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Chester Fox,1,2 Wilson Pace,1,3 Elias Brandt,1 Victoria Carter,4,5 Ku-Lang Chang,6 Chelsea Edwards,7 Alexander Evans,4 Gabriela Gaona,1 MeiLan K Han,8 Alan Kaplan,5,9,10 Rachel Kent,1 Janwillem WH Kocks,5,11– 13 Maja Kruszyk,5,7 Le Lievre Chantal,5,7 Tessa LiVoti,4,5 Cathy Mahle,14 Barry Make,15 Amanda Ratigan,1 Asif Shaikh,14 Neil Skolnik,16,17 Brooklyn Stanley,4 Barbara P Yawn,17 David B Price4,5,18 1DARTNet Institute, Aurora, CO, USA; 2University at Buffalo, Buffalo, NY, USA; 3University of Colorado, Denver, CO, USA; 4Optimum Patient Care, Cambridge, UK; 5Observational and Pragmatic Research Institute, Singapore; 6University of Florida College of Medicine, Gainesville, FL, USA; 7Optimum Patient Care, Brisbane, Queensland, Australia; 8University of Michigan, Ann Arbor, MI, USA; 9Family Physician Airways Group of Canada, Stouffville, Ontario, Canada; 10University of Toronto, Toronto, Canada; 11General Practitioners Research Institute, Groningen, the Netherlands; 12Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 13Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 14Boehringer Ingelheim, Ridgefield, CT, USA; 15Department of Medicine, NJH, Denver, CO, USA; 16Abington Jefferson Health, Jenkintown, PA, USA; 17University of Minnesota, Minneapolis, MN, USA; 18Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UKCorrespondence: David B Price, Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK, Tel +65 3105 1489, Email dprice@opri.sgIntroduction: Little is known about the variability in chronic obstructive pulmonary disease (COPD) management and how it may be affected by patient characteristics across different healthcare systems in the US. This study aims to describe demographic and clinical characteristics of people with COPD and compare management across five primary care medical groups in the US.Methods: This is a retrospective observational registry study utilizing electronic health records stored in the Advancing the Patient Experience (APEX) COPD registry. The APEX registry contains data from five US healthcare organizations located in Texas, Ohio, Colorado, New York, and North Carolina. Data on demographic and clinical characteristics of primary care patients with COPD between December 2019 and January 2020 were extracted and compared.Results: A total of 17,192 patients with COPD were included in analysis: Texas (n = 811), Ohio (n = 8722), Colorado (n = 472), New York (n = 1149) and North Carolina (n = 6038). The majority of patients at each location were female (> 54%) and overweight/obese (> 60%). Inter-location variabilities were noted in terms of age, race/ethnicity, exacerbation frequency, treatment pattern, and prevalence of comorbid conditions. Patients from the Colorado site experienced the lowest number of exacerbations per year while those from the New York site reported the highest number. Hypertension was the most common co-morbidity at 4 of 5 sites with the highest prevalence in New York. Depression was the most common co-morbidity in Ohio. Treatment patterns also varied by site; Colorado had the highest proportion of patients not on any treatment. ICS/LABA was the most commonly prescribed treatment except in Ohio, where ICS/LABA/LAMA was most common.Conclusions and Relevance: Our data show heterogeneity in demographic, clinical, and treatment characteristics of patients diagnosed with COPD who are managed in primary care across different healthcare organizations in the US.Keywords: quality of care, observational study, research database, patient-reported outcomes

Although the effectiveness of screening for lung cancer remains controversial, it is a fact that most lung cancers are diagnosed at an advanced stage outside of lung cancer screening programs. In 2013, the U.S. Preventive Services Task Force revised its lung cancer screening recommendation, now supporting lung cancer screening by low-dose computed tomography in patients at high risk This is also endorsed by many major medical societies and advocacy group stake-holders, albeit with different eligibility criteria. In Europe, population-based lung cancer screening has so far not been recommended or implemented, as some important issues remain unresolved. Among them is the open question of how enlarging pulmonary nodules detected in lung cancer screening should be managed. This article comprises two parts: a review of the current lung cancer screening approaches and the potential therapeutic options for enlarging pulmonary nodules, followed by a meeting report including consensus statements of an interdisciplinary expert panel that discussed the potential of the different therapeutic options.

Although the effectiveness of screening for lung cancer remains controversial, it is a fact that most lung cancers are diagnosed at an advanced stage outside of lung cancer screening programs. In 2013, the U.S. Preventive Services Task Force revised its lung cancer screening recommendation, now supporting lung cancer screening by low-dose computed tomography in patients at high risk This is also endorsed by many major medical societies and advocacy group stake-holders, albeit with different eligibility criteria. In Europe, population-based lung cancer screening has so far not been recommended or implemented, as some important issues remain unresolved. Among them is the open question of how enlarging pulmonary nodules detected in lung cancer screening should be managed. This article comprises two parts: a review of the current lung cancer screening approaches and the potential therapeutic options for enlarging pulmonary nodules, followed by a meeting report including consensus statements of an interdisciplinary expert panel that discussed the potential of the different therapeutic options. 2017 International Association for the Study of Lung Cancer. (C) Published by Elsevier Inc. All rights reserved.

Background: Patients suffering from drug-resistant tuberculosis (DR TB) avail of private care since Programmatic Management of DR TB (PMDT) is not universally available in India. Management of DR TB is challenging and involves great expertise. Chest physicians (CPs) play a major role in this area. The study was undertaken with the objective to see whether the practices of CPs comply with current guidelines and to identify areas where they could be involved to improve access to PMDT. Materials and Methods : For this cross-sectional study, CPs from Mumbai and Nagpur, Maharashtra, India, were given pretested questionnaires to be filled in and returned. Observations : Of 70 enlisted CPs, 29 (41%) responded. Twenty-six (89%) respondents used the drug susceptibility test (DST) for diagnosis: private labs and hospitals were preferred; 9 (31%) used standard treatment, 15 (51%) switched to individual treatment after starting standard therapy and 12 (41%) started empirical treatment later switched to individual treatment as per the WHO guidelines. Seven consultants (10%) used in addition drugs from alternative systems of medicine for immune modulation and adverse drug effects. Eighty-six per cent CPs monitored treatment by smear examination, 51% by culture and 93% used X-rays. Reported case holding in the form of regular follow-up consultation visits was around 70%, treatment success estimated to be between 30% and 70%, and deaths around 30%. Adverse drug reactions were reported in around 30% cases. Conclusion : This study shows that most private CPs generally comply with current guidelines for management of DR TB. Accreditation of private labs for DST, involving CPs in diagnosis, treatment and monitoring of patients through public private partnerships can improve access to PMDT.

Background: Despite the development and dissemination of guidelines for the diagnosis and management of asthma, a gap remains between current recommendations and actual practice. Objectives: To assess the physicians’ knowledge, practice and adherence to The Global Initiative for Asthma (GINA) guidelines before and after dissemination of guidelines and to identify causes of non adherence to these guidelines. Materials and Methods: A pretest-posttest design was used to evaluate GINA guidelines dissemination intervention. The study included all chest physician categories working in all chest hospitals in Alexandria. Total sample size included sixty chest physicians. An interview questionnaire was designed to collect data related to knowledge and practices of physicians in diagnosis and management of bronchial asthma and to their agreement with GINA guidelines and barriers to implementation of the guidelines. In addition, seven different case scenarios were used to assess the ability of the respondents to classify control and management of asthma. Results: Poor practice (70%) was more marked than poor knowledge (45%) before guidelines dissemination. After guidelines dissemination, poor practice was still high (41.7%) while poor knowledge Fell to zero. Written asthma plan was used poorly by the studied physicians before as well as after guideline dissemination (3.3% and 16.7%, respectively). The reasons for non adherence of chest physicians to asthma guidelines were namely; lack of agreement with specific guidelines (26%); external barriers including lack of time, equipment or clinical space, educational materials staff support and reimbursement for services (25.6%) and poor patients’ adherence to asthma guidelines (16.4%). Conclusion and Recommendations: Even though, Alexandria chest physicians, had improvement in their level of knowledge after GINA guidelines dissemination yet, their practice and adherence to asthma guidelines was still low. To overcome barriers of physicians' non adherence, educational programs and strategies are needed to ensure actual dissemination and implementation of the guidelines.

Background In lung cancer, early diagnosis is the strongest predictor of survival and stage 1 is detected in only 15% of patients incidentally. To improve the outcomes, screening for cancer in the early stage in high-risk groups is a promising strategy. Aim The aim of this study was to assess the attitudes and knowledge of lung cancer screening practice in chest physicians. Patients and methods A self-administered questionnaire was distributed to a total of 75 chest physicians and the data were analysed. Results The survey illustrated that chest physicians believe that low-dose computed tomography (LDCT) is the most useful tool in screening for lung cancer in former and current smokers (31.3–62.5%) and it is a very effective screening test in reducing cancer mortality in never, former and current smokers (70%, 61.3 and 85%, respectively). Despite 90% of doctors having LDCT available in their geographic areas, 82.5% do not provide lung cancer screening for risk groups. Conclusion In Egypt, chest physicians believe that the use of LDCT screening for patients at high risk of lung cancer is an evidence-based recommendation by most programmes. Still most of them do not follow any screening program for risk groups. Education for doctors may increase the awareness, accuracy and efficacy of screening of high-risk patients.

BACKGROUND: Continuing medical education (CME) including the life long post-graduate training considered very important and serious work done in this direction worldwide. In Turkey, CME workshop was done by the Turkish Medical Association in 1991 firstly and CME credit board has been created in 1994. We aimed to determine approachments and status of the pulmonologists on CME, in Turkey. MATERIAL-METHOD: The cross-sectional, questionnaire-based study was carried out among pulmonologists working in state or chest disease hospitals in Turkey. 130 pulmonologists in 36 provinces those did not work in training hospitals invited to participate to study. RESULTS: Response rate was 54.6%. 28.2% of the participants had been participating to post-graduate education activities regularly. The participants that follow-up a publication and a web site about their specialty on a regular basis were 58.8% and 63.5%; respectively. 58.8% of the physicians sometimes feel themselves regressed in their profession and 72.9% of them request for rotation to training and research hospitals to develop themselves in professional respect. CONCLUSION: In conclusion, not yet fully evolved concept of CME in our country threatens the quality of healthcare, and indirectly, safety of the physician. There are needs to be done as well as those made of.