Trends in Pulmonary Critical Care Fellowship Applications and Match Rates before and after the Onset of the COVID-19 Pandemic.

Background: Because of the coronavirus disease (COVID-19) pandemic, fellowship interviews for pulmonary disease and critical care medicine (PCCM) switched from an in-person to virtual interview format. Objective: This study aimed to examine the changes that resulted from this switch (appointment year 2021 and beyond) for both the individual applicants and the match process as a whole. Methods: This cross-sectional study used longitudinal data from the Electronic Residency Application Service and the National Resident Matching Program from appointment years 2017 to 2022. Data from the Electronic Residency Application Service included the number of programs applicants applied to, and National Resident Matching Program data included the number of fellowship positions available, number entering the match, match rate, and the number of applicants who matched within the same region/program as their core residency training program. Descriptive and summary statistics and unadjusted linear models were used to identify if trends appeared in post-COVID-19 appointment years (2021 and beyond). Results: The number of PCCM positions increased by 33 (95% confidence interval, 26.2, 39.8) yearly between 2017 and 2022, with almost twice as many applicants (62.6; 95% CI confidence interval, 37.8, 87.4) entering the PCCM fellowship match during that same period. There was a decrease in the percentage of applicants matched each year, a trend unchanged before and after COVID-19, by an average of -2.15%. Comparing before and after COVID-19 appointment years, there was no significant change in same-region or same-program matches. Conclusion: Our analysis shows steadily rising interest in application rates for PCCM fellowships through the onset of the pandemic. However, a lack of proportionate increase in fellowship positions led to a decrease in overall match rates for applicants. To mitigate this, an increase in PCCM fellowship positions should be considered, and surveillance of these trends should continue.

Improving Referral Patterns for Bronchoscopic Lung Volume Reduction: A Quality Improvement Initiative.

Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment option for patients with severe emphysema and hyperinflation refractory to optimal medical care. This therapy is effective in improving functional status and quality of life, underscoring the importance of identifying potential procedure candidates. To our knowledge, scalable strategies to improve the referral of advanced lung disease patients are lacking. This quality improvement project aimed to increase identification and referral for BLVR in a large Veterans Affairs academic medical center. We show implementing case identification within a pulmonary function testing report, in conjunction with provider education, increased referral rates for BLVR. Because of the ubiquity of lung function testing, other advanced lung disease programs may consider adopting this strategy to improve patients' access to timely clinical evaluation and therapy.

Belun Ring (Belun Sleep System BLS-100): Deep learning-facilitated wearable enables obstructive sleep apnea detection, apnea severity categorization, and sleep stage classification in patients suspected of obstructive sleep apnea.

GOAL AND AIMS: Our objective was to evaluate the performance of Belun Ring with second-generation deep learning algorithms in obstructive sleep apnea (OSA) detection, OSA severity categorization, and sleep stage classification. FOCUS TECHNOLOGY: Belun Ring with second-generation deep learning algorithms REFERENCE TECHNOLOGY: In-lab polysomnography (PSG) SAMPLE: Eighty-four subjects (M: F = 1:1) referred for an overnight sleep study were eligible. Of these, 26% had PSG-AHI<5; 24% had PSG-AHI 5-15; 23% had PSG-AHI 15-30; 27% had PSG-AHI ≥ 30. DESIGN: Rigorous performance evaluation by comparing Belun Ring to concurrent in-lab PSG using the 4% rule. CORE ANALYTICS: Pearson's correlation coefficient, Student's paired t-test, diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, Cohen's kappa coefficient (kappa), Bland-Altman plots with bias and limits of agreement, receiver operating characteristics curves with area under the curve, and confusion matrix. CORE OUTCOMES: The accuracy, sensitivity, specificity, and kappa in categorizing AHI ≥ 5 were 0.85, 0.92, 0.64, and 0.58, respectively. The accuracy, sensitivity, specificity, and Kappa in categorizing AHI ≥ 15 were 0.89, 0.91, 0.88, and 0.79, respectively. The accuracy, sensitivity, specificity, and Kappa in categorizing AHI ≥ 30 were 0.91, 0.83, 0.93, and 0.76, respectively. BSP2 also achieved an accuracy of 0.88 in detecting wake, 0.82 in detecting NREM, and 0.90 in detecting REM sleep. CORE CONCLUSION: Belun Ring with second-generation algorithms detected OSA with good accuracy and demonstrated a moderate-to-substantial agreement in categorizing OSA severity and classifying sleep stages.

Year two of virtual interviews: longitudinal changes and diverse perspectives.

BACKGROUND: The coronavirus disease (COVID-19) pandemic brought the virtual interview (VI) format to graduate medical education (GME) and the trainee recruitment process. It is unclear if applicants' VI experience is consistent across all demographic groups. Our group collected 2 years of survey data to assess longitudinal changes in applicants' attitudes towards the VI format. In addition, demographic data were collected, and analyses were performed to identify if between-group differences were present amongst a diverse applicant population. METHODS: We distributed an anonymous electronic survey to applicants to the pulmonary disease and critical care medicine fellowship programs at Case Western Reserve University/University Hospitals Cleveland Medical Center and MetroHealth Medical Center for the 2021 and 2022 appointment years. RESULTS: We received 112 responses (20% response rate) for our surveys. Although there was an overall stability of responses between the first 2 years, there were significant gender differences with applicants identifying as female more likely to recommend VI as a future model. Similarly, there were a significant difference in factor importance based on underrepresented minority (URM) status with applicants identifying as URM placing more emphasis on programs' social media presence. CONCLUSIONS: There were no significant change in the responses of applicants between the first 2 years of VI. However, subset analyses revealed multiple significant findings. These differences have implications for future iterations of the VI format.

Prevalence and clinical outcomes of hospitalized patients with upper extremity deep vein thrombosis.

OBJECTIVE: Upper extremity (UE) deep vein thrombosis (DVT) is a common and increasing complication in hospitalized patients. The objective of the present study was to determine the prevalence, treatment strategies, complications, and outcomes of UE-DVT. METHODS: We performed a retrospective single-institution study of patients with a diagnosis of UE-DVT from January 2016 through February 2018 (26 months). Patients aged ≥18 years who had been admitted to the hospital and who had had positive UE duplex ultrasound findings for acute UE-DVT were included in the present study. The outcomes were in-hospital mortality, major bleeding, pulmonary embolism (PE), and recurrent UE-DVT. RESULTS: Among 63,045 patients admitted to the hospital, 1000 (1.6%) had been diagnosed with UE-DVT. Of 3695 UE venous duplex ultrasound examinations performed during the study period, almost one third (27.0%) were positive for acute UE-DVT. The mean age was 55.0 ± 17.2 years, and most patients were men (58.3%), white (49.2%), and overweight (mean body mass index, 29.4 ± 10.3 kg/m2). The most affected vein was the right internal jugular vein (54.8%). Most of the patients (96.9%) has been receiving venous thromboembolism prophylaxis or anticoagulation therapy at the diagnosis. Most patients (77.8%) had had an intravenous device (IVD) in place at the diagnosis. Most of the patients (84.4%) were treated with anticoagulation therapy in the hospital but only one half (54.5%) were discharged with anticoagulation therapy. In-hospital mortality was 12.1% unrelated to UE-DVT, major bleeding occurred in 47.6% of the patients during hospitalization (fatal bleeding, 1%), PE was diagnosed in 4.8% of the patients, and 0.7% were fatal. Recurrent UE-DVT occurred in 6.1% of the patients. On multivariable analysis, the risk of death was increased by older age, cancer, intensive care unit admission, concomitant lower extremity DVT, and bleeding before the UE-DVT diagnosis. The presence of an IVD increased the risk of PE and the risk of recurrent UE-DVT. The risk of major bleeding was increased by the presence of an IVD, female sex, and concomitant lower extremity DVT. CONCLUSIONS: UE-DVT is a common complication in hospitalized patients (1.6%). Consequent acute PE and recurrent DVT remain important complications, as does bleeding. It is unclear whether standard thromboprophylaxis effectively protects against UE-DVT. More studies dedicated to UE-DVT are required to provide appropriate guidance on prophylaxis and treatment.

Virtual Interviews: Challenges and Opportunities for Pulmonary Disease and Critical Care Medicine Fellowship Programs.

The coronavirus disease (COVID-19) pandemic brought profound change to the medical education system, and residency and fellowship recruitment was not spared. Many of the activities required for recruitment of new fellows (e.g., airline travel and face-to-face meetings) were not able to be safely done. The rapid shift to all-virtual interviewing brought logistical challenges but, as the season concluded, called into question the value and validity of prior protocols. Our institutions (University Hospitals Cleveland Medical Center and MetroHealth Medical Center in Cleveland, Ohio) designed surveys to collect both applicants' and interviewers' perspectives on the virtual interview process for the 2020-2021 recruitment season to identify the challenges virtual interviews may bring to the current paradigm and what that may mean for the value of the traditional in-person model. Our results show that the absence of certain aspects of in-person interviews (e.g., travel costs and time required off-service) were welcome changes to both applicants and interviewers. However, there were new challenges identified, such as lack of formal training for virtual interviews and a shift in applicants' attention to fellowship program websites. We discuss how these observations could inform best practices for programs and applicants in the future.