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American College of Chest Physicians, Oct. 26-31

The 79th Annual Meeting of the American College of Chest Physicians

The annual meeting of the American College of Chest Physicians was held from Oct. 26 to 31 in Chicago and attracted approximately 6,000 participants from around the world, including specialists and heath care professionals focused on pulmonary, critical care, and sleep medicine. The conference featured presentations focusing on clinical updates in chest medicine, including advances in pulmonary, critical care, and sleep medicine.

In one study, Peter Mazzone, M.D., of the Cleveland Clinic, and colleagues found that a colorimetric sensor array-based breath test was capable of separating patients with lung cancer from those without the condition.

"There were two parts to this study. In the first part, we looked at how the breath collection instrument and sensor were performing and made adjustments to both in order to optimize its performance," said Mazzone.

In the second part of the study, the investigators used the improved device and sensor to see if they could accurately separate a sensor signal of their patients with lung cancer from those without lung cancer.

"We found good separation of lung cancer from non-cancer breath signals, and very good separation of signals of one type of lung cancer from another," said Mazzone. "We learned about ways that we can enhance the sensor and breath collection instrument, and showed enough promise that this can be an accurate test, that we hope to design a larger study with an improved system in hopes that this will be the final step towards having a clinically useful test."

This research was sponsored by industry; several authors disclosed financial ties to industry-related sources.

Abstract

In another study, Margarita Oks, M.D., of the Long Island Jewish Hospital, North Shore-Long Island Jewish Health System in New York, and colleagues found an association between using bedside ultrasound and a decreased number of formal radiology images such as chest X-rays; computed tomography of the chest, abdomen, and pelvis; deep vein thrombosis studies; and two-dimensional transthoracic echocardiography, despite the population studied having a higher one-year mortality.

"The impact on clinical practice is great since this is the first time, to our knowledge, that it has been shown that a medical intensive care unit that uses primarily bedside ultrasound has an association with a reduced number of formal radiology images," said Oks. "This has overreaching effects on reducing costs, improving safety, and also improving medical management of critically ill patients. We are hoping to increase the number of chart reviews as we move forward with our investigation."

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Researchers at the State University of New York-Upstate Medical University Hospital in Syracuse found that the use of beta-blockers during the perioperative period may increase the risk of adverse cardiovascular events during a non-cardiac surgical procedure.

"Maintaining perioperative clinically-indicated beta-blockers in patients undergoing surgery who have coronary artery disease or who are at high risk for cardiovascular events is a standard practice. Starting beta-blockers for surgical patients who do not have coronary disease and without at least moderate risk for cardiovascular events is not recommended," said David Gutterman, M.D., of the Medical College of Wisconsin in Milwaukee, and past president of the American College of Chest Physicians. "These results should alert physicians to the potential harm from beta-blockers, especially in patients who had hemodynamic difficulty with titrating to the dose they are on and in those who have impaired cardiac function and anticipate long anesthesia times. This would require closer monitoring and perhaps adjustments in doses given."

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Constantine Vardavas, M.D., of the Harvard School of Public Health in Boston, and colleagues found that smokers of long or ultra-long cigarettes had higher blood cadmium concentrations in comparison to smokers of regular-sized cigarettes.

"Previous reports have shown that perception of harm related to cigarette smoking could be mitigated by package (shape, size, color, and opening) and cigarette stick design (e.g., the light cigarette myth)," said Vardavas. "Hence, the take-home point is that clinicians should convey that all forms of cigarette smoking are harmful to one's health. Slim cigarettes commonly smoked by females are likely to impact blood cadmium levels at least as much as, if not more than, regular cigarettes. Smoking cessation should be a central part of daily clinical practice."

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Researchers at the Northside Medical Center in Youngstown, Ohio, found that electronic intensive care units (eICUs) were an effective way to provide round-the-clock intensive care to patients in remote locations.

"Provision of high-level intensive care in remote locations is challenging, and e-ICU offers a unique approach to addressing this need," Curtis Sessler, M.D., president-designate of the American College of Chest Physicians, said in a statement. "While the favorable trends in selected outcomes were encouraging, larger and more comprehensive studies are needed."

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