Chest
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This narrative review emphasizes the growing interest in palliative care for people with serious lung diseases such as COPD. It reflects on recent publications from the American Thoracic Society, the World Health Organization, and European Respiratory Society, with a focus on nonpharmacologic palliative care for people with COPD from both the health care professional and organizational perspective. ⋯ Therefore, services should be based on the understanding that palliative care is not only specific standardized actions and treatments, but rather a holistic approach that includes compassionate communication, treatment, and care addressing the patient and informal and formal caregivers. Living with and dying of COPD is much more than objective measurements. It is the sum of relationships with others and the experience of living in the best possible harmony with one's own values and hopes, despite having a serious illness.
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The promise of artificial intelligence has generated enthusiasm among patients, health care professionals, and technology developers who seek to leverage its potential to enhance the diagnosis and management of an increasing number of chronic and acute conditions. Point-of-care testing increases access to care because it enables care outside of traditional medical settings. Collaboration among developers, clinicians, and end users is an effective best practice for solving clinical problems. A common set of clearly defined terms that are easily understood by research teams is a valuable tool that fosters these collaborations.
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The small airways comprise generations 8 to 23 of the bronchial tree, consist of airways with an internal diameter <2mm, and are classically difficult to assess and treat in persistent asthma. Small airways dysfunction (SAD) is integral to the asthma management paradigm as it is associated with poorer symptom control, greater levels of type 2 inflammation, and has been proposed as a potential treatable asthma trait. ⋯ To rectify the unrecognized value of oscillometry in the asthma community, a consortium of authors who are investigators with knowledge and experience of oscillometry wished to address the most important clinical questions raised by our colleagues who are considering using this technique, including its clinical utility. In this article, we discuss integral concepts including applicability of oscillometry as a predictive tool for asthma exacerbations and disease control; adequacy of spirometry and oscillometry in assessing SAD; potential limitations of oscillometry; as well as treatment options for SAD.
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When an understanding of pathogenesis exists, skin lesions that have the appearance of blood in the skin can provide insight into the mechanisms leading to a systemic process that results in cutaneous manifestations. Of the vascular disturbances of the skin that occur in patients who are critically ill, some result from a nonhemorrhagic process, whereas others represent bleeding into the skin. ⋯ The tactile component of palpability in their clinical evaluation can denote that inflammation is part of the process. The goal of this review is to provide a conceptual approach not only to the diagnosis of vascular disturbances of the skin, but also to the pathophysiologic processes occurring that might offer clues to the underlying disease process.
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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.