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Revue Des Maladies Respiratoires Mar 2024
Topics: Humans; Pulmonologists; Lung Neoplasms
PubMed: 38514242
DOI: 10.1016/j.rmr.2024.03.001 -
Chest Apr 2008
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Neoplasm Invasiveness; Neoplasm Staging; Thoracic Wall; Tomography, X-Ray Computed; Ultrasonography
PubMed: 18398111
DOI: 10.1378/chest.07-2770 -
Respiration; International Review of... 2019The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials... (Clinical Trial)
Clinical Trial
BACKGROUND
The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials that show a lack of increase in diagnostic yield and specimen adequacy associated with its usage.
OBJECTIVE
We aimed to verify whether a pulmonologist can assess endosonography-derived lymph node samples after a comprehensive and reproducible training provided by a specialist pathologist.
METHODS
Prospective, observational trial structured in three phases. In the first (training) phase, a pathologist critically evaluated the smears from 150 archival endosonography cases with a pulmonologist. In the second (test) phase, the pulmonologist was asked to assess 50 archival endosonography-derived samples. In the last (real-life) phase, the pulmonologist classified the samples from 200 patients during the endosonography. The overall agreement between pulmonologist and pathologist (gold standard), assessed through κ-statistics, was the primary outcome. The agreement for the identification of specific cytological categories was the secondary outcome.
RESULTS
The overallagreement between pulmonologist and pathologist was 84% (κ0.765, 95% CI 0.732-0.826) in the test phase and 89.7% (κ 0.844, 95% CI 0.799-0.881) in the real-life phase. The agreement for specific cytological categories was 92.7% (95% CI 0.824-0.980) for inadequate samples, 90.3% (95% CI 84.5-94.5%) for reactive lymphadenopathies, 90.5% (95% CI 0.845-0.946) for malignancy, and 73% (95% CI 0.515-0.897) for granulomatous samples.
CONCLUSIONS
A trained pulmonologist can reliably assess adequacy and malignancy for endosonography-derived samples, which could be useful in institutions where a cytopathologist/cytotechnician is not available regularly.
Topics: Aged; Clinical Competence; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Female; Humans; Lymph Nodes; Male; Middle Aged; Observer Variation; Pulmonary Medicine; Reproducibility of Results
PubMed: 30982053
DOI: 10.1159/000496549 -
Revue Des Maladies Respiratoires Jun 2020Numerous studies about poor communication and altered quality of life of patients with chronic obstuctive pulmonary disease (COPD) lead to the conclusion that overall...
INTRODUCTION
Numerous studies about poor communication and altered quality of life of patients with chronic obstuctive pulmonary disease (COPD) lead to the conclusion that overall palliative management of COPD remains to be improved. The aim of this study was to describe pulmonologists' practice of palliative care for COPD patients in order to identify obstacles to it.
MATERIAL AND METHOD
A survey was sent to all pulmonologists whose email appeared in the 2017 French-language Respiratory Medicine Society's directory.
RESULTS
A total of 294 responses were obtained, among which 287 were analysed. Overall, 81.6% of the pulmonologists said that they identify a distinct palliative phase from "sometimes to often" in the care of COPD patients. When not identified, the most common reason given (68.8%) was the difficulty of defining when to start palliative care. Aspects of the palliative approach, which were considered the most problematic for pulmonologists, were the discussion of end of life care, and the impression that COPD patients have a low demand for information. 31% of pulmonologists reported that they gathered information about patients' wishes to undergo resuscitation and endotracheal intubation in 61 % to 100% of patients who they judged to have the most severe disease.
CONCLUSION
Uncertainty as to when to begin a palliative approach for COPD patients and perceptions around communication in chronic diseases appear to be the main obstacles to a palliative approach.
Topics: Adult; Advance Directives; Aged; Female; France; Humans; Male; Middle Aged; Palliative Care; Perception; Physician-Patient Relations; Practice Patterns, Physicians'; Pulmonary Disease, Chronic Obstructive; Pulmonary Medicine; Pulmonologists; Quality of Life; Terminal Care
PubMed: 32505369
DOI: 10.1016/j.rmr.2020.04.011 -
Annals of the American Thoracic Society May 2015Up to 80% of patients with lung cancer have comorbid chronic obstructive pulmonary disease (COPD). Many of them are poor candidates for stage-specific lung cancer...
RATIONALE
Up to 80% of patients with lung cancer have comorbid chronic obstructive pulmonary disease (COPD). Many of them are poor candidates for stage-specific lung cancer treatment due to diminished lung function and poor functional status, and many forego treatment. The negative effect of COPD may be moderated by pulmonologist-guided management.
OBJECTIVES
This study examined the association between pulmonologist management and the probability of receiving the recommended stage-specific treatment modality and overall survival among patients with non-small cell lung cancer (NSCLC) with preexisting COPD.
METHODS
Early- and advanced-stage NSCLC cases diagnosed between 2002 and 2005 with a prior COPD diagnosis (3-24 months before NSCLC diagnosis) were identified in Surveillance, Epidemiology, and End Results tumor registry data linked to Medicare claims. Study outcomes included receipt of recommended stage-specific treatment (surgical resection for early-stage NSCLC and chemotherapy for advanced-stage NSCLC [advNSCLC]) and overall survival. Pulmonologist management was considered present if one or more Evaluation and Management visit claims with pulmonologist specialty were observed within 6 months after NSCLC diagnosis. Stage-specific multivariate logistic regression tested association between pulmonologist management and treatment received. Cox proportional hazard models examined the independent association between pulmonologist care and mortality. Two-stage residual inclusion instrumental variable (2SRI-IV) analyses tested and adjusted for potential confounding based on unobserved factors or measurement error.
MEASUREMENTS AND MAIN RESULTS
The cohorts included 5,488 patients with early-stage NSCLC and 6,426 patients with advNSCLC disease with preexisting COPD. Pulmonologist management was recorded for 54.9% of patients with early stage NSCLC and 35.7% of patients with advNSCLC. Of those patients with pulmonologist involvement, 58.5% of patients with early NSCLC received surgical resection, and 43.6% of patients with advNSCLC received chemotherapy. Pulmonologist management post NSCLC diagnosis was associated with increased surgical resection rates (odds ratio, 1.26; 95% confidence interval, 1.11-1.45) for early NSCLC and increased chemotherapy rates (odds ratio, 1.88; 95% confidence interval, 1.67-2.10) for advNSCLC. Pulmonologist management was also associated with reduced mortality risk for patients with early-stage NSCLC but not AdvNSCLC.
CONCLUSIONS
Pulmonologist management had a positive association with rates of stage-specific treatment in both groups and overall survival in early-stage NSCLC. These results provide preliminary support for the recently published guidelines emphasizing the role of pulmonologists in lung cancer management.
Topics: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Clinical Competence; Disease Management; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Neoplasm Staging; Odds Ratio; Proportional Hazards Models; Pulmonary Disease, Chronic Obstructive; Pulmonary Medicine; Retrospective Studies; Risk Factors; SEER Program; Treatment Outcome; United States; Workforce
PubMed: 25760983
DOI: 10.1513/AnnalsATS.201406-230OC -
Respiratory Care May 2024Inhaler education for patients with asthma and patients with COPD is typically provided by non-pulmonologists. We studied inhaler education by pulmonologists to...
BACKGROUND
Inhaler education for patients with asthma and patients with COPD is typically provided by non-pulmonologists. We studied inhaler education by pulmonologists to determine changes in clinical outcomes and inhaler use.
METHODS
This was a retrospective study of 296 subjects diagnosed with asthma, COPD, or both that evaluated use of inhaler technique education and its impact on (1) inhaler/dosage change consisting of dosage change in the same class of inhaler and/or change in number of inhalers, (2) forced expiratory volume in one second/forced vital capacity (FEV/FVC%), (3) disease symptom control, (4) out-patient visits, (5) urgent care visits (6) emergency department visits, and (7) hospital admissions. One group received inhaler technique education by a pulmonologist while the other group did not.
RESULTS
The pulmonologist inhaler technique-educated group had significantly decreased relative risk for inhaler/dosage increase (relative risk 0.57 [95% CI 0.34-0.96], = .03) and significantly increased odds for symptom control (odds ratio 2.15 [95% CI 1.24-3.74], = .01) at 1-y follow-up as compared to the no education group. No differences occurred for FEV/FVC%, out-patient visits, urgent care visits, emergency department visits, and hospital admissions.
CONCLUSIONS
Pulmonologist education of inhaler technique for patients with asthma and patients with COPD was associated with decreased relative risk for inhaler/dosage increase and increased odds for symptom control. We recommend pulmonologists provide education of inhaler technique to patients with asthma and patients with COPD and not rely on non-pulmonologist education alone. Prospective research is needed to confirm the importance of proper inhaler techniques.
PubMed: 38688545
DOI: 10.4187/respcare.11478 -
Southern Medical Journal May 2008Flexible bronchoscopy remains an important tool in the staging, diagnosis, and treatment of primary and metastatic lung malignancies. Endobronchial ultrasound is a new... (Review)
Review
Flexible bronchoscopy remains an important tool in the staging, diagnosis, and treatment of primary and metastatic lung malignancies. Endobronchial ultrasound is a new technology utilized with bronchoscopy that has been shown to identify bronchial wall invasion by malignant tumors, aid in the fine needle aspiration of peripheral lung lesions and mediastinal/hilar lymph nodes, and determine the course of treatment in patients with pulmonary carcinoma in situ. The decision to invest both time and money in this technology is determined by several factors such as the cost of the equipment, reimbursement for the procedure, availability of training, the number of bronchoscopies one performs in a year, and access to endoscopic ultrasound and mediastinoscopy. This article reviews the literature to determine the utility of endobronchial ultrasound in the management of patients with lung cancer and to provide information to practicing pulmonologists that may aid in determining whether and where this technology fits into their clinical armamentarium.
Topics: Biopsy, Fine-Needle; Bronchi; Bronchoscopy; Cost-Benefit Analysis; Costs and Cost Analysis; Humans; Lung Neoplasms; Neoplasm Invasiveness; Sensitivity and Specificity; Transducers; Ultrasonography, Interventional
PubMed: 18414171
DOI: 10.1097/SMJ.0b013e31816c01bd -
Pediatric Pulmonology 1985
Topics: Australia; Humans; Lung Diseases; Pediatrics
PubMed: 4094818
DOI: 10.1002/ppul.1950010602 -
Le Journal Medical Libanais. the... 2002Gastroesophageal reflux (GER) is a common situation that can express with digestive, extra-digestive, respiratory or otolaryngologic symptoms. Some chronic pulmonary... (Review)
Review
Gastroesophageal reflux (GER) is a common situation that can express with digestive, extra-digestive, respiratory or otolaryngologic symptoms. Some chronic pulmonary disorders include in their setting GER as well. This review will address pathogenesis, clinical signs, complications and treatment of GER with a special focus towards the pulmonologist field. GER is a physiological post-prandial phenomenon of limited duration. It is induced by transient lower esophageal sphincter relaxation (tLESR) or by factors that impede LES function by reducing its tone or disrupting its contractions. Extra-digestive symptoms are caused by vagal stimulation through common autonomic pathways to the esophagus and bronchi. This reflex is triggered by gastric acid stimulation of esophageal receptors and by acid micro-aspirations into the airways. The responsibility of GER towards respiratory symptoms is often difficult to attest despite thorough investigations. Results of one to three-month treatment trial with proton pump inhibitors can be of value. Gastroesophageal assessment is mandatory as pulmonary manifestations might indicate disease severity.
Topics: Esophagogastric Junction; Gastroesophageal Reflux; Humans; Respiratory Tract Diseases
PubMed: 12841314
DOI: No ID Found -
Endoscopy Jun 2006
Review
Topics: Biopsy, Fine-Needle; Carcinoma, Non-Small-Cell Lung; Endosonography; General Surgery; Humans; Lung Neoplasms; Lymphatic Metastasis; Mediastinum; Neoplasm Staging; Positron-Emission Tomography; Pulmonary Medicine; Sensitivity and Specificity; Survival Analysis; Tomography, X-Ray Computed
PubMed: 16802240
DOI: 10.1055/s-2006-946659