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https://www.readbyqxmd.com/read/28212836/point-of-care-ultrasonography-for-evaluation-of-acute-dyspnea-in-the-emergency-department
#1
Maurizio Zanobetti, Margherita Scorpiniti, Chiara Gigli, Peiman Nazerian, Simone Vanni, Francesca Innocenti, Valerio T Stefanone, Caterina Savinelli, Alessandro Coppa, Sofia Bigiarini, Francesca Caldi, Irene Tassinari, Alberto Conti, Stefano Grifoni, Riccardo Pini
BACKGROUND: Acute dyspnea is a common symptom in the emergency department (ED). Standard approach to dyspnea often relies on radiologic and laboratoristic results, causing excessive delay before adequate therapy is started; an integrated point-of-care ultrasonography (PoCUS) approach can shorten the time needed to formulate a diagnosis maintaining an acceptable safety profile. METHODS: Consecutive adult patients presenting with dyspnea and admitted after ED evaluation were prospectively enrolled...
February 14, 2017: Chest
https://www.readbyqxmd.com/read/28212835/chest-computed-tomography-signs-in-pulmonary-disease-a-pictorial-review
#2
REVIEW
Shine Raju, Subha Ghosh, Atul C Mehta
Computed tomography (CT) of the chest is one of the most important imaging modalities available to a pulmonologist. The advent of high-resolution CT of the chest has led to its increasing use. While chest radiographs are still useful as an initial test, their utility is limited in the diagnosis of lung diseases which depend on higher resolution images such as interstitial lung diseases and pulmonary vascular diseases. Several metaphorical chest CT signs have been described linking abnormal imaging patterns to lung diseases...
February 14, 2017: Chest
https://www.readbyqxmd.com/read/28202342/the-impact-of-statin-use-on-all-cause-mortality-in-patients-with-copd-a-population-based-cohort-study
#3
A J N Raymakers, M Sadatsafavi, D D Sin, M A De Vera, L D Lynd
BACKGROUND: Patients with chronic obstructive disease (COPD) are often prescribed statins due to the increased prevalence of cardiovascular disease (CVD). There is considerable debate about the benefits conferred by statins in patients with COPD. This study evaluates the association of statin use with all-cause and pulmonary-related mortality in COPD patients. METHODS: This study uses population-based administrative data for the province of British Columbia, Canada...
February 12, 2017: Chest
https://www.readbyqxmd.com/read/28192114/sirolimus-and-autophagy-inhibition-in-lam-results-of-a-phase-i-clinical-trial
#4
Souheil El-Chemaly, Angelo Taveira-Dasilva, Hilary J Goldberg, Elizabeth Peters, Mary Haughey, Don Bienfang, Amanda M Jones, Patricia Julien-Williams, Ye Cui, Julian A Villalba, Shefali Bagwe, Rie Maurer, Ivan O Rosas, Joel Moss, Elizabeth P Henske
BACKGROUND: Animal and cellular studies support the importance of autophagy inhibition in lymphangioleiomyomatosis (LAM). In a cohort of subjects with LAM, we tested the hypothesis that treatment with sirolimus and hydroxycholoroquine (an autophagy inhibitor) at 2 different dose levels is safe and well tolerated. Secondary endpoints included changes in lung function. METHODS: This 48-week, two-center Phase I trial evaluated the safety of escalating oral hydroxychloroquine doses (100-200 mg) given twice a day in combination with sirolimus to eligible patients ≥18 years old with LAM...
February 10, 2017: Chest
https://www.readbyqxmd.com/read/28192113/a-randomised-clinical-trial-comparing-the-effects-of-antitussives-on-respiratory-centre-output-in-patients-with-chronic-cough
#5
Claudia Mannini, Federico Lavorini, Alessandro Zanasi, Federico Saibene, Luigi Lanata, Giovanni Fontana
BACKGROUND: Cough is produced by the same neuronal pool implicated in respiratory rhythm generation and antitussive drugs acting at the central level, such as the opioids, may depress ventilation. Levodropropizine is classified as a non-opioid, peripherally-acting antitussive drug acting at the level of airway sensory nerves. However, the lack of a central action by Levodropropizine remains to be fully established. We set out to compare the effects of Levodropropizine and the opioid antitussive agent Dihydrocodeine on the respiratory responses to a conventional CO2 re-breathing test in patients with chronic cough of any origin...
February 10, 2017: Chest
https://www.readbyqxmd.com/read/28185772/impact-of-weight-loss-management-in-osa
#6
REVIEW
Simon A Joosten, Garun S Hamilton, Matthew T Naughton
The interaction between obesity and obstructive sleep apnea (OSA) is complex. Whilst it is often assumed that obesity is the major cause of OSA, and that treatment of the OSA might mitigate further weight gain, new evidence is emerging that suggest these statements may not be the case. Obesity explains about 60% of the variance of the apnea hypopnea index definition of OSA, mainly in those < 50 years and less so in the elderly. Moreover, long term treatment of OSA with continuous positive airway pressure is associated with small but significant weight gain...
February 6, 2017: Chest
https://www.readbyqxmd.com/read/28153671/insomnia-and-risk-of-cardiovascular-disease
#7
REVIEW
Sogol Javaheri, Susan Redline
Insomnia is the most prevalent sleep disorder in the United States and is highly comorbid with a number of cardiovascular diseases. In the last decade a number of observational studies have demonstrated an association between insomnia and incident cardiovascular disease (CVD) morbidity and mortality, including hypertension, coronary heart disease, and heart failure. Despite some inconsistencies in the literature, likely due to variation in how insomnia is defined and measured, the existing data suggest that insomnia, especially when accompanied by short sleep duration, is associated with increased risk for hypertension, coronary heart disease and recurrent acute coronary syndrome, and heart failure...
January 30, 2017: Chest
https://www.readbyqxmd.com/read/28143696/management-of-children-with-chronic-wet-cough-and-protracted-bacterial-bronchitis-chest-guideline-and-expert-panel-report
#8
Anne B Chang, John J Oppenheimer, Miles Weinberger, Bruce K Rubin, Cameron C Grant, Kelly Weir, Richard S Irwin
BACKGROUND: Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews relating to the management of chronic wet cough in children (aged ≤14-years) based on key questions (KQ1)-how effective are antibiotics in improving the resolution of cough? If so, what and for how long? and; (KQ2)-when should children be referred for further investigations? METHODS: We used the CHEST expert cough panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and GRADE framework...
January 28, 2017: Chest
https://www.readbyqxmd.com/read/28132754/interventional-pulmonology-fellowship-accreditation-standards-executive-summary-of-the-multi-society-interventional-pulmonology-fellowship-accreditation-committee
#9
John J Mullon, Kristin M Burkart, Gerard Silvestri, D Kyle Hogarth, Francisco Almeida, David Berkowitz, George Eapen, David Feller-Kopman, Henry E Fessler, Erik Folch, Colin Gillespie, Andrew Haas, Shaheen Islam, Carla Lamb, Stephanie M Levine, Adnan Majid, Fabien Maldonado, Ali Musani, Craig Piquette, Cynthia Ray, Chakravarthy Reddy, Otis Rickman, Michael Simoff, Momen M Wahidi, Hans Lee
Interventional Pulmonology (IP) is a rapidly evolving subspecialty of pulmonary medicine. In the last ten years formal IP fellowships have increased substantially in number from just five to now over thirty. The vast majority of IP fellowship trainees are selected through the National Residency Matching Program, and validated in-service and certification exams for IP exist. Practice standards and training guidelines for IP fellowship programs have been published, however considerable variability in the environment, curriculum, and experience offered by the various fellowship programs still exists and there is currently no formal accreditation process in place to standardize IP fellowship training...
January 26, 2017: Chest
https://www.readbyqxmd.com/read/28130045/hematopoietic-processes-in-eosinophilic-asthma
#10
Brittany M Salter, Roma Sehmi
Airway eosinophilia is a hallmark of allergic asthma and understanding mechanisms that promote increases in lung eosinophil numbers is important for effective pharmaco-therapeutic development. It has become evident that expansion of hemopoietic compartments in the bone marrow promotes differentiation and trafficking of mature eosinophils to the airways. Hematopoietic progenitor cells egress the bone marrow and home to the lungs, where in-situ differentiative processes within the tissue provide an ongoing source of pro-inflammatory cells...
January 24, 2017: Chest
https://www.readbyqxmd.com/read/28130044/effects-of-cpap-and-mads-on-health-related-quality-of-life-in-osa-a-systematic-review-and-meta-analysis
#11
Eric Kuhn, Esther I Schwarz, Daniel J Bratton, Valentina A Rossi, Malcolm Kohler
BACKGROUND: Untreated obstructive sleep apnea (OSA) is associated with impaired health-related quality of life (QoL) and excessive daytime sleepiness which have been shown to improve with treatment. The aim was to compare the effects of continuous positive airway pressure (CPAP) and mandibular advancement devices (MAD) on health-related QoL in OSA. METHODS: MEDLINE and Cochrane Library were searched up to November 2015. Randomized controlled trials (RCTs) comparing the effect of CPAP, MADs or an inactive control on health-related QoL assessed by the 36-item short form (SF-36) in OSA...
January 24, 2017: Chest
https://www.readbyqxmd.com/read/28115168/heterogeneity-in-survival-among-adult-cystic-fibrosis-patients-with-fev1-30-of-predicted-in-the-united-states
#12
Kathleen J Ramos, Bradley S Quon, Sonya L Heltshe, Nicole Mayer-Hamblett, Erika D Lease, Moira L Aitken, Noel S Weiss, Christopher H Goss
BACKGROUND: Lung transplantation (LTx) is frequently considered for patients with cystic fibrosis (CF) when FEV1 reaches <30%. This study estimated transplant-free survival for CF patients and FEV1 <30% and identified predictors of death without LTx. METHODS: We conducted a retrospective cohort study using the CF Foundation Patient Registry, 1/1/2003-12/31/2013. Adult patients (≥18 years) with FEV1 <30% prior to LTx were included. We performed Kaplan-Meier survival estimates censored at LTx...
January 20, 2017: Chest
https://www.readbyqxmd.com/read/28115167/physician-assessment-of-pre-test-probability-of-malignancy-and-adherence-with-guidelines-for-pulmonary-nodule-evaluation
#13
Nichole T Tanner, Alexander Porter, Michael Gould, Xiao-Jun Li, Anil Vachani, Gerard A Silvestri
BACKGROUND: The annual incidence of pulmonary nodules is estimated at 1.57 million. Guidelines recommend utilizing an initial assessment of nodule probability for malignancy (pCA). A previous study found that despite this recommendation, physicians did not follow guidelines. METHODS: Physician (n= 337) and two previously validated risk model assessment of cancer pre-test probability were evaluated for performance in 337 patients with pulmonary nodules based on final diagnosis and compared...
January 20, 2017: Chest
https://www.readbyqxmd.com/read/28109962/endothelial-permeability-and-hemostasis-in-septic-shock-results-from-the-process-trial
#14
Peter Hou, Michael Filbin, Henry Wang, Long Ngo, David T Huang, William C Aird, Donald M Yealy, Derek C Angus, John A Kellum, Nathan I Shapiro
BACKGROUND: We studied patients from the Protocolized Care in Early Septic Shock (ProCESS) trial to determine: the effects of alternative resuscitation strategies on circulating markers of endothelial cell permeability and hemostasis, and; the association between biomarkers and mortality. METHODS: Prospective study of biomarkers of endothelial cell permeability (vegf, sflt-1, ang-2) and hemostasis (vwf, thrombomodulin, tpa) in 605 of the 1341 ProCESS participants in a derivation cohort and 305 in validation...
January 18, 2017: Chest
https://www.readbyqxmd.com/read/28108179/symptomatic-treatment-of-cough-among-adult-patients-with-lung-cancer-chest-guidelines-and-expert-panel-report
#15
Alex Molassiotis, Jaclyn A Smith, Peter Mazzone, Fiona Blackhall, Richard S Irwin
BACKGROUND: Cough among patients with lung cancer is a common but often undertreated symptom. We have used a recent Cochrane systematic review, among other sources of evidence, to update the recommendations and suggestions of the CHEST 2006 guideline on this topic. METHODS: The American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on data from the Cochrane systematic review on the topic, uncontrolled studies, case studies, and the clinical context...
January 17, 2017: Chest
https://www.readbyqxmd.com/read/28108178/reference-values-for-peak-exercise-cardiac-output-in-healthy-individuals
#16
Piergiuseppe Agostoni, Carlo Vignati, Piero Gentile, Costanza Boiti, Stefania Farina, Elisabetta Salvioni, Massimo Mapelli, Damiano Magrì, Stefania Paolillo, Nicoletta Corrieri, Gianfranco Sinagra, Gaia Cattadori
AIMS: Cardiac output (Q) is a key parameter in the assessment of cardiac function, its measurement being crucial for the diagnosis, treatment and prognostic evaluation of all heart diseases. Until recently, Q determination at peak exercise has been possible through invasive methods, so that normal values were obtained in studies based on small populations. METHODS AND RESULTS: Nowadays, peak Q can be measured noninvasively by means of inert gas rebreathing technique (IGR)...
January 17, 2017: Chest
https://www.readbyqxmd.com/read/28104362/use-of-management-pathways-or-algorithms-in-children-with-chronic-cough-chest-guideline-and-expert-panel-report
#17
Anne B Chang, John J Oppenheimer, Miles M Weinberger, Bruce K Rubin, Kelly Weir, Cameron C Grant, Richard S Irwin
BACKGROUND: Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤14-years) based on key questions using the PICO format. METHODS: We used the CHEST expert cough panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and GRADE framework...
January 16, 2017: Chest
https://www.readbyqxmd.com/read/28093269/invasive-disease-versus-urinary-antigen-confirmed-pneumococcal-community-acquired-pneumonia
#18
Adrian Ceccato, Antoni Torres, Catia Cilloniz, Rosanel Amaro, Albert Gabarrus, Eva Polverino, Elena Prina, Carolina Garcia-Vidal, Eva Muñoz-Conejero, Cristina Mendez, Isabel Cifuentes, Jorge Puig de la Bella Casa, Rosario Menendez, Michael S Niederman
OBJECTIVES: The burden of pneumococcal disease is measured only through patients with invasive pneumococcal disease. The urinary antigen test (UAT) for pneumococcus has exhibited a high sensitivity and specificity. We aimed to compare the pneumococcal pneumonias diagnosed as invasive disease with pneumococcal pneumonias defined by UAT. METHODS: Prospective observational study on consecutive non-immunosuppressed patients with community-acquired pneumonia from January 2000 to December 2014...
January 13, 2017: Chest
https://www.readbyqxmd.com/read/28093268/bronchiectasis-rheumatoid-overlap-syndrome-bros-is-an-independent-risk-factor-for-mortality-in-patients-with-bronchiectasis-a-multicentre-cohort-study
#19
Anthony De Soyza, Melissa J McDonnell, Pieter C Goeminne, Stefano Aliberti, Sara Lonni, John Davison, Lieven J Dupont, Thomas C Fardon, Robert M Rutherford, Adam T Hill, James D Chalmers
INTRODUCTION: We studied if Bronchiectasis (BR) and Rheumatoid arthritis (RA) when manifesting as an overlap syndrome (BROS) was associated with worse outcomes than other BR aetiologies applying the Bronchiectasis Severity Index (BSI). METHODS: We interrogated the Bronchiectasis Severity Index (BSI) databases of 1716 patients across 6 centres: Edinburgh, UK (608 patients), Dundee, UK (N=286), Leuven, Belgium (N=253), Monza, Italy (N=201), Galway Ireland (N=242) and Newcastle, UK (N=126)...
January 13, 2017: Chest
https://www.readbyqxmd.com/read/28089817/patient-centered-specialty-practice-defining-the-role-of-specialists-in-value-based-healthcare
#20
REVIEW
Lawrence Ward, Rhea E Powell, Michael L Scharf, Andrew Chapman, Mani Kavuru
Healthcare is at a crossroads, under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. Yet primary care accounts for only a small portion of total healthcare spending, and there is a need for policies and frameworks to support high quality, cost-efficient care in specialty practices of the "medical neighborhood". The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance...
January 13, 2017: Chest
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