Laser-Assisted Technology Allows Easier Removal of IVC Filters

MedicalResearch.com Interview with:

William T. Kuo, MD, FSIR, FCCP, FSVM Director, Stanford IVC Filter Clinic Director, IR Fellowship Program Founding Director, IR-DR Residency Program Associate Professor, Interventional Radiology Stanford University Medical Center Stanford, CA

Dr. William T. Kuo

William T. Kuo, MD, FSIR, FCCP, FSVM
Director, Stanford IVC Filter Clinic
Director, IR Fellowship Program
Founding Director, IR-DR Residency Program
Associate Professor, Interventional Radiology
Stanford University Medical Center
Stanford, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In the USA, over 250,000 IVC filters are now implanted each year, and rising filter use has led to an increase in filter-related morbidity and recognition of the potential complications from indwelling IVC filters. Consequently, the FDA has issued two safety communications alerting all physicians caring for patients with IVC filters to consider removing the filter as soon as protection from pulmonary embolism is no longer needed:

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm?so urce=govdelivery&utm_medium=email&utm_source=govdelivery

Despite heightened awareness, up to 40-60% of IVC filters cannot be easily removed using standard methods alone, after the filter becomes firmly embedded. Additionally, many patients have undergone prior placement of a permanent-type filter not even designed for retrieval, leaving them with few options for safe device removal. Although all of these patients can develop filter-related morbidity especially after chronic implantation, there is currently no routine option for removing embedded IVC filters refractory to standard retrieval methods. Our 5-year first-in-human study of a novel procedure—laser-assisted filter removal— demonstrates the safety and efficacy of this technique to treat such patients. In a cohort refractory to standard retrieval methods and high force, endovascular laser-assisted retrieval was overall safe and successful in removing a variety of filter types including permanent filters, regardless of dwell time and without the need for open surgery.

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Epidemic of Wound Botulism From Black Tar Heroin

MedicalResearch.com Interview with:
Guy Soo Hoo, MD
West Los Angeles VA Medical Center
Los Angeles, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Wound botulism occurs as a result of infection by material contaminated with C. botulinum. While typically associated with trauma and crush injury, it is also an infection associated with injection drug users especially with “skin popping”. Black tar heroin is an especially common vehicle for the development of wound botulism. Black tar heroin is the predominant form of heroin used in the western United States and there has been an epidemic of wound botulism cases associated with black tar heroin users especially in California. In fact, the vast majority of wound botulism cases in California occurs in injection drug users, specifically those who inject the drug subcutaneously or intramuscularly.

The typical presentation in wound botulism in an acute neurologic illness with cranial nerve palsies, flaccid descending paralysis. Respiratory failure requiring mechanical ventilation may occur and may require an extended period of ventilator support for recovery. A high index of suspicion as well as general supportive care is needed for optimal treatment and recovery. Optimal treatment includes wound debridement, early administration of botulinum antitoxin and penicillin therapy. This case is unique in that the initial presentation was bilateral vocal cord paralysis and cranial nerve function was initially intact. The patient subsequently developed a flaccid paralysis that included cranial nerve palsies, functional quadriplegia and respiratory failure. He recovered to be discharged to a rehabilitation facility about six weeks after his initial presentation.

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C-section carries a 4-fold increased risk of blood clots, compared with vaginal deliveries

MedicalResearch.com Interview with:
Marc Blondon, MD
Division of Angiology and Hemostasis, Department of Specialties of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Venous thromboembolism, a condition including deep vein thrombosis (blood clots) and pulmonary embolism, is more common in older than younger patients. However, pregnancy and particularly the postpartum period are times at greater risk of blood clots in women. It is important to understand the risk and the risk factors for thrombosis in the postpartum period to guide the use of preventive measures such as heparin, an anticoagulant treatment, or leg compression devices.

Our study summarizes the evidence on the link between C-sections and blood clots from the past 35 years.
Our meta-analysis demonstrates that:

  • C-section carries a 4-fold increased risk of blood clots in the postpartum period, compared with vaginal deliveries ;
  • that this risk is most prominent but not restricted to emergency C-section ;
  • and that women who undergo elective C-section are also at higher risk than women who have a vaginal delivery.
  • Importantly, we estimated an absolute risk of blood clots after a C-section of 2-4 per 1000 pregnancies: on average, 3 out of 1000 women after C-section will develop a blood clot.

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More ICU Use in Hospitals With Worse Quality of Care for Heart Failure or MI

MedicalResearch.com Interview with:

Thomas Valley, MD, MSc Fellow, Pulmonary and Critical Care University of Michigan Ann Arbor, MI 48109-2800

Dr. Thomas Valley

Thomas Valley, MD, MSc
Fellow, Pulmonary and Critical Care
University of Michigan
Ann Arbor, MI 48109-2800

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hospitalizations for cardiovascular condition such as acute myocardial infarction (AMI) and heart failure (HF) are incredibly common and costly. Yet, about 20% of hospitalized patients with these conditions receive substandard care. We assessed whether there was an association between the quality of care a hospital provided for AMI or heart failure and how frequently a hospital used the ICU. We found that hospitals with the highest rates of ICU use for AMI or HF delivered worse quality of care and had higher 30-day mortality for these conditions.

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Marijuana Smoke Could Have Similar Effects on Lungs as Tobacco

MedicalResearch.com Interview with:

Stefania I. Papatheodorou, MD, PhD Cyprus International Institute for Environmental and Public Health Limassol, Cyprus

Dr. Stefania Papatheodorou

Stefania I. Papatheodorou, MD, PhD
Cyprus International Institute for Environmental and Public Health
Limassol, Cyprus

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Marijuana is the most commonly used illicit drug in the United States. Despite increasing use and acceptance of marijuana, both medically and recreationally, gaps remain in our knowledge regarding potential health effects.

In this study, we aimed to evaluate associations between recent marijuana use, exhaled Nitric Oxide (eNO) and pulmonary function. We performed a cross-sectional study of 10,327 US adults participating in the National Health and Nutrition Examination Survey (NHANES) in the years 2007 to 2012.

Exhaled Nitric Oxide was lower among participants who used marijuana in the past 0 to 4 days and those who last used marijuana 5 to 30 days before the examination compared with the never users. FEV1 was higher among participants who used marijuana within 0 to 4 days before the examination compared with those who never used marijuana, while FVC was higher in both past and current marijuana users compared with never users. The FEV1/FVC ratio was significantly lower among those who used marijuana in the 0 to 4 days before the examination compared with never users.

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Computerized Triggers May Help Prevent Delays in X-Ray Reports

MedicalResearch.com Interview with:

Daniel R. Murphy, M.D., M.B.A. Assistant Professor - Interim Director of GIM at Baylor Clinic Department of Medicine Health Svc Research & General Internal Medicine Baylor College of Medicine Houston, TX

Dr. Daniel Murphy

Daniel R. Murphy, M.D., M.B.A.
Assistant Professor – Interim Director of GIM at Baylor Clinic
Department of Medicine
Health Svc Research & General Internal Medicine
Baylor College of Medicine
Houston, TX

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Murphy: Electronic health records (EHRs) have improved communication in health care, but they have not eliminated the problem of patients failing to receive appropriate and timely follow up after abnormal test results. For example, after a chest x-ray result where a radiologist identifies a potentially cancerous mass and suggests additional evaluation, about 8% of patients do not receive follow-up imaging or have a visit with an appropriate specialist within 30 days. Identifying patients experiencing a delay with traditional methods, like randomly reviewing charts, is not practical. Fortunately, EHRs collect large amounts of data each day that can be useful in automating the process of identifying such patients.

We evaluated whether an electronic “trigger” algorithm designed to detect delays in follow up of abnormal lung imaging tests could help medical facilities identify patients likely to have experienced a delay. Of 40,218 imaging tests performed, the trigger found 655 with a possible delay. Reviewing a subset of these records showed that 61% were truly delays in care that required action. We also found that the trigger had a sensitivity of 99%, indicating that it missed very few actual delays.

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Veterans with PTSD Require More Sedatives in Critical Care Units

Jad Kebbe, MD Jacobs School of Medicine and Biomedical Sciences Department of Medicine University of Buffalo

Dr. Jad Kebbe

MedicalResearch.com Interview with:
Jad Kebbe, MD
Jacobs School of Medicine and Biomedical Sciences
Department of Medicine
University of Buffalo

Medical Research: What is the background for this study? What are the main findings?

Dr. Kebbe: This study proceeded after sensing that post-traumatic stress disorder (PTSD) was a major contributor to ill outcomes in Veterans who are hospitalized in general, and mechanically ventilated in the intensive care unit (ICU) in particular. There is plenty of data depicting the comorbid roles PTSD plays in other medical conditions, leading to an increase in the use of medical services. Furthermore, PTSD affects a Veteran’s adherence to both medical and psychiatric therapies. Having said this, the ICU course could itself negatively affect a pre-existing PTSD, or even lead to the inception of such a condition de novo. However, to date, there has been no study looking at the effect a pre-existing PTSD diagnosis may have on the ICU hospitalization and thereafter.

Our study confirmed that PTSD led to an increase in sedative requirements (opiates and benzodiazepines) for Veterans who were mechanically ventilated for more than 24h between 2003 and 2013, and revealed a trend towards an increase in mortality when compared to Veterans not suffering from PTSD. This is why many veterans are trying to claim disability benefits using va benefits and disability lawyer Tennessee to help them fight their case.

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3D Printers Make Accurate Low Cost Bronchoscopes for Education

Dr. George Cheng MD Beth Israel Deaconess Medical Center

Dr. George Cheng

MedicalResearch.com Interview with:
Dr. George Cheng MD
Beth Israel Deaconess Medical Center 

Medical Research: What is the background for this study? What are the main findings?

Dr. Cheng: Since the introduction of flexible bronchoscope in late 1960s, flexible bronchoscopy has gained wide popularity and with over 500,000 procedures being performed in the USA annually.  Bronchoscopy training has been undergoing rapid advancement in recent years.  Virtual bronchoscopy, either web-based training or VR bronchoscopic simulators, were used to teach and to improve performance in bronchoscopy.  However, virtual reality simulators often cost over $100,000 dollars.  Given the prohibitive high cost, recent CHEST expert panel recommended that high fidelity simulators be offered only in regional simulation centers.  Therefore, low cost realistic bronchoscopy training models are an area of need.

Recent development in 3D printing and 3D medical modeling has allowed clinicians to utilize CT scans to create physical models.  This approach can be used to create affordable 3D printed, anatomically accurate bronchoscopy training models.  However, the 3D printed tracheobronchial model has never been evaluated as a bronchoscopy simulation tool.  We aimed to address this question with our study.

The 3D printed bronchoscopy model was generated from flexible nylon material and stained to match the airway mucosa coloration.  Participants of varies training levels performed bronchoscopy on both standard and 3D printed bronchoscopy model, graded each on a sliding scale from 0-100.  Overall, clinicians preferred the 3D printed model regardless of their level of training.

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Denim Sandblasters At High Risk of Pulmonary Silicosis

MedicalResearch.com Interview with:
Metin Akgun, MD, FCCP

Department of Pulmonary Medicine
Atatürk University, Faculty of Medicine
Erzurum, Turkey

Medical Research: What is the background for this study? What are the main findings?

Dr. Akgun: The first cases of silicosis due to denim sandblasting were reported in 2005. In 2007, we evaluated 145 former male denim sandblasters who had an exposure history to at least 1 month with a latency period at least ten months; 77 (53%) were diagnosed as silicosis according to the profusion category of opacities of 1/0 or greater. In this study, we reported 4-year follow-up results of this cohort. Out of 83 sandblasters who were evaluated in this follow-up study, nine died and of the remaining 74, 96% had radiographic evidence of silicosis based on the same criteria and 66% had pulmonary function loss, which was defined as at least 12% or more decrease on FVC, predicted.

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Study Confirms Validity of Bova Score For Pulmonary Embolism Patients

MedicalResearch.com Interview with:
David Jimenez PhD, FCCP
Respiratory Department and Medicine Department
Ramon y Cajal Hospital IRYCIS, and Alcala de Henares University
Madrid Spain

Medical Research: What is the background for this study? What are the main findings?

Dr. Jimenez: Normotensive patients that have an estimated high-risk for pulmonary embolism (PE)-related complications (i.e., intermediate-risk PE) might benefit from surveillance in an intensive care setting or from the administration of specific advanced therapy. The Bova score was developed for identifying these patients. This study confirms the validity and reproducibility of the Bova score.

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Elevated Body Position Improves Respiratory Safety In Postpartum Women

dr-matthias-eikermann.jpgMedicalResearch.com Interview with:
Matthias Eikermann, MD, PhD
Associate Professor of Anaesthesia, Harvard Medical School
Director of Research, Critical Care Division
Massachusetts General Hospital

Medical Research: What is the background for this study? What are the main findings?

Dr. Eikermann: Obstructive sleep apnea occurs in about 5% of pregnant women, worsens as pregnancy progresses and is likely to persist into the early postpartum period. A main cause of anesthesia-related maternal death is postpartum airway obstruction. We observed among early postpartum women, that 45° upper body elevation increased upper airway diameter and mitigated sleep apnea, without adverse effects on quality of sleep after delivery.

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Too Much Time Spent Sitting, TV Viewing May Increase Sleep Problems

Matthew Buman PhD Asst Professor SNHP Exercise & Wellness Arizona State UniversityMedicalResearch.com Interview with:
Matthew Buman PhD Asst Professor
SNHP Exercise & Wellness
Arizona State University

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Buman: A lack of physical activity is a known risk factor for insomnia, poor sleep, and obstructive sleep apnea. In addition to physical activity, sedentary behavior has emerged as an important behavior. Sedentary behavior is not just the lack of physical activity, but actually refers to the time someone spend sitting. This behavior has been shown to, independent of physical activity, be related to many poor health outcomes including cardiovascular disease, diabetes, and even premature death. This is the first study to examine whether there is a relationship between excess sitting and insomnia, poor sleep, and risk for obstructive sleep apnea.

We found, after adjusting for physical activity and body weight (among other confounding factors), that total daily sitting was associated with poor sleep quality but not other sleep metrics or OSA risk. However, we also examined sitting while watching television and found a significant relationship between this type of sitting and a host of sleep quality metrics as well as risk for OSA. In a subsequent analysis we found that despite the independent relationship between sitting while watching television with OSA risk, those that were physically active were protected from this negative impact.

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No Benefit of Omega-3 acid Supplements for Exercise-Induced Bronchoconstriction in Asthma

John Brannan PhD Firestone Institute for Respiratory Health at St Joseph’s Healthcare & McMaster University, Hamilton, Ontario, CanadaMedicalResearch.com Interview with:
John Brannan PhD

Firestone Institute for Respiratory Health at St Joseph’s Healthcare & McMaster University, Hamilton, Ontario, Canada

Medical Research: What is the background for this study?

Response: The use of omega-3 acid supplements as treatments for allergic diseases including asthma is controversial. Studies by investigators from Indiana University in the USA have repeatedly demonstrated a beneficial effect of high dose omega-3 fatty acid supplements over 3 weeks in attenuating exercise-induced bronchoconstriction (EIB) similar or possibly better in potency to what may be expected with a regular inhaled corticosteroids. The study by Brannan et al. attempted to validate these findings by using inhaled mannitol, a bronchial provocation test that was derived from the understanding of exercise-induced bronchoconstriction and which has demonstrated experimentally to be a useful model for exercise-induced bronchoconstriction. All pharmacotherapies that modify exercise-induced bronchoconstriction can modify the airway sensitivity to inhaled mannitol in persons with asthma, thus it was of interest to see if an ‘alternative’ treatment that demonstrated efficacy in exercise-induced bronchoconstriction could too modify the airway response to mannitol.

Medical Research: What are the main findings?

Response: The main findings were, to our surprise, there was no benefit of high dose omega-3 fatty acid supplements on bronchial hyperresponsiveness to mannitol over 3 weeks. This was associated with no changes in airway inflammation (sputum eosinophils), lung function or asthma symptom control. We also found no benefit on resting urinary mast cell metabolites, in contrast to the findings in studies showing a benefit of omega-3 fatty acids on EIB. Our findings suggest that omega-3 supplements in tissues may not be able to penetrate tissue and/or modify the substrate flow of eicosanoids in tissue such as the airways of the asthmatic. We did observed the expected reductions in blood triglycerides which suggests that these doses of omega-3s can modify metabolism in the blood or to some extent tissues that are highly perfused.

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COPD: Most Hospital Readmissions Not Due To COPD

Tina Shah, MD University of Chicago Medicine Department of Pulmonary and Critical Care University of ChicagoMedicalResearch.com Interview with:
Tina Shah, MD
University of Chicago Medicine
Department of Pulmonary and Critical Care
University of Chicago

Medical Research: What is the background for this study? What are the main findings?

Dr. Shah: The reason why we undertook this study is to better understand the Medicare COPD population that falls under the purview of the CMS Hospital Readmissions Reduction Program (HRRP). This program places up to a 3% penalty on all Medicare revenues for hospitals that take care of beneficiaries should a hospital exceed its “expected readmission rate.” Previously 30 day readmissions after index admissions for congestive heart failure, acute myocardial infarction and pneumonia fell subject to the HRRP. As of October 2014, COPD has been added to the list, despite minimal evidence to guide hospitals in how to curb COPD readmissions. The goal of this research was to provide an epidemiological background for this population and identify trends as a hypothesis generating first step to predict who is most likely to be readmitted and to identify targets for successful future interventions on this group. Our study population is unique in that we longitudinally look at about 1/2 of all Medicare admissions for COPD exacerbations, using the CMS guideline definition which is based on discharge ICD-9 codes. As described in previous literature, there is a large discrepancy between identification of COPD by provider versus coding algorithm, however since the Hospital Readmissions Reduction Program is based on discharge coding it is important to examine this particular group.
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COPD: Nutritional Supplements Improved Outcomes and Reduced Costs

Refaat Hegazi, MD, PhD, MS, MPH Medical Director, Abbott Nutrition Affiliate Research Associate Professor, The Brody School of Medicine at East Carolina UniversityMedicalResearch.com Interview with:
Refaat Hegazi, MD, PhD, MS, MPH
Medical Director, Abbott Nutrition
Affiliate Research Associate Professor,
The Brody School of Medicine at East Carolina University

Medical Research: What is the background for this study? What are the main findings?

Dr. Hegazi: This study stems from the need to address the financial and health burdens that Chronic Obstructive Pulmonary Disease (COPD) places on the United States. It is the third leading cause of death in the U.S. and costs us about $50 billion a year. It’s a devastating and chronic condition that plagues patients on a daily basis, and previous studies have shown that proper nutrition is essential for proper pulmonary function and rehabilitation.

In a retrospective study of inpatient medical records, we found that by ensuring the nutritional needs of COPD patients were met with oral nutritional supplements (ONS), we were able to tackle the issue of cost, as well as better health outcomes. Specifically, the COPD patients that received oral nutritional supplements, experienced reduced length of hospitalization, lower average hospital costs, and lower readmission rates within 30 days, compared to those that did not.

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CHEST 2014: Breath Test May Become Accurate Enough For Lung Cancer Detection

Peter J. Mazzone, MD, FCCP MPH Director of the Lung Cancer Program for the Respiratory Institute Cleveland ClinicMedicalResearch.com Interview with:
Peter J. Mazzone, MD, FCCP MPH
Director of the Lung Cancer Program for the Respiratory Institute
Cleveland Clinic

Medical Research: What are the main findings of this study?

Dr. Mazzone:   There were 2 parts to this study. In the first part we looked at how the breath collection instrument and sensor were performing and made adjustments to both in order to optimize its performance.

In the second part we used the improved device and sensor to see if we could accurately separate a sensor signal of our patients with lung cancer from those without lung cancer. We found good separation of lung cancer from non-cancer breath signals, and very good separation of signals of one type of lung cancer from another.

We have concluded that a colorimetric sensor array based breath test is capable of separating those with lung cancer from those without.
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Rheumatoid Arthritis: Mycobacterial Infections Relatively Common

MedicalResearch.com Interview with:
Theodore Marras, MD, FRCPC, M.Sc.
Assistant Professor, University of Toronto
Respirologist, Toronto Western Hospital
University Health Network
Toronto, ON, Canada

Medical Research: What are the main findings of the study?

Dr. Marras: Mycobacterial infections (TB and nontuberculous mycobacteria (NTM)) are more common in patients with rheumatoid arthritis (RA). Nontuberculous mycobacteria disease was far more common than TB disease in RA patients in Ontario, Canada. Nontuberculous mycobacteria disease was also associated with increased age, COPD, asthma, and GERD. The presence of nontuberculous mycobacteria disease was associated with increased mortality.
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CHEST Consensus Statement: Care of the Critically Ill and Injured During Pandemics and Disasters

The American College of Chest Physicians released an expert consensus statement, Care of the Critically Ill and Injured During Pandemics and Disasters
while the global health-care community cares for patients with the Ebola virus.Three of the authors discussed this important statement with MedicalResearch.com.

Asha V. Devereaux, MD, MPH Sharp Hospital, Coronado, CAAsha V. Devereaux, MD, MPH
Sharp Hospital
Coronado, CA

Jeffrey R. Dichter, MD Allina Health, Minneapolis, MN, and Aurora Health, Milwaukee, WIJeffrey R. Dichter, MD
Allina Health, Minneapolis, MN
and Aurora Health, Milwaukee, WI

 

Niranjan Kissoon, MBBS, FRCP(C) BC Children's Hospital and Sunny Hill Health Centre University of British Columbia, Vancouver, CanadaNiranjan Kissoon, MBBS, FRCP(C)
BC Children’s Hospital and Sunny Hill Health Centre
University of British Columbia, Vancouver, Canada


Medical Research: What are the main ethical concerns and criteria for evaluating
who may be eligible for treatment during a pandemic or disaster?

Dr. Asha Devereaux: The main ethical concerns regarding eligibility for treatment during a pandemic will be access to limited or scarce resources. Who should get treatment and who decides will be some significant questions whenever there is a scarcity of healthcare resources. Transparency and the fairness of the ethical framework for decision-making will need to be made public and updated based upon the changing dynamics of resources and disease process.

Dr. Niranjan Kissoon: There is work to be done in this area and engagement of citizens, government, medical community, ethicists and legal experts in the process is important.

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ICU Admission For Pulmonary Embolism Varies By Hospital

Dr. Colin Cooke MD, MSc, MS Assistant Professor, Department of Internal Medicine University of Michigan Center for Healthcare Outcomes and Policy Ann Arbor, MIMedicalResearch.com Interview with:
Dr. Colin Cooke MD, MSc, MS
Assistant Professor, Department of Internal Medicine
University of Michigan
Center for Healthcare Outcomes and Policy
Ann Arbor, MI

Medical Research: What are the main findings of the study?

Dr. Cooke: We determined that when patients who are hospitalized for pulmonary embolism (PE), a blood clot in the lung, approximately 1 in 5 will be admitted to an intensive care unit (ICU). However, the chances that a patient will go to an ICU is highly dependent upon which hospital they are admitted to. For example, some hospitals admitted only 3% of patients with pulmonary embolism to an ICU while others admitted almost 80%.

Importantly, the differences in how hospitals use their ICU for patients with pulmonary embolism was not entirely related to the patient’s need for life support measures, the things that the ICU is designed to deliver. For example, the ICU patients in high ICU-use hospitals tended to receive fewer procedures, including mechanical ventilation, arterial catheterization, central lines, and medications to dissolve blood clots. This suggest that high utilizing hospitals are admitting patients to the ICU with weaker indications for ICU admission.
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Pulmonary Arterial Hypertension Guidelines Discussed

MedicalResearch.com Interview with:
James R. Klinger, MD, FCCP
Professor of Medicine, Brown University
Darren Taichman, MD, PhD, FCCP
Adjunct Associate Professor of Medicine, University of Pennsylvania
Greg Elliott, MD, MACP, FCCP
Professor of Medicine, University of Utah School of Medicine

Background: The authors discuss the June 17, 2014 CHEST publication:

Pharmacological Therapy for Pulmonary Arterial Hypertension in Adults: CHEST Guideline

MedicalResearch: How widespread is the problem of Pulmonary Arterial Hypertension (PAH)?

Greg Elliott: PAH is an uncommon, but important disorder because untreated it is usually progressive and fatal, AND there are effective treatments. This makes the guidelines important for physicians, patients and insurers.

MedicalResearch: What are the most common causes of PAH?

Greg Elliott: Common causes are connective tissues diseases like scleroderma, toxins like methamphetamine and cases for which the cause is not known, i.e. idiopathic. Some (about 20 %) idiopathic cases are caused by gene mutations.
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Why Are Patients With Lung Cancer Admitted to ICUs?

Colin R. Cooke, MD, MSc, MS; Assistant Professor of Medicine, Division of Pulmonary & Critical Care Medicine Faculty, Center for Healthcare Outcomes & Policy University of MichiganMedicalResearch.com Interview with:
Colin R. Cooke, MD, MSc, MS;
Assistant Professor of Medicine,
Division of Pulmonary & Critical Care Medicine
Faculty, Center for Healthcare Outcomes & Policy
University of Michigan

MedicalResearch: What are the main findings of the study?

Dr. Cooke: There were three primary findings from our study.

First, we determined that between 1992 and 2005 there was almost a 40% increase in the number of admissions to an intensive care unit (ICU) among patients with lung cancer who were hospitalized for reasons other than surgical removal of their cancer.

Second, most of this increase was because doctors were admitting these patients to intermediate intensive care units. These are units that provide greater monitoring and nurse staffing than typically available in general hospital wards, but usually also have less ability to provide life support measures than full service ICUs.

Third, over the same period the reasons for ICU admission have changed. Although the most common reason for admission continues to be for problems related to the patients’ lung cancer, problems such as breathing difficulties requiring a ventilator and severe infections are increasingly common.

These findings suggest that although overall use of the ICU for patients with lung cancer is increasing over time, providers may be shifting some of the intensive care for lung cancer patients toward less aggressive settings such as the intermediate care unit.
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COPD: Benefits of high dose N-acetylcysteine

Dr. Hoi Nam Tse,  FCCP, MRCP, MBChB Associate Consultant, Kwong Wah Hospital, Hong Kong Life member and Council member of Hong Kong Thoracic SocietyMedicalResearch.com Interview with:
Dr. Hoi Nam Tse,  FCCP, MRCP, MBChB
Associate Consultant, Kwong Wah Hospital, Hong Kong
Life member and Council member of Hong Kong Thoracic Society

MedicalResearch: What are the main findings of the study?

Dr. Hoi Nam Tse: N-acetylcysteine (NAC) is an oral mucolytic containing anti-oxidative and anti-inflammatory property. Our study demonstrated that long term use of high-dose : N-acetylcysteine (600 mg twice daily for 1 year) was a well-tolerated treatment, and it reduced exacerbations and prolonged time to first exacerbation in ‘high-risk’ COPD patients–which was defined as patients who had 2 or more exacerbations per year, FEV1<50% or both. Such beneficial effect was not obvious in the ‘low-risk’ COPD patients.

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Pulmonary Embolism: Evaluation of Age-Adjusted Threshold of D-Dimer Blood Test

Scott C. Woller, MD Co-Director Thrombosis Program Intermountain Medical Center Associate Professor of Internal Medicine University of Utah School of Medicine Murray, UT 84157-7000MedicalResearch.com Interview with
Scott C. Woller, MD
Co-Director Thrombosis Program
Intermountain Medical Center
Associate Professor of Internal Medicine
University of Utah School of Medicine
Murray, UT 84157-7000

Dr. Woller: By way of background, D-dimer, a simple blood test that is used to investigate the diagnosis of suspected pulmonary embolism (PE), and it increases with age.  Recent research suggests that the use of an age-adjusted d-dimer threshold may improve diagnostic efficiency without compromising safety. We wished to assess the safety of using an age-adjusted d-dimer threshold in the work-up of patients with suspected pulmonary embolism.

MedicalResearch:  What are the main findings of the study?

Dr. Woller: In this retrospective cohort study we identified 923 patients age > 50 years who presented to our emergency department with suspected pulmonary embolism, and had their pretest probability of PE calculated along with a d-dimer performed. All patients underwent computed tomography pulmonary angiography (CTPA). We observed that among patients unlikely to have PE, adoption of an age-adjusted D-dimer cut-off (compared with a conventional D-dimer cut-off) reduced the need for CTPA in an additional 18.3% of patients, and was associated with a low 90-day rate of failure to diagnose PE.
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Obstructive Sleep Apnea Associated with Hypertension in Perimenopausal Women

MedicalResearch.com Interview with:
Rodrigo Pinto Pedrosa, MD, PhD
Sleep and Heart Laboratory,
Pronto Socorro Cardiológico de Pernambuco
Pernambuclo, Brazil

MedicalResearch.com: What are the main findings of the study?

Dr. Pedrosa: Perimenopause is associated with increased cardiovascular risk. This study evaluated the association between obstructive sleep apnea (OSA) and arterial stiffness and hypertension in perimenopausal women. OSA (apnea-hypopnea index: ≥5 events/hour) and moderate/severe OSA (apnea-hypopnea index: ≥15 events/h) were diagnosed in 111 (40.1%) and 31 (11.1%) of women, respectively.  Women with moderate/severe obstructive sleep apnea  had a higher prevalence of hypertension, were prescribed more medications for hypertension, had higher awake blood pressure,  nocturnal blood pressure,  diastolic blood pressure, as well as higher arterial stiffness (pulse wave velocity: 11.5 [10.1 to 12.3] vs 9.5 [8.6 to 10.8] m/s, p<0.001) than women without obstructive sleep apnea, respectively. Oxygen desaturation index during the night was independently associated with 24h arterial blood pressure and with arterial stiffness.
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Lung Cancer: Free Fatty Acids as Potential Biomarkers

Daniel I. Sessler, M.D. Michael Cudahy Professor and Chair, Department of Outcomes Research Cleveland Clinic, Cleveland,MedicalResearch.com Interview with:
Daniel I. Sessler, M.D.
Michael Cudahy Professor and Chair, Department of Outcomes Research
Cleveland Clinic, Cleveland, OH


MedicalResearch.com: What are the main findings of the study?

Dr. Sessler: Free fatty acids, arachidonic acid and linoleic acid, and their metabolites hydroxyeicosatetraenoic acids (5-HETE, 11-HETE, 12-HETE, and 15-HETE) were 1.8 to 5.7-fold greater in 37 patients with adenocarcinoma versus 111 patients without cancer (all P<0.001). Areas under the receiver operating characteristics (ROC) curve were significantly greater than 0.50 discriminating lung cancer patients and controls for all biomarkers and phospholipids, and ranged between 0.69 and 0.82 (all P<0.001) for lung cancer patients versus controls. Arachidonic acid, linoleic acid, and 15-HETE showed sensitivity and specificity >0.70 at the best cutpoint. Concentrations of free fatty acids and their metabolites were similar in 18 squamous-cell carcinoma patients and 54 non-cancer controls.

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