Clinics in chest medicine
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Clinics in chest medicine · Sep 2013
ReviewQuality-of-life improvement and cost-effectiveness of interventional pulmonary procedures.
Most interventional pulmonology studies focus on the technical success of procedures without measuring validated quality-of-life (QoL) outcomes. Studies are now incorporating end points that include QoL measurements and there are examples of interventional procedures that likely improve QoL. It is vital for the interventional pulmonary literature to incorporate cost-effectiveness when introducing new technology. While not uniformly analyzed in a rigorous manner in all studies, there are examples of interventional pulmonary studies that analyze cost-effectiveness through avoidance of more expensive procedures, cost savings per day free of emergency room visit, or cost savings per day not requiring intensive care unit care.
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There has been an exciting expansion in the practice of medical pleuroscopy in recent years. As technology has become more available and confidence in the use of equipment has grown, medical thoracoscopy has become a core diagnostic and therapeutic tool in pleural disease care. ⋯ More knowledge is needed in those areas where there is currently a degree of equipoise. Many areas where pleuroscopy currently has a marginal role require high-quality randomized trials be undertaken with a view to informing future practice and guidelines.
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Clinics in chest medicine · Sep 2013
ReviewTracheobronchomalacia and excessive dynamic airway collapse.
Tracheobronchomalacia and excessive dynamic airway collapse are morphologic types of expiratory central airway collapse with specific pathophysiology, cause, and structural changes in airway wall. Physicians caring for symptomatic patients with expiratory central airway collapse must localize the flow-limiting airway segments amenable to bronchoscopic or surgical interventions. Functional bronchoscopy and dynamic radiologic studies are performed for the initial evaluation and to design follow-up strategies. Research is needed to determine noninvasive and reliable physiologic methods for localizing the flow-limiting segments that might guide patient selection for treatment and predict response to interventions.
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Pediatric interventional bronchoscopy includes a variety of diagnostic and therapeutic procedures. Restoration of airway patency, management of tracheoesophageal fistula, and difficult airway intubation are just a few pertinent examples. ⋯ Although no comparative studies are available, the authors compare the different techniques as reported in the literature. Respective advantages and drawbacks are discussed in light of their own practice, with particular emphasis on technical difficulties encountered in younger children.
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Clinics in chest medicine · Sep 2013
Review Historical ArticleLung cancer screening: past, present and future.
Lung cancer is the leading cause of cancer death for men and women. Most lung cancer cases are diagnosed at an advanced stage, when cure is no longer an option; this heavily influences mortality. ⋯ However, the recent National Lung Screening Trial demonstrated that low-dose computed tomography screening for lung cancer decreases mortality. This article outlines the history of lung cancer screening, the current state of screening and possible future adjuncts to screening.