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1.
Respir Res ; 22(1): 50, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579277

RESUMO

The importance of vaccinations for COPD patients has been previously described. However, there is still a gap between guideline recommendations and the implementation of preventive care delivery for these patients. Specially, the rise of SARS-CoV-2 pandemic has made the significance of vaccination adherence more critical to address. Our study showed that referral to pulmonary clinic is associated with increased odds of receiving influenza (OR = 1.97, [95% CI 1.07, 3.65]) and pneumococcal vaccinations (PCV13 OR = 3.55, [1.47, 8.54]; PPSV23 OR = 4.92, [1.51, 16.02]). These data suggest that partnerships between primary care physicians and pulmonologists can potentially improve the vaccination rates for patients with COPD.


Assuntos
Padrões de Prática Médica , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica/terapia , Pneumologia , Encaminhamento e Consulta , Vacinação , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Vacinas contra Influenza/uso terapêutico , Masculino , Pessoa de Meia-Idade , Vacinas Pneumocócicas/uso terapêutico , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Estudos Retrospectivos
3.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(12): 1055-1060, 2020 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-33333639

RESUMO

Objective: To compare the values of the YEARS algorithm and the simplified Wells combined with age-adjusted D-dimer (sWells-Age) algorithm in the evaluation of patients with suspected acute pulmonary embolism (APE). Methods: Patients with suspected APE receiving CT pulmonary angiography (CTPA) were enrolled from 2016 to 2017. With CTPA results as the gold standard, we evaluated and compared the performance of the two algorithms in the whole population and in symptom-onset site (in-hospital, out-of-hospital) subgroups. Results: Among the 285 patients included, APE was confirmed by CTPA in 80 patients (28.1%). The two algorithms had a high level of diagnostic agreement (κ=0.855, P<0.05). The evaluated performance of the YEARS algorithm and the sWells-Age algorithm was as follows: 21.8% and 17.2% for the efficiencies; 1.6% and 0.0% for the failure rates; 29.8% and 23.9% for the specificities(P<0.05); 98.8% and 100.0% for the sensitivities. The efficiencies and the specificities of the two algorithms differed in the subgroups divided by symptom-onset sites (in-hospital, out-of-hospital). For the patients with symptoms-onset outside the hospital, the YEARS algorithm and the sWells-Age algorithm showed efficiencies of 33.0% and 26.9%, respectively, and specificities of 44.7% and 37.1%, respectively, (P<0.05).For the patients with symptoms-onset in hospital, the YEARS algorithm and the sWells-Age algorithm showed efficiencies of 1.9% and 0.0%, respectively, and specificities of 2.7% and 0.0%, respectively. Conclusions: The YEARS algorithm and the sWells-Age algorithm had a good diagnostic agreement and low failure rates and both could safely rule out APE. More patients with suspected APE could be safely excluded by the YEARS algorithm than the sWells-Age algorithm, especially in those suspected APE patients with out-of-hospital symptom-onset. However, both two algorithms were not applicable to suspected APE patients with in-hospital symptom-onset.


Assuntos
Angiografia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Embolia Pulmonar/diagnóstico por imagem , Algoritmos , China/epidemiologia , Medicina de Emergência , Serviço Hospitalar de Emergência , Hospitais , Humanos , Pneumologia , Tomografia Computadorizada por Raios X
5.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33169599

RESUMO

The pandemic of COVID-19 has emerged as a serious health crisis globally and India too has been extensively affected with 604,641 active cases reported, till date. The present study focuses on the demographic, clinical and laboratory profile of such patients from a tertiary level non-COVID respiratory care hospital. This is a retrospective observational study. Seventy-seven sick patients fulfilling COVID suspect criteria were admitted to the isolation area. Their RT-PCR test was done from the designated laboratory and 35 of them  were confirmed to be COVID-19 patients. The detailed demographic, clinical and laboratory profile of these COVID-19 patients was studied. The mean age was 46±17 years with male predominance (57%). Majority  of the cases (83%) were symptomatic. The most common symptom was cough (66%) followed by breathlessness and fever. Nineteen (54.3%) patients had one or the other co-morbidity and 16 (45.7%) had chronic lung diseases as one of the comorbidities. Nearly half of the patients (51%) required supplementary oxygen on presentation. Two patients were put on invasive mechanical ventilation while 4 patients required non-invasive ventilation before being shifted to the COVID hospital. Hence, it can be concluded that COVID-19 in patients of chronic respiratory diseases  manifests with higher prevalence of symptoms and also higher severity of disease. Further, the  symptomatology of COVID-19 closely mimics the acute exacerbation of chronic lung diseases, so cautious screening and testing should be done, especially at the pulmonary department.


Assuntos
Infecções por Coronavirus/fisiopatologia , Diabetes Mellitus/epidemiologia , Hospitais Especializados , Hipertensão/epidemiologia , Hipóxia/fisiopatologia , Pneumopatias/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumologia , Centros de Atenção Terciária , Adulto , Asma/epidemiologia , Betacoronavirus , Bronquiectasia/epidemiologia , Doença Crônica , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Índia/epidemiologia , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva , Oxigenoterapia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Respiração Artificial , Estudos Retrospectivos
9.
Eur Respir Rev ; 29(157)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33020069

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.


Assuntos
Comitês Consultivos/organização & administração , Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Cooperação Internacional , Pneumonia Viral/epidemiologia , Pneumologia/normas , Sociedades Médicas , Europa (Continente) , Humanos , Pandemias , Estados Unidos
10.
Eur Respir Rev ; 29(157)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33004526

RESUMO

Artificial intelligence (AI) is transforming healthcare delivery. The digital revolution in medicine and healthcare information is prompting a staggering growth of data intertwined with elements from many digital sources such as genomics, medical imaging and electronic health records. Such massive growth has sparked the development of an increasing number of AI-based applications that can be deployed in clinical practice. Pulmonary specialists who are familiar with the principles of AI and its applications will be empowered and prepared to seize future practice and research opportunities. The goal of this review is to provide pulmonary specialists and other readers with information pertinent to the use of AI in pulmonary medicine. First, we describe the concept of AI and some of the requisites of machine learning and deep learning. Next, we review some of the literature relevant to the use of computer vision in medical imaging, predictive modelling with machine learning, and the use of AI for battling the novel severe acute respiratory syndrome-coronavirus-2 pandemic. We close our review with a discussion of limitations and challenges pertaining to the further incorporation of AI into clinical pulmonary practice.


Assuntos
Algoritmos , Inteligência Artificial , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Assistência à Saúde/métodos , Aprendizado de Máquina , Pneumonia Viral/diagnóstico , Pneumologia/métodos , Humanos , Pandemias
11.
Pulmonology ; 26(6): 386-397, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32868252

RESUMO

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by a novel SARS-CoV-2 pathogen. Its capacity for human-to-human transmission through respiratory droplets, coupled with a high-level of population mobility, has resulted in a rapid dissemination worldwide. Healthcare workers have been particularly exposed to the risk of infection and represent a significant proportion of COVID-19 cases in the worst affected regions of Europe. Like other open airway procedures or aerosol-generating procedures, bronchoscopy poses a significant risk of spreading contaminated droplets, and medical workers must adapt the procedures to ensure safety of both patients and staff. Several recommendation documents were published at the beginning of the pandemic, but as the situation evolves, our thoughts should not only focus on the present, but should also reflect on how we are going to deal with the presence of the virus in the community until there is a vaccine or specific treatment available. It is in this sense that this document aims to guide interventional pulmonology throughout this period, providing a set of recommendations on how to perform bronchoscopy or pleural procedures safely and efficiently.


Assuntos
Betacoronavirus , Broncoscopia/métodos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumologia/métodos , Aerossóis , Consenso , Surtos de Doenças , Humanos , Portugal , Sociedades
12.
Wien Klin Wochenschr ; 132(Suppl 3): 89-113, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32990821

RESUMO

Scientific Members of the Austrian Society of Pneumology describe the expected development in respiratory health and provide guidance towards patient-oriented and cost-efficient respiratory care in Austria.Methods: In November 2017, respiratory care providers (physicians, nurses, physiotherapists) together with patient's advocacy groups and experts in health development, collaborated in workshops on: respiratory health and the environment, bronchial asthma and allergy, COPD, pediatric respiratory disease, respiratory infections, sleep disorders, interventional pneumology, thoracic oncology and orphan diseases.Results: Respiratory disease is extremely prevalent and driven by ill-health behavior, i.e. cigarette smoking, over-eating and physical inactivity. For the majority of respiratory diseases increased prevalence, but decreased hospitalizations are expected.The following measures should be implemented to deal with future challenges:1. Screening and case-finding should be implemented for lung cancer and COPD.2. E-health solutions (telemedicine, personal apps) should be used to facilitate patient management.3. Regional differences in respiratory care should be reduced through E­health and harmonization of health insurance benefits across Austria.4. Patient education and awareness, to reduce respiratory health illiteracy should be increased, which is essential for sleep disorders but relevant also for other respiratory diseases.5. Respiratory care should be inter-professional, provided via disease-specific boards beyond lung cancer (for ILDs, sleep, allergy)6. Programs for outpatient's pulmonary rehabilitation can have a major impact on respiratory health.7. Increased understanding of molecular pathways will drive personalized medicine, targeted therapy (for asthma, lung cancer) and subsequently health care costs.


Assuntos
Pneumopatias Obstrutivas , Pneumologia , Transtornos Respiratórios , Asma/terapia , Áustria , Criança , Efeitos Psicossociais da Doença , Humanos , Pneumopatias Obstrutivas/terapia , Doença Pulmonar Obstrutiva Crônica , Pneumologia/normas , Pneumologia/tendências , Transtornos Respiratórios/terapia , Sociedades Médicas
15.
J Rehabil Med ; 52(9): jrm00100, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32896863

RESUMO

OBJECTIVE: We present a case report that complements the conclusion of Stam et al. in their call to rehabilitation facilities to anticipate and prepare to address post intensive care syndrome in post-Covid-19 patients. METHODS: The case report presented here provides insight into treating mechanically ventilated post-Covid-19 patients. RESULTS: Early intervention with dysphagia therapy and speech therapy and ventilator-compatible speak-ing valves, provided within an interprofessional collaborative team, can mitigate the potentially negative consequences of prolonged intubation, long-term use of cuffed tracheostomy, and post intensive care syndrome resulting from Covid-19. CONCLUSION: Such a treatment approach can be used to address what is important to patients: to be able to speak with family and friends, eat what they want, and breathe spontaneously.


Assuntos
Infecções por Coronavirus/reabilitação , Transtornos de Deglutição/reabilitação , Terapia da Linguagem/métodos , Pneumonia Viral/reabilitação , Pneumologia/métodos , Fonoterapia/métodos , Betacoronavirus , Infecções por Coronavirus/virologia , Cuidados Críticos , Transtornos de Deglutição/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/virologia , Respiração , Respiração Artificial/efeitos adversos , Fala , Síndrome , Traqueostomia/efeitos adversos , Traqueostomia/métodos
19.
Rev. am. med. respir ; 20(3): 267-269, sept. 2020. tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1123089

RESUMO

Los avances en los tratamientos médicos y las mejoras en la calidad de la atención logran que un número creciente de adolescentes con enfermedades crónicas lleguen a la adultez y requieran la atención de médicos especialistas de adultos1-3. El pasaje de un centro asistencial pediátrico a otro de adultos es un proceso complejo que puede traer aparejado dificultades para todos los actores intervinientes. .


Assuntos
Humanos , Pneumologia , Terapêutica , Doença Crônica
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