Faculty Bibliography

Antibiotic therapy against non-tuberculous mycobacteria (NTM) is prolonged and can be associated with toxicity. We sought to evaluate whether chest physical therapy (PT) was associated with clinical improvement in patients with NTM not receiving anti-mycobacterial pharmacotherapy. A retrospective review of 77 subjects that were followed from June 2006 to September 2014 was performed. Baseline time point was defined as the first positive sputum culture for NTM; symptoms, pulmonary function, and radiology reports were studied. Subjects were followed for up to 24 months and results analyzed at specified time points. Half of the subjects received chest PT at baseline. Cough improved at 12 (p = 0.001) and 24 months (p = 0.003) in the overall cohort when compared with baseline, despite lack of NTM antibiotic treatment. Cough decreased at 6 (p = 0.01), 9 (p = 0.02), 12 (p = 0.02) and 24 months (p = 0.002) in subjects that received chest PT. Sputum production also improved at 24 months in the overall cohort (p = 0.01). There was an increase in the percent change of total lung capacity in subjects that received chest PT (p = 0.005). Select patients with NTM may have clinical improvement with chest PT, without being subjected to prolonged antibiotic therapy. Future studies are warranted to prospectively evaluate outcomes in the setting of non-pharmacologic treatment and aid with the decision of antibiotic initiation.

Background/Purpose: In 2008, 18% of rheumatology fellowship program (RFP) program directors (PDs) included musculoskeletal ultrasound (MSUS) in their training programs. Overall goal of this study was to assess the current state and ascertain the needs for MSUS education among RFPs. The objective of this study was to determine if fellowship program size impacts inclusion of MSUS in training. Methods: Out of two surveys sent via QualtricsTM in 2015, a 13-item needs assessment survey was sent to all RFP PDs determining implementation of MSUS teaching including machine accessibility, faculty training, and institutional support. The second survey assessed teaching and evaluation methods used. For the first survey, Fischer's Exact Test was used to test differences between fellowship programs based on size. Small programs were defined as programs with 1-2 fellows yearly, while big programs were those with at least 3 fellows yearly. Results: Out of 113 RFPs, 103 (91%) PDs responded to the needs assessment survey. In total, 94% of RFPs are currently offering some form of MSUS training. Of 73 small programs, 91.8% offered MSUS training; 97.1% of big programs offered MSUS training. By large, there was no statistically significant difference between small and big programs (p=0.429). Majority of both small and big programs (81.8 vs. 93.9%) cited at least one faculty who was competent in performing MSUS (p=0.212). Majority of the teaching was done by a key clinical faculty member other than the PD (39.7% vs. 54.5%). Majority owned an US machine (72.1 vs. 87.9%; p=0.037). When asked if they wanted MSUS to be part of the Rheumatology fellowship training curriculum, majority wanted its inclusion however most wanted it they wanted MSUS to be part of the Rheumatology fellowship training curriculum, majority wanted its inclusion however most wanted it only to be optional (66.2% vs. 66.7%), as compared to those wanted it to be a standard requirement (29.4% vs. 30.3%). Conclusion: MSUS has become prevalent among RFPs. The size of a fellowship program is not a factor in determining inclusion of a MSUS teaching program. Small programs have comparable capacity to include MSUS in teaching programs when compared to big programs. There is openness to including MSUS in Rheumatology fellowship training, whether as an optional or standard part of the curriculum