Apr 212012
 
Pneumothorax in the ICU

Mechanisms of Pneumothorax in the Critically Ill Air can accumulate in the pleural space in three ways: Rupture of the visceral pleura allowing air to travel from alveoli to the pleural space (an “internal” pneumothorax, as from barotrauma from mechanical ventilation, or the rupture of a bulla or bleb); Entry of air from the atmosphere [… read more]

Apr 202012
 
Texting resident fails to stop warfarin; hemopericardium ensues

Texting while doctoring is a newly hyped threat to patient safety. Multitasking and the constant flow of new distracting information in the form of alarms, interruptions, pages, etc. have always been inherent to the practice of medicine. But some are wondering if the ubiquitous temptations of personal social media-enabled smartphones and tablets in the medical [… read more]

Apr 172012
 
Most oncologists dump end-of-life talks on other MDs (Ann Intern Med)

(image: Plioz.com) Ever cared for that patient with metastatic cancer in your ICU, intubated for acute respiratory failure and surrounded by a bewildered and stressed family who cope by emotionally blaming you, the intensivist, because “He just saw his oncologist last week, and he said everything was OK!”? Forcing you to begin painful end-of-life discussions [… read more]

Apr 162012
 
NYT runs press release for new OSA treatment Provent. Does it work?

Provent is the trade name for disposable, stick-on nose plugs made by Ventus Medical that are a relatively new (second-line) treatment for obstructive sleep apnea. The bandage-like device has pinholes cut in the nostrils that let air in during inspiration, but create back pressure during exhalation, helping prevent airway collapse. The New York Times just [… read more]

Apr 132012
 
Vitamin D supplements don't prevent COPD exacerbations in RCT

Vitamin D deficiency has been linked to many chronic medical conditions, including asthma and chronic obstructive pulmonary disease (COPD). In some cases, more severe vitamin D deficiency is associated with more severe chronic illness. However, it’s never been shown that vitamin D deficiency supplemenation improves or prevents illness; i.e., that vitamin D deficiency causes or exacerbates [… read more]

Apr 122012
 
Release the data on Relenza and Tamiflu, Cochrane implores Pharma (NYT)

Antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) made big bucks for Roche and GSK respectively during the H1N1 influenza pandemic: Roche reportedly sold  about $3 billion of Tamiflu in 2009. Although sales have dropped off precipitously, the drugs are still recommended by CDC for serious cases of seasonal influenza. But do Relenza and Tamiflu even [… read more]

Apr 112012
 
Lack of ICU beds has no effect on mortality ... in Canada?

What happens when the “Rapid Response Team” is called for an acutely deteriorating patient, but there’s no ICU bed available to send her to? In Alberta, Canada, not much, apparently. Henry Stelfox, Brenda Hemmelgarn, and Braden Manns analyzed 3,494 consecutive patients with “Code MET (medical emergency team)” rapid-response activations in Calgary between 2007 and 2009. [… read more]

Apr 062012
 

The 5-year results of the Danish Lung Cancer Screening Trial (DLCST) were reported in the April 2012 Thorax, and they show no mortality benefit from annual screening for lung cancer with chest CT. Rather, it appeared that more harmless early stage cancers were identified through screening — “overdiagnosis” of cancers that would never have advanced [… read more]

Apr 052012
 

A large proportion of primary care doctors were easily fooled by numbers that seemed to support cancer screening, but were actually irrelevant. Just as bad, they ignored data supporting screening that would genuinely save lives, in a questionnaire simulation published in the March 6 Annals of Internal Medicine. 412 primary care docs were given surveys testing [… read more]

Apr 052012
 

The Joint Commission (previously called “JCAHO”) launched its new “Tobacco Cessation Performance Measure Set” on January 1, 2012. Like most New Years’ resolutions, we all promptly ignored it. But it’s time to pay attention — your hospital might be. Wasn’t there already a smoking cessation performance measure? Yes, in 2004 hospitals were required to report the proportion [… read more]

Apr 022012
 

This post was featured on KevinMD.com; an excerpt follows. “Full code” is the universal default status for patients who haven’t chosen otherwise. Yet I suspect most physicians believe this policy is wrong. We feel in our hearts we’re doing harm when we perform CPR on poor souls whose bodies are trying to naturally end their [… read more]

Apr 012012
 

You might think you’re just writing a prescription and signing your name. But the innocent ink (or pixels) you leave behind in your daily routine turns into liquid gold for an entire industry that makes big profits from understanding and interpreting your behavior to pharmaceutical and insurance companies. As Lawrence Gostin points out in a [… read more]

Mar 252012
 

“The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care,” writes Ezekiel Emanuel, Obama’s former health care advisor who’s now back at University of Pennsylvania in a big-thinker job spanning ethics, economics and medicine. In a JAMA essay with co-author Viktor Fuchs, they opine that [… read more]

Mar 242012
 

(Comments by first author James T. Good follow this post.) For 58 patients with refractory asthma at National Jewish, James Good et al devised a systematic, bronchoscopy-driven approach that they feel resulted in improved asthma symptoms and identification of potential phenotypes of refractory asthma among the enrolled subjects. Their methodology was highly detailed and time- and labor-intensive. It included using [… read more]

Mar 232012
 

An observational trial by Jim Kutsoguiannis, Cathy Alberda, Daren Heyland et al published in the December 2011 Critical Care Medicine showed no difference in 60-day survival among critically ill, mechanically ventilated patients started on parenteral nutrition (TPN) “early” (within 48 hours of ICU admission) or “late” (after 48 hours). Only 258 patients were included in the [… read more]

Mar 192012
 

This post was featured on KevinMD.com; an excerpt follows: An essay in JAMA by Vinay Prasad (Northwestern of Chicago), Adam Cifu (U. of Chicago) and John Ioannidis (Stanford) should be required reading for every medical student, resident, and to pass every board certification exam in any specialty. In my humble opinion. John Ioannidis became one [… read more]