Chest
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Despite literature suggesting benefits of using regional anesthesia, the impact of neuraxial anesthesia on perioperative outcomes in patients undergoing lung surgery remains unstudied. We studied the effect of combined neuraxial/general anesthesia (vs general anesthesia) on perioperative outcome in a large national sample of patients who underwent open lung resection. ⋯ This study illustrates the association between adding neuraxial to general anesthesia in open lung resections among patients with cancer and perioperative outcomes. Neuraxial anesthesia use was associated with decreased risk for blood transfusion but increased thromboembolic risks. Additional studies are needed to elucidate mechanisms by which neuraxial anesthesia may affect these outcomes.
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Patient satisfaction is an important factor for consideration in pulmonary practice management. Although evidence regarding the correlation of patient satisfaction with care quality remains mixed, there is an increasing national emphasis on the importance of patient experience in physician reimbursement, credentialing, and public opinion. ⋯ Physician credentialing may also be impacted by the American Board of Internal Medicine's Maintenance of Certification program and potential future requirements for physicians to assess the patient experience to maintain certification. In the continually evolving health-care delivery, credentialing, and reimbursement climate, a thorough understanding of the increasing importance of patient satisfaction as well as strategies for successfully approaching this issue are essential to modern pulmonary inpatient and outpatient practice management.
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Biography Historical Article
Giants in Chest Medicine: John (Jack) G. Weg, MD, Master FCCP.
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There is a bidirectional association between OSA and systemic hypertension. The strengths of this relationship appear to be modulated by factors such as age, sex, and somnolence. The 24-h BP circadian pattern also appears to be influenced by OSA. ⋯ The effects of oral appliances on BP in patients with OSA must be evaluated in randomized controlled trials. In the absence of additional data reported by clinical studies on other antihypertensive drug treatments, diuretics, particularly antialdosteronic diuretic agents, should be considered the first-line antihypertensive drug treatment in patients with OSA. By reducing parapharyngeal edema and secondary upper airway obstruction, these drugs appear to improve OSA severity and also to reduce BP.