American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Feb 2013
Stakeholder priorities for comparative effectiveness research in chronic obstructive pulmonary disease: a workshop report.
Comparative effectiveness research (CER) is intended to address the expressed needs of patients, clinicians, and other stakeholders. Representatives of 54 stakeholder groups with an interest in chronic obstructive pulmonary disease (COPD) participated in workshops convened by the COPD Outcomes-based Network for Clinical Effectiveness and Research Translation (CONCERT) over a 2-year period. Year 1 focused on chronic care and care coordination. ⋯ Research priorities varied across stakeholder groups, but generally focused on studies to evaluate different approaches to healthcare delivery (e.g., spirometry for diagnosis and treatment, integrated healthcare strategies during transitions in care) rather than head-to-head comparisons of medications. This research agenda may help to inform groups intending to respond to CER funding opportunities in COPD. The methodologies used, detailed in the online supplement, may also help to inform prioritization efforts for CER in other health conditions.
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Am. J. Respir. Crit. Care Med. · Feb 2013
Integrating mortality and morbidity outcomes: using quality-adjusted life years in critical care trials.
Outcome measures that integrate mortality and morbidity, like quality-adjusted life years (QALYs), have been proposed for critical care clinical trials. ⋯ QALYs may be a feasible outcome in critical care trials yielding a patient-centered result and major gains in statistical power under certain conditions, but this approach is susceptible to several threats, including loss to follow-up.
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Am. J. Respir. Crit. Care Med. · Feb 2013
Elevated fibrinogen levels are associated with risk of pulmonary embolism, but not with deep venous thrombosis.
It is unclear whether elevated plasma fibrinogen is associated with both deep venous thrombosis (DVT) and its complication, pulmonary embolism (PE), and whether elevated fibrinogen is a direct cause of these disorders. ⋯ Elevated plasma fibrinogen levels are associated with increased risk of PE in combination with DVT but not with DVT alone. Elevated fibrinogen levels per se may not be causally associated with PE or DVT. Limitations include imprecise definitions of PE and DVT.
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Am. J. Respir. Crit. Care Med. · Feb 2013
Epithelial Pten controls acute lung injury and fibrosis by regulating alveolar epithelial cell integrity.
Injury to alveolar epithelial cells (AECs) and to their repair process is integral to the pathogenesis of acute lung injury (ALI) and idiopathic pulmonary fibrosis (IPF). The mechanisms regulating the integrity of AECs and their intrinsic regulators remain unclear. Pten is a tumor suppressor, and its function in epithelial cells during organ fibrosis is unknown. ⋯ Our results highlight epithelial Pten as a crucial gatekeeper controlling ALI and lung fibrosis by modulating AEC integrity, and the Pten/PI3K/Akt pathway as a potential therapeutic target in these intractable diseases.