Chest
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Review Meta Analysis
Stroke, Major Bleeding and Mortality Outcomes in Warfarin Users with Atrial Fibrillation and Chronic Kidney Disease: A Meta-analysis of Observational Studies.
The use of warfarin in patients with atrial fibrillation (AF) and chronic kidney disease (CKD) can be problematic because of increased bleeding risk. We performed a systematic review and meta-analysis of observational studies that evaluated the use of warfarin in patients with AF and CKD to evaluate the risks of ischemic stroke/thromboembolism, major bleeding, and mortality. ⋯ Based on this meta-analysis, the use of warfarin for AF may have an unfavorable risk/benefit ratio in patients with end-stage CKD but not in those with non-end-stage CKD.
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Review Meta Analysis
Stroke, Major Bleeding and Mortality Outcomes in Warfarin Users with Atrial Fibrillation and Chronic Kidney Disease: A Meta-analysis of Observational Studies.
The use of warfarin in patients with atrial fibrillation (AF) and chronic kidney disease (CKD) can be problematic because of increased bleeding risk. We performed a systematic review and meta-analysis of observational studies that evaluated the use of warfarin in patients with AF and CKD to evaluate the risks of ischemic stroke/thromboembolism, major bleeding, and mortality. ⋯ Based on this meta-analysis, the use of warfarin for AF may have an unfavorable risk/benefit ratio in patients with end-stage CKD but not in those with non-end-stage CKD.
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In spite of significant strides in the treatment of sickle cell disease (SCD), SCD crises are still responsible for high morbidity and early mortality. While most patients initially seek care in the acute setting for a seemingly uncomplicated pain episode (pain crisis or vaso-occlusive crisis), this initial event is the primary risk factor for potentially life-threatening complications. The pathophysiological basis of these illnesses is end-organ ischemia and infarction combined with the downstream effects of hemolysis that results from red blood cell sickling. ⋯ Blood transfusions remain the mainstay of therapy for all severe acute crises. Recommendations and indications for the safest and most efficient implementation of transfusion strategies in the critical care setting are therefore presented and discussed, together with their pitfalls and potential future therapeutic alternatives. In particular, the importance of extended phenotypic red blood cell matching cannot be overemphasized, due to the high prevalence of severe complications from red cell alloimmunization in SCD.
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Review
Developing an Interventional Pulmonary Service in a Community-Based Private Practice: a case study.
Interventional pulmonology (IP) is a field that uses minimally invasive techniques to diagnose, treat, and palliate advanced lung disease. Technology, formal training, and reimbursement for IP procedures have been slow to catch up with other interventional subspecialty areas. A byproduct of this pattern has been limited IP integration in private practice settings. ⋯ A philosophical and financial buy-in by stakeholders and a regionalization of services, within and external to a larger practice, are crucial to success. Our experience demonstrates that a successful launch of an IP program increases overall visits as well as procedural volume without cannibalizing existing practice volume. We hope this might encourage others to provide this valuable service to their own communities.
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In-laboratory, attended polysomnography has long been the gold standard for the diagnosis of sleep-disordered breathing (SDB). In recent years, economic pressures and long wait times have driven interest in home sleep testing, which has, in turn, led to the development of algorithms that bypass the sleep laboratory in favor of portable monitoring studies and in-home initiation of positive airway pressure therapy. ⋯ In the inpatient setting, in which SDB is both highly prevalent and associated with adverse outcomes in certain populations, the literature is evolving on the use of portable monitors to expedite diagnosis and treatment of SDB. This review discusses society guidelines and recent research in the growing field of portable monitoring.