On Membership, Humility, and Pedagogical Responsibilities: A Correspondence on the Work of Wendell Berry

Wendell Berry is a novelist, essayist, conservation activist and farmer who has had a lot to say over the last half century about the impact of modern industrial society on small farm communities and the land especially since WWII. In this three-way conversation, the authors take up central aspects of Berry’s work to think about how it has influenced their thinking as teacher educators focused on the intersections between social and ecological crises challenging our world. Themes of responsibility, leadership, community membership, friendship, “settler colonialism,” racism, land use, and ecological sustainability are brought to bear on education for just and healthy communities

Diagnostic and treatment standards in idiopathic pulmonary fibrosis in the era of antifibrotic drugs in Poland: A real-world practice survey

Background Currently, only two drugs have been shown to modify the inevitable natural history of idiopathic pulmonary fibrosis (IPF). Changes in the reimbursement policy for antifibrotic drugs in Poland have led to the availability of pirfenidone from January 2017 and nintedanib from March 2018 for the treatment of Polish patients with IPF. This study aimed to evaluate the possible changes and shortcomings in the clinical practice standards in IPF in the era of access to antifibrotic therapy in Poland. Methods A real-world data survey was performed among physicians attending the Polish Respiratory Society Congress held in May 2018. The present survey was a follow-up to the previous survey undertaken in 2016, before the availability of antifibrotics in Poland. Results A total of 99 physicians participated in the survey, among which 80% were pulmonologists. The majority of participants (83%) represented hospital-based clinicians and most of them (93%) were involved in interstitial lung diseases (ILD) management. As many as 63% of the respondents elaborate the final diagnosis of IPF working with the expert radiologist routinely, 47% do that in the cooperation with other pulmonologists, and if a biopsy was performed 39% discuss its results with the expert pathologist. Bronchoalveolar lavage (BAL) and surgical lung biopsy (SLB) would never be recommended in the differential diagnosis of IPF by 9% and 16% of the respondents, respectively. Corticosteroids (CS) or a combination of CS and immunosuppressants (IS) is still recommended by 22% of participants. Proton pump inhibitors (PPI) in the case of symptomatic GERD are prescribed by 44% of the respondents, and 12% prescribe PPI regardless of GERD symptoms. Pirfenidone is used by 70%, and nintedanib by 48% of the respondents. Only 39% of the respondents refer patients with IPF to professional rehabilitation centers. Conclusions The level of cooperation between pulmonologists and other specialists in the diagnostic workup of IPF is unsatisfactory. IPF treatment practices in the era of access to effective drugs in Poland require immediate improvement. There is an urgent need to develop the local Polish practical guidelines to improve the management of IPF

Idiopathic pulmonary fibrosis (IPF) ― common practice in Poland before the “antifibrotic drugs era”

  INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and debilitating lung disease with a median survival time of 3–5 years. For now, pirfenidone (PIR) and nintedanib (NTB) are the only drugs that can slow down the disease’s progression. In Poland, these drugs, although registered for legal use, had not been reimbursed for IPF patients until the end of the year 2016. Aim of the study was to assess what was common practice in terms of diagnosis and treatment in the period before antifibrotic drugs became available for IPF patients in Poland. MATERIAL AND METHODS: We performed a survey among participants of two nationwide pulmonological congresses held in 2016. RESULTS: One hundred and fifty physicians took part in the study. Only 55% of respondents would reach their final diagnosis in collaboration with a radiologist. Just 40% of those sending patients for surgical lung biopsy (SLB) would discuss the case directly with a pathologist. 22% would never refer the patient suspected of having IPF for SLB. 85% believed that bronchoalveolar lavage (BAL) may be useful for diagnosis. 41% of respiratory professionals would not use any drug for the treatment of IPF patients. 23% of physicians would prescribe corticosteroids in high doses (CS), either in monotherapy or in combination with other drugs. Only 43% of respondents would use antacid drugs in case of symptomatic gastro-oesophageal reflux disease (GERD), and only 11% would prescribe these drugs regardless of GERD diagnosis. CONCLUSIONS: The majority of Polish pulmonologists were not supported by radiologists and pathologists in the diagnostic process. Treatment standards were unsatisfactory, mostly due to a lacking of reimbursement regulations. Further education is necessary to improve management of IPF patients in Poland.

Sarcoidosis in coexistence with chronic granulomatous disease

Granulomas formations are present in many lung diseases. Coexistence of one or more of these diseases is very rare. Diagnostics of such cases always poses a challenge. We present a case of coexistence of chronic granulomatous disease (CGD) and sarcoidosis

The influence of sexual arousal on subjective pain intensity during a cold pressor test in women

Background & objectives Pain can be significantly lessened by sex/orgasm, likely due to the release of endorphins during sex, considered potent analgesics. The evidence suggests that endorphins are also present during sexual arousal (that is, prior to sex/orgasm). It follows then that pain can be modulated during sexual arousal, independent of sex/orgasm, too. Accordingly, sexual arousal induced by erotic slides has been demonstrated to lessen pain in men, but not in women. One explanation could be that for women, the erotic slides were not potent enough to elicit a lasting primed state of sexual arousal by the time pain was induced. Thus, the current study aims to optimize the means of inducing a potent state of sexual arousal and subsequently examine the potentially analgesic influence of sexual arousal on pain in women. As a subsidiary aim, the study also assesses whether the anticipated analgesic effect of sexual arousal would be stronger than that of distraction or generalized (non-sexual) arousal. Methods Female participants (N = 151) were randomly distributed across four conditions: sexual arousal, generalized arousal, distraction, neutral. Mild pain was induced using a cold pressor while participants were concurrently exposed to film stimuli (pornographic, exciting, distracting, neutral) to induce the targeted emotional states. A visual analogue scale was utilized to measure the subjective level of pain perceived by the participants. Results Sexual arousal did not reduce subjective pain. Generalized arousal and distraction did not result in stronger analgesic effects than the neutral condition. Conclusion The present findings do not support the hypothesis that sexual arousal alone modulates subjective pain in women. This might be due to the possibility that genital stimulation and/or orgasm are key in pain reduction, or, that feelings of disgust may inadvertently have been induced by the pornographic stimulus and interfered with sexual arousal in influencing pain

Idiopatyczne włóknienie płuc (IPF) — powszechna praktyka kliniczna w Polsce przed erą leków antyfibrotycznych

WSTĘP: Idiopatyczne włóknienie płuc (IPF, Idiopathic pulmonary fibrosis) jest przewlekłym, postępującym i destrukcyjnym schorzeniem układu oddechowego, z medianą przeżycia wynoszącą 3–5 lat. Pirfenidon (PIR) i nintedanib (NTB) to jedyne leki, które skutecznie spowalniają progresję choroby. Choć są zarejestrowane w Polsce, nie były w naszym kraju powszechnie dostępne do końca 2016 roku z powodu braku zasad finansowania. Celem badania była ocena powszechnej praktyki klinicznej w Polsce w odniesieniu do rozpoznawania i leczenia IPF w okresie przed wprowadzeniem leków przeciwzwłóknieniowych. MATERIAŁ I METODY: Przeprowadzono badanie ankietowe wśród lekarzy uczestniczących w dwóch ogólnopolskich kongresach pulmonologicznych w 2016 roku. WYNIKI: W badaniu wzięło udział 150 lekarzy. Tylko 55% respondentów deklarowało, że ostateczne rozpoznanie jest stawiane we współpracy z radiologiem. Tylko 40% lekarzy kierujących chorych na chirurgiczną biopsję płuca omawia jej wyniki bezpośrednio z patologiem. Nigdy nie kieruje chorych z podejrzeniem IPF na chirurgiczną biopsję płuca 22%. Wśród respondentów 85% uważa, że płukanie oskrzelowo-pęcherzykowe (BAL, bronchoalveolar lavage) może być przydatne dla rozpoznania. Niestosowanie żadnych leków u chorych na IPF deklarowało 41% respondentów, a 23% lekarzy deklarowało stosowanie kortykosteroidów w większych dawkach w monoterapii lub w skojarzeniu z innymi lekami. Tylko 43% respondentów zastosowałoby leki obniżające kwasowość soku żołądkowego u chorego z objawami refluksu żołądkowo-przełykowego (GERD, gastro-esophageal reflux disease), a tylko 11% niezależnie od rozpoznania GERD. WNIOSKI: Większość polskich pulmonologów nie jest wspierana przez radiologów w procesie diagnostycznym. Standardy leczenia były niesatysfakcjonujące, głównie z powodu braku regulacji dotyczących finansowania leczenia. Dalsza edukacja jest wskazana w celu poprawy standardów leczenia chorych na IPF w Polsce.WSTĘP: Idiopatyczne włóknienie płuc (IPF, Idiopathic pulmonary fibrosis) jest przewlekłym, postępującym i destrukcyjnym schorzeniem układu oddechowego, z medianą przeżycia wynoszącą 3–5 lat. Pirfenidon (PIR) i nintedanib (NTB) to jedyne leki, które skutecznie spowalniają progresję choroby. Choć są zarejestrowane w Polsce, nie były w naszym kraju powszechnie dostępne do końca 2016 roku z powodu braku zasad finansowania. Celem badania była ocena powszechnej praktyki klinicznej w Polsce w odniesieniu do rozpoznawania i leczenia IPF w okresie przed wprowadzeniem leków przeciwzwłóknieniowych. MATERIAŁ I METODY: Przeprowadzono badanie ankietowe wśród lekarzy uczestniczących w dwóch ogólnopolskich kongresach pulmonologicznych w 2016 roku. WYNIKI: W badaniu wzięło udział 150 lekarzy. Tylko 55% respondentów deklarowało, że ostateczne rozpoznanie jest stawiane we współpracy z radiologiem. Tylko 40% lekarzy kierujących chorych na chirurgiczną biopsję płuca omawia jej wyniki bezpośrednio z patologiem. Nigdy nie kieruje chorych z podejrzeniem IPF na chirurgiczną biopsję płuca 22%. Wśród respondentów 85% uważa, że płukanie oskrzelowo-pęcherzykowe (BAL, bronchoalveolar lavage) może być przydatne dla rozpoznania. Niestosowanie żadnych leków u chorych na IPF deklarowało 41% respondentów, a 23% lekarzy deklarowało stosowanie kortykosteroidów w większych dawkach w monoterapii lub w skojarzeniu z innymi lekami. Tylko 43% respondentów zastosowałoby leki obniżające kwasowość soku żołądkowego u chorego z objawami refluksu żołądkowo-przełykowego (GERD, gastro-esophageal reflux disease), a tylko 11% niezależnie od rozpoznania GERD. WNIOSKI: Większość polskich pulmonologów nie jest wspierana przez radiologów w procesie diagnostycznym. Standardy leczenia były niesatysfakcjonujące, głównie z powodu braku regulacji dotyczących finansowania leczenia. Dalsza edukacja jest wskazana w celu poprawy standardów leczenia chorych na IPF w Polsce

Cardiac sarcoidosis - own experiences

Zajęcie serca przez sarkoidozę może przebiegać w sposób bezobjawowy. Brak odpowiednio wcześnie postawionego rozpoznania, a co za tym idzie - włączenia odpowiedniego leczenia, wiąże się z bardzo poważnym dla chorego rokowaniem. Nowe techniki diagnostyczne wydają się bardzo użyteczne we wczesnym rozpoznawaniu i monitorowaniu przebiegu zmian. Autorzy pracy przedstawiają przypadek 53-letniej kobiety, u której rozpoznano sarkoidozę z zajęciem serca, mimo braku jakichkolwiek odczuwalnych objawów choroby.Cardiac involvement in sarcoidosis may be incidentally discovered without any symptoms of the disease. When undiagnosed and untreated it is potentially fatal. Although there is no recommended strategy for the diagnosis, the introduction of newer technology is promising and may be useful for early diagnosis of sarcoid heart disease and for the evaluation of response to therapy. We present a case of 53-years old woman, with asymptomatic cardiac arrhythmias and x-ray chest picture changes without any respiratory symptoms. Further assessment and the use of cardiac magnetic resonance imaging allowed a diagnosis of cardiac sarcoidosis to be made

Guidelines of the Polish Respiratory Society for diagnosis and treatment of idiopathic pulmonary fibrosis

Introduction: This document presents the guidelines of the Polish Respiratory Society (PTChP, Polskie Towarzystwo Chorób Płuc) for diagnosis and treatment of idiopathic pulmonary fibrosis (IPF), developed by a group of Polish experts.Material and methods: The recommendations were developed in the form of answers to previously formulated questions concer-ning everyday diagnostic and therapeutic challenges. They were developed based on a current literature review using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.Results: We formulated 28 recommendations for diagnosis (8), pharmacological treatment (12) as well as non-pharma-cological and palliative therapy (8). The experts suggest that surgical lung biopsy (SLB) not be performed in patients with the probable usual interstitial pneumonia (UIP) pattern, with an appropriate clinical context and unanimous opinion of a  multidisciplinary team. The experts recommend using antifibrotic agents in IPF patients and suggest their use irrespective of the degree of functional impairment. As regards non-pharmacological and palliative treatment, strong re-commendations were formulated regarding pulmonary rehabilitation, oxygen therapy (in patients with chronic respiratory failure), preventive vaccinations as well as referring IPF patients to transplant centres. Table 1 presents an aggregate list of recommendations.Conclusions: The Polish Respiratory Society Working Group developed guidelines for IPF diagnosis and treatment