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

Community acquired pneumonia is a common illness with significant morbidity and mortality and a high cost to society. Guidelines for management in the UK issued by the British Thoracic Society have been in existence since 1993 (Br J Hosp Med 1993; 49: 346-350). These have been updated in 2001 (Thorax 2001; 56(Suppl IV)). This review summarises the guidelines with emphasis on aetiology, investigations and antibiotic treatment.
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PMID:Evidence based medicine: review of BTS guidelines for the management of community acquired pneumonia in adults. 1285 Jan 71

Community acquired pneumonia is a common illness with significant morbidity and mortality in children and a high cost to society. Guidelines for management in the UK were issued by the British Thoracic Society in 2002 [Thorax 57 (2002) 1]. This review summarises the guidelines with emphasis on aetiology, investigations and antibiotic treatment.
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PMID:Evidence based paediatrics: review of BTS guidelines for the management of community acquired pneumonia in children. 1472 Apr 88

This NIV audit was conducted across the North Central London network area, for a 3-month period in 2003. Five trusts participated (on 6 hospital sites) and 141 audit forms were returned, allowing data analysis for individual hospitals and for comparisons between hospitals. The results are discussed in line with the British Thoracic Society guidelines on NIV [British Thoracic Society Guideline. Non-invasive ventilation in acute respiratory failure. Thorax 2002;57:192-211] and the Modernisation Agency document [Critical Care Programme. Weaning and Long Term Ventilation. NHS Modernisation Agency; 2002]. Key areas for future work have been identified to facilitate service improvement.
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PMID:Non-invasive ventilation (NIV). An audit across the North Central London Critical Care Network (NCLCCN). 1603 62

Guidelines have been compiled by The Joint Tuberculosis Committee of the British Thoracic Society to quantify the risks of reactivation of tuberculosis with anti-tumour necrosis factor alpha (anti-TNF-alpha) treatment. These guidelines are intended to inform respiratory physicians, gastroenterologists, rheumatologists and dermatologists, together with specialist nurses in those disciplines.
Thorax 2005 Oct
PMID:BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. 1605 11

Screening of the close contacts of patients with pulmonary tuberculosis remains an important component in the control and prevention of the disease. It is carried out to identify active and latent infection, and those requiring BCG vaccination. Guidelines suggest giving chemoprophylaxis to asymptomatic contacts with a positive Heaf test (grades 2-4) and normal chest radiograph [Control and prevention of tuberculosis in the United Kingdom: code of practice 2000. Joint Tuberculosis Committee of the British Thoracic Society. Thorax 2000;55:887-901]. We report a case involving a close contact where current guidelines were followed, but failed to prevent subsequent development of active disease from the same strain of M. tuberculosis.
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PMID:Reactivation of tuberculosis after apparently adequate chemoprophylaxis. 1632 45

Through systematic literature review and a consensus-based approach from an expert panel, standards on the organization for delivering thoracic cancer surgery in a single-payer healthcare environment were developed. Thirty-two studies and six organizational reports were identified. Results from 32 studies showed a trend toward higher volumes and improved patient outcomes, and six consensus reports provided recommendations on thoracic care standards. Thoracic surgical oncology standards in a single-payer healthcare system were developed. The benefits associated with the implementation of thoracic cancer surgery standards should result in increased regionalization of care, improved processes of care, and better patient outcomes.
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PMID:Standards for thoracic surgical oncology in a single-payer healthcare system. 1844 11

Idiopathic pulmonary fibrosis (IPF) is a devastating disease that afflicts patients with relentlessly progressive shortness of breath [Joint Statement of the American Thoracic Society and the European Respiratory Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. Am J Respir Crit Care Med 2000;161:646-64(1)]. Despite nearly 30 years of intense investigation, effective therapy for IPF remains elusive; median survival rates have stubbornly remained less than five years from the time of diagnosis [Bjoraker JA, Ryu JH, Edwin MK, Meyers J, Tazelaar H, Schroeder D, et al. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 1998;157:199-203(2), Flaherty KR, Thwaite E, Kazerooni EA, Gross B, Toews GB, Colby TV, et al. Radiological versus histological diagnosis in UIP and NSIP: survival implications. Thorax 2003;58:143-48(3)], and no medical therapy has been proved to be in any way effective for the treatment of this disease. Without medications that help IPF patients live longer, an important question to ask is whether there are interventions that might allow these people to live better-to be more active; to experience less dyspnea, less depression, less anxiety; to possess a greater sense of control over their disease; and to have better quality of life. Pulmonary rehabilitation helps to accomplish many of these goals in patients with chronic obstructive pulmonary disease, and emerging data suggest that it may do the same for patients with IPF.
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PMID:Pulmonary rehabilitation in idiopathic pulmonary fibrosis: a call for continued investigation. 1884 71

In 2005, Cancer Care Ontario (CCO) released Thoracic Surgical Oncology Standards. These standards were aimed at providing the best level of care for those undergoing thoracic surgery and encompass surgeon training, hospital ancillary services and minimum volume thresholds for surgeries of the lung and esophagus. The objective of the current study was to explore variations in thoracic cancer surgical volumes at the hospital level across Canada. Using data from the Discharge Abstract Database for 2007-2008, the cohort included patients admitted to hospital with a most responsible diagnosis of cancer and who had a lung or esophageal surgery. To determine the volume of surgeries performed per facility, we grouped patients according to the hospital facility performing the surgery. In Canada (excluding Quebec and Prince Edward Island), there were a total 4,509 lung and 587 esophageal cancer procedures performed in 94 hospitals in 2007-2008. For both types of surgeries, Ontario hospitals performed approximately half of the procedures. Overall, 12 hospitals performed at or over the volume of surgeries for lung cancer as indentified by the CCO standards, while 10 did so for esophageal cancer. Nine hospitals performed both lung and esophageal cancer surgeries at or over the suggested volumes. Higher volumes of lung and esophageal cancer-related surgeries have been associated with improved patient outcomes. Here we present a snapshot of the distribution of cancer-related lung and esophageal surgeries across Canada (excluding Quebec and Prince Edward Island).
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PMID:Thoracic cancer surgeries. 1955 62

Objectives To assess the incidence, severity and risk factors of bronchial fistula following pneumonectomy for cancer. Patients and methods From 1989 to 2003, 690 consecutive patients underwent a pneumonectomy for thoracic cancer in Sercive of Thoracic Surgery of the Teaching Hospital of Sainte Marguerite in Marseilles (France). The M/F sex ratio was 5,44 . Mean age was 59+/-9,9 years [16 - 81]. Clinical and surgical variables were studied retrospectively, and their possible association with the occurrence of a bronchial fistula was assessed by univariate and multivariate analysis. Results Fifty one patients (7,7%) experienced a bronchial fistula. This complication accounted for 56% (45/80) of the cases of reoperation and 25,5% (13/51) of early deaths. At univariate analysis, the following factors were identified as statistically significant: tobacco consumption (p<0,003), presence of COPD (p =0,02), preoperative radiotherapy (p=0,03), previous thoracic surgery (p=0,03), right side of the resection (p<0,001), hand-fashioned bronchial suture (p=0,05) and squamous cell histology (p= 0,04). Multivariate logistic regression analysis disclosed tobacco consumption (p=0,002), presence of COPD (p=0,01), previous thoracic surgery (p=0,03), extended procedures (p=0,05), right pneumonectomy (p<0,001) and squamous cell histology (p=0,02) as independent predictors of bronchial fistula. Conclusion The occurrence of a bronchial fistula following pneumonectomy is a frequent life threatening event, especially in cases of right sided resections and extended procedures. Tobacco cessation, preoperative rehabilitation, and reinforcement of the bronchial suture are possible means of prevention.
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PMID:Dehiscences of the bronchial joining after pneumonectomy for cancers: Incidence, gravity and risk factor. 1961 68

BACKGROUND Thoracic ultrasound-guided pleural procedures are associated with fewer adverse events than 'blind' procedures for patients with pleural effusion. Ultrasound is increasingly practised by respiratory physicians but there has been no prospective assessment of its safety and diagnostic accuracy when delivered by respiratory physicians. METHODS The activity level, safety and diagnostic accuracy of thoracic ultrasound delivered by respiratory physicians were prospectively assessed. Diagnostic accuracy was assessed using a stepwise pragmatic approach (recording if pleural fluid was obtained or effusion was present on another radiological modality). In the absence of the above, ultrasound clips were reviewed by a blinded radiologist. The number of ultrasounds referred to radiologists and adverse events within 1 week were recorded. The complication rate was compared with the published literature. RESULTS 960 ultrasound scans occurred over a 3 year period. The activity of the service increased over time, as a result of increased use of interventional ultrasound. The referral rate to radiology remained constant over the study period (mean proportion 4.0%). Physician-delivered ultrasound correctly identified the presence/absence of pleural fluid in 951 of 955 evaluable scans (99.6% CI 98.9% to 99.9%). The major complication rate was 3/558=0.5% (95% CI 0.1% to 1.6%), which compared favourably with the identified published literature. CONCLUSION Respiratory physician-delivered thoracic ultrasound appears to be safe and effective in the diagnosis/intervention of pleural effusion, and is associated with a major complication rate comparable with that of published studies. Continued liaison with the radiology service has here been demonstrated as a requirement for a physician-based service.
Thorax 2010 May
PMID:Diagnostic accuracy, safety and utilisation of respiratory physician-delivered thoracic ultrasound. 2043 70


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