Chest
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Randomized Controlled Trial
Effects of CPAP on Metabolic Syndrome in Patients With OSA: A Randomized Trial.
OSA is associated with metabolic syndrome (MS), but it is unclear whether OSA treatment with CPAP can revert MS. ⋯ Despite the higher rate of MS reversibility after CPAP therapy as compared with placebo, most patients retained this diagnosis. The lack of significant or relevant effects on adiposity biomarkers and depots supports the modest role of OSA in modulating MS.
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Multicenter Study
Identification of Sputum Biomarkers Predictive of Pulmonary Exacerbations in Chronic Obstructive Pulmonary Disease.
Improved understanding of the pathways associated with airway pathophysiologic features in COPD will identify new predictive biomarkers and novel therapeutic targets. ⋯ Biomarker evaluation implicated pathways involved in mucus hydration, adenosine metabolism, methionine salvage, and oxidative stress in COPD airway pathophysiologic characteristics. Therapies that target these pathways may be of benefit in COPD, and a simple model adding sputum-soluble phase biomarkers improves prediction of pulmonary exacerbations.
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Pleural disease is a common presentation and spans a heterogeneous population across broad disease entities; a common feature is the requirement for interventional procedures. Despite the frequency of such procedures, there is little consensus on rates of complications and risk factors associated with such complications. This narrative review was based on a structured search of the literature. ⋯ Data on safety and complication rates in procedural interventions are limited by methodologic problems, and novel methods to study this topic should be considered. Although complications remain rare events, once encountered, they have the potential to rapidly escalate. It is of paramount importance for operators to prepare and have in place plans for such events to ensure high quality and, above all, safe care.
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Multicenter Study
Drivers of Burnout Among Critical Care Providers: A Multicenter Mixed-Methods Study.
Critical care practitioners have some of the highest levels of burnout in health care. ⋯ High levels of burnout were identified through the MBI, but participants did not self-report high levels of burnout, suggesting a lack of awareness. Drivers of burnout were highly interconnected, but factors related to team dynamics and hospital culture were most prominent and shared across provider types. The shared drivers of burnout across multiple provider types highlights the need for interventions focused on team- and system-level drivers.
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Physical frailty commonly is associated with COPD, and its evaluation in COPD may provide important prognostic information for risk stratification. ⋯ The study supports the use of physical frailty in addition to lung function and dyspnea in multidimensional evaluation of COPD.