Chest最新文献

{"title":"A 47-Year-Old Woman With Recurrent Fever and Productive Cough.","authors":"Lingjian Wang, Xin Sun, Yuhong Li, Min Peng, Xiaoqing Li, Li Gao, Rui'e Feng, Yunzhi Zhou, Juhong Shi","doi":"10.1016/j.chest.2024.10.053","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.053","url":null,"abstract":"<p><strong>Case presentation: </strong>A 47-year-old woman initially presented with recurrent coughing caused by the ingestion of gritty foods such as nuts over 20 years ago. Subsequently, she experienced frequent postprandial episodes of white sputum containing food particles and suffered from acid reflux and heartburn, which were originally overlooked.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"e183-e188"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282647","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":"Conservative Management of Ground-Glass Nodules?: Yes, Please.","authors":"Douglas A Arenberg","doi":"10.1016/j.chest.2025.01.023","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.023","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"1535-1536"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282653","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":"Fenglan Li, Linlin Qi, Jianwei Wang","doi":"10.1016/j.chest.2025.01.032","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.032","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"e207-e210"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282657","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":"How Do Clinicians Use Quotations in Goals of Care Notes?","authors":"Gina M Piscitello, Ruthe Ali, Katrina Hauschildt, Jane Schell","doi":"10.1016/j.chest.2025.01.014","DOIUrl":"10.1016/j.chest.2025.01.014","url":null,"abstract":"<p><strong>Background: </strong>Quoting patients in electronic medical record (EMR) notes is controversial. Quotations may be used to promote accuracy in documentation. However, they also may be used to cast skepticism on patient speech. Little is known about how quotations are used in EMR notes documenting goals-of-care (GOC) conversations.</p><p><strong>Research question: </strong>How often are quotations used in GOC notes, what content do clinicians quote, and how does quotation use vary by clinician specialty and patient sociodemographic characteristics?</p><p><strong>Study design and methods: </strong>This multihospital, cross-sectional study assessed quotation use in GOC notes for seriously ill adult patients hospitalized between July and October 2021. Quotation frequency was evaluated and thematic analysis was used to assess the content of language quoted in GOC notes. The odds of quotation use by clinician specialty and patient sociodemographic group were determined using multivariable logistic regression.</p><p><strong>Results: </strong>Our review of 1,003 GOC notes across 14 hospitals found that quotations were used in 32% of notes and were used more often by palliative clinicians when compared with nonpalliative clinicians (38% vs 21%; unadjusted OR, 2.34 [95% CI, 1.74-3.14]; adjusted OR, 2.62 [95% CI, 1.66-4.13]). Quotations were present more often in notes of Black vs White patients (41% vs 30%; unadjusted OR, 1.61 [95% CI, 1.08-2.38]; adjusted OR, 1.73 [95% CI, 1.11-2.71]). The content of language included in quotations most often detailed patient feelings, family preferences, and patient discussion about death.</p><p><strong>Conclusions: </strong>This multicenter study found that quotations were used in almost one-third of GOC notes, were used more often by palliative vs nonpalliative clinicians, and were present more often in notes for Black vs White patients. Future research must explore clinician intentions in using quotations and identify whether quotation use may contribute to racial disparities in patient care.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1737-1745"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028044","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":"Diagnostic Performance of the Modified Lung CT Screening Reporting and Data System in a TB-Endemic Country: The Korean National Lung Cancer Screening Program.","authors":"Hyungjin Kim, Eunseo Jo, Jinseob Kim, Nayoung Lee, Jin Mo Goo, Yeol Kim","doi":"10.1016/j.chest.2025.01.020","DOIUrl":"10.1016/j.chest.2025.01.020","url":null,"abstract":"<p><strong>Background: </strong>In 2019, Korea initiated the world's first national low-dose CT imaging lung cancer screening (LCS) program, adapting the Lung CT Screening Reporting and Data System (Lung-RADS) to counteract the high false-positive rates driven by prevalent TB.</p><p><strong>Research question: </strong>Does the modified Lung-RADS enhance screening specificity while maintaining sensitivity?</p><p><strong>Study design and methods: </strong>This nationwide, retrospective cohort study included high-risk individuals aged 54 to 74 years with active tobacco use of at least 30 pack-years participating in the national LCS program from 2019 through 2020. The modified Lung-RADS 1.0 introduced category 2b for nodules matching the size of categories 3 or 4, but showing benign features like granulomas and juxtapleural nodules, and enhanced details for category 4X. Lung cancer diagnosis rates within 1 year of screening and the diagnostic performance of the modified and original Lung-RADS were evaluated.</p><p><strong>Results: </strong>Among 152,918 participants (98.2% male; mean [SD] age, 61.7 [5.3] years), lung cancer was diagnosed in 0.68% of participants (1,047 of 152,918). A linear trend in cancer rates across Lung-RADS categories was noted (P < .001). Category 2b showed a higher cancer rate than category 2 (0.25% [45 of 18,120] vs 0.14% [33 of 23,467]; P = .01), but lower than category 3 (0.53% [37 of 7,009]; P = .001). Category 4X showed a cancer rate of 36.88% (416 of 1,128). The modified Lung-RADS demonstrated improved specificity (91.96% [139,664 of 151,871] vs 80.06% [121,589 of 151,871]; P < .001) compared with the original criteria. Although sensitivity showed a modest decrease (81.9% [858 of 1,047] vs 86.2% [903 of 1,047]; P < .001), the modification substantially reduced the follow-up burden, decreasing the number of positive screening results needed to detect 1 case of cancer from 34.5 to 15.2. The positive predictive value improved significantly (from 2.90% [903 of 31,185] to 6.57% [858 of 13,065]; P < .001), whereas the negative predictive value remained consistently high (modified, 99.86% [139,664 of 139,853] vs original, 99.88% [121,589 of 121,733]; P = .23).</p><p><strong>Interpretation: </strong>Our results show that Korea's modified Lung-RADS enhanced screening efficiency through improved specificity, despite a small reduction in sensitivity.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1778-1787"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063999","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":"\"Fatty Muscle\": The Hidden Player in Lung Function.","authors":"Ming Yang","doi":"10.1016/j.chest.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.007","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"1525-1527"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282646","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 Effects of Low-Dose Morphine on Sleep and Breathlessness in COPD: A Randomized Trial.","authors":"Thomas J Altree, Alison J Pinczel, Barbara Toson, Kelly A Loffler, Anna L Hudson, Jim Zeng, Simon Proctor, Ganesh Naik, Sutapa Mukherjee, Peter Catcheside, Andrew Somogyi, David C Currow, Danny J Eckert","doi":"10.1016/j.chest.2024.11.040","DOIUrl":"10.1016/j.chest.2024.11.040","url":null,"abstract":"<p><strong>Background: </strong>Low-dose morphine may be prescribed to reduce chronic breathlessness in COPD. Subjective findings suggest morphine may influence breathlessness through sleep-related mechanisms. However, concerns exist regarding opioid safety in COPD. The effects of morphine during sleep in COPD have not been objectively investigated. This study aimed to objectively determine the effects of low-dose morphine on sleep in COPD.</p><p><strong>Research question: </strong>What are the effects of low-dose morphine on sleep efficiency and other sleep parameters in COPD?</p><p><strong>Study design and methods: </strong>This was a randomized, double-anonymized, crossover trial of sustained-release morphine (20 mg/d for 3 days) (steady-state) vs placebo in 19 breathless people with COPD (n = 7 female participants). The primary outcome was sleep efficiency during in-laboratory overnight polysomnography. Secondary and exploratory outcome measures included sleep-disordered breathing (events/h), oxygenation, transcutaneous CO₂ levels, blood and physiology biomarkers, the relationship between sleep and breathlessness, external resistive load responses, and driving simulator performance. Physiology outcomes and pharmacokinetics were measured before and after each polysomnogram.</p><p><strong>Results: </strong>Sleep efficiency was similar between placebo and morphine (66 ± 17% vs 67 ± 19%; P = .89). Morphine did not change the frequency of sleep-disordered breathing events but reduced breathing frequency. Morphine reduced mean and nadir overnight oxygen saturation by 2% (95% CI, -2.8% to -1.2%) and 5% (95% CI, -8% to -1%), respectively. Mean transcutaneous CO₂ was 3.3 mm Hg (95% CI, 1.6-5.1 mm Hg) higher during sleep with morphine vs placebo. Eight participants (42%) met American Academy of Sleep Medicine criteria for nocturnal hypoventilation with morphine vs four (21%) receiving placebo (P = .02). Morphine did not systematically reduce breathlessness or impair next-day driving simulator performance. Adverse events (most frequently nausea) were increased with morphine.</p><p><strong>Interpretation: </strong>Steady-state, low-dose morphine does not change sleep efficiency, sleep-disordered breathing frequency, or next-day alertness but may cause hypoventilation during sleep, a potentially harmful effect.</p><p><strong>Clinical trial registration: </strong>Australian New Zealand Clinical Trials Registry; No.: ACTRN12621000752864; URL: https://www.anzctr.org.au.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1578-1590"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827584","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":"Preserved Ratio Impaired Spirometry Prevalence, Risk Factors, and Outcomes: A Systematic Review and Meta-Analysis.","authors":"Nicole M Robertson, Connor S Centner, Vickram Tejwani, Shakir Hossen, Dipan Karmali, Sibei Liu, Trishul Siddharthan","doi":"10.1016/j.chest.2024.12.025","DOIUrl":"10.1016/j.chest.2024.12.025","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of chronic respiratory diseases is increasing globally. There is evidence that those with spirometric impairment and no signs of obstruction (termed preserved ratio impaired spirometry [PRISm]) have an increased risk of morbidity and mortality compared with those with normal lung function. Several gaps remain in characterizing PRISm.</p><p><strong>Research question: </strong>What are the prevalence, risk factors, and clinical outcomes associated with PRISm globally?</p><p><strong>Study design and methods: </strong>In this systematic review, a comprehensive search using MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials databases was conducted to include epidemiologic studies; there were no language or data restrictions. Two reviewers independently screened citations and shortlisted full-text articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and data were extracted. Quality was assessed with the Effective Public Health Practice Project tool.</p><p><strong>Results: </strong>A total of 52 studies met the inclusion criteria, and 33 studies were included in the meta-analysis. Pooled PRISm prevalence was 12% (95% CI, 0.10-0.15) with greater prevalence in low- and middle-income countries (LMICs) compared with high-income countries (19% vs 11%). Comorbid diabetes was a significant risk factor associated with PRISm, but the data for female sex and smoking were mixed. PRISm was associated with increased all-cause (OR, 1.41; 95% CI, 1.08-1.83; P = .02), cardiovascular (OR, 1.84; 95% CI, 1.31-2.58; P < .01), and respiratory (OR, 1.82; 95% CI, 1.08-3.05; P = .03) mortality. PRISm was not associated with a reduced rate of lung cancer diagnosis (P = .46). Quality assessment analysis found that 34.6% (n = 18) of studies were rated \"strong,\" 42.3% (n = 22) \"moderate,\" and 23.1% (n = 12) \"weak.\" Studies conducted in LMICs had lower quality ratings.</p><p><strong>Interpretation: </strong>Our findings show that individuals with PRISm have an increased risk of all-cause, cardiovascular, and respiratory mortality. Recognizing and targeting modifiable PRISm risk factors may reduce the growing burden of PRISm and transition to obstructive lung disease globally. Additional studies in LMICs are needed to assess unique exposures and disease trajectories relevant to these populations.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1591-1614"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913575","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":"An Older Adult Man With a Massive Pleural Effusion.","authors":"Wesley Teck Wee Loo, Sandra Li Yan Hui","doi":"10.1016/j.chest.2024.12.024","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.024","url":null,"abstract":"<p><strong>Case presentation: </strong>A 94-year-old man presented with a 1-day history of dyspnea and no infective symptoms. There was no associated chest pain, cough, or fever. Systemic review was negative for loss of appetite or weight. He had a medical history of ischemic heart disease with an ejection fraction of 45%, hypertension, hyperlipidemia, and Alzheimer dementia.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"e189-e194"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282649","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":"Prehospital Cricothyrotomy for Emergency Airway Management.","authors":"Aditya C Shekhar, Michael McCartin, Timothy Friedmann, Graham Sabo, Jacob Stebel, Joshua Kimbrell, Bojana Milekic, Ethan Abbott, Ira J Blumen","doi":"10.1016/j.chest.2025.01.015","DOIUrl":"10.1016/j.chest.2025.01.015","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1684-1686"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045552","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}