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1. Reducing hospital admissions in patients with malignant pleural effusion: a quality improvement study

Author

Jing Peng, Carolyn Presley, Rebecca R Cloyes, Enambir Josan, Nicholas Pastis, Jianing Ma, Marilly Palettas, Susan Vasko-Wood, Chelsea Mohrman, Christian Ghattas, Alberto Revelo, and Jasleen Pannu

Subjects
Medicine (General), R5-920
Abstract

Background Malignant pleural effusions (MPE) can cause severe dyspnoea leading to greater than 125 000 hospitalisations per year and cost greater than US$5 billion per year in the USA. Timely insertion of tunnelled pleural catheters (TPCs) is associated with fewer inpatient days and emergency department visits. We conducted a quality improvement study to reduce hospital admissions of patients with MPE.Methods Key stakeholders were surveyed, including thoracic and breast oncology teams, general pulmonary and interventional pulmonology (IP) to help identify the underlying causes and solutions. Our preintervention group consisted of 51 patients who underwent TPC placement by our IP service. In our first intervention, we reviewed referrals for MPE with the scheduling team and triaged them based on urgency. In the second intervention, we added a follow-up phone call 1 week after the initial thoracentesis performed by IP to assess for the recurrence of symptoms.Results Demographic and clinical characteristics were summarised across the three groups. We evaluated the rate ratio (RR) of admissions in the intervention groups with the multivariable Poisson regression and adjusted for race, gender and cancer. Compared with the preintervention group, intervention I showed trends towards a 41% lower hospital admission rate (RR 0.59 (0.33–1.07), p=0.11). Compared with the preintervention group, intervention II showed trends towards a 40% lower hospital admission rate (RR 0.6 (0.36–0.99), p=0.07). The results did not reach statistical significance. Exploratory comparisons in readmission rates between interventions I and II showed no difference (RR 0.89 (0.43–1.79), p=0.75).Conclusions Both interventions showed trends toward fewer hospital readmissions although they were not statistically significant. Larger-size prospective studies would be needed to demonstrate the continued effectiveness of these interventions.

Published
2023
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2. Ultrasound guided pulmonary artery catheter insertion: An alternative to fluoroscopic guidance

Author

Enambir Josan, Nicholas Pastis, and Ziad Shaman

Subjects
Swan Ganz, Pulmonary artery catheter, Pulmonary hypertension, Shock, Ultrasound, POCUS, Diseases of the respiratory system, RC705-779
Abstract

Pulmonary artery catheters (PACs) can provide extremely valuable objective data in select patients. They are usually advanced by floatation of balloon tip along the normal blood flow and their placement is confirmed under pressure waveform guidance. Imaging such as fluoroscopy is often employed in low flow states and in cardiac catheterization suite to reduce the failure rate and time to wedge; but is not readily available at bedside. In critically ill patient, bedside insertion is feasible but can be complicated by repeated attempts to float the balloon tip through various cardiac chambers. Point of care ultrasound can be used to visualize the balloon tip of PAC inside the cardiac chambers alongside the confirmatory pressure waveform changes.

Published
2022
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4. Key Highlights for the College of American Pathology Statement on Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies

Author

Sinchita Roy-Chowdhuri, J I I Nicholas Pastis, Lonny Yarmus, Christopher R. Gilbert, and Momen M. Wahidi

Subjects
Pulmonary and Respiratory Medicine, Ebus tbna, medicine.medical_specialty, medicine.diagnostic_test, Statement (logic), business.industry, General surgery, Biopsy, Cytodiagnosis, MEDLINE, Critical Care and Intensive Care Medicine, United States, Specimen Handling, Cytology, medicine, Humans, Cardiology and Cardiovascular Medicine, business, Thoracic Wall, Societies, Medical
Published
2020

5. Effect of Zephyr Endobronchial Valves on Dyspnea, Activity Levels, and Quality of Life at One Year. Results from a Randomized Clinical Trial

Author

Mark T. Dransfield, Justin L. Garner, Surya P. Bhatt, Dirk-Jan Slebos, Karin Klooster, Frank C. Sciurba, Pallav L. Shah, Nathaniel T. Marchetti, Richard D. Sue, Shawn Wright, Hiram Rivas-Perez, Tanya A. Wiese, Momen M. Wahidi, Hugo Goulart de Oliveira, Brian Armstrong, Sri Radhakrishnan, Narinder S. Shargill, Gerard J. Criner, Lewis Katz, Francis Cordova, Parag Desai, Nathaniel Marchetti, Victor Kim, Kartik Shenoy, John Travaline, Jiji Thomas, Lii-Yoong H. Criner, Richard Sue, Aaron Thornburg, Terry Thomas, Mark Dransfield, Surya Bhatt, James Michael Wells, Necole Seabron-Harris, Umair Gauhar, Crissie Despirito, Frank Sciurba, Jessica Bon Field, Divay Chandra, Joseph Leader, Roy Semaan, Christina Ledezma, Pallav Shah, Samuel Kemp, Justin Garner, Arafa Aboelhassan, Karthi Srikanthan, Eric Tenda, Anita Abraham, Cai Sim, Momen Wahidi, Kamran Mahmood, Scott Shofer, Kathleen Coles, Guilherme Augusto Oliveira, Betina Machado, Igor Benedetto, Fabio Svartman, Amarilio de Macedo Neto, Leonardo Schreiner, Taiane Vieira, Brian Morrissey, Ken Yoneda, Tina Tham, Daniel Tompkins, Paulo F. Guerreiro Cardoso, Rodrigo Athanazio, Felipe Nominando, Samia Rached, Luciana Cassimiro, Steven Hays, Eric Seeley, Pavan Shrestha, Gabriela R. Dincheva, Adnan Majid, Daniel Alape-Moya, Mihir Parikh, Alichia Paton, Alexis Agnew, Nicholas Pastis, Charlie Strange, Tatsiana Beiko, Danielle Woodford, Mary Blanton, Lisa Kopas, Timothy Connolly, Jose Fernando Santacruz, Bhavin Shah, Mark Vollenweider, Luis Herrera, Rumi Khan, Kristine Sernulka, P. Michael McFadden, Richard Barbers, Michelle Hernandez, Michael Machuzak, Francisco Almeida, Joseph Cicenia, Thomas Gildea, Atul Mehta, Sonali Sethi, Yvonne Meli, David Hsia, Richard Casaburi, William Stringer, Leticia Diaz, Arthur Sung, Meghan Ramsey, Ryan Van Wert, Karen Morris, Nabil Jarad, Tim Batchelor, Iara Sequeiros, Katy Tucker, Malgorzata Kornaszweska, Hazem Fallouh, Ramsey Sabit, Hatam Naase, Joseph George, Azin Salimian, Helen Dyer, Stephen Hazelrigg, Kristal Adams, Karen Bade, Ganesh Krishna, Bryan S. Benn, Michelle Canfield, Sharmila Vetri Villalan, Travis Stewart, Dirk-Ja n Slebos, Nick H. T. ten Hacken, Jorine Hartman, Sonja Augustijn, and Groningen Research Institute for Asthma and COPD (GRIAC)

Subjects
Male, Exacerbation, medicine.medical_treatment, EMPHYSEMA, Bronchoscopic lung volume reduction, law.invention, 0302 clinical medicine, Randomized controlled trial, Quality of life, law, Forced Expiratory Volume, Surveys and Questionnaires, interventional bronchoscopy, Medicine, PREDICTS MORTALITY, 030212 general & internal medicine, LUNG-VOLUME-REDUCTION, Pneumonectomy, Zephyr Valve, Lung function, Original Research, Rehabilitation, Exercise Tolerance, Patient-centered outcomes, Prostheses and Implants, respiratory system, Middle Aged, Treatment Outcome, Pulmonary Emphysema, patient-reported outcomes, Anesthesia, Female, Pulmonary and Respiratory Medicine, REHABILITATION, Adult, Bronchi, Severe copd, OBSTRUCTIVE PULMONARY-DISEASE, CAPACITY, chronic obstructive pulmonary disease, 03 medical and health sciences, severe emphysema, SEVERE COPD, Bronchoscopy, PATIENT-CENTERED OUTCOMES, Humans, Aged, business.industry, respiratory tract diseases, PHYSICAL-ACTIVITY, 030228 respiratory system, EXACERBATION, Quality of Life, business, Adult Pulmonary
Abstract

Rationale: Bronchoscopic lung volume reduction with Zephyr Valves improves lung function, exercise tolerance, and quality of life of patients with hyperinflated emphysema and little to no collateral ventilation. Objectives: Post hoc analysis of patient-reported outcomes (PROs), including multidimensional measures of dyspnea, activity, and quality of life, in the LIBERATE (Lung Function Improvement after Bronchoscopic Lung Volume Reduction with Pulmonx Endobronchial Valves used in Treatment of Emphysema) study are reported. Methods: A total of 190 patients with severe heterogeneous emphysema and little to no collateral ventilation in the target lobe were randomized 2:1 to the Zephyr Valve or standard of care. Changes in PROs at 12 months in the two groups were compared: dyspnea with the Transitional Dyspnea Index (TDI), focal score; the Chronic Obstructive Pulmonary Disease Assessment Test (CAT; breathlessness on hill/stairs); Borg; the EXAcerbations of Chronic pulmonary disease Tool–PRO, dyspnea domain; activity with the TDI, magnitude of task/effort/functional impairment, CAT (limited activities), and the St. George’s Respiratory Questionnaire (SGRQ), activity domain; and psychosocial status with the SGRQ, impacts domain, and CAT (confidence and energy). Results: At 12 months, patients using the Zephyr Valve achieved statistically significant and clinically meaningful improvements in the SGRQ; CAT; and the TDI, focal score, compared with standard of care. Improvements in the SGRQ were driven by the impacts and activity domains (P

Published
2020

6. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE)

Author

Gerard J. Criner, Richard Sue, Shawn Wright, Mark Dransfield, Hiram Rivas-Perez, Tanya Wiese, Frank C. Sciurba, Pallav L. Shah, Momen M. Wahidi, Hugo Goulart de Oliveira, Brian Morrissey, Paulo F. G. Cardoso, Steven Hays, Adnan Majid, Nicholas Pastis, Lisa Kopas, Mark Vollenweider, P. Michael McFadden, Michael Machuzak, David W. Hsia, Arthur Sung, Nabil Jarad, Malgorzata Kornaszewska, Stephen Hazelrigg, Ganesh Krishna, Brian Armstrong, Narinder S. Shargill, Dirk-Jan Slebos, Francis Cordova, Parag Desai, Nathaniel Marchetti, Victor Kim, Kartik Shenoy, John Travaline, Jiji Thomas, Lii-Yoong H. Criner, Aaron Thornburg, Terry Thomas, Surya Bhatt, James Michael Wells, Necole Seabron-Harris, Umair Gauhar, Crissie Despirito, Frank Sciurba, Jessica Bon Field, Divay Chandra, Joseph Leader, Roy Semaan, Christina Ledezma, Pallav Shah, Samuel Kemp, Justin Garner, Arafa Aboelhassan, Karthi Srikanthan, Eric Tenda, Anita Abraham, Cai Sim, Momen Wahidi, Kamran Mahmood, Scott Shofer, Kathleen Coles, Guilherme Augusto Oliveira, Betina Machado, Igor Benedetto, Fabio Svartman, Amarilio de Macedo Neto, Leonardo Schreiner, Taiane Vieira, Ken Yoneda, Tina Tham, Daniel Tompkins, Paulo F. Guerreiro Cardoso, Rodrigo Athanazio, Felipe Nominando, Samia Rached, Luciana Cassimiro, Eric Seeley, Pavan Shrestha, Gabriela R. Dincheva, Daniel Alape-Moya, Mihir Parikh, Alichia Paton, Alexis Agnew, Charlie Strange, Tatsiana Beiko, Danielle Woodford, Mary Blanton, Timothy Connolly, Jose Fernando Santacruz, Bhavin Shah, Luis Herrera, Rumi Khan, Kristine Sernulka, Richard Barbers, Michelle Hernandez, Francisco Almeida, Joseph Cicenia, Thomas Gildea, Atul Mehta, Sonali Sethi, Yvonne Meli, David Hsia, Richard Casaburi, William Stringer, Leticia Diaz, Meghan Ramsey, Ryan Van Wert, Karen Morris, Tim Batchelor, Iara Sequeiros, Katy Tucker, Malgorzata Kornaszweska, Hazem Fallouh, Ramsey Sabit, Hatam Naase, Joseph George, Azin Salimian, Helen Dyer, Kristal Adams, Karen Bade, Bryan S. Benn, Michelle Canfield, Sharmila Vetri Villalan, Travis Stewart, Nick H. T. ten Hacken, Karin Klooster, Jorine Hartman, Sonja Augustijn, and Groningen Research Institute for Asthma and COPD (GRIAC)

Subjects
Male, Pulmonary and Respiratory Medicine, CLINICAL-OUTCOMES, medicine.medical_specialty, Randomization, SURGERY, lung reduction, Bronchi, Critical Care and Intensive Care Medicine, OBSTRUCTIVE PULMONARY-DISEASE, chronic obstructive pulmonary disease, MEDICAL THERAPY, Collateral ventilation, law.invention, 03 medical and health sciences, 0302 clinical medicine, Primary outcome, Randomized controlled trial, law, Forced Expiratory Volume, Surveys and Questionnaires, Internal medicine, Bronchoscopy, Correspondence, Humans, COPD, Medicine, 030212 general & internal medicine, LUNG-VOLUME-REDUCTION, Respiratory system, Exercise Tolerance, IMPORTANT DIFFERENCE, business.industry, Walk distance, OPERATIVE MORTALITY, Endobronchial valve, Equipment Design, Prostheses and Implants, Middle Aged, NATIONAL EMPHYSEMA, medicine.disease, Treatment Outcome, emphysema, Pulmonary Emphysema, 030228 respiratory system, TESTS, Female, business
Abstract

Rationale: This is the first multicenter randomized controlled trial to evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV) in patients with little to no collateral ventilation out to 12 months.Objectives: To evaluate the effectiveness and safety of Zephyr EBV in heterogeneous emphysema with little to no collateral ventilation in the treated lobe.Methods: Subjects were enrolled with a 2:1 randomization (EBV/standard of care [SoC]) at 24 sites. Primary outcome at 12 months was the Delta EBV-SoC of subjects with a post-bronchodilator FEV1 improvement from baseline of greater than or equal to 15%. Secondary endpoints included absolute changes in post-bronchodilator FEV1, 6-minute-walk distance, and St. George's Respiratory Questionnaire scores.Measurements and Main Results: A total of 190 subjects (128 EBV and 62 SoC) were randomized. At 12 months, 47.7% EBV and 16.8% SoC subjects had a Delta FEV1 greater than or equal to 15% (P Conclusions: Zephyr EBV provides clinically meaningful benefits in lung function, exercise tolerance, dyspnea, and quality of life out to at least 12 months, with an acceptable safety profile in patients with little or no collateral ventilation in the target lobe.

Published
2018
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7. Contributors

Author

Alex A. Adjei, Mjung-Ju Ahn, Chris I. Amos, Alberto Antonicelli, Hisao Asamura, Todd Atwood, Paul Baas, Joan E. Bailey-Wilson, David Ball, Fabrice Barlesi, Jose G. Bazan, José Belderbos, Andrea Bezjak, Lucinda J. Billingham, Paolo Boffetta, Martina Bonifazi, Julie R. Brahmer, Elisabeth Brambilla, Fraser Brims, Alessandro Brunelli, Ayesha Bryant, Nicholas Campbell, Brett W. Carter, Robert Cerfolio, Byoung Chul Cho, William C.S. Cho, Hak Choy, Chia-Yu Chu, Glenda Colburn, Henri Colt, Rafael Rosell Costa, Gail E. Darling, Mellar Davis, Patricia M. de Groot, Harry J. de Koning, Paul De Leyn, Dirk De Ruysscher, Ayşe Nur Demiral, Jules Derks, Frank C. Detterbeck, Siddhartha Devarakonda, Anne-Marie C. Dingemans, Jessica S. Donington, Carolyn M. Dresler, Steven M. Dubinett, Grace K. Dy, Jeremy J. Erasmus, Alysa Fairchild, Dean A. Fennell, Hiran C. Fernando, Pier Luigi Filosso, Raja Flores, Kwun Fong, Jesme Fox, David R. Gandara, Leena Gandhi, Laurie Gaspar, Stefano Gasparini, Adi F. Gazdar, Giuseppe Giaccone, Nicolas Girard, Peter Goldstraw, Elizabeth M. Gore, Glenwood Goss, Ramaswamy Govindan, Alissa K. Greenberg, Dominique Grunenwald, Matthias Guckenberger, Swati Gulati, Raffit Hassan, Christopher Hazzard, Fiona Hegi, Thomas Hensing, Roy Herbst, Fred R. Hirsch, Nanda Horeweg, David M. Jablons, James R. Jett, Andrew Kaufman, Paul Keall, Karen Kelly, Feng-Ming (Spring) Kong, Kaoru Kubota, Ite A. Laird-Offringa, Primo N. Lara, Janessa Laskin, Quynh-Thu Le, Cécile Le Péchoux, Elvira L. Liclican, Yolande Lievens, Chia-Chi (Josh) Lin, Billy W. Loo, Michael Mac Manus, Homer A. Macapinlac, Fergus Macbeth, William J. Mackillop, Christopher Maher, Isa Mambetsariev, Sumithra J. Mandrekar, Aaron S. Mansfield, Lawrence B. Marks, Céline Mascaux, Pierre P. Massion, Julien Mazieres, Annette McWilliams, Tetsuya Mitsudomi, Tony Mok, Daniel Morgensztern, Francoise Mornex, James L. Mulshine, Reginald F. Munden, Kristiaan Nackaerts, Shinji Nakamichi, Masayuki Noguchi, Krista Noonan, Silvia Novello, Anna K. Nowak, Kenneth J. O’Byrne, Nisha Ohri, Morihito Okada, Jamie S. Ostroff, Mamta Parikh, Elyse R. Park, Keunchil Park, Harvey I. Pass, Nicholas Pastis, Luis Paz-Ares, Nathan Pennell, Maurice Perol, Rathi N. Pillai, Pieter E. Postmus, Suresh S. Ramalingham, Sara Ramella, Ramón Rami-Porta, Martin Reck, Mary W. Redman, Niels Reinmuth, Umberto Ricardi, David Rice, Carole A. Ridge, William N. Rom, Kenneth E. Rosenzweig, Enrico Ruffini, Valerie W. Rusch, Ravi Salgia, Montse Sanchez-Cespedes, Anjali Saqi, Giorgio V. Scagliotti, Selma Schimmel, Ann G. Schwartz, Suresh Senan, Francis A. Shepherd, Jill M. Siegfried, Gerard A. Silvestri, George R. Simon, Egbert F. Smit, Stephen B. Solomon, Laura P. Stabile, Matthew A. Steliga, Thomas E. Stinchcombe, Nicholas S. Stollenwerk, Jong-Mu Sun, Anish Thomas, Ming-Sound Tsao, Jun-Chieh J. Tsay, Paul Van Houtte, Paul E. Van Schil, Nico van Zandwijk, J.F. Vansteenkiste, Marileila Varella-Garcia, Giulia Veronesi, Shalini K. Vinod, Everett E. Vokes, Heather Wakelee, Tonya C. Walser, Shun-ichi Watanabe, Walter Weder, Benjamin Wei, Ignacio I. Wistuba, James Chih-Hsin Yang, David F. Yankelevitz, Kazuhiro Yasufuku, Ken Y. Yoneda, Gérard Zalcman, Caicun Zhou, Yang Zhou, and Daniel Zips

Published
2018
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8. Diffuse T-wave inversions associated with electroconvulsive therapy

Author

Jamie B. Conti, Nicholas Pastis, and Kevin E. O'Brien

Subjects
Male, medicine.medical_specialty, Digoxin, medicine.medical_treatment, behavioral disciplines and activities, Coronary artery disease, Electrocardiography, Electroconvulsive therapy, T wave, Internal medicine, mental disorders, Humans, Medicine, Electroconvulsive Therapy, Prospective cohort study, Aged, Aged, 80 and over, ST depression, medicine.diagnostic_test, Depression, business.industry, Arrhythmias, Cardiac, medicine.disease, Anesthesia, Circulatory system, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Electroconvulsive therapy (ECT) can lead to ST depression and arrhythmias in patients with coronary artery disease, most likely secondary to increased myocardial oxygen demand. This report describes a case of ECT-associated, global T-wave inversions in a patient with chronic atrial fibrillation treated with digoxin. Laboratory evaluation and echocardiography were normal. These T-wave changes may result from increased sympathetic activity associated with ECT. Prospective studies suggest that this finding may be seen in up to 4% of patients undergoing ECT.

Published
2004
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9. The electrocardiogram in patients with pacemakers

Author

Agustin Castellanos, Cesar A. Castillo, Nicholas Pastis, and Juan Ortiz

Subjects
medicine.medical_specialty, Pacemaker, Artificial, Refractory period, business.industry, Left bundle branch block, Beat (acoustics), Stimulation, Arrhythmias, Cardiac, Anatomy, Right bundle branch block, medicine.disease, QRS complex, Electrocardiography, Fusion beat, Internal medicine, cardiovascular system, Cardiology, medicine, Humans, In patient, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business
Abstract

A study of the pacemaker-induced ventricular complexes can be of help in determining the site of stimulation. The first step consists in separating the stimulus artefacts from the QRS complexes. Right ventricular pacing usually produces a complete left bundle branch block (CLBBB) morphology. The electrical axis can be left, normal or even right, as pacing is performed from the apex to the outflow tract. Rarely an S1-S2-S3 pattern (with negative deflection in V1 and V2) appears during right ventricular apical pacing. Left ventricular stimulation usually produces a right bundle branch block pattern with inferior and rightwards deviation of the AQRS, although a superior axis is rarely seen with inferior stimulation. In the absence of pacer failure the basic QRS morphology produced by late diastolic stimuli can change if: (a) there are significant respiratory movements; (b) stimulation occurs during the relative refractory period; and (c) fusion beats occur. The classical Wolff-Parkinson-White beat was interpreted as a fusion beat, as long as exclusive Kent bundle conduction was not present. In the latter instances pacing from the preexcited area appeared to have produced similar QRS complexes.

Published
1970

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