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1.
Respir Med ; 141: 52-55, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30053972

RESUMO

BACKGROUND: Routine lung cancer surveillance has resulted in early detection of pulmonary nodules and masses. Combined endobronchial ultrasound (EBUS) and trans-esophageal endoscopic ultrasound (EUS) are approved methods for sampling lymph nodes or masses. Furthermore, EUS allows for adrenal sampling as part of staging, and can assist with fiducial placement for stereotactic body radiation therapy (SBRT). OBJECTIVES: Promote use of EUS by interventional pulmonologists in the United States when diagnosing and staging lung cancer or when placing fiducials. METHODS: All patients undergoing EUS and/or EBUS were serially entered into a prospectively maintained database. Only patients undergoing EUS guided lung and/or adrenal biopsy and/or fiducial placement were selected for analysis. All patients underwent a post-procedure chest radiograph and were followed outpatient. RESULTS: 20 of 39 patients underwent sampling of a suspicious lung mass. An adequate sample was obtained in 19 of 20 patients. In all 19 patients a definitive diagnosis was achieved (95%). In all 13 patients who underwent adrenal sampling, presence or absence of metastasis was conclusively established. 6 patients successfully underwent fiducial placement. In all 39 patients, no major procedure related complications were noted for a period of 30 days. One patient had a small pneumothorax that resolved spontaneously. CONCLUSIONS: EUS can be safely performed by a trained interventional pulmonologist for the diagnosis of lung, adrenal masses and placement of fiducials. We think that interventional pulmonologists in the United States involved in lung cancer staging should receive training in EUS techniques.


Assuntos
Endossonografia/instrumentação , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Pneumologia/métodos , Ultrassonografia de Intervenção/instrumentação , Glândulas Suprarrenais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer , Endossonografia/efeitos adversos , Feminino , Marcadores Fiduciais , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Estadiamento de Neoplasias , Estudos Prospectivos , Pneumologistas/educação , Radiocirurgia/instrumentação , Ultrassonografia de Intervenção/métodos
2.
COPD ; 15(5): 503-511, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30822239

RESUMO

Severe chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD) is undertreated and few patients access specialist palliative care in the years before death. This study aimed to determine if symptom palliation or a palliative approach were delivered during the final hospital admission in which death occurred. Retrospective medical record audits were completed at two Australian hospitals, with all patients who died from COPD over 12 years between 1 January 2004 and 31 December 2015 included. Of 343 patients included, 217 (63%) were male with median age 79 years (IQR 71.4-85.0). Median respiratory function: FEV1 0.80L (42% predicted), FVC 2.02L (73% predicted) and DLco 9 (42% predicted). 164 (48%) used domiciliary oxygen. Sixty (18%) patients accessed specialist palliative care and 17 (5%) wrote an advance directive prior to the final admission. In the final admission, 252 (74%) patients had their goal of care changed to aim for comfort (palliation) and 99 (29%) were referred to specialist palliative care. Two hundred and eighty-six (83%) patients received opioids and 226 (66%) received benzodiazepines, within 1 or 2 days respectively after admission to palliate symptoms. Median starting and final opioid doses were 10 mg (IQR = 5-20) and 20 mg (IQR = 7-45) oral morphine equivalent/24 h. Hospital site and year of admission were significantly associated with palliative care provision. Respiratory and general physicians provided a palliative approach to the majority of COPD patients during their terminal admission, however, few patients were referred to specialist palliative care. Similarly, there were missed opportunities to offer symptom palliation and a palliative approach in the years before death.


Assuntos
Assistência à Saúde , Dispneia/diagnóstico , Cuidados Paliativos , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/terapia , Assistência Terminal , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Austrália , Benzodiazepinas/uso terapêutico , Dispneia/mortalidade , Dispneia/terapia , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Morfina/administração & dosagem , Morfina/uso terapêutico , Pneumologistas/educação , Qualidade de Vida , Estudos Retrospectivos , Estresse Psicológico/prevenção & controle , Doente Terminal
3.
COPD ; 15(5): 526-535, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30822245

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) has been associated with an increased risk of type 2 diabetes (T2D). However, the mechanisms linking COPD and T2D is not fully understood and contradicting results are reported in the literature. AIM: The aim of this study is to investigate whether COPD is associated with an increased risk of T2D. METHODS: A systematic review and meta-analysis of cohort and case-control studies were performed. Search for studies and data extraction was carried out by two authors independently. Study quality was assessed by NOS. Adjusted data were pooled using the random effects model to calculate summary odds ratios (ORs) with corresponding 95% confidence intervals (CIs). RESULTS: We identified four cohort studies and three case-control studies with a total of 1,369,560 participants of whom 42,716 were COPD patients. The quality of the studies was acceptable, with an average on 7.7 indicating overall good study quality. The meta-analysis on adjusted data from all seven studies showed that the COPD group had a higher risk of T2D compared with the non-COPD group: random effect OR = 1.17 (1.01-1.35), p = 0.03. No heterogeneity was found I2 = 0%. When including only studies diagnosing both COPD and T2D according to recommended guidelines the association did not remain statistically significant, OR =1.17 (0.96-1.42), p = 0.12. CONCLUSION: This systemic review and meta-analyses showed that the association between COPD and T2D might be influenced by the diagnostic method and should be further investigated in studies using diagnostic definition according to guidelines. Nevertheless, physicians should be aware of comorbidities in COPD patients.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Citocinas , Diabetes Mellitus Tipo 2/sangue , Hemoglobina A Glicada/análise , Guias como Assunto , Humanos , Inflamação , Doença Pulmonar Obstrutiva Crônica/mortalidade , Pneumologistas/educação , Espirometria , Terminologia como Assunto
4.
Semin Respir Crit Care Med ; 39(6): 693-703, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30641587

RESUMO

Thoracoscopy is an increasingly common procedure that provides significant clinical information and therapeutic applications. The procedure allows the physician to biopsy the parietal pleura under direct visualization with high accuracy. In addition, one can drain pleural fluid, place a chest tube in a precise location, and perform poudrage pleurodesis. Medical thoracoscopy (MT) is carried out in the operating room or procedure suite under moderate sedation with spontaneous ventilation. In comparison, video-assisted thoracoscopic surgery (VATS) is performed under general anesthesia with single lung ventilation and through multiple ports in the operating room. MT is less invasive, has a comparable diagnostic yield, and may be better tolerated in high-risk patients. The indications, complications, and advances in thoracoscopy will be discussed in this article. In the era of rapidly evolving therapeutics for lung cancer, immune-modulation and ever-increasing risks of immunosuppression, MT will evolve and continue to play a pivotal role in the evaluation and research of pleuropulmonary diseases.


Assuntos
Neoplasias Pulmonares/cirurgia , Derrame Pleural Maligno/cirurgia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Biópsia , Humanos , Pleura/patologia , Pneumologistas/educação
5.
Int J Chron Obstruct Pulmon Dis ; 12: 2695-2702, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28979111

RESUMO

PURPOSE: Pulmonary rehabilitation (PR) is recognized as the chief non-pharmacologic management approach for patients with COPD, but is clinically under-utilized. In Taiwan, respiratory therapists (RTs) are one of the first-line health care providers who spend vast amounts of time with COPD patients in PR programs. To better enhance patients' knowledge of and participation in PR, it is necessary to understand how PR is viewed by RTs, as well as how these views influence their behavioral intentions toward promoting PR. This study applied the Theory of Planned Behavior (TPB) to investigate both the behavioral intentions and the influential factors surrounding PR in RTs. PATIENTS AND METHODS: This cross-sectional study used structured self-administered questionnaires at a national symposium for RTs to collect data on their knowledge, attitudes, subjective norms, perceived behavioral controls, and behavioral intentions with regard to promoting PR. Multiple linear regression analysis was used to identify significant factors affecting the intended promotion of PR by RTs. RESULTS: The response rate after excluding respondents with incomplete data was 88.1% (n=379). A majority of the participants were college graduates, aged over 30 years, and women. The respective percentage scores derived from questionnaires gauging the knowledge, attitudes, subjective norms, self-efficacy, and behavioral intentions components of total PR scores were 63.12%, 71.33%, 68.96%, 66.46%, and 80.29%. The factors significantly affecting RTs' intentions to suggest PR participation to COPD patients or encourage it were attitudes, subjective norms, and self-efficacy. The total model explained 22.5% of the variance in behavioral intentions. CONCLUSION: The results of the study suggest that RTs strongly intend to promote PR, but are hindered by insufficient knowledge, attitudes, and self-efficacy with regard to it. Applying TPB provided insight into which factors can be addressed, and by whom. For example, enhancing RTs' self-efficacy can be achieved through PR training via school curricula, further regular continuing education and/or courses, and practical experience.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Intenção , Pulmão/fisiopatologia , Padrões de Prática Médica , Doença Pulmonar Obstrutiva Crônica/reabilitação , Pneumologistas/psicologia , Terapia Respiratória/métodos , Adulto , Competência Clínica , Estudos Transversais , Educação Médica , Feminino , Pesquisas sobre Serviços de Saúde , Promoção da Saúde , Humanos , Modelos Lineares , Masculino , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Pneumologistas/educação , Terapia Respiratória/educação , Autoeficácia , Taiwan
7.
Medicine (Baltimore) ; 95(23): e3849, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27281093

RESUMO

Nonanesthesiologist administered propofol (NAAP) sedation for flexible bronchoscopy is controversial, because there is no established airway management (AM) training for pulmonologists. The aim was to investigate the performance and acceptance of a proposed AM algorithm and training for pulmonologists performing NAAP sedation. The algorithm includes using 3 maneuvers including bag mask ventilation (BMV), laryngeal tube (LT), and needle cricothyrotomy (NCT). During training (consisting of 2 sessions with a break of 9 weeks in between), these maneuvers were demonstrated and exercised, followed by 4 consecutive attempts to succeed with each of these devices. The primary outcome was the improvement of completion time needed for a competent airway. Secondary outcomes were the trainees' overall reactions to the training and algorithm, and the perceptions of psychological safety (PS). The 23 staff members of the Department of Pulmonology performed a total of 552 attempts at AM procedures (4 attempts at each of the 3 maneuvers in 2 sessions), and returned a total of 42 questionnaires (4 questionnaires were not returned). Median completion times of LT and NCT improved significantly between Sessions 1 and 2 (P = 0.005 and P = 0.04, respectively), whereas BMV was only marginally improved (P = 0.05). Trainees perceived training to be useful and expressed satisfaction with this training and the algorithm. The perception of PS increased after training. An AM algorithm and training for pulmonologists leads to improved technical AM skills, and is considered useful by trainees and raised their perception of PS during training. It thus represents a promising program.


Assuntos
Manuseio das Vias Aéreas/métodos , Broncoscopia/educação , Competência Clínica , Sedação Consciente/métodos , Educação Médica Continuada/métodos , Propofol/administração & dosagem , Pneumologistas/educação , Adulto , Manuseio das Vias Aéreas/normas , Feminino , Seguimentos , Humanos , Hipnóticos e Sedativos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
10.
Ann Am Thorac Soc ; 13(4): 502-11, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26989810

RESUMO

RATIONALE: Rigid bronchoscopy is increasingly used by pulmonologists for the management of central airway disorders. However, an assessment tool to evaluate the competency of operators in the performance of this technique has not been developed. We created the Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) to serve as an objective, competency-oriented assessment tool of basic rigid bronchoscopic skills, including rigid bronchoscopic intubation and central airway navigation. OBJECTIVES: To assess whether RIGID-TASC scores accurately distinguish the basic rigid bronchoscopy skills of novice, intermediate, and expert operators, and to determine whether RIGID-TASC has adequate interrater reliability when used by different independent testers. METHODS: At two academic medical centers in the United States, 30 physician volunteers were selected in three categories: 10 novices at rigid bronchoscopy (performed at least 50 flexible, but no rigid, bronchoscopies), 10 operators with intermediate experience (performed 5-20 rigid bronchoscopies), and 10 experts (performed ≥100 rigid bronchoscopies). Participants included pulmonary and critical care fellows, interventional pulmonology fellows, and faculty interventional pulmonologists. Each subject then performed rigid bronchoscopic intubation and navigation on a manikin, while being scored independently by two testers, using RIGID-TASC. MEASUREMENTS AND MAIN RESULTS: Mean scores for three categories (novice, intermediate, and expert) were 58.10 (±4.6 [SE]), 78.15 (±3.8), and 94.40 (±1.1), respectively. There was significant difference between novice and intermediate (20.05, 95% confidence interval [CI] = 7.77-32.33, P = 0.001), and intermediate and expert (16.25, 95% CI = 3.97-28.53, P = 0.008) operators. The interrater reliability (intraclass correlation coefficient) between the two testers was high (r = 0.95, 95% CI = 0.90-0.98). CONCLUSIONS: RIGID-TASC showed evidence of construct validity and interrater reliability in this setting and group of subjects. It can be used to reliably and objectively score and classify operators from novice to expert in basic rigid bronchoscopic intubation and navigation.


Assuntos
Broncoscopia/educação , Competência Clínica/normas , Pneumologia/normas , Pneumologistas/educação , Centros Médicos Acadêmicos , Adulto , Feminino , Humanos , Masculino , Manequins , Médicos , Reprodutibilidade dos Testes , Estados Unidos
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