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The article discusses the development of an integrated care pathway for occupational pulmonary diseases, emphasizing the importance of early detection and collaboration between health care providers and occupational health professionals. The pathway consists of five steps, including medical consultation, occupational history assessment, diagnostic work-up, counseling, and follow-up. The ultimate goal is to ensure optimal prevention and care for work-related pulmonary diseases through collaboration among specialists and the registration of patient data in a national database. This Dutch model could serve as practical guidance for other countries aiming to optimize care for occupational pulmonary diseases. [Extracted from the article]

Despite advances in precision medicine for non-small cell lung cancer (NSCLC), biomarker testing for these therapies remains frequently underused, delayed, and inequitable. Pulmonologists often play a critical role in the initial diagnostic steps for patients with lung cancer, and previous data show variability in their knowledge and practices regarding biomarker testing. The purpose of this study is to better understand how pulmonologists view their role in lung cancer care. With the increasing importance of biomarker testing and precision medicine, how do pulmonologists view their role in lung cancer care? An electronic survey consisting of 31 items focused on attitudes and practices regarding diagnostic steps for NSCLC was randomly distributed to a sample of practicing pulmonologists in the American College of Chest Physicians (CHEST) analytics database. Inferential statistics were performed using χ2 tests and multivariable logistic regression models. A total of 401 pulmonologists responded to the survey. Most (92%) were general pulmonologists, and more than one-half (62%) indicated they order biomarker testing. Longer practice tenure, higher case volumes, and participation in a multidisciplinary tumor board were associated with ordering biomarkers (P <.05). Pulmonology was identified to have the leading responsibility for the initial diagnostic biopsy by most respondents (83%) and less often for staging (45%), leading discussions about biomarker testing with patients (28%), and for ordering biomarkers (22%). The most common reasons for not ordering biomarkers included the following: oncology was responsible (84%), it was not within their scope of practice (46%), or lack of the necessary knowledge (51%). This study shows that pulmonologists vary in their practices for ordering biomarkers, and many defer this responsibility to oncology. Despite the role of bronchoscopy and pulmonology societal guidelines for staging, many defer leadership of this process. Many pulmonologists lack the necessary resources and multidisciplinary infrastructure likely required to efficiently accomplish biomarker testing. [Display omitted] [ABSTRACT FROM AUTHOR]

Individuals with chronic obstructive pulmonary disease (COPD) experience high symptom burden, severe illness, and frequent deterioration in quality of life. Women with COPD represent a unique population with potential unmet care needs yet remain underrepresented in palliative care (PC) literature. The purpose of this study was to investigate specific needs of women with COPD, learn how COPD symptoms impact women, and explore factors related to PC knowledge, access, and barriers. A total of 30 individuals were enrolled in this prospective, single-arm multimethod study, using an adapted Maslow's hierarchy of needs framework. Fifteen participated in semistructured interviews. Women with advanced COPD identified care needs and barriers including access to medications/oxygen and resources (pulmonary rehabilitation/support groups), information about disease/treatment, and effect of weather conditions on symptoms. Some participants were not under the direct care of a pulmonologist but recognized the importance of their services. None of the participants had been referred to or received PC. This study provides evidence that women have unmet care needs, high symptom burden, and disease uncertainty. Women with COPD should have the opportunity to have the supportive care that PC offers. Palliative care and hospice nurses have opportunities to address unmet care needs, increased symptom burden, and disease uncertainty. [ABSTRACT FROM AUTHOR]

We are pleased to introduce the abstracts of the XXIII National Congress of the Italian Society of Thoracic Endoscopy (SIET), which will be held in Florence from 17 to 19 October 2024. The principal objectives of SIET are to (1) Promote research and innovation in the fields of thoracic surgery and endoscopy, facilitating the development and implementation of innovative techniques and technologies; (2) Provide education and training for surgeons, endoscopists, pulmonologists and other related specialties; and (3) Facilitate the exchange of knowledge with the aim of creating a cohesive and active scientific community. The Congress will address the integration of traditional surgical and endoscopic techniques with emerging technologies, with the goal of promoting innovation and education among professionals. The theme of integration will be explored throughout the programme, with a particular focus on the collaborative efforts of different medical specialties to improve patient outcomes. This event will host a multidisciplinary cohort comprising thoracic surgeons, endoscopists, pulmonologists, oncologists, pathologists, radiologists and anaesthetists, who will assume a pivotal role in the multidisciplinary sessions of the scientific programme. The Congress will include several core areas of expertise, including lung cancer, interventional endoscopy, pathology, and upper airway reconstruction. Emphasis will be placed on both the theoretical aspects of these subjects and their practical applications in patient care. The theme of integration will be explored throughout the programme, with particular attention on the impact of recent technological developments in the fields of thoracic surgery and endoscopy. Additionally, the Congress will examine the contributions of allied health professionals, including nurses, physiotherapists, and speech pathologists, to patient care. [ABSTRACT FROM AUTHOR]

Objective: Smoking, with a prevalence of about 25%-30% in Switzerland, is proven to cause major systemic, avoidable diseases including lung cancer, increasing societies morbidity and mortality. Diverse strong quitting smoking recommendations have been made available providing advice facilitating smoking cessation globally. In other European countries like Germany, clinical practice guidelines for smoking cessation services have been implemented. However, in Switzerland, there is still no national consensus on a comprehensive smoking cessation program for lung cancer patients nor on the adequate provider. Our primary aim was to assess the current status of smoking cessation practice among specialists, mainly involved in lung cancer care, in Switzerland in order to uncover potential shortcomings. Material and methods: A self-designed 14-items questionnaire, which was reviewed and approved by our working group consisting of pneumologists and thoracic surgeons, on demographics of the participants, the status of smoking cessation in Switzerland and specialists' opinion on smoking cessation was sent to thoracic surgeons and pneumologists between January 2024 and March 2024 via the commercially available platform www.surveymonkey.com. Data was collected and analysed with descriptive statistics. Results: Survey response rate was 22.25%. Smoking cessation was felt to positively affect long term survival and perioperative outcome in lung cancer surgery. While 33 (37.08%) physicians were offering smoking cessation themselves usually and always (35.96%), only 12 (13.48%) were always referring their patients for smoking cessation. Patient willingness was clearly identified as main factor for failure of cessation programs by 63 respondents (70.79%). Pneumologists were deemed to be the most adequate specialist to offer smoking cessation (49.44%) in a combination of specialist counselling combined with pharmaceutic support (80.90%). Conclusion: The development of Swiss national guidelines for smoking cessation and the implementation of cessation counselling in standardized lung cancer care pathways is warranted in Switzerland to improve long-term survival and perioperative outcome of lung cancer patients. [ABSTRACT FROM AUTHOR]

Background: The etiological diversity of pulmonary hypertension and its association with other accompanying unrelated symptoms is why this disease may be primarily diagnosed by physicians of different medical specialties. In this study, we sought to evaluate the awareness of physicians regarding pulmonary hypertension across different regions in Egypt and among different medical specialties this is because we believed that pulmonary hypertension disease awareness differed among different specialties. Methodology: The survey is conducted from January 2023 to April 2023 targeting certified physicians of different medical specialties in Egypt. A self-administered questionnaire is designed to evaluate and capture information on the awareness of physicians of different medical specialties regarding the diagnosis and management of disease. The questionnaire is offered through an online Google form link, that is made available in two languages English and Arabic for dissemination. Results: A total number of 177 physicians of different medical specialties participated in the questionnaire, 97 (54.8%) participants were males, and 80 (45.2%) participants were females with a mean age of 36.88 ± 7.18. Among different medical specialties, 89.4% (n = 76) of the pulmonologists and 91.9% (n = 34) of the cardiologists participating in the survey have satisfactory PH disease knowledge above 75% with a statistically high significant difference of 0.000, in addition, 87.1% (n = 74) of the pulmonologists and 94.6% (n = 35) of the cardiologists have satisfactory PH disease management knowledge above 75% with a statistically significant difference of 0.000. Coincidentally most participants encountering PH patients in their daily clinical practice have satisfactory PH disease knowledge above 75% and satisfactory PH disease management knowledge above 75% with percentages of 84.8% and 82.3% respectively with statistically significant differences of 0.000 and 0.043 respectively. Conclusions: Our research highlights the importance of appropriate awareness of the healthcare providers of different medical specialties regarding PH disease essential to abide by the current guidelines in management as well as prioritizing the establishment of geographically available designated expert centers enforcing proper clinical practice. Thus, aiming at reducing the prereferral malpractice noted as the prescription of targeted therapy based on the clinical and imaging assessment only without hemodynamic study. [ABSTRACT FROM AUTHOR]

Background: In the postacute phase of coronavirus disease-2019 (COVID-19), survivors may have persistent symptoms, lung function abnormalities, and sequelae lesions on thoracic computed tomography (CT). This new entity has been defined as post-COVID interstitial lung disease (ILD) or residual disease. Aims: To evaluate the characteristics, risk factors and clinical significance of post-COVID ILD. Study Design: Multicenter cross-sectional analysis of data from a randomized clinical study. Methods: In this study, patients with persistent respiratory symptoms 3 months after recovery from COVID-19 were evaluated by two pulmonologists and a radiologist. post-COVID ILD was defined as the presence of respiratory symptoms, hypoxemia, restrictive defect on lung function tests, and interstitial changes on follow-up high-resolution computed tomography (HRCT). Results: At the three-month follow-up, 375 patients with post-COVID-19 syndrome were evaluated, and 262 patients were found to have post- COVID ILD. The most prevalent complaints were dyspnea (n = 238, 90.8%), exercise intolerance (n = 166, 63.4%), fatigue (n = 142, 54.2%), and cough (n = 136, 52%). The mean Medical Research Council dyspnea score was 2.1 ± 0.9, oxygen saturation was 92.2 ± 5.9%, and 6-minute walking distance was 360 ± 140 meters. The mean diffusing capacity of the lung for carbon monoxide was 58 ± 21, and the forced vital capacity was 70% ± 19%. Ground glass opacities and fibrotic bands were the most common findings on thoracic HRCT. Fibrosis-like lesions such as interlobular septal thickening and traction bronchiectasis were observed in 38.3% and 27.9% of the patients, respectively. No honeycomb cysts were observed. Active smoking [odds ratio (OR), 1.96; 95% confidence interval (CI), 1.44-2.67), intensive care unit admission during the acute phase (OR, 1.46; 95% CI, 1.1-1.95), need for high-flow nasal oxygen (OR, 1.55; 95% CI, 1.42-1.9) or non-invasive ventilation (OR, 1.31; 95% CI, 0.8-2.07), and elevated serum lactate dehydrogenase levels (OR, 1.23; 95% CI 1.18-1.28) were associated with the development of post-COVID ILD. At the 6-month follow-up, the respiratory symptoms and pulmonary functions had improved spontaneously without any specific treatment in 35 patients (13.4%). The radiological interstitial lesions had spontaneously regressed in 54 patients (20.6%). Conclusion: The co-existence of respiratory symptoms, radiological parenchymal lesions, and pulmonary functional abnormalities which suggest a restrictive ventilatory defect should be defined as post-COVID-19 ILD. However, the term "fibrosis" should be used carefully. Active smoking, severe COVID-19, and elevated lactate dehydrogenase level are the main risk factors of this condition. These post-COVID functional and radiological changes could disappear over time in 20% of the patients. [ABSTRACT FROM AUTHOR]

Objectives: The present study aims to evaluate the knowledge and awareness levels of pulmonologists regarding local anesthetic (LA) toxicity and the use of intravenous lipid therapy. Methods: This study included research assistants, specialists, and faculty members working in the field of chest diseases in Türkiye, who agreed to participate. A survey consisting of 16 questions was prepared to assess physicians’ knowledge regarding local anesthetic toxicity and the use of intravenous lipid therapy for its treatment. The survey was used to obtain participants’ general knowledge of local anesthetic drugs, their toxicities, and general knowledge of toxicity treatment. Results: A total of 109 physicians participated in this study. The highest participation was received from university hospitals (49.5%), and 47.7% of the participants had been working in this specialty for over 10 years. Lidocaine was the most commonly used agent (94.5%). Allergy (23.85%) and arrhythmia (21.1%) among the early signs of toxicity, and hepatotoxicity (34.86%) and cardiac arrest (33.94%) among the late signs, were frequently selected. While 21.1% of the physicians encountered toxicity, symptomatic treatment (54.13%) was the most frequently chosen method upon encountering toxicity. It was found that 57.8% of the physicians had not heard of lipid therapy for toxicity, and 6.4% used lipid therapy when encountering toxicity. Significant differences were found in the knowledge about treatment application among physicians by their roles in pulmonary clinics (p=0.00). Conclusion: This study revealed a consistent lack of education and awareness among pulmonologists regarding local anesthetic toxicity and its treatment. [ABSTRACT FROM AUTHOR]

Introduction Chronic obstructive pulmonary disease (COPD) is a common disease, yet it is often overlooked by the general public, patients themselves, and doctors due to its slow and insidious progression. Changing the natural history of COPD requires first of all the diagnosis of the disease, so its early detection seems an important element. It then becomes possible to set the objectives and criteria for the assessment of management and to choose the most appropriate treatments for each individual according to his characteristics. Patients and methods A prospective observational study in COPD patients who were hospitalized in the Department of Pneumology, University Hospital Center of Setif from January 2017 to March 2020 to analyze the quality of outpatient management of these patients. Results In all, 349 patients were included in the study of which 82.2% were men with an average age of 62 years. On admission, only 28.6% or 100 patients were diagnosed and confirmed to have COPD. The general practitioner received COPD patients first in more than 1/3 of cases (37.5%). Pneumologists received 34.6% of patients and diagnosed 99 cases out of 121 consultations, so the diagnosis was made in 81.8% of cases. Spirometry is essential for the diagnosis of COPD. It is simple, inexpensive, and safe; however, it was only performed for 100 patients or 28.6% of cases, confirming the sub-diagnosis of COPD in outpatients. In terms of therapeutic management, the differences between international recommendations and current practice are significant, particularly those concerning the prescription of inhaled or systemic corticosteroid therapy, as well as antibiotic therapy, without forgetting the underestimated therapies in these COPD patients, such as vaccinations (influenza vaccination rate at 27.2% of cases, pneumococcal at 8.26%), Long-term oxygen therapy, and the initiation of smoking cessation (4.1% of cases). Conclusion The publication of recommendations reviewed by experts enables updating the diagnostic management of COPD. We can hope that the recommendations will be followed up and that practices will be harmonized. However, differences between international recommendations and current practice are significant for COPD patients. Early diagnosis and effective therapeutic management of COPD remain, particularly current issues; they would reduce disability and improve the quality of life of the patient.

BACKGROUND: Inhaler education for patients with asthma and patients with COPD is typically provided by non-pulmonologists. We studied inhaler education by pulmonologists to determine changes in clinical outcomes and inhaler use. METHODS: This was a retrospective study of 296 subjects diagnosed with asthma, COPD, or both that evaluated use of inhaler technique education and its impact on (1) inhaler/dosage change consisting of dosage change in the same class of inhaler and/or change in number of inhalers, (2) forced expiratory volume in one second/forced vital capacity (FEV1/FVC%), (3) disease symptom control, (4) out-patient visits, (5) urgent care visits (6) emergency department visits, and (7) hospital admissions. One group received inhaler technique education by a pulmonologist while the other group did not. RESULTS: The pulmonologist inhaler technique--educated group had significantly decreased relative risk for inhaler/dosage increase (relative risk 0.57 [95% CI 0.34-0.96], P = .03) and significantly increased odds for symptom control (odds ratio 2.15 [95% CI 1.24-3.74], P = .01) at 1-y follow-up as compared to the no education group. No differences occurred for FEV1/FVC%, out-patient visits, urgent care visits, emergency department visits, and hospital admissions. CONCLUSIONS: Pulmonologist education of inhaler technique for patients with asthma and patients with COPD was associated with decreased relative risk for inhaler/dosage increase and increased odds for symptom control. We recommend pulmonologists provide education of inhaler technique to patients with asthma and patients with COPD and not rely on non-pulmonologist education alone. Prospective research is needed to confirm the importance of proper inhaler techniques. [ABSTRACT FROM AUTHOR]

The introduction of a new vaccine into immunization programs represents a significant advancement in the global effort to combat vaccine-preventable diseases. Data from the World Health Organization support that immunization prevents between 2 and 3 million deaths each year across various diseases, underscoring its pivotal role in global health. The present study aims to assess the knowledge, attitudes, and anticipated vaccination practices among health professionals in Central Greece in response to the potential introduction of new Respiratory Syncytial Virus (RSV) vaccination guidelines by the National Vaccines Committee. Among the 450 health professionals solicited for the study, 219 provided responses, yielding a response rate of approximately 55%. A substantial majority (70.3%) accurately identified the vaccine's current availability, and 62.1% were aware of the current recommendation for RSV vaccination in pregnant women. In response to whether health professionals support the inclusion of an RSV vaccine in the national vaccination program if it becomes commercially available and is recommended by the Greek National Immunization Program, general practitioners showed the most support, with an average score of 4.86 (95% CI, 4.69–5.00), followed by pediatricians at 4.76 (95% CI, 4.63–4.89), pulmonologists at 4.68 (95% CI, 4.36–5.00), and obstetricians at 4.33 (95% CI, 3.95–4.71). Concerning general opinions on vaccinations, a high level of agreement was noted among the majority of health professionals, excluding nurses. Pharmacists recorded the highest agreement, with a perfect score of 5 (CI, 5.00–5.00), followed closely by pediatricians at 4.99 (CI, 4.97–5.00), GPs at 4.95 (CI, 4.85–5.00), pulmonologists at 4.93 (CI, 4.83–5.00), obstetricians at 4.74 (CI, 4.42–5.00), and nurses at 3.80 (CI, 3.06–4.54). A tailored approach to education is needed to ensure that healthcare professionals can communicate more effectively about RSV risks and vaccination benefits, fostering a proactive stance towards disease prevention and patient care. In essence, our study underscores the importance of knowledge in shaping a compassionate and responsive healthcare environment, ready to meet the challenges of RSV head-on. [ABSTRACT FROM AUTHOR]

Background: Malignant pleural effusions (MPEs) are common, and a third of them have underlying trapped lung (TL). Management of MPE and TL is suspected to be heterogeneous. Understanding current practices in Australasia is important in guiding policies and future research. Aims: Electronic survey of Australia‐New Zealand respiratory physicians, thoracic surgeons and their respective trainees to determine practice of MPE and TL management. Results: Of the 132 respondents, 56% were respiratory physicians, 23% were surgeons and 20% were trainees. Many respondents defined TL as >25% or any level of incomplete lung expansion; 75% would use large‐volume thoracentesis to determine whether TL was present. For patients with TL, indwelling pleural catheters (IPCs) were the preferred treatment irrespective of prognosis. In those without TL, surgical pleurodesis was the most common choice if prognosis was >6 months, whereas IPC was the preferred option if survival was <3 months. Only 5% of respondents considered decortication having a definite role in TL, but 55% would consider it in select cases. Forty‐nine per cent of surgeons would not perform decortication when the lung does not fully expand intra‐operatively. Perceived advantages of IPCs were minimisation of hospital time, effusion re‐intervention and usefulness irrespective of TL status. Perceived disadvantages of IPCs were lack of suitable drainage care, potentially indefinite duration of catheter‐in‐situ and catheter complications. Conclusion: This survey highlights the lack of definition of TL and heterogeneity of MPE management in Australasia, especially for patients with expandable lungs. This survey also identified the main hurdles of IPC use that should be targeted. [ABSTRACT FROM AUTHOR]

Background: Rapid On-Site Evaluation (ROSE) during bronchoscopy allows us to assess sample adequacy for diagnosis and molecular analyses in the context of precision oncology. While extemporaneous smears are typically evaluated by pathologists, their presence during bronchoscopy is not always possible. Our aim is to assess the concordance between ROSE performed by interventional pulmonologists and cytopathologists. Methods: We performed ROSE on 133 samples collected from 108 patients who underwent bronchoscopy for the diagnosis of suspect thoracic findings or for mediastinal lymph node staging (May 2023–October 2023). Randomly selected smears (one for each collection site) were independently evaluated for adequacy by a pulmonologist and a pathologist to assess the concordance of their evaluation. Results: Among 133 selected smears evaluated by a pulmonologist and pathologist, 100 were adequate for both, 10 were inadequate for both and 23 were discordant; hence, global concordance was 82.7%; Cohen's Kappa was 0.385, defining fair agreement. Concordance was similar irrespective of sample collection site (lymph nodes vs. pulmonary lesions; p = 0.999) and among samples which were considered adequate or inadequate by the pulmonologist (p = 0.608). Conclusions: Trained pulmonologists can evaluate the appropriateness of sampling with good concordance with cytopathologists. Our work supports autonomous ROSE by pulmonologists where pathologists are not immediately available. [ABSTRACT FROM AUTHOR]

The study aimed to reach a consensus on the most relevant patient-reported outcomes (PROs), the corresponding measures (PROMs), and measurement frequency during severe asthma patient follow-up. Two Delphi rounds were conducted. The questionnaire was developed based on a systematic literature review, a focus group with patients, and a nominal group with experts. It assessed PROs' relevance and the appropriateness (A) and feasibility (F) of PROMs using a Likert scale (1=totally agree; 9=totally disagree). The consensus was established when ≥75% of participants agreed (1-3) or disagreed (7-9). Sixty-three professionals (25 hospital pharmacists, 14 allergists, 13 pulmonologists, and 11 nurses) and 5 patients answered the Delphi questionnaire. A consensus was reached on all PROs regarding their relevance. Experts agreed on the use of ACT (A:95.24%; F:95.24%), mini AQLQ (A:93.65; F:79.37%), mMRC dyspnea scale (A:85.71%; F:85.71%), TAI (A:92.06%; F:85.71%), MMAS (A:75.40%; F:82%), and the dispensing register (A:96.83%; F:92.06%). Also considered suitable were: SNOT-22 (A:90.48%; F:73.80%), PSQI (A:82.54; F:63.90%), HADS (A:82.54; F:64%), WPAI (A:77.78%; F:49.20%), TSQM-9 (A:79.37; F:70.50%) and knowledge of asthma questionnaire (A:77%; F:68.80%); however, their use in clinical practice was considered unfeasible. Panelists also agreed on the appropriateness of EQ-5D, which was finally included despite being considered unfeasible (A: 84.13%; F:67.20%) in clinical practice. Agreement was reached on using ACT, TAI, mMRC, and a dispensing register every three months; mini-AQLQ and MMAS every six months; and EQ-5D every twelve months. This consensus paves the way toward patient-centered care, promoting the development of strategies supporting routine assessment of PROs in severe asthma management. [ABSTRACT FROM AUTHOR]

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Background and objective: Lung cancer is increasingly common, and accurate diagnosis is important for personalized treatment. Ultrasound-guided percutaneous fine-needle aspiration (FNA) is a useful method to obtain a specimen for a histological diagnosis of peripheral lung lesions. The aim of this study is to evaluate the diagnostic accuracy and complication rate of the procedure performed by pulmonologists. The result is compared with that of ultrasound-guided core needle biopsy performed by radiologists. Methods: We retrospectively evaluated the diagnostic accuracy and complication rates of pulmonologist-performed ultrasound-guided FNAs of lung lesions in the period of 1 August 2019 to 30 June 2021 (pulmonologist group) and radiologist-performed ultrasound-guided core needle biopsies (CNBs) of lung lesions in the period of 1 January 2010 to 31 December 2014 (radiologist group). A logistic regression analysis was used to identify independent influence factors associated with diagnostic accuracy in the pulmonologist group and in the combination of both groups. Results: In a 23-month period, pulmonologists in a tertiary center performed 113 episodes of ultrasound-guided fine-needle aspiration for peripheral lung lesions. The diagnostic accuracy and complication rates were 80.4% and 5.3%, respectively, compared to 86.8% and 7.4% in a historical cohort consisting of 68 episodes of ultrasound-guided core needle biopsies performed by radiologists in the same hospital. Lung lesions located in the upper lobe were predictive of successful diagnoses. Conclusions: An ultrasound-guided fine-needle aspiration by a pulmonologist is an easily accessible and reliable method to obtain specimens for histological diagnoses. [ABSTRACT FROM AUTHOR]

BackgroundIncidental and screening-identified lung nodules are common, and a bronchoscopic evaluation is frequently nondiagnostic. The Percepta Genomic Sequencing Classifier (GSC) is a genomic classifier developed in current and former smokers which can be used for further risk stratification in these patients. Percepta GSC has the capability of up-classifying patients with a pre-bronchoscopy risk that is high (> 60%) to "very high risk" with a positive predictive value of 91.5%. This prospective, randomized decision impact survey was designed to test the hypothesis that an up-classification of risk of malignancy from high to very high will increase the rate of referral for surgical or ablative therapy without additional intervening procedures while increasing physician confidence.MethodsData were collected from 37 cases from the Percepta GSC validation cohort in which the pre-bronchoscopy risk of malignancy was high (> 60%), the bronchoscopy was nondiagnostic, and the patient was up-classified to very high risk by Percepta GSC. The cases were randomly presented to U.S pulmonologists in three formats: a pre-post cohort where each case is presented initially without and then with a GSG result, and two independent cohorts where each case is presented either with or without with a GSC result. Physicians were surveyed with respect to subsequent management steps and confidence in that decision.ResultsOne hundred and one survey takers provided a total of 1341 evaluations of the 37 patient cases across the three different cohorts. The rate of recommendation for surgical resection was significantly higher in the independent cohort with a GSC result compared to the independent cohort without a GSC result (45% vs. 17%, p

Diagnostic and therapeutic decision-making in pregnancy with suspected pulmonary embolism (PE) is challenging. European and other international professional societies have proposed various recommendations that are ambiguous, probably due to the unavailability of randomized controlled trials. In the following sections, we discuss the supporting diagnostic steps and treatments. We suggest a standardized diagnostic work-up in pregnant patients presenting with symptoms of PE to make evidence-based diagnostic and therapeutic decisions. We strongly recommend that clinical decisions on treatment in pregnant patients with intermediate- or high-risk pulmonary embolism should include a multidisciplinary team approach involving emergency physicians, pulmonologists, angiologist, cardiologists, thoracic and/or cardiovascular surgeons, radiologists, and obstetricians to choose a tailored management option including an interventional treatment. It is important to be aware of the differences among guidelines and to assess each case individually, considering the specific views of the different specialties. This review summarizes key concepts of the diagnostics and acute management of pregnant women with suspected PE that are supportive for the clinician on duty. [ABSTRACT FROM AUTHOR]

Traditionally, doctors in most specialties work in relative isolation, frequently caring for patients alone or with just a nurse. State-of-the-art care for voice disorders involves a multidisciplinary model that has evolved since the 1980s. Optimal care includes not only a laryngologist who specializes in voice, but also a skilled speech-language pathologist, singing voice specialist, nurse clinician and/or an extended care provider such as a nurse practitioner or physician assistant; and arts medicine specialists in numerous other disciplines including pulmonology, endocrinology, gastroenterology, psychology, psychiatry and many other fields. Voice problems in singers are diagnosed and resolved most efficiently in an integrated team setting. [ABSTRACT FROM AUTHOR]

Little is known about the experiences of frontline professionals in Kazakhstan. Although studies of frontline workers have been conducted worldwide, it is imperative that caution should be exercised when extrapolating findings from disparate societies and generalizing them to Central Asian countries. As such, the purpose of this study was to explore and describe the firsthand experiences, perceptions, and knowledge gained from the experience of Kazakh frontline physicians and nurses during the COVID-19 pandemic. An exploratory-descriptive qualitative (EDQ) study was conducted over the course of a year in COVID-19 hospitals in Kazakhstan, with physicians (n = 23) and nurses (n = 7). Each participant was interviewed three times between May 2021 and May 2022. Braun and Clarke's six-step method was used for the thematic analysis. Three overarching themes and subthemes were identified: (1) Longitudinal Journey ("Nobody knew, nobody understood, nobody was ready"; "It's just life"); (2) Facets of Professionalism ("In my lifetime this is something unique"; "Who else if not us"; "We survived the war and the enemy"); and (3) Facets of Resilience ("God's providence"; "A good word heals too"). In light of the lack of research that has previously been conducted in Kazakhstan, the results of this study offer important new insight into the experiences of medical professionals during the COVID-19 epidemic. [ABSTRACT FROM AUTHOR]

Introduction: Chronic cough (CC) presents a widespread and intricate challenge for diagnosis and treatment, revealing a significant lack of information on medical strategies. This study aims to gather insights from different practitioners in Southern Italy regarding their views and methodologies towards CC. Methods: The investigation engaged 102 medical practitioners from Southern Italy, encompassing 23 general practitioners, 30 pulmonologists, 25 allergologists, and 24 otolaryngologists. It examined their understanding, attitudes, and approaches towards managing CC, with an emphasis on diagnostic processes, treatment preferences, and adherence to guidelines. Results: The findings highlight distinct variations in the management of chronic cough among different medical specialists. Notably, otolaryngologists and pulmonologists tend to categorize chronic cough as lasting for more extended periods than allergists and general practitioners. Pulmonologists, in particular, are more prone to suggest chest X-rays for chronic cough patients, reflecting their focus on lung-related conditions. In terms of the primary causes of CC, allergists and pulmonologists often attribute it to asthma, general practitioners to gastro-esophageal reflux disease, and otolaryngologists to upper airways cough syndrome. Pulmonologists are also observed to have the most comprehensive awareness of the various conditions associated with coughing, which is likely due to their specialization in respiratory health. Conclusions: The research underscores the necessity for enhanced education and standardized procedures among healthcare providers in Southern Italy for managing CC, highlighting the importance of interdisciplinary cooperation and customized treatment plans to improve the outcomes for patients with CC and guide future therapeutic strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND. Patients were likely hesitant to communicate with physicians during the pandemic, when everyone saw others as potentially infectious. Every other was seen as the most likely to be infected as they were in close contact with infected persons. Likewise, physicians might have been wary of communicating with their patients, who might have been virus carriers. In our study, the communication between physicians (particularly pulmonologists) and geriatric patients was evaluated to develop recommendations for improvement if necessary. MATERIAL AND METHODS. The study was conducted as an online evaluation questionnaire via e-mail or WhatsApp. The evaluation form, the Social Communication Skills Rating Scale, collected data regarding the respondents' demographic characteristics, whose reliability and validity have been proven in previous studies. The volunteer pulmonologists completed the questionnaire. RESULTS. The research comprised 200 doctors; 111 (55.5%) were women and 89 (44.5%) were men. Of the doctors who participated in the study, over 40% were in their forties. Pulmonologists' communication skills with their geriatric patients were deemed adequate, and their interactions were evaluated as successful, despite the high risk of infection during the pandemic, the difficulty of examining patients while wearing protective clothing, and the typical communication difficulties of geriatric patients. This has been a crucial advantage for the senior patient group, as, throughout the COVID-19 pandemic, this group has communicated with pulmonologists predominantly owing to medical needs. CONCLUSION. The pulmonologists' effective communication with their geriatric patients could have made them feel good during the difficult time of the past pandemic period. It could have also been a source of pride for physicians. [ABSTRACT FROM AUTHOR]

Background: Patient experiences with COVID-19 aftercare remain largely unknown. We evaluated COVID-19 aftercare from a patient perspective one year after hospitalization, assessing satisfaction and its associated factors, and unmet needs. Methods: The Satisfaction with COVID-19 Aftercare Questionnaire (SCAQ) was developed as part of a multicenter prospective cohort study and administered one year after hospital discharge. The SCAQ assesses (1) patient satisfaction, comprising information provision, rehabilitation, follow-up by hospitals and general practitioners (GPs), the most important aftercare topics, and overall satisfaction, and (2) unmet needs. Results: 487/561 (87%) COVID-19 patients completed the SCAQ, all had been discharged from the hospital between March 2020 and May 2021. Among responders, the median age of patients was 60 (IQR 54–67) years, 338 (69%) were male, and the median length of stay in the hospital was 13 (6–27) days. Patients were least satisfied with information on who could be contacted with questions when health problems arise (59% satisfied or very satisfied). Many patients (75%) received rehabilitation, most frequently community-based (70%). Across the different community-based therapies, ≥ 60% of patients were satisfied with shared-decision making and ≥ 70% with the received therapy; a majority (≥ 79%) indicated a preference for receiving the same therapy again if needed. Regarding follow-up by hospitals, 86% of patients received this follow-up, most frequently visiting a pulmonologist (96%), being generally satisfied with the received aftercare. Aftercare from GPs was received by 39% of patients, with 88% being satisfied with the GP's availability and 79% with referral to appropriate aftercare providers. Patients (> 50%) considered information-related items most important in aftercare. Overall, patients rated their satisfaction with aftercare 8/10 (7–9) points. Those who received medical rehabilitation (versus no rehabilitation, adjusted beta 0.61 [95%CI 0.11 to 1.11], p = 0.02) or aftercare by a hospital medical specialist (1.1 [0.46 to 1.64], p < 0.001) or GP (0.39 [0.053 to 0.72], p = 0.023) reported significantly higher satisfaction than those without such aftercare. Unmet needs were reported by 35% of patients, with lack of information (20%) and lack of additional aftercare and/or involvement of their GP (19%) being the most frequently reported. Conclusion: Despite the forced quick development of COVID-19 aftercare, patients were generally satisfied. Follow-up by healthcare professionals and information provision is important to meet patients' aftercare needs. Highlights: Our findings hold potential implications for enhancing aftercare after hospitalization for COVID-19 and for future pandemics. COVID-19 patients receiving aftercare from hospital medical specialists or general practitioners generally expressed higher satisfaction with COVID-19 aftercare than those who did not. Facilitating this aftercare is recommended to meet the patient's aftercare needs. COVID-19 patients experienced unmet information needs after hospitalization, while they considered information most important in aftercare. Early implementation and promotion of a central online information point, providing up-to-date knowledge (e.g., on the disease, procedures, and recovery), can address the patients' information needs. [ABSTRACT FROM AUTHOR]

The analysis covers the case of a driver suffering from epilepsy for many years, who during an epileptic seizure, in a state of profound disturbance of consciousness, caused a road accident. Such situations usually result in the perpetrator being considered insane in relation to the allegation. The task of expert psychiatrists and psychologists is then to assess the likelihood of the perpetrator of the prohibited act repeating it, and to indicate to the court the optimal therapeutic precautionary or penal measure. These legal solutions also apply to perpetrators who were considered insane due to disturbances of consciousness occurring in the course of various somatic diseases, and not permanent mental disorders. Currently, there are no grounds for appointing expert neurologists, diabetologists, cardiologists, pulmonologists, and other specialists who would assess the legitimacy of taking precautionary measures, which may raise judicial doubts. Moreover, applying in such cases only the measures indicated in Article 93a § 1 of the Penal Code does not find any psychiatric and psychological justification. Consideration should be given to extending the catalog of protective measures to include the therapy of various somatic diseases in order to minimize the risk of developing deep mental disorders in the future. The work proposes new opinion-making solutions, which, however, requires changes in legal regulations. [ABSTRACT FROM AUTHOR]

Introduction: The investigation of peripheral pulmonary lesions (PPLs) can be challenging. Several bronchoscopic modalities have been developed to reach and biopsy PPL but the level of adoption of these techniques by interventional pulmonologists (IPs) is unknown. This international survey was conducted to describe current practices in PPL investigation among IP. Methods: This survey was sent to all members of the World Association for Bronchology and Interventional Pulmonology, Canadian Thoracic Society Procedures Assembly, AABIP, and the Groupe d'Endoscopie Thoracique et Interventionnel Francophone. The survey was composed of 48 questions and three clinical cases to establish a portrait of modalities used to investigate and treat PPL by IP around the world. Results: Three hundred and twelve IP responded to the survey. Most of them practice in Europe (n = 122), North America (n = 97), and Asia (n = 49). Half of responders perform more than 100 endoscopic procedures for PPL annually. General anesthesia and conscious sedation are used in similar proportions (53% and 47%, respectively). Rapid on site evaluation (ROSE) is used when sampling PPL by 42%. Radial EBUS (69%), fluoroscopy (55%), and electromagnetic navigation (27%) are the most widely used techniques. Most IP combine techniques (89%). Robotic bronchoscopy (15%) and cone-beam CT (8%) are almost exclusively used in the USA where, respectively, 60% and 37% of respondents reported using these modalities. Ten percent of IP currently had access to endoscopic treatment modalities for PPL. However, half of the remaining IP plan to acquire an endoscopic treatment modality in the next 2 years. Conclusion: Available techniques and practices worldwide vary significantly regarding PPL investigation and treatment. [ABSTRACT FROM AUTHOR]

Objective The goal of this case report is to describe the process, challenges, and opportunities of implementing rehabilitation for individuals who were critically ill and required both mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) support following a coronavirus 2019 (COVID-19) infection in an academic medical center. Methods This administrative case report is set in a heart and vascular intensive care unit, a 35-bed critical care unit that provides services for patients with various complex cardiovascular surgical interventions, including transplantation. Patients were admitted to the heart and vascular intensive care unit with either COVID-19 acute respiratory distress syndrome or pulmonary fibrosis for consideration of bilateral orthotropic lung transplantation. The authors describe the process of establishing rehabilitation criteria for patients who, by previously established guidelines, would be considered too ill to engage in rehabilitation. Results The rehabilitation team, in coordination with an interprofessional team of critical care providers including physicians, respiratory care providers, perfusionists, and registered nurses, collaborated to implement a rehabilitation program for patients with critical COVID-19 being considered for bilateral orthotropic lung transplantation. This was accomplished by (1) reviewing previously published guidelines and practices; (2) developing an interdisciplinary framework for the consideration of rehabilitation treatment; and (3) implementing the framework for patients in our heart and vascular intensive care unit. Conclusion In response to the growing volume of patients admitted with critical COVID-19, the team initiated and developed an interprofessional framework and successfully provided rehabilitation services to patients who were critically ill. While resource-intensive, the process demonstrates that rehabilitation can be implemented on a case-by-case basis for select patients receiving extracorporeal membrane oxygenation and MV, who would previously have been considered too critically ill for rehabilitation services. Impact Rehabilitating patients with end-stage pulmonary disease on extracorporeal membrane oxygenation and MV support is challenging but feasible with appropriate interprofessional collaboration and knowledge sharing. [ABSTRACT FROM AUTHOR]

Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes. [ABSTRACT FROM AUTHOR]

Background: Pulmonary arterial hypertension (PAH) is a life-threatening, progressive disease often diagnosed late in its course. Objectives: To present patient-reported data that were captured within a large, multinational, point-in-time survey of PAH-treating physicians and their patients to better understand the diagnostic journey. Design: Cross-sectional survey conducted in five European countries (EU5), Japan and the USA. Methods: PAH-treating pulmonologists, cardiologists, rheumatologists or internists (USA only) completed a patient record form (PRF) for the next four consecutive adult PAH patients they saw; these patients filled in a patient self-completion (PSC) form on an anonymous, voluntary basis. Our report focuses on patient data; data are from PSC forms unless stated otherwise. Results: Physician-reported PRFs and self-completed PSC forms were obtained for 1152 and 572 patients, respectively. Patients' mean (SD) age was 59.1 (14.0) years, 55.6% were female, and 57.3% had idiopathic PAH. Patient-reported data showed an average delay of 17.0 months between symptom onset and PAH diagnosis. This is longer than physicians estimated (13.8 months): this disparity may be partly due to the time taken by patients to consult a physician about their symptoms [9.6 months overall, longest in the USA (15.3 months)]. Most patients (71.6%) initially consulted primary care physicians about their symptoms and 76.4% of patients were referred to a specialist. Misdiagnoses occurred in 40.9% of patients [most frequent in the USA (51.3%), least common in Japan (27.6%)] and they saw an average of 2.9 physicians overall (3.5 in EU5 versus 2.0 in Japan/USA) before being diagnosed. Diagnosis was most often made by cardiologists (50.4%) or pulmonologists (49.3%). Conclusion: Our data suggest that diagnostic delay in PAH results from patient- and physician-related factors, which differ across regions and include lack of awareness of PAH on both sides. Development of better screening strategies may help address this barrier to timely PAH diagnosis. [ABSTRACT FROM AUTHOR]

Successful participant recruitment for pediatric studies can be challenging and even result in study discontinuation. In conducting a 2-year pilot study for a pediatric mobile health (mHealth) asthma intervention, a group of researchers experienced multiple barriers and failures in all 4 areas of recruitment: generating initial contacts, screening, consenting, and enrollment and retention. The main failures that resulted in minimal participant enrollment were poor participation, communication issues, and difficulties related to recruiting in an emergency department during a pandemic. The following is a report on this study's recruitment efforts, including preliminary and adapted strategies, the results of these strategies, and considerations for researchers who conduct studies with children. The research team concluded that frequent and clear communication, flexibility, and a willingness to alter initial recruitment plans are essential elements for recruitment success in pediatric studies. [ABSTRACT FROM AUTHOR]

Key Points: Question: Can a nurse and social worker palliative telecare team improve quality of life in outpatients with chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD)? Findings: This randomized clinical trial included 306 participants with COPD, HF, or ILD at high risk of hospitalization or death, who reported poor quality of life. Compared with usual care, participants in the intervention reported significantly improved quality of life on the Functional Assessment of Chronic Illness Therapy–General (FACT-G) measure at 6 months (difference in change from baseline, 4.6 points; minimal clinically important difference, ≥4 points). Meaning: For adults with COPD, HF, or ILD at high risk of hospitalization and death and poor quality of life, a nurse and social worker palliative telecare team demonstrated clinically meaningful improvements in quality of life at 6 months. Importance: Many patients with chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD) endure poor quality of life despite conventional therapy. Palliative care approaches may benefit this population prior to end of life. Objective: Determine the effect of a nurse and social worker palliative telecare team on quality of life in outpatients with COPD, HF, or ILD compared with usual care. Design, Setting, and Participants: Single-blind, 2-group, multisite randomized clinical trial with accrual between October 27, 2016, and April 2, 2020, in 2 Veterans Administration health care systems (Colorado and Washington), and including community-based outpatient clinics. Outpatients with COPD, HF, or ILD at high risk of hospitalization or death who reported poor quality of life participated. Intervention: The intervention involved 6 phone calls with a nurse to help with symptom management and 6 phone calls with a social worker to provide psychosocial care. The nurse and social worker met weekly with a study primary care and palliative care physician and as needed, a pulmonologist, and cardiologist. Usual care included an educational handout developed for the study that outlined self-care for COPD, ILD, or HF. Patients in both groups received care at the discretion of their clinicians, which could include care from nurses and social workers, and specialists in cardiology, pulmonology, palliative care, and mental health. Main Outcomes and Measures: The primary outcome was difference in change in quality of life from baseline to 6 months between the intervention and usual care groups (FACT-G score range, 0-100, with higher scores indicating better quality of life, clinically meaningful change ≥4 points). Secondary quality-of-life outcomes at 6 months included disease-specific health status (Clinical COPD Questionnaire; Kansas City Cardiomyopathy Questionnaire-12), depression (Patient Health Questionnaire-8) and anxiety (Generalized Anxiety Disorder-7) symptoms. Results: Among 306 randomized patients (mean [SD] age, 68.9 [7.7] years; 276 male [90.2%], 30 female [9.8%]; 245 White [80.1%]), 177 (57.8%) had COPD, 67 (21.9%) HF, 49 (16%) both COPD and HF, and 13 (4.2%) ILD. Baseline FACT-G scores were similar (intervention, 52.9; usual care, 52.7). FACT-G completion was 76% (intervention, 117 of 154; usual care, 116 of 152) at 6 months for both groups. Mean (SD) length of intervention was 115.1 (33.4) days and included a mean of 10.4 (3.3) intervention calls per patient. In the intervention group, 112 of 154 (73%) patients received the intervention as randomized. At 6 months, mean FACT-G score improved 6.0 points in the intervention group and 1.4 points in the usual care group (difference, 4.6 points [95% CI, 1.8-7.4]; P =.001; standardized mean difference, 0.41). The intervention also improved COPD health status (standardized mean difference, 0.44; P =.04), HF health status (standardized mean difference, 0.41; P =.01), depression (standardized mean difference, −0.50; P <.001), and anxiety (standardized mean difference, −0.51; P <.001) at 6 months. Conclusions and Relevance: For adults with COPD, HF, or ILD who were at high risk of death and had poor quality of life, a nurse and social worker palliative telecare team produced clinically meaningful improvements in quality of life at 6 months compared with usual care. Trial Registration: ClinicalTrials.gov Identifier: NCT02713347 This randomized clinical trial compares differences in quality of life among 306 adults at high risk of death who have COPD, heart failure, or interstitial lung disease and who received nurse and social worker palliative telecare vs usual care. [ABSTRACT FROM AUTHOR]

This article discusses a study that aimed to improve the detection of Alpha-1 Antitrypsin Deficiency (AATD) through provider education. A web-based education module was developed and deployed to healthcare providers, focusing on addressing barriers to screening for AATD. The study found that provider confidence in identifying high-risk patients for AATD improved after completing the module, and the rate of screening for AATD also increased. The study highlights the importance of targeted healthcare provider education in improving AATD detection and emphasizes the value of testing in high-risk individuals. [Extracted from the article]

Interventional pulmonologists require a unique set of skills including precise motor abilities and physical endurance, but surprisingly the application of ergonomic principles in the field of bronchoscopy remains limited. This is particularly intriguing when considering the significant impact that poor ergonomics can have on diagnostic aptitude, income potential and overall health. It is therefore imperative to provide comprehensive education to physicians regarding the significance of ergonomics in their work, especially considering the introduction of advanced diagnostic and therapeutic procedures. By implementing simple yet effective measures (e.g. maintaining neutral positions of the wrist, neck and shoulder; adjusting the height of tables and monitors; incorporating scheduled breaks; and engaging in regular exercises), the risk of injuries can be substantially reduced. Moreover, objective tools are readily available to assess ergonomic postures and estimate the likelihood of work-related musculoskeletal injuries. This review aims to evaluate the current literature on the impact of procedure-related musculoskeletal pain on practising pulmonologists and identify modifiable factors for future research. [ABSTRACT FROM AUTHOR]

The coronavirus disease-19 (COVID-19) increased the already heavy workload in the pulmonary and respiratory departments, which therefore possibly increased the prevalence of burnout among pulmonologists or respiratory therapists. We aimed to compare the differences in burnout among pulmonologists or respiratory therapists pre- and post-COVID-19 by doing a systematic review with meta-analysis. We searched pulmonologist, or pulmonary, or respiratory, and burnout up to 29 January 2023 in six databases. We included studies investigating pulmonologists or respiratory therapists and reporting the prevalence of burnout among them. The risk of bias was assessed by a tool for prevalence studies. The overall prevalence of burnout was pooled. A total of 2859 records were identified and 16 studies were included in the final analysis. The included studies reported 3610 responding individuals and 2336 burnouts. The pooled prevalence of burnout was 61.7% (95% confidence interval (CI), 48.6–73.2%; I2 = 96.3%). The pooled prevalence of burnout during COVID-19 was significantly higher than it was prior to the outbreak (68.4% vs. 41.6%, p =.01). The result of the meta-regression revealed that COVID-19 coverage was significantly associated with the prevalence of burnout (p =.04). Burnout was widely prevalent among pulmonologists or respiratory therapists and increasingly perceived during COVID-19. Therefore, interventions were needed to reduce burnout in this specialty. The coronavirus disease-19 increased the already heavy workload in the pulmonary and respiratory departments. Burnout was widely prevalent among pulmonologists or respiratory therapists and increasingly perceived during COVID-19. [ABSTRACT FROM AUTHOR]

Background: There is an evidence gap on whether the choice of specialty care beneficially affects health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). This study analyzes how newly initiated pulmonologist care affects the generic and disease-specific HRQoL in COPD patients over a period of 1 year. Methods: We linked claims data with data from two survey waves to investigate the longitudinal effect of specialty care on HRQoL using linear Difference-in-Difference models based on 1:3 propensity score matched data. Generic HRQoL was operationalized by EQ-5D-5L visual analog scale (VAS), and disease-specific HRQoL by COPD assessment test (CAT). Subgroup analyses examined COPD patients with low (GOLD AB) and high (GOLD CD) exacerbation risk. Results: In contrast to routine care patients, pulmonologists' patients (n = 442) experienced no significant deterioration in HRQoL (VAS − 0.0, p = 0.9870; CAT + 0.5, p = 0.0804). Models unveiled a small comparative advantage of specialty care on HRQoL (mean change: CAT − 0.8, VAS + 2.9), which was especially pronounced for GOLD AB (CAT − 0.7; VAS + 3.1). Conclusion: The uptake of pulmonologist care had a statistically significant, but not clinically relevant, beneficial impact on the development of HRQoL by slowing down overall HRQoL deterioration within 1 year. Including specialty care more appropriately in COPD management, especially at lower disease stages (GOLD AB), could thus improve patients' health outcome. [ABSTRACT FROM AUTHOR]

Interstitial lung disease (ILD) is a frequent complication of rheumatoid arthritis (RA) that is associated with a significant increase in mortality. Several risk factors for the development of ILD in patients with RA have been identified, but ILD can still develop in the absence of these risk factors. Screening tools for RA‐ILD are required to facilitate early detection of RA‐ILD. Close monitoring of patients with RA‐ILD for progression is crucial to enable timely implementation of treatment strategies to improve outcomes. Patients with RA are commonly treated with immunomodulatory therapies, although their efficacy in slowing the progression of RA‐ILD remains the subject of debate. Clinical trials have shown that antifibrotic therapies slow decline in lung function in patients with progressive fibrosing ILDs, including patients with RA‐ILD. The management of patients with RA‐ILD should be based on multidisciplinary evaluation of the severity and progression of their ILD and the activity of their articular disease. Close collaboration between rheumatologists and pulmonologists is essential to optimize patient care. [ABSTRACT FROM AUTHOR]

Objective: Juvenile systemic sclerosis (SSc) is an orphan disease, associated with high morbidity and mortality. New treatment strategies are much needed, but clearly defining appropriate outcomes is necessary if successful therapies are to be developed. Our objective here was to propose such outcomes. Methods: This proposal is the result of 4 face‐to‐face consensus meetings with a 27‐member multidisciplinary team of pediatric rheumatologists, adult rheumatologists, dermatologists, pediatric cardiologists, pulmonologists, gastroenterologists, a statistician, and patients. Throughout the process, we reviewed the existing adult data in this field, the more limited pediatric literature for juvenile SSc outcomes, and data from 2 juvenile SSc patient cohorts to assist in making informed, data‐driven decisions. The use of items for each domain as an outcome measure in an open label 12‐month clinical trial of juvenile SSc was voted and agreed upon using a nominal group technique. Results: After voting, the domains agreed on were global disease activity, skin, Raynaud's phenomenon, digital ulcers, musculoskeletal, cardiac, pulmonary, renal, and gastrointestinal involvement, and quality of life. Fourteen outcome measures had 100% agreement, 1 item had 91% agreement, and 1 item had 86% agreement. The domains of biomarkers and growth/development were moved to the research agenda. Conclusion: We reached consensus on multiple domains and items that should be assessed in an open label, 12‐month clinical juvenile SSc trial as well as a research agenda for future development. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es la tercera causa de muerte a nivel global y en Argentina tiene una prevalencia de 14,5%, pero se desconoce el manejo de los pacientes en la vida real. Los objetivos del trabajo fueron: a) conocer las opiniones de los neumólogos de Argentina que manejan pacientes con EPOC en la práctica diaria. b) Comparar nuestros hallazgos con los especialistas de España y c) considerar nuestros resultados para planificar futuras directrices en el manejo de la EPOC en nuestro país. Material y métodos: Participaron de un consenso Delphi 89 neumólogos de Argentina, expertos en EPOC, quienes respondieron una encuesta con cinco dominios: a) adhesión al tratamiento, b) control de la EPOC, c) rasgos tratables, d) dispositivos de inhalación y e) accesibilidad a los recursos terapéuticos. Resultados: Tras dos rondas, se alcanzó el consenso en 77,6% del total de las afirmaciones y discriminando por dominio los resultados fueron: adhesión al tratamiento: 5/9 (55,5%). Control de la EPOC: 10/14 (71,4%). Rasgos tratables: 6/6 (100%). Dispositivos de inhalación: 10/14 (71,4%) y accesibilidad al tratamiento: 6/6 (100%). En la mayoría de las afirmaciones los resultados fueron similares a los obtenidos por los neumólogos españoles. Conclusiones: Los neumólogos argentinos manejamos a los pacientes con EPOC de manera similar y con mínimas diferencias con nuestros colegas españoles. Se evidenció que, en la práctica diaria, existen factores que impactan negativamente en el acceso a los tratamientos indicados. Nuestro trabajo podría servir como punto de partida para mejorar esta situación. Abstract: Introduction: COPD is the third cause of death globally and in Argentina COPD has a prevalence of 14.5%, but the management of patients in real life is unknown. The objectives of this work were: a) To know the opinions of pulmonologists in Argentina who manage patients with COPD in different aspects of daily practice. b) Compare our findings with specialists from Spain and c) Consider our results to plan future directives in the management of COPD in our country. Material and methods: 89 pulmonologists from Argentina, experts in COPD, participated in a Delphi consensus, who responded to a survey with five domains. a) Adherence to treatment, b) Control of COPD, c) Treatable features, d) Inhalation devices and e) Accessibility to therapeutic resources. Results: After two rounds of questions, total consensus was achieved in 77.6% of the statements and discriminating by domain: Treatment adherence: 5/9 (55.5%). COPD control: 10/14 (71.4%). Treatable traits: 6/6 (100%). Inhalation devices: 10/14 (71.4%) and Accessibility to treatment: 6/6 (100%). In most of the affirmations, the results were similar to those obtained by Spanish pulmonologists. Conclusions: Pulmonologists from Argentina manage COPD patients in a similar way and with minimal differences with our Spanish colleagues. It became evident that, in daily practice, there are factors that negatively impact access to the indicated treatments. Our work could serve as a starting point to improve this situation.

Background: Idiopathic pulmonary fibrosis (IPF) is a serious illness with an unpredictable disease course and survival rates comparable with some cancers. Patients with IPF suffer considerable symptom burden, declining quality of life, and high health care resource utilization. Patients and caregivers report many unmet needs, including a desire for more education regarding diagnosis and assistance with navigating disease trajectory. Compelling evidence suggests that palliative care (PC) provides an extra layer of support for patients with serious illness. Research Question: The purpose of this survey was to gain perspectives regarding PC for patients with IPF by board-certified pulmonologists in South Carolina (SC). Study Design and Methods: A 24-item survey was adapted (with permission) from the Pulmonary Fibrosis Foundation PC Survey instrument. Data were analyzed and results are presented. Results: Pulmonologists (n?=?32, 44%) completed the survey; 97% practice in urbanized settings. The majority agreed that PC and hospice do not provide the same service. There were varying views about comfort in discussing prognosis, disease trajectory, and addressing advance directives. Options for ambulatory and inpatient PC are limited and early PC referral does not occur. None reported initiating a PC referral at time of initial IPF diagnosis. Interpretation: Pulmonologists in SC who participated in this survey are aware of the principles of PC in providing comprehensive care to patients with IPF and have limited options for PC referral. PC educational materials provided early in the diagnosis can help facilitate and guide end-of-life planning and discussions. Minimal resources exist for patients in underserved communities.

BackgroundInterstitial lung abnormalities (ILA) may represent undiagnosed early-stage or subclinical interstitial lung disease (ILD). ILA are often observed incidentally in patients who subsequently develop clinically overt ILD. There is limited information on consensus definitions for, and the appropriate evaluation of, ILA. Early recognition of patients with ILD remains challenging, yet critically important. Expert consensus could inform early recognition and referral.Research questionCan consensus-based expert recommendations be identified to guide clinicians in the recognition, referral, and follow-up of patients with or at risk of developing early ILDs?Study design and methodsPulmonologists and radiologists with expertise in ILD participated in two iterative rounds of surveys. The surveys aimed to establish consensus regarding ILA reporting, identification of patients with ILA, and identification of populations that might benefit from screening for ILD. Recommended referral criteria and follow-up processes were also addressed. Threshold for consensus was defined a priori as ≥ 75% agreement or disagreement.ResultsFifty-five experts were invited and 44 participated; consensus was reached on 39 of 85 questions. The following clinically important statements achieved consensus: honeycombing and traction bronchiectasis or bronchiolectasis indicate potentially progressive ILD; honeycombing detected during lung cancer screening should be reported as potentially significant (eg, with the Lung CT Screening Reporting and Data System "S-modifier" [Lung-RADS; which indicates clinically significant or potentially significant noncancer findings]), recommending referral to a pulmonologist in the radiology report; high-resolution CT imaging and full pulmonary function tests should be ordered if nondependent subpleural reticulation, traction bronchiectasis, honeycombing, centrilobular ground-glass nodules, or patchy ground-glass opacity are observed on CT imaging; patients with honeycombing or traction bronchiectasis should be referred to a pulmonologist irrespective of diffusion capacity values; and patients with systemic sclerosis should be screened with pulmonary function tests for early-stage ILD.InterpretationGuidance was established for identifying clinically relevant ILA, subsequent referral, and follow-up. These results lay the foundation for developing practical guidance on managing patients with ILA.

A pilot study was conducted to assess the inhalation technique in asthmatic children using video clips recorded at home. The study found that in about 82% of cases, the video clips were of sufficient quality to assess the technique. Additionally, the study identified errors in inhalation technique in two-thirds of the children, which could potentially hinder the effectiveness of treatment. The use of home video assessment could be a valuable tool in remotely correcting and improving inhalation technique without waiting for a scheduled visit. Further research is needed to evaluate this method in different care settings and with different devices. [Extracted from the article]

AbstractObjectives The coronavirus disease-19 (COVID-19) increased the already heavy workload in the pulmonary and respiratory departments, which therefore possibly increased the prevalence of burnout among pulmonologists or respiratory therapists. We aimed to compare the differences in burnout among pulmonologists or respiratory therapists pre- and post-COVID-19 by doing a systematic review with meta-analysis.Methods We searched pulmonologist, or pulmonary, or respiratory, and burnout up to 29 January 2023 in six databases. We included studies investigating pulmonologists or respiratory therapists and reporting the prevalence of burnout among them. The risk of bias was assessed by a tool for prevalence studies. The overall prevalence of burnout was pooled.Results A total of 2859 records were identified and 16 studies were included in the final analysis. The included studies reported 3610 responding individuals and 2336 burnouts. The pooled prevalence of burnout was 61.7% (95% confidence interval (CI), 48.6–73.2%; I2 = 96.3%). The pooled prevalence of burnout during COVID-19 was significantly higher than it was prior to the outbreak (68.4% vs. 41.6%, p = .01). The result of the meta-regression revealed that COVID-19 coverage was significantly associated with the prevalence of burnout (p = .04).Conclusions Burnout was widely prevalent among pulmonologists or respiratory therapists and increasingly perceived during COVID-19. Therefore, interventions were needed to reduce burnout in this specialty.KEY MESSASGESThe coronavirus disease-19 increased the already heavy workload in the pulmonary and respiratory departments.Burnout was widely prevalent among pulmonologists or respiratory therapists and increasingly perceived during COVID-19.

Objective: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. Methods: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. Results: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. Conclusions: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care. [ABSTRACT FROM AUTHOR]

Objective: Lung disease (LD) is an increasingly recognized complication of systemic juvenile idiopathic arthritis (sJIA). As there are no currently available guidelines for pulmonary screening in sJIA, we sought to develop such an algorithm at our institution. Methods: A multidisciplinary workgroup was convened, including members representing rheumatology, pulmonary, stem cell transplantation, and patient families. The workgroup leaders drafted an initial algorithm based on published literature and experience at our center. A modified Delphi approach was used to achieve agreement through three rounds of anonymous, asynchronous voting and a consensus meeting. Statements approved by the workgroup were rated as appropriate with moderate or high levels of consensus. These statements were organized into the final approved screening algorithm for LD in sJIA. Results: The workgroup ultimately rated 20 statements as appropriate with a moderate or high level of consensus. The approved algorithm recommends pulmonary screening for newly diagnosed patients with sJIA with clinical features that the workgroup agreed may confer increased risk for LD. These "red flag features" include baseline characteristics (young age of sJIA onset, human leukocyte antigen type, trisomy 21), high disease activity (macrophage activation syndrome [MAS], sJIA‐related ICU admission, elevated MAS biomarkers), respiratory symptoms or abnormal pulmonary examination findings, and features of drug hypersensitivity‐like reactions (eosinophilia, atypical rash, anaphylaxis). The workgroup achieved consensus on the recommended pulmonary work‐up and monitoring guidelines. Conclusion: We developed a pulmonary screening algorithm for sJIA‐LD through a multidisciplinary consensus‐building process, which will be revised as our understanding of sJIA‐LD continues to evolve. [ABSTRACT FROM AUTHOR]

Background: The utilization of Complementary and Alternative Medicine (CAM) has grown remarkably over the years as people seek alternative treatment methods to conventional medicine to manage various health conditions. Aim: The study aimed to assess the utilization of herbal remedies in treating respiratory disorders, enhance the safe and efficient use of herbal medicinal products, and raise awareness of the effectiveness of CAM in respiratory tract diseases in Northern Cyprus. Materials and Methods: The study was conducted on 610 respiratory patients, 10 pulmonologists, and 150 pharmacists, who participated voluntarily in the survey. The data was collected through three tailored questionnaires distributed to the target participants face-to-face and online. The collected data were analyzed using the SPSS software. Results: The data obtained from the survey indicated that patients with lower income and educational attainment tend to use herbal medicinal products less frequently compared to those with higher income (p= 0.026) and educational levels (p= 0.003). Pharmacists aged under 45 were more knowledgeable about herbal medicinal products than pharmacists over 45 (p<0.05). It was observed that a substantial majority (96%) of pharmacists recommend herbal medicinal products to their patients, primarily for preventive purposes. Additionally, pulmonologists lacked knowledge of herbal medicinal compositions, posology, administration, indications, side effects, and usage warnings. Conclusion: The study highlights the lack of adequate information among pharmacists, patients and pulmonologists regarding using herbal medicinal products for respiratory diseases. There is a pressing need for seminars and credible resources to address this knowledge deficit. [ABSTRACT FROM AUTHOR]

The primary defect in Kartagener's syndrome is at the ciliary level and so the normal ciliary activity is compromised causing impaired respiratory tract clearance, infertility and defective organ(s) orientation and left-right laterality predisposition during organogenesis. The authors came across the case of a 20-year-old female that was later diagnosed with Kartagener's syndrome. This case may be of particular interest to general physicians and pulmonologists. [ABSTRACT FROM AUTHOR]

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Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare chronic disease of the small pulmonary arteries that causes right heart failure and death. Accurate management of PAH is necessary to decrease morbidity and mortality. Understanding current practices and perspectives on PAH is important. For this purpose, we intended to determine physicians' knowledge, attitudes, and practice patterns in adult pulmonary arterial hypertension (PAH) in Turkey. Materials and Methods: Between January and February 2022, an online questionnaire was sent via e-mail to all cardiologists and pulmonologists who were members of the Turkish Society of Cardiology (TSC) and the Turkish Thoracic Society (TTS). Results: A total of 200 physicians (122 pulmonologists and 78 cardiologists) responded to the questionnaire. Cardiologists were more frequently involved in the primary diagnosis and treatment of PAH than pulmonologists (37.2% vs. 23.8%, p = 0.042). More than half of the physicians had access to right heart catheterization. In mild/moderate PAH patients with a negative vasoreactivity test, the monotherapy option was most preferred (82.8%) and endothelin receptor antagonists (ERAs) were the most preferred group in these patients (73%). ERAs plus phosphodiesterase-5 inhibitors (PDE-5 INH) were the most preferred (69%) combination therapy, and prostacyclin analogues plus PDE-5 INH was preferred by only pulmonologists. Conclusions: Overall, clinical management of patients with PAH complied with guideline recommendations. Effective clinical management of PAH in specialized centers that having right heart catheterization achieve better outcomes. [ABSTRACT FROM AUTHOR]

Massimiliano Polastri and Gian Maria Paganelli discuss the clinical tools used to predict the clinical progress of patients undergoing lung transplantation. [ABSTRACT FROM AUTHOR]

Background: Delays in health care have been observed in the U.S. during the COVID-19 pandemic; however, the prevalence of inability to get needed care and potential disparities in health care access have yet to be assessed. Methods: We conducted a nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults between 12/2020–2/2021 (baseline) and 8/16/2021–9/9/2021 (6-month follow-up). Participants were asked "Since the start of the pandemic, was there any time when you did not get medical care that you needed?" Those who responded "Yes" were asked about the type of care and the reason for not receiving care. Poisson regression was used to estimate the association between sociodemographics and inability to receive needed care; all analyses were stratified by chronic condition status. Chronic conditions included: chronic obstructive pulmonary disease (COPD), heart conditions, type 2 diabetes, chronic kidney disease or on dialysis, sickle cell disease, cancer, and immunocompromised state (weakened immune system). Results: Overall, 20.0% of participants at baseline and 22.7% at follow-up reported not getting needed care. The most common reasons for being unable to get needed care included fear of COVID-19 (baseline: 44.1%; follow-up: 47.2%) and doctors canceled appointment (baseline: 25.3%; follow-up: 14.1%). Routine care (baseline: 59.9%; follow-up: 62.6%) and chronic care management (baseline: 31.5%; follow-up: 30.1%) were the most often reported types of delayed care. Fair/poor self-reported physical health was significantly associated with being unable to get needed care despite chronic condition status (≥ 1 chronic condition: aPR = 1.36, 95%CI = 1.04–1.78); no chronic conditions: aPR = 1.52, 95% CI = 1.28–1.80). The likelihood of inability to get needed care differed in some instances by race/ethnicity, age, and insurance status. For example, uninsured adults were more likely to not get needed care (≥ 1 chronic condition: aPR = 1.76, 95%CI = 1.17–2.66); no chronic conditions: aPR = 1.25, 95% CI = 1.00–1.56). Conclusions: Overall, about one fifth of participants reported being unable to receive needed care at baseline and follow-up. Delays in receiving needed medical care may exacerbate existing conditions and perpetuate existing health disparities among vulnerable populations who were more likely to have not received needed health care during the pandemic. [ABSTRACT FROM AUTHOR]

Background: The Hepatic hydrothorax is a pleural effusion related to portal hypertension; its diagnosis and therapeutic management may be difficult. The aims of this article are which follows: To gather the practices of hepatogastroenterologists or pulmonologists practitioners regarding the diagnosis and management of the hepatic hydrothorax. Methods: Practitioners from 13 French- speaking countries were invited to answer an online questionnaire on the hepatic hydrothorax diagnosis and its management. Results: Five hundred twenty-eight practitioners (80% from France) responded to this survey. 75% were hepatogastroenterologists, 20% pulmonologists and the remaining 5% belonged to other specialities. The Hepatic hydrothorax can be located on the left lung for 64% of the responders (66% hepatogastroenterologists vs 57% pulmonologists; p = 0.25); The Hepatic hydrothorax can exist in the absence of clinical ascites for 91% of the responders (93% hepatogastroenterologists vs 88% pulmonologists; p = 0.27). An Ultrasound pleural scanning was systematically performed before a puncture for 43% of the responders (36% hepatogastroenterologists vs 70% pulmonologists; p < 0.001). A chest X-ray was performed before a puncture for 73% of the respondeurs (79% hepatogastroenterologists vs 54% pulmonologists; p < 0.001). In case of a spontaneous bacterial empyema, an albumin infusion was used by 73% hepatogastroenterologists and 20% pulmonologists (p < 0.001). A drain was used by 37% of the responders (37% hepatogastroenterologists vs 31% pulmonologists; p = 0.26).An Indwelling pleural catheter was used by 50% pulmonologists and 22% hepatogastroenterologists (p < 0.01). TIPS was recommended by 78% of the responders (85% hepatogastroenterologists vs 52% pulmonologists; p < 0.001) and a liver transplantation, by 76% of the responders (86% hepatogastroenterologists vs 44% pulmonologists; p < 0.001). Conclusions: The results of this large study provide important data on practices of French speaking hepatogastroenterologists and pulmonologists; it appears that recommendations are warranted. [ABSTRACT FROM AUTHOR]