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Zanforlin A, Tursi F, Marchetti G, Pellegrino GM, Vigo B, Smargiassi A, Inchingolo R, Centanni S, Gasparini S, Blasi F, Soldati G, Sferrazza Papa GF. Clinical Use and Barriers of Thoracic Ultrasound: A Survey of Italian Pulmonologists. Respiration 2020; 99:171-176. [PMID: 31927551 DOI: 10.1159/000504632] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/05/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Thoracic ultrasound is accurate in the diagnosis of a wide range of respiratory diseases. Yet the extent of its use is unknown. Through a national survey, we aimed to explore the clinical use of thoracic ultrasound and the barriers to the diffusion of the technique in Italy. METHODS Accademia di Ecografia Toracica (AdET) developed a self-administered survey which was sent by email to Italian pulmonologists via national scientific societies and networks. RESULTS Of the 2010 physicians invited, 514 completed the survey (26% response rate). According to 99% of responders, thoracic ultrasound had a relevant clinical role. Seventy-nine percent of the responders used thoracic ultrasound at least once a month. The main settings were: 53% pulmonology ward, 15% outpatient clinic, 15% interventional pulmonology room, 10% internal medicine ward, 4% respiratory intensive care units, and 9% other. Thoracic ultrasound was primarily used: (1) with both diagnostic and interventional aims (72%), (2) as diagnostic imaging (17%), and (3) as guidance for interventional procedures (11%). The main clinical applications were: (1) diagnosis and management of pleural effusion, (2) pneumothorax, (3) pneumonia, (4) cardiac failure, and (5) acute dyspnea. Twenty-one percent of the responders do not use thoracic ultrasound. The main reported bar-riers were: (1) availability of an ultrasound system (52%), (2) lack of protected time and training (22%), and (3) use of the technique by other specialists (15%). CONCLUSION Thoracic ultrasound is widely used by Italian pulmonologists and considered a clinically relevant tool. The availability of dedicated ultrasound systems seems to be a major limit of the use of the technique.
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Affiliation(s)
- Alessandro Zanforlin
- Medicina Interna, Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy,
| | | | - Giampietro Marchetti
- Cardiothoracic Department, Division of Pulmonary Medicine, Spedali Civili Hospital of Brescia, Brescia, Italy
| | - Giulia Michela Pellegrino
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy.,Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Beatrice Vigo
- Respiratory Unit, ASST Santi Paolo e Carlo, Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Andrea Smargiassi
- UOC di Pneumologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Universitá Politecnica delle Marche, Ancona, Italy.,Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Internal Medicine, University of Milan, Milan, Italy.,Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gino Soldati
- Emergency Medicine Unit, Valle del Serchio General Hospital, Castelnuovo di Garfagnana, Italy
| | - Giuseppe Francesco Sferrazza Papa
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy.,Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy
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Yang LY, Manhas DS, Howard AF, Olson RA. Patient-reported outcome use in oncology: a systematic review of the impact on patient-clinician communication. Support Care Cancer 2018; 26:41-60. [PMID: 28849277 DOI: 10.1007/s00520-017-3865-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are an increasingly popular tool to optimize care and bridge the gap between patient experience and clinician understanding. The aim of this review was to identify mechanisms through which PROs facilitate patient-clinician communication in the adult oncology population. METHODS We conducted a systematic review of the published literature using the following data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Cab Direct, and CDSR. Studies included in this review reported on the outcomes of PRO use, used PROs as an intervention and not as a study outcome measurement tool, included cancer patients or survivors as study participants, and analyzed patient-clinician communication. RESULTS We identified 610 unique records, of which 43 publications met the inclusion and exclusion criteria. Synthesis of the reviewed studies provided evidence of the usefulness of PROs in facilitating patient-clinician communication on a variety of topics. We identified mechanisms though which PROs influenced patient-clinician communication to include increasing symptom awareness, prompting discussion, streamlining consultations, and facilitating inter-professional communication. Barriers to PRO use in communication improvement include technical problems impeding its administration and completion, compliance issues due to lack of incentive or forgetfulness, and use of PROs that do not appropriately assess issues relevant to the patient. Facilitators include increased education on PRO use, using PRO tools that patients find more acceptable, and providing patient data summaries in an easily accessible format for clinicians. CONCLUSIONS Our review suggests that PROs facilitate patient-clinician communication through various mechanisms that could perhaps contribute to improvements in symptom management and survival. The impact of PROs on clinical outcomes, however, remains poorly studied.
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