Brian Linde, MD

All Publications

• Increasing face-mask compliance among healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic. Infection control and hospital epidemiology Datta, R., Glenn, K., Pellegrino, A., Tuan, J., Linde, B., Kayani, J., Patel, K., Calo, L., Dembry, L. M., Fisher, A. 2022; 43 (5): 616-622

  Abstract

  Prior studies of universal masking have not measured face-mask compliance. We performed a quality improvement study to monitor and improve face-mask compliance among healthcare personnel (HCP) during the coronavirus disease 2019 (COVID-19) pandemic.Mixed-methods study.Tertiary-care center in West Haven, Connecticut.HCP including physicians, nurses, and ancillary staff.Face-mask compliance was measured through direct observations during a 4-week baseline period after universal masking was mandated. Frontline and management HCP completed semistructured interviews from which a multimodal intervention was developed. Direct observations were repeated during a 14-week period following implementation of the multimodal intervention. Differences between units were evaluated with χ2 testing using the Bonferroni correction. Face-mask compliance between baseline and intervention periods was compared using time-series regression.Among 1,561 observations during the baseline period, median weekly face-mask compliance was 82.2% (range, 80.8%-84.4%). Semistructured interviews were performed with 16 HCP. Qualitative analysis informed the development of a multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership. Among 2,651 observations during the intervention period, median weekly face-mask compliance was 92.6% (range, 84.6%-97.9%). There was no difference in weekly face-mask compliance between COVID-19 and non-COVID-19 units. The multimodal intervention was associated with an increase in face-mask compliance (β = 0.023; P = .002).Face-mask compliance remained suboptimal among HCP despite a facility-wide mandate for universal masking. A multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership was effective in increasing face-mask compliance among HCP.

  View details for DOI 10.1017/ice.2021.205

  View details for PubMedID 33938417

  View details for PubMedCentralID PMC8144836

• Guidance on PFAS Exposure, Testing, and Clinical Follow-Up Linde, B. The National Academies Press. Washington, DC. 2022 ; National Academies of Sciences, Engineering, and Medicine
• Occupational Disease in the 21st Century: COVID-19, Climate Change, and the Fourth Industrial Revolution Hager , K., Linde , B., Redlich , C. . In Modern Occupational Diseases Diagnosis, Epidemiology, Management and Prevention, ed KM Bang, Bentham Science Publishers. 2022
• Climate Change. In Yale Office-based Medicine Curriculum, eds. James , E., Linde , B. Yale University. New Haven, CT. 2021 ; Katherine A. Gielissen, Seonaid F. Hay, and Laura Whitman, 10th edition.
• Symptomatic Responses to Low-Level Occupational and Environmental Exposures Linde , B., Redlich , C. In Patty’s Industrial Hygiene, Seventh Edition, eds B Cohrssen and JS Birkner, John Wiley & Sons, Inc. Hoboken, NJ. 2021
• Environmental Pulmonary Disorders Linde , B., James , E., Redlich , C. Merck Manuals Professional Edition. . 2021
• Master Clinician and Public Health Practitioner: Selected Occupational and Environmental Pulmonary Cases. Clinics in chest medicine James, E., Linde, B., Redlich, C. A. 2020; 41 (4): 567-580

  Abstract

  Occupational and environmental exposures contribute to the development and progression of most lung diseases, yet their impact is greatly under-recognized in clinical practice. Clinicians caring for patients with respiratory diseases should maintain a high index of suspicion for occupational and environmental contributing factors. Mastering occupational and environmental medicine clinical decision making requires specialized clinical skills. These skills include obtaining an appropriate work and exposure history; making an assessment of the magnitude and relevance of exposures and their contribution to a patient's respiratory disease; utilizing appropriate resources for evaluation and management of exposure-related disease; and considering socioeconomic and public health factors.

  View details for DOI 10.1016/j.ccm.2020.08.019

  View details for PubMedID 33153680

• Occupational lung diseases in the 21st century: the changing landscape and future challenges. Current opinion in pulmonary medicine Fazen, L. E., Linde, B., Redlich, C. A. 2020; 26 (2): 142-148

  Abstract

  Occupational exposures remain an underrecognized and preventable cause of lung disease in high-income countries. The present review highlights the emergence of cleaning-related respiratory disease and the re-emergence of silicosis as examples of trends in occupational lung diseases in the 21st century.Employment trends, such as the shift from large-scale manufacturing to a service economy, the growth of the healthcare sector, and changing consumer products have changed the spectrum of work-related lung diseases. Following decades of progress in reducing traditional hazards such as silica in U.S. workplaces, cases of advanced silicosis have recently re-emerged with the production of engineered stone countertops. With growth in the healthcare and service sectors in the United States, cleaning products have become an important cause of work-related asthma and have recently been associated with an increased risk of chronic obstructive pulmonary disease (COPD) in women. However, these occupational lung diseases largely go unrecognized by practicing clinicians.The present article highlights how changes in the economy and work structure can lead to new patterns of inhalational workplace hazards and respiratory disease, including cleaning-related respiratory disease and silicosis. Pulmonary clinicians need to be able to recognize and diagnose these occupational lung diseases, which requires a high index of suspicion and a careful occupational history.

  View details for DOI 10.1097/MCP.0000000000000658

  View details for PubMedID 31895883

• Disability Forms. In Yale Office-based Medicine Curriculum, eds. James , E., Linde , B. Yale University. New Haven, CT. 2020 ; 10th edition
• Building-related illness and building-related symptoms Ahasic , A., Redlich , C., Linde , B. In M.D. Aronson (Ed.). 2020
• Bronchial hyper-responsiveness: a technical update. Occupational medicine (Oxford, England) Borak, J., Lefkowitz, R. Y., Linde, B. 2018; 68 (8): 519-522

  Abstract

  Bronchial hyper-responsiveness (BHR) is often regarded as a 'hallmark' of asthma, and bronchoprovocation testing is frequently performed to support a diagnosis of asthma. The European Respiratory Society (ERS) and American Thoracic Society (ATS) have recently updated their technical standards and guidelines for performing methacholine challenge testing (MCT), the most commonly performed clinical test of BHR.To review the updated guidelines and discuss the various changes and their potential impact on clinicians.We performed a systematic review of references identified using Medline and hand searches of identified articles.The new ERS and ATS guidelines recommend that MCT be performed using tidal breathing, not deep inspirations with breath holding, that results be reported as the PD20 (cumulative dose causing a 20% fall in forced expiratory volume in 1 s [FEV1]), rather than PC20 (concentration causing a 20% fall in FEV1), and that manufacturers of nebulizers and other delivery systems provide performance characteristics to allow calculation of PD20 values. Our preliminary survey found that the new guidelines are only slowly being adopted.Clinicians should be aware that recommended BHR testing methods, particularly for MCT, have changed. As a result, they should anticipate that test outcomes will increasingly be reported in terms of PD20, which will facilitate longitudinal assessment of their patients. Compliance with the new guidelines will increase the sensitivity of MCT in mild and asymptomatic asthmatics.

  View details for DOI 10.1093/occmed/kqy122

  View details for PubMedID 30192977

• Acute kidney injury in pregnancy-current status. Advances in chronic kidney disease Acharya, A., Santos, J., Linde, B., Anis, K. 2013; 20 (3): 215-22

  Abstract

  Pregnancy-related acute kidney injury (PR-AKI) causes significant maternal and fetal morbidity and mortality. Management of PR-AKI warrants a thorough understanding of the physiologic adaptations in the kidney and the urinary tract. Categorization of etiologies of PR-AKI is similar to that of acute kidney injury (AKI) in the nonpregnant population. The causes differ between developed and developing countries, with thrombotic microangiopathies (TMAs) being common in the former and septic abortion and puerperal sepsis in the latter. The incidence of PR-AKI is reported to be on a decline, but there is no consensus on the exact definition of the condition. The physiologic changes in pregnancy make diagnosis of PR-AKI difficult. Newer biomarkers are being studied extensively but are not yet available for clinical use. Early and accurate diagnosis is necessary to improve maternal and fetal outcomes. Timely identification of "at-risk" individuals and treatment of underlying conditions such as sepsis, preeclampsia, and TMAs remain the cornerstone of management. Questions regarding renal replacement therapy such as modality, optimal prescription, and timing of initiation in PR-AKI remain unclear. There is a need to systematically explore these variables to improve care of women with PR-AKI.

  View details for DOI 10.1053/j.ackd.2013.02.002

  View details for PubMedID 23928385

• Becoming a doctor: a qualitative evaluation of challenges and opportunities in medical student wellness during the third year. Academic medicine : journal of the Association of American Medical Colleges Kligler, B., Linde, B., Katz, N. T. 2013; 88 (4): 535-40

  Abstract

  To improve understanding of the impact of the third year on medical student wellness and help educators improve approaches to promoting wellness.The authors used an interpretive description approach to conduct a qualitative analysis of required essays written by 173 third-year medical students as part of a May 2011 final exam at the Albert Einstein College of Medicine of Yeshiva University. In these essays, students reflected on how the transition to clinical responsibilities during the third year of medical school had affected their own health and wellness behaviors.Four themes emerged. Students described the difficulty of making healthy choices in the face of time challenges, the effect of becoming a role model for patients, and the impact of information on their view of their own health and wellness. A subset reflected on the tension between self-care and dedication to work that is inherent in developing a professional identity as a physician. Some students characterized these as challenges that encouraged them to be more active and effective in managing their own health; others viewed them as insurmountable obstacles that prevented them from making healthy choices.The new responsibilities in the third year of medical school comprise a unique set of opportunities and challenges that affect how students make choices regarding health and wellness. Educators should develop strategies for identifying and supporting students who are likely to experience the transition as difficult, and for capitalizing on learning opportunities by framing these challenges as part of students' professional development.

  View details for DOI 10.1097/ACM.0b013e3182860e6d

  View details for PubMedID 23425993