Chest
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Multicenter Study
Association between shared decision-making during family meetings and surrogates' trust in their ICU physician.
Although trust is central to successful physician-family relationships in ICUs, little is known about how to promote surrogates' trust of ICU physicians in this setting. ⋯ The conduct of family meetings and physicians' use of SDM behaviors during meetings were both associated with increases in surrogates' trust in the treating physician.
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Observational Study
Motile ciliary disorders of the nasal epithelium in adults with bronchiectasis.
Motile ciliary disorder (MCD) has been implicated in chronic inflammatory airway diseases such as asthma and COPD. ⋯ Nasal ciliary markers profiling provides complimentary information to clinical endotyping of bronchiectasis.
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Observational Study
Racial Disparities in Lung Cancer Stage of Diagnosis among Adults Living in the Southeastern U.S.
Black Americans receive a diagnosis at later stage of lung cancer more often than White Americans. We undertook a population-based study to identify factors contributing to racial disparities in lung cancer stage of diagnosis among low-income adults. ⋯ Reducing racial disparities in lung cancer stage at presentation will require interventions on both structural and individual-level factors.
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Value-based care aims to improve the health outcomes of patients, eliminate waste and unwarranted clinical variation, and reduce the total cost of care. Professional medical societies have put forward guidelines to raise awareness on unproven practice patterns (Choosing Wisely Campaign), and payers have sought to replace the traditional fee-for-service payment models with value-based contracts that share financial gains or losses based on achieving high-quality outcomes and lowering the cost of care. Regardless of whether their practices are engaged in value-based arrangements, chest physicians should seek understanding of these principles, participate in designing and implementing practical and impactful high-value initiatives in their practices, and have a national voice on the path forward.
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Multicenter Study
Achieving Molecular profiling in Pleural Biopsies: a multicentre, retrospective cohort study.
Pleural biopsy findings offer greater diagnostic sensitivity in malignant pleural effusions compared with pleural fluid. The adequacy of pleural biopsy techniques in achieving molecular marker status has not been studied, and such information (termed "actionable" histology) is critical in providing a rational, efficient, and evidence-based approach to diagnostic investigation. ⋯ Although previous studies have shown comparable overall diagnostic yields, in the modern era of targeted therapies, this study found that LAT offers far superior results to image-guided techniques at achieving molecular profiling and remains the optimal diagnostic tool.