Chest
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The use of mechanical circulatory support (MCS) devices has increased sixfold since 2006. Although there is an established legal and ethical consensus that patients have the right to withdraw and withhold life-sustaining interventions when burdens exceed benefits, this consensus arose prior to the widespread use of MCS technology and is not uniformly accepted in these cases. ⋯ Our center recently encountered the challenge of an awake and functionally improving patient with a total artificial heart (TAH) who requested its deactivation. We present a narrative description of this case with discussion of the following questions: (1) Is it ethically permissible to deactivate this particular device, the TAH? (2) Are there any particular factors in this case that are ethical contraindications to proceeding with deactivation? (3) What are the specific processes necessary to ensure a compassionate and respectful deactivation? (4) What proactive practices could have been implemented to lessen the intensity of this case's challenges? We close with a list of recommendations for managing similar cases.
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Linear endobronchial ultrasound (EBUS) allows real-time guidance of transbronchial needle aspiration of thoracic structures and has become an increasingly important diagnostic tool for chest physicians. Little has been published about the learning experience of operators with this technology. The purpose of this study was to define the learning experience of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) among pulmonary trainees. ⋯ Pulmonary trainees needed an average of 13 procedures to achieve first independent successful performance of EBUS-TBNA following a training protocol that included a didactic curriculum and simulation-based practice. Our findings could guide pulmonary fellowship directors in planning EBUS training and establishing a reasonable juncture to assess EBUS skills with validated assessment tools.
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Diffuse Lung Disease Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Granulomatosis with polyangiitis (Wegener's), abbreviated as GPA, is an antineutrophil cytoplasmic antibody (ANCA) - associated vasculitides which have mainly upper and lower airways, and renal involvement. ⋯ Prompt diagnosis of GPA is very important due to the fact that the immunosuppressive therapy may save the life of the patient.Reference #1: Hogan SL, Falk RJ, Chin H, et al. Predictors of relapse and treatment resistance in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis. Ann Intern Med 2005; 143:621.Reference #2: Hogan SL, Falk RJ, Nachman PH, Jennette JC. Various forms of life in antineutrophil cytoplasmic antibody-associated vasculitis. Ann Intern Med 2006; 144:377.Reference #3: J. Charles Jennette, M.D., and Ronald J. Falk, M.D. N Engl J Med 1997; 337:1512-1523DISCLOSURE: The following authors have nothing to disclose: Claudia Toma, Ionela Belaconi, Stefan Dumitrache-Rujinski, Liliana Grigoriu, Alina Croitoru, Miron BogdanNo Product/Research Disclosure Information.
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Lung Cancer Posters IISESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Half of non-small cell lung cancers are diagnosed in locally advanced stages (LA-NSCLC) and treated by combining chemotherapy, radiation (RT), and surgery (S). Induction chemo (iCT) and chemoradiation (iCRT) are at least as effective as adjuvant therapies are, and allow to infer survival predictions depending on the grade of response. The 18-FDG-PET-CT-Scan (PET) is slowly introducing in the evaluation of those responses. We analyzed the impact of changes in re-staging PET in the outcome of patients with LA-NSCLC treated with induction therapies ⋯ Diego Marquez-Medina: Grant monies (from industry related sources): Llilly advisor, Grant monies (from industry related sources): Roche advisor, Grant monies (from industry related sources): Astra Zeneca speacher The following authors have nothing to disclose: Ariadna Gasol-Cudos, Antonio Martin-MarcoNo Product/Research Disclosure Information.
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Lung Cancer ISESSION TYPE: Slide PresentationsPRESENTED ON: Saturday, March 22, 2014 at 02:15 PM - 03:45 PMPURPOSE: To report local control and overall survival following CyberKnife treatment for central NSCLC conventional radiation failures. ⋯ Sean Collins: Consultant fee, speaker bureau, advisory committee, etc.: Consultant Accuray Inc. Brian Collins: Consultant fee, speaker bureau, advisory committee, etc.: Speaker Bureau Accuray Inc. The following authors have nothing to disclose: Ryan Malik, Shaan Kataria, Catherine Jamis, Leonard Chen, Simeng Suy, Cristina Reichner, Eric AndersonNo Product/Research Disclosure Information.