Brenda Varela

Hospital Alemán

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i-10 index

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Co-Authors

Gabriela Tabaj

Instituto Nacional del Tórax

Sílvia Quadrelli

University of Buenos Aires

Juan Ignacio Enghelmayer

University of Buenos Aires

María Laura Alberti

Hospital Fernández

Carlos Alberto Nigro

Hospital Alemán

Viviana Moyano

Servicio Diabetología Hospital Córdoba

María Otaola

Instituto Nacional de Rehabilitación Psicofísica

Fabián Caro

Hospital Fernández

Javier Sebastiani

Hospital Privado de Comunidad

Francisco Paulín

Hospital Fernández

Cooperative Institutions

Royal Prince Alfred Hospital

Isabela State University

Hospital Alemán

Imperial College London

Royal Brompton Hospital

National Health and Medical Research Council

Pulmonary and Critical Care Associates

Interstitial Cystitis Association

Hospital de Clínicas "José de San Martín"

Cooperative Trials Group for Neuro-Oncology

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Essential Features of an Interstitial Lung Disease Multidisciplinary Meeting: An International Delphi Survey

Annals of the American Thoracic Society (2021)

Alan Teoh Anne E. Holland Julie Morisset Kevin R. Flaherty Athol U. Wells

Rationale: The interstitial lung disease (ILD) multidisciplinary meetings (MDM), composed of pulmonologists, radiologists, and pathologists, is integral to the rendering of an accurate ILD diagnosis. However, there is significant heterogeneity in the conduct of ILD MDMs, and questions regarding their best practices remain unanswered. Objectives: To achieve consensus among ILD experts on essential components of an ILD MDM. Methods: Using a Delphi methodology, semi-structured interviews with ILD experts were used to identify key themes and features of ILD MDMs. These items informed two subsequent rounds of online questionnaires that were used to achieve consensus among a broader, international panel of ILD experts. Experts were asked to rate their level of agreement on a five-point Likert scale. An a priori threshold for consensus was set at a median score 4 or 5 with an interquartile range of 0. Results: We interviewed 15 ILD experts, and 102 ILD experts participated in the online questionnaires. Five items and two exploratory statements achieved consensus on being essential for an ILD MDM following two questionnaire rounds. There was consensus that the presence of at least one radiologist, a quiet setting with a visual projection system, a high-quality chest high-resolution computed tomography, and a standardized template summarizing collated patient data are essential components of an ILD MDM. Experts also agreed that it would be useful for ILD MDMs to undergo an annual benchmarking process and a validation process by fulfilling a minimum number of cases annually. Twenty-seven additional features were considered to be either highly desirable or desirable features based on the degree of consensus. Although our findings on desirable features are similar to the current literature, several of these remain controversial and warrant further research. The study also showed an agreement among participants on several future concepts to improve the ILD MDM, such as performing regular self-assessments and conducting research into shared practices to develop an international expert guideline statement on ILD MDMs. Conclusions: This Delphi study showed consensus among international ILD experts on essential and desirable features of an ILD MDM. Our data represent an important step toward potential collaborative research into future standardization of ILD MDMs.

Delphi Method

Pulmonologists

10.1513/annalsats.202011-1421oc

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Citations (24)

Interstitial Lung Diseases Virtual Clinics: a novel medical education method during pandemic times

12.01 - Idiopathic interstitial pneumonias (2022)

Brenda Varela G C Tabaj L Sheridan

Introduction: SARS-COV-2 pandemic challenged the medical education face-to-face meetings. ILD Virtual Clinics (ILD-VC) were thought as a non-traditional medical education model to address topics about a holistic management of ILDs. Weekly videoconferencing interviews with local experts and Q&A from the public were developed. Objective: To describe a virtual medical education model with an innovative format through interviews with experts in different ILD topics as a best practice. Implementation: 20 episodes of ILD-VC were carried out with an audience of pulmonologists, rheumatologists and general physicians from Argentina, Paraguay and Uruguay. Each 60 minutes duration episode with the presence of the coordinators and an expert in a specific topic for each episode recognized as an unmet need. The main objective was to discuss ILD management from different points of view and create a digital library with advices from the chosen experts. Some of the topics were: antigen searching for HP; determining progression in PF-ILDs; among others. The number of virtual assistants was 217 per episode (average) with a maximum of 382 and more de 4300 connections in total. A third season in planned for 2022. Conclusions: This innovate format provided a better understanding of ILD holistic management. Disclosures: The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE). The authors did not receive payment related to the development of the abstract. Boehringer Ingelheim (BI) was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations. The study was supported and funded by BI.

Pulmonologists

Videoconferencing

Pandemic

Face-to-face

10.1183/13993003.congress-2022.1111

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Citations (0)

[Primary lung lymphoma].

Medicina (2010)

Mariano E Díaz Silvana Malnis Brenda Varela Gonzalo Garate Carlos Alberto Nigro

Source

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The Interstitial Lung Disease Patient Pathway: From Referral To Diagnosis

ERJ Open Research (2024)

Graham Lough Rayid Abdulqawi Gina Amanda Katerina Antoniou Arata Azuma

Background Suspected Interstitial Lung Disease (ILD) patients may be referred to an ILD-specialist centre or non-ILD-specialist centre for diagnosis and treatment. Early referral and management of patients at ILD-specialist centres has been shown to improve survival and reduce hospitalisations. The COVID-19 pandemic has affected the ILD patient diagnostic pathway and prompted centres to adapt. Aims This study investigates and contrasts ILD patient pathways in ILD-specialist and non-ILD-specialist centres, focusing on referrals, caseloads, diagnostic tools, multi-disciplinary team (MDT) meeting practices, and resource accessibility. Methods Conducted as a cross-sectional study, a global self-selecting survey ran from September 2022 to January 2023. Participants included ILD specialists and healthcare professionals (HCPs) from ILD-specialist centres and non-ILD-specialist centres. Results Of 363 unique respondents from 64 countries, 259 were from ILD-specialist centres and 104 from non-ILD-specialist centres. ILD centres had better resource availability, exhibiting higher utilisation of diagnostic tests (median: 12 tests), than non-ILD centres (9 tests); and better access to specialist professions attending MDTs (median: 6 professions at meeting) in specialist centres than non-ILD centres (3 professions at meeting). Transitioning to virtual MDTs allowed HCPs from outside of centres to join meetings in nearly 90% of all centres, increasing regular participation in 60% of specialist centres and 72% of non-ILD centres. For treatment of patients, specialist centres had better access to antifibrotic drugs (91%) compared to non-ILD centres (60%). Conclusions Diagnostic pathways for ILD patients diverged between specialist centres and non-ILD centres. Disparities in resource and specialist availability existed between centres.

Patient referral

10.1183/23120541.00899-2024

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Critically Ill Patients With Acute Respiratory Failure Due To H1N1 2009 Influenza Infection: Characteristics And Outcome

Rosa Reina Fernando Lambert Pablo Montefiore Leandro Tumino Martin Beldarrain

Acute respiratory failure

H1N1 influenza

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a6115

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Clinical and Functional Behavior in Interstitial Lung Diseases Associated to Connective Tissue Diseases

CHEST Journal (2016)

Brenda Varela Gabriela Tabaj Maria Victoria Gallardo Mariana Salomon Cecilia González Ginestet

DLCO

CTD

Vital capacity

10.1016/j.chest.2016.08.491

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Interstitial Pneumonia With Autoimmune Features: Clinical, Morphological, and Serological Features

CHEST Journal (2016)

Gabriela Tabaj Brenda Varela Maria Victoria Gallardo Cecilia González Ginestet Georgina Gramblicka

10.1016/j.chest.2016.08.488

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Agreement in the evaluation of interstitial lung diseases between multiples observers and a mobile app in Argentina

12.01 - Idiopathic interstitial pneumonias (2021)

Brenda Varela Gabriela Tabaj Lucas Sheridan

Introduction: The EPIDIA App is an application for mobile devices (App) to assist physicians in the care of Interstitial Lung Diseases (ILD) patients. Primary objective: To evaluate the agreement in the diagnosis of ILD between multiples observers vs EPIDIA in Argentina. Methods: Patients with diagnosis of ILD were analyzed retrospectively. The clinical cases were reviewed by 5 pulmonologists (4 of them with 5 to 10 years of experience in the management of patients with ILD, and the last one with more than 20 years of experience in the management of these patients) and EPIDIA app. Relevant clinical and laboratory data, including autoantibodies, bronchoalveolar lavage, transbronchial biopsy, lung function and high resolution computed tomography (HRCT) were evaluated in each case. The interobserver agreement was evaluated analyzing the final diagnosis of each observer. Descriptive analysis was performed. The kappa was calculated for multiple observers. Results: Twenty patients with diagnosis of ILD were evaluated. The mean age was 63 ± 11.75 years old. 70% were current or former smokers. The mean forced vital capacity (FVC) was 2.86± 0.77 L in absolute values and 73% ± 11.85, and the mean DLCO was 58% ± 18.31. Regarding the final diagnosis, the agreement was 0.73 (CI 95%: 0.66-0.89), with a good degree of agreement in the diagnosis of the collagen tissue diseases (CTD-ILD) 0.84 (CI 95% 0.67-1.00), moderate in idiopathic pulmonary fibrosis (IPF) 0.64 (CI 95%: 0.47-0.73) and weak in possible UIP 0.20 (CI 95%: 0.015-051). Conclusions: The overall agreement in the final diagnosis was good. EPIDIA might be a useful too, specially for those physicians who have no access to MDD.

Pulmonologists

DLCO

Vital capacity

Pulmonologists

High-resolution computed tomography

Lung biopsy

Kappa

Usual interstitial pneumonia

10.1183/13993003.congress-2021.pa402

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Argentine Patients With Autoimmune Related Interstitial Lung Diseases: First Results From the EPIMAR II Registry

J.I. Enghelmayer Norma Naval A. Gaser Viviana Moyano Diana Lancellotti

10.1164/ajrccm-conference.2024.209.1_meetingabstracts.a1832

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EPIDIA: an App to to assist physicians in the care of patients with interstitial lung diseases

12.01 - Idiopathic interstitial pneumonias (2021)

Gabriela Tabaj Brenda Varela Lucas Sheridan

Introduction: Interstitial lung diseases (ILD) is an umbrella term used for a large group of diseases that may cause scarring (fibrosis) of the lung.They represent a very large group of more than 200 different entities, many of which are rare or "orphan" diseases. Although current guidelines emphasize multidisciplinary discussion (MDD) as the gold standard for the diagnosis of ILD, MDD is not always available in clinical practice. Besides, there is a significant diagnostic delay and misdiagnosis of ILD at primary health care level. Objective: Introduce a software application for mobile devices to assist physicians in the care of ILD patients. Methods: We developed an app called EPIDIA, a tool where the physician enters different elements of the medical history, pulmonary function tests, images and pathological features of a hypothetical patient and the system provides one or two diagnostic options as well as the prognosis according to validated scores for idiopatic pulmonary fibrosis (IPF). It has also the “treatment”, “monitoring” and “library” sections. Results: EPIDIA was released on November 24th,2020 in Argentina and, until February 12nd, they were documented 173 users and 1290 access.Of the users, 84% were pulmonary physicians, 5% rheumatologists, 5% clinicians and 6% others. Seventy percent of the users had more than 10 years of clinical experience, 20% between 5 and 10 and 10% less than 10 years. In regard to workplace, 52% of the users were from public hospitals, 30% from private attendance and 18% from private hospitals. Conclusion: We are introducing the first App to quickly and effectively look up for the most relevant aspects in ILD.

Attendance

Gold standard (test)

Group B

10.1183/13993003.congress-2021.pa401

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