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Annals of the American Thoracic Society

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https://www.readbyqxmd.com/read/28099054/association-between-do-not-resuscitate-do-not-intubate-status-and-resident-physician-decision-making-a-national-survey
#1
Elizabeth K Stevenson, Hashim M Mehter, Allan J Walkey, Renda Soylemez Wiener
RATIONALE: Compared to their Full Code counterparts, patients with Do Not Resuscitate/Do Not Intubate (DNR/DNI) status receive fewer interventions and have higher mortality than predicted by clinical characteristics. OBJECTIVES: To assess whether internal medicine residents, the front-line providers for many hospitalized patients, would manage hypothetical patients differently based on code status. We hypothesized respondents would be less likely to provide a variety of interventions to DNR/DNI patients than Full Code patients...
January 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28086029/implementation-of-a-professional-society-core-curriculum-and-integrated-maintenance-of-certification-program
#2
W Graham Carlos, Jason T Poston, Gaetane C Michaud, Charles S Dela Cruz, Andrew M Luks, Debra Boyer, Paul E Moore, Jakob I McSparron, Margaret M Hayes, Jay S Balachandran, Tisha S Wang, Eileen Larsson, Jennifer Siegel-Gasiewski, Alan Kantz, James M Beck, Carey C Thomson
Medical professional societies exist to foster collaboration, guide career development, and provide continuing medical education opportunities. Maintenance of certification is a process by which physicians complete formal educational activities approved by certifying organizations. The American Thoracic Society (ATS) established an innovative maintenance of certification program in 2012 as a means to formalize and expand continuing medical education offerings. This program is unique as it includes explicit opportunities for collaboration and career development in addition to providing continuing medical education and maintenance of certification credit to society members...
January 13, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28086028/-busy-being-born-my-path-in-medical-education
#3
Robert M Kotloff
None required.
January 13, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28079399/safety-and-efficacy-of-tissue-plasminogen-activator-tpa-and-deoxyribonuclease-dnase-for-complicated-pleural-effusions-secondary-to-abdominal-pathology
#4
Adnan Majid, Sebastian Ochoa, Sumit Chatterji, Sebastian Fernandez-Bussy, Fayez Kheir, Estefania Rivera, George Cheng, Erik Folch
RATIONALE: Exudative pleural effusions may arise secondary to inflammation of intra-abdominal structures. Pleural space loculations can complicate these effusions, preventing adequate chest tube drainage and leading to consideration of surgical intervention. Previous studies have demonstrated that intrapleural administration of tissue plasminogen activator (tPA) combined with human recombinant deoxyribonuclease (DNase) can improve fluid drainage and reduce surgery for patients with loculated parapneumonic effusions; however, the efficacy of this treatment has not been evaluated for complicated pleural effusions attributed to intraabdominal inflammation...
January 12, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28076701/reduced-expiratory-flow-rate-among-heavy-smokers-increases-lung-cancer-risk-results-from-the-nlst-acrin-cohort-n-18-714
#5
Raewyn J Hopkins, Fenghai Duan, Caroline Chiles, Erin M Greco, Greg D Gamble, Denise Aberle, Robert P Young
RATIONALE: While epidemiological studies consistently show that chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer, debate exists as to whether there is a linear relationship between the severity of airflow limitation and lung cancer risk. OBJECTIVES: We examined this in a large prospective study of older heavy smokers from the American College of Radiology Imaging Network sub-cohort of the National Lung Screening Trial (NLST-ACRIN)...
January 11, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28076685/diffusion-of-evidence-based-intensive-care-unit-organizational-practices-a-state-wide-analysis
#6
Rachel Kohn, Vanessa Madden, Jeremy M Kahn, David A Asch, Amber E Barnato, Scott D Halpern, Meeta Prasad Kerlin
RATIONALE: Several intensive care unit (ICU) organizational practices have been associated with improved patient outcomes. However, the uptake of these evidence-based practices is unknown. OBJECTIVE: To assess diffusion of ICU organizational practices across the state of Pennsylvania. METHODS: We conducted two web-based, cross-sectional surveys of ICU organizational practices in Pennsylvania acute care hospitals, in 2005 (chief nursing officer respondents) and 2014 (ICU nurse manager respondents)...
January 11, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28076684/radiographic-differentiation-of-advanced-fibrocystic-lung-diseases
#7
Masanori Akira
The concept of end-stage lung disease suggests a final common pathway for most diffuse parenchymal lung diseases. In accordance with this concept, end-stage disease is characterized radiographically and pathologically by the presence of extensive honeycombing. However, sequential computed tomographic (CT) scans obtained from patients with chronic diffuse lung disease evolve over time to show various advanced lung disease patterns other than honeycombing. Also, several radiographically distinct honeycomb patterns, including microcystic, macrocystic, mixed, and combined emphysema and honeycombing differentiate one advanced lung disease from another...
January 11, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28033033/long-term-outcomes-and-health-care-utilization-following-prolonged-mechanical-ventilation
#8
Andrea D Hill, Robert A Fowler, Karen E A Burns, Louise Rose, Ruxandra L Pinto, Damon C Scales
RATIONALE: Limited data are available to characterize the long-term outcomes and associated costs for patients who require prolonged mechanical ventilation (PMV) (defined here as mechanical ventilation for longer than 21 days). OBJECTIVES: To examine the association between prolonged mechanical ventilation and mortality, health care utilization, and costs after critical illness. METHODS: Population-based cohort study of adults who received mechanical ventilation in an intensive care unit (ICU) in Ontario, Canada between 2002 and 2013...
December 29, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28033032/dynamic-and-personalized-risk-forecast-in-step-down-units-implications-for-monitoring-paradigms
#9
Lujie Chen, Ogundele Olufunmilayo, Gilles Clermont, Marilyn Hravnak, Michael R Pinsky, Artur W Dubrawski
RATIONALE: Cardiorespiratory insufficiency (CRI) is a term applied to the manifestations of loss of normal cardiorespiratory reserve and portends a bad outcome. CRI occurs commonly in hospitalized patients, but its risk escalation patterns are unexplored. OBJECTIVES: To describe the dynamic and personal character of CRI risk evolution observed through continuous vital sign monitoring of individual Step-Down Unit patients. METHODS: Using a machine learning model, we estimated risk trends for CRI (defined as exceedance of vital sign stability thresholds) for each of 1,971 admissions (1,880 unique patients) to a 24-bed adult surgical-trauma step-down unit at an urban teaching hospital in Pittsburgh, Pennsylvania using continuously-recorded vital signs from standard bedside monitors...
December 29, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28029806/summary-for-clinicians-liberation-from-mechanical-ventilation-in-critically-ill-adults
#10
Eddy Fan, Bishoy Zakhary, Andre Amaral, Jessica McCannon, Timothy D Girard, Peter E Morris, Jonathon D Truwit, Kevin C Wilson, Carey C Thomson
No abstract text is available yet for this article.
December 28, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28029805/therapeutic-laryngoscopy-during-exercise-for-treatment-of-refractory-exercise-induced-laryngeal-obstruction-a-personal-experience
#11
Alice E Hargrove, M Blake Hargrove, J Tod Olin
No abstract text is available yet for this article.
December 28, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28029801/sinus-computed-tomographic-findings-in-adult-smoking-and-non-smoking-asthmatics-analysis-of-clinical-indices-and-biomarkers
#12
Hirokazu Kimura, Satoshi Konno, Yuji Nakamaru, Hironi Makita, Natsuko Taniguchi, Kaoruko Shimizu, Masaru Suzuki, Junya Ono, Shoichiro Ohta, Kenji Izuhara, Masaharu Nishimura
RATIONALE: When the two conditions occur together, sinusitis and asthma are often thought to represent anatomically separate components of the same chronic inflammatory airway disease. Information about the effect of smoking on the interaction between sinusitis and asthma in patients who have both disorders is limited. OBJECTIVES: This study aimed to evaluate the effect of cigarette smoking on the relationship between the presence and severity of sinusitis and selected asthma-related indices in adults who have asthma...
December 28, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28006108/preliminary-assessment-of-safety-pharmacokinetics-and-dose-finding-for-digitoxin-for-airway-inflammation-in-cystic-fibrosis
#13
Pamela L Zeitlin, Marie Diener-West, Karen A Callahan, Seakwoo Lee, C Conover Talbot, Bette Pollard, Michael P Boyle, Noah Lechtzin
RATIONALE: Cystic Fibrosis (CF) lung disease progresses by a combination of airways inflammation, bacterial colonization, and infection. Airways inflammation is predominantly neutrophilic and complicates airway clearance therapies through cellular debris, excessive DNA, excessive and viscous mucous, and high concentrations of neutrophils, Il-8 and related cytokines liberated along the NFkB signaling pathway. OBJECTIVE: We conducted a single site, randomized, double blind, placebo-controlled, preliminary study in which we evaluated the effects of 28 days of two dose levels (0...
December 22, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28005410/results-of-a-medicare-bundled-payments-for-care-improvement-initiative-for-copd-readmissions
#14
Surya P Bhatt, J Michael Wells, Anand S Iyer, deNay P Kirkpatrick, Trisha M Parekh, Lauren T Leach, Erica M Anderson, J Greg Sanders, Jessica K Nichols, Cindy C Blackburn, Mark T Dransfield
RATIONALE: Approximately 20% of Medicare beneficiaries hospitalized for acute exacerbations of COPD are readmitted within 30 days of discharge. In addition to implementing penalties for excess readmissions, the United States Centers for Medicare & Medicaid Services (CMS) has developed Bundled Payments for Care Improvement (BPCI) initiatives to improve outcomes and control costs. OBJECTIVES: To evaluate whether a comprehensive COPD multidisciplinary intervention focusing on inpatient, transitional and outpatient care as part of our institution's BPCI participation initiative would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs...
December 22, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27997817/on-the-reportability-of-nontuberculous-mycobacterial-disease-to-public-health-authorities
#15
Kevin L Winthrop, Emily Henkle, Aryn Walker, Maureen Cassidy, Katrina Hedberg, Sean Schafer
Nontuberculous mycobacteria (NTM) are environmental pathogens that are an increasingly common cause of pulmonary and extrapulmonary disease. Electronic laboratory-based reporting is a straightforward mechanism for identifying NTM infections, and for monitoring trends in disease. Oregon was the first state to make NTM reportable, although at this time the reporting requirement is limited to extrapulmonary infection. This has assisted authorities in detecting outbreaks and healthcare-related infections. Further consideration should be given to the reportability of pulmonary NTM disease...
December 20, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27997808/clinical-momentum-in-the-intensive-care-unit-a-latent-contributor-to-unwanted-care
#16
Jacqueline M Kruser, Christopher E Cox, Margaret L Schwarze
Many older adults in the United States receive invasive medical care near the end of life, often in an intensive care unit (ICU). However, most older adults report preferences to avoid this type of medical care and to prioritize comfort and quality of life near death. We propose a novel term, "clinical momentum," to describe a system-level, latent, previously unrecognized property of clinical care that may contribute to the provision of unwanted care in the ICU. The example of chronic critical illness illustrates how clinical momentum is generated and propagated during the care of patients with prolonged illness...
December 20, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27983872/recovery-of-dysphagia-symptoms-after-oral-endotracheal-intubation-in-ards-survivors-a-5-year-longitudinal-study
#17
Martin B Brodsky, Minxuan Huang, Carl Shanholtz, Pedro A Mendez-Tellez, Jeffrey B Palmer, Elizabeth Colantuoni, Dale M Needham
RATIONALE: Nearly 60% of patients who are intubated in intensive care units (ICUs) experience dysphagia after extubation, and approximately 50% of them aspirate. Little is known about dysphagia recovery time after patients are discharged from the hospital. OBJECTIVE: To determine factors associated with recovery from dysphagia symptoms after hospital discharge for acute respiratory distress syndrome (ARDS) survivors who received oral intubation with mechanical ventilation...
December 16, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27983871/difficult-airway-characteristics-associated-with-first-attempt-failure-at-intubation-using-video-laryngoscopy-in-the-intensive-care-unit
#18
Raj Joshi, Cameron D Hypes, Jeremy Greenberg, Linda Snyder, Josh Malo, John W Bloom, Harsharon Chopra, John C Sakles, Jarrod M Mosier
RATIONALE: Video laryngoscopy has overcome the need to align the anatomic axes to obtain a view of the glottic opening in order to place a tracheal tube. However, despite this advantage, a large number of attempts are unsuccessful. There are no existing data on anatomic characteristics in critically ill patients associated with a failed first attempt at laryngoscopy when using video laryngoscopy. OBJECTIVES: To identify characteristics associated with first attempt failure at intubation when using video laryngoscopy in the intensive care unit...
December 16, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27983865/suicide-risk-management-protocol-in-post-cardiac-arrest-survivors-development-feasibility-and-outcomes
#19
Rachel A Bucy, Kaitlyn A Hanisko, Lee A Kamphuis, Brahmajee K Nallamothu, Theodore J Iwashyna, Paul N Pfeiffer
RATIONALE: Suicidal ideation is an important part of the spectrum of depression, but studies of outcomes following cardiac events often avoid asking about suicide as part of their assessment due to perceived resource constraints and the complexity of managing this finding. OBJECTIVES: To describe the development, feasibility, and outcomes of a suicide risk management protocol implemented by research assistants (RAs) administering the Patient Health Questionnaire Depression Scale (PHQ-9)...
December 16, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27977294/house-dust-endotoxin-levels-are-associated-with-adult-asthma-in-a-u-s-farming-population
#20
Megan Ulmer Carnes, Jane A Hoppin, Nervana Metwali, Annah B Wyss, John L Hankinson, Elizabeth Long O'Connell, Marie Richards, Stuart Long, Laura E Beane Freeman, Dale P Sandler, Paul K Henneberger, Christie Barker-Cummings, David M Umbach, Peter S Thorne, Stephanie J London
RATIONALE: Endotoxin initiates a pro-inflammatory response from the innate immune system. Studies in children suggest endotoxin exposure from house dust may be an important risk factor for asthma, but few studies have been conducted in adult populations. OBJECTIVES: To investigate the association of house dust endotoxin levels with asthma and related phenotypes (wheeze, atopy, and pulmonary function) in a large U.S. farming population. METHODS: Dust was collected from the bedrooms (n=2,485) of participants enrolled in a case-control study of current asthma (927 cases) nested within the Agricultural Health Study...
December 15, 2016: Annals of the American Thoracic Society
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