Detecting Alpha-1 Antitrypsin Deficiency: Current State, Impediments, Opportunities, and Future Directions.

Alpha-1 antitrypsin deficiency (AATD) is an under-recognized condition with only a small minority of affected individuals detected, long delays between initial symptoms and diagnosis, and evidence that affected individuals may see many physicians with suggestive symptoms before an initial diagnosis is made. In the context that failure to detect AATD confers harm and that specific therapy is currently available, there is a clear need for enhanced detection. Impediments to enhanced detection include inadequate knowledge about AATD by physicians caring for at-risk patients, inattention to guidelines which endorse testing, a sense of therapeutic nihilism among some physicians (i.

An Electronic Health Record-Based Strategy to Enhance Detection of Alpha-1 Antitrypsin Deficiency.

Background: Because alpha-1 antitrypsin deficiency is severely underrecognized and delayed diagnosis is associated with harm, strategies to enhance early detection of alpha-1 antitrypsin deficiency are needed.

Methods: The study intervention was placing a reminder to test for alpha-1 antitrypsin deficiency within an electronic medical record health maintenance dashboard that houses prompts to providers to implement guideline-based recommendations. This recommendation was for all patients assigned a diagnosis of COPD based on relevant International Classification of Diseases, Tenth Revision codes.

Rapidly progressive cystic lung disease in a patient with a scalp lesion.

We describe an elderly patient presenting with pneumothorax, cystic lung disease and a scalp lesion. The pneumothorax resolved after placing a chest tube and suction but recurred within a week. Progression of cystic features was also seen, and biopsies of the lung and scalp lesions were performed.

Area under the inspiratory flow-volume curve (AIN): Proposed normative values.

Rationale: Area under expiratory flow-volume curve (AEX) has been shown to be a valuable functional measurement in respiratory physiology. Area under inspiratory flow-volume loop (AIN) also shows promise in characterizing upper and/or lower airflow obstruction.

Objectives: we aimed here to develop normative reference values for AIN, able to ascertain deviations from normal.

A Systematic Review of Metrics Utilized in the Selection and Prediction of Future Performance of Residents in the United States.

Aligning resident and training program attributes is critical. Many programs screen and select residents using assessment tools not grounded in available evidence. This can introduce bias and inappropriate trainee recruitment.

Global "systemness" in medical education: A rationale and framework to assess performance.

Healthcare is global. The challenges of the "triple aim" - achieving high-quality healthcare, maximal value, and an excellent patient experience and outcomes - are universal. Medical education is similarly global with worldwide efforts towards competency-based reform, the adoption and adaptation of accreditation standards, and the expansion of international collaborations between healthcare organizations (HCOs).

Trajectory of a medical career: a perspective regarding a proposed model.

A career as a physician offers so many options-clinical care, research, education, leadership, etc. Still, a general trajectory of a medical career can be usefully modelled. Based on a USA-centric lens, this proposed model-which is based on a personal reflection and conversation with colleagues-consists of an initial two-component linear phase, followed later by a non-linear phase.

Authentic leadership at the Cleveland Clinic: psychological safety in the midst of crisis.

Objectives: The goal of this research was to examine the leadership experiences of senior leaders at the Cleveland Clinic during the recent COVID-19 pandemic crisis. A secondary goal was to examine lessons that could inform other healthcare organisations as they move into subsequent crisis situations.

Design: The authors examined publicly available podcast transcripts where interviewees shared their leadership experiences on the Cleveland Clinic Beyond Leadership Podcast.

Advancing Research in Health Professions Education Through an Innovative Accelerator Panel.

Introduction: Research and scholarship are critical to advance the effective design, implementation, and evaluation of health professions education activities as well as to study outcomes and disseminate observations to the community. Yet, many educators are neither involved in nor equipped to conduct quality education research. This gap underscores the continuing education need to guide and train health professions educators to rigorously investigate, prepare, and report their educational research.

Radiographic Distribution as a Diagnostic Clue in Pulmonary Disease.

Because some disease processes produce radiographic abnormalities that occur in characteristic distributions in the chest, classifying the position and appearance of these suggestive features and the underlying diseases provides a tool by which diagnostic accuracy might be improved. The goal of this review is to offer to the chest clinician a taxonomy of these disease entities that can produce characteristic chest radiographic distributions. These radiographic distributions often reflect anatomic or physiologic conditions that drive the radiographic appearance; for example, foramen of Morgagni diaphragmatic hernias most commonly present in the right ventral chest, consistent with the anatomic location of the diaphragmatic foramen.

Estimating the costs of physician turnover in hospital medicine.

Background And Objective: Costs of physician turnover are lacking for specialties organized around a site of care. We sought to estimate the cost of physician turnover in adult hospital medicine (HM).

Design, Setting, Participants: A retrospective cohort study within a large integrated health system between July 2017 and June 2020.

Post-ictal diffuse alveolar haemorrhage: clinical profile based on case reports.

Diffuse alveolar haemorrhage (DAH) after a generalized tonic-clonic seizure is a rarely described illness likely involving physical disruption of alveolar-capillary interface similar to the mechanism of neurogenic pulmonary oedema. Based on our review of the English literature, only 11 cases have been reported to date. Recognition of this sparsely reported entity is important for optimal management, including avoidance of medications that have been implicated in causing DAH.

Area under the expiratory flow-volume curve: normative values in the National Health and Nutrition Survey (NHANES) study.

The area under the expiratory flow-volume (AEX-FV) loop has been evaluated before as a spirometric tool for assessing respiratory functional impairment. We computed the AEX-FV curves in spirometry tests performed on 20,313 participants in the National Health and Nutrition Examination Survey (NHANES) study.We analyzed 108,939 spirometry tests performed between 2007 and 2012 (5964 children; 14,349 adults).

A 21-Year-Old Man With Dyspnea, Wheezing, and Cough.

A 21-year-old male college student presented for a second opinion with low alpha-1 antitrypsin (AAT) levels and complaints of episodic dyspnea with wheezing and cough. He was a never smoker with a medical history of frequent respiratory tract infections in early childhood and allergy to dander, dust mites, peanuts, and eggs. There was no travel history outside of the continental United States.

A Novel Detection Method to Identify Individuals with Alpha-1 Antitrypsin Deficiency: Linking Prescription of COPD Medications with the Patient-Facing Electronic Medical Record.

Background: Alpha-1 antitrypsin deficiency (AATD) is under-recognized, prompting the need for enhanced detection strategies. The primary aim of this study is to determine the feasibility of using the electronic medical record (EMR) and linked electronic patient messages (EPM) to encourage AATD testing by patients with chronic obstructive pulmonary disease (COPD).

Methods: Study participants were eligible, untested adult patients who were prescribed an inhaled medication which is exclusively Food and Drug Administration-approved for treating COPD.

Designing Clinical Trials in "Regular" COPD Versus Alpha-1 Antitrypsin Deficiency-Associated COPD: "More Alike Than Unalike?".

Alpha-1 antitrypsin deficiency (AATD) predisposes to emphysema, liver disease, and panniculitis. This emphysema risk naturally invites a comparison between "regular" chronic obstructive pulmonary disease (COPD) (i.e.