Chest
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Concomitant tricuspid valve repair (TVR) and double lung transplantation (DLTx) has been a surgical option at our institution since 2004 in an attempt to improve the outcome of DLTx for end-stage pulmonary hypertension, severe tricuspid regurgitation, and right ventricle (RV) dysfunction. This study is a review of that single institutional experience. ⋯ Combined TVR and DLTx procedures were successfully performed without an increase in morbidity or mortality and contributed to decreased primary graft dysfunction. In our experience, this combined operative approach achieves clinical outcomes equal or superior to the outcomes seen in DLTx patients without RV dysfunction and severe tricuspid regurgitation.
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Patients with COPD generally have a poor peak aerobic capacity and, therefore, may experience more inconvenience during domestic activities of daily life (ADLs). Yet, task-related oxygen uptake and symptom perception during ADLs have been studied rarely in COPD. Therefore, it remains unknown whether and to what extent differences may exist in task-related oxygen uptake and symptom perception during ADLs in patients with COPD after stratification for sex; GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage; Medical Research Council (MRC) dyspnea grade; or score on the BMI, obstruction, dyspnea, exercise capacity (BODE) index. ⋯ Patients with COPD experience a relatively high metabolic load and symptom perception during the performance of ADLs that is not the same as seen in their healthy peers, particularly in patients with GOLD stage IV, MRC dyspnea grade 5, or BODE score ≥ 6 points.
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The delivery of state-of-the-art medical care is complex, with large numbers of treatment strategies often available to individual patients. It is paramount to ensure that each patient receives optimal treatment in a safe, effective, and timely manner. Evidence suggests that an unacceptably high number of patients currently experience suboptimal care as the result of adverse events and medical error. ⋯ Selection, credentialing, and revalidation of medical professionals are also possible in a simulation setting, enabling maintenance of standards of practice throughout a medical career. In order for simulation to become a part of the medical curriculum, collaborative efforts are required from academics, physicians, managers, and policy makers alike. Bringing these groups together, while a challenge, can lead to high-level outputs in medical care, which will benefit all.
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Paragonimiasis is a parasitic infection endemic in Asia but uncommon in the United States. It presents most frequently with cough and hemoptysis. ⋯ The case is also unique because it occurred in a native Californian who had not traveled to Asia and was infected by eating raw crabs at a local sushi restaurant. The freshwater crabs had been imported from Asia.