Chest最新文献

{"title":"Association of Shared Decision-Making With Long-Term Adherence to Lung Cancer Screening","authors":"YoonKyung Chung PhD, Chi-Mei Liu PhD, Elizabeth Y. Rula PhD, Farouk Dako MD MPH, Ruth C. Carlos MD, Ryan K. Lee MD MBA, Eric Christensen PhD","doi":"10.1016/j.chest.2025.06.026","DOIUrl":"https://doi.org/10.1016/j.chest.2025.06.026","url":null,"abstract":"Lung cancer screening (LCS) by low-dose CT imaging reduces lung cancer mortality and is covered by Medicare, yet adherence to screening for eligible Medicare beneficiaries is low. Medicare requires a shared decision-making (SDM) visit before the initial LCS, with a stated goal of promoting adherence to annual screening, but it is unknown whether these visits improve adherence over time.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"4 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low tidal volume ventilation and mortality in patients with acute brain injury: a secondary analysis of an international observational study.","authors":"Julian F Daza,Doulia M Hamad,Martin Urner,Kuan Liu,Sarah Wahlster,Chiara Robba,Robert D Stevens,Victoria A McCredie,Raphael Cinotti,Shaurya Taran","doi":"10.1016/j.chest.2025.06.042","DOIUrl":"https://doi.org/10.1016/j.chest.2025.06.042","url":null,"abstract":"BACKGROUNDLow tidal volume ventilation (LTVV) improves outcomes in critically ill patients, but its impact in patients with acute brain injuries (ABI) is less certain.RESEARCH QUESTIONWhat is the association between LTVV and mortality in mechanically ventilated patients with ABI?STUDY DESIGN AND METHODSWe did a secondary analysis of a prospective observational study (NCT03400904). We compared LTVV (≤8 mL/kg predicted body weight [PBW]) with tidal volumes >8 mL/kg PBW over the first 7 days of mechanical ventilation. Alternate analyses used lower thresholds for LTVV. Marginal structural Cox models were used to evaluate the association between LTVV and ICU mortality up to 60 days. Stabilized inverse probability treatment and censoring weights were generated using multivariable logistic regression adjusted for baseline and time-dependent confounders.RESULTS1,510 patients from 73 intensive care units across 18 countries were included. Mean age was 52 years, 513 (34.0%) patients were female, and the most common ABI etiology was traumatic brain injury (n= 726; 48.1%). Acute respiratory distress syndrome (ARDS) developed in 137 (9.2%) patients. In patients receiving LTVV, adjusted incidence of ICU mortality was 40.2% (95% confidence interval [CI] 19.2%-61.1%), versus 59.7% (95% CI 44.0%-75.4%) in patients receiving tidal volumes >8mL/kg PBW (marginal hazard ratio 0.54, 95% CI 0.33-0.88). There was no heterogeneity of treatment effect in subgroup analyses, and sensitivity analyses for unmeasured confounding yielded similar results. However, associations were less clear at lower thresholds of LTVV.INTERPRETATIONIn this predominantly non-ARDS cohort of patients with ABI, LTVV over the first 7 days of mechanical ventilation was associated with lower ICU mortality up to 60 days, versus tidal volumes >8 mL/kg PBW. Future research should investigate effects in ABI patients with ARDS, use of lower LTVV thresholds, and impact on additional endpoints including functional outcomes and adverse events.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"107 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Hospital Policies on Clinicians' Decisions to Withhold or Withdraw Life-sustaining Treatment.","authors":"Gina M Piscitello,Edlyn Lopez Wolwowicz,Michael T Huber,Kelly C Vranas,Donald R Sullivan,Katrina E Hauschildt,Patrick G Lyons","doi":"10.1016/j.chest.2025.06.036","DOIUrl":"https://doi.org/10.1016/j.chest.2025.06.036","url":null,"abstract":"BACKGROUNDThere is considerable variation in clinicians' approaches to decisions to withhold or withdraw life sustaining treatment (LST) across US hospitals. These differences are not explained by patient preferences alone and are likely influenced by other factors such as hospital policies, hospital culture, state laws, and medical society guidelines.RESEARCH QUESTIONHow do hospital policies influence clinician approaches to decisions to withhold or withdraw LST among patients admitted to an intensive care unit (ICU)?STUDY DESIGN AND METHODSWe conducted semi-structured interviews with ICU nurses and physicians at three geographically diverse hospital systems across the United States between July and October 2024. We asked clinicians about their experiences with, and perceptions of, hospital policies on withholding or withdrawing LST and the relationship between these policies and clinician decision-making in ethically challenging scenarios.RESULTSWe interviewed ten nurses and eight attending physicians with median 5 years (range 2-36 years) in practice. Clinicians described limited awareness of, and familiarity with, their hospital's policies that addressed withholding or withdrawing LST. Clinicians with knowledge of these policies could identify their location but described barriers to accessing them. While clinicians perceived hospital policies as helpful in some ways (e.g., legal protection and ethical guidance), they viewed them as neither acknowledging nor addressing sociodemographic disparities or clinician value judgments in LST decision-making. Perceptions varied about whether clinicians followed their own hospital policy guidance when making decisions to withhold or withdraw LST.INTERPRETATIONClinicians lack detailed understanding about their hospitals' policies that address withholding or withdrawing LST and perceive these policies as having limited applicability to clinical practice. These findings suggest that hospital policies may have little influence on clinician behavior in addressing decisions to withhold or withdraw LST in ethically challenging scenarios.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"37 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Activity in Pediatric Pulmonary Hypertension: Expanding Opportunities to Advance Clinical Trial Design and Impact.","authors":"Eric D Austin","doi":"10.1016/j.chest.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.023","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"50 1","pages":"13-15"},"PeriodicalIF":9.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of Preserved Ratio Impaired Spirometry as a Risk Factor for Development of COPD, Also in Those Who Do Not Smoke.","authors":"Helena Backman, Tomi Myrberg, Linnea Hedman, Caroline Stridsman, Eva Rönmark, Anne Lindberg","doi":"10.1016/j.chest.2025.02.025","DOIUrl":"10.1016/j.chest.2025.02.025","url":null,"abstract":"<p><strong>Background: </strong>COPD is largely underdiagnosed. Active identification of cases is crucial to establish preventive measures before manifestation of clinical disease. The significance of different spirometric patterns preceding COPD, especially preserved ratio impaired spirometry (PRISm), has been highlighted but remains unclear.</p><p><strong>Research question: </strong>Which clinical characteristics, smoking habits, and spirometric patterns, with primary focus on PRISm findings, precede the development of airway obstruction (AO)?</p><p><strong>Study design and methods: </strong>The OLIN COPD Study was established from 2002 through 2004. After re-examination of population-based cohorts, individuals with AO (n = 993; FEV₁ to VC ratio < 0.70) were identified together with control participants without AO (n = 993; FEV₁ to VC ratio ≥ 0.70). Most of these people had participated in examinations during the 1980s or 1990s, and in total, 902 cases and 819 control participants had previous clinical data. Logistic regression was performed with case status as outcome and spirometric patterns, age, sex, smoking habits, and BMI at first examination as covariates.</p><p><strong>Results: </strong>The mean (SD) person-years between first examination and inclusion in the OLIN COPD Study was 10.5 (4.0) years. At first examination, the prevalence of PRISm was higher in cases (18.6%) vs control participants (13.4%). Current smoking was more common in cases (45.1% vs 18.2%), whereas former smoking was similar (31.8% vs 34.9%). Cases reported more respiratory symptoms (78.0% vs 44.3%) than control participants. At first examination, PRISm, current smoking, and former smoking were strongly associated with becoming a case when adjusted for confounders, with adjusted OR (aOR) of 3.5, 4.1, and 1.5, respectively. When stratifying for smoking habits, aORs for PRISm in those with current smoking, former smoking, and nonsmoking status were 2.9, 3.8 and 3.7, respectively.</p><p><strong>Interpretation: </strong>In this study, PRISm was associated with transition into AO corresponding to COPD within 1 decade, independent of smoking habits and with similar strength of association among those who have never smoked, who formerly smoked, and who currently smoke.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"83-94"},"PeriodicalIF":9.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving A Rapid Response System at a Teaching Hospital: Lessons Learned From Implementation of a Novel Performance Self-Evaluation Tool.","authors":"Henrik Ghantarchyan, Alexander T Phan, Jasmine Toor, Aftab Qadir, Aldin Malkoc, Janet Gukasyan, Sarkis Arabian","doi":"10.1016/j.chest.2024.10.055","DOIUrl":"10.1016/j.chest.2024.10.055","url":null,"abstract":"<p><p>Rapid assessment and treatment (RAT) calls, facilitated by rapid response teams (RRTs), have become vital to the care of hospitalized patients whose conditions are deteriorating outside of the ICU in many institutions worldwide. A significant body of data has recognized the efficacy of rapid response systems (RRSs) in improving patient care; however, there is no standardized protocol that all RRSs practice. Even when the recognition of patient clinical deterioration is rapidly noted, further treatment may be delayed because of issues with clinical knowledge and communication between parties present, especially in training institutions. At our institution in Southern California, the RRT consists of resident physicians supervised by an attending physician, a respiratory therapist, a critical care nurse, and a pharmacist. In our study, we assessed our responses to RAT calls at baseline, using a standardized rubric. We then implemented an educational intervention to resident physicians, including clinical and communication components. Finally, we reassessed our responses to RAT calls postintervention. We found that an educational intervention improved patient outcomes and several key process measures in our RRS. This article describes the process and lessons learned from our initiative.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"183-188"},"PeriodicalIF":9.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed Opportunities for Lung Cancer Screening Among Patients With Behavioral Health Disorders With Elevated Cigarette Smoking Rates: Lung Cancer Screening and Behavioral Health.","authors":"Anastasia Rogova, Lisa M Lowenstein, Lorraine R Reitzel, Kathleen Casey, Robert J Volk","doi":"10.1016/j.chest.2024.11.039","DOIUrl":"10.1016/j.chest.2024.11.039","url":null,"abstract":"<p><p>Annual lung cancer screening using low-dose CT (LDCT) imaging effectively reduces mortality from lung cancer and is recommended for people who are at high risk of developing the disease. The utilization of lung cancer screening, however, has remained low. Due to significantly higher cigarette smoking rates, patients with behavioral health disorders (those living with mental illness and/or substance use disorders) are more likely to be diagnosed with and die of lung cancer; at the same time, they are less likely to undergo cancer screenings. There is an urgent need for targeted efforts to improve access to lung cancer screening among this population disproportionately affected by the disease. In this commentary, we propose integrating lung cancer screening facilitation into services provided by behavioral health professionals who are uniquely positioned to reach these patients and deliver interventions to increase uptake of cancer screenings. We suggest several measures that could improve lung health outcomes of patients with behavioral health disorders: (1) training behavioral health professionals in lung cancer screening eligibility assessment; (2) providing patients with educational materials; (3) integrating shared decision-making counseling for lung cancer screening into behavioral health care settings; (4) providing the practical support needed to access screening; and (5) establishing effective partnerships with community organizations. Regardless of the level of engagement, possibly ranging from brief training to the implementation of comprehensive programs, any involvement will benefit patients. This integrated approach will contribute to reducing lung cancer mortality among patients with behavioral health disorders who have long experienced systemic health inequities.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"269-275"},"PeriodicalIF":9.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the Causal Effect of Double-Blind Peer Review for a Pulmonary, Critical Care, and Sleep Medicine Journal.","authors":"Hayley B Gershengorn, Kelly C Vranas, Colin R Cooke, Christopher G Slatore, Stephanie M Levine","doi":"10.1016/j.chest.2025.02.016","DOIUrl":"10.1016/j.chest.2025.02.016","url":null,"abstract":"<p><strong>Background: </strong>Double-blind peer review (DBPR; reviewers masked to author identities and vice versa) aims to reduce biases. The effectiveness of DBPR has not been studied in pulmonary, critical care, and sleep journals.</p><p><strong>Research question: </strong>What was the causal effect on bias of DBPR at CHEST?</p><p><strong>Study design and methods: </strong>From January 2020 to June 2022, CHEST and Annals of the American Thoracic Society (AATS) used single-blind peer review (reviewers concealed from authors only); in July 2022, CHEST switched to DBPR. We estimated the causal effect of DBPR on manuscript acceptance at CHEST using AATS as a control. The co-primary exposures were first and last author gender; author residence in English-fluent countries was considered as a secondary exposure. To estimate DBPR's differential impact according to exposure, multivariable regression models were constructed with triple interaction terms (eg, author gender × CHEST vs AATS × pre- vs post-DBPR), all component factors (eg, author gender), paired interactions (eg, author gender × CHEST vs AATS), and covariables (year, topic).</p><p><strong>Results: </strong>The study included 4,651 manuscripts (CHEST, 3,494; AATS, 1,157) sent for peer review; 4,645 (99.9%) had identifiable author gender. From 2020 to 2024, CHEST submissions (compared with AATS) were less frequently authored by women (first, 38.7% vs 45.5% [standardized mean difference (SMD), 0.14]; last, 23.9% vs 31.2% [SMD, 0.16]) or people from English-fluent countries (first, 56.0% vs 77.7% [SMD, 0.47]; last, 57.9% vs 79.0% [SMD, 0.47]), and acceptance rates were lower (30.7% vs 48.4%; SMD, 0.37). Following adjustment, no difference was appreciated in the impact of DBPR on acceptance for women vs men authors (first, -7.4 [95% CI, -20.9 to 6.0] percentage points [P = .28]; last, -10.1 [95% CI, -25.1 to 5.0] percentage points [P = .19]). DBPR negatively affected first (but not last) authors from English-fluent countries (vs non-fluent, -16.8 [95% CI, -32.1 to -1.6] percentage points; P = .030).</p><p><strong>Interpretation: </strong>Our results show that DBPR did not differentially affect authors by gender but did by presumed English fluency.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"160-170"},"PeriodicalIF":9.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growing Up With Developmental Lung Diseases: A Review for the Adult Pulmonologist.","authors":"Yadira Rivera-Sanchez, Zachary W Blair, Tyler J Wall, Kara N Goss","doi":"10.1016/j.chest.2025.02.014","DOIUrl":"10.1016/j.chest.2025.02.014","url":null,"abstract":"<p><strong>Topic importance: </strong>Improved childhood management strategies have decreased the early life morbidity and mortality of severe developmental lung disorders, such that an increasing number of individuals ultimately transition care to adult pulmonologists for management. Alternatively, individuals with milder malformations may present in adulthood or may have an increased risk for the development of more common adult pulmonary comorbidities (eg, COPD, pulmonary hypertension). As such, there is a critical need for adult pulmonologists to understand how developmental lung disorders may impact respiratory morbidity over the lifespan.</p><p><strong>Review findings: </strong>There is growing recognition that abnormal lung development contributes to lung disease across the lifespan. This article reviews commonly encountered complex developmental lung diseases, including bronchopulmonary dysplasia, congenital diaphragmatic hernia, Down syndrome, and representative isolated airway and vascular anomalies. Their childhood and adult clinical presentations and comorbidities will be discussed.</p><p><strong>Summary: </strong>This review aims to provide the adult pulmonologist with a framework for evaluating and managing individuals with developmental lung diseases.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"95-105"},"PeriodicalIF":9.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Airflow Limitation and Emphysema in Lung Cancer Screening Populations: A Systematic Review and Meta-Analysis.","authors":"Hyewon Choi, Il-Youp Kwak, Chung Ryul Oh, Jin Mo Goo, Soon Ho Yoon","doi":"10.1016/j.chest.2025.02.021","DOIUrl":"10.1016/j.chest.2025.02.021","url":null,"abstract":"<p><strong>Background: </strong>Early detection and treatment of COPD are becoming important for improving the prognosis of individuals who have a history of heavy tobacco use. Despite the higher risk of COPD among individuals participating in lung cancer screening, many of these patients continue to show rates of underdiagnosis of lung cancer.</p><p><strong>Research question: </strong>How many participants in lung cancer screening have emphysema or airflow limitation? If spirometry is incorporated into the screening, how many additional patients with airflow limitation could be identified?</p><p><strong>Study design and methods: </strong>The Ovid-MEDLINE and Embase databases were searched from inception through November 30, 2023. We included original studies reporting the prevalence of CT scan-confirmed emphysema and spirometry-confirmed airflow limitation. The primary outcomes were the prevalence of emphysema and airflow limitation. For studies reporting severity, we analyzed the percentage of mild vs moderate to severe disease. We also calculated the proportion of newly confirmed cases of airflow limitation via spirometry.</p><p><strong>Results: </strong>In total, 42 studies were included (emphysema, n = 18; airflow limitation, n = 13; both, n = 11), comprising 126,842 individuals with emphysema and 72,209 individuals with airflow limitation. The pooled prevalence of emphysema was 45.3% (95% CI, 39.3%-51.2%), and that of airflow limitation was 40.1% (95% CI, 33.4%-46.8%). Moderate to severe emphysema was observed in 28.8% of patients with emphysema (95% CI, 24.2%-33.4%), whereas 54.3% patients with airflow limiation (95% CI, 40.6%-60.6%) showed moderate to very severe airflow limitation. Furthermore, 65.2% of patients with airflow limitation (95% CI, 55.7%-74.7%) identified by spirometry had been unrecognized previously.</p><p><strong>Interpretation: </strong>Among screening participants, 45.3% demonstrated emphysema and 40.1% demonstrated airflow limitation, with 28.8% and 54.3% of these patients showing moderate to severe disease, respectively. Furthermore, 65% of patients with airflow limitation had not received a diagnosis previously. These findings suggest that incorporating spirometry into screening programs may enhance COPD detection and management.</p><p><strong>Clinical trial registry: </strong>International Prospective Register of Systematic Reviews; No.: CRD42024513248; URL: https://www.crd.york.ac.uk/prospero/.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"67-82"},"PeriodicalIF":9.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}