China
Africa
Explore chapters and articles related to this topic
What's on the horizon?
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
Another peripheral lesson from the TAVR experience is the power of combining disciplines as the interventional cardiologists and cardiac surgeons forged relationships which became ever more symbiotic. Not only these two disciplines, but also greater partnership with imaging specialists has grown out of this experience as well. These types of partnerships create possibilities with education across disciplines which can be very useful. For example, electrophysiologists may adopt techniques of interventional cardiologists in the placement of coronary sinus leads (Figure 48.6), which can be facilitated by having the interventional cardiologists and electrophysiologists working together.32 Combining forces even outside of cardiology may have meaningful benefits to patients. Involving specifically trained interventional cardiologists in acute stroke teams may allow for greater availability of acute stroke interventions than what might be possible given current work force in neurointerventional radiology.33 Interventional pulmonology has adapted several techniques from interventional cardiology, such as stenting, and opening occluded structures.34 Joining forces with those involved in that fledgling discipline may allow them to benefit from the experience interventional cardiologists have in problem-solving, both in achieving a desired result, as well as in recovering from complications occurring during the attempts.
Transbronchial Biopsies: Clinical Perspective
Published in Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley, Diagnostic Pulmonary Pathology, 2008
Endobronchial ultrasound (EBUS) is a diagnostic technique permitting visualization of the tracheobronchial wall and the immediately adjacent structures. The ERS/ATS consensus statement on interventional pulmonology recommends that this technique should be reserved for experienced bronchoscopists who have participated in approximately 40 supervised procedures and undertake 25 procedures per year. Currently, EBUS-assisted transbronchial lung biopsy has been used to evaluate peripheral or fluoroscopically occult pulmonary nodules. The procedure involves advancing a thin ultrasound probe through a working channel of the bronchoscope (using anatomical cues based on prior CT estimation of site of lesion). An EBUS picture consistent with a proximate lesion identifies the sampling site. The prior addition of a guide sheath surrounding the probe permits control of the site (for bleeding) and repeat sampling of the site to increase yield. Diagnostic yield for otherwise bronchoscopically occult lesions has been reported to be as high as 84% when an EBUS image is acquired (11). Lesions smaller than 2 cm continue to have a relatively low diagnostic yield (29%) (12).
Bronchoscopy during the COVID-19 pandemic: effect on current practices and strategies to reduce procedure-associated transmission
Published in Expert Review of Respiratory Medicine, 2021
Fotios Sampsonas, Loukas Kakoullis, Theodoros Karampitsakos, Ourania Papaioannou, Matthaios Katsaras, Eleni Papachristodoulou, George Kyriakou, Aggeliki Bellou, Argyrios Tzouvelekis
For respiratory specialists, who are at the forefront of the fight against the pandemic, the greatest change in everyday practice is perhaps seen in the bronchoscopy suite. Whereas bronchoscopy and other interventional pulmonology procedures were performed daily, both for emergent as well as non-emergent procedures, the pandemic has forced pulmonologists to think twice before attempting the procedure, due to the danger of SARS-CoV-2 transmission; this risk exists both for healthcare personnel (HCP), as well as patients. As a result, non-emergent procedures such as lung cancer staging have been postponed due to the pandemic, which can have detrimental results on the management and prognosis of these patients, as bronchoscopy is the cornerstone of the diagnostic workup of lung cancer [1].
Implementation of an academic hospital medicine procedure service: 5-year experience
Published in Hospital Practice, 2021
Hillary Spangler, John R. Stephens, Emily Sturkie, Ria Dancel
The MPS refers complex cases to interventional radiology, neuroradiology, and, under a mutually agreed upon algorithm for thoracentesis (Figure 1), interventional pulmonology. MPS also receives referrals from these groups and the vascular access service in order to optimize patient flow within the hospital. Cases are also referred if the procedure cannot be safely performed at the bedside or deferred if it is not appropriate after MPS evaluation. Medical decision-making and point-of-care ultrasound images are documented in a consult note after discussion with all relevant teams. Conscious sedation is not performed by the MPS. Patients can also defer a bedside procedure by MPS, but this is rare. Generally, interventional radiology and interventional pulmonology do not perform procedures overnight, unless needed emergently.
Medical thoracoscopy in the diagnosis of pleural disease: a guide for the clinician
Published in Expert Review of Respiratory Medicine, 2020
Faisal Shaikh, Robert J. Lentz, David Feller-Kopman, Fabien Maldonado
MT is typically performed by pulmonologists who have been deemed competent after suitable training in the procedure. There is no international governing body at present responsible for certifying proficiency in MT, however certain national agencies have published some guidelines regarding procedural competence. In the United States, the American College of Chest Physicians requires at least 20 supervised thoracoscopies with or without biopsiesbefore independent practice can be considered [32]. Whereas in the UK, the BTS guidelines suggest that competency should be scored (Level I, II, III) in respect to the intricacy of the procedure being performed. Level I refers to competency in performing basic diagnostic and therapeutic (talc insufflation) thoracoscopy while level III refers to competency with surgical thoracoscopy for performing more advanced procedures such as lung resection [33]. With a growing number of accredited training programs in interventional pulmonology (IP) requiring competency-based certification in MT [34], it is increasingly being recognized that MT falls under the purview of the IP physician.