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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Virtually only researchers from developed countries have done studies of risk factors for acute respiratory infections (ARIs) since these countries have an infrastructure that can support large multidimensional epidemiologic studies while developing countries do not. Yet results from these countries studies are not always relevant to developing countries since risk factor exposures in developing countries. For example, the predominant problem in developing countries is that ARIs in children is that ARIs in children 5 years old often result in death whereas in developed countries morbidity predominates. Based on studies in developed countries, there is plenty of evidence that strong associations exist between ARIs and chronic disease in adults, direct and passive smoking, and breast feeding. Thus policy need not request additional studies to base proper changes in public health policy. Yet researchers do need to collect more data on the associations between ARIs and HIV infections, low birth weight, and other possible risk factors. In fact, some are now examining relationships between ARIs and malnutrition, vitamin A supplementation, and indoor air pollution in developing countries. Some of the more important issues in developed countries are the links between maternal antibody levels and passive immunity in infants, the links between air pollution and ARIs, and the reasons for a rise in pneumonia in the aged. Another area that scientists need to explore is the association between respiratory infection (especially between 1-12 months old) and subsequent ARI. Further epidemiologists should standard data collection methods in both developed and developing countries. For example, the chronic respiratory questionnaire of the American Thoracic Society can serve as a model for acute symptom questionnaires.
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PMID:The epidemiology of acute respiratory infections in children and adults: a global perspective. 228 16

There are many factors resulting in a changing pattern of pneumonia. This varies from the impact of an aging population, patients surviving longer with underlying chronic disease, severe illness, and various causes of immunosuppression and the effect of new investigations, new antibiotics, and the recognition of new pathogens. Numerous studies have been performed over the last few years regarding the cause and outcome of community-acquired pneumonia (CAP). Marked variation in results has been seen related to the criteria used for defining and diagnosing pneumonia, the population studied, and the use of differing investigations and diagnostic criteria. This is particularly apparent when comparing the different incidence of pneumococcal infection as a cause of CAP in studies from different parts of the world. Extrapolation of the findings from the multicenter British Thoracic Society (BTS) study of pneumonia suggests that pneumococcal infection is more common than several studies suggest. Having said that, it is clear from examination of the many studies that CAP is a diverse disease and that different part of the world will have to develop individual management strategies based on a critical analysis of the best available study data appropriate to their local or national situation.
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PMID:An overview of community acquired pneumonia with lessons learned from the British Thoracic Society Study. 783 37

Asthma is a chronic disease estimated to affect 6-7% of the total UK population. In addition, a number of studies have shown that asthma has become commoner since the 1970s, especially in children. The diagnosis of asthma can be difficult and its management requires the involvement of patients in a long-term treatment plan, something which general practitioners may be unable to achieve easily in the average 10-min consultation. As a consequence, asthma is underdiagnosed and undertreated. Deaths from the disease are often avoidable with timely and sufficient use of the available medication. In order to support this, the British Thoracic Society (BTS) has published guidelines for asthma management based upon a stepwise approach, in which a patient is categorized as being on one of five steps according to the severity of his or her asthma. The guidelines give "rules of thumb" for deciding when the patient should move up or down the steps. The most recent version of the guidelines also included special rules for children. Within a recent European Community project on Advanced Informatics in Medicine (AIM), we developed a prototype decision support system for asthma management targeted at the primary care setting and based on the British Thoracic Society guidelines. This paper reports this development, and describes the further work needed on the prototype. Plans for evaluation of the knowledge bases and for future full application production are also described.
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PMID:A prototype computer decision support system for the management of asthma. 870 91

To analyze compliance with recommendations on the diagnosis and treatment of pleural effusion (PE), we conducted a retrospective study of 60 consecutive patients with PE. Thirty had been treated on the internal medicine ward (IM) and 30 had been cared for in the pneumology unit (P). Twelve variables were studied: 3 reflected the efficacy of medical intervention and 9 were related to diagnostic and therapeutic procedures as recommended by the American Thoracic Society and the American College of Physicians. PE was generally managed in accordance with the aforementioned guidelines. However, a number of unnecessary analytical tests were performed on pleural liquid from the first thoracocentesis. Although IM patients were comparable to P ward patients as to age, sex and concurrent chronic disease, the mean hospital stay was shorter for P ward patients (16 days versus 18 days in the IM ward, p < 0.05), and the percentage for whom an etiological diagnosis had been achieved upon discharge was higher in the P group (56% of P patients versus 26% of IM patients, p < 0.002). More P group patients than IM patients were followed up after discharge (83% versus 40%, respectively; p < 0.001). There were no significant differences in the remaining variables. Within the limitations of any retrospective study, these results allow us to conclude that PE is generally managed in accordance with international guidelines at our hospital and that diagnostic efficacy is greater on the pneumology ward, where mean stay is shorter.
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PMID:[Application of clinical guidelines in the management of pleural effusion]. 955 84

The advent of computer-based prescribing in general practice has made it possible to study a patient's drug use in detail. This study compared the use of inhaled therapy in 100 patients with chronic disease by examining every prescription issued during the year before and the year after initial consultation at a nurse-run asthma clinic. The majority were poorly controlled in that 79% scored high on the Jones Morbidity Index at their first visit. The number of patients on inhaled corticosteroid and salmeterol xinafoate rose from 87 to 100% and 6 to 28%, respectively, while those instructed to take their beta-agonist 'when required' as opposed to a regular dose rose from 26 to 82%. The daily median intake of short-acting beta-agonist fell from 5.0 to 3.8 doses (P < 0.0001). In the 87 patients on inhaled corticosteroid throughout, the mean daily dose increased from 532.1 to 793.1 micrograms (P < 0.0001), and compliance (defined as the total dose issued in 1 year expressed as a percentage of that recommended) increased from 61.5 to 69.3% (P = < 0.05). Attendance at a nurse-run asthma clinic was associated with a number of significant alterations in inhaled therapy. These changes conformed to the British Thoracic Society's guidelines.
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PMID:Implementing the British Thoracic Society's guidelines: the effect of a nurse-run asthma clinic on prescribed treatment in an English general practice. 961 23

The General Medical Services (GMS) contract has focused the attention of United Kingdom (UK) general practitioners (GPs) on the provision of high quality routine care for patients with chronic disease. The quality markers defined by the contract endorse the need for objective diagnosis and structured care recommended by the British Thoracic Society/Scottish Intercollegiate Guideline Network (BTS-SIGN) guideline for the management of asthma and the National Institute for Clinical Excellence (NICE) guideline on the management of chronic obstructive pulmonary disease (COPD). In this paper the key recommendations of these guidelines and their implementation in the pragmatic world of general practice are discussed, with specific focus on diagnosis, monitoring, management, self-management and delivery of care.
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PMID:Respiratory medicine. 1523 18

Thoracic involvement of amyloidosis is relatively rare, but mediastinal lymphadenopathy in the absence of pulmonary parenchymal involvement is extremely rare. The case presented here is of a previously healthy elderly woman who developed a palpable mass in the right supraclavicular area. The chest CT scan showed extensive, contiguous and homogeneous low attenuated lymphadenopathy with stippled calcification in the right supraclavicular area and mediastinum. Amyloidosis was confirmed histopathologically on a biopsy specimen from a right supraclavicular lymph node. Because there were no other sites found to be affected by amyloidosis and there was no underlying chronic disease, we made a final diagnosis of primary localized amyloidosis involving only the supraclavicular and mediastinal lymph nodes.
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PMID:Primary localized amyloidosis manifested as supraclavicular and mediastinal lymphadenopathy. 1770 7

Asthma is a highly prevalent chronic disease which, if not properly controlled, can limit the patient's activities and lifestyle. In recent decades, owing to the diffusion of educational materials, the application of clinical guidelines and, most importantly, the availability of effective pharmacological treatment, most patients with asthma are now able to lead normal lives. Significant social changes have also taken place during the same period, including more widespread pursuit of sporting activities and tourism. As a result of these changes, individuals with asthma can now participate in certain activities that were inconceivable for these patients only a few years ago, including winter sports, underwater activities, air flight, and travel to remote places with unusual environmental conditions (deserts, high mountain environments, and tropical regions). In spite of the publication of several studies on this subject, our understanding of the effects of these situations on patients with asthma is still limited. The Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has decided to publish these recommendations based on the available evidence and expert opinion in order to provide information on this topic to both doctors and patients and to avert potentially dangerous situations that could endanger the lives of these patients.
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PMID:[Guidelines on asthma in extreme environmental conditions]. 1918 99

Pulmonary diseases are major causes of morbidity and death in persons with HIV infection. Millions of people with HIV/AIDS throughout the world are at risk of opportunistic pneumonias such as tuberculosis, bacterial pneumonia, and Pneumocystis pneumonia. However, the availability of combination antiretroviral therapy has turned HIV into a chronic disease, and noninfectious lung diseases such as lung cancer, chronic obstructive pulmonary disease, and pulmonary arterial hypertension are also emerging as important causes of illness. Despite the importance of these diseases and the rapidly evolving understanding of their pathogenesis and epidemiology, few avenues exist for the discussion and dissemination of new clinical and basic insights. In May of 2008, the American Thoracic Society sponsored a 1-day workshop, "Emerging Issues and Current Controversies in HIV-Associated Pulmonary Diseases," which brought together basic and clinical researchers in HIV-associated pulmonary disease. A review of the literature was performed by workshop participants, and the workshop included 18 presentations on diverse topics summarized in this article.
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PMID:An official ATS workshop report: Emerging issues and current controversies in HIV-associated pulmonary diseases. 2136 16

Asthma still has high morbidity and cost despite all advances in pathogenesis, diagnosis and treatment. Although asthma can be controlled with proper diagnosis and treatment, the low rates of control in our country and in the world can not be attributed to the variable course of the disease and patients' psycho-social behaviours for chronic disease. In this context, Turkish Thoracic Society (TTS) has decided to update Asthma Diagnosis and Management Guide latest published in 2000. National data were collected, compiled and prepared by authors, and final form given by the TTS Asthma and Allergy Study Group, after presenting to consultant individuals and institutions. In June 2009, the National Asthma Management and Prevention Guideline were published in Turkish. In this paper, we aimed to present the national guide in English with its basics and individual differences.
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PMID:Turkish Thoracic Society asthma management and prevention guideline: key points. 2208 28


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