RESUMO
BACKGROUND: The COVID-19 pandemic has highlighted the importance of rapid dissemination of scientific and medical discoveries. Current platforms available for the distribution of scientific and clinical research data and information include preprint repositories and traditional peer-reviewed journals. In recent times, social media has emerged as a helpful platform to share scientific and medical discoveries. OBJECTIVE: This study aimed to comparatively analyze activity on social media (specifically, Twitter) and that related to publications in the form of preprint and peer-reviewed journal articles in the context of COVID-19 and gastroenterology during the early stages of the COVID-19 pandemic. METHODS: COVID-19-related data from Twitter (tweets and user data) and articles published in preprint servers (bioRxiv and medRxiv) as well as in the PubMed database were collected and analyzed during the first 6 months of the pandemic, from December 2019 through May 2020. Global and regional geographic and gastrointestinal organ-specific social media trends were compared to preprint and publication activity. Any relationship between Twitter activity and preprint articles published and that between Twitter activity and PubMed articles published overall, by organ system, and by geographic location were identified using Spearman's rank-order correlation. RESULTS: Over the 6-month period, 73,079 tweets from 44,609 users, 7164 journal publications, and 4702 preprint publications were retrieved. Twitter activity (ie, number of tweets) peaked in March 2020, whereas preprint and publication activity (ie, number of articles published) peaked in April 2020. Overall, strong correlations were identified between trends in Twitter activity and preprint and publication activity (P<.001 for both). COVID-19 data across the three platforms mainly concentrated on pulmonology or critical care, but when analyzing the field of gastroenterology specifically, most tweets pertained to pancreatology, most publications focused on hepatology, and most preprints covered hepatology and luminal gastroenterology. Furthermore, there were significant positive associations between trends in Twitter and publication activity for all gastroenterology topics (luminal gastroenterology: P=.009; hepatology and inflammatory bowel disease: P=.006; gastrointestinal endoscopy: P=.007), except pancreatology (P=.20), suggesting that Twitter activity did not correlate with publication activity for this topic. Finally, Twitter activity was the highest in the United States (7331 tweets), whereas PubMed activity was the highest in China (1768 publications). CONCLUSIONS: The COVID-19 pandemic has highlighted the potential of social media as a vehicle for disseminating scientific information during a public health crisis. Sharing and spreading information on COVID-19 in a timely manner during the pandemic has been paramount; this was achieved at a much faster pace on social media, particularly on Twitter. Future investigation could demonstrate how social media can be used to augment and promote scholarly activity, especially as the world begins to increasingly rely on digital or virtual platforms. Scientists and clinicians should consider the use of social media in augmenting public awareness regarding their scholarly pursuits.
Assuntos
COVID-19/epidemiologia , Disseminação de Informação , Pandemias , Pesquisa/estatística & dados numéricos , Pesquisa/tendências , Mídias Sociais/estatística & dados numéricos , Mídias Sociais/tendências , China/epidemiologia , Cuidados Críticos/estatística & dados numéricos , Cuidados Críticos/tendências , Humanos , Estudos Longitudinais , PubMed/estatística & dados numéricos , Saúde Pública , Pneumologia/estatística & dados numéricos , Pneumologia/tendências , SARS-CoV-2 , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
GOAL: To study the effect of the first COVID-19 wave in combination with the lockdown on acute care in the Netherlands. DESIGN: Retrospective cohort study METHOD: For this study, data was collected from patients who visited the emergency department (ED) and Cardiac Care Unit of Noordwest Ziekenhuisgroep in Alkmaar and Den Helder. This data collection took place from 1 February to 28 June in 2019 and during the same period in 2020. The number of visits per day was investigated. The outcome measures for hospital occupation were the number of admissions per day and the average length of stay. Outcome measures for health damage were length of stay and mortality. RESULTS: The number of ED visits fell by 27% during the lockdown. For the specialties of internal medicine and pulmonary medicine, the number of admissions from the ED was the same during the lockdown, but the length of stay was longer. For all other specialties, the number of admissions from the ED was lower during the lockdown, but the admission duration was the same. Mortality was higher and hospital stay longer for patients admitted to the specialties of internal medicine and pulmonary medicine. In all other specialisms studied, there was no higher mortality or longer hospital stay. CONCLUSION: From the start of the lockdown, there was a sharp drop in the number of ED visits. The number of ED visits recovered slowly after this drop. For specialties that did not treat COVID-19 patients, hospital occupation was lower than usual. The number of admissions from the ED had decreased for these specialties. Based on the outcome measures length of stay and mortality, we were unable to find any indications of health damage as a result of the drop in admissions.
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Ocupação de Leitos/estatística & dados numéricos , COVID-19 , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Mortalidade Hospitalar , Humanos , Países Baixos , Pneumologia/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2RESUMO
BACKGROUND: Study reproducibility is valuable for validating or refuting results. Provision of reproducibility indicators, such as materials, protocols, and raw data in a study improve its potential for reproduction. Efforts to reproduce noteworthy studies in the biomedical sciences have resulted in an overwhelming majority of them being found to be unreplicable, causing concern for the integrity of research in other fields, including medical specialties. Here, we analyzed the reproducibility of studies in the field of pulmonology. METHODS: 500 pulmonology articles were randomly selected from an initial PubMed search for data extraction. Two authors scoured these articles for reproducibility indicators including materials, protocols, raw data, analysis scripts, inclusion in systematic reviews, and citations by replication studies as well as other factors of research transparency including open accessibility, funding source and competing interest disclosures, and study preregistration. FINDINGS: Few publications included statements regarding materials (10%), protocols (1%), data (15%), and analysis script (0%) availability. Less than 10% indicated preregistration. More than half of the publications analyzed failed to provide a funding statement. Conversely, 63% of the publications were open access and 73% included a conflict of interest statement. INTERPRETATION: Overall, our study indicates pulmonology research is currently lacking in efforts to increase replicability. Future studies should focus on providing sufficient information regarding materials, protocols, raw data, and analysis scripts, among other indicators, for the sake of clinical decisions that depend on replicable or refutable results from the primary literature.
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Pesquisa Biomédica/ética , Pneumologia/normas , Reprodutibilidade dos Testes , Pesquisa Biomédica/economia , Pesquisa Biomédica/estatística & dados numéricos , Estudos Transversais , Gerenciamento de Dados , Medicina Baseada em Evidências , Humanos , Metanálise como Assunto , Publicações/economia , Publicações/estatística & dados numéricos , Pneumologia/estatística & dados numéricos , Revisões Sistemáticas como AssuntoRESUMO
BACKGROUND: Chronic cough (CC) of 8 weeks or more affects about 10% of adults and may lead to expensive treatments and reduced quality of life. Incomplete diagnostic coding complicates identifying CC in electronic health records (EHRs). Natural language processing (NLP) of EHR text could improve detection. RESEARCH QUESTION: Can NLP be used to identify cough in EHRs, and to characterize adults and encounters with CC? STUDY DESIGN AND METHODS: A Midwestern EHR system identified patients aged 18 to 85 years during 2005 to 2015. NLP was used to evaluate text notes, except prescriptions and instructions, for mentions of cough. Two physicians and a biostatistician reviewed 12 sets of 50 encounters each, with iterative refinements, until the positive predictive value for cough encounters exceeded 90%. NLP, International Classification of Diseases, 10th revision, or medication was used to identify cough. Three encounters spanning 56 to 120 days defined CC. Descriptive statistics summarized patients and encounters, including referrals. RESULTS: Optimizing NLP required identifying and eliminating cough denials, instructions, and historical references. Of 235,457 cough encounters, 23% had a relevant diagnostic code or medication. Applying chronicity to cough encounters identified 23,371 patients (61% women) with CC. NLP alone identified 74% of these patients; diagnoses or medications alone identified 15%. The positive predictive value of NLP in the reviewed sample was 97%. Referrals for cough occurred for 3.0% of patients; pulmonary medicine was most common initially (64% of referrals). LIMITATIONS: Some patients with diagnosis codes for cough, encounters at intervals greater than 4 months, or multiple acute cough episodes may have been misclassified. INTERPRETATION: NLP successfully identified a large cohort with CC. Most patients were identified through NLP alone, rather than diagnoses or medications. NLP improved detection of patients nearly sevenfold, addressing the gap in ability to identify and characterize CC disease burden. Nearly all cases appeared to be managed in primary care. Identifying these patients is important for characterizing treatment and unmet needs.
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Tosse/diagnóstico , Registros Eletrônicos de Saúde , Pneumologia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Respiratory support has been increasingly used after extubation for the prevention of re-intubation and improvement of prognosis in critically ill medical patients. However, the optimal respiratory support method is still under debate. This network meta-analysis (NMA) aims to evaluate the comparative effectiveness of various respiratory support methods used for preventive purposes after scheduled extubation in critically ill medical patients. METHODS: A systematic database search was performed from inception to December 19, 2019, for randomized controlled trials (RCTs) that compared a preventive use of different respiratory support methods, including conventional oxygen therapy (COT), noninvasive ventilation (NIV), high-flow oxygen therapy (HFOT), and combinational use of HFOT and NIV (HFOT+NIV), after planned extubation in adult critically ill medical patients. Study selection, data extraction, and quality assessments were performed in duplicate. The primary outcomes included re-intubation rate and short-term mortality. RESULTS: Seventeen RCTs comprising 3341 participants with 4 comparisons were included. Compared with COT, NIV significantly reduced the re-intubation rate [risk ratio (RR) 0.55, 95% confidence interval (CI) 0.39 to 0.77; moderate quality of evidence] and short-term mortality (RR 0.66, 95% CI 0.48 to 0.91; moderate quality of evidence). Compared to COT, HFOT had a beneficial effect on the re-intubation rate (RR 0.55, 95% CI 0.35 to 0.86; moderate quality of evidence) but no effect on short-term mortality (RR 0.79, 95% CI 0.56 to 1.12; low quality of evidence). No significant difference in the re-intubation rate or short-term mortality was found among NIV, HFOT, and HFOT+NIV. The treatment rankings based on the surface under the cumulative ranking curve (SUCRA) from best to worst for re-intubation rate were HFOT+NIV (95.1%), NIV (53.4%), HFOT (51.2%), and COT (0.3%), and the rankings for short-term mortality were NIV (91.0%), HFOT (54.3%), HFOT+NIV (43.7%), and COT (11.1%). Sensitivity analyses of trials with a high risk of extubation failure for the primary outcomes indicated that the SUCRA rankings were comparable to those of the primary analysis. CONCLUSIONS: After scheduled extubation, the preventive use of NIV is probably the most effective respiratory support method for comprehensively preventing re-intubation and short-term death in critically ill medical patients, especially those with a high risk of extubation failure.
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Extubação/métodos , Medicina Preventiva/métodos , Pneumologia/normas , APACHE , Extubação/normas , Estado Terminal/terapia , Humanos , Metanálise em Rede , Pneumologia/métodos , Pneumologia/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricosRESUMO
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.
Assuntos
Cuidados Paliativos/psicologia , Cuidados Paliativos/estatística & dados numéricos , Percepção , Padrões de Prática Médica/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Pneumologistas , Adulto , Diretivas Antecipadas/psicologia , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/normas , Relações Médico-Paciente , Padrões de Prática Médica/normas , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Pneumologia/normas , Pneumologia/estatística & dados numéricos , Pneumologistas/psicologia , Pneumologistas/estatística & dados numéricos , Qualidade de Vida , Assistência Terminal/métodos , Assistência Terminal/psicologia , Assistência Terminal/estatística & dados numéricosRESUMO
Objective: To describe the characteristics and management of asthma in clinical practice in the Czech Republic in the context of international guidelines and clinical realities.Methods: Data were collected over four seasons from summer 2016 to spring 2017 and are mostly presented using descriptive statistics.Results: We obtained valid data for 4557 adult patients with asthma, including detailed phenotyping (71% eosinophilic allergic, 10% eosinophilic non-allergic, 19% non-eosinophilic non-allergic asthma) from 58 allergologists and 56 pulmonologists. The average time to diagnosis was 3 years. In more than half of the subjects, bronchodilator testing (BDT) results were available at primary diagnosis. More than 10% of physicians did not test for mold allergy. Occupational asthma was diagnosed in 0.7% of subjects. According to the attending physician, 68% of patients had well-controlled and 10% had uncontrolled asthma. Ninety-four percent of patients were on preventive treatment, with 91% using an inhaled corticosteroids (ICS) at an average dose of 705 µg/day budesonide equivalent. Approximately 75% of patients were on an ICS/LABA, with 91% using fixed combinations. Among patients using ICS/formoterol, a maintenance and reliever therapy regime was prescribed in 67%.Conclusions: The quality of asthma management in the Czech Republic is comparable to that of other developed countries and better in some respects (frequent BDT, phenotyping, and use of preventive treatment). Nevertheless, there is unnecessary delay in diagnosis and lack of research on possible environmental causes (workplace, molds). Pharmacotherapy shows good adherence to guidelines. Although 10% of patients show poor control, there is concurrently a trend for overtreatment.
Assuntos
Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Glucocorticoides/administração & dosagem , Fidelidade a Diretrizes/estatística & dados numéricos , Administração por Inalação , Adulto , Idoso , Alergia e Imunologia/normas , Alergia e Imunologia/estatística & dados numéricos , Alergia e Imunologia/tendências , Asma/diagnóstico , Budesonida/administração & dosagem , Estudos Transversais , República Tcheca , Diagnóstico Tardio/estatística & dados numéricos , Combinação de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Quimioterapia Combinada/métodos , Quimioterapia Combinada/estatística & dados numéricos , Feminino , Fumarato de Formoterol , Fidelidade a Diretrizes/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Pneumologia/normas , Pneumologia/estatística & dados numéricos , Pneumologia/tendências , Sociedades Médicas/normas , Adulto JovemRESUMO
OBJECTIVES: A current diagnosis of asthma cannot be objectively confirmed in many patients with physician-diagnosed asthma. Estimates of resource use in overdiagnosed cases of asthma are necessary to measure the burden of overdiagnosis and to evaluate strategies to reduce this burden. We assessed differences in asthma-related healthcare resource use between patients with a confirmed asthma diagnosis and those with asthma ruled out. DESIGN: Population-based, prospective cohort study. SETTING: Participants were recruited through random-digit dialling of both landlines and mobile phones in the province of British Columbia, Canada. PARTICIPANTS: We included 345 individuals ≥12 years of age with a self-reported physician diagnosis of asthma. The diagnosis of asthma was reassessed at the end of 12 months of follow-up using a structured algorithm, which included a bronchodilator reversibility test, methacholine challenge test, and if necessary medication tapering and a second methacholine challenge test. PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported annual asthma-related direct healthcare costs (2017 Canadian dollars), outpatient physician visits and medication use from the perspective of the Canadian healthcare system. RESULTS: Asthma was ruled out in 86 (24.9%) participants. The average annual asthma-related direct healthcare costs for participants with confirmed asthma were $C497.9 (SD $C677.9) and for participants with asthma ruled out, $C307.7 (SD $C424.1). In the adjusted analyses, a confirmed diagnosis was associated with higher direct healthcare costs (relative ratio (RR)=1.60, 95% CI 1.14 to 2.22), increased rate of specialist visits (RR=2.41, 95% CI 1.05 to 5.40) and reliever medication use (RR=1.62, 95% CI 1.09 to 2.35), but not primary care physician visits (p=0.10) or controller medication use (p=0.11). CONCLUSIONS: A quarter of individuals with a physician diagnosis of asthma did not have asthma after objective re-evaluation. These participants still consumed a significant amount of asthma-related healthcare resources. The population-level economic burden of asthma overdiagnosis could be substantial.
Assuntos
Asma/diagnóstico , Custos de Cuidados de Saúde/estatística & dados numéricos , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Antiasmáticos/economia , Antiasmáticos/uso terapêutico , Asma/economia , Asma/fisiopatologia , Asma/terapia , Colúmbia Britânica , Testes de Provocação Brônquica , Estudos de Coortes , Feminino , Volume Expiratório Forçado , Humanos , Estudos Longitudinais , Masculino , Uso Excessivo dos Serviços de Saúde/economia , Pessoa de Meia-Idade , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Pneumologia/economia , Pneumologia/estatística & dados numéricos , Adulto JovemRESUMO
Pirfenidone and nintedanib are oral antifibrotic agents approved for the treatment of idiopathic pulmonary fibrosis (IPF). Real-world data on factors that influence IPF treatment decisions are limited. Physician characteristics associated with antifibrotic therapy initiation following an IPF diagnosis were examined in a sample of US pulmonologists. An online, self-administered survey was fielded to pulmonologists between April 10, 2017, and May 17, 2017. Pulmonologists were included if they spent >20% of their time in direct patient care and had ≥5 patients with IPF receiving antifibrotics. Participants answered questions regarding timing and reasons for considering the initiation of antifibrotic therapy after an IPF diagnosis. A total of 169 pulmonologists participated. The majority (81.7%) considered initiating antifibrotic therapy immediately after IPF diagnosis all or most of the time (immediate group), while 18.3% considered it only some of the time or not at all (delayed group). Pulmonologists in the immediate group were more likely to work in private practice (26.1%), have a greater mean percentage of patients receiving antifibrotic therapy (60.8%), and decide to initiate treatment themselves (31.2%) versus those in the delayed group (16.1%, 30.5%, and 16.1%, respectively). Most pulmonologists consider initiating antifibrotic treatment immediately after establishing an IPF diagnosis all or most of the time versus using a "watch-and-wait" approach. Distinguishing characteristics between pulmonologists in the immediate group versus the delayed group included practice setting, percentage of patients receiving antifibrotic therapy, and the decision-making dynamics between the patient and the pulmonologist.
Assuntos
Antineoplásicos/uso terapêutico , Fibrose Pulmonar Idiopática/tratamento farmacológico , Indóis/uso terapêutico , Padrões de Prática Médica , Pneumologia/estatística & dados numéricos , Piridonas/uso terapêutico , Antineoplásicos/administração & dosagem , Tomada de Decisão Clínica , Humanos , Indóis/administração & dosagem , Participação do Paciente , Prática Privada/estatística & dados numéricos , Piridonas/administração & dosagem , Inquéritos e Questionários , Fatores de Tempo , Estados Unidos , Conduta Expectante/estatística & dados numéricosRESUMO
OBJECTIVES: Multiple practice guidelines discourage indiscriminate use of broad panels of allergen-specific IgE (sIgE) tests due to increased risk of false positives and misinterpretation of results. We provide an analytical framework to identify specialty-specific differences in ordering patterns and effectiveness, which can be used to improve test utilization. METHODS: Test results from a tertiary pediatric hospital were analyzed by ordering specialty to evaluate size of allergen workups. Positivity rates were analyzed to determine effectiveness in selecting tests with high positive pretest probabilities. Laboratory test menu components were also evaluated. RESULTS: Our findings demonstrate 29% of sIgE tests are ordered as part of broad workups (>20 sIgE tests/date of service) contrary to the recommended testing approach. Detailed descriptions of ordering patterns and positivity rates are provided. CONCLUSIONS: This study provides a framework for using a cross-sectional analytical approach to assess test utilization patterns and evaluate components of laboratory testing menus.
Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Hipersensibilidade/diagnóstico , Imunoglobulina E/sangue , Padrões de Prática Médica/estatística & dados numéricos , Alergia e Imunologia/estatística & dados numéricos , Criança , Estudos Transversais , Dermatologia/estatística & dados numéricos , Feminino , Gastroenterologia/estatística & dados numéricos , Humanos , Masculino , Naturologia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Pneumologia/estatística & dados numéricosRESUMO
Objetivo: Avaliar o conhecimento da população sobre pneumologia, doença pulmonar obstrutiva crônica , asma e tabagismo. Métodos: Estudo transversal conduzido entre julho e outubro de 2017, avaliando o conhecimento da população de Curitiba, a partir de 18 anos, a respeito de pneumologia, asma, doença pulmonar obstrutiva crônica e tabagismo, por meio de questionários aplicados em espaços públicos. Médicos foram excluídos. Resultados: Foram entrevistadas 384 pessoas, com idade média de 35±14 anos, sendo 52% mulheres. Tinham Ensino Superior (completo ou incompleto) 55%, 44% não ultrapassaram o Ensino Médio e 5%, o Fundamental. Fumantes atuais ou pregressos representaram 32% da amostra. Sabiam o significado da palavra pneumologista 77%, já o termo "doença pulmonar obstrutiva crônica" foi reconhecido por apenas 7%. A maioria procuraria um clínico geral se apresentasse tosse persistente (69%) ou dispneia (63%). As doenças associadas ao tabagismo mais lembradas foram neoplasia de pulmão (86%) e doenças pulmonares (37%). O tabagismo foi reconhecido como causador de dependência por 98% e como doença por 64%. Em relação aos sintomas da asma, foram citados dispneia (90%), tosse (18%), aperto no peito (16%) e chiado (10%). Da amostra, 53% acreditavam que os dispositivos inalatórios engordavam e 59% que geravam dependência. Maior escolaridade associou-se com menor frequência de tabagismo, maior conhecimento sobre o pneumologista e sobre a associação do tabagismo com doença pulmonar obstrutiva crônica. Conclusão: Os curitibanos têm conhecimento limitado a respeito da doença pulmonar obstrutiva crônica, asma e tabagismo, além de acreditarem em mitos relacionados aos dispositivos inalatórios. A procura pelo médico pneumologista é baixa. (AU)
Objective: To evaluate the population knowledge about pneumology, chronic obstructive pulmonary disease, asthma and smoking. Methods: This is a cross-sectional study conducted from July to October 2017 to evaluate the knowledge of the population of the city of Curitiba, above 18 years old, about pneumology, chronic obstructive pulmonary disease, asthma and smoking, using questionnaires applied in public places. Physicians were excluded. Results: A total of 384 people was interviewed, with an average age of 35±14 years, 52% of them being women. Fifty-five percent reported (complete or incomplete) higher education, 44% did not go further than high school, and 5%, intermediate school. Current or past smokers accounted for 32% of the sample. The meaning of the word pulmonologist was known by 77% of people, while the term "chronic obstructive pulmonary disease" was recognized by only 7%. Most would go to a general practitioner if they had persistent cough (69%) or dyspnea (63%). The most remembered smoking-related diseases were: lung cancer (86%) and lung diseases (37%). Smoking was recognized to cause dependence by 98%, and as a disease by 64%. Dyspnea (90%), cough (18%), chest tightness and wheezing (10%) were mentioned as symptoms of asthma. Fifty-three percent of the sample believed that inhaling devices led to weight gain, and 59% believed they generated dependence. Higher level of education was associated with a lower smoking frequency, greater knowledge about the pulmonologist and about the association of smoking with respiratory diseases. Conclusions: The population of Curitiba has a limited knowledge about chronic obstructive pulmonary disease, asthma and smoking, and frequently believes in myths related to inhaling devices. The search for a pulmonologist is low. (AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Asma , Tabagismo , Pneumologia/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Doença Pulmonar Obstrutiva Crônica , Estudos Transversais , Inquéritos e Questionários , Distribuição por Sexo , Distribuição por Idade , Escolaridade , Fumantes/estatística & dados numéricosRESUMO
BACKGROUND: Medical malpractice data can be leveraged to understand specialty-specific risk. METHODS: Malpractice claims were examined from the Comparative Benchmarking System (2007-2016), a national database containing > 30% of claims data in the United States. Claims were identified with either internal medicine or pulmonary/critical care (PCC) physicians as the primary provider involved in the harm. Claim characteristics were compared according to specialty and care setting (inpatient vs outpatient), and multiple regression analysis was performed to predict claim payment. RESULTS: Claims involving PCC physicians differed from those involving internal medicine physicians in terms of harm severity, allegation, final diagnosis, procedure involvement, payment rate, and contributing factors. The majority of claims involving PCC physicians resulted from inpatient care (63%), of which only 26% occurred delivering intensive care. Eighty-one percent were from harm events that resulted in death/permanent injury. The most common diagnosis was laceration during a procedure for inpatient claims (6%) and lung cancer for outpatient claims (28%). Thirty-one percent of claims overall involved procedures. Although only 26% were paid, the median indemnity per paid claim of $285,769 ranked PCC as the twelfth highest of 69 specialties. The two variables associated with indemnity payment were outpatient care (OR, 1.70; 95% CI, 1.01-2.86) and temporary harm (OR, 0.36; 95% CI, 0.15-0.87). CONCLUSIONS: Malpractice claims involving PCC physicians were distinct from claims involving internal medicine physicians. Although only one-quarter of claims was paid, the indemnity per claim was high among specialties. Specialty-specific prevention strategies must be developed to mitigate both patient harm and provider malpractice risk.
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Compensação e Reparação , Imperícia/estatística & dados numéricos , Pneumologia/estatística & dados numéricos , Adulto , Idoso , Assistência Ambulatorial , Cuidados Críticos , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Seguro de Responsabilidade Civil , Medicina Interna , Lacerações , Neoplasias Pulmonares , Masculino , Pessoa de Meia-Idade , Estados UnidosAssuntos
Tosse/epidemiologia , Tosse/terapia , Padrões de Prática Médica/estatística & dados numéricos , Algoritmos , Alergia e Imunologia/organização & administração , Alergia e Imunologia/estatística & dados numéricos , Doença Crônica , Tosse/diagnóstico , Diagnóstico Diferencial , França/epidemiologia , Humanos , Pneumologia/organização & administração , Pneumologia/estatística & dados numéricos , Sociedades Médicas , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To assess current adherence to international guidelines for practitioners of bronchoscopy in the Kingdom of Saudi Arabia. Methods: A cross-sectional survey was conducted in Saudi Arabia between December 2016 and March 2017. Pulmonologists, thoracic surgeons, and intensivists were invited to answer an emailed self-administered questionnaire survey seeking information on how they performed flexible bronchoscopy in adults. The data collected were compared between the 3 specialties. Results: Eighty-two (18%) of 456 invited practitioners completed the survey. Fifty-eight (72%) of the 82 respondents were pulmonologists. Forty (53%) of 76 respondents (93%) who had received bronchoscopy training received it abroad. Twenty-seven respondents (33%) had also received training in endobronchial ultrasound, electrocautery, brachytherapy, stent insertion, and laser procedures. Fifty-eight respondents (70%) preferred patients to undergo fasting for at least 4 hours before the procedure. Lidocaine was used for topical anesthesia, mainly by aerosol spray or nebulization. Midazolam was used by 62%, fentanyl by 50%, and propofol by 12% of respondents. Ninety percent of pulmonologists reported requesting a chest radiograph after transbronchial lung biopsy. Safety procedures for bronchoscopists, for example, wearing masks and eye protection, and for patients, for example, availability of anesthetic reversal agents, were not universally applied. Conclusion: Bronchoscopy is not standardized in Saudi Arabia. National guidelines for the indications and practice of bronchoscopy are required.
Assuntos
Broncoscopia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Pneumologia/estatística & dados numéricos , Cirurgia Torácica/estatística & dados numéricos , Adulto , Anestésicos Intravenosos , Anestésicos Locais , Broncoscopia/educação , Broncoscopia/métodos , Estudos Transversais , Feminino , Fentanila , Humanos , Lidocaína , Masculino , Midazolam , Pessoa de Meia-Idade , Segurança do Paciente/estatística & dados numéricos , Cuidados Pré-Operatórios/estatística & dados numéricos , Propofol , Equipamentos de Proteção/estatística & dados numéricos , Radiografia Torácica/estatística & dados numéricos , Arábia Saudita , Inquéritos e QuestionáriosRESUMO
The increasing prevalence and incidence of bronchiectasis leads to a substantial health care burden. Quality standards for the management of bronchiectasis were formulated by the British Thoracic Society following publication of guidelines in 2010. They can be used as a benchmark for quality of care. It is, however, unclear how and whether they apply outside of the UK. Between May and November 2017, we conducted an online survey among respiratory physicians caring for adult bronchiectasis patients in Belgium. About 186 cases were submitted by 117 treating physicians. Patients were mostly female (58%), of Caucasian descent (84%) with a remarkably low median age of 59.8 (IQR 47-73) years. 41% had Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and/or Enterobacteriaceae isolated from respiratory samples in the past. 21% had three or more exacerbations, however, more than 58% were receiving long-term oral antibiotics (of which 90% azithromycin). In 40% of patients the diagnostic testing was insufficient. Surveillance of sputum bacteriology in stable patients and composing a self-management plan was missing in 53% and 68% of patients, respectively. Airway clearance techniques were implemented in 84%. Respiratory physicians complied with 60% or more to five out of the eight applicable quality standards, which is encouraging. Increasing educational act could further raise awareness and increase quality of care.
Assuntos
Antibacterianos/uso terapêutico , Bronquiectasia/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Pneumologia/estatística & dados numéricos , Escarro/microbiologia , Adulto , Idoso , Antibacterianos/administração & dosagem , Azitromicina/uso terapêutico , Bélgica , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/microbiologia , Bronquiectasia/reabilitação , Progressão da Doença , Enterobacteriaceae/isolamento & purificação , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto/normas , Guias de Prática Clínica como Assunto , Pseudomonas aeruginosa/isolamento & purificação , Autocuidado , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Severe asthma (SA) is defined by treatment intensity. The availability of national databases allows accurate estimation of the prevalence, long-term outcomes, and costs of SA. OBJECTIVE: To provide accurate information on SA, focusing on comorbidities, mortality, health care resource consumption, and associated costs. METHODS: A cohort of patients with SA identified in 2012 was extracted from a French representative claims database and followed for 3 years. Their characteristics, comorbidities, mortality, and direct costs were compared with a matched control group without asthma. RESULTS: A total of 690 patients with SA were matched to 2070 patients without asthma (mean age, 61 years; 65.7% women). The prevalence of SA was estimated to be 0.18% to 0.51% of the French adult population. Comorbidities were more frequent in patients with SA (73.9% suffered from cardiovascular disease vs 54.3% in controls; P < .001). A total of 58.7% of patients with SA used oral corticosteroids (OCS) in 2012 with a mean intake of 3.3 boxes/year/patient and 9% received ≥6 dispensings of OCS. A total of 6.7% were treated by omalizumab. Patients with SA were more frequently hospitalized (33.2% vs 19.7%; P < .001), more frequently consulted a general practitioner (97.8% vs 83.9%; P < .001) (9.8 ± 6.8 vs 6.2 ± 5.3 consultations/year; P < .001), and 31% have consulted a private respiratory physician. Compared with controls, 3-year cumulative mortality was higher in SA (7.1% vs 4.5%; P = .007). Direct medical cost was $9227 versus $3950 (P < .001) mostly driven by medication costs. CONCLUSIONS: The prevalence of SA in the French adult population is at least 18 of 10,000. Burden of disease is high with respect to comorbidities, mortality, and asthma-related health care resource use.
Assuntos
Asma/epidemiologia , Doenças Cardiovasculares/epidemiologia , Medicina Geral/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Pneumologia/estatística & dados numéricos , Administração Oral , Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/economia , Asma/fisiopatologia , Asma/terapia , Comorbidade , Bases de Dados Factuais , Diabetes Mellitus/epidemiologia , Custos de Medicamentos/estatística & dados numéricos , Dislipidemias/epidemiologia , Feminino , França/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Obesidade/epidemiologia , Omalizumab/uso terapêutico , Prevalência , Encaminhamento e Consulta/estatística & dados numéricos , Índice de Gravidade de DoençaRESUMO
AIM: To describe the bibliometric characteristics of Tunisian publications on respiratory tract diseases, during the quinquennium 2010-2014. METHODS: This is a descriptive bibliometric study of respiratory medicine publications, indexed in "Medline", based on their MSDSs. All included articles were written by Tunisian researchers regardless of their position in the list of co-authors. The topics of the publications were explored through their "major" and "generic" keywords. RESULTS: A total of 340 publications was captured in Medline. These articles were co- authored by 218 authors in first position and 163 in last position. They were signed by pulmonologists, in first and last position respectively in 21.5% and 22.4% of articles. The A. Mami Hospital was the major affiliation of the first authors in 19.7% of the publications. These articles were published by 138 journals including "La Tunisie Medicale" in 11.8% of cases. They were "case reports" and written in English respectively in 44.4% and 54.1% of cases. Among 639 major keywords indexing, three were dominant: «Lung Neoplasms¼ (Tumeurs du poumon), «Chronic Obstructive Pulmonary Disease¼ (Broncho-pneumopathie chronique obstructive) and «Tuberculosis, Pulmonary¼ (Tuberculose pulmonaire), in 13.5%, 10.3% and 7.4% of articles respectively. CONCLUSION: Tunisian research on respiratory tract diseases has been thematically concordant with the public health needs. However, it has often been of low-level evidence and published in low-impact factor journals.
Assuntos
Bibliometria , Pesquisa Biomédica/estatística & dados numéricos , Publicações/estatística & dados numéricos , Editoração/estatística & dados numéricos , Pneumologia/estatística & dados numéricos , Doenças Respiratórias , Bibliometria/história , Pesquisa Biomédica/história , Pesquisa Biomédica/métodos , Pesquisa Biomédica/tendências , História do Século XXI , Humanos , Fator de Impacto de Revistas , Publicações/história , Publicações/provisão & distribuição , Publicações/tendências , Editoração/história , Editoração/tendências , Pneumologia/história , Pneumologia/tendências , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/terapia , Faculdades de Medicina/história , Faculdades de Medicina/estatística & dados numéricos , Faculdades de Medicina/tendências , Tunísia/epidemiologiaRESUMO
BACKGROUND: Disease control is an important objective of COPD management. The SINCON study evaluated the level of control in terms of respiratory symptoms and exacerbations in Spanish patients with COPD for ≥2 years. METHODS: SINCON was a descriptive, cross-sectional, multicenter study that assessed degree of control using a combined index comprising COPD assessment test (CAT), modified Medical Research Council dyspnea scale (mMRC), and number of moderate/severe exacerbations in the last year. Based on this score, patients were categorized as "well controlled" or "poorly controlled". Degree of control was also assessed relative to patient phenotype, setting (primary care [PC] vs respiratory care [RC]), and impact of treatment on morning symptoms. RESULTS: Of the 481 patients (PC: 307, RC: 174) analyzed, COPD was poorly controlled in 63.2%. Some differences were found between clinical settings: PC patients were more poorly controlled (PC: 66.4% vs RC: 57.5%; P = 0.06) and had higher CAT score (PC: 17.9 vs RC: 15.5; P < 0.05), and higher rate of moderate/severe exacerbations during previous year (PC: 1.5 vs RC: 1.1; P < 0.05), while dyspnea degree was similar in both settings. Regarding phenotypes, non-exacerbators demonstrated better control vs exacerbators. Morning symptoms score improved between waking and 3 h after bronchodilator treatment (P < 0.05), with greater improvements in PC patients (PC: - 6.5 vs RC: - 5.0 points; P < 0.05). CONCLUSIONS: Most COPD patients were poorly controlled with some differences observed between PC and RC settings and between patient phenotypes. Our index may be easily used in PC settings to optimize COPD treatment.
Assuntos
Manuseio das Vias Aéreas/métodos , Broncodilatadores/uso terapêutico , Dispneia , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica , Pneumologia , Exacerbação dos Sintomas , Idoso , Estudos Transversais , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Gravidade do Paciente , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Fenótipo , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Pneumologia/métodos , Pneumologia/normas , Pneumologia/estatística & dados numéricos , Melhoria de Qualidade , Índice de Gravidade de Doença , Espanha/epidemiologiaRESUMO
INTRODUCTION: The aim of the study was to assess, compliance with maintenance treatment in patients with persistent asthma in clinical practice. METHODS: This observational, cross-sectional, prospective, multicenter study was conducted in metropolitan France on patients with persistent asthma under the care of a representative sample of general practitioners and pneumologists. Compliance was determined via access to the Health Insurance database allowing comparison between the actual consumption of medications and the corresponding theoretical consumption related to prescription. Additional compliance data were obtained using the validated Morisky questionnaire. RESULTS: Eighty one physicians included 488 patients, mean age of 51 years, 55% women. The statement of consumption (SC) was available for 35% of patients however the Morisky questionnaire (present for 85% of patients) showed a similar compliance between patients with or without SC. The good compliance rate (compliance ≥80%) was observed in 51% based on the SC and in 38% based on the Morisky questionnaire. Among possible predictive factors, only obesity was associated with a bad compliance (19% vs 7%, P<0.05). Patients with poor compliances displayed more severe symptoms and a higher rate of non-control (21.7% vs 5.7%, P<0.01). CONCLUSIONS: The statement of consumption is a useful tool to provide quantitative measurement of compliance in daily practice.