Chest
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Practice Guideline
Unsupervised Exercise in Interstitial Lung Disease: A Delphi Study to Develop a Consensus Preparticipation Screening Tool for Lymphangioleiomyomatosis.
Little research is available to provide practical guidance to health-care providers for exercise preparticipation screening and referral of patients with interstitial lung diseases (ILDs), including lymphangioleiomyomatosis (LAM), to participate in remote, unsupervised exercise programs. ⋯ A modified Delphi study approach was useful to develop disease-specific recommendations for safety and preparticipation screening prior to unsupervised, remotely administered exercise in LAM. The primary product of this study is a clinical decision aid for providers to use when medically screening patients prior to participation in the newly launched LAMFit remote exercise program.
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Review
How We Do It: Using Sotatercept in the Care of Patients with Pulmonary Arterial Hypertension.
Pulmonary arterial hypertension (PAH) is a rare disease of the pulmonary microvasculature leading to elevated precapillary pulmonary hypertension. Pulmonary vascular remodeling, a characteristic of PAH, is driven by dysfunctions in the signaling between the pulmonary smooth muscle and endothelial cells with abnormalities that affect cell proliferation and immune dysregulation. ⋯ Often, recommendations from these data are unclear or too general, due to remaining gaps in knowledge. In this edition of "How I Do It," we provide a case-based discussion of common clinical decisions regarding diagnostic testing, choice of first-line agents, escalation of therapy, potential timing of sotatercept, safety awareness, practical use, potential management changes, and the future use of sotatercept in other pulmonary hypertension cohorts.
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Sepsis, especially septic shock, and its complications have been linked to the hyperadrenergic stress response. ⋯ The study was underpowered to detect a reduction in in-hospital mortality or norepinephrine equivalent dose in patients with septic shock with dexmedetomidine. However, dexmedetomidine may reduce epinephrine infusion rescue, persistent AF, the APACHE II score, and CRP.
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The eighth edition of lung cancer N staging assignment includes the location of lymph node metastasis, but does not include single-N and multiple-N descriptors. ⋯ Patients with NSCLC with one metastatic lymph node, whether in N1 or N2 stations, showed better survival than those with more than one lymph node involved. Patients with NSCLC with a single-skip N2 lymph node metastasis showed survival similar to patients with multiple N1 lymph nodes, and the number of lymph nodes involved in N1 resections up to four or more was sequentially prognostic.
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With telemedicine's expansion during the COVID-19 pandemic, it became critical to evaluate whether patients have equitable access and capabilities to optimally use televisits for improved COPD outcomes such as reduced hospitalizations. This scoping review evaluated whether televisit-based interventions are evaluated and equitably effective in improving healthcare utilization outcomes among diverse patient populations with COPD. ⋯ Most studies failed to report on participants' race or income leading to a lack of data on equity of interventions' effectiveness across diverse patient populations. Multi-modality televisit-based interventions, particularly with an in-person component, were most commonly effective; no associations were seen with study quality or size. With the increasing reliance on telemedicine to provide chronic disease care, the lack of data among diverse populations since the COVID-19 pandemic began limits generalizability of these findings for real-world clinical settings. More comprehensive evaluations of televisit-based interventions are needed in the post-pandemic era within and across diverse patient populations.