Chest
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There is an urgent need for population-based studies on managing patients with pulmonary nodules. ⋯ The NLP algorithm identified pulmonary nodules and associated characteristics with high accuracy. In our community practice settings, the documentation of nodule characteristics is incomplete. Our results call for better documentation of nodule findings. The NLP algorithm can be used in population-based studies to identify pulmonary nodules, avoiding labor-intensive chart review.
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Practice Guideline
Screening for Lung Cancer: CHEST Guideline and Expert Panel Report.
Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part because of the results of the National Lung Screening Trial (NLST). Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, and increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not. ⋯ Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can impact this balance.
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Observational Study
Diagnostic outcomes and safety of cryobiopsy added to conventional sampling methods: an observational study.
Cryobiopsy enables specialists to perform high-quality, large, entirely circumferential biopsies; therefore, it may improve the diagnostic yield of peripheral pulmonary lesions (PPLs), as has been previously observed regarding endobronchial tumors and interstitial lung diseases. ⋯ Cryobiopsy improves the diagnostic yield of PPLs when combined with other conventional sampling methods; however, caution is required because of the possibility of complications.
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Decannulation from venovenous extracorporeal membrane oxygenation (ECMO) at the earliest and safest possible time may improve outcomes and reduce cost. Yet, no prospective studies have compared weaning strategies for liberation from ECMO. ⋯ The ECMO-free protocol is feasible and may identify patients for decannulation earlier than gradual approaches to weaning.
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COPD medications reduce exacerbations and improve quality of life. Despite this, some individuals do not receive medications recommended by practice guidelines. ⋯ COPD medications seem underused by the COPD population, and various factors are associated with suboptimal receipt. Targeting these factors would help improve the care and health of people with COPD.