Chest
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Guidelines recommend pulmonary rehabilitation (PR) after hospitalization for an exacerbation of COPD, but few patients enroll in PR. We explored whether density of PR programs explained regional variation and racial disparities in receipt of PR. ⋯ Greater PR program density was associated with higher rates of PR for non-Hispanic white but not black beneficiaries. Further research is needed to identify reasons for this discrepancy and strategies to increase receipt of PR for black patients.
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The concerns regarding air leak after lung surgery or spontaneous pneumothorax include detection and duration. Prior studies have suggested that digital drainage systems permit shorter chest tube duration and hospital length of stay (LOS) by earlier detection of air leak cessation. We conducted a systematic review to assess the impact of digital drainage on chest tube duration and hospital LOS after pulmonary surgery and spontaneous pneumothorax. ⋯ Most studies show no significant differences in chest tube duration and hospital LOS with digital vs analog drainage systems for patients with air leak after pulmonary resection. For post-spontaneous pneumothorax air leak, the limited published evidence suggests shorter chest tube duration and hospital LOS with digital drainage systems.
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A 75-year-old man was referred to our institution for worsening dyspnea, decreased activity tolerance, myalgias, and an increase in oxygen requirement. Nine months before the initial referral, the patient presented to an outside hospital for acute hypoxemic respiratory failure requiring a right-sided video-assisted thoracoscopic surgery (VATS) lung biopsy that disclosed organizing pneumonia (OP). ⋯ Prior attempts to further reduce prednisone resulted in worsening dyspnea, fevers, and myalgias. Despite optimal medical treatment for 3 months, he presented to our institution with progressive dyspnea, an increased oxygen requirement to 6 L/min, fatigue, and muscle weakness.
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Recent policy initiatives aim to improve the value of care for patients hospitalized with pneumonia. It is unclear whether higher 30-day episode spending at the hospital level is associated with any difference in patient mortality among fee-for-service Medicare beneficiaries. ⋯ Higher hospital-level spending for a 30-day episode of care for pneumonia was not associated with any difference in patient mortality.