Medicina Pulmonar e Respiratória

Purpose:Incidentally discovered pulmonary nodules on computed tomography are common. Executing appropriate follow-up is challenging. The purpose of this study was to assess the impact of a standardized template of follow-up recommendations in radiology interpretation reports and an electronic messaging system on the rate of radiographic follow-up of indeterminate pulmonary nodules identified on computed tomography.

Materials and methods:This retrospective study examined rates of appropriate follow-up, as defined by the Fleischner Society guidelines, of incidental pulmonary nodules over a seven-month period both before (17 patients; mean age 62.7 years) and after (72 patients, mean age 61.6 years) the commencement of the quality improvement initiatives. Further analysis by risk group, patient and nodule characteristics, notification type and location of imaging request were performed.

Results:There was a trend towards improved time-appropriate follow-up from 35.3% (6/17) to 56.9% (49/72) [p=0.18]. The largest change was noted in high-risk patients with an improvement from 11.1% (1/9) appropriate follow-up to 51.4% (18/35) [p=0.06] following the interventions. The largest improvement in on-time follow-up imaging was a reduction in premature imaging, which decreased from 17.6% (3/17) to 6.9% (5/72) [p=0.18]. Rates of on-time follow-up after the interventions were similar irrespective of patient age, nodule size or origin of initial imaging request.

Conclusions: Ensuring use of a rigorous approach to indeterminate pulmonary nodule reporting reporting that includes standardized follow-up recommendations may improve rates of appropriate follow-up.

Aims:Effectiveness of combination of pulmonary rehabilitation (PR) and neuromuscular electrical stimulation (NMPR) in severe chronic obstructive pulmonary disease (COPD) is well established. We verified the effects of NMPR compared with pulmonary rehabilitation and sham stimulation (SSPR) in patients with moderately impaired COPD.

Methods:Quadriceps strength (sit-to-stand test: STST) and exercise capacity (6 minute walking test: 6MWT) were considered primary outcomes. Lung function, dyspnoea (modified Medical Research Council: mMRC) and quality of life (St. George’s Respiratory Questionnaire: SGRQ) secondary outcomes.

Results:83 stable patients in stage II, moderate COPD (23 female; mean age, 61.7 ± 9.1 years; FEV1 59.8 ± 7.3% of predicted) were enrolled. Quadriceps strength was enhanced by SSPR (STST + 7±1.7 repetitions; p≤0.001); NMPR further increased strength (+10±1.6 repetitions; p≤0.001) with a significant difference (p≤0.05) between the treatments. SSPR significantly increased exercise capacity (6MWD + 85.3±11.5 m; p=0.01); NMPR further increased the distance walked (6MWD +146.4±32.7 m; p=0.01) with a significant difference (p≤0.05) between the treatments. None of the two treatments influenced lung function. Quality of life score (SGRQ – 8.3±2.1; p=0.01) and dyspnoea score (mMRC-0.7±0.18; p=0.01) decreased after SSPR suggesting a positive effect. NMPR did not further improve the score.

Conclusions:This study confirms that PR is able to ameliorate quadriceps strength, exercise capacity, quality of life and dyspnoea in moderately impaired COPD patients. NMPR may further improve quadriceps strength and exercise capacity with respect to PR alone.