Chest
-
Pragmatic Clinical Trial
Implementation of Lung Cancer Screening in Primary Care and Pulmonary Clinics: Pragmatic Clinical Trial of Electronic Health Record-Integrated Everyday Shared Decision Making Tool and Clinician-Facing Prompts.
Although low-dose CT (LDCT) scan imaging lung cancer screening (LCS) can reduce lung cancer mortality, it remains underused. Shared decision-making (SDM) is recommended to assess the balance of benefits and harms for each patient. ⋯ Clinician-facing EHR prompts and an EHR-integrated everyday SDM tool are promising approaches to improving LCS in the primary care setting. However, room for improvement remains. As such, further research is warranted.
-
Identifying individuals at risk of progressing to COPD may allow for initiation of treatment to potentially slow the progression of the disease or the selection of subgroups for discovery of novel interventions. ⋯ Heterogeneous structural changes occur in the lungs of individuals at risk that can be quantified using CT imaging features, and evaluation of these features together with conventional risk factors improves performance for predicting progression to COPD.
-
Safe and timely liberation from venovenous extracorporeal membrane oxygenation (ECMO) would be expected to reduce the duration of ECMO, the risk of complications, and costs. However, how to liberate patients from venovenous ECMO effectively remains understudied. ⋯ Practices on liberation from venovenous ECMO are heterogeneous and are influenced strongly by clinician preference. Additional research on liberation thresholds is needed to define optimal liberation strategies and to close existing knowledge gaps in essential topics on liberation from venovenous ECMO.
-
A 19-year-old woman with no medical history who did not use tobacco presented to the hospital with post-COVID-19 cough for 2 months and new onset of shortness of breath and blood-tinged sputum. She was initially treated empirically for community-acquired pneumonia because her chest radiograph showed a right upper lobe infiltrate. Further CT scan imaging revealed a right hilar lymph node conglomerate and extensive lymphadenopathy. ⋯ She was treated for pain, and she left for insurance reasons. Two months later, the patient presented with progressive shortness of breath and hemoptysis and a 23-kg weight loss over the past 4 months. Because of the patient's increasing medical needs, she was transferred to our institution, where she was admitted to the medical ICU.
-
A 38-year-old man presented to the ED complaining of persistent fever, dry cough, shortness of breath, and diarrhea for 7 days. He reported a history of OSA with inconsistent CPAP use, tobacco use of less than one pack per day, and daily e-cigarette use or "vaping." He denied any contact with ill people or recent travels and was up to date on recommended COVID-19 vaccinations. Prior to his presentation, he had been seen at an urgent care facility twice in the last week, where he was given IV fluids and prescribed steroids without improvement.