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Advances in Respiratory Medicine Jan 2022Rapid on-site evaluation (ROSE) during transbronchial needle aspiration (TBNA) is conventionally performed by pathologists. However, availability of a pathologist in the...
INTRODUCTION
Rapid on-site evaluation (ROSE) during transbronchial needle aspiration (TBNA) is conventionally performed by pathologists. However, availability of a pathologist in the bronchoscopy suite is often an issue. We aimed to study if a pulmonologist, after receiving a short period of training in cytopathology, is able to assess the adequacy of onsite samples during TBNA.
MATERIAL AND METHODS
A pulmonologist was initially trained by a pathologist in examining cytology slides and assessing sample adequacy on TBNA smears. During TBNA, one slide from each needle pass was stained on-site using rapid Giemsa stain and was labelled as ROSE slide. The remaining slides were sent to the pathology laboratory for definitive cytological analysis. The ROSE slides were examined by a pulmonologist and a pathologist blinded to each other's interpretation. Level of agreement between the pulmonologist and pathologist was assessed by estimating Cohen's kappa.
RESULTS
A total of 172 slides from 35 patients were prepared for ROSE and evaluated independently by pulmonologist and pathologist. For adequacy, the pulmonologist and pathologist agreed in 143 out of the 172 slides (83% agreement), κ 0.649 (p < 0.001). For diagnostic categories, the pulmonologist and the pathologist agreed in 143 out of the 172 slides (83% agreement); κ 0.696 (p < 0.001). The sensitivity, specificity and accuracy of ROSE performed by the pulmonologist with respect to that performed by the pathologist was 66.2%, 96.8% and 83.1% respectively.
CONCLUSION
After a short period of training in cytopathology, a pulmonologist can assess for adequacy of TBNA ROSE slides in the bronchoscopy suite.
PubMed: 35099056
DOI: 10.5603/ARM.a2022.0020 -
Clinical Medicine & Research Jun 2023Burnout syndrome is common in physicians, but little is known about burnout in lung transplant physicians specifically. The purpose of this study was to explore burnout...
Burnout syndrome is common in physicians, but little is known about burnout in lung transplant physicians specifically. The purpose of this study was to explore burnout and its relationship to job factors and depression in lung transplant physicians. A cross-sectional study that included lung transplant pulmonologists and surgeons was performed via electronic survey. The lung transplant physicians surveyed practiced worldwide. The survey incorporated questions about demographics and job characteristics as well as the Maslach Burnout Inventory and Patient Health Questionnaire-2. Burnout was defined by high emotional exhaustion or depersonalization. Ninety physicians worldwide completed the survey. Of the 90 physicians who completed the entire survey, 44 (48.9%) had burnout with 38 (42.2%) having high emotional exhaustion, 15 (16.7%) having high depersonalization, and 9 (10.0%) with both. Of the respondents, 14 (15.6%) had high risk of depression, and of these, 13 also had high emotional exhaustion. There was a positive correlation between depression score and emotional exhaustion score (=0.67, <0.001). Depression was more common in surgeons compared with pulmonologists (35.7% versus 11.8%, =0.02). There was a trend toward more burnout by emotional exhaustion in physicians with more versus less work experience (68.4% versus 31.6%, =0.056). Emotional exhaustion is common in lung transplant physicians and is associated with depression and a negative impact on life.
Topics: Humans; Cross-Sectional Studies; Depersonalization; Burnout, Psychological; Burnout, Professional; Surveys and Questionnaires; Surgeons
PubMed: 37407217
DOI: 10.3121/cmr.2023.1809 -
The Lancet. Respiratory Medicine Apr 2021
Topics: COVID-19; Critical Care; Humans; Infectious Disease Transmission, Patient-to-Professional; Intensive Care Units; Leadership; Patient Care Team; Peer Group; Pulmonologists; Work-Life Balance; Workload
PubMed: 33581082
DOI: 10.1016/S2213-2600(21)00039-4 -
Journal of Oral and Maxillofacial... Aug 2022Since the relationship between mandibular setback surgery and obstructive sleep apnea (OSA) occurrence still remains controversial, the aim of this study was to assess...
PURPOSE
Since the relationship between mandibular setback surgery and obstructive sleep apnea (OSA) occurrence still remains controversial, the aim of this study was to assess the impact of bimaxillary orthognathic surgery on the probability of OSA development, using a home sleep test (HST) device.
METHODS
The authors implemented a double-blinded prospective cohort study. All healthy patients with skeletal class III deformity were included in this study. Subjects were candidates for bimaxillary orthognathic surgery. OSA monitoring was performed by the pulmonologist, week 1 preoperatively (T0), 1 and 6 months postoperatively (T1, T2), with a specific brand of a HST device. The predictor variables were the amount of mandibular setback and maxillary advancement, separately. Changes in apnea-hypopnea index (AHI) and SpO2 1 and 6 months after surgery relative to T0 were the outcome variables. OSA severity was measured using AHI, and classified as mild (5
30). Age, sex, and body mass index were the study covariates. The outcome assessor (pulmonologist), and the data analyzer were blind in this study. The significance level was set at 0.05, using the SPSS19. RESULTS
The sample was composed of 30 patients, (15 females, 15 males) with an average age of 25.73 ± 5.26 years and a mean body mass index of 19.90 ± 3.6 kg/m. The mean amount of mandibular setback was 4.5 ± 1.1 (ranged from 2-7 mm), while the average maxillary advancement was 2.9 ± 1.2 mm (ranged 1-5 mm). Mean AHI at T0, T1, and T2 was 1.8 ± 1.0, 3.4 ± 1.5, and 1.9 ± 0.9 events per hour events, respectively. The AHI scores increased from T0 to T1 but again decreased until T2, which were statistically significant (P < .001). The mean amount of SpO2 at T0, T1, and T2 was 96.7 ± 0.9, 94.0 ± 1.3, 96.7 ± 0.7%, respectively. Postoperative AHI in T1 and T2 had direct statistical significant relationships with the amount of mandibular setback (R = .404, .574, respectively and P < .05). Postoperative AHI scores were lower in patients with <5 mm mandibular setback in comparison to subjects who underwent ≥5 mm setback (P < .05).
CONCLUSIONS
Bimaxillary orthognathic surgery (concomitant maxillary advancement and mandibular setback) did not increase the incidence of OSA in young healthy non-obese class III patients, in the case of mandibular setback up to 7 mm.
Topics: Adult; Female; Humans; Male; Maxilla; Orthognathic Surgery; Orthognathic Surgical Procedures; Prospective Studies; Sleep Apnea, Obstructive; Young Adult
PubMed: 35594908
DOI: 10.1016/j.joms.2022.04.010 -
Current Medical Research and Opinion Aug 2022Cough is one of the most common health issues for which medical attention is sought. A chronic cough (CC) is understood as a cough that lasts longer than 8 weeks. CC...
BACKGROUND
Cough is one of the most common health issues for which medical attention is sought. A chronic cough (CC) is understood as a cough that lasts longer than 8 weeks. CC encompasses two subsets referred to as refractory chronic cough (RCC) and unexplained chronic cough (UCC). This study aims to assess the current understanding and perceptions of a RCC and UCC, from a physician's perspective in Switzerland and how this understanding and practical work leads to the relevant diagnosis and treatment.
METHODS
In October 2020, 549 GPs and 338 pulmonologists in Switzerland, received an invite to participate in the online-based quantitative survey. Data collection was carried out through a 25-minute online survey. The questionnaire was based on structured questions, and conducted on a randomized sample of doctors (general practitioners -GPs and pulmonologists) in the German- and French-speaking part of Switzerland.
RESULTS
Overall, 33 pulmonologists and 52 GPs participated in the online survey. Only 39% of GPs, but 73% of pulmonologists, defined chronic cough as a cough lasting 8 weeks or longer. The majority of physicians (72%), especially pulmonologists (88%), perceived a clinical gap regarding the treatment of persistent cough. 74% of the sampled physicians agreed that persistent cough is a high burden of disease for patients. Based on the answers, the annual number of new patients with RCC and UCC in Switzerland is estimated at 9322 patients.
CONCLUSIONS
Results of this study have highlighted differences in the terminology used to describe CC (RCC and UCC), in the diagnostic tests used and, in the treatments used between GPs and pulmonologists. These findings suggest the need to align the current language regarding the disease to facilitate a standardized approach for diagnosis and treatment and towards improving patient care and reduce burden of disease for CC (RCC and UCC) patients.
Topics: Carcinoma, Renal Cell; Chronic Disease; Cough; General Practitioners; Humans; Kidney Neoplasms; Perception; Surveys and Questionnaires; Switzerland
PubMed: 35369836
DOI: 10.1080/03007995.2022.2057154 -
Journal of Visualized Experiments : JoVE Jun 2023Flexible bronchoscopy is a technically difficult procedure and has been identified as the most important procedure that should be integrated into a simulation-based...
Flexible bronchoscopy is a technically difficult procedure and has been identified as the most important procedure that should be integrated into a simulation-based training program for pulmonologists. However, more specific guidelines that govern bronchoscopy training are needed to meet this demand. To ensure patients a competent examination, we propose a systematic, stepwise approach, splitting the procedure into four "landmarks" to support novice endoscopists navigating the bronchial maze. The procedure can be evaluated based on three established outcome measures to ensure a thorough and effective inspection of the bronchial tree: diagnostic completeness, structured progress, and procedure time. The stepwise approach relying on the four landmarks is used at all simulation centers in Denmark and is being implemented in the Netherlands. To provide instant feedback to novice bronchoscopists when training and to relieve time constraints from consultants, we suggest that future studies should implement artificial intelligence as a feedback and certification tool when training new bronchoscopists.
Topics: Humans; Bronchoscopy; Artificial Intelligence; Clinical Competence; Bronchi; Computer Simulation
PubMed: 37427954
DOI: 10.3791/65358 -
Pulmonary Therapy Dec 2021Due to frequent lung involvement, the pulmonologist is often the reference physician for management of sarcoidosis, a systemic granulomatous disease with a heterogeneous... (Review)
Review
Due to frequent lung involvement, the pulmonologist is often the reference physician for management of sarcoidosis, a systemic granulomatous disease with a heterogeneous course. Treatment of sarcoidosis raises some issues. The first challenge is to select patients who are likely to benefit from treatment, as sarcoidosis may be self-limiting and remit spontaneously, in which case treatment can be postponed and possibly avoided without any significant impact on quality of life, organ damage or prognosis. Systemic glucocorticosteroids (GCs) are the drug of first choice for sarcoidosis. When GCs are started, there is a > 50% chance of long-term treatment. Prolonged use of prednisone at > 10 mg/day or equivalent is often associated with severe side effects. In these and refractory cases, steroid-sparing options are advised. Antimetabolites, such as methotrexate, are the second-choice therapy. Biologics, such as anti-TNF and especially infliximab, are third-choice drugs. The three treatments can be used concomitantly. Regardless of whether treatment is started, the clinician needs to organize regular follow-up to monitor remissions, flares, progression, complications, toxicity and relapses in order to promptly adjust the drugs used.
PubMed: 34143362
DOI: 10.1007/s41030-021-00160-x -
The Hastings Center Report Jan 2020I first became aware of bioethics in the spring of 1980. I had spent a thirty-six-hour shift shadowing a medical resident, and I was struck that many of the resident's...
I first became aware of bioethics in the spring of 1980. I had spent a thirty-six-hour shift shadowing a medical resident, and I was struck that many of the resident's decisions had ethical dimensions. The next day, I came across the Hastings Center Report, and I realized I wanted to explore ethical issues I found implicit in clinical care, even though I still wanted to become a pediatrician. In September 2019, when I attended my first meeting of the U.S. Food and Drug Administration's Pediatric Advisory Committee, as a pediatric pulmonologist, I had the same sense of awe and curiosity that I had forty years ago. What had appeared initially as somewhat technical decisions about the regulation of drug labeling was suffused with ethical questions. The committee was asked to discuss possible changes to the labeling of two previously approved drugs.
Topics: Acetates; Advisory Committees; Bioethics; Cyclopropanes; Drug Labeling; Humans; Oxymorphone; Pediatrics; Quinolines; Sulfides; United States; United States Food and Drug Administration
PubMed: 32068277
DOI: 10.1002/hast.1074 -
Chest Feb 2022Interstitial lung abnormalities (ILA) may represent undiagnosed early-stage or subclinical interstitial lung disease (ILD). ILA are often observed incidentally in... (Review)
Review
BACKGROUND
Interstitial lung abnormalities (ILA) may represent undiagnosed early-stage or subclinical interstitial lung disease (ILD). ILA are often observed incidentally in patients who subsequently develop clinically overt ILD. There is limited information on consensus definitions for, and the appropriate evaluation of, ILA. Early recognition of patients with ILD remains challenging, yet critically important. Expert consensus could inform early recognition and referral.
RESEARCH QUESTION
Can consensus-based expert recommendations be identified to guide clinicians in the recognition, referral, and follow-up of patients with or at risk of developing early ILDs?
STUDY DESIGN AND METHODS
Pulmonologists and radiologists with expertise in ILD participated in two iterative rounds of surveys. The surveys aimed to establish consensus regarding ILA reporting, identification of patients with ILA, and identification of populations that might benefit from screening for ILD. Recommended referral criteria and follow-up processes were also addressed. Threshold for consensus was defined a priori as ≥ 75% agreement or disagreement.
RESULTS
Fifty-five experts were invited and 44 participated; consensus was reached on 39 of 85 questions. The following clinically important statements achieved consensus: honeycombing and traction bronchiectasis or bronchiolectasis indicate potentially progressive ILD; honeycombing detected during lung cancer screening should be reported as potentially significant (eg, with the Lung CT Screening Reporting and Data System "S-modifier" [Lung-RADS; which indicates clinically significant or potentially significant noncancer findings]), recommending referral to a pulmonologist in the radiology report; high-resolution CT imaging and full pulmonary function tests should be ordered if nondependent subpleural reticulation, traction bronchiectasis, honeycombing, centrilobular ground-glass nodules, or patchy ground-glass opacity are observed on CT imaging; patients with honeycombing or traction bronchiectasis should be referred to a pulmonologist irrespective of diffusion capacity values; and patients with systemic sclerosis should be screened with pulmonary function tests for early-stage ILD.
INTERPRETATION
Guidance was established for identifying clinically relevant ILA, subsequent referral, and follow-up. These results lay the foundation for developing practical guidance on managing patients with ILA.
Topics: Disease Progression; Early Diagnosis; Female; Humans; Lung Diseases, Interstitial; Male; Pulmonologists; Radiologists; Referral and Consultation; Respiratory Function Tests; Surveys and Questionnaires; Tomography, X-Ray Computed
PubMed: 34197782
DOI: 10.1016/j.chest.2021.06.035 -
Respirology (Carlton, Vic.) Sep 2022Genetic analysis is emerging for interstitial lung diseases (ILDs); however, ILD practices are not yet standardized. We surveyed patients', relatives' and...
BACKGROUND AND OBJECTIVE
Genetic analysis is emerging for interstitial lung diseases (ILDs); however, ILD practices are not yet standardized. We surveyed patients', relatives' and pulmonologists' experiences and needs on genetic testing in ILD to evaluate the current situation and identify future needs.
METHODS
A clinical epidemiologist (MT) together with members of the ERS taskforce and representatives of the European Idiopathic Pulmonary Fibrosis and related disorders Federation (EU-IPFF) patient organisation developed a survey for patients, relatives and pulmonologists. Online surveys consisted of questions on five main topics: awareness of hereditary ILD, the provision of information, genetic testing, screening of asymptomatic relatives and clinical impact of genetic analysis in ILD.
RESULTS
Survey respondents consisted of 458 patients with ILD, 181 patients' relatives and 352 pulmonologists. Most respondents think genetic testing can be useful, particularly for explaining the cause of disease, predicting its course, determining risk for developing disease and the need to test relatives. Informing patients and relatives on genetic analysis is primarily performed by the pulmonologist, but 88% (218) of pulmonologists identify a need for more information and 96% (240) ask for guidelines on genetic testing in ILD. A third of the pulmonologists who would offer genetic testing currently do not offer a genetic test, primarily because they have limited access to genetic tests. Following genetic testing, 72% (171) of pulmonologists may change the diagnostic work-up and 57% (137) may change the therapeutic approach.
CONCLUSION
This survey shows that there is wide support for implementation of genetic testing in ILD and a high need for information, guidelines and access to testing among patients, their relatives and pulmonologists.
Topics: Genetic Testing; Humans; Idiopathic Pulmonary Fibrosis; Lung Diseases, Interstitial; Pulmonologists; Surveys and Questionnaires
PubMed: 35652243
DOI: 10.1111/resp.14303