Chest
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Randomized Controlled Trial
Survivors of intensive care with type 2 diabetes and the effect of shared care follow-up clinics: the SWEET-AS randomized controlled pilot study.
Follow-up clinics after ICU admission have demonstrated limited benefit. However, existing trials have evaluated heterogeneous cohorts and used physicians who had limited training in outpatient care. ⋯ Outcomes for ICU survivors with type 2 diabetes are poor. Because of low participation and high mortality, a larger trial of a shared-care follow-up clinic in this cohort, using the present design, does not appear feasible.
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CPAP effectiveness is limited by suboptimal adherence. Prior studies of adherence have focused on middle-aged men. ⋯ CPAP adherence rates vary substantially by demographics, with 18- to 30-year-old women having the lowest adherence. The pattern of use over the first 90 days also varies substantially by age and sex. Further research to understand and address the causes of disparities will be crucial to maximizing the benefits of CPAP therapy.
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Multicenter Study Observational Study
Critically Ill Adults with COVID-19 in New Orleans and Care with an Evidence-based Protocol.
Characteristics of critically ill adults with coronavirus disease 2019 (COVID-19) in an academic safety net hospital and the effect of evidence-based practices in these patients are unknown. ⋯ Care of critically ill COVID-19 patients with an evidence-based protocol is associated with increased time alive and free of invasive mechanical ventilation. In-hospital survival occurred in most critically ill adults with COVID-19 admitted to an academic safety net hospital's ICUs despite a high rate of comorbidities.
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Review Case Reports
How I Do It: The PERT Concept: A Step-by-Step Approach to Managing PE.
Pulmonary embolism (PE) is a major source of morbidity and mortality. The presentation of acute PE varies, ranging from few or no symptoms to sudden death. Patient outcome depends on how well the right ventricle can sustain the increased afterload caused by the embolic burden. ⋯ Clinical consensus statements have been published that offer a guide to PE management, but areas remain for which the evidence is inadequate. Although the management of low-risk and high-risk patients is more straightforward, optimal management of intermediate-risk patients remains controversial. In this document, we offer a case-based approach to PE management, beginning with diagnosis and risk stratification, followed by therapeutic alternatives, and finishing with follow-up care.
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Lung cancer is currently the most common malignancy in the world. A lobectomy is the standard of care for most patients with operable lung cancer and accounts for 60% to 70% of lung resection. The chest radiograph may appear normal after a lobectomy, particularly in uncomplicated cases. ⋯ We retrospectively evaluated the plain radiographic appearances of the postlobectomy chest, free of postoperative complications or recurrent/metastatic lung cancer. On the basis of our observations, the changes that occur in pulmonary and extrapulmonary anatomy can differ according to the resected lobe. Recognition of these changes will make it easier to identify which lobe has been removed surgically.