135 results on '"James, K."'
Search Results
2. Development and Validation of a Risk Assessment Model for Pulmonary Nodules Using Plasma Proteins and Clinical Factors
- Author
-
Vachani, Anil, Lam, Stephen, Massion, Pierre P., Brown, James K., Beggs, Michael, Fish, Amanda L., Carbonell, Luis, Wang, Shan X., and Mazzone, Peter J.
- Published
- 2023
- Full Text
- View/download PDF
3. Prevalence of Alpha-1 Antitrypsin Deficiency, Self-Reported Behavior Change, and Health Care Engagement Among Direct-to-Consumer Recipients of a Personalized Genetic Risk Report
- Author
-
Agee, Michelle, Aslibekyan, Stella, Auton, Adam, Babalola, Elizabeth, Bell, Robert K., Bielenberg, Jessica, Bryc, Katarzyna, Bullis, Emily, Cameron, Briana, Coker, Daniella, Partida, Gabriel Cuellar, Dhamija, Devika, Das, Sayantan, Elson, Sarah L., Filshtein, Teresa, Fletez-Brant, Kipper, Fontanillas, Pierre, Freyman, Will, Gandhi, Pooja M., Heilbron, Karl, Hicks, Barry, Hinds, David A., Huber, Karen E., Jewett, Ethan M., Jiang, Yunxuan, Kleinman, Aaron, Kukar, Katelyn, Lane, Vanessa A., Lin, Keng-Han, Lowe, Maya, Luff, Marie K., McCreight, Jennifer C., McIntyre, Matthew H., McManus, Kimberly F., Micheletti, Steven J., Moreno, Meghan E., Mountain, Joanna L., Mozaffari, Sahar V., Nandakumar, Priyanka, Noblin, Elizabeth S., O’Connell, Jared, Petrakovitz, Aaron A., Poznik, G. David, Schumacher, Morgan, Shastri, Anjali J., Shelton, Janie F., Shi, Jingchunzi, Shringarpure, Suyash, Tian, Chao, Tran, Vinh, Tung, Joyce Y., Wang, Xin, Wang, Wei, Weldon, Catherine H., Wilton, Peter, Ashenhurst, James R., Nhan, Hoang, Wu, Shirley, and Stoller, James K.
- Published
- 2022
- Full Text
- View/download PDF
4. Serum IgG Levels and Risk of COPD Hospitalization: A Pooled Meta-analysis
- Author
-
Leitao Filho, Fernando Sergio, Mattman, Andre, Schellenberg, Robert, Criner, Gerard J., Woodruff, Prescott, Lazarus, Stephen C., Albert, Richard K., Connett, John, Han, Meilan K., Gay, Steven E., Martinez, Fernando J., Fuhlbrigge, Anne L., Stoller, James K., MacIntyre, Neil R., Casaburi, Richard, Diaz, Philip, Panos, Ralph J., Cooper, J. Allen, Jr., Bailey, William C., LaFon, David C., Sciurba, Frank C., Kanner, Richard E., Yusen, Roger D., Au, David H., Pike, Kenneth C., Fan, Vincent S., Leung, Janice M., Man, Shu-Fan Paul, Aaron, Shawn D., Reed, Robert M., and Sin, Don D.
- Published
- 2020
- Full Text
- View/download PDF
5. Association of Guideline-Recommended COPD Inhaler Regimens With Mortality, Respiratory Exacerbations, and Quality of Life: A Secondary Analysis of the Long-Term Oxygen Treatment Trial
- Author
-
Keller, Thomas, Spece, Laura J., Donovan, Lucas M., Udris, Edmunds, Coggeshall, Scott S., Griffith, Matthew, Bryant, Alexander D., Casaburi, Richard, Cooper, J. Allen, Jr., Criner, Gerard J., Diaz, Philip T., Fuhlbrigge, Anne L., Gay, Steven E., Kanner, Richard E., Martinez, Fernando J., Panos, Ralph J., Shade, David, Sternberg, Alice, Stibolt, Thomas, Stoller, James K., Tonascia, James, Wise, Robert, Yusen, Roger D., Au, David H., and Feemster, Laura C.
- Published
- 2020
- Full Text
- View/download PDF
6. Response
- Author
-
Stoller, James K., primary, Ashenhurst, James R., additional, Nhan, Hoang, additional, Shelton, Janie F., additional, Wu, Shirley, additional, Tung, Joyce Y., additional, and Elson, Sarah L., additional
- Published
- 2023
- Full Text
- View/download PDF
7. Prevalence of Alpha-1 Antitrypsin Deficiency, Self-Reported Behavior Change, and Health Care Engagement Among Direct-to-Consumer Recipients of a Personalized Genetic Risk Report
- Author
-
James R. Ashenhurst, Hoang Nhan, Janie F. Shelton, Shirley Wu, Joyce Y. Tung, Sarah L. Elson, James K. Stoller, Michelle Agee, Stella Aslibekyan, Adam Auton, Elizabeth Babalola, Robert K. Bell, Jessica Bielenberg, Katarzyna Bryc, Emily Bullis, Briana Cameron, Daniella Coker, Gabriel Cuellar Partida, Devika Dhamija, Sayantan Das, Teresa Filshtein, Kipper Fletez-Brant, Pierre Fontanillas, Will Freyman, Pooja M. Gandhi, Karl Heilbron, Barry Hicks, David A. Hinds, Karen E. Huber, Ethan M. Jewett, Yunxuan Jiang, Aaron Kleinman, Katelyn Kukar, Vanessa A. Lane, Keng-Han Lin, Maya Lowe, Marie K. Luff, Jennifer C. McCreight, Matthew H. McIntyre, Kimberly F. McManus, Steven J. Micheletti, Meghan E. Moreno, Joanna L. Mountain, Sahar V. Mozaffari, Priyanka Nandakumar, Elizabeth S. Noblin, Jared O’Connell, Aaron A. Petrakovitz, G. David Poznik, Morgan Schumacher, Anjali J. Shastri, Jingchunzi Shi, Suyash Shringarpure, Chao Tian, Vinh Tran, Xin Wang, Wei Wang, Catherine H. Weldon, and Peter Wilton
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,Genotype ,Critical Care and Intensive Care Medicine ,Direct-To-Consumer Screening and Testing ,alpha 1-Antitrypsin Deficiency ,Health care ,Prevalence ,medicine ,Humans ,Genetic Testing ,Allele frequency ,Genetic testing ,COPD ,Alpha 1-antitrypsin deficiency ,medicine.diagnostic_test ,business.industry ,Behavior change ,Primary care physician ,Odds ratio ,Middle Aged ,medicine.disease ,Female ,Self Report ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Alpha-1 antitrypsin deficiency (AATD) is an autosomal co-dominant condition that predisposes to emphysema, cirrhosis, panniculitis, and vasculitis. Under-recognition has prompted efforts to enhance early detection and testing of at-risk individuals. Direct-to-consumer (DTC) genetic testing represents an additional method of detection. Research Question The study addressed three questions: 1) Does a DTC testing service identify previously undetected individuals with AATD? 2) What was the time interval between initial AATD-related symptoms and initial diagnosis of AATD in such individuals? and 3) What was the behavioral impact of learning about a new diagnosis of AATD through a DTC test? Study Design and Methods In this cross-sectional study, 195,014 individuals responded to a survey within the 23andMe, Inc. research platform. Results Among 195,014 study participants, the allele frequency for either the PI*S and PI*Z AATD variants was 21.6% (6.5% for PI*Z and 15.1% for PI*S); 0.63% were PI*ZZ, half of whom reported having a physician confirm the diagnosis. Approximately 27% of those with physician-diagnosed AATD reported first becoming aware of AATD through the DTC test. Among those newly-aware participants, the diagnostic delay interval was 22.3 years. Participants frequently shared their DTC test results with healthcare providers (HCPs) and the reported impact of learning a diagnosis of AATD was high. For example, 51.1% of PI*ZZ individuals shared their DTC result with an HCP. The odds ratio for PI*ZZ smokers to report smoking reduction as a result of receiving the DTC result was 1.7 [CI 1.4, 2.2] compared to those without a Z allele and for reduced alcohol consumption was 4.0 [CI 2.6, 5.9]. Interpretation In this largest available report on DTC testing for AATD, this test, in combination with clinical follow-up, can help to identify previously undiagnosed AATD patients. Moreover, receipt of the DTC AATD report was associated with positive behavior change, especially among those with risk variants.
- Published
- 2022
8. Development and Validation of a Risk Assessment Model for Pulmonary Nodules Using Plasma Proteins and Clinical Factors
- Author
-
Vachani, Anil, primary, Lam, Stephen, additional, Massion, Pierre P., additional, Brown, James K., additional, Beggs, Michael, additional, Fish, Amanda L., additional, Carbonell, Luis, additional, Wang, Shan X., additional, and Mazzone, Peter J., additional
- Published
- 2022
- Full Text
- View/download PDF
9. A 21-Year-Old Man With Dyspnea, Wheezing, and Cough
- Author
-
Uddalak, Majumdar, Umur, Hatipoğlu, and James K, Stoller
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Total Lung Capacity ,Vital Capacity ,Antibodies, Monoclonal, Humanized ,Critical Care and Intensive Care Medicine ,Asthma ,Respiratory Function Tests ,Diagnosis, Differential ,Residual Volume ,Young Adult ,Dyspnea ,Cough ,Forced Expiratory Volume ,alpha 1-Antitrypsin ,alpha 1-Antitrypsin Deficiency ,Humans ,Pulmonary Diffusing Capacity ,Anti-Asthmatic Agents ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Respiratory Sounds - Abstract
A 21-year-old male college student presented for a second opinion with low alpha-1 antitrypsin (AAT) levels and complaints of episodic dyspnea with wheezing and cough. He was a never smoker with a medical history of frequent respiratory tract infections in early childhood and allergy to dander, dust mites, peanuts, and eggs. There was no travel history outside of the continental United States. His mother had asthma. His symptoms were not controlled on inhaled corticosteroids and bronchodilators. His AAT genotype was found to be PI∗SZ, and augmentation therapy (with pooled human-plasma derived AAT) was recommended locally.
- Published
- 2022
10. Strategic Planning for the Chest Clinician
- Author
-
James K Stoller, Peter Rea, and Raed A. Dweik
- Subjects
Pulmonary and Respiratory Medicine ,Process management ,Process (engineering) ,Metaphor ,media_common.quotation_subject ,Organizational culture ,Context (language use) ,Plan (drawing) ,Critical Care and Intensive Care Medicine ,GeneralLiterature_MISCELLANEOUS ,03 medical and health sciences ,0302 clinical medicine ,Critical success factor ,Humans ,Organizational Objectives ,Medicine ,030212 general & internal medicine ,media_common ,Strategic planning ,Academic Medical Centers ,business.industry ,Organizational Culture ,Strategic Planning ,Intensive Care Units ,030228 respiratory system ,Element (criminal law) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Having a strategic plan is important to reach organizational goals. Equally important is knowing how to develop and execute that plan. Also, such plans evolve and are executed in the context of the organization's culture, which is another critical success element. Using a garden metaphor, the arrangement of the plants in the garden is like the strategy. With a good strategy, the arrangement of the plants will be appealing. But the soil in the garden is the organizational culture. If the soil is fouled, no plants will grow, regardless of how appealing the garden plan. This "How We Do It" paper addresses the issue of developing and executing a strategy and then, in a companion piece, the related process of envisioning and cultivating an organizational culture. The strategic planning discussion invokes a "real-win-worth" paradigm to address the real-world case of assuring uniform, best-in-class ICU outcomes across multiple ICUs in a large academic medical center system.
- Published
- 2021
11. Development and Validation of a Risk Assessment Model for Pulmonary Nodules Using Plasma Proteins and Clinical Factors
- Author
-
Anil Vachani, Stephen Lam, Pierre P. Massion, James K. Brown, Michael Beggs, Amanda L. Fish, Luis Carbonell, Shan X. Wang, and Peter J. Mazzone
- Subjects
Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine - Abstract
Deficiencies in risk assessment for patients with pulmonary nodules (PNs) contribute to unnecessary invasive testing and delays in diagnosis.What is the accuracy of a novel PN risk model that includes plasma proteins and clinical factors? How does the accuracy compare with that of an established risk model?Based on technology using magnetic nanosensors, assays were developed with seven plasma proteins. In a training cohort (n = 429), machine learning approaches were used to identify an optimal algorithm that subsequently was evaluated in a validation cohort (n = 489), and its performance was compared with the Mayo Clinic model.In the training set, we identified an support vector machine algorithm that included the seven plasma proteins and six clinical factors that demonstrated an area under the receiver operating characteristic curve of 0.87 and met other selection criteria. The resulting risk reclassification model (RRM) was used to recategorize patients with a pretest risk of between 10% and 84%, and its performance was assessed across five risk strata (low, ≤ 10%; moderate, 10%-34%; intermediate, 35%-70%; high, 71%-84%; very high,85%). Stratification by the RRM decreased the proportion of intermediate-risk patients from 26.7% to 10.8% (P .001) and increased the low-risk and high-risk strata from 16.8% to 21.9% (P .001) and from 3.7% to 12.1% (P .001), respectively. Among patients classified as low risk by the RRM and Mayo Clinic model, the corresponding true-negative to false-negative ratios were 16.8 and 19.5, respectively. Among patients classified as very high risk by the RRM and Mayo Clinic model, the corresponding true-positive to false-positive ratios were 28.5 and 17.0, respectively. Compared with the Mayo Clinic model, the RRM provided higher specificity at the low-risk threshold and higher sensitivity at the very high-risk threshold.The RRM accurately reclassified some patients into low-risk and very high-risk categories, suggesting the potential to improve PN risk assessment.
- Published
- 2022
12. Creating an Organizational Culture for the Chest Physician
- Author
-
James K. Stoller, Peter Rea, and Raed A. Dweik
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,media_common.quotation_subject ,Organizational culture ,Compassion ,Psychological safety ,Public relations ,Critical Care and Intensive Care Medicine ,Organizational performance ,Critical success factor ,Medicine ,Justice (ethics) ,Open communication ,Cardiology and Cardiovascular Medicine ,business ,media_common ,Courage - Abstract
Organizational culture matters Culture is a key driver of organizational performance and underpins strategy. As previously discussed, if the strategy is the plants and the garden plan for a garden, the culture is the soil. Without a healthy culture, nothing will grow, irrespective of how well planned the garden or how beautiful the individual flowers. Using the case of establishing the culture in an institute at the Cleveland Clinic, the article examines an approach to establishing and maintaining an organizational culture. Anchors for this process are a situational assessment of the current culture as a new leader steps in and mindfulness by the leader of how members of the institute should experience the organization. Critical success factors include open communication and establishing psychological safety as well as modeling integrity. Fundamentally, when cultures are grounded in the seven classical virtues—trust, compassion, courage, justice, wisdom, temperance, and hope—they are best positioned to unleash the discretionary effort of its members. When people expend discretionary effort, they do the right thing when nobody is watching and the performance drivers are internal motivation and alignment with mission rather than external drivers to seek reward (carrots) or to avoid punishment (sticks).
- Published
- 2021
13. Emotional Intelligence
- Author
-
James K Stoller
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Emotional intelligence ,Applied psychology ,Rubric ,Customer relationship management ,Burnout ,Critical Care and Intensive Care Medicine ,Medicine chest ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Health care ,Critical success factor ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Organizational effectiveness - Abstract
Emotional intelligence (EI) has become widely appreciated as an important leadership attribute, in business, education and, increasingly, in health care. Defined as "the capacity to understand your own and others' emotions and to motivate and develop yourself and others in service of improved work performance and enhanced organizational effectiveness," EI is correlated with a number of success attributes in several sectors; for example, in business, with enhanced business performance and enhanced personal career success, and in health care, with enhanced patient satisfaction, lower burnout, lower litigation risk, and enhanced leadership success. While multiple models of EI have evolved, perhaps the most popular model is framed around four general rubrics with component competencies. The general rubrics are: self-awareness, self-management, social awareness, and relationship management. EI can be measured by using available instruments, and it can be learned and taught. Indeed, teaching EI has become increasingly common in health-care organizations in service of improving health care and health-care leadership. Although more research is needed, ample evidence supports the notion that EI is a critical success element for success as a health-care leader, especially because EI competencies differ markedly from the clinical and scientific skills that are core to being a clinician and/or investigator. This review of EI presents evidence in support of the relevance of EI to health care and health-care leadership, discusses how and when EI can be developed among health-care providers, and considers remaining questions.
- Published
- 2021
14. Response
- Author
-
James K. Stoller, James R. Ashenhurst, Hoang Nhan, Janie F. Shelton, Shirley Wu, Joyce Y. Tung, and Sarah L. Elson
- Subjects
Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine - Published
- 2023
15. Leadership Essentials for CHEST Medicine Professionals
- Author
-
James K. Stoller
- Subjects
Pulmonary and Respiratory Medicine ,Strategic thinking ,Leadership development ,business.industry ,Emotional intelligence ,Lifelong learning ,Organizational culture ,Public relations ,Critical Care and Intensive Care Medicine ,Medicine chest ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Health care ,Medicine ,Leadership style ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
In the context that leadership matters and that leadership competencies differ from those needed to practice medicine or conduct research, developing leadership competencies for physicians is important. Indeed, effective leadership is needed ubiquitously in health care, both at the executive level and at the bedside (eg, leading clinical teams and problem-solving on the ward). Various leadership models have been proposed, most converging on common attributes, like envisioning a new and better future state, inspiring others around this shared vision, empowering others to effect the vision, modeling the expected behaviors, and engaging others by appealing to shared values. Attention to creating an organizational culture that is informed by the seven classic virtues (trust, compassion, courage, justice, wisdom, temperance, and hope) can also unleash discretionary effort in the organization to achieve high performance. Health care-specific leadership competencies include: technical expertise, not only in one's clinical/scientific arena to garner colleagues' respect but also regarding operations; strategic thinking; finance; human resources; and information technology. Also, knowledge of the regulatory and legislative environments of health care is critical, as is being a problem-solver and lifelong learner. Perhaps most important to leadership in health care, as in all sectors, is having emotional intelligence. A spectrum of leadership styles has been described, and effective leaders are facile in deploying each style in a situationally appropriate way. Overall, leadership competencies can be developed, and leadership development programs are signature features of leading health-care organizations.
- Published
- 2021
16. Prevalence of Alpha-1 Antitrypsin Deficiency, Self-Reported Behavior Change, and Health Care Engagement Among Direct-to-Consumer Recipients of a Personalized Genetic Risk Report
- Author
-
Ashenhurst, James R., primary, Nhan, Hoang, additional, Shelton, Janie F., additional, Wu, Shirley, additional, Tung, Joyce Y., additional, Elson, Sarah L., additional, Stoller, James K., additional, Agee, Michelle, additional, Aslibekyan, Stella, additional, Auton, Adam, additional, Babalola, Elizabeth, additional, Bell, Robert K., additional, Bielenberg, Jessica, additional, Bryc, Katarzyna, additional, Bullis, Emily, additional, Cameron, Briana, additional, Coker, Daniella, additional, Partida, Gabriel Cuellar, additional, Dhamija, Devika, additional, Das, Sayantan, additional, Filshtein, Teresa, additional, Fletez-Brant, Kipper, additional, Fontanillas, Pierre, additional, Freyman, Will, additional, Gandhi, Pooja M., additional, Heilbron, Karl, additional, Hicks, Barry, additional, Hinds, David A., additional, Huber, Karen E., additional, Jewett, Ethan M., additional, Jiang, Yunxuan, additional, Kleinman, Aaron, additional, Kukar, Katelyn, additional, Lane, Vanessa A., additional, Lin, Keng-Han, additional, Lowe, Maya, additional, Luff, Marie K., additional, McCreight, Jennifer C., additional, McIntyre, Matthew H., additional, McManus, Kimberly F., additional, Micheletti, Steven J., additional, Moreno, Meghan E., additional, Mountain, Joanna L., additional, Mozaffari, Sahar V., additional, Nandakumar, Priyanka, additional, Noblin, Elizabeth S., additional, O’Connell, Jared, additional, Petrakovitz, Aaron A., additional, Poznik, G. David, additional, Schumacher, Morgan, additional, Shastri, Anjali J., additional, Shi, Jingchunzi, additional, Shringarpure, Suyash, additional, Tian, Chao, additional, Tran, Vinh, additional, Wang, Xin, additional, Wang, Wei, additional, Weldon, Catherine H., additional, and Wilton, Peter, additional
- Published
- 2022
- Full Text
- View/download PDF
17. Serum IgG Levels and Risk of COPD Hospitalization
- Author
-
Shu Fan Paul Man, Kenneth C. Pike, Neil R. MacIntyre, James K. Stoller, Anne L. Fuhlbrigge, Robert M. Reed, Fernando J. Martinez, Richard E. Kanner, Janice M. Leung, Shawn D. Aaron, Roger D. Yusen, Andre Mattman, J. Allen D. Cooper, Richard Casaburi, William C. Bailey, Fernando Sergio Leitao Filho, Don D. Sin, David C. LaFon, Stephen C. Lazarus, Vincent S. Fan, MeiLan K. Han, David H. Au, Frank C. Sciurba, Gerard J. Criner, Ralph J. Panos, Philip T. Diaz, Richard K. Albert, Prescott G. Woodruff, John E. Connett, and R. Robert Schellenberg
- Subjects
Pulmonary and Respiratory Medicine ,COPD ,medicine.medical_specialty ,biology ,business.industry ,Critical Care and Intensive Care Medicine ,medicine.disease ,Azithromycin ,Immunoglobulin G ,3. Good health ,Hypogammaglobulinemia ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Interquartile range ,Simvastatin ,Meta-analysis ,Internal medicine ,biology.protein ,Medicine ,Cumulative incidence ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background Hypogammaglobulinemia (serum IgG levels Research Question To determine the relationship between hypogammaglobulinemia and the risk of hospitalization in patients with COPD. Study Design and Methods Serum IgG levels were measured on baseline samples from four COPD cohorts (n = 2,259): Azithromycin for Prevention of AECOPD (MACRO, n = 976); Simvastatin in the Prevention of AECOPD (STATCOPE, n = 653), Long-Term Oxygen Treatment Trial (LOTT, n = 354), and COPD Activity: Serotonin Transporter, Cytokines and Depression (CASCADE, n = 276). IgG levels were determined by immunonephelometry (MACRO; STATCOPE) or mass spectrometry (LOTT; CASCADE). The effect of hypogammaglobulinemia on COPD hospitalization risk was evaluated using cumulative incidence functions for this outcome and deaths (competing risk). Fine-Gray models were performed to obtain adjusted subdistribution hazard ratios (SHR) related to IgG levels for each study and then combined using a meta-analysis. Rates of COPD hospitalizations per person-year were compared according to IgG status. Results The overall frequency of hypogammaglobulinemia was 28.4%. Higher incidence estimates of COPD hospitalizations were observed among participants with low IgG levels compared with those with normal levels (Gray's test, P Interpretation Hypogammaglobulinemia is associated with a higher risk of COPD hospital admissions.
- Published
- 2020
18. Association of Guideline-Recommended COPD Inhaler Regimens With Mortality, Respiratory Exacerbations, and Quality of Life
- Author
-
Thomas Keller, Laura J. Spece, Lucas M. Donovan, Edmunds Udris, Scott S. Coggeshall, Matthew Griffith, Alexander D. Bryant, Richard Casaburi, J. Allen Cooper, Gerard J. Criner, Philip T. Diaz, Anne L. Fuhlbrigge, Steven E. Gay, Richard E. Kanner, Fernando J. Martinez, Ralph J. Panos, David Shade, Alice Sternberg, Thomas Stibolt, James K. Stoller, James Tonascia, Robert Wise, Roger D. Yusen, David H. Au, and Laura C. Feemster
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,COPD ,Exacerbation ,business.industry ,Hazard ratio ,Critical Care and Intensive Care Medicine ,medicine.disease ,Rate ratio ,Obstructive lung disease ,Hypoxemia ,Regimen ,Quality of life ,Internal medicine ,medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Although inhaled therapy reduces exacerbations among patients with COPD, the effectiveness of providing inhaled treatment per risk stratification models remains unclear. Research Question Are inhaled regimens that align with the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy associated with clinically important outcomes? Study Design and Methods We conducted secondary analyses of Long-term Oxygen Treatment Trial (LOTT) data. The trial enrolled patients with COPD with moderate resting or exertional hypoxemia between 2009 and 2015. Our exposure was the patient-reported inhaled regimen at enrollment, categorized as either aligning with, undertreating, or potentially overtreating per the 2017 GOLD strategy. Our primary composite outcome was time to death or first hospitalization for COPD. Additional outcomes included individual components of the composite outcome and time to first exacerbation. We generated multivariable Cox proportional hazard models across strata of GOLD-predicted exacerbation risk (high vs low) to estimate between-group hazard ratios for time to event outcomes. We adjusted models a priori for potential confounders, clustered by site. Results The trial enrolled 738 patients (73.4% men; mean age, 68.8 years). Of the patients, 571 (77.4%) were low risk for future exacerbations. Of the patients, 233 (31.6%) reported regimens aligning with GOLD recommendations; most regimens (54.1%) potentially overtreated. During a 2.3-year median follow-up, 332 patients (44.9%) experienced the composite outcome. We found no difference in time to composite outcome or death among patients reporting regimens aligning with recommendations compared with undertreated patients. Among patients at low risk, potential overtreatment was associated with higher exacerbation risk (hazard ratio, 1.42; 95% CI, 1.09-1.87), whereas inhaled corticosteroid treatment was associated with 64% higher risk of pneumonia (incidence rate ratio, 1.64; 95% CI, 1.01-2.66). Interpretation Among patients with COPD with moderate hypoxemia, we found no difference in clinical outcomes between inhaled regimens aligning with the 2017 GOLD strategy compared with those that were undertreated. These findings suggest the need to reevaluate the effectiveness of risk stratification model-based inhaled treatment strategies.
- Published
- 2020
19. A 21-Year-Old Man With Dyspnea, Wheezing, and Cough
- Author
-
Majumdar, Uddalak, primary, Hatipoğlu, Umur, additional, and Stoller, James K., additional
- Published
- 2022
- Full Text
- View/download PDF
20. Epidemiology of Adult Pleural Disease in the United States
- Author
-
Mummadi, Srinivas R., primary, Stoller, James K., additional, Lopez, Rocio, additional, Kailasam, Karthik, additional, Gillespie, Colin T., additional, and Hahn, Peter Y., additional
- Published
- 2021
- Full Text
- View/download PDF
21. Epidemiology of Adult Pleural Disease in the United States
- Author
-
Karthik Kailasam, Rocio Lopez, James K. Stoller, Peter Y. Hahn, Srinivas R. Mummadi, and Colin T. Gillespie
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,Pleural effusion ,Pleural Neoplasms ,Critical Care and Intensive Care Medicine ,Patient Readmission ,03 medical and health sciences ,Pleural disease ,Young Adult ,0302 clinical medicine ,Internal medicine ,Epidemiology ,medicine ,Malignant pleural effusion ,Humans ,030212 general & internal medicine ,Mesothelioma ,Empyema ,Aged ,business.industry ,Incidence ,Mesothelioma, Malignant ,Pneumothorax ,Retrospective cohort study ,Health Care Coalitions ,Tuberculosis, Pleural ,respiratory system ,Middle Aged ,Pleural Diseases ,medicine.disease ,United States ,respiratory tract diseases ,Pleural Effusion, Malignant ,Hospitalization ,Pleural Effusion ,surgical procedures, operative ,030228 respiratory system ,Female ,Health Expenditures ,Cardiology and Cardiovascular Medicine ,business - Abstract
Comprehensive US epidemiologic data for adult pleural disease are not available.What are the epidemiologic measures related to adult pleural disease in the United States?Retrospective cohort study using Healthcare Utilization Project databases (2007-2016). Adults (≥ 18 years of age) with malignant pleural mesothelioma, malignant pleural effusion, nonmalignant pleural effusion, empyema, primary and secondary spontaneous pneumothorax, iatrogenic pneumothorax, and pleural TB were studied.In 2016, ED treat-and-discharge (TD) visits totaled 42,215, accounting for charges of $286.7 million. In 2016, a total of 361,270 hospitalizations occurred, resulting in national costs of $10.1 billion. A total of 64,174 readmissions contributed $1.16 billion in additional national costs. Nonmalignant pleural effusion constituted 85.5% of ED TD visits, 63.5% of hospitalizations, and 66.3% of 30-day readmissions. Contemporary sex distribution (male to female ratio) in primary spontaneous pneumothorax (2.1:1) differs from older estimates (6.2:1). Decadal analyses of annual hospitalization rates/100,000 adult population (2007 vs 2016) showed a significant (P .001) decrease for malignant pleural mesothelioma (1.3 vs 1.09, respectively), malignant pleural effusion (33.4 vs 31.9, respectively), iatrogenic pneumothorax (17.9 vs 13.9, respectively), and pleural TB (0.20 vs 0.09, respectively) and an increase for empyema (8.1 vs 11.1, respectively) and nonmalignant pleural effusion (78.1 vs 100.1, respectively). Empyema hospitalizations have high costs per case ($38,591) and length of stay (13.8 days). The mean proportion of readmissions attributed to a pleural cause varied widely: malignant pleural mesothelioma, 49%; malignant pleural effusion, 45%; nonmalignant pleural effusion, 31%; empyema, 27%; primary spontaneous pneumothorax, 27%; secondary spontaneous pneumothorax, 27%; and iatrogenic pneumothorax, 20%. Secondary spontaneous pneumothorax had the shortest time to readmission in 2016 (10.3 days, 95% CI, 8.8-11.8 days).Significant epidemiologic trends and changes in various pleural diseases were observed. The analysis identifies multiple opportunities for improvement in management of pleural diseases.
- Published
- 2021
22. Creating an Organizational Culture for the Chest Physician
- Author
-
Stoller, James K., primary, Dweik, Raed, additional, and Rea, Peter, additional
- Published
- 2021
- Full Text
- View/download PDF
23. Emotional Intelligence
- Author
-
Stoller, James K., primary
- Published
- 2021
- Full Text
- View/download PDF
24. Response
- Author
-
Stoller, James K., Banga, Amit, and Mehta, Atul C.
- Published
- 2015
- Full Text
- View/download PDF
25. Rebuttal From Dr Mehta et al
- Author
-
Mehta, Atul C., Banga, Amit, and Stoller, James K.
- Published
- 2015
- Full Text
- View/download PDF
26. COUNTERPOINT: Are the CHEST Guidelines Global in Coverage? No
- Author
-
Mehta, Atul C., Banga, Amit, and Stoller, James K.
- Published
- 2015
- Full Text
- View/download PDF
27. Change
- Author
-
Stoller, James K., primary
- Published
- 2021
- Full Text
- View/download PDF
28. Leadership Essentials for CHEST Medicine Professionals
- Author
-
Stoller, James K., primary
- Published
- 2021
- Full Text
- View/download PDF
29. Strategic Planning for the Chest Clinician
- Author
-
Dweik, Raed, primary, Rea, Peter, additional, and Stoller, James K., additional
- Published
- 2021
- Full Text
- View/download PDF
30. A Perspective on the Educational “SWOT” of the Coronavirus Pandemic
- Author
-
Stoller, James K., primary
- Published
- 2021
- Full Text
- View/download PDF
31. Building Teams in Health Care
- Author
-
James K. Stoller
- Subjects
Pulmonary and Respiratory Medicine ,Service (systems architecture) ,Appreciative inquiry ,Best practice ,media_common.quotation_subject ,education ,Context (language use) ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Curriculum ,Referral and Consultation ,media_common ,Medical education ,Teamwork ,business.industry ,030228 respiratory system ,Education, Medical, Graduate ,Effective team ,Clinical Competence ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care - Abstract
Because teams can accomplish goals that individuals cannot, teams matter. Indeed, teams especially matter in settings such as health care, where favorable outcomes depend critically on the contributions of many different people with diverse skills. As important as effective teambuilding is for health care, how to build teams is often not included in medical curricula, and physicians learn to build teams through "hidden curricula." In the context that we can do better, this "How I Do It" presents an approach to building a team in a common scenario for the chest physician: picking up the inpatient Pulmonary Consult Service. The approach is informed by considering the attributes of an effective team, knowledge of common team dysfunctions, and best practices for building a team. The importance of teambuilding is underscored by substantial evidence that effective teamwork produces superior clinical outcomes.
- Published
- 2020
32. Leadership Essentials for CHEST Medicine Professionals: Models, Attributes, and Styles
- Author
-
Stoller, James K.
- Subjects
InformationSystems_GENERAL ,Leadership ,CHEST Reviews ,change ,Pulmonary Medicine ,Humans ,Universal Health Care ,Clinical Competence ,Physician's Role ,Emotional Intelligence - Abstract
In the context that leadership matters and that leadership competencies differ from those needed to practice medicine or conduct research, developing leadership competencies for physicians is important. Indeed, effective leadership is needed ubiquitously in healthcare, both at the executive level and at the bedside, e.g., leading clinical teams and problem-solving on the ward. Various leadership models have been proposed, most converging on common attributes – as described by Kouzes and Posner – of envisioning a new and better future state, inspiring others around this shared vision, empowering others to effect the vision, modeling the expected behaviors, and engaging others by appealing to shared values. Attention to creating an organizational culture that is informed by the 7 classic virtues – trust, compassion, courage, justice, wisdom, temperance, and hope – can also unleash discretionary effort in the organization to achieve high performance. Healthcare-specific leadership competencies include technical expertise, not only in one’s clinical/scientific arena in order to garner colleagues’ respect, but also regarding operations, strategic thinking, finance, human resources, and information technology. Also, knowledge of the regulatory and legislative environments of healthcare is critical, as is being a problem-solver and life-long learner. Perhaps most important to leadership in healthcare, as in all sectors, is having emotional intelligence. A spectrum of leadership styles has been described, and effective leaders are facile in deploying each style in a situationally appropriate way. Overall, leadership competencies can be developed and leadership development programs are signature features of leading healthcare organizations.
- Published
- 2020
33. Emotional Intelligence: Leadership Essentials for Chest Medicine Professionals
- Author
-
James K, Stoller
- Subjects
Leadership ,Health Personnel ,Pulmonary Medicine ,Humans ,Emotional Intelligence - Abstract
Emotional intelligence (EI) has become widely appreciated as an important leadership attribute, in business, education and, increasingly, in health care. Defined as "the capacity to understand your own and others' emotions and to motivate and develop yourself and others in service of improved work performance and enhanced organizational effectiveness," EI is correlated with a number of success attributes in several sectors; for example, in business, with enhanced business performance and enhanced personal career success, and in health care, with enhanced patient satisfaction, lower burnout, lower litigation risk, and enhanced leadership success. While multiple models of EI have evolved, perhaps the most popular model is framed around four general rubrics with component competencies. The general rubrics are: self-awareness, self-management, social awareness, and relationship management. EI can be measured by using available instruments, and it can be learned and taught. Indeed, teaching EI has become increasingly common in health-care organizations in service of improving health care and health-care leadership. Although more research is needed, ample evidence supports the notion that EI is a critical success element for success as a health-care leader, especially because EI competencies differ markedly from the clinical and scientific skills that are core to being a clinician and/or investigator. This review of EI presents evidence in support of the relevance of EI to health care and health-care leadership, discusses how and when EI can be developed among health-care providers, and considers remaining questions.
- Published
- 2020
34. Change: Leadership Essentials for Chest Medicine Professionals
- Author
-
James K, Stoller
- Subjects
Leadership ,Pulmonary Medicine ,Humans ,Clinical Competence ,Diffusion of Innovation ,Physician's Role ,Emotional Intelligence - Abstract
Change is a fact of life; the absence of change creates stagnation. This is perhaps especially true in health care, where progress in treating disease depends on innovation and progress. At the same time, change is often uncomfortable. Thus, it is helpful to model the change process to optimize the chances of successfully effecting change. Furthermore, how to lead change is a critical leadership competency. Three models for leading change are reviewed: the first-the eight stages of change-which was not designed for health care; the second called "switch"; and the third called Amicus, which was uniquely designed for health care. The models share many common features, with the explicit reminder in the third model that physicians should be involved in the change effort early. Although sparse, the evidence does suggest the applicability of these models to health care. Beyond having a roadmap for leading change, it is helpful to assess the worthiness of undertaking a change effort and of predicting the phasic response to change efforts, given that humans are often change-averse. In this regard, both the "payoff matrix" and the change curve, derived from the work of Kübler-Ross on grieving, are offered as tools. Finally, physicians' avidity for change is framed by two opposing vectors. On the one hand, physicians share in the general human aversion to change. On the other hand, physicians are data-reverent and also wish to do their best for patients, which encourages their embrace of ever-increasing evidence and change.
- Published
- 2020
35. Serum IgG Levels and Risk of COPD Hospitalization: A Pooled Meta-analysis
- Author
-
Fernando Sergio, Leitao Filho, Andre, Mattman, Robert, Schellenberg, Gerard J, Criner, Prescott, Woodruff, Stephen C, Lazarus, Richard K, Albert, John, Connett, Meilan K, Han, Steven E, Gay, Fernando J, Martinez, Anne L, Fuhlbrigge, James K, Stoller, Neil R, MacIntyre, Richard, Casaburi, Philip, Diaz, Ralph J, Panos, J Allen, Cooper, William C, Bailey, David C, LaFon, Frank C, Sciurba, Richard E, Kanner, Roger D, Yusen, David H, Au, Kenneth C, Pike, Vincent S, Fan, Janice M, Leung, Shu-Fan Paul, Man, Shawn D, Aaron, Robert M, Reed, and Don D, Sin
- Subjects
Hospitalization ,Male ,Pulmonary Disease, Chronic Obstructive ,Agammaglobulinemia ,Immunoglobulin G ,Incidence ,Humans ,Female ,Middle Aged ,Risk Assessment ,Aged - Abstract
Hypogammaglobulinemia (serum IgG levels 7.0 g/L) has been associated with increased risk of COPD exacerbations but has not yet been shown to predict hospitalizations.To determine the relationship between hypogammaglobulinemia and the risk of hospitalization in patients with COPD.Serum IgG levels were measured on baseline samples from four COPD cohorts (n = 2,259): Azithromycin for Prevention of AECOPD (MACRO, n = 976); Simvastatin in the Prevention of AECOPD (STATCOPE, n = 653), Long-Term Oxygen Treatment Trial (LOTT, n = 354), and COPD Activity: Serotonin Transporter, Cytokines and Depression (CASCADE, n = 276). IgG levels were determined by immunonephelometry (MACRO; STATCOPE) or mass spectrometry (LOTT; CASCADE). The effect of hypogammaglobulinemia on COPD hospitalization risk was evaluated using cumulative incidence functions for this outcome and deaths (competing risk). Fine-Gray models were performed to obtain adjusted subdistribution hazard ratios (SHR) related to IgG levels for each study and then combined using a meta-analysis. Rates of COPD hospitalizations per person-year were compared according to IgG status.The overall frequency of hypogammaglobulinemia was 28.4%. Higher incidence estimates of COPD hospitalizations were observed among participants with low IgG levels compared with those with normal levels (Gray's test, P .001); pooled SHR (meta-analysis) was 1.29 (95% CI, 1.06-1.56, P = .01). Among patients with prior COPD admissions (n = 757), the pooled SHR increased to 1.58 (95% CI, 1.20-2.07, P .01). The risk of COPD admissions, however, was similar between IgG groups in patients with no prior hospitalizations: pooled SHR = 1.15 (95% CI, 0.86-1.52, P =.34). The hypogammaglobulinemia group also showed significantly higher rates of COPD hospitalizations per person-year: 0.48 ± 2.01 vs 0.29 ± 0.83, P .001.Hypogammaglobulinemia is associated with a higher risk of COPD hospital admissions.
- Published
- 2019
36. Developing Physician Leaders
- Author
-
James K. Stoller
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Perspective (graphical) ,MEDLINE ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Engineering ethics ,030212 general & internal medicine ,Current (fluid) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
37. Giants in Chest Medicine: Professor Atul C. Mehta, MBBS, FCCP
- Author
-
James K. Stoller
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,business.industry ,General surgery ,MEDLINE ,History, 20th Century ,Critical Care and Intensive Care Medicine ,Medicine chest ,United States ,medicine ,Pulmonary Medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Physician's Role - Published
- 2018
38. Building Teams in Health Care.
- Author
-
Stoller, James K.
- Subjects
- *
HEALTH care teams , *TREATMENT effectiveness , *TEAM building , *PHYSICIANS , *GOAL (Psychology) - Abstract
Because teams can accomplish goals that individuals cannot, teams matter. Indeed, teams especially matter in settings such as health care, where favorable outcomes depend critically on the contributions of many different people with diverse skills. As important as effective teambuilding is for health care, how to build teams is often not included in medical curricula, and physicians learn to build teams through "hidden curricula." In the context that we can do better, this "How I Do It" presents an approach to building a team in a common scenario for the chest physician: picking up the inpatient Pulmonary Consult Service. The approach is informed by considering the attributes of an effective team, knowledge of common team dysfunctions, and best practices for building a team. The importance of teambuilding is underscored by substantial evidence that effective teamwork produces superior clinical outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
39. Emotional Intelligence: Leadership Essentials for Chest Medicine Professionals.
- Author
-
Stoller, James K.
- Subjects
- *
EMOTIONAL intelligence , *ORGANIZATIONAL effectiveness , *LEADERSHIP , *PATIENT satisfaction , *OCCUPATIONAL achievement , *MEDICAL care - Abstract
Emotional intelligence (EI) has become widely appreciated as an important leadership attribute, in business, education and, increasingly, in health care. Defined as "the capacity to understand your own and others' emotions and to motivate and develop yourself and others in service of improved work performance and enhanced organizational effectiveness," EI is correlated with a number of success attributes in several sectors; for example, in business, with enhanced business performance and enhanced personal career success, and in health care, with enhanced patient satisfaction, lower burnout, lower litigation risk, and enhanced leadership success. While multiple models of EI have evolved, perhaps the most popular model is framed around four general rubrics with component competencies. The general rubrics are: self-awareness, self-management, social awareness, and relationship management. EI can be measured by using available instruments, and it can be learned and taught. Indeed, teaching EI has become increasingly common in health-care organizations in service of improving health care and health-care leadership. Although more research is needed, ample evidence supports the notion that EI is a critical success element for success as a health-care leader, especially because EI competencies differ markedly from the clinical and scientific skills that are core to being a clinician and/or investigator. This review of EI presents evidence in support of the relevance of EI to health care and health-care leadership, discusses how and when EI can be developed among health-care providers, and considers remaining questions. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
40. Change: Leadership Essentials for Chest Medicine Professionals.
- Author
-
Stoller, James K.
- Subjects
- *
LEADERSHIP , *MEDICAL care , *PROFESSIONAL employees , *PHYSICIANS , *AVERSION - Abstract
Change is a fact of life; the absence of change creates stagnation. This is perhaps especially true in health care, where progress in treating disease depends on innovation and progress. At the same time, change is often uncomfortable. Thus, it is helpful to model the change process to optimize the chances of successfully effecting change. Furthermore, how to lead change is a critical leadership competency. Three models for leading change are reviewed: the first-the eight stages of change-which was not designed for health care; the second called "switch"; and the third called Amicus, which was uniquely designed for health care. The models share many common features, with the explicit reminder in the third model that physicians should be involved in the change effort early. Although sparse, the evidence does suggest the applicability of these models to health care. Beyond having a roadmap for leading change, it is helpful to assess the worthiness of undertaking a change effort and of predicting the phasic response to change efforts, given that humans are often change-averse. In this regard, both the "payoff matrix" and the change curve, derived from the work of Kübler-Ross on grieving, are offered as tools. Finally, physicians' avidity for change is framed by two opposing vectors. On the one hand, physicians share in the general human aversion to change. On the other hand, physicians are data-reverent and also wish to do their best for patients, which encourages their embrace of ever-increasing evidence and change. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
41. Giants in Chest Medicine: Professor Atul C. Mehta, MBBS, FCCP
- Author
-
Stoller, James K., primary
- Published
- 2019
- Full Text
- View/download PDF
42. Developing Physician Leaders: A Perspective on Rationale, Current Experience, and Needs
- Author
-
James K, Stoller
- Subjects
Physician Executives ,Leadership ,Models, Organizational ,Humans ,Clinical Competence ,Delivery of Health Care ,United States - Published
- 2017
43. Developing Physician Leaders
- Author
-
Stoller, James K., primary
- Published
- 2018
- Full Text
- View/download PDF
44. The Challenge of Rare Diseases
- Author
-
Stoller, James K., primary
- Published
- 2018
- Full Text
- View/download PDF
45. Symptom and Airflow Correlates of Delayed Diagnosis in Alpha-1 Antitrypsin Deficiency
- Author
-
James K. Stoller, Amy S. Nowacki, Erica Fye, Christopher Sanders, and Vickram Tejwani
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Alpha 1-antitrypsin deficiency ,business.industry ,Internal medicine ,Airflow ,Medicine ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business ,medicine.disease ,Delayed diagnosis ,Gastroenterology - Published
- 2017
46. Response
- Author
-
James K. Stoller, Amit Banga, and Atul C. Mehta
- Subjects
Pulmonary and Respiratory Medicine ,Thoracic Diseases ,Practice Guidelines as Topic ,Disease Management ,Humans ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,Societies, Medical - Published
- 2015
47. Counterpoint: Are the CHEST guidelines global in coverage? No
- Author
-
James K. Stoller, Amit Banga, and Atul C. Mehta
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Alternative medicine ,Disease Management ,Evidence-based medicine ,Critical Care and Intensive Care Medicine ,Counterpoint ,United States ,Thoracic Diseases ,Family medicine ,Thoracic diseases ,Practice Guidelines as Topic ,medicine ,Humans ,Disease management (health) ,Cardiology and Cardiovascular Medicine ,business ,Societies, Medical - Published
- 2015
48. Rebuttal from Dr Mehta et al
- Author
-
Amit Banga, James K. Stoller, and Atul C. Mehta
- Subjects
Pulmonary and Respiratory Medicine ,Biomedical Research ,business.industry ,Rebuttal ,Guidelines as Topic ,Evidence-based medicine ,Critical Care and Intensive Care Medicine ,Nursing ,Thoracic Diseases ,Relevance (law) ,Medicine ,Humans ,Program Development ,Cardiology and Cardiovascular Medicine ,business ,Societies, Medical - Abstract
We appreciate Drs Nathanson and Oulette’s 1 response and concur that American College of Chest Physicians (now branded as CHEST) evidence-based guidelines (EBGs) are rigorously prepared and are of high quality. Notwithstanding their considerable value, CHEST EBGs still fail to achieve global coverage. To off er global coverage and relevance, EBGs must satisfy the condition of addressing clinical issues and circumstances of global patient populations (ie, patients throughout the range of socioeconomic circumstances and access to health-care technology and expertise). Our colleagues off er four lines of reasoning to defend their “pro” position; we believe that this rebuttal debunks each.
- Published
- 2015
49. Developing Physician Leaders: A Perspective on Rationale, Current Experience, and Needs.
- Author
-
Stoller, James K
- Subjects
- *
CLINICAL competence , *LEADERSHIP , *MANAGEMENT , *MEDICAL care - Published
- 2018
- Full Text
- View/download PDF
50. Utility of a Near-Infrared Reflectance Spectroscopy Oximeter in Shock
- Author
-
Michael A. Morris, Leslie Wood, Kevin K. Chung, Victor A. Convertino, James K. Aden, John Hunninghake, and David Bell
- Subjects
Pulmonary and Respiratory Medicine ,Optics ,business.industry ,Medicine ,Near infrared reflectance spectroscopy ,Spectrum analysis ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business ,Shock (mechanics) - Published
- 2014
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.