Update in environmental and occupational medicine 2010. Budinger GRS, Mutlu GM. AJRCCM 2011;183:1614-1619.
The erection-producing drug is a more potent PDE-5 inhibitor than sildenafil or tadalafil. Jing et al enrolled 66 people with pulmonary arterial hypertension (IPAH and other types; NYHA class II and III functional class) and randomized them to vardenafil or placebo in a 2:1 ratio. After 12 weeks, vardenafil-takers walked 69 m farther in 6 [... read more]
Elliott et al (of ANZICS) randomized 195 survivors of >24h mechanical ventilation to get 3 home physical therapy visits and telephone support, or usual care, over the 8 weeks after hospital discharge. At 26 weeks, there was no difference in 6-minute walk, quality-of-life measures, or objective physical function measures. (n=195) Critical Care 2011;15:R142. FREE FULL [... read more]
Bafadhel et al collected procalcitonin and CRP on 161 people admitted for COPD exacerbations, 96 for asthma exacerbations, and 62 for pneumonia (groups were discriminated by presence of consolidation on chest film), at 2 UK hospitals. The assays performed extremely well (area under the curve >0.93 for each) at differentiating pneumonia from non-infectious causes of [... read more]
Update in sleep medicine 2010. Mokhlesi B, Gozal D. AJRCCM 2011;183:1472-1476. Sleep review.
Managing cystic fibrosis: strategies that increase life expectancy and improve quality of life. Cohen-Cymberknoh M et al. AJRCCM 2011;183:1463-1471.
Lee et al report phase III trial results for this prodrug of gabapentin. It improved symptoms in people with moderate-to-severe RLS at the end of 12 weeks, compared to placebo. However, time (placebo) also worked well. The FDA approved the drug for moderate-to-severe RLS in April 2011. J Clin Sleep Med 2011;7:282-292.
Sharma et al retrospectively observed >200,000 total patient-days for 9 months before and 27 months after implementation of a rapid response team at a single institution (U of Texas Galveston). Code rates and mortality did not change. CHEST 2011;139:1361-1367. Many cohort studies with historical controls over the past decade suggested benefits of RRTs, although others [... read more]
Parasitic infections of the lung: a guide for the respiratory physician. Kunst H et al. Thorax 2011;66:528-536.
Although universally recommended, there was no evidence that nebulized hypertonic saline actually reduced inflammation in the airways of cystic fibrosis patients. Reeves et al proved that it does (specifically, by disrupting IL-8 from glycosaminoglycan matrices before they can recruit neutrophils by chemotaxis to wreak havoc). AJRCCM 2011;183:1517-1523.
What the pulmonary specialist should know about the new inhalation therapies. Laube BL, ERJ 2011;37:1308-1417.
A brief historical and theoretical perspective on patient autonomy and medical decision making: Part II: the autonomy model. Will JF, CHEST 2011;139:1491-1497. ICU Ethics review.
In 63 Swedish men with obstructive sleep apnea, a one-year weight loss program initiated by a supervised 9-week crash diet resulted in a ~12 kg weight loss. At one year, patients’ apnea-hypopnea index improved by ~17 events / hour; 48% no longer needed CPAP, and 10% were cured. The more weight lost, the greater the [... read more]
Allen et al surveyed 266 people under treatment for RLS for symptoms of augmentation. Fully 20% treated for ~2.7 years had definite or very likely augmentation; only 25% were completely free of augmentation symptoms, as assessed using NIH guidelines. Sleep Med 2011;12:431-439.
Rice et al randomized 200 mechanically ventilated patients to either trophic feedings (10 mL/hr) or full enteric feedings for 6 days. There were no differences in mortality or ventilator-free days. The trophic-fed patients had fewer episodes of “high residuals.” (n=200) Crit Care Med 2011;39:967-974.
Bitter et al performed CPAP titration on 192 patients with congestive heart failure and obstructive sleep apnea, unmasking residual central sleep apnea (so-called complex sleep apnea) in 34 (18%). Providing adaptive servoventilation (dynamic delivery of pressure support to achieve a target minute ventilation) improved AHI, NYHA class, BNP levels, ejection fraction, and other variables, at ~1 year [... read more]
Canessa et al observed 17 people with untreated obstructive sleep apnea and 15 age-matched healthy controls, performing sleep studies, cognitive testing, and MRIs on all. At baseline, OSA patients had shrinkage in brain areas responsible for memory and executive function (hippocampus, posterior parietal cortex, and superior frontal gyrus, as quantitated by voxel based morphometry) and were neurocognitively impaired [... read more]
Zanobetti et al prospectively evaluated 404 consecutive people presenting to one emergency room for dyspnea with point-of-care ultrasonography (all done by one MD) followed by chest radiograph. In the 118 instances when the tests provided discordant diagnoses, chest CT was obtained and was used as the gold standard. Concordance between US and CXR was high across all [... read more]
Zinberg writes on predicted effects of the Affordable Care Act on reimbursements. As 30 million patients pour into the system, half onto Medicaid rolls, and cash-strapped state governments likely reduce payments for their visits (after federal prop-up payments shrink in 2016), Zinberg asks whether most physicians will see Medicaid patients at all, since many already [... read more]
Dyrbye & Shanafelt from Mayo sound a warning that the impending influx of 30 million newly insured patients into doctors’ offices after full implementation of health insurance reform, simultaneous with declining reimbursements, are likely to increase physician stress and burnout. They urge a lot of doctor-friendly policy measures (like a committee to set limits on [... read more]