMWR)
Sep 132011
 
Millions of adults quit smoking since 2005 (MMWR)

From 2005 to 2010, the percent of U.S. adults identifying themselves as smokers fell from 20.9% to 19.3% — about 3 million fewer smokers than would be expected. The results come from the CDC’s national telephone health surveys. More remarkably, adults reported smoking far fewer cigarettes: The proportion of adults reporting smoking more than a [… read more]

Sep 122011
 

Several favorable randomized trials and a meta-analysis have suggested procalcitonin is a reliable and useful biomarker of infection, including in the ICU. In contrast, Jensen et al report use of a procalcitonin-driven algorithm to guide antimicrobial therapy in 9 ICUs in Denmark seemed to cause a bit of harm. They randomized 1,200 patients to either [… read more]