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Cover Story 

14 Dialing In to Better Care 

A videoconferencing system nicknamed PICU Bot has become a staple 

in connecting the pediatric intensive care unit night-shift team at 

MassGeneral Hospital for Children, Boston, with remote physicians. As 

new approaches to telemedicine become more common, pulmonology 

and respiratory care clinicians are looking at ways to improve care 

through a new lens. By Kristen Ziegler. Cover image: ADVANCE thanks 

Phoebe Yager, MD, and Natan Noviski, MD, of MassGeneral Hospital for 

Children for their help with this month's cover; Photo by Kyle Kielinksi. 

Feature 

18 Shifting Susceptibility 

COPD has widened its grip, constricting airways of blacks and females as 

they embrace smoking with the same fervor as did white males half a 

century ago. By Valerie Newitt 

Departments 

ADVANCE Job Fair Guide 3 

Allergy & Asthma 8 

Ventilation Today 10 

Sleep Tracks 12 

Education Opportunities 21 

■ CONTENTS 

for 

Respratory Care 

& Sleep Medicine 

June 2011 

Volume 20 / Number 6 

Classified Employment 

Opportunities 23 

Physicians Roundtable 25 

Barely Breathing 26 

Products 

Product Advertiser Index 6 

ADVANCE Healthcare Shop 11 

PUBLISHER - Ann Wiest Kielinski; GENERAL MANAGER - W.M. “Woody” Kielinski; EDITORIAL 

- Editor: Sharlene George Managing Editor: Valerie Newitt; Associate Editor: Kristen Ziegler; 

Web Manager: Jennifer Montone; Design - Vice President, Director of Creative Services: 

Sue Basile; Design Director: Walt Saylor; Multimedia Director: Todd Gerber; Art Director: Doris 

Mohr; Senior Graphic Artist: Aaron Roshong; advertising - Director of Marketing Services: 

Christina Allmer; events - Public Relations Director: Maria Senior; Job Fair Manager: Laura 

Smith; Events Product Manager: Mike Connor; administration - Vice President, Director 

of Human Resources: Jaci Nicely; Vice President of Business Technology Operations: Joe 

Romello; Information & Business Systems Director: Ken Nicely; Circulation Manager: Maryann 

Kurkowski; Billing Manager: Christine Marvel; Subscriber Services Manager: Vikram Khambatta; 

Media & marketing opportunities: Display Advertising - Sales Director: Amy 

Turnquist; Area Sales Manager: Kevin Miller; National Account Executives: Hilary Druker, Doreen 

Gates; Sales Associate: Andrea Halderman; Education Opportunities - Sales Manager: Ed 

Zeto; Account Executive: Brock Bamber; Sales Associate: Ashley Wayne; Healthcare Facility 

Advertising - Sales Director: David Gorgonzola; Group Manager: Christina Schmidt; Sales 

Associates: Jennifer Campbell, Ryan Casey, Bill Egan, James Harrigan, Andrew Reynolds, Kate 

Sanoski, Cassandra Santiago; CUSTOM PROMOTIONS - Sales Manager: Mike Kerr; Senior 

Account Executives: Terri Klein, Noel Lopez, Sue Borjeson-Romano; Sales Associates: Kristen 

Erskine, Desirae Slaugh, Leah Stashko, Gina Willett 

Copyright 2011 by Merion Publications Inc. All rights reserved. 

Reproduction in any form is forbidden without written 

permission of publisher. ADVANCE for Respiratory Care 

& Sleep Medicine (USPS #15-959) is published 12 times a year on 

a monthly basis by Merion Publications Inc., 2900 Horizon Drive, P.O. Box 61556, King of 

Prussia, PA 19406-0956. Periodicals Postage Paid at Norristown, PA, and additional mailing 

offices. Postmaster: Send address changes to: Circulation, Merion Publications Inc., 

ADVANCE for Respiratory Care & Sleep Medicine, 2900 Horizon Drive, P.O. Box 61556, 

King of Prussia, PA 19406-0956. 

■ ONLINE CONTENTS 

www.advanceweb.com/respiratory 

THIS MONTH’S HIGHLIGHTS 

Health Care Salary 

Comparison Guide 

What would you be if you weren’t a respiratory 

therapist or sleep tech A nurse, doctor, or maybe 

a physician assistant The grass always seems 

greener on the other side, so for those of you 

seriously thinking about hopping the fence, we 

counted up the dollars and cents handed out to nearly 8,000 health care 

professionals. The results will surprise you. Available for download June 16 at 

advanceweb.com/respiratory_sleep_insider. 

The 8 Things I Hate About My Staff 

If you’re like most managers, you deal with employee-driven pet peeves 

daily. Discover how to help them change their annoying workplace habits 

— and make your day better. Read this article in our Features section 

beginning June 28. 

“Wash ‘Em” Music Video 

Thomas Jefferson University Hospital takes 

preventing infections seriously, but also creatively. 

Lace up your dancing shoes for this catchy 

six-minute takeoff on Michael Jackson’s classic 

dance number "Beat It." Look for this fun video 

July 4 under Multimedia. 

Career Coach: Laid Off, Not Fired 

What if potential employers think I was, gulp, fired Debby Stone, JD, CPCC, 

PCC, answers a reader’s question about how to avoid the stigma of being 

"let go." Watch this video series beginning June 20. 

Large Print Asthma Patient Education 

Stiff joints, aching limbs, and loss of muscle strength can create coordination 

issues that make it hard for elderly patients to use asthma inhalers correctly. 

Download this large print handout to remind them of delivery devices 

available to assist them. Click "Patient Primers" under the Education menu. 

FREE webinar 

Managing Young Children with 

Asthma Webinar 

Children younger than 5 are hospitalized more and 

seen in the emergency room three times as often as 

children 5 to 15 years-old. Join Thomas F. Plaut, MD, a 

nationally known asthma specialist and author, to learn 

how to create a plan to keep young children with asthma on track and out of 

the hospital in a free live webinar at 2 p.m. Eastern Time, July 6. Register at 

https://www1.gotomeeting.com/register/553235153. 

Join the discussion 

Do you feel like you’ve been given 

the opportunity to use all of you 

skills at work 

Do you know someone who’s making a 

difference in respiratory care 

Nominate them in the best department, best manager, 

and best practitioner categories of the National 

Respiratory Acheivement Awards. Submit an entry at 

www.advanceweb.com/respiratorycontest2011. 



5

■ Advertiser Index 

ENTRY DEADLINE: JULY 8, 2011 

Get the info you need by logging on to: 


Our searchable online Resource Directory allows you to access 

detailed information about the companies listed below and the products 

or services they offer, as well as submit requests for free info. 

Support the companies that support your profession. 

The companies listed below support the respiratory care and sleep professions by placing advertisements 

in ADVANCE for Respiratory Care & Sleep Medicine. Their support keeps our publication coming to you free of 

charge. Please visit these advertisers’ websites to learn more about their products or services. 

ADVERTISER Website address PG # 

❏ ADVANCE Healthcare Shop www.advancehealthcareshop.com 11 

❏ ADVANCE Virtual Job Fairs www.advanceweb.com/events 3 

❏ ADVANCE Educational Webinar https://www1.gotomeeting.com/register/579890729 16 

❏ Braebon Medical www.braebon.com 5 

❏ Cadwell Laboratories www.cadwell.com 2 

❏ Cleveland Medical Devices www.clevemed.com 27 

❏ Compumedics www.compumedics.com 28 

❏ Embla www.embla.com 2, 9 

❏ GE Healthcare Systems www.gehealthcare.com/respiratorycare 7, 13 

❏ Independence University www.independence.edu 21 

❏ MedWay Interactive Educational Series www.ssbinc.com/medway 21 

❏ Rue Education www.rueeducation.com 22 

❏ Southmedic www.southmedic.com 15 

❏ The Compliance Team www.thecomplianceteam.org 17 

❏ Tutorial Systems www.tutorialsystems.com 22 

■ Advisory Boards 

Editorial Advisory Board 

Gerard J. Criner, MD 

Director of RICU, Ventilator 

Rehabilitation Unit and Critical 

Care Services, Temple University 

Hospital, Philadelphia 

Michael Cutaia, MD, Chief of 

Pulmonary and Critical Care, 

New York Harbor Health Care 

System, New York City 

Andrew DesRosiers, MS, RRT, 

RPSGT, Director of the Caritas 

Centers for Sleep Medicine, 

Caritas Christi Health Care, 

Methuen, MA 

Terry DesJardins, MEd, RRT 

Professor Emeritus, Parkland 

College, Champaign, IL 

Michael J. Hewitt, RRT-NPS, 

RCP, FAARC, FCCM, Director, 

Respiratory Care Services, 

St. Joseph’s Hospital, BayCare 

Health System, Tampa, FL 

Lana Hilling, RCP 

Coordinator of Lung Health 

Services, John Muir Health, 

Concord, CA 

Felix Khusid, RRT-NPS, RPFT 

Administrative Director for 

Respiratory Therapy and 

Pulmonary Physiology Center, 

New York Methodist Hospital, 

New York City 

George W. Lantz, MPS, BS, 

RRT, CPFT, AE-C, FAARC 

Clinical Manager of Respiratory 

Care, EKG, and Special 

Diagnostics, Doctors Hospital, 

Augusta, GA 

Vernon R. Pertelle, MBA, RRT 

Senior Director/Assistant Vice 

President, Tri-City Healthcare 

District, Oceanside, CA 

Michael McPeck, BS, RRT, 

FAARC, Executive Director of 


Long Beach Memorial Medical 

Center/Miller Children’s 

Hospital, Long Beach, CA 

Thomas F. Plaut, MD, FAAP 

President, Pedipress Publishers, 

Amherst, MA 

Alphonso A. Quinones, 

DHA(C), MA, CHE, RRT-NPS, 

RPSGT, RPFT, CCT, AE-C 

Director of Respiratory 

Therapy, North Shore University 

Hospital, Manhasset, NY 

John A. Sestito, BA, RRT 

Associate Executive Director, 

Clinical Practices of the 

University of Pennsylvania, 

Department of Neonatology 

and Newborn Services, 

Philadelphia 

Helen Sorenson, MA, RRT, 

FAARC, Associate Professor, 

Department of Respiratory 

Care, UT Health Science Center, 

San Antonio, TX 

Jeffrey L. Tarnow, RRT, RCP 

Adult Clinical Coordinator of 


Clinical Research Coordinator 

Department of Anesthesiology, 

University of California, 

San Francisco 

Kimberly Trotter, MA, RPSGT 

Practice Manager, UCSF Sleep 

Disorders Center, Pulmonary 

Function Lab at Mount Zion, 

San Francisco 

Editorial Consultants 

George G. Burton, MD, FCCP, 

FAARC, Medical Director, Sleep 

Disorders Center Kettering 

Medical Center Kettering, OH 

Allen Goldberg, MD, MBA, 

Master FCCP, Past-president 

American College of Chest 

Physicians, Chicago 

Industry Advisory Board 

John Ancy, MA, RRT 

Senior Clinical Consultant 

Instrumentation Laboratory 

Bill Antilla, RPSGT 

Senior Product Manager 

Cadwell Laboratories 

David Baker 

President and CEO 

Embla 

Richard A. Bonato, PhD 


BRAEBON Medical Corp. 

Krystanne Borgen 

Manager, Marketing 

Communications 

nSpire Health Inc. 

Steve Chaucer, RRT 

National Sales Manager 

Hamilton Medical Inc. 

Edwin Coombs, MA, RRT 

Associate Director of Marketing 

Respiratory Care Systems 

Draeger Medical 

Terry deBruyn, RRT 

Sales Manager for Specialty 

Markets 

Nonin Medical Inc. 

Louis Fuentes, RRT 

Clinical Marketing Specialist 

Maquet Inc. 

Jeff Kuznia 

Director, Business Development 

Compumedics Limited 

Natalie Morin, RPSGT 


Sleep Strategies Inc. 

Peggy Powers, RRT 

Clinical Product Specialist 

Fisher & Paykel Healthcare 

Mark Rizk, RPSGT 

Business Unit Manager, 

Sleep Products 

Nihon Kohden America 

Judy Tietsort, RN, RRT, 

FAARC 

CEO, Respiratory Management 

Consultants 

Stan Van Gent 

Vice President for Global 

Product Marketing for 

Ventilation and Airway 

Covidien 

Michael Waldman, BBA 

Marketing Product Manager 

PARI Respiratory Equipment Inc. 

IT’S TIME FOR 

RESPIRATORY 

RECOGNITION! 

You or someone you know could be 

named a winner in the 11th Annual 

National Respiratory Achievement 

Awards from ADVANCE for 

Respiratory Care & Sleep Medicine. 

Gain recognition from fellow respiratory 

care professionals and win a cash prize! 

• Best Respiratory Department: $500 

• Best Respiratory Manager: $250 

• Best Respiratory Therapist: $250 

Winners also receive a keepsake plaque to commemorate 

their achievements. Plus, ADVANCE for Respiratory Care & 

Sleep Medicine will feature the winners in an upcoming issue 

as part of our celebration of National Respiratory Care Week. 

ENTER ONLINE 

Visit www.advanceweb.com/respiratory and click on 

the National Respiratory Achievement Awards icon to 

nominate a department, manager or therapist. 

QUESTIONS 

Contact Valerie Newitt at 

610-278-1400, ext. 1107, or 

vnewitt@advanceweb.com. 

If your nominee wins, you’ll 

receive a $25 gift certificate to 

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7

■ Allergy and asthma 

By Valerie Neff Newitt 

Gender-based 

Asthma Mysteries 

Researcher hopes to discover why asthma 

symptoms vary between sexes 

Asthma is known to play favorites in the gender department. 

In young childhood, asthma is much more common in males. As 

children near puberty, asthma is much more common in females. Then, 

at about the age of puberty, the prevalence is equal in males and females. 

Finally, after puberty, it is more common in females. Why is there a 

variance in asthma prevalence according to age and gender 

“That’s what everyone is trying to figure out,” said Jennifer McCallister, 

MD, assistant professor in the division of pulmonary medicine at Ohio 

State University (OSU) Medical Center, Columbus, Ohio. She is leading 

a pilot study dealing with gender-based asthma profiling. “Intuitively 

researchers and asthma clinicians want to place all the blame on sex 

hormones, since this transition in asthma prevalence occurs at a key 

time — puberty — when these hormones are becoming key players in 

the reproductive lives of women.” 

But it’s not quite that simple. Not all research has supported a direct 

causal relationship between sex hormones and symptom exacerbation. 

“Some literature suggests that at menopause the use of hormone 

replacement therapy is associated with an increase in asthma prevalence 

in older women. That would support the relationship between asthma 

and sex hormones,” Dr. McCallister said. “However, in women of 

childbearing potential there has been research using manipulation of 

the hormones, specifically the administration of oral contraceptives, to 

try to decrease asthma symptoms. The majority of this research fails to 

RELATED ARTICLE 

Read “Why Gender Matters” online to learn more about individualizing treatment 

plans for women: http://respiratory-care-sleep-medicine.advanceweb. 

com/Columns/From-Our-Alliance-AAE/Why-Gender-Matters.aspx. 

show any relationship between the use of oral contraceptives in women 

and asthma. It seemed clear cut before that.” 

Up to 40 percent of women with asthma note an increase of symptoms 

prior to menses, according to McCallister. “Prior to menstruation, there 

is an abrupt drop in sex hormones. That has led some researchers to 

hypothesize that it is the change in the level of sex hormones that may 

be directly linked and not so much the amount.” 

Tom Utigard, RRT, director of respiratory care at Yakima Regional 

Medical & Cardiac Center, has dealt with post-pubescent girls throughout 

his career while providing therapy at an asthma camp. He has seen 

the cycle-based flare-ups all too often. 

“Either right before their period or during their period the girls’ 

symptoms seem to worsen, and they require more treatments than they 

did a day or two before when they were having as much or more activity,” 

Utigard noted. “How come all of a sudden For one or two to have 

those issues would be one thing, but it is a fairly common occurrence.” 

Pilot study at OSU 

McCallister will do her part to unravel the gender-based mysteries 

surrounding asthma by leading a pilot study funded by the Center for 

Women’s Health and the Center for Clinical and Translational Science at 

OSU. The study will concentrate on that 40 percent sub-population of 

women who have a worsening of asthma symptoms at the time of menses 

in hopes of discovering why some, but not all, women experience this. 

Some 20 women, 10 with self-described premenstrual worsening of 

asthma and 10 without, will be enrolled for evaluation of inflammatory 

markers, including leukotrienes, known to be elevated in patients 

with asthma. In addition, micro-RNA will be examined to evaluate the 

patients’ genetic makeup. 

The researchers will look at participants at two points during their 

menstrual cycle: one midway through their menstrual cycle, when 

hormones are most stable; the second point will be right before the onset 

of menses. Blood tests will be done to compare the leukotriene level at 

those two points in the two patient populations. 

The study’s findings could hold important implications for treatment 

going forward. “There are asthma medications now that specifically 

target the leukotriene pathway,” Dr. McCallister said. “If research shows 

a spike in leukotrienes among women with premenstrual worsening of 

symptoms, we as clinicians would know they would be potentially 

excellent candidates for these medications.” 

Utigard would welcome research that could shed light on the issue, 

as a way to reinforce medication compliance among the female campers 

with asthma. “It would be helpful to be able to pinpoint a specific time 

of the month and stress; this is the most important time to stay on 

therapies and medicines to stay out of trouble,” Utigard said. 

While Dr. McCallister and fellow researchers are anxious to get the 

study into full gear, they’re struggling to find young menstruating 

women to participate. “OSU is a huge university with over 50,000 

students, so you’d think it would be easy to get the right participants,” 

she said. “But with the birth control pills available today, many young 

women don’t menstruate. They take pills that allow them to have a 

period every four to six months.” n 

Valerie Neff Newitt can be reached at vnewitt@advanceweb.com. 

Jeff leeser 

8 ADVANCE for Respiratory Care & Sleep Medicine June 2011 www.advanceweb.com/respiratory 


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9

■ Ventilation Today 

By Kristen Ziegler 

nurse complete one hour before a scheduled transport. 

“The power isn’t in the positives, it’s in the negatives,” said Terry 

Hulme, MD, FRCPC, medical director of Rockyview General Hospital 

of the Calgary Health Region of Canada. “It is putting the brakes on 

transports where the risk to the patient has been under-recognized.” 

Test drive 

One of the new system’s first steps is for the RT to assess whether the 

patient can remain properly oxygenated in the position required during 

transport and the entire diagnostic test. For intubated patients, RTs check 

for endotracheal tube positioning and conduct a trial. The patient is 

switched from the mechanical ventilator to a transport ventilator or 

manual bagging for the length of time that they will be outside the ICU. 

If the patient demonstrates high ventilatory requirements reflecting 

potential difficulty in oxygenating the patient adequately, the RT documents 

it on the scorecard, and then notifies the attending physician. 

“The original concept with this scoring was to help level communication 

fields for RTs and nurses with physicians,” Dr. Hulme said. 

“What we have tried to do is take away opinion and clinical judgment 

and make it black and white.” 

With that objective data in mind, RTs and physicians can work 

together to reconfigure ventilator settings to better ventilate the patient. 

Or they may decide to cancel the transport and use an alternative 

bedside test to gather the same information. 

Ready for 

Transport 

Checklist identifies risk 

factors for adverse events 

Sending a critically ill patient off unit for diagnostic testing 

seems safe. A registered nurse is with them during transport, and clinicians 

fill the corridors and floors around them. But up to 9 percent of 

intrahospital transports end in a life-threatening event. 1 

After two intensive care unit patients sent for CT scans in the Calgary 

Health Region of Canada suffered cardiopulmonary arrest during 

transport, a team of respiratory therapists, nurses, and physicians created 

a decision scorecard to help determine when a patient is stable enough 

for transport. Five years later, they’re revising the scorecard to bring 

greater attention to respiratory problems that can turn a typical transport 

into a critical emergency. The new form puts “showstopper” respiratory 

items first in a series of decision points that the RT and bedside 

Elective intubation 

Non-intubated patients appear to be less acute or less likely to have 

complications, but “that’s not always the case” said Greg Duchscherer, 

RRT, FCSRT, quality improvement and patient safety leader for the 

department of critical care. The new decision scorecard provides specific 

criteria to help RTs identify underlying respiratory or neurological 

issues and take action to prevent problems during transport. 

For example, if the patient has a history of difficult intubation or 

anatomical features that put them at risk for a difficult airway, the RT 

must notify the attending physician and fellow to reconsider the transport. 

If they decide that the patient must be sent for diagnostic testing, 

as least one RT and physician accompany the nurse on the transport. 

RTs also use the 10-point Richmond Agitation Sedation Scale to 

classify whether a patient is alert enough to protect his airway. Patients 

who are breathing fast on high-flow oxygen or have risk factors for 

aspiration may be electively intubated. “That still is a judgment call,” 

Dr. Hulme said. “The argument here is that we’re trying to prevent 

serious harm, prevent death.” 

No official studies of the revised patient decision scorecard are being 

done, but the committee will use staff feedback to continue improving 

the form. The ultimate goal is to be able to provide the same level of 

monitoring and care in transporting patients as inside the ICU. n 

Kristen Ziegler can be reached at kziegler@advanceweb.com. 

Reference 

1. Papson JP, Russell KL, Taylor DM. Unexpected events during 

the intrahospital transport of critically ill patients. Acad Emerg Med. 

2007 Jun; 14(6):574-7. 

Jeff leeser 



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11

■ Sleep Tracks 


Going Night-Night 

Duke’s pediatric lab drives satisfaction 

with child-centered approach 

The Duke Pediatric Sleep Lab in Durham, N.C., treats all 

children, all the time — seven nights a week, 363 days a year. The 

staff, including four sleep technologists, runs 450 studies annually, 

and numbers are increasing. 

Based in the division of pediatric pulmonary and sleep medicine of 

Duke University Medical School’s department of pediatrics, which is 

nationally ranked No. 9 by U.S. News & World Report, the Duke 

Pediatric Sleep Lab does its part to uphold that lofty reputation by 

earning multiple internal awards for driving high patient satisfaction. 

The physical components at Duke are kid-friendly — bright colors, 

a big fish tank, kid-sized equipment. And while a multidisciplinary 

team of care providers ensures a diversity of expertise at the clinic, team 

staffers all have one thing in common: Pediatrics. Period. 

At some sleep centers that mostly serve adults and the occasional 

child, their sleep techs may be competent but not necessarily adept at 

working with children. “If you go to an adult lab, the vast majority of 

patients are obese with sleep-disorder breathing,” explained Richard 

M. Kravitz, MD, associate professor of pediatrics at Duke University 

Medical School and medical director of the Duke Pediatric Sleep Lab. 

“Yes, we have children with sleep-disorder breathing, but while the 

disease may be the same, the etiology is different.” 

Dr. Kravitz described the lab’s usual patient population: Fifty percent 

have sleep-disorder breathing related to enlarged tonsils and adenoids, 

20 percent are related to obesity, and 10 percent related to cranial facial 

abnormalities and concerns about associated sleep apnea. 

“The rest are hypersomnolent kids — they might have ADD or be 

sleep-deprived because of sleep apnea,” he said. “And we’re finding more 

narcolepsy among children than anyone suspected existed. It was rarely 

ever diagnosed because the mindset was, ‘Children don’t get narcolepsy, 

so no need to look for it.’ Now we’re realizing most narcoleptics 

probably had symptoms presenting in childhood. But what you don’t 

look for, you never find.” 

Sleep study not a ‘given’ 

Securing positive outcomes for Duke’s young charges begins by taking 

a history. Even at this preliminary phase, some sleep centers drop the 

ball. “It’s a matter of under-recognizing kids; that’s problem number 

one,” Dr. Kravitz said. 

Essential inquiries include: 

• Does the child snore 

• If the child snores, are other things going on 

• Is he doing poorly at school 

• Is she drowsy 

• Is there a strong history for sleep apnea 

• Does he have pauses Gasps 

• Does she experience restless sleep 

• Is there secondary enuresis 

• Does the child experience morning headaches 

• Daytime tiredness 

Next comes an assessment, of which a sleep study might be part. 

Dr. Kravitz is adamant that too many unnecessary pediatric sleep 

studies are undertaken. 

“A parent could say, ‘Johnny won’t fall asleep at night. I want a sleep 

study.’ So a study is done, and guess what It’s normal,” Dr. Kraviz said. 

“That parent has just spent thousands of dollars on a study Johnny 

never needed because he has behavioral sleep problems. Parents need 

to discuss root causes and get their child proper therapy. Every child 

with a sleep problem deserves a sleep assessment, but not every child 

requires a sleep study.” 

Patience makes the difference 

Dr. Kravitz gives credit for Duke’s high patient satisfaction scores to 

his sleep techs’ ability to focus simultaneously on the child and the 

parent. “We tell families what to expect, and explain they have to be 

comfortable before the child will be comfortable,” Dr. Kravitz said. 

“An invested, cooperative parent is priceless.” 

He also praises his sleep techs for their consummate calm and patience. 

It’s a nightly challenge to spend a half hour or more hooking up a young 

child who immediately wants to yank off the set of electrodes. 

“You have to keep going into the room, explain to the child why they 

have to keep all this stuff on,” said Stephen Glinka, RPSGT, lead sleep 

photo COURTESY/DUKE PEDIATRICS 

Lead technician Stephen Glinka, RPSGT, positions sensors 

as he preps his young patient, Aaliyah Wilson, for a sleep study 

at Duke Pediatric Sleep Lab in Durham, N.C. 


Duke’s Top 10 for 

Patient Satisfaction 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

Sleep Tracks n 

Be sure the referring physician has thoroughly explained 

why the study is being ordered. 

Send educational material to the family detailing what the 

study entails and what they need to do prior to the study. 

When possible, have the family watch a video of a night in 

the sleep center. 

Orient the patient and family to the bedroom and 

bathroom, using age-specific bedside manner. 

Use equipment that is non-threatening in appearance. 

Maintain a comfortable bed for the patient and a separate 

bed/cot for a family member. 

Have only one family member come and stay with the 

child. 

Start the sleep study close to the child’s normal sleep time. 

Provide or ask family to bring reading materials, homework, 

or other quiet activities to occupy the child during hook-up. 

Maintain a sleep environment that ensures patient comfort 

and testing integrity. 

technologist at Duke Pediatric Sleep Lab. “And of course, you have to 

explain to parents and answer their questions, too. You’re talking to two 

or three people at different levels of understanding every time. Some 

techs make the mistake of explaining everything to the parents while 

ignoring the child.” 

Instead, Glinka advises getting down to eye level, letting the child 

touch and hold an electrode. “Say, ‘Look what you get to wear tonight!’ 

and then let them play with it a little bit. If you keep children involved, 

99 percent of the time they will be OK with the process.” 

Positive airway pressure titrations, too, are more difficult with children. 

“With pediatrics, if we’re doing a titration there is usually an underlying 

illness,” Glinka said. And that means a constant dialogue with the 

patient’s physician throughout the night. “The doctors want to try 

different things, so we’re in contact several times during the night. It’s 

a different mindset — more teamwork, more active.” 

Survey says … 

At the end of each study, parents fill out a satisfaction survey. “On a 

scale of one to five, five being the best, we score mostly fives,” Dr. Kravitz 

said. “Parents often make notations like, ‘Technician was wonderful, 

patient with my child, made her feel at home, explained everything to 

me, and made sure I understood.’” 

The high scores, he said, are wholly reflective of the staff’s collective 

pediatric-centered mentality. “Here, our expertise is pediatric sleep.” n 

Valerie Neff Newitt can be contacted at vnewitt@advanceweb.com 

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n Xxxx cover story 

Respiratory therapists have reaped telemedicine’s benefit with increased 

attention to their clinical opinions. Here, Amy Davidovich, RRT, shows how 

she uses MGHfC's robotic telemedicine system to consult with attending 

physician Phoebe Yager, MD. 

Dialing In to Better Care 

Telemedicine Connects PICU with Remote Physicians 


PICU Bot looks like a bored respiratory therapist’s off-duty 

craft project: a thin metal pole cart tricked out with a laptop, large screen television, and 

camera. But the understated appearance belies the robot’s powerful clinical utility. 

Bot, as it’s nicknamed by staff, combines off-the-shelf video conferencing and remote 

monitoring equipment with a high-speed, secure internet connection. He gives MassGeneral 

Hospital for Children’s eight pediatric critical care on-call physicians a way to “see” patients 

in real time from home. 

“It is extremely powerful to have the visual and audio capabilities so that you can have a 

whole team meeting and talk together about a plan,” said Phoebe Yager, MD, an intensivist 

who also is director of telemedicine for the PICU at MGHfC. “There is no other way to get 

that without telemedicine.” 

In just two short years, Bot has become a staple in connecting the night-shift care 

team with remote physicians. On average, its videoconference capabilities are used two 

to three times a week. It is a scenario that is increasingly familiar throughout the country. 

As of 2009, more than 200,000 patients annually have been cared for by tele-ICU 

systems. 1 As its utility expands, pulmonology and respiratory care clinicians are looking 

at telemedicine through a new lens. 

VIEW VIDEO 

See PICU Bot in action at MassGeneral Hospital for Children. Video 

available June 14 under “Multimedia” at www.advanceweb.com/ 

respiratory. 

Pan, zoom, action 

Multiple commercial providers have established 

tele-ICU infrastructure in health 

systems, while other hospitals have assembled 

their own technology, as the MGHfC information 

technology department and clinical 

staff did with Bot. 

Using a joystick remote control at their 

home portal, the doctor can pan and zoom 

a high definition camera to look at patients 

and their monitors. Bedside staff can operate 

a magnifying video camera with a bright 

light to visualize capillary perfusion and 

conduct rash exams and use an electronic 

stethoscope to give the doctor a listen to a 

patient’s heart and lungs. 

“When the room is quiet, I feel like I have 

been able to get a very good exam,” Dr. Yager 

said. However, ambient noise can make it 

harder to detect subtle changes in an asthmatic’s 

wheezing or normal vs. abnormal 

rhythms on a cardiac exam. 

More sophisticated stethoscope technology 

now available could help improve the 

kyle kielinski 



cover story n 

“hearing” of the telemedicine system, and Bot also could benefit from 

a wireless connection to the internet, which would speed set-up time 

for the in-hospital staff. 

Adoption of the Bot technology did not come without some initial 

misgivings. Some nursing staff worried this system might replace the 

attending physician’s presence at the bedside. 

“I think we have shown over time that that is definitely not the case,” 

Dr. Yager said. “There are times when, based on the visual on telemedicine, 

I have decided to jump in my car and just come in where I 

might not have before.” 

On the other hand, Bot has helped her decide when to stay put and 

take immediate action. For example, during a videoconference to investigate 

a report of a patient’s difficulty breathing, Dr. Yager recognized 

that his impending respiratory failure required intubation. “I was able 

to sort of virtually stand back, oversee the procedure, give my input and 

advice,” she said. Once the patient stabilized, Dr. Yager drove to the 

hospital to provide further bedside care. 

Facilitating communication 

RTs have reaped telemedicine’s benefits with increased attention to 

their clinical opinions. Consulting a physician through conventional 

methods has always been like a game of “Whisper Down the Lane.” 

RTs and nurses talk to the fellow who calls the attending physician 

and reports back on the conversation. “(But) maybe he or she didn’t 

Telemedicine’s road ahead 

“Ridiculous and counterproductive.” That’s how Gary 

Capistrant, senior policy director for the American Telemedicine 

Association, describes the restrictions on telemedicine imposed in 

Medicare’s new accountable care model. Capistrant is tired of what he 

sees as the Centers for Medicare & Medicaid Services “talking nice” 

about telemedicine but not taking advantage of its opportunities. 

On the heels of health care reform laws that charged networks of 

doctors, hospitals, and insurers with bringing down the cost of care 

through innovative solutions such as telehealth and remote monitoring, 

CMS issued guidelines restricting video conferencing from being used to 

treat the 35 million Medicare beneficiaries who live in the country’s 

metropolitan counties. Any accountable care organization outside Alaska 

and Hawaii also can not transmit recorded medical images such as skin 

exams for remote evaluation. “They pretty well shut out accountable care 

organizations from using teleheath,” Capistrant said. 

But the news is not all bad for telemedicine hopefuls. Thirty-nine 

states reimburse for telemedicine services for Medicaid patients, and an 

additional 12 states now have laws on the books requiring insurers to 

reimburse telehealth providers for any service covered in person. Six 

more states were considering that kind of legislation this last year, 

Capistrant said. 

ATA also has proposed six current procedural terminology (CPT) 

codes to be added for Medicare telehealth coverage in 2012, including 

codes for critical care and evaluation and one for online internet 

assessment and management by a physician and by a non-physician. 

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15

n cover story 

relay your message clearly,” said Amy Davidovich, RRT, a staff 

therapist at MGHfC. 

Bot eliminates the middle man. When a patient’s condition deteriorates, 

RTs can call an attending physician for an immediate video 

consultation in the patient’s room. “You can have an open discussion 

about everyone’s opinion, and everyone can talk back and forth about 

what their ideas are for the patient,” Davidovich said. 

This open exchange helped avert a particularly high risk procedure 

for a 2-year-old patient. The boy was in respiratory distress late one 

night after laryngotracheal reconstruction surgery, and the care team 

was prepared to re-intubate him. 

“He was just very difficult to manage,” Davidovich recalled. “We 

were at his bedside all night, giving him epi nebs and heliox, and 

eventually starting CPAP.” During a videoconference, the attending 

physician reassured Davidovich that the therapies she had initiated were 

working, and they avoided the reintubation. 

“Sometimes you need an extra set of eyes, especially from an attending 

physician, to confirm what you are doing,” Davidovich said. 

Reassuring parents 

Bot also helps keep parents involved in their child’s care by connecting 

them to the attending physician after regular hours. At admission, 

parents receive a one-page educational worksheet outlining how Bot 

is used to enhance communication and they sign a consent form for 

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and keep their children out of the emergency room and the hospital. 

Children younger than 5 are hospitalized more and seen in the emergency 

room three times as often as children 5 to 15. There are several reasons 

for this: 

• Their airways are smaller and become blocked more easily. 

• They cannot use a peak flow meter. 

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the robot to be used with their child. Staff also show them how to use 

the device. 

Parents come in contact with Bot if they request a videoconference 

meeting during their child’s stay or if the clinical staff requests a 

consultation with the on-call physician at the bedside. 

The outcomes of these encounters can be pretty amazing, Dr. Yager 

said. She remembered one mother who had participated in a video consultation 

on how to treat her son’s traumatic brain injury and was able to 

provide direction to the nurses when his brain pressure spiked. “The mother 

had absorbed it all,” Dr. Yager said. “It just went to show that having a 

conversation with everyone listening, everyone was on the same page.” 

Davidovich also described the calming effect that Bot can have for 

worried parents. When a 2-year-old wasn’t responding to treatment for 

acute respiratory distress, his mother wouldn’t leave the bedside. 

“The doctor was able to reassure her that her son was in trouble, but 

he looked OK,” Davidovich said. “It was good confirmation hearing it 

right from the attending rather than a relayed message.” After the 

videoconference, the mother was finally able to sleep for a few hours. 

Evidence for telemedicine 

Dr. Yager has many other anecdotes about how telemedicine helped 

avoid unnecessary CT scans or avert further complication. 

The most recent studies of telemedicine in ICUs show that the 

technology can improve patient outcomes and reduce hospital costs. In 

one study, monitoring by remote doctors reduced preventable complications, 

decreased hospital and ICU length of stay, and decreased patient 

mortality, in part because ICU clinicians responded quicker to alarms 

and were more likely to follow best practices. 2 Another study of more 

than 5,000 patients documented a more than $1.25 million cost savings 

because the telemedicine program reduced the number of transports to 

higher acuity institutions. 3 

However, the role of the remote clinician determines the utility of a 

telemedicine programs. In two published studies where tele-ICU systems 

were prevented from providing care outside of life-threatening situations, 

there were no significant changes in patient mortality, complications 

or length of stay. 1 

As the evidence grows, telemedicine has Dr. Yager’s ardent support. 

“The visual is extremely powerful in patient care. One look can be worth 

a thousand words.” n 

References 

1. Jarrah S, Van der Kloot TE. Tele-ICU: Remote Critical Care 

Telemedicine. PCCSU. July 2010; 24. Available from: http://www.chestnet.org/accp/pccsu/tele-icu-remote-critical-care-telemedicinepage=0,3. 

2. Lilly CM, Cody S, Zhao H, et al. Hospital Mortality, Length of 

Stay and Preventable Complications Among Critically Ill Patients Before 

and After Tele-ICU Reengineering of Critical Care Processes. JAMA. 

June 2011; 305(21) 2175-83. 

3. Zawada ET, Herr P, Larson D, et al. Impact of an intensive care 

unit telemedicine program on a rural healthcare system. Postgrad Med. 

2009;121(3)160-70. 

Kristen Ziegler can be reached at kziegler@advanceweb.com. 


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17

n CHRONIC OBSTRUCTIVE PULMONARY DISEASE 

to correct perceptions and help blacks seek 

appropriate treatment earlier.” 

Shifting Susceptibility 

COPD is no longer a ‘white man’s problem’ 


White meN once had the dubious 

distinction of “owning” chronic 

obstructive pulmonary disease. Not 

any more. COPD has widened its grip, constricting 

airways of blacks and females as they 

embrace smoking with the same fervor as did 

white males half a century ago. 

The public misperception that COPD primarily 

strikes caucasian men has only added to the 

problem. Pulmonologist Jermaine Jackson, MD, 

sees a diverse patient population in his practice 

at Georgia Lung Associates, Austell, Ga. “What 

I observe is this: African Americans with COPD 

are younger and have more severe disease than 

white counterparts.” 

And while his patients may realize smoking 

causes heart and lung problems, “… they think 

they are immune to COPD. I hear, ‘I didn’t think 

that was applicable to me. This is not an African 

American problem; it’s a white man’s problem. I 

just thought I was getting older,’” Dr. Jackson 

said. “By the time an African American patient 

gets to me, in early to mid-50s, he is already in 

severe COPD. We in health care are challenged 

COPD RESOURCES 

Our COPD spotlight offers targeted articles, relevant jobs, columns, 

blogs and other helpful information. Visit http://respiratory-caresleep-medicine.advanceweb.com/COPD/default.aspx. 

The leap to statistical data 

That anecdotal snapshot on the COPD ethnic/ 

gender chasm is backed up by hard data, subject 

to interpretation. 

“If we look at the incidence of COPD and 

mortality rates over the last century, they track 

according to when different demographics actually 

started smoking,” said Mark Dransfield, 

MD, of Birmingham, Ala., who spoke May 16 

before the American Thoracic Society 2011 

International Conference in Denver on the topic 

of “Racial Disparities in COPD.” 

In the 1900s, the first group to start smoking 

heavily was white men. Next, white women 

started smoking in numbers, followed by black 

men, then black women. The effects on disease 

frequency and death, Dransfield said, become 

evident 30 to 50 years later. 

But on top of increased smoking habits, is 

there a superimposed increased susceptibility for 

COPD among women and African Americans, 

causing their current statistical numbers to catch 

up with those of white males 

“It depends on what study you look at,” 

Dr. Dransfield said. “Some suggest there could 

be differences in nicotine metabolism — that 

it’s easier for African Americans to become 

addicted to cigarettes. But we don’t know yet 

if that’s definitively true.” 

There is also a persistent hypothesis suggesting 

a female’s airway caliber is narrower than 

a male’s, thus a similar injury from smoking 

would result in more airway obstruction for 

women than men. Again, this idea is likely to 

be true, but not yet proven. 

“If you look at cross-sectional studies, you 

find at the same level of lung function impairment, 

women and African Americans have 

smoked less and tend to be younger,” 

Dr. Dransfield said. “At 60 percent of lung 

function left, the average woman would be 

several years younger than the average man with 

the same level of lung function.” 

He also pointed to studies that appear to show 

differences between races in the distribution of 

the emphysema that they get. “Looking at people 

with very advanced COPD who were being 

evaluated for lung transplant, we’ve seen that 

African Americans have less emphysema and the 

pattern is different than that seen in whites. So 

it looks like the biological response to smoke 

jeff leeser 


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19

n CHRONIC OBSTRUCTIVE PULMONARY DISEASE 

CALLING 

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might be different between the races.” 

Does the evidence hold up 

Gerard J. Criner, MD, serves as Philadelphia 

clinical center director for the National Institute 

of Health’s massive COPDGene study. The 

underlying purpose of the study, Dr. Criner said, 

is to discover if there are independent genetic 

factors that can explain racial and gender differences 

in susceptibility to smoking and COPD. 

“We’re identifying different patterns found on 

X-ray — more airway disease, more emphysema, 

more airways obstruction — things that no one 

could articulate before, without study information,” 

Dr. Criner said. “We may discover separate 

clinical phenotypes found in COPD patients 

that have some relationship to race.” 

While variables of susceptibility may exist, 

Dr. Criner emphasized that in more than 10,000 

COPD patients involved in the study there is a 

substantial amount of genetic mixture that has 

occurred over the generations. “So, there may 

be more variability than can be explained by 

gender or race,” he said. “But we won't know 

for sure until data has been analyzed. We need 

to use caution. It still remains to be seen.” 

But Dr. Dransfield drew a line in the genetic 

susceptibility debate, noting there are most certainly 

differences between the races. “It’s a touchy 

subject, but there clearly are,” he said. “It’s not all 

about access of care and quality of care, as some 

might suggest. That’s another issue that is valid. 

But there is still more. Just as there are differences 

between men and women that have to do 

with hormones, so are there differences between 

the races in a variety of gene frequencies. There 

could be lots of differences, including nicotine 

metabolism, how well the body deals with oxygen 

stress, or how aggressively the neutrophils in the 

body respond to the stimulus from cigarette 

smoke. We are not all exactly the same.” 

And both men agreed that genetic factors, 

working in concert with environmental factors 

— such as an urban or rural atmosphere, or 

exposure to certain pollutants or chemical substances 

— could point toward heightened COPD 

susceptibility. 

Why does it matter 

“Biological Environmental Physiological I 

don’t know. It could be all of them, none of them, 

or a combination,” said a reflective Dr. Criner, 

who is also a professor, chief of pulmonary and 

critical care medicine, and director of the intensive 

care unit and ventilator rehabilitation unit 

at Temple University Hospital, Philadelphia. 

But he stated with certainty that when it comes 

to patient care, defining the susceptibility variables 

will have landmark effects. Once it is established 

that there are distinct presentations of this disease 

predicted by certain characteristics of gender or 

race, patients will be followed earlier, more carefully, 

and their outcomes may be different. 

“If we can identify certain proteins or genes 

or combinations that could indicate a different 

prognosis or even identify potential targets for 

treatment, that will have significant impact on 

improved practice,” Dr. Criner said. “And it will 

certainly give more credence to the notion of 

personalized health care. We can’t treat everybody 

the same.” n 

Contact Valerie Neff Newitt at vnewitt 

@advanceweb.com 

ENTER ONLINE 

Visit www.advanceweb.com/respiratory 

and click on “Faces of the Future” icon to 

submit your 1,400 word article. 

ENTRY DEADLINE: 

JUNE 20, 2011 

QUESTIONS 

Contact Kristen Ziegler at 

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or kziegler@advanceweb.com 

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New Jersey, Pennsylvania, Illinois 

Career Opportunities 

1 Middle Atlantic . . . . . . . . . . . . . . . . . . . . . p. 23 

2 East North Central . . . . . . . . . . . . . . . . . . p. 23 

3 West North Central . . . . . . . . . . . . . . . . . . p. 24 

4 West South Central. . . . . . . . . . . . . . . . . . p. 24 

5 Mountain . . . . . . . . . . . . . . . . . . . . . . . . . p. 24 

MIDDLE ATLANTIC 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

University of Cincinnati 

College of Allied Health Sciences 

Department of Analytical & Diagnostic Sciences 

Position Announcement 

Director, Respiratory Care Program 

Position: One full-time, 12-month Director (Clinical Track). This is a three-year position that is available 

starting July 1, 2011 and is renewable based on available funding and performance. 

Qualifications: Master’s degree in Respiratory Care or related Allied Health field (doctorate is ideal but 

not required). Holds current RRT credential by the NBRC with minimum of 5 years related experience; 

maintains current license or is eligible for a license by the Ohio Respiratory Care Board. Preference will 

be given to applicants with a minimum of 3 years RT teaching experience including online, and evidence 

of educational leadership, program management and on-line learning in the field. 

Responsibilities: 

• Curriculum development (including semester conversion) 

• Faculty hiring and oversight (including faculty workload assignments) 

• Budget oversight and fiscal management 

• Design and implementation of policies that support academic excellence 

• Teach online courses in Respiratory Care (3-4 cr hours/term) 

• Develop courses for on-line program 

• Serve on Department, College, and University committees 

• Student advising; adjudicate student issues as necessary 

• Research/scholarship activities are encouraged 

• Participate in professional organizations (AARC) 

• Liaison with enrollment partner (Embanet Compass Knowledge) 

Application: Applications will be accepted until the position is filled. Applicants should apply at 

www.jobsatuc.com (search for position: #211UC0621) and attach a letter of application, official 

transcripts, vitae, and names of three references. Requests for further information about the position may 

be directed to Dr. Terri Premo at terri.premo@uc.edu. 

The University of Cincinnati (UC) is an affirmative action/equal opportunity employer. Women, minorities, 

disabled persons, Vietnam era and disabled veterans are encouraged to apply. 

 

 

 

 

 

 

 

 

 

www.capitalhealth.org, Job ID #1548. 

 

Springhill Medical Group has a position open 

for a respiratory therapist to perform Pulmonary 

Function studies in our Pittsburg, CA office 3 to 

4 days month. $55 per hour, non benefited position. 

Flexible week days - hours 8:30am to 5pm. Must have 

prior experience performing PFTs. Send e-mail to 

Deeann at: delriod@springhillmed.com 

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ADVANCE is free to qualified recipients, 

but you must subscribe in order to 

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magazine. To subscribe or renew, go to 

www.advanceweb.com/respiratory or call 

(800) 355-1088. 

LOYOLA 

RESPIRATORY CARE 

PRACTITIONER III 

Loyola University Health System, located 10 

miles west of Chicago, is seeking a full-time 

Respiratory Care Practitioner for a pm/ 

evening shift opportunity (3pm – 11:30pm). 

Under the general supervision of the Manager 

of Respiratory Care, the Respiratory 

Care Practitioner will provide intensive and 

general respiratory care services to neonatal, 

pediatric, adolescent, adult, and geriatric 

patients upon receiving written prescriptions 

from a physician. The selected candidate 

will also function as an adult team leader 

within the structure of the department’s 

clinical ladder. 

Requirements include current/valid State of 

IL license, Associates degree (Bachelors preferred), 

1-2 yrs. exp. (3-5 yrs. preferred), CRT 

and CPR certification. ACLS and/or PALS 

and RRT certifications are preferred. 

APPLY ONLINE: 

www.LoyolaMedicine.org/jobs 

Click: “ Staff Positions” 

Select: “ Clin/Allied Health/Research” category 

View: “ Respiratory Care Practitioner III” 

position 

Loyola is an equal opportunity and affirmative action 

employer/educator and is committed to a drug-free 

and smoke-free workplace. 

www.advanceweb.com/respiratory June 2011 ADVANCE FOR RESPIRATORY CARE & SLEEP MEDICINE 23 


23

WEST NORTH CENTRAL 

Director of Clinical Education 

Respiratory Therapy Program 

Jefferson College is seeking a highly-qualified 

and motivated full-time Director of Clinical 

Education/faculty member for the Respiratory 

Therapy Program. For more detailed information 

about Jefferson College, the position, and the application 

procedure, please visit our website at 

www.jeffco.edu and click on 

“Employment Opportunities”. 

Jefferson College, 1000 Viking Drive 

Hillsboro, Missouri 63050 

Jefferson College is an Equal Opportunity Employer 

WEST SOUTH CENTRAL 

Missouri, Oklahoma, Montana 

KEEPING YOUR 

OPTIONS OPEN 

advancecustompromotions.com 

1-877-776-6680 

in Lawton, Oklahoma is seeking a 

Program Coordinator 

Advanced Respiratory Therapy 

Career Training Program 

We offer a salary commensurate with 

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Oklahoma Teacher Retirement System. 

For a job description and application click: 

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MOUNTAIN 

RESPIRATORY 

THERAPIST 

Our 25-bed multi-specialty acute care hospital 

and physicians’ clinics are looking for you. 

We are a progressive and technology driven 

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The qualified candidate is an RRT or CRTT. 

We welcome new graduates and take pride 

in the opportunities for advancement and 

training which are given to our staff. You must 

be licensed in the State of Montana and a 

graduate from an AMA approved School of 

Respiratory Therapy. 

We offer comprehensive benefits, flexible 

scheduling, relocation assistance, a friendly 

work environment, and career advancement. 

If you are a self motivated team player who is 

looking for “the last best place,’ contact: 

Human Resources 

Marcus Daly Memorial Hospital 

1200 Westwood Drive 

Hamilton, MT 59840 

406.375.4466 • humanresources@mdmh.org 

{ ADVANCE } 

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Have a comment on an article 

E-mail Mike Bederka at at mbederka@ 

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24 ADVANCE FOR RESPIRATORY CARE & SLEEP MEDICINE June 2011 www.advanceweb.com/respiratory 


■ PhysicianS Roundtable 


Say Aloha to Learning 

CHEST 2011 offers new educational opportunities 

in a tropical island setting 

Divers off the coast of Hawaii can 

catch a glimpse of sea horses, spotted eagle rays, 

or something really rare: scuba-diving clinicians 

learning the finer points of dive and hyperbaric 

medicine. Yes, folks, the interactive, 

hands-on sessions that have become a hallmark 

of CHEST annual meetings will reach new 

heights — and depths — as the American 

College of Chest Physicians convenes in 

Honolulu from Oct. 22 to 26. 

CHEST 2011 attendees can look forward to 

globally focused topics, upgraded simulation 

centers, and 300 continuing education courses 

built around the ACCP’s year-long goal to 

enhance learning in critical care, ultrasonography, 

mechanical ventilation, thoracic imaging, 

and sleep medicine. “(We’re) really identifying 

various practice gaps and tailoring our meeting 

toward addressing these,” said former ACCP 

President Mark Rosen, MD, chair of the college's 

education committee. 

Kicking off this year’s meeting are cutting-edge 

postgraduate presentations Saturday, Oct. 22, 

about critical care, advanced lung disease management, 

health care reform and quality improvement, 

sleep medicine, pulmonary vascular 

disease, and pleural problems. Attendees can pay 

a flat fee for postgraduate multipass courses. 

An additional lineup of learning opportunities 

is available Saturday. Those who register for the 

dive and hyperbaric medicine update and pay 

an additional fee for a dive excursion will tie 

practical experience to topics covered in morning 

panel discussions. Other courses offered that day 

include neuromuscular respiratory medicine, and 

bronchology and interventional pulmonology. 

Sunday, Oct. 23, jumpstarts four days of informative 

programs including a keynote address, 

problem-based learning sessions, case reports, 

poster presentations, and literature reviews. Many 

sessions will offer a global perspective, as CHEST 

2011 will feature the highest number of international 

speakers in meeting history, said program 

chair Kevin Chan, MD, FCCP. 

More than 25 percent of the regular program 

will focus on critical care. Requests for the 

subject poured in from last year’s attendees. 

“We’re taking advantage of non-pulmonary 

critical care topics such as neuro-critical care 

and other organ system failure,” Dr. Chan 

said. “But we still have a lot of discussion on 

acute lung injury, ARDS, and various alternative 

modes of ventilation.” The emerging use 

of biotechnology to treat patients with lung 

cancer and other advanced lung disease also 

will be a focus. 

New to this year’s conference is the Center 

of Excellence, where exemplary hospital and 

practice-based health systems will highlight 

what they are doing to improve patient care. 

Vendor representatives will be on hand to 

further discuss the products used by those 

health care systems. 

Attendees looking for more continuing 

education credits and to explore Hawaii’s islands 

can sign up for three after-CHEST postgraduate 

courses Oct. 28 and 29. A course covering 

emerging topics in thoracic imaging will take 

place on Maui, and a lung cancer state of the 

art session will be held on the Kohala Coast. 

Mechanical ventilation enthusiasts can stay 

on Oahu to attend a postgraduate course 

developed by renowned author and clinician 

Neil MacIntyre, MD, that will go beyond the 

basic waveform identification covered in the 

meeting’s simulation center. 

“There will be much more detail involved,” 

Chan said. “This is a two-day, in-depth, handson 

management of mechanical ventilation with 

experts.” The course will include practice using 

high-fidelity patient simulation mannequins. 

CHEST 2011 sessions begin at 7 a.m. to give 

attendees time to enjoy the tropical surroundings. 

So make room in your conference bag for 

an alarm clock and beach towel, and say “Aloha” 

to a unique educational experience. 

Registration for CHEST 2011 is open, and 

those who register by Aug. 31 receive a discount. 

Visit www.accpmeeting.org for more 

information. n 

Kristen Ziegler can be reached at kziegler 

@advanceweb.com. 

Photo Courtesy/American College of Chest Physicians 

Physicians Roundtable is a joint venture 

of ADVANCE and the American College of 

Chest Physicians. For 

more information on 

ACCP activities and 

offerings, contact 

David Eubanks, EdD, 

RRT, FCCP(Hon) at 

(847) 498-1400. For 

membership information, 

call Chris Derbes at the same number, 

or write to ACCP, 3300 Dundee Road, 

Northbrook, IL 60062-2348. You also can 

reach the ACCP online at www.chestnet 

.org or email accp@chestnet.org. 

Attendees can 

look forward to 

upgraded simulation 

centers, 

globally focused 

topics, and 300 

continuing education 

courses at the 

CHEST 2011 

meeting. 



25

■ Barely BreathinG 

By Brent Swager, RRT 

Late To Work 

Excuse No. 641 

EAST NORTH CENTRAL 

New Jersey, Pennsylvania, Illinois 

University of Cincinnati 

College of Allied Health Sciences 

Department of Analytical & Diagnostic Sciences 

Position Announcement 

my friend, is the last thing 

you want to hear when 

you’ve got a load of 

Pavulon® on board. 

Career Opportunities 

“He eventually got 

1 Middle Atlantic . . . . . . . . . . . . . . . . . . . . . p. 23 

a No. 8 in me. Then 

2 East North Central . . . . . . . . . . . . . . . . . . p. 23 

came the dreaded 

Director, Respiratory Care Program 

“Your shift started 3 West North 22 Central minutes . . . . . ago,” . . . . . . . . . consequently, . . . . p. 24 I 

blood gas. Since I was 

Danny barked when 4 West I burst South into Central. the . . respiratory 

department. “Where 5 Mountain have . . . . you . . . . . been” . . . . . . . . . . . . little . . . . p. trouble 24 

out (except no one 

. . . . . . . . . . . was . . . . p. having 24 a Position: One full-time, 12-month Director (Clinical Track). This is supposedly a three-year position knocked that is availa 

starting July 1, 2011 and is renewable based on available funding and performance. 

Qualifications: Master’s degree in Respiratory Care or related Allied Health field (doctorate is ideal 

“You aren’t going to believe this,” I said, “but getting my not required). Holds current RRT credential by the NBRC with minimum thought of 5 years of related an experien 

last night I awoke to a light shining in my eyes. breath. 

maintains current license or is eligible for a license by the Ohio Respiratory opiate to Care go Board. along Preference 

be given to applicants with a minimum of 3 years RT teaching experience including online, and evide 

It was like someone throwing MIDDLE on ATLANTIC an overhead “And there, of educational leadership, program management and on-line learning with the in the muscle field. relaxer) 

1,000,000-watt light bulb while forgetting that standing over me, Responsibilities: was a 

wouldn’t it be a good time 

the person directly under said light has just shiny new therapist • Curriculum saying, development (including semester to let conversion) a student try their hand at an ABG 

 

• Faculty hiring and oversight (including faculty workload assignments) 

gotten off a grueling 

12-hour night shift and ‘Let me tube him. I’ll • Budget tube him oversight if you and fiscal management Now I know I’ve had my share of misses over 

 

is a nanosecond away 

from drooling-on-thepillow, 

coma-like sleep. 

• Teach online courses in Respiratory Care (3-4 cr hours/term) 

want me to. I think • we Design should and tube implementation him. I’ve of policies the years, that support but I swear academic that kid excellence hit my radial nerve 

got a No. 8 all ready to go. Want me to tube a dozen times before he gave up and started 

 

• Develop courses for on-line program 

“Anyway, fingers 

had pried my eyes open him’ 

• Serve on Department, College, and poking University around committees the antecubital area. With his 

wide enough to shine 

• Student advising; adjudicate student issues as necessary 

a laser beam back and “I thought of all the times I’d said those very perfect record of nerve damage he had the gall 

 

• Research/scholarship activities are encouraged 

forth, torturing my 

pupils as I struggled to words and all the patients • Participate who must in professional have been organizations to say, (AARC) ‘He’s a really tough stick. His arteries 

 

awaken. ‘I must be dreaming,’ I thought to laying there as helpless • Liaison as I was. with I enrollment was relieved partner (Embanet roll.’ Compass Knowledge) 

 

myself, ‘or nightmaring. I think I’ll go splash to hear the physician Application: suggest knocking Applications me out. will be accepted “I’ll have until you the know, position my is filled. arteries Applicants do not roll; should apply 

www.jobsatuc.com (search for position: #211UC0621) and attach a letter of application, offi 

some water in my face.’ 

I felt a needle find transcripts, its way into vitae, my and arm. names It was of three I’ve references. stuck Requests them myself for further … once, information respiratory about the position m 

 

“It was one of those dreams that was so strong an unfortunate effect be directed of the to drug Dr. Terri that Premo I was at terri.premo@uc.edu. 

school. (Don’t look at me that way!) 

that I was rendered helpless. When 

 

I tried to unable to make my The lips University work, or of I’d Cincinnati have given (UC) is an affirmative “Then they action/equal hooked opportunity me up to employer. a vent, rolled Women, minori 

sit up, nothing happened! I took a 

disabled persons, Vietnam era and disabled veterans are encouraged to apply. 

quick inventory 

and realized I was cold and flat on my morphine with pancuronium bromide. alone, water bubbling in my vent tubing until 

the whole crowd the lecture on why you give me into a room, and there I sat neglected and 

 

back. In fact, I never 

sleep on my back and “And then the intubation. UPGRADE Note YOUR to self: WORK I realized, ‘I’ve got LOYOLA to get to work!’ I yanked 

Although front teeth appear strong enough my tube — and yes, I always deflate the bulb 

 

GEAR THIS SEASON! 

to use as a lever for the laryngoscope, looks before self or any other RESPIRATORY extubation — and made CAR 

 

■ Off The Cuff can be deceiving. The FIND sound THE LATEST of teeth TRENDS cracking 

from the inside of ADVANCE your head HEALTHCARE is almost as SHOP“That has to be the worst excuse for being 

AT my THE way down the stairs PRACTITIONER to work.” III 

 

By Dave Riddle, RRT, CPFT 

 

Loyola University Health System, located 

disturbing as hearing Scrubs the l Lab person Coats l Shoes doing l Medical this Equipment late I’ve ever heard,” 

miles 

Danny 

west 

said 

of Chicago, 

dryly. 

is seeking a full-t 

deed humming something from the Neil “How about this then” Respiratory I suggested. Care Practitioner “I woke for a pm/ 

evening shift opportunity (3pm – 11:30p 

www.capitalhealth.org, Job ID Diamond #1548. catalog. And he’s wearing some 70s up to find myself standing Under the outside general The supervision Pearly of the Ma 

cologne — Hai Karate or Brut maybe — Gates …” ager of Respiratory Care, the Respiratory 

Care Practitioner will provide intensive an 

which is really not what advancehealthcareshop.com 

you want wafting “You used that general one last respiratory month,” care Danny services to neon 

down into your gasping aveoli. 

said. 

pediatric, adolescent, adult, and geriatric 

patients upon receiving written prescript 

“I could feel him punching around my vocal “I overslept” I whimpered. 

from a physician. The selected candidate 

chords, trying to 

Don’t 

find his way 

Miss 

in. I would 

an 

have 

Issue“That’s more like will it,” also Danny function said. as an “Now adult get team leader 

within the structure of the department’s 

yanked the thing ADVANCE out of his is hand free and to qualified done it recipients, to work." n clinical ladder. 

myself, except I heard but you him must mutter, subscribe ‘Dang, in the order to 

Springhill Medical Group has a position open 

Requirements include current/valid State 

for a respiratory therapist to perform blasted Pulmonary 

Function studies in our Pittsburg, CA office 3 to 

ferred), 1-2 yrs. exp. (3-5 yrs. preferred), C 

light went receive out on this it. And thing.’ current And subscribers that, Brent must Swager is a practitioner IL license, in Associates St. Petersburg, degree Fla. (Bachelors 

renew annually to continue getting the 

4 days month. $55 per hour, non benefited position. 

and CPR certification. ACLS and/or PALS 

and RRT certifications are preferred. 

Flexible week days - hours 8:30am to 5pm. Must have magazine. To subscribe or renew, go to 

prior experience performing PFTs. Send e-mail to 

www.advanceweb.com/respiratory TAKE A BREAK or call 

Deeann at: delriod@springhillmed.com 

APPLY ONLINE: 

Pause from the stresses of your work day and have some fun. Treat yourself 

(800) 355-1088. 

www.LoyolaMedicine.org/jo 

to our special collection of themed crossword puzzles, cartoons, humor columns, 

and more. Visit http://respiratory-care-sleep-medicine.advanceweb 

Click: “ Staff Positions” 

.com/Web-Extras/Online-Extras/Take-a-Break.aspx. Select: “ Clin/Allied Health/Research” cat 

Visit www.advanceweb.com/respiratory for a 

View: “ Respiratory Care Practitioner III” 

free Off the Cuff e-book. 

position 

26 ADVANCE for Healthcare Careers 

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