Chest
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Oxygen therapy is an integral part of the treatment of critically ill patients. Maintenance of adequate oxygen delivery to vital organs often requires the administration of supplemental oxygen, sometimes at high concentrations. Although oxygen therapy is lifesaving, it may be associated with deleterious effects when administered for prolonged periods at high concentrations. Here, we review the recent advances in our understanding of the molecular responses to hypoxia and high levels of oxygen and review the current guidelines for oxygen therapy in critically ill patients.
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Obstructive sleep apnea (OSA) is a strong and independent risk factor for the development of hypertension, particularly resistant hypertension, and cardiovascular diseases. Patients with resistant hypertension have a high prevalence of OSA in association with elevated aldosterone levels, high salt intake, and salt-sensitive BP. The objective of this study was to determine whether dietary salt and aldosterone are associated with severity of OSA in patients with resistant hypertension. ⋯ The findings suggest that dietary salt is related to the severity of OSA in patients with resistant hypertension and hyperaldosteronism. The results support dietary salt restriction as a treatment strategy for reduction of OSA severity in these patients.
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It is well known that oral corticosteroid and anti-tumor necrosis factor-α agents increase the risk of TB. However, little is known about whether inhaled corticosteroid (ICS) increases the risk of TB. We performed this study to assess the risk of pulmonary TB among ICS users, based on the presence of the radiologic sequelae of pulmonary TB. ⋯ ICS use increases the risk of pulmonary TB in patients with COPD and the risk is greater in patients who have radiologic sequelae of prior pulmonary TB.
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The concept of the accountable care organization (ACO) offers the opportunity to better integrate the health system into a value proposition aligned toward improved care, more efficient delivery, and higher patient satisfaction. As a significant component of health reform, the ACO has many implications for physicians. Physicians interested in joining ACOs have a variety of options, including forming their own, integrating (virtual or otherwise) with larger health systems, or joining multiple, existing ACOs. ⋯ Physicians will also need to embrace the "era of persuasion" with its underlying assumption that engaging patients and other physicians are as necessary as a proper diagnosis and treatment plan. As there is a wide array of options in the marketplace, providers must have a clear understanding of patient attribution, financial incentives, and quality metrics within any ACO agreement. Finally, the health-care system must acknowledge the difficulties associated with the pace of change itself and invest in resources to aid in the adaptive reserve of all components of the health-care system.