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Chest Medicine

CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning – Stanford ML Group (free)

“We develop an algorithm that can detect pneumonia from chest X-rays at a level exceeding practicing radiologists”

 


World Chronic Obstructive Pulmonary Disease Day, 15 November 2017: A round up of Cochrane evidence – Evidently Cochrane (free)

 


White Smoke From the Vatican? Not From Cigarettes – The New York Times (10 articles per month are free)

Related: No more Holy Smokes – Vatican bans sale of cigarettes – Reuters (free) AND Holy smoke: Vatican bans duty-free cigarette sales – BBC (free)

“WHO welcomes the Vatican’s decision to ban the sale of cigarettes as of next year. Tobacco kills more than 7 million people every year” (RT @WHO see Tweet)

 


Literature review: the economic costs of lung disease and the cost effectiveness of policy and service interventions – British Lung Foundation and British Thoracic Society (free PDF)

News release: New report identifies the most cost effective NHS activities and programmes to improve lung health – British Thoracic Society (free)

Source: Most cost effective treatments for lung disease identified – The BMJ News ($)

“The most cost effective treatments are: patient education and self management for asthma; stop smoking support for chronic obstructive pulmonary disease (COPD); vaccination programmes for pneumonia; and awareness campaigns for lung cancer” (from The BMJ).

 


The Lancet Commission on pollution and health (Report, Executive Summary, Video, Audio and Comments – free registration required)

Commentaries: Report: Pollution Kills 3 Times More than AIDS, TB And Malaria Combined – NPR (free) AND Pollution linked to one in six deaths – BBC (free)

 


High-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis – Systematic Reviews (free)

“In patients with acute hypoxemic respiratory failure HFNC was not associated with a difference in mortality compared to Noninvasive ventilation or standard oxygen”

 


Testing blood procalcitonin levels to decide when to start and stop antibiotics in adults with acute respiratory tract infections – Cochrane Library (free)

Original Article: Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections – Cochrane Library (link to abstract – $ for full-text)

“the use of procalcitonin to guide initiation and duration of antibiotic treatment results in lower risks of mortality, lower antibiotic consumption, and lower risk for antibiotic-related side effects”.

 


Interventions to reduce harm in people who use tobacco. The latest Cochrane Evidence – Cochrane Tobbaco Edition (free summaries) (RT @CochraneUK see Tweet)

Comprehensive resource on evidence-based interventions to reduce tobacco related harm.

 


#LIVES2017 – Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial – JAMA (free)

Editorial: Lung Recruitment and Titrated PEEP in Moderate to Severe ARDS: Is the Door Closing on the Open Lung? (free)

Commentary: Open Lung Ventilation May Worsen ARDS Mortality – MedPage Today (free registration required)

“A strategy using a lung recruitment maneuver and titrated PEEP, in association with volume-assist control ventilation, increased mortality of patients with moderate to severe ARDS”.

 


Interventions for treating tuberculous pericarditis – Cochrane Library (free)

News release: Treatment for tuberculosis infection of the membrane around the heart (free)

“For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant”.

 


Do interventions that reduce the cost of smoking cessation treatment increase quit rates, quit attempts or use of treatments? – Cochrane Library (free)

Original article: Healthcare financing systems for increasing the use of tobacco dependence treatment – Cochrane Library (link to abstract – $ for full-text)

“Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting”.

 


Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults – Cochrane Library (free)

Original article: Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults – Cochrane Library (link to abstract – $ for full-text)

“Tailoring asthma interventions based on sputum eosinophils is beneficial in reducing the frequency of asthma exacerbations in adults with asthma. Adults with frequent exacerbations and severe asthma may derive the greatest benefit from this additional monitoring test”.

 


Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment: A Systematic Review Meta-analysis – JAMA Neurology (link to abstract – $ for full-text)

Commentaries: Breathing Disorders During Sleep Tied to Cognitive Issues – MedPage Today (free registration required) AND Sleep-Disordered Breathing Raises Risk for Cognitive Decline – Medscape (free registration required)

This meta-analysis of observational studies suggests a possible association. Further studies are needed to examine whether the treatment of this condition can help in the prevention of dementia and in improvement of cognition.

 


Community-acquired Pneumonia Visualized on Computed Tomography but Not Chest X-Ray: Pathogens, Severity, and Clinical Outcomes – Chest (link to abstract – $ for full-text)

Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)

“Adults hospitalized with CAP who had radiologic evidence of pneumonia on CT but not concurrent CXR had similar pathogens, disease severity, and outcomes compared with patients who had signs of pneumonia on CXR”.

 


Gastrointestinal Safety of Direct Oral Anticoagulants: A Large Population-Based Study – Gastroenterology (free)

Commentary: Which NOACS are riskiest for gastrointestinal bleeding? – Pharmacy News (free)

Source: ACP Journal Club ($)

Observational study suggests Apixaban may be associated with a more favorable gastrointestinal safety profile. Further randomized trials are needed to confirm these findings.

 


Effect of 0.5 mg versus 1 mg varenicline for smoking cessation: a randomized controlled trial – Addiction (link to abstract – $ for full-text)

“No difference in smoking cessation effectiveness between 1 mg and 0.5 mg twice daily varenicline” (46.5% vs 46.4%) (RT @JorgeMTamayo see Tweet)

 


Self-management interventions including action plans for patients with Chronic Obstructive Pulmonary Disease (COPD) – Cochrane Library (free)

Full review: Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease (link to summary – $ for full-text)

Related: Asthma self-management programmes can reduce unscheduled care – NIHR Signal (free)

Self-management interventions that include a COPD exacerbation action plan are associated with improvements in health-related quality of life and lower probability of respiratory-related hospital admissions.

 


Systematic Review: Sildenafil for pulmonary hypertension in neonates – Cochrane Library (link to summary – $ for full-text)

“Sildenafil may help reduce mortality and improve oxygenation in neonates with pulmonary hypertension” (RT @CochraneUK see Tweet)

 


Effects of CPAP and Mandibular Advancement Devices on Health-Related Quality of Life in OSA – Chest (free)

See also a recent study showing CPAP does not reduce cardiovascular events in our July 13th issue (see #2)

“CPAP is effective in improving health-related quality of life in OSA, and Mandibular Advancement Devices may be just as effective, but further RCTs comparing the two treatments are required”.

 


Effects of CPAP and Mandibular Advancement Devices on Health-Related Quality of Life in OSA – Chest (free)

See also a recent study showing CPAP does not reduce cardiovascular events in our July 13th issue (see #2)

“CPAP is effective in improving health-related quality of life in OSA, and Mandibular Advancement Devices may be just as effective, but further RCTs comparing the two treatments are required”.

 


Efficacy of corticosteroid treatment for severe community-acquired pneumonia: A meta-analysis – American Journal of Emergency Medicine (link to abstract – $ for full-text)

Source: More Evidence That Steroids Are Beneficial in Community-Acquired Pneumonia – Journal Watch ($)

In this meta-analysis of randomized controlled trials in patients with severe community-acquired pneumonia, corticosteroid treatment was associated with reduced in-hospital mortality and length of hospital stay.

 


2017 ACS Quality and Safety Conference: “Strong for Surgery” Shows Promise in Reducing Smoking Rates for Patients Facing Surgery – American College of Surgeons, via NewsWise (free)

“Study suggests big drop in smoking rates when surgeons help patients quit before their operations”.

 


Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-Analysis – Chest (free)

Source: Video Laryngoscopy Does Not Improve First-Pass Success in ICU Patients – Journal Watch ($)

“The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients”.

 


Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease – Cochrane Library (free)

NIV reduces mortality and endotracheal intubation in patients with acute hypercapnic respiratory failure secondary to an acute exacerbation COPD.

 


Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis – JAMA (link to abstract – $ for full-text)

Commentaries: More Doubt Cast on CPAP for Reducing CVD Risk in Sleep Apnea Patients – MedPage Today (free registration required) AND Positive airway pressure doesn’t reduce heart risk with sleep apnea – Reuters (free)

“PAP for obstructive sleep apnea improves quality of life but not CV events or BP with up to 5 years of follow up” (RT @AnilMakam see Tweet)

 


Pub smoking ban: 10 charts that show the impact – BBC News (free)

“It’s 10 years since smoking was banned in enclosed workplaces in England, following similar moves in the rest of the UK. But how has the “pub smoking ban” changed the country?”

 


Interventions for preventing high altitude illness: Part 1. Commonly-used classes of drugs – Cochrane Library (link to summary – $ for full-text) (RT @CochraneUK see Tweet)

Acetazolamide seems to be effective to prevent acute high altitude illness in dosages of 250 to 750 mg/day.

 


Antibiotics for acute bronchitis – Cochrane Library (link to abstract – $ for full-text)

“There is limited evidence of clinical benefit to support the use of antibiotics in acute bronchitis”

 


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