18 research outputs found

    Review of the Role of EBUS-TBNA for the Pulmonologist, Including Lung Cancer Staging

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    This review focuses on the role of endobronchial ultrasound-guided transbronchial needle aspiration in day-to-day pulmonology practice. Case examples are given of the common indications for endobronchial ultrasound-guided transbronchial needle aspiration which are: (i) lung cancer staging; (ii) confirming a diagnosis of malignancy in thoracic lymph nodes; (iii) diagnosing central pulmonary masses; (iv) sarcoidosis; and (v) inflammatory/benign thoracic lymph nodes. The technique is widely used, and after appropriate training by experienced bronchoscopists can be easily integrated into a bronchoscopy service

    A new bronchoscopy teaching tool (a high definition lap top based simulator—The Circular Checklist) shows training benefit in a cross over evaluation

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    International audienceIntroduction/Aim: Simulated training is fundamental for all trainees starting bronchoscopy training. Access to simulators can be difficult and costly. A new high definition laptop based training tool (The Circular Checklist, CCL) has been developed. It simulates the experience of moving around the bronchial tree in a sequential fashion using the Boyden classification of bronchial naming. Subjects must sequentially name and move into bronchial openings before moving on to the next bronchus, starting at B1 and finishing at B10 on each side.Methods: At a bronchoscopy training school, a prospective study was conducted with informed consent of participants. Trainees who had bronchoscopy experience were new to the Boyden classification, which were divided into two groups after stratification based on anatomy knowledge. After a bronchoscopic anatomy lecture, Group 1 was given 1 h to train on the CCL, completing all tasks and then assessed on a low fidelity bronchoscopy model with a real bronchoscope, using the Bronchoscopy Skills and Tasks Assessment Tool (B STAT). Group 2 had no such training but had the BSAT. BSTAT tests at each point were done in duplicate with the second test reported. Then there was a cross over with Group 2 having CCL training and both groups had repeat BSTAT. Maximum score on BSTAT is 42.Results: Nineteen subjects completed the CCL training and did both sets of assessment. Group 2 showed a significant learning gain. Group 1 results were on the whole better after their first CCL training. Subjects found the CCL easy to use and had high satisfaction from the training. BSTAT results (Mean, SD) Test 1Test 2Group 1 (CCL training before BSTAT test 1)32.9 ± 9.831.1 ± 6.5P = 0.3,NSGroup 2 (CCL training after BSTAT Test 1)20.7 ± 14.127.7 ± 9.3P = 0.019Conclusion: The CCL assists in bronchoscopic anatomy learning and sequential bronchial navigation

    A combined hands-on teaching programme and clinical pathway focused on pleural ultrasound and procedure supervision transforms pleural procedure outcomes

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    Management of pleural effusions is a common diagnostic and management problem.We reviewed the outcomes from pleural procedures after the instigation of pleural effusion management guidelines, focusing on pleural ultrasound and a hands-on teaching programme followed by procedure supervision that enabled many operators to perform such procedures.This is a retrospective analysis of all procedures performed for pleural effusions on medical patients. Outcomes were assessed prior to the instigation of pleural effusion management guidelines (pleural pathway) and hands-on teaching (January 2010 to June 2011) and following these interventions (January 2012 to June 2013).A total of 171 procedures involving 129 patients (pre-pathway group) and 146 procedures involving 115 patients (post-pathway group) was analysed. The rate of complications prior to the pleural pathway was 22.2% (38 of 171 procedures). Following the pathway, the rate of complications declined to 7.5% (11 of 146 procedures, P

    A new instrument to assess physician skill at chest tube insertion: the TUBE-iCOMPT

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    Currently no tool exists to assess proceduralist skill at chest tube insertion. As inadequate doctor procedural competence has repeatedly been associated with adverse events, there is a need for a tool to assess procedural competence. This study aims to develop and examine the validity of a tool to assess competency at insertion of a chest tube, using either the Seldinger technique or blunt dissection. A 5-domain 100-point assessment tool was developed inline with British Thoracic Society guidelines and international consensus - the Chest Tube Insertion Competency Test (TUBE-iCOMPT). The instrument was used to assess chest tube insertion in mannequins and live patients. 29 participants (9 novices, 14 intermediate and 6 advanced) were tested by 2 blinded expert examiners on 2 occasions. The tool's validity was examined by demonstrating: (1) stratification of participants according to expected level of expertise (analysis of variance), and (2) test-retest and intertester reliability (intraclass correlation coefficient). The intraclass correlation coefficient of repeated scores for the Seldinger technique and blunt dissection, were 0.92 and 0.91, respectively, for test-retest results, and 0.98 and 0.95, respectively, for intertester results. Clear stratification of scores according to participant experience was seen (

    Risk stratification in the investigation of pulmonary nodules in a high-risk cohort: positron emission tomography/computed tomography outperforms clinical risk prediction algorithms

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    Background: Clinical prediction models and 18-fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) are used for the assessment of solitary pulmonary nodules (SPN); however, a biopsy is still required before treatment, which carries risk. Aim: To determine the combined predictive benefit of one such model combined with modern PET/CT data to improve decision-making about biopsy prior to treatment and possibly reduce costs. Methods: Patients with a SPN undergoing 18F-FDG-PET/CT from January 2011 to December 2012 were retrospectively identified; 143 patients met inclusion criteria. PET/CT studies were rated (5-point visual scale), and CT characteristics were determined. Tissue was obtained by endobronchial ultrasonography with guide sheath (EBUS-GS), CT-guided biopsy and/or surgery. EBUS-transbronchial needle aspiration (TBNA) was used instead of nodule biopsy if there were PET-positive sub-centimetre lymph nodes. Results: The prediction model yielded an area under the receiver operating characteristic curve (AUC-ROC) of 64% (95% confidence interval (CI) 0.55–0.75). PET/CT increased this to 75% (95% CI 0.65–0.84). The 11% improvement is statistically significant. PET/CT score was the best single predictor for malignancy. A PET score of 1–2 had a specificity of 100% (CI 0.73–1.0), whereas a score of 4–5 had a sensitivity of only 76% (CI 0.68–0.84). No significant difference in clinical prediction scores between groups was noted. PET/CT showed the greatest benefit in true negatives and in detecting small mediastinal lymph nodes to allow EBUS-TBNA with a higher diagnostic rate. Cost analysis did not support a policy of resection-without-tissue diagnosis. Conclusion: PET/CT improves the clinical prediction of SPN, but its greatest use is in proving benignity. High PET scores had high false positive rates and did not add to clinical prediction. PET should be incorporated early in decision-making to allow for more effective biopsy strategies