Interventional pulmonology

Interventional pulmonology is a rapidly growing field of pulmonary medicine. It is a procedure-based subspecialty focusing on minimally invasive advanced diagnostic and therapeutic interventions. Current interventions include advanced bronchoscopic imaging, guidance methods for diagnostic bronchoscopy, therapeutic modalities for central airway obstructions, pleural interventions, and novel therapies for asthma and chronic obstructive pulmonary disease. This article is an introduction to pertinent interventions within the context of the diseases encountered by the trained interventional pulmonologist.     

介入治疗作为小肝癌综合治疗手段的临床疗效分析

目的 评价介入治疗作为小肝癌综合治疗手段的临床疗效。方法 回顾性分析经病理学或细胞学证实、直径≤３ｃｍ、在治疗过程中１８例曾选用介入治疗的原发性肝癌的临床疗效。结果 全组７例手术患者后复发。２例发生远处转移。Ｋａｐｌａｎ－ｍｅｉｅｒ法计算１、２年累积生存率分别为１００％、８３．３％。结论 手术是小肝癌的首选治疗方法,切除手肿瘤复发是影响小肝癌远期疗效的重要因素,预防术后复发是延长生存期最理想的措施,亚临床复发的早期发现是提高复发后生存率的关键。介入治疗是小肝癌综合治疗方法中非手术治疗的重要手段。     

A Review of Primary Care Training Programs in Correctional Health for Physicians

Background: Despite the health consequences of incarceration, there are no national standards for teaching physicians about correctional health. The purpose of this study was to survey existing correctional health training programs for primary care physicians. Summary: Programs were identified through literature and Web search, snowballing, and professional meetings. Programs were contacted and asked to complete a survey. Correctional health programs exist in a variety of disciplines. We identified 22 in primary care. Programs seek to improve public health, reduce stigma, and recruit physicians to correctional health. Curricula covered specific health problems as well as the impact of incarceration on families and communities. Relationships between the academic center and the correctional facilities were varied. Barriers include issues of security, time, financial resources, and stigma. Programs evaluate their learners, as well as educational and clinical outcomes. Conclusions: A variety of correctional health programs currently exist. A national model curriculum could strengthen teaching in correctional health.     

Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians

Introduction

Osteoarthritis (OA) constitutes a growing public health burden and the most common cause of disability in the United States. Non-pharmacologic modalities and conservative pharmacologic therapies are recommended for the initial treatment of OA, including acetaminophen, and topical and oral non-steroidal anti-inflammatory drugs. However, safety concerns continue to mount regarding the use of these treatments and none have been shown to impact disease progression. Viscosupplementation with injections of hyaluronans (HAs) are indicated when non-pharmacologic and simple analgesics have failed to relieve symptoms (e.g., pain, stiffness) associated with knee OA. This review evaluates literature focusing on the efficacy and/or safety of HA injections in treating OA of the knee and in other joints, including the hip, shoulder, and ankle.

Methods

Relevant literature on intra-articular (IA) HA injections as a treatment for OA pain in the knee and other joints was identified through PubMed database searches from inception until January 2013. Search terms included “hyaluronic acid” or “hylan”, and “osteoarthritis”.

Discussion

Current evidence indicates that HA injections are beneficial and safe for patients with OA of the knee. IA injections of HAs treat the symptoms of knee OA and may also have disease-modifying properties, potentially delaying progression of OA. Although traditionally reserved for second-line treatment, evidence suggests that HAs may have value as a first-line therapy in the treatment of knee OA as they have been shown to be more effective in earlier stages and grades of disease, more recently diagnosed OA, and in less severe radiographic OA.

Conclusion

For primary care physicians who treat and care for patients with OA of the knee, IA injection with HAs constitutes a safe and effective treatment that can be routinely administered in the office setting.     

The Top 10 Pulmonary Pearls for Primary Care Physicians

Pulmonary diseases are commonly encountered by primary care physicians in the outpatient setting. Despite their prevalence, many physicians may be unfamiliar with the diagnosis and appropriate management of these disorders. The evidence-based pearls in this article will help primary care physicians navigate important topics in pulmonary medicine and guide their decision to refer their patients to a pulmonary specialist.     

Interventional treatments for hepatic hemangioma: A state-of-the-art review

Hepatic hemangiomas (HHs) are the most common benign tumors of the liver. These tumors are mainly asymptomatic and do not require treatment. Nevertheless, there are some special cases that require therapeutic intervention, and surgery and intervention are currently the primary treatment modalities. Despite significant advances in the development of minimally invasive techniques and their popularization, interventional treatment of HH is still the preferred choice. In the present review, we discuss the pathological properties, type of blood supply, and treatment indications for HH and assess the status and progress of the existing interventional treatments.     

Palliative Care as a Primary Therapeutic Approach in Advanced Dementia: A Narrative Review

PurposeThe goal of this narrative review was to identify and summarize the ways in which palliative care could benefit patients who have advanced dementia.MethodsThis case-based discussion article examines current literature on palliative care for dementia.FindingsDementia is an incurable, progressive disease that affects millions of subjects. The prevalence has grown in the last decade and is projected to continue on this trajectory. In the later stages of dementia, subjects require increasing levels of care due to severe cognitive and functional impairment. Although the field of palliative medicine focuses on improving the quality of life of patients with life-limiting illnesses, many patients with advanced dementia do not receive palliative care services.ImplicationsPalliative care has been shown to improve patient and caregiver satisfaction, quality of life, and symptom burden at the end of life. Patients with advanced dementia would benefit from increased access to palliative care.     

A new role for nurses as Primary Care Cancer Lead Clinicians in Primary Care Trusts in England

AIM: The aim of this study was to evaluate the Primary Care Cancer Lead Clinician initiative in England. One of the objectives was to examine the impact of the Primary Care Cancer Lead Clinicians' clinical background on how they perform their role. This study compares nurses and General Practitioners in the Primary Care Cancer Lead Clinician role. BACKGROUND: The Primary Care Cancer Lead Clinician initiative developed from the National Health Service Cancer Plan. Primary Care Cancer Lead Clinicians are expected to work strategically to raise the standards of cancer care within primary care. METHODS: A postal questionnaire survey was sent to Primary Care Cancer Lead Clinicians and one manager in each Primary Care Trust in England. Telephonic interviews were also undertaken with a range of stakeholders in six case study areas. RESULTS: There were striking similarities between nurses and General Practitioners in the Primary Care Cancer Lead Clinician role. Differences related to the wider roles of the two groups. Nurses placed greater emphasis on fitting in whereas General Practitioners were more likely to expect to take charge and look for administrative support. CONCLUSIONS: There is evidence to show that whether the Primary Care Cancer Lead Clinician was a nurse or a General Practitioner was less important than having local credibility and the support of their Primary Care Trust.     

Biliary Catheter Placement in Interventional Radiology for Oncology Care

Percutaneous transhepatic biliary drainage has become an essential part of the treatment of biliary obstruction. Biliary drainage is a well-accepted means of palliation for malignant biliary obstruction and has been used as the primary treatment. This article will focus on the education for the preprocedure, intraprocedure, and postprocedure nursing care for a patient receiving a biliary tube placement.     

Community Partnership Primary Care: A New Paradigm for Primary Care

Abstract Primary care has become the focal point of health care reform. For too long primary care has been narrowly conceptualized as office-based care for common problems of individuals. In this article, a nurse practitioner describes a new model for primary care, community partnership primary care (CPPC), which moves beyond typical primary care practice to create what may be a new paradigm for primary care. This proposed new paradigm moves beyond older models of primary care into new dimensions of practice. The CPPC model emphasizes new roles for clinicians and a unique goal to foster the empowerment of individuals, families, and community. Innovative features of the CPPC model include blending a clinical role with a new area of practice called community practice. CPPC emphasizes new, innovative roles for nurse practitioners and nurses in community development and community empowerment activities. A 4-year funded project permitted the development and implementation of the CPPC model in an urban Hispanic community. This article provides an overview of the CPPC model and the initial steps of model implementation.