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]
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]
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]
Skeletal muscle dysfunction is common in people with COPD, although debate exists as to whether that’s simply due to deconditioning, or something more. In people with severe COPD (GOLD stage III and IV), it’s known that pulmonary rehabilitation improves some of these muscle abnormalities. Vogiatzis et al report the results of putting 46 people with [… read more]
Walker et al give us a nice picture and high-yield tutorial on the reversed halo sign, in this case from cryptogenic organizing pneumonia: J Thorac Imaging 2011;26:w80. (FREE)
An impedance threshold device (essentially a one-way valve) attached to an endotracheal tube prevents air from leaving the chest during compressions, improving venous return, cardiac output and (in animal studies) perfusion. Auferheide and the ROC investigators report results of a huge randomized trial testing the ITD. 8,718 victims of out-of-hospital cardiac arrest were randomized to [… read more]
Stiell et al (the ROC investigators) report results of a 10-center randomized trial in the U.S. and Canada. Among 9,933 patients with out-of-hospital cardiac arrest randomized to receive either 30-60 seconds or 2 minutes of uninterrupted CPR before rhythm analysis, there were no differences in survival, or survival to discharge with good functional status (primary [… read more]
ATS / ERS guidelines recommend using % predicted FEV1 as the metric to define severity of obstructive, restrictive, and mixed ventilatory disorders. The main driver: FEV1 is the most robust variable as an overall measure of health (epidemiologically speaking). Critics charge that this overestimates severity of obstruction when restriction is also present, causing confusion, misdiagnosis, [… read more]
Asthma’s complex and protean inflammatory processes vary between individuals, some of whom have elevated levels of interleukin-13 despite maximal treatment with inhaled steroids. IL-13 prompts airway epithelial cells to secrete periostin, which acts on fibroblasts and may contribute to airway remodeling in asthma. Lebrikizumab is a monoclonal antibody inhibiting IL-13. Corren et al used a [… read more]
Part 1 of Levine et al’s excellent review on toxicology in the ICU. Some of their helpful recommendations/reminders: False positive UDS are common for tricyclics (diphenhydramine/Benadryl, carbamazepine, quetiapine/Seroquel), as are false negatives for benzodiazepines (lorazepam/Ativan, alprazolam/Xanax). The osmolal gap is elevated in ethanol, methanol, ethylene glycol, isopropanol, propylene glycol toxicity, but also in shock and [… read more]
Enriquez et al analyzed data from the NHLBI Dynamic Registry, comparing 860 people with COPD to 10,048 without who underwent percutaneous coronary intervention between 1999-2006. Their main findings: COPD patients were sicker and had worse outcomes. Demographically, they had a higher rate of diabetes, slightly more lesions (3.2 vs. 3.0), and slightly lower ejection fractions. Only [… read more]
Everything new in COPD from the 10th Lund COPD Symposium, including biomarkers, risk factors, research into systemic effects and exacerbation prevention, and the latest cutting edge treatment: “Activity Promotion” (the article declares this a “paradigm shift” …. but wasn’t trying to get people to move more also part of the old paradigm?) Proc Am Thorac [… read more]
September’s Current Opinion in Pulmonary Medicine has 4-5 review articles each on sarcoidosis (how to handle calcium problems; cardiac sarcoid); interstitial lung disease (biologics for connective-tissue disease related ILD; LAM therapies; stem cell therapy for pulmonary fibrosis), and pulmonary vascular disease. Curr Opin Pulm Med 2011;17.
LaPar et al prospectively followed 39 people undergoing lung transplantation, collecting circulating fibrocytes at periodic intervals. Numbers of circulating fibrocytes (analyzed by flow cytometry) were higher in those who developed bronchiolitis obliterans syndrome, and correlated with clinical stage of BOS. Ann Thorac Surg 2011;92:470-477.
Grijalva et al analyzed the Nationwide Inpatient Sample (data from U.S. hospitalizations) and found that the rate of hospitalization for parapneumonic empyema doubled from 3 per 100,000 in 1996, to 6 in 2008. The rate of empyemas due to Streptococcus pneumoniae was stable; the increases were in non-pneumococcal infections like Staphylococcus. Mortality was unchanged overall [… read more]
It’s long been known in the pediatric cystic fibrosis population that exacerbations accelerate decline of lung function. de Boer et al show that exacerbations are just as bad or worse in adults. Following 446 adults with CF in Ontario for 3 years, those with >2 exacerbations per year had a hazard ratio of 4.05 for [… read more]
Annual Review of Advances in Non-small Cell Lung Cancer Research: A Report for the Year 2010 Stinchcombe, Thomas E. et al. Journal of Thoracic Oncology. 6(8):1443-1450, August 2011.
Sun et al pooled 21 studies (n=3,266) over 20 years. Autofluorescence added to traditional white light bronchoscopy appeared to possibly improve the sensitivity of detecting intraepithelial neoplasia, but not invasive lung cancer. J Thorac Oncol 2011;6(8):1336-1344. Review.
Antimicrobial Stewardship for the Community Hospital: Practical Tools & Techniques for Implementation. Clin Infect Dis 2011;53(suppl 1).
Wisnivesky et al crunched through the SEER data on 3,399 people who underwent resection for N1 non-small cell lung cancer. They found that the number of cancerous lymph nodes predicted survival: 1 positive N1 lymph node: 8.8 years mean lung cancer-specific survival 2-3 positive N1 lymph nodes: 8.2 years 4-8 positive N1 lymph nodes: 6.0 [… read more]