Annals of the American Thoracic Society
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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established technique for the diagnosis of thoracic malignancies. Non-ultrasound-guided transbronchial needle injection has been used previously to deliver chemotherapeutic agents. ⋯ This is the first description of EBUS-TBNI to treat local recurrence of lung cancer and one of the first reports of the use of EBUS for intratumoral therapy. Additional research is warranted to determine the clinical usefulness and safety of this therapeutic approach.
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Randomized Controlled Trial Multicenter Study
The influence of hospitalization or intensive care unit admission on declines in health-related quality of life.
Survivors of critical illness report impaired health-related quality of life (HRQoL) after hospital discharge, but the degree to which these impairments are attributable to critical illness is unknown. ⋯ Prehospital HRQoL is a significant determinant of HRQoL after hospitalization or ICU admission. Hospitalization is associated with increased risk of impairment in HRQoL after discharge, yet the overall magnitude of this reduction is small and similar between non-ICU hospitalized and critically ill patients.
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Randomized Controlled Trial
Pharmacometabolomics of l-carnitine treatment response phenotypes in patients with septic shock.
Sepsis therapeutics have a poor history of success in clinical trials, due in part to the heterogeneity of enrolled patients. Pharmacometabolomics could differentiate drug response phenotypes and permit a precision medicine approach to sepsis. ⋯ The results of this preliminary study, which were not readily apparent from the parent clinical trial, show a unique metabolite profile of l-carnitine responders and introduce pharmacometabolomics as a viable strategy for informing l-carnitine responsiveness. The approach taken in this study represents a concrete example for the application of precision medicine to sepsis therapeutics that warrants further study.
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Multicenter Study
Effect of public reporting on intensive care unit discharge destination and outcomes.
Public reporting of hospital performance is designed to improve healthcare outcomes by promoting quality improvement and informing consumer choice, but these programs may carry unintended consequences. ⋯ Public reporting of ICU in-hospital mortality rates was associated with changes in discharge patterns but no change in risk-adjusted mortality.
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The late Peter Stewart developed an approach to the analysis of acid-base disturbances in biological systems based on basic physical-chemical principles. His key argument was that the traditional carbon dioxide/bicarbonate analysis with just the use of the Henderson-Hasselbalch equation does not account for the important role in the regulation of H(+) concentration played by strong ions, weak acids and water itself. Acceptance of his analysis has been limited because it requires a complicated set of calculations to account for all the variables and it does not provide simple clinical guidance. ⋯ These include the traditional PCO2 component and the addition of four metabolic processes, which we classify as "water-effects," "chloride-effects," "albumin effects," and "others." Six values are required for the analysis: [Na(+)], [Cl(-)], pH, Pco2, albumin concentration, and base excess. The advantage of this approach is that it gives a better understanding of the mechanisms behind acid-base abnormalities and more readily leads to clinical actions that can prevent or correct the abnormalities. We have developed a simple free mobile app that can be used to input the necessary values to use this approach at the bedside (Physical/Chemical Acid Base Calculator).