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The need for cognitive closure describes the extent to which a person, faced with a decision, prefers any answer in lieu of continued uncertainty. This construct may be relevant in lung cancer screening, which can both reduce and increase uncertainty. We examined whether individual differences in need for cognitive closure are associated with Veterans' completion of lung cancer screening using a self-administered survey (N = 361). We also assessed whether need for cognitive closure moderates an association between screening completion and lung cancer risk perception. Contrary to our main hypothesis, high need for cognitive closure Veterans were not more likely to complete lung cancer screening and need for cognitive closure did not have a moderating role. [ABSTRACT FROM AUTHOR]

Key questions--and answers based on the latest evidence ABSTRACT: The supposition suggested by numerous smaller trials that systemic corticosteroids can reduce exacerbations of chronic obstructive pulmonary disease (COPD) has been [...]

BACKGROUND: Because standard home oxygen (O2) systems deliver O2 at fixed rates, these systems are not designed to ensure optimal oxygen delivery based on physiologic need. We tested the ability of the AccuO2 (OptiSat Medical, Minneapolis, Minnesota), a portable, closed-loop, oximetry-driven, O2-conserving device to maintain Spo2 at ≥ 90%, compared to continuous-flow oxygen and a standard O2-conserving device (CR-50, Puritan-Bennett, Pleasanton, California). METHODS: We randomly assigned 28 patients who were on continuous home O2 for COPD to use each of 3 O2 delivery systems (continuous-flow O2, CR-50, and AccuO2) for 8 hours a day, for 2 consecutive days, at home, at their current O2 prescription. We recorded SpO2 and calculated the conservation ratio (duration of a given O2 supply with an O2-conserving device compared to continuous-flow O2). RESULTS: Twenty-two patients completed all 3 study arms; 2 additional patients completed the AccuO2 arm and the continuous-flow O2 arm. The mean ± SD Spo2 was 92 ± 4% with continuous-flow O2, 92 ± 4% with the CR-50, and 91 ± 2% with AccuO2 (P = .006 for the AccuO2 vs continuous-flow O2, P= .03 for the AccuO2 vs the CR-50). Spo2 variability was less with the AccuO2 (P < .001 vs continuous-flow O2 and vs the CR-50). The conservation ratios were 9.9 ± 7.3 for the AccuO2 and 2.6 ± 1.0 for the CR-50 (P < .001). CONCLUSIONS: Compared to continuous-flow O2 or the CR-50, the AccuO2 maintained Spo2 closer to the target, and AccuO2 had a higher conservation ratio than CR-50. [ABSTRACT FROM AUTHOR]

Presents letters to editors on topics related to internal medicine. Cases of patients who developed hypotension and myocardial ischemia secondary to sublingual nifedipine; Alternate methods of heparin administration; Antimicrobial therapy for salmonella infections in AIDS.

Introduction The National Lung Screening Trial recently reported that annual low-dose computed tomography screening is associated with decreased lung cancer mortality in high-risk smokers. This study sought to identify the factors patients consider important in making lung cancer screening (LCS) decisions, and explore variations by patient characteristics and LCS participation. Material and methods This observational survey study evaluated the Minneapolis VA LCS Clinical Demonstration Project in which LCS-eligible Veterans (N = 1388) were randomized to either Direct LCS Invitation (mailed with decision aid, N = 926) or Usual Care (provider referral, N = 462). We surveyed participants three months post-randomization (response rate 44%) and report the proportion of respondents rating eight decision-making factors (benefits, harms, and neutral factors) as important by condition, patient characteristics, and LCS completion. Results Overall, the most important factor was personal risk of lung cancer and the least important factor was health risks from LCS. The reported importance varied by patient characteristics, including smoking status, health status, and education level. Overall, the potential harms of LCS were reported less important than the benefits or the neutral decision-making factors. Exposure to Direct LCS Invitation (with decision aid) increased Veterans’ attention to specific decision-making factors; compared to Usual Care respondents, a larger proportion of Direct LCS Invitation respondents rated the chance of false-positive results, LCS knowledge, LCS convenience, and anxiety as important. Those completing LCS considered screening harms less important, with the exception of incidental findings. Conclusion Decision tools influence Veterans’ perceptions about LCS decision-making factors. As the factors important to LCS decision making vary by patient characteristics, targeted materials for specific subgroups may be warranted. Attention should be paid to how LCS incidental findings are communicated. [ABSTRACT FROM AUTHOR]

Objectives: To describe participation rates, results, and lessons learned from a lung cancer screening (LCS) demonstration project., Study Design: Prospective observational study at 1 of 8 centers participating in a national Veterans Health Administration LCS demonstration project., Methods: An electronic health record (EHR) algorithm and tobacco pack-year (TPY) information prompt identified patients potentially eligible for LCS. LCS invitation was planned to consist of shared decision-making materials, an invitation letter to call the LCS manager, a reminder letter, and an outreach phone call for nonresponders. The outreach call was subsequently dropped due to time constraints on the LCS manager. Lung nodules and incidental findings on LCS low-dose computed tomography (LDCT) were recorded in templated radiology reports and tracked with EHR notes., Results: Of 6133 potentially eligible patients, we identified 1388 patients with eligible TPY information: 918 were invited for LCS and 178 (19%) completed LCS. LCS completion was more likely in patients in the mailing-plus-call outreach group (phase I) compared with the mail-only group (phase II) (22% vs 9%; P <.001). Among those completing an LDCT, 61% had lung nodules requiring follow-up: 43% of the nodules were less than 4 mm in diameter, 12 patients required further diagnostic evaluation, and 2 had lung malignancies. There were 179 incidental LDCT findings in 116 patients, and 20% were clinically significant., Conclusions: Important considerations in LCS are accurate identification of eligible patients, balancing invitation approaches with resource constraints, and establishing standardized methods for tracking numerous small lung nodules and incidental findings detected by LDCT.

Only minor disparities were found between patients at rural and urban clinics in this examination of the differences in the quality of health care for patients with COPD., Competing Interests: Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.

Background: Because standard home oxygen (O2) systems deliver O2 at fixed rates, these systems are not designed to ensure optimal oxygen delivery based on physiologic need. We tested the ability of the AccuO2 (OptiSat Medical, Minneapolis, Minnesota), a portable, closed-loop, oximetry-driven, O2-conserving device to maintain SpO2 at ≥ 90%, compared to continuous-flow oxygen and a standard O2-conserving device (CR-50, Puritan-Bennett, Pleasanton, California)., Methods: We randomly assigned 28 patients who were on continuous home O2 for COPD to use each of 3 O2 delivery systems (continuous-flow O2, CR-50, and AccuO2) for 8 hours a day, for 2 consecutive days, at home, at their current O2 prescription. We recorded SpO2 and calculated the conservation ratio (duration of a given O2 supply with an O2-conserving device compared to continuous-flow O2)., Results: Twenty-two patients completed all 3 study arms; 2 additional patients completed the AccuO2 arm and the continuous-flow O2 arm. The mean ± SD SpO2 was 92 ± 4% with continuous-flow O2, 92 ± 4% with the CR-50, and 91 ± 2% with AccuO2 (P = .006 for the AccuO2 vs continuous-flow O2, P = .03 for the AccuO2 vs the CR-50). SpO2 variability was less with the AccuO2 (P < .001 vs continuous-flow O2 and vs the CR-50). The conservation ratios were 9.9 ± 7.3 for the AccuO2 and 2.6 ± 1.0 for the CR-50 (P < .001)., Conclusions: Compared to continuous-flow O2 or the CR-50, the AccuO2 maintained SpO2 closer to the target, and AccuO2 had a higher conservation ratio than CR-50.