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ATS 2015

ATS 2015

New research was presented at ATS 2015, the American Thoracic Society’s annual meeting, from May 15 to 20 in Denver. The features below highlight some of the studies that emerged from the conference. Predicting COPD Exacerbation Readmissions The Particulars: Previous studies have found that the 30-day readmission rate following an acute exacerbation of COPD (AECOPD) can be as high as 23%. However, predictors of readmission after AECOPD have not been well established in clinical investigations. Data Breakdown: For a study, researchers used uni­variate analysis to identify predictors of 30-day readmission among patients hospitalized with a primary diagnosis of AECOPD. The authors found that low forced ejection fraction in 1 second (FEV1) and a history of depression independently predicted 30-day readmission. Take Home Pearl: Depression and low FEV1 appear to predict 30-day readmission following hospitalizations for AECOPD. E-Cigarette Use in Older Adults The Particulars: Elec­tronic cigarettes (e-cigar­ettes) are increasingly being used by smokers. However, data are lacking on the use of e-cigarettes in older Americans, those with smoking-related lung disease, or ethnic minorities. Data Breakdown: Researchers assessed e-cigarette use among more than 10,000 Caucasian and African-American current and former smokers with at least 10-pack years. Those who had tried e-cigarettes were significantly more likely to be current smokers, compared with those who had not. About 91% of e-cigarette users reported using them to cut down on tobacco cigarette use, but only 47% did so. COPD exacerbation and chronic bronchitis rates were similar among e-cigarette users and non-users. Take Home Pearl: E-cigarette use does not appear to reduce tobacco cigarette use or alter the progression of COPD. Detecting Lung Changes During...
Guidelines for Metastatic Castration-Resistant Prostate Cancer

Guidelines for Metastatic Castration-Resistant Prostate Cancer

According to current estimates, prostate cancer is the second leading cause of cancer deaths among North American men, with more than 33,000 dying from the disease in 2013. For men with androgen-sensitive metastatic disease, continuous androgen-deprivation therapy is considered the current standard of care, but many of these individuals will go on to develop castration-resistant prostate cancer (CRPC). When this occurs, patients will need additional lines of treatments to support their androgen-deprivation therapy. These additional therapies have the potential to improve survival and quality of life (QOL). A Welcome Guideline Recently, the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO) released a joint clinical practice guideline for treating men with metastatic CRPC. Published in the Journal of Clinical Oncology, the guideline builds upon previous ASCO/CCO recommendations based on a systematic review of 28 randomized clinical trials published between 1979 and 2004. Since the previous guideline was released, an additional 28 trials on systemic therapies have been identified for treating metastatic CRPC, including analyses involving targeted therapies and immunotherapies. These additional randomized trials helped inform the current recommendations. The updated guideline includes recommendations on systemic therapies indicated for use along with androgen deprivation. They address survival and QOL benefits, side effects, and cost considerations for each of these therapies (Table). The expert panel also recommends that palliative care be offered to all patients, particularly for those exhibiting symptoms or QOL decrements. Recently, there has been significant progress in the care of advanced prostate cancer, with several new treatments gaining FDA approval over the last few years, says Ethan Basch, MD, MSc, who co-chaired the ASCO/CCO expert writing...

Do OR Checklists Improve Outcomes?

“Implementation of the WHO Surgical Safety Checklist was associated with robust reduction in morbidity and length of in-hospital stay and some reduction in mortality,” says the conclusion of a paper in the May 2015 issue of Annals of Surgery. Now I am not against checklists. When I was a surgical chairman, I implemented and used one in both the operating room and the SICU. They probably do not add costs and may be helpful. However, there are some problems with the paper. The authors looked at 5,295 operations done in two Norwegian hospitals. The intervention was a 20-item checklist consisting of three critical steps–the sign in before anesthesia, the timeout before the operation began, and the sign out before the surgeon left the operating room. Using a stepped wedge cluster design, patients were randomized to control or the checklist. Complications occurred in 19.9% of the control patients and 11.5% in those who got the checklist, a significant difference with p<0.001. A look at Table 2 finds that of 27 complications or groups of complications, 14 occurred in significantly fewer patients in the checklist group. Of the significant 14, a few, such as cardiac or mechanical implant complications, could possibly have been prevented by the implementation of the checklist. For most of the others, the relationship between the use of a checklist and a post-operative complication is tenuous. How could a checklist possibly prevent technical complications like bleeding requiring transfusion, surgical wound dehiscence, and unintended punctures or lacerations? Urinary tract infection, pneumonia, asthma, pleural effusion, dyspnea, and the nebulous categories of “complications after surgical and medical procedures” and “complications to...
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