Let’s read an article a month – October 2020

A cropped screenshot 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.

Link to the article: https://erj.ersjournals.com/content/erj/56/2/1900495.full.pdf

Link to the blog post: https://respiratory.blog/lets-read-an-article-a-month-october-2020/

This month I found a great piece to share with you.  This one falls under original research and Tuberculosis. The objective of this paper is to “ to evaluate the EUROHIS-QOL tool for quantifying QOL in TB-affected people (patients and their contacts) versus healthy community controls, and to assess whether QOL at the time of diagnosis predicts treatment outcome, including survival. ” (p 2).  

Quality of life, tuberculosis and treatment outcome; a case-control and nested cohort study

By: Sumona Datta, Robert H. Gilman, Rosario Montoya, Luz Quevedo Cruz, Teresa Valencia, Doug Huff, Matthew J. Saunders, and Carlton A. Evans.

European Respiratory Journal 2020 56: 1900495;
DOI: 10.1183/13993003.00495-2019

Common abbreviations used in this post and article include Tuberculosis (TB), Quality of Life (QOL), and Activities of daily living (ADL).

Top 3 reasons why I enjoyed reading this article

  • It is a reminder of the impact of this disease.  Infects 10 million people annually with 1.5 million of them passing away because of it (p.2).
  • The authors express that the treatment of a condition is not just the identification and its treatment.  There are psychological and socioeconomic elements that also need to be considered. “It highlights the need to improve TB-related QOL, including the profound dissatisfaction with one’s self, relationships, global QOL, potentially worsened by TB-related distress, stigma and isolation” (p.10). 
    This article also supports the WHO recommendation “such as education and counseling to improve adherence and treatment completion” (p.11)
      
  • The authors were clear about the strengths and weaknesses of their article.
    (-) It was shared that QOL questionnaires are subjective (p12). 
    (+) The authors recognized the diversity in their study: “15 peri-urban shantytowns and 17 urban communities” (p.12).  

Personal thoughts and reflections

In this article, the World Health Organization’s The End TB Strategy was brought up. I located the page on the WHO’s website: https://www.who.int/tb/strategy/en/.
There is a vast amount of information available, including tabs for Strategy Pillars, Strategy Principles, Adapting the Strategy, Measuring Progress, and TB Elimination.  TB is not unique to other countries.  A 2017 Canadian government statistics showed that “4.9 per 100, 000 of the population” has active TB (https://www.canada.ca/en/public-health/services/diseases/tuberculosis/surveillance.html). I encourage you to take a moment and learn more about TB and its impact on people.

What are your thoughts on this article?  Do you have any experience treating patients with TB? 

Happy learning and reading!

Farzad Refahi

October 1st, 2020

https://respiratory.blog/lets-read-an-article-a-month-october-2020/

Happy at work?

Woman giving the thumbs up.
Image by Robin Higgins from Pixabay 

Wondering what kind of employer you need to work for? Or wondering how to keep your team happy?   

Prior to the pandemic I occasionally attended networking events.  I heard an interesting mindset from a hard-working, loyal and driven presenter. He asks himself these three questions before applying for any job:

  • Would the opportunity lead to new knowledge or skillset?
  • Would the position give you access to quality mentorship and coaching?
  • Does the role and workplace rate highly on: compensation, work culture and work flexibility.   

Have you ever asked yourself what you are looking for in a workplace?  What makes you choose one offer over the other? What’s your career development look like?

Several factors play into this, including but not limited to one’s personality (intro-/extro-vert), stages in life, career goals, financial needs, work-life balance, available opportunities and many more. 

If you are a manager and/or employer, there are things that you can do to keep your employees happy.  These may include but are not limited to: offering compatible compensation, growth and learning opportunities, providing constructive feedback, flexible scheduling if applicable, and encouraging a respectful work environment among many others. 

Yesterday I attended an anniversary celebration at work to support those who are receiving recognition for their service.  At such challenging times, a small token of appreciation through recognizing people for their loyalty goes a long way.

What are some ways working for your employer keeps you happy, motivated and feeling valued?

Farzad Refahi
September 23, 2020
https://respiratory.blog/sept232020/

Patient Experience in Patient Care

A lady on headset pointing to a clipboard and stethoscope.

In my opinion, patient care and patient experience are closely intertwined, especially in highly structured, organized and timed clinical settings such as Pulmonary Function Testing (PFT) labs.  I must emphasize that even at PFT labs, patient-focused care is still at the core. 

There are a few simple ways that I try to improve the patient experience at the lab.  

  • I keep my work station neat and clean.  
  • I anticipate the patient’s needs beforehand.  For example, I have the mouthpiece, nose clips, pen, spacer, requisition, PPE ready before calling the patient in. 
  • If the patient has previously been in the lab, I review the previous comments to be better informed.  For example, if the patient is on home O2, I have the wall O2 extension tubing and nasal prongs ready.  Another example is having the forehead probe ready if the previous 6MWT indicated that forehead probe was used during the walk.
  • I try to be on time, if not a little bit earlier.  This gives me the buffer time just in case the patient requires a little bit more time.  If I start the test early and the testing goes smoothly, at least I get a few minutes for a break until the next person arrives.
  • Working in the Greater Toronto Area exposes me to different languages and different cultures.  To better pronounce people’s last names I Google pronunciations.  I know how silly that may sound.  Search “pronounce [insert last name]” and in most cases, you find some useful resources.  I am not particular with the pronunciation of my first or last name, but this may not be the same with others so I put in a minute to optimize customer service for patient care.


What are some of the ways that you optimize customer service in your patient care?

Farzad Refahi

Sept. 18 2020

https://respiratory.blog/Sept182020/

Weekly DLCO and Monthly Biological

Mouth piece on and mask off to do a weekly DLCO and monthly biological testing.  Quality control.

Performing my weekly DLCO biological testing and monthly full PFT biological testing.

If you are curious about Hospital and Independent PFT simulations and #calibration, here is a CPSO document: www.cpso.on.ca/admin/CPSO/media/Documents/physician/your-practice/quality-in-practice/cpgs-other-guidelines/ihf-standards-pulmonary-function-studies.pdf

While on this topic, a quick shoutout to Bernie Ho and Tony Kajnar!

Farzad Refahi

Let’s read an article a month – September 2020

Cropped screenshot 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.

Link to the article: https://doi.org/10.1016/j.chest.2020.03.052

Link to the blog post: https://respiratory.blog/lets-read-an-article-a-month-september-2020/

This month I found a great piece to share with you.  This one falls under Asthma and Original Research. The objective of this paper is to “examine the proportion of participants with negative BDR testing who had a positive MCT (and its predictors) result and characteristics of MCT, including effects of controller medication tapering and temporal variability (and predictors of MCT result change), and concordance between MCT and pulmonologist asthma diagnosis.” (1st page of the article, p.479)

Performance Characteristics of Spirometry With Negative Bronchodilator Response and Methacholine Challenge Testing and Implications for Asthma Diagnosis

By: Janannii Selvanathan BSc, Shawn D. Aaron MD, Jenna R. Sykes, MMath, Katherine L. Vandemheen MScN, J. Mark FitzGerald MD, Martha Ainslie MD, Catherine Lemière MD, Stephen K. Field MD, R. Andrew McIvor MD, Paul Hernandez MD, Irvin Mayers MD, Sunita Mulpuru MD, Gonzalo G. Alvarez MD, Smita Pakhale MD, Ranjeeta Mallick PhD, Louis-Philippe Boulet MD, Samir Gupta MD 

Edition: VOLUME 158, ISSUE 2, P479-490

Link to the article: https://doi.org/10.1016/j.chest.2020.03.052

Common abbreviations used in this study and blog post include PFT= pulmonary function testing, BDR= bronchodilator response and MCT= methacholine challenge testing (p.479).

Reasons you may find this article interesting:

  • It is on asthma which impacts many individuals in the population (“the third most common chronic disease in adults” p.480).
  • This article involves many recognisable and respectable experts.  The authors of this study have also taken part in many other research projects as well.  For my Canadian followers, many of these authors work in Canada!  I have been lucky enough to attend and enjoy talks, in person and virtually, by Dr. Shawn Aaron, Dr. Gonzalo G. Alvarez and Dr. Samir Gupta. 
  • There were follow up testings to assess the accuracy and consistency of the findings.  
  • This article is an excellent reminder for clinicians who order these tests to properly instructs patients to prepare for PFT and MCT.  Variability in MCT results based on seasons, environmental allergies, and impacts of other medications are important considerations.
  • This is a well-written article.  There is a nice flow that guides the reader through the method and the reasoning behind those decisions.  The results, conclusions and reflections are also nicely done.

My reflections and thoughts after reading this article

If you have almost no time to read the full article: Firstly, make time as this is a great article.  Secondly, if you still don’t have time then check out the ‘Take-home Point’ on the second page of the article where authors have included a quick summary and conclusions from this article (p.480).

I am worried that many patients may go undiagnosed or misdiagnosed.  Asthma can be properly managed;  Prolonged uncontrolled asthma can lead to more frequent exacerbations but also permanent changes to the lungs.  

As respiratory health community and excerpts, we need to educate clinicians and patients so they get tested.  Also, we need to raise the minimum standard so testing gets performed by trained individuals who have access to proper, accurate and well-maintained equipment. In addition, we have to make sure these clinicians know how to interpret and follow up with patients correctly.   For example, not to just rely on a pre-spirometry.  In case post-spirometry was done, we need to have knowledgeable clinicians who don’t automatically exclude asthma when no significant improvement was evident.  We need clinicians who know the importance of MCT, and organizations to support the costs related to the testing.  Besides, we want clinicians to understand that there are factors that could impact the MCT outcomes. 6.9% of participants who initially had a negative MCT end up having a positive reaction in the follow-up testing and 55.6% of those who initially had a positive MCT end up having a negative one in the follow-up testing ( Figure 2B, p.484).   On the bigger image, it is essential to understand that PFT and MCT are not the ultimate answers and they are just assessment tools that need to be tied with other clinical assessments and evidence. 

What are your thoughts on this?

Happy learning and reading!

Farzad Refahi

September 1st, 2020

https://respiratory.blog/lets-read-an-article-a-month-september-2020/