Chest
-
Excessive erythrocytosis (EE) is a prevalent condition in populations living at high altitudes (> 2,500 m above sea level). Few large population-based studies have explored the association between EE and multiple subject-specific traits including oxygen saturation, iron status indicators, and pulmonary function. ⋯ We found a lower prevalence of EE than in previous reports in the Peruvian Andes. Although the presence of hypoxemia and decreased vital capacity were strongly associated with excessive erythrocytosis, being overweight or having metabolic syndrome were associated with an important fraction of cases in our study population.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Novel use of pleural ultrasound can identify malignant entrapped lung prior to effusion drainage.
The presence of entrapped lung changes the appropriate management of malignant pleural effusion from pleurodesis to insertion of an indwelling pleural catheter. No methods currently exist to identify entrapped lung prior to effusion drainage. Our objectives were to develop a method to identify entrapped lung using tissue movement and deformation (strain) analysis with ultrasonography and compare it to the existing technique of pleural elastance (PEL). ⋯ This novel ultrasound technique can identify entrapped lung prior to effusion drainage, which could allow appropriate choice of definitive management (pleurodesis vs indwelling catheter), reducing the number of interventions required to treat malignant pleural effusion.
-
Our objective was to determine stroke and thromboembolism event rates in patients with atrial fibrillation (AF) classified as "low risk" using the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) score and to ascertain event rates in this group in relation to the stroke risk assessment advocated in the 2012 European Society of Cardiology (ESC) guidelines (based on the CHA2DS2-VASc [congestive heart failure, hypertension, age ≥ 75 years, diabetes, previous stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category] score). We tested the hypothesis that the stroke risk assessment scheme advocated in the ESC guidelines would be able to further refine stroke risk stratification in the low-risk category defined by the ATRIA score. ⋯ Patients categorized as low risk using an ATRIA score 0 to 5 are not necessarily low risk, with 1-year event rates as high as 36.94 per 100 person-years. Thus, the stroke risk stratification scheme recommended in the ESC guidelines (based on the CHA2DS2-VASc score) would be best at identifying the "truly low risk" subjects with AF who do not need any antithrombotic therapy.
-
Throughout medical history, physicians have rarely formed unions and/or carried out strikes. In a profession faced with the turmoil of health reform and increasing pressure to change their practices and lifestyles, will physicians resort to unionization for collective bargaining, and will a strike weapon be used to fight back against the array of corporate and government powers involved in the transformation of the American health-care system? This article examines the question of whether there could be such a thing as an ethical physician strike. Although physicians have not historically used collective bargaining or the strike weapon, the rapidly changing practice environment in the United States might push physicians and other health-care professionals toward unionization. This article considers the ethical questions that would arise if physicians started taking advantage of labor laws, and it lays out criteria for an ethical strike.