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MMW Fortschritte Der Medizin Oct 2019
Review
Topics: Artificial Intelligence; Humans; Physicians; Pulmonologists; Respiratory Function Tests
PubMed: 31587207
DOI: 10.1007/s15006-019-0955-0 -
BMC Medical Education Nov 2022The availability of new immuno-oncology therapeutics markedly impacts oncology clinicians' treatment decision-making. To effectively support healthcare professionals...
BACKGROUND
The availability of new immuno-oncology therapeutics markedly impacts oncology clinicians' treatment decision-making. To effectively support healthcare professionals (HCPs) in their practice, it is important to better understand the challenges and barriers that can accompany the introduction of these agents. This study aimed to establish the types and causes of clinical challenges posed by the introduction of new immuno-oncology agents.
METHODS
The mixed-methods design included qualitative in-depth interviews and group discussions with HCPs, in which participants discussed clinical challenges and potential underlying reasons for these challenges. Qualitative findings informed a quantitative survey. This survey investigated the extent and distribution of challenges using HCPs' self-rating of knowledge, skill, confidence, and exposure to system-level effects. These two phases were conducted sequentially with distinctly stratified samples of oncologists, nurse practitioners (NPs), physician assistants (PAs), pathologists, clinical pharmacists, interventional radiologists, rheumatologists, pulmonologists, and emergency department physicians. Participants were from the United States and had various levels of clinical experience and represented both academic and community-based settings.
RESULTS
The final sample included 107 HCPs in the qualitative phase and 554 in the quantitative phase. Analyses revealed clinical challenges related to the use of pharmacodiagnostics. For example, 47% of pathologists and 42% of oncologists reported skill gaps in identifying the appropriate marker and 46% of oncologists, 61% of PAs, 66% of NPs, 74% of pulmonologists and 81% of clinical pharmacists reported skill gaps in selecting treatment based on test results. Challenges also emerged regarding the integration of immuno-oncology agents, as oncologists, rheumatologists, pulmonologists, clinical pharmacists, PAs, and NPs reported knowledge gaps (74-81%) of the safety profiles of recently approved agents. In addition, 90% of clinical pharmacists reported skill gaps weighing the risks and benefits of treating patients with immuno-oncology agents while affected by lupus. Finally, patient communication challenges were identified: HCPs reported difficulties discussing essential aspects of immunotherapy to patients as well as how they might compare to other types of therapies.
CONCLUSION
The challenges highlighted in this study reveal substantial educational gaps related to the integration of immuno-oncology agents into practice for various groups of HCPs. These findings provide a strong base of evidence for future educational initiatives.
Topics: Humans; Medical Oncology; Neoplasms; Health Personnel; Communication; Nurse Practitioners
PubMed: 36371179
DOI: 10.1186/s12909-022-03847-0 -
Clinics in Chest Medicine Mar 2020In the diagnosis of lung cancer, pulmonologists have several tools at their disposal. From the tried and true convex probe endobronchial ultrasound (EBUS)-guided... (Review)
Review
In the diagnosis of lung cancer, pulmonologists have several tools at their disposal. From the tried and true convex probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration to robotic bronchoscopy for peripheral lesions and new technology to unblind the biopsy tools, this article elucidates and expounds on the tools currently available and being developed for lung cancer diagnosis.
Topics: Biopsy; Bronchoscopy; Female; Humans; Lung; Lung Neoplasms; Male; Pulmonologists
PubMed: 32008625
DOI: 10.1016/j.ccm.2019.11.002 -
Pediatrics International : Official... Jan 2022Auscultation is an easy way to evaluate and diagnose patients with lung conditions but has the shortcoming of being subjective. Using the spectrogram, it is possible to...
BACKGROUND
Auscultation is an easy way to evaluate and diagnose patients with lung conditions but has the shortcoming of being subjective. Using the spectrogram, it is possible to visualize wheezing. We therefore conducted a study to compare the efficacy of diagnosing wheezing by auscultation versus diagnosing wheezing by spectrogram.
METHODS
This was an investigation of interrater reliability and agreement in which the subject population consisted of children, and the rater population consisted of pediatric pulmonologists. We recorded 55 respiratory sound files from June to November 2019. Three pediatric pulmonologists listened to the respiratory sound files and assessed whether wheezing was present. All respiratory sound files were also converted into spectrograms; the same pulmonologists viewed these and assessed whether wheezing was present. We tested for interrater reliability and agreement between the auscultation results and spectrographic results and investigated the diagnostic reliability of auscultation versus spectrogram.
RESULTS
Agreement among the three raters of our auscultation respiratory recordings was 88% and reliability was good (κ = 0.76, P < 0.001). Agreement among the three raters of our spectrograms was 83% and reliability was good (κ =0.66, P < 0.001). The level of agreement between each rater's spectrographic findings and diagnosed wheezing was 91%, 75%, and 93%, respectively. Reliability was accordingly very good, moderate, and very good (κ = 0.82, 0.49, 0.85, P < 0.001), respectively.
CONCLUSIONS
A spectrogram may be a valuable tool for evaluating wheezing in children. It may also be used to improve a young clinician's ability to accurately diagnose wheezing in the future.
Topics: Humans; Child; Respiratory Sounds; Reproducibility of Results; Auscultation
PubMed: 34582093
DOI: 10.1111/ped.15003 -
Annual Review of Medicine Jan 2024Interventional pulmonary medicine has developed as a subspecialty focused on the management of patients with complex thoracic disease. Leveraging minimally invasive... (Review)
Review
Interventional pulmonary medicine has developed as a subspecialty focused on the management of patients with complex thoracic disease. Leveraging minimally invasive techniques, interventional pulmonologists diagnose and treat pathologies that previously required more invasive options such as surgery. By mitigating procedural risk, interventional pulmonologists have extended the reach of care to a wider pool of vulnerable patients who require therapy. Endoscopic innovations, including endobronchial ultrasound and robotic and electromagnetic bronchoscopy, have enhanced the ability to perform diagnostic procedures on an ambulatory basis. Therapeutic procedures for patients with symptomatic airway disease, pleural disease, and severe emphysema have provided the ability to palliate symptoms. The combination of medical and procedural expertise has made interventional pulmonologists an integral part of comprehensive care teams for patients with oncologic, airway, and pleural needs. This review surveys key areas in which interventional pulmonologists have impacted the care of thoracic disease through bronchoscopic intervention.
Topics: Humans; Pulmonary Medicine; Bronchoscopy; Thoracic Diseases
PubMed: 37827195
DOI: 10.1146/annurev-med-050922-060929 -
Chest May 2021Advising patients before air travel is a frequently overlooked, but important, role of the physician, particularly primary care providers and pulmonary specialists....
Advising patients before air travel is a frequently overlooked, but important, role of the physician, particularly primary care providers and pulmonary specialists. Although physiologic changes occur in all individuals during air travel, those with underlying pulmonary disease are at increased risk of serious complications and require a specific approach to risk stratification. We discuss the available tools for assessment of preflight risk and strategies to minimize potential harm. We also present a case discussion to illustrate our approach to assessing patients for air travel and discuss the specific conditions that should prompt a more thorough preflight workup.
Topics: Aerospace Medicine; Air Travel; Altitude; Humans; Lung Diseases; Medical History Taking; Oxygen Inhalation Therapy; Physical Examination; Pulmonologists; Respiratory Function Tests; Risk Assessment
PubMed: 33212136
DOI: 10.1016/j.chest.2020.11.002 -
Pulmonology 2021Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic interstitial lung disease of unknown cause, which predominantly manifests in older males. IPF...
INTRODUCTION AND OBJECTIVES
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic interstitial lung disease of unknown cause, which predominantly manifests in older males. IPF diagnosis is a complex, multi-step process and delay in diagnosis cause a negative impact on patient survival. Additionally, a multidisciplinary team of pulmonologists, radiologists and pathologists is necessary for an accurate IPF diagnosis. The present study aims to assess how diagnosis and treatment of IPF are followed in Portugal, as well as the knowledge and implementation of therapeutic guidelines adopted by the Portuguese Society of Pulmonology.
MATERIALS AND METHODS
Seventy-eight practicing pulmonologists were enrolled (May-August 2019) in a survey developed by IPF expert pulmonologists comprised of one round of 31 questions structured in three parts. The first part was related to participant professional profile, the second part assessed participant level of knowledge and practice agreement with national consensus and international guidelines for IPF as well as their access to radiology and pathology for IPF diagnosis, and the third part was a self-evaluation of the guidelines adherence for diagnosis and treatment in their daily practice.
RESULTS
Participants represented a wide spectrum of pulmonologists from 14 districts of Portugal and autonomous regions of Azores and Madeira. The majority were female (65%), with 5-19 years of experience (71%) and working in a public clinical center (83%). Importantly, the majority of pulmonologists follow their IPF patients (n=45) themselves, while 26% referred IPF patients to ILD experts in the same hospital and 22% to another center. Almost all pulmonologists (98%) agreed or absolutely agreed that multidisciplinary discussion is recommended to accurately diagnose IPF. No pulmonologists considered pulmonary biopsy as absolutely required to establish an IPF diagnosis. However, 87% agreed or absolutely agree with considering biopsy in a possible/probable UIP context. If a biopsy is necessary, 96% of pulmonologists absolutely agree or agree with considering criobiopsy as an option for IPF diagnosis. Regarding IPF treatment, 98% absolutely agreed or agreed that antifibrotic therapy should be started once the IPF diagnosis is established. Finally, 76% stated that 6 months is the recommended time for follow-up visit in IPF patients.
CONCLUSIONS
Portuguese pulmonologists understand and agree with national consensus and international guidelines for IPF treatment but their implementation in Portugal is heterogeneous.
Topics: Adult; Awareness; Biopsy; Consensus; Cross-Sectional Studies; Female; Follow-Up Studies; Guideline Adherence; Humans; Idiopathic Pulmonary Fibrosis; Interdisciplinary Communication; Lung; Male; Middle Aged; Pathologists; Portugal; Practice Guidelines as Topic; Pulmonologists; Radiologists
PubMed: 32561352
DOI: 10.1016/j.pulmoe.2020.05.017 -
Chronic Obstructive Pulmonary Diseases... Oct 2022The objective of this study was to assess health care professionals' (HCPs) knowledge of an increased herpes zoster (HZ) risk and burden for patients with chronic...
OBJECTIVES
The objective of this study was to assess health care professionals' (HCPs) knowledge of an increased herpes zoster (HZ) risk and burden for patients with chronic obstructive pulmonary disease (COPD), HCPs' familiarity with the Advisory Committee on Immunization Practices' (ACIP) HZ vaccine recommendations, and the HCPs' current adult vaccine practices. Another objective was to evaluate the impact of a short educational video on knowledge and future vaccine intent.
PARTICIPANTS AND METHODS
An online survey of family physicians (FPs), pulmonologists, nurse practitioners (NPs), and physician assistants (PAs) querying demographics, awareness of ACIP HZ vaccine recommendations, and HZ burdens and risks in patients with COPD and their current recommendations for HZ, influenza, and pneumococcal vaccines was conducted. For those not strongly recommending HZ vaccines concordant with ACIP recommendations, a 5-minute educational video was presented, and post video questions assessed future intended HZ vaccine recommendations.
RESULTS
Among 1020 HCP responders, awareness and ACIP concordant HZ vaccine recommendations ranged from 59.0% to 95.2% across HCPs. Lowest recommendation rates were consistently reported by pulmonologists for the 2-dose HZ vaccine beginning at age 50; for the 2-dose vaccine use in those with prior 1-dose HZ vaccinations, and for those with prior HZ. Among all HCPs, HZ vaccine recommendations were lower than for pneumococcal and influenza vaccines. After viewing the educational video, reported vaccine recommendation intent increased significantly in all groups of HCPs, as did awareness of increased HZ risk among patients with COPD.
CONCLUSIONS
Significant educational opportunities exist for HCPs related to HZ and its vaccine prevention among patients with COPD which may be responsive to brief, targeted interventions.
PubMed: 36199223
DOI: 10.15326/jcopdf.2022.0322 -
Journal of Thoracic Disease Jul 2022To evaluate the impact of training primary care physicians (PCPs) in the use of the practical approach lung health-global alliance against chronic respiratory diseases... (Review)
Review
BACKGROUND
To evaluate the impact of training primary care physicians (PCPs) in the use of the practical approach lung health-global alliance against chronic respiratory diseases (PAL-GARD) upon their diagnostic skills.
METHODS
In this real-life three-phase study, PCPs were allocated to a PAL-GARD training or control group. Patients who sought a primary care health facility due to cough, dyspnea and/or wheezing were eligible. The clinical diagnoses made by PCPs during the baseline and post-intervention phase were audited by a panel of pulmonologists. Kappa inter-rater statistics was used to compare agreement between PCPs and pulmonologists.
RESULTS
Thirty PCPs evaluated 536 patients, 358 in the intervention and 178 in the control group. According to Kappa, there was an increase in the agreement in the diagnosis of asthma (from 0.546 to 0.638), tuberculosis (from 0.393 to 0.655) and acute respiratory infections (ARI) (from 0.577 to 0.584) was observed in the PAL-GARD group, but there was a reduction in chronic obstructive pulmonary disease (COPD) (from 0.430 to 0.284).
CONCLUSIONS
In this setting, PAL-GARD-based guide and training improved the clinical diagnosis of common respiratory diseases with the exception of COPD.
PubMed: 35928608
DOI: 10.21037/jtd-21-1345 -
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