Chest (CHEST )

Publisher: American College of Chest Physicians, American College of Chest Physicians

Description

Chest: the Cardiopulmonary and Critical Care Journal is the official publication of the American College of Chest Physicians. Each month it features cutting edge clinical investigations in the multidisciplinary specialties of chest medicine, such as pulmonology, cardiology, thoracic surgery, transplantation, sleep and breathing, airways disease, and more. Chest also features basic science, special reports, case reports, board review questions, and more. Editorials and communications to the editor explore controversial issues and encourage further discussion by physicians dealing with chest medicine.

  • Impact factor
    7.13
    Hide impact factor history
     
    Impact factor
  • 5-year impact
    6.42
  • Cited half-life
    8.60
  • Immediacy index
    3.39
  • Eigenfactor
    0.08
  • Article influence
    2.19
  • Website
    Chest website
  • Other titles
    Chest (American College of Chest Physicians), Chest
  • ISSN
    0012-3692
  • OCLC
    1554067
  • Material type
    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

Publisher details

American College of Chest Physicians

  • Pre-print
    • Author cannot archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Conditions
    • NIH authors to accompany deposit in PubMed Central with set statement (see policy)
  • Classification
    ​ white

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although mechanisms and pathways mediating acute respiratory distress syndrome (ARDS) have been extensively studied, less attention has been given to mechanisms and pathways that counteract injury responses. This study uncovered that the apelin-APJ pathway is an endogenous counter-injury mechanism that protects against ARDS.
    Chest 11/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Gas-exchange and airway pressures are markedly altered during percutaneous dilatational tracheostomy (PDT). A double lumen endotracheal tube (DLET) has been developed for better airway management during PDT. The current study was designed to prospectively evaluate the in-vivo feasibility, gas-exchange and airway pressures during PDT with DLET compared to a conventional endotracheal tube (ETT).
    Chest 11/2014;
  • Chest 11/2014; 146(5):1135-6.
  • Article: Response
    [Show abstract] [Hide abstract]
    ABSTRACT: Author response to Manifold embryonic ciliary functions in the genesis of kartagener syndrome and heterotaxy, Chest. 2014 Nov 1;146(5):e167. doi: 10.1378/chest.14-0673.
    Chest 11/2014; 146(5):e167-68.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract: Background:Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability in the US. Patients with COPD are at high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplements (ONS) have been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. Methods:We first identified Medicare patients aged 65+ hospitalized with a primary diagnosis of COPD in the Premier Research Database. We then identified hospitalizations in which ONS was provided and used propensity score matching to compare LOS, hospitalization cost and 30-day readmission rates in a 1-1 matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also utilized instrumental variables (IV) analysis to study the effects of ONS. Model covariates included patient and provider characteristics and a time trend. Results:Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N=14,326). IV analysis indicated that ONS use was associated with: a 1.88 day (21.5%) decrease in LOS, from 8.75 to 6.87 days (p<0.01); hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (p<0.01); and a 13.1% decrease in probability of 30-day readmission, from 0.335 to 0.291 (p<0.01). Conclusions:ONS may offer an inexpensive, effective means for reducing LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD. Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability in the US. Patients with COPD are at high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplements (ONS) have been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. Methods: We first identified Medicare patients aged 65+ hospitalized with a primary diagnosis of COPD in the Premier Research Database. We then identified hospitalizations in which ONS was provided and used propensity score matching to compare LOS, hospitalization cost and 30-day readmission rates in a 1-1 matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also utilized instrumental variables (IV) analysis to study the effects of ONS. Model covariates included patient and provider characteristics and a time trend. Results: Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N=14,326). IV analysis indicated that ONS use was associated with: a 1.88 day (21.5%) decrease in LOS, from 8.75 to 6.87 days (p<0.01); hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (p<0.01); and a 13.1% decrease in probability of 30-day readmission, from 0.335 to 0.291 (p<0.01). Conclusions: ONS may offer an inexpensive, effective means for reducing LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD.
    Chest 10/2014;
  • Chest 10/2014;
  • Chest 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract: BackgroundThe potential role of environmental M. tuberculosis in the epidemiology of tuberculosis (TB) remains unknown. We investigated the transmission of M. tuberculosis from humans to the environment and the possible transmission of M. tuberculosis from the environment to humans. MethodsA total of 1,500 samples were collected from three counties of the Tehran metropolitan area, Iran from February 2012 to January 2014. A total of 700 (47%) water and 800 (53%) soil samples were collected. Spoligotypes and MIRU-VNTR typing method performed on DNA extracted from single colonies. Genotypes of M. tuberculosis strains isolated from the environment were compared with the genotypes obtained from 55 confirmed pulmonary TB patients diagnosed during the study period in the same three counties. ResultsM. tuberculosis was isolated from (11/800, 1%) of soil and (71/700, 10%) of water samples. T family (56/82; 68%) followed by Delhi/CAS (11/82; 13.4%) were the most frequent M. tuberculosis superfamilies in both water and soil samples. Overall, 27.7% of isolates in clusters were related. No related typing patterns were detected between soil, water and clinical isolates. The most frequent superfamily of M. tuberculosis in clinical isolates was Delhi/CAS (142; 30.3%) followed by NEW-1(127;27%). The bacilli in contaminated soil (36%) and damp water (8.4%) remained reculturable in some samples up to 9 months. ConclusionAlthough the dominant M. tuberculosis superfamilies in soil and water did not correspond to the dominant M. tuberculosis family in patients, the presence of circulating genotypes of MTB in soil and water highlight the risk of transmission. Background: The potential role of environmental M. tuberculosis in the epidemiology of tuberculosis (TB) remains unknown. We investigated the transmission of M. tuberculosis from humans to the environment and the possible transmission of M. tuberculosis from the environment to humans. Methods: A total of 1,500 samples were collected from three counties of the Tehran metropolitan area, Iran from February 2012 to January 2014. A total of 700 (47%) water and 800 (53%) soil samples were collected. Spoligotypes and MIRU-VNTR typing method performed on DNA extracted from single colonies. Genotypes of M. tuberculosis strains isolated from the environment were compared with the genotypes obtained from 55 confirmed pulmonary TB patients diagnosed during the study period in the same three counties. Results: M. tuberculosis was isolated from (11/800, 1%) of soil and (71/700, 10%) of water samples. T family (56/82; 68%) followed by Delhi/CAS (11/82; 13.4%) were the most frequent M. tuberculosis superfamilies in both water and soil samples. Overall, 27.7% of isolates in clusters were related. No related typing patterns were detected between soil, water and clinical isolates. The most frequent superfamily of M. tuberculosis in clinical isolates was Delhi/CAS (142; 30.3%) followed by NEW-1(127;27%). The bacilli in contaminated soil (36%) and damp water (8.4%) remained reculturable in some samples up to 9 months. Conclusion: Although the dominant M. tuberculosis superfamilies in soil and water did not correspond to the dominant M. tuberculosis family in patients, the presence of circulating genotypes of MTB in soil and water highlight the risk of transmission.
    Chest 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract: Background:Involving family as part of the patient's rehabilitation plan of care might enhance the management of Chronic Obstructive Pulmonary Disease (COPD). The primary aim of this study was to investigate the impact of a family-based pulmonary rehabilitation (PR) program on patients and family members' coping strategies to manage COPD. Methods:Family dyads (patient and family member) were randomly assigned to family-based (experimental) or conventional PR (control). Patients from both groups underwent exercise training three times a week and psychosocial support and education once a week, during 12 weeks. Family members of the family-based PR attended the psychosocial support and education sessions together with patients. In the conventional PR, family members did not participate. Family coping and psychosocial adjustment to illness were assessed in patients and family members of both groups. Patients' exercise tolerance, functional balance, muscle strength and health-related quality of life were also measured. All measures were collected pre/post-program. Results:Forty-two dyads participated (patients: FEV1 70.4+/-22.1% predicted). Patients (p=0.048) and family members (p=0.004) in the family-based PR had significantly greater improvements in family coping than the control group. Family members of the family-based PR had significantly greater changes in sexual relationships (p=0.026) and in psychological distress (p=0.033) compared to the control group. Patients from both groups experienced significant improvements in exercise tolerance, functional balance, knee extensors strength and health-related quality of life after intervention (p<0.001). Conclusions:This research supports family-based PR programs to enhance coping and psychosocial adjustment to illness of the family system. Clinical Trials registration number:NCT02048306. Background: Involving family as part of the patient's rehabilitation plan of care might enhance the management of Chronic Obstructive Pulmonary Disease (COPD). The primary aim of this study was to investigate the impact of a family-based pulmonary rehabilitation (PR) program on patients and family members' coping strategies to manage COPD. Methods: Family dyads (patient and family member) were randomly assigned to family-based (experimental) or conventional PR (control). Patients from both groups underwent exercise training three times a week and psychosocial support and education once a week, during 12 weeks. Family members of the family-based PR attended the psychosocial support and education sessions together with patients. In the conventional PR, family members did not participate. Family coping and psychosocial adjustment to illness were assessed in patients and family members of both groups. Patients' exercise tolerance, functional balance, muscle strength and health-related quality of life were also measured. All measures were collected pre/post-program. Results: Forty-two dyads participated (patients: FEV1 70.4+/-22.1% predicted). Patients (p=0.048) and family members (p=0.004) in the family-based PR had significantly greater improvements in family coping than the control group. Family members of the family-based PR had significantly greater changes in sexual relationships (p=0.026) and in psychological distress (p=0.033) compared to the control group. Patients from both groups experienced significant improvements in exercise tolerance, functional balance, knee extensors strength and health-related quality of life after intervention (p<0.001). Conclusions: This research supports family-based PR programs to enhance coping and psychosocial adjustment to illness of the family system. Clinical Trials registration number: NCT02048306.
    Chest 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the United States as well as the rest of the world. An exacerbation of COPD, periodic escalations of symptoms of cough, dyspnea and sputum production, is a major contributor to the worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and costs of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has recently accumulated about the prevention of acute exacerbations.
    Chest 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a common disease with substantial associated morbidity and mortality. Patients with COPD usually have a progression of airflow obstruction that is not fully reversible and can lead to a history of progressive worsening breathlessness that can impact daily activities and health-related quality of life. COPD is the fourth leading cause of death in Canadian men and women and the third in the U.S., it claimed 133,965 U.S. lives in 2009. In 2011, 12.7 million U.S. adults were estimated to have COPD. However, approximately 24 million U.S. adults have evidence of impaired lung function, indicating an under diagnosis of COPD. While 4% of Canadians aged 35 to 79 self-reported being diagnosed with COPD, direct measurements of lung function from the Canadian Health Measures Survey (CHMS) indicate that 13% of Canadians had a lung function score indicative of COPD.
    Chest 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Omega-3 fatty acid supplements have been reported to inhibit exercise-induced bronchospasm (EIB). It has not been determined if omega-3 supplements inhibit airway sensitivity to inhaled mannitol, a test for bronchial hyperresponsiveness (BHR) and model for EIB in persons with mild-moderate asthma.
    Chest 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Evidence regarding nighttime physician staffing of intensive care units (ICUs) is suboptimal. We aimed to determine how nighttime physician staffing models influence patient outcomes.
    Chest 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Overuse of medical tests and treatments wastes health care resources and leads to unnecessary complications, while underuse results in delayed or missed diagnoses and treatment opportunities. Such problems are well recognized and there have been multiple attempts to correct inappropriate diagnostic testing and treatment over the past several decades. However, sustainable solutions have proven to be elusive.
    Chest 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background:Few studies have prospectively reported outcomes in pulmonary arterial hypertension (PAH) patients treated with epoprostenol in the modern-day era of oral therapy and combination treatments. The Registry to PROSPECTively Describe Use of Epoprostenol for Injection [Veletri, prolonged Room Temperature Stable Epoprostenol (RTS-Epo)] in Patients with Pulmonary Arterial Hypertension (PROSPECT) was established to prospectively describe the course of PAH in patients prescribed RTS-Epo. Methods:PROSPECT is a multicenter, US-based drug registry of primarily Group I PAH patients treated with RTS-Epo who were parenteral-naïve or parenteral-transitioned at enrollment. Patients were followed until discontinuation of RTS-Epo, withdrawal, loss to follow-up, death, or end of study (maximum 1 year). One-year freedom from hospitalization (FH) and survival estimates were summarized by prostacyclin history (parenteral-naïve or parenteral-transitioned), gender, and chronic renal insufficiency (CRI). Results:A total of 336 patients were included. The overall one-year FH estimate was 51.0% ±2.8% and was lower in parenteral-naive patients than parenteral-transitioned patients (42.8% ±4.3% vs. 57.1% ±3.7%, respectively; p=0.002). FH estimates were lower in male patients than female patients (38.3% ±5.9% vs. 54.6% ±3.2%, respectively; p<0.015) and in patients with CRI than patients without CRI (17.0% ±8.4% vs. 53.7% ±2.9%, respectively; p<0.001). The overall one-year survival estimate was 84.0% ±2.1%. Survival was poorer in parenteral-naive patients, male patients, and patients with CRI. Conclusions:Risk of hospitalization and mortality remain high in PAH patients. In particular, patients who are parenteral-naïve at initiation of RTS-Epo therapy, male patients, and patients with CRI require close monitoring and aggressive clinical management.
    Chest 10/2014;