Bedside Assessment of the Respiratory System During Invasive Mechanical Ventilation.

Assessing the respiratory system of a patient receiving mechanical ventilation is complex. We provide an overview of an approach at the bedside underpinned by physiology. We discuss the importance of distinguishing between extensive and intensive ventilatory variables.

Lung Cancer Diagnosed Through Screening, Lung Nodule, and Neither Program: A Prospective Observational Study of the Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta Cohort.

Purpose: Lung cancer screening saves lives, but implementation is challenging. We evaluated two approaches to early lung cancer detection-low-dose computed tomography screening (LDCT) and program-based management of incidentally detected lung nodules.

Methods: A prospective observational study enrolled patients in the early detection programs.

Survival Before and After Direct Surgical Quality Feedback in a Population-Based Lung Cancer Cohort.

Background: Surgical resection is the main curative modality for non-small cell lung cancer (NSCLC), but variation in the quality of care contributes to suboptimal survival rates. Improving surgical outcomes by eliminating quality deficits is a key strategy for improving population-level lung cancer survival. We evaluated the long-term survival effect of providing direct feedback on institutional performance in a population-based cohort.

Pragmatic trial of a multidisciplinary lung cancer care model in a community healthcare setting: study design, implementation evaluation, and baseline clinical results.

Background: Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenges. Adoption of the highly recommended multidisciplinary care model suffers from a dearth of good quality evidence. Leading up to a prospective comparative-effectiveness study of multidisciplinary serial care, we studied the implementation of a rigorously benchmarked multidisciplinary lung cancer clinic.

Evolution in the Surgical Care of Patients With Non-Small Cell Lung Cancer in the Mid-South Quality of Surgical Resection Cohort.

Surgery is the most important curative treatment modality for patients with early-stage non-small cell lung cancer (NSCLC). We examined the pattern of surgical resection for NSCLC in a high incidence and mortality region of the United States over a 10-year period (2004-2013) in the context of a regional surgical quality improvement initiative. We abstracted patient-level data on all resections at 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions in North Mississippi, East Arkansas, and West Tennessee.

Prognostic Value of National Comprehensive Cancer Network Lung Cancer Resection Quality Criteria.

Background: The National Comprehensive Cancer Network (NCCN) surgical resection guidelines for non-small cell lung cancer recommend anatomic resection, negative margins, examination of hilar/intrapulmonary lymph nodes, and examination of three or more mediastinal nodal stations. We examined the survival impact of these criteria.

Methods: A population-based observational study was done using patient-level data from all curative-intent, non-small cell lung cancer resections from 2004 to 2013 at 11 institutions in four contiguous Dartmouth Hospital referral regions in three US states.

Prevention of poison ivy dermatitis with oral homeopathic Rhus toxicodendron.

Acute allergic contact dermatitis to poison ivy is acommon and miserable dermatosis which affectsmillions of Americans each year. Preventativemeasures, such as avoidance, protective clothing,barrier creams, soaps, and solvents often fail despiteour patients' best attempts. Severe allergic reactionsto poison ivy are a significant source of decreasedemployee productivity owing to inability to work anda major health care expenditure.

Deploying Team Science Principles to Optimize Interdisciplinary Lung Cancer Care Delivery: Avoiding the Long and Winding Road to Optimal Care.

The complexity of lung cancer care mandates interaction between clinicians with different skill sets and practice cultures in the routine delivery of care. Using team science principles and a case-based approach, we exemplify the need for the development of real care teams for patients with lung cancer to foster coordination among the multiple specialists and staff engaged in routine care delivery. Achieving coordinated lung cancer care is a high-priority public health challenge because of the volume of patients, lethality of disease, and well-described disparities in quality and outcomes of care.

Preoperative Evaluation of Lung Cancer in a Community Health Care Setting.

Background: We examined the presurgical evaluation of suspected lung cancer patients in a community-based health care system to establish current benchmarks of care that will lay the groundwork for an evidence-based quality improvement project.

Methods: We retrospectively reviewed clinical records of all recipients of lung resection at two institutions, and classified all lung cancer relevant procedures into five "nodal points": lesion detection, diagnostic biopsy, radiologic staging, invasive staging, and treatment. We analyzed the frequency of passage through each nodal point, the time intervals between nodal points, and the use of staging modalities.

Candida albicans intralesional injection immunotherapy of warts.

Often, the treatment of verrucae is frustrating for both the physician and patient. Treatment may be painful, scarring, ineffective, and costly. The object of this study was to compare the clinical outcomes and safety of Candida albicans intralesional injection immunotherapy (CI) versus conventional wart treatment.

A pilot study of 5 percent permethrin cream versus 0.75 percent metronidazole gel in acne rosacea.

Acne rosacea is a common skin condition characterized by flushing episodes, erythema, telangiectasia, and recurrent crops of inflammatory papules and pustules that involve the face in a symmetrical distribution. A pilot study was conducted to compare topical 5 percent permethrin cream and 0.75 percent metronidazole gel in the treatment of acne rosacea.

Effect of hydroxymethylglutaryl-CoA reductase inhibitors on the functional properties of erythrocyte membranes.

We studied 56 patients affected by primary hypercholesterolemia treated with placebo for 1 month and with simvastatin (20 mg/day) or pravastatin (20 mg/day) for 6 months during a double-blind clinical trial. At 1-month intervals we determined the following parameters in the serum: total and HDL cholesterol, triglycerides, and apolipoprotein A-1 and B. At the same time intervals we also determined the cholesterol and phospholipid concentration, the Na+/K+ ATPase activity, and the fluidity of erythrocyte membranes.

Alopecia of myxedema: clinical response to levothyroxine sodium.

Noncicatricial alopecia resulting from myxedema developed in a 58-year-old woman. We report the response of her alopecia to treatment with levothyroxine sodium and review the literature on the subject.