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https://www.readbyqxmd.com/read/29216855/impact-of-rapid-investigation-clinic-on-timeliness-of-lung-cancer-diagnosis-and-treatment
#1
Nicole Ezer, Asma Navasakulpong, Kevin Schwartzman, Linda Ofiara, Anne V Gonzalez
BACKGROUND: Guidelines recommend timely evaluation of patients with suspected lung cancer. We evaluated the impact of a Rapid Investigation Clinic (RIC) on timeliness of lung cancer diagnosis and treatment between February 2010 and December 2011. METHODS: Investigation within the RIC was conducted by a pulmonologist and a nurse clinician. Controls were patients with lung cancer, investigated outside the RIC at the same institution during the same time period. The primary outcome was time between first contact with a local physician for suspected lung cancer (T0) and first treatment...
December 8, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29214061/medical-thoracoscopy-and-its-evolving-role-in-the-diagnosis-and-treatment-of-pleural-disease
#2
REVIEW
Vivek Murthy, Jamie L Bessich
Establishing the etiology of exudative pleural effusions in the setting of an unrevealing pleural fluid analysis often requires biopsies from the parietal pleura. While closed pleural biopsy (CPB) has been a popular minimally-invasive approach, it has a poor diagnostic yield, barring a diagnosis of tuberculous pleurisy. Medical thoracoscopy (MT) is a minimally-invasive ambulatory procedure performed under local anesthesia or moderate sedation which allows for direct visualization of biopsy targets as well as simultaneous therapeutic interventions, including chemical pleurodesis and indwelling tunneled pleural catheter (ITPC) placement...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29212107/-expenditure-on-the-care-of-copd-patients-under-everyday-conditions-in-pneumological-practices-differentiated-according-to-patients-in-chronic-care-and-new-patients-and-severity-of-the-illness
#3
A Hellmann, T Hering, J Andres
New patients in the secondary respiratory care require more time for the first consultation and place a higher diagnostic and therapeutic demand if compared to patients already in chronic care. More diagnostic procedures and patient's education by the team are required. No such burden is observed regarding differential degrees of severity of respiratory diseases, e. g. COPD. The overall demands add up to twice the demands of patients already in care. Thus the time required for the treatment of 50 new patients allows consultations for 100 patients already known in the office...
December 6, 2017: Pneumologie
https://www.readbyqxmd.com/read/29209527/pembrolizumab-as-second-line-therapy-in-non-small-cell-lung-cancer-in-northern-norway-budget-impact-and-expected-gain-a-model-based-analysis
#4
Jan Norum, Margareth Aarag Antonsen, Terje Tollåli, Khalid Al-Shibli, Gry Andersen, Kristin Helene Svanqvist, Nina Helbekkmo
Background: Pembrolizumab is a new drug approved in several countries for second-line therapy in non-small cell lung cancer (NSCLC) being programmed cell death ligand (PD-L1) positive. This drug has a high cost, and the cost-effectiveness ratio has been debated. Patients and methods: The budget impact to the Northern Norwegian Regional Health Authority trust of implementing pembrolizumab in second-line therapy in patients with PD-L1-positive NSCLC was calculated...
2017: ESMO Open
https://www.readbyqxmd.com/read/29202589/interstitial-lung-disease-in-systemic-autoimmune-rheumatic-diseases-a-comprehensive-review
#5
Fabiola Atzeni, Maria Chiara Gerardi, Giuseppe Barilaro, Ignazio Francesco Masala, Maurizio Benucci, Piercarlo Sarzi-Puttini
Interstitial lung diseases (ILDs) are among the most serious complications associated with systemic rheumatic diseases, and lead to significant morbidity and mortality; they may also be the first manifestation of connective tissue diseases (CTDs). The aim of this narrative review is to summarise the data concerning the pathogenesis of CTD/ILD and its distinguishing features in different rheumatic diseseas. Areas covered: The pathogenesis, clinical aspects and treatment of ILD associated with rheumatic systemic diseases and CTDs were reviewed by searching the PubMed, Medline, and Cochrane Library databases for papers published between 1995 and February 2017 using combinations of words or terms...
December 5, 2017: Expert Review of Clinical Immunology
https://www.readbyqxmd.com/read/29195577/perspectives-on-managing-solitary-pulmonary-nodules-a-survey-of-primary-care-physicians
#6
Geena Wu, Martin Consunji, Rebecca A Nelson, Kenny Yeung, Canlan Sun, Jae Y Kim, Dan J Raz
Primary care physicians (PCPs) may be involved in the evaluation of solitary pulmonary nodules (SPNs) detected through lung cancer screening. Little is known about their perspectives on the management or the referral of SPN. Using the American Medical Association's Physician Masterfile, we randomly surveyed 1384 PCPs between January and October 2015 with an 18% response rate. A subset analysis was performed on SPN management and referral practices of PCP. These results and those relating to practice characteristics were compared between family practice and internal medicine physicians...
2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29191588/timeliness-of-access-to-lung-cancer-diagnosis-and-treatment-a-scoping-literature-review
#7
REVIEW
Margo M Jacobsen, Sophie C Silverstein, Michael Quinn, Leo B Waterston, Christian A Thomas, James C Benneyan, Paul K J Han
The Institute of Medicine recently called for increased understanding of and commitment to timely care. Lung cancer can be difficult to diagnose, resulting in delays that may adversely affect survival; rapid diagnosis and treatment therefore is critical for enabling improved patient outcomes. This scoping review provides an update on timeliness of lung cancer care over the past decade. We searched PubMed for English-language articles published from 2007 to 2016 that report wait time intervals related to diagnosis and treatment of lung cancer...
October 2017: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
https://www.readbyqxmd.com/read/29166411/a-machine-learning-approach-to-triaging-patients-with-chronic-obstructive-pulmonary-disease
#8
Sumanth Swaminathan, Klajdi Qirko, Ted Smith, Ethan Corcoran, Nicholas G Wysham, Gaurav Bazaz, George Kappel, Anthony N Gerber
COPD patients are burdened with a daily risk of acute exacerbation and loss of control, which could be mitigated by effective, on-demand decision support tools. In this study, we present a machine learning-based strategy for early detection of exacerbations and subsequent triage. Our application uses physician opinion in a statistically and clinically comprehensive set of patient cases to train a supervised prediction algorithm. The accuracy of the model is assessed against a panel of physicians each triaging identical cases in a representative patient validation set...
2017: PloS One
https://www.readbyqxmd.com/read/29164080/the-incidence-and-short-term-outcomes-of-acute-respiratory-illness-with-cough-in-children-from-a-socioeconomically-disadvantaged-urban-community-in-australia-a-community-based-prospective-cohort-study
#9
Kerry K Hall, Anne B Chang, Jennie Anderson, Daniel Arnold, Vikas Goyal, Melissa Dunbar, Michael Otim, Kerry-Ann F O'Grady
Background: Acute respiratory illnesses with cough (ARIwC) are predominant causes of morbidity in Australian Indigenous children; however, data on disease burden in urban communities are scarce. This study aimed to determine the incidence of ARIwC, the predictors of recurrent (≥4 episodes) ARIwC, and development of chronic cough following an ARIwC in urban, predominantly Indigenous, children aged <5 years from northern Brisbane, Australia. Methods: Prospective cohort study of children aged <5 years registered with a primary healthcare center...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29157038/applying-u-s-national-guidelines-for-ototoxicity-monitoring-in-adult-patients-perspectives-on-patient-populations-service-gaps-barriers-and-solutions
#10
Dawn Konrad-Martin, Gayla L Poling, Angela C Garinis, Candice E Ortiz, Jennifer Hopper, Keri O'Connell Bennett, Marilyn F Dille
OBJECTIVES: To promote establishment of effective ototoxicity monitoring programs (OMPs), this report reviews the U.S. national audiology guidelines in relation to "real world" OMP application. Background is provided on the mechanisms, risks and clinical presentation of hearing loss associated with major classes of ototoxic medications. DESIGN: This is a non-systematic review using PubMed, national and international agency websites, personal communications between ototoxicity experts, and results of unpublished research...
November 20, 2017: International Journal of Audiology
https://www.readbyqxmd.com/read/29147774/assessment-of-mediastinal-lymph-node-size-in-pneumococcal-pneumonia-with-bacteremia
#11
Amit Chopra, Aakash Modi, Haroon Chaudhry, Recai Yucel, Neha Rane, John Fantauzzi, Frederic J Hellwitz, Marc A Judson
INTRODUCTION: The significance of mediastinal lymphadenopathy in bacterial pneumonia is unclear. METHODS: We performed a retrospective analysis of mediastinal lymph node size determined by chest CT in patients with bacteremic pneumococcal pneumonia. All patients who had positive blood cultures for streptococcus pneumonia over an 11-year period and had a chest CT scan (index CT) within 2 weeks of the positive blood culture were included in the study. Two thoracic radiologists and one pulmonologist independently examined the index CT plus any chest CT scans performed prior (pre-CT) or after (post-CT) the bacteremic episode...
November 16, 2017: Lung
https://www.readbyqxmd.com/read/29143503/-lung-and-pleural-space-ultrasonography-for-pulmonologist
#12
Leslie Noirez, Laurent P Nicod
In the past twenty years ultrasound has been the subject of renewed interest in lung exploration in the broad sense. The necessity of accessing a means of rapid exploration at the bed of the patient in a critical situation has led to the development of a pleuro-pulmonary ultrasound semiology to make it a diagnostic tool of choice which exceeds the strict framework intensive care units and emergency services. With the diagnosis of thoracic tumors or the exploration of interstitial syndromes, it tends to integrate more into the daily practice of the pulmonologist...
November 15, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29138407/spirometry-is-not-enough-to-diagnose-copd-in-epidemiological-studies-a-follow-up-study
#13
Elena Andreeva, Marina Pokhaznikova, Anatoly Lebedev, Irina Moiseeva, Olga Kuznetsova, Jean-Marie Degryse
A hallmark of the diagnosis of chronic obstructive pulmonary disease (COPD) is the measurement of post-bronchodilator (post-BD) airflow obstruction (AO) by spirometry, but spirometry is not enough for the provision of a clinical diagnosis. In the majority of previous epidemiological studies, COPD diagnosis has been based on spirometry and a few clinical characteristics. The aim of our study was to identify outcomes in patients newly diagnosed with airflow obstruction (AO) based on a diagnostic work-up conducted as part of a population-based cross-sectional study in North-Western Russia...
November 14, 2017: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/29119403/evaluation-of-the-efficiency-of-single-inhaler-combination-therapy-with-budesonide-formoterol-fumarate-in-patients-with-bronchial-asthma-in-daily-clinical-practice
#14
Michał Pirożyński, Piotr Hantulik, Agnieszka Almgren-Rachtan, Jerzy Chudek
INTRODUCTION: The effectiveness of single-inhaler budesonide/formoterol fumarate combination therapy for asthma has been previously shown for the original product. The aim of this nonrandomized, open-label, postauthorization efficacy study (PAES) real-life clinical assessment was to evaluate the clinical effectiveness of a second product (Bufomix Easyhaler(®)) in the daily clinical practice of asthma therapy. METHODS: This multicenter PAES was conducted by 220 unselected allergologists and pulmonologists who enrolled 2200 adult outpatients (age 49...
November 8, 2017: Advances in Therapy
https://www.readbyqxmd.com/read/29111174/-first-treatment-strategies-in-the-2-years-following-lung-cancer-diagnosis-escap-2011-cphg-a-real-life-study-carried-out-in-french-general-hospitals
#15
M Grivaux, F Goupil, B Asselain, F Blanchon, T Collon, D Coëtmeur, C Dayen, C Locher, O Molinier, F Martin, D Debieuvre
INTRODUCTION: The objective of the ESCAP-2011-CPHG cohort study was to perform a real-life analysis of therapeutic strategies used during the first 2years of follow-up after a diagnosis of primary lung cancer. This paper presents the study and its first results in non-small-cell lung cancer (NSCLC). METHODS: Pulmonologists in the respiratory disease departments of 53 general hospitals consecutively included all patients aged 18years and over with lung cancer newly diagnosed in 2010...
October 27, 2017: Revue des Maladies Respiratoires
https://www.readbyqxmd.com/read/29103009/metastatic-melanoma-a-rare-cause-of-central-airway-obstruction
#16
Mohamed Faisal Abdul Hamid, Andrea Ban Yu-Lin, Tidi Maharani Hassan, Nurashikin Mohammad
A middle-aged woman with recurrent malignant melanoma presented initially with massive left pleural effusion. There was a complete obliteration of the left main bronchus on flexible bronchoscopy caused by a mass. Serial cryo-debulking of the tumour was done under rigid bronchoscopy; however, the outcome was not favourable due to the aggressive tumour growth. Vemurafenib was planned after thoracic radiation. She was not keen for the biologics treatment due to financial constraints. We report a case of central airway obstruction due to recurrent aggressive melanoma...
November 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29101086/beyond-idiopathic-pulmonary-fibrosis-diagnosis-multidisciplinary-care-with-an-early-integrated-palliative-approach-is-associated-with-a-decrease-in-acute-care-utilization-and-hospital-deaths
#17
Meena Kalluri, Francisca Claveria, Emily Ainsley, Maged Haggag, Susan Armijo-Olivo, Janice Richman-Eisenstat
CONTEXT: Idiopathic Pulmonary Fibrosis (IPF) is a progressive, incurable interstitial lung disease with heavy symptom burden and poor quality of life. The last year of life is characterized by increased acute care utilization and hospital deaths. Clinical guidelines recommend early integration of palliative care but is rarely implemented. In 2012, we reorganized our clinic into a multidisciplinary team comprising two pulmonologists (expertise in ILD and palliative respiratory care respectively), nurse, respiratory therapist, physiotherapist, and a dietitian...
October 31, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29097432/endoscopic-ultrasound-fine-needle-aspiration-by-experienced-pulmonologists-a-cusum-analysis
#18
Paul Leong, Sheetal Deshpande, Louis B Irving, Philip G Bardin, Michael W Farmer, Barton R Jennings, Daniel P Steinfort
Endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA) is an established, minimally invasive way to sample intrathoracic abnormalities. The EBUS scope can be passed into the oesophagus to perform endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA). In cases of suspected lung cancer, a combination of the two techniques is now recommended by consensus guidelines. EBUS TBNA is usually performed by pulmonologists; however, the learning curve for EUS-B-FNA, which may be performed during the same procedure, has not been described...
November 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29094889/chronic-rhinosinusitis
#19
Ahmad R Sedaghat
Chronic rhinosinusitis is an inflammatory disease of the paranasal sinuses that occurs in 1% to 5% of the U.S. POPULATION: It may significantly decrease quality of life. Chronic rhinosinusitis is defined by the presence of at least two out of four cardinal symptoms (i.e., facial pain/pressure, hyposmia/anosmia, nasal drainage, and nasal obstruction) for at least 12 consecutive weeks, in addition to objective evidence. Objective evidence of chronic rhinosinusitis may be obtained on physical examination (anterior rhinoscopy, endoscopy) or radiography, preferably from sinus computed tomography...
October 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/29094873/chronic-cough-evaluation-and-management
#20
REVIEW
Charlie Michaudet, John Malaty
Although chronic cough in adults (cough lasting longer than eight weeks) can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastroesophageal reflux disease/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis. Patients should be evaluated clinically (with spirometry, if indicated), and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea...
November 1, 2017: American Family Physician
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