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https://www.readbyqxmd.com/read/29331474/clinical-databases-for-chest-physicians
#1
REVIEW
Andrew M Courtwright, Peter E Gabriel
A clinical database is a repository of patient medical and sociodemographic information focused on one or more specific health condition or exposure. Although clinical databases may be used for research purposes, their primary goal is to collect and track patient data for quality improvement, quality assurance, and/or actual clinical management. This article aims to provide an introduction and practical advice on the development of small-scale clinical databases for Chest physicians and practice groups. Through example projects we discuss the pros and cons of available technical platforms, including Microsoft Excel and Access, relational database management systems such as Oracle and PostgreSQL, and REDCap...
January 10, 2018: Chest
https://www.readbyqxmd.com/read/29331473/a-randomized-trial-of-itraconazole-versus-prednisolone-in-acute-stage-abpa-complicating-asthma
#2
Ritesh Agarwal, Sahajal Dhooria, Inderpaul Singh Sehgal, Ashutosh N Aggarwal, Mandeep Garg, Biman Saikia, Digambar Behera, Arunaloke Chakrabarti
BACKGROUND AND AIMS: Whether itraconazole monotherapy is effective in the acute-stage of allergic bronchopulmonary aspergillosis (ABPA) remains unknown. Herein, we compare the efficacy and safety of itraconazole and prednisolone monotherapy in ABPA. METHODS: We randomized treatment-naïve subjects with ABPA complicating asthma (January 2012 to December 2013) to receive either oral itraconazole or prednisolone for four months. The study was not blinded. The primary outcomes were proportion of subjects showing composite response after six weeks, percentage decline in IgE after treatment, and numbers of subjects experiencing exacerbation...
January 10, 2018: Chest
https://www.readbyqxmd.com/read/29329694/management-of-refractory-vasodilatory-shock
#3
REVIEW
Jacob C Jentzer, Saraschandra Vallabhajosyula, Ashish K Khanna, Lakhmir S Chawla, Laurence W Busse, Kianoush B Kashani
Refractory shock is a lethal manifestation of cardiovascular failure defined by an inadequate hemodynamic response to high doses of vasopressor medications. Approximately 7% of critically ill patients will develop refractory shock, with short-term mortality exceeding 50%. Refractory vasodilatory shock develops from uncontrolled vasodilation and vascular hyporesponsiveness to endogenous vasoconstrictors, causing failure of physiologic vasoregulatory mechanisms. Standard approaches to initial management of shock include fluid resuscitation and initiation of norepinephrine...
January 9, 2018: Chest
https://www.readbyqxmd.com/read/29325986/the-challenge-of-rare-diseases
#4
James K Stoller
Rare diseases pose particular challenges to patients who are affected, to the clinicians who care for them, and to the investigators who study their conditions. Though individually uncommon, rare diseases are common in the aggregate, with the ∼7000 described rare diseases affecting 25-30 million Americans. Challenges posed to affected individuals and their families largely regard being diagnosed; receiving optimal care; and affording disease-specific medications. Challenges facing clinicians who care for affected individuals include gaining knowledge and experience in caring for such patients, and the availability of local experts and of expert guidelines...
January 8, 2018: Chest
https://www.readbyqxmd.com/read/29325985/platelet-activating-antibodies-are-detectable-at-the-earliest-onset-of-heparin-induced-thrombocytopenia-with-implications-for-the-operating-characteristics-of-the-serotonin-release-assay
#5
Theodore E Warkentin, Donald M Arnold, John G Kelton, Jo-Ann I Sheppard, James W Smith, Ishac Nazy
BACKGROUND: HIT is a prothrombotic drug reaction caused by platelet-activating antibodies that recognize PF4/heparin complexes. It is unknown whether platelet-activating antibodies are detectable at the onset of the HIT-related platelet count fall. METHODS: Available blood samples from 18 patients obtained at onset of HIT were tested using the serotonin-release assay (SRA), a test for platelet-activating antibodies, and a PF4-dependent ELISA. Patient samples showing a delay of >2 days between ELISA and SRA seroconversion were tested for subthreshold levels of platelet-activating antibodies using two modifications of the SRA that amplify detection of HIT antibodies...
January 8, 2018: Chest
https://www.readbyqxmd.com/read/29289687/a-comparison-of-the-quick-sofa-and-systemic-inflammatory-response-syndrome-criteria-for-the-diagnosis-of-sepsis-and-prediction-of-mortality-a-systematic-review-and-meta-analysis
#6
Rodrigo Serafim, Jose Andrade Gomes, Jorge Salluh, Pedro Póvoa
BACKGROUND: Several studies were published to validate the quick Sepsis-related Organ Failure Assessment (qSOFA), namely in comparison with the systemic inflammatory response syndrome (SIRS) criteria. We performed a systematic review and meta-analysis with the aim of comparing the qSOFA and SIRS in patients outside the ICU. METHODS: We searched MEDLINE, CINAHL, and the Web of Science database from February 23, 2016 until June 30, 2017 to identify full-text English-language studies published after the Sepsis-3 publication comparing the qSOFA and SIRS and their sensitivity or specificity in diagnosing sepsis, as well as hospital and ICU length of stay and hospital mortality...
December 28, 2017: Chest
https://www.readbyqxmd.com/read/29289686/the-therapeutic-potential-of-hyaluronan-in-copd
#7
Gerard M Turino, Shuren Ma, Yong Y Lin, Jerome O Cantor
Insights into the clinical course in COPD indicate the need for new therapies in COPD. The discovery of alpha-1 antitrypsin deficiency (AATD) led to the protease-antiprotease imbalance hypothesis which was applied to COPD related and not related to AATD. The discovery of AATD brought recognition to the importance of elastin fibers in maintaining lung matrix structure. Two cross-linking amino acids are unique to mature elastin, desmosine and isodesmosine (DI), which can serve as biomarkers of the degradation of elastin...
December 28, 2017: Chest
https://www.readbyqxmd.com/read/29289685/tgf-%C3%AE-signalling-pathways-in-different-compartments-of-the-lower-airways-of-stable-copd-patients
#8
Antonino Di Stefano, Claudia Sangiorgi, Isabella Gnemmi, Paolo Casolari, Paola Brun, Fabio Lm Ricciardolo, Marco Contoli, Alberto Papi, Pio Maniscalco, Paolo Ruggeri, Giuseppe Girbino, Francesco Cappello, Stelios Pavlides, Yike Guo, Kian Fan Chung, Peter J Barnes, Ian M Adcock, Bruno Balbi, Gaetano Caramori
BACKGROUND: The expression and localization of transforming growth factor-beta (TGF-β) pathway proteins in different compartments of the lower airways of stable COPD patients is unclear. OBJECTIVE: To determine TGF-β pathway protein expression in patients with stable COPD. METHODS: The expression and localization of TGF-β pathway components was measured in the bronchial mucosa and peripheral lung of patients with stable COPD (n=44), control smokers with normal lung function (n=24) and control non-smoking subjects (n=11) using immunohistochemistry...
December 28, 2017: Chest
https://www.readbyqxmd.com/read/29288645/the-effect-of-alcohol-consumption-on-the-risk-of-ards-a-systematic-review-and-meta-analysis
#9
Evangelia Simou, Jo Leonardi-Bee, John Britton
BACKGROUND: To conduct a systematic review and meta-analysis evaluating the association between alcohol consumption and the risk of Acute Respiratory Distress Syndrome (ARDS) in adults. METHODS: Medline, EMBASE and Web of Science were searched to identify observational studies evaluating the association between prior alcohol intake and the occurrence of ARDS among adults, published between 1985 and 2015 and with no language restriction. Reference lists were also screened...
December 27, 2017: Chest
https://www.readbyqxmd.com/read/29275134/comparative-safety-of-drugs-targeting-the-nitric-oxide-pathway-in-pulmonary-hypertension-a-mixed-approach-combining-a-meta-analysis-of-clinical-trials-and-a-disproportionality-analysis-from-the-who-pharmacovigilance-database
#10
C Khouri, M Lepelley, M Roustit, F Montastruc, M Humbert, J L Cracowski
BACKGROUND: Recent guidelines recommend riociguat, a soluble guanylate cyclase (sGC) stimulator, as well as the type 5 phosphodiesterase inhibitor (PDE5i) tadalafil or sildenafil as treatments for pulmonary arterial hypertension. We compared the safety profiles of sildenafil, tadalafil and riociguat in pulmonary hypertension. METHODS: We combined two approaches: First, we performed a meta-analysis of safety data extracted from randomized controlled trials. Secondly, we conducted a disproportionality analysis of data from VigiBase, the WHO global database of individual case safety reports, to compare the safety profiles with real life data...
December 21, 2017: Chest
https://www.readbyqxmd.com/read/29275133/inert-gas-washout-in-bronchiolitis-obliterans-following-hematopoietic-cell-transplantation
#11
Sylvia Nyilas, Luzia Baumeler, Michael Tamm, Jörg P Halter, Spasenija Savic, Insa Korten, Anja Meyer, Florian Singer, Jakob R Passweg, Philipp Latzin, Daiana Stolz
BACKGROUND: Bronchiolitis obliterans (BO) syndrome is a leading cause of chronic graft-versus-host disease (cGvHD) and is associated with mortality after allogeneic hematopoietic stem cell transplantation (alloHCT). Nitrogen multiple breath washout test (N2-MBW) measures ventilation inhomogeneity, a biomarker of central and peripheral airways obstruction. The aim of the study was to examine ventilation inhomogeneity according to cGvHD score and histologically defined BO. METHODS: This single center prospective cross-sectional study included 225 adults (mean age 52...
December 21, 2017: Chest
https://www.readbyqxmd.com/read/29274319/histopathologic-findings-in-lungs-of-patients-treated-with-extracorporeal-membrane-oxygenation
#12
Hee Eun Lee, Eunhee S Yi, Jeffrey T Rabatin, J Kyle Bohman, Anja C Roden
BACKGROUND: The outcome of extracorporeal membrane oxygenation (ECMO) might be influenced by its complications. Only limited information is available regarding the pathologic consequences of ECMO especially in the era of modern ECMO technology. METHODS: We studied the histopathologic findings in autopsy lungs of patients treated with ECMO as compared to those without ECMO. Autopsy files were queried for cases with ECMO. An age and gender-matched control group, comprised of patients who died in the Intensive Care Unit without acute respiratory distress syndrome, pneumonia, or ECMO, was compared with patients with ECMO for cardiac reason...
December 20, 2017: Chest
https://www.readbyqxmd.com/read/29274318/the-burden-of-viruses-in-pneumonia-associated-with-acute-respiratory-failure-an-underappreciated-issue
#13
Andrew F Shorr, Kristen Fisher, Scott T Micek, Marin H Kollef
BACKGROUND: Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for antibiotic utilization. The role of viruses in this setting is unclear. Identifying a viral etiology such instances could facilitate antibiotic stewardship. METHODS: We performed a secondary analysis of a prospective cohort with pneumonia requiring MV. We included both community and hospital-onset cases and classified patients as to the pneumonia's etiology...
December 20, 2017: Chest
https://www.readbyqxmd.com/read/29273515/nasal-versus-oronasal-cpap-for-obstructive-sleep-apnea-treatment-a-meta-analysis
#14
Rafaela G S Andrade, Fernanda M Viana, Juliana A Nascimento, Luciano F Drager, Adriano Moffa, André R Brunoni, Pedro R Genta, Geraldo Lorenzi-Filho
BACKGROUND: Nasal continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). However, oronasal masks are frequently used in clinical practice. The aim of this study was to perform a meta-analysis of all randomized and non-randomized trials that compared nasal versus oronasal masks on CPAP level, residual apnea-hypopnea index (AHI) and CPAP adherence to treat OSA. METHODS: Cochrane Central Register of Controlled Trials, Medline and Web of Science were searched for relevant studies in any language with the following terms: "sleep apnea" AND "CPAP" OR "sleep apnea" AND "oronasal mask" OR "OSA" AND "oronasal CPAP" OR "oronasal mask" AND "adherence"...
December 19, 2017: Chest
https://www.readbyqxmd.com/read/29253555/the-impact-of-listening-to-music-during-a-high-intensity-exercise-endurance-test-in-people-with-chronic-obstructive-pulmonary-disease-copd
#15
Annemarie L Lee, Thomas E Dolmage, Matthew Rhim, Roger Goldstein, Dina Brooks
INTRODUCTION: In people with chronic obstructive pulmonary disease (COPD), dyspnea is the primary symptom limiting exercise tolerance. One approach to reducing dyspnea during exercise is through music listening. A constant speed endurance test reflects a high intensity aerobic exercise training session, but whether listening to music effects endurance time is unknown. This study aimed to determine the effects of listening to music during a constant speed endurance test in COPD. METHODS: Participants with COPD completed two endurance walk tests, one with and one without listening to self-selected music throughout the test...
December 15, 2017: Chest
https://www.readbyqxmd.com/read/29253554/heparin-induced-thrombocytopenia-in-the-critically-ill-patient
#16
REVIEW
James M East, Christine Cserti- Gazdewich, John T Granton
Heparin induced thrombocytopenia (HIT) is associated with significant morbidity and mortality. Critically ill patients are commonly thrombocytopenic and exposed to heparin. Although HIT should be considered, it is not usually the cause of thrombocytopenia in the medical-surgical ICU population. A systematic approach to the critically ill patient with thrombocytopenia using clinical features, complemented by appropriate laboratory confirmation should lead to a reduction in inappropriate laboratory testing and reduce the use of more expensive and less reliable anticoagulants...
December 15, 2017: Chest
https://www.readbyqxmd.com/read/29253553/the-risk-of-tuberculosis-disease-in-type-2-diabetes-patients-initiating-metformin-versus-sulfonylureas
#17
Sheng-Wei Pan, Yung-Feng Yen, Yu Ru Kou, Pei-Hung Chuang, Vincent Yi-Fong Su, Jia-Yih Feng, Yu-Jiun Chan, Wei-Juin Su
BACKGROUND: Metformin and sulfonylureas are common initial antidiabetic agents; the former has demonstrated anti-tuberculosis action in in vitro and animal studies. The comparative effect of metformin versus sulfonylureas on tuberculosis risk in type 2 diabetes mellitus (T2DM) patients remains unclear. METHODS: In this retrospective cohort study, patients with T2DM diagnosis during 2003-2013, without chronic kidney disease, were identified from the Taiwan National Health Insurance Research Database...
December 15, 2017: Chest
https://www.readbyqxmd.com/read/29248621/asthma-is-a-risk-factor-for-respiratory-exacerbations-without-increased-rate-of-lung-function-decline-five-year-follow-up-in-adult-smokers-from-the-copdgene-study
#18
Lystra P Hayden, Megan E Hardin, Weiliang Qiu, David A Lynch, Matthew J Strand, Edwin J van Beek, James D Crapo, Edwin K Silverman, Craig P Hersh
BACKGROUND: Previous investigations in adult smokers from the COPDGene Study have shown that early-life respiratory disease is associated with reduced lung function, COPD, and airway thickening. Using five-year follow-up data we assessed disease progression in subjects with early-life respiratory disease. We hypothesized that there are alternative pathways to reaching reduced FEV1 and subjects with childhood pneumonia, childhood asthma, or asthma-COPD overlap (ACO), would have less lung function decline than subjects without these conditions...
December 14, 2017: Chest
https://www.readbyqxmd.com/read/29248620/inter-observer-reliability-of-the-berlin-ards-definition-and-strategies-to-improve-the-reliability-of-ards-diagnosis
#19
Michael W Sjoding, Timothy P Hofer, Ivan Co, Anthony Courey, Colin R Cooke, Theodore J Iwashyna
BACKGROUND: Failure to reliably diagnose the Acute Respiratory Distress Syndrome (ARDS) may be a major driver of negative clinical trials and under-recognition and treatment in clinical practice. We sought to examine the inter-observer reliability of the Berlin ARDS definition and examine strategies for improving the reliability of ARDS diagnosis. METHODS: 205 patients with hypoxic respiratory failure from four intensive care units were reviewed independently by three clinicians, who evaluated whether patients developed ARDS, their diagnostic confidence, whether patients met individual ARDS criteria, and the time when criteria were met...
December 14, 2017: Chest
https://www.readbyqxmd.com/read/29247616/the-brics-bronchiectasis-radiologically-indexed-ct-score-a-multi-center-study-score-for-use-in-idiopathic-and-post-infective-bronchiectasis
#20
P Bedi, J D Chalmers, P C Goeminne, C Mai, P Saravanamuthu, P Palani Velu, M K Cartlidge, M R Loebinger, J Jacob, F Kamal, N Schembri, S Aliberti, U Hill, M Harrison, C Johnson, N Screaton, C Haworth, E Polverino, E Rosales, A Torres, M N Benegas, A G Rossi, D Patel, A T Hill
OBJECTIVES: The aim of our study was to develop a simplified radiological score that could assess clinical disease severity in bronchiectasis. METHODS: The BRICS (Bronchiectasis Radiologically Indexed CT Score) was devised based on multivariable analysis of the Bhalla score and their ability in predicting clinical parameters of severity. The score was then externally validated in 6 centers in 302 patients. RESULT: 184 HRCT scans were scored for the validation cohort...
December 13, 2017: Chest
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