BACKGROUND:Electromagnetic navigation bronchoscopy (ENB) is widely used for diagnosing peripheral pulmonary nodules (PPNs), but its diagnostic yield remains variable. Mobile cone-beam computed tomography (mCBCT) enables intraprocedural assessment of the tool-lesion relationship and navigation correction; however, prospective data on its incremental clinical value remain limited. RESEARCH QUESTION:Clinical value of mCBCT-guided navigation correction on the tool-lesion relationship and diagnostic yield during ENB for PPNs. STUDY DESIGN AND METHODS:This prospective, single-centre, single-arm trial evaluated the diagnostic performance of mCBCT-assisted ENB for PPNs and the incremental clinical value of mCBCT-guided navigation correction. Intraoperative mCBCT assessed the tool-lesion relationship and guided correction before sampling. The primary endpoint was overall diagnostic yield after mCBCT assessment and adjustment. The key secondary endpoint was the tool-in-lesion improvement rate. RESULTS:A total of 108 patients were enrolled. Median nodule size was 21.0 (IQR, 17.0-25.0) mm, and a CT 'bronchus sign' was present in 77.8%. Nodules were peripheral (47.2%), intermediate (33.3%), or central (19.4%) and solid (83.3%), mixed ground-glass opacities (13.9%), or pure ground-glass opacities (2.8%). The overall diagnostic yield was 79.6% (86/108). Navigation correction was required in 42.6% (46/108). Following mCBCT-guided navigation correction, the tool-in-lesion rate increased from 54.6% (59/108) to 87.0% (94/108), an absolute improvement of 32.4%. Procedure-related atelectasis was identified by mCBCT in 8 (7.4%) patients. No serious adverse events occurred. CONCLUSION:mCBCT-guided navigation correction improved the tool-lesion relationship and provided incremental clinical value beyond conventional ENB, particularly for smaller lesions and those without a CT bronchus sign, while maintaining an acceptable safety profile.
BACKGROUND:Tuberculosis (TB) remains the leading infectious cause of death globally, disproportionately affecting people living with HIV and those with drug-resistant TB. In Portugal, TB incidence and notification rates exceed the European average, with diagnostic delays affecting underserved populations. RESEARCH QUESTION:This study investigated factors contributing to total diagnostic delay among people with TB in Portugal, particularly underserved groups, and identified strategies to reduce these delays. STUDY DESIGN AND METHODS:A convergent-parallel mixed-methods approach was used. Quantitative data came from 55 surveys, and qualitative data through 27 semi-structured interviews and two focus group discussions. Descriptive statistics and thematic analysis identified patterns of total diagnostic delay, contributing factors, and potential interventions. RESULTS:Median total diagnostic delay was 45 days (IQR 21-60 days). In exploratory comparisons, underserved groups reported longer total diagnostic delay than the general population. Key person-related barriers included symptom normalisation, financial and logistical constraints, stigma, and fragmented referral pathways. System-level obstacles such as complex paperwork, limited clinic hours, staff indifference, and language barriers compounded delays. Proposed solutions included clear and non-judgemental communication, mobile screening units, integrated electronic records, anti-stigma campaigns, and social support teams for healthcare navigation. CONCLUSION:Diagnostic delays remain a major challenge in TB control in Portugal, especially among underserved populations. Reducing these delays requires multi-level interventions, including enhanced primary care awareness, stigma reduction, compensation for indirect costs, and simpler administrative procedures. Addressing these barriers is essential to reduce preventable morbidity, limit ongoing transmission, and tackle health inequities, while supporting progress towards national and global TB targets.
BACKGROUND:Excessive sleepiness while driving is a public safety concern. The Bordeaux Sleepiness Scale (BOSS) is a brief patient-reported measure designed to assess driving-related sleepiness. However, a Portuguese version is not currently available. OBJECTIVE:To cross-culturally adapt the BOSS and evaluate its internal consistency and construct validity in a Portuguese population, in accordance with COSMIN recommendations. STUDY DESIGN AND METHODS:We conducted a cross-sectional observational study of adults attending a Sleep Disorders Clinic. The BOSS was translated into Portuguese following a standardised cross-cultural adaptation process. Participants completed the Portuguese BOSS, the Epworth Sleepiness Scale (ESS) and two questions assessing driving-related sleepiness. Internal consistency was evaluated using Cronbach's alpha. Construct validity was assessed through Spearman correlations with the ESS (convergent validity) and by comparing scores between participants with and without a history of sleepiness-related accidents or near-misses (criterion-related validity). ROC curve analysis further assessed criterion validity. RESULTS:A total of 234 patients were included; 94.4% had obstructive sleep apnoea and 9.4% reported sleepiness-related accidents or near-misses in the previous year. The BOSS demonstrated moderate internal consistency (α = 0.683) and acceptable accuracy in identifying patients with sleepiness-related events (AUC = 0.895), compared with the ESS (AUC = 0.842). Both scales showed significantly higher scores in participants with sleepiness-related accidents or near-misses than in those without (p < 0.001). A moderate correlation with ESS (ρ = 0.551, p < 0.001) was observed. CONCLUSION:The Portuguese BOSS shows moderate internal consistency and evidence of construct validity. These findings provide preliminary support for its use in identifying driving-related sleepiness in patients with sleep disorders.
BACKGROUND:In the general population, supernormal lung function is associated with a lower risk of all-cause mortality. RESEARCH QUESTION:It remains unclear whether sleep-disordered breathing (SDB) affects this relationship. METHODS:This cohort analysis included 4,839 adults. Lung function was categorised as supernormal (FEV1 > ULN), normal (LLN ≤ FEV1 ≤ ULN), and below normal (FEV1 < LLN). SDB severity was classified using apnoea-hypopnoea index categories: no SDB (<5 events/hour), mild SDB (5-<15 events/hour), moderate SDB (15-<30 events/hour), and severe SDB (≥30 events/hour). The association between lung function and all-cause mortality was assessed using Cox proportional hazards models with subgroup analyses according to SDB severity and formal testing for interaction. Analyses were repeated using FVC-defined lung function groups as an alternative definition of supernormal lung function. RESULTS:Among the included participants, 4,068 (84.1%) had normal lung function, 369 (7.6%) had supernormal lung function, and 402 (8.3%) had below normal lung function. During 52 421.5 person-years of follow-up (median 11.72 years; IQR, 10.46-12.56), 1,188 deaths occurred. Compared with the normal lung function group, the supernormal lung function group had a lower prevalence of baseline hypertension and cardiovascular disease. The association between lung function and all-cause mortality varied across SDB severity strata (P for interaction = 0.034). A lower mortality risk associated with supernormal lung function was observed in participants without SDB (HR: 0.24, 95% CI: 0.06-0.97), whereas this association was not statistically significant in the mild, moderate, or severe SDB strata. Below normal lung function was generally associated with an increased all-cause mortality risk. Sensitivity analyses using FVC-defined lung function groups yielded broadly consistent findings. CONCLUSION:Supernormal lung function was associated with lower all-cause mortality primarily among individuals without SDB. These findings underscore the importance of considering SDB severity when assessing the health implications of lung function.
BACKGROUND:Cone-beam CT-guided navigation bronchoscopy (CBCT-NB) is a minimally invasive technique for diagnosing pulmonary nodules combining endoscopic navigation with real-time 3D imaging. The procedure requires advanced bronchoscopic skills and interpretation of multiple imaging modalities. Despite evidence that simulation-based education enhances procedural safety and performance, no standardised training programmes for CBCT-NB have yet been established. This study describes the development and evaluation of a structured training programme for pulmonologists new to CBCT-NB. METHODS:A multidisciplinary expert panel developed a stepwise CBCT-NB training programme comprising online theoretical e-learning, live case observation at an expert centre, a structured one-day hands-on simulation session, and on-site supervision during the initial clinical procedures. Pulmonologists from Dutch hospitals preparing to implement CBCT-NB were enrolled. Participants' expectations, perceived learning needs, and post-training experiences were explored through semi-structured interviews and analysed using thematic analysis. RESULTS:Nine pulmonologists from five hospitals participated. Participants expressed a strong need for structured, practical instructions, particularly regarding procedural workflow, multimodal image interpretation, equipment handling, and use of augmented fluoroscopy software. Following completion of the programme, all reported increased self-confidence and improved perceived competency. Hands-on simulation was consistently identified as a key component for developing technical and cognitive skills and was considered essential preparation before independent clinical practice. CONCLUSION:The structured multimodal CBCT-NB training programme facilitates confidence and addresses learner-identified competency needs among novice navigation bronchoscopists. The findings offer practical guidance for the structured implementation and training of novel medical technological interventions. Future research should evaluate long-term skill retention, objective competency outcomes, and clinical effectiveness.
