Chest
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Pulmonary arteriovenous malformations (PAVMs) are direct connections between the pulmonary artery and vein, creating a right-to-left shunt (RLS). Embolization is indicated to prevent complications. Guidelines recommend follow-up chest CT scans to confirm persistent occlusion and embolization of all treatable PAVMs. Graded transthoracic contrast echocardiography (TTCE) after PAVM embolization may offer a reliable alternative in a subgroup of patients while preventing radiation exposure. ⋯ This study shows chest CT scan might be forgone in patients with RLS grades 0 and 1 after PAVM embolization.
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It remains uncertain how long pure ground-glass nodules (pGGNs) detected on low dose computed tomography (LDCT) should be followed. Further studies with longer follow-up periods are needed to determine the optimal follow-up duration for pGGNs. ⋯ Among pGGNs that remained stable for 10 years, 3.9% eventually grew, indicating that some pGGNs can grow even after a long period of stability. We suggest that pGGNs may need to be followed for more than 10 years to confirm growth.
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There are physician shortages in the United States including the cardiopulmonary specialty. Nonphysician advanced practice providers, including nurse practitioners or physician assistants, have been proposed to meet some more routine patient care needs. A supplementary provider called an advanced practice respiratory therapist (APRT) has been proposed. ⋯ The study exposed a set of survey-derived metrics about potential content signaling whether there was endorsement among physicians, nonphysician advanced practice providers, and APRT graduates. Metrics are described from these and other subgroups plus the committee's decisions are explained about what content to assess and how. Most of the surveyed content was endorsed for being part of the APRT role; therefore, the committee proceeded to make design decisions about the outcome assessment.
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Although it is generally accepted that aerobic exercise training does not change lung structure or function, some work suggests that greater pulmonary vascular structure and function is associated with higher exercise capacity (peak oxygen consumption [Vo2peak]). ⋯ Our results suggest that pulmonary vascular structure and Dlco are independently associated with Vo2peak, regardless of severity of airflow limitation and emphysema, suggesting that these associations are not limited to COPD.