Chest
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Multicenter Study
Blastomycosis in Indiana: Clinical and Epidemiologic Patterns of Disease Gleaned from a Multicenter Retrospective Study.
To better understand clinical and epidemiologic patterns of blastomycosis, we report on a large series of blastomycosis in Indiana. ⋯ The incidence of blastomycosis in Central Indiana may be on the rise. Physicians in endemic areas should be aware of the potentially fulminant consequences of the disease.
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Randomized Controlled Trial Multicenter Study
Delirium and circadian rhythm of melatonin during weaning from mechanical ventilation: An ancillary study of a weaning trial.
Delirium is frequent in patients in the ICU, but its association with the outcome of weaning from mechanical ventilation has not been assessed. Circadian rhythm alteration may favor delirium. In the current study, we assessed the impact of delirium during weaning and associated alterations in the circadian rhythm of melatonin excretion. ⋯ Delirium is frequent at the initiation of ventilator weaning. It is associated with a prolongation of weaning and an alteration in the circadian rhythm of melatonin excretion.
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Multicenter Study
Profusion of opacities in simple coal workers' pneumoconiosis is associated with reduced lung function.
A large body of evidence demonstrates dose-response relationships of cumulative coal mine dust exposure with lung function impairment and with small-opacity profusion. However, medical literature generally holds that simple coal worker's pneumoconiosis (CWP) is not associated with lung function impairment. This study examines the relationship between small-opacity profusion and lung function in US underground coal miners with simple CWP. ⋯ We observed progressively lower lung function across the range of small-opacity profusion. These findings address a long-standing question in occupational medicine and point to the importance of medical surveillance and respiratory disease prevention in this workforce.
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Multicenter Study
Discontinuation of inhaled corticosteroids in COPD and the risk reduction of pneumonia.
The widespread use of inhaled corticosteroids (ICSs) for COPD treatment has been questioned. Recent studies of weaning some patients with COPD off ICSs found little or no adverse consequences compared with long-acting bronchodilators. It is unclear, however, whether discontinuation of ICSs reduces the elevated risk of pneumonia associated with these drugs. ⋯ Discontinuation of ICS use in COPD is associated with a reduction in the elevated risk of serious pneumonia, particularly so with fluticasone.
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Multicenter Study
Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers.
Although the benefits of early tracheostomy in patients dependent on ventilators are well established, the reasons for variation in time from intubation to tracheostomy remain unclear. We identified clinical and demographic disparities in time to tracheostomy. ⋯ Early tracheostomy was associated with increased survival. Yet, there were still significant disparities in time to tracheostomy according to sex, race, and type of insurance. Application of evidence-based algorithms for tracheostomy may reduce unequal treatment and improve overall mortality rates. Additional research into this apparent bias in referral/rendering of tracheostomy is needed.