Chest最新文献

{"title":"Trends in Medicare Spending on Drugs for Pulmonary Arterial Hypertension, 2012-2022.","authors":"Jenny A Shih,Charlie Lee,William B Feldman","doi":"10.1016/j.chest.2025.04.031","DOIUrl":"https://doi.org/10.1016/j.chest.2025.04.031","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"106 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920990","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":"Nurse Practitioners and Physician Assistants: Building a Team and Optimizing Practice in the Medical ICU.","authors":"Carolyn Dickens, Amber Beserra, Joe Keller, Susan Corbridge, Melissa Carlucci","doi":"10.1016/j.chest.2024.11.019","DOIUrl":"10.1016/j.chest.2024.11.019","url":null,"abstract":"<p><p>The integration of nurse practitioners (NPs) and physician assistants (PAs) into the medical ICU (MICU) is becoming increasingly vital due to the rising number of critically ill patients and the shortage of board-certified intensivists. Successful recruitment and utilization of NPs and PAs in the MICU setting require a unique understanding of potential variations of the scope of practice based on state law and educational backgrounds, as well as the implementation of best practices around training and leadership support. The purpose of this article was to review the best strategies for creating a MICU team with NPs and PAs. Key strategies for identifying suitable NP and PA candidates include assessing their education, certification, licensure, and clinical experience, particularly in critical care settings. It is important for organizations to have structured orientation programs, which should define roles, establish clear reporting structures, and provide competency-based training to ensure effective team integration. Simulation-based training and professional mentoring are emphasized as critical elements for developing clinical competency and promoting job satisfaction. There are variations in state laws and institutional policies that affect NP and PA practice that should be understood by the organization to manage expectations for the NP and PA job responsibilities. Effective productivity measurement methods are proposed to accurately assess the contributions of NPs and PAs in the MICU. This article provides comprehensive strategies for successfully hiring, onboarding, and integrating these professionals into MICU teams, ensuring high-quality care delivery in critical care settings.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1451-1457"},"PeriodicalIF":9.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754859","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 Minnesota Critical Care Working Group 1: Monitoring and Coordinating Statewide Critical Care Surge Response in the COVID-19 Pandemic, March 2020 Through July 1, 2021.","authors":"Jeffrey R Dichter, Daniel Brown, Clara Zamorano, Joshua Cohen, Elizabeth A Miller, David E Niccum, Michele LeClaire, Christina Bastin De Jong, Deanna Diebold, Jacob Lyons, Ronald Reilkoff, Heidi L Erickson, Joseph Martinelli, Jennifer A Fischer, Kyle Mairose, Jason Kallestad, Christine Chell, Adam Shadiow, Shawn Stoen, John L Hick, Cheryl Petersen-Kroeber, Judy Seaberg, Erin McLachlan, Alexandra T Waterman, Walter Y James, Sean MacDonell, James Risser, Tom Klemond, Erin S DeMartino, Joel Wu, Debra DeBruin, Susan M Wolf, Nneka O Sederstrom, Karyn D Baum, Kay Greenlee, Helen Strike, Paul A Kettler, Andrea Boehland, Kimberly A Goodman, Ken K Maslonka, Jack M Wolf, Jennifer Schoenecker, Sarah M Kesler","doi":"10.1016/j.chest.2024.10.057","DOIUrl":"10.1016/j.chest.2024.10.057","url":null,"abstract":"<p><strong>Background: </strong>In response to the COVID-19 pandemic and as part of the statewide health care coalition response, the Minnesota Critical Care Working Group (CCWG), composed of interprofessional leaders from the state's 9 largest health systems, was established and entrusted to plan and coordinate critical care support for Minnesota from March 2020 through July 1, 2021.</p><p><strong>Research question: </strong>Can a statewide CCWG develop contingency and crisis-level surge strategies and indicators in response to the COVID-19 pandemic while evolving into a highly collaborative team?</p><p><strong>Study design and methods: </strong>CCWG members (intensivists, ethicists, nurses, Minnesota Department of Health and Minnesota Hospital Association leaders) met by audio video conferencing as often as daily assessing COVID-19 and non-COVID-19 hospitalization data, developed surge evidence reflecting contingency vs crisis conditions, and planned responses collaboratively. A foundation of collaboration and teamwork developed which facilitated an effective statewide response.</p><p><strong>Results: </strong>Pandemic surge health care system strategies included use of surge ICU beds, adapted staffing models, restriction of nonemergency procedures, augmentation of tele-ICU care, ability to recognize increasing staff shortages, use of PICU beds for younger adults, and use of noninvasive ventilation in non-ICU settings. CCWG supported development of the Minnesota Medical Operations Coordination Center, which was instrumental in load balancing and mitigating crisis conditions. Minnesota surge strategies are compared with published prepandemic and pandemic experiences regarding staff, space, supplies and medications/equipment, and system strategies. Adopted severe surge best practices included use of adapted staffing models and noninvasive ventilation in non-ICU settings. CCWG effectively developed shared strategies and facilitated ICU load balancing, which supported a regionally consistent standard of care.</p><p><strong>Interpretation: </strong>The CCWG developed statewide critical care surge strategies assisting health care organization response to COVID-19 surges, providing a platform for clinical and operational activities. Collaboration, trust, and teamwork between CCWG leaders and health care organizations was essential to success and serves as a model for future events.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1356-1370"},"PeriodicalIF":9.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766620","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":"Response.","authors":"Alexander A Kon","doi":"10.1016/j.chest.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.004","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 5","pages":"e172-e173"},"PeriodicalIF":9.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978350","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":"Not All Tele-Pulmonary Rehabilitation Models for Chronic Respiratory Disease Are Created Equal.","authors":"Marilyn L Moy,Surya P Bhatt,Richard Casaburi,Chris Garvey,Linda Nici","doi":"10.1016/j.chest.2024.12.036","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.036","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"17 1","pages":"e169-e170"},"PeriodicalIF":9.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932906","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":"A 7-Year-Old Girl With Multiple Pulmonary Nodules.","authors":"Jie Jiang,Yamin Rao,Chenglei Liu,Shih-Jen Chang,Yajing Qiu,Xiaoxi Lin","doi":"10.1016/j.chest.2024.12.017","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.017","url":null,"abstract":"A 7-year-old girl was referred to our vascular anomaly center for further evaluation of multiple lung nodules. These nodules were incidentally detected on a CT scan during hospitalization for treatment of mycoplasma pneumonia at another hospital. The biopsy results suggested the possibility of vascular tumors. Physical examination revealed clear breath sounds without rales. Furthermore, no skin lesions or other positive signs were observed. The patient was not receiving supplemental oxygen. Before she came to our center, the patient had received antibiotic treatment for mycoplasma pneumonia. The CT scan after recovery revealed that the multiple nodules in both lungs persisted despite the resolution of the infection.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"3 1","pages":"e161-e165"},"PeriodicalIF":9.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932921","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":"Trends in All-Cause Mortality Among US Veterans With Sarcoidosis, 2004-2022.","authors":"Mohamed I Seedahmed, Mohamed T Albirair, Aaron D Baugh, Walid F Gellad, S Mehdi Nouraie, Kevin F Gibson, Mary A Whooley, Charles E McCulloch, Laura L Koth, Mehrdad Arjomandi","doi":"10.1016/j.chest.2024.10.043","DOIUrl":"10.1016/j.chest.2024.10.043","url":null,"abstract":"<p><strong>Background: </strong>Sarcoidosis is an idiopathic multiorgan disease with variable clinical outcomes. Comprehensive analysis of sarcoidosis mortality in US veterans is lacking.</p><p><strong>Research question: </strong>What are the trends in all-cause mortality among US veterans with sarcoidosis, and how are these trends influenced by demographics, Black vs White racial disparities, and geographic variability in relationship to mortality?</p><p><strong>Study design and methods: </strong>Using Veterans Health Administration (VHA) electronic health records (EHRs), we conducted a population-based retrospective cohort study of adjusted all-cause mortality from 2004 through 2022 among veterans with a diagnosis of sarcoidosis who received care through the VHA. Demographics, region of residence, service branch, tobacco use, and comorbidities were extracted from the EHR. Annual trends in all-cause mortality and patient-level characteristics associated with mortality were examined with multivariable ungrouped Poisson regression. We visualized trends and analyzed state-by-state mortality using the marginal means procedure. In subgroup analysis (2015-2022), we considered the impact of neighborhood-level socioeconomic disparities using the Area Deprivation Index (ADI).</p><p><strong>Results: </strong>In all, 23,745 veterans received a diagnosis of sarcoidosis between 2004 and 2019 and were followed up through 2022. After adjustment, including age and sex, all-cause mortality increased annually by 4.7% (P < .0001) and was 6.4% higher in Black than White veterans (mortality rate ratio, 1.064; P = .02). A subgroup analysis comparing models with and without ADI adjustment showed no meaningful change in mortality trends. Risk factors for increased all-cause mortality included older age, male sex, Black race, Northeast residence, and lower risk with other service branches. Despite distinct geographical variations in mortality rates, no clear patterns emerged.</p><p><strong>Interpretation: </strong>Mortality among veterans with sarcoidosis is rising. Differences identified by service branch and higher risk among male Veterans raise questions about differences in environmental exposures. The narrower racial disparities and smaller impact of ADI than in other studies may highlight the role of universal health care access in achieving equitable outcomes.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1416-1427"},"PeriodicalIF":9.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615785","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 Kafka's Disease\": Tracheal TB and the Role of Ultrasound.","authors":"Pietro Impellizzeri,Guido Levi,Alessia Di Mari,Santi Nolasco,Claudia Crimi,Carlo Vancheri,Gian Pietro Marchetti","doi":"10.1016/j.chest.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.011","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"125 1","pages":"e155-e159"},"PeriodicalIF":9.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932919","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":"Epicardial Adipose Tissue as an Independent Risk Factor for Mortality in Pulmonary Arterial Hypertension.","authors":"Breanne E McCarthy, Rui Feng, Drew A Torigian, Yubing Tong, Jason S Fritz, Jasleen K Minhas, Jeremy A Mazurek, K Akaya Smith, Harold I Palevsky, Steven C Pugliese, Natalie Z Homer, Margaret R MacLean, Jayaram K Udupa, Nadine Al-Naamani","doi":"10.1016/j.chest.2024.11.020","DOIUrl":"10.1016/j.chest.2024.11.020","url":null,"abstract":"<p><strong>Background: </strong>Increased epicardial adipose tissue (EAT) has adverse effects in cardiovascular diseases, independent of BMI. Estrogen levels may affect EAT accumulation. Little is known about the predictors and potential impact of EAT in pulmonary arterial hypertension (PAH).</p><p><strong>Research question: </strong>Is EAT associated with estrogen levels, disease severity, and mortality in PAH?</p><p><strong>Study design and methods: </strong>We conducted a retrospective cohort study of patients with PAH enrolled in the Penn Pulmonary Hypertension registry and used chest CT scans to quantify EAT. Serum estrone and estradiol levels were also measured.</p><p><strong>Results: </strong>A total of 221 patients were included in the analysis, with median follow-up of 88 months. Mean age was 55.1 years, 74.7% were female, mean BMI was 27.20 kg/m², and the most common PAH etiology was connective tissue disease-associated PAH (43.0%) followed by idiopathic or heritable PAH (35.3%). Median EAT volume was 52.1 mL/m². Of the 102 patients with a follow-up chest CT scan, EAT increased over time in 74 (71.8%). High EAT volume (hazard ratio, 2.62; 95% CI, 1.62-4.24; P < .001) and greater accumulation of EAT over time (hazard ratio, 1.09; 95% CI, 1.01-1.17; P = .03) were both independently associated with worse survival. Patients with high EAT volume had lower serum estrone (13.70 vs 30.60 pg/mL; P = .009) and estradiol (6.05 vs 19.40 pg/mL; P = .002) levels compared with those with low EAT volume.</p><p><strong>Interpretation: </strong>In patients with PAH, high EAT and a greater rate of accumulation of EAT volume were independently associated with worse survival. Higher EAT volume was also associated with lower estrogen levels. The association of EAT volume with survival was independent of BMI and disease severity, suggesting that EAT may be a marker for a unique PAH phenotype. Future research should investigate the role of EAT-modifying therapies in PAH and consider incorporating EAT into PAH risk models.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1481-1492"},"PeriodicalIF":9.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754821","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":"Response.","authors":"Narelle S Cox, Christine F McDonald, Angela T Burge, Catherine J Hill, Janet Bondarenko, Anne E Holland","doi":"10.1016/j.chest.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.008","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 5","pages":"e170-e171"},"PeriodicalIF":9.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984438","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}