Chest
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Culture is a key driver of organizational performance and underpins strategy. As previously discussed, if the strategy is the plants and the garden plan for a garden, the culture is the soil. Without a healthy culture, nothing will grow, irrespective of how well planned the garden or how beautiful the individual flowers. ⋯ Critical success factors include open communication and establishing psychological safety as well as modeling integrity. Fundamentally, when cultures are grounded in the seven classical virtues-trust, compassion, courage, justice, wisdom, temperance, and hope-they are best positioned to unleash the discretionary effort of its members. When people expend discretionary effort, they do the right thing when nobody is watching and the performance drivers are internal motivation and alignment with mission rather than external drivers to seek reward (carrots) or to avoid punishment (sticks).
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Lung cancer screening with a low radiation dose chest CT scan is the standard of care for screening-eligible individuals. The net benefit of screening may be optimized by delivering high-quality care, capable of maximizing the benefit and minimizing the harms of screening. Valid, feasible, and relevant indicators of the quality of lung cancer screening may help programs to evaluate their current practice and to develop quality improvement plans. ⋯ Potential quality indicators were explored through surveys of multidisciplinary lung cancer screening experts. Those that achieved predefined measures of consensus for each of the validity, feasibility, and relevance domains are proposed as quality indicators. Each of the proposed indicators is described in detail, with guidance on how to define, measure, and improve program performance within the indicator.
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Chest radiography (CXR) often is performed in the acute setting to help understand the extent of respiratory disease in patients with COVID-19, but a clearly defined role for negative chest radiograph results in assessing patients has not been described. ⋯ Initial CXR in adult patients suspected of having COVID-19 is a strong exclusionary test for hospital admission, mechanical ventilation, ARDS, and mortality. The value of CXR as an exclusionary test for adverse clinical outcomes is highest among young adults, patients with few comorbidities, and those with a prolonged duration of symptoms.
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Multicenter Study Observational Study
Potential Disparities by Sex and Race or Ethnicity in Lung Cancer Screening Eligibility Rates.
Criteria for low-dose CT scan lung cancer screening vary across guidelines. Knowledge of the eligible pool across demographic groups can enable policy and programmatic decision-making, particularly for disproportionately affected populations. ⋯ Screening eligibility rates vary widely across guidelines, with disparities evident in E-I ratios, including among non-Hispanic Black men, despite higher lung cancer burden. Consideration of smoking duration in risk assessment criteria may address current disparities.
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A 72-year-old woman, nonsmoker, presented with approximately 2 months of nonproductive cough. The cough was initially intermittent, occurred more regularly during bedtime, but gradually became more frequent throughout the day with no reported triggering factors. The remaining review of associated symptoms was negative; she did not complain of shortness of breath, fever, chest pain, muscle weakness, weight loss, night sweats, or fatigue. ⋯ Patient was free of disease on follow up from her endocrinologist, to optimize levothyroxine treatment. Her regular prescription included statins. Her professional occupation was not related to special exposure, and she reported no alcohol consumption, illicit drug use, or any recent travel.