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The provision of palliative care for severe COPD remains low, resulting in unmet needs in patients and carers. ⋯ Palliative care increasingly is being implemented for nonmalignant diseases including COPD throughout the United Kingdom, although models of working vary. A theoretical model was developed to illustrate the concept and pathway of the integration of palliative care support. A standardized screening and needs assessment tool is required to improve timely palliative care and to address the significant needs of this population.
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In Japan, public dialogue on allocation of life-saving medical resources remains taboo, and discussion largely has been avoided. ⋯ Most respondents supported allocation principles developed internationally and disagreed with the idea of first-come, first-served allocation during resource shortages. The Japanese public seems largely to be prepared to discuss the ethical dilemmas and possible solutions regarding fair and transparent allocation of critical care resources as a necessary step in confronting present and future pandemics and disasters.
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Increased pleural pressure affects the mechanics of breathing of people with class III obesity (BMI > 40 kg/m2). ⋯ In ambulatory patients with class III obesity, CPAP titrated to match pleural pressure decreased work of breathing and improved respiratory mechanics while maintaining hemodynamic stability, without impairing right heart function.
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Since COVID-19 was identified, its clinical and biological heterogeneity has been recognized. Identifying COVID-19 phenotypes might help guide basic, clinical, and translational research efforts. ⋯ Hypothesis-free LCA-defined phenotypes and subphenotypes of patients with COVID-19 can be identified. These may help clinical investigators conduct stratified analyses in clinical trials and assist basic science researchers in characterizing the pathobiology of the spectrum of COVID-19 presentations.
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A 67-year-old woman, who recently immigrated to the United States from Afghanistan, presented to the hospital after sustaining a mechanical fall. She had no significant medical history and was not on any medication routinely. ⋯ The patient had no prior personal history or exposure to TB. Results of a previous purified protein derivative skin test upon immigration were negative.