A case series describing common radiographic and pathologic patterns of hard metal pneumoconiosis.

INTRODUCTION: Hard metal pneumoconiosis is a rare but serious disease of the lungs associated with inhalational exposure to tungsten or cobalt dust. Little is known about the radiologic and pathologic characteristics of this disease and the efficacy of treating with immunosuppression. OBJECTIVE: We describe the largest cohort of patients with hard metal pneumoconiosis in the literature, including radiographic and pathologic patterns as well as treatment options. METHODS: We retrospectively identified patients from the University of Pittsburgh pathology registry between the years of 1985 and 2016. Experts in chest radiology and pulmonary pathology reviewed the cases for radiologic and pathologic patterns. RESULTS: We identified 23 patients with a pathologic pattern of hard metal pneumoconiosis. The most common radiographic findings were ground glass opacities (93%) and small nodules (64%). Of 20 surgical biopsies, 17 (85%) showed features of giant cell interstitial pneumonia. Most patients received systemic corticosteroids and/or steroid-sparing immunosuppression. CONCLUSIONS: Hard metal pneumoconiosis is characterized predominately by radiographic ground glass opacities and giant cell interstitial pneumonia on histopathology. Systemic corticosteroids and steroid-sparing immunosuppression are common treatment options.

A comprehensive educational program improves clinical outcome measures in inner-city patients with asthma.

BACKGROUND: Despite improved understanding of the pathophysiology of asthma, morbidity and mortality continue to rise, with disproportionate increases occurring among urban, indigent minorities. New approaches in the management of asthma are therefore necessary to reverse these dramatic and costly trends. OBJECTIVE: To determine if patients who are admitted to the hospital with acute asthma and receive inpatient education will have improved outpatient follow-up and clinical outcome measures compared with those receiving conventional care. METHODS: Patients enrolled in the study had a primary admission diagnosis of asthma and were between ages 18 and 45 years. Exclusion criteria included comorbid disease, inability to speak English, absence of a telephone in the primary residence, or pregnancy. Seventy-seven patients admitted from the emergency department with asthma were randomized to either the inpatient educational program (IEP) or routine care (control group). Patients in the IEP received asthma education, bedside spirometry, a telephone call 24 hours after discharge, and scheduled follow-up in an outpatient asthma program within 1 week of discharge. Those individuals randomized to the routine management group received conventional inpatient asthma care and routine follow-up. RESULTS: The patients enrolled in the IEP had a markedly higher follow-up rate compared with outpatient appointments (60% vs. 27%; P = .01) and significantly fewer emergency department visits (P = .04) and hospitalizations (P = .04) for asthma in the 6 months following IEP intervention, as compared with control patients. This represented a substantial cost savings to the managed care organization. CONCLUSION: Our study suggests that an IEP in the treatment of indigent, inner-city patients hospitalized with asthma reduces the need for subsequent emergent care and improves outpatient follow-up in a cost-effective manner.

Nursing strategies for smoking cessation.

The purpose of this article is to provide the staff nurse with an overview of the Agency for Health Care Policy and Research Smoking Cessation guidelines. The authors outline the practical components of the guidelines to enable nurses in any clinical setting to implement various smoking cessation strategies according to individual patient needs. Treatment options, including behavioral modification and a comprehensive review of pharmacological therapy, are discussed.

Using arterial blood gases to interpret acid-base balance.

Arterial blood gas (ABG) interpretation can be a source of concern. However with use of the review and principles discussed in this article, the nurse's role in blood gas interpretation can become much easier.