Warfarin is the best drug for stroke prevention in atrial fibrillation. In people with a-fib for whom warfarin was unsuitable (unstable INR, unlikely adherence, etc, but excluding those with prior bleeding on warfarin), twice daily oral direct Xa inhibitor apixaban had a hazard ratio of 0.45 over aspirin for the primary outcome of stroke (absolute [… read more]
Normal sleep in African-Americans and Caucasians: Ruiter ME, Sleep Medicine 2011;12:209-214. Race & racial differences in sleep review.
Valdyanathan et al gave prednisolone 25 mg (equivalent to prednisone) or placebo daily for 2 weeks to sufferers of chronic rhinosinusitis in the UK, followed by 8 months of nasal fluticasone (drops, then spray) for all. The orally-treated group had a 2.1-point fall in their polyp grade and could smell better, at 6 months. Ann [… read more]
Occupational asthma – Assessment, treatment, compensation: Cowl TC, CHEST 2011;139:674-681.
How “hard” should we “hit” our patients with Lasix? And does that hurt? Felker et al asked that (sort of) in a NHLBI-funded trial. They gave furosemide to 308 patients hospitalized for ADHF in an IV dose either equivalent to their home dose, or at 2.5 times their home dose, and either at q12-hour intervals [… read more]
Pulmonary Sarcoidosis: Concise Clinical Review. Baughman RP, AJRCCM 2011;183:573-581.
Treating NSCLC with tyrosine kinase / EGFR inhibitors erlotinib & gefitinib: Cataldo VD, NEJM 2011;364:947-955. Non small cell lung cancer chemotherapy treatment review.
Radiation risks from imaging; pharmacy and lactation; critical illness; interventional chest procedures; asthma; smoking; cystic fibrosis; pneumonia; infiltrative lung diseases; pulmonary embolism; pulmonary hypertension, and sleep-disordered breathing in pregnancy. Coming in just under 200 pages. Clinics in Chest Medicine 2011;32:1-198.
Imaging, airflow, rhinosinusitis, congestion, allergies, the sense of smell … more than a dozen articles on “the other airway” is nothing to sneeze at. Proc Am Thorac Soc 2011; 8: 1-140.
In a rare encouraging positive study in the chronically critically ill, 71% of vent-dependent patients (~6 weeks on MV) who did multiple sets of daily inspirations backwards through a PEEP valve weaned from mechanical ventilation (defined as >72 hrs off the vent), vs. 47% receiving a sham treatment. MIP also improved by 10 cmH2O in [… read more]
Pleural imaging; CHF pleural effusions; hepatic hydrothorax; parapneumonic effusions and empyema; malignant pleural effusions and disease; chylothorax; thoracoscopy; the chest tube size debate; pneumothorax — did they miss anything? In 130 pages, probably not much. Sem Resp Crit Care Med Dec 2010.
Cardiopulmonary exercise testing in people with heart and lung disease: Arena R, Circulation 2011;123:668-680.
Tashkin et al randomized 504 patients at 27 centers with COPD and FEV1 > 49% to varenicline or placebo for 12 weeks, with 52 weeks follow up. Smoking cessation / abstinence rate (carbon monoxide-confirmed) was 42% vs 9% in weeks 9 – 12 (1′ endpoint), and 19% vs. 6% in weeks 9 – 52 (p<0.0001). [… read more]
Point-of-care ultrasonography: Moore CL, NEJM 2011;364:749-757.
Clinical Course & Prediction of Survival in Idiopathic Pulmonary Fibrosis: Ley B, AJRCCM 2011;183:431-440.
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]
Using Medicare records from more than 30,000 beneficiaries with congestive heart failure, Javaheri et al suggest in this observational epidemiologic study that sleep apnea may be woefully overlooked and undertreated in people with CHF. The 2% of the cohort who were tested and treated for sleep apnea had one-third the 2-year mortality of their risk-matched [… 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