Air Pollution Exposure and Interstitial Lung Features in SPIROMICS Participants with Chronic Obstructive Pulmonary Disease.

It is unknown whether air pollution is associated with radiographic features of interstitial lung disease in individuals with chronic obstructive pulmonary disease (COPD). To determine whether air pollution increases the prevalence of interstitial lung abnormalities (ILA) or percent high-attenuation areas (HAA) on computed tomography (CT) in individuals with a heavy smoking history and COPD. We performed a cross-sectional study of SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study), focused on current or former smokers with COPD.

Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD.

Background: Older adults with advanced non-dialysis-dependent chronic kidney disease (NDD-CKD) face a high risk of hospitalization and related adverse events.

Methods: This prospective cohort study followed nephrology clinic patients ≥60 years old with NDD-CKD stages 4-5. After an eligible patient's office visit, study staff asked the patient's provider to rate the patient's risk of death within the next year using the surprise question ("Would you be surprised if this patient died in the next 12 months?") with a 5-point Likert scale response (1, "definitely not surprised" to 5, "very surprised").

Addressing Patients' Mental Health Needs at a Student-Run Free Clinic.

Student-run free clinics are uniquely positioned to understand the barriers to accessing mental health resources. We abstracted patient demographics and clinical characteristics from 355 patient charts and examined referral patterns for a subset of patients. Seventy-three (21%) of patients were found to have a psychiatric diagnosis and were more likely to have more medical comorbidities (10 versus 6, p < 0.

Serious Illness Treatment Preferences for Older Adults with Advanced CKD.

Background: Patient-centered care for older adults with CKD requires communication about patient's values, goals of care, and treatment preferences. Eliciting this information requires tools that patients understand and that enable effective communication about their care preferences.

Methods: Nephrology clinic patients age ≥60 years with stage 4 or 5 nondialysis-dependent CKD selected one of four responses to the question, "If you had a serious illness, what would be important to you?" Condensed versions of the options were, "Live as long as possible;" "Try treatments, but do not suffer;" "Focus on comfort;" or "Unsure.

The Surprise Question and Self-Rated Health Are Useful Screens for Frailty and Disability in Older Adults with Chronic Kidney Disease.

Self-rated health (SRH) and the surprise question (SQ) capture perceptions of health and are independent risk factors for poor outcomes. Little is known about their association with physiologic and functional decline. Determine the association of SRH and SQ with frailty and functional status in older adults with chronic kidney disease (CKD) and their utility as screening tools.

The Effect of a Student-Run Free Clinic on Hospital Utilization.

Student-run free clinics (SRFCs) serve uninsured patients and offer unique educational opportunities. However, the impact of these clinics on hospital utilization is unclear. In this pre-post observational study, we used multivariable modeling to test the hypothesis that patients of Shade Tree Clinic, the SRFC affiliated with Vanderbilt University Medical Center (VUMC), would have decreased hospital utilization after joining the clinic.