Exercise Capacity, Lung Function, and Quality of Life After Interventional Bronchoscopy

Introduction:Malignant airway obstruction accounts for significant morbidity and mortality in patients with lung and metastatic cancer. We prospectively assessed the effects of bronchoscopic interventions for the treatment of malignant airway obstruction, with specific attention to exercise capacity and quality of life (QoL).Methods:This is a prospective cohort study. Patients with high-grade, symptomatic central malignant airway obstruction were assessed at baseline and then at days 30, 90, and 180 after bronchoscopic intervention with spirometry, 6-minute walk test (6MWT), and QoL and dyspnea questionnaires (European Organization for Research and Treatment of Cancer Quality of Life [C30] and Lung Cancer [LC-13] modules).Results:Thirty-seven patients were included in the final statistical analysis. Increases in 6MWT distance by 99.7 m (95% CI 33.2-166.2 m, p = 0.002), FEV1 by 448 ml (95% CI 203-692 ml, p < 0.001), and FVC by 416 ml (95% CI 130-702 ml, p = 0.003) were seen at day 30 compared with baseline. Clinically and statistically significant improvements were noted in composite dyspnea scores at day 30 by both QoL C30 (decrease of 39.9, 95% CI 21.4-58.4, p < 0.001) and LC-13 (decrease of 28.2, 95% CI 12.9-43.5, p < 0.001) questionnaires.Conclusions:Bronchoscopic intervention for malignant airway obstruction is associated with improvement in 6MWT, spirometry, and dyspnea at 30 days

A randomised controlled trial of compression therapies for the treatment of venous leg ulcers (VenUS 6) : study protocol for a pragmatic, multicentre, parallel group, three arm randomised controlled trial

Background Venous leg ulcer(s), are common, recurring, open wounds on the lower leg, resulting from diseased or damaged leg veins impairing blood flow. Wound healing is the primary treatment aim for venous leg ulceration, alongside management of pain, wound exudate and infection. Full (high) compression therapy delivering 40mmHg of pressure at the ankle is the recommended first line treatment for venous leg ulcers. There are several different forms of compression therapy available including wraps, two-layer hosiery, and two-layer or four-layer bandages. There is good evidence for the clinical and cost effectiveness of four-layer bandage and two-layer hosiery but more limited evidence for other treatments (two-layer bandage and compression wraps). Robust evidence is required to compare clinical and cost effectiveness of these and to investigate which is the best compression treatment for reducing time to healing of venous leg ulcers whilst offering value for money. VenUS 6 will therefore investigate the clinical and cost effectiveness of evidence-based compression, two-layer bandage and compression wraps for time to healing of venous leg ulcers. Methods VenUS 6 is a pragmatic, multi-centre, three arm, parallel group, randomised controlled trial. Adult patients with a venous leg ulcer will be randomised to receive 1) compression wraps, 2) two-layer bandage or 3) evidence-based compression (two-layer hosiery or four-layer bandage). Participants will followed up for between 4 and 12 months. The primary outcome will be time to healing (full epithelial cover in absence of a scab) in days since randomisation. Secondary outcomes will include key clinical events (e.g., healing of the reference leg; ulcer recurrence; ulcer/skin deterioration, amputation, admission/discharge, surgery to close/remove incompetent superficial veins, infection, or death), treatment changes, adherence and ease of use, ulcer related pain, health-related quality of life and resource use. Discussion VenUS 6 will provide robust evidence on the clinical and cost-effectiveness of the different forms of compression therapies for venous leg ulceration. VenUS 6 opened to recruitment in January 2021 and is currently recruiting across 30 participating centres. Clinical Trial Registry: ISRCTN 67321719 (https://doi.org/10.1186/ISRCTN67321719). Prospectively Registered: 14.09.202

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Severe Airway Injury Due to Alendronate Aspiration

Sequelae of foreign body aspiration can range from clinically silent and asymptomatic to immediate asphyxiation and death. Only two previous cases of bisphosphonate tablet aspiration have been reported. Ulcerative esophagitis, a known adverse effect of oral bisphosphonate formulations, occurs primarily with prolonged exposure of esophageal mucosa to the medication. Little is known about the effects of bisphosphonates on the airway mucosa. The authors present a case involving an 84-year-old woman who required multiple bronchoscopic debridements, intubation for airway protection and intensive care unit admission following airway injury believed to be due to delayed recognition of aspiration of an alendronate tablet

Severe Airway Injury Due to Alendronate Aspiration

Sequelae of foreign body aspiration can range from clinically silent and asymptomatic to immediate asphyxiation and death. Only two previous cases of bisphosphonate tablet aspiration have been reported. Ulcerative esophagitis, a known adverse effect of oral bisphosphonate formulations, occurs primarily with prolonged exposure of esophageal mucosa to the medication. Little is known about the effects of bisphosphonates on the airway mucosa. The authors present a case involving an 84-year-old woman who required multiple bronchoscopic debridements, intubation for airway protection and intensive care unit admission following airway injury believed to be due to delayed recognition of aspiration of an alendronate tablet.Peer Reviewe

Wet Laboratory Versus Computer Simulation for Learning Endobronchial Ultrasound: A Randomized Trial

BACKGROUND: Linear endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a revolutionary bronchoscopic procedure that is challenging to learn.OBJECTIVES: To compare two methods used to teach EBUS-TBNA: wet laboratory (lab) versus computer EBUS-TBNA simulation.METHODS: A prospective, randomized study of respirologists, thoracic surgeons and trainees learning EBUS-TBNA at a two-day continuing medical education course. All subjects received education via a series of lectures and live cases, followed by randomization to learn EBUS-TBNA predominantly either by wet lab simulation (n=6) or computer simulation (n=6). All subjects then completed testing of their EBUS-TBNA skills via a previously validated method using simulated cases on EBUS-TBNA simulators and questionnaires evaluating learner preferences.RESULTS: There were no significant differences between the computer EBUS-TBNA simulator group and the wet lab group in procedure time (25.3±6.1 min versus 25.2±2.5 min; P=0.984) and percentage of successful biopsies (81.3±14.9% versus 74.0±17.3%; P=0.453). The computer simulator group performed significantly better than the wet lab group in the percentage of lymph nodes correctly identified (70.4±16.7% versus 42.9±19.9%; P=0.002). Wet lab simulation was associated with increased learner confidence with operating the real EBUS-TBNA bronchoscope. All subjects responded that wet lab and computer EBUS-TBNA simulation offered important complementary learning opportunities.DISCUSSION: Computer EBUS-TBNA simulation leads to improved skill at correctly identifying lymph nodes, while wet lab simulation provided increased learner confidence due to increased realism.CONCLUSION: Computer EBUS-TBNA simulation and wet lab simulation are effective methods of learning basic EBUS-TBNA skills and appeared to be complementary.Peer Reviewe