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Advances in Therapy Nov 2022Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly underdiagnosed disorders. Telemedicine made it possible to continue diagnosis,...
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly underdiagnosed disorders. Telemedicine made it possible to continue diagnosis, follow-up visits and treatment modifications during the COVID-19 pandemic. The present study describes the management of patients with COPD and asthma, and their treatments during the pandemic from the pulmonologist's perspective.
METHODS
NEUMOBIAL was an ecological study with aggregated data. A total of 279 Spanish pulmonologists answered a 60-question survey about their last 10 patients, focused on the characterisation and changes in visits and treatments during the pandemic.
RESULTS
Most pulmonologists (72.0%) considered that the pandemic negatively altered the diagnosis and follow-up of patients with asthma or COPD. Diagnostic tests were reduced during the pandemic, mainly because they were not recommended by pulmonologists (68.1% and 72.7% in the case of COPD and asthma tests, respectively). Moreover, 17.3% of the COPD and 19.1% of the asthma visits were remote visits. According to pulmonologists, low adherence to treatment was mainly due to a lack of patient knowledge about their disease (75.3% and 81.7% in COPD and asthma, respectively). Other factors that also influenced adherence were inadequate use of the inhaler (59.5% for COPD and 57.7% for asthma) and a lack of knowledge about the device (57.3% for COPD and 57.7% for asthma). Pulmonologists chose Zonda for COPD because of the ease of use of the device (73.1%) and the ability to check whether the entire dose was inhaled (69.5%). For asthma, Spiromax was chosen because of the ease of use of the device (85.7%) and the possibility of using a single device for maintenance and reliever treatment (82.4%).
CONCLUSION
According to pulmonologists, during the pandemic, treatments for COPD and asthma were mainly chosen on the basis of their ease of use; treatment adherence was good; and the number of remote visits increased.
Topics: Administration, Inhalation; Asthma; COVID-19; Humans; Pandemics; Pulmonary Disease, Chronic Obstructive; Pulmonologists
PubMed: 36114950
DOI: 10.1007/s12325-022-02313-z -
Iranian Journal of Kidney Diseases Jan 2020Whether working in intensive care unit or not as nephrologists we are all facing complicated cases with different sign and symptoms. Among them is a category of patients... (Review)
Review
Whether working in intensive care unit or not as nephrologists we are all facing complicated cases with different sign and symptoms. Among them is a category of patients presenting with concomitant respiratory and kidney failure called pulmonary renal syndrome, which needs mutual connection between nephrologist and pulmonologist closely for the best decision-making. Although this is not a common entity, still associated with high rate of morbidity and mortality involving diffuse alveolar hemorrhage and glomerulonephritis. Understanding the updates in the field of management would benefit both the patients and caregivers providing clear answers to present obstacles.
Topics: Clinical Decision-Making; Critical Care; Glomerulonephritis; Hemorrhage; Humans; Lung Diseases; Nephrologists; Pulmonologists
PubMed: 32156835
DOI: No ID Found -
European Clinical Respiratory Journal 2019The evaluation of patients with lung lesions is challenging. The nature of the lesion can be determined by pathological evaluation of biopsies. The pulmonologists will... (Review)
Review
The evaluation of patients with lung lesions is challenging. The nature of the lesion can be determined by pathological evaluation of biopsies. The pulmonologists will be met by increasing demands with regard to biopsy techniques including ultrasound-guided transthoracic needle biopsy (US-TTNB). The aim of this paper is to present the pulmonologist to a systematic step-by-step guide for performing US-TTNB and to assess the evidence for this approach. : Indications, contraindications and a step-by-step guide for the techniques used when performing US-TTNB are presented, and major complications and handling of these are described. : US-TTNB performed by pulmonologists is a safe and feasible procedure.
PubMed: 30815241
DOI: 10.1080/20018525.2019.1579632 -
The European Respiratory Journal Nov 2013
Topics: Europe; Humans; Interdisciplinary Communication; Interprofessional Relations; Lung Neoplasms; Medical Oncology; Patient Care Team; Pulmonary Medicine; Quality of Life; Societies, Medical; Treatment Outcome; United States
PubMed: 24178934
DOI: 10.1183/09031936.00145813 -
The European Respiratory Journal Jan 2020
Topics: Humans; Pulmonologists; RNA; RNA-Seq; Sequence Analysis, RNA; Exome Sequencing
PubMed: 31601712
DOI: 10.1183/13993003.01625-2018 -
Annals of the American Thoracic Society Jul 2017Endobronchial ultrasound (EBUS) has transformed mediastinal staging in lung cancer. A systematic approach, beginning with lymph nodes contralateral to the primary tumor...
RATIONALE
Endobronchial ultrasound (EBUS) has transformed mediastinal staging in lung cancer. A systematic approach, beginning with lymph nodes contralateral to the primary tumor (N3), is considered superior to selective sampling of radiographically abnormal nodes. However, the extent to which this recommendation is followed in practice remains unknown.
OBJECTIVES
To assess the frequency with which pulmonologists, pulmonary fellows, and interventional pulmonologists endoscopically stage lung cancer appropriately.
METHODS
Bronchoscopists currently performing EBUS were surveyed about their practice patterns, procedural volume, and self-confidence in EBUS skills; they then performed a proctored simulated staging EBUS. The primary outcome was the proportion of participants who appropriately initiated ultrasonographic evaluation with the N3 nodal stations in a simulated patient undergoing EBUS for mediastinal staging.
RESULTS
Sixty physicians (22 interventional pulmonologists, 18 general pulmonologists, and 20 pulmonary fellows) participated in the study. The rates of appropriate staging by study group were 95.5% (21 of 22) for interventional pulmonologists, 44.4% (8 of 18) for general pulmonologists, and 30.0% (6 of 20) for pulmonary fellows (P < 0.001). Increased procedural volume correlated with appropriate staging practices (P < 0.001). Within each group, we assessed the concordance between self-confidence in EBUS and simulation performance. Among interventional pulmonologists, the concordance was 95.4%, followed by 61.1% for general pulmonologists and 40.0% for pulmonary fellows.
CONCLUSIONS
General pulmonologists and pulmonary fellows were less likely than interventional pulmonologists to perform appropriate EBUS staging. In addition, the lack of concordance between self-confidence and appropriate staging performance among noninterventionists signals a need for improved dissemination of guidelines for EBUS-guided mediastinal staging.
Topics: Bronchoscopy; Fellowships and Scholarships; Humans; Lung Neoplasms; Mediastinal Neoplasms; Neoplasm Staging; Ultrasonography
PubMed: 28399376
DOI: 10.1513/AnnalsATS.201606-487OC -
Scientific Reports Dec 2021Anesthesiologists commonly use video bronchoscopy to facilitate intubation or confirm the location of the endotracheal tube; however, depth and orientation in the...
Anesthesiologists commonly use video bronchoscopy to facilitate intubation or confirm the location of the endotracheal tube; however, depth and orientation in the bronchial tree can often be confused because anesthesiologists cannot trace the airway from the oropharynx when it is performed using an endotracheal tube. Moreover, the decubitus position is often used in certain surgeries. Although it occurs rarely, the misinterpretation of tube location can cause accidental extubation or endobronchial intubation, which can lead to hyperinflation. Thus, video bronchoscopy with a decision supporting system using artificial intelligence would be useful in the anesthesiologic process. In this study, we aimed to develop an artificial intelligence model robust to rotation and covering using video bronchoscopy images. We collected video bronchoscopic images from an institutional database. Collected images were automatically labeled by an optical character recognition engine as the carina and left/right main bronchus. Except 180 images for the evaluation dataset, 80% were randomly allocated to the training dataset. The remaining images were assigned to the validation and test datasets in a 7:3 ratio. Random image rotation and circular cropping were applied. Ten kinds of pretrained models with < 25 million parameters were trained on the training and validation datasets. The model showing the best prediction accuracy for the test dataset was selected as the final model. Six human experts reviewed the evaluation dataset for the inference of anatomical locations to compare its performance with that of the final model. In the experiments, 8688 images were prepared and assigned to the evaluation (180), training (6806), validation (1191), and test (511) datasets. The EfficientNetB1 model showed the highest accuracy (0.86) and was selected as the final model. For the evaluation dataset, the final model showed better performance (accuracy, 0.84) than almost all human experts (0.38, 0.44, 0.51, 0.68, and 0.63), and only the most-experienced pulmonologist showed performance comparable (0.82) with that of the final model. The performance of human experts was generally proportional to their experiences. The performance difference between anesthesiologists and pulmonologists was marked in discrimination of the right main bronchus. Using bronchoscopic images, our model could distinguish anatomical locations among the carina and both main bronchi under random rotation and covering. The performance was comparable with that of the most-experienced human expert. This model can be a basis for designing a clinical decision support system with video bronchoscopy.
Topics: Anesthesiology; Artificial Intelligence; Bronchi; Bronchoscopy; Deep Learning; Humans; Image Interpretation, Computer-Assisted; Image Processing, Computer-Assisted; Reproducibility of Results
PubMed: 34887497
DOI: 10.1038/s41598-021-03219-6 -
Monaldi Archives For Chest Disease =... Jun 2018Pneumomediastinum is defined as the presence of air or gas within the mediastinum and it rarely complicates bronchoscopy. We report, to our best knowledge, the first...
Pneumomediastinum is defined as the presence of air or gas within the mediastinum and it rarely complicates bronchoscopy. We report, to our best knowledge, the first case of pneumomediastinum following a transbronchial cryobiopsy (TBLC). TBLC is considered a safe procedure as compared with both transbronchial biopsy and surgical lung biopsy. Systematic reviews, metanalysis and a Pubmed research, revealed that in literature no pneumomediastinum has been mentioned after TBLC. We report this case for to make it known to interventional pulmonologists the possibility that a pneumomediastinum can follow a TBLC. In our case the spontaneous resolution in few days did not require any intervention.
PubMed: 29929353
DOI: 10.4081/monaldi.2018.909 -
Respiratory Medicine 2021Hematopoietic stem cell transplantation (HSCT) is used for treatment of a myriad of both malignant and non-malignant disorders. However, despite many advances over the... (Review)
Review
Hematopoietic stem cell transplantation (HSCT) is used for treatment of a myriad of both malignant and non-malignant disorders. However, despite many advances over the years which have resulted in improved patient mortality, this subset of patients remains at risk for a variety of post-transplant complications. Pulmonary complications of HSCT are categorized into infectious and non-infectious and occur in up to one-third of patients undergoing HSCT. Infectious etiologies include bacterial, viral and fungal infections, each of which can have significant mortality if not identified and treated early in the course of infection. Advances in the diagnosis and management of infectious complications highlight the importance of non-infectious pulmonary complications related to chemoradiation toxicities, immunosuppressive drugs toxicities, and graft-versus-host disease. This report aims to serve as a guide and clinical update of pulmonary complications following HSCT for the general pulmonologist who may be involved in the care of these patients.
Topics: Clinical Competence; Female; Health Knowledge, Attitudes, Practice; Hematopoietic Stem Cell Transplantation; Humans; Infection Control; Infections; Male; Patient Care; Postoperative Complications; Pulmonologists; Risk
PubMed: 34107323
DOI: 10.1016/j.rmed.2021.106493 -
La Radiologia Medica Apr 2018To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution...
OBJECTIVES
To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution computed tomography (HRCT) of patients with fibrosing lung disease (FLD).
METHODS
The writing committee selected the HRCT criteria-the Delphi items-for rating from both radiology panelists (RP) and pulmonology panelists (PP). The Delphi items were first rated by RPs as "essential", "optional", or "not relevant". The items rated "essential" by < 80% of the RP were selected for the PP rating. The format of reporting was rated by both RP and PP.
RESULTS
A total of 42 RPs and 12 PPs participated to the survey. In both Delphi round 1 and 2, 10/27 (37.7%) items were rated "essential" by more than 80% of RP. The remaining 17/27 (63.3%) items were rated by the PP in round 3, with 2/17 items (11.7%) rated "essential" by the PP. PP proposed additional items for conclusion domain, which were rated by RPs in the fourth round. Poor consensus was observed for the format of reporting.
CONCLUSIONS
This study provides a template for structured report of FLD that features essential items as agreed by expert thoracic radiologists and pulmonologists.
Topics: Adult; Aged; Delphi Technique; Female; Humans; Male; Middle Aged; Models, Theoretical; Prospective Studies; Pulmonary Fibrosis; Pulmonary Medicine; Radiology; Research Report; Tomography, X-Ray Computed
PubMed: 29230680
DOI: 10.1007/s11547-017-0835-6