Chest
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The integration of nurse practitioners (NPs) and physician assistants (PAs) into the medical ICU (MICU) is becoming increasingly vital due to the rising number of critically ill patients and the shortage of board-certified intensivists. Successful recruitment and utilization of NPs and PAs in the MICU setting require a unique understanding of potential variations of the scope of practice based on state law and educational backgrounds, as well as the implementation of best practices around training and leadership support. The purpose of this article was to review the best strategies for creating a MICU team with NPs and PAs. ⋯ There are variations in state laws and institutional policies that affect NP and PA practice that should be understood by the organization to manage expectations for the NP and PA job responsibilities. Effective productivity measurement methods are proposed to accurately assess the contributions of NPs and PAs in the MICU. This article provides comprehensive strategies for successfully hiring, onboarding, and integrating these professionals into MICU teams, ensuring high-quality care delivery in critical care settings.
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Increased epicardial adipose tissue (EAT) has adverse effects in cardiovascular diseases, independent of BMI. Estrogen levels may affect EAT accumulation. Little is known about the predictors and potential impact of EAT in pulmonary arterial hypertension (PAH). ⋯ In patients with PAH, high EAT and a greater rate of accumulation of EAT volume were independently associated with worse survival. Higher EAT volume was also associated with lower estrogen levels. The association of EAT volume with survival was independent of BMI and disease severity, suggesting that EAT may be a marker for a unique PAH phenotype. Future research should investigate the role of EAT-modifying therapies in PAH and consider incorporating EAT into PAH risk models.
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Impaired pulmonary function carries significant risks for lung, cardiovascular, and metabolic disorders. ⋯ This study identified proteomic signatures of reduced lung function linked to comorbidities, paving the way for improved diagnostics for and treatment of lung disease.
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COPD-associated expiratory central airway collapse (ECAC) is a frequently overlooked benign airway obstructive disease with complex causes and unclear pathologic and physiologic mechanisms. Although interventions such as noninvasive positive pressure ventilation, airway stenting, and tracheobronchoplasty have shown definite efficacy in the treatment of COPD-associated ECAC, the diagnosis and treatment of this disease remain challenging. This review provides a systematic evaluation and outlook on the epidemiologic features, cause, pathophysiologic characteristics, clinical manifestations, diagnosis, and treatment of COPD-associated ECAC. ⋯ Although COPD-associated ECAC is attracting considerable attention, its pathophysiologic mechanisms, diagnosis, and management are full of challenges. In the future, randomized controlled trials on different therapies using patient-centered outcomes, cost-effective analysis on different interventions, and consensus guidelines on COPD-associated ECAC are needed urgently.
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Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease affecting women and is characterized by the proliferation of abnormal smooth muscle-like cells within the lungs, kidneys, and lymphatic system. FEV1 and diffusing capacity of the lungs for carbon monoxide (Dlco) are 2 commonly used markers for evaluating the status of LAM, although the disease may be associated predominantly with changes in only 1 of these parameters. In this special feature, we trace the historical evolution of Dlco and FEV1 in LAM up to their current uses, beginning with their relationship in early studies with histopathologic features and imaging. ⋯ The LAM histologic score, which measures the involvement of cysts and LAM cells in the lung via biopsy, relates to disease stages and aligns more with Dlco than FEV1. The cyst score, calculated from high-resolution CT (HRCT) scans, is a measure of the lung parenchyma occupied by cysts and correlates with disease progression. Large cysts as visualized by HRCT imaging predominantly influence FEV1, whereas smaller cysts, which impact a greater surface area of the lung and may be underestimated, tend to affect Dlco.