Chest
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Pulmonary disease caused by nontuberculous mycobacteria (NTM) is steadily increasing worldwide. ⋯ As a sustained microbiological response without surgery is unsatisfactory in treating M abscessus, MX, and M malmoense, functional and quality of life aspects should be given more emphasis in the individual evaluation of treatment outcome. Further, properly planned studies with sufficient power are needed, as are new drugs or better-tolerated application of current antibiotics, or both.
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Lung transplantation has evolved into a life-saving treatment with improved quality of life for patients with end-stage respiratory failure unresponsive to other medical or surgical interventions. With improving survival rates, the number of lung transplant recipients with preexisting and posttransplant comorbidities that require attention continues to increase. ⋯ The goals of this partnership include timely referral and assistance with transplant evaluation, optimization of comorbidities and preparation for transplantation, management of common posttransplant medical comorbidities, immunization, screening for malignancy, and counseling for a healthy lifestyle to maximize the likelihood of a good outcome. We aim to provide an outline of the main aspects of the care of candidates for and recipients of lung transplants for nontransplant physicians and other care providers.
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Lung cancer screening with low-dose CT (LDCT) scan was shown to reduce lung cancer mortality in the National Lung Screening Trial, a large randomized controlled trial of high-risk current and former smokers. Despite ongoing uncertainty over the effectiveness of LDCT scan in the real-world setting, the Centers for Medicare and Medicaid Services (CMS) decided to cover LDCT scan as a preventive service. As part of its National Coverage Determination, CMS set forth a series of requirements for reimbursement of LDCT scan, including a counseling and shared decision-making visit prior to a LDCT scan being ordered. ⋯ Two new billing codes were introduced for the counseling and shared decision-making visit and subsequent LDCT scan. In this review, we summarize the evidence around lung cancer screening and describe practical aspects of the counseling and shared decision-making, including billing considerations. We conclude with a discussion of the greater implications of CMS National Coverage Determination, especially as it pertains to quality assurance around new screening tests.