Chai-Coetzer et al designed and validated a predictive model for diagnosing obstructive sleep apnea without polysomnography in 157 general primary care patients considered at average risk for obstructive sleep apnea. Berlin/Epworth questionnaires, snoring, waist size, witnessed apneas and age were fit into an algorithm, followed by home oximetry in a sample of mostly high-Berlin-scoring patients. [… read more]
MedPAC wants the next generation of MDs to be cost-conscious, evidence-minded, and amenable to standardization of care. To prod GME programs to train young MDs thusly, the influential government advisory body recommends allocating $3.5B of the $9.5B annual GME outlay as at-risk incentive payments. A proposed committee would have 3 years to design metrics for [… read more]
DeMets & Califf give a historical play-by-play, lament the current state of affairs, and issue a call to arms for academics to leverage the current political climate favoring comparative-effectiveness and translational research, in order to build a new clinical trials edifice that favors the public’s health over profits. JAMA 2011;305:713-714.
Moses & Martin see an impending crisis of public trust in the entire enterprise. They call for an epic shift in national priorities, policy, and funding of research, envisioning a more collaborative, value-based system– while acknowledging that such a sea change would take decades. NEJM 2011;364:567-571. FREE FULL TEXT
Cao et al report experience with 186 patients with resected bronchopulmonary carcinoid in Australia; median survival was 20 years. Those older than 60 at presentation and/or with higher-grade/atypical tumor histopathology had worse survival. Ann Thorac Surg 2011;91:339-343.
The IASLC, ATS, and ERS got together to better incorporate clinical logic into classification of NSCLC. No more bronchioloalveolar carcinoma (they propose adenocarcinoma in situ or invasive mucinous adenocarcinoma, depending on its size). Large cell carcinoma with neuroendocrine features gets separated out of NSCLC entirely, so it can be treated as small cell. And so [… read more]
Song et al retrospectively reviewed 461 cases of IPF (269 biopsy-proven) in Korea. More than a third of patients were hospitalized for respiratory deteriorations over a 2-year period. About half the deteriorations were attributed to acute exacerbations of IPF, with most of the rest attributed to infections (half the patients had BAL and/or ET aspirates [… read more]
The once-daily beta-agonist was better than placebo and at least as good as twice-daily salmeterol, as measured by the SGRQ, TDI, and FEV1 after 12 weeks. The drug previously matched up well against tiotropium. Indacaterol is available in Europe, but not in the U.S. (n=838). ERJ 2011;37:273-279.
McCormack et al randomized 89 women with lymphangioleiomyomatosis to receive 2 mg rapamycin or placebo daily for 12 months, followed by 12 months of drug-free observation. Women receiving sirolimus had stable lung function on spirometry, fewer symptoms, fewer “respiratory events,” and better quality of life during the treatment period. This was tempered by GI, dermatologic, [… read more]
Pulmonary Complications of Lung Transplantation: Ahmad, CHEST 2011;139:402-411.
ARDS and multi-organ failure: Curr Opin Crit Care 2011;17:1-6. Hemodynamic monitoring of ventilated patients: Ibid, pp. 36-42 The ‘ABCDE’ bundle for critical care: Ibid, pp. 43-49. Managing severely hypoxemic patients: Ibid.
Ciclesonide, a new inhaled corticosteroid that seems to cause thrush less often than others, reached for equivalency with salmeterol/fluticasone in mild persistent asthma. Ciclesonide was better than placebo in controlling asthma but Advair users had a longer time to first asthma exacerbation. CHEST 2011;139: online supplement. A Cochrane review on ciclesonide could not establish its [… read more]
Patients with on-site evaluation of TBNA samples had fewer sites sampled (1 vs. 2) and general complications (6% vs. 20%), with an equivalent yield compared to patients undergoing usual TBNA (n=168). CHEST 2011;139:395-401.
Louie et al report results of a phase 3 industry-funded trial of fidaxomicin, a poorly absorbed oral macrolide that’s bacteriocidal vs C. difficile. The new drug was equivalent to oral vanco in curing C.diff infections (~90%), and superior at preventing recurrences (~14% vs 24%). It did not prevent recurrences of the more lethal and increasingly [… read more]
Inspiratory muscle training in COPD: Gosselink R, ERJ 2011;37:416-425.
The hygiene hypothesis got a boost from Ege et al, who analyzed dust from 16,000 European children’s bedrooms and mattresses (stored with clinical/demographic data in two huge repositories, GABRIELA and PARSIFAL), for bacterial DNA or growth on bacterial/fungal culture media. Children living on farms had odds ratios for asthma of 0.49 to 0.76, compared to [… read more]
Priou et al followed 130 patients with OHS after initiation with noninvasive positive pressure ventilation. Mean follow up was 4 years. Most (96) were started on NPPV in the stable state; 38 had had an acute hypercapneic exacerbation. Survival at 1 year was 97.5%; 2 years (93%); 3 years (88%); 5 years (77%). The large [… read more]
In case there was any question, no you can’t use the femoral vein to collect ScvO2 samples. Davison et al found a bias of 4% between femoral and nonfemoral sources in 39 critically ill patients (with an interestingly wide standard deviation of 12% in blood obtained from either source). In more than half the patients, [… read more]
Cavallazzi et al reviewed 10 cohort studies and concluded that compared to daytime admission, being admitted to an ICU at night did not increase the odds ratio for mortality. Being admitted on a weekend supposedly did, but the odds ratio was only 1.08. CHEST 2010;138:68-75. FREE FULL TEXT