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Tropical Medicine and Infectious Disease Dec 2023During the early stages of the pandemic, computed tomography (CT) of the chest, along with serological and clinical data, was frequently utilized in diagnosing COVID-19,...
During the early stages of the pandemic, computed tomography (CT) of the chest, along with serological and clinical data, was frequently utilized in diagnosing COVID-19, particularly in regions facing challenges such as shortages of PCR kits. In these circumstances, CT scans played a crucial role in diagnosing COVID-19 and guiding patient management. The COVID-19 Reporting and Data System (CO-RADS) was established as a standardized reporting system for cases of COVID-19 pneumonia. Its implementation necessitates a high level of agreement among observers to prevent any potential confusion. This study aimed to assess the inter-observer agreement between physicians from different specialties with variable levels of experience in their CO-RADS scoring of CT chests for confirmed COVID-19 patients, and to assess the feasibility of applying this reporting system to those having little experience with it. All chest CT images of patients with positive RT-PCR tests for COVID-19 were retrospectively reviewed by seven observers. The observers were divided into three groups according to their type of specialty (three radiologists, three house officers, and one pulmonologist). The observers assessed each image and categorized the patients into five CO-RADS groups. A total of 630 participants were included in this study. The inter-observer agreement was almost perfect among the radiologists, substantial among a pulmonologist and the house officers, and moderate-to-substantial among the radiologists, the pulmonologist, and the house officers. There was substantial to almost perfect inter-observer agreement when reporting using the CO-RADS among observers with different experience levels. Although the inter-observer variability among the radiologists was high, it decreased compared to the pulmonologist and house officers. Radiologists, house officers, and pulmonologists applying the CO-RADS can accurately and promptly identify typical CT imaging features of lung involvement in COVID-19.
PubMed: 38133455
DOI: 10.3390/tropicalmed8120523 -
European Respiratory Review : An... Sep 2022Single-cell ribonucleic acid sequencing is becoming widely employed to study biological processes at a novel resolution depth. The ability to analyse transcriptomes of... (Review)
Review
Single-cell ribonucleic acid sequencing is becoming widely employed to study biological processes at a novel resolution depth. The ability to analyse transcriptomes of multiple heterogeneous cell types in parallel is especially valuable for cell-focused lung research where a variety of resident and recruited cells are essential for maintaining organ functionality. We compared the single-cell transcriptomes from publicly available and unpublished datasets of the lungs in six different species: human (), African green monkey (), pig (), hamster (), rat () and mouse () by employing RNA velocity and intercellular communication based on ligand-receptor co-expression, among other techniques. Specifically, we demonstrated a workflow for interspecies data integration, applied a single unified gene nomenclature, performed cell-specific clustering and identified marker genes for each species. Overall, integrative approaches combining newly sequenced as well as publicly available datasets could help identify species-specific transcriptomic signatures in both healthy and diseased lung tissue and select appropriate models for future respiratory research.
Topics: Animals; Base Sequence; Chlorocebus aethiops; Cricetinae; Humans; Lung; Mice; Pulmonologists; Rats; Species Specificity; Swine; Transcriptome
PubMed: 35896273
DOI: 10.1183/16000617.0056-2022 -
Nederlands Tijdschrift Voor Geneeskunde Dec 2022In current practice, radiological diagnostics are often assessed by both the referring clinician as well as the radiologist. Specific medical specialists like...
In current practice, radiological diagnostics are often assessed by both the referring clinician as well as the radiologist. Specific medical specialists like pulmonologists and orthopaedic surgeons make treatment decisions mostly on their own expertise and interpretation of radiological images, before the radiological report is available. For health care as a whole, a single assessment gives efficiency gains, and the radiologist is not disturbed by getting rid of 'bulk' and can focus on the more complex matter in which he or she is indispensable. Regular multidisciplinary meetings may serve to jointly assess images about which there is ambiguity. Combining clinical information and radiological expertise then leads to optimisation of both quality and efficiency. It makes sense and is efficient to have clinicians with specific radiological expertise, such as pulmonologists and orthopaedists, assess certain radiological examinations independently, allowing the radiologist to concentrate on more complex imaging.
Topics: Female; Humans; Radiography; Radiology; Diagnostic Imaging; Radiologists; Orthopedic Surgeons
PubMed: 36633040
DOI: No ID Found -
Revue Des Maladies Respiratoires May 2019Behavioral therapies have been developed from Pavlov and Skinner's theories on learning. They have been enriched with knowledge about the processing of information, a... (Review)
Review
Behavioral therapies have been developed from Pavlov and Skinner's theories on learning. They have been enriched with knowledge about the processing of information, a process organizing the perception of events. For these two reasons they are called behavioral and cognitive therapies (CBT). CBTs take place in four stages: therapeutic alliance, functional analysis, behavioral and cognitive methods, and evaluation. Seven techniques allow the pulmonologist to increase motivation in patients, particularly at the contemplation stage: the motivational interviewing, the decision-making balance technique, recognition of vicious circles and their substitution by constructive circles, short and long-term evaluation of life, the "I owe it", being the Devil's advocate and the letter of rupture. The analysis of the literature highlights the effectiveness of CBT techniques, especially when they are combined with pharmacological treatments for smoking cessation (dual nicotine replacement therapy, bupropion or varenicline).
Topics: Behavior Therapy; Bupropion; Cognitive Behavioral Therapy; Humans; Motivation; Pulmonary Medicine; Pulmonologists; Smoking; Smoking Cessation; Tobacco Use Cessation Devices; Varenicline
PubMed: 31202599
DOI: 10.1016/j.rmr.2019.04.001 -
Respirology (Carlton, Vic.) May 2019
Topics: Biopsy, Needle; Bronchoscopy; Electromagnetic Phenomena; Humans; Pulmonologists
PubMed: 30803118
DOI: 10.1111/resp.13508 -
Journal of Thoracic Disease Aug 2021Critical care ultrasound has shifted the paradigm of thoracic imaging by enabling the treating physician to acquire and interpret images essential for clinical... (Review)
Review
Critical care ultrasound has shifted the paradigm of thoracic imaging by enabling the treating physician to acquire and interpret images essential for clinical decision-making, at the bedside, in real-time. Once considered impossible, lung ultrasound based on interpretation of artifacts along with true images, has gained momentum during the last decade, as an integral part of rapid evaluation algorithms for acute respiratory failure, shock and cardiac arrest. Procedural ultrasound image guidance is a standard of care for both common bedside procedures, and advanced procedures within interventional pulmonologist's (IP's) scope of practice. From IP's perspective, the lung, pleural, and chest wall ultrasound expertise is a prerequisite for mastery in pleural drainage techniques and transthoracic biopsies. Another ultrasound application of interest to the IP in the intensive care unit (ICU) setting is during percutaneous dilatational tracheostomy (PDT). As ICU demographics shift towards older and sicker patients, the indications for closed pleural drainage procedures, bedside transthoracic biopsies, and percutaneous dilatational tracheostomies have dramatically increased. Although ultrasound expertise is considered an essential IP operator skill there is no validated curriculum developed to address this component. Further, there is a need for developing an educational tool that matches up with the curriculum and could be integrated real-time with ultrasound-guided procedures.
PubMed: 34527370
DOI: 10.21037/jtd-19-3564 -
Chest Oct 2018Patients with advanced respiratory illness are often hospitalized, requiring close follow-up after discharge and also requiring care coordination outside of traditional... (Review)
Review
Patients with advanced respiratory illness are often hospitalized, requiring close follow-up after discharge and also requiring care coordination outside of traditional face-to-face outpatient visits. Primary care providers and specialists often provide services outside of outpatient visits that have not been captured and reimbursed with traditional billing evaluation and management codes. Within the last 5 years, the Centers for Medicare & Medicaid added new codes to the Medicare Physician Fee Schedule that reimburse for care coordination services not paid for by traditional evaluation and management codes. Transitional care management includes the 30-day period following hospitalization in which a clinician is responsible for care of the patient postdischarge from the hospital. Chronic care management provides reimbursement for coordination of care for chronic conditions that is performed by any clinician and his or her staff on a monthly basis that is > 20 min in duration.
Topics: Chronic Disease; Clinical Coding; Humans; Informed Consent; Insurance Coverage; Insurance, Health; Lung Diseases; Pulmonologists; Transitional Care
PubMed: 29859886
DOI: 10.1016/j.chest.2018.05.031 -
Drugs & Aging May 2017Asthma has been demonstrated to be as common in the elderly as in younger age groups. Although no specific recommendations exist to manage the disease differently in... (Review)
Review
Asthma has been demonstrated to be as common in the elderly as in younger age groups. Although no specific recommendations exist to manage the disease differently in older individuals, functional features and clinical presentations may be affected by age per se, and by age-related conditions, such as comorbidities and polypharmacy. In this review article, we aimed to explore the efficacy and safety in elderly asthmatic patients of one of the most currently used inhaled treatments for asthma, that is, the fixed-dose combination of budesonide/formoterol. We attempted to address some practical questions that are relevant to the daily practice of clinicians. We focused on the efficacy and real-world effectiveness of inhaled corticosteroids and long-acting β-adrenergic bronchodilators (ICS/LABA) as treatment in the elderly population, since data are extrapolated from younger populations. We investigated whether a maintenance and reliever therapy approach is more effective in the elderly as opposed to maintenance regimens, from both the general practitioner's and the pulmonologist's perspective. To address these questions, we scanned electronic databases (PubMed, MEDLINE, Embase, Scopus and Google Scholar) from the date of inception up to October 2016 with a cross-search using the following keywords: 'asthma', 'elderly', 'SMART therapy', 'MART therapy', 'Turbuhaler', and 'budesonide/formoterol'. The available literature on the topic confirms that when the age-associated changes are properly managed in clinical practice, asthma in older populations can be optimally controlled with inhaled treatment including ICS/LABA. This also applies for the budesonide/formoterol fixed combination, thus allowing for the maintenance and reliever therapy approach.
Topics: Administration, Inhalation; Aged; Anti-Asthmatic Agents; Asthma; Budesonide, Formoterol Fumarate Drug Combination; Databases, Factual; Drug Interactions; Humans; Middle Aged; Practice Guidelines as Topic; Treatment Outcome
PubMed: 28258535
DOI: 10.1007/s40266-017-0449-7 -
Journal of the American Society of... 2023Pulmonologists can biopsy structures below the diaphragm using the convex curvilinear ultrasound bronchoscope via the esophagus (EUS-B). The literature with respect to... (Review)
Review
INTRODUCTION
Pulmonologists can biopsy structures below the diaphragm using the convex curvilinear ultrasound bronchoscope via the esophagus (EUS-B). The literature with respect to the value of EUS-B, rapid on-site evaluation, and final diagnostic yield for structures below the diaphragm is limited. We review our institutional experience.
MATERIALS AND METHODS
Our database was queried retrospectively for EUS-B fine needle aspirations (FNAs) from 2013 to 2021. All procedures involving EUS-B-FNA of subdiaphragmatic structures were selected for analysis. The following data elements were collected for each patient: age, gender, clinical indication, sample site, on-site adequacy (OSA), preliminary and final diagnoses, and sufficiency of cell block for ancillary studies.
RESULTS
A total of 75 subdiaphragmatic sites were biopsied in 74 patients. Of which, 87% of samples subjected to rapid on-site evaluation were deemed to contain adequate material (OSA+). There were no false-positive OSAs. Six cases remained nondiagnostic at the final diagnosis. The final diagnostic yield (with cell block) was 92% (69/75 cases). Cell block was sufficient for immunohistochemistry or special stains in all applicable cases (n = 36). Molecular testing was requested for 11 cases and successful in 10 (91%). Sampling of subdiaphragmatic sites changed the stage in 67% (38/57) of lung cancer patients.
CONCLUSIONS
Pulmonologists can perform EUS-B-FNA of subdiaphragmatic sites with high OSA and final diagnostic yield when assisted by cytopathologists. Strong correlations exist between OSA, cell block adequacy, and subsequent capacity to perform ancillary testing. EUS-B below the diaphragm can make an important contribution to the diagnosis of lung cancer, nonpulmonary malignancies, and other diseases.
Topics: Humans; Retrospective Studies; Pulmonologists; Endosonography; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Lung Neoplasms
PubMed: 37336683
DOI: 10.1016/j.jasc.2023.05.004 -
Revue Des Maladies Respiratoires Jan 2024Ultrasonography is an emerging tool that helps to assess diaphragmatic function. It is now widely used in ICUs to predict weaning from mechanical ventilation.... (Review)
Review
INTRODUCTION
Ultrasonography is an emerging tool that helps to assess diaphragmatic function. It is now widely used in ICUs to predict weaning from mechanical ventilation. Ultrasonography is readily available, harmless (no radiation), and repeatable with good interoperator reproducibility. Over the past few years, ultrasonography has seen increasing use in patients with chronic pulmonary pathologies.
STATE OF THE ART
The aim of this review is (1) to describe the ultrasound techniques used to assess diaphragmatic excursion and thickening, (2) to indicate the expected, normal values in healthy patients, and (3) to summarize the main findings and clinical applications in treatment of chronic respiratory disorders.
CONCLUSIONS
Chronic pulmonary diseases are associated with diaphragmatic dysfunction that can be assessed with ultrasound. Diaphragmatic dysfunction is primary in neuromuscular disorders and secondary to respiratory disease in other chronic pulmonary conditions (COPD, ILD). Ultrasound is correlated with the severity of the underlying disease (functional and clinical parameters).
PERSPECTIVES
The prognostic interest of diaphragm ultrasonography remains to be established, after which its utilization should become routine.
Topics: Humans; Diaphragm; Pulmonologists; Reproducibility of Results; Lung; Ultrasonography
PubMed: 37980184
DOI: 10.1016/j.rmr.2023.10.005