Schulzhjorth9323

Background Little is known about the concordance of atopy with asthma COPD overlap (ACO). Among individuals with COPD, a better understanding of the phenotypes characterized by asthma overlap and atopy is needed to better target therapies. Research question What is the overlap between atopy and asthma status among individuals with COPD, and how are categories defined by the presence of atopy and asthma status associated with clinical and radiologic phenotypes and outcomes in the SPIROMICS and COPDGene studies? Study design and methods 403 individuals with COPD from SPIROMICS and 696 individuals from COPDGene with data about specific IgEs to 10 common allergens and mixes (simultaneous assessment of combination of allergens in similar category) were included. Comparison groups were defined by atopic and asthma status (neither, atopy alone, atopic asthma, non-atopic asthma, with atopy defined as any positive specific IgE (>0.35 KU/L) to any of the 10 allergens or mixes and asthma defined as self-report of doctormpared to the group without atopy or asthma. Those with atopy and atopic asthma were not at increased risk for adverse outcomes. Interpretation Asthma and atopy had incomplete overlap among former and current smokers with COPD in COPDGene and SPIROMICS. Non-atopic asthma was associated with adverse outcomes and exacerbation risk in COPD, while groups having atopy alone and atopic asthma had less risk.Teaching clinical reasoning is challenging, particularly in the time-pressured and complicated environment of the Intensive Care Unit. Clinical reasoning is a complex process in which one identifies and prioritizes pertinent clinical data to develop a hypothesis and a plan to confirm or refute that hypothesis. Clinical reasoning is related to and dependent on critical thinking skills, which are defined as one's capacity to engage in higher cognitive skills such as analysis, synthesis, and self-reflection. The authors review how an understanding of the cognitive psychological principles that contribute to effective clinical reasoning have led to strategies for teaching clinical reasoning in the ICU. With familiarity with System 1 and System 2 thinking, which represent intuitive versus analytical cognitive processing pathways, respectively, the clinical teacher can use this framework to identify cognitive patterns in clinical reasoning. In addition, the authors describe how internal and external factors in the clinical environment can affect students' and trainees' clinical reasoning abilities, as well as their capacity to understand and incorporate strategies for effective critical thinking into their practice. Utilizing applicable cognitive psychological theory, the relevant literature on teaching clinical reasoning is reviewed and specific strategies to effectively teach clinical reasoning and critical thinking in the ICU and other clinical settings are provided. Definitions, operational descriptions, and justifications for a variety of teaching interventions are discussed, including the 'one minute preceptor' model, the use of concept or mechanism maps, and cognitive de-biasing strategies.Background A number of circulating plasma biomarkers have been shown to predict survival in patients with idiopathic pulmonary fibrosis (IPF), but most were identified prior to the use of anti-fibrotic therapy (AF) in this population. Because pirfenidone and nintedanib have been shown to slow IPF progression and may prolong survival, the role of such biomarkers in AF treated patients is unclear. Research question To determine whether plasma concentration of CA-125, CXCL13, MMP7, SP-D, YKL-40, VCAM-1 and OPN is associated with differential transplant-free survival (TFS) in AF exposed and non-exposed patients with IPF. Study design and methods A pooled, multi-center, propensity-matched analysis of IPF patients with and without AF exposure was performed. Optimal thresholds for biomarker dichotomization were identified in each group using iterative Cox regression. Longitudinal biomarker change was assessed in a subset of patients using linear mixed regression modeling. A clinical-molecular signature of IPF TFS wal research for optimization and validation.Background Bronchoscopy is a useful tool for the diagnosis of lesions near central airways; however, the diagnostic accuracy of these procedures for peripheral pulmonary lesions (PPL) is a matter of ongoing debate. In this setting, electromagnetic navigation bronchoscopy (ENB) is a technique utilized to navigate and obtain samples from these lesions. This systematic review and meta-analysis aims to explore the sensitivity of ENB in patients with PPL suspected of lung cancer. Methods A comprehensive search of several databases was performed. Rapamycin Extracted data included sensitivity of ENB for malignancy, adequacy of the tissue sample, and complications. The study quality was assessed using the QUADAS-2 tool, and the combined data was meta-analyzed using a bivariate method model. A summary receiving operating curve (sROC) was created. Finally, the quality of evidence was rated using the GRADE approach. Results Forty studies with a total of 3,342 participants were included in our analysis. ENB reported a pooled sensitivity of 77% (95% CI, 72 - 82%), I2= 80.6%; and specificity of 100% (CI, 99 - 100%), I2= 0% for malignancy. The sROC showed an area under the curve of 0.955, p=0.03. ENB achieved a sufficient sample for ancillary tests in 90.9% (84.8 - 96.9%), I2=80.7%. Risk of pneumothorax was 2.0% (95% CI, 1.0-3.0), I2=45.2%. We found subgroup differences according to the risk of bias and the number of sampling techniques. Meta-regression showed an association between sensitivity, and the mean distance of the sensor tip to the center of the nodule, the number of tissue sampling techniques, and the cancer prevalence in the study. Conclusion ENB is very safe with good sensitivity for diagnosing malignancy in patients with PPL. The applicability of our findings is limited as the majority of studies were done with the superDimension navigation system and heterogeneity was high. PROSPERO CRD42019109449.Background Bronchopulmonary dysplasia (BPD) is the most common respiratory disorder in extremely low birth weight infants. Although most BPD symptoms improve, some late complications exist, even with regular treatment. Gastroesophageal reflux (GER), also common in extremely premature infants, may be related to many cardiorespiratory symptoms. However, the potential of GER as a risk factor for late complications associated with BPD is still unclear. Research question Does GER increase the risk of late complications of BPD in infants? Study design and Methods A multi-center prospective cohort of 131 infants (79 males, 52 females) with BPD was enrolled. The development of late complications was assessed over an 18-month follow-up. A 24h pH-multichannel intraluminal impedance (pH-MII) and gastric sodium concentration were analyzed in all infants at 36 weeks' postmenstrual age and at the last interview. Prevalence and risk factors of late complications of BPD were analyzed by forward logistic regression. Results The prevalence of late complications in BPD infants was 63.