Betel quid is a widely consumed substance that has been associated with higher mortality and increased risk of several diseases.

Over 300,000 patients experience in-hospital cardiac arrest in the United States each year, resulting in substantial morbidity, mortality, and loss of disability-adjusted life years. Although survival following in-hospital cardiac arrest improved over the past two decades, outcomes remain poor and many initial survivors of in-hospital cardiac arrest are discharged with substantial disability. Across the United States, risk-standardized survival following in-hospital cardiac arrest varies significantly, reflecting potential for process improvement. Improving processes of care and outcomes following in-hospital cardiac arrest is a priority of national organizations such as the Joint Commission, the American Hospital Association, and other professional bodies. Nevertheless, best approaches to improving in-hospital cardiac arrest care have not been well defined. Performance of regular, multidisciplinary in-situ cardiac arrest simulations has been identified as a trait common to best performing hospitals with respect to in-hospital cardiac arrest outcomes. Yet, no clear approach to establishing an in-situ cardiac arrest program has been established. In this How I Do It installment, we describe the creation of a robust and sustainable in-situ cardiac program including securing sponsorship and assembling a multidisciplinary team, acquiring and maintaining equipment and resources, execution of realistic simulations, and facilitating structured debriefings and continuous quality improvement. Our framework and ready-to-use tools will enable hospitals to implement sustainable in-situ IHCA simulation programs and drive measurable improvements in care and outcomes.

Interstitial Lung Disease (ILD) is a term encompassing a wide array of pulmonary conditions characterized by inflammation and fibrosis of the pulmonary parenchyma. Pulmonary hypertension (PH) is frequently encountered in patients with fibrotic ILDs and poses unique difficulties for both diagnosis and management. Patients with ILD associated pulmonary hypertension (ILD-PH) are complex, often ailing and presenting with multiple comorbidities whose individual contributions to the underlying PH can be challenging to disentangle. Evidence supporting treatment with PH-specific medications in ILD-PH is limited. This edition of "How I Do It" presents a longitudinal case-based discussion of ILD-PH to address these challenges, highlight pearls and pitfalls in the diagnostic workup of these patients, and provide a framework for the practical evidence-based approach to accurate diagnosis and management of these challenging patients.

Air pollution and extreme temperatures exposure during pregnancy is associated with lung function in schoolchildren.

Peer support could be beneficial for smoking cessation. Randomized controlled trial (RCT) evidence on mobile-based behavioral support by ex-smoking peers on smoking cessation in community people who smoke is lacking.

Breathlessness on exertion is a common, distressing and limiting symptom that can be quantified on incremental cardiopulmonary exercise testing (CPET) using normative reference equations.

Many patients are unaware of the need to repeat lung cancer screening (LCS) annually despite shared decision-making. We tested a health communication intervention to improve patient knowledge, tobacco-related stigma, and self-efficacy in LCS.

The population-level impact of risk factors for unfavorable tuberculosis treatment outcomes depends on their relative prevalence in the population. We calculated unadjusted and adjusted attributable fractions (AFs) to estimate the proportion of unfavorable tuberculosis treatment outcomes that can be attributed to key risk factors in India.

Fibrinolysis and complicated parapneumonic effusion/empyema have a longstanding relationship. Many of the first major breakthroughs in the discovery of plasminogen and its activators were made using Streptococcus species isolated from a patient with empyema. Fatefully, the first clinical use of plasminogen activators to treat human disease involved administering the identified Streptococcal plasminogen activator, streptokinase, intrapleurally to treat parapneumonic effusion and empyema. Refinement of fibrinolytic therapy over the last decades has led to the common practice of adjunctive intrapleural fibrinolytic therapy using a combination of recombinant human tissue plasminogen activator and deoxyribonuclease 1. However, current intrapleural fibrinolytic therapy for is inefficient resulting in an average hospital stay of 14 days. Further, many patients demonstrating residual pleural effusion after therapy, some of whom ultimately require surgery. This leads to billions of dollars of healthcare expenditure annually in the United States. This Special Feature aims to provide a historical overview of intrapleural fibrinolysis, review the current clinical fibrinolytic therapy practices for treatment of complicated parapneumonic effusion/empyema, and highlight knowledge gaps in our understanding of the pathobiology of resistance to intrapleural fibrinolytic therapy. While non-fibrinolytic modalities such as pleural irrigation and surgery are referenced for context, they are not the focus of this review and will not be discussed in depth. Improved knowledge of the mechanisms underlying aberrant fibrinolysis in the pleural space has the potential to improve prognostication, guide precision therapeutics, and enhance the care of CPE/E patients, leading to better individual outcomes and reduced healthcare expenditure.

Uptake of evidence-based practices (EBPs) in pulmonary and critical care medicine is frequently incomplete. To address these gaps implementation scientists seek to understand the clinical and societal contexts in which innovations and EBP are introduced. They also design and evaluate complex interventions to facilitate the adoption of an EBP in those contexts. We propose that well-established methods for analyzing hierarchical, observational data can complement and strengthen this process by identifying sources of practice variability. This manuscript reviews the dominant framework used to understand the clinical context of implementation programs, describes how measuring practice variability could help streamline this approach, and tests an assumption of the proposed combined methodology using observational data from a national study of mechanically ventilated patients conducted by The Prevention and Early Treatment of Acute Lung Injury (PETAL) Network. We discuss how the combined approach can be used to 1) focus the search for determinants of practice, 2) quantify the impact of evidence generation and evaluate the success of implementation projects, and 3) facilitate comparisons between implementation strategies when multiple approaches are trialed simultaneously.

In a context of overwhelming demand, mass transfers between intensive care units (ICU) were organized in France during the first COVID-19 epidemic wave (spring 2020). According to early reports, transferred patients experienced a 3-to-4-fold lower ICU case fatality. It is not known whether this difference stems only from the selection of healthier patients for transfer.

Mycobacterium abscessus complex (MABC) is a major causative pathogen of nontuberculous mycobacterial pulmonary disease (PD) and is notoriously difficult to treat. However, the impact of culture conversion on survival has not been explored in previous studies. Herein, we investigated the relationship between culture conversion and mortality in patients with MABC-PD.

An 85-year-old man had undergone hormone therapy with bicalutamide (androgen receptor antagonist) and leuprorelin (gonadotropin-releasing hormone agonist) for prostate adenocarcinoma with a Gleason score of 4 + 5 for approximately 3 years. The patient presented to the emergency department with dyspnea, respiratory failure, and loss of appetite. He also had a history of COPD with a 20-pack-year smoking history. The patient worked as a cook and had no history of occupational exposure to asbestos. Chest radiography showed a left pleural effusion , and he was admitted to our hospital for further examination of the pleural effusion.

A 27-year-old previously healthy woman with no known exposure history presented with a 20-day history of progressively worsening breathlessness. She progressed from being breathless while hurrying on level ground to becoming breathless at rest and unable to complete sentences within 2 days. She reported multiple episodes of hemoptysis (approximately 30 mL daily) over the past 6 to 7 days, along with generalized weakness and fatigue for the last 7 days, and sudden onset of hair loss for the past 2 days. She reported episodic bluish discoloration of fingers on exposure to cold for the last 3 years but denied history of joint pain or skin rash.

Granulomatous venulitis is an exceedingly rare condition characterized by granulomatous inflammation and obliteration of small pulmonary veins, leading to the development of pulmonary venoocclusive disease. The prognosis is poor, with most patients surviving less than 1 year after diagnosis. We present the first case, to our knowledge, of successful management of this disease by lung transplantation.

Managing bronchiectasis exacerbations is a priority for patients/parents/caregivers of children with bronchiectasis, yet evidence-based strategies among the pediatric population remain limited.

Nocturnal SpO2 monitoring is recommended for detecting residual sleep-disordered breathing (SDB), including nocturnal hypoventilation, in patients treated by non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP). It is a general assumption that different pulse oximetry devices will provide similar results. This may, however, not be correct.

Hypoglossal nerve stimulation (HNS) to treat obstructive sleep apnea (OSA) currently requires placement of a cuff or 'saddle' electrode around or adjacent to the hypoglossal nerve(s). Limitations for this therapy include cost, invasiveness, and variable efficacy.

Digital health technologies (DHT) such as mobile health technologies, wearables, telehealth and telemonitoring are increasingly used in healthcare. This is particularly true for respiratory conditions such as asthma, cystic fibrosis, tuberculosis, interstitial lung disease and COPD as DHTs can support diagnosis, self-management, and ongoing care. However, respiratory conditions change across an individual's lifespan in both their presentation and management priorities for the clinician and patient. This creates new challenges and opportunities for using DHT. Adopting an 'all-of-life' approach is key when considering DHT use within each life stage and across the lifespan.

Sepsis-induced cardiomyopathy (SICM) is a heterogeneous cardiovascular dysfunction associated with sepsis and septic shock. While traditionally defined by reversible left ventricular (LV) systolic dysfunction, recent evidence has revealed a broader spectrum, including LV diastolic dysfunction, hyperdynamic LV systolic states, and right ventricular (RV) injury, occurring independently or in combination. Despite their prognostic significance, these phenotypes remain underrecognized and understudied.