33,669 results match your criteria Chest[Journal]


Tumor spread through air spaces identifies a distinct subgroup with poor prognosis in surgically resected lung pleomorphic carcinoma.

Chest 2018 Jun 19. Epub 2018 Jun 19.

Department of Surgery, Kurume University School of Medicine, Kurume, Japan.

Background: Tumor spread through air spaces (STAS) has recently been reported as a novel form of lung adenocarcinoma invasion that can negatively impact survival; however, its role in pleomorphic carcinoma remains unclear. This study aimed to characterize tumor STAS in pleomorphic carcinoma, including its association with clinicopathological features and prognosis.

Methods: Tumor specimens obtained from 35 consecutive patients with pleomorphic carcinoma who underwent surgical resection between 2009 and 2015 were reviewed. Read More

View Article

ICU Telemedicine Reduces Interhospital ICU Transfers in the Veterans Health Administration.

Chest 2018 Jun 5. Epub 2018 Jun 5.

Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.

Background: The effect of ICU telemedicine on transfers is not well studied. This study tests the hypothesis that ICU telemedicine decreases ICU patient interhospital transfers.

Methods: Data were retrieved for patients admitted to 306 Veterans Affairs ICUs in 117 acute care facilities between 2011 and 2015. Read More

View Article
June 2018
1 Read

Efficacy of dexamethasone in preventing acute mountain sickness in COPD patients. Randomized trial.

Chest 2018 Jun 14. Epub 2018 Jun 14.

Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja Ashu, Kyrgyz, Republic; Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic. Electronic address:

Background: Patients with chronic obstructive pulmonary disease (COPD) may experience acute mountain sickness (AMS) and other altitude-related adverse health effects (ARAHE) when travelling to high altitude. We evaluated whether dexamethasone, a drug used for AMS prevention in healthy individuals, would prevent AMS/ARAHE in COPD.

Methods: In this placebo-controlled, double-blind, parallel-design trial COPD patients, GOLD grade 1-2, living below 800m, were randomized to receive dexamethasone (8mg/day) or placebo starting on the day before ascent and while staying in a high altitude clinic at 3100m for 2 days. Read More

View Article

Lean Methodology in Healthcare.

Authors:
Rubin I Cohen

Chest 2018 Jun 14. Epub 2018 Jun 14.

Pulmonary and Critical Medicine, Amarillo Veterans Affairs Health Care System, Texas Tech University Health Sciences Center at Amarillo. Electronic address:

To improve the delivery of patient care, governments and healthcare institutions adopted quality improvement methods that had been developed decades earlier in manufacturing industries. Many healthcare practitioners are either unaware or are inexperienced about what these practices entail and whether they are successful in healthcare. This article reviews Lean, an improvement philosophy made famous by the Toyota Motor Company. Read More

View Article

Synergistic environmental exposures and the airways: capturing complexity in humans.

Authors:
Chris Carlsten

Chest 2018 Jun 14. Epub 2018 Jun 14.

Chan-Yeung Centre for Occupational and Environmental Lung Disease, University of British Columbia. Electronic address:

Paradoxically, the vast majority of research models intended to understand the relationship between exogenous exposures and lung disease are reduced to a single inhalant. This is understandable given the practical challenges of investigation, but is problematic in terms of translation to the real-world human condition. Furthermore, use of data from such models can lead to under-estimation of effect, which may adversely impact regulatory imperatives to protect public health based on the most robust information. Read More

View Article
June 2018
1 Read

Pharmacokinetics of Continuous Infusion Beta-Lactams in the Treatment of Acute Pulmonary Exacerbations in Adult Cystic Fibrosis Patients.

Chest 2018 Jun 13. Epub 2018 Jun 13.

University of Utah College of Pharmacy. Salt Lake City, Utah; University of Utah Health Care. Salt Lake City, Utah.

Background: Several clinical trials have demonstrated the efficacy of continuous infusion (CI) beta-lactam (BL) antibiotics in cystic fibrosis (CF) patients; however, little is known regarding pharmacokinetic changes during treatment of an acute pulmonary exacerbation (APE). Identifying and understanding these changes may assist in optimizing antibiotic dosing during APE treatment.

Methods: This study is a retrospective cohort study of 162 adult CF patients admitted to the University of Utah Hospital between January 1, 2008 and May 15, 2014 for treatment of an APE with both a CI BL and intravenous tobramycin. Read More

View Article
June 2018
2 Reads

An Integrative Transcriptomic and Metabolomic Study of Lung Function in Asthmatic Children.

Chest 2018 Jun 13. Epub 2018 Jun 13.

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston MA 02115, USA.

Background: Single-omic analyses have provided some insight into the basis of lung function in asthmatic children, but the underlying biological pathways are still poorly understood.

Methods: Weighted gene co-expression network analysis (WGCNA) was used to identify modules of co-regulated gene transcripts and metabolites in blood, among 325 children with asthma from the 'Genetic Epidemiology of Asthma in Costa Rica' study. The biology of modules associated with lung function; as measured by FEV, FEV/FVC-ratio, bronchodilator response, and airway responsiveness to methacholine, was explored. Read More

View Article

Testing for Respiratory Viruses in Adults with Severe Lower Respiratory Infection.

Chest 2018 Jun 13. Epub 2018 Jun 13.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine.

Viral pathogens are a common cause of severe lower respiratory tract infection (LRTI) in adults. Our ability to rapidly and accurately identify viral infections has dramatically improved as slow culture-based techniques have been largely replaced by multiplex high-throughput systems. Given these advances, reevaluation of the role of respiratory viral testing in adults presenting with LRTI is important. Read More

View Article

Reducing Readmissions in Patients with Both Heart Failure and Chronic Obstructive Pulmonary Disease.

Chest 2018 Jun 13. Epub 2018 Jun 13.

Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address:

Patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) pose particularly high costs to the healthcare system. These diseases arise from similar root causes, have overlapping symptoms, and share similar clinical courses. Because of these strong parallels, strategies to reduce readmissions in patients with both conditions share synergies. Read More

View Article
June 2018
1 Read

Visual estimate of coronary artery calcium predicts cardiovascular disease in COPD.

Chest 2018 Jun 8. Epub 2018 Jun 8.

UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.

Background: COPD is associated with cardiovascular disease (CVD), and coronary artery calcification (CAC) provides additional prognostic information. With increasing use of non-gated CT scans in clinical practice, we hypothesized that the visual Weston CAC score would perform as well as Agatston score in predicting prevalent and incident coronary artery (CAD) and CVD in COPD.

Methods: We measured CAC using Agatston and Weston scores on baseline CT scans in 1875 current and former smokers enrolled in the COPDGene study. Read More

View Article

A 68-Year-Old Lung Transplant Recipient With Shortness of Breath, Weight Loss, and Abnormal Chest CT.

Chest 2018 Jun;153(6):e153-e157

Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ. Electronic address:

Case Presentation: A 68-year-old man presented to our ED with shortness of breath, weakness, and a 25-lb unintentional weight loss. He had undergone bilateral lung transplantation (cytomegalovirus [CMV]: donor+, recipient+; Epstein-Barr virus: donor+; recipient+) for idiopathic pulmonary fibrosis (IPF) 18 months prior. His posttransplant course was fairly unremarkable until 1 month earlier, when he was admitted for breathlessness and weakness. Read More

View Article

A 47-Year-Old Man With Fever, Dry Cough, and a Lung Mass After Redo Lung Transplantation.

Chest 2018 Jun;153(6):e147-e152

Department of Pulmonary Medicine, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ. Electronic address:

Case Presentation: A 47-year-old man who was a redo double lung transplant recipient (cytomegalovirus [CMV] status: donor positive/recipient positive; Epstein-Barr virus status: donor positive/recipient positive) presented to the hospital with 1 week of generalized malaise, low-grade fevers, and dry cough. His redo lung transplantation was necessitated by bronchiolitis obliterans syndrome, and his previous lung transplantation 5 years earlier was for silicosis-related progressive massive fibrosis. He denied any difficulty breathing or chest pain. Read More

View Article

A 68-Year-Old Man With Dyspnea on Exertion and Cough.

Chest 2018 Jun;153(6):e139-e145

Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, Northwell Health, New Hyde Park, NY.

A 68-year-old man with a history of chronic lymphocytic leukemia well controlled on ibrutinib, hypertension, obesity, and a remote history of smoking (10 pack-years) presented with increasing dyspnea on exertion and cough. He had previously finished two courses of oral antibiotics for his symptoms without significant improvement. On presentation, he had no fevers or sputum production. Read More

View Article

A 45-Year-Old Man With Severe Respiratory Failure After Cardiac Arrest.

Chest 2018 Jun;153(6):e133-e137

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Respirology (Critical Care), University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address:

View Article

A Young Adult Male Presenting Posttrauma With Hypotension Despite Fluid Resuscitation.

Chest 2018 Jun;153(6):e129-e131

Departments of Anesthesiology and Emergency Medicine, Division of Critical Care Medicine, Washington University in St Louis, St Louis, MO.

View Article

Air in the Pleural Cavity Enhances Detection of Pleural Abnormalities by CT Scan.

Chest 2018 Jun;153(6):e123-e128

Pleural Medicine Unit, Institute of Respiratory Health and Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia. Electronic address:

Detection of pleural abnormalities on CT scan is critical in diagnosis of pleural disease. CT scan detects minute parenchymal lung nodules, but often fails to detect similar-sized pleural nodularity. This is likely because the density of the visceral/parietal pleura and pleural fluid is similar. Read More

View Article

Chest CT Scan Signs: A Few Noteworthy Additions.

Chest 2018 Jun;153(6):1516-1517

Department of Radiology, All India Institute of Medical Sciences Ringgold Standard Institution, New Delhi, India.

View Article

Acupuncture and Smoking Cessation? One Swallow Doesn't Make a Summer!

Chest 2018 Jun;153(6):1516

University of Exeter, Exeter, United Kingdom.

View Article

Response.

Chest 2018 Jun;153(6):1515-1516

Department of Radiology, New York University - Langone Medical Center, New York, NY.

View Article

Response.

Authors:
Steven Q Simpson

Chest 2018 Jun;153(6):1513

Division of Pulmonary and Critical Care Medicine, University of Kansas, Kansas City, KS. Electronic address:

View Article

CT Chest in Cavitary Lung Disease: Looking Beyond the Lungs.

Chest 2018 Jun;153(6):1513-1515

Department of Radiology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.

View Article

SIRS in the Time of Sepsis-3: What About the Children?

Chest 2018 Jun;153(6):1512

Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

View Article

Response.

Chest 2018 Jun;153(6):1511

Pulmonary Critical Care and Sleep Division, Department of Medicine, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY.

View Article

Bronchoscopy in Patients With Hemoptysis and Negative Imaging Tests.

Chest 2018 Jun;153(6):1510-1511

Clinical Epidemiology and Medical Statistics Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.

View Article

Response.

Chest 2018 Jun;153(6):1509-1510

Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address:

View Article

Immortal Time Bias Can Occur in the Analysis of Dose-Dependent Effect of Statin.

Authors:
Chun-Yu Lin

Chest 2018 Jun;153(6):1508-1509

Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address:

View Article

The Curious Omission of Treatment as a Predictor of Pulmonary Sarcoidosis Mortality.

Authors:
Jerome M Reich

Chest 2018 Jun;153(6):1507

Thoracic Oncology Program, Earle A Chiles Research Institute, Portland, OR. Electronic address:

View Article

Response.

Chest 2018 Jun;153(6):1507-1508

Department of Chest Disease, University of Firat, Elazığ, Turkey.

View Article

Response.

Chest 2018 Jun;153(6):1506

Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.

View Article

Checklists for Safety During ICU Intubations: The Details Matter.

Chest 2018 Jun;153(6):1505-1506

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

View Article

The Academic.

Authors:
Jerome Cantor

Chest 2018 Jun;153(6):1504

Queens, NY.

View Article

Asthma.

Chest 2018 Jun;153(6):1503

Boston, MA.

View Article

Servo-Ventilation Therapy for Sleep-Disordered Breathing.

Chest 2018 Jun;153(6):1501-1502

Yale University School of Medicine, New Haven, CT.

As seen in this CME online activity (available at http://journal.cme.chestnet. Read More

View Article
June 2018
2 Reads

COPD Home Oxygen Therapy and Home Mechanical Ventilation: Improving Admission-Free Survival in Persistent Hypercapnic COPD.

Chest 2018 Jun;153(6):1499-1500

St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.

As seen in this CME online activity (available at http://journal.cme.chestnet. Read More

View Article

COPD Advanced Patient Management.

Chest 2018 Jun;153(6):1497-1498

Hopital Nord Albert Michallon Quai Michallon, Grenoble, France.

COPD is the third leading cause of death in the United States, with current rates of both morbidity and mortality persisting and contributing significantly to long-term disability. More than 11 million Americans are diagnosed with COPD, with an additional 13 million people estimated to be living with undiagnosed disease. For patients diagnosed with COPD, the turning point will be hospitalization. Read More

View Article
June 2018
1 Read

Rebuttal From Dr Mazzone.

Authors:
Peter J Mazzone

Chest 2018 Jun;153(6):1306-1308

Lung Cancer Program and Lung Cancer Screening Program, Respiratory Institute, Cleveland Clinic, Cleveland, OH. Electronic address:

View Article

Rebuttal From Dr Wood.

Authors:
Douglas E Wood

Chest 2018 Jun;153(6):1305-1306

Department of Surgery, University of Washington, Seattle, WA. Electronic address:

View Article

COUNTERPOINT: Should Lung Cancer Screening Be Expanded to Persons Who Don't Currently Meet Accepted Criteria Set Forth by the CHEST Guidelines on Lung Cancer Screening? No.

Authors:
Peter J Mazzone

Chest 2018 Jun;153(6):1303-1305

Lung Cancer Program and Lung Cancer Screening Program, Respiratory Institute, Cleveland Clinic, Cleveland, OH. Electronic address:

View Article

Giants in Chest Medicine: Dirkje S. Postma, MD, PhD.

Chest 2018 Jun;153(6):1296-1298

Department of Pulmonary Medicine and Tuberculosis, University of Groningen, and University Medical Center Groningen, Groningen, the Netherlands. Electronic address:

View Article

High Stakes: Direct to Consumer Marketing of Unproven Stem Cell Treatments for Lung Disease.

Chest 2018 Jun;153(6):1294-1295

Department of Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL.

View Article

Enlisting the Host to Fight TB.

Chest 2018 Jun;153(6):1292-1293

Singapore Immunology Network, A∗STAR, Singapore.

View Article

Combining Dual Bronchodilation and β-Blockade in Patients With an Overlap Between COPD and Cardiovascular Diseases.

Chest 2018 Jun;153(6):1289-1291

Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli, Naples, Italy.

View Article

Can patients with COPD assimilate disease-specific information during an acute exacerbation? Results of a pilot randomized controlled trial.

Chest 2018 Jun 4. Epub 2018 Jun 4.

Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada; Department of Physical Therapy, University of Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.

Background: The study aimed to determine the feasibility and effectiveness of an introductory disease-specific education program delivered during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) on objective measures of disease-specific knowledge.

Methods: Patients admitted to a community hospital with an AECOPD were randomly assigned to a control group (standard care) or intervention group (standard care + brief education). The intervention group received two 30-minute education sessions in hospital or at home within two weeks of hospital admission. Read More

View Article

Sleep and Nocturnal Gastroesophageal Reflux: An Update.

Chest 2018 May 31. Epub 2018 May 31.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Nocturnal gastroesophageal reflux has been associated with poor sleep quality. Normal physiologic adaptations of the aerodigestive system to sleep prolong and intensify nocturnal reflux events. This occurrence leads to sleep disruption, as well as esophageal, laryngeal, and laryngopharyngeal reflux. Read More

View Article

Value-based Proposition for a Dedicated Interventional Pulmonology Suite: an Adaptable Business Model.

Chest 2018 May 31. Epub 2018 May 31.

Chicago Chest Center; Suburban Lung Associates; Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago. Electronic address:

Value-based care is evolving with a focus on improving efficiency, reducing cost, and enhancing the patient experience. Interventional pulmonology has the opportunity to lead an effective value-based care model. This model is supported by the relatively low cost of pulmonary procedures and has the potential to improve efficiencies in thoracic care. Read More

View Article

Review of Transitional Care Management and Chronic Care Management Codes for Pulmonologists.

Chest 2018 May 31. Epub 2018 May 31.

Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine. Electronic address:

Patients with advanced respiratory illness are often hospitalized, requiring close follow up after discharge and also requiring care coordination outside of traditional face-to-face outpatient visits. Primary Care providers and specialists often provide services outside of outpatient visits that have not been captured and reimbursed with traditional billing evaluation and management codes (E/M). Within the last five years, the Centers for Medicare and Medicaid (CMS) added new codes to the Medicare Physician Fee Schedule that reimburse for care coordination services not paid for by traditional evaluation and management codes (E/M). Read More

View Article

In-hospital Deaths among Adults with Community-Acquired Pneumonia.

Chest 2018 May 30. Epub 2018 May 30.

Northwestern University Feinberg School of Medicine, Chicago, IL.

Introduction: Adults hospitalized with community-acquired pneumonia are at high risk for short-term mortality. However, it is unclear whether improvements in in-hospital pneumonia care could substantially lower this risk. We extensively reviewed all in-hospital deaths in a large prospective CAP study to assess the cause of each death and assess the extent of potentially preventable mortality. Read More

View Article
May 2018
1 Read

Effectiveness of reprocessing for flexible bronchoscopes and endobronchial ultrasound bronchoscopes.

Chest 2018 May 30. Epub 2018 May 30.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

Background: Infections have been linked to inadequately-reprocessed flexible bronchoscopes, and recent investigations determined that pathogen transmission occurred even when bronchoscope cleaning and disinfection practices aligned with current guidelines. This multisite, prospective study evaluated the effectiveness of real-world bronchoscope reprocessing methods using a systematic approach.

Methods: This study involved direct observation of reprocessing methods for flexible bronchoscopes, multifaceted evaluations performed after manual cleaning and after high-level disinfection, and assessments of storage conditions. Read More

View Article

Left atrial volume as a biomarker of target organ damage in cardio-nephrology: a study in a wide range of renal function.

Chest 2018 May 30. Epub 2018 May 30.

Radiology.

Background: Cardiac chambers' sizes were previously studied by echocardiography, among patients with progressive kidney disease only. We aimed to explore the relations between all heart chambers' volumes as assessed by CT pulmonary angiography and renal function - throughout all ranges.

Methods: Using a novel technology of automatic four chamber volumetric analysis, we analyzed CT pulmonary angiographies of 744 consecutive patients (between January 1 and December 31, 2014) without pulmonary embolism, and correlated the chambers' volumes indexed to body surface area, to the estimated glomerular filtration rates. Read More

View Article