Allergy Department Research Articles

Nursing experience of inhalation of steroid for patients after endoscopy surgery

Objective To explore the nursing experience of inhalation of steroid for patients after endoscopy surgery. Methods From September to December 2016, we selected 200 patients with transnasal endoscopic frontal surgery of Allergy Department at Beijing Tongren Hospital, Capital Medical University as subjects. All of the patients were treated with the inhalation of glucocorticoid. Nurses provided the guidance of inhalation of steroid for patients and observed the effects. Results A total of 200 patients accepted inhalation. After inhalation, patients' subjective symptoms improved. A total of 182 patients were very satisfied with the nursing service and 18 patients were satisfied with the nursing service. Three months after surgery, there were 152 patients without edema, 24 with the mild edema and 24 with obvious edema in operation cavity of patients. Conclusions Reasonable guidance by nurses can optimize the effects of inhalation of steroid, promote the recovery of patients after surgery and improve patient satisfaction. Key words: Sinusitis; Nasal septum deviation; Endoscopy surgery; Inhalation

NİKEL ALLERJİSİYLE İLİŞKİLİ PERİODONTİTİS: BİR OLGU SUNUMU

Nikel alerjisi kadinlarda daha sik olmakla birlikte toplumlarda yaygin olarak gorulmektedir. Nikel alerjisi agizda yanma hissi, gingival hiperplazi, dilde uyusukluk, tat kaybi gibi bulgularla ortaya cikabilir. Ayrica nikel, alerjik hastalarda periodontal degisikliklere yol acabilir.35yasinda kadin hasta disetinde kanama sikayeti ile Ankara Universitesi DisHekimligi Fakultesi Periodontoloji Anabilim Dali’na basvurmustur. Sistemik bir hastaligiolmayan hastanin sigara kullanmadigi ogrenilmistir. Alinan anamnezde hastaninprotetik restorasyonlarinin 8 ay once yapildigi ve sikayetlerinin bu tarihtensonra ortaya cikmaya basladigi ogrenilmistir. Yapilan agiz ici muayenedehastanin restorasyonlu dislerinde derin patolojik cepler saptanmis, radyografikmuayenede de bu bolgelerde kemik kayiplari izlenmistir. Hastaya herhangi birmetal alerjisi olup olmadigi sorulmus ve takilara karsi alerjisi oldugunu soyleyen hasta Ni alerjisi suphesi ile alerji bolumune konsulte edilmistir. Nialerjisi oldugu ortaya cikan hastanin oncelikle restorasyonlari cikarilmis,prognozu kotu olan disleri cekilmis periodontal tedavisi tamamlanmistir. Dahasonra dis eksikligi olan bolgelerde implant uygulamasi yapilmis ve hastanin tumprotetik restorasyonlarinda zirkonyum kullanilmistir. Restorasyonlartamamlandiktan 1 yil sonra yapilan klinik muayenede periodontal patolojiizlenmeyen hastaya daha ileri takipleri icin randevu verilmistir. Anahtar kelimeler: Nikel, alerji, periodontitis Periodontitis Associated with Nickel Allergy: A Case Report Abstract An allergy to nickel is commonly seen in the population, more frequently in women. The clinical signs and symptoms of nickel allergy include burning sensation, gingival hyperplasia, numbness on sides of tongue, loss of taste etc. And also nickel can promote periodontal changes in allergic patients A 35 year old woman referred to Ankara University Faculty of Dentistry Department of Periodontology with a complaint of gingivalbleeding. It was learned that the prosthetic restorations were made 8 monthsago and her complaints have been commenced after this date The patient was in good general health and non smoker. Intraoral examination revealed deep probing depth on teeth with prosthetic restoration and radiographic examination revealed severe bone loss these teeth.The patient was asked as to whether she are allergic to any metal, and was learned to be allergic to the jewelery. She was consulted immunology and allergy department. The patient was found to be allergic to nickel and than firstly prosthetic restoration was removed. Teeth which poor diagnosis was extracted and her periodontal treatment was finished. Dental implants was performed at edentolus site and zirconium was used for patients prosthetic restorations. 1 year after the restorations have been completed any clinical pathology was observed. The patient was given further follow-up appointments inside. Key words: Nickel, allergy, periodonti

Perioperative allergy. A 3-year experience

Perioperative hypersensitivity reactions constitute a global health problem, with an estimated incidence of 1 per 100,000 procedures and a mortality rate of 0.1 to 9 %. Main risk factors are a history of allergy to other drugs, atopy, associated psychiatric disorders and previous surgeries. To determine the frequency of sensitization and the type of drugs involved in perioperative allergy in a tertiary care hospital, over a 3-year period. Retrospective, cross-sectional, descriptive study of perioperative allergy, corroborated by skin tests for each drug and latex, of patients treated at the Allergy and Clinical Immunology Department of Hospital General de Mexico. Twenty-eight patients diagnosed with perioperative allergy were included. Main triggers were neuromuscular blocking agents (46.42 %), latex (28.52 %) and propofol (14.28 %). The main risk factor was a history of previous surgeries (89.28 %). Most perioperative allergic reactions were mild (71.42 %) and occurred within the postoperative period (60.71 %). Initial diagnosis and Treatment should always be carried out by the anesthesiologist or surgeon, who should focus on the withdrawal of possible causative agents.

The sensitization feature of Cypress pollen in urban area of Beijing

Objective: To explore the sensitization features of Cypress pollen in urban area of Beijing and analyze the seasonal changes. Methods: Four thousand two hundred and one patients in Department of Allergy of Beijing Shijitan Hospital during January to December 2017 were enrolled in this study and received skin prick test (SPT) of Cypress extract. Cypress sensitization was divided into two types: mono-sensitization and multiple-sensitization. Difference of sensitization rate between age, gender and visiting month was analyzed by chi-square test. Difference of visiting rate and sensitization rate among each month was analyzed by K-W test. Pearson test was carried out for correlation analysis. Results: Positive rate of Cypress pollen was 32.3% (1 358/4 201) in overall patients in which male had a higher positive rate than female (35.6% vs 30.1%, χ(2)=13.465, P<0.001). The positive rate was highest in age 11-20 years and 31-40 years and then decreased with age (P<0.001). Multi-sensitization was observed in this study with a rate of 27.5% (1 154/4 201) while mono-sensitization of Cypress was only 4.7% (199/4 201). The consultation rate during January to December was positively correlated with SPT positive rate of Cypress pollen (r(2)=0.715 9, P=0.001). The positive rate varied with season with the highest rate in March (53.0%, 316/596), followed by April (36.6%, 208/568). The season peak of positive rate was observed in adults but not children. Mono-sensitization rate varied with one season peak (spring) while multi-sensitization showed two season peaks (spring and autumn). Conclusion: Cypress sensitization is prevalent in urban area of Beijing and is prone to multi-sensitization, which changes with season with the peak in March.

Editorial introductions

Editorial introductions

Pharmaceutical Preparations for Intradermal Drug Tests

AbstractOur department of pharmacy takes over all the medical skin tests prescribed by the allergy department. The production takes place in specific premises, with qualified and calibrated equipment, by a qualified and regularly assessed staff—in compliance with the French preparation guidelines. The whole activity is under the responsibility of a pharmacist—handlings are performed by hospital pharmacy technicians. Each new intradermal skin test demand leads to a feasibility analysis—irritating nature, dilution solvent, concentration—this information is gathered in a thesaurus. The manufacturing steps are the following: prescription validation, production sheet and label printing, preparation of the needed equipment, batch numbers and expiration date checking, handling under a vertical laminar flow hood and control after production. The preparation activity increases continuously and the thesaurus currently contents 302 rows with following information: drug, dilution and reconstitution solvent, pure solution concentration and maximum concentration to test with intradermal tests. Work would prospect in costs reduction and resources optimization. Thanks to the allergists’ confidence, the partnership between the two departments can go on. This guarantees the quality of the preparations tested on patients but also the skin tests reproducibility.

Anaphylaxis to beta-lactam antibiotics at pediatric age: Six-year survey

IntroductionBeta-lactams are the most frequently used antibiotics in pediatric age. Anaphylactic reactions may occur and need to be properly studied, but studies in children are scarce. ObjectiveCharacterization of case reports of anaphylaxis in children referred to an allergy department with suspected beta-lactams hypersensitivity. Materials and methodsRetrospective analysis of all children referred to our Drug Allergy Center with suspected beta-lactams hypersensitivity between January 2011 and December 2016. Description of the drug allergy work-up performed studied according to standardized diagnostic procedures of ENDA/EAACI, including specific-IgE assay, skin prick and intradermal tests and diagnostic/alternative drug challenge tests. Results146 children with suspected beta-lactams hypersensitivity were studied, and in 21 (14.4%) the diagnosis was confirmed. In all of them, except for three children, an alternative beta-lactam was found. In seven children (33.3% of those with confirmed beta-lactams hypersensitivity) anaphylaxis was confirmed, and all of them described reactions with cutaneous and respiratory or gastrointestinal involvement. The culprit drug was amoxicillin in six and flucloxacillin in one. In this sample, we also performed oral challenge with cefuroxime, being negative in all cases. Almost all cases of confirmed anaphylaxis (six from seven cases) were IgE mediated, with positive skin tests despite negative serum specific-IgE. ConclusionsAllergic reactions to beta-lactams, although rare in children, require a detailed clinical history and a specialized drug allergy work-up to allow a correct diagnosis as well as to avoid the possibility of a potential life-threatening reaction and provide alternative drugs.

Aerial fungal spectrum of Kolkata, India, along with their allergenic impact on the public health: a quantitative and qualitative evaluation

Airborne fungal spores are well documented to trigger respiratory allergy. The present study provides baseline information on the quantitative and qualitative aspects of aerospores for the first time in a typical urban area of Kolkata metropolis, India. An aeromonitoring was performed by Burkard volumetric 7-day sampler for two consecutive years (August 2012–July 2014). Total concentration, seasonal variations and intradiurnal periodicities of fungal spores were estimated. Spearman’s rank correlation analysis was performed using various weather parameters. The prevalence of fungal spore allergy was investigated among patients reporting to the Department of Allergy and Asthma, Mediland Diagnostics, Kolkata. A retrospective review of patients was conducted with a standard questionnaire and performing skin prick test with 20 fungal extracts. Thirty-eight fungal genera were identified with the highest spore concentration in August. Relative humidity and rainfall were found to be positively correlated with spore concentration. A comparatively higher frequency of sufferers was observed for males and 15–35-year age group. Patients with an atopic family history and insidious onset of symptoms were prone to suffer more, and bronchial asthma was diagnosed in most. Out of 742 patients, 592 patients noticed to have positive skin reactivity toward one or more fungal extracts. Aspergillus fumigatus followed by Curvularia pallescens and Fusarium lateritium elicited maximum sensitization. Each of these genera also represented a considerable fraction of the total aeromycota, thereby indicating potential risk to the sensitized individuals. Further serological analysis along with the identification of fungal allergens would pave the way of immunotherapy.

Administering a Telemedicine Program.

The purpose of this review is to describe the process of administering a telemedicine program including reviewing telemedicine guidelines; discussing licensing, credentialing, and privileging of providers; outlining scheduling and recruitment of patients; and measuring outcomes of a telemedicine program. Recent literature findings suggest that telemedicine in specialty clinics continues to grow at a rapid pace. Medical specialty programs should prepare to adopt a practice that includes telemedicine to better serve their patients and families who have expressed significant satisfaction with the delivery of healthcare in this manner. With the appropriate support, any specialty clinic can provide their patients with a telemedicine option which has shown to be highly successful for Children's Mercy Allergy, Asthma, & Immunology Department.

Proven immunologically-mediated drug hypersensitivity in children with a history of multiple drug intolerances

BackgroundChildren may be referred to pediatric allergy clinics for reactions to multiple drugs. Multiple drug hypersensitivity (MDH) is defined as immunologically-mediated hypersensitivity to 2 or more chemically different drugs. ObjectiveThe aim of this study is to report the allergy workup results of children who had a history of potential hypersensitivity reactions to 2 or more unrelated drugs. MethodsThis study was conducted in the Pediatric Allergy and Immunology department of our hospital. Children who described hypersensitivity reactions to 2 or more drugs were included and were evaluated by allergy workup (skin and/or provocation tests) between January 2011 and July 2016. ResultsDuring the study period, 886 children were evaluated for a history of drug intolerance. Of these children, 73 (8.2%) had a history of drug reactions to 2 or more chemically different drugs. The median age of the children who had a history of reactions to 2 or more drugs was 7.8 (min-max: 2.5-16.4) years, and 59% (n = 43) were male. Among the suspected drugs, antibiotics (65.9%) ranked first, and nonsteroid anti-inflammatory drugs (34.1%) were the second. All 73 children were evaluated with skin or provocation tests with the suspected drugs, and MDH was confirmed in only 2 (2.7%) children. ConclusionMultiple drug hypersensitivity is uncommon in children. The incidence and prevalence of MDH may vary with the specific population studied. Evaluating children with a history of MDH, by performing drug hypersensitivity testing, will help avoid the morbidity associated with unnecessary drug avoidance.

Sociodemographic and clinical factors affecting the quality of life of patients with chronic obstructive pulmonary disease.

BackgroundCOPD remains a significant challenge for contemporary medicine. It is one of the most common respiratory illnesses and leads to disability as well as deteriorating patient’s quality of life (QOL).ObjectiveThe objective of this study was to determine the impact of selected sociodemographic and clinical factors on QOL and level of illness acceptance (LIA) of patients with COPD.DesignThis study was a cross-sectional, prospective, observational study.Patients and methodsThe study involved 100 patients (34 women and 66 men) suffering from COPD for at least half a year, treated in the Allergology Clinic at the Department of Internal Medicine, Geriatrics and Allergy, Wroclaw Medical University in Poland. Standardized questionnaires such as Short Form-36 Health Survey, Saint George’s Respiratory Questionnaire, Acceptance of Illness Scale, and COPD Author’s Questionnaire were used to assess QOL and LIA.ResultsAmong the most significant results, there were no statistically significant differences between the patients’ sex and their QOL and LIA (P>0.05). It has been observed that with an increase in the age of patients, a statistically significant decrease in LIA is observed, especially after 60 years of age (P=0.001). It was found that the higher level of education of the patients was statistically significant in the higher QOL (P<0.05) and in the greater LIA (P<0.05). Interestingly, there was no statistically significant effect of active smoking and overweight on QOL and LIA (P>0.05).ConclusionSex of COPD patients does not affect their QOL or LIA, nonetheless, the age decreases the level of QOL and LIA. Higher education improves QOL scores; however, factors such as dyspnea, longer duration of illness, comorbidities, oxygen therapy undertaking, and family burden of respiratory disease affect deterioration of QOL.

Patients with small-vessel vasculitides have the highest mortality among systemic autoimmune diseases patients treated in intensive care unit: A retrospective study with 5-year follow-up

PurposeSystemic autoimmune diseases are a heterogeneous group of disorders associated with dysfunction of multiple organs and unpredictable course. Complicated management and treatment become even more challenging when patients require critical care. This study aims to compare outcomes of small-vessel vasculitides (SVV) and other systemic autoimmune diseases (SAD) patients admitted to the intensive care unit (ICU). Materials and methodsRetrospective, observational study conducted in the ICU of Allergy and Immunology Department at the University Hospital in Krakow, Poland, between years 2001–2014, with 5-years follow-up and no lost to follow-up patients. Results74 patients with autoimmune diseases were enrolled in the study - 23 with SVV and 51 with SAD. Patients in the SVV group achieved higher scores in APACHE II and III SAPS II and SOFA at ICU admission. The SVV patients required renal replacement techniques, blood products transfusion and immunosuppressive treatment more often. SVV patients had higher ICU mortality (60.9% vs. 35.3%, p = .04), however after discharge from ICU, in long term follow-up (1 year and 5 years) mortality was similar in both studied groups. ConclusionsAmong systemic autoimmune diseases small vessel vasculitides appear to be associated with the highest ICU mortality, higher requirement for advanced procedures and aggressive immunosuppressive therapy.

Improving allergy office scheduling increases patient follow up and reduces asthma readmission after pediatric asthma hospitalization

BackgroundPediatric asthma is a major contributor to emergency room utilization and hospital readmission rates. ObjectiveTo develop an allergy department‒based intervention to improve follow-up appointment scheduling processes for pediatric asthma patients after discharge for asthma exacerbation. MethodsThis quality improvement study was conducted in the allergy clinic of an urban, tertiary children's hospital. Children receiving subspecialty allergy care for asthma were included into the intervention group during the intervention period. The quality improvement intervention consisted of 3 attempts by telephone to reach the family to schedule the follow-up appointment. If this was unsuccessful or if the appointment was not kept, then a reminder letter was sent to the family. The primary outcome of interest in this study was the percent of postdischarge follow-up appointments scheduled within 30 days of discharge. Secondary outcomes measured were the percent of allergy appointments attended within 30 days of discharge and the 30-day hospital readmission rate. ResultsDemographics did not differ significantly between the intervention and baseline preintervention year. The initial baseline scheduled allergy follow-up visit rate was 48.8 ± 13.3% of patients discharged per month. This increased to an overall rate of 75.7 ± 20.1% patients scheduling allergy follow-up within 30 days of discharge during the intervention year. We also observed a significant increase in attended allergy visits 30 days postdischarge from 35.5 ± 15.6% in year 1 to 53.9 ± 25.5% during the intervention year and a significant decrease in the 30-day readmission rate on the allergy service. ConclusionThese data suggests that minor changes in allergy practice organization can significantly affect posthospitalization follow-up rates and decrease asthma readmission rates.

The assessment of mental health status in adults with persistent allergic rhinitis by Kessler10 scale

Objective To investigate the mental health status of adult patients with persistent allergic rhinitis. Methods From November 2016 to April 2017, 86 cases of adult patients with persistent allergic rhinitis who were admitted to the department of otorhinolaryngology head and neck surgery outpatient allergy center of our hospital were selected as the study subjects.The subjects were analyzed by Kessler10 scale and homemade general information questionnaire. Results The score of K10 in 41 patients was between 10 to 15 scores and 24 patients with K10 scores between 16 to 21, 18 patients with K10 scores between 22 to 29 points, and 3 patients with K10 scores between 30 to 50 points. Conclusions 24.4% of adults with persistent allergic rhinitis have poor mental health.The degree of education and marital status have influence on the mental health of adult patients with persistent allergic rhinitis.Clinical medical personnel should take specific psychological intervention measures for different individuals on the basis of understanding patients' mental health status. Key words: Allergic rhinitis; Mental health; Kessler10

Evaluation of high resolution computed tomography findings of cystic fibrosis.

Background/AimsMorphological changes due to lung disease in patients with cystic fibrosis (CF) were evaluated using high resolution computed tomography (HRCT), and the HRCT scores obtained using the Bhalla scoring system were correlated with those obtained using clinical and laboratory indicators.MethodsMedical records of 28 children with CF who underwent chest CT in Department of Pediatric Allergy and Immunology, Cukurova University Balcali Hospital between March 2011 and January 2016 were retrospectively reviewed. Demographic data and physical examination, respiratory cultures, pulmonary function tests, and chest HRCT findings were evaluated. Patients were divided into the following two groups according to their forced expiratory volume in the first second (FEV1) values: normal FEV1 (≥ 80% of predicted values) and low FEV1 (< 80% of predicted values). Deep throat or sputum cultures were evaluated for the presence of Pseudomonas aeruginosa (PsA) and other bacteria. HRCT scans were scored using the Bhalla scoring system.ResultsNo significant correlation was found between the Bhalla scores and sex, age group, or height percentiles. Significant relationships were found between the Bhalla score and weight (p = 0.036) and body mass index (BMI) (p = 0.032) percentiles below the third percentile, bacterial growth in the sputum/ deep throat cultures (p = 0.009), and presence of PsA (p = 0.004). Moreover, a significant correlation was found between the Bhalla score and FEV1 (r = −0.315, p = 0.0272), forced vital capacity (FVC; r = −0.381, p = 0.0178), forced expiratory flow between 25% and 75% of FVC (r = −0.229, p = 0.0431), and BMI (r = −3.368, p = 0.050).ConclusionsChest HRCT is an important diagnostic tool for the pulmonary evaluation of children with CF.

Eficacia a largo plazo del omalizumab en pacientes con queratoconjuntivitis vernal resistente a tratamiento convencional

Background: In vernal keratoconjunctivitis, traditional treatments are sometimes insufficient for symptom control; the results with omalizumab are promising in resistant cases. Case report: 15-year-old female adolescent with vernal keratoconjunctivitis who had received multiple ophthalmic treatments, immunotherapy and systemic steroids with no clinical response. She attended a clinical immunology and allergy department where she was started on omalizumab 225 mg every 2 weeks. After 6 months, she showed a decrease in pruritus and photophobia; two years later, both papillae and Horner- Trantas dots had disappeared. She remained symptom-free, and the use of ophthalmic drugs was therefore reduced. The patient missed omalizumab application on 4 occasions; however, symptoms recurred, and the papillae reappeared, but remitted upon drug re-initiation. Conclusion: There is a temporal relationship between omalizumab administration and ocular symptom control, with evidence of relapse upon discontinuation.

Long-term efficacy of omalizumab in patients with conventional treatment-resistant vernal keratoconjunctivitis

In vernal keratoconjunctivitis, traditional treatments are sometimes insufficient for symptom control; the results with omalizumab are promising in resistant cases. 15-year-old female adolescent with vernal keratoconjunctivitis who had received multiple ophthalmic treatments, immunotherapy and systemic steroids with no clinical response. She attended a clinical immunology and allergy department where she was started on omalizumab 225 mg every 2 weeks. After 6 months, she showed a decrease in pruritus and photophobia; two years later, both papillae and Horner-Trantas dots had disappeared. She remained symptom-free, and the use of ophthalmic drugs was therefore reduced. The patient missed omalizumab application on 4 occasions; however, symptoms recurred, and the papillae reappeared, but remitted upon drug re-initiation. There is a temporal relationship between omalizumab administration and ocular symptom con-trol, with evidence of relapse upon discontinuation.

Alergológica 2015: A National Survey on Allergic Diseases in the Adult Spanish Population.

The frequency of allergic diseases is increasing worldwide, particularly in industrialized countries. From a clinical, management, and public heath perspective, it is important to determine the reasons for consulting an allergist, the distribution by frequency of allergic diseases, and how health care is provided. Objective: Alergológica 2015 was carried out to obtain information on clinical practice in allergy departments in Spain, and compare it with the previous study editions. The data cover the year 2014 and the first quarter of 2015. The target sample was 6000 patients seen at public and private centers throughout Spain. A total of 500 allergists were invited to participate. Data were collected on an electronic case report form. Data were compared with the Alergológica surveys for 1992 and 2005 to identify differences. The final study population comprised 2914 patients (mean age 33.6 [18.9] years, 58% women, 17% children), of whom 6.1% were foreign-born. The frequency distribution was as follows: rhinitis, 62%; asthma, 23.4%; drug allergy, 17.7%; urticaria/angioedema, 11.5%; food allergy, 10.4%; contact dermatitis, 4%; atopic dermatitis, 3%; insect venom allergy, 2%. A statistically significant increase was observed between data from 2005 and from 2015 with respect to the prevalence for allergic rhinitis, food allergy and drug hypersensitivity. An increase in the prevalence of a personal history of asthma, rhinitis, conjunctivitis, and eczema/atopic dermatitis were also observed. Besides, the number of relevant allergens in the same patient also increased. Most patients were referred from primary care, although a considerable percentage were referred by ENT specialists and dermatologists. Increasing trends were observed for allergic rhinitis, drug allergy, and food allergy, and a decreasing trend was observed for asthma. Findings for other diseases remained practically unchanged. Allergic patients are increasingly complex and present with a myriad of atopic manifestations.

Hand-biting Lesions in a Child — a Challenging Diagnosis

AbstractBackground:Self-induced skin lesions, especially in young children, can create confusion within pediatricians, dermatologists, or other medical care providers, leading to different diagnoses, unnecessary investigations, and delaying the correct therapeutic psychiatric evaluation.Case report:We report the case of a 4-year-old boy who was referred to Dermatology after being hospitalized in the Allergy Department for a chronic allergic contact dermatitis. He had been previously diagnosed with chronic hand dermatitis, atopic dermatitis, and psoriasis, and treated with no favorable outcome. Scaly erythematous plaques were noticed on the dorsal aspects of both hands and on the lateral folds of the fingers. The skin lesions were distributed in a non-symmetrical way. A diagnosis of self-injurious behavior was presumed, and psychiatric evaluation was asked. The child was transferred to the Psychiatry Department, and a diagnosis of schizophrenia was concluded.

Providing Palliative Care in the Medical ICU: A Qualitative Study of MICU Physicians' Beliefs and Practices.

With the current and projected shortage of palliative care (PC) specialists, an integrative model of PC will be needed to meet the needs of patients in intensive care units (ICUs). Prior studies of PC interventions suggest that success depends upon meeting the needs of individual institutions or ICUs. The objective of this study was to qualitatively explore the beliefs and practices of one institution's medical ICU (MICU) physicians in regard to providing an integrative model of PC. This qualitative study used semistructured interviews of 17 physicians within a Department of Allergy, Pulmonary, and Critical Care Medicine at one large academic hospital. Interviews were conducted, transcribed, and coded according to qualitative research methods. Selected interviews were tested for interrater reliability and negotiated agreeability. All critical care physicians interviewed affirmed that providing PC was part of their job, and the majority expressed that providing PC gave them professional or personal satisfaction. Physicians also identified many ways that PC consultants enhance patient care in the MICU. They discussed several motivations for obtaining a PC consult, with the most frequently acknowledged motivation being lack of time. Developing an integrative model of PC in the ICU ought to take into account both studied interventions shown likely to be effective in the ICU setting and the specific needs and barriers to PC in that unit. This study demonstrates one way that needs and barriers can be identified and provides important findings that might be applicable to other institutions.