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Trust in Science Now Deeply Polarized 对科学的信任现在已经两极分化
Pub Date : 2022-01-27 DOI: 10.13175/swjpcc2005-22
R. Robbins
No abstract available. Article truncated after 150 words. The Associated Press is reporting that Republicans' faith in science is falling as Democrats rely on it even more, with a trust gap in science and medicine widening substantially during the COVID-19 pandemic, new survey data shows (Figure 1) (1). Overall, 48% of Americans say they have "a great deal" of confidence in the scientific community, the 2021 General Social Survey data shows. Sixty-four percent of Democrats say that, compared with roughly half as many Republicans, 34%. The gap was much smaller in 2018, when 51% of Democrats and 42% of Republicans had high confidence. It's the largest gap in nearly five decades of polling by the General Social Survey, a widely respected trend survey conducted by NORC at the University of Chicago that has been measuring confidence in institutions since 1972. The most recent survey was conducted Dec. 1, 2020, through May 3, 2021, and includes interviews with 4,032 …
没有摘要。文章在150字后被删节。美联社报道称,共和党人对科学的信心正在下降,而民主党人对科学的依赖更加严重,新的调查数据显示,在2019冠状病毒病大流行期间,科学和医学的信任差距大幅扩大(图1)(1)。总体而言,2021年综合社会调查数据显示,48%的美国人表示他们对科学界“非常”有信心。64%的民主党人这么认为,而持同样观点的共和党人只有34%。2018年,这一差距要小得多,51%的民主党人和42%的共和党人对此抱有高度信心。这是综合社会调查(General Social Survey)近50年来的最大差距。综合社会调查是芝加哥大学(University of Chicago) NORC开展的一项广受尊敬的趋势调查,自1972年以来一直在衡量人们对机构的信心。最近的调查于2020年12月1日至2021年5月3日进行,包括对4,032名……
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引用次数: 0
Symptomatic Improvement in Cicatricial Pemphigoid of the Trachea Achieved with Laser Ablation Bronchoscopy 激光消融支气管镜治疗瘢痕性类天疱疮的疗效观察
Pub Date : 2022-01-18 DOI: 10.13175/swjpcc058-21
E. Benge, Vincent Tran, Nazanin Sheikan, S. Bhatia, Yi Mcwhorter, J. Collier, Arnold Chung
Cicatricial pemphigoid (CP) with tracheal involvement is a rare and potentially deadly condition. Here, we report the first case in which Nd:YAG laser (1064nm) laser ablation bronchoscopy was used to treat CP with tracheal involvement. Our patient is a 71-year-old male with a history of CP refractory to medical therapy affecting his trachea who presented to the emergency department with dyspnea. He ultimately underwent bronchoscopy with Nd: YAG laser (1064nm) laser ablation, which resulted in a temporary alleviation of his respiratory symptoms. A repeat laser ablation was planned in hopes of prolonging the patient’s remission, but due to interval changes in the patient’s airway anatomy, it was deemed unsafe. While our patient’s uniquely advanced disease was not amenable to further laser-mediated intervention, it is possible that patients with less advanced disease may experience better outcomes with similar therapy. This case shows the promise laser ablation could hold for patients with tracheal cicatricial pemphigoid.
瘢痕性类天疱疮(CP)与气管累及是一种罕见和潜在致命的条件。在此,我们报告首例使用Nd:YAG激光(1064nm)激光消融支气管镜治疗累及气管的CP。我们的病人是一名71岁男性,有CP病史,药物治疗难治,影响气管,以呼吸困难就诊于急诊科。他最终接受了Nd: YAG激光(1064nm)激光消融支气管镜检查,导致他的呼吸症状暂时缓解。计划重复激光消融,希望延长患者的缓解期,但由于患者气道解剖的间隔变化,被认为是不安全的。虽然我们的患者独特的晚期疾病不适合进一步的激光介导干预,但有可能不那么晚期的疾病患者通过类似的治疗可能会获得更好的结果。本病例显示了激光消融治疗气管瘢痕性类天疱疮的前景。
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引用次数: 0
January 2022 medical image of the month: bronchial obstruction due to pledget in airway following foregut cyst resection 2022年1月医学影像:前肠囊肿切除术后气管内异物导致支气管梗阻
Pub Date : 2022-01-02 DOI: 10.13175/swjpcc065-21
P. Panse, K. Sakata
No abstract available. Article truncated after 150 words. A 37-year-old woman complaining of chest pain and cough underwent resection of a mediastinal foregut duplication cyst complicated by a 10-day hospitalization with a prolonged air leak. Seven years later, she presented with worsening cough and shortness of breath, complaining of similar symptoms intermittently in the 7 years between her surgery and presentation. Chest CT showed a hyperattenuating lesion obstructing the medial basal segmental airways, with bronchoscopy revealing suture and a pledget obstructing the medial basal segmental right lower lobe bronchus. The pledget and suture were successfully removed. Repeat bronchoscopy several months later showed no residual airway foreign body, although medial basal subsegmental bronchial stenosis prevented advancement of the bronchoscope distally; this finding correlated with the CT impression of airway stenosis or occlusion in this region on the follow up CT. Bronchogenic cysts result from abnormal lung budding and development of the ventral foregut during the first trimester (1). Many …
没有摘要。文章在150字后被删节。一名37岁女性,主诉胸痛和咳嗽,接受了纵隔前肠重复囊肿切除术,并因长时间漏气住院10天。7年后,患者表现为咳嗽加重和呼吸急促,在手术至就诊之间的7年中间歇性地抱怨类似症状。胸部CT显示一个超衰减病变阻塞了内侧基段气道,支气管镜显示缝合线和一个异物阻塞了右下叶内侧基段支气管。纱布和缝线已成功取出。几个月后再次支气管镜检查未发现残留气道异物,但内侧基底支气管亚段狭窄阻止了支气管镜远端前进;这一发现与随访CT显示该区域气道狭窄或闭塞相关。支气管源性囊肿是由妊娠早期前肠的异常肺芽出和发育引起的(1)。
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引用次数: 0
January 2022 Critical Care Case of the Month: Ataque Isquémico Transitorio in Spanish 2022年1月本月重症监护案例:西班牙语Ataque Isquémico Transitorio
Pub Date : 2022-01-01 DOI: 10.13175/swjpcc051-21
Mohammad T. Mahmoud, Bo Gu, Benito Armenta, Nikita Samra
No abstract available. Article truncated after 150 words. History of Present Illness: The patient is a previously healthy 61-year-old Spanish-speaking woman who was unable to speak after awakening. Per Emergency Medical Service she was found to be aphasic upon their arrival. While in the Emergency Room the patient was able to speak, alert and oriented x4, with all her symptoms spontaneously resolved. The patient denied fever, chills, blurred vision, headache or any history of migraines, TIA, or stroke. The patient had a similar event about two weeks earlier which also spontaneously resolved. During that time, the patient had a non-contrast CT head and an MRI of the brain, both of which were unremarkable. Her home medications include aspirin 81 mg and atorvastatin 40 mg daily. Past Medical History, Family History and Social History: The patient denies tobacco use or use of illicit drugs. She reports that she will occasionally drink alcohol. There is no family history of strokes. …
没有可用的摘要。文章在150字后被截断。目前病史:患者是一名健康的61岁西班牙语女性,苏醒后无法说话。根据紧急医疗服务中心的说法,她在他们到达时被发现失语症。在急诊室时,患者能够说话,警觉且定向x4,所有症状都能自发缓解。患者否认发烧、发冷、视力模糊、头痛或任何偏头痛、短暂性脑缺血发作或中风病史。患者在大约两周前也发生过类似的事件,但也自行解决。在此期间,患者进行了非对比CT头部检查和脑部MRI检查,这两项检查都不明显。她的家庭用药包括每天81毫克阿司匹林和40毫克阿托伐他汀。既往病史、家族史和社会史:患者否认吸烟或使用非法药物。她报告说她偶尔会喝酒。没有中风家族史…
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引用次数: 0
Protecting the Public’s Health-Except in Tennessee 保护公众健康,田纳西州除外
Pub Date : 2021-12-15 DOI: 10.13175/swjpcc067-21
R. Robbins
No abstract available. Article truncated after 150 words. State regulatory boards that regulate professionals such as doctors, nurses, psychologists, etc. are often appointed by politicians and headed by lawyers. Under this category has been most Medical Boards and their parent organization the Federation of State Medical Boards. Although they claim to be protecting the public, they seem more concerned with identifying “disruptive” physicians and blacklisting them through the National Practitioner Data Bank (1). However, in July the Federation issued a warning to physicians against propagating COVID-19 vaccine misinformation and disinformation citing a "dramatic increase" by physicians (2). The statement gave some hope that the Federation was striving to maintain some degree of professional standards by saying that spreading disinformation to the public was dangerous because physicians enjoy a high degree of public credibility. The Tennessee Board of Medical Examiners followed the Federation’s lead by issuing a verbatim restatement warning that physicians who spread false information about COVID-19 vaccinations …
没有摘要。文章在150字后被删节。管理医生、护士、心理学家等专业人员的国家管理委员会通常由政治家任命,并由律师领导。属于这一类的是大多数医疗委员会及其上级组织——国家医疗委员会联合会。尽管他们声称是在保护公众,但他们似乎更关心的是识别“破坏性”医生,并通过国家从业者数据库将他们列入黑名单(1)。7月,联合会以医生“急剧增加”为理由,警告医生不要传播COVID-19疫苗的错误信息和虚假信息(2)。该声明称,向公众传播虚假信息是危险的,因为医生享有高度的公众信誉,这给人们带来了一些希望,表明联合会正在努力保持一定程度的专业标准。田纳西州医学检查委员会跟随联合会的领导,发布了一份逐字重述,警告那些传播有关COVID-19疫苗虚假信息的医生……
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引用次数: 0
Payer Coverage of Valley Fever Diagnostic Tests 山谷发烧诊断测试的付款人覆盖范围
Pub Date : 2021-12-11 DOI: 10.13175/swjpcc052-21
Chloe Grace Rose, Joshua E. Kessler, Jennifer Weisbrod, Brittanie Hoang, A. Grizzle, J. Hurwitz, J. Galgiani
Background The nonspecific symptoms of Valley fever, or coccidioidomycosis, hinders its proper diagnosis. This results in unnecessary health care costs and antibiotic usage. Thus, this study seeks to determine the coverage of the Valley fever diagnostic test as provided by Arizona insurance companies to increase early diagnosis rates. Methods Through scripted messaging and telephone communications, we contacted 40 health insurance companies in Arizona about their coverage of CPT 86635 (antibody diagnostic assay for Coccidioides) without prior authorization under all plan types provided in both primary and urgent care settings. If prior authorization was required, we discussed the coverage of ICD-10 codes J18.9 (pneumonia, unspecified organism), J18.1 (lobar pneumonia, unspecified organism), or L52 (erythema nodosum). Results Of the 40 health insurance companies contacted, 25 did not answer our inquiries, most requiring member-specific information to share coverage data. The remaining 15 companies covered Valley fever testing, of which 4 required prior authorization for the ICD-10 codes of interest. Of these 15 companies, 14 provided coverage in primary and urgent care settings, and 13 provided coverage for all available plans. Conclusion All payers that provided information covered Valley Fever testing. Most of the insurance companies that were unable to answer our inquiry likely cover Valley fever testing, but were unable to share information with third party inquiries. Obtaining general coverage information is difficult, which can potentially impact patient care.
背景谷热或球孢子菌病的非特异性症状阻碍了其正确诊断。这导致了不必要的医疗费用和抗生素的使用。因此,本研究旨在确定亚利桑那州保险公司提供的谷热诊断测试的覆盖率,以提高早期诊断率。方法通过脚本短信和电话沟通,我们联系了亚利桑那州的40家健康保险公司,了解他们在没有事先授权的情况下,在初级和紧急医疗机构提供的所有计划类型下,CPT 86635(球虫抗体诊断测定)的覆盖范围。如果需要事先授权,我们讨论了ICD-10代码J18.9(肺炎,未指明的生物体)、J18.1(大叶性肺炎,未指明的生物体)或L52(结节性红斑)的覆盖范围。结果在我们联系的40家健康保险公司中,有25家没有回答我们的询问,其中大多数要求会员提供特定信息以共享保险数据。其余15家公司提供谷热检测,其中4家需要事先获得ICD-10相关代码的授权。在这15家公司中,14家在初级保健和紧急保健环境中提供保险,13家为所有现有计划提供保险。结论:所有提供信息的支付者均涵盖谷热检测。大多数无法回答我们询问的保险公司可能包括谷热测试,但无法与第三方查询共享信息。获得一般覆盖信息是困难的,这可能会影响患者护理。
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引用次数: 0
December 2021 Pulmonary Case of the Month: Interstitial Lung Disease with Red Knuckles 2021年12月当月肺部病例:伴有红节的间质性肺病
Pub Date : 2021-12-10 DOI: 10.13175/swjpcc066-21
R. Robbins, S. Klotz
No abstract available. Article truncated after 150 words. We thought a follow-up to our original brief review of COVID-19 in February, 2020 might be useful. As we write this in early December 2021, we again caution that this area is rapidly changing and what is true today will likely be outdated tomorrow. We again borrowed heavily from the Centers for Disease Control (CDC) CDC website and the NIH website which have extensive discussions over numerous pages covering COVID-19. Our hope is to condense those recommendations. We do not discuss inpatient care in any detail. COVID-19 Variants The initial steps of coronavirus infection involve the specific binding of the coronavirus spike (S) protein to the cellular entry receptors which are normally on a cell. These include human aminopeptidase N (APN; HCoV-229E), angiotensin-converting enzyme 2 (ACE2; HCoV-NL63, SARS-CoV and SARS-CoV-2) and dipeptidyl peptidase 4 (DPP4; MERS-CoV). All viruses, but especially simple single-stranded RNA viruses like COVID-19, constantly change through mutation …
没有可用的摘要。文章在150字后被截断。我们认为,对2020年2月新冠肺炎的最初简要回顾进行后续可能会有用。当我们在2021年12月初写这篇文章时,我们再次警告说,这一领域正在迅速变化,今天的真实情况明天可能会过时。我们再次大量借鉴了美国疾病控制中心(CDC)CDC网站和美国国立卫生研究院网站,这些网站在涉及新冠肺炎的众多页面上进行了广泛讨论。我们希望精简这些建议。我们不详细讨论住院护理。新冠肺炎变体冠状病毒感染的最初步骤涉及冠状病毒刺突蛋白与细胞进入受体的特异性结合,细胞进入受体通常在细胞上。其中包括人氨基肽酶N(APN;HCoV-229E)、血管紧张素转换酶2(ACE2;HCoV-NL63、SARS-CoV和SARS-CoV-2)和二肽基肽酶4(DPP4;MERS-CoV)。所有病毒,尤其是像新冠肺炎这样的简单单链RNA病毒,都会通过突变不断变化…
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引用次数: 0
December 2021 Medical Image of the Month: Aspirated Dental Implant 2021年12月月度医学图像:吸入式种植牙
Pub Date : 2021-12-02 DOI: 10.13175/swjpcc040-21
P. Panse, S. Biswas Roy, R. Viggiano
No abstract available. Article truncated after first 150 words. A 76-year-old woman with a past medical history significant for left-sided breast cancer status post lumpectomy recently underwent an extensive dental procedure about 1 month prior to presentation. The dental procedure was prolonged, and the patient reported falling asleep during the procedure several times. She presented with fatigue, right pleuritic chest pain, low-grade fevers, and drenching sweats. She underwent chest radiography at an outside institution which disclosed pneumonia, for which she was treated with cefdinir and doxycycline without improvement. Thoracostomy tube drainage of the pleural effusion was performed and showed empyema. Imaging showed an airway foreign body which was retrieved bronchoscopically. The patient made an uneventful recovery. Aspiration during dental procedures is rare but reported (1). Dental items have been reported as the second most commonly ingested/aspirated foreign objects in adults. If the airway is not compromised, assessment for any lost or missing instrument and its component should be done …
没有可用的摘要。文章前150字后被截断。一位76岁的女性,其既往病史对左侧乳腺癌症状态具有重要意义,最近在肿块切除术前约1个月接受了广泛的牙科手术。牙科手术时间延长,患者多次报告在手术过程中睡着。她表现为疲劳、右胸膜炎性胸痛、低热和淋汗。她在一家外部机构接受了胸部X光检查,发现肺炎,并接受了头孢地尼和多西环素治疗,但没有好转。胸腔造口管引流胸腔积液,显示脓胸。影像显示气道异物,经支气管镜检查取出。病人平安无事地康复了。牙科手术中的抽吸现象很少见,但有报道(1)。据报道,牙科用品是成年人第二常见的摄入/吸入异物。如果气道没有受损,应评估任何丢失或丢失的仪器及其组件…
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引用次数: 0
December 2021 Pulmonary Case of the Month: Interstitial Lung Disease with Red Knuckles 2021年12月月度病例:间质性肺病伴红指关节
Pub Date : 2021-12-01 DOI: 10.13175/swjpcc063-21
L. Wesselius
No abstract available. Article truncated after 150 words. History of Present Illness A 56-year-old man was referred for a second opinion on recent onset of diffuse parenchymal lung disease. He had started noting mild dyspnea with yard work approximately in March 2021. His symptoms progressed over the next month with increasing shortness of breath and some fever. He presented to outside emergency department on April 17, 2021 and chest CT showing patchy ground-glass opacities with some areas of irregular consolidation (Figure 1). He was subsequently seen by an outside pulmonologist and started empirically on prednisone (50 mg/day). An outside lung biopsy had been performed which showed nonspecific interstitial pneumonitis. There was some improvement in his symptoms and his prednisone dose was reduced to 20 mg/day; however, his symptoms subsequently worsened with saturations noted to drop to 85% with any ambulation. He also had swelling of his left face and a biopsy of the parotid gland with the findings …
没有摘要。文章在150字后被删节。一名56岁男性,因近期出现弥漫性肺实质疾病而求诊第二意见。大约在2021年3月,他在院子里工作时开始注意到轻微的呼吸困难。他的症状在接下来的一个月里不断恶化,呼吸越来越急促,还有些发烧。患者于2021年4月17日到外部急诊科就诊,胸部CT显示斑片状磨玻璃影,部分区域不规则实变(图1)。随后由外部肺科医生诊治,并开始体验性使用强的松(50 mg/天)。肺外活检显示非特异性间质性肺炎。他的症状有所改善,他的强的松剂量减少到20mg /天;然而,他的症状随后恶化,血液饱和度下降到85%。他左脸肿胀,腮腺活检显示…
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引用次数: 0
Rapidly Fatal COVID-19-associated Acute Necrotizing Encephalopathy in a Previously Healthy 26-year-old Man 一名先前健康的26岁男子患上快速致命的COVID-19相关急性坏死性脑病
Pub Date : 2021-11-17 DOI: 10.13175/swjpcc039-21
R. Raschke, Cristan Jivcu
No abstract available. Article truncated after 150 words. A 26-year-old man presented to our Emergency Department at 0200 on the day of admission with chief complaints of subjective fever, leg myalgias, and progressive dyspnea of one week duration. An oropharyngeal swab PCR had revealed SARS-CoV-2 RNA three days previously. He had not received a SARS CoV-2 vaccination, but had made an appointment to receive it just a few days prior to the onset of his symptoms. The patient had no significant past medical history, was taking no medications except for ibuprofen and acetaminophen over the past week, and did not take recreational drugs. He specifically denied headache and had no prior history of seizure. On admission, his HR was 150 bpm (sinus), RR 22, BP 105/46 mmHg, temp 40.2° C. and SpO2 92% on room air. He was ill-appearing, but alert and oriented, his neck was supple and lung auscultation revealed bilateral rhonchi, but physical examination was otherwise …
没有摘要。文章在150字后被删节。一名26岁男性于入院当日0200就诊于急诊科,主诉为主观发热、腿部肌痛和持续一周的进行性呼吸困难。三天前,口咽拭子PCR发现了SARS-CoV-2 RNA。他没有接种过SARS - CoV-2疫苗,但在症状出现前几天预约了接种。患者无明显既往病史,除布洛芬和对乙酰氨基酚外,过去一周未服用任何药物,未服用消毒品。他明确否认头痛,并无癫痫病史。入院时,他的心率为150 bpm(窦性),RR 22,血压105/46 mmHg,体温40.2℃,室内空气中SpO2为92%。他外表不太好,但神志清醒,方向明确,颈部柔软,肺部听诊显示双侧隆chi,但体格检查却不然……
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引用次数: 1
期刊
Southwest journal of pulmonary & critical care
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