Annals of the American Thoracic Society最新文献

{"title":"Effectiveness and Implementation of A Clinical Risk Score for Early Diagnosis of Tuberculosis in Uganda: A Pragmatic, Clustered Randomization Clinical Trial.","authors":"Yeonsoo Baik, Muhammad Musoke, Amon Twinamasiko, Maureen Lamunu, Vivian Nabacwa, Agnes Sanyu, Katherine O Robsky, Joowhan Sung, Alex Kityamuwesi, Achilles Katamba, David W Dowdy","doi":"10.1513/AnnalsATS.202404-422OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202404-422OC","url":null,"abstract":"<p><p>Background Undertreatment of tuberculosis (TB) is common in resource-limited settings where same-day microbiological diagnosis is unavailable. We evaluated if a simple clinical risk score for predicting active TB could facilitate treatment initiation among individuals at high risk for TB. Methods We conducted a pragmatic, implementation-effectiveness study in peri-urban primary health clinics in Uganda. Four intervention clinics were paired with standard-of-care comparison clinics. Providers in intervention clinics were trained to use the score and set a threshold score for considering same-day treatment initiation; treatment decisions were at the providers' discretion. Our primary effectiveness outcome was the change in the proportion of individuals with confirmed TB who started on treatment within seven days of presentation, comparing pre-intervention and post-intervention periods. Results Among intervention clinics, 594/720 (83%) people diagnosed with TB started treatment within seven days during the pre-intervention period, versus 264/316 (84%) after implementation (pre-post difference 1%; 95% confidence interval [95%CI]: -6, 8%). In comparison clinics, seven-day treatment initiation changed from 312/363 (86%) pre-intervention to 153/211 (73%) post-intervention (pre-post difference -13%; 95%CI: -22, -5%). A difference-in-differences estimate was 14% (95%CI: 10, 19%). In intervention clinics, 1,206 of 1,826 (66%) people presenting with TB symptoms were administered the risk score. 229 (19%) had a score above the treatment threshold and 105 (46%) initiated treatment on the same day. Conclusions An easy-to-use clinical risk score did not increase seven-day empiric treatment initiation in intervention clinics. However, it improved rapid treatment initiation relative to clinics using the prevailing standard-of-care. The score was also highly acceptable to clinical providers. Clinical trial registration available at www.clinicaltrials.gov, ID: __NCT05122624 __________.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COPD and Inhaled Treatment Effects on Mortality in Lung Cancer Patients.","authors":"Jinwoo Lee, Jiyu Sun, Hyun Woo Lee","doi":"10.1513/AnnalsATS.202409-990OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202409-990OC","url":null,"abstract":"<p><strong>Introduction: </strong>In lung cancer patients, the impact of COPD diagnosis and subsequent management on mortality remains uncertain, as evidence supporting the efficacy of inhaled therapies in improving clinical outcomes in this population is limited. This study aims to assess whether COPD worsens outcomes in lung cancer patients and to investigate whether inhaled treatments for COPD can improve these outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study used the Korea Central Cancer Registry (K-CURE) database from 2012 to 2019. Lung cancer patients aged 40 and older with health screening records were included. Patients were classified into COPD and non-COPD groups, and within the COPD group, further classified based on inhaled therapy status. The primary outcome was all-cause mortality, and secondary outcomes included healthcare resource utilization. Subgroup analyses were conducted based on lung cancer stage, histologic subtypes, and treatment modalities.</p><p><strong>Results: </strong>Among 113,071 lung cancer patients, 38,145 (33.7%) had COPD. COPD was associated with higher all-cause mortality (adjusted HR=1.327, 95% CI=1.305-1.350, P-value<0.001), increased use of steroids, antibiotics, higher rates of hospital admissions, and more frequent emergency room visits. COPD patients receiving inhaled treatment had lower mortality rates at the 3-month landmark (adjusted HR=0.934, 95% CI=0.895-0.975, P-value=0.002). Notably, the dual bronchodilator combination (LABA/LAMA) was associated with a significant mortality reduction, as observed across multiple landmark time points.</p><p><strong>Conclusions: </strong>COPD is linked to worse clinical outcomes in lung cancer patients. Among the inhaled treatments, the LABA/LAMA dual therapy showed a beneficial effect on mortality, while adding ICS as part of triple therapy did not provide an additional survival benefit. This study suggests the importance of early COPD detection and timely initiation of inhaled therapy in patients with lung cancer.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Pediatric Asthma Disparities through RI-AIR's Community Approach: A Randomized Trial.","authors":"Elizabeth L McQuaid, David Barker, Elizabeth S Chen, Maria T Coutinho, Grace K Cushman, Linnea Drew, A Rani Elwy, Cynthia A Esteban, Barbara N Jandasek, Sheryl J Kopel, Deborah Pearlman, Ronald Seifer, Patrick Vivier, Daphne Koinis-Mitchell","doi":"10.1513/AnnalsATS.202501-016OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-016OC","url":null,"abstract":"<p><strong>Rationale: </strong>Clustering of social and environmental risks in low-income neighborhoods is a key factor in racial and ethnic asthma disparities. Integrating school and in-home programs, with treatment tailored to disease risk, is a promising approach for children with high disease burden.</p><p><strong>Objectives: </strong>We evaluated the Rhode Island-Asthma Integrated Response (RI-AIR) Program in improving asthma outcomes at the individual and community levels. RI-AIR leverages existing community collaborations and technological advances to identify children with asthma at highest risk for poor outcomes through a system of identification, screening, and intervention.</p><p><strong>Methods: </strong>We conducted a stepped wedge cluster randomized hybrid type-II effectiveness-implementation study. School-based catchment areas (n=32) of high asthma burden were identified using geospatial mapping of asthma-related urgent healthcare use from 2010-2018. Families received only school-based interventions if the child's asthma was Not Well Controlled or school and home-based interventions if the child's asthma was Poorly Controlled. Community Health Workers facilitated communication between families, schools, and healthcare providers. Follow-ups occurred every 3 months to 1-year post-intervention.</p><p><strong>Results: </strong>Individual level: At 3-months, asthma control (primary outcome) improved (d=0.47 [95% confidence interval = 0.33; 0.61]) and symptom-free days increased (d=0.37 [0.24; 0.51]); both were sustained at 12 months. Community level: Healthcare utilization remained the same or increased (RR = 1.16 [1.00; 1.36]); however, sensitivity analyses indicated utilization was slightly lower in areas with greater family participation (penetration; active=0.93 [0.87; 0.99]; post=0.91 [0.86; 0.97]).</p><p><strong>Conclusions: </strong>Intensive, multi-component interventions and community engagement are needed to improve asthma outcomes in areas of high burden.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Donor Utilization Decisions: A Data-free Zone.","authors":"Tijana Milinic, Kathleen J Ramos","doi":"10.1513/AnnalsATS.202506-646ED","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202506-646ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Link Between Job Mobility, Health Insurance, and Health Related Financial Outcomes in People with Cystic Fibrosis.","authors":"Ryan C Perkins, Laura F Garabedian, Gregory S Sawicki","doi":"10.1513/AnnalsATS.202503-276RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202503-276RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure to Violence and Asthma Endotypes in Puerto Rican Youth.","authors":"Kristina Gaietto, Molin Yue, Yueh Ying Han, Franziska J Rosser, Glorisa Canino, Erick Forno, Wei Chen, Juan C Celedón","doi":"10.1513/AnnalsATS.202502-151OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202502-151OC","url":null,"abstract":"<p><strong>Background and objectives: </strong>Exposure to violence has been associated asthma and worse asthma outcomes in youth, but no study has tested for an association between exposure to violence and specific asthma endotypes including T helper (T)2-low endotypes. We sought to determine if exposures to violence are associated with T2-high, T17-high, and T2-low/T17-low endotypes.</p><p><strong>Methods: </strong>We analyzed data from Puerto Rican youth aged 9-20 years with (cases) and without (controls) asthma in the Epigenetic Variation and Childhood Asthma in Puerto Ricans study (EVA-PR). Using nasal (airway) epithelial transcriptomic profiles, participants with asthma were categorized into T2-high, T17-high, or T2-low/T17-low endotypes. Lifetime exposure to violence (ETV), past year ETV, and gun violence exposure (assessed using the validated ETV Scale questionnaire) and violence-related distress, assessed using the validated Checklist Children's Distress Symptoms questionnaire, were our exposures of interest, and asthma endotype was our outcome of interest.</p><p><strong>Results: </strong>There were 236 cases (69 (29%) T2-high, 82 (35%) T17-high, and 85 (36%) T2-low/T17-low) and 243 controls. In multivariable analyses, ETV was associated with T17-high asthma (odds ratio [OR]=1.13, 95% confidence interval [CI]=1.002-1.274), gun violence exposure was associated with both T2-high asthma (OR=2.49, 95% CI=1.22-5.08) and T17-high asthma (OR=1.99, 95% CI=1.05-3.74), and violence-related distress was associated with T2-high asthma (OR=1.69, 95% CI=1.11-2.59). Neither exposure to violence nor related distress was associated with T2-low/T17-low asthma.</p><p><strong>Conclusions: </strong>Exposure to violence or related distress was associated with T2-high asthma and T17-high asthma, but not T2-low/T17-low asthma in Puerto Rican youth, a minoritized population with high asthma burden.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Every Person with Asthma Need an Inhaled Corticosteroid?","authors":"Harold J Farber","doi":"10.1513/AnnalsATS.202501-058VP","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-058VP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multidisciplinary Survey Comparing Academic and Community Critical Care Clinicians' ARDS Practice and the COVID-19 Pandemic.","authors":"Diane Masket, Carey C Thomson, Andre Carlos Kajdacsy-Balla Amaral, Catherine L Hough, Nicholas J Johnson, David A Kaufman, Jonathan M Siner, Jennifer P Stevens, Lipisha Agarwal, Peymaan Banankhah, Marcel Casasola, Adriana Flores, Brenda D Garcia, Joseph Khoory, Giulia Paliotti, Arashdeep Rupal, Harpreet Singh, Alex Walker, Joe Watson, Curtis H Weiss","doi":"10.1513/AnnalsATS.202501-089OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-089OC","url":null,"abstract":"<p><strong>Rationale: </strong>Barriers to recognizing and treating acute respiratory distress syndrome (ARDS) exist. Prior studies have not investigated whether these barriers differ between academic and community settings, nor whether there were differences in critical care clinicians' reported ARDS management strategies during the COVID-19 pandemic.</p><p><strong>Objectives: </strong>Grounded in the Consolidated Framework for Implementation Research, we sought to determine whether there are differences between academic and community critical care clinicians in their team- and ICU-based culture; interprofessional communication; knowledge, attitudes, and perceived barriers to ARDS recognition and management; and their ICU organization and ARDS management associated with the COVID-19 pandemic.</p><p><strong>Methods: </strong>Multidisciplinary survey from September, 2020 to April, 2021 of critical care physicians, nurses, advanced practice providers, and respiratory therapists (RTs) in six academic and nine community hospitals across the United States and Canada. Individual item and cumulative domain scores were compared between academic and community clinicians. Statistical adjustment was performed for multiple comparisons.</p><p><strong>Results: </strong>1,906 clinicians responded to at least one survey item (53% response rate). Mean (SD) culture scores were higher for community physicians vs. academic physicians (5.3 [1.8] vs. 4.4 [2.0], <i>P</i><0.001) and community nurses vs. academic nurses (4.4 [2.2] vs. 3.8 [2.1], <i>P</i>=0.007). Academic nurses and RTs had higher knowledge scores compared to community nurses and RTs (<i>P</i><0.001 for each comparison). Community physicians, nurses, and RTs reported higher mean (SD) number of changes in ICU organization and practice during the COVID-19 pandemic compared to academic clinicians (e.g., community physicians: 13.7 [2.7] changes vs. academic physicians: 11.8 [4.3] changes, <i>P</i>=0.001). While academic physicians, nurses, and RTs were approximately twice as likely to care for ARDS patients daily or several days per week compared to community clinicians, ARDS management, attitudes, and belief in evidence was similar between academic and community clinicians in most respects.</p><p><strong>Conclusions: </strong>A large, multidisciplinary survey identified differences between academic and community critical care clinicians' culture and knowledge in the care of ARDS patients. The COVID-19 pandemic had a greater impact on community ICU organization and ARDS management. Multifaceted implementation strategies should target implementation barriers differently in academic and community settings.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Mellitus and Lung Cancer Screening Outcomes in the National Lung Screening Trial.","authors":"Robert P Young, Ralph C Ward, Raewyn J Scott, Gerard A Silvestri","doi":"10.1513/AnnalsATS.202411-1235OC","DOIUrl":"10.1513/AnnalsATS.202411-1235OC","url":null,"abstract":"<p><strong>Background: </strong>Current eligibility criteria for lung cancer (LC) screening are derived from randomized controlled trials and largely based on age and smoking history. However, the individualised benefits of screening are highly variable and may be mediated by the presence of co-existing comorbid disease, including diabetes mellitus (DM). This study examines in detail screening outcomes for those reporting a prior diagnosis of DM.</p><p><strong>Methods: </strong>This was a secondary analysis of 53,452 high-risk subjects from the National Lung Screening Trial (NLST), and compared outcomes following screening with computed tomography (CT) or chest x-ray (CXR) stratified according to DM status. Models of LC mortality were derived after adjustment and LC rate ratios (per 1000 person years), including 95% Confidence Intervals (95% CI), were examined according to screening arm and DM status.</p><p><strong>Findings: </strong>Compared to those without DM, DM subjects (N=5,174, 9.7%) had a 2-fold greater baseline cardiovascular comorbidity (p<0.0001), 2-fold greater non-LC mortality (p<0.0001) and greater LC lethality (p=0.02), with more late-stage lung cancer (p=0.03). We found comparable stage shift and surgical rates, favouring those randomised to CT relative to CXR, for both DM and non-DM subgroups. However, we found no reduction in LC mortality for DM subjects favouring CT (2.2% vs 2.1% respectively, Rate ratio per 1000 person years (RR)=1.03, 95%CI 0.71-1.49, p=0.89), contrasting with non-DM subjects (RR=0.83, 95%CI 0.73-0.95, p=0.006)(p for interaction 0.28). In a modified Cox-Proportional Hazard model for dying of lung cancer by screening arm, adjusting for relevant co-variables, DM was associated with a hazard ratio (HR)=1.03, 95%CI=0.71-1.50, p=0.88) compared to non-DM (HR=0.82, 95%CI=0.72-0.94, p=0.003). LC mortality for those randomised to CT was greater for DM vs non-DM subjects (2.2% vs 1.6%, RR=1.35 (95% CI 1.02-1.79, p=0.033) but no different for CXR (2.1% vs 2.0%, RR=1.09 (95% CI 0.82-1.44, p=0.55).</p><p><strong>Interpretation: </strong>The significant reduction in LC mortality favouring CT-based screening found in non-DM subjects was not observed in those reporting DM. While study design (under-powering), collider/confounder effects (bias) and newer treatment modalities remain possible limitations, the findings from this clinical trial data support simulation studies suggesting LC screening outcomes may be attenuated by comorbidity such as DM.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Race and Preferred Language Influence the Use of Physical Restraints in Non-intubated ICU Patients.","authors":"Samuel K McGowan, Hayley B Gershengorn, Andrew Sudler, Edie Espejo, John Boscardin, Lingsheng Li, Alexander K Smith, Deepshikha C Ashana, Karthik Raghunathan, Shannen Kim, Teva Brender, Kristen Vossler, Mary Han, Julien Cobert","doi":"10.1513/AnnalsATS.202411-1143OC","DOIUrl":"10.1513/AnnalsATS.202411-1143OC","url":null,"abstract":"<p><strong>Rationale: </strong>Physical limb restraints are commonly used in intensive care units (ICUs) to protect patients and staff but are associated with increased morbidity. While many intubated patients in the US are physically restrained, predictors for restraints in non-intubated patients remain less clear.</p><p><strong>Objective: </strong>To identify whether patient race, ethnicity, and preferred language are associated with restraint use in non-intubated patients across multiple ICUs in a large US hospital system.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using electronic health record (EHR) data across five ICUs within the University of California, San Francisco from 2013-2022. We included adults ≥18 years of age. We excluded patients who received mechanical ventilation during their ICU stay. Our primary independent variables were primary language and race. The outcome of interest was restraint use, defined as at least one restraint order placed during the patient's ICU stay. We modeled any restraint use using a multivariable logistic regression adjusted for sociodemographic and clinical covariates and explored interactions of our two primary exposures using sensitivity analyses and Wald testing.</p><p><strong>Results: </strong>Across 22,259 unique ICU admissions, we identified 11,676 non-ventilated patients. Of these, 2,411 (20%) received an order for physical restraints. In a multivariable regression model, compared to English language, Chinese language (All Dialects) (OR 1.57 [95% CI 1.31, 1.87]) and a language other than Chinese, English or Spanish (OR 1.60 [95% CI 1.36, 1.89]) were associated with increased use of restraints. Patients identifying as Black or African American were also more likely to be restrained at least once during the encounter (OR 1.51 [95% CI 1.27 - 1.79]) compared to Non-Hispanic White patients. Dialysis (OR 9.15 [95% CI 7.74, 10.83]), tube feeds (OR 4.65 [95% CI 3.44, 6.29]), and SOFA score (OR 1.17 [95% CI 1.15, 1.19] per 1 point increase) also independently increased odds of restraint use.</p><p><strong>Conclusions: </strong>Patients preferring a language other than English or Spanish and those identifying as Black are more likely to be restrained in the ICU when not intubated. Interventions to minimize the use of unnecessary physical restraints could improve an inequity known to be associated with downstream harms.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}