Chest
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Cardiac sarcoidosis (CS) is known to be associated with congestive heart failure, conduction disorders, and tachyarrhythmias. Ventricular arrhythmias are the most feared cardiac manifestation because they often are unpredictable, may be the fi rst manifestation of the disease, and may be fatal. The propensity for the development of supraventricular arrhythmias (SVAs) in patients with CS has not been described. The aim of this study was to assess the prevalence as well as the predictors of SVA. ⋯ The study systematically evaluated the frequency of SVA in a large number of patients with CS. SVA in patients with CS is frequent and associated with symptoms. LAE was clearly associated with the development of SVA in this patient population. The extent to which LAE predicts the occurrence of SVA in larger, more diverse CS populations should be evaluated prospectively.
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The lack of mandatory clinical registries for idiopathic pulmonary fibrosis (IPF) has meant a reliance on routine clinical data to provide trends in disease incidence. Death certificate and primary care data suggest that the incidence of IPF has increased in the United Kingdom at a rate of approximately 5% per year, but due to possible concerns about the diagnostic validity of these clinical datasets, it is helpful also to analyze data from secondary care. We used national secondary care data to determine trends in hospital admissions for IPF clinical syndrome (IPF-CS) in England between 1998 and 2010. ⋯ Hospital admissions for IPF-CS in England follow a similar trend to other data sources in the United Kingdom . This has resulted in escalating costs of inpatient care, which is a significant financial burden on health-care resources.
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We explore some philosophical and scientific underpinnings of clinical research and evidence at the patient-clinician encounter scale. Insufficient evidence and a common failure to use replicable and sound research methods limit us. Both patients and health care may be, in part, complex nonlinear chaotic systems, and predicting their outcomes is a challenge. ⋯ Obtaining a benefit at the patient-clinician encounter scale requires human (clinician) behavior modification. We believe that serious rethinking and restructuring of the clinical research and care delivery systems is necessary to assure the profession and the public that we continue to do more good than harm. We need to evaluate whether, and how, detailed decision-support tools may enable reproducible clinician behavior and beneficial use of evidence.
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α1-Antitrypsin (AAT) deficiency variants reduce the concentration of serum AAT protease inhibitor and can lead to the development of pulmonary and hepatic disease. Relative frequencies of rare AAT variant phenotypes (non-M, Z, and S) and associated serum concentrations in the clinical population have not been thoroughly described. ⋯ This analysis provides novel information on serum AAT concentrations associated with different AAT phenotypes and provides insight into the severity of depression of AAT concentration in the presence of rare deficiency variants. Additionally, it allows for evaluation of efficacy of testing algorithms incorporating AAT serum concentration determination.
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Case Reports
Long-term safety of nebulized lidocaine for adults with difficult-to-control chronic cough: a case series.
The long-term safety of patient-administered nebulized lidocaine for control of chronic cough has not been established. ⋯ Adults tolerated self-administration of nebulized lidocaine for difficult-to-control chronic cough. No serious adverse effects occurred while providing symptomatic control in 49% of patients.