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Pulmonology and critical care

Martin Ritt, Karl-Günter Gaßmann, Cornel Christian Sieber
Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians...
October 2016: Zeitschrift Für Gerontologie und Geriatrie
Michael P Leovic, Hailey N Robbins, Michael R Foley, Roman Starikov
Management of the critically-ill pregnant patient presents a clinical dilemma in which there is sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness...
August 20, 2016: American Journal of Obstetrics and Gynecology
Sameer S Kadri, Chanu Rhee, Gabriela Magda, Jeffrey R Strich, Rongman Cai, Junfeng Sun, Brooke K Decker, Naomi P O'Grady
BACKGROUND: An increasing number of physicians are seeking dual training in critical care medicine (CCM) and infectious diseases (ID). Understanding experiences and perceptions of CCM-ID physicians could inform career choices and programmatic innovation. METHODS: All physicians trained and/or certified in both CCM and ID to date in the United States were sent a Web-based questionnaire in 2015. Responses enabled a cross-sectional analysis of physician demographics and training and practice characteristics and satisfaction...
October 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Chanu Rhee, Sameer S Kadri, Robert L Danner, Anthony F Suffredini, Anthony F Massaro, Barrett T Kitch, Grace Lee, Michael Klompas
BACKGROUND: Sepsis is the focus of national quality improvement programs and a recent public reporting measure from the Centers for Medicare and Medicaid Services. However, diagnosing sepsis requires interpreting nonspecific signs and can therefore be subjective. We sought to quantify interobserver variability in diagnosing sepsis. METHODS: We distributed five case vignettes of patients with suspected or confirmed infection and organ dysfunction to a sample of practicing intensivists...
2016: Critical Care: the Official Journal of the Critical Care Forum
Kamran Mahmood, Momen M Wahidi, Kathryn E Osann, Kathleen Coles, Scott L Shofer, Ellen E Volker, Mohsen Davoudi
RATIONALE: Rigid bronchoscopy is increasingly used by pulmonologists for the management of central airway disorders. However, an assessment tool to evaluate the competency of operators in the performance of this technique has not been developed. We created the Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) to serve as an objective, competency-oriented assessment tool of basic rigid bronchoscopic skills, including rigid bronchoscopic intubation and central airway navigation...
April 2016: Annals of the American Thoracic Society
Hans J Lee, Ashutosh Sachdeva
Interventional pulmonary (IP) is an emerging subspecialty of pulmonary medicine which focuses on procedures of the airway, lung, and pleura. As the number of advance procedures increases with the growth of this field, additional formal training is required to offer the full complement of techniques. IP fellowship is a dedicated 12 months fellowship in the United States which occurs after pulmonary/critical care fellowship. There have been several recent milestones in this field which include validated exams based on didactic knowledge and structural organization of fellowship organizations...
December 2015: Journal of Thoracic Disease
Arber Kodra, Maciej Walczyszyn, Craig Grossman, Daniel Zapata, Tarak Rambhatla, Bushra Mina
Kaposi Sarcoma (KS) is an angioproliferative tumor associated with human herpes virus 8 (HHV-8).  Often known as one of the acquired immunodeficiency syndrome (AIDS)-defining skin diseases, pulmonary involvement in KS has only been discussed in a handful of case reports, rarely in a non-HIV patient. Herein we report the case of a 77 year-old- male who presented with a 6-week history of progressive dyspnea on exertion accompanied by productive cough of yellow sputum and intermittent hemoptysis. His past medical history was significant for Non-Hodgkin's Follicular B-Cell Lymphoma (NHL)...
2015: F1000Research
Kam Lun Ellis Hon, King Woon Alan So, William Wong, Hon Ming Cheung, Kam Lau Cheung
Many indices and scores are used in critical care medicine to aid management and predict risk of mortality. We report 2 cases of submersion injury and discuss the usefulness and application of common respiratory and critical care indices. The respiratory indices help better understand the pulmonary pathophysiology and characterize the severity of lung injury and ventilation/perfusion mismatch. Severe lung injury resolved after ventilation support with appropriate positive end-expiratory pressure in both cases...
September 2016: Pediatric Emergency Care
Anthony S McLean
The development of Intensive Care Medicine as a recognizable branch of medicine has been underway for more than half a century, with delivery by a number of different service models. This delivery may be entirely by related medical specialties, such as anesthesiology or pulmonology; alternatively, it may be as a standalone-recognized specialty and frequently by a hybrid of these two extremes. A country may have a completely different delivery model from neighboring countries, and different models may exist within a single country...
September 2015: Critical Care Medicine
Jose Luis Lopez-Campos, Luis Jara-Palomares, Xavier Muñoz, Víctor Bustamante, Esther Barreiro
Despite the overwhelming evidence justifying the use of non-invasive ventilation (NIV) for providing ventilatory support in chronic obstructive pulmonary disease (COPD) exacerbations, recent studies demonstrated that its application in real-life settings remains suboptimal. European clinical audits have shown that 1) NIV is not invariably available, 2) its availability depends on countries and hospital sizes, and 3) numerous centers declare their inability to provide NIV to all of the eligible patients presenting throughout the year...
April 2015: Annals of Thoracic Medicine
Adam Belanger, Jason Akulian
Bedside percutaneous tracheostomy and gastrostomy tube placement are cost-effective and safe techniques employed in the management of critically ill patients requiring prolonged mechanical ventilation. Both procedures have been well characterized and studied in the surgical and gastroenterology literature. Recently the performance of these procedures by interventional pulmonologists have been reported. This review focuses on the role of the interventional pulmonologist in the ICU, specifically in regard to the placement of percutaneous tracheostomies and gastrostomy tubes...
December 2014: Seminars in Respiratory and Critical Care Medicine
David Feller-Kopman, Lonny Yarmus
The field of interventional pulmonology (IP) is a rapidly growing subspecialty of pulmonary and critical care medicine (PCCM), primarily focused on the evaluation and management of patients with lung nodules, masses, mediastinal and hilar adenopathy, central airway obstruction, and pleural disease. Traditionally passed on in the apprenticeship model, dedicated fellowships began in the early 2000s and there are currently approximately 24 IP fellowships throughout the United States. In addition to the evaluation and management of patients with the above diseases, the additional year provides training in advanced diagnostic and minimally invasive therapeutic procedures that are not specifically taught during a standard PCCM fellowship...
December 2014: Seminars in Respiratory and Critical Care Medicine
Daniel Lichtenstein
PURPOSE OF REVIEW: Lung ultrasound, which allows a bedside visualization of the lungs, is increasingly used in critical care. This review aims at highlighting a simple approach to this new discipline. RECENT FINDINGS: The 10 basic signs are the bat sign (indicating pleural line), lung sliding (yielding the seashore sign), the A line (horizontal artifact), the quad and sinusoid sign indicating pleural effusion regardless of its echogenicity, the tissue-like and shred sign indicating lung consolidation, the B line and lung rockets (artifacts indicating interstitial syndrome), abolished lung sliding with the stratosphere sign, suggesting pneumothorax, and the lung point, indicating pneumothorax...
June 2014: Current Opinion in Critical Care
Takero Naito, Haruhisa Ohtani, Kazuo Kobayashi, Masanobu Miyazaki, Kouji Yamada, Masahiro Sugawara, Yoshikazu Naka, Takao Saruta
OBJECTIVE: The goal of this study was to elucidate how the subspecialty and training history of primary care physicians(PCPs) influence CKD management and medical cooperation in Japan. METHODS: We conducted a nationwide questionnaire survey on CKD management for PCPs from December 2012 to March 2013. The questionnaire included 32 items about CKD management and medical cooperation. PCPs' subspecialties were categorized as follows: general internal medicine, nephrology, cardiology, diabetology/endocrinology, gastroenterology, pulmonology, neurology, neurosurgery, hematology, collagen disease/rheumatology, allergology...
2013: Nihon Jinzo Gakkai Shi
Katherine A Hendricks, Mary E Wright, Sean V Shadomy, John S Bradley, Meredith G Morrow, Andy T Pavia, Ethan Rubinstein, Jon-Erik C Holty, Nancy E Messonnier, Theresa L Smith, Nicki Pesik, Tracee A Treadwell, William A Bower
The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax...
February 2014: Emerging Infectious Diseases
Daniel A Lichtenstein
Lung ultrasound is a basic application of critical ultrasound, defined as a loop associating urgent diagnoses with immediate therapeutic decisions. It requires the mastery of ten signs: the bat sign (pleural line), lung sliding (yielding seashore sign), the A-line (horizontal artifact), the quad sign, and sinusoid sign indicating pleural effusion, the fractal, and tissue-like sign indicating lung consolidation, the B-line, and lung rockets indicating interstitial syndrome, abolished lung sliding with the stratosphere sign suggesting pneumothorax, and the lung point indicating pneumothorax...
January 9, 2014: Annals of Intensive Care
Gary A Mueller, Stephen Wolf, Elizabeth Bacon, Shalini Forbis, Leora Langdon, Charlotte Lemming
Disorders of the respiratory system are commonly encountered in the primary care setting. The presentations are myriad and this review will discuss some of the more intriguing or vexing disorders that the clinician must evaluate and treat. Among these are dyspnea, chronic cough, chest pain, wheezing, and asthma. Dyspnea and chest pain have a spectrum ranging from benign to serious, and the ability to effectively form a differential diagnosis is critical for reassurance and treatment, along with decisions on when to refer for specialist evaluation...
July 2013: Current Problems in Pediatric and Adolescent Health Care
Michele Gallo
SESSION TYPE: Imaging PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: HHUSM utilization is spreading outside radiology department at the point of care to guide some procedures and to assist clinical evaluation. The aim of this study was to evaluate the impact of HHUSM utilization in the pulmonologist's hospital practice .METHODS: An ultrasound report was written by the P after each examination Thoracic ultrasound evaluation (TUSE) a database was created after nine months. This database was analized to deduce the impact of HHUSM in pulmonology practice...
October 1, 2012: Chest
B F Jacobson, S Louw, H Büller, M Mer, P R de Jong, P Rowji, E Schapkaitz, D Adler, A Beeton, H-C Hsu, P Wessels, S Haas
BACKGROUND: Pharmacological prophylactic anticoagulation in many countries, including South Africa, is under-prescribed. This has resulted in unacceptable rates of morbidity and mortality. METHOD: The Southern African Society of Thrombosis and Haemostasis held a meeting to update the previous guideline and review new literature including guidelines from other societies. The following specialties were represented on the committees: anaesthetics, cardiology, clinical haematology, critical care, obstetrics and gynaecology, haematopathology, internal medicine, neurology, orthopaedic surgery and pulmonology...
April 2013: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Hans J Lee, David Feller-Kopman, R Wesley Shepherd, Francisco A Almeida, Rabih Bechara, David Berkowitz, Mohit Chawla, Erik Folch, Andrew Haas, Colin Gillespie, Robert Lee, Adnan Majid, Rajiv Malhotra, Ali Musani, Jonathan Puchalski, Daniel Sterman, Lonny Yarmus
BACKGROUND: Interventional pulmonology (IP) is an emerging subspecialty with a dedicated 12 months of additional training after traditional pulmonary and critical care fellowships with fellowships across the country. A multiple-choice question (MCQ) examination was developed to measure didactic knowledge acquired in IP fellowships. METHODS: Interventional pulmonologists from 10 academic centers developed a MCQ-based examination on a proposed curriculum for IP fellowships...
June 2013: Chest
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