Annals of the American Thoracic Society
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Clinical practice guidelines are usually developed by a group of experts coming together to review the evidence in a field to make evidence-based recommendations on how to integrate new evidence into practice. The development process often draws on strict methodological rules to assess and assign quality grades to the evidence used to underpin the recommendations. Yet the goal of clinical practice guidelines--to help guide clinicians to understand, translate, and apply new evidence into everyday practice--can be thwarted by a lack of diversity and plurality of committee members, by limitations in the published evidence base, and by the design of the randomized controlled trials (RCTs) that largely underpin their pronouncements. ⋯ Although RCTs can adequately demonstrate efficacy of a specific treatment, pragmatic trials and postmarketing observational studies are usually required to evaluate the long-term safety of therapeutic interventions. The practical usefulness of clinical practice guidelines may be enhanced by ensuring representation of a broad stakeholder group within guideline committees (e.g., patients, primary and secondary care clinicians, policy makers, and health insurers) and by integrating effectiveness as well as efficacy data. Only in this way can clinical practice guidelines achieve their goal of guiding the meaningful implementation of new research into practice, for the benefit of all stakeholders.
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Observational Study
An index of daily step count and systemic inflammation predicts clinical outcomes in chronic obstructive pulmonary disease.
Identification of persons with chronic obstructive pulmonary disease (COPD) at risk for acute exacerbations (AEs) targets them for close monitoring. ⋯ An index combining daily step count and systemic inflammation can predict AEs and COPD-related hospitalizations. A validation study in a separate cohort is needed to confirm the utility of the proposed index as a clinical tool to risk stratify persons with COPD.
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There are no published data regarding use of the STOP-BANG sleep apnea questionnaire in populations referred to Veterans Affairs (VA) sleep facilities. If a particular STOP-BANG score cutpoint had high positive predictive value in this referral population, it could reduce the need for diagnostic sleep studies. ⋯ The STOP-BANG questionnaire alone is insufficient to confirm the presence of significant sleep apnea. A maximal score of 8 did not have a high enough positive predictive value to forego confirmatory sleep testing.
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Predictions of duration of mechanical ventilation are frequently made by intensivists and influence clinical decisions. ⋯ The accuracy of intensivists' early clinical predictions of duration of mechanical ventilation is limited, particularly for identifying patients who will require prolonged mechanical ventilation.
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Health care professionals in pulmonary, critical care, and sleep medicine play key roles as teachers for learners of all levels in both clinical care and scientific investigation. Teaching excellence requires training in principles of adult learning and the acquisition and practice of key professional skills including assessment and feedback techniques, curriculum development, and strategies for effective teaching across venues ranging from the bedside to the lecture hall. Those interested in pursuing teaching as the focus of their academic career and basis for promotion should invest in professional development as a teacher and educator. ⋯ Aspiring clinician-educators should also seek out opportunities to participate in a community of medical educators locally, regionally, nationally, and internationally. At each of these levels, there exist opportunities to contribute to course or program design, development, and evaluation. Finally, for those interested in promotion as an academic clinician-educator, there are increasing requirements to produce academic scholarship ranging from curricular materials to journal articles focused on education and education research.