3541. Clinical and Genomic Characteristics of Small Cell Lung Cancer in Never Smokers: Results From a Retrospective Multicenter Cohort Study.
作者: Anish Thomas.;Idrees Mian.;Camille Tlemsani.;Lorinc Pongor.;Nobuyuki Takahashi.;Kathleen Maignan.;Jeremy Snider.;Gerald Li.;Garrett Frampton.;Siraj Ali.;Sehyun Kim.;Samantha Nichols.;Vinodh Rajapakse.;Udayan Guha.;Elad Sharon.;Junya Fujimoto.;Cesar A Moran.;Ignacio I Wistuba.;Jun S Wei.;Javed Khan.;Eva Szabo.;Aracelis Z Torres.;Kenneth R Carson.
来源: Chest. 2020年158卷4期1723-1733页
Small cell lung cancer (SCLC) has the strongest association with smoking among lung cancers. The characteristics of never smokers with SCLC is not known.
3544. Emotional Experiences and Coping Strategies of Family Members of Critically Ill Patients.
作者: Emily A Harlan.;Jacquelyn Miller.;Deena K Costa.;Angela Fagerlin.;Theodore J Iwashyna.;Emily P Chen.;Kyra Lipman.;Thomas S Valley.
来源: Chest. 2020年158卷4期1464-1472页
Two out of three family members experience symptoms of posttraumatic stress, depression, or anxiety lasting for months after the ICU stay. Interventions aimed at mitigating these symptoms have been unsuccessful.
3545. Beclomethasone Has Lesser Suppressive Effects on Inflammation and Antibacterial Immunity Than Fluticasone or Budesonide in Experimental Infection Models.
作者: Faisal Kamal.;Nicholas Glanville.;Wangmingyu Xia.;Eteri Bakhsoliani.;Julia Aniscenko.;Nathan W Bartlett.;Michael R Edwards.;Sebastian L Johnston.;Aran Singanayagam.
来源: Chest. 2020年158卷3期947-951页 3546. Clinical Phenotypes of Atopy and Asthma in COPD: A Meta-analysis of SPIROMICS and COPDGene.
作者: Nirupama Putcha.;Ashraf Fawzy.;Elizabeth C Matsui.;Mark C Liu.;Russ P Bowler.;Prescott G Woodruff.;Wanda K O'Neal.;Alejandro P Comellas.;MeiLan K Han.;Mark T Dransfield.;J Michael Wells.;Njira Lugogo.;Li Gao.;C Conover Talbot.;Eric A Hoffman.;Christopher B Cooper.;Laura M Paulin.;Richard E Kanner.;Gerard Criner.;Victor E Ortega.;R Graham Barr.;Jerry A Krishnan.;Fernando J Martinez.;M Bradley Drummond.;Robert A Wise.;Gregory B Diette.;Craig P Hersh.;Nadia N Hansel.
来源: Chest. 2020年158卷6期2333-2345页
Little is known about the concordance of atopy with asthma COPD overlap. Among individuals with COPD, a better understanding of the phenotypes characterized by asthma overlap and atopy is needed to better target therapies.
3548. Teaching Clinical Reasoning and Critical Thinking: From Cognitive Theory to Practical Application.
Teaching clinical reasoning is challenging, particularly in the time-pressured and complicated environment of the ICU. Clinical reasoning is a complex process in which one identifies and prioritizes pertinent clinical data to develop a hypothesis and a plan to confirm or refute that hypothesis. Clinical reasoning is related to and dependent on critical thinking skills, which are defined as one's capacity to engage in higher cognitive skills such as analysis, synthesis, and self-reflection. This article reviews how an understanding of the cognitive psychological principles that contribute to effective clinical reasoning has led to strategies for teaching clinical reasoning in the ICU. With familiarity with System 1 and System 2 thinking, which represent intuitive vs analytical cognitive processing pathways, respectively, the clinical teacher can use this framework to identify cognitive patterns in clinical reasoning. In addition, the article describes how internal and external factors in the clinical environment can affect students' and trainees' clinical reasoning abilities, as well as their capacity to understand and incorporate strategies for effective critical thinking into their practice. Utilizing applicable cognitive psychological theory, the relevant literature on teaching clinical reasoning is reviewed, and specific strategies to effectively teach clinical reasoning and critical thinking in the ICU and other clinical settings are provided. Definitions, operational descriptions, and justifications for a variety of teaching interventions are discussed, including the "one-minute preceptor" model, the use of concept or mechanism maps, and cognitive de-biasing strategies.
3549. Circulating Plasma Biomarkers of Survival in Antifibrotic-Treated Patients With Idiopathic Pulmonary Fibrosis.
作者: Ayodeji Adegunsoye.;Shehabaldin Alqalyoobi.;Angela Linderholm.;Willis S Bowman.;Cathryn T Lee.;Janelle Vu Pugashetti.;Nandini Sarma.;Shwu-Fan Ma.;Angela Haczku.;Anne Sperling.;Mary E Strek.;Imre Noth.;Justin M Oldham.
来源: Chest. 2020年158卷4期1526-1534页
A number of circulating plasma biomarkers have been shown to predict survival in patients with idiopathic pulmonary fibrosis (IPF), but most were identified before the use of antifibrotic (AF) therapy in this population. Because pirfenidone and nintedanib have been shown to slow IPF progression and may prolong survival, the role of such biomarkers in AF-treated patients is unclear.
3550. Sensitivity and Safety of Electromagnetic Navigation Bronchoscopy for Lung Cancer Diagnosis: Systematic Review and Meta-analysis.
作者: Erik E Folch.;Gonzalo Labarca.;Daniel Ospina-Delgado.;Fayez Kheir.;Adnan Majid.;Sandeep J Khandhar.;Hiren J Mehta.;Michael A Jantz.;Sebastian Fernandez-Bussy.
来源: Chest. 2020年158卷4期1753-1769页
Bronchoscopy is a useful tool for the diagnosis of lesions near central airways; however, the diagnostic accuracy of these procedures for peripheral pulmonary lesions (PPLs) is a matter of ongoing debate. In this setting, electromagnetic navigation bronchoscopy (ENB) is a technique used to navigate and obtain samples from these lesions. This systematic review and meta-analysis aims to explore the sensitivity of ENB in patients with PPLs suspected of lung cancer.
3551. Differential Effect of School-Based Pollution Exposure in Children With Asthma Born Prematurely.
作者: Jonathan M Gaffin.;Marissa Hauptman.;Carter R Petty.;Mehtap Haktanir-Abul.;Sigfus Gunnlaugsson.;Peggy S Lai.;Sachin N Baxi.;Perdita Permaul.;William J Sheehan.;Jack M Wolfson.;Brent A Coull.;Diane R Gold.;Petros Koutrakis.;Wanda Phipatanakul.
来源: Chest. 2020年158卷4期1361-1363页 3552. Gastroesophageal Reflux Poses a Potential Risk for Late Complications of Bronchopulmonary Dysplasia: A Prospective Cohort Study.
作者: Luo-Jia Wang.;Yu Hu.;Wei Wang.;Chun-Yan Zhang.;Yu-Zuo Bai.;Shu-Cheng Zhang.
来源: Chest. 2020年158卷4期1596-1605页
Bronchopulmonary dysplasia (BPD) is the most common respiratory disorder in extremely low birth weight infants. Although most symptoms of BPD improve, some late complications exist, even with regular treatment. Gastroesophageal reflux (GER), also common in extremely premature infants, may be related to many cardiorespiratory symptoms. However, the potential of GER as a risk factor for late complications associated with BPD is still unclear.
3553. CPAP Adherence, Mortality, and Progression-Free Survival in Interstitial Lung Disease and OSA.
作者: Ayodeji Adegunsoye.;Julie M Neborak.;Daisy Zhu.;Benjamin Cantrill.;Nicole Garcia.;Justin M Oldham.;Imre Noth.;Rekha Vij.;Tomasz J Kuzniar.;Shashi K Bellam.;Mary E Strek.;Babak Mokhlesi.
来源: Chest. 2020年158卷4期1701-1712页
OSA, a common comorbidity in interstitial lung disease (ILD), could contribute to a worsened course if untreated. It is unclear if adherence to CPAP therapy improves outcomes.
3554. A Systematic Review of the Effect of Delayed Appropriate Antibiotic Treatment on the Outcomes of Patients With Severe Bacterial Infections.
作者: Evan J Zasowski.;Matteo Bassetti.;Francesco Blasi.;Herman Goossens.;Jordi Rello.;Giovanni Sotgiu.;Lara Tavoschi.;Mick R Arber.;Rachael McCool.;Jacoby V Patterson.;Christopher M Longshaw.;Sara Lopes.;Davide Manissero.;Sean T Nguyen.;Keiko Tone.;Stefano Aliberti.
来源: Chest. 2020年158卷3期929-938页
Patients with severe bacterial infections often experience delay in receiving appropriate treatment. Consolidated evidence of the impact of delayed appropriate treatment is needed to guide treatment and improve outcomes.
3555. Vaping-Related Acute Parenchymal Lung Injury: A Systematic Review.
The outbreak of vaping-related acute lung injury in the United States, named EVALI (e-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature revealed 216 patient cases that spanned 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, and pathologic patterns of lung injury that are attributable to vaping and provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most commonly vaped substance, and vitamin E acetate was found in BAL specimens from many affected individuals. However, no specific component or contaminant has been identified conclusively to date as the cause for the injury. Patients present with cough, dyspnea, constitutional symptoms, and GI symptoms. Radiologic and histopathologic findings demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the keys to an accurate diagnosis. Treatment is supportive; the mortality rate is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease, but more rigorous studies are needed to clarify their role in the treatment of vaping-related lung injury.
3556. Screening Adherence in the Veterans Administration Lung Cancer Screening Demonstration Project.
作者: Nichole T Tanner.;Paul Bradley Brasher.;Barbara Wojciechowski.;Ralph Ward.;Christopher Slatore.;Mulugeta Gebregziabher.;Gerard A Silvestri.
来源: Chest. 2020年158卷4期1742-1752页
Adherence to annual low-dose CT was 95% in the National Lung Screening Trial and must be replicated to achieve mortality benefit from screening.
3557. Serum IgG Levels and Risk of COPD Hospitalization: A Pooled Meta-analysis.
作者: Fernando Sergio Leitao Filho.;Andre Mattman.;Robert Schellenberg.;Gerard J Criner.;Prescott Woodruff.;Stephen C Lazarus.;Richard K Albert.;John Connett.;Meilan K Han.;Steven E Gay.;Fernando J Martinez.;Anne L Fuhlbrigge.;James K Stoller.;Neil R MacIntyre.;Richard Casaburi.;Philip Diaz.;Ralph J Panos.;J Allen Cooper.;William C Bailey.;David C LaFon.;Frank C Sciurba.;Richard E Kanner.;Roger D Yusen.;David H Au.;Kenneth C Pike.;Vincent S Fan.;Janice M Leung.;Shu-Fan Paul Man.;Shawn D Aaron.;Robert M Reed.;Don D Sin.
来源: Chest. 2020年158卷4期1420-1430页
Hypogammaglobulinemia (serum IgG levels < 7.0 g/L) has been associated with increased risk of COPD exacerbations but has not yet been shown to predict hospitalizations.
3558. Pressure-Support Ventilation vs T-Piece During Spontaneous Breathing Trials Before Extubation Among Patients at High Risk of Extubation Failure: A Post-Hoc Analysis of a Clinical Trial.
作者: Arnaud W Thille.;Rémi Coudroy.;Mai-Anh Nay.;Arnaud Gacouin.;Alexandre Demoule.;Romain Sonneville.;François Beloncle.;Christophe Girault.;Laurence Dangers.;Alexandre Lautrette.;Quentin Levrat.;Anahita Rouzé.;Emmanuel Vivier.;Jean-Baptiste Lascarrou.;Jean-Damien Ricard.;Keyvan Razazi.;Guillaume Barberet.;Christine Lebert.;Stephan Ehrmann.;Alexandre Massri.;Jeremy Bourenne.;Gael Pradel.;Pierre Bailly.;Nicolas Terzi.;Jean Dellamonica.;Guillaume Lacave.;René Robert.;Stéphanie Ragot.;Jean-Pierre Frat.; .
来源: Chest. 2020年158卷4期1446-1455页
Spontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs.
3559. Clinical Characteristics and Outcomes of 421 Patients With Coronavirus Disease 2019 Treated in a Mobile Cabin Hospital.
作者: Wei Wang.;Can Xin.;Zhongwei Xiong.;Xixi Yan.;Yuankun Cai.;Keyao Zhou.;Chuanshun Xie.;Tingbao Zhang.;Xiaohui Wu.;Kui Liu.;Zhiqiang Li.;Jincao Chen.
来源: Chest. 2020年158卷3期939-946页
In December 2019, a novel coronavirus-associated pneumonia, now known as coronavirus disease 2019 (COVID-19), was first detected in Wuhan, China. To prevent the rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and treat patients with mild symptoms, sports stadiums and convention centers were reconstructed into mobile hospitals.
3560. The Lung Function Laboratory to Assist Clinical Decision-making in Pulmonology: Evolving Challenges to an Old Issue.
The lung function laboratory frequently provides relevant information to the practice of pulmonology. Clinical interpretation of pulmonary function and exercise tests, however, has been complicated more recently by temporal changes in demographic characteristics (higher life expectancy), anthropometric attributes (increased obesity prevalence), and the surge of polypharmacy in a sedentary population with multiple chronic degenerative diseases. In this narrative review, we concisely discuss some key challenges to test interpretation that have been affected by these epidemiologic shifts: (a) the confounding effects of advanced age and severe obesity, (b) the contemporary controversies in the diagnosis of obstruction (including asthma and/or COPD), (c) the importance of considering the diffusing capacity of the lung for carbon monoxide (Dlco)/"accessible" alveolar volume (carbon monoxide transfer coefficient) in association with Dlco to uncover the causes of impaired gas exchange, and (d) the modern role of the pulmonary function laboratory (including cardiopulmonary exercise testing) in the investigation of undetermined dyspnea. Following a Bayesian perspective, we suggest interpretative algorithms that consider the pretest probability of abnormalities as indicated by additional clinical information. We, therefore, adopt a pragmatic approach to help the practicing pulmonologist to apply the information provided by the lung function laboratory to the care of individual patients.
|