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Article: Improving the specificity of autofluorescence bronchoscopy.

Maceachern, Paul / Tremblay, Alain

Journal of bronchology & interventional pulmonology

2009 Volume 16, Issue 3, Page(s) 155–157

Language	English
Publishing date	2009-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2478320-1
ISSN	1948-8270 ; 1944-6586
ISSN (online)	1948-8270
ISSN	1944-6586
DOI	10.1097/LBR.0b013e3181af7d5a
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Article: How should we manage empyema complicating tunneled pleural catheter placement?

Tremblay, Alain / Stather, David R / Maceachern, Paul

Journal of bronchology & interventional pulmonology

2010 Volume 17, Issue 2, Page(s) 106–108

Language	English
Publishing date	2010-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2478320-1
ISSN	1948-8270 ; 1944-6586
ISSN (online)	1948-8270
ISSN	1944-6586
DOI	10.1097/LBR.0b013e3181dab03d
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Article ; Online: Severe airway injury due to alendronate aspiration.

Maceachern, Paul R / Brazil, Aiden / Tremblay, Alain / Stather, David R / Chee, Alex C / Chou, Julie

Canadian respiratory journal

2013 Volume 20, Issue 6, Page(s) 410–412

Abstract: Sequelae of foreign body aspiration can range from clinically silent and asymptomatic to immediate asphyxiation and death. Only two previous cases of bisphosphonate tablet aspiration have been reported. Ulcerative esophagitis, a known adverse effect of ... ...

Abstract	Sequelae of foreign body aspiration can range from clinically silent and asymptomatic to immediate asphyxiation and death. Only two previous cases of bisphosphonate tablet aspiration have been reported. Ulcerative esophagitis, a known adverse effect of oral bisphosphonate formulations, occurs primarily with prolonged exposure of esophageal mucosa to the medication. Little is known about the effects of bisphosphonates on the airway mucosa. The authors present a case involving an 84-year-old woman who required multiple bronchoscopic debridements, intubation for airway protection and intensive care unit admission following airway injury believed to be due to delayed recognition of aspiration of an alendronate tablet.
MeSH term(s)	Acute Lung Injury/diagnosis ; Acute Lung Injury/etiology ; Aged, 80 and over ; Alendronate/adverse effects ; Bone Density Conservation Agents/adverse effects ; Bronchi ; Female ; Foreign Bodies/diagnosis ; Foreign Bodies/etiology ; Humans ; Respiratory Aspiration/complications
Chemical Substances	Bone Density Conservation Agents ; Alendronate (X1J18R4W8P)
Language	English
Publishing date	2013-10-17
Publishing country	Egypt
Document type	Case Reports ; Journal Article
ZDB-ID	1213103-9
ISSN	1916-7245 ; 1198-2241
ISSN (online)	1916-7245
ISSN	1198-2241
DOI	10.1155/2013/753906
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Article ; Online: Trainee impact on advanced diagnostic bronchoscopy: an analysis of 607 consecutive procedures in an interventional pulmonary practice.

Stather, David Ryan / Maceachern, Paul / Chee, Alex / Dumoulin, Elaine / Tremblay, Alain

Respirology (Carlton, Vic.)

2013 Volume 18, Issue 1, Page(s) 179–184

Abstract: Background and objective: Complications during advanced diagnostic bronchoscopy are rare and include: pneumothorax, bleeding, mediastinitis and lymphadenitis. Increased complications have been demonstrated in patients undergoing routine bronchoscopy ... ...

Abstract	Background and objective: Complications during advanced diagnostic bronchoscopy are rare and include: pneumothorax, bleeding, mediastinitis and lymphadenitis. Increased complications have been demonstrated in patients undergoing routine bronchoscopy procedures performed by trainees. This study aimed to determine the impact of trainees during advanced diagnostic bronchoscopy on procedure time, sedation use and complications. Methods: A retrospective review of a quality improvement database including consecutive pulmonary procedures performed by an interventional pulmonologist (D.R.S.) at the University of Calgary, from 1 July 2007 to 1 April 2011. Results: Six hundred seven (55.2%) of the 1100 procedures involved an advanced diagnostic procedure defined as: endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), electromagnetic navigation bronchoscopy (ENB) and/or peripheral EBUS. A trainee participated in 512 (84.3%) procedures. A complication occurred in 25 patients (4.1%), with a trend towards increased complication rates in the trainee group (4.7% vs 1.1%, difference 3.6%, P = 0.076). Significant differences were seen when a trainee participated versus when no trainee participated for procedure length (58.32 min vs 37.69 min, difference 20.63 min (95% confidence interval: 19.07-22.19), P = 0.001) and for the dose of propofol (178.3 mg vs 137.1 mg, difference 41.2 mg (95% confidence interval: 19.81-63.38), P = 0.002). Conclusions: In an academic interventional pulmonology practice utilizing the apprenticeship model, trainee participation in advanced diagnostic bronchoscopy increased procedure time, increased the amount of sedation used and resulted in a trend to increased complications. Attempts to modify trainee procedural training to reduce the burden of procedural learning for patients are warranted.
MeSH term(s)	Aged ; Biopsy, Needle/adverse effects ; Biopsy, Needle/methods ; Bronchoscopy/adverse effects ; Bronchoscopy/methods ; Education, Continuing ; Female ; Humans ; Lung Diseases/diagnosis ; Male ; Middle Aged ; Retrospective Studies ; Ultrasonography, Interventional/adverse effects ; Ultrasonography, Interventional/methods
Language	English
Publishing date	2013-01
Publishing country	Australia
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1435849-9
ISSN	1440-1843 ; 1323-7799
ISSN (online)	1440-1843
ISSN	1323-7799
DOI	10.1111/j.1440-1843.2012.02270.x
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Article: Repair costs for endobronchial ultrasound bronchoscopes.

Hergott, Christopher A / Maceachern, Paul / Stather, David R / Tremblay, Alain

Journal of bronchology & interventional pulmonology

2010 Volume 17, Issue 3, Page(s) 223–227

Abstract: Background: The development of endobronchial ultrasound (EBUS) has revolutionized the diagnostic approach to lung cancer and mediastinal lymphadenopathy. The capital costs associated with implementing EBUS are easily obtained from manufacturers, but the ...

Abstract	Background: The development of endobronchial ultrasound (EBUS) has revolutionized the diagnostic approach to lung cancer and mediastinal lymphadenopathy. The capital costs associated with implementing EBUS are easily obtained from manufacturers, but the ongoing maintenance and repair costs are unknown. Objective: The purpose of this study was to delineate the maintenance and repair costs associated with EBUS. Methods: For the period between October 2005 and June 30, 2009, the number of procedures and the maintenance and repair costs for both EBUS and flexible bronchoscopes were recorded. Two BF-160UCF-OL8 (Olympus, Canada) linear convex EBUS bronchoscopes were used for EBUS procedures during the course of the study. Total costs were calculated on a yearly basis and on a per procedure basis for EBUS and standard bronchoscopes and are presented in Canadian and US dollars ($1 CAN=$0.88 USD). Results: During the period of October 2005 and June 2009, a total of 949 linear convex EBUS procedures and 2767 flexible bronchoscopies were carried out. During this period, 13 separate repair issues were encountered with the EBUS bronchoscopes and control unit. The total cost for maintenance and repair of the EBUS and flexible bronchoscopes was $110,151.46 ($96,933.28 USD) and $67,301.49 ($59,225.31 USD), respectively. The average cost per procedure for EBUS and flexible bronchoscopy was $116.00 ($102.08 USD) and $24.32 ($21.42 USD), respectively. Conclusions: The cost of EBUS repairs per procedure is significant and illustrates the importance of understanding the ongoing maintenance issues inherent in these delicate pieces of medical equipment.
Language	English
Publishing date	2010-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2478320-1
ISSN	1948-8270 ; 1944-6586
ISSN (online)	1948-8270
ISSN	1944-6586
DOI	10.1097/LBR.0b013e3181e77280
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Article ; Online: Use of a drug eluting pleural catheter for pleurodesis.

Tremblay, Alain / Dumitriu, Severian / Stather, David R / Maceachern, Paul / Illanes, Oscar / Kelly, Margaret M

Experimental lung research

2012 Volume 38, Issue 9-10, Page(s) 475–482

Abstract: Purpose: Repeated administration of low-dose silver nitrate (SN) has been shown to be effective in creating pleurodesis. This study aimed to determine the effectiveness of a SN-eluting pleural catheter for pleurodesis.: Methods: Catheters with a ... ...

Abstract	Purpose: Repeated administration of low-dose silver nitrate (SN) has been shown to be effective in creating pleurodesis. This study aimed to determine the effectiveness of a SN-eluting pleural catheter for pleurodesis. Methods: Catheters with a chitosan-SN-hyaluronic acid hydrogel coating designed to release SN over 14 days, or placebo uncoated catheters, were inserted in rabbit and lamb pleurodesis models. Pleurodesis was assessed at 28 days according to a 1-8 point scoring system and pleural fibrosis and inflammation assessed histologically on a 0-4 point scale. Results: In the rabbit model, pleurodesis scores were significantly increased in both the 24 mg and 50 mg SN catheters versus control animals as well as compared to the contralateral untreated pleural space (median-treated side scores were 5, 8, and 1, respectively, median score for contralateral side was 1 in all groups). In the lamb model, pleurodesis scores were significantly increased in both the 750 mg and 1000 mg catheter groups versus control animals as well as compared to the contralateral untreated pleural space (median-treated side scores were 7, 7, and 1, respectively, median score for contralateral pleural space was 1 in all groups). Catheters appeared well tolerated, although higher than expected mortality was seen in the 50 mg catheter rabbit group. Conclusions: A catheter designed to deliver SN to the pleural space over 14 days appears to be effective in creating pleurodesis. Further investigations to determine in-vivo catheter pharmacokinetics, toxicity, dose and optimal coating methods are warranted.
MeSH term(s)	Animals ; Anti-Infective Agents, Local/administration & dosage ; Catheterization/methods ; Disease Models, Animal ; Pleural Cavity/pathology ; Pleurodesis/methods ; Rabbits ; Sheep ; Silver Nitrate/administration & dosage
Chemical Substances	Anti-Infective Agents, Local ; Silver Nitrate (95IT3W8JZE)
Language	English
Publishing date	2012-11
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603791-4
ISSN	1521-0499 ; 0190-2148
ISSN (online)	1521-0499
ISSN	0190-2148
DOI	10.3109/01902148.2012.731715
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Zs.A 1568: Show issues

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Article ; Online: Exercise capacity, lung function, and quality of life after interventional bronchoscopy.

Oviatt, P Leland / Stather, David R / Michaud, Gaëtane / Maceachern, Paul / Tremblay, Alain

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer

2011 Volume 6, Issue 1, Page(s) 38–42

Abstract: Introduction: Malignant airway obstruction accounts for significant morbidity and mortality in patients with lung and metastatic cancer. We prospectively assessed the effects of bronchoscopic interventions for the treatment of malignant airway ... ...

Abstract	Introduction: Malignant airway obstruction accounts for significant morbidity and mortality in patients with lung and metastatic cancer. We prospectively assessed the effects of bronchoscopic interventions for the treatment of malignant airway obstruction, with specific attention to exercise capacity and quality of life (QoL). Methods: This is a prospective cohort study. Patients with high-grade, symptomatic central malignant airway obstruction were assessed at baseline and then at days 30, 90, and 180 after bronchoscopic intervention with spirometry, 6-minute walk test (6MWT), and QoL and dyspnea questionnaires (European Organization for Research and Treatment of Cancer Quality of Life [C30] and Lung Cancer [LC-13] modules). Results: Thirty-seven patients were included in the final statistical analysis. Increases in 6MWT distance by 99.7 m (95% CI 33.2-166.2 m, p = 0.002), FEV1 by 448 ml (95% CI 203-692 ml, p < 0.001), and FVC by 416 ml (95% CI 130-702 ml, p = 0.003) were seen at day 30 compared with baseline. Clinically and statistically significant improvements were noted in composite dyspnea scores at day 30 by both QoL C30 (decrease of 39.9, 95% CI 21.4-58.4, p < 0.001) and LC-13 (decrease of 28.2, 95% CI 12.9-43.5, p < 0.001) questionnaires. Conclusions: Bronchoscopic intervention for malignant airway obstruction is associated with improvement in 6MWT, spirometry, and dyspnea at 30 days.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Airway Obstruction/physiopathology ; Airway Obstruction/surgery ; Bronchoscopy ; Cohort Studies ; Exercise/physiology ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Lung/physiology ; Lung Volume Measurements ; Male ; Middle Aged ; Palliative Care ; Prognosis ; Prospective Studies ; Quality of Life ; Respiratory Function Tests ; Stents
Language	English
Publishing date	2011-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2432037-7
ISSN	1556-1380 ; 1556-0864
ISSN (online)	1556-1380
ISSN	1556-0864
DOI	10.1097/JTO.0b013e3181f8a298
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Article ; Online: Validation of an endobronchial ultrasound simulator: differentiating operator skill level.

Stather, David R / Maceachern, Paul / Rimmer, Karen / Hergott, Christopher A / Tremblay, Alain

Respiration; international review of thoracic diseases

2011 Volume 81, Issue 4, Page(s) 325–332

Abstract: Background: Endobronchial ultrasound (EBUS) is a revolutionary diagnostic procedure. There is currently no accepted method of assessing EBUS technical skill or competency.: Objectives: This study aimed to validate a computer EBUS simulator in ... ...

Abstract	Background: Endobronchial ultrasound (EBUS) is a revolutionary diagnostic procedure. There is currently no accepted method of assessing EBUS technical skill or competency. Objectives: This study aimed to validate a computer EBUS simulator in differentiating between operators of varying clinical EBUS experience. Methods: A convenience sample (n = 22) of bronchoscopists was separated into four cohorts based on previous bronchoscopy experience: group A = novice bronchoscopists, no EBUS experience (n = 4), group B = expert bronchoscopists, no EBUS experience (n = 5), group C = basic clinical EBUS training (n = 9), group D = EBUS experts (n = 4). After a standardized introduction session on the EBUS simulator, participants performed 2 simulated cases on an EBUS simulator with performance metrics measured by the simulator. Results: Significant differences between groups were noted for total procedure time, percentage of lymph nodes identified and percentage of successful biopsies (p < 0.05, ANOVA). Group D performed significantly better than all other groups for total procedure time and percentage of lymph nodes identified (p < 0.05). Group C performed significantly better than groups A and B for total procedure time, percentage of lymph nodes identified and percentage of successful biopsies (p < 0.05, ANOVA). Conclusions: An EBUS simulator can accurately discriminate between operators with different levels of clinical EBUS experience. EBUS simulators show promise as a tool for assessing training and evaluating competency.
MeSH term(s)	Adult ; Biopsy, Fine-Needle ; Bronchi/diagnostic imaging ; Bronchoscopy/education ; Clinical Competence ; Computer Simulation ; Endosonography ; Female ; Humans ; Lymph Nodes/pathology ; Male ; Middle Aged
Language	English
Publishing date	2011
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Validation Studies
ZDB-ID	206674-9
ISSN	1423-0356 ; 0025-7931
ISSN (online)	1423-0356
ISSN	0025-7931
DOI	10.1159/000323520
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Article ; Online: Assessment and learning curve evaluation of endobronchial ultrasound skills following simulation and clinical training.

Stather, David R / Maceachern, Paul / Rimmer, Karen / Hergott, Christopher A / Tremblay, Alain

Respirology (Carlton, Vic.)

2011 Volume 16, Issue 4, Page(s) 698–704

Abstract: Background and objective: Endobronchial ultrasound is a revolutionary diagnostic pulmonary procedure. The use of a computer endobronchial ultrasound simulator could improve trainee procedural skills before attempting to perform procedures on patients. ... ...

Abstract	Background and objective: Endobronchial ultrasound is a revolutionary diagnostic pulmonary procedure. The use of a computer endobronchial ultrasound simulator could improve trainee procedural skills before attempting to perform procedures on patients. This study aims to compare endobronchial ultrasound performance following training with simulation versus conventional training using patients. Methods: A prospective study of pulmonary medicine and thoracic surgery trainees. Two cohorts of trainees were evaluated using simulated cases with performance metrics measured by the simulator. Group 1 received endobronchial ultrasound training by performing 15 cases on an endobronchial ultrasound simulator (n=4). Group 2 received endobronchial ultrasound training by doing 15-25 cases on patients (n=9). Results: Total procedure time was significantly shorter in group 1 than group 2 (15.15 (±1.34) vs 20.00 (±3.25) min, P<0.05). The percentage of lymph nodes successfully identified was significantly better in group 1 than group 2 (89.8 (±5.4) vs 68.1 (±5.2), P < 0.05). There was no difference between group 1 and group 2 in the percentage of successful biopsies (100.0 (±0.0) vs 90.4 (±11.5), P=0.13). The learning curves for simulation trained fellows did not show an obvious plateau after 19 simulated cases. Conclusions: Using an endobronchial ultrasound simulator leads to more rapid acquisition of skill in endobronchial ultrasound compared with conventional training methods, as assessed by an endobronchial ultrasound simulator. Endobronchial ultrasound simulators show promise for training with the advantage of minimizing the burden of procedural learning on patients.
MeSH term(s)	Adult ; Bronchi/diagnostic imaging ; Bronchoscopy/education ; Bronchoscopy/methods ; Clinical Competence ; Computer Simulation ; Female ; Humans ; Learning Curve ; Male ; Pulmonary Medicine/education ; Thoracic Surgical Procedures/education ; Ultrasonography
Language	English
Publishing date	2011-05
Publishing country	Australia
Document type	Controlled Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1435849-9
ISSN	1440-1843 ; 1323-7799
ISSN (online)	1440-1843
ISSN	1323-7799
DOI	10.1111/j.1440-1843.2011.01961.x
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Article ; Online: Idiopathic subglottic stenosis: a familial predisposition.

Dumoulin, Elaine / Stather, David R / Gelfand, Gary / Maranda, Bruno / Maceachern, Paul / Tremblay, Alain

The Annals of thoracic surgery

2010 Volume 95, Issue 3, Page(s) 1084–1086

Abstract: Idiopathic subglottic stenosis is a narrowing of the trachea at the level of the cricoid cartilage of unknown etiology. It is a rare condition for which the real incidence has never been established owing to the difficulty of making the diagnosis. ... ...

Abstract	Idiopathic subglottic stenosis is a narrowing of the trachea at the level of the cricoid cartilage of unknown etiology. It is a rare condition for which the real incidence has never been established owing to the difficulty of making the diagnosis. Although there is a female preponderance, no familial cases have been reported in the literature. We describe two pairs of sisters as well as a mother and daughter presenting with idiopathic subglottic stenosis. All known causes of tracheal stenosis were excluded, including prolonged intubation, surgery, autoimmune and inflammatory disorders, infection and gastroesophageal reflux disease. These are the first cases reported in the literature that suggest a genetic predisposition for idiopathic subglottic stenosis.
MeSH term(s)	Adult ; Bronchoscopy ; Diagnosis, Differential ; Dilatation/methods ; Female ; Follow-Up Studies ; Genetic Predisposition to Disease ; Humans ; Middle Aged ; Siblings ; Tracheal Stenosis/diagnosis ; Tracheal Stenosis/genetics ; Tracheal Stenosis/therapy ; Young Adult
Language	English
Publishing date	2010-04-01
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2012.07.076
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