Let’s read an article a month – March 11, 2020

Screenshot of the first page of the article by Morgan et al. Ready by Farzad Refahi and shared on www.Respiratory.Blog

An Article A Month

Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

I found an article on March 9th, 2020. I spent a few days with it, and now I share it with you.

Variability In Expiratory Flow Requirements Among Oscillatory Positive Expiratory Pressure Devices 

by Sherwin E. Morgan, RRT, Steven Mosakowski, RRT, MBA, Brenda L. Giles, MD, Edward Naureckas, MD, Avery Tung, MD, FCCM
Published online March 4, 2020. Available on The Canadian Journal of Respiratory Therapy (CJRT) : https://www.cjrt.ca/wp-content/uploads/cjrt-2019-025.pdf

Top 3 Reasons Why I enjoyed this Article

Firstly, this article is quick and easy to read.

Secondly, I had forgotten about the various Oscillatory Positive Expiratory Pressure (OPEP) devices on the market. This article was a nice introduction to various flows and pressures required to operate the units. The authors provide a recommendation for which units to be used by which population (small vs. larger patients) on page 10.

Thirdly, in the introduction the authors discuss the proper technique for using these devices (referencing Olsen et. al). You can find this description on pages 7 and 8.

Once again, you can view this article by visiting CJRT (which is owned by Canadian Society of Respiratory Therapists): https://www.cjrt.ca/wp-content/uploads/cjrt-2019-025.pdf

Happy Reading! Let me know what you think.

Farzad Refahi

Let’s read an article a month – March 06, 2020

Snapshot of the first page of the article.

Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

I found an article on Feb 27th, 2020. I spent a few days with it, and now I share it with you.

A spatially restricted fibrotic niche in pulmonary fibrosis is sustained
by M-CSF/M-CSFR signalling in monocyte-derived alveolar macrophages by Nikita Joshi et al.
 Eur Respir J 2020 55:1900646; published ahead of print 2019, doi: 10.1183/13993003.00646-2019 https://erj.ersjournals.com/content/erj/55/1/1900646.full.pdf

This article is well written and easy to follow. I must admit that it is too specialized and technical for my comfort level, but I still enjoyed it.

What this study demonstrates? Many elements were discussed but here is a very simple summary to get you interested:

“Our findings suggest that inhibition of M-CSFR (macrophage colony-stimulating factor receptor) signalling during fibrosis disrupts an essential fibrotic niche that includes monocyte-derived alveolar macrophages and fibroblasts during asbestos-induced fibrosis.” p1

Happy reading!

Farzad Refahi

Let’s read an article a month –Feb. 21, 2020

Photo of the article’s first page.

Every month I try to read an open access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to reads articles, stay up to date and continue to grow.

The article I read on Friday was:

Bilateral hypoglossal nerve stimulation for treatment of adult obstructive sleep apnoea by Peter R. Eastwood et al.

Eur Respir J 2020 55:1901320; published ahead of print 2019, doi:10.1183/13993003.01320-2019 OPEN ACCESS ARTICLE http://erj.ersjournals.com/content/55/1/1901320?etoc

I am not here to endorse this technology or this approach to manage Obstructive Sleep Apnea (OSA). I am learning about it and sharing it with you. It did open my eyes to another approach which apparently has been around for some time. I appreciated the innovations. Compliance with CPAP units, the current gold stands, is low. The authors do mention that, and I have personally witnessed it when I worked for a CPAP company (casually for around 2 years).

I don’t need to express my personal thoughts on this as the authors have done a great job of describing the technology (GEnio system), what’s make it unique, the limitation of the study, and also the opportunities it brings.

It is a small study, n=22, with few participants. There is no control group.

This approach did open up the discussion to devices that deliver bilateral stimulation of hypoglossal nerve, includes minimal incision, and lacks an implanted battery (p10).

What are your thoughts and take on this?

Gino De Pinto

Used with permission from Mr. Gino De Pinto.
Mr. Gino De Pinto

I first heard of Mr. Gino De Pinto through other Respiratory Therapists (RTs) and indirectly through social media interactions.   At the 2018 Vancouver Canadian Society of Respiratory Therapists (CSRT) conference, I had the opportunity to meet him in person.  During the 2018 Respiratory Therapy Society of Ontario’s (RTSO) Leadership Summit, and through my discussions with him, I recognized his genuine care and passion for our field.  When I spoke to one of his past students, he appreciated Gino’s evident care for students.  His past and current students have commented on Gino’s direct and open communication, and his wiliness to stand by and for students in our field.  I personally got to witness and appreciate his character as a fellow RTSO volunteer.  He has brought enthusiasm to our board of directors and has re-energized our student engagement committee.  I am happy to share my interview with Gino below.

Gino, thank you for taking the time to answer my questions.  Let’s go to the beginning.  How did you get involved with the field of respiratory therapy?

With the respiratory therapy profession having a low profile on television and in the media compared to the nursing, physician and paramedic fields, finding out about the profession was by accident. Going back to high school I enjoyed taking science courses and I was always fascinated with the cardio-respiratory system. My title for my final presentation for OAC Biology was “Exploring the World of the Blue Bloater and Pink Puffer”. A strong interest in science  led me to the University of Waterloo where I received my Honours Degree in Science. During my final year at Waterloo, like many other RRTs I came to the realization that I needed to further my education if I wanted a career. Having both a brother and sister working in healthcare I started exploring opportunities. I applied to both the Medical Radiation Technology program and the Respiratory Therapy program at Fanshawe College. I was accepted into both programs. After going back and forth on a decision that would affect the rest of my life. I reached out to a family friend that was working as a RRT at the Timmins and District Hospital and I made arrangements to spend the day with a RRT to help with my decision. I spent the day with Susan Boisvert who showed me all the roles of the profession from PFTs to managing a patient on a ventilator. That was all I needed to make my decision and later that day I accepted my offer to Fanshawe College in the fall of 2000.

The graduating class of 2003 all faced the same challenge of entering a profession with much uncertainty. A few months from graduating, healthcare in Canada was dealing with the SARS crisis. As RRTs we were front line workers dealing with an infectious respiratory disease that people knew little about. Infection Control practices changed immensely since 2003. My students can testify how much emphasis I put on infection control practices during competency testing and I can trace that influence back to working in the aftermath of SARS. Since they were limiting visitors to hospitals during that time, I was offered a telephone interview for a temporary full-time job at Grand River Hospital. I was not able to set foot in the hospital but accepted the offer of employment as I thought it was a tremendous opportunity. During my time at Grand River Hospital I had some great mentors like Deb Bester and Jocelyn Hurst who helped mold my career. They set a high standard for patient care and for being accountable. Within a couple of years, I was able to take on a role as Resource Respiratory Therapist where I was able to learn how to create and maintain Policies and Procedures. I was a member of ICU council where I was able to use my voice as a RT to help with VAP protocols, help establish the RRTs role with the Critical Care Response Team and give my input into the design of the new ICU. This is where I could really see the importance of the interprofessional model that is so important with the patient-centered approach to medicine. After 16 years I continue to work at Grand River Hospital as a casual RRT. I have far less influence on the department as a casual but the position allows me to keep current with practice.

Thank you to Susan for introducing Gino to our field!  Since graduation you have been involved with various roles, activities, and volunteering positions.  Can you share with the readers some of your memorable roles so far?

I also had an opportunity to work at St. Mary’s General hospital on a part-time basis for 4 years. Working at a cardiovascular hospital gave me a new perspective on the profession. Working with great mentors like Danny Veniott and Rob McGivern exposed me to how a great work ethic and positive attitude can dramatically change a culture of a department. With their leadership the role of the RT grew dramatically. Inserting of arterial lines became the norm, establishing an Anesthesia Assistant program and a Weaning centre of excellence were just a few highlights that I witnessed firsthand that influenced my career. Never satisfied with the status quo of the profession are lessons that I learned from my time at St. Mary’s. This is where I first met Lori Peppler-Beechey whose professionalism, positive attitude and leadership skills were evident early. After working with her for a years she resigned from St. Mary’s to start a new RT program at Conestoga College. On one of her last shifts I told her if she ever needed anyone to teach part-time to give me a ring. I thoroughly enjoyed being a Preceptor for students at the bedside and thought this would be a great opportunity. The phone rang a few months later and an opportunity to teach in the lab presented itself.

Teaching part-time for the first 2 years of the program was stressful and exhilarating. Going back to the textbook to refresh on content to ensure I was teaching concepts appropriately was nerve racking but rewarding. Students came with a tremendous passion to learn about respiratory therapy which made the stress all worth while. After teaching part-time for 2 years there was an opportunity to teach on a full-time basis with the focus of teaching and facilitating the clinical year of the program. After finally having a regular full-time job at St. Mary’s another difficult decision crossed my path. Do I leave a stable full-time job for another full-time job at a College with a program that was yet to be accredited? With the support of my wife, I made the decision to take the job. The decision was made a bit easier knowing that I would be working with great people like Lori Peppler-Beechey, Tim LePage, Kelly Hassal and Karl Weiss. With this great team we were able to attain full program accreditation from CoARTE.

During my first years of teaching at Conestoga College I am most proud of the relationships formed with our clinical partners. Ensuring all stakeholders had a voice in the education of RTs from Conestoga College positioned our students for success and eventual employment. Helping establish and integrating clinically immersive simulation into the program was another career highlight. Working with a mentor like Karl Weiss on the design and implementation of simulation into our curriculum was stressful and gratifying. Then being able to present our findings at the 2013 CSRT conference in Niagara Falls allowed us to showcase all our hard work. Another highlight was working with Karl Weiss on developing our pediatric/neonatal hybrid rotation. With a bottleneck of pediatric rotations shared with other college programs. We had to create a clinical immersive simulation in combination with a traditional hospital rotation to best prepare our students to meet those neonatal/pediatric competencies. At that time, I was able to work with amazing subject matter experts like Gary Tang, Ernie Matchett, Cathy Trocchi, Tami Tesseyman, Catherine Burke-Trembley and Pam Hall. Collaboration was the key to success and their input and expertise made for a great learning environment for the students and faculty.

Four years ago I transitioned from a full-time professor responsible for the clinical year to a more traditional teaching position in the classroom. During that time the program said good-bye to Lori Peppler-Beechey as she took on new roles in leadership. Currently I have the pleasure of working with Pam Hall who is now the program coordinator. Seeing the passion she has for teaching her students is infectious. She is a tremendous leader, passionate for the profession and a hard worker that has inspired me to be a better teacher in the classroom.

In the context of a clinical setting, which area did you enjoy the most? Also, how can RTs be better clinicians?

I enjoy working in Critical Care the most. Learning about and applying new ventilator strategies is what makes our profession unique. Being at the bedside and looking back at the past 16 years of optimizing the patient while on the ventilator, I can look back and reflect on the trends. I have worked with mostly adults and seeing the adoption and implementation of ARDSnet, the use of APRV, HFO, prone ventilation, tracheal gas insufflation and the use of inhaled prostaglandin are just few examples of different strategies used to help patient’s breath. Being a patient advocate in my opinion is the best quality an RT can have. Being able to speak up and provide suggestions to help our patients is key. Recognizing that patients don’t all fit in the same box is the first step in ensuring your patient will receive the best possible care. Looking at waveforms, interpreting blood gases, looking at chest x-rays and providing evidence informed literature are all keys to making appropriate suggestions at the bedside. If you continue to advocate and look for solutions, you can sleep better at night knowing you tried all possible treatments to help your patient with their specific disease process.

Seems like the decision to become an instructor was not at random.  Can you expand on that?  Also, any advice for RTs who may want to get involved with this role?

As I mentioned earlier, I always enjoyed being a Preceptor to a student. Being able to showcase your expertise and help students apply theory to patient care was always rewarding. For those of you who are interested in teaching I recommend that you respect the learner, this will ultimately create a positive learning environment. Look for teaching opportunities within your organization like becoming a BCLS or NRP instructor. Build your resume by going to conferences and participate in webinars. When meeting educators express an interest in teaching, gather their contact information and send them your resume. When an opportunity presents itself be flexible and accountable. This will help ensure you do not miss on future teaching opportunities.

What advice do you have for RTs and preceptors to better assist students in their growth?  What advice do you have for students to maximize their learning and growth?

Having students can present challenges. Listening and reframing your question will better assist a student with their growth as a professional. Do your best to be patient and try to remember what is was like when you were a student. Students come to the hospital or home care setting wanting to do their best. If a student is struggling with a certain topic try to remember what stage of the clinical rotation they are at. Is it their first day or have they been in the rotation for a couple of weeks? Knowing this will help you determine how to best guide your student. Do they need to see a procedure for the first time or an additional time? Do they need to review pharmacology or pathophysiology so they can best understand treatment modalities?  Once you have the answers to these questions you can determine the appropriate feedback that will stimulate connections to theory and help them grow as a learner.

Advice I give to students to maximize their learning is to be flexible. Having multiple Preceptors can add stress to a student’s learning and growth as a practitioner. At this point in your educational journey you would have had multiple teachers with different teaching philosophies and styles. Not all the teachers would have resonated with your learning. The same can be said about Preceptors, but as a student if you respect what they want to teach you and appreciate the time they are taking to demonstrate a practical skill will help foster a relationship. By building relationships and trust, preceptors are more likely to invest in your learning. If a preceptor invests in your learning you will maximize all learning opportunities that present themselves.

Your contributions to the field include holding few past and present volunteering roles.  Can you expand on that?  Also, this is a good time for me to ask about your involvement with RTSO.

When I was a student at Fanshawe College I had great teachers who all volunteered their time outside the classroom. Paul Williams, Dennis Hunter and Sandy Annett led by example and all were volunteering with different aspects of the profession. For myself, helping establish a new respiratory therapy program for the first 8 years of my teaching career was very busy. Now that the program successfully navigated through two accreditations and has graduated over 10 classes, I am able to find time to give back. Our program had developed great relations with CRTO and CSRT. The next step was to build a strong relationship with RTSO. I had the pleasure of meeting Dilshad Moosa at the CSRT conference in Vancouver a couple of years ago. This meeting led to an opportunity to gain a position as a Co-chair of the student affairs committee. Once in that role I was able to see the importance and need of connecting the Ontario Respiratory Therapy programs with the RTSO. The RTSO plays an important role providing a voice to the profession. Being able to connect with great leaders like Sue Jones, Sue Martin and Nancy Garvey have given me a great perspective on the profession and where it is going. Once in this position I was approached to be on the Board and was happy to take on this new role. Since taking on this role I have had the pleasure to work with the Ontario colleges to increase student membership and provide contributions to the RTSO Airwaves. At this point I am more than happy to give a shout out to Shawna MacDonald editor of RTSO Airwaves who continues to provide excellent resources for the RT community and remember if you are an RRT in Ontario #MembershipMatters. Being able to model leadership traits in the profession to my students will hopefully encourage them to be great leaders when they graduate.

It is interesting how we are positively influenced by the great work of others.  I was a student when RTSO held an educational day at The Michener Institute.  I volunteered and was very impressed by the leadership and professionalism of its president at the time, Mr. Jeff Dionne.  I also enjoyed and looked forward to Airwaves (thank you Shawna!).  The decision to join RTSO and volunteer with the organization was an easy one.  As I mentioned in the introduction, I am impressed and appreciative of all of your contributions to our organization!

I am going to take a step back to talk about the bigger image of our field.   How do you see our field changing over the next few years?  Also, what changes do you hope to see?

The role of the community RT has changed dramatically over the past decade. More patients are at home needing support with their oxygen needs, tracheostomy care and home ventilation. The government has funding to support theses new initiatives so hopefully we will see continued support from leaders in our profession to take advantage of these opportunities and promote our profession. I am hoping we can learn from our Paramedic friends who are now offering their services to patients in the community. Community Paramedicine (CP) programs provide opportunities for Paramedics to apply their training and skills in the community outside of their traditional 911 emergency response role.  CP programs promote Paramedics to work in collaboration with other health care professionals and community agencies to connect patients with needed health and community services. These connections assist patients to participate in their care, maintain independence and promote involvement in their communities. I see a real opportunity for RTs to take on a similar role in the community and I hope to see initiatives like this trickle down into our profession.

Outside of work and volunteering, what do you enjoy doing?  

I love spending time with my family. I have a wonderful and supportive wife named Judit and 3 beautiful children who keep me busy. I love basketball and I am a die-hard Raptors fan. From watching Alvin Robertson drain the first points in franchise history at Skydome to watching this magical run of the Raptors hoisting the Larry OB has been a dream come true. Now I patiently wait for the release of the next season of Stranger Things.

Before we end this interview, do you have any final words to share with the readers?

Farzad, it has been a pleasure knowing and working with you over the past couple of years. I am hoping the passion and dedication that you have for the profession spreads through our wonderful community. I appreciate your inclusiveness while advocating for the profession. Keep doing what you are doing.

Thanks Gino.  The credit really goes to all the wonderful RTs out there, like yourself, who perform quality work and push to raise the bar despite all the obstacles along the way.  I have simply been lucky enough to share my journey of learning and discovery with my followers.

Once again, thank you Gino for sharing your insights with me and the followers.  Also, thank you to the followers of this blog for taking the time to read this interview. Hope you enjoyed this interview as much as I did.

This post is put together by Farzad ‘Raffi’ Refahi and made available online by the support of John Meloche of the Melotel company.

Lynard Higoy

Lynard Higoy is a Registered Respiratory Therapist (RRT) whose presentation I attended at the 2019 Canadian Society of Respiratory Therapists’ (CSRT) annual conference.  He was energetic and passionate about the topics he presented. He works as a community RT, covering a vast area. His role greatly depends on interprofessional collaboration.  I wanted to find out more about his work, and the work of independent or community RTs, so I connected with him over many emails. Thank you Lynard for sharing your perspective.  Also, a big thank you to CSRT for exposing me to many amazing speakers at your conferences, such as Lynard.

Please join me as I interview Lynard:

I have a great interest in hearing about the spark or series of events that shape people’s decision to study respiratory therapy.  How did you find out about the Respiratory Therapy field? Why did you choose to study RT?

It was pure accidental!  I did not get in to the pharmacy program so I went to U of M’s school of Med Rehab open house. My original plan was to attend the open house for the physiotherapy program. Then I remember seeing different types of ventilators, Intubation kits, Jackson-reese and a pig lung.   It was love at first sight and the rest was history.

You have been practicing for some time now.  Can you share with us some of your memorable roles so far?

First one is when I was invited to be a speaker in the previous CSRT conference held in Niagara Falls. And also, when I was part of the Deer Lodge Centre Pulmonary Rehab Team In Winnipeg that won the 2014 Commitment to Care and Service Award, Collaborative Team Initiative.

I love the rural practice because you can spread your wings and maximize your scope of practice! Everyday is a different challenge! I may not be flying with STARS or part of the transport team, I may not be assisting with intubation in the trauma room but the acknowledgment and appreciation of my clients made me think that I’m a very valuable asset in the community. Since I’m the only respiratory therapist in Vegreville , Two Hills and Lamont employed by Alberta Health services, I have the feeling of accomplishment whenever doctors value my recommendation. The most memorable in my role as a community RT is when I was in doing some grocery shopping and my former pulmonary rehab client approached me with her daughter and told her “ This is the guy that helped me breathe better! Without him and his breathe easy program I won’t be here.”  that is the most memorable moment for me so far as a community RT.

I think most of us go through the RT program thinking of the acute care aspect; Appreciating the immediate life and death decision making that can impact patients. With experience and exposure to patient care, we realize that there are multiple dimensions to patient care.  Each role or setting is unique and vital to patient care. Seems like you have had the opportunity to experience and contribute to patient care in various settings. I have a quick question about the location. How did you end up covering Vegreville, Two Hills and Lamont ? Are you originally from that area or moved there for work?   If you moved there for work, what contributed to that decision?

So I’m originally from Manitoba (U of M alumnus) and practiced there for 3 years. I followed my heart and moved to Alberta to be with back with my then girlfriend and now my Fiancée. It was a challenge to find a fulltime job in Edmonton especially as a community care RRT. I got a job offer in the private sector (Lakeland Respiratory) in Vegreville which is approximately 100 km east of Edmonton. The selling factor for this job was I’m going to run a pulmonary rehab in the town hospital so I said yes and took the offer. Then after 8 months my current position opened and I applied for it. I been in this position for 2 years now and liking it every single day.   : )

Because of my current and previous work settings, I have had in person RT support within seconds to minutes away.  Your experience has been different. Can you tell me about the planning, consideration, thinking framework, challenges and opportunities when working by yourself?  

My piece of advice when you are in rural practice and working by yourself….. Don’t be scared to ask for help! I think this is when Inter professional collaboration comes in as a very important tool to be successful. I don’t work in my own silo anymore, I welcome ideas and expertise from other healthcare professionals such as OT, Physios, Exercise Specialist. Recreation, Social Work, Therapy assistants, Sleep Language Pathologists, Nurses and Admin assistants. At the end of the day, we all wanted one goal and that is to improve the well-being of our clients. My CSRT presentation “Screening for Dysphagia in COPD assessments” was a product of collaborating with our community SLP to reduce the rates of COPD exacerbations due to aspiration Pneumonia. The camaraderie of healthcare professionals working in rural areas are something that I admire, they are always there to help you all the time.  

Also, working alone makes you realized how your research methodology course back when you were an undergrad is not to be discarded. Consider research journals as your friend if you have to work alone. If doctors asked me a respiratory question and I don’t know the answer, I’ll either contact my professional practice lead or search the Web for evidence-based practice research that can support my ideas.    

Interprofessional efforts, communication, collaboration and trust are important part of patient care, as you have already mentioned. Was that the culture in place when you began working there, or was it something that had to be worked on?

The answer is both! The culture was in place before I started working here but just like every other worksite, you have to earn your keep. You have to prove that you are trustworthy, easygoing,  that you value not only your job but the rest of the team and that you are not just there for the money but rather to always put your heart in what you do.

You mentioned articles and journals as one of your references.  Do you have any favourite resources that you can share with us?  Also, how do you support your growth? What’s your approach to continuing education? Beside teaching patients and their families, do you get the opportunity/train other healthcare providers?

Yes, The CJRT, Pubmed, Science direct, and others. I’m a big fan of everything as long as it came from a reliable source. I totally support professional growth and continuing education. I’m currently pursuing my post baccalaureate diploma in Leadership and Management through Athabasca University, Faculty of Business which is one of my prerequisites for the MBA program. If time permits, I attend workshops, read journals, webinars and seminars that will help me with my everyday practice.

Yes, because of the nature of my work since I’m the only Community RT in my rural area, I serve as a respiratory clinical resource and I cross train other healthcare disciplines with RT work such as oxygen therapy, emergency trach changes, lung volume recruitment strategies and many more.

What’s your approach to teaching students and staff?   What advice you have for RTs to be better preceptors? Also…what advice do you have for students to maximize their opportunity to grow and learn?  In your opinion, what are some qualities that makes one a quality RT?

My advice, don’t be a smart aleck! I’m a big advocate of transformational leadership in healthcare. In order for them to succeed, you have to motivate them, inspire them and let them grow away from judgment and intimidation. Also, being a role model for students in order to raise interest and understanding with the stream that you work. Allow them to know their strengths and weaknesses so they would be able to self-reflect on their performance. You know you did a good job if one day they came back and say.. Hey you’re my RT hero and I’m following your footsteps. A quality to say this RT is the best?? I would say……. Being able to look beyond self-interest to the common good.

What has attracted you to the Leadership and Management? What made you decide to pursue MBA?

Management is where I have wanted to be since I was an RT student. I know as a community RT I am helping respiratory clients with my respiratory expertise such as smoking cessation, pulmonary rehab etc., but I think I want to work and be a catalyst for change in the management/senior leadership level. In this level, I would be able to work upstream and be involved in health policies that can substantially improve not only the respiratory health of Canadians but rather the whole Canadian healthcare system.   

How do you see the future of our field?

I want to see more RRTs stepping into management and senior leadership roles. I mean not just respiratory therapy managers but management roles that have been dominated by other healthcare professionals. With our RRT skills such as juggling multiple tasks, time management, grace under pressure and resiliency, I believe we would be successful in these roles.

Outside of work, what do you enjoy doing? What are your hobbies?

If I’m not at work, either you’ll see me at the gym or at the lake. I like working out pretty much every day. I love both fishing and ice fishing. I also love to explore the world with my fiancée.

Any final words?

Keep the Respiratory Therapy Passion burning!

Thank you Lynard for opening my eyes to more unique perspectives.  Also, thank you for your dedication to our field and the interprofessional team that looks after the patients.  By sharing your views and experiences, you have helped to further represent our field and the work of respiratory therapists across all the healthcare settings.  Congratulations on your engagement and good luck with your studies. I expect that the RT community will hear more about your achievements in near future.

A special thank you to the followers of this blog.  Thank you for supporting a stronger RT presence!

Lynard Higoy

Farzad Refahi