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Let’s read an article a month –December 2020

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The cropped screenshot of the first page of the article. It also includes the URL or link to 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://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029208/

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

This month I found a great piece to share with you.  This one is a case study. The authors of this paper have tried to “report a case of a middle-aged lady who was initially misdiagnosed as having acute asthma after brief tracheal intubation” (p.1). 

Tracheal stenosis mimicking severe acute asthma

Ali Bin Sarwar Zubairi, Babar Dildar, Shahid Javed Husain and Mohammad Faisal Khan

BMJ Case Rep. 2010; 2010: bcr1220092517.

Link to the article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029208/pdf/bcr.12.2009.2517.pdf

Reasons you may find this article interesting 

  • Tracheal stenosis post intubation is rare but it can happen.  To make the case even rarer, this lady was intubated for less than 48 hours. 
  • This article includes images that are interesting to view.  Two are from the bronchoscopy view of the narrowing (Figures 1 and 2. on pages 2 and 3).  The other image is a CT scan of the neck which shows the tracheal stenosis (Figure 3 page 4).  I greatly enjoyed seeing the visual aspect of this case!
  • I enjoyed reading the differential diagnosis from her ER visit:
    “New-onset severe asthma, bilateral vocal-cord paralysis, foreign-body aspiration, tracheal tumours, post-intubation/tracheostomy tracheal stricture, Wegener’s granulomatosis, obstruction of trachea or mainstem bronchi due to external compression from mediastinal tumours or adenopathy” (p.2).

I encourage you to read this interesting and short case study as the authors also review the potential reasons why this stenosis occurred and also the potential treatment options.

If you enjoyed this article, consider liking this blog post and sharing it with others who may benefit from it.

Happy learning and reading!

Farzad Refahi

December 1st, 2020https://respiratory.blog/lets-read-an-article-a-month-december-2020/


Happy learning and reading!

Farzad Refahi
December 1st, 2020
https://respiratory.blog/lets-read-an-article-a-month-december-2020/

Let’s read an article a month – November 2020

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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/56/2/2000418.full.pdf

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

This month I found a great piece to share with you.  This one falls under COPD. The objective of this paper is to “ assess the role of sensitisation on clinical outcomes in COPD using a large Asian cohort recruited across three countries, and, for the first time, assess the influence of environmental allergen exposure using a metagenomics sequencing approach.” (p2).

Environmental fungal sensitisation associates with poorer clinical outcomes in COPD

By:  Pei Yee Tiew, Fanny Wai San Ko, Sze Lei Pang, Sri Anusha Matta, Yang Yie Sio, Mau Ern Poh, Kenny J.X. Lau, Micheál Mac Aogáin, Tavleen Kaur Jaggi, Fransiskus Xaverius Ivan, Nicolas E. Gaultier, Akira Uchida, Daniela I. Drautz-Moses, Huiying Xu, Mariko Siyue Koh, David Shu Cheong Hui, Augustine Tee, John Arputhan Abisheganaden, Stephan C. Schuster, Fook Tim Chew, and Sanjay H. Chotirmall

European Respiratory Journal 2020 56: 2000418; DOI: 10.1183/13993003.00418-2020 https://erj.ersjournals.com/content/56/2/2000418?etoc

Commonly used abbreviations in this article include home dust mite (HDM) and Global Initiative for Chronic Obstructive Lung Disease (GOLD).

When it comes to restriction to environmental sensitivities, asthma is the first in my mind.  This article reminded me that people with COPD may also benefit from the identification of their sensitivities and in turn limiting their exposure to them.

Top 3 Reasons why I enjoyed this article

>> Individual care. There are so many variances in personal experiences with diseases. This article is an example of this.  “Sensitisation responses and their respective allergen profiles exhibit geographical variation, largely determined by climate, environment, genetics, cultural and social practices and account, at least in part, for the variable reports in the COPD literature“ (p9).

>> I value the effort by these authors to exclude asthma/ACOS patients as it increases the value and accuracy of their study.

>>  How caring for patients, especially those prone to exacerbations may take indoor and outdoor irritants into consideration:  “… we observe that the outdoor and indoor (home) environment serves as an important reservoir of fungal allergen exposure translating to sensitisation responses to outdoor air fungi in a subgroup of COPD patients. Indoor (home) environments demonstrating a higher fungal allergen burden associate with greater COPD symptoms and poorer lung function illustrating the importance of environmental exposures on COPD outcomes.” (p9)

This article is a great reminder of how we need to look at each patient as a person with a unique circumstance, genes, environments and living space.  With a better understanding of the impact of fungal allergen exposure in some patients with COPD, clinicians have more variables to assess and monitor. 

Happy learning and reading!

Farzad Refahi

November 1st, 2020

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

Let’s read an article a month – October 2020

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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?

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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

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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/