Henri Colt | University of California, Irvine (original) (raw)

Papers by Henri Colt

Background: Technically challenging professions such as those of the defense and transportation i... more Background: Technically challenging professions such as those of the defense and transportation industries increasingly use computer-based simulation and written self-learning instruments for education and to determine competency. A structured learning curriculum does not exist, however, for flexible bronchoscopy, a minimally invasive diagnostic procedure performed on thousands of patients by respiratory specialists, otolaryngologists, anesthesiologists, and surgeons worldwide. Objective: To explore an analogous strategy of measuring theoretical knowledge in flexible bronchoscopy and specific technical skills using written knowledge assessments and a virtual reality bronchoscopy simulator. Methods: Twelve trainees from a university pulmonary medicine training program were asked to identify and enter five specific bronchial segments on command using a virtual reality bronchoscopy skill station, and to complete a 50question examination pertaining to bronchoscopy theory. Their performance scores and opinions pertaining to

Cho Ray Hospital is one of 3 large hospitals in Ho Chi Minh City (formerly known as Saigon), Viet... more Cho Ray Hospital is one of 3 large hospitals in Ho Chi Minh City (formerly known as Saigon), Vietnam. Despite limited resources and equipment, more than 3000 flexible bronchoscopies are performed there each year, usually for diagnosis of infection, lung cancer, and airway stenosis. Members of the World Bronchology Foundation (Philanthropic arm of the World Bronchology Foundation) went on-site to deliver a rigid bronchoscope and accessories (Bryan Corp, Woburn, MA). Hands-on training of 2 experienced flexible bronchoscopists occurred daily for 5 days, to achieve proficiency in rigid bronchoscopic resection, dilation, and electrocautery, as well as to recognize indications, contraindications, and patient safety measures pertaining to interventional procedures in patients with central airway obstruction. In addition, a national 5-day continued medical education curriculum devoted to rigid and flexible bronchoscopy was organized for 83 chest physicians and otolaryngologists. Precurriculum and postcurriculum assessments demonstrated increased knowledge acquisition, satisfaction with course content, and a unanimous desire to participate in future national symposia. Subsequent to this intervention, rigid bronchoscopic interventions are now being performed at Cho Ray Hospital, and in other tertiary referral centers in both Ho Chi Minh City and Hanoi.

More than 500,000 flexible bronchoscopies are performed annually by chest physicians in the Unite... more More than 500,000 flexible bronchoscopies are performed annually by chest physicians in the United States (Ernst et al., Chest 123:1693-1717, 2003). Indications include diagnosis of lung cancer and airway tumors, benign strictures, pulmonary infections, and treatment of central airway obstruction, emphysema, and intraepithelial lesions such as carcinoma in-situ. Anesthesiologists, cardiothoracic and trauma surgeons, otolaryngologists, and critical are physicians also perform this procedure as part of difficult airway management, intubation or airway inspection and bronchial toilet. Compared to the expanding body of simulation-related literature that is available in other procedural fields, however, the volume of published work relating to bronchoscopy is scant. The purpose of this paper is to provide an overview of the available literature pertaining to the use of simulation in bronchoscopy education, and to demonstrate how this limited yet valuable body of work lays a foundation for the future use of simulator-based bronchoscopy training.

Bronchoscopy in the new millennium spells an exciting time for the pulmonologist, which likens to... more Bronchoscopy in the new millennium spells an exciting time for the pulmonologist, which likens to Alice peering through the looking glass into a wonderland of miniaturized probes, optics, and technology that are advancing at a maddening pace. Although scientists continue to push the envelope using nanotechnology that may facilitate further miniaturization of probes to allow imaging at the cellular or molecular level, it is opportune to evaluate the strengths and weaknesses of available technologies and bronchoscopic techniques for the diagnosis and staging of lung cancer, in its early detection and palliation. We appraise current technologies and what they hold for the future.

Revista americana de medicina respiratoria, Jun 1, 2014

El rol del neumonólogo en el estudio de los marcadores moleculares en el cáncer de pulmón no pequ... more El rol del neumonólogo en el estudio de los marcadores moleculares en el cáncer de pulmón no pequeñas células

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, May 12, 2008

Objective/Hypothesis-Recurrent respiratory papillomatosis (RRP) of the central airways requires r... more Objective/Hypothesis-Recurrent respiratory papillomatosis (RRP) of the central airways requires removal in order to potentially reduce recurrence and risk for malignant transformation. Analogous to the principles of treatment for early lung cancer, a precise determination of the extent of cartilage invasion could help guide therapeutic decisions and monitor response to treatment. The purpose of this study was to determine whether a bronchoscopy platform comprised of white light bronchoscopy (WLB), endobronchial ultrasound (EBUS), and optical coherence tomography (OCT) could identify layered microstructure of RRP and underlying cartilage. Study Design-Case study Methods-A bronchoscopy platform consisting of commercially available WLB, EBUS using a 7.5MHz convex probe (BF-UC 160F: Olympus Optical Co. Ltd, Tokyo, Japan) and a time-domain OCT with front-imaging and inside-actuation (Niris® Imaging system, Imalux® Corp, Cleveland, USA) was used in a patient with tracheal stenosis from RRP. Findings are compared with results of histology and the characteristics of imaging modalities are discussed. Results-WLB revealed tracheal pedunculated lesions. EBUS showed a 1 cm hypoechogenic density corresponding to the papilloma, visualized above a hyperechogenic density corresponding to tracheal cartilage. There was no sonographic evidence of cartilage disruption or adjacent lymphadenopathy. OCT revealed a layer of heterogeneous light backscattering suggesting the mucosal papilloma, and a layer of high degree scattering, corresponding to the central fibrovascular core noted on histology. Conclusions-Layered microstructures of RRP and underlying airway cartilage can be identified using a combination of acoustic and optical bronchoscopic imaging modalities with different resolution and depth of penetration characteristics.

Revista americana de medicina respiratoria, Dec 1, 2014

Oscar Wilde (1854-1900) was an Irish playwright, poet, novelist and essayist who was tried for gr... more Oscar Wilde (1854-1900) was an Irish playwright, poet, novelist and essayist who was tried for gross indecency and condemned to two years hard labor atReading prison, outside London. Two years after leaving prison, he died in Paris, a ruined and broken man. 2 Henry Murger (1822-1861) was a French poet and novelist. 3 Italian composers Ruggeri Leoncavallo (1897), and Giacomo Puccini (1896) are also known for their operas Pagliacci and Tosca respectively

Clinical Pulmonary Medicine, Jul 1, 1996

Journal of Bronchology, Jul 1, 2008

Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2006

Laryngoscope, Jun 30, 2010

Objective/Hypothesis-Laser-induced damage of tracheal wall microstructures might contribute to re... more Objective/Hypothesis-Laser-induced damage of tracheal wall microstructures might contribute to recurrence after bronchoscopic treatment of tracheal strictures. The purpose of this study was to demonstrate how multimodal imaging using white light bronchoscopy (WLB), endobronchial ultrasound (EBUS), and optical coherence tomography (OCT) might identify in vivo airway wall changes before and resulting from Nd:YAG laser ablation and dilation of tracheal stenosis. Study Design-Case study. Methods-Commercially available WLB, high frequency EBUS using a 20-MHz radial probe and time-domain, frontal imaging OCT systems were used to characterize the extent, morphology, and airway wall microstructures at the area of hypertrophic fibrotic tissue formation before, during and after treatment of postintubation tracheal stenosis. Results-WLB revealed the location of a complex, extensive, severe stricture. EBUS showed a homogeneous layer overlying a hyperechogenic layer corresponding to disrupted cartilage. OCT showed a homogeneous light backscattering layer and absence of layered microstructures, confirming absence in close proximity of normal airway wall. After laser ablation, OCT of charred tissue showed high backscattering and shadowing artifacts. OCT of noncharred tissue showed a thinner, homogeneous, light backscattering layer. EBUS showed thinner but persistent hypertrophic tissue suggesting incomplete treatment. WLB revealed improved airway patency postprocedure and recurrence 3 weeks later. Conclusions-EBUS identified cartilage disruption and residual hypertrophic tissue, the evidence of which might contribute to recurrence. OCT revealed homogeneous light backscaterring representing persistent noncharred hypertrophic tissues but it did not visualize cartilage disruption. Future studies are warranted to confirm whether these technologies can help guide bronchoscopic treatments.

Interactive Cardiovascular and Thoracic Surgery, Feb 13, 2013

OBJECTIVES: Severity of airway narrowing is relevant to management decision-making processes in p... more OBJECTIVES: Severity of airway narrowing is relevant to management decision-making processes in patients with laryngotracheal stenosis. Airway lumen is frequently assessed subjectively based on still images obtained during airway examinations or objectively using image analysis software applied to radiological or bronchoscopic images. The purpose of this study was to determine whether strictures classified as mild, moderate or severe degrees of airway narrowing based on subjective assessments by a group of experienced bronchoscopists using still images, matched the classifications derived from morphometric bronchoscopy measurements and whether the results of subjective assessments correlated with the level of bronchoscopic experience. METHODS: Thirty-five bronchoscopic doublet still images of benign causes of laryngotracheal stenosis containing normal and abnormal airway cross-sectional areas were objectively analysed using morphometric bronchoscopy and classified as mild (<50%), moderate (50-70%) or severe (>70%). These images were then subjectively assessed by 42 experienced bronchoscopists participating in an interventional bronchoscopy course. Descriptive statistics were used to explore the accuracy of the participants' classifications. Correlation coefficients were used to study the relationship between participants' subjective assessments and bronchoscopy experience. RESULTS: Only 47% of strictures were correctly classified by study participants (mean 16.48 ± 2.8). Of the 1447 responses included in this analysis, 755 were incorrect: 71 (9%) were over-classifications of strictures' severity and 684 (91%) were under-classifications. There was no correlation between number of strictures correctly classified and number of lifetime bronchoscopies or number of strictures seen by bronchoscopists in an average month. CONCLUSIONS: Experienced bronchoscopists often misclassify the degree of airway narrowing when using still bronchoscopic images to subjectively assess strictures of benign aetiology.

Annals of Emergency Medicine, Feb 1, 1989

To compare the opinions of patients and physicians regarding physician dress and demeanor in the ... more To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED.