Annals of the American Thoracic Society
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Rationale: Chronic respiratory diseases, among which chronic obstructive pulmonary disease (COPD) remains the largest contributor, are the fourth leading cause of death in the United States. Updated mortality trends provide insight for targeted interventions. Objectives: To provide detailed insights into COPD mortality trends. ⋯ This trend was also present for those with COPD; 451.4 per 1,000 respondents in 2011 were vaccinated against influenza compared with 352.1 per 1,000 respondents in 2018, resulting in an APC of -1.8% (95% CI, -3.3% to -0.2%). Pneumococcal vaccination rates between 2011 and 2018 remained unchanged; meanwhile, deaths caused by pneumococcal disease with COPD decreased, with an APC of -10.1% (95% CI, -16.6% to -3.1%). Conclusions: COPD mortality has decreased among Americans overall; however, there remain important sociodemographic groups that have not secured the same deceleration in death rates.
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Randomized Controlled Trial
A Pilot Randomized Trial of an Interactive Web-based Tool to Support Surrogate Decision-makers in the ICU.
Rationale: Breakdowns in clinician-family communication in intensive care units (ICUs) are common, yet there are no easily scaled interventions to prevent this problem. Objectives: To assess the feasibility, usability, acceptability, and perceived effectiveness of a communication intervention that pairs proactive family meetings with an interactive, web-based tool to help surrogates prepare for clinician-family meetings. Methods: We conducted a two-arm, single-blind, patient-level randomized trial comparing the Family Support Tool with enhanced usual care in two ICUs in a tertiary-care hospital. ⋯ Compared with the control group, surrogates who used the tool reported higher overall quality of communication (mean, 8.9/10 ± 1.6 vs. 8.0/10 ± 2.4) and higher quality in shared decision-making (mean, 8.7/10 ± 1.5 vs. 8.0/10 ± 2.4), but the difference did not reach statistical significance. Conclusions: It is feasible to deploy an interactive web-based tool to support communication and shared decision-making for surrogates in ICUs. Surrogates and clinicians rated the tool as highly usable, acceptable, and effective.
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Rationale: The Epic Deterioration Index (EDI) is a proprietary prediction model implemented in over 100 U. S. hospitals that was widely used to support medical decision-making during the coronavirus disease (COVID-19) pandemic. The EDI has not been independently evaluated, and other proprietary models have been shown to be biased against vulnerable populations. ⋯ Among the 286 patients hospitalized for at least 48 hours who had not experienced the composite outcome, 14 (13%) never exceeded an EDI of 37.9, with a negative predictive value of 90% and a sensitivity above this threshold of 91%. Conclusions: We found the EDI identifies small subsets of high-risk and low-risk patients with COVID-19 with good discrimination, although its clinical use as an early warning system is limited by low sensitivity. These findings highlight the importance of independent evaluation of proprietary models before widespread operational use among patients with COVID-19.
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Rationale: Patients with hematologic malignancies requiring mechanical ventilation have historically experienced poor outcomes. Objectives: We aimed to determine whether body composition characteristics derived from thoracic computed tomographic (CT) imaging were associated with time to liberation from mechanical ventilation. Methods: We evaluated mechanically ventilated patients with hematological malignancies admitted between 2014 and 2018. ⋯ Skeletal muscle CSA was not associated with time to liberation from ventilation (sHR, 1.08; 95% CI, -0.94 to 1.23). Conclusions: Body composition measurements based on thoracic CT scans were associated with time to liberation from ventilation. These could represent novel surrogate markers of physical frailty in patients with hematologic malignancies receiving mechanical ventilation.