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BACKGROUND: Theoretical testing provides the necessary foundation to perform technical skills. Additionally, testing improves the retention of knowledge.OBJECTIVES: The aims of this study were to develop a multiple-choice test in endosonography for pulmonary diseases and to gather validity evidence for this test.METHODS: Initially, 78 questions were constructed after informal conversational interviews with 4 international experts in endosonography. The clarity and content validity of the questions were tested using a Delphi-like approach. Construct validity was explored by administering the test to 3 groups with different levels of endosonography experience: 27 medical students, 18 respiratory physicians with limited endosonography experience, and 14 experts in endosonography.RESULTS: Two Delphi iterations reduced the test to 52 questions. After item analysis, the final test consisted of 46 questions with a mean item discrimination of 0.47 and a mean item difficulty of 0.63. The internal consistency reliability was calculated at 0.91. The 3 groups performed significantly differently (ANOVA: p < 0.001), and post hoc tests were significant. The experts performed significantly more consistently than the novices (p = 0.037) and the intermediates (p < 0.001).CONCLUSIONS: This study provides a theoretical test in endosonography consisting of multiple-choice questions. Validity evidence was gathered, and the test demonstrated content and construct validity.

BACKGROUND: Theoretical testing provides the necessary foundation to perform technical skills. Additionally, testing improves the retention of knowledge.OBJECTIVES: The aims of this study were to develop a multiple-choice test in endosonography for pulmonary diseases and to gather validity evidence for this test.METHODS: Initially, 78 questions were constructed after informal conversational interviews with 4 international experts in endosonography. The clarity and content validity of the questions were tested using a Delphi-like approach. Construct validity was explored by administering the test to 3 groups with different levels of endosonography experience: 27 medical students, 18 respiratory physicians with limited endosonography experience, and 14 experts in endosonography.RESULTS: Two Delphi iterations reduced the test to 52 questions. After item analysis, the final test consisted of 46 questions with a mean item discrimination of 0.47 and a mean item difficulty of 0.63. The internal consistency reliability was calculated at 0.91. The 3 groups performed significantly differently (ANOVA: p < 0.001), and post hoc tests were significant. The experts performed significantly more consistently than the novices (p = 0.037) and the intermediates (p < 0.001).CONCLUSIONS: This study provides a theoretical test in endosonography consisting of multiple-choice questions. Validity evidence was gathered, and the test demonstrated content and construct validity.

Introduction : Le COPD Assessment Test (CAT) est un nouvel outil développé pour l’évaluation de la qualité de vie de patients souffrant de bronchopneumopathie chronique obstructive (BPCO). Les caractéristiques du score dérivé du CAT en fonction de divers paramètres d’évaluation de la gravité restent à décrire. Méthodes : Le CAT a été soumis de manière prospective à 213 patients BPCO consécutifs en état stable vus en consultation dans un hôpital universitaire. La valeur discriminative du score CAT et son association avec divers paramètres d’intérêt ont été analysées. Résultats : L’augmentation progressive du score CAT en fonction de la gravité de la maladie évaluée par le stade GOLD, l’index BODE et la dyspnée démontre les qualités discriminatives du score CAT. En analyse multivariée, seuls le rapport volume résiduel/capacité pulmonaire totale (VR/CPT) et la distance parcourue au test de marche de six minutes sont significativement associés au score CAT dont 27 % seulement de la variabilité est expliquée. L’inclusion de la dyspnée au modèle permet d’expliquer 42 % de la variabilité du score CAT, seuls la dyspnée et le rapport VR/CPT y étant significativement associés. Conclusion : Le score CAT présente des qualités discriminatives satisfaisantes et semblables à des outils plus complexes d’évaluation de la qualité de vie dans la BPCO.

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Background: Induced sputum (IS) is a noninvasive tool, which can be used to collect cellular and soluble materials from lung airways. Objective: To evaluate if IS may be a useful and safe tool for the detection of airway inflammation in patients with interstitial lung disease (ILD) in systemic sclerosis (SSc). Methods: Sixty-eight patients with SSc and ILD as well as 18 healthy individuals (controls) were selected and submitted to IS examination. In 34 of 68 patients with SSc, bronchoalveolar lavage (BAL) was also performed. Safety of IS was assessed by comparison of forced expiratory volume in the first second (FEV1), FEV1/forced vital capacity ratio and peak expiratory flow before and after the IS procedure. Cell composition in samples collected by BAL and IS was correlated, and IS total and differential cell count in SSc patients and controls were compared. Results: The total number of cells was significantly higher in IS samples of SSc patients compared to those of healthy controls. Mean percentage of neutrophils was also higher in SSc patients (41.79 ± 23.89 vs. 27.37 ± 17.90), as well as lymphocytes (17.42 ± 19.70 vs. 3.13 ± 2.28) and eosinophils (2.35 ± 4.43 vs. 0.41 ± 0.46). On the other hand, mean percentage of macrophages was higher in healthy individuals (69.10 ± 19.15 vs. 36.96 ± 20.68). In fluid recovered by BAL, the most frequent cells were macrophages (67.89% ± 17.26), while neutrophils (14.77 ± 17.18%) and lymphocytes (15.62 ± 13.46%) were less frequent and eosinophils (1.66 ± 2.08%) were rare. A similar pattern of cell composition was found in IS samples (41.15 ± 21.67% of macrophages, 39.72 ± 23.15% of neutrophils, 15.28 ± 19.46% of lymphocytes and 2.56 ± 5.03% of eosinophils). Strength of correlation between BAL and IS was significant for macrophages and neutrophils. After IS procedure was performed, improvement of FEV1 (mean value before IS was 85.09 ± 14.44 and 88.93 ± 16.40 after IS) and FEV1/forced vital capacity (mean value before IS was 98.5

Manual compression of the abdomen (MCA) during spontaneous expiration is a simple method for the detection of flow limitation in the chronic obstructive pulmonary disease (COPD) patients during resting breathing, based on comparison of flow/volume curves obtained during MCA with that of the preceding control breath. It was assessed whether this nonstandardized technique is also feasible during exercise. MCA was performed during resting breathing and constant-exercise work at one- and two-thirds maximal mechanical power output (W'max) in six normal subjects and 12 COPD patients. Changes in end-expiratory lung volume (EELV) were also studied. With the aid of inspection, abdominal palpation and lung auscultation, MCA could always be applied during expiration. Flow limitation was never detected in the six normal subjects, whereas four of the COPD patients were flow limited at rest, seven during exercise at one-third W'max and nine during exercise at two-thirds W'max. Expiratory flow limitation detected by MCA was always associated with an increase in EELV during exercise, indicating dynamic hyperinflation occurrence or increase. It is concluded that manual compression of the abdomen is a very simple and reliable method for the detection of flow limitation during exercise., Journal Article, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

Manual compression of the abdomen (MCA) during spontaneous expiration is a simple method for the detection of flow limitation in the chronic obstructive pulmonary disease (COPD) patients during resting breathing, based on comparison of flow/volume curves obtained during MCA with that of the preceding control breath. It was assessed whether this nonstandardized technique is also feasible during exercise. MCA was performed during resting breathing and constant-exercise work at one- and two-thirds maximal mechanical power output (W'max) in six normal subjects and 12 COPD patients. Changes in end-expiratory lung volume (EELV) were also studied. With the aid of inspection, abdominal palpation and lung auscultation, MCA could always be applied during expiration. Flow limitation was never detected in the six normal subjects, whereas four of the COPD patients were flow limited at rest, seven during exercise at one-third W'max and nine during exercise at two-thirds W'max. Expiratory flow limitation detected by MCA was always associated with an increase in EELV during exercise, indicating dynamic hyperinflation occurrence or increase. It is concluded that manual compression of the abdomen is a very simple and reliable method for the detection of flow limitation during exercise., Journal Article, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published