No abstract

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

No abstract

Background: Diagnosis of interstitial lung disease (ILD) is based on multidisciplinary team discussion (MDD) with the incorporation of clinical, radiographical, and histopathologic information if available. We aim to evaluate the diagnostic yield and safety outcomes of transbronchial lung cryobiopsy (TBLC) in the diagnosis of ILD.Methods: We conducted a meta-analysis by comprehensive literature search to include all studies that evaluated the diagnostic yields and/or adverse events with TBLC in patients with ILD. We calculated the pooled event rates and their 95% confidence intervals (CIs) for the diagnostic yield by MDD, histopathologic diagnostic yield, and various clinical adverse events.Results: We included 68 articles (44 full texts and 24 abstracts) totaling 6386 patients with a mean age of 60.7 ± 14.1 years and 56% men. The overall diagnostic yield of TBLC to achieve a definite or high-confidence diagnosis based on MDD was 82.3% (95% CI: 78.9%-85.2%) and histopathologic diagnosis of 72.5% (95% CI: 67.7%-76.9%). The overall rate of pneumothorax was 9.6% (95% CI: 7.9%-11%), while the rate of pneumothorax requiring drainage by a thoracostomy tube was 5.3% (95% CI: 4.1%-6.9%). The rate of moderate bleeding was 11.7% (95% CI: 9.1%-14.9%), while the rate of severe bleeding was 1.9% (95% CI: 1.4%-2.6%). The risk of mortality attributed to the procedure was 0.9% (95% CI: 0.7%-1.3%).Conclusion: Among patients with undiagnosed or unclassified ILD requiring tissue biopsy for diagnosis, transbronchial cryobiopsy represents a reliable alternative to surgical lung biopsy with decreased incidence of various clinical adverse events.

One fifth of school aged children in the US have a chronic medical illness and represent an underserved and educationally disadvantaged population. In particular, children with sickle cell disease (SCD) of all genotypes spend significant amounts of time in the medical settings and represent a potentially "captive audience" where hospitalization time can include educational activities. Accordingly, we saw an opportunity for Biomedical Engineering (BME) undergraduates at Georgia Institute of Technology, who are taught biology, medicine, engineering, and design to implement a new paradigm of K-12 Science, Technology, Engineering, and Mathematics (STEM) programming, where human physiology is used as a model framework. In collaboration with hospital school teachers at Children's Healthcare of Atlanta, we created a novel educational program where we (1) leverage the patient's own medical experience as motivation for learning, (2) develop hands-on interactive activities to teach STEM concepts that are adaptable for the patient's cognitive level, (3) provide undergraduate students with high quality meaningful patient interactions and clinical experiences, and (4) provide innovative educational programming for hospitals. The BME undergraduates enrolled in a human-centered design course focusing on iterative design, development and implementation of hands-on interactive STEM activities rooted in human physiology (Fig. 1A). Each activity contains state and national K-12 STEM standards. The BME undergraduates are well-suited to teach in the hospital environment, as they experience a strong STEM curriculum and are able to capture the true interdisciplinary nature of medical science in each activity. The undergraduates and patients are near-peer age, relationship-building occurs quickly, the patients admire them and enjoy their time together. During the 2018-19 school year we developed learning assessment questions for 2 of the most requested activities, assessing each SCD patient's mastery of the learning objectives. In the Blood Jar activity (Fig. 1B), the SCD patient builds a model of blood, learning the composition, function of each component, and importance of hydration. Sixty-five patients participated, 43% of grade K - 2, 61% of 3 - 5, 85% of 6th through High School scored Thoroughly Demonstrated. In the Bone activity (Fig. 1C), each SCD patient constructs a bone model to understand the function and structure of a bone. Twenty-nine patients participated, 28% of grade K - 2, 30% of 3 - 5, 88% of 6 - 8, and 75% of high school scored Thoroughly Demonstrated. Patient feedback (Fig. 1D) has been overwhelmingly positive, stating the activities are "fun" and "engaging" and requesting additional visits from the BME undergraduates. BME undergraduate expressed growth and learning of: disease pathophysiology, teaching and learning styles, and effective and succinct communication skills. In Georgia, Life Science is taught in 5th and 7th grade, our target demographic. Our results show at least 75% of patients in 6th grade and above demonstrated thorough understanding of the STEM topics taught, while K - 5 grade did not achieve that level of understanding. Lower scores for those patients are attributed to difficulties remembering new scientific vocabulary. Many of the BME undergraduates in our program are pre-med and use the experiences and meaningful interactions with patients in their medical school applications. As stated by a BME undergraduate after a patient interaction, "the white blood cells are like soldiers in the army! I like that! This analogy prompted the patient to think of his future. It reminded me the littlest things can make a big difference. This makes me even more excited to go into medicine." Our program represents an innovative approach to teaching STEM by: engaging SCD children, who are uniquely suited to learn important STEM concepts within the context of their own disease, provide learning to SCD patients during extended absences from school, allowing BME undergraduate students to design, develop, and teach STEM activities, provide meaningful clinical experience, and supplying quality educational programming for the hospital. This collaborative program can be straightforwardly implemented at other pediatric institutions with robust college volunteer programs and hospital school programs. Our activities can be exported and implemented at other institutions. Disclosures Lam: Sanguina, Inc: Current equity holder in private company.

No abstract

Chronic illness requires frequent medical treatments and lifestyle restrictions that increase academic and socioemotional stressors for families. This paper presents academic intervention recommendations based on a hospital's approach to improving educational outcomes for children with chronic illness. A case study on an intervention for a girl with sickle cell disease (SCD) and a history of stroke. SCD is a relatively common chronic illness that has physical and psychosocial side effects that are central to other chronic illnesses (Platt, Eckman, & Hsu, 2016). A quality improvement approach resulted in five cycles of interventions that were assessed with both qualitative and quantitative measures. The initial strategy of improving academics through collaboration among the school, hospital, and family resulted in psychosocial, but not academic, improvements. Frequent tutoring, which was most achievable using online platforms, resulted in the greatest gains. The girl passed previously failed classes and advanced to the next grade. Recommendations for how to improve academic outcomes for children with chronic illness using the presented intervention strategies are discussed.

No abstract