Chest
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Current data on bronchiectasis prevalence, trends, and risk factors are lacking; such data are needed to estimate the burden of disease and for improved medical care and public health resource allocation. The objective of the present study was to estimate the trends and burden of bronchiectasis-associated hospitalizations in the United States. ⋯ The average annual age-adjusted rate of bronchiectasis-associated hospitalizations increased from 1993 to 2006. This study furthers the understanding of the impact of bronchiectasis and demonstrates the need for further research to identify risk factors and reasons for the increasing burden.
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The 2008 National Coverage Determination by the US Centers for Medicare and Medicaid Services (CMS) authorizing coverage of positive airway pressure (PAP) treatment of obstructive sleep apnea on the basis of diagnosis by portable monitoring was seen by some as a major advance in reimbursement policy for sleep medicine services. However, along with the national coverage decision came additional rules (local coverage determinations) setting forth the conditions that would apply in order for reimbursement to continue beyond 90 days. These rules specified the means by which adherence must be measured, a rigid threshold for the acceptable degree of adherence, and a requirement for face-to-face evaluation by the clinician to document clinical response, all of which must take place within a specific timeframe. ⋯ What has become abundantly clear to many is the burden that these rules impose on clinicians and DME providers and, more importantly, that indiscriminate enforcement may well result in adverse consequences for some patients. The latter include not only the inconvenience and added expense for patients of complying with the rules, but those resulting from failure by CMS to recognize that a dose-response relationship exists with respect to the degree of PAP adherence and clinical outcome. Moreover, there is reason to believe that patients of low socioeconomic class, or who are unmarried, or who have psychiatric disease will have more difficulty achieving the required adherence and therefore will, in effect, be victims of government-mandated discrimination in the provision of a vital healthcare service.
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Myocardial dysfunction in sepsis may be associated with changes in left ventricular (LV) size. The goal of this study was to evaluate the impact of myocardial dysfunction and changes in LV diameter on hemodynamics and survival in a murine model of sepsis. ⋯ In a clinically relevant murine model of sepsis, animals with LV dilation had better cardiovascular performance and increased survival. Our results suggest that LV dilation is associated with improved SV and CO, a pattern resulting in greatly improved survival. These studies highlight the importance of diastolic function in septic shock.