Chest
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Multicenter Study
Anaerobic antibiotic coverage in aspiration pneumonia and the associated benefits and harms: A retrospective cohort study.
Antibiotics with extended anaerobic coverage are used commonly to treat aspiration pneumonia, which is not recommended by current guidelines. ⋯ We found that extended anaerobic coverage likely is unnecessary in aspiration pneumonia because it was associated with no additional mortality benefit, only an increased risk of C difficile colitis.
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Multicenter Study Observational Study
International variation in severe exacerbation rates in patients with severe asthma.
Exacerbation frequency strongly influences treatment choices in patients with severe asthma. ⋯ Individuals with similar patient characteristics but coming from different jurisdictions have varied severe exacerbation risks, even after controlling for patient and disease characteristics. This suggests unknown patient factors or system-level variations at play. Disease management guidelines should recognize such between-country variability. Risk prediction models that are calibrated for each jurisdiction will be needed to optimize treatment strategies.
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Multicenter Study
Achieving Goals of Care Decisions in Chronic Critical Illness: A Multi-Institutional Qualitative Study.
Physicians, patients, and families alike perceive a need to improve how goals of care (GOC) decisions occur in chronic critical illness (CCI), but little is currently known about this decision-making process. ⋯ Intensivists described a complex time- and labor-intensive group process to achieve GOC decision-making in CCI. System-level interventions that improve how information is shared between physicians and decrease logistical and relational barriers to timely and consistent communication are key to improving GOC decision-making in CCI.