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Jin Y, Ma L, Zhou J, Xiong B, Fernando A, Snelgrove H. A call for improving of musculoskeletal education on physical medicine and rehabilitation studies: a systematic review with meta-analysis. BMC MEDICAL EDUCATION 2024; 24:1163. [PMID: 39420313 PMCID: PMC11488140 DOI: 10.1186/s12909-024-06178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 10/11/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND The incidence of musculoskeletal diseases is increasing in clinical practice, leading to a growing demand for rehabilitation medicine. However, education in musculoskeletal education is lacking in the training of physical medicine and rehabilitation students. This study aims to evaluate the impact of musculoskeletal education on medical students' learning of rehabilitation medicine and analyze the correlation between influencing factors and education. OBJECTIVES The primary objective of this study is to evaluate the impact of musculoskeletal education on medical students' learning of rehabilitation medicine. Furthermore, the authors aim to analyze the correlation between various influencing factors and the effectiveness of this education, with the goal of informing future educational interventions and enhancing student outcomes. METHODS A comprehensive search was conducted across the Pubmed, Ovid, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for relevant articles published from January 2012 to September 2024. The search focused on medical students as the research subjects and musculoskeletal education as the intervention method. Both randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) were included. The selected studies underwent a systematic review, and meta-analysis was performed using R 3.4.4 software. RESULTS After a thorough search, 41 studies were included. The retrospective study indicated that the most common impacts were knowledge acquisition, self-confidence, and satisfaction. The subsequent meta-analysis revealed significant increases in students' knowledge acquisition [standardized mean differences (SMD) = 2.15, 95% confidence interval [CI] (1.36, 2.94), I2 = 97%, random effect model] and self-confidence [SMD = 5.81, 95% CI (2.88, 8.75), I2 = 97%, random effect model]. Compared with the general teaching control group, the knowledge acquisition of students in the observation group improved [SMD = 0.25, 95% CI (0.00, 0.51), I2 = 83%, in the random effect model]; However, no significant difference in satisfaction occurred [SMD = 0.27, 95% CI (-0.47, 1.01), P > 0.05, I2 = 89%, in the random effects model]. CONCLUSION Musculoskeletal education primarily impacts knowledge acquisition self-confidence, and satisfaction among physical medicine and rehabilitation students. The meta-analysis further establishes that musculoskeletal education significantly enhances knowledge acquisition and confidence in these students. TRIAL REGISTRATION CRD42024563899 (completed on July 17, 2024).
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Affiliation(s)
- Ying Jin
- Department of Rehabilitation in Traditional Chinese Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China.
| | - Liqian Ma
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou, Zhejiang, 310053, China
| | - Jie Zhou
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou, Zhejiang, 310053, China
| | - Bing Xiong
- Department of Rehabilitation in Traditional Chinese Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Asanga Fernando
- Department of Education and Development - GAPS Simulation & Skills Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Huon Snelgrove
- Department of Education and Development - GAPS Simulation & Skills Centre, St George's University Hospitals NHS Foundation Trust, London, UK
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Sarmento A, Adodo R, Hodges G, Webber SC, Sanchez-Ramirez DC. Virtual pulmonary rehabilitation approaches in patients with post COVID syndrome: a pilot study. BMC Pulm Med 2024; 24:139. [PMID: 38500051 PMCID: PMC10949685 DOI: 10.1186/s12890-024-02965-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The characteristics of optimal virtual pulmonary rehabilitation (PR) for individuals with post-COVID syndrome (PCS) have not been identified. This study aimed to assess the feasibility, safety, and satisfaction associated with a virtual PR program with the exercise component delivered through group or self-directed sessions. METHODS Adults with PCS-respiratory symptoms were randomly assigned to the video conference (PRVC) or self-directed (PRSD) group and completed an exercise program (aerobic, strengthening, and breathing exercises) three times/week for eight weeks. PRVC sessions were led by a physiotherapist via Zoom, whereas the PRSD group exercised individually following a pre-recorded video. Both groups received personalized exercise recommendations, education related to the condition, and a weekly follow up call. Satisfaction was assessed through a patient survey. Lung function, dyspnea, fatigue, sit-to-stand capacity, health-related quality of life, and participation were assessed pre- and post-PR. RESULTS Fourteen PCS individuals (49 ± 9 years, 86% females) completed 83% of the sessions. All participants were satisfied with information provided by the therapist and frequency of data submission, whereas most were satisfied with the frequency and duration of exercise sessions (88% in PRVC and 83% in PRSD). A higher proportion of participants in the PRVC (88%) were satisfied with the level of difficulty of exercises compared with the PRSD (67%), and 84% of the sample reported a positive impact of the program on their health. No adverse events were reported. Significant changes in sit-to-stand capacity (p = 0.012, Cohen's r = 0.67) and questions related to fatigue (p = 0.027, Cohen's r = 0.58), neurocognitive (p = 0.045, Cohen's r = 0.53), and autonomic (p = 0.024, Cohen's r = 0.60) domains of the DePaul Symptom Questionnaire short-form were also found between groups. CONCLUSION Virtual PR with exercises delivered via video conference or pre-recorded video were feasible, safe, and well-received by individuals with PCS. TRIAL REGISTRATION NCT05003271 (first posted: 12/08/2021).
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Affiliation(s)
- Antonio Sarmento
- Department of Respiratory Therapy, University of Manitoba, Room 334 - 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
| | - Rachel Adodo
- Department of Respiratory Therapy, University of Manitoba, Room 334 - 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
| | - Greg Hodges
- Health Sciences Centre. Winnipeg, Winnipeg, MB, Canada
| | - Sandra C Webber
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Diana C Sanchez-Ramirez
- Department of Respiratory Therapy, University of Manitoba, Room 334 - 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada.
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Reis N, Costa Dias MJ, Sousa L, Canedo F, Rico MT, Henriques MA, Baixinho CL. Telerehabilitation Intervention in Transitional Care for People with COVID-19: Pre-Post Study with a Non-Equivalent Control Group. Healthcare (Basel) 2023; 11:2561. [PMID: 37761758 PMCID: PMC10531287 DOI: 10.3390/healthcare11182561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
SARS-CoV-2 infection and its resulting sequelae have increased the prevalence of people with respiratory symptoms, with impacts on functional capacity, quality of life, anxiety, depression, and mental health. To mitigate this problem, one challenge has been the design and implementation of interventions that simultaneously allow for education, rehabilitation, and monitoring of people with long COVID, at a time when health services were on the verge of rupture due to the volume of people with active COVID and in need of intensive care. Telerehabilitation emerged as a mode for providing rehabilitative care that brought professionals closer to patients and enabled continuity of care. The present study aimed to evaluate the results of a telerehabilitation intervention for people with injuries associated with SARS-CoV-2 infection in hospital-community transitions, considering their degree of dependence in performing activities of daily living, respiratory symptoms, fatigue, gait capacity, muscle strength, and experience with anxiety and depression. A pre-post study with a non-equivalent control group was carried out with a total of 49 participants (intervention group n = 24; control group n = 25). The post-intervention results showed an increase in saturation, a decrease in heart rate, an improvement in the impact of post-COVID functionality, a decrease in fatigue, a decrease in perceived effort, and a decrease in depressive and anxiety symptoms. The telerehabilitation intervention, which combined educational strategies with respiratory and motor rehabilitation, helped improve global functionality and self-care, with clinical and functional impacts.
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Affiliation(s)
- Neuza Reis
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
- Centro Hospitalar Universitário Lisboa Central, 169-045 Lisboa, Portugal;
| | | | - Luís Sousa
- Higher School of Atlantic Health, 2730-036 Barcarena, Portugal;
- Portugal Comprehensive Health Research Centre (CHRC), 7000-811 Evora, Portugal
| | - Filipa Canedo
- NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade NOVA de Lisboa, 169-056 Lisbon, Portugal; (F.C.); (M.T.R.)
| | - Miguel Toscano Rico
- NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade NOVA de Lisboa, 169-056 Lisbon, Portugal; (F.C.); (M.T.R.)
| | - Maria Adriana Henriques
- Lisbon Nursing School, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal;
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Pimenta S, Hansen H, Demeyer H, Slevin P, Cruz J. Role of digital health in pulmonary rehabilitation and beyond: shaping the future. ERJ Open Res 2023; 9:00212-2022. [PMID: 36923569 PMCID: PMC10009701 DOI: 10.1183/23120541.00212-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Pulmonary rehabilitation (PR) is a cost-effective intervention with well-known benefits to exercise capacity, symptoms and quality of life in patients with chronic respiratory diseases. Despite the compelling evidence of its benefits, PR implementation is still suboptimal, and maintenance of PR benefits is challenging. To overcome these pitfalls, there has been a growing interest in developing novel models for PR delivery. Digital health is a promising solution, as it has the potential to address some of the most reported barriers to PR uptake and adherence (such as accessibility issues), help maintain the positive results following a PR programme and promote patients' adherence to a more active lifestyle through physical activity (tele)coaching. Despite the accelerated use of digital health to deliver PR during the coronavirus disease 2019 pandemic, there are still several factors that contribute to the resistance to the adoption of digital health, such as the lack of evidence on its effectiveness, low acceptability by patients and healthcare professionals, concerns about implementation and maintenance costs, inequalities in access to the internet and technological devices, and data protection issues. Nevertheless, the trend towards reducing technology costs and the higher availability of digital devices, as well as the greater ease and simplicity of use of devices, enhance the opportunities for future development of digitally enabled PR interventions. This narrative review aims to examine the current evidence on the role of digital health in the context of PR, including strengths and weaknesses, and to determine possible threats and opportunities, as well as areas for future work.
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Affiliation(s)
- Sara Pimenta
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
| | - Henrik Hansen
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Respiratory Division, University Hospitals Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Patrick Slevin
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Dublin
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
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Valverde-Martínez MÁ, López-Liria R, Martínez-Cal J, Benzo-Iglesias MJ, Torres-Álamo L, Rocamora-Pérez P. Telerehabilitation, A Viable Option in Patients with Persistent Post-COVID Syndrome: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11020187. [PMID: 36673555 PMCID: PMC9859291 DOI: 10.3390/healthcare11020187] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/26/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The number of patients with post-COVID-19 syndrome continues to increase considerably, having serious healthcare, social and economic repercussions. The objective of this study is to describe the effectiveness of telerehabilitation to alleviate the symptoms of post-COVID-19 syndrome. A systematic review was conducted using the information available on four databases (PubMed, Medline, Scielo and PEDRo) on these patients until November 2022. The MeSH search terms were: Post-COVID syndrome, Post-COVID-19, Long COVID, Telerehabilitation, Physiotherapy, Rehabilitation, Virtual, Home care. Six articles were included which provided information on 140 patients, detailing their symptomatology, assessment, treatment and monitoring. The variables measured were dyspnea, fatigue, physical performance and quality of life. All studies included aerobic and anaerobic exercises. Most notable among the techniques used were rib cage expansion exercises, respiratory control and thoracic cage stretching, patient education, Mindfulness and virtual reality games to address physical, mental and relaxation aspects. The use of telerehabilitation could be an effective tool for the treatment of persistent symptoms after suffering from COVID-19. It has been shown in these studies that patients improve both their physical performance and their quality of life.
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Evaluating Virtual and Inpatient Pulmonary Rehabilitation Programs for Patients with COPD. J Pers Med 2022; 12:jpm12111764. [PMID: 36573730 PMCID: PMC9699594 DOI: 10.3390/jpm12111764] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 12/30/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an increasingly frequent disorder that is likely to become the third leading cause of morbidity worldwide. It significantly degrades the quality of life of patients affected and poses a significant financial burden to the healthcare systems providing treatment and rehabilitation. Consequently, our study’s purpose was to compare conventional inpatient pulmonary rehabilitation (PR) with virtual (online) PR using a mobile phone application. During a three-month period, two groups of patients followed the research protocol by participating in a pulmonary rehabilitation program administered and supervised by a physical therapist five times per week. A number of respiratory variables were examined before and after the test. At the end of the study period, a total of 72 patients completed the rehabilitation in the inpatient group, respectively 58 in the online group. It was observed that post-test comparison between patients undergoing the traditional and online rehabilitation methods did not show any significant differences. However, the calculated mean differences between pre-test and post-test results were significantly higher in favor of the virtual method. The most significant variations were encountered in maximal inspiratory pressure (MIP) (6.6% vs. 8.5%, p-value < 0.001), 6-min walking test (6MWT) (6.7% vs. 9.4%, p-value < 0.001), and COPD assessment test (CAT) values (4.8 vs. 6.2, p-value < 0.001), respectively. However, the maximal expiratory pressure (MEP) variation was significantly higher in patients undergoing the traditional rehabilitation method, from an average of 4.1% to 3.2% (p-value < 0.001). In this preliminary study, the online pulmonary rehabilitation program proved non-inferiority to the traditional method, with significantly better results in several measurements. Additional studies using larger cohorts of patients and longer exposure to the online rehabilitation program are required to validate these findings.
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Brennan L, Sadeghi F, O’Neill L, Guinan E, Smyth L, Sheill G, Smyth E, Doyle SL, Timon CM, Connolly D, O’Sullivan J, Reynolds JV, Hussey J. Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study. Cancers (Basel) 2022; 14:2707. [PMID: 35681687 PMCID: PMC9179413 DOI: 10.3390/cancers14112707] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Telehealth has enabled access to rehabilitation throughout the pandemic. We assessed the feasibility of delivering a multi-disciplinary, multi-component rehabilitation programme (ReStOre@Home) to cancer survivors via telehealth. METHODS This single-arm mixed methods feasibility study recruited participants who had completed curative treatment for oesophago-gastric cancer for a 12-week telehealth rehabilitation programme, involving group resistance training, remotely monitored aerobic training, one-to-one dietetic counselling, one-to-one support calls and group education. The primary outcome was feasibility, measured by recruitment rates, attendance, retention, incidents, acceptability, Telehealth Usability Questionnaire (TUQ) and analysis of semi-structured interviews. RESULTS Characteristics of the twelve participants were: 65.42 ± 7.24 years; 11 male; 10.8 ± 3.9 months post-op; BMI 25.61 ± 4.37; received neoadjuvant chemotherapy 7/12; received adjuvant chemotherapy 4/12; hospital length of stay 16 days (median). Recruitment rate was 32.4%, and retention rate was 75%. Mean attendance was: education 90%; dietetics 90%; support calls 84%; resistance training 78%. Mean TUQ score was 4.69/5. Adaptations to the planned resistance training programme were required. Participants reported that ReStOre@Home enhanced physical and psychological wellbeing, and online delivery was convenient. Some reported a preference for in-person contact but felt that the online group sessions provided adequate peer support. CONCLUSION Telehealth delivery of ReStOre@Home was most feasible in individuals with moderate to high levels of digital skills. Low level of digitals skills was a barrier to recruitment and retention. Participants reported high levels of programme adherence and participant satisfaction. Adaptations to future programmes, including introducing elements of in-person contact, are required.
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Affiliation(s)
- Louise Brennan
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Fatemeh Sadeghi
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Linda O’Neill
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Emer Guinan
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- School of Medicine, Trinity College, D08 W9RT Dublin, Ireland
| | - Laura Smyth
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Grainne Sheill
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- Physiotherapy Department, St. James Hospital, D08 NHY1 Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Suzanne L. Doyle
- School of Biological and Health Sciences, Technological University Dublin, D07 ADY7 Dublin, Ireland;
| | - Claire M. Timon
- Centre for eIntegrated Care, School of Nursing, Psychotherapy and Community Health, Dublin City University, D09 X984 Dublin, Ireland;
| | - Deirdre Connolly
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- Discipline of Occupational Therapy, Trinity College, D08 W9RT Dublin, Ireland
| | - Jacintha O’Sullivan
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, St James’s Hospital Dublin, D08 W9RT Dublin, Ireland
| | - John V. Reynolds
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, St James’s Hospital Dublin, D08 W9RT Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
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Joshi M, Varkey B. Editorial: COPD in the COVID-19 era, challenging concepts and developments in COPD, and occupational exposures and susceptibilities. Curr Opin Pulm Med 2022; 28:73-75. [PMID: 34930865 PMCID: PMC8828313 DOI: 10.1097/mcp.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Manish Joshi
- Department of Medicine (Pulmonary & Critical Care Division), University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
| | - Basil Varkey
- Department of Medicine (Pulmonary & Critical Care), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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