Thorax最新文献

Reduced diffusing capacity of the lungs for carbon monoxide (DLco) reflects microvasculopathy in chronic thromboembolic pulmonary hypertension, yet its clinical value is uncertain. In a Japanese nationwide registry (2018-2023) we studied 1270 patients: 486 formed an event cohort and 299 a treatment cohort who underwent pulmonary endarterectomy or balloon pulmonary angioplasty. Lower baseline DLco was indicative of smaller postprocedural improvements in mean pulmonary artery pressure, pulmonary vascular resistance and cardiac index (all p≤0.023) and a higher risk of clinical events (HR 0.971, p=0.005). Outcomes deteriorated below 59.6%, indicating DLco may help stratify prognosis and treatment benefit.

Introduction: Integrating smoking cessation supports into lung cancer screening can improve abstinence rates. However, healthcare decision-makers need evidence of cost-effectiveness to understand the cost/benefit of adopting this approach.

Methods: To evaluate the cost-effectiveness of smoking cessation interventions, and service delivery, we used a cohort-based Markov model, adapted from previous National Institute for Health and Care Excellence (NICE) guidelines on smoking cessation. This uses long-term epidemiological data to capture the prevalence of the smoking-related illnesses, updated through targeted literature searches as required from the core NICE model, with costs extracted from publicly recognised UK sources.

Results: All smoking cessation interventions appeared cost-effective at a threshold of £20 000 per quality-adjusted life year, compared with no intervention or behavioural support alone. Offering immediate smoking cessation as part of lung cancer screening appointments, compared with usual care (onward referral to stop smoking services), was also estimated to be cost-effective with a net monetary benefit of £2198 per person, and a saving of between £34 and £79 per person in reduced workplace absenteeism among working age attendees. Estimated healthcare cost savings were more than four times greater in the most deprived quintile compared with the least deprived, alongside a fivefold increase in quality adjusted life years accrued.

Conclusions: Smoking cessation interventions within lung cancer screening are cost-effective and should be integrated, so that treatment is initiated during screening visits. This is likely to reduce overall costs to the health service, and wider integrated care systems, improve quality and length of life, and may lessen health inequalities.

Background: The increasing number of patients treated by long-term non-invasive ventilation (NIV) challenges the capacity of specialised centres to perform in-hospital follow-up evaluations and requires, therefore, from the clinician a thorough and critical appraisal of the information provided by ventilator software as an important component of follow-up assessment. A systematic approach of the information is required along with a knowledge of the limitations in the reliability of some parameters and the variability in modes of reporting, which may be confusing.

Methods: This review reports the summary of observations made by a multinational group of experts in this field (SomnoNIV) over several years, and the relevant items from the medical literature.

Results: We suggest a framework for a systematic approach of items provided by ventilator software, as well as a discussion of the different modes of reporting physiological variables according to manufacturers and pitfalls associated with some variables. An extensive iconography is included to illustrate and explicit the presentation of respiratory events occurring under NIV (impact of leaks, different patient-ventilator asynchronies, impact of inappropriate settings).

Conclusion: The analysis of the detailed tracings provided by the ventilator, and, importantly, the knowledge that these signals are modified and processed by the ventilator software and are not raw data, is important for the understanding of patient-ventilator interaction.