CHEST pulmonary最新文献

{"title":"Adapting the Tools of Our Trade","authors":"","doi":"10.1016/j.chpulm.2024.100048","DOIUrl":"10.1016/j.chpulm.2024.100048","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100048"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294978922400014X/pdfft?md5=1cc8501f0999a6eb9d2d64ca327addbb&pid=1-s2.0-S294978922400014X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277756","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":"Tackling Comprehensive Asthma Education for Providers One Breath at a Time","authors":"","doi":"10.1016/j.chpulm.2024.100061","DOIUrl":"10.1016/j.chpulm.2024.100061","url":null,"abstract":"<div><h3>Background</h3><p>Exponential growth of knowledge in asthma has advanced the diagnosis and treatment of personalized, phenotype- and endotype-driven care in asthma leading to improved clinical outcomes. However, many knowledge and practice gaps persist among health care professionals. Microlearning has demonstrated efficacy in educational outcomes but is often limited by fragmentation and incomplete information. To integrate the benefits of microlearning into a comprehensive asthma curriculum that addresses knowledge gaps in this rapidly growing field, we built an extensive curriculum in bite-sized, “one breath at a time” portions for physicians managing asthma.</p></div><div><h3>Research question</h3><p>Is creating an asthma curriculum online educational program with modules of microlearning feasible and useful in improving knowledge of clinicians?</p></div><div><h3>Study Design and Methods</h3><p>The CHEST Curriculum Pathway for Asthma was published online on the American College of Chest Physicians (CHEST) learning management site in September 2022. It was derived from existing asthma education at the CHEST organization and was vetted by asthma experts. Pretests and posttests, satisfaction surveys, and user engagement data were collected.</p></div><div><h3>Results</h3><p>In the first 6 months, 523 participants engaged with the CHEST Curriculum Pathway for Asthma. Participant satisfaction was high, and participants answered 68% of the knowledge pretest correctly and 82% of the posttest correctly. Participants completed 82.8% of the individual videos that they opened. Completion rates for each asthma chapter ranged from 22.6% to 57.9%.</p></div><div><h3>Interpretation</h3><p>This educational program is, to our knowledge, the first comprehensive microlearning online curriculum issued by a medical association on asthma. Our results suggest that the CHEST Curriculum Pathway for Asthma was effective in improving knowledge and had high user satisfaction. Comprehensive online educational programs broken into microlearning components may be useful in other topics in pulmonary medicine.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100061"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000278/pdfft?md5=36d1504b247ffeaf3e7dae6225b345e4&pid=1-s2.0-S2949789224000278-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141035240","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":"Dynamic Digital Radiography Pulmonary Function Testing","authors":"","doi":"10.1016/j.chpulm.2024.100052","DOIUrl":"10.1016/j.chpulm.2024.100052","url":null,"abstract":"<div><h3>Background</h3><p>Common diagnostic tests for pulmonary disorders include chest radiography and pulmonary function tests (PFTs). Although essential, these tests only offer a static assessment. Chest dynamic digital radiography (DDR) integrates lung and diaphragm motion in one study with limited radiation exposure. DDR is relatively easy to obtain, but barriers to its clinical adoption include time-consuming manual analysis and unclear correlation with PFTs.</p></div><div><h3>Research Question</h3><p>Can a machine learning pipeline automate DDR analysis? What is the strength of the relationship between PFT measures and automated DDR-based lung area measurements?</p></div><div><h3>Study Design and Methods</h3><p>PFT and DDR studies were obtained in 55 participants. We developed an analysis pipeline using convolutional neural networks capable of quantifying lung areas in DDR images to generate DDR-based PFTs (dPFTs). PFT and dPFT measures were correlated in patients with normal, obstructive, and restrictive lung physiology.</p></div><div><h3>Results</h3><p>We observed statistically significant (<em>P</em> &lt; 1 × 10^-6), strong correlations between dPFT areas and PFT volumes, including total lung capacity (<em>r</em> = 0.764), FEV₁ (<em>r</em> = 0.591), vital capacity (<em>r</em> = 0.763), and functional residual capacity (<em>r</em> = 0.756). Automated DDR and lung shape tracking revealed differences between normal, restrictive, and obstructive physiology using diaphragm curvature indices and strain analysis measurements. Linear regressions allowed for derivation of PFT values from dPFT measurements.</p></div><div><h3>Interpretation</h3><p>Statistically significant correlations found between dPFTs and PFTs suggest that dPFTs can act as a surrogate to PFTs when these are not available or unable to be performed. This study contributes to the potential integration of DDR as a reliable alternative to PFTs.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000187/pdfft?md5=9d2d97c098696dc1a1baf8a3c6ae782b&pid=1-s2.0-S2949789224000187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400217","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":"POINT: Liquid Markers for Risk Stratification of Pulmonary Nodules, Ready for Prime Time? Yes!","authors":"","doi":"10.1016/j.chpulm.2024.100071","DOIUrl":"10.1016/j.chpulm.2024.100071","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000370/pdfft?md5=95f5260546ce40846f6351f049ffdf87&pid=1-s2.0-S2949789224000370-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141389423","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":"Critical Analysis of Hemodynamic Risk Assessment","authors":"Arif Albulushi MD ,&nbsp;Rawan Al Bulushi MD","doi":"10.1016/j.chpulm.2024.100085","DOIUrl":"10.1016/j.chpulm.2024.100085","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000515/pdfft?md5=56201a859709ccd1a4728451fda60728&pid=1-s2.0-S2949789224000515-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696462","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":"Response","authors":"Adam J. Brownstein,&nbsp;Christopher B. Cooper,&nbsp;Sonia Jasuja,&nbsp;Alexander E. Sherman,&nbsp;Rajan Saggar,&nbsp;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}