Chest
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As a result of many interacting variables, including crowded shelters and limited access to health care, homeless persons are at high risk for tuberculosis. Using traditional approaches, control of tuberculosis in this population has been difficult. Decision analysis was used to investigate the cost-effectiveness of BCG (bacillus Calmette-Guérin) vaccination in persons attending homeless shelters. ⋯ Using conservative assumptions, a vaccine that was at least 40 percent effective would result in a net cost savings. If the efficacy of the vaccine were 50 percent, $4,000 would be saved, 12 life-years gained, and 23 cases of active tuberculosis prevented for every 1,000 persons vaccinated. Further study of the BCG vaccine in homeless persons and other populations at risk is warranted.
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Letter Case Reports
Pneumothorax complicating BiPAP therapy for Pneumocystis carinii pneumonia.
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Randomized Controlled Trial Clinical Trial
A computer-controlled ventilator weaning system. A clinical trial.
The purpose of this study was to determine if a computer-directed weaning system could wean patients with complex medical problems from mechanical ventilation and appropriately respond to signs of respiratory failure more effectively than traditional physician-directed weaning methods. In a prospective, randomized, controlled study, we tested the system in 15 patients who had required prolonged mechanical ventilation and met predetermined weaning tests. Patients were randomly assigned to one of two groups: (1) automatic, computer-directed weaning or (2) physician-controlled weaning. ⋯ The number of arterial blood gas samples drawn during the study was 1.4 +/- 0.7 for the computer group, 7.2 +/- 4.3 for the control group. The number of minutes per hour outside acceptable limits of RR > 30, RR < 8, or TV < 5 ml/kg was 3.2 +/- 2.8 min for the computer group and 6.6 +/- 4.1 min for the control group. The study suggests that use of the computer-directed weaning system results in fewer arterial blood gas samples, shorter weaning times, and less time spent outside acceptable RR and TV parameters.
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Randomized Controlled Trial Clinical Trial
Screening for lung cancer re-examined. A reinterpretation of the Mayo Lung Project randomized trial on lung cancer screening.
In the 1970s, three randomized trials, each involving approximately 10,000 male subjects, were carried out to determine the value of lung cancer screening in cigarette smokers. These studies have been widely interpreted as providing strong evidence that screening does not contribute to decreased death rates, and, accordingly, the American Cancer Society firmly recommends against lung cancer screening. No randomized trial, however, has evaluated screening for lung cancer in women, who currently comprise 39% of the lung cancer population. ⋯ This explanation is statistically plausible, but, given the status of lung cancer as the most lethal of malignancies, is biologically unlikely. An alternative hypothesis is that chance alone might have accounted for the observed 0.98% difference in lung cancer detection rates. Were this the case, then 46 additional cases would have been detected in the control group had this chance event not occurred.(ABSTRACT TRUNCATED AT 400 WORDS)
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Currently, only a few chemotherapeutic agents (ifosfamide, mitomycin, vinblastine, and vindesine) have consistently produced single-agent response rates greater than 15% in patients with non-small-cell lung cancer (NSCLC). While combination chemotherapy with these and other agents may prolong survival in some patients with advanced disease, complete responses and long-term disease control are achieved only infrequently. ⋯ These results have brightened the prospects for chemotherapy against NSCLC. This article reviews available data for several of these agents: navelbine, which is an analogue of vinblastine, the camptothecins CTP-11 and topotecan, and taxol, the first of a novel class of antimicrotubule drugs.