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Annals of the American Thoracic Society

Anuja Bandyopadhyay, A Ioana Cristea, Stephanie D Davis, Veda L Ackerman, James E Slaven, Hasnaa E Jalou, Deborah C Givan, Ameet Daftary
RATIONALE: There is a lack of evidence regarding factors associated with failure of tracheostomy decannulation. OBJECTIVES: We aimed to identify characteristics of pediatric patients who fail a tracheostomy decannulation challenge Methods: A retrospective review was performed on all patients who had a decannulation challenge at a tertiary care center from June 2006 to October 2013. Tracheostomy decannulation failure was defined as reinsertion of the tracheostomy tube within 6 months of the challenge...
October 21, 2016: Annals of the American Thoracic Society
Rui Wang, Yan Dong, Jia Weng, Emily Z Kontos, Ronald D Chervin, Carol L Rosen, Carole L Marcus, Susan Redline
RATIONALE: Prior research found that individual-level environmental and social indicators did not explain the racial disparity in obstructive sleep apnea syndrome. Neighborhood socioeconomic variables, risk factors for a range of adverse behavioral and health outcomes, may better explain this racial disparity and help identify modifiable intervention targets. OBJECTIVES: To evaluate the associations of neighborhood socioeconomic variables with obstructive sleep apnea severity and to assess whether the neighborhood variables explain the association between race and obstructive sleep apnea severity...
October 21, 2016: Annals of the American Thoracic Society
Anuj B Mehta, Colin R Cooke, Ivor S Douglas, Peter K Lindenauer, Renda Soylemez Wiener, Allan J Walkey
RATIONALE: In the United States, approximately 20% of patients hospitalized with pneumonia are readmitted to a hospital within 30 days. Given the significant costs and healthcare system utilization due to unplanned readmissions, pneumonia readmission rates are a target of national quality measures. Patient do-not-resuscitate (DNR) status strongly influences hospital pneumonia mortality measures; however, associations between DNR status and 30-day readmissions following pneumonia are unclear...
October 18, 2016: Annals of the American Thoracic Society
Christopher Henry, Carl Boethel, Laurel A Copeland, Shekhar Ghamande, Alejandro C Arroliga, Heath D White
RATIONALE: Legionella pneumophila is an uncommon cause of community-acquired pneumonia in south central United States and regular testing may not be cost-effective in areas of low incidence. OBJECTIVES: To evaluate the incidence of Legionella in central Texas and determine the costeffectiveness of Legionella urinary antigen testing. METHODS: We performed a single-center retrospective cohort study of patients admitted with pneumonia between January 2001 and December 2013...
October 14, 2016: Annals of the American Thoracic Society
Eitan Halper-Stromberg, Michael H Cho, Carla Wilson, Dipti Nevrekar, James D Crapo, George Washko, Raúl San José Estépar, David A Lynch, Edwin K Silverman, Sonia Leach, Peter J Castaldi
RATIONALE: Automated analysis of computed tomographic (CT) lung images for epidemiologic nand genetic association studies is increasingly common, but little is known about the utility of visual versus semi-automated emphysema and airway assessments for genetic association studies. OBJECTIVES: Assess the relative utility of visual versus semi-automated emphysema and airway assessments for genetic association studies. METHODS: A standardized inspection protocol was used to visually assess chest CTs for 1540 non-Hispanic white subjects within the COPDGene Study for the presence and severity of radiographic features representing airway wall thickness and emphysema...
October 14, 2016: Annals of the American Thoracic Society
Praful Schroff, Jason Hitchcock, Christopher Schumann, J Michael Wells, Mark T Dransfield, Surya P Bhatt
Rationale Current practice guidelines recommend pulmonary rehabilitation as an adjunct to standard pharmacologic therapy for individuals with moderate to severe chronic obstructive pulmonary disease (COPD). Whether pulmonary rehabilitation benefits all subjects with COPD independent of baseline disease burden is not known. Objective To test whether pulmonary rehabilitation benefits patients with COPD independent of baseline exercise capacity, dyspnea and lung function. Methods Data from a prospectively maintained database of participants with COPD enrolled in pulmonary rehabilitation at the University of Alabama at Birmingham from 1996 to 2013 was retrospectively analyzed...
October 14, 2016: Annals of the American Thoracic Society
Peter B Terry, Richard J Traystman
Oxygen delivery and carbon dioxide removal being critical to cell survival, mammals have developed collateral vascular and ventilation systems to ensure tissue viability. Collateral ventilation, defined as ventilation of alveoli via pathways that bypass normal airways, is present in humans and many other species. The presence of collateral ventilation can be beneficial in certain disease states, while its relative absence can predispose to other diseases. These well defined anatomical pathways contribute little to ventilation in normal humans, but modulate ventilation perfusion imbalance in a variety of diseases including obstructive diseases such as asthma and emphysema...
October 14, 2016: Annals of the American Thoracic Society
Nishant Gupta, Dale Langenderfer, Francis X McCormack, Daniel P Schauer, Mark H Eckman
RATIONALE: Patients without a known history of lung disease presenting with a spontaneous pneumothorax are generally diagnosed as primary spontaneous pneumothorax. However, occult diffuse cystic lung diseases such as Birt-Hogg-Dubé syndrome (BHD), lymphangioleiomyomatosis (LAM), and pulmonary Langerhans cell histiocytosis (PLCH) can also first present with a spontaneous pneumothorax, and their early identification by high-resolution computed tomographic (HRCT) imaging of chest has implications for subsequent management...
October 13, 2016: Annals of the American Thoracic Society
Laveena Munshi, Hayley B Gershengorn, Eddy Fan, Hannah Wunsch, Niall D Ferguson, Therese A Stukel, Gordon D Rubenfeld
RATIONALE: Adoption and de-adoption of adjuvant strategies to mechanical ventilation for acute respiratory failure (ARF), and factors associated with their selection, have not been extensively evaluated. OBJECTIVES: To evaluate change in use of adjuvants to mechanical ventilation for ARF (2008-2013), the impact of landmark publications on adoption and de-adoption, and factors associated with use. METHODS: Changes in use of four adjuvants for ARF from 2008-2013, the impact of landmark publications on use, and factors associated with use were evaluated using the Premier Database...
October 13, 2016: Annals of the American Thoracic Society
Sigall K Bell, Stephanie D Roche, Anna C Johansson, Kristin P O'Reilly, Barbara S Lee, Kenneth E Sands, Daniel S Talmor, Samuel M Brown
RATIONALE: Communication in the intensive care unit (ICU) often falls short of patient and family needs, putting them at risk for significant physical and emotional harm. As electronic patient portals rapidly evolve, one designed specifically for the ICU might potentially enhance communication among patients, family members, and clinicians; however, the views of frontline ICU staff on such technology are unknown. OBJECTIVES: To identify clinician perspectives on the current state of communication among patients, families and clinicians in the ICU, and assess their views on whether and how an electronic portal may address existing communication deficits and improve care...
October 4, 2016: Annals of the American Thoracic Society
Michael C Sklar, Eric Sy, Laurance Lequier, Eddy Fan, Hussein D Kanji
BACKGROUND: The optimal anticoagulation strategy for venovenous extracorporeal membrane oxygenation (VV-ECMO) is not known. OBJECTIVE: To evaluate the safety of anticoagulation strategies and monitoring during VV-ECMO for respiratory failure. DATA SOURCES: We conducted a systematic review to evaluate the association between anticoagulation strategies during VV-ECMO and pre-specified outcomes including major bleeding episodes, thrombotic events, and in-hospital mortality...
October 3, 2016: Annals of the American Thoracic Society
Whitney R Buckel, Edward Stenehjem, Jeff Sorensen, Nathan Dean, Brandon Webb
RATIONALE: Guidelines recommend a switch from intravenous to oral antibiotics once patients who are hospitalized with pneumonia achieve clinical stability. However, little evidence guides the selection of an oral antibiotic for patients with healthcare-associated pneumonia, especially where no microbiological diagnosis is made. OBJECTIVES: To compare outcomes between patients who were transitioned to broad vs narrow spectrum oral antibiotics after initially receiving broad-spectrum intravenous antibiotic coverage...
October 3, 2016: Annals of the American Thoracic Society
Tetyana Kendzerska, Richard S Leung, Andrea S Gershon, George Tomlinson, Najib Ayas
RATIONALE: The inter-relationships between obstructive sleep apnea (OSA) and obesity are complex and bidirectional; however, the current evidence regarding their combined effect o cardiovascular risk is limited and conflicting. Animal studies suggest that obesity may exacerbate the cardiovascular consequences of intermittent hypoxemia. OBJECTIVES: In this historical observational study, we investigated whether obesity increases the effect of nocturnal hypoxemia on the incidence of cardiovascular events in adults with suspected OSA...
September 30, 2016: Annals of the American Thoracic Society
Catherine L Granger, Linda Denehy, Louisa Remedios, Sarah Retica, Pimsiri Phongpagdi, Nicholas Hart, Selina M Parry
RATIONALE: Evidence-based clinical practice guidelines recommend physical activity (physical activity) for people with lung cancer, however evidence has not translated into clinical practice and the majority of patients do not meet recommended activity levels. OBJECTIVES: To identify factors (barriers and enablers) that influence clinicians' translation of the physical activity guidelines into practice. METHODS: Qualitative study involving 17 participants (three respiratory physicians, two thoracic surgeons, two oncologists, two nurses, eight physical therapists) who were recruited using purposive sampling from five hospitals in Melbourne, Australia...
September 30, 2016: Annals of the American Thoracic Society
Harold J Farber, Smita Pakhale, Enid R Neptune
An important approach to reduce youth tobacco use is the adoption of regulations to prohibit tobacco product sale to individuals under 21 years of age, termed Tobacco 21. In the United States, close to 90% of current smokers started smoking before the age of 18, and 99% before age 26 years. Earlier age of tobacco use initiation is associated with lower rates of smoking cessation. Increasing minimum age to purchase has been shown to reduce tobacco product use among youth. The critical determinant is likely the loss of social sources of tobacco products...
September 30, 2016: Annals of the American Thoracic Society
William T Harris, J Todd Boyd, Gary L McPhail, Alan S Brody, Rhonda D Szczesniak, Leslie L Korbee, Michael L Baker, John P Clancy
RATIONALE: Refractory lung function decline in association with recurrent pulmonary exacerbations is a common, yet poorly explained finding in CF. We reviewed clinically-indicated lung biopsy specimens obtained during a period of persistent decline to investigate histopathologic mechanisms of pulmonary deterioration during adolescence and early adulthood. OBJECTIVES: To determine if peribronchiolar remodeling is prominent in lung biopsy specimens obtained in CF adolescents refractory to conventional therapy...
September 29, 2016: Annals of the American Thoracic Society
Meredith C McCormack, Andrew J Belli, Darryn Waugh, Elizabeth C Matsui, Roger D Peng, D'Ann Williams, Laura Paulin, Anik Saha, Charles M Aloe, Gregory B Diette, Patrick N Breysse, Nadia N Hansel
RATIONALE: There is limited evidence of the effect of exposure to heat on COPD morbidity and the interactive effect between indoor heat and air pollution has not been established. OBJECTIVES: To determine the effect of indoor and outdoor heat exposure on COPD morbidity and to determine whether air pollution concentrations modify the effect of temperature. METHODS: Sixty-nine participants with COPD were enrolled in a longitudinal cohort study and data from the 601 participant days that occurred during the warm weather season were included in the analysis...
September 29, 2016: Annals of the American Thoracic Society
David Looney, Valentin Goverdovsky, Ivana Rosenzweig, Mary J Morrell, Danilo P Mandic
RATIONALE: To date the only quantifiable measure of neural changes that define sleep is electroencephalography (EEG). Although widely used for clinical testing, scalp-electrode EEG is costly and poorly tolerated by sleeping patients. OBJECTIVES: This is a pilot study to assess the agreement between EEG recordings obtained from a new ear-EEG sensor and those obtained simultaneously from standard scalp electrodes. METHODS: Participants were 4 healthy men, ages 25 to 36 years...
September 29, 2016: Annals of the American Thoracic Society
Yuzo Suzuki, Masahiro Shirai, Kazuhiro Asada, Seiichi Miwa, Masato Karayama, Yutaro Nakamura, Naoki Inui, Toshihiro Shirai, Hiroshi Hayakawa, Satoshi Baba, Takafumi Suda
RATIONALE: Tuberculosis (TB) is a leading cause of death among infectious diseases worldwide. Accumulated knowledge has revealed that macrophages are deeply involved in the progression and pathogenesis of TB. We hypothesized that the evaluation of a macrophage activation marker may be useful in the diagnosis and assessment of pulmonary TB. OBJECTIVES: To examine the utility of the macrophage-activation marker sCD163 as a diagnostic tool and measure of disease severity for pulmonary TB and tuberculous pleurisy...
September 29, 2016: Annals of the American Thoracic Society
Maura J Donohue, Larry Wymer
RATIONALE: Many nontuberculous mycobacteria (NTMs) are clinically significant pathogens that cause disease in a variety of different human organs and tissues. OBJECTIVES: A population-based study was undertaken to investigate the prevalence of patients with a positive specimen for (NTM) within 5 states of United States. METHODS: We determined the case and age distribution of patients with at least one specimen positive for NTM using data submitted to the disease surveillance systems of 5 states (Maryland, Mississippi, Missouri, Ohio, and Wisconsin) between 2008 and 2013...
September 28, 2016: Annals of the American Thoracic Society
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