Chest
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Deficiencies in risk assessment for patients with pulmonary nodules (PNs) contribute to unnecessary invasive testing and delays in diagnosis. ⋯ The RRM accurately reclassified some patients into low-risk and very high-risk categories, suggesting the potential to improve PN risk assessment.
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Respiratory therapists (RTs) are credentialed health professionals who specialize in assessment of pulmonary conditions, performing assessment of pulmonary function and delivering pulmonary therapeutics including aerosol therapy, and noninvasive and invasive mechanical ventilation. Respiratory therapists work closely with various clinicians including physicians, nurses, and therapy staff in a number of different settings including outpatient clinics, long-term facilities, EDs, and ICUs. ⋯ In this review, we outline the importance, the elements of, and an approach to building a comprehensive RT program that allows delivery of high-quality care while ensuring RTs practice at the full scope of their licensure. Over the last two decades, we have implemented a suite of changes to the training, functioning, deployment, continuing education, and capacity building in our Lung Partners Program practice, under the supervision of a medical director, that have allowed us to create an effective inpatient and outpatient model of primary respiratory care.
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The role of sex differences in clinical presentation, TB drug pharmacokinetic variables, and treatment outcomes is unclear. ⋯ Women present with lower mycobacterial burden, achieve higher TB drug exposure, and are less likely to have unfavorable treatment outcomes than men. Strategies to improve TB treatment success should take into account sex differences in risk factors for unfavorable outcomes.
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Beyond the question of short-term survival, days spent at home could be considered a patient-centered outcome in critical care trials. ⋯ Many patients had complex health care trajectories after surviving critical illness. Wide variations in the ability to return home after ICU discharge were observed between clusters, which represents an important patient-centered outcome.
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A 21-year-old Hispanic woman with no significant medical history presented with complaints of progressive skin lesions for 3 months, associated with dyspnea and scant hemoptysis for 1 week. She initially developed painless subcutaneous nodules on her right forearm, which progressed to superficial ulcers and gradually spread to involve bilateral arms, thighs, chest, abdomen, and gluteal region. The lesions spared the head, neck, palms, and soles. ⋯ She was born in El Salvador but had spent most of her life in New York. She did not report any recent international travel or sick contacts. There was no personal or family history of immunodeficiency or malignancies.