Chest
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Direct oral anticoagulants (DOACs) are used as an alternative for traditional antithrombotic therapy. However, the safety profile of DOACs in patients with renal failure (RF) has not been determined. ⋯ As a class, DOACs are associated with a reduced risk for hemorrhagic stroke compared with VKAs in patients with RF. However, DOACs may differ from each other in their relative risk for major bleeding in patients with eCrCL < 50 mL/min.
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The role of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in the adjuvant treatment of non-small cell lung cancer (NSCLC) has not been well-established. Our meta-analysis aimed to determine whether the administration of EGFR-TKIs could improve the outcomes of patients with NSCLC undergoing complete resection. ⋯ Adjuvant EGFR-TKI treatment may enhance disease-free survival and reduce the risk of distant metastasis in patients with EGFR-mutant NSCLC undergoing complete resection.
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Auditors in Medicare overpayment or False Claims Act (FCA) cases often use statistical extrapolation to estimate a health-care provider's total liability from a small sample of audited claims. Courts treat statistical extrapolation differently depending on the context. ⋯ In recent cases, however, multiple courts have allowed the use of extrapolation in FCA cases. When auditors attempt to use statistical extrapolation, providers should closely inspect the sample and challenge the extrapolation when any reasonable argument exists that the sample does not constitute a reliable or accurate representation of all the provider's claims.
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A link between metabolic syndrome (MetS) and lung diseases has been observed in several cross-sectional and longitudinal studies. This syndrome has been identified as an independent risk factor for worsening respiratory symptoms, greater lung function impairment, pulmonary hypertension, and asthma. This review will discuss several potential mechanisms to explain these associations, including dietary factors and the effect of adiposity and fat-induced inflammation on the lungs, and the role of other comorbidities that frequently coexist with MetS, such as OSA and obesity. ⋯ There is, however, uncertainty as to the relative contribution that each metabolic factor has in adversely affecting the respiratory system; also, it is unclear how much of the MetS-related lung effects occur independently of obesity. In spite of these epidemiological limitations, the proposed mechanistic pathways strongly suggest that this association is likely to be causal. Given the wide prevalence of MetS in the general population, it is imperative that we continue to further understand how this metabolic disorder impacts the lung and how to prevent its complications.
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There is a widening gap between sleep provider access and patient demand for it. An American Academy of Sleep Medicine position paper recently recognized sleep telemedicine as one tool to narrow that divide. We define the term sleep telemedicine as the use of sleep-related medical information exchanged from one site to another via electronic communications to improve a patient's health. ⋯ While large, randomized trials are lacking, smaller studies comparing telemedicine with in-person care suggest noninferiority in terms of patient satisfaction, adherence to treatment, and symptomatic improvement. Sleep telemedicine is feasible from a technological and quality-driven perspective, but cost uncertainties, complex reimbursement structures, and variable licensing rules remain significant challenges to its feasibility on a larger scale. As legislative reform pends, larger randomized trials are needed to elucidate impact on patient outcomes, cost, and health-care system accessibility.