Articles related to Pulmonology

Unraveling Patient Perspectives on DOAC Safety: Key Findings and Implications for Healthcare Practice A recent study that delves into the complex interactions of direct oral anticoagulants (DOACs) usage offers insightful information about patient experiences and suggests ways to increase patients’ safety and adherence.

Navigating the Interplay of Eliquis and Dietary Habits As physicians, understanding the nuances of apixaban (Eliquis) and its interaction with diet is crucial for optimal patient care. While taking Eliquis, there are no specific foods to avoid, but people with cardiovascular issues should steer clear of coffee and foods heavy in fat.

Uncover vital insights about supplemental oxygen use, demystify misconceptions, and learn best practices for managing respiratory diseases. Good day, physicians. Let’s talk about the controversial issue of supplemental oxygen use, frequently discussed by patients, clinicians, advocacy groups, and even politicians. In this summary, we’ll untangle misconceptions and illuminate best practices. To start with, the body’s oxygen utilization depends on three things: lung function, heart efficiency, and muscle oxygen use. These factors can improve with exercise, but worsen with inactivity. Remember, exercise matters. Why does oxygen matter? For patients with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF), or pulmonary hypertension (PH), impaired oxygenation can lead to hypoxemia and hypoxia. Hence, supplemental oxygen becomes a necessity. How do we assess oxygen levels? Two tests can be employed: arterial blood gas (ABG) or pulse oximetry. Normal partial pressure of oxygen, as per ABG, is around 75-100 mmHg, and a drop below 60 necessitates supplemental oxygen. Oxygen saturation, measurable via either test, should ideally be 95% or above, and values dropping to 90 or below indicate the need for supplemental oxygen. Now, let’s dispel some myths. Shortness of breath doesn’t always equate to hypoxia. A patient can experience breathlessness even with normal oxygen […]

Delve into the changes in the updated Beers criteria and their implications for medication use in older patients. The American Geriatrics Society (AGS) has recently revised the Beers criteria. Significantly, these guidelines advise physicians to be cautious when prescribing medications like warfarin and sodium-glucose cotransporter-2 (SGLT2) inhibitors for patients over 65. Importantly, warfarin is now a drug to avoid in initial therapy for venous thromboembolism or nonvalvular atrial fibrillation unless alternatives are contraindicated or face significant usage barriers. The Beers criteria are organized into five distinct categories. These include potentially inappropriate medications, ones that might be inappropriate for patients with certain conditions, medications requiring careful usage, potential drug-drug interactions, and medications needing renal function-based dosage adjustments. An expert panel sifted through evidence from June 1, 2017, to May 31, 2022, to create these updates. These guidelines apply to patients aged 65 years and older in most care settings in the US, excluding hospice and end-of-life care situations. Among the notable changes since 2019 is the inclusion of warfarin. For older patients using warfarin long-term, continuation might be reasonable if they show well-controlled international normalized ratios and no adverse effects. Additional drugs introduced since 2019 include ticagrelor and SGLT2 inhibitors (use […]

In the realm of lung cancer screening, understanding the right approach for high-risk patients is paramount. This summary navigates through a quiz about lung cancer screening. Centered on a 63-year-old woman, she’s a former smoker. Moreover, she has COPD. The objective is to identify her optimal screening test. Presented are five options. These comprise chest X-ray, PET scan, low-dose CT, sputum cytology, and opting for no screening. Turning to the NLST for guidance, it emerges that one of these has the upper hand. USPSTF, among other societies, backs the method. Importantly, it’s fitting for high-risk groups. Given her age and past smoking habit, the woman meets the criteria. Consequently, it is suggested the woman receives this screening annually. However, screening bears risks. Potential harms span from further tests to patient distress. Additional concerns include overdiagnosis and radiation exposure. Therefore, advanced facilities are ideal for screening. Two of the choices are ruled out. Strikingly, they don’t improve mortality rates. In fact, one of the choices presented isn’t designed for routine screening. Instead, this type of scan evaluates previously identified nodules or masses. Notably, overlooking this type of screening may lead to premature mortality. This particularly holds for high-risk, asymptomatic patients. The […]

In a recent single-center prospective cohort study, the effect of unsuccessful treatment of ventilator-associated pneumonia (VAP) on mortality rates in patients with severe pneumonia was evaluated. The study involved 585 mechanically ventilated patients with severe pneumonia and respiratory failure, including 190 with severe COVID-19, all of whom underwent at least one bronchoalveolar lavage. A novel machine learning approach, CarpeDiem, was employed to group similar ICU patient-days into clinical states based on electronic health record data. Findings indicated that the lengthy ICU stays experienced by COVID-19 patients were largely due to prolonged periods of respiratory failure. The study discovered that although VAP wasn’t a contributing factor to mortality rates overall, patients with a single episode of unsuccessfully treated VAP demonstrated a significantly higher mortality rate (76.4%) compared to those with successfully treated VAP (17.6%). Furthermore, the CarpeDiem model highlighted that unresolved VAP was linked with transitions to clinical states associated with increased mortality. The study underscores that unsuccessful treatment of VAP is correlated with higher mortality and that patients with COVID-19 are at an elevated risk of VAP due to prolonged respiratory failure.