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The Journal of Nutrition, Health & Aging 2022The present study aimed to investigate the incidence of and risk factors for postoperative pneumonia and aspiration pneumonia after hip fracture surgery.
OBJECTIVES
The present study aimed to investigate the incidence of and risk factors for postoperative pneumonia and aspiration pneumonia after hip fracture surgery.
DESIGN
Retrospective cohort study from 2005 to 2021.
SETTING
Asan Medical Center in Seoul, Republic of Korea.
PARTICIPANTS
A total 1,208 patients aged ≥ 65 years who underwent hip fracture surgery.
MEASUREMENTS
Postoperative pneumonia was defined as cases with new infiltration on chest x-ray or chest computed tomography (CT) after surgery or confirmed by a pulmonologist's consultation and diagnosis. Aspiration pneumonia was defined as: 1) radiologic findings of hospital-acquired pneumonia on chest radiographs or CT, medical record of aspiration pneumonia confirmed by a pulmonologist's consultation, and history of vomiting or aspiration, or 2) gravity-dependent opacity on chest CT when the history of vomiting or aspiration is ambiguous. Patient demographics, past medical history, pre-injury Koval score, Charlson Comorbidity Index (CCI), blood test results, length of hospital stay, and in-hospital mortality were evaluated. A comparison analysis and binary logistic regression were performed to identify the incidence and risk factors for postoperative pneumonia and aspiration pneumonia.
RESULTS
Postoperative pneumonia was diagnosed in 47 patients (3.9%), including 20 with aspiration pneumonia (1.7%). In the multivariate analysis, postoperative delirium (odds ratio [OR], 3.42; P < 0.001), American Society of Anesthesiologists (ASA) scores ≥ 3 (OR, 2.11; P = 0.021), and CCI (OR, 1.21; P = 0.013) were significant risk factors for postoperative pneumonia. Male sex (OR, 3.01; P = 0.017), postoperative delirium (OR, 3.16; P = 0.014), and preoperative serum albumin levels < 3.5 g/dL (OR, 7.00; P = 0.010) were significant risk factors for aspiration pneumonia.
CONCLUSION
ASA classification ≥ 3, higher CCI, and postoperative delirium were the risk factors for postoperative pneumonia. Male sex, postoperative delirium, and lower preoperative serum albumin level were the risk factors for aspiration pneumonia. Thus, physicians should pay attention to patients with the risk factors.
Topics: Aged; Delirium; Hip Fractures; Humans; Male; Pneumonia; Pneumonia, Aspiration; Postoperative Complications; Retrospective Studies; Risk Factors; Serum Albumin; Vomiting
PubMed: 35842764
DOI: 10.1007/s12603-022-1821-9 -
Journal of Thoracic Disease Sep 2023Lung transplantation (LTx) in Japan has taken steps toward increasing the number of donors and recipients and is at the maturity stage of development, at which point... (Review)
Review
BACKGROUND AND OBJECTIVE
Lung transplantation (LTx) in Japan has taken steps toward increasing the number of donors and recipients and is at the maturity stage of development, at which point pulmonologists (hereinafter referred to as "respirologists") become involved in transplant practice. Because of severe donor shortage and limited number of LTx surgeries, most of transplant process from candidacy evaluation to post-operative management has been handled only by thoracic surgeons, which takes away opportunities from respirologists to manage LTx recipients. Given the growth of both LTx and the number of patients with complex problems, cooperation with respirologists in transplant practice is urgently needed to achieve transplant success in Japan.
METHODS
Authors summarized current transplant circumstance in Japan from the transplant physician's standpoint. A systematic search through PubMed database and Google Scholar was performed by terms of "respirologists", "pulmonologist", "lung transplant" or "Japan" from 2000 and 2022. Thoracic surgeons working at each transplant center were asked to complete a questionnaire on physicians' intervention to LTx.
KEY CONTENT AND FINDINGS
The roles of respirologists in LTx differ with facility size and function, depending on whether they are working at a non-transplant center with other respirologists or at a transplant center with transplant physicians. LTx centers are currently devoted to educating respirologists who work at non-transplant or low-volume transplant centers in order for them to deal with patients before and after transplantation.
CONCLUSIONS
Joint efforts and training of outstanding personnel who can take care of recipients are required, this being the greatest issue for the success of transplantation in Japan.
PubMed: 37868896
DOI: 10.21037/jtd-22-1716 -
Respiration; International Review of... 2022Financial relationships between healthcare professionals and pharmaceutical companies have historically caused conflicts of interest and unduly influenced patient care....
BACKGROUND
Financial relationships between healthcare professionals and pharmaceutical companies have historically caused conflicts of interest and unduly influenced patient care. However, little was known about such relationship and its effect in clinical practice among specialists in respiratory medicine.
METHODS
Based on the retrospective analysis of payment data made available by all 92 pharmaceutical companies in Japan, this study evaluated the magnitude and trend of financial relationships between all board-certified Japanese respiratory specialists and pharmaceutical companies between 2016 and 2019. Magnitude and prevalence of payments for specialists were analyzed descriptively. The payment trends were assessed using the generalized estimating equations for the payment per specialist and the number of specialists with payments.
RESULTS
Among all 7,114 respiratory specialists certified as of August 2021, 4,413 (62.0%) received a total of USD 53,547,391 and 74,195 counts from 72 (78.3%) pharmaceutical companies between 2016 and 2019. The median (interquartile range) 4-year combined payment values per specialist were USD 2,210 (USD 715-8,178). At maximum, one specialist received USD 495,332 personal payments over the 4 years. Both payments per specialist and number of specialists with payments significantly increased during the 4-year period, with 7.8% (95% CI: 5.5-9.8; p < 0.001) in payments and 1.5% (95% CI: 0.61-2.4; p = 0.001) in number of specialists with payments, respectively.
CONCLUSION
The majority of respiratory specialists had increasingly received more personal payments from pharmaceutical companies for the reimbursement of lecturing, consulting, and writing between 2016 and 2019. These increasing financial relationships with pharmaceutical companies might cause conflicts of interest among respiratory physicians.
Topics: Humans; Conflict of Interest; Drug Industry; Japan; Retrospective Studies; Pulmonologists; Pharmaceutical Preparations
PubMed: 36353778
DOI: 10.1159/000526576 -
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 -
Liver Transplantation : Official... Apr 2023Portopulmonary hypertension (POPH) is a type of pulmonary arterial hypertension occurring exclusively in those with portal hypertensive liver disease. Liver...
Portopulmonary hypertension (POPH) is a type of pulmonary arterial hypertension occurring exclusively in those with portal hypertensive liver disease. Liver transplantation (LT) can significantly improve outcomes. Current guidelines counsel against immediate adjustments to targeted therapy after LT and suggest routine echocardiography as sufficiently informative to guide therapeutic adjustments. Current practice patterns for adjusting targeted therapy after LT in POPH, and how they compare with guidelines, are not well established. To answer this question, we performed an institutional review board-approved, cross-sectional mixed-methods survey-based study of US POPH providers. Anonymized requests to complete the survey were sent through professional networks between January 20, 2022, and April 20, 2022. Responses were compared between cardiologists and pulmonologists using Fisher's exact tests, at a significance of 0.05. A total of 85 POPH physicians were included in the final analysis (66% pulmonologists and 34% cardiologists). Following LT, the majority of respondents routinely used a combination of standard cardiopulmonary assessment modalities to guide adjustment of targeted therapy following LT. Most respondents (69%) started by adjusting parenteral prostacyclins with small titrations and frequent reassessments within 3 months of LT, but some (19.7%) adjusted targeted therapy immediately after LT. Our results showed that the majority of respondents favored serial integrated cardiopulmonary testing (including routine right heart catheterization) to guide the adjustment of targeted therapy in POPH after LT, and almost one-fifth of respondents weaned therapy immediately after LT. Our study demonstrates heterogeneity in POPH practice patterns after LT, highlights differences between current practice patterns and the most recent guidelines, emphasizes the need for additional research, and supports a team-based approach to standardize care for these high-risk patients and optimize post-LT outcomes.
Topics: Humans; Liver Transplantation; Pulmonary Arterial Hypertension; Hypertension, Pulmonary; Cross-Sectional Studies; Hypertension, Portal
PubMed: 36117426
DOI: 10.1002/lt.26575 -
European Respiratory Review : An... Dec 2020Monogenic type I interferonopathies are inherited heterogeneous disorders characterised by early onset of systemic and organ specific inflammation, associated with...
Monogenic type I interferonopathies are inherited heterogeneous disorders characterised by early onset of systemic and organ specific inflammation, associated with constitutive activation of type I interferons (IFNs). In the last few years, several clinical reports identified the lung as one of the key target organs of IFN-mediated inflammation. The major pulmonary patterns described comprise children's interstitial lung diseases (including diffuse alveolar haemorrhages) and pulmonary arterial hypertension but diagnosis may be challenging. Respiratory symptoms may be either mild or absent at disease onset and variably associated with systemic or organ specific inflammation. In addition, associated extrapulmonary clinical features may precede lung function impairment by years, and patients may display severe/endstage lung involvement, although this may be clinically hidden during the long-term disease course. Conversely, a few cases of atypical severe lung involvement at onset have been reported without clinically manifested extrapulmonary signs. Hence, a multidisciplinary approach involving pulmonologists, paediatricians and rheumatologists should always be considered when a monogenic interferonopathy is suspected. Pulmonologists should also be aware of the main pattern of presentation to allow prompt diagnosis and a targeted therapeutic strategy. In this regard, promising therapeutic strategies rely on Janus kinase-1/2 (JAK-1/2) inhibitors blocking the type I IFN-mediated intracellular cascade.
Topics: Child; Humans; Inflammation; Interferon Type I; Lung; Lung Diseases, Interstitial
PubMed: 33328278
DOI: 10.1183/16000617.0001-2020 -
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 -
Revue Des Maladies Respiratoires Oct 2021The obstructive sleep apnoea syndrome (OSAS) affects 1-4% of adolescents. It represents a transitional stage between paediatric and adult OSA and is characterized by... (Review)
Review
The obstructive sleep apnoea syndrome (OSAS) affects 1-4% of adolescents. It represents a transitional stage between paediatric and adult OSA and is characterized by specific symptoms. BACKGROUND: The persistence of childhood OSAS during adolescence is not frequent. Risk factors are male sex, obesity and a history of tonsillectomy or adenoidectomy. Symptoms may be misleading such as tiredness and depressive disorders. In adolescence, untreated OSAS may result in neuro-behavioural and cognitive deficits, systemic inflammation, cardiovascular and metabolic disorders. The French Society of Research and Sleep Medicine organized a meeting on OSAS in adolescents. A multidisciplinary group of specialists (pulmonologists, pediatricians, ENT and maxillo-facial surgeons, dentofacial orthopedists/orthodontists, myofunctional therapists and sleep specialists) exchanged their experience, discussed publications and drew up a consensus document on the diagnosis and polysomnographic criteria for OSAS in adolescents. They proposed a practical diagnostic guideline and follow-up for these adolescents. OUTLOOK AND CONCLUSION: A good knowledge of the particularities of this pathology by the physician will lead to an early diagnosis, propose adapted multifactorial treatments and avoid the deleterious consequences of this pathology at adult age.
Topics: Adolescent; Child; Humans; Male; Polysomnography; Risk Factors; Sleep; Sleep Apnea, Obstructive
PubMed: 34565640
DOI: 10.1016/j.rmr.2021.06.006