Chest
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In the United States, lung cancer kills more men and woman than the next three most common cancers combined. Unfortunately, the long-term outcome of lung cancer is still dismal with a 5-year survival rate of 15%. However, significant improvements in median survival times and 1-year and 2-year survival rates have been achieved in the last decade. ⋯ Platinum-based doublet chemotherapy regimens are now the standard of care in patients with advanced stage NSCLC, and non-platinum-based combination therapies are reasonable alternatives in certain populations. The combination of the vascular endothelial growth factor inhibitor bevacizumab and chemotherapy has proven to prolong survival. As agents such as monoclonal antibodies, small molecules inhibitors of tyrosine kinase, and direct inhibitors of proteins involved in lung cancer proliferation are being developed and tested, we are optimistic that these agents will result in improvement in the survival and quality of life of lung cancer patients.
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COPD affects up to one third of patients with chronic heart failure. The coexistence of COPD and chronic heart failure presents clinicians with diagnostic and therapeutic challenges. ⋯ Patients with COPD or chronic heart failure have skeletal muscle abnormalities that limit functional capacity independently from primary organ failure. Exercise training reverses skeletal muscle abnormalities in patients with COPD or chronic heart failure and may be particularly indicated in patients with coexistent COPD and chronic heart failure.
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Randomized Controlled Trial
Effect of rollator use on health-related quality of life in individuals with COPD.
The purpose of this study was to evaluate the influence of rollator use on health-related quality of life in patients with COPD. ⋯ Despite evidence of effectiveness during acute testing, this study did not demonstrate a rollator effect on quality of life or exercise capacity when the rollator was provided at home, for a longer period. Actual use of a rollator may be an important determinant of its effect. Therefore, when prescribing a rollator, health-care professionals should attempt to identify those most likely to use it.
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The goal of this investigation was to determine whether vancomycin pharmacokinetic indexes (eg, serum trough concentrations or area under the concentration curve [AUC] values) were associated with mortality for patients with health-care-associated pneumonia (HCAP) attributed to methicillin-resistant Staphylococcus aureus (MRSA). ⋯ We found no evidence that greater vancomycin trough concentrations or AUC values correlated with hospital outcome. Based on these results, aggressive dosing strategies for vancomycin (eg, trough concentrations of > 15 microg/mL) may not offer any advantage over traditional dose targets (range, 5 to 15 microg/mL).
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The prevalence and prognostic significance of nontraumatic hypotension measured in the emergency department (ED) have not been studied. We hypothesized that ED hypotension confers risk of in-hospital mortality. ⋯ Nontraumatic hypotension was documented in 19% of a random sample of ED patients admitted to the hospital. Patients exposed to hypotension had a significantly increased risk of death during hospitalization.