Chest
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Many patients with advanced cystic fibrosis (CF) lung disease receive intensive treatments such as noninvasive and invasive mechanical ventilation for respiratory failure after little or no communication with physicians. ⋯ CF physicians describe numerous patient/family factors barriers to communicating about intensive treatments for respiratory failure. They recommend changing physician and organizational factors to improve practice and promote effective communication. Innovation in clinical training, team roles, and decision support may prompt changes in practice standards.
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The present study investigated alterations in both the sensory (intensity) and the affective (unpleasantness) components of dyspnea in patients with medically unexplained dyspnea during repeated hypercapnic challenges. ⋯ Patients with medically unexplained dyspnea are particularly hypersensitive to the unpleasantness of dyspnea. The elevated breathlessness further increases across repeated challenges, documenting sensitization and suggesting that basic learning mechanisms contribute to exaggerated response to respiratory challenges.
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The four previous articles in this series have traced the history of patient autonomy and have identified its ethical and legal foundations. Patient autonomy is highly valued in the United States to the extent that the patient does not lose the right of self-determination when he or she loses the capacity to make health-care decisions for him or herself. The law has devised several tools to promote "prospective autonomy." One mechanism is the instructional advance directive or living will. ⋯ Unfortunately, surrogate performance is often mediocre or poor. There are significant and persistent obstacles to good surrogate decision making. After explaining these problems, the article concludes by identifying several solutions.
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Because many different reference equations are available for pulmonary function testing (PFT), and because different interpretive strategies could affect the interpretation of results, we assessed the variation in practice among 17 PFT laboratories. ⋯ This survey demonstrated substantial variation in PFT laboratory practices, including the choice of reference equations, the criteria used to define abnormality, and the strategies for interpreting tests. The degree of variation raises concern about the consistency of the interpretation of results among laboratories and emphasizes the value of compliance with official guidelines to drive standardization.
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B cells play an important role in allergic asthma. However, the mechanisms by which these cells are activated in the airways remain poorly understood. ⋯ All together, these findings suggest that CXCL13 is involved in the allergic airway inflammatory process, and targeting this chemokine may constitute a novel approach in asthma.