ObjectivesInternational experts recently characterized interstitial pneumonia with autoimmune features (IPAF) as a provisional diagnosis for patients with interstitial lung disease who have characteristics of autoimmune disease but do not meet criteria for a specific autoimmune disease. We describe clinical characteristics of IPAF patients and examine responses to mycophenolate as a therapy for IPAF.MethodsThis retrospective cohort included adult patients meeting European Respiratory Society/American Thoracic Society classification criteria for IPAF. Sociodemographic, clinical, and pulmonary function test data were abstracted for patients with and without mycophenolate treatment and followed longitudinally from interstitial lung disease diagnosis for change in pulmonary function test results.ResultsWe identified 52 patients who met criteria for IPAF. Of 52 IPAF patients, 24 did not receive mycophenolate and 28 did, with median time to mycophenolate treatment 22 months. Changes in FVC% and percentage predicted lung diffusion capacity for carbon monoxide (DLCO%) between the mycophenolate-treated and untreated groups were not significantly different (FVC% change P=0.08, DLCO% change P=0.17). However, there was a trend toward more rapid baseline decline of both FVC% and DLCO% in the mycophenolate-treated cohort before vs after mycophenolate therapy. The slope of both FVC% and DLCO% values improved after onset of mycophenolate exposure for the treated group, although this finding was not statistically significant.ConclusionPatients with IPAF might benefit from mycophenolate therapy. Larger prospective clinical trials are needed to evaluate the efficacy of mycophenolate for patients who meet criteria for IPAF.

No abstract

No abstract

Background Currently there is no consensus on ideal teaching method to train novice trainees in EBUS. Simulation-based procedure training allows direct observation of trainees in a controlled environment without compromising patient safety. Objective We wanted to develop a comprehensive assessment of endobronchial ultrasound (EBUS) performance of pulmonary fellows and assess the impact of a multimodal simulation-based curriculum for EBUS-guided transbronchial needle aspiration. Methods Pretest assessment of 11 novice pulmonary fellows was performed using a three-part assessment tool, measuring EBUS-related knowledge, self-confidence, and procedural skills. Knowledge was assessed by 20 multiple-choice questions. Self-confidence was measured using the previously validated EBUS–Subjective Assessment Tool. Procedural skills assessment was performed on Simbionix BRONCH Express simulator and was modeled on a previously validated EBUS–Skills and Task Assessment Tool (EBUS-STAT), to create a modified EBUS-STAT based on internal faculty input via the Delphi method. After baseline testing, fellows participated in a structured multimodal curriculum, which included simulator training, small-group didactics, and interactive problem-based learning sessions, followed by individual debriefing sessions. Posttest assessment using the same three-part assessment tool was performed after 3 months, and the results were compared to study the impact of the new curriculum. Results The mean knowledge score improved significantly from baseline to posttest (52.7% vs. 67.7%; P = 0.002). The mean EBUS–Subjective Assessment Tool confidence scores (maximum score, 50) improved significantly from baseline to posttest (26 ± 7.6 vs. 35.2 ± 6.3 points; P < 0.001). The mean modified EBUS-STAT (maximum score, 105) improved significantly from baseline to posttest (44.8 ± 10.6 [42.7%] vs. 65.3 ± 11.4 [62.2%]; P < 0.001). There was a positive correlation ( r = 0.81) between the experience of the test participants and the modified EBUS-STAT scores. Conclusion This study suggests a multimodal simulation-based curriculum can significantly improve EBUS-guided transbronchial needle aspiration–related knowledge, self-confidence, and procedural skills among novice pulmonary fellows. A validation study is needed to determine if skills attained via a simulator can be replicated in a clinical setting.