Community-acquired pneumonia in 2015

Fresh article on CAP in todays Lancet!

Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. 

Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria. New approaches for fast clinical (lung ultrasound) and microbiological (molecular biology) diagnoses are promising. Community-acquired pneumonia is associated with early and late mortality and increased rates of cardiovascular events. Studies are needed that focus on the long-term management of pneumonia.

Full text: 

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960733-4/abstract

Standards for Diagnosis and Management of Individuals with Alpha-1 Antitrypsin Deficiency

In 2003, the American Journal of Respiratory and Critical Care Medicine published the ATS/ERS: Standards for Diagnosis and Management of Individuals with Alpha-1. The Standards recommend testing for Alpha-1 in all of your adult patients suffering from COPD, emphysema, incompletely reversible asthma, unexplained liver disease, and siblings of an individual with Alpha-1. 

Full text:

http://www.atsjournals.org/doi/abs/10.1164/rccm.168.7.818#.VdCbNpcXyUk

2015 Current Understanding and Future Research Needs in Tobacco Control and Treatment by American Thoracic Society

Yesterday in Am J Respir Crit Care Med was published An Official American Thoracic Society Research Statement: Current Understanding and Future Research Needs in Tobacco Control and Treatment.

Introduction: Since the mid-20th century, the scientific community has substantially improved its understanding of the worldwide tobacco epidemic. Although significant progress has been made, the sheer enormity and scope of the global problem put it on track to take a billion lives this century. Curbing the epidemic will require maximizing the impact of proven tools as well as the development of new, breakthrough methods to help interrupt the spread of nicotine addiction and reduce the downstream morbidity.

Methods: Members of the Tobacco Action Committee of the American Thoracic Society queried bibliographic databases, including Medline, Embase, and the Cochrane Collaborative, to identify primary sources and reviews relevant to the epidemic. Exploded search terms were used to identify evidence, including tobacco, addiction, smoking, cigarettes, nicotine, and smoking cessation. Evidence was consolidated into three thematic areas: (1) determinants of risk, (2) maternal-fetal exposure, and (3) current tobacco users. Expert panel consensus regarding current gaps in understanding and recommendations for future research priorities was generated through iterative discussion.

Results: Although much has been accomplished, significant gaps in understanding remain. Implementation often lags well behind insight. This report identifies a number of investigative opportunities for significantly reducing the toll of tobacco use, including: (1) the need for novel, nonlinear models of population-based disease control; (2) refinement of “real-world” models of clinical intervention in trial design; and (3) understanding of mechanisms by which intrauterine smoke exposure may lead to persistent, tobacco-related chronic disease.

Discussion: In the coming era of tobacco research, pooled talent from multiple disciplines will be required to further illuminate the complex social, environmental and biological codeterminants of tobacco dependence.

Read More:  

http://www.atsjournals.org/doi/abs/10.1164/rccm.201506-1081ST#.Vc68j5cXyUk

Take A Nap (6 benefits of napping)

The stigma against napping is finally starting to wane - and for good reason. Taking a timeout to sleep during the day does much more than just give us a quick energy boost. It also confers some serious cognitive and health advantages as well.

Benefits of napping: 

• prevents heart attacks 
• Improved cognitive performance 
• Increased alertness 
• Improved memory 
• Improved relaxation 
• Stress reduction

Even a short 20 minute nap in the afternoon can provide all the benefits of napping. However, the length of your nap will determine what sort of benefits you’re likely to experience. According to the WebMD napping can be broken up into different categories:

20 Minute Nap – While a short 20 minute power nap does enhance memory, it has a more dramatic effect on mental alertness and motor learning skills.

20 To 30 Minute Nap – This length of nap will typically enhance creativity while at the same time also boosting memory.

30 To 60 Minute Nap – This type of nap has an incredibly beneficial impact one’s decision making skills. It also improves the part of your memory that’s responsible for memorizing things such as the alphabet; directions and etc.

60 To 90 Minute Nap – Taking this type of nap will ensure that you get REM (Rapid Eye Movement) sleep, and as such, this type of nap is the most beneficial of them all. Once you reach REM sleep, it’s almost as if the brain resets itself. One could say it’s like starting at the beginning again. Studies have shown that a 60 to 90 minute nap can have a dramatic effect on the brain in terms of problem solving. Here again, NASA has conducted their own studies, and they land up with the same result.

2015 guidelines for the investigation and management of pulmonary nodules

This guideline is based on a comprehensive review of the literature on pulmonary nodules and expert opinion. Although the management pathway for the majority of nodules detected is straightforward it is sometimes more complex and this is helped by the inclusion of detailed and specific recommendations and the 4 management algorithms below. The Guideline Development Group (GDG) wanted to highlight the new research evidence which has led to significant changes in management recommendations from previously published guidelines. These include the use of two malignancy prediction calculators (section ‘Initial assessment of the probability of malignancy in pulmonary nodules’, algorithm 1) to better characterise risk of malignancy. There are recommendations for a higher nodule size threshold for follow-up (≥5 mm or ≥80 mm³) and a reduction of the follow-up period to 1 year for solid pulmonary nodules; both of these will reduce the number of follow-up CT scans (sections ‘Initial assessment of the probability of malignancy in pulmonary nodules’ and ‘Imaging follow-up’, algorithms 1 and 2). Volumetry is recommended as the preferred measurement method and there are recommendations for the management of nodules with extended volume doubling times (section ‘Imaging follow-up’, algorithm 2). Acknowledging the good prognosis of sub-solid nodules (SSNs), there are recommendations for less aggressive options for their management (section ‘Management of SSNs’, algorithm 3). 

The guidelines provide more clarity in the use of further imaging, with ordinal scale reporting for PET-CT recommended to facilitate incorporation into risk models (section ‘Further imaging in management of pulmonary nodules’) and more clarity about the place of biopsy (section ‘Non-imaging tests and non-surgical biopsy’, algorithm 4). There are recommendations for the threshold for treatment without histological confirmation (sections ‘Surgical excision biopsy’ and ‘Non-surgical treatment without pathological confirmation of malignancy’, algorithm 4).

Finally, and possibly most importantly, there are evidence-based recommendations about the information that people need and which should be provided. This document is intended to be used both as a summary in the day to day management of a person with a pulmonary nodule and a comprehensive reference text. 

link to free full text:

http://thorax.bmj.com/content/70/Suppl_2/ii1.full

2015-2016 Influenza Vaccination Guidelines

Updated recommendations on influenza vaccination for the 2015-16 season have been issued by the CDC's Advisory Committee on Immunization Practices. As reported in MMWR, changes from the 2014-2015 season include the following:

• Trivalent vaccines will include A/California/7/2009 (H1N1)-like virus, an A/Switzerland/9715293/2013 (H3N2)-like virus, and a B/Phuket/3073/2013-like (Yamagata lineage) virus. These A (H3N2) and B viruses are different from the previous season.
• The Fluzone Intradermal Quadrivalent vaccine is expected to replace the trivalent Fluzone Intradermal vaccine for adults aged 18 to 64.
• Children aged 6 months to 8 years who are receiving their first influenza vaccine still need two doses at least 4 weeks apart, but special consideration of influenza A(H1N1)pdm09 vaccination is no longer needed, since current vaccines incorporate that viral antigen.
• Live-attenuated vaccine (previously preferred for children aged 2–8 years) is no longer recommended over inactivated vaccine, because observational studies failed to support the superiority of live-attenuated vaccine seen in randomized trials.

Free links:

1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm 
2. http://www.jwatch.org/na38646/2015/07/29/high-dose-influenza-vaccine-no-more-effective-standard
   

CHEST 2015 Annual Meeting in Montreal Canada

We are happy to invite you to Chest 2015 meeting!

Join CHEST 2015 Annual Meeting in Montreal Canada, your connection to learning opportunities that will help optimize the clinical decisions you make. We’ve packed as many education deliverables as we can into 4 days to make the BIGGEST impact on your professional development and patient care. We’ll offer a full schedule of sessions that address topics from an interdisciplinary and interprofessional perspective to ensure a comprehensive (and BIG) understanding of chest medicine. And, our international faculty and attendees will give you a worldwide viewpoint on clinical issues. It doesn’t get much BIGGER than that!

Don’t miss:

• Interdisciplinary programs
• Simulation programs
• Postgraduate courses
• More than 300 general sessions
• Expanded MOC opportunities
• Original investigation presentations
• New diagnostic and treatment solutions in the exhibit hall

more info:
http://chestmeeting.chestnet.org/