Distinct gene expression signatures comparing latent tuberculosis infection with different routes of Bacillus Calmette-Guérin vaccination.

Tuberculosis remains an international health threat partly because of limited protection from pulmonary tuberculosis provided by standard intradermal vaccination with Bacillus of Calmette and Guérin (BCG); this may reflect the inability of intradermal vaccination to optimally induce pulmonary immunity. In contrast, respiratory Mycobacterium tuberculosis infection usually results in the immune-mediated bacillary containment of latent tuberculosis infection (LTBI). Here we present RNA-Seq-based assessments of systemic and pulmonary immune cells from LTBI participants and recipients of intradermal and oral BCG. LTBI individuals uniquely display ongoing immune activation and robust CD4 T cell recall responses in blood and lung. Intradermal BCG is associated with robust systemic immunity but only limited pulmonary immunity. Conversely, oral BCG induces limited systemic immunity but distinct pulmonary responses including enhanced inflammasome activation potentially associated with mucosal-associated invariant T cells. Further, IL-9 is identified as a component of systemic immunity in LTBI and intradermal BCG, and pulmonary immunity following oral BCG.

Evaluating and Improving the Efficiency of Patient Flow in the Bronchoscopy Suite in a Tertiary Care Center: A QI Project!

PURPOSE: The bronchoscopy suite is where pulmonologists perform the majority of their procedures like bronchoscopy, endobronchial ultrasound, and navigational bronchoscopy among others. Faculty and fellows in our division have reported multiple delays in the procedure start time in our bronchoscopy. OBJECTIVES: Objectives of the study were (1) to identify the areas of delays in procedure start time, (2) to identify potential high-yield areas of interventions to reduce delays, (3) to assess the impact of interventions on efficacy of bronchoscopy suit. METHODS: We have conducted a quality improvement project aiming at identifying areas of delays and implemented an intervention aiming at minimizing those delays. We retrospectively collected the data about the patient flow from arrival to hospital to discharge between June and August 2016. We used fishbone technique to identify the potential reasons for delay in procedures and to identify low-effort high-yield areas. Our intervention was raising awareness and education among the personnel and designing the process to reduce time delays and improve efficacy. We collected the data about the patient flow prospectively after the invention was implemented. RESULTS: The study showed that 76.4% of our preintervention procedures had a late start time. The postintervention results revealed a statistically significant reduction in the procedure late start times by 24.4% (P = .02). Signing the procedure H and P was also identified as a major area of delay, which has improved postintervention (65.5 % vs 33.3%, P = 0.017). CONCLUSION: The faculty and fellows' perceptions were translated into objective data, which serves as a first step in our division to improve the patient flow process in the bronchoscopy suite. Areas of delays were identified and our intervention resulted in significant improvement, but more work needs to be done to achieve a more efficient patient flow in the bronchoscopy suite while maintaining a safe patient care.