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.
THIS STUDY HAS BEEN RETRACTED. Kupfer et al looked retrospectively at 168 vented patients with transudative pleural effusions at Maimonides in Brooklyn. The half that got chest tubes (with an average of 1,200 mL drained) spent 3.8 days on the vent, vs 6.5 days for the group that got only thoracentesis, with no complications reported. [... read more]
Cochrane systematic review and meta-analysis: Pooling 11 randomized trials, n=1,971, Blackwood et al suggested there are some benefits to using a standardized weaning protocol. There was a reduction in weaning and ventilation time in the groups that had weaning protocols; we won’t report them here, because they would be misleading in this small space. They [... read more]
Drospirenone is the new progesterone analog in heavily marketed new oral contraceptive pills (trade names Yaz, Yasmin, Angelique). Using a large insurance claims database, Jick et al identified 186 cases of DVT or PE in women aged 15-44 taking oral contraceptives and compared them to controls. Those taking drospirenone-containing OCPs had a nonfatal DVT/PE incidence [... read more]
Sara Erickson et al examined data from 9,518 ICU patients in California hospitals, and concluded that race & ethnicity did not influence mortality or length of stay, after adjusting for disease severity and other factors. Crit Care Med 2011;39:429-435.
Autonomy and beneficence, a historical perspective. Will JF, CHEST 2011;139:669-673. ICU ethics review.
Busse et al randomized 419 inner-city kids (age 6-20) with uncontrolled, skin-test-positive, mostly severe allergic asthma and IgE < 1,300 IU/mL to 60 weeks of omalizumab or placebo. The treated group had modest improvements: ~1 fewer day of symptoms per month and a 5% absolute reduction in hospitalizations (1.5% vs 6.3%); 18% fewer of them [... read more]
As Andy Rooney might say, “With all the diagnoses doctors like to make these days, didjever wonder if anyone is actually healthy anymore?” When it comes to heart health, according to Bambs et al, the answer is yes: one person is. Circulation 2011;123:850-857.
Critical care for patients with stroke. Lukovits TG, CHEST 2011;139:694-700.
DVT of the upper extremity: Kucher N, NEJM 2011;364:861-869.
Sacanella et al prospectively observed 230 generally healthy, cognitively intact, highly functional & independently living Spaniards 65 years or older (mean age 75) after urgent admission to a single MICU. About half received mechanical ventilation (54%). Seventy died in-hospital; 48 died within a year, for a one-year survival of 49%. But among the 112 survivors, [... read more]
Heparin-induced thrombocytopenia in the ICU. Sakr Y, Critical Care 2011;15:211.
Roquilly et ses amis francais randomized 150 critically ill victims of severe French trauma to hydrocortisone or placebo for 7 days. The treated group had an absolute 16-19% lower risk for hospital-acquired pneumonia, the primary endpoint (36% vs. 51-54% depending on which intention-to-treat analysis you prefer, p=0.007 to 0.01). (n=150). JAMA 2011;305:1201-1209.
The effect of light on critical illness. Castro R, Critical Care 2011; 15:218