Chest
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Chest radiography (CXR) continues to be the most frequently performed imaging examination worldwide, yet it remains prone to frequent errors in interpretation. These pose potential adverse consequences to patients and are a leading motivation for medical malpractice lawsuits. ⋯ The medicolegal implications of such errors are explained. Awareness of commonly missed CXR findings, their causes, and their consequences are important in developing approaches to reduce and mitigate these errors.
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Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality. Corticosteroids may be a beneficial adjunct in the treatment of bacterial pneumonia. ⋯ Corticosteroid therapy is associated with a lower incidence of progression to requiring mechanical ventilation among patients hospitalized with CAP. No association was found between corticosteroid therapy and mortality, treatment failure, or adverse events.
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Chest radiography (CXR), the most frequently performed imaging examination, is vulnerable to interpretation errors resulting from commonly missed findings. Methods to reduce these errors are presented. ⋯ Artificial intelligence is among the emerging and promising methods to enhance detection of CXR abnormalities. Despite their potential adverse consequences, errors offer opportunities for continued education and quality improvements in patient care, if managed within a just, supportive culture.
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Septic shock is defined by the need for vasopressor agents to correct hypotension and lactic acidosis resulting from infection, with 30%-40% case fatality rates. The care of patients with worsening septic shock involves multiple treatment decisions involving vasopressor choices and adjunctive treatments. In this edition of "How I Do It", we provide a case-based discussion of common clinical decisions regarding choice of first-line vasopressor, BP targets, route of vasopressor delivery, use of secondary vasopressors, and adjunctive medications. We also consider diagnostic approaches, treatment, and monitoring strategies for the patient with worsening shock, as well as approaches to difficult weaning of vasopressors.
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Bronchodilator responsiveness (BDR) in obstructive lung disease varies over time and may be associated with distinct clinical features. ⋯ Demonstration of BDR, even once, describes an obstructive lung disease phenotype with a history of asthma and greater small airways disease. Consistent demonstration of BDR indicated a high risk of lung function decline over time in the entire cohort and was associated with higher risk of progression to COPD in patients with GOLD stage 0 disease.