Chest
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The hemoglobin value to trigger RBC transfusion for patients receiving venovenous extracorporeal membrane oxygenation (ECMO) is controversial. Previous guidelines recommended transfusing to a normal hemoglobin level, but recent studies suggest that more RBC transfusions are associated with increased adverse outcomes. ⋯ We observed a decrease in number of RBC units per day of ECMO over time, but changes were not associated temporally with implementation of transfusion thresholds. A transfusion threshold of hemoglobin < 8 g/dL was associated with a lower hazard of death, but these findings are limited by study methodology. Further research is needed to investigate optimal RBC transfusion practices for patients supported with venovenous ECMO.
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With telemedicine's expansion during the COVID-19 pandemic, it has become critical to evaluate whether patients have equitable access to and capabilities to use televisits optimally for improved COPD outcomes such as reduced hospitalizations. This scoping review evaluated whether televisit-based interventions are evaluated among and equitably effective in improving health care use outcomes among diverse patient populations with COPD. ⋯ Most studies failed to report on participants' race or income, leading to a lack of data on the equity of interventions' effectiveness across diverse patient populations. Multimethod televisit-based interventions, particularly with an in-person component, most commonly were effective; no associations were seen with study quality or size. With the increasing reliance on telemedicine to provide chronic disease care, the lack of data among diverse populations since the COVID-19 pandemic began limits generalizability of these findings for real-world clinical settings. More comprehensive evaluations of televisit-based interventions are needed in the era after the pandemic within and across diverse patient populations.
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Review
Recommendations for Clinicians to Combat Environmental Disparities in Pediatric Asthma: A Review.
Asthma is a common and complex lung disease in children, with disproportionally higher prevalence and related adverse outcomes among children in racial and ethnic minority groups and of lower socioeconomic position. Environmental factors, including unhealthy housing and school-based exposures, can contribute to increased asthma morbidity and widening disparities. This underscores a significant environmental justice issue and suggests the need for clinical interventions to reduce sources of environmental exposures and ultimately diminish the observed disparities in childhood asthma. ⋯ Racial, ethnic, and socioeconomic disparities exist in asthma morbidity in children, and such disparities are driven in part by environmental factors at the housing and school level. Clinicians can make evidence-based recommendations to drive effective exposure reduction strategies to mitigate asthma morbidity and reduce observed disparities.
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Multicenter Study
"Occupational exposure to charcoal smoke and dust, a major risk factor for COPD: a multiregional cross-sectional study in the Democratic Republic of Congo".
Occupational exposure to charcoal smoke and dust is a threat to workers' respiratory systems. ⋯ In rural areas of DRC, producing or selling charcoal is associated with a higher risk of COPD.
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Randomized Controlled Trial
Dexmedetomidine for Reducing Mortality in Patients with Septic Shock: A Randomized Controlled Trial (DecatSepsis).
Sepsis, especially septic shock, and its complications have been linked to the hyperadrenergic stress response. ⋯ gov.