Planer et al randomized 151 smokers admitted for acute coronary syndrome to receive either bupropion sustained-release or placebo for 8 weeks. There was no difference in abstinence rates at 3, 6, or 12 months. Those who had an invasive procedure during hospitalization were 4 times more likely to quit, though. (n=151) Arch Intern Med 2011;171:1055-1060.
Hashimoto et al randomized 95 adults taking chronic prednisone for severe asthma to usual care or home-tapering guided by spirometry, exhaled nitric oxide (from hand-held devices) and a symptom diary. The self-tapered group used significantly less prednisone without a worsening in symptoms (primary endpoint), hospitalizations or exacerbations (2′ endpoints). (n=95) Thorax 2011;66:514-520.
Inactivity has not yet been shown to increase risk for VTE, until now. Among 69,000 women in the Nurses Health Study 1990-2008, the cohort that spent the most time sitting experienced twice as many pulmonary emboli as the cohort that spent the least time sitting, with a hazard ratio of 2.34 after mulitvariate analysis, report [… read more]
Parent et al report that among 398 people with sickle cell disease, the prevalence of pulmonary hypertension seemed to be 27% by echocardiography. By right heart catheterization, it was 6%. NEJM 2011;365:44-53.
Widespread beliefs among physicians that people with mental illness are more addicted, or less desirous or capable of quitting smoking, are wrong and perpetuate a deadly problem, argues J.J. Prochaska. You should nag mentally ill folks to quit smoking as you would anyone else, she urges. NEJM 2011;365:196-198. FULL FREE TEXT
Kuniyoshi et al prospectively observed people admitted to Mayo for myocardial infarction, performing polysomnography and measuring flow-mediated dilation in their brachial arteries. A whopping 69% (45 of 64) were found to have obstructive sleep apnea. Those with moderate to severe OSA had poorer arterial responsiveness, a surrogate marker for subsequent cardiovascular risk, compared to people [… read more]
In a great essay, Coller proposes re-engineering the health care system before Obamacare amplifies our skyrocketing cost problem under fee-for-service. Sounds like a twist on accountable care organizations, but more plausible and on its face politically palatable (after the bloody noses heal). JAMA 2011;306:204-205.
King et al report a series of 80 otherwise healthy young vets who failed a 2-mile run fitness test due to dyspnea at Fort Campbell, KY. Many had been exposed to sulfur fires or other inhalational exposures. Among 49 who underwent open lung biopsy, 38 had constrictive bronchiolitis, an extremely rare condition in otherwise healthy [… read more]
Among ~26,000 patients discharged from 129 VA hospitals for COPD exacerbation, those living in isolated rural areas had a 5.0% 30-day mortality, compared to 3.8% for those living in urban areas. Those in not-so-isolated rural areas didn’t seem to be at elevated risk, report Abrams et al. Ann Intern Med 2011;155:80-86.
Particulate matter causes cardiovascular deaths, and also worsens respiratory illness. The Environmental Protection Agency plans to reduce acceptable levels of PM and ozone, a move that would force industry to pay for new upgrades. NEJM 2011;365:198-201.
The 18,000 clinical trials published each year aren’t doing much to improve human health, argues Peter Pronovost. Health delivery research can, by improving delivery and impact of already-proven interventions. But doing so will require cutting a slice of the funding pie for social scientists and other untouchables in the “omics”-loving academic caste system. JAMA 2011;306:310-311.
Anraku et al report a series of 40 patients previously treated for lung cancer who underwent endobronchial ultrasound guided transbronchial needle aspiration for new mediastinal or hilar abnormalities between 2008-2010 at University of Toronto. After EBUS-TBNA of mediastinal/hilar lymph nodes, 28 of 40 were found to have lung cancer. In 21, an identical cell type [… read more]
Brown et al report that 21% of patients in the REVEAL registry were diagnosed with IPAH >2 years after the onset of symptoms. Younger patients, and those picking up a diagnosis of obstructive lung disease or sleep apnea along the way, were more likely to have a delay in diagnosis. CHEST 2011;140:19-26.
3% saline infusions have become standard care for increased intracranial pressure at many centers, based on mostly anecdotal evidence. Hauer et al looked retrospectively at 100 patients receiving 3% saline for severe stroke in 2008-2009 (intracerebral hemorrhage, subarachnoid hemorrhage, or ischemic) and compared them to 115 historical controls, 2007-2008 with “equal” underlying disease. Hypertonic saline [… read more]
Lore has it that pure-right sided heart disease in pulmonary arterial hypertension doesn’t cause pleural effusions. Luo et al report here that it does, in 35 of 89 people (39%) with connective-tissue disease-related PAH. (29 of the 35 had no other discernible cause for the effusion.) CHEST 2011;140:42-47. Their group previously reported that people with [… read more]
Teo et al randomized 24 people with newly diagnosed obstructive sleep apnea (AHI > 15) to crossover between nasal and oronasal (full-face) masks during 2 consecutive nights of CPAP titration. The nasal mask had more leaks and people wearing it had more arousals. However, they liked it better than the face mask, and there was [… read more]
In a prospective observational study of hospitalized patients with pneumonia, 20% met criteria for HCAP. Those with health care associated pneumonia were sicker of course, but it was impossible to tease out attributable mortality due to the multitude of interrelated confounders present. Antibiotic resistant organisms per se were not shown to cause death often enough [… read more]
Tranexamic acid has a small beneficial effect on hemorrhage from trauma or surgery. Among 270 subjects with intracranial hemorrhage due to trauma, those randomized to tranexamic acid showed a trend toward improved outcomes (mortality, hemorrhage extension, new bleeding foci) compared to placebo. Authors propose a large trial to explore further. BMJ 2011;343:d3795. FREE FULL TEXT
The Research Agenda in ICU Telemedicine: A Statement From the Critical Care Societies Collaborative. Kahn JM et al. CHEST 2011;140:230-238.
Rapid response teams. Jones DA et al. NEJM 2011;365:139-146. FULL FREE TEXT