CHEST pulmonary最新文献_第7页

Pulmonary Manifestations of Inflammatory Bowel Disease and Treatment Strategies 炎症性肠病的肺部表现和治疗策略

CHEST pulmonary Pub Date : 2023-12-01 DOI: 10.1016/j.chpulm.2023.100018

Subha Ghosh MD, MBA , Himanshu Deshwal MD , Rebecca Haraf MD , Shine Raju MD , Mnahi Bin Saeedan MBBS, MPH , Pralay Sarkar MD, FCCP , Thomas Gildea MD , Carol F. Farver MD , Atul C. Mehta MD, FCCP

{"title":"Pulmonary Manifestations of Inflammatory Bowel Disease and Treatment Strategies","authors":"Subha Ghosh MD, MBA , Himanshu Deshwal MD , Rebecca Haraf MD , Shine Raju MD , Mnahi Bin Saeedan MBBS, MPH , Pralay Sarkar MD, FCCP , Thomas Gildea MD , Carol F. Farver MD , Atul C. Mehta MD, FCCP","doi":"10.1016/j.chpulm.2023.100018","DOIUrl":"10.1016/j.chpulm.2023.100018","url":null,"abstract":"<div><h3>Topic Importance</h3><p>Ulcerative colitis and Crohn’s disease are multisystem illnesses that primarily affect the gut, but present with various extraintestinal manifestations. The pathogenesis behind these clinical features is poorly understood, and pulmonary manifestations of inflammatory bowel disease (IBD) are no exception. Research has suggested an intricate interplay between the mucosal immune system and the microbiotic environment between the gut and the lung, often termed the <em>gut-lung axis</em>. This dysregulated communication is demonstrated in a wide range of pulmonary complications involving the large and small airways, lung parenchyma, serosal tissues, and pulmonary vasculature; fistulous connection between the gastrointestinal tract and thoracic cavity; and drug toxicities. Most of these diseases have been well documented in case reports to respond to corticosteroid treatment regimens. However, a notable lack of treatment recommendations guiding the dosage and duration of steroid use and managing the disease refractory to therapy are available. In addition, the progressive and debilitating disease often remains a therapeutic challenge.</p></div><div><h3>Review Findings</h3><p>This review sheds light on the different strategies documented to treat the spectrum of pulmonary complications of IBD, including novel therapeutic approaches using immunomodulatory therapy, and summarizes their clinical and radiologic features with pathologic correlation.</p></div><div><h3>Summary</h3><p>Although their existence is well documented, further research is needed to develop evidence-based guidelines for diagnosing, managing, and preventing pulmonary complications of IBD.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"1 3","pages":"Article 100018"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000181/pdfft?md5=08e6072816e229b0f88a7156fcc4b9e9&pid=1-s2.0-S2949789223000181-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acquisition of Cardiac Point-of-Care Ultrasound Images With Deep Learning 心脏护理点超声图像的深度学习获取

CHEST pulmonary Pub Date : 2023-12-01 DOI: 10.1016/j.chpulm.2023.100023

Evan Baum MD , Megha D. Tandel MPH , Casey Ren MD , Yingjie Weng MS , Matthew Pascucci MD , John Kugler MD , Kathryn Cardoza MD , Andre Kumar MD, MEd

{"title":"Acquisition of Cardiac Point-of-Care Ultrasound Images With Deep Learning","authors":"Evan Baum MD , Megha D. Tandel MPH , Casey Ren MD , Yingjie Weng MS , Matthew Pascucci MD , John Kugler MD , Kathryn Cardoza MD , Andre Kumar MD, MEd","doi":"10.1016/j.chpulm.2023.100023","DOIUrl":"10.1016/j.chpulm.2023.100023","url":null,"abstract":"<div><h3>Background</h3><p>Point-of-care ultrasonography (POCUS) machines may use deep learning, a subfield of artificial intelligence (AI), to improve image interpretation and acquisition in real time. The impact of AI on POCUS learning is unknown.</p></div><div><h3>Research Question</h3><p>Do AI-enhanced devices equipped with deep learning aid in cardiac image acquisition and interpretation among POCUS novices?</p></div><div><h3>Study Design and Methods</h3><p>We conducted a single-center investigation from 2021 through 2022. Internal medicine trainees (N = 43) with limited POCUS experience were randomized to receive a POCUS device with (Echonous; n = 22) or without (Butterfly; n = 21) AI functionality for 2 weeks while on inpatient rotations. AI device functionality included guidance for optimal probe placement to acquire an apical four-chamber (A4C) view and ejection fraction estimations based on deep learning. Participants used the devices at their discretion for patient-related care after randomization. The primary outcome was the time to acquire A4C images on a standardized patient. Secondary outcomes included A4C image quality using a validated scale, image quiz performance, and attitudes. Measurements were performed at randomization and at 2-week follow-up using the same standardized patient.</p></div><div><h3>Results</h3><p>Both AI and non-AI groups showed similar scan times and image quality scores at baseline. At follow-up, the AI group showed faster scan times (57 s [interquartile range (IQR), 32-75 s] vs 85 s [IQR, 50-172 s]; <em>P</em> = .01), higher image quality scores (4.5 [IQR, 2-5.5] vs 2 [IQR, 1-3]; <em>P</em> < .01), and more accurately identified reduced systolic function on the image quiz (85% vs 50%; <em>P</em> = .02) vs the non-AI group. The AI group used the devices more than the non-AI group (median, 5.5 times [IQR, 4-10 times] vs 2 times [IQR, 0-4 times]; <em>P</em> < .01). Trust in the AI features did not change during the intervention.</p></div><div><h3>Interpretation</h3><p>POCUS devices with deep learning functionality may improve A4C image acquisition and interpretation by novices. Future studies are needed to determine the extent that AI impacts POCUS learning.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"1 3","pages":"Article 100023"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000235/pdfft?md5=f2f40d80c3cfa78dc9225371899bac67&pid=1-s2.0-S2949789223000235-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Hurdles to Annual Low-Dose Chest CT Scan Adherence for Lung Cancer Screening Parallel Those to Initial Low-Dose Chest CT Scan Uptake 坚持每年进行低剂量胸部 CT 扫描以筛查肺癌的障碍与坚持首次低剂量胸部 CT 扫描的障碍并存

CHEST pulmonary Pub Date : 2023-12-01 DOI: 10.1016/j.chpulm.2023.100027

Alireza Nathani MD, Abbie Begnaud MD

引用次数: 0

Automated CT-Based Quantification of Pulmonary Veins Shows Greater Central Venous Dilation in Group 2 Pulmonary Hypertension Compared With Group 1 Pulmonary Arterial Hypertension and Control Subjects 基于自动ct的肺静脉定量显示，与1组肺动脉高压和对照组相比，2组肺动脉高压患者中心静脉扩张更大

CHEST pulmonary Pub Date : 2023-12-01 DOI: 10.1016/j.chpulm.2023.100020

Andrew J. Synn MD, MPH , Eileen M. Harder MD , Pietro Nardelli PhD , James C. Ross PhD , Bradley A. Maron MD , Jane A. Leopold MD , Aaron B. Waxman MD, PhD , Raúl San José Estépar PhD , George R. Washko MD , Farbod N. Rahaghi MD, PhD

引用次数: 0

Experiences With Tobacco Dependence Treatment Training Among Respiratory Care Clinicians 呼吸内科医师烟草依赖治疗培训的体会

CHEST pulmonary Pub Date : 2023-12-01 DOI: 10.1016/j.chpulm.2023.100022

Lorraine Mascarenhas DO , Megan Campbell MPH , Hildi Hagedorn PhD , Steven S. Fu MD, MSCE , Anne C. Melzer MD, MS

引用次数: 0

Changes in National Prescribing Trends of Pharmacotherapy to Treat Tobacco and Nicotine Dependence in Relationship to the COVID-19 Pandemic 治疗烟草和尼古丁依赖的药物疗法的全国处方趋势变化与 COVID-19 大流行的关系

CHEST pulmonary Pub Date : 2023-11-23 DOI: 10.1016/j.chpulm.2023.100031

Adam Edward Lang PharmD , Tiffany Lee PhD, MPH , Mark Eatherly BS , Urvashi Patel PharmD , Chester B. Good MD, MPH

引用次数: 0

Respiratory Syncytial Virus Prophylaxis With Palivizumab Is Not Associated With Improved Lung Function in Infants of Very Low Birth Weight at Early School Age 使用帕利珠单抗预防呼吸道合胞病毒与学龄前极低出生体重儿肺功能的改善无关

CHEST pulmonary Pub Date : 2023-11-07 DOI: 10.1016/j.chpulm.2023.100026

Ingmar Fortmann , Marie-Theres Dammann , Alexander Humberg , Hannah Kraft , Alexander Herz , Kathrin Hanke , Kirstin Faust , Isabell Ricklefs , Michael Zemlin , Johannes Liese , Geraldine Engels , Christoph Härtel , Carsten Fortmann-Grote , Matthias Volkmar Kopp , Folke Brinkmann , Egbert Herting , Wolfgang Göpel , Guido Stichtenoth , for the German Neonatal Network

{"title":"Respiratory Syncytial Virus Prophylaxis With Palivizumab Is Not Associated With Improved Lung Function in Infants of Very Low Birth Weight at Early School Age","authors":"Ingmar Fortmann , Marie-Theres Dammann , Alexander Humberg , Hannah Kraft , Alexander Herz , Kathrin Hanke , Kirstin Faust , Isabell Ricklefs , Michael Zemlin , Johannes Liese , Geraldine Engels , Christoph Härtel , Carsten Fortmann-Grote , Matthias Volkmar Kopp , Folke Brinkmann , Egbert Herting , Wolfgang Göpel , Guido Stichtenoth , for the German Neonatal Network","doi":"10.1016/j.chpulm.2023.100026","DOIUrl":"10.1016/j.chpulm.2023.100026","url":null,"abstract":"<div><h3>Background</h3><p>Prematurity and infection with respiratory syncytial virus (RSV) are major risk factors for impaired lung function beyond the neonatal period.</p></div><div><h3>Research Question</h3><p>What are the long-term effects of palivizumab immunoprophylaxis in the first year of life on lung function and frequency of bronchitis episodes in 5- to 6-year-old preterm infants?</p></div><div><h3>Study Design and Methods</h3><p>Preterm infants with a birth weight < 1,500 g (very low-birth weight infants [VLBWIs]) were enrolled in a German Neonatal Network cohort study between 2009 and 2016. Children were examined by a single follow-up team at 5 to 6 years of age. VLBWIs who received at least five doses of palivizumab were compared with children who never received palivizumab. Analyses were stratified by bronchopulmonary dysplasia (BPD) and gestational age. We analyzed FVC, FEV<sub>1</sub>, FEV<sub>1</sub> to FVC ratio, and the risk of respiratory tract infections at 5 to 6 years of age via univariate analyses and linear and logistic regression models.</p></div><div><h3>Results</h3><p>Of 1,986 VLBWIs with follow-up at 5 to 6 years of age, 951 infants (48%) received immunoprophylaxis with palivizumab. Children with BPD (n = 1,019) showed a much lower FEV<sub>1</sub> than children without BPD (median FEV<sub>1</sub> <em>z</em> score, –1.51 vs –1.09; <em>P</em> < .001). However, FEV<sub>1</sub> in children with BPD was not altered by palivizumab (median FEV<sub>1</sub> <em>z</em> score in 698 children with BPD who received palivizumab, –1.57 [interquartile range, –0.75 to –2.43] vs in 320 children with BPD who did not receive palivizumab, –1.37 [interquartile range, –0.69 to –2.25]; <em>P</em> = .1). As for FEV<sub>1</sub>, we did not find any protective effects of palivizumab for other end points or in other risk groups.</p></div><div><h3>Interpretation</h3><p>Palivizumab immunoprophylaxis in VLBWIs is not associated with improved lung function or lower rates of respiratory tract infections in early school-age infants.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100026"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000260/pdfft?md5=6bd3d313db74a7149105b66f5c8408f9&pid=1-s2.0-S2949789223000260-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135510209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A 29-Year-Old With Iron Deficiency and Multifocal Cerebral Infarcts 29岁，缺铁伴多灶性脑梗死

CHEST pulmonary Pub Date : 2023-09-14 DOI: 10.1016/j.chpulm.2023.100021

Erika Becerra-Ashby MD , Tiffany Gardner MD , Kelli Robertson MD , Katie E. Raffel MD , Peter Hountras MD

引用次数: 0

Veteran and Lung Cancer Screening Coordinator Perspectives on Improving Adherence to Lung Cancer Screening 退伍军人和肺癌筛查协调员对提高肺癌筛查依从性的看法

CHEST pulmonary Pub Date : 2023-09-09 DOI: 10.1016/j.chpulm.2023.100016

Jonathan Angotti MD , Charlene Pope PhD , Nichole T. Tanner MD

{"title":"Veteran and Lung Cancer Screening Coordinator Perspectives on Improving Adherence to Lung Cancer Screening","authors":"Jonathan Angotti MD , Charlene Pope PhD , Nichole T. Tanner MD","doi":"10.1016/j.chpulm.2023.100016","DOIUrl":"https://doi.org/10.1016/j.chpulm.2023.100016","url":null,"abstract":"<div><h3>Background</h3><p>Lung cancer screening (LCS) with low-dose CT scan has been shown to reduce mortality from lung cancer, the deadliest cancer killer. More than one-half of incident lung cancers detected in the National Lung Screening Trial were identified after the first year of screening, which highlights the importance of annual adherence to achieve mortality benefit from LCS. Although National Lung Screening Trial adherence across three rounds of screening was 95%, adherence in the community is lower and highly variable even within the same health system.</p></div><div><h3>Research Question</h3><p>What are patient and LCS coordinator perspectives on barriers and potential solutions to ensuring adherence to annual LCS?</p></div><div><h3>Study Design and Methods</h3><p>In this qualitative study, we conducted six veteran focus groups of 21 veterans who had undergone at least one LCS examination and individual interviews of eight LCS coordinators. Interviews and focus groups were transcribed and coded using qualitative content analysis. Codes were sorted into categories reflecting veteran perceptions, LCS ideas, observations, barriers, facilitators, preferences, recommendations, and LCS program issues. These codes were then analyzed and used to identify themes influencing adherence.</p></div><div><h3>Results</h3><p>The following four themes were identified from qualitative analysis: (1) direct communication about the repeat annual nature of screening was a driver for patient adherence, (2) patients recommended using other modalities including text messaging and mobile applications to improve adherence, (3) LCS coordinators reported a lack of emphasis and focus on adherence because of a lack of resources, and (4) the variability in program practices for bringing patients back every year and inability to measure adherence are barriers that need to be addressed.</p></div><div><h3>Interpretation</h3><p>Direct and multimodal communication may improve patient adherence to annual LCS, and system-level changes (eg, tracking dashboard and metrics) could assist LCS coordinators in addressing and focusing on LCS program adherence.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"1 3","pages":"Article 100016"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000168/pdfft?md5=03d6629b141da27d83cf0758bbdc4791&pid=1-s2.0-S2949789223000168-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92026089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Guideline Alignment and Medication Concordance in COPD 慢性阻塞性肺病的指南调整和用药一致性

CHEST pulmonary Pub Date : 2023-09-04 DOI: 10.1016/j.chpulm.2023.100017

Meredith A. Case MD, MHS , Eric P. Boorman PhD , Elizabeth Ruvalcaba MSPH , Michael T. Vest DO , Nadia N. Hansel MD, MPH , Nirupama Putcha MD, MHS , Michelle N. Eakin PhD

{"title":"Guideline Alignment and Medication Concordance in COPD","authors":"Meredith A. Case MD, MHS , Eric P. Boorman PhD , Elizabeth Ruvalcaba MSPH , Michael T. Vest DO , Nadia N. Hansel MD, MPH , Nirupama Putcha MD, MHS , Michelle N. Eakin PhD","doi":"10.1016/j.chpulm.2023.100017","DOIUrl":"10.1016/j.chpulm.2023.100017","url":null,"abstract":"<div><h3>Background</h3><p>Provider adherence to clinical treatment guidelines in COPD is low. However, for patients to receive guideline-aligned care, providers not only must prescribe guideline-aligned care, but also must communicate that regimen successfully to patients to ensure medication concordance. The rate of medication concordance between patients and providers and its impact on clinical management is unknown in COPD.</p></div><div><h3>Research Question</h3><p>To examine rates of guideline alignment and medication concordance and to identify patient-level factors that place patients at risk for these types of poor disease management outcomes.</p></div><div><h3>Study Design and Methods</h3><p>This study was a secondary data analysis of the Medication Adherence Research in COPD study (2017-2023). Participants were categorized into 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Medication regimens were classified as aligned or nonaligned with 2017 GOLD guidelines. Nonaligned regimens were stratified further into overuse and underuse categories. Medication concordance between provider-reported and participant-reported regimens was determined. Factors associated with guideline alignment and medication concordance were evaluated using logistic regression.</p></div><div><h3>Results</h3><p>Of 191 participants, 51% of provider-reported regimens were guideline aligned, with 86% of nonaligned regimens reflecting overuse with an inhaled corticosteroid (ICS). Thirty-eight percent of participants reported different regimens than their providers, of which > 80% reflected participants not reporting medications their providers reported prescribing. Participants did not report long-acting muscarinic antagonists and long-acting beta-agonists at similar rates as ICSs. Greater symptom burden and absence of a pulmonologist on the care team were associated with both guideline misalignment and medication discordance. Cognitive impairment and Black race additionally were associated with medication discordance.</p></div><div><h3>Interpretation</h3><p>Guideline misalignment and medication discordance were common and were driven by overuse of ICSs and unreported medications, respectively. The patient-level factors associated with medication discordance highlight the importance of improving patient-provider communication to improve clinical management in COPD.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100017"},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294978922300017X/pdfft?md5=28678bcf29fd4fa96c270a415bf9106b&pid=1-s2.0-S294978922300017X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91551452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0