Chest
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The role of portable high-efficiency particulate air (HEPA) filters for supplemental aerosol mitigation during exercise testing is unknown and might be relevant during COVID-19 pandemic. ⋯ The portable HEPA filter reduced the concentration of aerosols generated during exercise testing by 96% ± 2% for all particle sizes and reduced aerosol room clearance time in clinical exercise testing laboratories. Portable HEPA filters therefore might be useful in clinical exercise testing laboratories to reduce the risk of COVID-19 transmission.
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In recent months, medical institutions across the United States redoubled their efforts to examine the history of race and racism in medicine, in classrooms, in research, and in clinical practice. In this essay, I explore the history of racialization of the spirometer, a widely used instrument in pulmonary medicine to diagnose respiratory diseases and to assess eligibility for compensation. Beginning with Thomas Jefferson, who first noted racial difference in what he referred to as "pulmonary dysfunction," to the current moment in clinical medicine, I interrogate the history of the idea of "correcting" for race and how researchers explained difference. ⋯ Over more than two centuries, as ideas of innate difference hardened, few questioned the conceptual underpinnings of race correction in medicine. At a moment when "race norming" is under investigation throughout medicine, it is essential to rethink race correction of spirometric measurements, whether enacted through the use of a correction factor or through the use of population-specific standards. Historical analysis is central to these efforts.
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Randomized Controlled Trial
Randomized Controlled Trial of a Novel Communication Device Assessed during Noninvasive Ventilation Therapy.
Noninvasive ventilation (NIV), a form of positive airway pressure (PAP) therapy, is the standard of care for various forms of acute respiratory failure (ARF). Communication impairment is a side effect of NIV, impedes patient care, contributes to distress and intolerance, and potentially increases intubation rates. This study aimed to evaluate communication impairment during CPAP therapy and demonstrate communication device improvement with a standardized protocol. ⋯ Use of this PAP communication device significantly improves both intelligibility and comfort. This is one of the first studies quantifying communication impairment during PAP delivery.
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A 51-year-old woman with a history of diabetes mellitus and anemia sought treatment at the emergency room for a 2-month history of dry cough and shortness of breath and a 1-week history of substernal chest tightness. One month before her presentation, she was seen at a separate hospital for dyspnea and was found to be anemic. She underwent chest radiography and CT scanning of the chest that was unrevealing to the cause of dyspnea. ⋯ Medications included an oral diabetic medication. She had no significant family history. She never smoked and had no history of illicit drug or alcohol use.
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Worldwide, health-care professionals are experiencing unprecedented stress related to the coronavirus disease 2019 pandemic. Responding to a new virus for which there is no effective treatment yet and no vaccine is beyond challenging. ⋯ We explore here, guided by evidence, the concept and features of moral distress and individual resilience. Mitigation strategies involve individual and institutional responsibilities; the importance of solidarity, peer support, psychological first aid, and gratitude are highlighted.