Chest
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Randomized Controlled Trial Comparative Study
The effect of placebo conditioning on capsaicin-evoked urge to cough.
The urge to cough is a clinical symptom of respiratory disease that precedes the motor act of coughing. Although previous studies have shown that cough is particularly susceptible to placebo suppression, it is unclear whether the perception of an urge to cough is also modifiable by placebo. Therefore, we tested the hypothesis that capsaicin-evoked urge to cough could be suppressed by placebo conditioning. ⋯ These data confirm that the urge to cough is susceptible to placebo inhibition. This provides further evidence that higher brain networks are involved in the processing of respiratory sensations related to airway irritation.
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Review
The expanding role of biomarkers in the assessment of smoking-related parenchymal lung diseases.
Recent advances in the field of clinical biomarkers suggest that quantification of serum proteins could play an important role in the diagnosis, classification, prognosis, and treatment response of smoking-related parenchymal lung diseases. COPD and idiopathic pulmonary fibrosis (IPF), two common chronic progressive parenchymal lung diseases, share cigarette smoke exposure as a common dominant risk factor for their development. We have recently shown that COPD and interstitial lung disease may represent distinct outcomes of chronic tobacco use, whereas others have demonstrated that both diseases coexist in some individuals. ⋯ Additionally, given the current lack of sensitive and effective metrics to determine an individual's response to treatment, we evaluate the potential role of biomarkers as surrogate markers of clinical outcomes. Finally, we examine the possibility that changes in levels of select protein biomarkers can provide mechanistic insight into the common origins and unique individual susceptibilities that lead to the development of smoking-related parenchymal lung diseases. This discussion is framed by a consideration of the properties of ideal biomarkers for different clinical and research purposes and the best uses for those biomarkers that have already been proposed and investigated.
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Comparative Study
Secondhand smoke exposure predicted COPD and other tobacco-related mortality in a 17-year cohort study in China.
Prospective evidence on the association between secondhand smoke (SHS) and COPD and ischemic stroke is scarce. ⋯ This study shows dose-response relationships between SHS and major tobacco-related mortality and provides new evidence to support causation for COPD and ischemic stroke.
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Comparative Study Clinical Trial
Transvenous phrenic nerve stimulation in patients with Cheyne-Stokes respiration and congestive heart failure: a safety and proof-of-concept study.
Cheyne-Stokes respiration (CSR), which often occurs in patients with congestive heart failure (CHF), may be a predictor for poor outcome. Phrenic nerve stimulation (PNS) may interrupt CSR in patients with CHF. We report the clinical use of transvenous PNS in patients with CHF and CSR. ⋯ The preliminary results showed that in a small group of patients with CHF and CSR, 1 night of unilateral transvenous PNS improved indices of CSR and was not associated with adverse events.
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Clinical documentation improvement is an important aspect to achieve top performance. Clinical documentation in a patient's record includes any and all documentation that relates to the care of the patient during the patient's stay or encounter at the hospital. Documentation is key to accurate clinical coding, validating length of stay, resource utilization, physician profiling, case management, severity of illness, risk of mortality, quality management, risk management, clinical outcomes, critical pathways, regulatory compliance, Joint Commission accreditation, managed care, and reimbursement. ⋯ Implementing quality improvement strategies that make documentation and coding an organizational priority can positively influence operations, services, and revenue. Other external and internal coding audits show that the cause of improper coding is due to lack of proper physician documentation to support reimbursement at the appropriate level. The purpose of this article is to provide tips for documenting pulmonary diagnoses that not only would ensure appropriate reimbursement but also would accurately represent the severity of a patient's condition.