CHEST pulmonary最新文献

{"title":"Response","authors":"Adam J. Brownstein, Christopher B. Cooper, Sonia Jasuja, Alexander E. Sherman, Rajan Saggar, Richard Channick","doi":"10.1016/j.chpulm.2024.100086","DOIUrl":"10.1016/j.chpulm.2024.100086","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000527/pdfft?md5=989b51e16c9349352350ac7e13ff0e27&pid=1-s2.0-S2949789224000527-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Value of a High-Volume Bronchoscopic Lung Volume Reduction Program for Patients With Severe Emphysema","authors":"Amrita D. Karambelkar MD,&nbsp;Juan P. Uribe MD,&nbsp;Alichia Paton ACNP-BC,&nbsp;Mihir S. Parikh MD,&nbsp;Jason A. Beattie MD,&nbsp;Chenchen Zhang MD, PhD,&nbsp;Adnan Majid MD","doi":"10.1016/j.chpulm.2024.100095","DOIUrl":"10.1016/j.chpulm.2024.100095","url":null,"abstract":"<div><h3>Background</h3><div>Bronchoscopic lung volume reduction (BLVR) has emerged as a promising therapeutic option for patients with COPD. The development of a dedicated BLVR program requires significant resources, both from an interventional pulmonology (IP) team and from the medical center. The financial value of this program is important to assess to develop a feasible and sustainable plan for providing this service in the future.</div></div><div><h3>Research Question</h3><div>Can a BLVR program bring value to a medical center in terms of patient referrals, revenue, and contribution margin?</div></div><div><h3>Study Design and Methods</h3><div>We retrospectively reviewed the charts of patients who were referred for BLVR to the interventional pulmonology clinic at Beth Israel Deaconess Medical Center (BIDMC). Patient demographics were obtained. Outpatient services used to determine candidacy for endobronchial valve placement were analyzed and revenue was estimated. For patients who had valve placement, revenue from the bronchoscopic procedure and subsequent inpatient hospitalization was calculated and the contribution margin of the procedure was estimated.</div></div><div><h3>Results</h3><div>An estimated total of $1 to 1.4 million in revenue was generated in the workup and placement of endobronchial valves for 37 patients. The total revenue for the care of 52 patients deemed not to be candidates for the valve procedure was $144,000 to $170,000. The contribution margin for the procedure was estimated to be 25%. The median length of stay was 3 days. Among all 89 patients referred for BLVR, 26 referrals were made to other specialties at BIDMC during workup. Of these patients, 69.6% were new patients referred to BIDMC for BLVR.</div></div><div><h3>Interpretation</h3><div>In addition to the established therapeutic benefit of BLVR for patients with COPD, a BLVR program in a dedicated, specialized center is economically valuable and sustainable, attracts referrals from other medical centers and health care systems, and generates internal referrals within the medical center.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100095"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the Presence of Lung Incidental Findings on Low-Dose CT for Lung Cancer Screening Lead to Additional Testing?","authors":"Jeffrey Larson MD ,&nbsp;Hyun Joo Kim MD ,&nbsp;Rebecca Freese MS ,&nbsp;Abbie Begnaud MD","doi":"10.1016/j.chpulm.2024.100096","DOIUrl":"10.1016/j.chpulm.2024.100096","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Clinical Impact of Revised Pulmonary Hypertension Definitions at Moderate Altitude","authors":"August Longino MD, MPH ,&nbsp;Alexandra N. Fuher MD ,&nbsp;Kaitlyn Mcleod MD ,&nbsp;Roger S. Winters MD ,&nbsp;William K. Cornwell MD ,&nbsp;Lindsay M Forbes MD ,&nbsp;Todd Bull MD","doi":"10.1016/j.chpulm.2024.100093","DOIUrl":"10.1016/j.chpulm.2024.100093","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension (PH) and precapillary PH definitions have been revised. Before 2018, PH was defined by a mean pulmonary arterial pressure ≥ 25 mm Hg, and precapillary PH was defined by a pulmonary vascular resistance ≥ 3 Wood units and a pulmonary arterial wedge pressure ≤ 15 mm Hg. In 2018, the mean pulmonary arterial pressure threshold dropped to 20 mm Hg. In 2022, the diagnostic threshold of pulmonary vascular resistance dropped from ≥ 3 to &gt; 2 Wood units. The implications of the revised definitions at altitude remain unclear.</div></div><div><h3>Research Question</h3><div>Do revised definitions capture similar patients at altitude and sea level?</div></div><div><h3>Study Design and Methods</h3><div>We analyzed hemodynamic data from patients’ right heart catheterization procedures at 1,609 m. We extracted clinical data on PH diagnosis, progression, and mortality from the electronic medical record and the National Death Index.</div></div><div><h3>Results</h3><div>A total of 2,382 patients were analyzed. Mean resident altitude ± SD was 1,631.1 ± 674 m. Pre-2018, 1,412 patients (59.2%) had PH and 508 patients (21.3%) had precapillary PH. Applying the post-2018 definition resulted in 307 patients (12.8%) being diagnosed with PH, including 86 (3.6%) with a diagnosis of precapillary PH. Applying the post-2022 definition resulted in 306 patients (12.8%) being diagnosed with precapillary PH (<em>P</em> &lt; .05). Patients newly diagnosed with PH had age- and sex-adjusted mortality lower than patients with pre-2018 PH (hazard ratio [HR], 0.67; 95% CI, 0.54-0.83; <em>P</em> &lt; .001) and higher than patients without PH (HR, 0.46; 95% CI, 0.39-0.56). Compared with patients with pre-2018 precapillary PH, patients with post-2022 precapillary PH demonstrated mortality (HR, 0.7; 95% CI, 0.53-0.91; <em>P</em> = .009). There was no significant difference in mortality or progression between patients with post-2018 and pre-2018 precapillary PH.</div></div><div><h3>Interpretation</h3><div>In this study, at moderate altitude, revised definitions of PH identified patients with a greater likelihood of mortality, similar to sea level findings. The post-2022 definition of precapillary PH increased the prevalence of precapillary PH, identifying a population with lower mortality, without progressive disease. Further research on this population is needed.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Collaborative, Interinstitutional Program to Improve the Care of Patients With Chronic Thromboembolic Pulmonary Hypertension","authors":"Bryan A. Kelly DO ,&nbsp;Vikas Aggarwal MD ,&nbsp;Prachi P. Agarwal MD ,&nbsp;Samuel Allen DO ,&nbsp;Rana Awdish MD ,&nbsp;Wael Berjaoui MD ,&nbsp;Domingo J. Franco-Palacios MD ,&nbsp;Reda E. Girgis MD ,&nbsp;Gillian Grafton DO ,&nbsp;Jonathan W. Haft MD ,&nbsp;Brandon Hooks DO ,&nbsp;Reem Ismail NP ,&nbsp;Sheila Krishnan DO ,&nbsp;Scott Visovatti MD ,&nbsp;Vallerie V. McLaughlin MD, FACC ,&nbsp;Victor M. Moles MD","doi":"10.1016/j.chpulm.2024.100092","DOIUrl":"10.1016/j.chpulm.2024.100092","url":null,"abstract":"<div><div>Chronic thromboembolic pulmonary hypertension (CTEPH), a subcategory of pulmonary hypertension and chronic sequela of acute pulmonary embolism, is often underdiagnosed due to nonspecific symptoms. Pulmonary endarterectomy remains the optimal, potentially curative therapy; however, determination of operability is based on multiple factors that may be relatively unique to each patient and largely based on physician expertise. Patients with CTEPH should be referred to CTEPH centers for comprehensive confirmatory diagnostics and operability assessments by multidisciplinary teams. Because CTEPH center experience and expertise are key to improving clinical outcomes, challenges arise when they are not available or easily accessible to patients. This article describes the Michigan Multi-Center CTEPH Collaboration, a multidisciplinary, interinstitutional collaboration program developed by health care centers in Michigan. Pulmonary hypertension and pulmonary embolism teams from centers across the state share expertise and clinical opinions in a monthly virtual conference. This collaborative approach tackles the two main challenges in the treatment of CTEPH head on: accurate diagnosis and patient access to CTEPH centers. Our collaboration model can be used as a best practice across the nation to benefit patients, multidisciplinary teams, and CTEPH centers.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100092"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Looking to Philadelphia for Trends in Lung Cancer Risk and Screening Adherence Among Asian American Patients","authors":"Travis L. Dotson MD,&nbsp;Christina R. Bellinger MD","doi":"10.1016/j.chpulm.2024.100090","DOIUrl":"10.1016/j.chpulm.2024.100090","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100090"},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142719652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic and Clinical Factors Associated With Diagnostic Confidence in Interstitial Lung Disease","authors":"Mary Beth Scholand MD ,&nbsp;Sachin Gupta MD ,&nbsp;Kevin R. Flaherty MD ,&nbsp;Rosalinda V. Ignacio MS ,&nbsp;Zhongze Li MS ,&nbsp;Ayodeji Adegunsoye MD","doi":"10.1016/j.chpulm.2024.100084","DOIUrl":"10.1016/j.chpulm.2024.100084","url":null,"abstract":"<div><h3>Background</h3><div>Accurate diagnosis of interstitial lung disease (ILD) can be challenging. Accordingly, clinicians may attribute a diagnostic certainty based on guideline criteria and clinical judgment. However, further research is needed to refine this approach and improve diagnostic clarity.</div></div><div><h3>Research Question</h3><div>What are the real-world factors associated with diagnostic confidence in fibrotic ILD?</div></div><div><h3>Study Design and Methods</h3><div>Data were included from all patients enrolled in the Pulmonary Fibrosis Foundation Patient Registry from March 2016 to August 2018. Baseline demographic and clinical characteristics were collected at enrollment, or at the test date closest to the date of consent for longitudinal measures. Descriptive analyses were performed separately for all participants, and for subgroup participants with idiopathic pulmonary fibrosis (IPF) and participants with non-IPF ILD, stratified by the level of investigator diagnostic confidence (high vs medium/low) assigned at registry enrollment. Adjusted ORs and 95% CIs were calculated using multivariable logistic regression, with the aforementioned characteristics as predictors.</div></div><div><h3>Results</h3><div>Data up to April 2022 from 1,992 participants were included. In adjusted logistic regression analyses among all participants, antifibrotic use (OR, 1.51; 95% CI, 1.09-2.07), longer time since diagnosis (OR, 0.94; 95% CI, 0.89-0.98) at the research unit of 365 days, and diabetes (OR, 2.56; 95% CI, 1.01-6.44) were significantly associated with higher diagnostic confidence, and non-IPF idiopathic interstitial pneumonia (vs IPF; OR, 0.36; 95% CI, 0.24-0.55), insurance - other (OR, 0.65; 95% CI, 0.43-0.97), and Hispanic ethnicity (OR, 0.54; 95% CI, 0.31-0.94) were significantly associated with lower diagnostic confidence. Factors associated with diagnostic confidence in the IPF and/or non-IPF ILD groups included age, male sex, region, immunomodulatory medication use, multidisciplinary team discussion, surgical lung biopsy, and definite high-resolution CT pattern.</div></div><div><h3>Interpretation</h3><div>These findings suggest that certain demographic and clinical factors may influence physicians’ confidence in diagnosis of IPF and non-IPF ILD. Tailored physician education may help to reduce biases and improve consistency in diagnosis.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchoscopy Without Sedation in Healthy Volunteers","authors":"Dean Kellogg III MD ,&nbsp;Diego Maselli MD ,&nbsp;Kevin Proud MD ,&nbsp;Eusondia Arnett PhD ,&nbsp;Larry S. Schlesinger MD ,&nbsp;Jay I. Peters MD","doi":"10.1016/j.chpulm.2024.100075","DOIUrl":"10.1016/j.chpulm.2024.100075","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Lung Function in Asthma Across the Ages","authors":"Celine Chedraoui MD ,&nbsp;Battoul Fakhry MD ,&nbsp;Joelle Sleiman MD ,&nbsp;Bo Hu PhD ,&nbsp;Amy Attaway MD ,&nbsp;Peter Bazeley MD ,&nbsp;Hyun Jo Kim MS ,&nbsp;Peng Zhang MD ,&nbsp;Joe G. Zein MD, PhD","doi":"10.1016/j.chpulm.2024.100047","DOIUrl":"10.1016/j.chpulm.2024.100047","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 2","pages":"Article 100047"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000138/pdfft?md5=75b83b575f4ae0481188e80fe2d808cb&pid=1-s2.0-S2949789224000138-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diagnostic Yield of Cone Beam CT Combined With Radial-Endobronchial Ultrasound for the Diagnosis of Peripheral Pulmonary Nodules","authors":"Michael V. Brown ,&nbsp;Arash Badiei ,&nbsp;Matthew Arnold ,&nbsp;Hubertus Jersmann ,&nbsp;Thomas Sullivan ,&nbsp;David Fielding ,&nbsp;Phan Nguyen","doi":"10.1016/j.chpulm.2024.100037","DOIUrl":"10.1016/j.chpulm.2024.100037","url":null,"abstract":"<div><h3>Background</h3><p>Identification of peripheral pulmonary nodules (PPNs) is becoming increasingly common with modern imaging and lung cancer screening programs. Navigational bronchoscopy has been developed to augment the diagnostic yield of sampling these nodules. Cone beam CT (CBCT) scan is one navigational tool which can be used alongside the historical criterion standard of fluoroscopy and radial endobronchial ultrasound (r-EBUS).</p></div><div><h3>Research Question</h3><p>What is the diagnostic yield and safety profile of combining CBCT scan with r-EBUS for the diagnosis of PPNs?</p></div><div><h3>Study Design and Methods</h3><p>Embase, PubMed, and Cochrane Central Register of Controlled Trials were searched in March 2023. Eligible studies used CBCT scan with r-EBUS as the primary navigation technique. The primary outcome, diagnostic yield, was analyzed using random effects meta-analysis. Additional subgroup analysis was based on the use of additional navigational technologies. Risk of bias was assessed using the Critical Appraisal Skills Programme tool for diagnostic studies. The Grading of Recommendations Assessment, Development, and Evaluation tool was used to assess the quality of outcomes.</p></div><div><h3>Results</h3><p>Fourteen studies (865 patients and 882 lesions) were included. The risk of bias was significant as assessed using the Critical Appraisal Skills Programme tool, which identified multiple confounders. The pooled diagnostic yield of combined CBCT scan and r-EBUS-guided biopsy for the diagnosis of PPNs was 80% (95% CI, 76%-84%). Subgroup analysis of diagnostic yield for CBCT scan and r-EBUS alone was 80% (95% CI, 76%-83%). The diagnostic yield of CBCT scan and r-EBUS combined with additional navigational technology (electromagnetic navigational bronchoscopy, virtual bronchoscopic navigation, and robotic-assisted bronchoscopy) was 80% (95% CI, 73%-87%). The quality of outcomes was assessed as low to very low using the Grading of Recommendations Assessment, Development, and Evaluation tool. There was a 2.01% pneumothorax rate and 1.08% bleeding rate. Although heterogeneously reported, the total radiation dose was between 19.59 and 85.9 Gy.cm², resulting in an approximate effective dose range of 3.1 to 13.8 mSv.</p></div><div><h3>Interpretation</h3><p>CBCT scan and r-EBUS for the diagnosis of PPNs has a high diagnostic yield and acceptable safety profile. Studies showed moderate heterogeneity with significant bias; hence, generalizability of the study is limited and further prospective trials are required.</p></div><div><h3>Clinical Trial Registration</h3><p>PROSPERO; No.: CRD42023410221; URL: <span>https://www.crd.york.ac.uk/prospero/</span><svg><path></path></svg>.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 2","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000035/pdfft?md5=bc2aa3bf83825252aa53afcfceb99568&pid=1-s2.0-S2949789224000035-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}