Thoracic surgery clinics
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Thoracic surgery clinics · Aug 2015
ReviewCoagulopathy and Anticoagulation During Thoracic Surgery.
Coagulopathy and bleeding in thoracic surgery may be compounded by the chronic use of anticoagulants and antiplatelet agents. Timely preoperative cessation and postoperative resumption of these antithrombotic drugs are critical in reducing the risks of perioperative major bleeding and thromboembolism. This article describes the various strategies for the optimal perioperative management of antithrombotics based on individual assessment of each patient and the most recent multisociety guidelines.
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Thoracic surgery clinics · May 2015
Randomized Controlled Trial Multicenter Study Comparative StudyResults of the national lung cancer screening trial: where are we now?
The National Lung Screening Trial was a large, multicenter, randomized controlled trial published in 2011. It found that annual screening with low-dose CT (LDCT) in a high-risk population was associated with a 20% reduction in lung cancer-specific mortality compared with conventional chest radiography. Several leading professional organizations have since put forth lung cancer screening guidelines that include the use of LDCT, largely on the basis of this study. Broad adoption of these screening recommendations, however, remains a challenge.
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Thoracic surgery clinics · May 2015
ReviewCurrent estimate of costs of lung cancer screening in the United States.
The United States Preventive Services Task Force recently endorsed the use of low-dose computed tomography for lung cancer screening in high-risk patients because of the potential to reduce deaths. Before implementation on a national level, it will be important to ensure that a safe, high-quality, and accessible service can be adequately provided. It will also be important to make sure that screening is cost-effective. This article summarizes the published analyses of lung cancer screening cost, provides a contemporary estimation of the annual cost of screening in the United States, and identifies areas for improvement in the future.
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To understand the challenges of screening for lung cancer, surgeons should be familiar with fundamental epidemiologic concepts pertaining to screening and have an understanding of the evidence regarding the various modalities used for screening lung cancer. One large, recent study has confirmed that screening for lung cancer with low-dose computed tomography decreases mortality in high-risk individuals. ⋯ High-quality programs should be safe, cost-effective, accessible to high-risk patients, and involve the participation of a multidisciplinary team. Surgeons should be engaged in the implementation of screening programs for lung cancer.
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Thoracic surgery clinics · May 2015
ReviewThe United States Preventive Services Task Force recommendations for lung cancer screening.
In 2013, the United States Preventive Services Task Force made a grade B recommendation for annual screening for lung cancer with low-dose computed tomography in adult patients 55 to 80 years of age who have a 30 pack-year smoking history and currently smoke or have quit within the last 15 years. In practical terms, the United States Preventive Services Task Force recommendations will likely mean a large increase in actual screening rates.