Targeted Phage Display-based Pulmonary Vaccination in Mice and Non-human Primates.

Background: The extensive alveolar capillary network of the lungs is an attractive route for administration of several agents. One key functional attribute is the rapid onset of systemic action due to the absence of first-pass metabolism.

Methods: Here we applied a combinatorial approach for ligand-directed pulmonary delivery as a unique route for systemic targeting in vaccination.

Forced oscillation technique in veterans with preserved spirometry and chronic respiratory symptoms.

Purpose: To evaluate the utility of the forced oscillation technique (FOT) among military veterans with preserved spirometry and chronic unexplained respiratory symptoms.

Methods: 178 veterans referred for evaluation of unexplained respiratory symptoms completed pulmonary function testing and FOT. Preserved spirometry was defined as FEV/FVC, FEV and FVC ≥ 5th percentile.

A Man in His 20s With Diffuse Lung Opacities and Acute Respiratory Failure After Hookah Smoking.

A man in his 20s with no medical history presented with 2 days of progressively worsening shortness of breath accompanied by subjective fevers, chills, body aches, decreased appetite, night sweats, and cough producing nonbloody sputum. He denied childhood lung diseases, allergies, or a family history of lung disease. He did not smoke cigarettes but had smoked hookah in Saudi Arabia before moving to the United States 1 month before presentation and had restarted 2 days before the start of symptoms.

Influenza immunization among resident physicians in an urban teaching hospital.

We surveyed resident physicians (RPs) at an academic medical center to determine the rate of influenza vaccination and reasons for nonvaccination. The overall self-reported immunization rate of RPs in 2013-2014 was 76.7%, and the most common reason for not being vaccinated was lack of time to get immunized (38.

Palliative and end-of-life educational practices in US pulmonary and critical care training programs.

Purpose: To describe educational features in palliative and end-of-life care (PEOLC) in pulmonary/critical care fellowships and identify the features associated with perceptions of trainee competence in PEOLC.

Methods: A survey of educational features in 102 training programs and the perceived skill and comfort level of trainees in 6 PEOLC domains: communication, symptom control, ethical/legal, community/institutional resources, specific syndromes, and ventilator withdrawal. We evaluated associations between perceived trainee competence/comfort in PEOLC and training program features, using regression analyses.

Association of patient-provider communication domains with lung cancer treatment.

Background: Patient-physician communication is critical for helping patients understand and complete the complex steps needed to diagnose stage and treat lung cancer. We assessed which domains of patient-physician communication about lung cancer and its treatment are associated with receipt of disease-directed, stage-appropriate treatment.

Methods: Patients with recently diagnosed lung cancer were recruited from four medical centers in New York City from 2008 to 2011.

Cultural factors associated with racial disparities in lung cancer care.

Rationale: Minority patients with lung cancer are less likely to receive stage-appropriate treatment. Along with access to care and provider-related factors, cultural factors such as patients' lung cancer beliefs, fatalism, and medical mistrust may help explain this disparity.

Objectives: To determine cultural factors associated with disparities in lung cancer treatment.

Impact of critical care medicine training programs' palliative care education and bedside tools on ICU use at the end of life.

Background: Intensive care unit (ICU) use at the end of life is rising. Little research has focused on associations among critical care fellows' training, institutional support, and bedside tools with ICU use at the end of life.

Objective: We evaluated whether hospital and critical care medicine program interventions were associated with ICU use in the last 6 months of life for patients with chronic illness.

Chest radiograph findings and time to culture conversion in patients with multidrug-resistant tuberculosis and HIV in Tugela Ferry, South Africa.

Background: The majority of patients with multidrug-resistant tuberculosis (MDR-TB) in South Africa are co-infected with HIV, but the radiographic features of MDR-TB and their relationship with time to sputum culture conversion in the antiretroviral therapy era have not been described.

Methods: We reviewed baseline chest radiographs for 56 patients with MDR-TB from a rural area of South Africa. We analyzed the association of cavities, consolidation, pleural effusion and hilar lymphadenopathy with time to sputum culture conversion, adjusting for HIV status, baseline sputum smear and CD4 count.

Racial and ethnic differences in beliefs about lung cancer care.

Background: Disparities in lung cancer treatment and palliative care are well documented. However,the mechanisms underlying these disparities are not fully understood. In this study, we evaluated racial and ethnic differences in beliefs and attitudes about lung cancer treatment and palliative care among patients receiving a new diagnosis of lung cancer.

Management of patients with end-stage chronic obstructive pulmonary disease.

Patients with end-stage chronic obstructive pulmonary disease (COPD) have poor quality of life, with limited activity, breathlessness, dependence on others, and recurrent needs for medical evaluation and treatment. Such patients demonstrate significant and progressive impairments in physical, mental, and social functioning. Because the rate of decline is variable, however, it is difficult to predict prognosis of survival.

Patients rate physician communication about lung cancer.

Background: High-quality lung cancer care includes physician-patient communication about the disease and treatment, patient needs/preferences, and care goals. In this study, the authors evaluated communication with patients at all stages across multiple topics.

Methods: A standardized questionnaire asked patients with lung cancer to rate (on 5-point, verbal descriptor scale) the extent of communication with physicians on symptoms, spiritual concerns, practical needs, proxy appointment, living will preparation, prognosis, care goals, potential complications of therapy, life support preferences, and hospice.

Diagnosis and treatment of pulmonary embolism in the elderly.

Pulmonary embolism (PE) is a difficult diagnosis in patients of all ages, but more so in the elderly. Nonspecific symptoms and laboratory results are often misattributed to common diseases or to age itself, and can delay or even deter the diagnosis and treatment of PE. Advanced age is sometimes mistakenly seen as a contraindication to anticoagulation and thrombolysis.