[The role of an interventional pulmonologist in the management of metastatic pleural effusions (MPE)]. / Place du pneumologue interventionnel dans la gestion des pleurésies métastatiques.

An interventional pulmonologist possesses expertise in minimally invasive diagnostic and therapeutic procedures involving the airways, lungs and pleura. A malignant pleural effusion (MPE), which occurs in 20% of cancer patients, can be a daunting diagnostic challenge insofar as the pleural cavity is a closed cavity. In these patients, treatment may consequently be delayed before a precise diagnosis can be given. In the meantime, an interventional pulmonologist is called upon to carry out a wide range of examinations in order to establish the etiological diagnosis and to treat the symptoms of an MPE patient. Classical medical thoracoscopy, also called "pleuroscopy", is the reference method in MPE diagnosis because it allows visualization of the pleural cavity, pleural biopsy under direct visual control, providing excellent diagnostic yield. Over the past decade, new diagnostic methods have emerged, such as ultrasound-guided biopsy, as well as different interventions, such as indwelling pleural catheters, aimed at improving the quality of life of MPE patients, for whom therapeutic options are limited. The objective of this review of the literature is to point out the role of the interventional pulmonologist in the management of MPE by detailing the various diagnostic and therapeutic methods he possesses at the present time.

[The advanced practice nurse in post-COViD-19 respiratory follow up]. / L'IPA dans le suivi respiratoire post-Covid-19.

The setting up of an advanced practice nursing activity to monitor patients with severe or very severe pneumonia associated with Severe Acute Respiratory Syndrome Coronavirus 2, is a reponse to the population's new health care needs and a massive influx of patients. The skills of the advanced practice nurse are mobilised in this context in order to carry out prevention missions and screening for potential sequelae which could lead to chronic respiratory failure.

[Contribution of high fidelity simulation to training in respiratory medicine]. / Apport de l'apprentissage par la simulation dans l'enseignement de la pneumologie.

INTRODUCTION: Simulation maintains patient safety by limiting the risk of errors. In the medical field, simulation is a method of learning that is developing more and more in the acute specialties but it is still not widespread in the field of respiratory medicine. OBJECTIVE: To evaluate the efficacy of high fidelity simulation as a teaching tool in respiratory medicine. METHODS AND POPULATION STUDIED: This was a prospective and descriptive study including students who had high fidelity simulation training sessions during their traineeship in respiratory medicine. Simulation learning took the form of four teaching sessions. The included students were assessed at the beginning and end of each session by a pre-test and post-test. Student satisfaction was assessed at the end of each session. RESULTS: Comparing the average student score before and after the simulation session showed an improvement in post-test scores. This improvement was statistically significant for all four scenarios. The majority of students, 60% (N=13), were satisfied with the progress of their internship in the Respiratory Department. CONCLUSION: High fidelity simulation is a teaching method that allows the acquisition and/or optimization of several skills. Nevertheless, this method remains undeveloped in respiratory medicine.

[Different approaches to chest drainage in the management of primary spontaneous pneumothorax]. / Facteurs influençant la réussite du drainage pleural d'un premier épisode de pneumothorax spontané primitif.

Drainage of primary spontaneous pneumothorax (PSP) may be managed by different techniques and with different types of drain. It is mainly performed in the pneumology department or in the emergency department. The aim of the study was to evaluate the factors that influence the success of PSP drainage. This retrospective, monocentric study performed in University Hospital of Toulouse, included patients with a first episode of PSP requiring drainage. The primary outcome was the rate of success according to the techniques of drainage. Data on the size of the drain (>14F or<14F), the drainage technique (small bore catheter or chest tube drainage) and the drainage department (pneumology or emergency) were collected. One hundred and twenty-four patients had a drainage between 2014 and 2016: the late recurrence free success rate was 59% (n=73). Compared with emergency, drainage in pneumology increased the success rate threefold regardless of the drainage technique (P=0.0001) The success rate was similar whatever the technique used (Seldinger or classic technique) (P=0.31). Success and complications rates were similar whether the drain was large (>14F) or small (<14F) (respectively P=0.99 and P=0.58). In our study, the drainage of PSP in the pneumology department, with a small caliber inserted by the Seldinger technique, was associated with a significantly higher success rate.

[Endoscopic lung volume reduction for emphysema]. / Réduction de volume pulmonaire endoscopique dans l'emphysème.

Lung hyperinflation which is a hallmark of advanced emphysema plays a major role in the exertional dyspnoea experienced by patients. This has led to the development of surgical lung volume reduction which, though effective, is also associated with significant morbidity and mortality. The goal of endoscopic lung volume reduction which has developed over several years is to decrease hyperinflation without exposing patients to the risks of surgery. Several endoscopic techniques have been assessed by high quality controlled studies: airway by-pass, instillation of glue, insertion of coils or unidirectional valves, vapour ablation. The aim of this review is to present the results of these studies in terms of functional benefit and side effects. Based on these studies, an algorithm for the endoscopic management of advanced forms of emphysema is proposed.

[Transbronchial cryobiopsy in diffuse interstitial lung diseases]. / Cryobiopsies trans-bronchiques au cours des pneumopathies interstielles diffuses ­ expériences préliminaires.

INTRODUCTION: In the diagnostic approach to interstitial lung disease (ILD), the use of transbronchial cryobiopsy (TBC) may offer an alternative to surgical lung biopsy (SLB). We report the diagnostic effectiveness and the safety of TBC in ILD based on the preliminary experience in two French university centers. METHODS: Twenty four patients underwent TBC for the diagnosis of ILD in the operating room between 2014 and 2017. All the histological diagnoses obtained were then reviewed and validated during multidisciplinary discussions (MDD). RESULTS: Patients had an average of 3 TBC.TBC samples were analyzable in 22/24 (91.7%) patients. In these, samples allowed a histological diagnosis to be made in 14/22 (63.6%) patients and a diagnosis with certainty in 13/22 (59%) after MDD. The overall diagnostic yield from TBC was 13/24 (54.2%). Nine (37.5%) patients had a pneumothorax. Five (20.8%) patients had a bleeding. There were no deaths. Taking into account a possible initial learning curve and considering only the 15 patients who had their TBC after 2015, we note that a diagnosis could be made after MDD for 12 of them, that is, 80%. CONCLUSION: A prospective randomized study is needed to evaluate the technique in France in order to specify its diagnostic performance and its safety profile in comparison to SLB.

[Relevance of fluoroquinolones prescriptions in medical service]. / Pertinence des prescriptions de fluoroquinolones dans un service de médecine.

INTRODUCTION: Fluoroquinolones (FQ) are antibiotics which favour the emergence of resistance and remain widely prescribed in the French hospital environment. A focus of prescription recommendation was published by the French Infectious Diseases Society (SPILF) in 2015 in order to preserve their use. The pneumology-oriented medical service of Salon de Provence's hospital had high FQ consumption for the year 2015; thus a relevant assessment of prescriptions was carried out. METHODS: This retrospective study was conducted between January 1 and December 31, 2015 and concerned patients who received at least one FQ administration during their hospitalization. RESULTS: Thirty-eight per cent of the prescriptions were justified, 37 % were inappropriate and 25 % unjustified. The majority of unjustified prescriptions were for lung infections. Only 35 % of the patients received bacteriological documentation and 53 % of the prescriptions were reassessed at 48-72hours. Twenty-two per cent of the justified prescriptions showed non-conformities concerning the duration of prescriptions, the dosage or an association with another antibiotic. CONCLUSION: The diffusion of these results, combined with the implementation of corrective actions, should make it possible to improve the relevance of the FQ prescription.

[Manual airway clearance techniques in adults and adolescents: What level of evidence?] / Techniques manuelles de drainage bronchique des adultes et adolescents : quel niveau de preuve ?

BACKGROUND: The aim of this systematic literature review was to grade the levels of evidence of the most widely used manual airway clearance techniques. METHODS: A literature search was conducted over the period 1995-2014 from the Medline, PEDro, ScienceDirect, Cochrane Library, REEDOC and kinedoc databases, with the following keywords: "postural drainage", "manual vibrations", "manual chest percussion", "directed cough", "increased expiratory flow", "ELTGOL", "autogenic drainage" and "active cycle of breathing technique". RESULTS: Two-hundred and fifty-six articles were identified. After removing duplicates and reading the titles and abstracts, 63 articles were selected, including 9 systematic reviews. This work highlights the lack of useful scientific data and the difficulty of determining levels of evidence for manual airway clearance techniques. Techniques were assessed principally with patients with sputum production (cystic fibrosis, DDB, COPD, etc.). It also shows the limited pertinence of outcome measures to quantify congestion and hence the efficacy of airway clearance techniques. CONCLUSION: The 1994 consensus conference summary table classifying airway clearance techniques according to physical mechanism provides an interesting tool for assessment, grouping together techniques having identical mechanisms of action. From the findings of the present systematic review, it appears that only ELTGOL, autogenic drainage and ACBT present levels of evidence "B". All other techniques have lower levels of evidence. LEVEL OF EVIDENCE: II.

[Respiratory diseases in black African carceral area]. / Pathologies respiratoires en milieu carcéral noir africain.

INTRODUCTION: The measures for people in specific situations such as prisoners are part of the Millennium Development Goals (MDGs). The objective of this study was to assess respiratory pathologies in a black African carceral center. METHODS: Retrospective study about the prevalence of respiratory pathologies in the arrest central house for men in Bamako (Mali), from May 2012 to April 2013. The admission records have served as data checking support on detainee's records. Statistical significance was investigated by the SAS 9.3 software with a threshold of 5%. RESULTS: Of 2740 admissions, 207 concerned respiratory pathologies (7.5%). All men, were of mean age 30±13 years (range 19-71). The respiratory diseases found were: pneumonia (33.8%), chronic bronchitis (26.6%), acute respiratory infection (14%), asthma (13.5%) and tuberculosis (5.3%). A definite diagnosis was made in 42% of cases. A tobacco intoxication was found in all age groups (CI 95%, R-square=0.01), without significant difference between the occurrence of cough in smoking and non-smoking men. CONCLUSION: According to their relative frequencies, the management of respiratory diseases requires collaboration between carceral health facilities and pneumological specialized services.

[Health care providers' knowledge and abilities to use inhalation devices and spacers]. / Évaluation des connaissances en aérosolthérapie du personnel hospitalier.

INTRODUCTION: Inhaled therapy is the mainstay of asthma treatment due to its local and rapid action. However, its efficiency relies on the teaching of a good inhalation technique by health care providers. We assessed health care providers' knowledge and practical skills in the use of inhalation devices. METHODS: An observational multicenter study was conducted in the pulmonology and paediatric wards in Marseille. The departments' common practices, theoretical knowledge and practical skills were assessed through a questionnaire and a demonstration using a spacer device. RESULTS: Forty health care providers were interviewed (9 attending physicians, 14 residents, 16 nurses and 1 physiotherapist), in 8 different pulmonology and paediatric wards. A total of 42.5% reported previous training in inhalation device technique. When evaluating theoretical knowledge, we found a mean of 54% correct answers. Attending physicians did significantly better than residents and nurses. With regard to practical skills, we found a mean of 1.12 failed steps out of 7. Here again attending physicians did significantly better than residents and nurses. CONCLUSION: Based on the results of our study, we recommend that attending physicians provide training of inhalation technique to nurses and residents, as they did significantly better theoretically and practically.

[Clinical, paraclinic and evolutive profile of HIV infected subject compared with that of non-HIV infected subject in pneumology hospitalization at Abidjan]. / Profil clinique, paraclinique et évolutif du sujet infecté par le VIH comparé à celui du sujet non infecté par le VIH en milieu pneumologique hospitalier à Abidjan.

INTRODUCTION: The HIV infection is a problem of public health in Côte d'Ivoire. Voluntary screening is encouraged for the premature management of HIV infected patients before the stage of serious opportunist affections. Antiretroviral therapy became free. The purpose of this study was to describe the characteristics of HIV infected subject infected in hospitalization of pneumology. METHODOLOGY: Our retrospective and analytic study concerned the activity period from January 2001 to December 2012 of pneumology department of Cocody university hospital. RESULTS: On 1141 recorded files, the prevalence of HIV infection was 48.20%. The multi-varied analysis showed the following results. Male patients were less HIV infected (OR=0.490 [0.363-0.661]) as the old patients of more than 64 years (OR=0.150 [0.080-0.280]). In case of HIV infection, infectious pathology, severe anemia and renal insufficiency were dominating respectively with OR=1.763 (1.212-2.564), OR=3.167 (2.125-4.720) and OR=2.054 (1.335-3.161). A stronger mortality was associated with HIV infection (OR=1.920 [1.312-2.809]). CONCLUSION: HIV infection always remains frequented in pneumology hospitalization in Abidjan with late discovery, source of complications and abnormally high death rate.

[Impact of COPD on quality of life and mental health among one hundred Tunisian patients]. / Impact de la BPCO sur la qualité de vie et l'état de santé mentale chez cent patients tunisiens.

UNLABELLED: Chronic obstructive pulmonary disease (COPD) constitutes a penalty in physical activities of patients. Its mental repercussions are important and expressed in a significant impairment of quality of life. OBJECTIVES: To evaluate the quality of life and its determinants in Tunisian patients with COPD. METHODS: We conducted a cross-sectional study over a period of 6 months from January 2008 to June 2008 and focused on patients with COPD hospitalized and monitored in the department of respiratory diseases in Farhat Hached Teaching hospital of Sousse in Tunisia. We used the French version of Saint George's respiratory questionnaire (SGRQ) to study the quality of life and the Hospital Anxiety Depression (HAD) for the exploration of anxiety and depression. RESULTS: Among 100 patients included in the study, the SGRQ overall score average was 44.31 ± 13.85%. Ten patients had depression and 9 patients had an anxiety state. The results of the multiple linear regression analysis showed that four factors were associated significantly with impaired quality of life: dyspnea, the number of exacerbations, comorbidity and depression. CONCLUSION: The psychological impact and effect on quality of life of COPD are additional tools combined with physical and spirometric data during the follow-up of treatment of patients and should be systematically sought by practitioners, which is still rare in Tunisia.

[Residents in respiratory medicine: Assessment of the course and wishes regarding their career]. / Appréciation du cursus et vœux relatifs à l'exercice futur des internes en pneumologie.

INTRODUCTION: The aim of this study was to assess the feelings of residents in respiratory medicine regarding the quality and organization of their training and towards their career prospects. METHODS: A prospective survey conducted over the Internet among all the members of the French Young Pulmonologists Association (AJPO2). RESULTS: One hundred and thirty-two (71.5%) members responded. The rating given to theoretical training was 6 [5-7] whereas the practical training was rated at 7 [6-8] out of 10. The majority of the residents considered that the length of their course should be adapted (80.3%). Of them, 74.2% wanted to add a mandatory semester. The proposed mandatory semester was in bronchoscopy (40.3%). Seventy-two percent of the resident wanted to acquire a specialisation, the most common of which was in oncology (36.6%). Among the residents, 96.2% wanted to conduct a fellowship. The main reason for this was their feeling of inability to correctly handle patients at the end of their residency. Of the residents, 55.3% were considering working in a public hospital. CONCLUSION: There are opportunities to improve the French respiratory residency training both in its theory and practical aspects. The modalities of this training could also be adapted. Access to a fellowship is a major concern for the residents.

[How practical guidelines can be applied in poor countries? Example of the introduction of a bronchoscopy unit in Cambodia]. / Comment appliquer les recommandations de bonnes pratiques dans les pays pauvres ? L'exemple de la mise en place d'une unité d'endoscopie bronchique au Cambodge.

According to UN, Cambodia is one of the poorest countries in the World. Respiratory diseases are current public health priorities. In this context, a new bronchoscopy unit (BSU) was created in the respiratory medicine department of Preah Kossamak hospital (PKH) thanks to a tight cooperation between a French and a Cambodian team. Aim of this study was to describe conditions of introduction of this equipment. Two guidelines for practice are available. They are respectively edited by the French and British societies of pulmonology. These guidelines were reviewed and compared to the conditions in which BS was introduced in PKH. Each item from guidelines was combined to a categorical value: "applied", "adapted" or "not applied". In 2009, 54 bronchoscopies were performed in PKH, mainly for suspicion of infectious or tumour disease. In total, 52% and 46% of the French and British guideline items respectively were followed in this Cambodian unit. Patient safety items are those highly followed. By contrast "staff safety" items were those weakly applied. Implementation of EBS in developing countries seems feasible in good conditions of quality and safety for patients. However, some recommendations cannot be applied due to local conditions.