Idiopathic pulmonary fibrosis (IPF) is a severe and progressive fibrosing interstitial lung disease, which ultimately results in respiratory failure and death. The median age at diagnosis is 66 years, and the incidence increases with age, making this a disease that predominantly affects the elderly population. IPF can often be difficult to diagnose, as its symptoms--cough, dyspnoea and fatigue--are non-specific and can often be attributed to co-morbidities such as heart failure and chronic obstructive pulmonary disease. Making an accurate diagnosis of IPF is imperative, as new treatments that appear to slow the progression of IPF have recently become available. Pirfenidone and nintedanib are two such treatments, which have shown efficacy in randomised controlled trials. As with all new treatments, caution must be advocated in the elderly, as these patients often lie outside the narrow clinical trial cohorts that are studied, and the benefits of therapy must be weighed against potential toxicities. Both medications, while relatively safe, have been associated with adverse effects, particularly gastrointestinal symptoms such as nausea, diarrhoea and anorexia. In this review, we highlight measures to improve recognition and accurate diagnosis of IPF, as well as co-morbidities that often affect the diagnosis and disease course. The gold standard for IPF diagnosis is a multidisciplinary meeting whereby clinicians, radiologists and histopathologists reach a consensus after interactive discussion. In many cases, a lung biopsy may not be available because of high risk or patient choice, particularly in the elderly. In these cases, there is debate as to whether a biopsy is required, given the high rates of IPF in patients over the age of 70 years with interstitial changes on computed tomography. We also discuss the management of IPF, drawing particular attention to specific issues affecting the elderly population, especially with regard to polypharmacy and end-of-life care. Through this article, we endeavour to improve awareness of this devastating disease and thus improve recognition of the disease and its outcomes in elderly patients.

IntroductionAn increasing number of patients search for their physicians online. Many hospital systems utilize Press-Ganey studies as internal tools to analyze patient satisfaction, but independent third-party websites have a large presence online. Patients’ trust in these third-party sites may occur despite a low number of reviews and a lack of validity of patients’ entries. Healthgrades.com has been shown as the most popular site to appear on Google searches for radiation oncologists (ROs) in the United States (US). The aim of this study was to analyze patient satisfaction scores and the factors that influence those scores for American ROs on Healthgrades.MethodsThe physician ratings website Healthgrades was manually queried to obtain reviews from all Medicare-participating ROs with reviews (n=2,679). Patient Review Satisfaction Scores (PRSS) were recorded in response to a variety of questions. All information in the survey was scored from 1 (poor) to 5 (excellent) for the following characteristics: likelihood to recommend (LTR), office environment, ease of scheduling, trust in the physician’s decision, staff friendliness, ability of the physician to listen and answer questions, ability of the physician to explain the condition, and whether the physician spent sufficient time with the patients. Associations amongst these factors were considered by computing Spearman correlation coefficients and utilizing Mann-Whitney and Kruskal-Wallis tests.ResultsThe ROs’ mean LTR score was 4.51±0.9 (median 5.0, 66% received the highest possible score of 5; 95% received a score>2). Patient reviews per RO ranged from 1 to 242 (4.50±0.9, median 2.0). LTR scores correlated very strongly with physician-related factors, ranging from r=0.85 (with appropriate time spent with patients) to r=0.89 (with level of trust in physician). LTR scores were not statistically significantly associated with gender, wait time, ROs’ years since graduation, academic status, or geographic region.ConclusionSatisfaction scores for ROs on a leading physician ratings website are very strong, and most patients leaving reviews are likely to recommend their own ROs to their friends and family. Understanding online ratings and identifying factors associated with positive ratings are important for both patients and ROs due to the recent growth in physician-rating third-party sites. ROs should have increased awareness regarding sites like Healthgrades and their online reputation.

Background The 32-item Motor Function Measure (MFM32) is a clinician-reported outcome measure used to assess the functional abilities of individuals with neuromuscular diseases, including those with spinal muscular atrophy (SMA). This two-part study explored the relationship between the functional abilities assessed in the MFM32 and activities of daily living (ADLs) from the perspective of individuals with Type 2 and Type 3 (non-ambulant and ambulant) SMA and their caregivers through qualitative interviews and a quantitative online survey. Methods In-depth, semi-structured, qualitative interviews were conducted with individuals with SMA and caregivers from the US. Subsequently, a quantitative online survey was completed by individuals with SMA or their caregivers from France, Germany, Italy, Poland, Spain, Canada, the United States (US) and the UK. In both parts of the study, participants were asked to describe the ADLs considered to be related to the functional abilities assessed in the MFM32. Results from the qualitative interviews informed the content of the quantitative online survey. Results Qualitative interviews were conducted with 15 adult participants, and 217 participants completed the quantitative online survey. From the qualitative interviews, all of the functional abilities assessed in the patient-friendly MFM32 were deemed as related to one or more ADL. The specific ADLs that participants considered related to the patient-friendly MFM32 items could be grouped into 10 key ADL domains: dressing, mobility/transferring, self-care, self-feeding, reaching, picking up and holding objects, physical activity, writing and technology use, social contact/engagement, toileting and performing work/school activities. These results were confirmed by the quantitative online survey whereby the ADLs reported to be related to each patient-friendly MFM32 item were consistent and could be grouped into the same 10 ADL domains. Conclusion This study provides in-depth evidence from the patient/caregiver perspective supporting the relevance of the patient-friendly MFM32 items to the ADLs of individuals with Type 2 and Type 3 SMA.

BATCH scores correlated strongly with pencil-and-paper measures of cognitive function. BATCH provides clinicians with a means of assessing cognitive function through behavioural observation, thus enabling assessment of patients with behavioural disturbance or severe psychopathology. This tool has practical application for adult and aged clients across all observational mental health settings.