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Article ; Online: ABCDE Approach for Massive Hemoptysis: A Novel Cognitive Aid.

New, Melissa L / Huie, Tristan J

ATS scholar

2022 Volume 3, Issue 2, Page(s) 197–203

Abstract: Massive hemoptysis is a high-risk, low-frequency clinical scenario, and teaching the management of this emergency should extend beyond reliance on clinical exposure. Massive hemoptysis requires emergent intervention to avoid asphyxiation and death. ... ...

Abstract	Massive hemoptysis is a high-risk, low-frequency clinical scenario, and teaching the management of this emergency should extend beyond reliance on clinical exposure. Massive hemoptysis requires emergent intervention to avoid asphyxiation and death. Practitioners need both cognitive and procedural skills to intervene in a high-stress situation. Cognitive aids have demonstrated benefits in other emergency settings, but no such tool exists for massive hemoptysis. Using expert recommendations, we developed the ABCDE Approach for Massive Hemoptysis, a cognitively accessible, prioritized toolbox of interventions designed to assist learners in organizing an approach to these high-risk and time-sensitive patient cases. Herein we present the elements and use of the ABCDE approach. Providing a cognitive approach to massive hemoptysis is an important first step in improving education for this potentially fatal clinical scenario.
Language	English
Publishing date	2022-06-30
Publishing country	United States
Document type	Journal Article
ISSN	2690-7097
ISSN (online)	2690-7097
DOI	10.34197/ats-scholar.2022-0008PS
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Article ; Online: Massive Hemoptysis Simulation Curriculum Improves Performance.

New, Melissa L / Amass, Timothy / Neumeier, Anna / Huie, Tristan J

Chest

2023 Volume 165, Issue 3, Page(s) 645–652

Abstract: Background: Massive hemoptysis is a rare, high-acuity presentation, which requires the integration of both cognitive and procedural skills. Simulation has been recommended to improve preparation for high-acuity, low-occurrence procedures; however, the ... ...

Abstract	Background: Massive hemoptysis is a rare, high-acuity presentation, which requires the integration of both cognitive and procedural skills. Simulation has been recommended to improve preparation for high-acuity, low-occurrence procedures; however, the effect of a simulation curriculum for massive hemoptysis management has never been investigated. Research question: Does simulation for hemoptysis management improve competence? Study design and methods: Kern's six steps for medical education curriculum design were used iteratively to develop a simulation curriculum for the management of massive hemoptysis. Pulmonary and critical care medicine fellows from the University of Colorado participated in a local needs assessment and a massive hemoptysis simulation curriculum. Using a manikin-based massive hemoptysis simulator developed for this curriculum, the simulation session used repetitive practice, clinical variation, a range of difficulties, and directed feedback in a group practice setting. Time to management and performance were assessed for each management attempt; competence was assessed using a combined metric of management-related priorities and global entrustment. Results: During the needs assessment, fellows viewed massive hemoptysis management skills as important, while expressing their current confidence as low. Nineteen fellows participated in a 90-min case-based hemoptysis simulation during which each was exposed to five different cases and acted as the primary manager for two cases. There was significant improvement in performance from the first to final simulation attempts measured by time to successful management (14.24 vs 10.26 min, P = .0067) and entrustment (Global Assessment Scale, 1 [should not perform] to 5 [independent]; 4.11 vs 4.61; P = .015). Fellow self-assessed knowledge and confidence in hemoptysis management and endobronchial blocker placement improved significantly after the simulation. Interpretation: Hemoptysis simulation experience improves fellow confidence and skill for management of this high-acuity, low-occurrence presentation.
MeSH term(s)	Humans ; Hemoptysis/diagnosis ; Hemoptysis/etiology ; Hemoptysis/therapy ; Clinical Competence ; Curriculum ; Education, Medical ; Simulation Training/methods
Language	English
Publishing date	2023-10-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2023.10.013
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Article ; Online: Creation and Validation of a Massive Hemoptysis Simulator.

New, Melissa L / Amass, Timothy / Neumeier, Anna / Jacobson, Nicholas M / Huie, Tristan J

Chest

2023 Volume 165, Issue 3, Page(s) 636–644

Abstract: Background: Simulation for the management of massive hemoptysis is limited by the absence of a commercially available simulator to practice procedural skills necessary for management.: Research question: Is it feasible to create and validate a ... ...

Abstract	Background: Simulation for the management of massive hemoptysis is limited by the absence of a commercially available simulator to practice procedural skills necessary for management. Research question: Is it feasible to create and validate a hemoptysis simulator with high functional task alignment? Study design and methods: Pulmonary and critical care medicine (PCCM) attending physicians from four academic institutions in the Denver, Colorado, area and internal medicine residents from the University of Colorado participated in this mixed-methods study. A hemoptysis simulator was constructed by connecting a 3-D-printed airway model to a manikin that may be intubated. Attending PCCM physicians evaluated the simulator through surveys and qualitative interviews. Attendings were surveyed to determine simulation content and appropriate assessment criteria for a hemoptysis simulation. Based on these criteria, expert and novice performance on the simulator was assessed. Results: The manikin-based hemoptysis simulator demonstrated adequate physical resemblance, high functional alignment, and strong affective fidelity. It was universally preferred over a virtual reality simulator by 10 PCCM attendings. Twenty-seven attendings provided input on assessment criteria and established that assessing management priorities (eg, airway protection) was preferred to a skills checklist for hemoptysis management. Three experts outperformed six novices in hemoptysis management on the manikin-based simulator in all management categories assessed, supporting construct validity of the simulation. Interpretation: Creation of a hemoptysis simulator with appropriate content, high functional task alignment, and strong affective fidelity was successful using 3-D-printed airway models and existing manikins. This approach can overcome barriers of cost and availability for simulation of high-acuity, low-occurrence procedures.
MeSH term(s)	Humans ; Hemoptysis/diagnosis ; Hemoptysis/therapy ; Clinical Competence ; Physicians ; Equipment Design ; Surveys and Questionnaires ; Computer Simulation
Language	English
Publishing date	2023-10-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2023.10.014
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Article ; Online: Extraneous Load, Patient Census, and Patient Acuity Correlate With Cognitive Load During ICU Rounds.

Held, Natalie / Neumeier, Anna / Amass, Timothy / Harry, Elizabeth / Pomponio, Raymond / Peterson, Ryan A / Huie, Tristan J / Moss, Marc

Chest

2024

Abstract: Background: Cognitive load theory asserts that learning and performance degrade when cognitive load exceeds working memory capacity. This is particularly relevant in the learning environment of ICU rounds, when multidisciplinary providers integrate ... ...

Abstract	Background: Cognitive load theory asserts that learning and performance degrade when cognitive load exceeds working memory capacity. This is particularly relevant in the learning environment of ICU rounds, when multidisciplinary providers integrate complex decision-making and teaching in a noisy, high-stress environment prone to cognitive distractions. Research question: What features of ICU rounds correlate with high provider cognitive load? Study design and methods: This was an observational, multisite study of multidisciplinary providers during ICU rounds. Investigators recorded rounding characteristics and hourly extraneous cognitive load events during rounds (defined as distractions, episodes of split-attention or repetition, and deviations from standard communication format). After rounds, investigators measured each provider's cognitive load using the provider task load (PTL), an instrument derived from the National Aeronautics and Space Administration Task Load Index survey that assesses perceived workload associated with complex tasks. Relationships between rounding characteristics, extraneous load, and PTL score were evaluated using mixed-effects modeling. Results: A total of 76 providers were observed during 32 rounds from December 2020 to May 2021. The mean rounding census ± SD was 12.5 ± 2.9 patients. The mean rounding time ± SD was 2 h 17 min ± 49 min. The mean extraneous load ± SD was 20.5 ± 4.5 events per hour, or one event every 2 min 51 s. This included 8.6 ± 3.4 distractions, 8.2 ± 4.2 communication deviations, 1.9 ± 1.4 repetitions, and 1.8 ± 1.3 episodes of split-attention per hour. Controlling for covariates, the hourly extraneous load events, number of new patients, and number of higher acuity patients were each associated with increased PTL score (slope, 2.40; 95% CI, 0.76-4.04; slope, 5.23; 95% CI, 2.02-8.43; slope, 3.35; 95% CI, 1.34-5.35, respectively). Interpretation: Increased extraneous load, new patients, and patient acuity were associated with higher cognitive load during ICU rounds. These results can help direct how the ICU rounding structure may be modified to reduce workload and optimize provider learning and performance.
Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2023.12.029
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Article ; Online: Idiopathic pulmonary fibrosis: the radiologist's role in making the diagnosis.

Mohning, Michael P / Richards, John Caleb / Huie, Tristan J

The British journal of radiology

2019 Volume 92, Issue 1099, Page(s) 20181003

Abstract: Radiologists have a critical role in the evaluation and diagnosis of suspected idiopathic pulmonary fibrosis (IPF). Accurate pattern identification on imaging is key in the multidisciplinary diagnostic process and frequently obviates the need for a ... ...

Abstract	Radiologists have a critical role in the evaluation and diagnosis of suspected idiopathic pulmonary fibrosis (IPF). Accurate pattern identification on imaging is key in the multidisciplinary diagnostic process and frequently obviates the need for a surgical lung biopsy. In this review, we describe the clinical and imaging features of IPF in the context of recently revised international guidelines; contrast findings in other diseases that may inform differential diagnosis of fibrotic lung disease; and highlight common complications associated with pulmonary fibrosis.
MeSH term(s)	Diagnosis, Differential ; Humans ; Idiopathic Pulmonary Fibrosis/diagnostic imaging ; Lung/diagnostic imaging ; Positron Emission Tomography Computed Tomography ; Radiologists ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2019-05-14
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20181003
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Article ; Online: Fellowship Education in Interstitial Lung Disease. A National Survey of Program Directors and Trainees.

Natalini, Jake G / Kassutto, Stacey M / Huie, Tristan J / Kreider, Maryl E

ATS scholar

2020 Volume 1, Issue 4, Page(s) 384–394

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2020-08-13
Document type	Journal Article
ISSN	2690-7097
ISSN (online)	2690-7097
DOI	10.34197/ats-scholar.2020-0065OC
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Article ; Online: Definitions of disease: should possible and probable idiopathic pulmonary fibrosis be enrolled in treatment trials?

Huie, Tristan J / Brown, Kevin K

Respiratory investigation

2015 Volume 53, Issue 3, Page(s) 88–92

Abstract: Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrosing interstitial lung disease of unknown etiology characterized by progressive lung scarring and a median survival of 3-5 years from the time of diagnosis. The most recent consensus guidelines adopt ...

Abstract	Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrosing interstitial lung disease of unknown etiology characterized by progressive lung scarring and a median survival of 3-5 years from the time of diagnosis. The most recent consensus guidelines adopt a diagnostic process that characterizes patients as having a final diagnosis of IPF, probable IPF, or possible IPF determined from a combination of the clinical context and specific chest imaging and histologic disease patterns. Based on currently available data, the enrollment criteria for treatment trials could be expanded to include not only patients with IPF but also those with probable and possible IPF without adversely affecting trial design or outcomes.
MeSH term(s)	Clinical Trials as Topic ; Humans ; Idiopathic Pulmonary Fibrosis/diagnosis ; Idiopathic Pulmonary Fibrosis/pathology ; Idiopathic Pulmonary Fibrosis/therapy ; Medical History Taking ; Radiographic Image Enhancement ; Radiography, Thoracic ; Tomography, X-Ray Computed
Language	English
Publishing date	2015-05
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2660821-2
ISSN	2212-5353 ; 2212-5345
ISSN (online)	2212-5353
ISSN	2212-5345
DOI	10.1016/j.resinv.2014.12.005
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Article ; Online: Emphysema and pulmonary fibrosis: coincidence or conspiracy?

Huie, Tristan J / Solomon, Joshua J

Respirology (Carlton, Vic.)

2013 Volume 18, Issue 8, Page(s) 1163–1164

MeSH term(s)	Arthritis, Rheumatoid/epidemiology ; Emphysema/epidemiology ; Emphysema/etiology ; Female ; Humans ; Idiopathic Pulmonary Fibrosis/epidemiology ; Lung Diseases, Interstitial/epidemiology ; Male ; Smoking/adverse effects
Language	English
Publishing date	2013-11
Publishing country	Australia
Document type	Comment ; Editorial
ZDB-ID	1435849-9
ISSN	1440-1843 ; 1323-7799
ISSN (online)	1440-1843
ISSN	1323-7799
DOI	10.1111/resp.12187
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Article: Delphi Consensus Recommendations on Management of Dosing, Adverse Events, and Comorbidities in the Treatment of Idiopathic Pulmonary Fibrosis with Nintedanib.

Rahaghi, Franck / Belperio, John A / Fitzgerald, John / Gulati, Mridu / Hallowell, Robert / Highland, Kristin B / Huie, Tristan J / Kim, Hyun J / Kolb, Martin / Lasky, Joseph A / Southern, Brian D / Swigris, Jeffrey J / de Andrade, Joao A

Clinical medicine insights. Circulatory, respiratory and pulmonary medicine

2021 Volume 15, Page(s) 11795484211006050

Abstract: Purpose: Nintedanib is an approved treatment for idiopathic pulmonary fibrosis (IPF), which slows disease progression. Management of patients with IPF receiving nintedanib can be complicated by tolerability issues, comorbidities, and concomitant ... ...

Abstract	Purpose: Nintedanib is an approved treatment for idiopathic pulmonary fibrosis (IPF), which slows disease progression. Management of patients with IPF receiving nintedanib can be complicated by tolerability issues, comorbidities, and concomitant medications. We developed consensus recommendations on the management of dosing, adverse events and comorbidities in patients with IPF treated with nintedanib. Methods: A modified Delphi process using 3 questionnaires was used to survey 14 pulmonologists experienced in using nintedanib. Panelists rated their agreement with statements on a Likert scale from -5 (strongly disagree) to +5 (strongly agree). Consensus was predefined as a mean score of ⩽-2.5 or ⩾+2.5 with a standard deviation not crossing zero. Results: The panelists' recommendations were largely aligned with clinical trial data, real-world evidence, and the prescribing information, and provided additional guidance regarding minimizing gastrointestinal effects, periodic monitoring for liver dysfunction, caution with respect to concomitant administration of cytochrome P450 3A4 and P-glycoprotein 1 inhibitors and inducers and anticoagulants, and management of comorbidities. The panelists unanimously agreed that adverse event management should be individualized, based on careful consideration of the risks and benefits of each possible intervention and discussion with the patient. Conclusions: These consensus recommendations provide additional guidance on the appropriate management of IPF with nintedanib, for use alongside evidence-based literature and the prescribing information.
Language	English
Publishing date	2021-03-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2583465-4
ISSN	1179-5484
ISSN	1179-5484
DOI	10.1177/11795484211006050
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Article: Duration of rheumatoid arthritis and the risk of developing interstitial lung disease.

Mohning, Michael P / Amigues, Isabelle / Demoruelle, M Kristen / Fernández Pérez, Evans R / Huie, Tristan J / Keith, Rebecca K / Olson, Amy L / Yunt, Zulma X / Chung, Jonathan H / Hobbs, Stephen / Swigris, Jeffrey J / Solomon, Joshua J

ERJ open research

2021 Volume 7, Issue 1

Abstract: Age of ILD onset is similar in patients with RA-UIP and RA-NSIP but duration of RA before ILD onset ... ...

Abstract	Age of ILD onset is similar in patients with RA-UIP and RA-NSIP but duration of RA before ILD onset differs
Language	English
Publishing date	2021-02-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2827830-6
ISSN	2312-0541
ISSN	2312-0541
DOI	10.1183/23120541.00633-2020
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