Chest
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Comparative Study
Assessment of left ventricular function by intensivists using hand-held echocardiography.
Bedside transthoracic echocardiography (TTE) provides rapid and noninvasive hemodynamic assessment of critically ill patients but is limited by the immediate availability of experienced sonographers and cardiologists. ⋯ Intensivists were able to estimate LV function with reasonable accuracy using a hand-held unit in the ICU, despite having undergone minimal training in image acquisition and interpretation.
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Multicenter Study Comparative Study
Race/Ethnicity differences in the inpatient management of acute asthma in the United States.
The only published US study on racial/ethnic disparities in inpatient asthma management was performed in 1989-1990 at a single center. The authors reported that black and Hispanic children were provided substandard care at hospital discharge compared to white children. The purpose of the present analysis was to reexamine this important issue in a large multicenter study. ⋯ We did not identify racial/ethnic disparities in the inpatient treatment and outcomes for children or adults with acute asthma. At hospital discharge, Hispanic children were less likely to receive an asthma action plan compared to white or black children, possibly due to language or socioeconomic differences.
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The objective of this study was to identify the relationship between a dynamic lung artifact, the dynamic air bronchogram, within alveolar consolidation and the diagnosis of pneumonia vs resorptive atelectasis. ⋯ In patients with alveolar consolidation displaying air bronchograms on an ultrasound, the dynamic air bronchogram indicated pneumonia, distinguishing it from resorptive atelectasis. Static air bronchograms were seen in most resorptive atelectases and one third of cases of pneumonia. This finding increases the understanding of the pathophysiology of lung diseases within the clinical context and decreases the need for fibroscopy in practice.
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Randomized Controlled Trial Multicenter Study
Impact of preoperative chemotherapy on pulmonary function tests in resectable early-stage non-small cell lung cancer.
Several chemotherapy agents, including gemcitabine and paclitaxel, have been reported to cause interstitial pneumonitis. The incidence of pulmonary toxicity from the combination of gemcitabine and paclitaxel is reported to be approximately 5%. In this report, pulmonary function test (PFT) results were analyzed from two similar randomized phase 2 trials that tested platinum and nonplatinum regimens preoperatively in patients with stage I or II non-small cell lung cancer (NSCLC). ⋯ In the preoperative setting, gemcitabine-based chemotherapy was well tolerated. The most commonly affected PFT parameter postchemotherapy was the Dlco. Although 15% of patients had a significant reduction in the Dlco postchemotherapy, it did not correlate with clinical symptoms or affect the ability to undergo surgical resection.
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Pain in patients who are critically ill remains undertreated despite decades of research, guideline development and distribution, and intense educational efforts. By nature of their complex medical conditions, these patients present unique challenges to the delivery of optimal pain treatment. ⋯ A multidisciplinary and patient-centered continuous quality improvement process is essential to identifying barriers and implementing evidence-based solutions to the problem of undertreated pain in hospital ICUs. This article addresses barriers common to the ICU setting and presents a number of structured approaches that have been shown to be successful in improving pain treatment in patients who are critically ill.