Psychiatrist Aaron Lazare from U-Mass has been writing and thinking about humiliation in medical education and practice for years. This engrossing article exposes the destructiveness and persistence of this toxic emotion that he argues is sadly endemic in our profession. CHEST 2011;139:746-751.
Serious Infections in Intensive Care Units: 100+ pages, 12 articles reflecting the state of the art on managing infections and antibotic usage in the ICU. Sem Resp Crit Care Med, April 2011. Review.
Lettieri et al prospectively observed 210 patients with obstructive sleep apnea, who were diagnosed & titrated in-lab or at home. Those who were diagnosed and titrated at home and managed through their primary care clinic had equivalent adherence with CPAP therapy (~70% of nights; ~4.5 hrs/night; regular use ~52%) to those diagnosed and titrated in-lab [… read more]
Workshop on molecular diagnostics for respiratory tract infections: Procalcitonin shows promise as a biomarker for differentiating bacterial from viral pneumonias, and to assess response to therapy. Rapid PCR for MRSA in sputum may become available after further development & testing. Molecular tests for S. pneumonia in respiratory secretions currently are uninterpretable in practice, due to [… read more]
Combating antimicrobial resistance; Policy recommendations to save lives: Clin Infect Dis 2011;52 (supplement 5). ** COMMENTARY by Brad Spellberg, MD **
Candida urinary tract infections: Clin Infect Dis 2011;52 (supplement 6).
Depriving young and old adults (n=16) of sleep for 24 hours, Robillard et al report that the elderly (mean 64 years) had increased systolic blood pressure and orthostasis, compared to the young people. Sleep 2011;34:online.
An excess amount of the chaos and stress endemic to ICUs is due to poor systems engineering (think alarm fatigue); a rational, integrated approach to design & technology selection is needed to make ICUs more effective and safer for patients, argue Mathews & Pronovost. Academic health systems should fill the leadership vacuum, organize stakeholders and [… read more]
Re-heating data from the APPLES study, Quan et al report that in a cohort of 1,204 adults with OSA randomized to sham or real CPAP and followed longitudinally, there was little detectable difference in cognitive functioning after treatment or sham treatment, suggesting untreated OSA has little effect on cognitive function. Sleep 2011;34:online.
Arthur Kleinman, physician and ethnographer, challenges you to abandon comforting but simplistic value constructions and look unblinkingly at your divided medical soul, if you dare. Lancet 2011;377:804-805.
Transtracheal oxygen therapy: Christopher KL, Schwartz MD
Long-term oxygen therapy: Christopher KL & Porte P, CHEST 2011;139:430-440
Long-term complications of critical care: Desai SV, Crit Care Med 2011;39:371-379.
Efficient private systems like Geisinger and Kaiser outperform academic institutions on accepted measures of quality . Dhalla & Detsky say that’s because academic docs aren’t trying, because thanks to misguided incentives, their careers suffer if they do. They encourage hospitals and payers to take the lead to reward quality improvement, since universities are unlikely to. [… read more]
Almost half of 115 Philadelphia veterans diagnosed with lung cancer had recently quit smoking, at a median 2.7 years prior to their lung cancer diagnosis; only 11% recalled having any symptoms of lung cancer at the time of quitting. J Thorac Oncol 2011;6:517-524.
In 186 patients who underwent transbronchial needle aspiration at an experienced center, followed by endoscopic biopsy or surgery as a gold standard, the positive predictive value of FNA cytology for adenocarcinoma was 92% and for squamous cell carcinoma, 82%. J Thorac Oncol 2011;6:489-493.
(1–>3) Beta-D-glucan, or BDG, is a component of the cell wall of most fungi (not Zygomycetes or Cryptococcus though). Karageorgopoulos et al pooled 16 studies, including 2,979 patients with definite or likely fungal infections, that reported the test characteristics of serum BDG. The pooled sensitivity of serum BDG for invasive fungal infection was 77% and [… read more]
Sadaka et al add their two cents and a cohort study to the Xigris efficacy/safety debate. In their retrospective, propensity-matched analysis of 563 patients sourced from the Project IMPACT database, the 108 who received activated protein C had 35% mortality, vs 54% for the 108 who did not (p=0.005). There were unusually low rates of [… read more]
The EMShockNet team previously claimed in JAMA that hyperoxia (paO2>300) after cardiac arrest could be deadly (63% in-hospital mortality vs 45% in normoxic patients). After looking at 12,108 database records in Australia/New Zealand, Bellomo et al beg to differ. By applying severity of illness/propensity models, they found no increased risk of death in those with [… read more]
Hooman et al pooled 5 randomized trials with 112 patients, who had 184 episodes of elevated intracranial pressure. They concluded hypertonic saline is better at reducing ICP; but the relative-risk-for-ICP-control confidence interval was 1.0-1.3 and the mean ICP reduction included zero (-1.6 to 5.7 mm Hg). So, maybe. Crit Care Med 2011;39:554-559.