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Hurdles to Annual Low-Dose Chest CT Scan Adherence for Lung Cancer Screening Parallel Those to Initial Low-Dose Chest CT Scan Uptake 坚持每年进行低剂量胸部 CT 扫描以筛查肺癌的障碍与坚持首次低剂量胸部 CT 扫描的障碍并存
Pub Date : 2023-12-01 DOI: 10.1016/j.chpulm.2023.100027
Alireza Nathani MD, Abbie Begnaud MD
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引用次数: 0
Automated CT-Based Quantification of Pulmonary Veins Shows Greater Central Venous Dilation in Group 2 Pulmonary Hypertension Compared With Group 1 Pulmonary Arterial Hypertension and Control Subjects 基于自动ct的肺静脉定量显示,与1组肺动脉高压和对照组相比,2组肺动脉高压患者中心静脉扩张更大
Pub Date : 2023-12-01 DOI: 10.1016/j.chpulm.2023.100020
Andrew J. Synn MD, MPH , Eileen M. Harder MD , Pietro Nardelli PhD , James C. Ross PhD , Bradley A. Maron MD , Jane A. Leopold MD , Aaron B. Waxman MD, PhD , Raúl San José Estépar PhD , George R. Washko MD , Farbod N. Rahaghi MD, PhD
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引用次数: 0
Experiences With Tobacco Dependence Treatment Training Among Respiratory Care Clinicians 呼吸内科医师烟草依赖治疗培训的体会
Pub Date : 2023-12-01 DOI: 10.1016/j.chpulm.2023.100022
Lorraine Mascarenhas DO , Megan Campbell MPH , Hildi Hagedorn PhD , Steven S. Fu MD, MSCE , Anne C. Melzer MD, MS
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引用次数: 0
Changes in National Prescribing Trends of Pharmacotherapy to Treat Tobacco and Nicotine Dependence in Relationship to the COVID-19 Pandemic 治疗烟草和尼古丁依赖的药物疗法的全国处方趋势变化与 COVID-19 大流行的关系
Pub Date : 2023-11-23 DOI: 10.1016/j.chpulm.2023.100031
Adam Edward Lang PharmD , Tiffany Lee PhD, MPH , Mark Eatherly BS , Urvashi Patel PharmD , Chester B. Good MD, MPH
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引用次数: 0
Respiratory Syncytial Virus Prophylaxis With Palivizumab Is Not Associated With Improved Lung Function in Infants of Very Low Birth Weight at Early School Age 使用帕利珠单抗预防呼吸道合胞病毒与学龄前极低出生体重儿肺功能的改善无关
Pub Date : 2023-11-07 DOI: 10.1016/j.chpulm.2023.100026
Ingmar Fortmann , Marie-Theres Dammann , Alexander Humberg , Hannah Kraft , Alexander Herz , Kathrin Hanke , Kirstin Faust , Isabell Ricklefs , Michael Zemlin , Johannes Liese , Geraldine Engels , Christoph Härtel , Carsten Fortmann-Grote , Matthias Volkmar Kopp , Folke Brinkmann , Egbert Herting , Wolfgang Göpel , Guido Stichtenoth , for the German Neonatal Network

Background

Prematurity and infection with respiratory syncytial virus (RSV) are major risk factors for impaired lung function beyond the neonatal period.

Research Question

What are the long-term effects of palivizumab immunoprophylaxis in the first year of life on lung function and frequency of bronchitis episodes in 5- to 6-year-old preterm infants?

Study Design and Methods

Preterm infants with a birth weight < 1,500 g (very low-birth weight infants [VLBWIs]) were enrolled in a German Neonatal Network cohort study between 2009 and 2016. Children were examined by a single follow-up team at 5 to 6 years of age. VLBWIs who received at least five doses of palivizumab were compared with children who never received palivizumab. Analyses were stratified by bronchopulmonary dysplasia (BPD) and gestational age. We analyzed FVC, FEV1, FEV1 to FVC ratio, and the risk of respiratory tract infections at 5 to 6 years of age via univariate analyses and linear and logistic regression models.

Results

Of 1,986 VLBWIs with follow-up at 5 to 6 years of age, 951 infants (48%) received immunoprophylaxis with palivizumab. Children with BPD (n = 1,019) showed a much lower FEV1 than children without BPD (median FEV1 z score, –1.51 vs –1.09; P < .001). However, FEV1 in children with BPD was not altered by palivizumab (median FEV1 z score in 698 children with BPD who received palivizumab, –1.57 [interquartile range, –0.75 to –2.43] vs in 320 children with BPD who did not receive palivizumab, –1.37 [interquartile range, –0.69 to –2.25]; P = .1). As for FEV1, we did not find any protective effects of palivizumab for other end points or in other risk groups.

Interpretation

Palivizumab immunoprophylaxis in VLBWIs is not associated with improved lung function or lower rates of respiratory tract infections in early school-age infants.

研究背景早产和感染呼吸道合胞病毒(RSV)是新生儿期后肺功能受损的主要风险因素。研究问题帕利珠单抗免疫预防在出生后第一年对 5-6 岁早产儿肺功能和支气管炎发作频率的长期影响如何?研究设计与方法2009年至2016年间,一项德国新生儿网络队列研究对出生体重为1500克的早产儿(极低出生体重儿[VLBWIs])进行了登记。儿童在5至6岁时由一个随访小组进行检查。接受过至少五次帕利珠单抗治疗的超低体重儿与从未接受过帕利珠单抗治疗的儿童进行了比较。根据支气管肺发育不良(BPD)和胎龄进行分层分析。我们通过单变量分析、线性回归模型和逻辑回归模型分析了 5-6 岁时的 FVC、FEV1、FEV1 与 FVC 比值以及呼吸道感染风险。患有 BPD 的儿童(n = 1,019)的 FEV1 远低于未患 BPD 的儿童(FEV1 z 评分中位数,-1.51 vs -1.09; P <.001)。然而,帕利珠单抗并未改变BPD患儿的FEV1(接受帕利珠单抗治疗的698名BPD患儿的FEV1 z评分中位数为-1.57[四分位距范围为-0.75至-2.43],而未接受帕利珠单抗治疗的320名BPD患儿的FEV1 z评分中位数为-1.37[四分位距范围为-0.69至-2.25];P = .1)。至于 FEV1,我们没有发现帕利珠单抗对其他终点或其他风险组有任何保护作用。
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引用次数: 0
A 29-Year-Old With Iron Deficiency and Multifocal Cerebral Infarcts 29岁,缺铁伴多灶性脑梗死
Pub Date : 2023-09-14 DOI: 10.1016/j.chpulm.2023.100021
Erika Becerra-Ashby MD , Tiffany Gardner MD , Kelli Robertson MD , Katie E. Raffel MD , Peter Hountras MD

Case Presentation

A 29-year-old man with a history of mood disorder was admitted with acute encephalopathy after friends had requested a welfare check. He initially was disoriented, with poor recall and reporting delusions of alien interaction. During interview, he was falling asleep intermittently but was able to be aroused. He denied any new symptoms except discomfort with eating because of insects inside his body. His friend reported the patient used alcohol 1 to 2 drinks weekly, and LSD and marijuana use the weekend prior. He also has a remote history of recreational cocaine use in college that stopped because of nosebleeds. The patient reported a daily medication for anxiety, but he was unable to recall the name.

病例介绍:一名29岁男性,有情绪障碍病史,在朋友要求进行福利检查后被诊断为急性脑病。他最初迷失了方向,记忆力差,并报告了与外星人互动的错觉。在采访过程中,他断断续续地睡着,但能够被唤醒。他否认有任何新症状,只是因为体内有昆虫而进食不舒服。他的朋友报告说,病人每周喝1到2杯酒,在此之前的周末还吸食过LSD和大麻。他还曾在大学期间吸食可卡因,后来因流鼻血而停止吸食。病人报告说,他每天都要服用治疗焦虑症的药物,但他记不起药物的名字。
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引用次数: 0
Veteran and Lung Cancer Screening Coordinator Perspectives on Improving Adherence to Lung Cancer Screening 退伍军人和肺癌筛查协调员对提高肺癌筛查依从性的看法
Pub Date : 2023-09-09 DOI: 10.1016/j.chpulm.2023.100016
Jonathan Angotti MD , Charlene Pope PhD , Nichole T. Tanner MD

Background

Lung cancer screening (LCS) with low-dose CT scan has been shown to reduce mortality from lung cancer, the deadliest cancer killer. More than one-half of incident lung cancers detected in the National Lung Screening Trial were identified after the first year of screening, which highlights the importance of annual adherence to achieve mortality benefit from LCS. Although National Lung Screening Trial adherence across three rounds of screening was 95%, adherence in the community is lower and highly variable even within the same health system.

Research Question

What are patient and LCS coordinator perspectives on barriers and potential solutions to ensuring adherence to annual LCS?

Study Design and Methods

In this qualitative study, we conducted six veteran focus groups of 21 veterans who had undergone at least one LCS examination and individual interviews of eight LCS coordinators. Interviews and focus groups were transcribed and coded using qualitative content analysis. Codes were sorted into categories reflecting veteran perceptions, LCS ideas, observations, barriers, facilitators, preferences, recommendations, and LCS program issues. These codes were then analyzed and used to identify themes influencing adherence.

Results

The following four themes were identified from qualitative analysis: (1) direct communication about the repeat annual nature of screening was a driver for patient adherence, (2) patients recommended using other modalities including text messaging and mobile applications to improve adherence, (3) LCS coordinators reported a lack of emphasis and focus on adherence because of a lack of resources, and (4) the variability in program practices for bringing patients back every year and inability to measure adherence are barriers that need to be addressed.

Interpretation

Direct and multimodal communication may improve patient adherence to annual LCS, and system-level changes (eg, tracking dashboard and metrics) could assist LCS coordinators in addressing and focusing on LCS program adherence.

低剂量CT扫描肺癌筛查(LCS)已被证明可以降低肺癌的死亡率,肺癌是最致命的癌症杀手。在国家肺部筛查试验中发现的肺癌病例中,有一半以上是在筛查的第一年之后发现的,这突出了每年坚持使用LCS以实现死亡率降低的重要性。尽管全国肺部筛查试验三轮筛查的依从性为95%,但即使在同一卫生系统内,社区的依从性也较低且差异很大。患者和LCS协调员对确保遵守年度LCS的障碍和潜在解决方案的看法是什么?研究设计与方法在本定性研究中,我们对21名至少接受过一次LCS检查的退伍军人进行了6个焦点小组的研究,并对8名LCS协调员进行了个别访谈。访谈和焦点小组使用定性内容分析进行转录和编码。代码被分为不同的类别,反映了老兵的看法、LCS的想法、观察、障碍、促进因素、偏好、建议和LCS项目问题。然后对这些代码进行分析并用于确定影响依从性的主题。结果定性分析确定了以下四个主题:(1)关于每年重复筛查性质的直接沟通是患者依从性的驱动因素;(2)患者建议使用其他方式,包括短信和移动应用程序来提高依从性;(3)由于缺乏资源,LCS协调员报告缺乏对依从性的重视和关注;(4)每年将患者带回来的项目实践的可变性和无法衡量依从性是需要解决的障碍。直接和多模式的沟通可以提高患者对年度LCS的依从性,系统层面的改变(例如,跟踪仪表板和指标)可以帮助LCS协调员解决和关注LCS计划的依从性。
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引用次数: 0
Guideline Alignment and Medication Concordance in COPD 慢性阻塞性肺病的指南调整和用药一致性
Pub Date : 2023-09-04 DOI: 10.1016/j.chpulm.2023.100017
Meredith A. Case MD, MHS , Eric P. Boorman PhD , Elizabeth Ruvalcaba MSPH , Michael T. Vest DO , Nadia N. Hansel MD, MPH , Nirupama Putcha MD, MHS , Michelle N. Eakin PhD

Background

Provider adherence to clinical treatment guidelines in COPD is low. However, for patients to receive guideline-aligned care, providers not only must prescribe guideline-aligned care, but also must communicate that regimen successfully to patients to ensure medication concordance. The rate of medication concordance between patients and providers and its impact on clinical management is unknown in COPD.

Research Question

To examine rates of guideline alignment and medication concordance and to identify patient-level factors that place patients at risk for these types of poor disease management outcomes.

Study Design and Methods

This study was a secondary data analysis of the Medication Adherence Research in COPD study (2017-2023). Participants were categorized into 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Medication regimens were classified as aligned or nonaligned with 2017 GOLD guidelines. Nonaligned regimens were stratified further into overuse and underuse categories. Medication concordance between provider-reported and participant-reported regimens was determined. Factors associated with guideline alignment and medication concordance were evaluated using logistic regression.

Results

Of 191 participants, 51% of provider-reported regimens were guideline aligned, with 86% of nonaligned regimens reflecting overuse with an inhaled corticosteroid (ICS). Thirty-eight percent of participants reported different regimens than their providers, of which > 80% reflected participants not reporting medications their providers reported prescribing. Participants did not report long-acting muscarinic antagonists and long-acting beta-agonists at similar rates as ICSs. Greater symptom burden and absence of a pulmonologist on the care team were associated with both guideline misalignment and medication discordance. Cognitive impairment and Black race additionally were associated with medication discordance.

Interpretation

Guideline misalignment and medication discordance were common and were driven by overuse of ICSs and unreported medications, respectively. The patient-level factors associated with medication discordance highlight the importance of improving patient-provider communication to improve clinical management in COPD.

背景慢性阻塞性肺病的临床治疗指南对医疗服务提供者的依从性很低。然而,要使患者接受与指南一致的治疗,医疗服务提供者不仅必须开具与指南一致的处方,还必须成功地将治疗方案传达给患者,以确保用药一致。在慢性阻塞性肺病中,患者与医疗服务提供者之间的用药一致性率及其对临床管理的影响尚不清楚。研究问题研究指南一致性率和用药一致性率,并确定使患者面临这类不良疾病管理结果风险的患者层面因素。研究设计和方法本研究是对慢性阻塞性肺病用药依从性研究(2017-2023 年)的二次数据分析。参与者被分为 2017 年慢性阻塞性肺病全球倡议(GOLD)阶段。药物治疗方案被分为与 2017 年 GOLD 指南一致或不一致。不一致的治疗方案进一步分为过度使用和使用不足两类。确定了提供者报告的用药方案与参与者报告的用药方案之间的一致性。结果 在 191 名参与者中,51% 的提供者报告的治疗方案与指南一致,86% 的非一致治疗方案反映出过度使用吸入式皮质类固醇 (ICS)。38% 的参与者报告的治疗方案与其提供者不同,其中 80% 反映出参与者未报告其提供者报告的处方药物。参与者报告的长效毒蕈碱拮抗剂和长效乙型受体激动剂的比例与 ICS 相似。更大的症状负担和护理团队中没有肺科医生与指南不一致和用药不一致有关。认知障碍和黑人种族也与用药不一致有关。释义指南不一致和用药不一致很常见,分别由过度使用 ICSs 和未报告用药引起。与用药不一致相关的患者层面因素凸显了加强患者与医护人员沟通以改善慢性阻塞性肺病临床管理的重要性。
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引用次数: 0
Pulmonary Function in Adults With Type 2 Diabetes With and Without Obesity 伴有和不伴有肥胖的成人2型糖尿病肺功能
Pub Date : 2023-09-03 DOI: 10.1016/j.chpulm.2023.100014
Charles F. Hayfron-Benjamin PhD , Ruth Korkor Tei MBChB , Josephine Korang Osei-Tutu BSc , Tracy Amo-Nyarko BSc , Patience Vormatu , Joana N. Ackam BSc , Gloria Odom Asante BSc , Latif Musah MPhil , Anastasia N.K. Bruce MBChB , Kwaku Amponsah Obeng MBChB

Background

Existing reports show a bidirectional association between type 2 diabetes (T2D) and pulmonary dysfunction. Obesity, which is causally related to both T2D and pulmonary dysfunction, could play an important role in this association. However, this has not been reported.

Research Question

What are the associations of measures of obesity with pulmonary function in T2D?

Study Design and Methods

This was a cross-sectional study among 464 adults with T2D. Spirometry was performed according to the American Thoracic Society/European Respiratory Society guidelines. The predicted values of the spirometric indices were determined using the Global Lung Function Initiative 2012 equations. The values of FEV1/FVC and FVC were used to categorize pulmonary function patterns as normal, obstructive, restrictive, or mixed. Waist circumference (WC) was measured at the midpoint between the lower margin of the lowest palpable rib and the top of the iliac crest.

Results

The mean age, diabetes duration, and female/male ratio of the participants were 55.09 ± 10.45 years, 10.00 ± 7.36 years, and 2:1, respectively. In a multiple linear regression model, WC was a significant predictor of FVC (P = .018) and FEV1/FVC ratio (P = .005), but not FEV1 (P = .472). BMI was a significant predictor of FEV1/FVC ratio (P = .031), but not FEV1 (P = .802) or FVC (P = .129). In a multivariable logistic regression model adjusted for age, sex, socioeconomic status, diabetes duration, glycated hemoglobin, statin use, and smoking pack-years, increasing z score WC was associated with higher odds of restrictive spirometry (OR, 1.32; 95% CI, 1.05-1.66; P = .019) but not airway obstruction (OR, 0.65; 95% CI, 0.42-1.03; P = .067). There were no significant associations of increasing z score BMI with restrictive spirometry (OR, 1.24; 95% CI, 0.98-1.58; P = .075) or airway obstruction (OR, 0.79; 95% CI, 0.51-1.24; P = .305).

Interpretation

Increasing WC is associated with restrictive spirometry, independent of conventional diabetes and pulmonary risk factors. Future research could explore the role of the reversal of central obesity on pulmonary function in T2D.

现有报告显示2型糖尿病(T2D)和肺功能障碍之间存在双向关联。肥胖与T2D和肺功能障碍都有因果关系,可能在这一关联中起重要作用。然而,这还没有报道。研究问题:肥胖测量与T2D肺功能有何关联?研究设计和方法这是一项横断面研究,纳入了464名成年T2D患者。肺量测定按照美国胸科学会/欧洲呼吸学会指南进行。肺活量测定指标的预测值采用全球肺功能倡议2012方程确定。FEV1/FVC值和FVC值用于将肺功能模式分为正常、阻塞性、限制性或混合型。测量腰围(WC)在最低可触肋下缘与髂骨顶部之间的中点。结果参与者的平均年龄为55.09±10.45岁,糖尿病病程为10.00±7.36岁,男女比例为2:1。在多元线性回归模型中,WC是FVC (P = 0.018)和FEV1/FVC比值(P = 0.005)的显著预测因子,而非FEV1 (P = 0.472)。BMI是FEV1/FVC比值的显著预测因子(P = 0.031),但不是FEV1 (P = 0.802)或FVC (P = 0.129)。在调整了年龄、性别、社会经济地位、糖尿病病程、糖化血红蛋白、他汀类药物使用和吸烟包年等因素的多变量logistic回归模型中,增加z评分WC与限制性肺活量测定的较高几率相关(OR, 1.32;95% ci, 1.05-1.66;P = 0.019),但未见气道阻塞(OR, 0.65;95% ci, 0.42-1.03;P = .067)。z评分BMI升高与限制性肺活量测定无显著相关性(OR, 1.24;95% ci, 0.98-1.58;P = 0.075)或气道阻塞(or, 0.79;95% ci, 0.51-1.24;P = .305)。结论:WC升高与限制性肺活量测定有关,与常规糖尿病和肺部危险因素无关。未来的研究可以探讨中心性肥胖逆转对T2D肺功能的作用。
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引用次数: 0
Long-Term Pulmonary Function Trajectories After Allogeneic Bone Marrow Transplantation 异基因骨髓移植后的长期肺功能轨迹。
Pub Date : 2023-09-01 DOI: 10.1016/j.chpulm.2023.100012
Hemang Yadav MBBS , Mehrdad Hefazi Torghabeh MD , William J. Hogan MD , Andrew H. Limper MD
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引用次数: 0
期刊
CHEST pulmonary
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