Chest

Change is a fact of life; the absence of change creates stagnation. This is perhaps especially true in healthcare, where progress in treating disease depends on innovation and progress. At the same time, change is often uncomfortable. Thus, it is helpful to model the change process in order to optimize the chances of successfully effecting change. Furthermore, how to lead change is a critical leadership competency. Three models for leading change are reviewed - the first by Kotter, which was not designed for healthcare, the second by Heath and Heath called "switch", and the third by Silversin and Kornacki, which was uniquely designed for healthcare...

Emergency airway management (EAM) is associated with a high rate of complications, morbidity and mortality. Handheld point-of-care ultrasound (POCUS) shows promise as an emerging technology to facilitate rapid screening for difficult laryngoscopy, identify the cricothyroid membrane (CTM) for potential cricothyroidotomy, assess for increased aspiration risk, as well as provide confirmation of proper endotracheal tube (ETT) positioning. This review summarizes the available evidence for the use of POCUS in EAM, provides an algorithm to facilitate its incorporation into existing EAM practice to improve patient safety and serve as a framework for future validation studies...

BACKGROUND: Early in the COVID-19 pandemic, there was serious concern that the United States (US) would encounter a short fall of mechanical ventilators. In response, the US government, utilizing the Defense Production Act ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities and it is not evident whether all are able to support COVID-19 patients. RESEARCH QUESTION: Evaluate ventilator requirements for affected COVID-19 patients, assess the clinical performance of current SNS ventilators employed during the pandemic, and finally compare ordered ventilators functionality based on COVID-19 patient needs...

Because teams can accomplish goals that individuals cannot, teams matter. Indeed, teams especially matter in settings like healthcare, where favorable outcomes depend critically on the contributions of many different people with diverse skills. As important as effective teambuilding is for healthcare, how to build teams is often not included in medical curricula and doctors learn to build teams by hidden curricula. In the context that we can do better, this "How I do it" presents an approach to building a team in a common scenario for the chest physician - picking up the inpatient Pulmonary Consult Service...

Pulmonary exacerbations (PEx) are significant life events in people with cystic fibrosis (CF), associated with declining lung function, reduced quality of life (QoL), hospitalisations and decreased survival. The adult CF population is increasing worldwide, with many patients surviving prolonged periods with severe multi-morbid disease. In many countries the number of adults with CF exceeds the number of children, and PEx are particularly burdensome for adults as they tend to require longer courses and more intravenous treatment than children...

BACKGROUND: Invasive mechanical ventilation is often initiated in the Emergency Department (ED), and mechanically ventilated patients may be kept in the ED for hours prior to intensive care unit (ICU) transfer. Although lung-protective ventilation is beneficial, particularly in acute respiratory distress syndrome (ARDS), it remains uncertain how often lung-protective tidal volumes are used in the ED, and whether lung-protective ventilation in this setting impacts patient outcomes. RESEARCH QUESTION: What is the association between the use of lung-protective ventilation in the ED and outcomes among invasively ventilated patients? STUDY DESIGN AND METHODS: Retrospective analysis (2011-2017) of a prospective registry from eight EDs enrolling consecutive adult patients (≥ 18 years) who received invasive mechanical ventilation in the ED...

No abstract text is available yet for this article.

BACKGROUND: The prevalence of burnout and depressive symptoms is high among physician trainees. RESEARCH QUESTION: What is the burden of burnout and depressive symptoms among fellows training in pulmonary and critical care medicine (PCCM) and what are associated individual fellow, program, and institutional characteristics? STUDY DESIGN/METHODS: We conducted a cross-sectional electronic survey of fellows enrolled in pulmonary, PCCM, and critical care medicine training programs in the United States to assess burnout and depressive symptoms...

In the context that leadership matters and that leadership competencies differ from those needed to practice medicine or conduct research, developing leadership competencies for physicians is important. Indeed, effective leadership is needed ubiquitously in healthcare, both at the executive level and at the bedside, e.g., leading clinical teams and problem-solving on the ward. Various leadership models have been proposed, most converging on common attributes - as described by Kouzes and Posner - of envisioning a new and better future state, inspiring others around this shared vision, empowering others to effect the vision, modeling the expected behaviors, and engaging others by appealing to shared values...

The coronavirus pandemic has disrupted clinical practice, healthcare organizations, and life. In the context that "a crisis is a terrible thing to waste," as disruptive as the pandemic has been to traditional practices - both clinically and educationally - opportunities have also presented. Clinical benefits have included the propulsion of clinical innovation, including development of novel vaccines; accelerated understanding of multiplex ventilation, etc. Approaches to educating students and other learners have also changed radically, with suspension of live teaching in most instances and a precipitous transition to virtual instruction...

BACKGROUND: With the advancement of cardio-respiratory interventions, the survival rate among patients with Duchenne muscular dystrophy has increased. Subsequently, pneumothorax has become a significant problem in patients with prolonged ventilatory support. RESEARCH QUESTION: We aimed to investigate the frequency, recurrence rate, risk factors, and prognosis of pneumothorax in patients with Duchenne muscular dystrophy requiring non-invasive ventilation. Also, we tried to evaluate whether there were known risk factors of pneumothorax on the chest CT...

Emotional intelligence (EI) has become widely appreciated as an important leadership attribute, in business, education and, increasingly, in healthcare. Defined as "the capacity to understand your own and others' emotions and to motivate and develop yourself and others in service of improved work performance and enhanced organizational effectiveness," EI is correlated with a number of success attributes in several sectors, e.g., in business, enhanced business performance and enhanced personal career success; and in healthcare, with enhanced patient satisfaction, lower burnout, lower litigation risk, and enhanced leadership success...

There is increasing interest in the effects of sleep and sleep disturbances on the brain, particularly in relation to aging and neurodegenerative processes. Parkinson's disease (PD) is the second most common neurodegenerative disorder, with growing prevalence worldwide. Sleep disorders, including sleep-disordered breathing (SDB), are amongst the most frequent non-motor manifestations of PD. They can substantially impair quality of life, and possibly affect the course of the disease. This article reviews the etiology, implications and management of sleep disturbances in PD, such as excessive daytime sleepiness, insomnia, restless legs syndrome, rapid eye movement sleep behavior disorder and SDB...

BACKGROUND: Chronic tobacco smoke exposure results in a broad range of lung pathologies including emphysema, airway disease and parenchymal fibrosis as well as a multitude of extra-pulmonary comorbidities. Prior work using computed tomography imaging has identified several clinically relevant subgroups of smoking related lung disease, but these investigations have generally lacked organ specific molecular correlates. RESEARCH QUESTION: Can computed tomography imaging be used to identify clinical phenotypes of smoking related lung disease that have specific bronchial epithelial gene expression patterns in order to better understand disease pathogenesis? STUDY DESIGN: and Methods: Using K-means clustering, we clustered participants from the COPDGene study (n=5273) based on CT imaging characteristics and then evaluated their clinical phenotypes...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Characteristics of critically ill adults with coronavirus disease 2019 (COVID-19) in an academic safety net hospital and the effect of evidence-based practices in these patients are unknown. RESEARCH QUESTION: What are the outcomes of critically ill adults with COVID-19 admitted to a network of hospitals in New Orleans, LA and is an evidence-based protocol for care associated with improved outcomes? STUDY DESIGN: and Methods: In this multi-center, retrospective, observational cohort study of intensive care units in four hospitals in New Orleans, LA, we collected data on adults admitted to an intensive care unit (ICU) and tested for SARS-CoV-2 between March 9, 2020 and April 14, 2020...

No abstract text is available yet for this article.

BACKGROUND: Self-reported tobacco pack-year history plays a large role in decisions about low-dose computed tomography (CT) lung cancer screening yet is challenging to measure accurately. RESEARCH QUESTION: To what extent does random measurement error in pack-year information impact screening decisions and screening effectiveness? STUDY DESIGN: and Methods: Retrospective cohort study of 10,449 patients with pack-year history documented at least twice between 10/2013-7/2017, across 8 academic Veterans Affairs sites...

COVID-19 has resulted in significant morbidity and mortality due to lack of effective therapies. Therapeutic strategies under investigation target the overactive cytokine response with anti-cytokine or immunomodulators therapies. We present a unique case of severe cytokine storm resistant to multiple anti-cytokine therapies, but eventually responsive to Etoposide. Thus, Etoposide may have a role as salvage therapy in treatment of cytokine storm in COVID-19. To our knowledge, this is the first reported case of use of Etoposide in COVID-19...