Chest
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Lung cancer screening with low-dose CT (LDCT) scan was shown to reduce lung cancer mortality in the National Lung Screening Trial, a large randomized controlled trial of high-risk current and former smokers. Despite ongoing uncertainty over the effectiveness of LDCT scan in the real-world setting, the Centers for Medicare and Medicaid Services (CMS) decided to cover LDCT scan as a preventive service. As part of its National Coverage Determination, CMS set forth a series of requirements for reimbursement of LDCT scan, including a counseling and shared decision-making visit prior to a LDCT scan being ordered. ⋯ Two new billing codes were introduced for the counseling and shared decision-making visit and subsequent LDCT scan. In this review, we summarize the evidence around lung cancer screening and describe practical aspects of the counseling and shared decision-making, including billing considerations. We conclude with a discussion of the greater implications of CMS National Coverage Determination, especially as it pertains to quality assurance around new screening tests.
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Malignant pleural mesothelioma is a highly aggressive tumor associated with asbestos exposure. There are few effective treatment options for mesothelioma, and patients have a very poor prognosis with a median survival of < 12 months from diagnosis. Biomarkers have been proposed as a cost-effective means of cancer management, and the search for a mesothelioma biomarker has been ongoing for the last 30 years. ⋯ Mesothelin is a glycoprotein normally expressed on the surface of mesothelial cells, and in the cancerous state it can be present in circulation. Mesothelin has a limited expression on normal, nonmalignant tissue and is thus an attractive therapeutic target for mesothelin-positive tumors. In this review we will focus on the discovery and clinical usages of mesothelin and provide an update on other mesothelioma biomarkers and show how such biomarker studies might impact on the management of this deadly tumor in the future.
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Randomized Controlled Trial
Intravenous magnesium sulfate for bronchiolitis: A randomized trial.
The goal of this study was to determine if IV magnesium, useful for severe pediatric asthma, reduces time to medical readiness for discharge in patients with bronchiolitis when added to supportive care. ⋯ IV magnesium did not provide benefit for patients with acute bronchiolitis and may be harmful.
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Guidelines recommend lung cancer screening (LCS), and it is currently being adopted nationwide. The American College of Chest Physicians advises inclusion of specific programmatic components to ensure high-quality screening. However, little is known about how LCS has been implemented in practice. We sought to evaluate the experience of early-adopting programs, characterize barriers faced, and identify strategies to achieve successful implementation. ⋯ Lung cancer screening implementation is a complex undertaking requiring coordination at many levels. The insight gained from evaluation of these early-adopting programs may inform subsequent design and implementation of LCS programs.
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Some patients with autoimmune characteristics and idiopathic interstitial pneumonia, particularly usual interstitial pneumonia (UIP), do not fit neatly into the category of connective tissue disease-associated interstitial lung disease (CTD-ILD), idiopathic pulmonary fibrosis (IPF), or recently proposed yet to be validated criteria for interstitial pneumonia with autoimmune features (IPAF). Outcomes of these patients are unknown. ⋯ No clinically significant differences in pulmonary function to distinguish between patients with AI-ILD, IPAF, CTD-ILD, and Lone-IPF were observed after 1 year. Longer periods of follow-up are needed to understand the outcomes of these patients. It is not yet clear whether AI-ILD is a distinct phenotype or a variant of the newly proposed entity IPAF.