Chest
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Treatment for lung cancer can improve prognosis, but 5-year survival remains low at 26%. An examination of treatment using data with higher population coverage, and among a broader number of treatment modalities and individual characteristics, would provide greater insight into differences in lung cancer treatment. ⋯ Chemotherapy and radiation were the most common types of first-course treatment reported. Receipt of at least one of the four treatments examined was lower among several groups, including certain racial and ethnic groups and those residing in counties with lower economic status. Future studies might further identify and intervene upon factors underlying differences.
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The Advanced Practice Respiratory Therapist (APRT) is a new healthcare practitioner trained to provide a scope of practice that exceeds that of the registered respiratory therapist (RRT) and is aligned with an advanced practice provider (APP) role. As part of a physician-led team, APRTs are trained to provide diagnostic and therapeutic patient care services in multiple settings across the health care spectrum, including critical care, acute and sub-acute inpatient care, and outpatient care such as preventative, ambulatory, and chronic care. Competency domains that must be included in accredited APRT education programs include medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and improvement, and systems-based practice. ⋯ APRT students also complete a variety of patient simulations using standardized patients, task trainers, and patient simulators to ensure they are prepared to complete clinical education. The clinical courses include a minimum of 1,200 hours of supervised practice by a licensed physician in outpatient clinics, interventional pulmonology, inpatient pulmonary services, peri-operative services, and intensive care units. The APRT is trained to assess patients, develop care plans, order, evaluate and modify care based on each patient's response, and can be incorporated as a valuable member of the cardiopulmonary patient care team.
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Recent treatment guidelines for chronic obstructive pulmonary disease (COPD) have replaced the long-acting beta2-agonist and inhaled corticosteroid (LABA-ICS) combination with single-inhaler triple therapy that adds a long-acting muscarinic antagonist (LAMA-LABA-ICS). Yet, the corresponding trials reported numerically higher incidences of cardiovascular adverse events with triple therapy compared with LABA-ICS. ⋯ In a real-world setting of COPD treatment, patients who initiated single-inhaler triple therapy had an increased incidence of MACE compared with similar patients treated with a LABA-ICS inhaler. This small increase was due to the all-cause mortality component, occurring mainly in the first four months after treatment initiation.
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Aspergillus species cause diverse clinical manifestations in bronchiectasis including allergic bronchopulmonary aspergillosis (ABPA), Aspergillus sensitization (AS), and raised IgG indicating exposure to or infection with Aspergillus. ⋯ Aspergillus lung disease is common in bronchiectasis. Raised IgG levels to Aspergillus are associated with significantly worse outcomes, whereas ABPA and AS are associated with severe disease and exacerbations with a risk that is attenuated by ICS use.