Survivorship care for a patient with cancer is often complex and requires a multidisciplinary approach. Cancer and its treatment can have late and long-term physical and psychosocial effects. After the acute and intense period of treatment and surveillance administered by oncology teams, cancer survivors slowly transition care to primary providers. Cancer survivors then enter into an extended phase of survivorship whether they are cancer-free, in remission, or living with cancer. In this phase, symptoms related to cancer and its treatment may vary over time. Developing a care plan can facilitate the transition of care between all providers taking care of cancer patients.

Remarkable advancements in therapeutic effectiveness over the past 30 years have created new cohorts of patients not previously seen. Once imminently fatal illnesses are now chronic manageable conditions, often treated with ongoing pharmacotherapy. The prolonged longevity enjoyed by these patients, combined with complicating factors from their diseases and/or treatments, expose patients to other conditions that were of little significance in past generations when life expectancy was very limited. Patients with congenital heart diseases, chronic heart failure, many forms of cancer, and human immunodeficiency virus (HIV) infection and others are at risk for serious comorbid conditions—in many cases, more likely to cause morbidity and mortality than their “primary” diagnoses. The specifics of care for these new patient groups, including differences in character and severity of the comorbid conditions, differences in treatment efficacy and tolerability in these individuals, and the significant likelihood of drug-induced disease and drug–drug interactions all suggest that specialization in providing their care may result in additional clinical benefits. In cardiovascular disease, cardio-oncology is an excellent example of this concept.1American College of Cardiology. Cardio-oncology.http://www.acc.org/clinical-topics/cardio-oncology#sort=%40fwhatstrendingscore86069%20descendingDate accessed: January 5, 2018Google Scholar With more efficacious and better-tolerated drug, radiation, and surgical treatments, many cancer patients are enjoying longer lifespans. Certain cancers are now themselves chronic diseases, with their sufferers enjoying markedly better survival but, consequently, a greater risk of dying from conditions other than cancer. Cardiovascular disease in particular may be influenced by complications of the malignancy, often by complications of the therapies, and sometimes by adverse drug interactions with the chemotherapeutic agents. Hence, the need for cardiologists to become experts in treating heart disease in oncology patients is now accepted. These specialists have gone far to establish cardio-oncology as a defined subspecialty of cardiovascular diseases and are to be applauded for their efforts.2Mayo Clinic Cardio-oncology clinics integrate specialty clinical care.https://www.mayoclinic.org/medical-professionals/clinical-updates/cardiovascular/cardio-oncology-clinics-integrate-specialty-clinical-careDate accessed: January 5, 2018Google Scholar Persons living with HIV constitute another new population with many similarities to the oncology patients discussed above. Approximately 1.1 million people in the United States are infected, with more than 37,000 new cases diagnosed each year.3US Centers for Disease Control and Prevention HIV in the United States: at a glance.https://www.cdc.gov/hiv/statistics/overview/ataglance.htmlDate accessed: January 5, 2018Google Scholar Most HIV+ patients have a life expectancy nearing that of their uninfected counterparts,4Samji H. Cescon A. Hogg R.S. et al.Closing the Gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada.PLoS One. 2013; 8 (e81355)Crossref Scopus (966) Google Scholar and infected patients are about as likely to die from HIV-independent comorbidities as from HIV/acquired immunodeficiency syndrome.5Smith C.J. Lene Ryom L. Rainer Weber R. et al.Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration.Lancet. 2014; 384 (for the; D:A:D Study Group): 241-248Abstract Full Text Full Text PDF PubMed Scopus (657) Google Scholar The average age of these patients has progressively increased (with one-third now over age 45 years),4Samji H. Cescon A. Hogg R.S. et al.Closing the Gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada.PLoS One. 2013; 8 (e81355)Crossref Scopus (966) Google Scholar, 6Canadian AIDS Treatment Information Exchange (CATIE). Home page http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo10a-eng.htmDate accessed: December 17, 2017Google Scholar placing many in the high-risk age range for atherosclerotic cardiovascular disease and hard major adverse cardiovascular events. Additionally, HIV+ patients seem to have an earlier onset of cardiovascular disease.7Vittecoq D. Escaut L. Chironi G. et al.Coronary heart disease in HIV-infected patients in the highly active antiretroviral treatment era.AIDS. 2003; 17: S70-S76Crossref PubMed Scopus (74) Google Scholar Human immunodefiency virus infection itself is associated with a 50%-100% greater cardiovascular risk,8Hemkens L.G. Bucher H.C. HIV infection and cardiovascular disease.Eur Heart J. 2014; 35: 1373-1381Crossref PubMed Scopus (152) Google Scholar even after controlling for traditional risk factors.9Ford E.S. Greenwald J.H. Richterman A.G. et al.Traditional risk factors and D-dimer predict incident cardiovascular disease events in chronic HIV infection.AIDS. 2010; 24: 1509-1517Crossref PubMed Scopus (155) Google Scholar Traditional risk factors seem to convey risk enhancements in HIV patients equal to those in noninfected patients10Schambelan M. Wilson P.W.F. Yaresheski K.E. et al.Development of appropriate coronary heart disease risk prediction models in HIV-infected patients.Circulation. 2008; 118: e48-e53Crossref PubMed Scopus (29) Google Scholar—though some (eg, smoking) may be comparatively more common in this population. The mechanism mediating this elevated independent risk is ill defined, though mounting evidence suggests vascular inflammation as contributory,8Hemkens L.G. Bucher H.C. HIV infection and cardiovascular disease.Eur Heart J. 2014; 35: 1373-1381Crossref PubMed Scopus (152) Google Scholar whereas direct cellular infection and a dysregulated host immune response are possible additional influencing factors. Patients living with HIV also suffer from metabolic syndrome and diabetes, dyslipidemias, hypertension,11Fedele F. Bruno N. Mancone M. Cardiovascular risk factors and HIV disease.AIDS Rev. 2011; 13: 119-129PubMed Google Scholar and conditions such as osteoporosis that can limit their ability to perform regular exercise. Some antiretroviral agents/classes seem to accelerate atherosclerosis directly (protease inhibitors12The DAD Study GroupClass of antiretroviral drugs and the risk of myocardial infarction.N Engl J Med. 2007; 356: 1723-1735Crossref PubMed Scopus (1254) Google Scholar) or indirectly through worsening dyslipidemia (nonnucleoside reverse transcriptase inhibitors13Desai M. Joyce V. Bendavid E. et al.Risk of cardiovascular events associated with current exposure to HIV antiretroviral therapies in a US veteran population.Clin Infect Dis. 2015; 61: 445-452Crossref PubMed Scopus (61) Google Scholar). Yet, data are clear that effective HIV therapy, confirmed by maintenance of minimum CD4+ counts and low or unmeasurable viral loads, is essential to reduce the event rate.14Strategies for Management of Antiretroviral Therapy (SMART) Study GroupCD4+ count-guided interruption of antiretroviral treatment.N Engl J Med. 2006; 355: 2283-2296Crossref PubMed Scopus (1884) Google Scholar The risk of drug interactions between antiretroviral drugs and many classes of cardiovascular medications is high, particularly for drugs metabolized through CYP 3A4. Statins reduce event rates in HIV+ patients,15Feinstein M.J. Achenbach C.J. Stone N.J. Lloyd-Jones D.M. A systematic review of the usefulness of statin therapy in HIV-infected patients.Am J Cardiol. 2015; 115: 1760-1766Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar though many patients cannot receive the high-intensity therapy recommended by guidelines for the general population, owing to pharmacokinetic interactions.16Gili S. Grosso Marra W. D'Ascenzo F. et al.Comparative safety and efficacy of statins for primary prevention in human immunodeficiency virus-positive patients: a systematic review and meta-analysis.Eur Heart J. 2016; 37: 3600-3609Crossref PubMed Scopus (38) Google Scholar Ezetimibe seems safe in these patients,17Chow D. Chen H. Glesby M.J. et al.Short-term ezetimibe is well tolerated and effective in combination with statin therapy to treat elevated LDL cholesterol in HIV-infected patients.AIDS. 2009; 23: 2133-2141Crossref PubMed Google Scholar but outcome data for this population are lacking. No data are available for newer lipid-lowering agents (PCSK-9 inhibitors18Sabatine M.S. Giugliano R.P. Keech A.C. et al.Evolocumab and clinical outcomes in patients with cardiovascular disease.N Engl J Med. 2017; 376 (for the; FOURIER Steering Committee and Investigators): 1713-1722Crossref PubMed Scopus (3163) Google Scholar) or anti-inflammatory drugs, such as the interleukin-1β inhibitor canakinumab,19Ridker P.M. Everett B.M. Thuren T. et al.Antiinflammatory therapy with canakinumab for atherosclerotic disease.N Engl J Med. 2017; 337 (for the; CANTOS Trial Group): 1119-1131Crossref Scopus (4601) Google Scholar for either primary or secondary prevention in HIV+ patients. Our ability to predict future major adverse cardiovascular events risk remains limited because risk equations developed for general populations, even with the addition of calibration constants, tend to underestimate higher-risk patients and overestimate lower-risk patients.20Begovac J. Dragovic G. Kusic J. Mihanovic M.P. Lukas D. Jevtovic D. Comparison of four international cardiovascular disease prediction models and the prevalence of eligibility for lipid lowering therapy in HIV infected patients on antiretroviral therapy.Croat Med J. 2015; 56: 14-23Crossref PubMed Scopus (20) Google Scholar One system, derived from the Data Collection on Adverse Events of Anti-HIV drugs (D:A:D),21Friis-Moller N. Ryom L. Smith C. et al.An updated prediction model of the global risk of cardiovascular disease in HIV-positive persons: the Data-collection on Adverse Effects of Anti-HIV Drugs (D:A:D) study.Eur J Prev Cardiol. 2016; 23: 214-223Crossref PubMed Scopus (144) Google Scholar includes a full model including some antiretroviral drug information. However, the highly questionable impact of abacavir on the myocardial infarction rate may invalidate this model.22Ding X. Andraca-Carrera E. Cooper C. et al.No association of abacavir use with myocardial infarction: findings of an FDA meta-analysis.J Acquir Immune Defic Syndr. 2012; 61: 441-447Crossref PubMed Scopus (140) Google Scholar A reduced D:A:D model (that does not use antiretroviral drug information) may be the best available at this time.6Canadian AIDS Treatment Information Exchange (CATIE). Home page http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo10a-eng.htmDate accessed: December 17, 2017Google Scholar Thus, as more data are collected on details of atherosclerotic mechanisms, treatment variances, and modifiable risk factor management and newer, more accurate risk estimation models are developed, the specific knowledge base for providing patient-specific cardiovascular care to patients with HIV will continue to grow. This, combined with the growing number of HIV+ patients at moderate-to-high cardiovascular risk, suggests that “cardio-virology” could be the next target population-based subspecialty in cardiology.

Post-marketing reporting of adverse drug events is essential for new medications, as pre-FDA approval studies lack sufficient subject numbers to detect signals for rare events. Prescriptions for the novel oral anticoagulant factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) have equaled or exceeded those for vitamin K antagonists in many clinical settings requiring chronic anticoagulation, and those of injectable heparins for deep vein thrombosis prophylaxis. We report the case of a 60-year-old woman followed for permanent atrial fibrillation who was prescribed apixaban. She rapidly developed worsening neurologic symptoms of imbalance and non-vertiginous dizziness preventing her from walking, headache, diplopia, and confusion/disorientation. Her symptoms began to resolve after stopping the drug, with return to baseline function within 72 h. Unbeknownst to her cardiology care team, the patient chose to re-challenge herself with apixaban at the same dose, producing identical symptoms and again total symptom resolution within 24 h of drug discontinuation. When seen by her physician, her physical examination was unchanged from her pre-treatment baseline. Symptoms did not recur when switched to rivaroxaban therapy.

Publications in peer-reviewed biomedical journals are essential for sharing knowledge and advancing healthcare. This article will articulate a 5-step approach for developing and publishing a manuscript, and provide academic clinicians with an instructional tool they can provide to their proteges and junior faculty. The authors attempt to distill existing advice for preparing manuscripts, which is found in myriad formats, combine these tutorials with their collective experience and present this approach for developing and publishing successfully a manuscript in a peer-reviewed journal. The 5 steps identified instruct would-be authors to (1) know their material and determine their audience; (2) outline their manuscript; (3) be ethically vigilant; (4) develop individual sections and submit their manuscript and (5) respond to reviewers' comments. This article describes each of these steps in detail. Rewards of publishing articles include recognition by peers and supervisors, contribution to academic promotion and dissemination of information to the medical community..

Chronic obstructive lung disease is among the leading causes of adult hospital admissions and readmissions in the United States. Preventing acute exacerbations is the primary approach in therapy. Combinations of smoking cessation, pulmonary rehabilitation, vaccinations and inhaled and oral medications may all reduce the overall risk of acute exacerbations. When prevention is unsuccessful, treatment of exacerbations often does not require hospitalization but can be safely executed in the outpatient setting. In the patient who does not require mechanical ventilation or who manifests respiratory acidosis, oxygen supplementation, frequent short-acting inhaled bronchodilators, oral corticosteroids and often antibiotics can abort the decompensation and sometimes return the patient to his or her pre-attack baseline lung function. Several models exist for delivering this care in the ambulatory setting. Follow-up care after an exacerbation has resolved is important, though there are few hard data suggesting which approach is best in this setting.

Many believe that mentoring is essential for new and developing faculty physicians to achieve their professional and personal goals, yet there are both positive and potential negative aspects of mentoring. Research reports on the process have few quantifiable objective outcomes, use mostly single-center study populations, lack controls and use mostly qualitative techniques. Absence of a standardized definition of mentorship has allowed widespread application of the term to other forms of protégé support. Several models have been developed, with other generalized descriptors used to differentiate the important qualities of mentoring relationships. Published evidence suggests some characteristic attitudes and personal qualities, knowledge, skills and behaviors are common among successful mentors. Identification and validation of better efficacy metrics, and use of these to design new programs to train effective mentors, are needed.

The end of life discussions can often be difficult for a multitude of reasons. Our culture is pervasive with ideas of mortality, and that medicine can avert this human constant. Medicine, as a field, must embrace our limitations so that we can engage in honest discussions with the families and the patients regarding the end of life care.

Patients infected with the human immunodeficiency virus (HIV+) are living longer and at heightened risk for developing cardiovascular events (CVEs). Commonly used prediction tools appear to misrepresent their CVE risk to varying degrees and in varying directions. Inclusion of markers of cellular infection, chronic immune activation and/or systemic inflammation into risk models might provide better predictive accuracy. Observational studies assessing the relationship of high-sensitivity C-reactive protein (hs-CRP) to CVE in HIV+ patients have reported inconsistent findings. This review of published studies attempted to determine if the available evidence supports its potential use in new models for stable, treated HIV+ patients. We searched the PubMed database using keywords and combinations of "HIV" AND "cardiovascular risk" AND "CRP". Papers presenting original analyses, associating hs-CRP concentration as an independent variable to hard cardiovascular outcomes (myocardial infarction and cardiovascular death), or to hard CVE as part of a composite endpoint, were included. Five observational studies met inclusion/exclusion criteria for review. Three papers identified an association between elevated hs-CRP and CVE, while two others failed to find any significant association. All reports were heterogeneous in terms of independent variables, controls, and designs. The larger and more rigorous studies, employing higher rates of confounder controls and more objective endpoints in their composites, showed positive associations. Though not conclusive, the preponderance of the evidence at this time supports CRP as a potentially valuable factor to be studied in prospective cardiovascular risk prediction investigations in HIV+ patients.

Primary aldosteronism (PA) is an important and commonly unrecognized cause of secondary hypertension. Idiopathic hyperaldosteronism and aldosterone-producing adenomas account for more than 95% of PA and are characterized, respectively, by bilateral or unilateral involvement of the adrenal glands. When there is suspicion for the presence of PA, a plasma aldosterone to renin ratio should be obtained initially. Localization to determine adrenal gland involvement is done by imaging, with computerized tomography or magnetic resonance imaging. After imaging, adrenal vein sampling is done to establish treatment options. Patients with unilateral disease, who are good surgical candidates, are most appropriately managed with adrenalectomy. A biochemical cure is almost certain following adrenalectomy; however, only 30-50% of patients would show adequate blood pressure improvement. Patients with bilateral adrenal disease and those believed not to be surgical candidates are managed with mineralocorticoid antagonists.

Allergic diseases are common in women of childbearing age. Both asthma and atopic conditions may worsen, improve or remain the same during pregnancy. Primary care physicians commonly encounter women receiving multiple medications for pre-existing atopic conditions, who then become pregnant and require medication changes to avoid potential fetal injury or congenital malformations. Each medication should be evaluated; intranasal and inhaled steroids are relatively safe to continue during pregnancy (budesonide is the drug of choice), second-generation antihistamines of choice are cetirizine and loratadine, leukotriene receptor antagonists are safe, sparing use of oral decongestants during the first trimester and omalizumab may be used for both uncontrolled asthma and for antihistamine-resistant urticaria. Medications to avoid during pregnancy include intranasal antihistamines, first-generation antihistamines, mycophenolate mofetil, methotrexate, cyclosporine, azathioprine and zilueton. Common allergic diseases may develop de novo during pregnancy, such as anaphylaxis.

Publications in peer-reviewed biomedical journals are essential for sharing knowledge and advancing healthcare. This article will articulate a 5-step approach for developing and publishing a manuscript, and provide academic clinicians with an instructional tool they can provide to their protégés and junior faculty. The authors attempt to distill existing advice for preparing manuscripts, which is found in myriad formats, combine these tutorials with their collective experience and present this approach for developing and publishing successfully a manuscript in a peer-reviewed journal. The 5 steps identified instruct would-be authors to (1) know their material and determine their audience; (2) outline their manuscript; (3) be ethically vigilant; (4) develop individual sections and submit their manuscript and (5) respond to reviewers׳ comments. This article describes each of these steps in detail. Rewards of publishing articles include recognition by peers and supervisors, contribution to academic promotion and dissemination of information to the medical community.

Among the minorities underserved by today׳s healthcare system, the lesbian, gay and bisexual (LGB) population may be the least studied, and the least understood by healthcare providers. High-quality evidence is often lacking regarding optimal preventive care measures, both in medical areas that (to date) fail to identify differences in need between LGB and heterosexual patients, and in those more prevalent in or more specific (or both) to sexual minorities. Issues of substance abuse, sexual health and sexually transmitted diseases, obesity and other eating disorders, cardiovascular prevention, cancer prevention and screening, depression and other psychological disorders, social isolation and personal and intimate partner violence are all as or more important to address in LGB patients as they are in the general American population. Although many barriers to the delivery of quality healthcare to these patients exist, support from governmental, professional and private organizations can assist both patients and providers in overcoming these barriers.

The advent of effective oral, molecular-targeted drugs in oncology has changed many incurable malignancies such as chronic myeloid leukemia into chronic diseases similar to coronary artery disease and diabetes mellitus. Oral agents including monoclonal antibodies, kinase inhibitors and hormone receptor blockers offer patients with cancer incremental improvements in both overall survival and quality of life. As it is imperative to recognize and manage side effects of platelet inhibitors, beta blockers, statins, human immunodeficiency virus drugs and fluoroquinolones by all healthcare providers, the same holds true for these newer targeted therapies; patients may present to their generalist or other subspecialist with drug-related symptoms. Cardiovascular adverse events are among the most frequent, and potentially serious, health issues in outpatient clinics, and among the most frequent side effects of targeted chemotherapy. Data support improved patient outcomes and satisfaction when primary care and other providers are cognizant of chemotherapy side effects, allowing for earlier intervention and reduction in morbidity and healthcare costs. With the implementation of accountable care and pay for performance, improved communication between generalists and subspecialists is essential to deliver cost-effective patient care.

The advent of effective oral, molecular-targeted drugs in oncology has changed many incurable malignancies such as chronic myeloid leukemia into chronic diseases similar to coronary artery disease and diabetes mellitus. Oral agents including monoclonal antibodies, kinase inhibitors and hormone receptor blockers offer patients with cancer incremental improvements in both overall survival and quality of life. As it is imperative to recognize and manage side effects of platelet inhibitors, beta blockers, statins, human immunodeficiency virus drugs and fluoroquinolones by all healthcare providers, the same holds true for these newer targeted therapies; patients may present to their generalist or other subspecialist with drug-related symptoms. Cardiovascular adverse events are among the most frequent, and potentially serious, health issues in outpatient clinics, and among the most frequent side effects of targeted chemotherapy. Data support improved patient outcomes and satisfaction when primary care and other providers are cognizant of chemotherapy side effects, allowing for earlier intervention and reduction in morbidity and healthcare costs. With the implementation of accountable care and pay for performance, improved communication between generalists and subspecialists is essential to deliver cost-effective patient care.

Academic tenure, introduced by the American Association of University Professors in 1915, is a status that protects employed faculty members from summary dismissal and, thereby, intends to preserve their academic freedom. Initially tied to financial security through salary guarantees, academic tenure has evolved into a concept associated less with monetary support and strict scholarly productivity than at its inception, primarily owing to the growing number of clinician educators with highly competitive salaries at university-affiliated academic health centers. Achievement of tenure continues to require significant additional time and effort, but modifications in the requisite probationary period and the allowance at some institutions of tenure for part-time faculty have offset some costs, while still maintaining leadership opportunities for the individual and academic benefits for both the individual and the institution. How institutions balance their own financial risk and the demands on faculty members is likely to determine the future of tenure.

The primary goal of cancer screening is to reduce cancer-related mortality without incurring significant harm. Screening efforts for solid tumors, therefore, have targeted the precursors of the most common and the most deadly cancers breast, cervical, colorectal, lung and prostate cancer. Balancing risk and benefit has led to controversy regarding the timing of cancer screening when to begin, how often to screen and when to stop and the nature of the modality of cancer screening invasive or noninvasive, laboratory-centered or imaging-centered. Evidence-based guidelines published by general medical societies, subspecialty societies and publicly funded task forces on population-based screening aid healthcare providers in making individualized decisions with their patients.

Cardiac-specific troponins (Tns) are sensitive and specific markers of myocardial injury that have been shown to be predictive of outcomes in many cardiac and noncardiac conditions. We sought to determine whether normal cardiac Tn concentrations obtained during the first 24 hours following blunt chest trauma would predict good cardiac outcomes. A PubMed/MEDLINE search was performed to identify prospective studies in patients with blunt chest trauma in which serial cardiac TnT or TnI values were measured within 24 hours of admission and clinical outcomes assessed. Ten studies qualified for review. Studies that used the lower reference limit of Tn as the cutoff for cardiac injury showed 100% negative predictive value (NPV) for developing cardiac complications, whereas studies using higher Tn cutoffs showed wider variation in NPV (50%-98%). Cardiac Tn measured within 24 hours using the lower reference limit (LRL) as the cutoff appears to have excellent NPV for clinically significant adverse cardiac events. This could allow for early discharge after a 24-hour observation period in otherwise uncomplicated blunt chest trauma patients and avoid the need for more expensive cardiac imaging and additional resource utilization.

Heart failure is a chronic disease afflicting millions of patients worldwide. Advances in treatment have allowed sufferers to enjoy overall prolonged survival and enhanced quality of life. Yet, a consequence of these therapeutic successes is that more patients survive to end-stage disease, with severe symptoms, poor quality of life, and no options available to prolong their survival reasonably. End-stage heart failure patients require a comprehensive palliative approach to care during their final months, with treatment goals focusing on symptom relief. Often, specific heart failure therapies can further this cause and should be administered when appropriate to alleviate specific symptoms, while other general palliative measures should also be considered as with other terminal patients. End-of-life palliative strategies must conform to accepted principles of ethical care. Constant communication with patients and families is essential to achieve best treatment goals for this growing segment of the population.

fer useful prognostic information in this population and might identify a group of patients to target for more intensive thera- peutic interventions.Cardiac troponins are specific and sensitive biomarkers used for diagnosis and prognosis in myocardial infarction. Troponin elevations can also occur in other disorders and may be useful to predict mortality. This systematic review is intended to determine whether or not elevated troponins are predictive of mortality (in-hospital, short term, and longer-term) among patients admitted with COPD exacerbation.PubMed/Medline was searched to identify relevant English language articles that measured troponin T or troponin I in patients hospitalized for COPD exacerbation and assessed mortality, with or without other clinical outcomes. Only studies of significant size that presented original data were included.Nine research reports (4 prospective, 5 retrospective) qualified for review. Mortality was consistently increased in seven of these studies among COPD patients who had elevated troponin levels during an exacerbation. One retrospective study found no effect on (in-hospital) mortality but reported increased morbidity (greater oxygen requirements and more ventilatory failure) and increased length of hospital stay in patients with elevated troponin whereas discharge troponin T in one prospective study predicted hospitalizations.The review shows a strong direct association between cardiac troponin and mortality in patients hospitalized for COPD exacerbations. Troponin monitoring could offer useful prognostic information in this population and might identify a group of patients to target for more intensive therapeutics interventions.

Abstract Lung cancer is the deadliest cancer in women. In the last decade, the first measurable decline in disease-related mortality has occurred and in the last 5 years, the first decline in lung cancer incidence in women in the United States has been reported. Five-year survival rates are much higher in early-stage disease, making effective screening a priority. Data on screening with low-dose computed tomography are controversial; existing guidelines are not sex specific and recommend testing only for patients at high risk for the disease. Although cigarette smoking remains the predisposing factor that is most often associated with tumor development, the advent of molecularly targeted therapy and the growing evidence that susceptible targets are more prevalent in never-smoking women have brought more attention to this particular subpopulation. Studies of both surgery and systemic therapy suggest that not only never-smoking women but also women overall experience better outcomes than men. Identifying all of the factors contributing to these sex differences presents us with an opportunity to identify potentially a distinct tumor biology in women who would warrant a distinct personalized treatment approach.