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Objective: Diagnosis of pulmonary hypertension (PH) in systemic sclerosis (SSc) requires an invasive right heart catheterization (RHC), often based on an elevated estimated pulmonary artery systolic pressure on screening echocardiography. However, because of the poor specificity of echocardiography, a greater number of patients undergo RHC than necessary, exposing patients to potentially avoidable complication risks. The development of improved prediction models for PH in SSc may inform decision‐making for RHC in these patients. Methods: We conducted a retrospective study of 130 patients with SSc; 66 (50.8%) were diagnosed with PH by RHC. We used data from pulmonary function testing, electrocardiography, echocardiography, and computed tomography to identify and compare the performance characteristics of 3 models predicting the presence of PH: 1) random forest, 2) classification and regression tree, and 3) logistic regression. For each model, we generated receiver operating curves and calculated sensitivity and specificity. We internally validated models using a train‐test split of the data. Results: The random forest model performed best with an area under the curve of 0.92 (95% confidence interval [95% CI] 0.83–1.00), sensitivity of 0.95 (95% CI 0.75–1.00), and specificity of 0.80 (95% CI 0.56–0.94). The 2 most important variables in our random forest model were pulmonary artery diameter on chest computed tomography and diffusing capacity for carbon monoxide on pulmonary function testing. Conclusions: In patients with SSc, a random forest model can aid in the detection of PH with high sensitivity and specificity and may allow for better patient selection for RHC, thereby minimizing patient risk. [ABSTRACT FROM AUTHOR]

Patients with systemic sclerosis complicated by both pulmonary hypertension (SSc- PH) and interstitial lung disease (SSc-PH-ILD) have poor prognosis compared to those with SSc-PH or SSc-ILD alone. Little is known of how ILD severity affects outcomes in those with SSc-PH, or how PH severity affects outcomes in thosewith SSc-ILD. Herein, we aimed to delineate clinical features of patients with SSc-PH and SSc-ILD and determine to what degree PH and ILD severity contribute to mortality in patients with SSc. We conducted parallel retrospective studies in cohorts of patients with SSc-PH and SSc-ILD. We categorized ILD severity by pulmonary function testing and PH severity by cardiopulmonary hemodynamics. Our primary outcome was all-cause mortality from time of PH or ILD diagnosis for the SSc-PH and SSc-ILD cohorts, respectively. We calculated adjusted risks of time to all-cause mortality using Cox proportional hazards models. In patients with SSc- PH, severe ILD (HR: 3.54; 95% CI: 1.05, 11.99) was associated with increased hazards for all-cause mortality. By contrast, mild and moderate ILD were not associated with increased mortality risk. In patients with SSc-ILD, both moderate (HR: 2.65; 95% CI: 1.12, 6.31) and severe PH (HR: 6.60; 95% CI: 2.98, 14.61) were associated with increased hazards for all-cause mortality, while mild PH was not. Through our parallel study design, the risk of all-cause mortality increases as severity of concomitant ILD or PH worsens. Therapies that target slowing disease progression earlier in the disease course may be beneficial. [ABSTRACT FROM AUTHOR]

Objective: Systemic sclerosis–related pulmonary hypertension (SSc‐PH) is a common complication of SSc associated with accelerated mortality. The present study was undertaken to investigate whether cardiac axis deviation indicates abnormalities in cardiac function allowing for prognostication of disease severity and mortality. Methods: This was a retrospective study in which electrocardiograms (ECGs) were reviewed for cardiac axis deviation and their association with echocardiography and cardiopulmonary hemodynamics on right‐sided heart catheterization. The primary outcome observed was all‐cause mortality from the time of PH diagnosis. Results: ECG results were reviewed from 169 patients with SSc‐PH. Right axis deviation (RAD) and left axis deviation (LAD) occurred in 28.4% and 30.8% of patients with SSc‐PH, respectively. Compared to those without RAD, patients with RAD exhibited predominantly right‐sided cardiac disease on echocardiography and increased PH severity by cardiopulmonary hemodynamics including a greater mean ± SD pulmonary artery pressure (42.0 ± 12.5 mm Hg versus 29.8 ± 7.0 mm Hg) and mean ± SD pulmonary vascular resistance (645.6 ± 443.2 dynes · seconds/cm5 versus 286.3 ± 167.7 dynes · seconds/cm5). LAD was associated with predominantly left‐sided cardiac disease on echocardiography but was not associated with PH severity on cardiopulmonary hemodynamics. Both RAD (hazard ratio 10.36 [95% confidence interval 4.90–21.93], P < 0.001) and LAD (hazard ratio 2.94 [95% confidence interval 1.53–5.68], P = 0.001) were associated with an increased hazard for all‐cause mortality. Conclusion: RAD and LAD reflect structural cardiac abnormalities and are associated with poor prognosis in patients with SSc‐PH. These findings support the importance of electrocardiography, an inexpensive, widely available noninvasive test, in risk stratification. [ABSTRACT FROM AUTHOR]

GLO:1C4K/01dec20:tct13151-toc-0004.jpg PHOTO (COLOR): . gl INTRODUCTION Intern orientation marks the beginning of a major turning point in medical education, when newly graduated medical students assume brand-new identities and roles as they enter the next stage of their clinical training. Despite their duties as the keepers of institutional knowledge, as well as the eventual supervisors and peer mentors to incoming interns, residents can often be excluded from intern orientation activities as a result of service demands. Intern orientation provides an early start to fostering and nurturing teamwork, not only among residents but also with other health care professionals CHALLENGES Retention of skills learned With the unending barrage of information disseminated throughout orientation, it is not entirely clear how much information interns retain. Although formulating and organising an intern orientation programme that appeals to learner needs is neither a simple nor an effortless task, these are decisive steps that are imperative to ensuring harmonious progress towards the improvement of intern training. [Extracted from the article]

While there continues to be a sense of unpredictability with the current COVID-19 pandemic as well as any other future pandemics, one thing will be certain - teachers will be better equipped to carry on training the next generation of healthcare learners. During a time of incredible uncertainty, the COVID-19 pandemic had catalysed the adoption of telehealth and virtual learning. The programme enabled learners to engage in a structured programme to simultaneously acquire health communication and coaching skills while addressing social and technological barriers to patient care. [Extracted from the article]

2 B Funding information b NIH/NHLBI, Grant/Award Number: 1F32HL156614-01; United Therapeutics Corporation REFERENCES 1 Hennel EK, Trachsel A, Subotic U, Lörwald AC, Harendza S, Huwendiek S. How does multisource feedback influence residency training? Through the process of feedback, learners gain insight on their training progress as well as actionable behavioural changes for self-improvement, growth, and development. Feedback is a fundamental component of the training and development of health professionals and is arguably the most essential interaction between the teacher and learner. [Extracted from the article]

publisher‐imprint‐name Springer volume‐issue‐count 1 issue‐article‐count 0 issue‐toc‐levels 0 issue‐pricelist‐year 2017 issue‐copyright‐holder The Author(s) issue‐copyright‐year 2017 article‐contains‐esm No article‐numbering‐style Unnumbered article‐registration‐date‐year 2017 article‐registration‐date‐month 7 article‐registration‐date‐day 27 article‐toc‐levels 0 toc‐levels 0 volume‐type Regular journal‐product ArchiveJournal numbering‐style Unnumbered article‐grants‐type OpenChoice metadata‐grant OpenAccess abstract‐grant OpenAccess bodypdf‐grant OpenAccess bodyhtml‐grant OpenAccess bibliography‐grant OpenAccess esm‐grant OpenAccess online‐first false pdf‐file‐reference BodyRef/PDF/40169_2017_Article_159.pdf target‐type OnlinePDF issue‐type Regular article‐type ReviewPaper journal‐subject‐primary Medicine & Public Health journal‐subject‐secondary Medicine/Public Health, general journal‐subject‐collection SC11 --> A number of methods have evolved through the years in probing the dysfunction that impacts mechanics and ventilation in asthma. What has been consistently found is the notion of heterogeneity that is not only captured in the frequency dependence of lung mechanics measurements but also rendered on imaging as patchy diffuse areas of ventilation defects. The degree of heterogeneity has been linked to airway hyperresponsiveness, a hallmark feature of asthma. How these heterogeneous constriction patterns lead to functional impairment in asthma have only been recently explored using computational airway tree models. By synthesizing measurements of lung mechanics and advances in imaging, computational airway tree models serve as a powerful engine to accelerate our understanding of the physiologic changes that occur in asthma. This review will be focused on the current state of investigational work on the role of heterogeneity in asthma, specifically exploring the structural and functional relationships. [ABSTRACT FROM AUTHOR]