Physicians In Respiratory Medicine Research Articles

Reflection on Improving the Efficiency of Standardized Training for Resident Physicians in Respiratory Medicine

Significant achievements have been made in the standardized training of resident physicians in China, but currently, there are still problems with weak teaching staff, rigid teaching methods, monotonous teaching content, and one-sided assessment indicators in the standardized training of resident physicians in respiratory medicine. The quality of standardized training for resident respiratory physicians can be improved through optimizing the teaching staff, applying new teaching methods to cultivate students' clinical, scientific research, and humanistic comprehensive qualities.

General Safety Guidelines for Ear, Nose and Throat (ENT) Practice in COVID-19 Era

The Coronavirus Disease 2019 (COVID 19) originated in Wuhan, China and has increased rapidly globally, making it a global pandemic. It is proven to spread via respiratory droplets of positive patients. As we are not aware of the COVID 19 status of all patients coming to the OutPatient Department (OPD), it is advisable to consider every patient as COVID 19 positive and take the essential precautions to avoid infection. All health care workers, especially otorhinolaryngologists, respiratory medicine physicians, and general medicine physicians, are more exposed to the virus daily, as they work closely with COVID 19 positive patients while treating them. Otorhinolaryngologists deal with patients' nasal and oral cavities daily, making them one of the most exposed categories of health-care workers. Thus, it is extremely important to remain vigilant when examining patients in OPD wards and performing surgeries in the operating room. Hence, proper knowledge is required of the healthcare system's guidelines in each country to prevent the spread of the infection in the medical and paramedical workers. As the disease is spreading rapidly and changing constantly, these recommendations and guidelines may change as the scenario changes. It is of utmost importance to remain up to date with the upcoming guidelines for our healthcare workers' safety.
 This article aims to provide an overview of guidelines for the safe practice of ENT that we follow in our tertiary care center, thus minimizing our exposure to COVID-19.

Management of vasculitis in pregnancy

Vasculitis in pregnancy is a rare disease-modifying effect on autoimmune connective tissue diseases such as vasculitis and that connective tissue disease can have an adverse effect on pregnancy. It is essential that pregnant women with vasculitis are managed to the highest standards of care in order to prevent negative outcomes not only for the mother but also for the child. Vasculitis in pregnancy is probably underdiagnosed and under-reported; cases of vasculitis are rare and so disease flares may not always be recognized by a general clinician. Preconceptual counseling is critical, and assessment of disease activity, major organ involvement, and risk factors, such as hypertension and renal impairment, will help to guide both the woman and her clinicians as to the risks entailed in embarking on a pregnancy. Such patients are best catered for in multidisciplinary settings where there is access to specialized care from nephrologists, rheumatologists and respiratory medicine physicians, as well as obstetricians and pediatricians skilled in caring for complex pregnancies. This article aims to provide an approach to managing these patients with the best current evidence-based practice.

Delay in the Provision of Medication by a Pharmacy Outside the Respiratory Outpatient Department.

Respiratory medicine physicians prescribe many different kinds of medications depending on patient's condition. To examine an outside pharmacy's ability to meet the demand of our respiratory prescription services, we developed a questionnaire for all the patients who came to our outpatient department from November 1, 2015 to January 31, 2016. A total of 298 of 330 patients answered the questionnaire. Overall, 169 patients mainly went to the pharmacy near our hospital, whereas 64 patients mainly went to another pharmacy. Specifically, 23 of 219 patients who answered the question "When you went to the pharmacy with prescription, have you ever been not immediately given medication?", were not immediately given medication by the pharmacy. The results show that the other pharmacy significantly delayed medication compared with the one near our hospital. Interestingly, there were many types of inhaler cases that were out of stock in both pharmacies. Also, we found that 9 of 11 patients who were not provided medication on the spot acquired the medication within 1 or 2 d. Further, 10 of 20 patients who were not provided medication on the spot were only able to obtain the medication once. We did not observe any changes in patients' physical condition due to the delay in medication.

Frequency and risk factors of COPD exacerbations and hospitalizations: a nationwide study in Greece (Greek Obstructive Lung Disease Epidemiology and health ecoNomics: GOLDEN study).

BackgroundCOPD exacerbations and hospitalizations have been associated with poor prognosis for the COPD patient.ObjectiveTo evaluate the frequency and risk factors of COPD exacerbations, hospitalizations, and admissions to intensive care units (ICUs) in Greece by a nationwide cross-sectional study.Materials and methodsA nationwide observational, multicenter, cross-sectional study was conducted in the clinical practice setting of respiratory medicine physicians over a 6 month-period (October 2010 to March 2011). A total of 6,125 COPD patients were recruited by 199 respiratory physicians.ResultsParticipants had a median age of 68.0 years, 71.3% were males, and 71.8% suffered from comorbidities. The median disease duration was 10.0 years. Of the patients, 45.3% were classified as having GOLD (Global initiative for chronic Obstructive Lung Disease) stage III or IV COPD. Patients with four or more comorbidities had 78.5% and threefold-higher than expected number of exacerbations and hospitalizations, respectively, as well as fivefold-higher risk of admission to the ICU compared to those with no comorbidities. Obese patients had 6.2% fewer expected exacerbations compared to those with a normal body mass index. Patients with GOLD stage IV had 74.5% and fivefold-higher expected number of exacerbations and hospitalizations, respectively, and nearly threefold-higher risk of admission to the ICU compared to stage I patients. An additional risk factor for exacerbations and hospitalizations was low compliance with treatment: 45% of patients reported forgetting to take their medication, and 81% reported a preference for a treatment with a lower dosing frequency.ConclusionComorbidities, disease severity, and compliance with treatment were identified as the most notable risk factors for exacerbations, hospitalizations, and ICU admissions. The results point to the need for a multifactorial approach for the COPD patient and for the development of strategies that can increase patient compliance with treatment.

Sex discrepancies in COPD patients and burden of the disease in females: a nationwide study in Greece (Greek Obstructive Lung Disease Epidemiology and health ecoNomics: GOLDEN study)

BackgroundThe prevalence of chronic obstructive pulmonary disease (COPD) in females appears to be increasing. Recent studies have revealed that the percentage of women with COPD in Greece is approximately 12.5%.AimsTo evaluate the burden of COPD among males and females in Greece through a nationwide cross-sectional survey and to explore sex differences regarding functional characteristics and exacerbation frequency.MethodsData collection was completed in a 6-month period. The present study followed a nationwide sampling approach of respiratory medicine physicians. The sampling approach included three steps: 1) estimation of expected incidence and prevalence of COPD cases in each prefecture of Greece and in total; 2) estimation of expected incidence of COPD cases per physician in each prefecture; and 3) creation of a frame of three different sampling zones. Following this sampling, data were provided by 199 respiratory physicians.ResultsThe participating physicians provided data from 6,125 COPD patients. Female patients represented 28.7% of the study participants. Female COPD patients were, on average, 5 years younger than male COPD patients. Never smokers accounted for 9.4% within female patients, compared to 2.7% of males (P<0.001). Female patients were characterized by milder forms of the disease. Comorbidities were more prevalent in men, with the exception of gastroesophageal reflux (14.6% versus 17.1% for men and women, respectively, P=0.013). Female COPD patients had a higher expected number of outpatient visits per year (by 8.9%) than males (P<0.001), although hospital admissions did not differ significantly between sexes (P=0.116). Females had fewer absences from work due to COPD per year, by 19.0% (P<0.001), compared to males.ConclusionThe differences observed between male and female COPD patients provide valuable information which could aid the prevention and management of COPD in Greece.

P249 Physicians' opinion: ceilings of therapy in chronic obstructive pulmonary disease (PILOT study)

IntroductionAcute exacerbations of chronic obstructive pulmonary disease (COPD) are a common reason for hospital admission. Treatment depends upon the severity of presentation and background physiological status. The COPD NICE guidelines...

Sleep apnoea – where are the physicians in respiratory medicine?

The Clinical Respiratory JournalVolume 2, Issue 4 p. 196-196 Sleep apnoea – where are the physicians in respiratory medicine? K. A. Franklin, K. A. Franklin Department of Respiratory Medicine, University Hospital, SE-901 85 Umeå, SwedenSearch for more papers by this author K. A. Franklin, K. A. Franklin Department of Respiratory Medicine, University Hospital, SE-901 85 Umeå, SwedenSearch for more papers by this author First published: 03 September 2008 https://doi.org/10.1111/j.1752-699X.2008.00099.x Karl A. Franklin, MD, PhD, Department of Respiratory Medicine, University Hospital, SE-901 85 Umeå, SwedenTel: +46 70 6884745Fax: +46 90 773817email: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue4October 2008Pages 196-196 RelatedInformation

Assessment and provision of home nebulizers for chronic obstructive pulmonary disease (COPD) in the Yorkshire region of the U.K.

A survey was undertaken to determine the current practice in the Yorkshire Health Region for the assessment and provision of home nebulizers for adults with chronic obstructive pulmonary disease (COPD). A detailed postal questionnaire on assessment methods was sent to each of the 22 consultant physicians in respiratory medicine. The 17 consultants who also organized the adult home nebulizer service for their health district were asked about the services offered and funding for the service. Replies were received from all consultants. All physicians use objective measurement for assessing patients for home nebulizer therapy, but there is a variable emphasis on laboratory studies, walking distance and home trials with peak flow measurements. The majority (86%) incorporate a home trial into their assessment. Many physicians also take into account subjective response to nebulized bronchodilators. There is considerable variation in the provision and funding of home nebulizer services. Those districts with a coordinated service appear to offer a more comprehensive service. A consensus on nebulizer provision, with recommendations for minimum levels of provision in each health district, should result in a more uniform delivery of service.

Controlled Utilization of Induced Sputum Analysis in the Diagnosis of Pneumocystis carinii Pneumonia

We investigated the outcome and potential cost savings of a system designed to limit physician access to induced sputum analysis (ISA) for the diagnosis of Pneumocystis carinii pneumonia (PCP). Four respiratory medicine physicians screened all requests for ISA to determine the pretest likelihood of PCP. Twenty-two of 102 requests for ISA over a 1-year period were denied due to a low clinical suspicion for PCP. Seven individuals had a definitive alternative diagnosis confirmed and the remaining 15 were empirically treated for a presumptive diagnosis. All individuals were followed for at least 60 days or until death. None of the 22 individuals developed PCP during the follow-up period. We estimate that this approach saved $27,474, avoided exposure of health care workers to Mycobacterium tuberculosis, and was educational for the referring physicians.