RESUMO
Lung Cancer is the primary cause of cancer-related death in the United States. We have recognized a need for novel methods of identification and consideration of enrollment into a lung cancer screening program for those at the highest risk of lung cancer. Our primary goal was to determine if pulmonary function test (PFT) demographic data would be useful in identifying patients for lung cancer screening. We retrospectively reviewed PFTs performed at Lahey Hospital & Medical Center (LHMC) January 2012 through January 2013 and found that of patients identified as high risk of lung cancer, 89% had passed through our PFT lab but had not yet been screened. Investigation into the barriers of lung cancer screening to better understand how to increase appropriate enrollment then followed. A total of 3098 PFTs were reviewed from January 2012 through January 2013 and 634 patients (20%) were identified as high risk for lung cancer. Of 634 patients, 70 (11%) were already in the LHMC lung cancer screening program. The remaining 564 patients (89%) were not enrolled, and of these, it was found that 292 patients identified as high risk for lung cancer represented missed opportunities for screening. The remaining 272 patients were appropriately not screened with the three most common reasons being prior imaging with positive finding, lung cancer within five years, and provider discussed but scan not yet performed. Appropriate enrollment in a lung cancer screening program may be increased with the careful use of demographic data obtained from a PFT lab.
Assuntos
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/fisiopatologia , Programas de Rastreamento/métodos , Testes de Função Respiratória/instrumentação , Idoso , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Médicos de Atenção Primária/educação , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To assess the degree of agreement between propensity score studies and randomized clinical trials in critical care research. DATA SOURCES: Propensity score studies published in highly cited critical care or general medicine journals or included in a previous systematic review; corresponding randomized clinical trials included in Cochrane Systematic Reviews or published in PubMed. STUDY SELECTION: We identified propensity score studies of the effects of therapeutic interventions on short- or long-term mortality. We systematically matched propensity score studies to randomized clinical trials based on patient selection criteria, interventions, and outcomes. DATA EXTRACTION: We appraised the methods of included studies and extracted treatment effect estimates to compare the results of propensity score studies and randomized clinical trials. When multiple studies were identified for the same topic, we performed meta-analyses to obtain summary treatment effect estimates. DATA SYNTHESIS: We matched 21 propensity score studies with 58 randomized clinical trials in 18 distinct comparisons (median, one propensity score study and two randomized clinical trials per comparison), for short- and long-term mortality. We found one statistically significant difference between designs (hyperoncotic albumin vs crystalloid fluids) among these 18 comparisons. Propensity score studies did not produce systematically higher (or lower) treatment effect estimates compared with randomized clinical trials, but estimates from the two designs differed by more than 30% in one third of the comparisons examined. Observational studies in critical care met widely accepted methodological standards for propensity score analyses. CONCLUSIONS: Across diverse critical care topics, propensity score studies published in high-impact journals produced results that were generally consistent with the findings of randomized clinical trials. However, caution is needed when interpreting propensity score studies because occasionally their results contradict those of randomized clinical trials and there is no reliable way to predict disagreements.
Assuntos
Cuidados Críticos , Estado Terminal/mortalidade , Estudos Observacionais como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Humanos , Pontuação de PropensãoRESUMO
While patients have been known to aspirate pills, they virtually never persist long enough to lead to complications. A spectrum of events, however, may arise especially from iron pill aspiration. If not identified and removed early, cytotoxic damage from local free-radical generation may result in airway damage. We report a case of an aspirated iron pill, which did not disintegrate and presented with chronic cough. Imaging revealed a foreign body in the right bronchus, and bronchoscopic removal allowed resolution of an associated pneumonia, without any further symptoms on subsequent surveillance.
Assuntos
Broncoscopia/métodos , Corpos Estranhos/cirurgia , Pneumonia/etiologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Ferro/efeitos adversosRESUMO
Many health care providers are concerned with the role environmental exposures play in the development of respiratory disease. While most individuals understand that outdoor air quality is important to their health status, many are unaware of the detrimental effects indoor air pollution can potentially have on them. The Environmental Protection Agency (EPA) regulates both outdoor and indoor air quality. According to the EPA, indoor levels of pollutants may be up to 100 times higher than outdoor pollutant levels and have been ranked among the top 5 environmental risks to the public. There has been a strong correlation between air quality and health, which is why it is crucial to obtain a complete environmental exposure history from a patient. This article focuses on the effects indoor air quality has on the respiratory system. Specifically, this article will address secondhand smoke, radon, carbon monoxide, nitrogen dioxide, formaldehyde, house cleaning agents, indoor mold, animal dander, and dust mites. These are common agents that may lead to hazardous exposures among individuals living in the United States. It is important for health care providers to be educated on the potential risks of indoor air pollution and the effects it may have on patient outcomes. Health problems resulting from poor indoor air quality are not easily recognized and may affect a patient's health years after the onset of exposure.
RESUMO
BACKGROUND: Infliximab is a chimeric monoclonal antibody against tumor necrosis factor (TNF)-alpha, used for the treatment of Crohn's disease and rheumatoid arthritis. Recently, an increased risk of infection due to Mycobacterium tuberculosis and rare cases of invasive fungal disease have been reported following infliximab therapy. CASE REPORT: A 73-year-old woman with chronic rheumatoid arthritis who had been treated with methotrexate, leflunomide, and prednisone was given the first of three doses of infliximab in June 2001. In July 2001, she presented with cough, and in August, she had a right upper lobe infiltrate that was treated with levofloxacin without improvement. In October, the patient had right upper and middle lobe infiltrates on a chest X-ray and computed tomography scan. At bronchoscopy, an endobronchial mass was biopsied, which demonstrated Aspergills fumigatus. Our patient had frequently accompanied her daughter on visits to another medical center following a stem cell transplant, where her daughter was instructed to wear a mask during all visits because of extensive building construction. We postulate that our patient may have acquired pulmonary aspergillosis during this period. Literature reviews on granulomatous diseases following infliximab therapy and hospital-acquired aspergillosis are presented. CONCLUSION: The temporal relationship between the administration of infliximab and A. fumigatus infection in this patient suggests a causal relationship and possible healthcare-associated acquisition. These data underscore the importance of both patient and family education on prevention strategies when potent immune-modulating medications such as infliximab have been prescribed.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Aspergilose/etiologia , Infecção Hospitalar/microbiologia , Pneumopatias Fúngicas/etiologia , Fator de Necrose Tumoral alfa/imunologia , Idoso , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Aspergilose/diagnóstico por imagem , Aspergilose/microbiologia , Aspergillus fumigatus/isolamento & purificação , Infecção Hospitalar/etiologia , Feminino , Humanos , Infliximab , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/microbiologia , Testes de Neutralização , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 42-year-old woman was hospitalized with fever and hypoxemia. The workup for fever was unrevealing. A computed tomographic scan of the chest showed centrilobular, small, nodular opacities throughout both the lung fields. A flexible bronchoscopy with transbronchial biopsy was performed. Pathology specimens consisted of intravascular foreign material with birefringent properties suggestive of microcrystalline cellulose. It was later determined that the patient was self-injecting herself with crushed pill fragments through a tunneled central venous catheter. The central venous catheter was removed and fever resolved.