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https://www.readbyqxmd.com/read/28923762/translating-basic-research-into-clinical-practice-vitamin-d-in-asthma-mechanisms-of-action-and-considerations-for-clinical-trials
#1
REVIEW
Paul E Pfeffer, Catherine M Hawrylowicz
There is increasing interest in the therapeutic utility of vitamin D in asthma, supported by a significant body of evidence on epidemiological associations between vitamin D insufficiency and worse asthma control. In support of a causal relationship, vitamin D beneficially modulates diverse immunological pathways in heterogeneous asthma endotypes, regulating the actions of lymphocytes, mast cells, antigen-presenting cells and structural cells to dampen excessive inflammatory responses. Allergic asthma is characterised by a failure of immune tolerance, and development of pathological responses to inhaled aeroallergens, and vitamin D has been extensively shown to support immune regulation...
September 15, 2017: Chest
https://www.readbyqxmd.com/read/28923761/surgical-treatment-of-obstructive-sleep-apnea-on-cardiovascular-outcomes-a-systematic-review
#2
Tyler R Halle, Melissa S Oh, Nancy A Collop, Arshed A Quyyumi, Donald L Bliwise, Raj C Dedhia
BACKGROUND: Obstructive sleep apnea (OSA) is an increasingly prevalent clinical problem with significant effects on quality of life and cardiovascular risk. Surgical therapy represents an important treatment for those unable to use positive airway pressure. This systematic review examines the available cardiovascular risk reduction data for surgical treatment of OSA. METHODS: A comprehensive literature search was performed. Articles were included if they met the following criteria: (1) adults >18 years (2) OSA diagnosed by sleep study; (3) surgical intervention performed for OSA; (4) one or more physical or biochemical cardiovascular and/or cerebrovascular variables was measured pre-operatively and at ≥14 days postoperatively...
September 15, 2017: Chest
https://www.readbyqxmd.com/read/28923760/commonly-used-patient-reported-outcomes-do-not-improve-prediction-of-copd-exacerbations-a-multicenter-4-5-year-prospective-cohort-study
#3
Alexandra Strassmann, Anja Frei, Sarah R Haile, Gerben Ter Riet, Milo A Puhan
BACKGROUND: Several cross-sectional and short-term studies suggest that patient-reported outcomes (PROs) may be useful to (help) predict COPD exacerbations but evidence from long-term prospective cohort studies is missing. Our aim was to assess if PROs add to the prediction of exacerbations. METHODS: 408 primary care COPD patients participated in the multicenter prospective ICE COLD ERIC cohort. PROs included the Chronic Respiratory Disease Questionnaire, the Hospital Anxiety and Depression Scale, the Feeling Thermometer and the LASA Physical Activity Questionnaire (LAPAQ)...
September 15, 2017: Chest
https://www.readbyqxmd.com/read/28923759/extending-the-reach-of-evidence-based-medicine-a-proposed-categorization-of-lower-level-evidence
#4
REVIEW
Frank C Detterbeck, Michael K Gould, Sandra Z Lewis, Sheena Patel
Clinical practice involves making many management decisions for which only limited formal evidence exists. While the methodology of evidence-based medicine has evolved tremendously, there is a need to better characterize lower-level evidence. This should enhance the ability to appropriately weigh the evidence against other considerations, and counter the temptation to think it is more robust than it actually is. A framework to categorize lower-level evidence is proposed, consisting of non-randomized comparisons, extrapolation using indirect evidence, rationale and clinical experience (i...
September 15, 2017: Chest
https://www.readbyqxmd.com/read/28923758/methacholine-challenge-testing-a-novel-method-for-measuring-pd20
#5
Beth E Davis, Samuel K Simonson, Christianne M Blais, Donald W Cockcroft
BACKGROUND: New guidelines for methacholine challenge testing recommend reporting the test outcome as dose rather than concentration. Jet nebulizers have historically been used for methacholine challenge testing but much of the weight loss, often (incorrectly) referred to as aerosol output, is actually evaporation. The Wright® nebulizer is well characterized and still widely used, but its availability is unclear and it is non-disposable. We developed a novel method using a vibrating mesh nebulizer (Aerogen Solo®)...
September 15, 2017: Chest
https://www.readbyqxmd.com/read/28923757/clinical-practice-and-infrastructure-review-of-fecal-microbiota-transplantation-for-clostridium-difficile-infection
#6
REVIEW
Brendan J Kelly, Pablo Tebas
A significant proportion of C. difficile infection (CDI) cases recur after completion of antibiotic therapy, and antibiotic cure rates diminish with each recurrence of CDI. Fecal microbiota transplantation (FMT) is an effective therapy for recurrent FMT, which otherwise requires prolonged or indefinite antibiotic treatment. FMT is performed by introducing the fecal microbial community obtained from a healthy donor or pool of donors into the stomach, small intestine, or colon of a patient with CDI. Multiple clinical trials support the utility of FMT in treating recurrent CDI, and CDI treatment guidelines now include consideration of FMT at the third CDI recurrence...
September 15, 2017: Chest
https://www.readbyqxmd.com/read/28917549/a-multicenter-randomized-trial-of-a-checklist-for-endotracheal-intubation-of-critically-ill-adults
#7
David R Janz, Matthew W Semler, Aaron M Joffe, Jonathan D Casey, Robert J Lentz, Bennett P deBoisblanc, Yasin A Khan, Jairo I Santanilla, Itay Bentov, Todd W Rice
BACKGROUND: Hypoxemia and hypotension are common complications during endotracheal intubation of critically ill adults. Verbal performance of a written, pre-intubation checklist may prevent these complications. We compared a written, verbally-performed, pre-intubation checklist to usual care with regard to lowest arterial oxygen saturation or lowest systolic blood pressure experienced by critically ill adults undergoing endotracheal intubation. METHODS: A multicenter trial in which 262 adults undergoing endotracheal intubation were randomized to a written, verbally-performed, pre-intubation checklist (checklist) or no pre-intubation checklist (usual care)...
September 13, 2017: Chest
https://www.readbyqxmd.com/read/28911910/point-should-cvvh-always-be-the-preferred-mode-of-rrt-for-the-patient-with-acute-brain-injury-yes
#8
EDITORIAL
Marcey Osgood, Susanne Muehlschlegel
No abstract text is available yet for this article.
September 9, 2017: Chest
https://www.readbyqxmd.com/read/28911911/rebuttal-from-drs-niemi-and-stoff
#9
EDITORIAL
Matthew A Niemi, Jeffrey S Stoff
No abstract text is available yet for this article.
September 8, 2017: Chest
https://www.readbyqxmd.com/read/28911912/rebuttal-from-dr-osgood-et-al
#10
EDITORIAL
Marcey Osgood, Susanne Muehlschlegel
No abstract text is available yet for this article.
September 6, 2017: Chest
https://www.readbyqxmd.com/read/28911909/counterpoint-should-cvvh-always-be-the-preferred-mode-of-rrt-for-the-patient-with-acute-brain-injury-no
#11
EDITORIAL
Matthew A Niemi, Jeffrey S Stoff
No abstract text is available yet for this article.
September 6, 2017: Chest
https://www.readbyqxmd.com/read/28887062/diaphragm-dysfunction-in-critical-illness
#12
REVIEW
Gerald S Supinski, Peter E Morris, Sanjay Dhar, Leigh Ann Callahan
The diaphragm is the major muscle of inspiration and its function is critical for optimal respiration. Diaphragmatic failure has long been recognized as a major contributor to death in a variety of systemic neuromuscular disorders. More recently, it is increasingly apparent that diaphragm dysfunction is present in a high percentage of critically ill patients, and is associated with increased morbidity and mortality. In these patients, diaphragm weakness is thought to develop from disuse secondary to ventilator-induced diaphragm inactivity, and as a consequence of the effects of systemic inflammation, including sepsis...
September 5, 2017: Chest
https://www.readbyqxmd.com/read/28887061/advances-in-audio-based-systems-to-monitor-patient-adherence-and-inhaler-drug-delivery
#13
REVIEW
Terence E Taylor, Yaniv Zigel, Céline De Looze, Imran Sulaiman, Richard W Costello, Richard B Reilly
Hundreds of millions of people suffer from asthma and chronic obstructive pulmonary disease (COPD) worldwide. Current medications to control these chronic respiratory diseases can be administered using inhaler devices, such as the pressurized metered dose inhaler (pMDI) and dry powder inhaler (DPI). Providing that they are used as prescribed, inhalers can improve patients' clinical outcomes and quality of life. Poor patient inhaler adherence (both time of use and user technique) is, however, a major clinical concern and is associated with poor disease control, increased hospital admissions and increased mortality rates, particularly in low-middle income countries...
September 5, 2017: Chest
https://www.readbyqxmd.com/read/28887060/ethnicity-in-pulmonary-arterial-hypertension-possibilities-for-novel-phenotypes-in-the-age-of-personalized-medicine
#14
Sarah K Medrek, Sandeep Sahay
In the last decade and a half, the introduction of new therapeutics has revolutionized the management of pulmonary arterial hypertension (PAH). These new treatment options have improved the quality of life and survival in PAH. With an armamentarium of options available, the identification of unique phenotypes can help practitioners choose tailored treatment regimens. Experts in other cardiovascular diseases such as congestive heart failure and hypertension have recommended race-specific treatments in their fields based on data highlighting variations in response to therapies...
September 5, 2017: Chest
https://www.readbyqxmd.com/read/28867295/asthma-outcomes-and-management-during-pregnancy
#15
REVIEW
Catherine A Bonham, Karen C Patterson, Mary E Strek
Asthma during pregnancy poses a common, increasingly prevalent threat to the health of women and their children. We review recent insights gained from the epidemiology of asthma during pregnancy, demonstrating the many short and long-term risks to mother and fetus incurred by poorly controlled maternal asthma. We further discuss emerging evidence that active asthma management during pregnancy can positively influence and perhaps completely mitigate these poor outcomes. Recent high-quality trials examining best methods for asthma treatment are reviewed and synthesized to offer an evidence-based pathway for comprehensive treatment of asthma in the outpatient setting...
August 31, 2017: Chest
https://www.readbyqxmd.com/read/28864055/tracheobronchopathy-from-inhaled-corticosteroids
#16
REVIEW
Bryan C Husta, Suhail Raoof, Serpil Erzurum, Atul C Mehta
Inhaled corticosteroids (ICSs) have become the mainstay of asthma control. They are also recommended as an add-on therapy to long-acting beta agonists and anticholinergics in moderate to severe COPD with recurrent exacerbations. Ultimately this clinical practice has led to the widespread use of ICSs, which are supported by a more favorable side effect profile than that of systemic steroids.
August 31, 2017: Chest
https://www.readbyqxmd.com/read/28866112/hemodynamic-assessment-of-septic-shock-patients-using-transpulmonary-thermodilution-and-critical-care-echocardiography-a-comparative-study
#17
Philippe Vignon, Emmanuelle Begot, Arnaud Mari, Stein Silva, Loïc Chimot, Pierre Delour, Frédéric Vargas, Bruno Filloux, David Vandroux, Julien Jabot, Bruno François, Nicolas Pichon, Marc Clavel, Bruno Levy, Michel Slama, Béatrice Riu-Poulenc
BACKGROUND: To assess the agreement between transpulmonary thermodilution (TPT) and critical care echocardiography (CCE) in ventilated septic shock patients. METHODS: Ventilated patients in sinus rhythm requiring advanced hemodynamic assessment for septic shock were included in this prospective multicenter descriptive study. Patients were assessed successively using TPT and CCE in random order. Data were interpreted independently at bedside by two investigators who proposed therapeutic changes based on predefined algorithms...
August 30, 2017: Chest
https://www.readbyqxmd.com/read/28864054/quality-gaps-and-comparative-effectiveness-of-management-strategies-for-recurrent-malignant-pleural-effusions
#18
David E Ost, Jiangong Niu, Hui Zhao, Horiana B Grosu, Sharon H Giordano
BACKGROUND: Guidelines for recurrent malignant pleural effusions (MPE) recommend definitive procedures, such as indwelling pleural catheters (IPC) or pleurodesis, over repeat thoracentesis. We hypothesized that many patients have multiple thoracenteses rather than definitive procedures and that this results in more procedures and complications. METHODS: Retrospective cohort study using SEER-Medicare data from 2007-2011. Patients age 66-90 with a MPE were included...
August 29, 2017: Chest
https://www.readbyqxmd.com/read/28864053/diaphragm-and-lung-ultrasound-to-predict-weaning-outcome-systematic-review-and-meta-analysis
#19
Ana M Llamas-Álvarez, Eva M Tenza-Lozano, Jaime Latour-Pérez
BACKGROUND: Deciding the optimal timing for extubation in mechanically ventilated patients can be challenging, and traditional weaning predictor tools are not very accurate. The aim of this systematic review and meta-analysis is to assess the accuracy of lung and diaphragm ultrasound for predicting weaning outcomes in critically ill adults. METHODS: We searched MEDLINE, the Cochrane Library, Web of Science, Scopus, LILACS, Teseo, Tesis Doctorales en Red, and OpenGrey, and we reviewed the bibliographies of relevant studies...
August 29, 2017: Chest
https://www.readbyqxmd.com/read/28851621/pulmonary-arterial-hypertension-associated-with-systemic-lupus-erythematosus-results-from-the-french-pulmonary-hypertension-registry
#20
Eric Hachulla, Xavier Jais, Gaël Cinquetti, Pierre Clerson, Laurence Rottat, David Launay, Vincent Cottin, Gilbert Habib, Grégoire Prevot, Céline Chabanne, Eléna Foïs, Zahir Amoura, Luc Mouthon, Véronique Le Guern, David Montani, Gérald Simonneau, Marc Humbert, Vincent Sobanski, Olivier Sitbon
BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare complication of systemic lupus erythematosus (SLE). METHODS: We identified all patients with SLE and PAH (SLE-PAH) who were enrolled in the French Pulmonary Hypertension Registry with a diagnosis confirmed by right heart catheterization (RHC). A control group of 101 patients with SLE without known PAH was selected from SLE expert centers participating in the Pulmonary Hypertension Registry. Survival was estimated by the Kaplan-Meier method...
August 26, 2017: Chest
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