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]
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.
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]
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]
Drug and device companies finance up to 60% of all CME in the U.S. Tabas et al surveyed 1,347 CME participants, 770 of whom responded. 88% felt that industry involvement biased their educational program…but only 42% said they’d be willing to pay higher CME fees to help reduce commercial influence. Participants almost universally (85-88%) underestimated the real [… read more]
Jones et al randomized 1,647 people with moderate to severe COPD for the two trials, to receive either aclidinium inhaled (a potential tiotropium competitor) once daily or placebo for 1 year. Aclidinium improved FEV1 by ~65 mL. An absolute ~8% more people taking the drug achieved a 4-point SGRQ improvement over those taking placebo. Time [… read more]
Most clinical trials for asthma drugs exclude ~95% of potential subjects and test under highly controlled conditions, limiting their results’ generalizability. Price et al publish results of 2 “pragmatic” open-label trials set in the real world. In #1, they randomized 300 symptomatic asthmatics in 53 U.K. primary care clinics to get either a leukotriene receptor [… read more]
Singh et al’s meta-analysis of 13 randomized trials of pioglitazone or rosiglitazone lasting for at least one year. There were 130 pneumonias among the 8,163 treated patients, and 100 among the 9,464 controls, for a relative risk of 1.40 for the thiazolidinedione group (CI 1.1-1.8, p=0.01). Pioglitazone showed more of a signal with a significant RR of [… read more]
Evans et al attempted a meta-analysis of 9 randomized trials (7 in adults) testing prolonged (4 to 52 weeks) antibiotics in people with bronchiectasis. There was an improvement in “clinical response rate,” a poorly-defined endpoint, in 2 trials, but no difference in exacerbation rates or lung function. Emergence of resistant bacteria was not tested or [… read more]
An attempted meta-analysis of 11 heterogeneous, moderate-quality randomized trials could demonstrate no benefit of incentive spirometry in preventing postoperative pulmonary complications or mortality, in 1,160 patients undergoing upper abdominal surgery, report Guimaraes et al. Cochrane Database Sys Rev 2011;3:CD006058.