Annals of the American Thoracic Society
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Comparative Study
Noninvasive Ventilation versus CPAP as Initial Treatment of Obesity Hypoventilation Syndrome.
Rationale: Obesity hypoventilation syndrome (OHS) is an undesirable consequence of obesity. Treatment consists of weight loss and positive airway pressure (PAP) therapy. However, the preferred mode of PAP is uncertain. ⋯ The effectiveness of CPAP is similar to that of NIV, but NIV is more costly and requires more resources than CPAP. Given that approximately 70% of patients with OHS have coexistent severe OSA, this recommendation applies to the great majority of patients with stable OHS, but it should not be extrapolated to patients with OHS without severe OSA. Patients of advanced age, with poor lung function, or with greater or recent acute ventilatory failure may not respond adequately to CPAP.
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Rationale: Older adults with chronic obstructive pulmonary disease (COPD) are at substantially increased risk for medication-related adverse events. Two frequently prescribed classes of drugs that pose a particular risk to this patient group are opioids and benzodiazepines. Research on this topic has yielded conflicting findings. ⋯ Conclusions: Among older adults with COPD, use of opioid and benzodiazepine medications alone or in combination were associated with increased adverse respiratory events. The adverse effects of these medications were not exacerbated in patients with COPD-OSA overlap syndrome. However, the adverse impact of dual opioid and benzodiazepine was greater in patients with high-complexity COPD.
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Rationale: Lung cancer screening with low-dose chest computed tomography decreases mortality for high-risk current or former smokers. Lifetime smoking intensity (cigarette pack-years), an essential eligibility criterion, is poorly recorded in electronic health records, which may contribute to the overall low appropriate use of screening. Objectives: We sought to assess whether elements commonly extractable from electronic health records may be useful as prescreening tools to identify individuals for formal assessment of eligibility. ⋯ Conclusions: These simplified criteria may be useful for identifying individuals who are eligible for lung cancer screening. Applying these criteria as a prescreening tool may improve appropriate referral and implementation of screening. Keywords: lung cancer; early detection of lung cancer; cancer prevention; tobacco abuse.
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Air quality data from satellites and low-cost sensor systems, together with output from air quality models, have the potential to augment high-quality, regulatory-grade data in countries with in situ monitoring networks and provide much-needed air quality information in countries without them. Each of these technologies has strengths and limitations that need to be considered when integrating them to develop a robust and diverse global air quality monitoring network. To address these issues, the American Thoracic Society, the U. ⋯ The participants focused on four topics: 1) current and near-term capabilities in air pollution monitoring, 2) data assimilation from multiple technology platforms, 3) critical issues for air pollution monitoring in regions without a regulatory-quality stationary monitoring network, and 4) risk communication and health messaging. Recommendations for research and improved use were identified during the workshop, including a recognition that the integration of data across monitoring technology groups is critical to maximizing the effectiveness (e.g., data accuracy, as well as spatial and temporal coverage) of these monitoring technologies. Taken together, these recommendations will advance the development of a global air quality monitoring network that takes advantage of emerging technologies to ensure the availability of free, accessible, and reliable air pollution data and forecasts to health professionals, as well as to all global citizens.
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Rationale: Clinical and research training opportunities in global health are of increasing interest to medical trainees, but little is known about such opportunities in U. S.-based pulmonary and pulmonary/critical care medicine (PCCM) fellowship programs. Objectives: Summarize currently available global health-related training opportunities and identify potential barriers to implementing global health curricula among U. ⋯ Among programs that would like to offer global health-related training components, the most common barriers included competing priorities for lecture content and a lack of in-division mentors with global health experience, a champion for global health-related activities, and established partnerships outside the United States. Conclusions: PCCM program leaders are interested in offering global health-related training opportunities, but important barriers include lack of mentorship, dedicated fellowship time, and established global partnerships. Future research is needed to better understand global health-related interests and training needs of incoming fellows and to design creative solutions for providing global health-related training across academic institutions with variable global health-related training capacities.