Chest
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Multicenter Study
Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients.
To review our experience in treatment of complicated parapneumonic effusion and pleural empyema by video-assisted thoracoscopic surgery (VATS). ⋯ VATS is safe and effective for treatment of complicated parapneumonic effusion and pleural empyema. Earlier intervention with VATS can produce better clinical results. A prospective study should be done to identify optimal timing and settings for VATS treatment for both complicated parapneumonic effusion and pleural empyema.
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Multicenter Study
Adverse events and treatment completion for latent tuberculosis in jail inmates and homeless persons.
Recently, a short-course treatment using 60 daily doses of rifampin and pyrazinamide was recommended for latent tuberculosis (TB) infection (LTBI). ⋯ This study detected the first treatment-associated fatality with the rifampin and pyrazinamide regimen, prompting surveillance that detected unacceptable levels of hepatotoxicity and retraction of recommendations for its routine use. Completion rates for LTBI treatment using a short-course regimen exceeds historical rates using isoniazid. Efforts to identify an effective short-course treatment for LTBI should be given a high priority.
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Multicenter Study
Indications, timing, and techniques of tracheostomy in 152 French ICUs.
To investigate the current practice of tracheostomy in French ICUs, focusing on the frequency, timing, indications, and techniques. ⋯ There is much heterogeneity in the reported practices of tracheostomy in French ICUs. Three fourths of physicians considered that a randomized study comparing prolonged translaryngeal intubation and early tracheostomy in patients expected to receive prolonged MV would be necessary to clarify those issues.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD.
Pulmonary rehabilitation (PR) improves exercise tolerance in COPD patients. Tiotropium is a once-daily, inhaled anticholinergic bronchodilator that provides sustained 24-h improvements in airflow and lung hyperinflation reduction. We hypothesized that ventilatory mechanics improvements from tiotropium would permit enhanced ability to train muscles of ambulation and therefore augment exercise tolerance benefits of PR. ⋯ Tiotropium in combination with PR improved endurance of a constant work rate treadmill task and produced clinically meaningful improvements in dyspnea and health status compared to PR alone. Improvements with tiotropium were sustained for 3 months following PR completion.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion.
To demonstrate the efficacy, safety, and appropriate mode of instillation of talc for sclerosis in treatment of malignant pleural effusions (MPEs). ⋯ Both methods of talc delivery are similar in efficacy; TTI may be better for patients with either a lung or breast primary. The etiology and incidence of respiratory complications from talc need further exploration.