Abstract:
BACKGROUND:Each year, > 1.5 million Americans are diagnosed with an incidentally detected lung nodule. Practice guidelines attempt to balance the benefit of early detection of lung cancer with the risks of diagnostic testing, but adherence to guidelines is low. The goal of this study was to determine guideline adherence rates in the setting of a multidisciplinary nodule clinic and describe reasons for nonadherence as well as associated outcomes. METHODS:This cohort study included 3 years of follow-up of patients aged ≥ 35 years with an incidentally detected lung nodule evaluated in a multidisciplinary clinic that used the 2005 Fleischner Society Guidelines. RESULTS:Among 113 patients, 67% (95% CI, 58-76) were recommended a guideline-concordant nodule evaluation; 7.1% (95% CI, 3.1-13) and 26% (95% CI, 18-25) were recommended less or more intense evaluation, respectively. In contrast, 58% (95% CI, 48-67), 22% (95% CI, 18-25), and 23% (95% CI, 16-32) received a guideline-concordant, less intense, or more intense evaluation. The most common reason for recommending guideline-discordant care was concern for two different diagnoses that would each benefit from early detection and treatment. A majority of lung cancer diagnoses (88%) occurred in patients who received guideline-concordant care. There were no lung cancer cases in those who received less intense nodule care. CONCLUSIONS:A multidisciplinary nodule clinic may serve as a system-level intervention to promote guideline-concordant care, while also providing a multidisciplinary basis by which to deviate from guidelines to address the needs of a heterogeneous patient population.
journal_name
Chestjournal_title
Chestauthors
Verdial FC,Madtes DK,Cheng GS,Pipavath S,Kim R,Hubbard JJ,Zadworny M,Wood DE,Farjah Fdoi
10.1016/j.chest.2019.11.032subject
Has Abstractpub_date
2020-04-01 00:00:00pages
985-993issue
4eissn
0012-3692issn
1931-3543pii
S0012-3692(19)34401-0journal_volume
157pub_type
杂志文章相关文献
CHEST文献大全abstract:OBJECTIVES:To evaluate the additional information provided by pulse transit time (PTT), a noninvasive tool, when using during polysomnography for the diagnosis of sleep breathing disorders in a pediatric population. MAIN FINDINGS:Respiratory and microarousals events were scored twice. The first scoring was performed u...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.127.3.722
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVE:In patients with advanced non-small cell lung cancer (NSCLC) treated with chemotherapy, we compared survival in patients with treated central airway obstruction to those who did not have central airway obstruction. METHODS:One hundred forty-four patients with advanced and inoperable NSCLC were included. Thes...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.130.6.1803
更新日期:2006-12-01 00:00:00
abstract::Uhl's disease is a rare disorder originally described in 1952 in an infant with severe diffuse right ventricular dysfunction with total absence of the myocardium. Uhl considered the disease to be congenital in origin. We report a patient with severe dilated congestive cardiomyopathy limited to the right ventricle but ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.90.2.300
更新日期:1986-08-01 00:00:00
abstract::Numerous clinical trials of chemotherapy for tuberculosis conducted throughout the world over the past 4 decades have established 2 basic principles of treatment: effective treatment requires the initial concomitant administration of at least 2 drugs to which the patient's organisms are susceptible; and cure of tuber...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.87.2.117s
更新日期:1985-02-01 00:00:00
abstract:STUDY OBJECTIVES:Biochemical and inflammatory markers in pleural inflammation were evaluated in pediatric cases of parapneumonic effusions, and interleukin (IL)-8 and tumor necrosis factor (TNF)-alpha concentrations were tested for possible differentiation of the complicated nature of effusions. PATIENTS:Twenty-eight ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.128.3.1436
更新日期:2005-09-01 00:00:00
abstract::POC testing provides an opportunity for clinicians and laboratorians to work together to consider how best to serve the patients within an individual institution. Each health system has unique characteristics relative to patient population, as well as a unique laboratory structure. If physicians, nurses, laboratorians...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.115.4.1140
更新日期:1999-04-01 00:00:00
abstract::Eosinophilic pulmonary infiltration is an uncommon presentation from cocaine abuse. We present a patient with migratory pulmonary infiltrates and eosinophilia consistent with Löffler's syndrome. Our review uncovered two other similar patients. The importance of early recognition is stressed in our report. Either absti...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.105.5.1599
更新日期:1994-05-01 00:00:00
abstract:BACKGROUND:C-reactive protein (CRP) has been well recognized as a strong independent predictor of short-term and long-term mortality after non-ST-segment elevation acute coronary syndromes. However, limited studies have been conducted correlating CRP levels within 6 h following the onset of ST-segment elevation (ST-se)...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.127.3.803
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Pulse pressure (PP) has been shown to predict risk for cardiovascular events in men; however, this association has not been well established in women. Hormone replacement therapy may improve arterial compliance, but findings from cross-sectional and prospective studies report inconsistent results. We sought ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.127.5.1498
更新日期:2005-05-01 00:00:00
abstract::Tropical pulmonary eosinophilia (TPE) usually affects people living in the tropics, especially those in Southeast Asia, India, and certain parts of China and Africa. However, owing to the rising frequency of world-wide travel and the migration between continents, this disease is increasingly seen in the West, where th...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.113.6.1673
更新日期:1998-06-01 00:00:00
abstract::We describe a case of unsuspected infrahepatic interruption of the inferior vena cava with hemiazygos continuation in a 67-year-old man presenting with chest pain and evidence of mitral regurgitation. He had no persistent superior vena cava, with the hemiazygos draining directly into the right superior vena cava. Poly...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.106.5.1626
更新日期:1994-11-01 00:00:00
abstract::The issue of tobacco industry responsibility for population health problems and compensation for their treatment has been growing since the 1960s. In 1999, the state attorneys general collectively launched the largest class action lawsuit in US history and sued the tobacco industry to recover the costs of caring for s...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.09-0982
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:The reported experience is sparse for patients with prior pneumonectomy who are undergoing surgery for ischemic or valvular heart disease. Such surgery poses special technical challenges. To expand the experience with this challenging clinical intervention, we reviewed the reported patients with prior pneumo...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.06-2545
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:High-resolution chest CT (HRCT) scan is recommended after pulmonary arteriovenous malformation (PAVM) embolotherapy to assess for PAVM persistence and untreated PAVM growth. Graded transthoracic contrast echocardiography (TTCE) predicts the need for embolotherapy in PAVM screening. This study sought to deter...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2019.11.023
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Both pulmonary hypertension and pulmonary overflow are associated with functional and structural changes of the pulmonary arterial wall. Current techniques to evaluate the pulmonary vasculature neglect the pulsatile nature of pulmonary flow. STUDY OBJECTIVES:To determine whether the dynamic properties of th...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.122.2.549
更新日期:2002-08-01 00:00:00
abstract::We have studied the crackling lung sounds of ten patients with cryptogenic fibrosing alveolitis, ten with bronchiectasis, ten with chronic obstructive pulmonary disease, and ten with heart failure by analyzing frequency, waveform, and timing of crackles. The upper frequency limit of inspiratory sounds was higher in CF...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.99.5.1076
更新日期:1991-05-01 00:00:00
abstract:STUDY OBJECTIVES:Previous studies have reported that magnesium (Mg) deficiency is associated with coronary spasm. However, little is known about the preventive effect of Mg on coronary spasm. The present study investigated whether Mg prevents coronary spasm in patients with vasospastic angina (VSA). DESIGN:Effectivene...
journal_title:Chest
pub_type: 临床试验,杂志文章
doi:10.1378/chest.118.6.1690
更新日期:2000-12-01 00:00:00
abstract::Four patients underwent exercise testing because of a history of pain in the chest; all four developed marked elevation of the S-T segment only during recovery after exercise. Three of the four patients showed ST-segment depression during exercise, but ST-segment elevation was absent until two or more minutes after ce...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.74.2.133
更新日期:1978-08-01 00:00:00
abstract::A 53-year-old woman with a large pericardial effusion and tamponade presented with signs of IHSS including a grade 4/6 apical systolic murmur, severe SAM, early systolic aortic valve closure and a small hypercontractile left ventricle but at most borderline left ventricular hypertrophy. Following pericardiocentesis, t...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.91.4.631
更新日期:1987-04-01 00:00:00
abstract::Aortic intramural hematoma (IMH) is related to but is pathologically distinct from aortic dissection. In this potentially lethal entity, there is hemorrhage into the aortic media in the absence of an intimal tear. Although intimal disruption is not present, the prognosis is similar to that of classic aortic dissection...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.120.4.1340
更新日期:2001-10-01 00:00:00
abstract:STUDY OBJECTIVE:To assess whether C-reactive protein (CRP) is a sensitive marker of pneumonia and to evaluate whether it may be used as an index of treatment response. DESIGN:A retrospective casenote review was carried out on 40 patients admitted with simple community acquired pneumonia and 20 patients admitted with p...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.107.4.1028
更新日期:1995-04-01 00:00:00
abstract:BACKGROUND:Venous thromboembolism (VTE) remains a major cause of morbidity following stroke. The optimal form of pharmacologic prophylaxis following stroke is unknown. METHODS:We identified randomized trials comparing unfractionated heparin (UFH) to low-molecular-weight heparin (LMWH) for VTE prevention in ischemic st...
journal_title:Chest
pub_type: 杂志文章,meta分析
doi:10.1378/chest.07-1826
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Exhaled nitric oxide (eNO) is a convenient noninvasive marker for airway inflammation in several pulmonary diseases. However, external factors such as nitrate-rich nutrition can affect the levels of eNO and thus compromise its diagnostic value. STUDY OBJECTIVES:The objective of this investigation was to hav...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.128.4.2465
更新日期:2005-10-01 00:00:00
abstract::To facilitate the studies in cell biology and drug sensitivity of non-small cell lung cancer, cell samples from 55 patients have been used to establish cell lines in culture using a chemically defined medium (ACL-4). A total of 20 cell lines (36 percent) were directly established and characterized: 14 (44 percent) fro...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.100.2.429
更新日期:1991-08-01 00:00:00
abstract:BACKGROUND:Augmentation therapy with pooled human plasma-derived alpha(1)-antitrypsin (AAT) has been shown to have biochemical efficacy in restoring serum AAT levels above the protective threshold. Also, clinical efficacy has been suggested. OBJECTIVE:To evaluate the bioequivalence of a new solvent detergent-treated p...
journal_title:Chest
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1378/chest.122.1.66
更新日期:2002-07-01 00:00:00
abstract::A rare form of paroxysmal supraventricular tachycardia (SVT), associated with swallowing solid food, is described. Repeated triggering of the arrhythmia during esophagoscopy was produced by mechanical stimulation of the anterior esophageal wall, 30 cm from the incisors. Treatment with verapamil abolished this tachycar...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.76.4.478
更新日期:1979-10-01 00:00:00
abstract:OBJECTIVE:To determine the usefulness of performing routine postprocedure chest radiographs (CXRs) following percutaneous dilatational tracheostomy (PDT) under bronchoscopic visualization. DESIGN:Retrospective, chart review. SETTING:Medical-surgical ICU of a teaching hospital. METHODS:Sixty patients who underwent PD...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.123.5.1603
更新日期:2003-05-01 00:00:00
abstract::The incidence and severity of catheter-induced tricuspid regurgitation has not been studied extensively. Given the frequency with which right heart catheters are employed to measure cardiac output, it is important to know whether the severity of catheter-induced tricuspid regurgitation is sufficient to invalidate the ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.99.3.651
更新日期:1991-03-01 00:00:00
abstract::Bronchial stump fistula occurred on the seventh postoperative day in a 45-year-old man who underwent right pneumonectomy for T2N2M0 adenocarcinoma of the lung. It was attributable to ventilator-related barotrauma during treatment of ARDS from multiple pulmonary emboli. A frequently lethal complication, its presentatio...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.93.3.654
更新日期:1988-03-01 00:00:00
abstract:BACKGROUND:The aim of this study was to characterize the practice of routinely obtaining tracheal aspirate cultures in children with tracheostomy tubes and to analyze the appropriateness of using this information to guide antibiotic selection for treatment of subsequent lower respiratory infections. METHODS:Pediatric ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.10-2539
更新日期:2012-03-01 00:00:00