Chest
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A large number of symptomatic individuals with central sleep apnea (CSA) in clinical practice have an indication for adaptive servoventilation (ASV) therapy. ⋯ gov.
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Pulmonary vascular disease (PVD), and in particular, pulmonary hypertension (PH), is a highly specialized area of medicine comprising complex diagnostics, classification systems, risk assessment tools, and therapeutics, the correct application of which has been shown to impact patient outcomes. The PVD scientific and patient community recognizes the importance of standardization of care patterns and thus has implemented a clinical accreditation process for PH care centers across the United States. However, a similar standardization system is lacking in PVD subspecialty provider training. ⋯ Second, the National Consortium on Pulmonary Vascular Disease Fellowship Training was founded to establish a common curriculum and set of training requirements across PVD programs in the United States. A particular emphasis was placed on the training requirements for provider competency in PH because (1) reliable access to patients with PH could be supported by all consortium institutions and (2) the consortium members believed that national PH training curriculums lacked standardization and detail. This article provides the results of the national survey, a guideline summary of the fellowship curriculum and training requirements, and a discussion of the impact of the consortium on PVD training and on the PVD subspecialty as a potential emerging formal discipline in internal medicine.
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Continuing data on racial bias in pulse oximeters and artificial intelligence has sparked calls for health systems to drive innovation against racial bias in health care device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions. ⋯ Health system purchasing professionals suggested interest and some nascent successes in diversity, equity, and inclusion considerations in health system purchasing processes, including diverse supplier initiatives, but also expressed a need for strong clinical partnership to ensure equitable performance. Explicit approaches for incorporating equitable performance into health care purchasing likely are needed.
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The management of incidental pulmonary nodules is guided by recommendations set forth by the Fleischner Society. Although most pulmonary nodules are benign, timely and evidence-based follow-up can reduce morbidity and mortality. There are known socioeconomic disparities for engagement with recommended cancer screenings; however, it is unclear whether disparities exist for follow-up of incidentally detected pulmonary lesions. ⋯ In the context of poor adherence overall, patients residing in the most socioeconomically deprived neighborhoods were less likely to receive care in concordance with Fleischner Society recommendations for management of incidental pulmonary nodules.
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Review
How I Do It: Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.
Coccidioidomycosis, caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii, is recognized as an increasing threat both nationally and worldwide. This is in large part secondary to the expanding range of Coccidioides species and increased international travel to endemic regions. Most individuals exposed to airborne Coccidioides organisms do not need medical attention, but approximately 30% will demonstrate primary pulmonary coccidioidomycosis with signs and symptoms that mimic community-acquired pneumonia or other respiratory illnesses. ⋯ Despite the long-term consequences of cavitary coccidioidomycosis in some individuals, the current literature review and practice guidelines demonstrate a paucity of clear management strategies to treat these patients. In this report, we focus on cavitary lesions in coccidioidomycosis with the goal of presenting a description of the evaluation and management of their various forms, manifestations, and complications. These recommendations are derived from a multidisciplinary group of experts.