The Mount Sinai journal of medicine, New York
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Pulmonary fibrosis is an unusual "end stage" in patients with sarcoidosis. Fibrosis occurs in a minority of patients, and presents with a unique physiologic combination of airways dysfunction (obstruction) superimposed on the more common restrictive dysfunction. Imagin techniques are essential to the diagnosis, assessment and treatment of pulmonary fibrosis. ⋯ With severe functional impariment and patient disability, pulmonary hypertension and right heart failure may supervene for which the patient will require treatment. Oxygen, careful diuresis, sildenafil and bosentan may be salutary. These patients are candidates for lung transplantation.
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The interstitial lung diseases are a heterogeneous group of disorders characterized by inflammation and/or fibrosis of the pulmonary interstitium. In 2002, the American Thoracic Society and the European Respiratory Society revised the classification of interstitial lung diseases and introduced the term diffuse parenchymal lung disease. The idiopathic interstitial pneumonias are a subtype of diffuse parenchymal lung disease. ⋯ Its primary objective is to illuminate the clinical challenges encountered by clinicians who manage the diffuse parenchymal lung diseases regularly and to offer potential solutions to those challenges. Treatment for the diffuse parenchymal lung diseases is limited, and for many patients with end-stage disease, lung transplantation remains the best option. Although much has been learned about the diffuse parenchymal lung diseases during the past decade, research in these diseases is urgently needed.
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Reducing nosocomial infection rates is a major component of healthcare improvement. This article reviews the epidemiology, prevention, and therapy for some of the most common healthcare-associated infections, including central line-associated bloodstream infections and catheter-associated urinary tract infections, and 3 common organisms: methicillin-resistant Staphylococcus aureus, multidrug- resistant gram-negative bacteria, and Clostridium difficile.
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Advanced restrictive lung diseases remain a challenge for both the clinician and patient alike. Because there are few available treatment options that prolong survival for patients with diseases such as idiopathic pulmonary fibrosis, improvement in quality of life and palliation of significant symptoms become realistic treatment goals. Several validated instruments that assess quality of life and health-related quality of life have demonstrated the dramatic impact that lung disease has on patients. ⋯ Physicians need to maintain their focus on quality-of-life issues as medical management shifts from curative therapies to comfort management therapies. Palliative care and hospice appear to be underused in patients with advanced diseases other than cancer. Because the only curative option for some end-stage restrictive lung diseases is lung transplantation, if transplantation is not an option, palliation of symptoms and hospice care may offer patients and families the opportunity to die with dignity and comfort.
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In fiscal year 2006, the US Government abruptly and drastically reduced its funding for programs to increase the racial and ethnic diversity of academic medicine, including programs to increase the development of minority medical faculty. Anticipating this reduction, 4 such programs-the Albert Einstein College of Medicine, Mount Sinai School of Medicine, University of Medicine and Dentistry in New Jersey-New Jersey Medical School, and University of Pennsylvania School of Medicine-decided to pool their resources, forming the Northeast Consortium of Minority Faculty Development. An innovation in minority faculty development, the Northeast Consortium of Minority Faculty Development has succeeded in exposing faculty trainees to research and teaching that they might not have considered otherwise, expanding the number and diversity of their mentors and role models, providing them potential access to larger and different populations and databases for purposes of research, and expanding their peer contacts. After introducing the Northeast Consortium of Minority Faculty Development, this article describes the origins and goals of each member program.