Evidence-Based Clinical Practice Guidelines

Since publication of the seventh American College of Chest Physicians (ACCP) supplement on antithrombotic and thrombolytic therapy, the results of clinical trials have provided important new information on the management of thromboembolic disorders, and the science of developing recommendations has advanced. In the accompanying supplement, we provide the new and updated recommendations and review several important changes that we have made in our guideline development process.

In the 19th century, lung cancer was an unusual tumor; so much so that single case reports of the rare cancer were published in the scientific literature of the day. Things have changed. Other than skin cancer, lung cancer is now the most common cancer and is the most frequent cause of death from cancer in both men and women.

A Successful and Transparent Approach Addressing Conflict of Interest, Funding, and Patient-Centered Recommendations

Suggestions from an American College of Chest Physicians task force

The impact of cough on health is substantial. It can (1) be an important defense mechanism that helps clear excessive secretions and foreign material from the airways; (2) be an important factor in the spread of infection; and (3) present as one of the most common symptoms for which patients seek medical attention and spend health-care dollars.¹

This evidence-based clinical practice guideline provides a summary of the most current literature on the management of postoperative atrial fibrillation following cardiac surgery, and provides recommendations for the prevention and management of this condition based on the reported scientific data. The expert panel that developed these guidelines relied on results from randomized controlled trials (RCTs) that were identified through specified criteria related to predefined research questions.

Introduction: The available clinical guidelines have been successful in improving awareness of the inflammatory nature of asthma and have promoted the use of inhaled corticosteroids (ICSs) to achieve long-term control of symptoms. Because of lingering concerns over the possible adverse consequences of ICS use, an expert panel was convened with a mandate to identify the critical questions that impact decisions regarding the use of ICSs and to evaluate the available evidence with respect to risk

We present a two-part review of the English-language literature pertaining to drug therapy for systemic high BP in patients with pulmonary diseases. Part I examines the literature pertaining to the use of antihypertensive drugs in patients with systemic hypertension and coexisting pulmonary conditions, especially COPD and asthma. Part II of the series reviews studies assessing the relationship between sleep-disordered breathing (including the role of the sympathetic nervous system) and systemic hypertension, and presents an approach to the management of these patients.

The discontinuation or withdrawal process from mechanical ventilation is an important clinical issue.12 Patients are generally intubated and placed on mechanical ventilators when their own ventilatory and/or gas exchange capabilities are outstripped by the demands placed on them from a variety of diseases. Mechanical ventilation also is required when the respiratory drive is incapable of initiating ventilatory activity either because of disease processes or drugs. As the conditions that warranted placing the patient on the ventilator stabilize and begin to resolve, attention should be placed on removing the ventilator as quickly as possible. Although this process often is termed “ventilator weaning” (implying a gradual process), we prefer the more encompassing term “discontinuation.”