CHEST pulmonary最新文献

英文中文

Adapting the Tools of Our Trade 改造我们的行业工具：艾滋病毒感染者肺癌筛查的共同决策辅助工具

CHEST pulmonary

Pub Date : 2024-09-01 DOI: 10.1016/j.chpulm.2024.100048

引用次数: 0

Tackling Comprehensive Asthma Education for Providers One Breath at a Time 一次呼吸，解决医疗工作者的哮喘综合教育问题：哮喘在线继续医学教育项目评估

CHEST pulmonary

Pub Date : 2024-09-01 DOI: 10.1016/j.chpulm.2024.100061

Background

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.

Research question

Is creating an asthma curriculum online educational program with modules of microlearning feasible and useful in improving knowledge of clinicians?

Study Design and Methods

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.

Results

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%.

Interpretation

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.

背景哮喘知识的飞速增长推动了个性化、表型和内型驱动的哮喘诊断和治疗，从而改善了临床疗效。然而，医护人员在知识和实践方面仍存在许多差距。微观学习在教育成果方面已显示出功效，但往往受到碎片化和信息不完整的限制。为了将微学习的优势整合到全面的哮喘课程中，以解决这一快速发展领域中的知识差距，我们为管理哮喘的医生建立了一个内容广泛的课程，分为 "一口一呼吸 "的部分。研究问题创建一个包含微学习模块的哮喘课程在线教育项目是否可行，是否有助于提高临床医生的知识水平？它源于CHEST组织现有的哮喘教育，并经过了哮喘专家的审核。结果在最初的6个月中，有523名参与者参与了CHEST哮喘课程路径。参与者的满意度很高，知识前测答对率为 68%，后测答对率为 82%。参与者完成了他们打开的 82.8% 的单个视频。据我们所知，该教育项目是首个由医学协会发布的有关哮喘的综合性微学习在线课程。我们的研究结果表明，CHEST哮喘课程路径能有效提高知识水平，用户满意度也很高。将综合在线教育项目拆分成微型学习组件可能对肺科医学的其他主题有用。

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引用次数: 0

Dynamic Digital Radiography Pulmonary Function Testing 动态数字射线肺功能测试：机器学习肺部研究替代方案

CHEST pulmonary

Pub Date : 2024-09-01 DOI: 10.1016/j.chpulm.2024.100052

Background

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.

Research Question

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?

Study Design and Methods

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.

Results

We observed statistically significant (P < 1 × 10^-6), strong correlations between dPFT areas and PFT volumes, including total lung capacity (r = 0.764), FEV₁ (r = 0.591), vital capacity (r = 0.763), and functional residual capacity (r = 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.

Interpretation

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.

背景肺部疾病的常见诊断检查包括胸片和肺功能检查（PFT）。尽管这些检查必不可少，但它们只能提供静态评估。胸部动态数字放射摄影（DDR）将肺和膈肌的运动整合到一项研究中，且辐射量有限。DDR 相对容易获得，但其临床应用的障碍包括人工分析耗时以及与 PFT 的相关性不明确。PFT测量值与基于DDR的自动肺面积测量值之间的关系强度如何？我们利用卷积神经网络开发了一个分析管道，能够量化 DDR 图像中的肺面积，从而生成基于 DDR 的 PFT（dPFT）。结果我们观察到 dPFT 面积和 PFT 容积之间存在显著的统计学相关性（P < 1 × 10-6），包括总肺活量（r = 0.764）、FEV1（r = 0.591）、生命容量（r = 0.763）和功能残余容量（r = 0.756）。自动 DDR 和肺形状跟踪利用膈肌曲率指数和应变分析测量结果显示了正常、限制性和阻塞性生理机能之间的差异。通过线性回归，可以从 dPFT 测量值推导出 PFT 值。释义在 dPFT 和 PFT 之间发现的统计学意义上的显著相关性表明，在没有或无法进行 PFT 时，dPFT 可以作为 PFT 的替代物。这项研究有助于将 DDR 潜在整合为 PFT 的可靠替代方法。

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引用次数: 0

POINT: Liquid Markers for Risk Stratification of Pulmonary Nodules, Ready for Prime Time? Yes! 用于肺结节风险分层的液体标记物，准备好了吗？是的！

CHEST pulmonary

Pub Date : 2024-09-01 DOI: 10.1016/j.chpulm.2024.100071

引用次数: 0

Critical Analysis of Hemodynamic Risk Assessment 血流动力学风险评估的关键分析：肺动脉高压热稀释法与直接菲克法的对比透视

CHEST pulmonary

Pub Date : 2024-09-01 DOI: 10.1016/j.chpulm.2024.100085

Arif Albulushi MD , Rawan Al Bulushi MD

引用次数: 0

Response 对 "血流动力学风险评估的关键分析：对肺动脉高压热稀释法与直接菲克法的见解"

CHEST pulmonary

Pub Date : 2024-09-01 DOI: 10.1016/j.chpulm.2024.100086

Adam J. Brownstein, Christopher B. Cooper, Sonia Jasuja, Alexander E. Sherman, Rajan Saggar, Richard Channick

引用次数: 0

Does the Presence of Lung Incidental Findings on Low-Dose CT for Lung Cancer Screening Lead to Additional Testing? 用于肺癌筛查的低剂量 CT 出现肺部意外发现是否会导致额外的检查？

CHEST pulmonary

Pub Date : 2024-08-17 DOI: 10.1016/j.chpulm.2024.100096

Jeffrey Larson MD , Hyun Joo Kim MD , Rebecca Freese MS , Abbie Begnaud MD

引用次数: 0

A Collaborative, Interinstitutional Program to Improve the Care of Patients With Chronic Thromboembolic Pulmonary Hypertension 改善慢性血栓栓塞性肺动脉高压患者护理的机构间合作计划

CHEST pulmonary

Pub Date : 2024-08-13 DOI: 10.1016/j.chpulm.2024.100092

Bryan A. Kelly DO , Vikas Aggarwal MD , Prachi P. Agarwal MD , Samuel Allen DO , Rana Awdish MD , Wael Berjaoui MD , Domingo J. Franco-Palacios MD , Reda E. Girgis MD , Gillian Grafton DO , Jonathan W. Haft MD , Brandon Hooks DO , Reem Ismail NP , Sheila Krishnan DO , Scott Visovatti MD , Vallerie V. McLaughlin MD, FACC , Victor M. Moles MD

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.

慢性血栓栓塞性肺动脉高压（CTEPH）是肺动脉高压的一个亚类，也是急性肺栓塞的慢性后遗症，由于症状无特异性，常常被漏诊。肺动脉内膜剥脱术仍然是最佳的、可能治愈的治疗方法；但是，能否进行手术取决于多种因素，而这些因素对于每位患者来说可能相对独特，并且主要取决于医生的专业知识。CTEPH 患者应转诊至 CTEPH 中心，由多学科团队进行全面的确诊和可手术性评估。由于 CTEPH 中心的经验和专业知识是改善临床预后的关键，因此当患者无法获得或难以获得 CTEPH 中心的经验和专业知识时，就会面临挑战。本文介绍了密歇根州多中心 CTEPH 协作计划，这是一项由密歇根州医疗保健中心开发的多学科、跨机构协作计划。来自全州各中心的肺动脉高压和肺栓塞团队在每月一次的虚拟会议上分享专业知识和临床意见。这种合作方式迎头解决了治疗 CTEPH 的两大难题：准确诊断和患者前往 CTEPH 中心就诊。我们的合作模式可作为全国范围内的最佳实践，使患者、多学科团队和 CTEPH 中心受益。

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引用次数: 0

Demographic and Clinical Factors Associated With Diagnostic Confidence in Interstitial Lung Disease 与间质性肺病诊断可信度相关的人口统计学和临床因素：肺纤维化基金会患者登记处的调查结果

CHEST pulmonary

Pub Date : 2024-07-15 DOI: 10.1016/j.chpulm.2024.100084

Mary Beth Scholand MD , Sachin Gupta MD , Kevin R. Flaherty MD , Rosalinda V. Ignacio MS , Zhongze Li MS , Ayodeji Adegunsoye MD

Background

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.

Research Question

What are the real-world factors associated with diagnostic confidence in fibrotic ILD?

Study Design and Methods

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.

Results

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.

Interpretation

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.

背景间质性肺病（ILD）的准确诊断具有挑战性。因此，临床医生可能会根据指南标准和临床判断来确定诊断的确定性。然而，还需要进一步的研究来完善这种方法并提高诊断的明确性。研究问题与纤维化 ILD 诊断可信度相关的真实世界因素有哪些？研究设计和方法纳入了 2016 年 3 月至 2018 年 8 月期间肺纤维化基金会患者登记处登记的所有患者数据。基线人口统计学和临床特征在入组时收集，纵向测量则在最接近同意日期的测试日期收集。对所有参与者、特发性肺纤维化（IPF）亚组参与者和非 IPF ILD 参与者分别进行了描述性分析，并根据注册登记时调查者的诊断信心水平（高 vs 中/低）进行了分层。以上述特征为预测因素，采用多变量逻辑回归法计算调整后的ORs和95% CI。在对所有参与者进行调整后的逻辑回归分析中，使用抗纤维化药物（OR，1.51；95% CI，1.09-2.07）、在研究单位诊断时间较长（OR，0.94；95% CI，0.89-0.98）（365 天）和糖尿病（OR，2.56；95% CI，1.01-6.44）与较高的诊断率显著相关。44）与较高的诊断信心明显相关，而非 IPF 特发性间质性肺炎（vs IPF；OR，0.36；95% CI，0.24-0.55）、保险-其他（OR，0.65；95% CI，0.43-0.97）和西班牙裔（OR，0.54；95% CI，0.31-0.94）与较低的诊断信心明显相关。与 IPF 和/或非 IPF ILD 组诊断信心相关的因素包括年龄、男性、地区、免疫调节药物的使用、多学科团队讨论、外科肺活检和明确的高分辨率 CT 模式。有针对性的医生教育可能有助于减少偏倚并提高诊断的一致性。

{"title":"Demographic and Clinical Factors Associated With Diagnostic Confidence in Interstitial Lung Disease","authors":"Mary Beth Scholand MD , Sachin Gupta MD , Kevin R. Flaherty MD , Rosalinda V. Ignacio MS , Zhongze Li MS , 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}

引用次数: 0

Bronchoscopy Without Sedation in Healthy Volunteers 无需镇静剂即可对健康志愿者进行支气管镜检查：一种可行的研究方法

CHEST pulmonary

Pub Date : 2024-07-04 DOI: 10.1016/j.chpulm.2024.100075

Dean Kellogg III MD , Diego Maselli MD , Kevin Proud MD , Eusondia Arnett PhD , Larry S. Schlesinger MD , Jay I. Peters MD

引用次数: 0

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