Tony Kajnar

Mr. Tony Kajnar is a senior therapist at the Sault Area Hospital.  His work experience extends from diagnostic testing to the anesthesia assistant (AA) role.  Beyond his main responsibilities at work, he has assisted with the expansion of the AA role at his hospital, co-chairs the Canadian Pulmonary Function Testing Symposium, leads the Pulmonary Diagnostic Committee with Respiratory Therapy Society of Ontario (RTSO), and assists RTs and PFT labs with adhering to the latest and best guidelines.  Tony and I crossed paths as we both actively look for clarity in the pulmonary diagnostic field.  His extensive knowledge, drive to improve the filed, and willingness to help others has positioned him to be a mentor to many including RTs.   He was kind enough to take time out of his busy schedule to answer my questions.

 

To begin, let me ask two of my favourite questions to ask RTs: When did you first hear about the respiratory therapy field? What made you decide to become an RT?

After my first years of college I realized I did not enjoy my choices and attempted to reevaluate my career options, I ultimately completed aptitude and interest testing to get career ideas.  I took a Myers-Briggs test and completed a book entitled “What Color is your Parachute”, these lead to several healthcare career suggestions.

At the top of the list was Respiratory Therapy, which I had never heard of.  I came up with a list of questions and contacted my local hospital RT department who were kind enough to provide a tour and answered my questions.  I was impressed with the freedom and variety that their daily role provided and then began working toward enrolment.

 

 

Since  graduating from the RT program you have had various roles, what are some of your memorable roles so far?

Like so many, I began as a staff therapist in a hospital.  The market was quite competitive so I worked part time for nine years.  I had obtained my CPR, ACLS and PALS instructor’s certificates and enjoyed providing continuing education as my schedule allowed.  During my instructor work I got involved with simulation education and simulation teaching, which I am pleased to see in concurrent education these days.

Over these years I also worked part time in my hospital’s pulmonary function lab.  When I first started it was a requirement to obtain certification as a cardiopulmonary technologist and so obtained my CACPT(P).  I certainly enjoy diagnostics

The most challenging role to date was as an anesthesia assistant.

 

 

 

What made you decide to study and pursue AA?

Previous exposure to OR/anesthesia rotations in the RT program and our staff anesthesia department were quite positive for me.  Our hospital was part of the MOHLTC pilot into anesthesia care teams, our site was designated for an intra-op RRT/AA component and a post-op pain management with an RNEC.  This pilot was externally funded for two years but has since become part of our hospital program.

 

 

How has your experience working as an AA been? What are some areas of satisfaction and challenges working as an AA?

This role forever changed my perspective and bolstered my interest in health care.  The role was a great opportunity with so many difficult challenges to navigate.  A mantra from the Michener’s AA programs was “you don’t know what you don’t know” and that truly was reflected in the things that we were exposed to.  The more you learn the greater the engagement.

Our hospital did not have an RT role in the OR prior to the AA pilot, this created a very challenging environment in addition to the significant time investment in completing the basic and advanced AA programs.  Travelling to the Michener for our practicums and the late hours completing weekly assignments were both difficult and awesome. 

 

 

Any comments or advice for RTs who may want to consider becoming an AA?

This is an excellent opportunity for anyone truly interested in a role related to anesthesia.  There is a lot of competition and the path is extremely challenging.  Exposure to this role could help provide a better idea if the commitment is the right fit for you.  The role will vary from site to site which may influence your decision, so it is best to learn what you can from those practicing in your area.

 

 

How has the field changed over the years and has it been due to change in technology/equipment? Pharmacology? Protocols/practices? How do you see the role of an AA and the field of AA in the future?

My AA involvement was during phase one of the MOHLTC’s anesthesia care team model.   This initiative involved the CAS, their engagement and support is extremely important.  An RRT background may provide an edge for the clinical components of the AA profession but my greatest learning challenges were with the pharmacology and physiology involved with the anesthesia role. 

Anesthesia offers a departure from the acute care RRT role.  I was surprised to learn how the AA role was present for many years in Toronto, this was highlighted by the great faculty of the Michener Institute’s AA programs.  Some of my classmates were Quebec-trained RRT’s and I was impressed to learn how much the Quebec RRT program’s entry to practice competencies focus on anesthesia, not acute care.

The AA role is young and will no doubt change in ways that we cannot foresee.  It is important that we continue to have RT involvement in this exciting role.

 

 

How did you get involved with working and managing a PFT lab?

Have always had exposure to the PFT lab through the different hospital postings I have held.  It was a role I rotated through initially then had more permanent assignment in.  This eventually led to my current senior role in our hospital based PFT lab.

It is a great blend between technology, instrumentation and patient care for me.  There are plenty of opportunities for direct patient feedback, which is a great source of satisfaction.

 

 

Any comments or advice for those who may want to work in a PFT lab?

Our entry to practice competencies provides an introduction to pulmonary diagnostics but there is a lot consider with providing a formal diagnosis of lung disease and how our findings support treatment.  The ATS, ERS, CPSO and CTS practice and quality assurance guidelines are a good place to start in understanding the technical requirements related to this area of practice.  Understand the contraindications to testing you are involved with and actively screen for them prior to testing.  The quality based procedures and certified educator roles are also important to review and understand as they apply to the continuum of care.

Knowledge and understanding of the published practice guidelines is also important.  As standards change we need to be aware how this affects both diagnosis and treatment for lung disease.

 

 

How can the field of PFT improve to better serve the population?

There are many quality assurance standards to consider with lung function testing which are essential in categorization of lung disease and treatment.  We can all appreciate that objective lung testing is required to establish lung disease but only 50% of asthmatics and even less COPD patients have had such testing.  We must appreciate that there is a care gap; we need to support more accurate diagnosis and follow up to guide appropriate treatment in any lung condition.  Many patients being treated for lung disease have not had appropriate lung function tests to confirm or rule out their diagnosis. 

 

 

For some RTs and HCPs working in the acute care settings, the only exposure they have to COPD and Asthma patients is during the exacerbations.  As someone who helps COPD and asthma patients during all stages of their disorder or disease, what advice you have to share with RTs?

We need to advocate for documenting accurate lung function, screening for post bronchodilator reversibility and ongoing follow-up testing in patients.  Many patients with COPD and Asthma are not optimized and follow-up testing or assessments may not be considered after symptoms have been controlled.  Testing can help support titration of their inhaled medications.   Careful review of treatment, effectiveness of treatment and accurate categorization is also important in an effort to prevent future exacerbations.  Many patients may not be aware of their diagnosis and some may not understand their treatment options and delivery devices.  There are many opportunities to help patients gain better control.

 

 

With a sudden burst of various puffers coming to the market over the last 3 years, what is important to keep in mind? How can RTs better assist their patients with their puffers?

The new treatment options require us to continually review and update our knowledge in order to maintain consistency for the patient.  The medications and their role in respiratory guidelines are part of our best practices.  Being familiar with these medications, their delivery devices, mechanisms of action, interactions and precautions is all part of our professional responsibility.

 

 

I am going to ask few questions about the leadership side of your career.   In Sault Area Hospital you have been involved in many projects which not only improved the quality of patient care, but also expanded the role of RTs and AAs.   How did you get involved with or initiate changes in your hospital?

Some experiences were the result of job postings; other initiatives came from interest or certifications I worked towards. 

Policy and procedure updates have always been a challenge for me.  Sometimes the need to change has been a result of ongoing best practice and clinical guideline updates.  Other times it was from staffing or operational changes that brought new duties or refined them.  Developing effective communication with administrators and clinical leaders to outline policy and training required to accomplish appropriate changes is an area where our profession could benefit from additional resources, groups and references. 

 

 

Any recommendations for those who want to initiate positive change in their work environment?

Get involved in areas you are passionate about, this makes the work you put into the role much more enjoyable.  There are many opportunities with your professional associations, get involved where you can as there is always need for our profession to support future growth with our ever-changing health care system.

 

 

You have been active in improving the quality and standards of diagnostic testing including PFT.  How did you get involved with the Canadian Pulmonary Function Symposium?   What have been your goals?   How could RTs benefit from this annual symposium?

Several clinical practice issues lead to a search for clinical resources in order to address them.  

I attended the Medgraphics Cardiorespiratory Diagnostics Seminar in 2014 and was shocked to learn that it has been offered every year since 1994.  

I got involved with the Canadian Pulmonary Function Symposium after it ran in 2015.  I attended and offered to get involved with my fellow co-chairs, Laura Seed and Murray Beaton.  The Canadian PFT symposium is intended to be a resource for any clinician interested in pulmonary diagnostics.  Speakers and topics reflect current topics in addition to reviewing best practices and quality assurance requirements for pulmonary diagnostics. 

This experience has provided opportunities to meet several individuals, researchers and manufacturers who have helped answer clinical questions and motivated my ongoing involvement in supporting pulmonary diagnostics advocacy.

 

 

On a path to clarify and improve guidelines and protocols, you have been active in asking questions, surveying practices across the country, and vocalizing important concerns that need attention.  In your opinion, what are some areas that need more attention?  What are some of the obstacles?  How can RTs get involved?

I believe communication and knowledge transfer is an obstacle for our profession given our relative numbers to other professional groups.  It is easy to get lost in our health care system. 

My hope is to have a supportive clinical practice network that includes respiratory therapists.  There are many clinical practice areas that would benefit from formal study and publication involving the RRT role across all practice settings.  Research is an area I hope to see more RRT’s getting involved in for benefit of patients, the profession and our health care system. 

 

 

Looking at the RT profession, what do you see as the next big growth area?

Don’t think I can accurately predict the next area of growth but I certainly hope that we will see the development of an advanced practice respiratory practitioner, similar to the nurse practitioner role.  Such a role could support patients with lung disease in ways that go beyond our current authorized acts.  This role could also support our profession through advocacy and research as well as providing a goal for other colleagues to work toward.

 

 

As we get close to the end of this interview, do you have any final words or comments for the readers?

Certainly hope to see more RT’s get involved in promoting health care, advocating health care reform and research.  Hope to see RT’s support others for the benefit of patient care and best practices.

 

 

Thank you, Tony, for taking the time to answer my questions.  Also, thank you for your ongoing contributions in the respiratory therapy field!

 

If you would like more information about the upcoming PFT Symposium check out http://www.cacpt.ca/PFT-Symposium-2018-Details.pdf  .  This year’s event is taking place in Calgary, AB, from September 21st to 22nd (2018).

[End]

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International Women’s Day

My blog would not be where it is today without the contributions of great RTs out there. Check out these blog posts profiling some of the amazing women in our industry!


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RT Social

I began my respiratory therapy program as a mature student, after few years of working after completing my undergraduate studies. It took me a full month to get my brain back to the speed at which it was absorbing information during my undergrad years. The RT program was intense but was made possible due to my amazing classmates. The challenges brought us closer and created quality friendships. As we got jobs with various schedules, finding a time to meet up became challenging. It would take our group around a month and half to organize a meet up. Maintaining friendship is as important as making new friendships. To support the RT community, to bringing RTs closer, meet new friends, and to nurture the existing friendships, I will begin to organize social events in Toronto for Greater Toronto Area (GTA) RTs. The first social event is happening on March 10th from 8 pm to 2 am at Jack Astor’s located and Yonge and Bloor. Check out the details of this event in Facebook. Join. Share the word and event. https://www.facebook.com/events/322816551562100/

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Christina Dolgowicz

I always enjoy attending Canadian Society of Respiratory Therapists (CSRT) conferences, as there are variety of speakers, topics and streams. In May 2107 at the CSRT Conference in Halifax, I attended a talk, titled ‘Creating a Regionalized Lung Health Program’, by Christina Dolgowicz and Michelle Maynard. While I enjoyed the talk, I was more blown away by the dedication and hard work of the speakers.

As I slowly become more involved with the RT community, read articles and speak to healthcare providers, I hear more about Christina’s work. Some of her current and past roles include Chair of Champlain LHIN Lung Health Network, Lung Health Coordinator, Certified Respiratory Educator, RRT at The Ottawa Hospital, member at Quality Ontario and many other RT roles. Her contributions in the respiratory field vary from direct patient care and education, advisory to policy making, to establishing and promoting community-based pulmonary rehabilitation program.

Christina is highly respected among her colleagues and in the RT community, so I was delighted when she agreed to answer few questions about her journey, thoughts and views.

When did you first hear about the respiratory therapy field? What made you decide to become an RT?

I was completing my 3rd year of University and didn’t know what I wanted to do but knew I had to find a job when it was all done! I wanted also to come back to Eastern Ontario and thought I could go to school in Ottawa and started looking into college courses. My criteria for a program:

1. I wanted to go into healthcare

2. I didn’t want to be a nurse

So I looked into the courses that Algonquin College offered and it was between Respiratory Therapy and Diagnostic imaging… I met with the Anita Gallant (course coordinator at the time) to find out what being an RT was all about. To be honest, the only thing that stuck with me was: I got to wear scrubs and hold a pager – that sounded like being a doctor and looking like they do on the TV show ER – so I applied – and got in! It was during that first week that I found out what RTs do –like an ABG! (up until that point I did NOT do well with blood) so I almost dropped out… but thankfully I met some awesome classmates and stuck it out.

With various roles and years of experience, what are some of your memorable roles so far?

To be honest, I have been lucky to enjoy all of the roles I have worked thus far. I started originally at the Ottawa Hospital (2004) and despite working full time in the community now, I still work casual at the hospital. The hospital allows you to react quickly to critical situations and work as part of an interdisciplinary team – RNs, PTs, MDs and other RRTs. It’s professionally and personally rewarding – you get some great experience and make lifelong friends along the way.

Currently – my role as coordinator of the Lanark Renfrew Lung Health Program – is my most exciting role so far. I work with an awesome group of RRTs who are passionate about lung health in primary care (education, early screening, management, rehab) and their passion and wanting to make a change (and willing to say yes to opportunities that come our way) is what makes my job so much fun.

What is your passion that drives you each day working as an RT?

My passion is seeing the difference our program makes in peoples lives. In my current role, unfortunately I have less contact with clients, but I hear the stories through the rest of the team I work with. Occasionally I get to work out in the rehab program and it’s a humbling experience to see the daily struggles that people with chronic lung conditions live with. I also hear about frustrations from clients in regards to the lack of services that are available – and this also drives me to work harder in creating partnerships with other organizations to increase access to lung health services in primary care.

How did you get involved with promotion, initiations, implementations and operation of community lung health education and community-based pulmonary rehab programs?

I originally started working in primary care in 2006 at the North Lanark Community Health Centre and gained so much experience from my supervisor, Karen Jones. She worked very hard and advocated for RTs in primary care and she grew the program from 3 sites with 1 RRT to more than 10 sites and 4 RTs. With working at the hospital and in the community, I got a good sense of where I wanted to spend the majority of my career. I was frustrated at the hospitals with the amount of time it took to make a simple change – only because big tertiary centers are so large and changing policies/procedures takes a looonnnggg time. Making simples changes in primary care was much easier and there is such a need for RTs in primary care, so it was a perfect fit for me to remain working in primary care. Because of Karen’s guidance and mentorship and the success of the lung health program – I was able to continue her work and advocate for services that spread further than the sites we were currently working out of. I’m also someone who can’t sit still and need to continue to push forward for improving care for clients with lung disease. This may be a downfall, but I say yes to many opportunities that come our way because who knows what may come out of it!

What have been some of the challenges along the way?

Some of the challenges that are lack of funding and lack of communication amongst health care organizations. We are all working to improve the health care system experience, but sometimes it feels like we are all doing it alone. By working together, advocating for change, utilizing existing resources – it can really make a difference.

How can other leaders, communities, and health programs learn from your experience?

Just reach out! We are all working to continuously improve the client experience, ensure that we are meeting their needs and goals. By sharing our experiences together, we can share what we’ve learnt so far (and I will get some ideas from you as well!).

Can you share some thoughts about the role of community based pulmonary rehab programs?

A community pulmonary rehab program plays such an important role– it connects people and creates a peer support group, care can be provided close to home and out of hospitals/tertiary care centres. By keeping it in the community and out of hospital, it decreases participants risk of getting sick, participants can be connected to local programs to exercise with after the program is done, it saves the participant cost/time of travelling to a large organization and paying for parking and finally, because our staff work in the community – they may already be connected to many of the primary care providers who send us clients and it makes connecting and consulting that much easier. It is also less expensive to run a community program than a hospital program.

How can RTs be more involved with such initiatives (planning, decision making and operations)?

Look to your supervisors/managers and share your ideas with them! It always helps if those ideas i) align with the goals of where you work ii) improve the client experience iii) improves outcomes/quality of care and iv) saves the organization money! And don’t get discouraged – sometimes these things take time – but when the ideas come to life – it’s all worth it.

Any advice on how new RT’s can build up their leadership experience?

Get involved in your provincial and national associations – even if you’re fresh out of school! You can learn so much from RTs across Canada and you never know when those friendships produce an opportunity. I was on the CSRT Board of Directors in 2007 – 3 years after I graduated – and to this day I still meet up with the friends I made while I was on the board and that experience of serving on a national board really opened up my eyes as to how the profession worked.

Can you tell us a little bit about your experience working as Quality Standards Committee for COPD, part of Health Quality Ontario?

Health Quality Ontario – COPD Quality Standards Committee was a great opportunity for me. I was able to be a part of a provincial group, bringing together top players and lived-experience advisors to talk about COPD in primary care – something I am very passionate about! It was great to ‘dream big’ and produce quality standards of care that people should receive if they are diagnosed with COPD. They will be officially released in Spring/Summer of 2018 and it will be great to see how practices are changed based on these quality standards.

What is the next big growth area that you see for the RT profession?

I believe that the trend now is to have more RTs working in primary care. Traditionally we have been a tertiary care discipline – and the majority of our training is focused around working in critical care areas. We are seeing more and more RTs taking on a role of a case manager in primary care, managing chronic ventilated patients in the community, running rehab programs, delving into the management of cardiac conditions – it is so exciting! Primary care wants RTs to work with them. Not once have I heard a primary care team say: we don’t need an RT. They are calling asking: can you send us an RT? J I encourage RTs who are interested in working in the community to take the certified respiratory educator course and look for opportunities in primary care. It may start as spirometry screening and grow into a pulmonary rehab program – you never know!

How can RTs be more involved with decision making and planning in the hospitals, communities and ministry levels?

As mentioned above, start by getting involved with your professional associations (many of them are working at the ministry level), local lung association or find a task force/working group or committee at your hospital to get involved with. Maybe there isn’t one? If you have an idea and some support – create one!

Any advice on how RTs can expand their framework to support each other in a uniform and national way?

Join your professional and national association! Your regulatory college is there to protect the public – your professional associations are there to promote RTs and work for you! The worst thing I hear is people complaining about their lack of pay, their lack of respect amongst other health care providers, the lack of change in their job – want something to change? Get involved! There are some amazing, engaged RTs in Canada who are facing the same struggles that you may be facing – and by working together, we can make a difference.

Thank you Christina for allowing me to share your perspective and views with others. Also, thanks for your great contributions to the field of Respiratory Therapy!
Farzad ‘Raffi’ Refahi

Feb 01, 2018

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2017 Highlights

Thank you for your ongoing support of Respiratory Therapy by Farzad (Respiratory Blog).   The intent for this blog has been to support the RT community, to assist in its growth, to celebrate the influential individuals, to share advice and perspective of experts,  and to share my own personal journey in this field.  I feel honoured that many individuals have allowed me to share their perspective.  While there are many posts, I would like to highlight some of the popular ones from this year (2017).


March   Advice from a personal Trainer for HCP -Keerthanan Kugathasan

April  Advice from a Nutritionist for HCP

May  Advice from a Chiropodist for HCP -Piyush Jadav

July   Influential people: Dr. Mika Nonoyama

August   Thank You Christiane 
and  The  Journey Back to Acute Care -Viral Patel 

September   PFT Symposium 2017

October  Working as an RT- Mieke Fraser
and          CPAP Gentleman – Andrew Wroblewski

November   COPD- Sheery Tso

December   Eric Cheng and RTWB

 

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Eric Cheng and Respiratory Therapists Without Borders

Respiratory Therapists Without Borders (RTWB) is a volunteer organization with the mission to “improve respiratory health through educational advancement of local healthcare providers worldwide” (RTWB.ca). This global organization is co-founded by Mr. Eric Cheng.  RTWB works with Healthcare Education Partners (HEPs) around the world (RTWB Prezi).  He accepted my invitation to talk and to answer few questions.


Google Maps:  http://goo.gl/LTHHO

Can you tell us a little bit about yourself?  How did you hear about the respiratory field and what made you decide to become an RT?

Growing up, I never thought I would do anything in the medical field. Born to a family of engineers, no one could stand the sight of blood – literally. My father and grandfather would faint at the sight of blood. But as a systems design engineering student, I had the privilege to do a co-op term at Princess Margaret Hospital (Ontario Cancer Institute) where I was exposed to animal models to verify imaging hardware. I always had an interest to work directly with people. So naturally after a failed academic term in engineering made the transition to respiratory therapy and kinesiology.

 

Outside of work, what do you enjoy to do?

I love my family. We can be found roaming around Port Moody in Beautiful British Columbia where we live, work and play. We do everything from stalking garbage trucks to exploring local trails or just hanging out. There is no shortage of world-class mountain biking trails to explore here too.

 

What were some aspects about yourself that you had to improve to  become a better RT/leader/ an RTWB-Contributor and Co-founder?

Interesting question, I’ve never really been a fan of the leadership title. I’ve been trained that “patient care in a privilege”. As such, we are to stand in the gap as patient advocates. The lives of my patients and people that we service through RTWB has taught me to be a more passionate/strategic advocate for patients – not just in resource limited settings, but also in our current healthcare system. I’m continuing to learn daily how to navigate various healthcare systems in order to improve the quality of care available.

 

Where do you see the future of the Respiratory Therapy field?

Great question! I believe that the future of healthcare will be led by those in the developing world. Developed world healthcare systems are often not as dynamic and flexible to the ever changing demands of our world. With technological advances, collecting data for best clinical practises is increasingly becoming easier and more accurate. Along with this will be challenge to stay current. Clinical teams need to be agile and quick to adopt practises/workflows at an ever increasing pace. The lack of structure and unfathomable demands of healthcare systems in the developing world make them highly adaptive ready to embrace emerging technologies to excel leaps and bounds. An example from the telecommunications sector: villagers who have never seen motorized transport or used a landline, are adept users of smartphones now readily available globally. Healthcare providers are now able to get latest research at their fingertips.

 

What is the story behind the birth of RTWB?

I wanted to volunteer on a medical mission of some sort. Medcines Sans Frontiers (Doctors without borders) at that time listed respiratory therapist as people not to contact for volunteer opportunities. This pained me along with Annette Lievaart (RRT in Edmonton), Clement Hui (SRT in Toronto) and Pauley Ting (Engineering classmate of mine). Together we met on Skype for the first time in 2010. We still have yet to all meet in person; but we have done board meetings in 3 different continents in 4 different time zones. With our mission of ‘improving respiratory health through educational advancement of local healthcare providers worldwide’ solidified, we’ve kept an open invitation to anyone and everyone interested in joining our cause to be empowered. Our team includes everyone from student and seasoned respiratory therapists to accountants/engineers/business professionals to vacationers who want to transport goods for us. We are a completely volunteer run organization with a clear vision and open door to anyone/everyone interested in improving respiratory care worldwide.

 

What is a typical day for you (as a leader at RTWB)?

As a completely volunteer run organization, everyone puts in whatever they can with spare moments. It is a charity for all respiratory therapists. We believe that every respiratory therapist has something to offer and my job is to facilitate opportunities for respiratory therapists to give back using our expert skills, knowledge and judgement. Getting back to your question, we have an excellent team of talented volunteer professionals making work light and fun.

 

Do does your organization find remote hospitals to help, or hospitals/clinics approach you/your organization?

Both, we’ve approached places and others have come to us. All healthcare education partners (HEPs) must be reputable healthcare establishments with a documented respiratory education gap. Some of our volunteers have signed on HEPs while on vacation and others have found us on the internet.

 

What are some of the current projects that RTWB is working on?

A list of deployment opportunities is available at www.rtwb.ca -> Get Involved -> Get Deployed or Volunteer Postings. If there isn’t anything that suits your strengths/passions within the organization, please feel free to write your own job description for something you are passionate about that “improves respiratory health through educational advancement of local healthcare providers worldwide.” It is my firm belief that each respiratory therapist has a unique way to contribute and I invite you to dream with us about how you can use your skills/passions to get involved in OUR charity.

 

What are your main obstacles (i.e. financial? RT volunteers? Supplies? International relations? Etc.)?

At this point, our biggest need to RT volunteers to be deployed. We have no shortage of sites eager to have an RT on the ground.

 

Where do you see the future of RTWB?

Wayne Gretzky once said, ‘you miss 100% of the shots you don’t take.’ Our vision is to see the respiratory profession synonymous with ‘giving back’. Within the Canadian healthcare system, RTs follow orders, I believe that RTs need to recognize the value of our collaborative voice at the interprofessional table and start taking more shots – especially in the charitable world. Our future is bright, but we are in desperate need of a generation of sharp shooters that will bring us to the next level of our game. RTs are the underdogs of the healthcare system and we don’t give up easily, we hope to be ever accelerating our global contributions to respiratory health whether it be in research or education.

 

E.g. of cool projects

  • Bubble biphasic – concept pitched by RTWB to team of engineers who have developed a product that attaches onto existing bubble CPAP systems to provide the next level of respiratory support with nothing more than an adaptor on already familiar equipment. Currently undergoing clinical safety trials
  • One of our volunteers has 2 young children and can’t travel, so she does skype in-services to a room full of ER docs periodically to help start using a retired home BIPAP in the ER… Results? COPD ICU admissions are reduced by 86%!!! https://drive.google.com/file/d/0B1xpscMQ_Xb1b1d5bW1NR1gyMFk/view

 

What are the ways RTs can get involved with RTWB? 

www.rtwb.ca -> Get Involved

 

What is the process for an RT who is interested to travel abroad to volunteer at a remote hospital?

www.rtwb.ca -> Get Involved -> Get Deployed

 

Can you give us an example of how it feels to volunteer at hospital abroad? What are some of the sources of satisfaction/challenges?

www.rtwb.ca -> Get Involved -> Share your story

https://drive.google.com/drive/folders/0B1xpscMQ_Xb1MmpOUWZFcmNYbmc

 

What are the ways companies/organizations can be involved with or give to RTWB?

www.rtwb.ca -> “DONATE”

Time, money, resources or whatever other creative idea you have. Pitch your ideas to ideas@rtwb.ca. We are eager to hear from you!

 

Any final words?

With the ease of global travel and communication, the RT practise is a global one. We need to have a global consideration in our practise. This includes learning from what our healthcare colleagues are doing in developing world contexts where clinical skills and education are pushed to their limits and beyond. I encourage everyone to explore how you can be involved. Thanks Farzad for these thought provoking questions. Thank you (the reader) for tuning in so far, if you have, I encourage you to get involved with RTWB where we hope to empower you to take your best shot at improving respiratory health.

Thank you Eric for taking the time to answer my questions, and to share your perspective and experience with us!

To learn more about Eric and RTWB, you visit his LinkedIn profile and RTWB’s website at:

https://www.linkedin.com/in/ericocheng/

www.rtwb.ca

Farzad ‘Raffi’ Refahi

Reference:

-RTWB Overview: https://drive.google.com/file/d/0B1xpscMQ_Xb1ZHBDRmNaeEhHMFk/view

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COPD Day 2017

November 15th is the World Chronic Obstructive Lung Disease (COPD) Day.  Based on a study by World Health Organization (WHO) in 2015, COPD is responsible for “5% of all death globally that year” (WHO. Nov 2016).   When it comes to care for COPD patients, many names come to mind; One of these dedicated individuals is Mrs. Sheery Tse.

Sheery is an active RRT who works and volunteers with COPD patients at Markham-Stouffville Hospital and Scarborough and Rough Hospital (Birchmount site).

The first time I met Sheery was in May of 2017 at a social event for COPD patients, where she was facilitating it on her own time.  She is passionate about her work and is full of energy.  She is praised and respected by her patients and colleagues as she truly cares and advocates for her patients.  To get to know her better, I sent Sheery few questions:

  • When did you first hear about the respiratory therapy field? What made you decide to become an RT?  I heard about being an RT when I did some volunteering at HSC. There I ran into a high school mate who was working as a RT. After spending some time with her and the team, I decided to apply to Michener for the respiratory technology course as it was called many, many years ago.

 

  • What are some of your memorable jobs/roles so far?  In an acute setting I was always more interested in helping patients in the ER, providing care so they may breathe easier and giving a quick education of their puffer needs was very rewarding.
    Now I love doing education whether it’s in the COPD clinic or at a healthcare office, seeing the patients understand their airway disease and why certain puffers work and how is rewarding.

 

  • What are your career goals? (and do you feel that you have accomplished them?)  Given my age and how many years I’ve been in their field, I feel I have accomplished most of what I set out to do. Starting the COPD clinics in Markham and Scarborough from scratch has been very rewarding.
    There are still a few goals I would like to see happen, a support group with just patients input and more exercise sessions available would be the biggies. Patients self-management at home is another area I would to see happen too.

 

  • How did you get involved with patient education (with COPD patients)?When Dr. M. Forse first came up with the idea of having a clinic for COPD patients, it sounded like something I would enjoy. I applied and was chosen as the educator. Now came the challenge, getting certified as an educator and quite trained.

 

  • How does a typical day look like for you?
    Don’t think there is ever a truly typical day. It could be as simple as setting up for the clinic with patients charts and assessing the patients to triaging all new referrals, returning phone calls and emails from patients to meeting with pharma reps to hear what’s new, studies and of course being the nosy educator what’s on the pipeline for puffers. In between that I also need to triage patients into the exercise programs we have and call to see if they are willing to come in and for afternoons or evenings. Tuesday’sWednesday’s and Thursdays, I try to go to the exercise classes to provide some support and answer any question the participants may have. I’ve been called the “spy” as I do inform the respirologists if there are concerns about the participants, including possible flare up and low sats. Through these interactions we have been able to prevent patients from being seen in ER when the respirologists could fax a script for them, or as simple as asking if they started their on-hold meds. Low sats often, if they are with ProResp, I could get a RT to come assess on the track, other vendors, I ask the patients to contact their 02 providers and ask to be reassessed and the respirologist is informed.

 

  • What are some of the challenges and joys of working with COPD patients?
    Joys is seeing the patients in a follow up visit tell us how well they are doing, having the patients return from a trip they did not think they would be able to go on because of their airway disease, seeing how well they’re exercising. Challenges is trying to convince the patients they need to use their maintenance puffers regularly, and the same with those on 02. Most often, they are so used to being deconditioned and breathless, they’ve adapted to do without. Smokers are the biggest challenge, getting them to even think about quitting is often a huge step. Cutting back with each follow up is rewarding to hear, telling us they’ve actually quit is even more so.

 

  • Based on your experience, what are some of the common struggles for COPD patients, and how can RTs better assist these individuals?
    The most common struggle, is self-management and deconditioning. They’re breathless so often they feel they can’t do much. Try is one of my favourite word to use at the clinic and at exercise classes. Knowing if and when they need to be seen is a biggie too. They really are independent and don’t want to bother their healthcare team and often end up getting worse and needing to be admitted.   Providing tools for them to figure out if it’s a simple cold, a flare up or more is something all healthcare providers need to give so they may manage their disease better and hopefully not get to the point they become very ill.

 

  • What are your thoughts on the latest 2017 COPD Guidelines and New Medications in the market? *
    New guidelines are constantly changing, latest is to decrease use of ISC with COPD patients unless they have at least one exacerbation a year to decrease the chance of getting pneumonia. When we first started the COPD clinic we had short acting puffers (Ventolin, Atrovent) ICS(Flovent) combo (Advair, Symbicort) and a LAAC(Spiriva) that just came on the market. Now we have choices, we can provide patients with the puffers they need in a device that is easier for them to use so compliance increases. There may be more I the future, good for the patients, more challenging for healthcare providers as we will need to know them, how they work and how to use them to provide better support for patients.

 

  • Any advice or final thoughts to share with RTs?
    Final words, healthcare is an amazing profession, there are many different streams available, even for RTs from in hospital, to clinics, to home care. Patients safety and wellbeing should be the most important thought in our work. Giving patients respect, support and information should be on going.
    The best review in the COPD clinic is when the patient comes in, and asks for a hug, calls you by your name and remembers what you said and did for them. At the end of the day, my hours spent volunteering means they get the support they need. From a simple support I have been given so much more I return from them. It is very rewarding, even in sadness when they pass. We have family call to let us know how much they appreciate all the support we gave to their loved ones.

 

Thank you Sheery for your dedication and hard work!

*To the readers of this post, please continue to refer to the guidelines and medication pathways provided by the facilities/organization you work at.  The answers provided my Mrs. Tse is to provide perspective and is not to replace the protocols provided by your employer or RT governing body.

Here are some useful resources I came across:

-Canadian Thoracic Society.  https://cts.lung.ca/guidelines

Alpha-1 antitrypsin deficiency targeted testing and augmentation therapy (2012)
https://cts.lung.ca/sites/default/files/documents/cts/1.%20FINAL%20A1AT%20GUIDELINE%20APRIL%202012.pdf

-Managing dyspnea in patients with advanced chronic obstructive pulmonary disease  (2011)
https://cts.lung.ca/sites/default/files/documents/cts/1.%20CTS%20COPD%20Dyspnea%20Guideline%202011%20EN.pdf

-Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease (2010)
https://cts.lung.ca/sites/default/files/documents/cts/CTS_COPD_Guidelines_Pulmonary_Rehab.pdf

 

-The Lung Association. Various PDF documents to study, to print and to share.  https://www.lung.ca/lung-health/lung-disease/chronic-obstructive-pulmonary-disease-copd/resources

 

-RTSO- COPD. https://lungontario.ca/disease/copd/

-Global Initiative for Chronic Obstructive Lung Disease . https://cts.lung.ca/sites/default/files/documents/cts/1.%20CTS%20COPD%20Dyspnea%20Guideline%202011%20EN.pdf http://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf

 

Farzad ‘Raffi’ Refahi
Nov 15 2017

References:

-WHO. World Health Organization. COPD. Fact Sheet. November 2016.

http://www.who.int/mediacentre/factsheets/fs315/en/

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Working as an RT – Mieke Fraser

  To share the views of an experienced RT for Respiratory Therapy Week, I reached out to Ms. Mieke Fraser.  I first met Mieke when she was one of  the supervising instructors for  Ventilation Lab during my studies at The Michener Institute.  I also ran into her at various professional development events including the latest Better Breathing and Canadian Network for Respiratory Care (CNRC) conferences.  She is passionate, caring and an authentic RT.  Her wisdom is built from years of experience, which includes but not limited to Mount Sinai Hospital and Bridgepoint Active Healthcare.  She is also in the process of getting ready for her upcoming talk at the CNRC National Respiratory Care and Education Conference in Calgary.  I asked Mieke what it means to her to be a respiratory therapist.  This is what she shared with us:

 

I was working with an enthusiastic and engaging RT student yesterday that brought to front of mind what it means to me, to be an RT:

First, it’s the moment of connection with a patient and then if I’m lucky, the building of a therapeutic relationship with the patient and their family. We are fortunate to be able to treat patients across the health care system.  I value being part of the team that helps patients with the most fundamental actions of life – their breathing.

Secondly, because I can make a human connection with them, and then help them with something as important as their breathing, I believe I can ease their suffering (maybe just a little or in some cases immensely).

We are a highly skilled and widely experienced profession.  As a brief example: in a given week, I could be optimizing ventilation for a patient in ICU, helping to protect lungs from injury and allow healing, recovery, and growth in NICU; providing treatment in the ED for patient with acute exacerbation of their chronic respiratory disease; providing education and facilitating greater self-management to that patient with chronic respiratory disease; counselling a patient towards smoking cessation; and, helping facilitate a peaceful death.

And finally, as a RT with a few years of experience, I value being able to share my experiences, my approach, my wisdom, my perspective, my skills and knowledge to the next generation of RTs.  Showing them how to assess a patient, to look at the details but also see the big picture, to make the differential list, to respectfully touch during assessment and treatments, to listen and connect with our patients, and so much more …

I am proud of the valuable role we have within a multi-disciplinary team, at times overshadowed by the larger-in-numbers presence of nursing and physicians.  I would have to say that those individuals – the patients and families – with whom we make that moment of connection know we are different, and maybe just a little bit special, for we intimately assist them with the most precious piece of their life – their breath.  For when you can’t breathe, nothing else matters.

Mieke
Mieke Fraser, BSc RRT CRE

Thank you Mieke for taking the time to share your thoughts with us!

Happy RT Week!

Farzad ‘Raffi’ Refahi
Oct 25, 2017
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Influential People In Respiratory Therapy: Andrew Wroblewski

There are many individuals contributing to the field of respiratory therapy who I may not know about as I have been practicing in the field for only a few years.  In my journey to learn more about this field and the people involved, I reached out to Mr. Andrew Wroblewski.
-YouTube (The CPAP Gentleman)

Andrew is a Respiratory Therapist and producer of a successful YouTube channel called ‘The CPAP Gentleman’. He has used his work experience of helping Obstructive Sleep Apnea, OSA, patients to create educational videos for patients. He has summarized and simplified relevant information into entertaining segments.  The topics range from “What is Sleep Apnea?” to “Nasal Bridge Irritations”. His first YouTube video dates back to Feb 2016. He is a dedicated, driven and successful RT who is contributing to patient education and the growth of our field.  He was kind enough to answer my questions.

1. How did you find out about the respiratory therapy field? What made you decide to become an RT?

I found out about the profession through a friend of my father’s. He graduated into the field about a year before I started, and currently works in the Hospital for Sick Children in Toronto.

I was one of those guys that had no idea what to do with his life upon finishing high school. My strengths and interests were in Biology and Physiology courses, so my parents and councillors suggested I go into healthcare. Respiratory Therapy seemed like an outgoing field with many different areas to work in.

 

2. a) Can you tell us a little bit about your YouTube channel? How did you come up with the idea? How did you get involved with it?

After many real-life encounters with actual patients diagnosed with sleep apnea, I grew to learn of the common issues people face with PAP therapy. Some were even fearful of the treatment, so I wanted to re-assure them and others in the world that sleep apnea was nothing to be scared about. The only way to do this was to educate them in a fun and informative way. And thus the character was born.

I believed that YouTube was the best option to communicate my message, and something that wasn’t being utilized to its fullest potential by other clinicians. I aimed to fill that void, and if I could help just one person by doing it, it would be worth it.

 

2. b) What are some of the challenges and satisfactions of making educational videos?

Time, time, time. Everything from coming up with script ideas, to video production, and post-editing takes up a lot of my free time. I don’t always produce in a noise-free environment either, so extra care needs to be taken to ensure videos come out in respectable quality. I hold myself to a certain standard, and strive to improve things whenever I can. The satisfaction comes directly from the people I help! I get a big smile on my face every time someone leaves a comment thanking me for my efforts. It also gives me the motivation to continue doing what I do.

 

2. c) How much time is required in making an educational video (roughly how much time is spent in research/script, recording of the videos, and editing)? Where do you find the time to do that in your already busy schedule?

It really depends on the topic I’m covering. Generally the research/script takes the most amount of time. If I’m very familiar with a particular topic, I can produce a script in a single day. If it’s something I’m not too sure about, it may take upwards of a week or more. Video production generally takes anywhere from 2-6 hours depending on the length of what I’m discussing. Video editing takes a similar amount of time. Sometimes I’m stubborn and I want things a certain way, so there’s been times where it’s taken days.

I don’t know where I find the time! I have many things going on right now from participating in multiple on-call programs to learning a new language. That’s probably why I’m only able to produce an average of one video per month. Hopefully my subscribers don’t mind!

 

2. d) Any thoughts/suggestions/comments for those who are thinking of starting their own educational related videos?

I would highly encourage others to participate in video production for the purposes of education. YouTube is a great avenue through which to do this, and also easily accessible through all hours of the day. I would recommend to start simple. Perhaps audio only, and images that relate to what you’re discussing. This way you don’t have to stress out about learning everything from proper lighting, sound production, and video quality. Not to mention, editing is a little more complicated when there’s a real person in front of the camera.

You’ll also save a lot of money! Cameras, lighting, microphones, backdrops…it all hurts the bank. But I’ve already healed from those wounds so it’s okay.

 

3. You work in the home oxygen and CPAP settings; Any advice or recommendations for RTs who are thinking of or may consider working with OSA patients (i.e. CPAP)?

Most OSA patients that you deal with, are for the most part, healthy. This is a far stretch from other environments respiratory therapists work in such as intensive care, emergency, and operative departments. This allows you a relatively stress-free environment where decisions do not have to be made quickly. You’re also able to communicate with your patients more effectively as they are fully alert and able to breathe on their own. I do recommend working on your customer service and interpersonal skills, as this will go a long way in developing a relationship of trust between you and your OSA patient.

 

4. You have vast knowledge and years of experience in improving the quality of sleep of your patients. Any advice for Healthcare Professionals (HCP) (i.e. How can they improve the quality of their sleep)?

Make sure you have good sleep hygiene. You should try to be consistent with bed times as often as possible. For some HCPs, this can understandably prove to be difficult due to varying shiftwork. Sleep duration is also important, and you should aim to get at least 7-8 hours of sleep per day. An average sleep cycle is around 1.5 hours, and you need five of them for the body to be ‘fully restored.’

Don’t drink coffee or workout too late! It can be difficult to fall asleep otherwise. And finally, if everything else is in check but you’re still feeling tired, make sure you get referred for a sleep study. You may have an undiagnosed sleep disorder that is effecting the quality of your sleep.

 

5. Any final thoughts or message you like to share with RRTs and HCP?

Do what interests you in your respective field. I know that seems sort of obvious, but many of us work in areas we don’t necessarily want to work in. This can be a result of the current job market and what’s available, or what others think is best for you. In the field of respiratory therapy, acute care is highly prioritized above all else. Home-care is sort of an after-thought. I personally had just two days to experience the home-care setting during my clinical rotations, but that was enough for me to make up my mind.

Don’t worry about passion, or lack thereof. Passion behind your work comes from experience, and a supportive environment. Work hard, play harder.

Thank you Andrew for sharing your views, recommendations and perspective.  Keep up the great work!

Image credit:  https://www.youtube.com/channel/UCO2DkdV_758nYdnuSc6wuLQ (accessed Sep 17, 2017 )

Farzad ‘Raffi’ Refahi
October 1nd 2017

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Merci Christiane

Ms. Christiane Menard is retiring from her position as the Executive Director of Canadian Society of Respiratory Therapists, after almost a decade of service (9 years).  As a thank you for her contributions to the respiratory therapy field, this blog post is dedicated to her.

The first time I met Christiane was at the 2016 Ottawa Conference.  Even as a relatively new respiratory therapist and a novice blogger, I was greeted with a big smile and a hug.  She is full of energy, passionate and is very driven.

From a quick glance at her career accomplishments you can see that Christiane’s dedication to excellence is evident.  Besides the position of Executive Director of CSRT, she held other positions such as the Communications Coordinator for Merck, Director with Society of Obstetricians and Gynecologists of Canada (overseeing Communications, Government Relations and Partnerships), and Director of Communications for the Canadian Association of Medical Radiation Technologists.

In 2017, she was the Honorary Lifetime Membership Recipient from CSRT.

I reached out to CSRT’s president, Mr. Jeff Dionne.  This is what he had to share about her:

When I think of Christiane, I think of a true visionary.  She took on the role as Executive Director for the Canadian Society of Respiratory Therapists during a time when things were quite unstable.  Our profession was going through an identity transformation; our membership numbers were steadily dropping, our impact within the RT community was dwindling, and our image as a national organization was blurry at best.  During her time as ED, we have witnessed numerous success stories emerge; from the Blueprint for Action for our profession in 2014, to our role in private practice, to the Anesthesia Assistant certification process, the CSRT is now a nationally recognized leader in the realm of professional association.  Not only have we seen our student memberships double, but we are also proud to say that we have well over 4,000 members in our association.  It has been through her tireless commitment and dedication for our profession that has placed us in such a positive situation for the years to come.  Thank you, Christiane.

 

I will share with you the brief conversation I had with Chriastiane.

  1. Looking back over the years as the Executive Director, what are some of the memorable moments that come to your mind that you can share with us?I have so many memorable moments and in each of these moments, it is the passion of the RT profession that was front and center.  Whenever I went to provincial meetings, I always tried to find out about RTs and to learn more about what they did and the projects in their region.  The most memorable moment was in 2014, I was in Vancouver for several meetings and on my way to the airport I accepted an invitation to visit the PROP program in Vancouver.  A young and most passionate RT named Esther Khor gave me the grand tour of her organization and it was the most amazing set up I have ever seen.  It was the first time, after working 40 years in the health care sector, that I saw an organization actually put in place a truly effective “patient centered approach” to care.  I immediately invited her and her patients to speak at the 2015 conference and I feel this was one of the most memorable presentation at a CSRT conference. 
  2. How has the RT field changed from your point of view?I see a profession that has gained a lot of confidence in their knowledge and clinical skills.  More and more RTs are working in less traditional roles like research, quality assurance, patient transport.  I am very proud of all the RTs who continue their education and keep building on their RT skills and knowledge.  Nine years ago, critical care was the most important area of practice.  Now we see more and more RTs working in community and home care.  Many RTs have entered a growing area of the health care that is most important – patient safety.  The profession constantly shows its versatility and ability to adapt to the changes required in the health care sector.  I have no doubt that RTs will continue to look for new applications of their skills and knowledge than any other profession. 
  3. What is next for you?I am retiring from being an Executive Director, but I love working.  I just feel I am no longer able to work at the Executive Director level and knew it was time to take a step back.  I plan to stay at CSRT in a lesser capacity for a number of months to support the transition of the new CEO.  I will then find some part-time work where I can still use my knowledge and skills.  As I will no longer travel for meetings, I look forward to attending more cultural events in Ottawa and going to the pool and gym more often. 
  4. What were some of the goals you set for yourself when you began as Executive Director and do you think you accomplished them?I had many objectives when I started – increase the CSRT membership, increase the number of participants at the CSRT conference, increase the income from sponsorship – and then I soon realized that none of these objectives could be achieved if we were not able to show the value of CSRT to our members and to our industry partners.  So I think we have achieved those objectives by showing value.  The most difficult objective to achieve had to do with the financial viability of the CSRT.  When I started in August 2009 we had absolutely no money in the bank … no money for rent, no money for payroll.  That was so overwhelming and I struggled with this for many years.  It took nine years, and inch by inch, we increased our financial stability.  This year is the first year that I feel we are on solid financial ground and that we do not have to borrow on the line of credit or on next year`s income to meet our financial commitments. 
  5. What are some words of advice for people in the industry who want to get more involved?Find something that is missing, something where you can make a difference, something that can be done better, and just do it!   If I look back at who has done just that I think of Jason Nickerson, who got involved in international health, not because of the money, but because there was a need and he knew he could make a difference.  Tom Piraino is another RT who saw a void in RT education with regards to the clinical applications of ventilation and he got involved in increasing knowledge and understanding in his institution, at the provincial level, at the national level and at the international level.  It just takes effort, constant effort, and you can achieve everything by doing an inch at a time, one step at a time.  The secret is to not get discouraged by hurdles … anyone can build a mountain one spoonful at a time! 
  6. What are some of the challenges you see in the future for RT’s and how can we as practicing RT’s prepare for those challenges?
    The biggest challenge for the RT profession is keeping up with the complexity of the health care sector.  As the health care sector always seems to be in transition, the RT profession will also continue to be in a transition and there is no way to go but forward and learn more complex clinical applications.  I do feel that the RT profession has been very quick to adapt to changes that have occurred in the past and I have no doubt that RTs will continue to increase their knowledge and clinical skills. RTs will surpass any challenge and will move forward where they are most needed and where they can make the most difference in the respiratory care of their patients.
     
  7.  Any final thoughts?
    My final thoughts ….I am so grateful that my last full time job was with the CSRT and that I had the privilege to have the trust and support of the RT profession who so generously shared their passion with me.   I can brag that my last job, after working in the health care sector for over 45 years, was the best ever!  Not many people brag about their job when they retire, but I do !

I want to thank Christiane for her dedication to our industry and for taking the time to speak with me.

 

Resources:
-Image: https://www.linkedin.com/in/christiane-menard-3946a140/detail/photo/

-Thank you to Carolyn McCoy and Jeff Dionne for taking the time to help me  with this article.

Farzad ‘Raffi’ Refahi HBSc RRT

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