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In 2012 we received a grant from the Veterans Health Administration Office of Specialty Care entitled, “Patient-Centered Model for the Management of Chronic Obstructive Pulmonary Disease.” The grant’s goals were to enhance the recognition and diagnosis of COPD and implement a Patient-Centered Model for the Management of COPD. As the work on that proposal progressed, we realized that providers did not have an up-to-date, comprehensive, easily read, “how to” manual for the management of COPD despite all the advances in COPD care that have occurred over the past 5 years. Consensus documents such as the VA-DOD Guidelines were abbreviated summaries that were rarely used. From those discussions, the concept for this volume, a COPD Primer, developed. The goal was to develop a practical book that concisely presented COPD to providers with sufficient background and explanation of the physiologic and scientific rationale for various management strategies without becoming an esoteric academic work. We hope that this COPD Primer has achieved that goal and will be a useful, practical text for practitioners and medical trainees alike. The COPD Primer begins with an examination of what COPD is; it is really a syndrome, a constellation of historical features and clinical, physiologic, and radiographic findings. However, those elements come together in many different ways to create multiple different COPD phenotypes that are only now being recognized and used to define specific management strategies. COPD research has progressed beyond the simple classification of “blue bloaters” and “pink puffers.” Next, the epidemiology and economic consequences of COPD are reviewed. Bill Eschenbacher presents an approach to the patient with respiratory symptoms with detailed discussions of pulmonary function testing and how airflow limitation/obstruction is identified by spirometry and the use of lung imaging to identify individuals with COPD. Michael Borchers and Gregory Motz summarize current evidence implicating genetics, proteolytic imbalance, oxidative stress, inflammation, occupational and environmental exposures, and innate and adaptive immune function in the pathogenesis of COPD and the implication of these findings to future treatments. The single most important intervention in the prevention and treatment of COPD is smoking cessation. Shari Altum, Katherine Butler, and Rachel Juran present a practical approach to smoking cessation utilizing motivational interviewing in combination with pharmacologic interventions. Then, they expand upon these concepts to provide practitioners with convenient, realistic suggestions to encourage patient self-management in all aspects of COPD care and overall health. Ahsan Zafar reviews the natural history, recently described COPD phenotypes, and gender differences that clearly illustrate the broad spectrum of disease that comprises the term, COPD. The cover illustration highlights Dr. Zafar’s creative and artistic talents. The extensive nonpulmonary aspects of COPD are reviewed by Ralph Panos in an examination of COPD’s multi-organ manifestations. Next, the effect of COPD on sleep and the overlap syndrome, the concurrence of COPD and obstructive sleep apnea, and its consequences are presented. Jean Elwing examines the effect of COPD on the pulmonary vasculature with a detailed discussion of the evaluation and management of pulmonary hypertension associated with COPD. COPD’s effects on psychosocial functioning and familial interactions are presented by Mary Panos and Ralph Panos. The focus of the Primer then shifts from manifestations to treatment with a discussion of stable COPD management. With the current plethora of devices for delivering respiratory medications, it is difficult for both patients and providers to sustain knowledge of their proper use. Aaron Mulhall presents a practical guide to correct inhaler use that reviews all the current devices. Folarin Sogbetun then reviews the management of outpatient COPD exacerbations and Nishant Gupta discusses the approach to the patient hospitalized with COPD. Because patients with COPD often see multiple subspecialty physicians in addition to their primary care providers, interdisciplinary communication and coordination of care is essential for their management; Sara Krzywkowski-Mohn reviews the interactions between primary and specialty care for the patient with COPD with suggestions for improved communication and care coordination. Finally, advance care planning including palliative care and hospice is reviewed with a discussion of how end stage COPD affects not only the patient but also their family and social network. This COPD Primer incorporates the knowledge that we have learned over the past several years during the development and implementation of a patient-centered model for the management of COPD. It was written with the explicit goal of assisting both the practicing provider and medical trainee in the care of patients with COPD.
This book provides teaching scripts for medical educators in internal medicine and coaches them in creating their own teaching scripts. Every year, thousands of attending internists are asked to train the next generation of physicians to master a growing body of knowledge. Formal teaching time has become increasingly limited due to rising clinical workload, medical documentation requirements, duty hour restrictions, and other time pressures. In addition, today’s physicians-in-training expect teaching sessions that deliver focused, evidence-based content that is integrated into clinical workflow. In keeping with both time pressures and trainee expectations, academic internists must be prepared to effectively and efficiently teach important diagnostic and management concepts. A teaching script is a methodical and structured plan that aids in effective teaching. The teaching scripts in this book anticipate learners’ misconceptions, highlight a limited number of teaching points, provide evidence to support the teaching points, use strategies to engage the learners, and provide a cognitive scaffold for teaching the topic that the teacher can refine over time. All divisions of internal medicine (e.g. cardiology, rheumatology, and gastroenterology) are covered and a section on undifferentiated symptom-based presentations (e.g. fatigue, fever, and unintentional weight loss) is included. This book provides well-constructed teaching scripts for commonly encountered clinical scenarios, is authored by experienced academic internists and allows the reader to either implement them directly or modify them for their own use. Each teaching script is designed to be taught in 10-15 minutes, but can be easily adjusted by the reader for longer or shorter talks. Teaching Scripts in Internal Medicine is an ideal tool for internal medicine attending physicians and trainees, as well as physician’s assistants, nurse practitioners, and all others who teach and learn internal medicine.
Sally Everett was about to turn fifty. A single parent and successful lawyer, she was, seemingly, a picture of health. She ate right, she didn't smoke, she was almost never sick, and she exercised regularly. Then a simple cold turned into pneumonia. She was hospitalized and x-rays were taken of her lungs. Subsequent blood tests clinched the diagnosis. Sally had chronic obstructive pulmonary disease (COPD) caused by Alpha-1, a genetic abnormality more common than cystic fibrosis. Her prognosis was, at best, ten years. At first Sally decided she could and would face this alone. Her subsequent struggles, candidly recounted here, are an invaluable resource for anyone with Alpha-1, COPD, or any chronic disease for that matter. Always careful to point out that your experience may not replicate hers, Sally walks you through her initial reaction to her diagnoses; learning how to cope; the role of exercise, oxygen and other therapies; genetic testing; clinical trials; facing depression and disability; and even end of life planning --
This book provides an overview of key issues with regards to implementing telemedicine services as well as an in depth overview of telemedicine in pulmonary, critical care, and sleep medicine. Topics range from specific practices to program development. Telemedicine has experienced explosive growth in recent years and yet, implementing telemedicine solutions is complex with substantial regulatory, legal, financial, logistical, and intra-organization/intra-personal barriers that must be overcome. This book provides the necessary information and guidance to address those complex issues. This book is broadly divided into two parts 1) a primer on requisite steps before embarking on telemedicine service development and 2) specific applications and examples where telemedicine is successfully utilized to improve quality of care in pulmonary, critical care, and sleep medicine. The first part includes coverage of telemedicine and finance, regulatory and legal issues, and program development. The second part delves into specifics with information on ambulatory telemedicine programs, inpatient consultations, and tele-ICU programs. All chapters are written by interprofessional authors that are leaders in the field of telemedicine with extensive knowledge of diverse telemedicine programs and robust real-world experience on the topic. This is an ideal guide for telehealth program managers, and pulmonary, critical care, and sleep medicine professionals interested in improving their telehealth practice.
This report provides a critical review of toxicologic, epidemiologic, and other relevant data on jet-propulsion fuel 8, a type of fuel in wide use by the U.S. Department of Defense (DOD), and an evaluation of the scientific basis of DOD's interim permissible exposure level of 350 mg/m3
Chronic Obstructive Pulmonary Disease (COPD) is growing in reocnition as a major chronic disease, and a key cause of acute medical admissions. It kills approximately 30,000 patients each year in England and Wales alone, and is set to be the third commonest cause of death by 2020 globally. This pocketbook is a concise companion for all health care professionals who come into contact with patients wtih COPD. It covers the full spectrum of COPD management, ranging from smoking cessation to advanced COPD, bridging both the primary and secondary care aspects of treatment and discussing the latest advances in our understanding of the pathophysiology and new drug treatments of this disease. This compact volume of the Oxford Respiratory Medicine Library summarizes up-to-date literature in a style that will have direct clinical application to busy health care professionals.
Chronic Obstructive Pulmonary Disease Exacerbations covers the definition, diagnosis, epidemiology, mechanisms, and treatment associated with COPD exacerbations. This text also addresses imaging and how it plays a pivotal role in the diagnosis and study of exacerbations.Written by today's top experts, Chronic Obstructive Pulmonary Disease Exacerbat
The newly introduced Specialty Certificate Examinations are a compulsory component of assessment for all UK medical trainees and represent the final examination barrier before getting the certificate of completion of training. This book provides a unique exam-specific revision guide for the Respiratory specialty certificate exam. Comprising of best of five test multiple choice questions and revision notes to facilitate targeted study, Revision Notes for the Respiratory Medicine Specialty Certificate Examination is the only book you need to prepare for this important examination. Questions are based around clinical scenarios and supplemented with images of radiological investigations such as x-rays, and lung function tests. Each question is structured as in the exam itself. The second half of the book comprises of a series of tutorials covering key areas and difficult concepts assessed in the examination including respiratory infection, respiratory malignancy, industrial lung disease, sleep disorders, standard respiratory tests and medical statistics. The combined approach allows trainees to become acquainted with the "best of five" format and facilitate recognition of areas of weakness and targeted study.
This book reviews the basics of pulmonary functional imaging using new CT and MR techniques and describes the clinical applications of these techniques in detail. The intention is to equip readers with a full understanding of pulmonary functional imaging that will allow optimal application of all relevant techniques in the assessment of a variety of diseases, including COPD, asthma, cystic fibrosis, pulmonary thromboembolism, pulmonary hypertension, lung cancer and pulmonary nodule. Pulmonary functional imaging has been promoted as a research and diagnostic tool that has the capability to overcome the limitations of morphological assessments as well as functional evaluation based on traditional nuclear medicine studies. The recent advances in CT and MRI and in medical image processing and analysis have given further impetus to pulmonary functional imaging and provide the basis for future expansion of its use in clinical applications. In documenting the utility of state-of-the-art pulmonary functional imaging in diagnostic radiology and pulmonary medicine, this book will be of high value for chest radiologists, pulmonologists, pulmonary surgeons, and radiation technologists.