Chest
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Indwelling pleural catheters (IPCs) are commonly used to manage malignant effusions. Tumor spread along the catheter tract remains a clinical concern for which limited data exist. We report the largest series of IPC-related catheter tract metastases (CTMs) to date, to our knowledge. ⋯ IPC-related CTM is uncommon but can complicate both mesothelioma and metastatic carcinomas. The duration of interval after IPC insertion is the key risk factor identified for development of CTM. Symptoms are generally mild and respond well to radiotherapy, which can be administered safely without removal of the catheter.
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Adaptation of guidelines for use at the national or local level can facilitate their implementation. We developed and evaluated an adaptation process in adherence with standards for trustworthy guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, aiming for efficiency and transparency. This article is the first in a series describing our adaptation of Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines for a Norwegian setting. ⋯ This case study demonstrates the feasibility of a novel guideline adaptation process. Replication is needed to further validate the usefulness of the process in increasing the organizational and methodologic efficiency of guideline adaptation.
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Spinal muscular atrophy (SMA) causes respiratory compromise that is difficult to assess in young children. The forced oscillation technique (FOT) is commercially available for children as young as 2 years of age and is nonvolitional. The aim of this study was to assess the usefulness of FOT in young children with SMA. ⋯ FOT is feasible in young children with SMA, with abnormal values of reactance and resistance on grouped data, worsening over 12 months. Xrs8 is related to respiratory tests used to monitor progress in SMA (FVC, PCF, AHI). Further research on the value of FOT in managing individuals is warranted.
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Letter Case Reports
Diffuse alveolar hemorrhage secondary to apixaban administration.
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In the 13 years since their promulgation, the Health Insurance Portability and Accountability Act (HIPAA) rules and their enforcement have shown considerable evolution, as has the context within which they operate. Increasingly, it is the health information circulating outside the HIPAA-protected zone that is concerning: big data based on HIPAA data that have been acquired by public health agencies and then sold; medically inflected data collected from transactions or social media interactions; and the health data curated by patients, such as personal health records or data stored on smartphones. HIPAA does little here, suggesting that the future of health privacy may well be at the state level unless technology or federal legislation can catch up with state-of-the-art privacy regimes, such as the latest proposals from the European Commission.