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Khan WB, Gallagher HM, Jayasimhan D, Dray M, Chang CL. The impact of bronchoalveolar lavage on the diagnosis of undifferentiated interstitial lung disease alongside a multidisciplinary discussion. Chron Respir Dis 2023; 20:14799731231196581. [PMID: 37585691 PMCID: PMC10434757 DOI: 10.1177/14799731231196581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Cellular analysis of bronchoalveolar lavage (BAL) fluid may aid diagnosis in patients with undifferentiated interstitial lung disease (ILD). The utility of this test in the diagnostic process in conjunction with a multidisciplinary discussion (MDD) is not known. We aim to assess and compare interobserver agreement and diagnostic confidence before and after presenting BAL results in an ILD-MDD. METHODS Patients undergoing investigations for ILD at Waikato Hospital were recruited. At the ILD-MDD two respiratory physicians and one respiratory radiologist participated in the discussion, and their diagnosis and diagnostic confidence were assessed at four sequential time points. Assessors were blinded to each others diagnosis and diagnostic confidence scores. The four sequential time points were (1) after clinical and radiology presentation; (2) after subsequent MDD; (3) after reviewing BAL results; (4) after final MDD with all results. Interobserver agreements were calculated using Fleiss κ statistic. RESULTS 36 patients were recruited, and 77.8% were male. In the first step, the interobserver agreement was substantial κ = 0.622 (95% CI 0.47-0.77), improving in step 2 following MDD to κ = 0.78 (95% CI 0.624-0.935), in step 3 κ = 0.776 (95% CI 0.614-0.937) and step 4 achieved almost perfect agreement of κ = 0.969 (95% CI 0.828-1.11). The diagnostic confidence for individual and group diagnosis increased with the presentation of BAL with and without multidisciplinary MDD. CONCLUSION We found that BAL cellular analysis improves interobserver agreement and confidence in diagnosis following MDD, thus aiding decision-making in cases with undifferentiated ILD.
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Affiliation(s)
- Wafa B Khan
- Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand
| | - Harry M Gallagher
- Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand
| | - Dilip Jayasimhan
- Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand
| | - Michael Dray
- Department of Pathology, Waikato District Health Board, Hamilton, New Zealand
| | - Catherina L Chang
- Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand
- Respiratory Research Unit, Waikato District Health Board, Hamilton, New Zealand
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Li LSK, Butler SJ, Ellerton L, Goldstein RS, Brooks D. Pain among Individuals with Chronic Respiratory Diseases Attending Pulmonary Rehabilitation. Physiother Can 2021; 73:304-312. [PMID: 34880534 DOI: 10.3138/ptc-2020-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study reports on the prevalence and impact of pain in individuals with different chronic respiratory diseases attending pulmonary rehabilitation (PR). Method: A retrospective review of medical records data was conducted for 488 participants who had attended a PR programme over a 2-year period. Data on pain and medication history taken from multidisciplinary medical records, together with participant demographics and PR outcomes, were extracted. We compared pain among participants with different types of chronic respiratory disease. Results: The overall prevalence of pain was 77%, with a significantly higher prevalence among individuals with obstructive lung diseases (80%) compared with restrictive lung diseases (69%; p = 0.04). Some participants (17%) who took pain medications did not discuss pain with their clinicians. The presence of pain and different reporting of pain did not have a negative impact on the PR programme completion rate (p = 0.74), improvements in exercise capacity (p = 0.51), or health-related quality of life (all four chronic respiratory disease questionnaire domains, p>0.05). Conclusions: The prevalence of pain is high among individuals with chronic respiratory disease attending PR. The presence or absence of pain was not negatively associated with the programme completion rate or PR outcomes; therefore, pain should not deter clinicians from referring patients to PR.
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Affiliation(s)
- Lok Sze Katrina Li
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Stacey J Butler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Essential Features of an Interstitial Lung Disease Multidisciplinary Meeting: An International Delphi Survey. Ann Am Thorac Soc 2021; 19:66-73. [PMID: 34191689 DOI: 10.1513/annalsats.202011-1421oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE The interstitial lung disease (ILD) multidisciplinary meetings (MDM) composing of pulmonologists, radiologists and pathologists, is integral to the rendering of an accurate ILD diagnosis. However, there is significant heterogeneity in the conduct of ILD MDMs and questions regarding its best practice remain unanswered. OBJECTIVE To achieve consensus among ILD experts on essential components of an ILD MDM. METHODS Using a Delphi methodology, semi structured interviews with ILD experts were used to identify key themes and features of ILD MDMs. These items informed two subsequent rounds of online questionnaires that were used to achieve consensus among a broader, international panel of ILD experts. Experts were asked to rate their level of agreement on a five-point Likert scale. An a priori threshold for consensus was set at a median score 4 or 5 with an interquartile range of 0. RESULTS We interviewed 15 ILD experts and 102 ILD experts participated in the online questionnaires. Five items and two exploratory statements achieved consensus on being essential for an ILD MDM following two questionnaire rounds. There was consensus that the presence of at least one radiologist, a quiet setting with a visual projection system, a high-quality chest high resolution computed tomography and a standardized template summarising collated patient data are essential components of an ILD MDM. Experts also agreed that it would be useful for ILD MDMs to undergo an annual benchmarking process and a validation process by fulfilling a minimum number of cases annually. Twenty-seven additional features were considered to be either highly desirable or desirable features based on the degree of consensus. Although our findings on desirable features are similar to the current literature, several of these remain controversial and warrant further research. The study also showed an agreement among participants on several future concepts to improve the ILD MDM such as performing regular self-assessments and conducting research into shared practices to develop an international expert guideline statement on ILD MDMs. CONCLUSION This Delphi study showed consensus among international ILD experts on essential and desirable features of an ILD MDM. Our data represents a first step toward potential collaborative research into future standardisation of ILD MDMs.
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Prasad JD, Mahar A, Bleasel J, Ellis SJ, Chambers DC, Lake F, Hopkins PMA, Corte TJ, Allan H, Glaspole IN. The interstitial lung disease multidisciplinary meeting: A position statement from the Thoracic Society of Australia and New Zealand and the Lung Foundation Australia. Respirology 2017; 22:1459-1472. [PMID: 28891101 DOI: 10.1111/resp.13163] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/28/2023]
Abstract
Interstitial lung diseases (ILD) are a diverse group of pulmonary diseases for which accurate diagnosis is critical for optimal treatment outcomes. Diagnosis of ILD can be challenging and a multidisciplinary approach is recommended in international guidelines. The purpose of this position paper is to review the evidence for the use of the multidisciplinary meeting (MDM) in ILD and suggest an approach to its governance and constitution, in an attempt to provide a standard methodology that could be applied across Australia and New Zealand. This position paper is endorsed by the Thoracic Society of Australia and New Zealand (TSANZ) and the Lung Foundation Australia (LFA).
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Affiliation(s)
- Jyotika D Prasad
- Department of Respiratory and Sleep Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Annabelle Mahar
- Pathology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jane Bleasel
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical Program, University of Sydney, Sydney, NSW, Australia
| | - Samantha J Ellis
- Radiology Department, Alfred Hospital, Melbourne, VIC, Australia
| | - Daniel C Chambers
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant Service, Brisbane, QLD, Australia
| | - Fiona Lake
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Peter M A Hopkins
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant Service, Brisbane, QLD, Australia
| | - Tamera J Corte
- Respiratory Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | | | - Ian N Glaspole
- Department of Respiratory and Sleep Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
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