Chest
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Randomized Controlled Trial Multicenter Study Observational Study
Clinical Application of the COPD Assessment Test: Longitudinal Data from the CHAIN Cohort.
The COPD Assessment Test (CAT) has been proposed for assessing health status in COPD, but little is known about its longitudinal changes. The objective of this study was to evaluate 1-year CAT variability in patients with stable COPD and to relate its variations to changes in other disease markers. ⋯ One-year longitudinal data show variability in CAT scores among patients with stable COPD similar to mMRC scale score, which is the best predictor of 1-year CAT changes. Further longitudinal studies should confirm long-term CAT variability and its clinical applicability.
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American College of Chest Physicians' (CHEST) new Living Guidelines Model will not only provide clinicians with guidance based on the most clinically relevant and current science but will also allow expert-informed guidance to fill in any gaps in the existing evidence. These guidance documents will be updated, as necessary, using one or more of three processes: (1) evidence-based guidelines, (2) trustworthy consensus statements, and (3) a hybrid of the other two. The new Living Guidelines Model will be more sustainable and will encourage maintenance of current and targeted recommendations and suggestions. ⋯ These reliable statements of guidance for health-care providers and patients are based on a rigorous methodology and transparency of process.
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Central sleep apnea (CSA) is common among patients with heart failure (HF) and is promoted by elevated CO2 chemosensitivity. Left atrial size is a marker of the hemodynamic severity of HF. The aim of this study was to determine if left atrial size predicts chemosensitivity to CO2 and CSA in patients with HF. ⋯ Increased LAVI is associated with heightened CO2 chemosensitivity and greater frequency of CSA. LAVI may be useful to guide referral for polysomnography for detection of CSA in patients with HF.
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Changes in medical practice, such as retiring, selling a practice, and switching employment, have significant legal impacts on physicians. These decisions should be carefully analyzed prior to being made. Physicians who do not make decisions in a well-considered manner may face economic penalties, licensure sanctions, and/or other legal issues. ⋯ Within these topics, sources of physicians' legal and ethical obligations are examined, including possible resolutions to identified issues. Not all changes affect physicians in the same manner. This article further considers how these important legal issues may impact differently situated physicians, such as retiring physicians vs transitioning physicians and physicians employed by groups or hospital systems vs physicians in solo practice.
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Pulmonary venoocclusive disease (PVOD) is a rare lung disease, diagnosed in 5% to 10% of patients with pulmonary hypertension (PH). The incidence, prevalence, and etiology of PVOD in children are not well defined. The mortality remains high, related, at least partly, to the limited treatment options. ⋯ PVOD is an important differential diagnosis for pediatric patients with PH. CT scanning is a valuable tool to image lung abnormalities; the definitive diagnosis can only be made by examination of lung biopsy specimens, which subjects the patient to additional risk. Early listing for lung transplantation is essential, as the mean survival time is only 14 months.