Annals of the American Thoracic Society
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Rationale: Determining when an intensive care unit (ICU) patient is ready for discharge to the ward is a complex daily challenge for any ICU care team. Patients who experience unplanned readmissions to the ICU have increased mortality, length of stay, and cost compared with those not readmitted during their hospital stay. The accuracy of clinician prediction for ICU readmission is unknown. ⋯ All other pairwise comparisons were not significantly different for predicting ICU readmission within 48 hours (P > 0.05 for all comparisons). Conclusions: We found that all clinicians surveyed in our ICU, regardless of the level of experience or clinician type, had only fair accuracy for predicting ICU readmission. Further research is needed to determine if clinical decision support tools would provide prognostic value above and beyond clinical judgment for determining who is ready for ICU discharge.
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Randomized Controlled Trial Multicenter Study
Prevalence, Symptom Burden, and Underdiagnosis of Chronic Obstructive Pulmonary Disease in a Lung Cancer Screening Cohort.
Rationale: Individuals eligible for lung cancer screening (LCS) by low-dose computed tomography (LDCT) are also at risk of chronic obstructive pulmonary disease (COPD) due to age and smoking exposure. Whether the LCS episode is useful for early detection of COPD is not well established. Objectives: To explore associations between symptoms, comorbidities, spirometry, and emphysema in participants enrolled in the Lung Screen Uptake Trial. ⋯ Conclusions: There is high burden of "undiagnosed COPD" and emphysema in LCS participants. Adding spirometry findings to the LDCT enhances identification of individuals with COPD. Clinical trial registered with www.clinicaltrials.gov (NCT02558101).
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Rationale: Even though idiopathic pulmonary fibrosis (IPF) is a disease with high morbidity and mortality and no cure, palliative care is rarely implemented, leading to high symptom burden and unmet care needs. In 2012, we implemented a multidisciplinary collaborative (MDC) care model linking clinic and community multidisciplinary teams to provide an early integrated palliative approach, focusing on early symptom management and advance care planning. Objectives: To evaluate the differences in resource use and associated costs of end-of-life care between patients with IPF who received early integrated palliative care and patients with IPF who received conventional treatment. ⋯ Conclusions: An integrated palliative approach in IPF is associated with improvements in the quality of end-of-life care and reduction in costs. Transformation of care models is required to deliver palliative care for patients with IPF. MDC teams within such models can address the high burden of unmet needs for symptom management, advance care planning, and community support in this complex population.