Chest
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Laryngeal dysfunction as a cause of chronic refractory cough (CRC) and episodic dyspnea is often missed, which results in unnecessary testing and delays in diagnosis. Understanding laryngeal roles in breathing and airway protection can help to appreciate the propensity to laryngeal dysfunction with aging, chronic lung disease, and sleep apnea. ⋯ Pulmonologists should incorporate assessment of laryngeal dysfunction during evaluation of CRC and dyspnea. Recognition of laryngeal hypersensitivity in patient with CRC can identify patients who may benefit from cough suppression therapies. Similarly, timely identification of inducible laryngeal obstruction may not only resolve episodic dyspnea but lessen the need for unnecessary testing and treatments.
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In health care, transforming individuals with diverse skills into an effective, cohesive team is fundamental to delivering and advancing patient care. All teams, however, are not created the same. ⋯ This review presents an overview of psychological safety in medicine, describing its impact on learning, patient safety, and quality improvement. The review also explores interventions and essential leadership behaviors that foster psychological safety in teams.
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Multicenter Study
Legionnaire's disease in solid organ transplant recipients: a decade nationwide study in France.
Legionnaires disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ transplant recipients. However, the epidemiologic features, clinical presentation, and outcomes of LD in this population are poorly described. ⋯ LD is a late and severe complication occurring in solid organ transplant recipients that may present as pulmonary nodules on which diabetes impacts its long-term prognosis.
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Because chest CT scan has largely supplanted surgical lung biopsy for diagnosing most cases of interstitial lung disease (ILD), tools to standardize CT scan interpretation are urgently needed. ⋯ A DL-based classifier for UIP demonstrated good test performance across a wide range of UIP prevalence and similarly discriminated survival when compared with radiologist-determined UIP. This automated tool could efficiently screen for UIP in patients undergoing chest CT scan and identify a high-risk phenotype among those with known ILD.
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Randomized Controlled Trial
Valaciclovir for Epstein-Barr virus suppression in moderate-to-severe COPD (EViSCO): A randomised, double-blind, placebo-controlled trial.
Epstein-Barr virus (EBV) frequently is measured at high levels in COPD using sputum quantitative polymerase chain reaction, whereas airway immunohistochemistry analysis has shown EBV detection to be common in severe disease. ⋯ Valaciclovir is safe and effective for EBV suppression in COPD and may attenuate the sputum inflammatory cell infiltrate. The findings from the current study provide support for a larger trial to evaluate long-term clinical outcomes.