Advancing Equitable Ambulatory Telehealth Through Dashboard Development.

Telehealth has the potential to improve access to health care by mitigating barriers related to geography, time, and finances. However, the increased adoption of ambulatory telehealth has inadvertently widened access gaps for socially disadvantaged and marginalized populations. Quality improvement approaches are a valuable strategy to address health care access inequities and disparities, involving data-driven implementation, assessment, and adaptation of tests of change over time.

Implementation, Maintenance, and Outcomes of an Electronic Referral to a Tobacco Quitline Across Five Health Systems.

Introduction: Electronic referral (e-referral) to quitlines helps connect tobacco-using patients to free, evidence-based cessation counseling. Little has been published about the real-world implementation of e-referrals across U.S.

Environmental Impact of Ambulatory Telehealth Use by a Statewide University Health System During COVID-19.

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Health System Implementation of a Tobacco Quitline eReferral.

Background: Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on "real-world" implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden.

Objectives: This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system.

When Will Telemedicine Appear in the ICU?

As our population ages and the demand for high-level intensive care unit (ICU) services increase, the ICU physician supply continues to lag. In addition, hospitals, physician groups, and patients are demanding rapid access for the highest level of expertise in the care of critically ill patients. Telemedicine in the ICU combined with remote patient monitoring has been increasingly touted as a model of care to increase efficiencies and quality of care.

Paradigms in chronic obstructive pulmonary disease: phenotypes, immunobiology, and therapy with a focus on vascular disease.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous syndrome that represents a major global health burden. COPD phenotypes have recently emerged based on large cohort studies addressing the need to better characterize the syndrome. Though comprehensive phenotyping is still at an early stage, factors such as ethnicity and radiographic, serum, and exhaled breath biomarkers have shown promise.

Percent Emphysema and Daily Motor Activity Levels in the General Population: Multi-Ethnic Study of Atherosclerosis.

Background: COPD is associated with reduced physical capacity. However, it is unclear whether pulmonary emphysema, which can occur without COPD, is associated with reduced physical activity in daily life, particularly among people without COPD and never smokers. We hypothesized that greater percentage of emphysema-like lung on CT scan is associated with reduced physical activity assessed by actigraphy and self-report.

Elderly Female Rhesus Macaques Preserve Lung Alveoli With Estrogen/Progesterone Therapy.

The aging lung is associated with increased susceptibility to chronic inflammatory diseases such as chronic obstructive pulmonary disease where females have been reported to be more susceptible than males. The changes in reproductive hormones due to aging may directly or indirectly affect lung structure and function and little is known on the mechanism of these changes. Twenty female rhesus macaques were divided into four groups.

SMAD Signaling in the Airways of Healthy Rhesus Macaques versus Rhesus Macaques with Asthma Highlights a Relationship Between Inflammation and Bone Morphogenetic Proteins.

Bone morphogenetic protein (BMP) signaling is important for correct lung morphogenesis, and there is evidence of BMP signaling reactivation in lung diseases. However, little is known about BMP signaling patterns in healthy airway homeostasis and inflammatory airway disease and during epithelial repair. In this study, a rhesus macaque (Macaca mulatta) model of allergic airway disease was used to investigate BMP signaling throughout the airways in health, disease, and regeneration.

Disability and recovery of independent function in obstructive lung disease: the cardiovascular health study.

Background: Chronic obstructive lung disease frequently leads to disability. Older patients may experience transitions between states of disability and independence over time.

Objective: To identify factors associated with transition between states of disability and independent function in obstructive lung disease.

Pulmonary vasculature and critical asthma syndromes: a comprehensive review.

One of the important factors and consequences in persistent asthma is the change in the vasculature of the airways and lung parenchyma. These changes could contribute to worsening asthma control and predispose asthmatics to critical asthma syndromes. For many years, the contribution of vasculature to severe asthma was limited to discussion of small and medium vessel vasculitis commonly referred to as Churg-Strauss syndrome.

Bidirectional relationship between cognitive function and pneumonia.

Rationale: Relationships between chronic health conditions and acute infections remain poorly understood. Preclinical studies suggest crosstalk between nervous and immune systems.

Objectives: To determine bidirectional relationships between cognition and pneumonia.

Non-cigarette tobacco and the lung.

Cigarette smoking is known to cause a wide range of damaging health outcomes; however, the effects of non-cigarette tobacco products are either unknown or perceived as less harmful than cigarettes. Smokeless tobacco, cigar smoking, and waterpipe smoking have increased in usage over the past few decades. Some experts believe that their use is reaching epidemic proportions.

The pharmacological approach to the elderly COPD patient.

The elderly patient (65 years and older) with chronic obstructive pulmonary disease (COPD) can be a challenge to the clinician. This begins with the correct and early diagnosis, the assessment of disease severity, recognizing complicating comorbidities, determining the burden of symptoms, and monitoring the frequency of acute exacerbations. Comprehensive management of COPD in the elderly patient should improve health-related quality of life, lung function, reduce exacerbations, and promote patient compliance with treatment plans.

The asthma-chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations.

Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is a commonly encountered yet loosely defined clinical entity. ACOS accounts for approximately 15-25% of the obstructive airway diseases and patients experience worse outcomes compared with asthma or COPD alone. Patients with ACOS have the combined risk factors of smoking and atopy, are generally younger than patients with COPD and experience acute exacerbations with higher frequency and greater severity than lone COPD.

Accelerated structural decrements in the aging female rhesus macaque lung compared with males.

Aging is associated with morphometric changes in the lung that lead to decreased lung function. The nonhuman primate lung has been shown to have similar architectural, morphological, and developmental patterns to that of humans. We hypothesized that the lungs of rhesus monkeys age in a pattern similar to human lungs.

Obesity is associated with a lower resting oxygen saturation in the ambulatory elderly: results from the cardiovascular health study.

Background: The contribution of obesity to hypoxemia has not been reported in a community-based study. Our hypothesis was that increasing obesity would be independently associated with lower SpO2 in an ambulatory elderly population.

Methods: The Cardiovascular Health Study ascertained resting SpO2 in 2,252 subjects over age 64.

Ozone exposure during the early postnatal period alters the timing and pattern of alveolar growth and development in nonhuman primates.

Exposure to oxidant air pollutants in early childhood, with ozone as the key oxidant, has been linked to significant decrements in pulmonary function in young adults and exacerbation of airway remodeling in asthma. Development of lung parenchyma in rhesus monkeys is rapid during the first 2 years of life (comparable to the first 6 years in humans). Our hypothesis is that ozone inhalation during infancy alters alveolar morphogenesis.

The critically ill asthmatic--from ICU to discharge.

Status asthmaticus (SA) is defined as an acute, severe asthma exacerbation that does not respond readily to initial intensive therapy, while near-fatal asthma (NFA) refers loosely to a status asthmaticus attack that progresses to respiratory failure. The in-hospital mortality rate for all asthmatics is between 1% to 5%, but for critically ill asthmatics that require intubation the mortality rate is between 10% to 25% primarily from anoxia and cardiopulmonary arrest. Timely evaluation and treatment in the clinic, emergency room, or ultimately the intensive care unit (ICU) can prevent the morbidity and mortality associated with respiratory failure.

In utero and postnatal exposure to environmental tobacco smoke (ETS) alters alveolar and respiratory bronchiole (RB) growth and development in infant monkeys.

Unlabelled: The direct effect of environmental tobacco smoke (ETS) exposure in utero on the development of the lung parenchyma is not known. We used design-based stereologic methods to evaluate in utero and postnatal ETS exposure on alveolar and respiratory bronchiole (RB) development in the rhesus macaque.

Methods: Timed-pregnant rhesus macaques and their offspring were exposed to filtered air or various amounts of ETS during the prenatal and postnatal period.

Difficult-to-control asthma in adults.

Difficult-to-control asthma in adults is under-diagnosed and under-treated in the United States, particularly in those 40 years of age or older. Increasing attention has been focused on the subset of adult patients with poorly controlled asthma because they consume up to 85% of all health care dollars spent on asthma, while representing 20% of all asthma patients. In this article, we define difficult-to-control asthma and discuss the problem of misdiagnosis.

Alveoli increase in number but not size from birth to adulthood in rhesus monkeys.

Postnatal developmental stages of lung parenchyma in rhesus monkeys is about one-third that of humans. Alveoli in humans are reported to be formed up to 8 yr of age. We used design-based stereological methods to estimate the number of alveoli (N(alv)) in male and female rhesus monkeys over the first 7 yr of life.