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BACKGROUND: Long-term cognitive impairment frequently occurs after critical illness; no treatments are known to improve long-term cognition. RESEARCH QUESTION: Does a single high-dose (540,000 IU) enteral treatment of vitamin D3 given shortly after hospital admission in vitamin D deficient, critically-ill patients improve long-term global cognition or executive function? STUDY DESIGN AND METHODS: This study evaluated long-term cognitive outcomes among patients enrolled in a multicenter, blinded, randomized clinical trial comparing vitamin D3 treatment versus placebo in critically-ill adults with vitamin D deficiency...

Identification of pathological changes in early and mild obstructive lung disease has revealed the importance of the small airways and their contribution to symptoms. Indeed, significant small airways dysfunction has been found before any overt airway obstruction is detectable by conventional spirometry techniques. However, most therapies for the treatment of obstructive lung disease target the physiological changes and associated symptoms that result from chronic lung disease, rather than directly targeting the specific underlying causes of airflow disruption or the drivers of disease progression...

No abstract text is available yet for this article.

Biomarkers in chronic obstructive pulmonary disease may be clinical (prior exacerbation history), physiological (forced expiratory volume in one second), or blood based (eosinophil count or fibrinogen level). There has been recent interest in using biomarkers to predict response to therapy in clinical practice. The benefits of inhaled therapy depend on correct use of the inhaler including an appropriate inspiratory flow. Of the available delivery systems, dry powder inhalers are unique as they have an internal resistance, are breath actuated, and are flow dependent...

Survivors of COVID-19 are a vulnerable population, with complex needs owing to lingering symptoms and complications across multiple organ systems. Those who required hospitalization or intensive care are also at risk for post-hospital syndrome and post-ICU syndromes, with attendant cognitive, psychological, and physical impairments, and high levels of healthcare utilization. Effective ambulatory care for COVID-19 survivors requires coordination across multiple subspecialties, which can be burdensome if not well-coordinated...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Delirium is a deleterious condition affecting up to 60% of patients in the surgical intensive care unit (SICU). Few SICU-focused delirium interventions have been implemented, including those addressing sleep-wake disruption, a modifiable delirium risk factor common in critically ill patients. RESEARCH QUESTION: What is the effect on delirium and sleep quality of a multicomponent non-pharmacological intervention aimed at improving sleep-wake disruption in patients in the SICU setting? STUDY DESIGN AND METHODS: Using a staggered pre-post design, we implemented a quality improvement intervention in two SICUs (general surgery/trauma and cardiovascular) in an academic medical center...

BACKGROUND: Family members of ICU patients experience a constellation of sequelae described as post-intensive care syndrome-family. The influence that an inter-ICU transfer has on psychological outcomes is unknown. RESEARCH QUESTION: Is inter-ICU transfer associated with poor psychological outcomes in families of Acute Respiratory Failure (ARF) patients? STUDY DESIGN: and Methods- Cross-sectional observational study of 82 families of patients admitted to adult ICUs (tertiary hospital)...

BACKGROUND: Visceral pleural invasion (VPI) with PL1 or PL2 increases the T classification from T1 to T2 in non-small cell lung cancers (NSCLCs) 3 cm or less. We proposed a modified T classification based on VPI to guide adjuvant therapy. RESEARCH QUESTION: Is it reasonable to upstage PL1-positive cases from T1 to T2 for NSCLCs 3 cm or less? STUDY DESIGN AND METHODS: In total, 1,055 resected NSCLC patients were retrospectively included. Tumor sections were re-stained with hematoxylin and eosin stain and Vitoria blue's elastic stain for the elastic layer...

No abstract text is available yet for this article.

BACKGROUND: Indwelling tunneled pleural catheters are commonly used for recurrent pleural effusion management. Catheter obstruction is not uncommon, often requiring intrapleural medications instillation (i.e., alteplase) to restore flow. The safety profile of intrapleural medications has been previously published, however most studies exclude anticoagulated patients. RESEARCH QUESTION: What is the safety profile of intrapleural alteplase and/or dornase alfa when utilized in indwelling tunneled pleural catheters, including patients that may be undergoing active anticoagulation? STUDY DESIGN AND METHODS: Retrospective review of previously placed indwelling tunneled pleural catheters from January 2009 - February 2020 undergoing intrapleural alteplase...

BACKGROUND: Lung cancer screening (LCS) is effective at reducing mortality for high-risk smokers. Mortality benefits go beyond early cancer detection, as shared-decision making (SDM) may present a "teachable moment" to reinforce cessation and provide resources. RESEARCH QUESTION: How well is smoking cessation performed during LCS SDM encounters and what patient and provider characteristics associated with smoking cessation assistance? STUDY DESIGN AND METHODS: This is a retrospective cohort study of current smokers participating in initial LCS SDM through a multisite program in Seattle, Washington between 2015-2018...

No abstract text is available yet for this article.

Sex and gender differences in lung health and disease are imperative to consider and study if precision pulmonary medicine is to be achieved. The development of reliable COPD biomarkers has been elusive and the translation of biomarkers to clinical care has been limited. Useful and effective biomarkers must be developed with attention to clinical heterogeneity of COPD-there is inherent heterogeneity related to grouping women and men together in the studies of COPD. Considering sex and gender differences and influences related to Omics may represent progress in susceptibility, diagnostic, prognostic and therapeutic biomarker development and clinical innovation to improve the lung health of men and women...

No abstract text is available yet for this article.

BACKGROUND: Joblessness is common after ARDS, but related risk factors are not fully understood. RESEARCH QUESTION: What is the association between survivors' pre-ARDS workload and post-ARDS functional impairment, pain, and fatigue with their return to work (RTW) status? STUDY DESIGN AND METHODS: The U.S. Occupational Information Network (O*NET) was used to determine pre-ARDS workload for participants in the ARDS Network Long-Term Outcomes Study (ALTOS)...

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most frequent healthcare-associated infection in severely ill patients and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination. RESEARCH QUESTION: Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in severe trauma patients? STUDY DESIGN AND METHODS: In this open-label, randomised-controlled superiority trial conducted in 13 French intensive care units, we enrolled adults (age ≥18 years) suffering from severe trauma (Injury severity score >15) and requiring invasive mechanical ventilation for 48 hours or longer...

BACKGROUND: Children have been less impacted by the Coronavirus disease 19 (COVID) pandemic, but its repercussions on pediatric illnesses may have been significant. We examined the indirect impact of the pandemic on a population of critically ill children in the United States. RESEARCH QUESTION: Were there significantly fewer critically ill children admitted to PICUs during the 2nd quarter of 2020, and were there significant changes in the types of diseases admitted? STUDY DESIGN AND METHODS: Retrospective observational cohort study using the Virtual Pediatric Systems (VPS, LLC) database...

BACKGROUND: Studies have reported an increased risk for asthma following lower respiratory tract infections, but few studies have specifically assessed this risk in children diagnosed with pneumonia in infancy. Further, it is not fully understood whether this association is indicative of a causal relationship or if certain children have a predisposition for both diseases. RESEARCH QUESTION: Are children diagnosed with pneumonia in infancy at increased risk for asthma and what is the role of familial confounding and pneumococcal conjugate vaccine immunization on the association? STUDY DESIGN AND METHODS: We performed a nationwide register-based cohort study of >900...