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Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. Rhee C, Jones TM, Hamad Y, et al. JAMA Netw Open. 2019 Feb 1;2(2):e187571. (2-19-19)

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Am J Respir Crit Care Med. 2019 Feb 1 [Epub ahead of print].  (2-4-19)

A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. Hajek P, Phillips-Waller A, Przulj D, et al. N Engl J Med. 2019 Jan 30. [Epub ahead of print]. (1-31-19)

Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU. Krag M, Marker S, Perner A, et al. N Engl J Med. 2018 Dec 6;379(23):2199-2208. (1-30-19)

Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers. Penn M, Bhatnagar S, Kuy S, Lieberman S, Elnahal S, Clancy C, Shulkin D. JAMA Netw Open. 2019 Jan 4;2(1):e187096. (1-21-19)  

The Importance of Smoking Cessation on Surgical Outcome in Primary Lung Cancer. Fukui M, Suzuki K, Matsunaga T, Oh S, Takamochi K. Ann Thorac Surg. 2019 Jan 2. pii: S0003-4975(18)31871-X. (1-20-19)

FDA Warns About Increased Risk of Ruptures or Tears in the Aorta Blood Vessel With Fluoroquinolone Antibiotics in Certain Patients. US Food and Drug Administration. December 20, 2018. (12/22/18).

Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. Jacobs SS, Lederer DJ, Garvey CM, et al. Ann Am Thorac Soc. 2018 Dec;15(12):1369-81. (12-13-18)

FDA Approves First Treatment for Lambert-Eaton Myasthenic Syndrome, A Rare Autoimmune Disorder. FDA News Releast. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm627093.htm (12-4-18)

Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients with Undifferentiated Hypotension? Atkinson PR, Milne J, Diegelmann L, et al. Ann Emerg Med. 2018 Oct;72(4):478-89. (11-8-18)

E-cigarette Use and Subsequent Smoking Frequency Among Adolescents. Barrington-Trimis JL, Kong G, Leventhal AM, et al. Pediatrics. November 05, 2018. [Epub ahead of print] (11-5-18)

Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. Magill SS, O'Leary E, Janelle SJ, et al. N Engl J Med. 2018 Nov 1;379(18):1732-1744. (11-1-18)

Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients with Mild Hypertension. Sheppard JP, Stevens S, Stevens R, Martin U, Mant J, Hobbs FDR, McManus RJ. JAMA Intern Med. October 29, 2018. (11-30-18)

Prevalence of Financial Conflicts of Interest Among Authors of Clinical Guidelines Related to High-Revenue Medications. Khan R, Scaffidi MA, Rumman A, Grindal AW, Plener IS, Grover SC. JAMA Intern Med. 2018 Oct 29. and Evaluation of Industry Relationships Among Authors of Clinical Practice Guidelines in Gastroenterology. CombsTR, Scott J, Jorski A, Heavener T, Vassar M. JAMA Intern Med. 2018 Oct 29. (10-30-18).

Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. Hayden FG, Sugaya N, Hirotsu N, et al. N Engl J Med. 2018 Sep 6;379(10):913-23. (10-25-18)

Assessment of Industry Data on Pulmonary and Immunosuppressive Effects of IQOS. Moazed F, Chun L, Matthay MA, Calfee CS, Gotts J.. Tob Control. 2018 Aug 29. pii: tobaccocontrol-2018-054296. [Epub ahead of print] (9-24-18)

Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018 Sep 16. [Epub ahead of print] (9-20-18)

Improved Empirical Antibiotic Treatment of Sepsis After an Educational Intervention: The ABISS-Edusepsis Study. Ferrer R, Martínez ML, Gomà G, et al. Crit Care. 2018 Jun 22;22(1):167. (8-31-18).

Effect of Azithromycin on Airflow Decline-Free Survival After Allogeneic Hematopoietic Stem Cell Transplant: The ALLOZITHRO Randomized Clinical Trial. Bergeron A, Chevret S, Granata A, et al. JAMA 2017;318(6):557-566. (8-8-18)

Depression, Antidepressant Use, and Risk of Venous Thromboembolism: Systematic Review and Meta-Analysis Of Published Observational Evidence. Kunutsor SK Seidu S, Khunti K. Ann Med. 2018 Jul 12:1-17. (7-30-18)

Electronic Health Records Associated with Lower Hospital Mortality After Systems Have Time to Mature. Lin SC, Jha AK, Adler-Milstein J. Health Aff (Millwood). 2018 Jul;37(7):1128-1135. (7-12-18)

Sodium Bicarbonate Therapy for Patients with Severe Metabolic Acidaemia in the Intensive Care Unit (BICAR-ICU): A Multicentre, Open-Label, Randomised Controlled, Phase 3 Trial. Jaber S, Paugam C, Futier E, et al. Lancet. 2018 Jun 14. pii: S0140-6736(18)31080-8. (7-6-18)

Combined Analysis of Asthma Safety Trials of Long-Acting β2-Agonists. Busse WW, Bateman ED, Caplan AL, Kelly HW, O'Byrne PM, Rabe KF, Chinchilli VM. N Engl J Med. 2018 Jun 28;378(26):2497-2505. (7-5-18)

Continuity of Care with Doctors-A Matter of Life and Death? A Systematic Review of Continuity of Care and Mortality. Pereira Gray D, Sidaway-Lee K, White E, Thorne A, Evans PH. BMJ Open. 2018 Jun 28;8(6):e021161. (7-3-18)

Minimally Invasive Lung Cancer Surgery Performed by Thoracic Surgeons as Effective as Thoracotomy. Boffa DJ, Kosinski AS, Furnary AP, et al. J Clin Oncol. 2018 May 23:JCO2018778977. [Epub ahead of print] (6-30-18)

Serotonergic Antidepressant Use and Morbidity and Mortality Among Older Adults with COPD. Vozoris NT, Wang X, Austin PC, et al. Eur Respir J  2018 Jun 26. [Epub ahead of print] (6-27-18)

Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set Process Measures. Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Ann Intern Med. 2018 Jun 12. [Epub ahead of print] (6-17-18)

Effects on Abstinence of Nicotine Patch Treatment Before Quitting Smoking: Parallel, Two Arm, Pragmatic Randomised Trial. The preloading investigators. BMJ. 2018 Jun 13;361:k2164. (6-15-18)

Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set Process Measures. Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Ann Intern Med. 2018. June 11, 2018. [Epub ahead of print] (6-12-18)

Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial. Yoon J, Chang E, Rubenstein LV, Park A, Zulman DM, Stockdale S, Ong MK, Atkins D, Schectman G, Asch SM. Ann Intern Med. 2018 Jun 5. [Epub ahead of print] (6-7-18)

Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education: A Randomized Clinical Trial. Finn KM, Metlay JP, Chang Y, Nagarur A, Yang S, Landrigan CP, Iyasere C.JAMA Intern Med. 2018 Jun 4 [Epub ahead of print]. (6-6-18)

Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. Sparano JA, Gray RJ, Makower DF, et al. N Engl J Med. 2018; June 3. (6-4-18)

Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients with Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, Cleghorn MR, McGill JW, Cole JB. JAMA. 2018 May 16. (6-1-18)

Association of Pharmaceutical Industry Marketing of Opioid Products to Physicians With Subsequent Opioid Prescribing. Hadland SE, Cerdá M, Li Y, Krieger MS, Marshall BDL. JAMA Int Med 2018; May 14. [Epub ahead of print] (5-14-18)

Low-Dose CT for the Diagnosis of Pneumonia in Elderly Patients: A Prospective, Interventional Cohort Study. Prendki V, Scheffler M, Huttner B, et al. Eur Respir J. 2018 Apr 12. pii: 1702375. [Epub ahead of print] (5-4-18)

Nivolumab plus Ipilimumab in Lung Cancer with a High Tumor Mutational Burden. Hellmann MD, Ciuleanu TE, Pluzanski A, et al. N Engl J Med. 2018 Apr 16 [Epub ahead of print] (4-17-18)

Four-gene Pan-African Blood Signature Predicts Progression to Tuberculosis. Suliman S, Thompson E, Sutherland J, et al. Am J Respir Crit Care Med. 2018 Apr 6. [Epub ahead of print] (4-10-18)

A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era. Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF. Fam Med. 2018 Feb;50(2):91-9. (3-28-18)

Impact of Temporary Methotrexate Discontinuation for 2 Weeks on Immunogenicity of Seasonal Influenza Vaccination in Patients with Rheumatoid Arthritis: A Randomised Clinical Trial. Park JK, Lee YJ, Shin K, Ha YJ, et al.  Ann Rheum Dis. 2018 Mar 23. pii: annrheumdis-2018-213222. (3-27-18)

Quantifying Population-Level Health Benefits and Harms of E-Cigarette Use in the United States. Soneji SS, Sung HY, Primack BA, Pierce JP, Sargent JD. PLoS One. 2018 Mar 14;13(3):e0193328. (3-15-18)

Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial. Krebs EE, Gravely A, Nugent S, et al. JAMA. 2018 Mar 6;319(9):872-82. (3-6-18)

Adolescent Exposure to Toxic Volatile Organic Chemicals from E-Cigarettes. Rubinstein ML, Delucchi K, Benowitz NL, et al. Pediatrics. 2018;141(4):e20173557. (3/5/18)

Electronic Cigarette Use and Progression from Experimentation to Established Smoking. Chaffee BW, Watkins SL, Glantz SA. Pediatrics. 2018;141(4):e20173594. (3/5/18)

Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population. Christensen CH, Rostron B, Cosgrove C, et al. Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population. JAMA Intern Med. 2018 Feb 19. [Epub ahead of print] (2-22-18)

Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. Svanes Ø, Bertelsen RJ, Lygre SH, et al.  Am J Respir Crit Care Med. 2018 Feb 16. [Epub ahead of print] (2-20-18)

Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture. Gonzalez AV, Coulombe J, Ernst P, Suissa S. Chest. 2018;153(2):321-8. (2-15-18)

Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU “Pneumonia Zero” Program.  Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, et al. Crit Care Med 2018;46:181-8. (2-8-18) 

Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia. Blackley DJ, Reynolds LE, Short C, Carson R, Storey,E, Halldin,CN, Laney AS. JAMA 2018;319(5):50-1. (2-6-18)

Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. Hackshaw A,  Morris JK, Boniface S, Tang JL, Milenković D. BMJ. 2018;360:j5855. (1-27-18)

Comparison of observed harms and expected mortality benefit for persons in the veterans health affairs lung cancer screening demonstration project. Caverly TJ, Fagerlin A, Wiener RS, Slatore CG, Tanner NT, Yun S, Hayward R. JAMA Intern Med. 2018 Jan 22. [Epub ahead of print] (1-22-18)

Risk of thromboembolism in cisplatin versus carboplatin-treated patients with lung cancer. Kim ES, Baran AM, Mondo EL, et al. PLoS One. 2017 Dec 11;12(12):e0189410. (1-8-18)

Association of cardiovascular risk with inhaled long-acting bronchodilators in patients with chronic obstructive pulmonary disease: A nested case-control study. Wang MT, Liou JT, Lin CW, Tsai CL, Wang YH, Hsu YJ, Lai JH. JAMA Intern Med. 2018 Jan 2. [Epub ahead of print] (1-5-18)

Previously selected articles that were thought important but had received little attention were summarized under our “News” section. However, the work of publication (review, DOAJ, doi, social media, etc.) has become too arduous to do justice to these publications. Therefore, we are beginning a new section titled “News from Other Journals” where selected articles are briefly summarized. Important articles that are published in journals commonly read by pulmonologists, intensivists or sleep physicians will not necessarily be reviewed but articles that are in general medicine journals or lower impact journals that might be of interest to the practicing physician are selected. As always, there will be links to the article via CrossRef and/or PubMed.

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Tuesday
Feb192019

Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals

Rhee C, Jones TM, Hamad Y, et al. JAMA Netw Open. 2019 Feb 1;2(2):e187571. [CrossRef] [PubMed]

Sepsis affects nearly 270,000 Americans each year and has a mortality risk of 30% to 60%. Nearly one in three patients who die in the hospital have sepsis, according to the Centers for Disease Control and Prevention and has been targeted as a preventable hospital-acquired infection by the Centers for Medicare and Medicaid Services. However, the extent to which sepsis is preventable, is unknown.

The authors conduced a retrospective cohort study of 568 randomly selected adults admitted to 6 US academic and community hospitals who died in the hospital or were discharged to hospice and not readmitted. The preventability of each sepsis-associated death was rated on a 6-point Likert scale.

Sepsis was present in 300 of the 568 subjects and was the immediate cause of death in 198 cases. The next most common immediate causes of death were progressive cancer (92) and heart failure (39). Suboptimal care, most commonly delays in antibiotics, was identified in 68 of 300 sepsis-associated deaths. However, only 11 sepsis-associated deaths (3.7%) were judged definitely or moderately likely preventable; another 25 sepsis-associated deaths (8.3%) were considered possibly preventable.

The authors conclude that in this cohort from 6 US hospitals, sepsis was the most common immediate cause of death. However, most underlying causes of death were related to severe chronic comorbidities and most sepsis-associated deaths were unlikely to be preventable through better hospital-based care.

Monday
Feb042019

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial

Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Am J Respir Crit Care Med. 2019 Feb 1 [Epub ahead of print]. [CrossRef] [PubMed]

The authors conducted a single-center, randomized, double-blind, placebo-controlled clinical trial was conducted in Bangkok, Thailand. The study enrolled 310 adults diagnosed with sepsis with hypotension. The patients were randomly divided into two groups: early norepinephrine (n=155) and standard treatment (n=155). The primary outcome was shock control rate (defined as achievement of mean arterial blood pressure >65mmHg, with urine flow >0.5mL/kg/h for 2 consecutive hours, or decreased serum lactate >10% from baseline) by 6 hours after diagnosis. Shock control rate by 6 hours was significantly higher in early norepinephrine group (118/155 [76.1%] vs.75/155 [48.4%]; P<0.001). 28-day mortality was not different between groups: 24/155(15.5%) in the early norepinephrine group versus 34/155(21.9%) in the standard treatment group (P=0.15). The authors conclude that further studies are needed to determine if early norepinephrine is associated with better outcomes such as mortality, ICU and hospital stay, etc.

Thursday
Jan312019

A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy

Hajek P, Phillips-Waller A, Przulj D, et al. N Engl J Med. 2019 Jan 30. [Epub ahead of print]. [CrossRef] [PubMed]

E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine or other products approved as smoking-cessation treatments. The authors randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg per milliliter]), with a recommendation to purchase further e-liquids of the flavor and strength of their choice. Treatment included weekly behavioral support for at least 4 weeks. The primary outcome was sustained abstinence for 1 year, which was validated biochemically at the final visit. A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). The authors conclude that E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support. Since 80% of those in the e-cigarette group that quit smoking continued to use e-cigarettes after 1 year, the long-term health benefits remain unclear.

Wednesday
Jan302019

Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU

Krag M, Marker S, Perner A, et al. N Engl J Med. 2018 Dec 6;379(23):2199-2208. [CrossRef] [PubMed]

Prophylaxis for gastrointestinal stress ulceration is frequently given to patients in the intensive care unit (ICU), but its risks and benefits are unclear. A recent meta-analysis suggested that proton-pump inhibitors result in a decrease in gastrointestinal bleeding but an increase in pneumonia. In this European, multicenter, parallel-group, blinded trial, adults who had been admitted to the ICU for an acute condition (i.e., an unplanned admission) and who were at risk for gastrointestinal bleeding were randomly assigned to receive 40 mg of intravenous pantoprazole (a proton-pump inhibitor) or placebo. The primary outcome was death by 90 days after randomization. A total of 3298 patients were enrolled; 1645 were randomly assigned to the pantoprazole group and 1653 to the placebo group. Data on the primary outcome were available for 3282 patients (99.5%). At 90 days, 510 patients (31.1%) in the pantoprazole group and 499 (30.4%) in the placebo group had died (relative risk, 1.02; 95% confidence interval [CI], 0.91 to 1.13; P=0.76). During the ICU stay, at least one clinically important event (a composite of clinically important gastrointestinal bleeding, pneumonia, Clostridium difficile infection, or myocardial ischemia) had occurred in 21.9% of patients assigned to pantoprazole and 22.6% of those assigned to placebo (relative risk, 0.96; 95% CI, 0.83 to 1.11). In the pantoprazole group, 2.5% of patients had clinically important gastrointestinal bleeding, as compared with 4.2% in the placebo group. The number of patients with infections or serious adverse reactions and the percentage of days alive without life support within 90 days were similar in the two groups. The authors conclude that the number of clinically important events were similar in those assigned to pantoprazole and those assigned to placebo.

Monday
Jan212019

Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers

Penn M, Bhatnagar S, Kuy S, Lieberman S, Elnahal S, Clancy C, Shulkin D. JAMA Netw Open. 2019 Jan 4;2(1):e187096. [CrossRef] [PubMed]

Concerns have been raised about the adequacy of health care access among patients cared for within the United States Department of Veterans Affairs (VA) health care system. The authors determined wait times for new patients receiving care at VA medical centers and compare wait times in the VA medical centers with wait times in the private sector (PS). A retrospective, repeated cross-sectional study was conducted of new appointment wait times for primary care, dermatology, cardiology, or orthopedics at VA medical centers in 15 major metropolitan areas in 2014 and 2017. Comparison data from the PS came from a published survey that used a secret shopper survey approach. Secondary analyses evaluated the change in overall and unique patients seen in the entire VA system and patient satisfaction survey measures of care access between 2014 and 2017. The outcome of interest was patient wait time. Wait times in the VA were determined directly from patient scheduling. Wait times in the PS were as reported in Merritt Hawkins surveys using the secret shopper method. Compared with the PS, overall mean VA wait times for new appointments in 2014 were similar (mean [SD] wait time, 18.7 [7.9] days PS vs 22.5 [7.3] days VA; P = .20). Department of Veterans Affairs wait times in 2014 were similar to those in the PS across specialties and regions. In 2017, overall wait times for new appointments in the VA were shorter than in the PS (mean [SD], 17.7 [5.9] vs 29.8 [16.6] days; P < .001). This was true in primary care (mean [SD], 20.0 [10.4] vs 40.7 [35.0] days; P = .005), dermatology (mean [SD], 15.6 [12.2] vs 32.6 [16.5] days; P < .001), and cardiology (mean [SD], 15.3 [12.6] vs 22.8 [10.1] days; P = .04). Wait times for orthopedics remained longer in the VA than the PS (mean [SD], 20.9 [13.3] vs 12.4 [5.5] days; P = .01), although wait time improved significantly between 2014 and 2017 in the VA for orthopedics while wait times in the PS did not change (change in mean wait times, increased 1.5 days vs decreased 5.4 days; P = .02). Secondary analysis demonstrated an increase in the number of unique patients seen and appointment encounters in the VA between 2014 and 2017 (4 996 564 to 5 118 446, and 16 476 461 to 17 331 538, respectively), and patient satisfaction measures of access also improved (satisfaction scores increased by 1.4%, 3.0%, and 4.0% for specialty care, routine primary care, and urgent primary care, P < .05). The authors conclude that although wait times in the VA and PS appeared to be similar in 2014, there have been interval improvements in VA wait times since then, while wait times in the PS appear to be static. These findings suggest that access to care within the VA has improved over time.