Chest
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Multicenter Study
Hospital-acquired infections in critically-ill COVID-19 patients.
Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19. ⋯ Critically ill patients with COVID-19 are at high risk for HAIs, especially VAPs and BSIs resulting from MDR organisms. HAIs prolong mechanical ventilation and hospitalization, and HAIs complicated by septic shock almost double mortality.
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Exogenous lipoid pneumonia (ELP) develops when lipid-containing substances enter the airways through aspiration or inhalation and incite an inflammatory response. The diagnosis of ELP often is difficult because findings may be nonspecific. The clinical course of ELP has not been well characterized. ⋯ ELP often is asymptomatic and may not manifest fatty attenuation on chest CT imaging. Clinical and radiologic abnormalities persist or worsen in most affected patients, even when the causative agent is discontinued.
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The formulation of expert opinion guidelines has several sources of bias that may adversely affect their quality. To minimize bias, guideline creators must use rigorous methodology. There has been no appraisal of the methodologic quality of basic critical care echocardiography (BCCE) training/education guidelines. ⋯ The methodologic appraisal of BCCE-training guidelines showed widespread deficiencies in guideline formulation processes. The impact of these deficiencies on the validity of the recommendations requires further evaluation in longitudinal studies.
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Mycobacterium abscessus pulmonary disease (M abscessus-PD) is challenging to treat because of its resistance to antibiotics. ⋯ Inhaled amikacin with or without clofazimine in the regimen provides favorable treatment outcomes in M massiliense-PD. However, more effective treatments are needed for M abscessus-PD.
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Lung cancer screening (LCS) is effective at reducing mortality for high-risk smokers. Mortality benefits go beyond early cancer detection, because shared decision-making (SDM) may present a "teachable moment" to reinforce cessation and provide resources. ⋯ Overall provision of smoking cessation resources was moderate during SDM encounters for LCS, and lower in patients with more comorbidities and when not performed by the patient's PCP or specialist. Interventions are needed to improve smoking cessation counseling and resource utilization at the time of LCS encounters.