Chest
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Alongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the Staging of Airflow Obstruction by Ratio (STAR) severity scheme has been proposed for categorizing COPD. ⋯ STAR exhibits a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation, but our preliminary findings do not endorse its utilization in the rehabilitation setting.
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Robotic assisted bronchoscopy has been enthusiastically adopted in the United States and has transformed the treatment of patients with indeterminate pulmonary nodules. Unprecedented industry investments in research, development, and marketing have profoundly affected the bronchoscopy landscape, leading to concerns that conflicts of interest could influence the validity of bronchoscopy studies. Disclosures of conflicts of interest in research are predicated on open and transparent self-reporting. ⋯ Relevant conflicts of interest appear to be inconsistently disclosed in publications on robotic assisted bronchoscopy, suggesting that self-reporting may be an insufficient strategy. A centralized disclosure process that is automated or easier to use should be considered.
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Evidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce. ⋯ Perioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was driven predominantly by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.
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Albumin infusions may be renally protective or harmful in patients with septic shock who have kidney impairment. This can affect the need for renal replacement therapy (RRT) and in-hospital mortality. ⋯ In patients with septic shock and kidney impairment on hospital admission, early albumin use may be associated with an increased composite outcome of RRT or in-hospital mortality. This increased risk is most associated with hyperoncotic albumin rather than iso-oncotic albumin.
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Critical illness can render patients at heightened risk of anonymity, loss of dignity, and dehumanization. Because dehumanization results in significant patient distress, it is imperative to find ways to humanize care in the ICU. A Get to Know Me board (GTKMB) is a personal patient profile designed to bring the patient from anonymity; however, its widespread adoption has been challenging. ⋯ The GTKMB was considered important in fostering humanized caring in the ICU by diverse members of an interprofessional ICU team, helping to facilitate communication, establish family connection, and guide care.