Background: Pulmonary hypertension (PH) is a common complication of sarcoidosis that is associated with increased mortality. The pathogenesis of PH in sarcoidosis is uncertain, and the role of pulmonary arterial hypertension (PAH)-specific therapies remains to be determined. Methods: We conducted a retrospective study of patients with sarcoidosis and PH at two referral centers. New York Heart Association (NYHA) functional class, exercise capacity, hemodynamic data, pulmonary function tests, and survival were collected and analyzed. Results: Twenty-two sarcoidosis patients treated with PAH-specific therapies were identified. After a median of 11 months of follow-up, NYHA class was improved in nine subjects. Mean 6-min walk distance (n ‫؍‬ 18) increased by 59 m (p ‫؍‬ 0.032). Patients with a higher FVC experienced a greater increment in exercise capacity. Among 12 patients with follow-up hemodynamic data, mean pulmonary artery pressure was reduced from 48.5 ؎ 4.3 to 39.4 ؎ 2.8 mm Hg (p ‫؍‬ 0.008). The 1-and 3-year transplant-free survival rates were 90% and 74%, respectively. Conclusions: PAH-specific therapy may improve functional class, exercise capacity, and hemodynamics in PH associated with sarcoidosis. Prospective, controlled trials of PAH therapies for sarcoidosis are warranted to verify this apparent benefit. Mortality among the study population was high, highlighting the need for urgent evaluation at a lung transplant center.

FCFM shows a high degree of image reliability and can detect changes in the respiratory bronchioles because of smoking and other diseases, but whether it can discriminate among diseases requires additional study.

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Background: Many hospitals, including those affiliated with New York University Medical Center, have adopted the use of rapid response teams (RRTs) to improve patient care. There is currently no standardized training for residents leading RRTs comparable to Advanced Cardiac Life Support (ACLS) training. We developed and validated an assessment tool of leadership skills for use in a new RRT leadership training program for second year internal medicine residents. Methods: Using a high-fidelity patient simulator, we created a patient scenario to assess resident leadership skills. The scenario involved an elderly post-surgical patient with multiple comorbidities who develops hypotension. Residents were expected to gather information, generate a differential diagnosis, plan and execute interventions, and manage the care team. After performing a literature search to identify twenty-nine components of excellent leadership in acute medical situations, we created a behavior-anchored scoring system using those components to assess resident performance during the scenario. These behaviors can be grouped under the domains of communication, decision making, implementation, resource management, situational awareness, teamwork, and workload management. Each was scored as "not done," "partly done," or "well done." Finally, each resident's leadership performance was assessed overall as being "poor," "average," or "good." Results: We assessed the internal consistency and reliability and found the Cronbach's alpha to be 0.907 for the overall score. Furthermore, the overall percentage of items well done varied with the overall global assessment. Residents with a "poor" overall performance only received a score of "well done" on 16.7% of behaviors (SD 13.6); those with an "average" overall performance received a score of well done on 29.5% of behaviors (SD 12.1); and those with a "good" overall performance received a score of "well done" on 55.9% of behaviors (SD 6.4), p < 0.001). The residents scores of percent "well done" in the six domains are described in table one. The overall behavior percent "well done" was 35% (SD 18.7). Conclusions: The tool we developed to evaluate resident leadership skills was internally consistent and the performance of the individual components predicted global performance. Overall, residents did not perform well either in percent of behaviors well done or in the six global domains. We plan to use this tool to help measure the effect of a training program to improve RRT management. Table One -Behavioral Domains (N=22) Behavioral Domain Mean Percentage Well Done Standard Deviation Communication 43.9% 24.4% Decision-Making 34.1% 28.4% Implementation 68.2% 36.3% Resource Management 51.5% 39.5% Situational Awareness 40.9% 36.6% Teamwork 26.4% 28% Workload Management 9.1% 15.2%

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