據Medscape網站10月16日報道，硬皮病肺部並發症研究Ⅱ(Scleroderma Lung Study II)的最新研究成果，將成為2015年美國胸科醫師學會大會(Chest 2015)上的一重大發現進行報告。

        此結果是基於該中心第一次研究結果，華盛頓塔科馬港市麥迪根軍隊醫學中心學術委員會主席-亞曆山大.尼文說：“環磷酰胺已成為硬皮病患者的基礎治療藥物。”

        為了提高環磷酰胺的療效，研究者們最近進行了一項新的研究-他們在同樣的硬皮病患者身上使用安慰劑和麥考酚酯與環磷酰胺做比較。

        尼文說，那些致力於SERVE-HF研究的呼吸專家和心髒病專家會對有關中樞性睡眠呼吸暫停伴慢性心力衰竭的研究感興趣。研討會提出了該研究與傳統觀念相悖的結果-在射血分數降低的心衰患者中采用適應性伺服式通氣方法治療會增加死亡率。

        蒙特利爾胸科協會主席布爾博說2015年《胸科學》會議為大家提供全麵的學習機會，為臨床提供新的指南。

       實踐模擬實驗

        尼文說，《胸科學》雜誌2007年已建立了模擬中心。在該中心我們把重症病房的病床裝上高仿真模擬人，雖然是無聲的但同樣有效。我們製造了一個包括氣道管理裝置，機械通氣區域和呼吸機的貨車，可以通過調節其中的參數來模擬氣胸，供大家實踐。今年我們還將模擬每一個危重氣道管理者都應具有的實踐經驗-環甲膜切開術。而像肺功能和超聲等實踐模擬將會放入標準化病人中。

        布爾博也說，我們不必進入臨床就能獲得實踐機會，而不是被動學習，我們將整合工作坊，問題式學習方法和遊戲教育等學習方法，使醫療保健成為主動學習。

       新時代醫療

        組織者們還開創一個多學科多領域的醫療模式，通過模擬真實生活環境將醫生護士呼吸治療師們整合到一起。

        布爾博說：“我們進入了一個全新的醫療時代，它不再是隻有重症管理、睡眠中心或長期護理，而是一個多學科多領域團隊合作的時代。”

        會議結束時組織者留了一個有關於膿毒症管理的疑問，有興趣者可以就膿毒症早期針對性治療及其發病，惡化，預後等方麵做出討論的參與拯救膿毒症運動或提出一些全新的臨床實踐依據。

        原文如下：

        標題：Scleroderma, Sleep Apnea, Sepsis Highlights of CHEST 2015

        正文：MONTREAL — Late-breaking results from the Scleroderma Lung Study II will be among the top findings reported at CHEST 2015: American College of Chest Physicians Meeting.

        The trial builds on the first Scleroderma Lung Study, previously reported by Medscape Medical News, which "established cyclophosphamide as one of the cornerstones of care for scleroderma patients," said Alexander Niven, MD, from the Madigan Army Medical Center in Tacoma, Washington, who is cochair of the scientific program committee.

        The lack of sustained improvement with cyclophosphamide led researchers to their latest investigation — a prospective randomized placebo-controlled trial comparing mycophenolate mofetil with cyclophosphamide. "It will be a very important session," Dr Niven predicted.

        Respiratory specialists and cardiologists still digesting the practice-changing SERVE-HF trial will be interested in the session on the impact of the trial results on the management of central sleep apnea in heart failure patients, he added. A panel discussion will explore the clinical implications of the trial's surprise finding that adaptive servo ventilation increased mortality in heart failure patients with reduced ejection fraction, signaling "a really a dramatic departure from the conventional thinking in this area," Dr Niven reported.

        The wide array of session formats aimed at providing a full range of learning opportunities is a unique strength of the CHEST meeting, said Jean Bourbeau, MD, from the Montreal Chest Institute, who is cochair of the scientific program committee. "We have a lot of different methods of education that allow clinicians to understand new practices, but also to practice," he told Medscape Medical News.

        Hands-on Simulation Experience

        CHEST has been building on a centerpiece of this concept — the simulation center — since 2007, Dr Niven reported.

        In one of these sessions, "we will reconstruct a clinical ICU room with a high-fidelity human simulator on a real hospital bed. The simulation community would recoil if we called it a 'dummy'!" he said. There will be a cart with all the equipment for airway management, a mechanical ventilation area, and a real ventilator connected with tubing to the 'patient'. We will have the opportunity to adjust some of the parameters to simulate things like pneumothorax" so our learners can troubleshoot, Dr Niven explained.

        This year there will be an opportunity to perform a cricothyroidotomy, "which is a rarely performed, but very important emergency skill that all intensivists who manage airways should have practical experience in," said Dr Niven.

        Some hands-on opportunities, such as pulmonary function testing and ultrasound procedures, will involve live "standardized patients."

        "Usually, you have to go to an institution to get that kind of practice," Dr Bourbeau explained, but this is offered onsite. "Probably the worst way to learn is just to have someone telling you. We have tried to incorporate many other methods, such as workshops, problem-based learning opportunities to put new guidelines into practice, and educational games. All are quite different but allow the healthcare professional to become an active learner."

        New Era of Medicine

        Organizers are offering interdisciplinary programs, which are designed to encourage a multidisciplinary and multiprofessional focus on care and to attract a mix of doctors, nurses, and respiratory therapists by simulating real-world settings.

        "We are entering a new era of practicing medicine — whether in the intensive care unit or sleep medicine clinic or in chronic care medicine — which will require more and more of a multidisciplinary and multiprofessional team," said Dr Bourbeau.

        Organizers have saved a potentially controversial session on sepsis management as an adrenaline bolus at the end of the meeting. On the heels of three recent studies that have challenged the early goal-directed therapy approach to sepsis (PROCESS, ARISE, and PROMISE), speakers will address the Surviving Sepsis Campaign and discuss the impact that new evidence will have on current clinical practice.