Annals of the American Thoracic Society
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Pragmatic Clinical Trial
One-Legged Cycle Training for Chronic Obstructive Pulmonary Disease. A Pragmatic Study of Implementation to Pulmonary Rehabilitation.
In patients with chronic obstructive pulmonary disease (COPD), partitioned exercise training using one-legged cycling leads to greater improvements in peak oxygen uptake than conventional two-legged cycling. ⋯ One-legged cycling was successfully implemented into a "real-life" pulmonary rehabilitation program, demonstrating improvements in cardiorespiratory fitness with associated improvement in function for patients with moderate/severe COPD. One-legged cycling should be recommended in professional pulmonary rehabilitation guidelines as an option for exercise training and be available in other pulmonary rehabilitation programs. Clinical trial registered with www.clinicaltrials.gov (NCT01930526).
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State-specific case numbers and costs are critical for quantifying the burden of pulmonary nontuberculous mycobacterial disease in the United States. ⋯ For a relatively rare disease, the financial cost of nontuberculous mycobacterial disease is substantial, particularly among older adults. Better data on disease dynamics and more recent prevalence estimates will generate more robust estimates.
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In right ventricular hypertrophy associated with severe pulmonary hypertension (PH), a shift of energy metabolism toward glycolysis occurs. There are few investigations regarding fatty acid metabolism in patients with PH and right ventricular hypertrophy. ⋯ This is the first study that uses 123I-BMIPP uptake imaging to show that fatty acid accumulates in the right ventricle of patients with CTEPH and that the increased accumulation is reversible after pulmonary thromboendarterectomy. This study suggests that this imaging modality may be useful for monitoring right ventricle metabolic functions in severe PH.
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Bedside diagnosis, including but not limited to the physical examination, can be lifesaving in the setting of critical illness and is a core competency in both medical school and at the postgraduate level. Data as to the clinical usefulness of bedside diagnosis in the modern intensive care unit (ICU) is sparse, however, and there are no clinical guidelines addressing performance, interpretation, and usefulness of the bedside assessment in critically ill patients. Bedside assessment and physical examination are used in a heterogeneous manner across institutions and even across ICUs within the same institution, which has implications for medical education, patient care, and the overuse/misuse of diagnostic testing. In this commentary, we review the existing data addressing bedside diagnosis in the ICU, describe various models of bedside assessment use in the ICU based on our clinical practice and on the limited evidence base, share our practical "checklist-based" approach to bedside assessment in the critically ill patient, and advocate for more formal study of physical examination and bedside assessment in the ICU to enhance clinical practice.
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Children's interstitial and diffuse lung disease (chILD) is a term that encompasses a large and diverse group of rare pediatric diseases and disorders. Significant progress has been made over the last 2 decades in classification, clinical care, research, and organizational structure to enhance the care of children with these high-morbidity and -mortality diseases. ⋯ The future horizon holds great promise to expand scientific discoveries, collaborate more broadly, and bring new treatment to these children. An overview of key historical past developments, major clinical and research updates, and opportunities for the future in chILD is reviewed in this Perspective.