Veno-venous extracorporeal membrane oxygenation (VV ECMO) cannula malposition identified with point-of-care ultrasound.

BACKGROUND: Point-of-care ultrasound (POCUS) has become a mainstay in the evaluation of critically ill patients in the intensive care unit (ICU). ECMO patients are susceptible to complications during prolonged ICU stay, including cannula malposition, which has deleterious consequences. Although the literature surrounding utility of ultrasound on ECMO patients is expansive, direct comparison between radiographic imaging versus ultrasound for identification of cannula malposition is lacking. CASE PRESENTATION: The authors identified four patients with cannula malposition discovered through POCUS that was missed on routine radiographic imaging. Identification and correction of malposition changed their ECMO course. CONCLUSION: This case series is the first in literature demonstrating that ultrasound may be superior to radiographic images for ECMO cannula malposition. Further investigation into this subject is warranted.

Lung Cancer Screening with Low-Dose CT: a Meta-Analysis.

BACKGROUND: Randomized controlled trials have evaluated the efficacy of low-dose CT (LDCT) lung cancer screening on lung cancer (LC) outcomes. OBJECTIVE: Meta-analyze LDCT lung cancer screening trials. METHODS: We identified studies by searching PubMed, Google Scholar, the Cochrane Registry, ClinicalTrials.gov , and reference lists from retrieved publications. We abstracted data on study design features, stage I LC diagnoses, LC and overall mortality, false positive results, harm from invasive diagnostic procedures, overdiagnosis, and significant incidental findings. We assessed study quality using the Cochrane risk-of-bias tool. We used random-effects models to calculate relative risks and assessed effect modulators with subgroup analyses and meta-regression. RESULTS: We identified 9 studies that enrolled 96,559 subjects. The risk of bias across studies was judged to be low. Overall, LDCT screening significantly increased the detection of stage I LC, RR = 2.93 (95% CI, 2.16-3.98), I2 = 19%, and reduced LC mortality, RR = 0.84 (95% CI, 0.75-0.93), I2 = 0%. The number needed to screen to prevent an LC death was 265. Women had a lower risk of LC death (RR = 0.69, 95% CI, 0.40-1.21) than men (RR = 0.86, 95% CI, 0.66-1.13), p value for interaction = 0.11. LDCT screening did not reduce overall mortality, RR = 0.96 (95% CI, 0.91-1.01), I2 = 0%. The pooled false positive rate was 8% (95% CI, 4-18); subjects with false positive results had < 1 in 1000 risk of major complications following invasive diagnostic procedures. The most valid estimates for overdiagnosis and significant incidental findings were 8.9% and 7.5%, respectively. DISCUSSION: LDCT screening significantly reduced LC mortality, though not overall mortality, with women appearing to benefit more than men. The estimated risks for false positive results, screening complications, overdiagnosis, and incidental findings were low. Long-term survival data were available only for North American and European studies limiting generalizability.

Insurance coverage and utilization of nicotine patches after receipt of a prescription.

Introduction: Changes in reimbursement policy have made nicotine replacement therapy (NRT) much more available, but little is known about what happens to patients after they receive their prescription. This study describes rates of successfully filling prescriptions for NRT and its association with type of insurance. Methods: We identified 224 patients who received a prescription for NRT during an outpatient visit to an academic medical center between January 1st 2016 and February 10th 2017. We conducted telephone surveys to assess whether they tried to fill their prescriptions and if so, determine the effects of insurance type on the ability to successfully fill the prescription. Results: Of 117 patients completing the survey, 23 (19.6%) did not attempt to fill and 6 (5.1%) had no insurance. Of the 90 patients with insurance who attempted to fill their prescription, 67 (74.4%) were successful and 23 (25.6%) were unsuccessful in obtaining medications. Success varied by insurance with successful fills ranging from 34 (87.2%) of those with commercial insurance, 24 (70.6%) with Medicaid, to 9 (52.9%) with Medicare. Of 37 participants living with another smoker, 31 (83.7%) wanted an NRT prescription specifically for their partner; several volunteered that they had shared patches with their partner. Conclusions: Despite widespread coverage for NRT, many patients may still encounter difficulties in getting their prescriptions filled. Some tobacco users might also benefit from getting NRT prescriptions for their partners that smoke.

Efficacy of a vision-screening tool for birth to 3 years early intervention programs.

PURPOSE: To validate a screening tool used to detect unsuspected visual pathway pathology in preschool children under 3 years of age with developmental disabilities enrolled in an early intervention program using guidelines from the Kansas Department of Health and Environment (KDHE). METHODS: The records of 300 consecutive children screened at a birth to 3 early intervention program from 2011 to 2014 were reviewed retrospectively. Inclusion criteria were documented KDHE vision screening examinations performed by trained early interventionist and full ophthalmic evaluations by a general ophthalmologist. The evaluation was only considered a pass if it was recorded on the chart and the child did not have any known risk factors. The visual pathway pathology status was determined after comprehensive ophthalmic examination, with the ophthalmologist masked to the vision screening results. RESULTS: A total of 216 children met inclusion criteria, of whom 137 were referred. The sensitivity was 95.3% (95% CI, 90.8-99.8); specificity, 57.25% (95% CI, 48.3-65.7); positive predictive value, 59.1% (95% CI, 50.4-67.3); negative predictive value, 94.9% (95% CI, 86.8-98.4); and negative likelihood ratio, 0.082 (95% CI, 0.031-0.22). A Pearson χ2 test for fit yielded an approximate P value of <0.0001. CONCLUSIONS: In this study population, good sensitivity and negative predictive value were demonstrated by the inexpensive screening examination coupled with associated risk factors for the 0-3 population of children with developmental disabilities.