Journal articles: 'Respiratory physicians'

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Ahmed, Mohammed, Cyrus Daneshvar, and David Breen. "Ultrasound-Guided Cervical Lymph Node Sampling Performed by Respiratory Physicians." Biomedicine Hub 4, no. 2 (July 26, 2019): 1–6. http://dx.doi.org/10.1159/000501119.

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Background: A variety of disease processes investigated by respiratory physicians can lead to cervical lymphadenopathy. Ultrasound (US) has revolutionised respiratory investigations, and neck ultrasound (NUS) is increasingly recognised as an additional important skill for respiratory physicians. Objectives: We aimed to assess the feasibility of NUS performed by respiratory physicians in the workup of patients with mediastinal lymphadenopathy. Methods: This is a single-centre retrospective cohort study. All patients that underwent US-guided cervical lymph node sampling were included. The diagnostic yield is reported, and specimen adequacy is compared for respiratory physicians and radiologists. Results: Over 5 years, 106 patients underwent NUS-guided lymph node sampling by respiratory physicians compared to 35 cases performed by radiologists. There was no significant difference in the adequacy of sampling between the two groups (respiratory physicians 91.5% [95% CI 84.5–96%] compared to 82.9% [95% CI 66.4–93.4%] for radiologists [p = 0.2]). In the respiratory physician group, a diagnosis was achieved based on lymph node sampling in 89 cases (84%). Neck lymph node sampling was the only procedure performed to obtain tissue in 48 cases (45.3%). Conclusion: NUS and sampling performed by respiratory physicians are feasible and associated with an adequacy rate comparable to that of radiologists. It can reduce the number of invasive procedures performed in a selected group of patients. Guidelines for training and competency assessment are required.

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Collins, Felicity A. "Genetics terminology for respiratory physicians." Paediatric Respiratory Reviews 10, no. 3 (September 2009): 124–33. http://dx.doi.org/10.1016/j.prrv.2009.04.003.

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Hernandez, Paul, Meyer S. Balter, Jean Bourbeau, Charles K. Chan, Darcy D. Marciniuk, and Shannon L. Walker. "Canadian Practice Assessment in Chronic Obstructive Pulmonary Disease: Respiratory Specialist Physician Perception Versus Patient Reality." Canadian Respiratory Journal 20, no. 2 (2013): 97–105. http://dx.doi.org/10.1155/2013/369019.

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INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition and the fourth leading cause of death in Canada. Optimal COPD management requires patients to participate in their care and physician knowledge of patients’ perceptions of their disease.METHODS: A prospective study in which respiratory specialist physicians completed a practice assessment questionnaire and patient assessments for 15 to 20 consecutive patients with COPD. Patients also completed a questionnaire regarding their perceptions of COPD and its management.RESULTS: A total of 58 respiratory specialist physicians from across Canada completed practice assessments and 931 patient assessments. A total of 640 patients with COPD (96% with moderate, severe or very severe disease) completed questionnaires. Symptom burden was high and most patients had experienced a recent exacerbation. Potential COPD care gaps were identified with respect to appropriate medication prescription, lack of an action plan, and access to COPD educators and pulmonary rehabilitation. Perceived knowledge needs and gaps differed between physicians and patients.CONCLUSIONS: Despite the dissemination of Canadian and international COPD clinical practice guidelines for more than a decade, potential care gaps remain among patients seen by respiratory specialist physicians. Differing perceptions regarding many aspects of COPD among physicians and patients may contribute to these care gaps.

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Chuchalin, A. G. "An educational model of respiratory physicians." PULMONOLOGIYA, no. 3 (June 28, 2008): 110–25. http://dx.doi.org/10.18093/0869-0189-2008-0-3-110-125.

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Parpa, Efi, Kyriaki Mystakidou, Eleni Tsilika, Pavlos Sakkas, Elisabeth Patiraki, Kyriaki Pistevou-Gombaki, Ourania Govina, and Lambros Vlahos. "Euthanasia and physician-assisted suicide in cases of terminal cancer: the opinions of physicians and nurses in Greece." Medicine, Science and the Law 48, no. 4 (October 2008): 333–41. http://dx.doi.org/10.1258/rsmmsl.48.4.333.

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The aim of this study was to investigate the opinions of physicians and nurses on euthanasia and physician-assisted suicide in advanced cancer patients in Greece. Two hundred and fifteen physicians and 250 nurses from various hospitals in Greece completed a questionnaire concerning issues on euthanasia and physician-assisted suicide. More physicians (43.3%) than nurses (3.2%, p<0.0005) reported that in the case of a cardiac or respiratory arrest, they would not attempt to revive a terminally ill cancer patient. Only 1.9% of physicians and 3.6% of nurses agreed on physician-assisted suicide. Forty-seven per cent of physicians and 45.2% of nurses would prefer the legalization of a terminally ill patient's hastened death; in the case of such a request, 64.2% of physicians and 55.2% of nurses (p=0.06) would consider it if it was legal. The majority of the participants tended to disagree with euthanasia or physician-assisted suicide in terminally ill cancer patients, probably due to the fact that these acts in Greece are illegal.

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Eremenko, A. A., and R. D. Komnov. "Smart Mode of Mechanical Lung Ventilation During Early Activation of Cardiosurgical Patients." General Reanimatology 16, no. 1 (March 2, 2020): 4–15. http://dx.doi.org/10.15360/1813-9779-2020-1-4-15.

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Purpose of the study: a comparative assessment of safety and quality of respiratory support carried out using the ASV mode vs. conventional protocol, in which ventilation parameters are set by an ICU physician during early postoperative period in cardiosurgical patients.Materials and methods. The modes of a respiratory support included automated ASV ventilation (40 patients) versus conventional ventilation (38 patients) managed by 8 ICU physicians were compared in a cohort of cardiosurgical patients in a randomized controlled study.The comparison included ventilation parameters, all eﬀorts of physicians to adjust ventilator settings and time it took, duration of respiratory support in ICU, incidence of adverse events in the course of weaning, total time in ICU and hospital, postoperative complications and mortality.Results. There was no reliable diﬀerence in the duration of postoperative trachea intubation, which was equal to 267±76 minutes (the ASV group) and 271±80 minutes (the control group).The number of manual adjustments, which was 2 vs. 4 (P<0.00001), and the time spent by a clinical physician near a ventilator, which was 99±35 seconds vs. 166±70 seconds, were reliably lower in the ASV group (P=0.00001).The time between restoration of patient’s own respiratory activity and transfer to the assisted breathing mode was longer in the control group and amounted to 30 (0–90) min. while in the smart mode, the transfer took place immediately after restoration (P=0.004969).When ASV was used, the driving pressure was reliably lower during all phases of respiratory support: ΔP 7.2±1.6 vs. 9.3±2.1 cm H2O, (P=0.000001); there was no reliable diﬀerence in the tidal volume: 7.0 (6–8.5) (ASV) vs. 7 (6–10) ml/kg/ideal body mass (the control group).Conclusion. ASV represents a lung-protective ventilation that reduces physician’s time cost and medical staﬀ eﬀorts in ALV management without compromising patient’s safety and respiratory support quality.

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Robinson, Christopher, Suzanne Hunt, Gary Gronseth, Sara Hocker, Eelco Wijdicks, Alejandro Rabinstein, and Sherri Braksick. "A Disclosure About Death Disclosure: Variability in Circulatory Death Determination." Kansas Journal of Medicine 14 (November 5, 2021): 277–81. http://dx.doi.org/10.17161/kjm.vol14.15512.

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Introduction. Circulatory-respiratory death declaration is a common duty of physicians, but little is known about the amount of education and physician practice patterns in completing this examination. Methods. We conducted an online survey of physicians evaluating the rate of formal training and specific examination techniques used in the pronouncement of circulatory-respiratory death. Data, including level of practice, training received in formal death declaration, and examination components were collected. Results. Respondents were attending physicians (52.4%), residents (30.2%), fellows (10.7%), and interns (6.7%). The majority of respondents indicated they had received no formal training in death pronouncement, however, most reported self-perceived competence. When comparing examination components used by our cohort, 95 different examination combinations were used for death pronouncement. Conclusions. Formal training in death pronouncement is uncommon and clinical practice varies. Implementation of formal training and standardization of the examination are necessary to improve physician competence and reliability in death declarations.

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Chia, Karen S. W., Peter K. K. Wong, Senen Gonzalez, Eugene Kotlyar, Steven G. Faux, and Christine T. Shiner. "Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension." Pulmonary Circulation 10, no. 2 (April 2020): 204589402092280. http://dx.doi.org/10.1177/2045894020922806.

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Exercise training was not traditionally recommended for patients with pulmonary hypertension. However, recent work has demonstrated that exercise improves endurance and quality-of-life in patients with pulmonary hypertension. Unfortunately, patients with pulmonary hypertension are often sedentary. While some studies have examined patient attitudes to exercise, none have investigated physician perspectives on exercise in patients with pulmonary hypertension. This multinational survey of physicians involved in treating patients with pulmonary hypertension sought to ascertain physician attitudes to exercise and physician-identified barriers and enablers of exercise in this patient population. We collected cross-sectional survey data from a cohort of 280 physicians, including rehabilitation physicians, cardiologists, respiratory physicians and rheumatologists. We found that overall, 86% physicians recommended exercise, in line with current guidelines, although there were differences in the rationale for prescribing exercise and in the type of exercise prescription. Barriers to exercise included patient-related factors, such as patient ill health preventing exercise; poor patient motivation and lack of understanding regarding the benefits of exercise. Systemic barriers included cost/funding issues and limited availability of appropriate services. Perceived enablers of exercise included access to appropriate programmes, provision of education and supportive treating clinicians. Further research is required to identify and implement interventions to promote physical activity in patients with pulmonary hypertension.

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Barlam, Tamar F., Jake R. Morgan, Lee M. Wetzler, Cindy L. Christiansen, and Mari-Lynn Drainoni. "Antibiotics for Respiratory Tract Infections: A Comparison of Prescribing in an Outpatient Setting." Infection Control & Hospital Epidemiology 36, no. 2 (December 29, 2014): 153–59. http://dx.doi.org/10.1017/ice.2014.21.

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ObjectiveTo examine inappropriate antibiotic prescribing for acute respiratory tract infections (RTIs) in ambulatory care to help target antimicrobial stewardship interventions.Design and SettingRetrospective analysis of RTI visits within general internal medicine (GIM) and family medicine (FM) ambulatory practices at an inner-city academic medical center from 2008 to 2010.MethodsPatient, physician, and practice characteristics were analyzed using multivariable logistic regression to determine factors predictive of inappropriate prescribing; physicians in the highest and lowest antibiotic-prescribing quartiles were compared using χ2 analysis.ResultsVisits with FM providers, female gender, and self-reported race/ethnicity as white or Hispanic were significantly associated with inappropriate antibiotic prescribing. Physicians in the lowest quartile prescribed antibiotics for 5%–28% (mean, 21%) of RTI visits; physicians in the highest quartile prescribed antibiotics for 54%–85% (mean, 65%) of RTI visits. High prescribers had fewer African-American patients and more patients who were younger and privately insured. High prescribers had more patients with chronic lung disease. A GIM practice pod with a low prescriber was 3.0 times more likely to have a second low prescriber than other practice pods, whereas pods with a high prescriber were 1.3 times more likely to have a second high prescriber.ConclusionsMedical specialty was the only physician factor predictive of inappropriate prescribing when patient gender, race, and comorbidities were taken into account. Possible disparities in care need further study. Stewardship education in medical school, enlisting low prescribers as physician leaders, and targeting interventions to the highest prescribers might be more effective approaches to antimicrobial stewardship.Infect Control Hosp Epidemiol 2014;00(0): 1–7

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Alsubaie, Sarah, Mohamad Hani Temsah, Ayman A. Al-Eyadhy, Ibrahim Gossady, Gamal M. Hasan, Abdulkarim Al-rabiaah, Amr A. Jamal, Ali AN Alhaboob, Fahad Alsohime, and Ali M. Somily. "Middle East Respiratory Syndrome Coronavirus epidemic impact on healthcare workers’ risk perceptions, work and personal lives." Journal of Infection in Developing Countries 13, no. 10 (October 31, 2019): 920–26. http://dx.doi.org/10.3855/jidc.11753.

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Introduction: Middle East respiratory syndrome coronavirus (MERS-CoV) continues to cause frequent outbreaks in hospitals in Saudi Arabia. Since healthcare workers (HCWs) have a higher risk of acquiring and spreading MERS-CoV, we aimed to evaluate the perceived risk and anxiety level of HCWs in Saudi Arabia regarding MERS. Methodology: An anonymous, self-administered questionnaire was sent online to HCWs at King Khalid University Hospital in Saudi Arabia. The total knowledge and anxiety scores were calculated. Logistic regression analyses were used to identify predictors of high anxiety scores. Results: Of 591 (70%) HCWs that responded, 284 (55%), 164 (32%), and 68 (13.2%) were physicians, nurses, and technicians, respectively. Physicians obtained a lower median knowledge score (6/9) compared to other professions (7/9). The mean anxiety score was similar for physicians and other HCWs (3/5); however, non-physicians expressed higher levels of anxiety toward the risk of transmitting MERS-CoV to their families, with an anxiety score of 4/5. The ability of the virus to cause severe disease or death was the most frequently reported reason for worry by physicians (89.7%) and non-physicians (87.2%). Overall, 80% of physicians and 90% of non-physicians reported improvement in adherence to hand hygiene and standard precautions while in hospital (p = 0.002). Concern over transmitting MERS-CoV to family members was the most predictive factor for anxiety among non-physician HCWs. Conclusion: A significant proportion of HCWs expressed anxiety about the risk of acquiring MERS-CoV infection. Healthcare institutions need to develop an integrated psychological response for HCWs to the occupational and psychological challenge of MERS-CoV outbreaks.

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Steiner, Mark E., D. Bradford Quigley, Frank Wang, Christopher R. Balint, and Arthur L. Boland. "Team Physicians in College Athletics." American Journal of Sports Medicine 33, no. 10 (October 2005): 1545–51. http://dx.doi.org/10.1177/0363546505275491.

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Background There has been little documentation of what constitutes the clinical work of intercollegiate team physicians. Team physicians could be recruited based on the needs of athletes. Hypothesis A multidisciplinary team of physicians is necessary to treat college athletes. Most physician evaluations are for musculoskeletal injuries treated nonoperatively. Study Design Descriptive epidemiology study. Methods For a 2-year period, a database was created that recorded information on team physician encounters with intercollegiate athletes at a major university. Data on imaging studies, hospitalizations, and surgeries were also recorded. The diagnoses for physician encounters with all undergraduates through the university's health service were also recorded. Results More initial athlete evaluations were for musculoskeletal diagnoses (73%) than for general medical diagnoses (27%) (P<. 05). Four percent of musculoskeletal injuries required surgery. Most general medical evaluations were single visits for upper respiratory infections and dermatologic disorders, or multiple visits for concussions. Football accounted for 22% of all physician encounters, more than any other sport (P<. 05). Per capita, men and women sought care at an equal rate. In contrast, 10% of physician encounters with the general pool of undergraduates were for musculoskeletal diagnoses. Student athletes did not require a greater number of physician encounters than did the general undergraduate pool of students on a per capita basis. Conclusion Intercollegiate team physicians primarily treat musculoskeletal injuries that do not require surgery. General medical care is often single evaluations of common conditions and repeat evaluations for concussions.

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Meurling, Imran Johan, Panagis Drakatos, and Guy Leschziner. "What respiratory physicians should know about parasomnias." Breathe 18, no. 3 (September 2022): 220067. http://dx.doi.org/10.1183/20734735.0067-2022.

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Parasomnias have significant quality-of-life, prognostic and potentially forensic implications for patients and their bed-partners. Identifying key clinical features will accelerate diagnosis and appropriate management for these patients. Parasomnias are undesirable physical events or experiences that arise out of, or during, sleep. They can include movements, behaviours, emotions, perceptions, dreams or autonomic nervous system activity. While more common during childhood, they can persist into, or present de novo, during adulthood. Parasomnias can arise out of non-rapid eye movement (NREM) sleep, as in confusional arousals, sleepwalking, sleep terrors or sleep-related eating disorder, or out of REM sleep, as in REM behaviour disorder, recurrent isolated sleep paralysis or nightmare disorder. Sleep-related hypermotor epilepsy is an important differential diagnosis to consider in patients presenting with a parasomnia. A thorough clinical history, including a collateral history if available, is crucial to identify characteristic clinical features. Video polysomnography is useful to identify macro- and micro-sleep architectural features, characteristic behavioural events, and any concomitant sleep pathologies. Treatment of parasomnias involves a combined approach of pharmacological and non-pharmacological intervention, including safety measures, sleep hygiene and medicines such as clonazepam or melatonin to improve sleep consolidation and reduce behavioural activity. As parasomnias can not only be disruptive for the patient and their bed-partner but have important prognostic or forensic consequences, an understanding of their pathophysiology, clinical features and management is valuable for any respiratory physician who may encounter them.Educational aimsTo understand the common features of NREM and REM parasomnias.To differentiate between the causes of motor behaviours during sleep.To discuss the treatment approach for NREM and REM parasomnias.

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Steigman, Daniel M. "Respiratory physicians tackle controversial subjects head-on." Lancet 349, no. 9065 (May 1997): 1607. http://dx.doi.org/10.1016/s0140-6736(05)61639-x.

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Avdeev, S. N., S. R. Aisanov, A. S. Belevskiy, A. V. Emel’yanov, O. M. Kurbacheva, I. V. Leshchenko, N. M. Nenasheva, and R. S. Fassakhov. "A strategy for improvement in diagnosis and treatment of bronchial asthma in primary care." Russian Pulmonology 29, no. 4 (October 24, 2019): 457–67. http://dx.doi.org/10.18093/0869-0189-2019-29-4-457-467.

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Recently, bronchial asthma is considered as a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is one of the most common chronic respiratory diseases in primary care. Patients with certain respiratory symptoms seek for medical aid initially in primary care physicians, such as therapeutists, general practitioners, and family physicians, who can suspect and diagnose chronic respiratory diseases such as bronchial asthma, chronic obstructive pulmonary disease (COPD), allergic rhinitis, etc. Currently, untimely diagnosis of asthma and late initiation of anti-inflammatory treatment are widespread, mainly due to insufficient knowledge of primary care physicians on diagnostic criteria and therapeutic standards for asthma. Feasible and convenient algorithms for asthma diagnosis and treatment in primary care were developed by experts of Russian Respiratory Society and Russian Association of Allergologists and Clinical Immunologists. A therapeutic algorithm for asthma treatment in primary care institutions uses an approach considering symptom severity both in patients with newly diagnosed and previously treated for asthma. Diagnostic tools, such as a questionnaire for asthma diagnosis and an algorithm for differential diagnosis between asthma and COPD are mainly intended to facilitate diagnosis of chronic respiratory disease, particularly bronchial asthma, by a primary care physician and to improve the healthcare quality for these patients.

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Howard, April E., Carrie Courtney-Shapiro, Lynn A. Kelso, Michele Goltz, and Peter E. Morris. "Comparison of 3 Methods of Detecting Acute Respiratory Distress Syndrome: Clinical Screening, Chart Review, and Diagnostic Coding." American Journal of Critical Care 13, no. 1 (January 1, 2004): 59–64. http://dx.doi.org/10.4037/ajcc2004.13.1.59.

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• Background Although the incidence of acute respiratory distress syndrome has been studied, few researchers have prospectively assessed the search tool used to identify cases. • Methods For 5 months, all patients admitted to a medical intensive care unit in a teaching hospital were evaluated daily to determine whether criteria for acute respiratory distress syndrome were met, and physicians’ progress notes and discharge summaries for these prospectively identified patients were reviewed for mention of the syndrome. Discharge forms were reviewed for the codes (International Classification of Diseases, Ninth Revision) specific to acute respiratory distress syndrome (518.82 or 518.85). • Results Of 314 patients admitted, 65 prospectively met the criteria for acute respiratory distress syndrome. Of these 65 patients, 31 had acute respiratory distress syndrome mentioned in their progress notes, and 4 of the 31 were subsequently assigned a code of 518.82 or 518.85. Patients with a physician’s notation for acute respiratory distress syndrome in their charts had a higher mortality (22/31 [71%]) than did the patients with no such notation (10/34 [29%]). This difference could not be accounted for by differences in length of stay, mean age, score on Acute Physiology and Chronic Health Evaluation III, or number of days in the unit before meeting the criteria. • Conclusions The incidence of acute respiratory distress syndrome is underestimated when based on either diagnostic coding or physicians’ notes without testing of the accuracy of coding. Both physicians and medical record coding specialists may require training in use of terms related to acute respiratory distress syndrome.

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Bhagat, Sagar, Saiprasad Patil, Sagar Panchal, and Hanmant Barkate. "Physicians perception in the management of allergic rhinitis: a Pan-India survey." International Journal of Otorhinolaryngology and Head and Neck Surgery 6, no. 12 (November 24, 2020): 2233. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20205065.

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Background: Allergic rhinitis (AR) affects a wide proportion of the population across all age groups. There are several guidelines and consensus statements in AR management, the effect of this is implicit from a physician's perspective. The present cross-sectional survey was conducted to understand physicians approach to the management algorithm in the treatment of allergic rhinitis and medication choice.Methods: Physicians from diverse specialties such as pulmonologists, consultant physician, paediatricians, Allergists, ENT specialists and general practitioners were invited to participate in the survey, which focused on recognizing the burden of disease, clinical presentation, and management methods.Results: 1,261 Physicians participated in this survey, belonging to different specialties. Oral H1 antihistamine was favoured as a first-line therapy, followed by the combination of oral H1 histamine and leukotriene receptor antagonist. Fexofenadine was the most frequently prescribed. Majority believed, bilastine as antihistamine with the least sedative potential and was identified as the most effective treatment. Bilastine was preferred in patients with mild- moderate hepatic/renal impairment and in patients with persistent allergic rhinitis. Most physicians prefer bilastine in all AR clinical profiles. Aside from AR, bilastine is also use in management of upper respiratory tract infections and urticaria respectively.Conclusions: AR is still a growing challenge in India with majority of physician preferring oral antihistamine either as monotherapy or in combination. Bilastine is a preferred choice in patients with impaired liver and renal function and was also referred as least sedative antihistamine by majority of physicians across India.

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Wang, Dan, Chenxi Liu, Xuemei Wang, and Xinping Zhang. "Association between Physicians’ Perception of Shared Decision Making with Antibiotic Prescribing Behavior in Primary Care in Hubei, China: A Cross-Sectional Study." Antibiotics 9, no. 12 (December 8, 2020): 876. http://dx.doi.org/10.3390/antibiotics9120876.

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Shared decision-making (SDM) has been advocated as one effective strategy for improving physician–patient relationships and optimizing clinical outcomes. Our study aimed to measure physicians’ perception of SDM and establish the relationship between physicians’ perception of SDM and prescribing behavior in patients with upper respiratory tract infections. One cross-sectional study was conducted in Hubei Province from December 2019 to January 2020. The SDM questionnaire and prescription data of 2018 from electronic health records data were matched for each physician in this study. Multilevel modeling was applied to explore the relationship between physicians’ perception of SDM and antibiotic prescribing in primary care. Analyses were statistically controlled for demographic characteristics of the physicians and patients. Physicians’ positive perception of SDM had small but statistically significant effects on lower prescribing of antibiotics in the patient group aged over 40 years (odds ratio (OR) < 1; p < 0.05). Moreover, female physicians (OR = 0.71; p = 0.007) with higher educational levels (bachelor’s degree and above; OR = 0.71; p = 0.024) were significantly associated with the prescribing of less antibiotics (p < 0.05). A more positive perception of SDM was demonstrated as one significant predictor of less prescribing of antibiotics in the patient group over 40 years. There may be a promising focus of implementing SDM strategies targeting physician–patient communication in primary care.

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Kastelik, J. A., M. Alhajji, S. Faruqi, R. Teoh, and A. G. Arnold. "Thoracic ultrasound: an important skill for respiratory physicians." Thorax 64, no. 9 (August 28, 2009): 825–26. http://dx.doi.org/10.1136/thx.2009.115378.

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McCabe, Colm, Quentin Jones, Aikaterini Nikolopoulou, Chris Wathen, and Raashid Luqmani. "Pulmonary-renal syndromes: An update for respiratory physicians." Respiratory Medicine 105, no. 10 (October 2011): 1413–21. http://dx.doi.org/10.1016/j.rmed.2011.05.012.

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Pelosi, P., and L. Gattinoni. "Respiratory mechanics in ARDS: a siren for physicians?" Intensive Care Medicine 26, no. 6 (June 2000): 653–56. http://dx.doi.org/10.1007/s001340051227.

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Currie, Grace, Anna Tai, Tom Snelling, and André Schultz. "Variation in treatment preferences of pulmonary exacerbations among Australian and New Zealand cystic fibrosis physicians." BMJ Open Respiratory Research 8, no. 1 (July 2021): e000956. http://dx.doi.org/10.1136/bmjresp-2021-000956.

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BackgroundDespite advances in cystic fibrosis (CF) management and survival, the optimal treatment of pulmonary exacerbations remains unclear. Understanding the variability in treatment approaches among physicians might help prioritise clinical uncertainties to address through clinical trials.MethodsPhysicians from Australia and New Zealand who care for people with CF were invited to participate in a web survey of treatment preferences for CF pulmonary exacerbations. Six typical clinical scenarios were presented; three to paediatric and another three to adult physicians. For each scenario, physicians were asked to choose treatment options and provide reasons for their choices.ResultsForty-nine CF physicians (31 paediatric and 18 adult medicine) participated; more than half reported 10+ years of experience. There was considerable variation in primary antibiotic selection; none was preferred by more than half of respondents in any scenario. For secondary antibiotic therapy, respondents consistently preferred intravenous tobramycin and a third antibiotic was rarely prescribed, except in one scenario describing an adult patient. Hypertonic saline nebulisation and twice daily chest physiotherapy was preferred in most scenarios while dornase alfa use was more variable. Most CF physicians (>80%) preferred to change therapy if there was no early response. Professional opinion was the most common reason for antibiotic choice.ConclusionsVariation exists among CF physicians in their preferred choice of primary antibiotic and use of dornase alfa. These preferences are driven by professional opinion, possibly reflecting a lack of evidence to base policy recommendations. Evidence from high-quality clinical trials is needed to inform physician decision making.

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Boulet, Louis-Philippe. "Do We Need an Annual Canadian Respiratory Conference?" Canadian Respiratory Journal 7, no. 5 (2000): 361–63. http://dx.doi.org/10.1155/2000/658946.

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Beginning in the fall of 2001, as decided at the 1999 Annual General Meeting of the Canadian Thoracic Society (CTS), the Society's annual and scientific meeting will take place jointly with the American College of Chest Physicians (ACCP). In the past, this annual event was held in conjunction with the Royal College of Physicians' meeting. Unfortunately, attendance at the Royal College meetings was quite low, and the event did not seem to fulfil the needs and interests of the Canadian respiratory community. Therefore, a three-year trial agreement was reached for a joint annual meeting with the ACCP. This joint meeting would offer, among many incentives, the opportunity for Canadian physicians and fellows to attend an international meeting at which Canadian initiatives would have a lot of visibility and educational activities would be available.

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Cottin, V. "The European Respiratory Review: meeting expectations of respiratory physicians through diversity and quality." European Respiratory Review 23, no. 131 (February 28, 2014): 1–2. http://dx.doi.org/10.1183/09059180.00000614.

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Hayes, Rebecca, Brandon Merritt, Stacee Lewis, Jessie Shields, Jennifer Gerlach, Todd W. Gress, and Joseph Evans. "Antibiotic Prescriptions for Upper Respiratory Infections in a Pediatric Office Versus an Urgent Care Center." Global Pediatric Health 6 (January 2019): 2333794X1983563. http://dx.doi.org/10.1177/2333794x19835632.

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It is estimated that as many as 10 million unnecessary antibiotic prescriptions are written each year for children. Children are more likely to receive antibiotics for an upper respiratory infection in an urgent care center compared with the primary care office. However, no study has examined the antibiotic prescribing practices of the same physicians in these settings. This retrospective chart review evaluated pediatricians’ antibiotic prescribing practices for patients with symptoms of an upper respiratory tract infection in the office setting and an urgent care setting. There was no difference in the total antibiotic prescribing rate by pediatricians in their primary care office versus an urgent care setting. Pediatricians who were high antibiotic prescribers in the office setting were also high prescribers in the urgent care. The highest prescribing physicians prescribed the appropriate recommended antibiotics for a particular diagnosis the lowest percentage of the time. Efforts to promote antimicrobial stewardship should be directed toward the individual physician and not toward the location where the patients are being evaluated.

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Löffler, Christin, Antje Krüger, Anne Daubmann, Julia Iwen, Marc Biedermann, Maike Schulz, Karl Wegscheider, Attila Altiner, Gregor Feldmeier, and Anja Wollny. "Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infection in German Primary Care: Study Protocol for Evaluation of the RESIST Program." JMIR Research Protocols 9, no. 9 (September 30, 2020): e18648. http://dx.doi.org/10.2196/18648.

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Background The emergence and increased spread of microbial resistance is a major challenge to all health care systems worldwide. In primary care, acute respiratory tract infection (ARTI) is the health condition most strongly related to antibiotic overuse. Objective The RESIST program aims at optimizing antibiotic prescribing for ARTI in German primary care. By completing a problem-orientated online training course, physicians are motivated and empowered to utilize patient-centered doctor-patient communication strategies, including shared decision making, in the treatment of patients with ARTI. Methods RESIST will be evaluated in the form of a nonrandomized controlled trial. Approximately 3000 physicians of 8 (out of 16) German federal states can participate in the program. Patient and physician data are retrieved from routine health care data. Physicians not participating in the program serve as controls, either among the 8 participating regional Associations of Statutory Health Insurance Physicians (control group 1) or among the remaining associations not participating in RESIST (control group 2). Antibiotic prescription rates before the intervention (T0: 2016, 1st and 2nd quarters of 2017) and after the intervention (T1: 3rd quarter of 2017 until 1st quarter of 2019) will be compared. The primary outcome measure is the overall antibiotic prescription rate for all patients insured with German statutory health insurance before and after provision of the online course. The secondary outcome is the antibiotic prescription rate for coded ARTI before and after the intervention. Results RESIST is publicly funded by the Innovations funds of the Federal Joint Committee in Germany and was approved in December 2016. Recruitment of physicians is now completed, and a total of 2460 physicians participated in the intervention. Data analysis started in February 2020. Conclusions With approximately 3000 physicians participating in the program, RESIST is among the largest real-world interventions aiming at reducing inadequate antibiotic prescribing for ARTI in primary care. Long-term follow up of up to 21 months will allow for investigating the sustainability of the intervention. Trial Registration ISRCTN Registry ISRCTN13934505; http://www.isrctn.com/ISRCTN13934505 International Registered Report Identifier (IRRID) RR1-10.2196/18648

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Hassan, Maged, Rachel M. Mercer, and Najib M. Rahman. "Thoracic ultrasound in the modern management of pleural disease." European Respiratory Review 29, no. 156 (April 29, 2020): 190136. http://dx.doi.org/10.1183/16000617.0136-2019.

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Physician-led thoracic ultrasound (TUS) has substantially changed how respiratory disorders, and in particular pleural diseases, are managed. The use of TUS as a point-of-care test enables the respiratory physician to quickly and accurately diagnose pleural pathology and ensure safe access to the pleural space during thoracentesis or chest drain insertion. Competence in performing TUS is now an obligatory part of respiratory speciality training programmes in different parts of the world. Pleural physicians with higher levels of competence routinely use TUS during the planning and execution of more sophisticated diagnostic and therapeutic interventions, such as core needle pleural biopsies, image-guided drain insertion and medical thoracoscopy. Current research is gauging the potential of TUS in predicting the outcome of different pleural interventions and how it can aid in tailoring the optimum treatment according to different TUS-based parameters.

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Álvarez-Dobaño, José Manuel, Malena Toubes, José Ángel Novo-Platas, Francisco Reyes-Santías, Gerardo Atienza, Manuel Portela, Carlos Rábade, et al. "Cost-Effectiveness of a New Outpatient Pulmonology Care Model Based on Physician-to-Physician Electronic Consultation." Canadian Respiratory Journal 2022 (October 31, 2022): 1–10. http://dx.doi.org/10.1155/2022/2423272.

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Introduction. This study assesses the impact of an electronic physician-to-physician consultation program on the waiting list and the costs of a Pulmonology Unit. Materials and Methods. A prepost intervention study was conducted after a new ambulatory pulmonary care protocol was implemented and the capacity of the unit was adopted. In the new model, physicians at all levels of healthcare send electronic consultations to specialists. Results. In the preintervention year (2019), the Unit of Pulmonology attended 7,055 consultations (466 e-consultations and 6,589 first face-to-face visits), which decreased to 6,157 (3,934 e-consultations and 2,223 first face-to-face visits; 12.7% reduction) in the postintervention year (all were e-consultations). The mean wait time for the first appointment was 25.7 days in 2019 versus 3.2 days in 2021 ( p < 0.001 ). In total, 43.5% of cases were solved via physician-to-physiciane-consultation. A total of 2,223 patients needed a face-to-face visit, with a mean wait time of 7.5 days. The mean of patients in the waiting listing decreased from 450.8 in 2019 to 44.8 in 2021 (90% reduction). The annual time devoted to e-consultations and first face-to-face visits following an e-consultation diminished significantly after the intervention (1,724 hours versus 2,312.8; 25.4% reduction). Each query solved via e-consultation represented a saving of €652.8, resulting in a total annual saving of €827,062. Conclusions. Physician-to-physiciane-consultations reduce waiting times, improve access of complex patients to specialty care, and ensure that cases are managed at the appropriate level. E-consultation reduces costs, which benefits both, society and the healthcare system.

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Linn, Alexandra, Li Wang, Fernanda P. Silveira, John V. Williams, Richard Zimmerman, Charles R. Rinaldo, and Marian Michaels. "When to Order a Respiratory Viral Panel (RVP): Physician Use in Clinical Practice." Open Forum Infectious Diseases 4, suppl_1 (2017): S354. http://dx.doi.org/10.1093/ofid/ofx163.855.

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Abstract Background Multiplex RVP assays are frequently offered at medical centers to screen for viruses using nucleic acid technology. The University of Pittsburgh Medical Center (UPMC) uses the Genmark eSensor RVP detecting 14 virus types/subtypes. This study evaluated how RVPs are used in a large medical center to better understand physician practices. Methods A 32 question, descriptive survey, created using the Qualtrics survey database, was sent via email to pediatric, emergency, internal, and family physicians at large academic hospitals in the UPMC network. The anonymous survey was sent 3 times between January 2017 and March 2017. Survey data were analyzed using the SPSS statistics software. Results 543/1,265 (43%) survey responses were received; 492 were evaluable. 56% were female; 42% see children, 45% see adults, 13% see both; 16% see patients in the ED. Training levels included 51% residents/fellows and 49% attendings. Of doctors responding, 87% order RVPs. Most (85%) have changed treatment decisions based on a RVP result; 53% changed management ~50% of the time. Conclusion Physicians order RVPs most frequently if they believe the results will change treatment. RVPs are ordered more for young and elderly patients, and those with underlying immunosuppression or chronic illness. Cost does not limit physician ordering and most are unaware of it. Suspected influenza or specific virus is also considered. Disclosures J. V. Williams, Quidel: Scientific Advisor, Consulting fee GlaxoSmithKline: Scientific Advisor, Consulting fee R. Zimmerman, Sanofi: Grant Investigator, Grant recipient

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Barbash, Ian J., Joseph M. Pilewski, and Bryan J. McVerry. "Closing the Loop: Engaging Leaders and Front-Line Physicians to Promote Physician Wellness." Annals of the American Thoracic Society 16, no. 8 (August 2019): 970–73. http://dx.doi.org/10.1513/annalsats.201812-866ps.

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Annema, Jouke T., and Klaus F. Rabe. "Why Respiratory Physicians Should Learn and Implement EUS-FNA." American Journal of Respiratory and Critical Care Medicine 176, no. 1 (July 2007): 99. http://dx.doi.org/10.1164/ajrccm.176.1.99.

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Spiro, Stephen G., and Sam Janes. "Why Respiratory Physicians Should Learn and Implement EUS-FNA." American Journal of Respiratory and Critical Care Medicine 176, no. 1 (July 2007): 99a. http://dx.doi.org/10.1164/ajrccm.176.1.99a.

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Franklin, K. A. "Sleep apnoea - where are the physicians in respiratory medicine?" Clinical Respiratory Journal 2, no. 4 (September 3, 2008): 196. http://dx.doi.org/10.1111/j.1752-699x.2008.00099.x.

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Crocker, Ken, Benvon Cramer, and James M. Hutchinson. "Antibiotic Availability and the Prevalence of Pediatric Pneumonia During a Physicians’ Strike." Canadian Journal of Infectious Diseases and Medical Microbiology 18, no. 3 (2007): 189–92. http://dx.doi.org/10.1155/2007/138792.

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BACKGROUND: Antibiotics are widely believed to be overpre-scribed for pediatric respiratory infections, yet there are few data available on the effect of a sudden decrease in antibiotic availability on pediatric infectious disease.OBJECTIVE: To determine whether the prevalence of radiographically diagnosed pneumonia changed over a period of decreased physician access and decreased antibiotic availability.DESIGN: A retrospective study was performed which reviewed the number of pediatric respiratory antibiotic prescriptions over a period which included a physicians’ strike. The study examined whether antibiotic availability had been affected by the strike. Pediatric chest radiograph reports were reviewed for the same period to determine whether changes in antibiotic availability had affected the prevalence of radiographically diagnosable pneumonias among children presenting to a pediatric emergency room.RESULTS: While prescriptions for antibiotics fell by a minimum estimate of 28% during the strike, there was no change in the frequency of radiographic diagnoses of pneumonia.CONCLUSIONS: Respiratory antibiotics appear to be available in the community in excess of the amount required to control pneumonia. A 28% decrease in antibiotic availability did not result in a significant increase in respiratory disease.

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Halalau, Alexandra, Madalina Halalau, Christopher Carpenter, Amr E. Abbas, and Matthew Sims. "Vestibular neuritis caused by severe acute respiratory syndrome coronavirus 2 infection diagnosed by serology: Case report." SAGE Open Medical Case Reports 9 (January 2021): 2050313X2110132. http://dx.doi.org/10.1177/2050313x211013261.

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Vestibular neuritis is a disorder selectively affecting the vestibular portion of the eighth cranial nerve generally considered to be inflammatory in nature. There have been no reports of severe acute respiratory syndrome coronavirus 2 causing vestibular neuritis. We present the case of a 42-year-old Caucasian male physician, providing care to COVID-19 patients, with no significant past medical history, who developed acute vestibular neuritis, 2 weeks following a mild respiratory illness, later diagnosed as COVID-19. Physicians should keep severe acute respiratory syndrome coronavirus 2 high on the list as a possible etiology when suspecting vestibular neuritis, given the extent and implications of the current pandemic and the high contagiousness potential.

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Brown, Lee K. "Physicians and sleep deprivation." Current Opinion in Pulmonary Medicine 14, no. 6 (November 2008): 507–11. http://dx.doi.org/10.1097/mcp.0b013e3283165e81.

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Wright, Christopher John, Russell Morton Allan, and Stuart A Gillon. "Medical High Dependency Unit series, Article 3: Respiratory Support in the MHDU." Acute Medicine Journal 16, no. 3 (July 1, 2017): 115–22. http://dx.doi.org/10.52964/amja.0669.

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Acute respiratory failure is a life threatening condition encountered by Acute Physicians; additional non-invasive support can be provided within the medical high dependency unit (MHDU). Acute Physicians should strive to be experts in the investigation, management and support of patients with acute severe respiratory failure. This article outlines key management principles in these areas and explores common pitfalls.

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Xu, Rixiang, Tingyu Mu, Wang Jian, Caiming Xu, and Jing Shi. "Knowledge, Attitude, and Prescription Practice on Antimicrobials Use Among Physicians: A Cross-Sectional Study in Eastern China." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 58 (January 2021): 004695802110599. http://dx.doi.org/10.1177/00469580211059984.

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Over-prescription of antimicrobials for patients is a major driver of bacterial resistance. The aim of the present study was to assess the knowledge, attitude, and prescription practices regarding antimicrobials among physicians in the Zhejiang province in China, and identify the determining factors. A total of 600 physicians in public county hospitals and township health institutions were surveyed cross-sectionally using a structured electronic questionnaire. The questionnaire was completed by 580 physicians and the response rate was 96.67%. The mean score of 11 terms related to antimicrobial knowledge was 6.81, and an average of 32.1% of patients with upper respiratory tract infections (URTIs) were prescribed antimicrobials. Multivariate analysis indicated that young general practitioners with less training are more likely to contribute to more frequent antimicrobial prescriptions ( P < .05). In contrast, older physicians with more training are more willing to provide patients with the correct knowledge regarding antimicrobials and less likely to prescribe antimicrobials for URTIs. Correlation analysis showed that the level of physician's knowledge, attitude, and prescription practice is related ( P < .05). In conclusion, proper prescription of antimicrobials depends on adequate knowledge and regular training programs for physicians.

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Poor, Armeen D., Samuel O. Acquah, Celia M. Wells, Maria V. Sevillano, Christopher G. Strother, Gary G. Oldenburg, and S. Jean Hsieh. "Implementing Automated Prone Ventilation for Acute Respiratory Distress Syndrome via Simulation-Based Training." American Journal of Critical Care 29, no. 3 (May 1, 2020): e52-e59. http://dx.doi.org/10.4037/ajcc2020992.

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Background Prone position ventilation (PPV) is recommended for patients with severe acute respiratory distress syndrome, but it remains underused. Interprofessional simulation-based training for PPV has not been described. Objectives To evaluate the impact of a novel interprofessional simulation-based training program on providers’ perception of and comfort with PPV and the program’s ability to help identify unrecognized safety issues (“latent safety threats”) before implementation. Methods A prospective observational quality improvement study was done in the medical intensive care unit of an academic medical center. Registered nurses, physicians, and respiratory therapists were trained via a didactic session, simulations, and structured debriefings during which latent safety threats were identified. Participants completed anonymous surveys before and after training. Results A total of 73 providers (37 nurses, 18 physicians, 18 respiratory therapists) underwent training and completed surveys. Before training, only 39% of nurses agreed that PPV would be beneficial to patients with severe acute respiratory distress syndrome, compared with 96% of physicians and 70% of respiratory therapists (P < .001). Less than half of both nurses and physicians felt comfortable taking care of prone patients. After training, perceived benefit increased among all providers. Comfort taking care of proned patients and managing cardiac arrest increased significantly among nurses and physicians. Twenty novel latent safety threats were identified. Conclusion Interprofessional simulation-based training may improve providers’ perception of and comfort with PPV and can help identify latent safety threats before implementation.

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El-Khatib, Mohamad F., Salah Zeineldine, Chakib Ayoub, Ahmad Husari, and Pierre K. Bou-Khalil. "Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia." American Journal of Critical Care 19, no. 3 (May 1, 2010): 272–76. http://dx.doi.org/10.4037/ajcc2009131.

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Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended.Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia.Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia.Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience.Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia.

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Gupta, Deepak, Sarwan Kumar, and Shushovan Chakrabortty. "SOHAM: SEARCHING OUR-OWN HEALTH AFTER MEDICINE By Understanding Physician Mortality Data from The United States." Indian Journal of Community Health 32, no. 1 (March 31, 2020): 154–60. http://dx.doi.org/10.47203/ijch.2020.v32i01.031.

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While SEARCHING OUR-OWN HEALTH AFTER MEDICINE (SOHAM), we as aging physicians have to first explore and expose our mortality with underlying uniqueness of causes for physician mortality. Herein, publicly available data at Centers for Disease Control and Prevention from National Occupational Mortality Surveillance program of the National Institute for Occupational Safety and Health comes in handy. As compared to all occupational workers in the United States, intentional self-harm, Parkinson’s disease, Alzheimer’s and other degenerative disease were more likely causes of death while chronic obstructive pulmonary disease, diseases of the respiratory system, ischemic heart disease and diseases of the heart were less likely causes of death among physicians in the United States. Summarily, we as physicians may have somewhat overcome sufferings of our lungs and hearts but surrendered to sufferings of our brains and minds and therefore must envisage devising physical, psychological, socioeconomic and spiritual interventions for constantly bettering our living.

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Marrie, Thomas J. "Survey of Physicians Concerning the Use of Chest Radiography in the Diagnosis of Pneumonia in Out-Patients." Canadian Journal of Infectious Diseases 8, no. 2 (1997): 95–98. http://dx.doi.org/10.1155/1997/162459.

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OBJECTIVE: To determine how physicians use chest radiography in the diagnosis of pneumonia in ambulatory patients.STUDY POPULATION: A convenience sample of 176 Nova Scotia family physicians and internists selected to represent all geographic areas of the province proportional to population.STUDY INSTRUMENT: A 35-item questionnaire covering demographics, experience with out-patients with pneumonia, use of chest radiographs to make this diagnosis and factors that were considered important in the decision to perform initial and follow-up chest radiographs. Two skill-testing questions were also included.RESULTS: One hundred and fourteen of 176 (64.7%) responded; 88% had treated out-patients with pneumonia in the previous three months. Fifty-seven per cent of physicians requested chest radiographs on 90% to 100% of out-patients in whom they had made a clinical diagnosis of pneumonia. These physicians were more likely to be internists and to have graduated before 1970. Factors that ranked most important in the decision to request the initial chest radiograph were clinical appearance, respiratory distress and physical findings, while age and smoking history contributed most to the decision to perform a follow-up chest radiograph.CONCLUSIONS: There is considerable variability among physicians in requesting chest radiographs on out-patients with a clinical diagnosis of pneumonia. Physician and patient factors contribute to this variability.

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Bateman, Lori Brand, Nancy M. Tofil, Marjorie Lee White, Leon S. Dure, Jeffrey Michael Clair, and Belinda L. Needham. "Physician Communication in Pediatric End-of-Life Care." American Journal of Hospice and Palliative Medicine® 33, no. 10 (July 11, 2016): 935–41. http://dx.doi.org/10.1177/1049909115595022.

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Objective: The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. Methods: Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. Results: Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely. Conclusion: Findings indicate that effective physician–parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units. Practice Implications: The findings in this study, particularly that physician–parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care.

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Laursen, Christian B., Therese M. H. Naur, Uffe Bodtger, Sara Colella, Matiullah Naqibullah, Valentina Minddal, Lars Konge, et al. "Ultrasound-guided Lung Biopsy in the Hands of Respiratory Physicians." Journal of Bronchology & Interventional Pulmonology 23, no. 3 (July 2016): 220–28. http://dx.doi.org/10.1097/lbr.0000000000000297.

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Klaus, Stephen, Aoife Carolan, Deirdre O'Rourke, and Barry Kennedy. "What respiratory physicians should know about narcolepsy and other hypersomnias." Breathe 18, no. 3 (September 2022): 220157. http://dx.doi.org/10.1183/20734735.0157-2022.

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Narcolepsy and related central disorders of hypersomnolence may present to the sleep clinic with excessive daytime sleepiness. A strong clinical suspicion and awareness of the diagnostic clues, such as cataplexy, are essential to avoid unnecessary diagnostic delay. This review provides an overview of the epidemiology, pathophysiology, clinical features, diagnostic criteria and management of narcolepsy and related disorders, including idiopathic hypersomnia, Kleine–Levin syndrome (recurrent episodic hypersomnia) and secondary central disorders of hypersomnolence.

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Gajdos, V., N. Beydon, L. Bommenel, B. Pellegrino, L. de Pontual, S. Bailleux, P. Labrune, and J. Bouyer. "Inter-observer agreement between physicians, nurses, and respiratory therapists for respiratory clinical evaluation in bronchiolitis." Pediatric Pulmonology 44, no. 8 (August 2009): 754–62. http://dx.doi.org/10.1002/ppul.21016.

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Lund, V. J. "Chest physicians discover the nose!" Respiratory Medicine 88, no. 5 (May 1994): 333–34. http://dx.doi.org/10.1016/0954-6111(94)90037-x.

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Khadjooi, Kayvan, Christos Dimopoulos, and John Paterson. "The Acute Physicians Unit in Scarborough Hospital." Acute Medicine Journal 8, no. 3 (July 1, 2009): 132–35. http://dx.doi.org/10.52964/amja.0590.

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Aim: The aim of Acute Physicians Unit (APU) in Scarborough Hospital is consultant led delivery of acute medical care. It operates weekdays from 9am to 5pm, staffed by a consultant physician, a trained nurse and an auxiliary nurse. We reviewed the APU activity over 38 months. Results: 7170 patients were referred to APU, mainly from GPs (59.6%) and A&E (26.5%). The most common type of referrals: cardiovascular 21%, neurological 16.9% and respiratory 15.1%. It prevented admission in 2217 cases (30.9%): 22.4% were sent home after assessment in APU and in 8.5% telephone advice was sufficient. Conclusion: The APU has led to early consultant review in 53% of admissions, discharge of 31% of patients and is a useful source of consultation for GPs.

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Freeman, S., M. Columbus, T. Nguyen, S. Mal, and J. Yan. "P049: Post-intubation sedation in the emergency department: a survey of national practice patterns." CJEM 21, S1 (May 2019): S80. http://dx.doi.org/10.1017/cem.2019.240.

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Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.

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Jaruseviciene, Lina, Ruta Radzeviciene-Jurgute, Jeffrey Lazarus, Arnoldas Jurgutis, Ingvar Ovhed, Eva Strandberg, and Lars Bjerrum. "A study of antibiotic prescribing: the experience of Lithuanian and Russian GPs." Open Medicine 7, no. 6 (December 1, 2012): 790–99. http://dx.doi.org/10.2478/s11536-012-0062-4.

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AbstractBackground. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients’ faith in antibiotics as medication for upper respiratory tract infections; patient potential to influence a GP’s decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing for upper respiratory tract infections. Conclusions. Understanding the nature of physician-patient interaction is critical to the effective pursuit of clinically grounded antibiotic use as this study undertaken in Lithuania and the Russian Federation has shown. Both physicians and patients must be targeted to ensure correct antibiotic use. Further, GPs should be supported in enhancing their communication skills about antibiotic use with their patients and encouraged to implement a shared decision-making model in their practices.

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Haga, Yoshihiro, Koichi Chida, Yuichiro Kimura, Shinsuke Yamanda, Masahiro Sota, Mitsuya Abe, Yuji Kaga, Taiichiro Meguro, and Masayuki Zuguchi. "Radiation eye dose to medical staff during respiratory endoscopy under X-ray fluoroscopy." Journal of Radiation Research 61, no. 5 (July 13, 2020): 691–96. http://dx.doi.org/10.1093/jrr/rraa034.

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Abstract Although the clinical value of fluoroscopically guided respiratory endoscopy (bronchoscopy) is clear, there have been very few studies on the radiation dose received by staff during fluoroscopically guided bronchoscopy. The International Commission on Radiological Protection (ICRP) is suggesting reducing the occupational lens dose limit markedly from 150 to 20 mSv/year, averaged over defined periods of five years. The purpose of this study was to clarify the current occupational eye dose of bronchoscopy staff conducting fluoroscopically guided procedures. We measured the occupational eye doses (3-mm-dose equivalent, Hp(3)) of bronchoscopy staff (physicians and nurses) over a 6-month period. The eye doses of eight physicians and three nurses were recorded using a direct eye dosimeter, the DOSIRIS. We also estimated eye doses using personal dosimeters worn at the neck. The mean ± SD radiation eye doses (DOSIRIS) to physicians and nurses were 7.68 ± 5.27 and 2.41 ± 1.94 mSv/6 months, respectively. The new lens dose limit, 20 mSv/year, may be exceeded among bronchoscopy staff, especially physicians. The eye dose of bronchoscopy staff (both physicians and nurses) was underestimated when measured using a neck dosimeter. Hence, the occupational eye dose of bronchoscopy staff should be monitored. To reduce the occupational eye dose, we recommend that staff performing fluoroscopically guided bronchoscopy wear Pb glasses. correct evaluation of the lens dose [Hp(3)] using an eye dosimeter such as the DOSIRIS is necessary for bronchoscopy staff.

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Journal articles on the topic 'Respiratory physicians'

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