Clinics in chest medicine
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Spreading beyond the realm of tertiary academic medical centers, point-of-care ultrasound in the intensive care unit is an important diagnostic tool. The real-time feedback garnered can lead to critical and clinically relevant changes in management and decrease potential complications. Bedside ultrasound evaluation in the intensive care setting with a small, portable equipment is well-suited for placement of central lines, lumbar puncture, thoracentesis or other bedside ICU procedures and in the evaluation of cardiac activity, pleural and abdominal cavity and the overall fluid volume. Formalized curriculums centering on point-of-care ultrasound are emerging that will enhance its applicability and relevance.
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Clinics in chest medicine · Mar 2018
ReviewThe Business of Bronchoscopy: How to Set up an Interventional Pulmonology Program.
Interventional pulmonology has advanced rapidly over the last decade and continues to evolve with new medical advances and changes in the health care landscape. Establishing and developing a new interventional pulmonology program entails careful planning, including a needs assessment, a business plan with financial and marketing considerations, and outcomes monitoring. Addressing these aspects will provide a framework to ensure the success of a new interventional pulmonology program that can provide valuable services to the local practice and community.
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Candidemia presents several challenges to the intensive care unit (ICU) community. Recognition and treatment of this infection is frequently delayed, with dramatic clinical deterioration and death often preceding the detection of Candida in blood cultures. ⋯ The absence of well-established molecular techniques for early detection of candidemia hinders efforts to reduce the heavy clinical and economic impact of this infection. Echinocandins are the recommended antifungal drug class for the treatment of ICU candidemia.
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Clinics in chest medicine · Jun 2017
ReviewPalliative and End-of-Life Care for Patients with Malignancy.
Patients with cancer continue to have unmet palliative care needs. Concurrent palliative care is tailored to the needs of patients as well as their families to relieve suffering. ⋯ Barriers to palliative care referral include workforce limitations, provider attitudes and perceptions, and potential ethnic and racial disparities in access to palliative care. Future work should focus on novel, patient-centered approaches to identify and address unmet palliative care needs for patients living with cancer.
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Clinics in chest medicine · Mar 2017
ReviewEpidemic and Emerging Coronaviruses (Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome).
Bats are the natural reservoirs of severe acute respiratory syndrome (SARS)-like coronaviruses (CoVs) and likely the reservoir of Middle East respiratory syndrome (MERS)-CoV. The clinical features of SARS-CoV infection and MERS-CoV infection are similar but MERS-CoV infection progresses to respiratory failure more rapidly. ⋯ The transmission route and the possibility of other intermediary animal sources remain uncertain among many sporadic primary cases. Clinical trial options for MERS-CoV infection include monotherapy and combination therapy.