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Journal and News Scan
This study investigated failure to rescue from cardiac arrest after cardiac surgery in a data set of nearly 80,000 pts in order to determine whether variability in this outcome might provide an opportunity for quality improvement in low-performing hospitals. The overall failure to rescue rate was 60% among over 4,100 pts who experienced postoperative cardiac arrest. The rate ranged from 50% to 83%, with the rate varying primarily according to insitutional rather than pt factors. Identification of best practices at high performing hospitals may offer a means to improve outcomes elsewhere.
Optimal management of superior sulcus tumors remains challenging. This SWOG protocol was a feasibility study of the utility of consolidation therapy with docetaxel in addition to cisplatin-etoposide, 45Gy, and possible resection. Of 46 registered pts, 86% completed induction therapy, 66% underwent resection, and 45% completed consolidation therapy. The R0 resection rate in surgical pts was 97%, and the complete or near-complete pathologic response rate in resected patients was 72%. Overall 3-year survival was 61%.
There is growing fear in the medical community and the pharmaceutical industry that an increasing number of people who participate in clinical trials may indeed compromise research by chatting about treatments, side effects and enrollment tips on Facebook, online forums and blogs, according to The Wall Street Journal.
To what extent this is a problem is unclear. But the paper illustrates the issue with an anecdote involving a woman named Jeri Burtchell. She was enrolled in a trial for an experimental multiple sclerosis drug and convinced she was getting the new medicine, which was not the standard therapy that some patients were randomly assigned to receive.
2014 consensus guidelines on the perioperative evaluation and management of patients undergoing NONCARDIAC surgery.
Using a retrospective analysis of pts undergoing VATS for suspected pleural malignancy, the authors assessed the utility of CT in diagnosing pleural malignancy. Of 370 pts studied, 211 had a pleural malignancy diagnosis established by biopsy. The sensitivity of CT for detecting malignancy was 68%, and the negative predictive value was 65%. CT alone is not highly effective in determining which patients should have invasive pleural biopsies.
Records of nearly 24,000 Australian patients with NSCLC were evaluated to determine the relationship between distance to the nearest speciality hospital (NASH) and survival. Increasing distance from a NASH was associated with decreasing likelihood of admission to a NASH and decreasing likelihood of lung cancer resection, resulting in an increasing hazard of lung cancer death. Lung cancer outcomes are best when patients are treated in a specialty hospital.
Using data from 2 centers in London, outcomes after induction therapy and resection for esophageal cancer were analyzed according to the pathological response to induction therapy. Downstaging was the strongest predictor of survival (HR 0.43). Downstaging was also associated with a lower rate of local recurrence (6% vs 13%) and systemic recurrence (19% vs 29%). Pathologic stage after induction therapy was a stronger predictor of survival that was pretreatment clinical stage.
Just a quick one and perhaps one to show patients, but a stark contrast between the best lungs and the worst.
Slightly sensationalist but might be effective for a patient that doesn't think that smoking makes a big difference !!
The authors deal with a dramatic complication of acute Type A aortic
dissection - mesenteric malperfusion. They reviewed 309 papers on acute
aortic dissection and concluded that initial interventional management of
mesenteric malperfusion followed by delayed proximal aortic repair is a
reasonable strategy, since the prognosis of those immediately operated on
the ascending aorta was extremely poor.
The authors queried whether PET has utility in clinically staging Tis or T1 esophageal cancers; this was a single institution retrospective study involving 79 pts. The incidence of FDG uptake increased with increasing T status, as did the SUV. Nodal staging was false positive in 3 pts and false negative all 13 pts with nodal involvement. Metastatic staging was false positive in 5 pts. PET is not recommended for pts with Tis or T1 disease on EUS.