Guidelines for Diagnosis and Management of Bronchial Asthma: Joint Recommendations of National College of Chest Physicians (India) and Indian Chest Society.

Bronchial asthma is an important public health problem in India with significant morbidity. Several international guidelines for diagnosis and management of asthma are available, however there is a need for country-specific guidelines due to vast differences in availability and affordability of health-care facilities across the globe. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have collaborated to develop evidence-based guidelines with an aim to assist physicians at all levels of health-care in diagnosis and management of asthma in a scientific manner. Besides a systematic review of the literature, Indian studies were specifically analysed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (1) definitions, epidemiology and impact, (2) diagnosis, (3) pharmacologic management of stable disease, (4) management of acute exacerbations, and (5) non-pharmacologic management and special situations. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.

Impostor Phenomenon Among Family Medicine Residency Program Directors: A CERA Study.

BACKGROUND AND OBJECTIVES: Impostor phenomenon (IP) can be described as feelings of inadequacy that exist despite apparent success. Although IP may be related to multiple important outcomes in physicians, it has not been examined among residency program directors (PDs). METHODS: The seven-item Leary Impostorism Scale (LIS) was added to the 2021 Council of Academic Family Medicine Educational Research Alliance (CERA) PD survey. In addition to standard questions, we surveyed PDs about their likelihood to leave their role, whether they started their PD role due to an unexpected transition, their beliefs concerning workplace evaluations relative to self-assessed performance, and their perceived support in completing PD responsibilities. RESULTS: Of the 257 PDs included in the survey (response rate approximately 41%), 28% (N=71) reported no IP. IP did not statistically differ across gender or race. LIS scores were lower among Hispanic/Latino respondents, but only 8% of our sample (N=20) identified as Hispanic/Latino. LIS scores did not significantly differ by PD likelihood to leave their position or for PDs starting their position due to a sudden transition. Respondents who felt that evaluations overestimated actual performance had higher LIS scores, as did those with lower levels of perceived support in completing administrative responsibilities and those with less time in their PD role. CONCLUSIONS: Most PD respondents did not report high levels of IP. Short duration of PD role, lack of programmatic support, and negative self-evaluations were correlated with higher levels of IP. Future research should examine interventions or resources to help those with IP thrive.

Faculty Competencies: An Exploration of Feasibility and Acceptance.

Introduction: A uniform method of iterative professional development for medical educators does not exist in the United States graduate medical education system. The Society of Teachers of Family Medicine Faculty Competencies Special Project Team, a subgroup of the Faculty Development Collaborative, sought to create a competency-based assessment framework for medical educators. This paper describes the feasibility and acceptance of a draft competencies resource using a survey. Methods: A mixed-methods, ten-question survey to assess the feasibility and acceptance of the draft competencies resource was created and distributed to medical educators through educational contacts from October 2019 to November 2019. Results: Eighty-six surveys were completed. Of the 86 respondents, 48 (55%) answered all the survey questions. Thematic analysis for acceptance of the draft yielded three groups, the accepting, neutral, and nonacceptance groups. Each group had distinct characteristics regarding the likelihood of accepting and using the draft competencies. Conclusions: The draft competencies are thought to be feasible, with overall acceptance in the current form. Further research will guide revisions of the competency resource before final distribution.

Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement.

BACKGROUND: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC. METHODOLOGY: This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on various technical aspects of BLC were framed. A literature search was conducted using PubMed and EMBASE databases. The expert group discussed the available evidence relevant to each question through e-mail and a face-to-face meeting, and arrived at a consensus. RESULTS: The experts agreed that patients should be carefully selected for BLC after weighing the risks and benefits of the procedure. Where appropriate, consideration should be given to perform alternate procedures such as conventional transbronchial biopsy or subject the patient directly to a surgical lung biopsy. The procedure is best performed after placement of an artificial airway under sedation/general anesthesia. Fluoroscopic guidance and occlusion balloon should be utilized for positioning the cryoprobe to reduce the risk of pneumothorax and bleeding, respectively. At least four tissue specimens (with at least two of adequate size, i.e., ≥5 mm) should be obtained during the procedure from different lobes or different segments of a lobe. The histopathological findings of BLC should be interpreted by an experienced pulmonary pathologist. The final diagnosis should be made after a multidisciplinary discussion. Finally, there is a need for structured training for performing BLC. CONCLUSION: This position statement is an attempt to provide practical recommendations for the performance of BLC in DPLDs.

Metformin: An Old Dog with a New Trick?

Idiopathic pulmonary fibrosis (IPF) remains an important medical challenge, but recent translational data have provided clues implicating deficient AMPK signaling in persistently activated myelofibroblasts within fibrotic foci. A new study in Nature Medicine reports that pharmacological activation of AMPK with metformin can reverse established fibrosis by facilitating deactivation and apoptosis of myofibroblasts.

Gastroesophageal reflux disease in bronchial asthma and the response to omeprazole.

The objective of this study was to determine the incidence of gastroesophageal reflux disease (GERD) in bronchial asthma and the role of omeprazole for asthmatics with symptoms of GERD. Seventy asthmatics were screened for GERD by questionnaire. Patients with a history suggestive of GERD were confirmed by Bernstein test and further investigated for airway responsiveness to instillation of HCl in the esophagus. Symptom score, drug score and spirometric values were recorded initially and after four weeks of treatment with omeprazole. It was found that 74.28% of asthmatics had a history of GERD. Forty patients tested positive by Bernstein test and also showed airway responsiveness to instillation of HCl in the esophagus. There was a significant improvement in symptom scores (p < 0.001), drug scores (p < 0.001) and spirometric values (p < 0.001) after adding omeprazole to their treatment regimen. It was concluded that bronchial asthma and GERD are associated in the majority of patients (57.14%) and such patients are likely to improve with omeprazole.

Hear today, gone tomorrow: an assessment of portable entertainment player use and hearing acuity in a community sample.

BACKGROUND: Noise-induced hearing loss (NIHL) is a common but preventable disability. The purpose of this study was to assess the understanding of NIHL in a community sample in the context of exposure to portable music players, including MP3 players, and personal hearing acuity as tested with the Welch Allyn Audioscope 3. METHODS: A cross-sectional convenience sample of 94 adults (18 to 65 years old) at a university recreation center completed an analysis of personal use of portable digital music players (MP3 players), concerns about hearing loss, and a 3-dB-level hearing test at 4 levels of speech frequency in a low ambient noise setting. RESULTS: The majority of participants (85%) were concerned about hearing loss, willing to protect their hearing with lower volume (77%), had little measurable hearing loss but were exposed to longer and louder periods of noise than other national samples, and mistakenly felt that NIHL is a medically reversible condition. Many (40%) also wanted their family medicine physician to be more concerned about their hearing. CONCLUSIONS: Family medicine physicians are in a key position to provide basic information on the preventability and negative consequences of NIHL, as well as to identify and refer patients with identified hearing loss.