Solmaz Ehteshami Afshar
Clinical Assistant Professor, Medicine - Pulmonary, Allergy & Critical Care Medicine
Bio
Dr. Ehteshami Afshar is a Clinical Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine at Stanford University. She earned her MSc from the University of British Columbia, specializing in health economics, before completing her residency in Internal Medicine at Yale New Haven Hospital. She furthered her training at Stanford University, pursuing fellowships in Pulmonary and Critical Care Medicine as well as Sleep Medicine. Dr. Ehteshami Afshar’s clinical expertise lies in the management of complex pulmonary conditions and sleep-related respiratory disorders, with a particular focus on home mechanical ventilation.
Academic Appointments
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Clinical Assistant Professor, Medicine - Pulmonary, Allergy & Critical Care Medicine
Professional Education
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Fellowship, Stanford University, Pulmonary and Critical Care Medicine Fellowship
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Fellowship, Stanford University, Sleep Medicine Fellowship
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Residency, Yale New Haven Hospital, Internal Medicine Residency
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Medical Education, Shahid Beheshti University of Medical Sciences
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MSc, University of British Columbia (UBC)
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Board Certification, American Board of Internal Medicine, Internal Medicine
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Board Certification, American Board of Internal Medicine, Sleep Medicine
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Board Certification, American Board of Internal Medicine, Pulmonary Disease
All Publications
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PREVALENCE AND CORRELATION OF DIURNAL AND NOCTURNAL HYPERCAPNIA IN CHRONIC OPIOID-INDUCED CENTRAL SLEEP APNEA: A RETROSPECTIVE OBSERVATIONAL STUDY
ELSEVIER. 2023: 6300A
View details for DOI 10.1016/j.chest.2023.07.4056
View details for Web of Science ID 001085062006058
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COVID-19 mRNA Vaccines and ILD Exacerbation: Causation or Just a Temporal Association?
American journal of respiratory and critical care medicine
2022
View details for DOI 10.1164/rccm.202205-0902LE
View details for PubMedID 35612912
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The underappreciated role of documentation in improving COPD care.
Cleveland Clinic journal of medicine
2022; 89 (5): 249-251
View details for DOI 10.3949/ccjm.89a.21044
View details for PubMedID 35500929
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Ischemic Gastritis in a Patient with Chronic Constipation
JOURNAL OF GENERAL INTERNAL MEDICINE
2022; 37 (4): 966-967
View details for DOI 10.1007/s11606-021-07190-w
View details for Web of Science ID 000742999700001
View details for PubMedID 35037177
View details for PubMedCentralID PMC8904702
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UNDER-RECOGNITION OF LEUKEMIC LUNG INFILTRATION IN PATIENTS WITH LEUKEMIA AND ACUTE RESPIRATORY ILLNESS
ELSEVIER. 2020: 708A
View details for DOI 10.1016/j.chest.2020.08.664
View details for Web of Science ID 000582625300603
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RADIOGRAPHIC PATTERNS IN PATIENTS WITH LEUKEMIC INFILTRATION
ELSEVIER. 2020: 1387A
View details for DOI 10.1016/j.chest.2020.08.1256
View details for Web of Science ID 000582625301391
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TEMPERATURE INSTABILITY IN PATIENTS WITH ACUTE MYELOID LEUKEMIA
ELSEVIER. 2020: 709A
View details for DOI 10.1016/j.chest.2020.08.665
View details for Web of Science ID 000582625300604
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A Systematic Review of Decision-Analytic Models for Evaluating Cost-Effectiveness of Asthma Interventions
VALUE IN HEALTH
2019; 22 (9): 1070-1082
Abstract
To demonstrate the landscape of model-based economic studies in asthma and highlight where there is room for improvement in the design and reporting of studies.A systematic review of the methodologies of model-based, cost-effectiveness analyses of asthma-related interventions was conducted. Models were evaluated for adherence to best-practice modeling and reporting guidelines and assumptions about the natural history of asthma.A systematic search of English articles was performed in MEDLINE, EMBASE, and citations within reviewed articles. Studies were summarized and evaluated based on their adherence to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). We also studied the underlying assumptions about disease progression, heterogeneity in disease course, comorbidity, and treatment effects.Forty-five models of asthma were included (33 Markov models, 10 decision trees, 2 closed-form equations). Novel biological treatments were evaluated in 12 studies. Some of the CHEERS' reporting recommendations were not satisfied, especially for models published in clinical journals. This was particularly the case for the choice of the modeling framework and reporting on heterogeneity. Only 13 studies considered any subgroups, and 2 explicitly considered the impact of comorbidities. Adherence to CHEERS requirements and the quality of models generally improved over time.It would be difficult to replicate the findings of contemporary model-based evaluations of asthma-related interventions given that only a minority of studies reported the essential parameters of their studies. Current asthma models generally lack consideration of disease heterogeneity and do not seem to be ready for evaluation of precision medicine technologies.
View details for DOI 10.1016/j.jval.2019.03.016
View details for Web of Science ID 000484836100014
View details for PubMedID 31511184
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Extent, trends, and determinants of controller/reliever balance in mild asthma: a 14-year population-based study
RESPIRATORY RESEARCH
2019; 20: 44
Abstract
The majority of patients with asthma have the mild form of the disease. Whether mild asthma patients receive appropriate asthma medications has not received much attention in the literature. We examined the trends in indicators of controller/reliever balance.Using administrative health databases of British Columbia, Canada (2000 to 2013), we created a population-based cohort of adolescents/adults with mild asthma using validated case definition algorithms. Each patient-year of follow-up was assessed based on two markers of inappropriate medication prescription: whether the ratio of controller medications (inhaled corticosteroids [ICS] and leukotriene receptor antagonists [LTRA]) to total asthma-related prescriptions was low (cut-off 0.5 according to previous validation studies), and whether short-acting beta agonists (SABA) were prescribed inappropriately according to previously published criteria that considers SABA in relation to ICS prescriptions. Generalized linear models were used to evaluate trends and to examine the association between patient-, disease-, and healthcare-related factors and medication use.The final cohort consisted of 195,941 mild asthma patients (59.5% female; mean age at entry 29.6 years) contributing 1.83 million patient-years. In 48.8% of patient-years, controller medications were suboptimally prescribed, while in 7.2%, SABAs were inappropriately prescribed. There was a modest year-over-year decline in inappropriate SABA prescription (relative change - 1.3%/year, P < 0.001) and controller-to-total-medications (relative change - 0.5%/year, P < 0.001). Among the studied factors, the indices of type and quality of healthcare (namely respirologist consultation and receiving pulmonary function test) had the strongest associations with improvement in controller/reliever balance.Large number of mild asthma patients continue to be exposed to suboptimal combinations of asthma medications, and it appears there are modifiable factors associated with such phenomenon.
View details for DOI 10.1186/s12931-019-1007-0
View details for Web of Science ID 000460082700004
View details for PubMedID 30819154
View details for PubMedCentralID PMC6394061
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Optimum cutoff values of anthropometric indices of obesity for predicting hypertension: more than one decades of follow-up in an Iranian population
JOURNAL OF HUMAN HYPERTENSION
2018; 32 (12): 838-848
Abstract
We determined cutoff points of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), for predicting hypertension in an Iranian population. Study sample included 6359 (3678 female) participants aged ≥20 and <60 years of a prospective cohort. The sex stratified multivariate hazard ratios (HRs) for all indices were estimated using Cox regression in two age groups (20-39 and 40-59 years). Receiver operating characteristic (ROC) was used to evaluate the predictive ability and determine the optimal cut-off values of the indices. In both genders and two age groups, the confounders adjusted HRs were significant for general and central obesity measures indices. AUCs of the indices were similar in men; however, among women 40-59 years, WC and WHtR had significantly higher AUC compared to BMI. Generally, the optimal cut-off values were higher in the 40-59 year age group. Optimal BMI, WC and WHR and WHtR cut-off values were 24.15 kg/m2, 90.5 cm, 0.90 and 0.49 among men, aged 20-39 years; the corresponding values were 28.41 kg/m2, 86.5 cm, 0.96 and 0.50 in men aged 40-59 years, respectively. In women, the aforementioned values were 26.38 kg/m2, 83.5 cm, 0.79 and 0.51 in the age group of 20-39 years, and 29.57 kg/m2, 90.5 cm, 0.88 and 0.59 in the 40-59 year age group, respectively. Our results suggest that gender and age differences in the association between anthropometric indices and hypertension should be considered.
View details for DOI 10.1038/s41371-018-0093-7
View details for Web of Science ID 000451433100006
View details for PubMedID 30082689
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CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE: INSIGHTS FROM PARADIGM-HF
ELSEVIER SCIENCE INC. 2017: 734
View details for DOI 10.1016/S0735-1097(17)34123-2
View details for Web of Science ID 000397342301256
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Asthma patient education, the overlooked aspect of disease management
CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE
2017; 1 (1): 43-45
View details for DOI 10.1080/24745332.2017.1304158
View details for Web of Science ID 000441798100006
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The impact of comorbidities on productivity loss in asthma patients
RESPIRATORY RESEARCH
2016; 17: 106
Abstract
Health-related productivity loss is an important, yet overlooked, component of the economic burden of disease in asthma patients of a working age. We aimed at evaluating the effect of comorbidities on productivity loss among adult asthma patients.In a random sample of employed adults with asthma, we measured comorbidities using a validated self-administered comorbidity questionnaire (SCQ), as well as productivity loss, including absenteeism and presenteeism, using validated instruments. Productivity loss was measured in 2010 Canadian dollars ($). We used a two-part regression model to estimate the adjusted difference of productivity loss across levels of comorbidity, controlling for potential confounding variables.284 adults with the mean age of 47.8 (SD 11.8) were included (68 % women). The mean SCQ score was 2.47 (SD 2.97, range 0-15) and the average productivity loss was $317.5 per week (SD $858.8). One-unit increase in the SCQ score was associated with 14 % (95 % CI 1.02-1.28) increase in the odds of reporting productivity loss, and 9.0 % (95 % CI 1.01-1.18) increase in productivity loss among those reported any loss of productivity. A person with a SCQ score of 15 had almost $1000 per week more productivity loss than a patient with a SCQ of zero.Our study deepens the evidence-base on the burden of asthma, by demonstrating that comorbidities substantially decrease productivity in working asthma patients. Asthma management strategies must be cognizant of the role of comorbidities to properly incorporate the effect of comorbidity and productivity loss in estimating the benefit of disease management strategies.
View details for DOI 10.1186/s12931-016-0421-9
View details for Web of Science ID 000384482100001
View details for PubMedID 27565431
View details for PubMedCentralID PMC5002149
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The Effect Of Co-Morbidities On Productivity Loss In Patients With Asthma
AMER THORACIC SOC. 2016
View details for Web of Science ID 000390749603102
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The global economic burden of asthma and chronic obstructive pulmonary disease
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
2016; 20 (1): 11-U38
Abstract
Non-communicable diseases are now the number one cause of disabilities and loss of life expectancy. Among them, chronic respiratory conditions constitute a major class. The burden of chronic respiratory diseases is generally increasing across the globe, and asthma and chronic obstructive pulmonary disease (COPD) are among the main causes of mortality and morbidity. However, the direct and indirect costs of these conditions vary across jurisdictions. This article reports on recent estimates of the costs of asthma and COPD, with a focus on comparing disease burden across different regions. Overall, there is tremendous variation in per capita annual costs of asthma and COPD. However, the methodology of the cost-of-illness studies is also vastly different, making it difficult to associate differences in reported costs to differences in the true burden of asthma and COPD. Suggestions are provided towards improving the validity and comparability of future studies.
View details for DOI 10.5588/ijtld.15.0472
View details for Web of Science ID 000389687800006
View details for PubMedID 26688525
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Silent coronary artery disease and incidence of cardiovascular and mortality events at different levels of glucose regulation; results of greater than a decade follow-up
INTERNATIONAL JOURNAL OF CARDIOLOGY
2015; 182: 334-339
Abstract
To determine the impact of silent coronary artery disease (CAD), in different levels of glucose regulation at baseline, i.e., those with normal fasting glucose/normal glucose tolerance (NFG/NGT), pre-diabetic and newly diagnosed diabetes mellitus (NDM), on cardiovascular disease (CVD) and total mortality in Iranian populations.The study population included 1809 individuals, aged ≥50years, free of CVD at baseline with a median follow-up of 12.1years. To explore the risk of CVD and mortality associated with the presence of silent CAD (as defined by Minnesota coding criteria for baseline electrocardiogram (ECG) in the absence of a history of CVD) in each of the glucose regulation categories, multivariate adjusted hazard ratios (HRs) were calculated for the presence of silent CAD, compared to the corresponding non-silent CAD counterpart, as reference.During follow-up 382 CVD (321 coronary heart disease) and 208 deaths (91 CVD mortality) occurred. Among the female population, the presence of silent CAD, independent of traditional risk factors, significantly increased the risk of CVD for population with NFG/NGT [2.40 (1.33-4.35)] and pre-diabetes [HR: 2.04 (1.14-3.63)]; however, in the male population the risk was significant for CVD [3.04 (1.53-6.05)] and mortality events [2.60 (1.22-5.56)] in the NDM population and marginally significant for mortality events in NFG/NGT.Different strategies should be considered for silent CAD in males and females with different levels of glucose regulation. It might be justified that screening ECG for prevention of CVD events should be considered mainly among non-diabetic women and men with NDM.
View details for DOI 10.1016/j.ijcard.2015.01.017
View details for Web of Science ID 000351927600099
View details for PubMedID 25585379
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The impact of smoking status on 9.3 years incidence of cardiovascular and all-cause mortality among Iranian men
ANNALS OF HUMAN BIOLOGY
2014; 41 (3): 249-254
Abstract
To examine the association of different smoking groups with cardiovascular disease (CVD), coronary heart diseases (CHD) and CVD attributed death and death due to all causes in a male Tehranian population.From a population-based study 3059 male individuals, aged ≥30 years, free of CVD at baseline were evaluated for a median of 9.3 years. The adjusted hazard ratios (HRs) for incident CVD/CHD, total and CVD mortality regarding their smoking status were calculated using Cox proportional regression analysis, considering never smoking as reference.A total of 158 deaths, in which 78 were CVD attributable, occurred. Considering CVD and CHD events, this study identified 299 and 257 events, respectively. Being a past smoker significantly increased the risk of CVD events (HR = 2.42, CI = 1.28-0.56), however, it has no effect on CHD events, total and CVD mortality. Being a current smoker (more than 10 cigarettes a day) dramatically increased the risk of CVD/CHD events and total/CVD mortality. However, smoking less than 10 cigarettes per day only increased the risk of CVD (HR = 2.12, CI = 1.14-3.95) and its mortality (HR = 4.57, CI = 1.32-15.79).The findings indicate that smoking increases the risk of incident CVD/CHD, total and CVD mortality, particularly CVD mortality. These outcomes were attributable to the daily amount of cigarettes smoked. Past smokers still had higher risk for CVD events, which cessation may not reduce.
View details for DOI 10.3109/03014460.2013.853834
View details for Web of Science ID 000335890700009
View details for PubMedID 24215537
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Is Certolizumab Pegol Safe and Effective in the Treatment of Patients with Moderate to Severe Crohn's Disease? A Meta-analysis of Controlled Clinical Trials
IRANIAN RED CRESCENT MEDICAL JOURNAL
2013; 15 (8): 668-675
Abstract
Tumor necrosis factor-α (TNF-α) antibodies are currently used in patients with moderate to severe Crohn's disease (CD) who are unresponsive to conventional therapies. Certolizumab pegol (Cp) is one of the anti-TNF-α agents introduced for the management of CD and rheumatoid arthritis.The aim of this meta-analysis is to assess the efficacy of Cp in inducing clinical response and remission in CD and the associated adverse events. The effect of Cp in terms of CD patients' C-reactive protein (CRP) level was also studied.Literature was searched for studies investigated the efficacy of Cp on inducing clinical response and maintaining remission in the patients with CD between 1966 and July 2012.Among 165 potentially relevant studies, six with a total of 1695 patients met the inclusion criteria and were meta-analyzed. In comparison to control groups, patients who received Cp had a relative risk (RR) of 1.38 with absolute risk reduction (ARR) = 0.12; 95% CI = 0.03 to 0.21), number needed for treatment (NNT) = 9; P < 0.0001 ) for clinical response and RR of 1.54 (ARR = 0.09; 95% CI = -0.0198 to 0.2), (NNT = 12; P < 0.0001) for maintenance of clinical remission and non-significant RR of 1.24 (P = 0.052) for induction of clinical remission. Baseline CRP did not significantly alter the magnitude or response. Adverse events were not significantly different among patients receiving Cp comparing to placebo.Cp is effective for inducing clinical response and maintenance of clinical remission in patients with moderate to severe CD with similar side-effect profile as the control arms.
View details for DOI 10.5812/ircmj.11258
View details for Web of Science ID 000329608600008
View details for PubMedID 24578833
View details for PubMedCentralID PMC3918190
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Wells' prediction rules for pulmonary embolism: valid in all clinical subgroups?
BLOOD COAGULATION & FIBRINOLYSIS
2012; 23 (7): 614-618
Abstract
Pulmonary embolism is major cause of hospital death. Clinical prediction rules such as Wells' prediction rules can help in selection of at-risk patients who need further testing for pulmonary embolism. We evaluated the usefulness of such criteria for detection of patients with diagnosed pulmonary embolism. Patients enrolled in National Research Institute of Tuberculosis and Lung Disease (NRITLD) deep venous thrombosis (DVT) registry were evaluated and those with objective data about presence or absence of pulmonary embolism were selected for this study. Diagnosis of pulmonary embolism was based on computed tomography pulmonary angiography (CTPA). We calculated the embolic burden in those with CTPA-confirmed pulmonary embolism. Eighty-six patients entered the study (58 males, 28 females, mean age = 54.39 ± 1.74 years). Fifty-four cases had coexisting pulmonary embolism (embolic burden score: 10.77 ± 1.181). Embolic burden score was correlated to presence of massive pulmonary embolism (Pearson rho: 0.43, P = 0.002). There was no association between Wells' pulmonary embolism score and the occurrence of pulmonary embolism (Spearman's rho: 0.085, P = 0.51). Dividing the patients into two, or three, risk groups according to Wells' model did not reveal an association with occurrence of pulmonary embolism either (P = 0.99 and P = 0.261, respectively). Tachycardia and hemoptysis were the only parameters from the Wells' pulmonary embolism score correlated to presence of pulmonary embolism (Spearman's rho: 0.373, P < 0.000 and Spearman's rho: 0.297, P = 0.005, correspondingly). Wells' pulmonary embolism score could not predict the occurrence of pulmonary embolism in DVT patients suspected of having coexisting pulmonary embolism. Until further studies shed light on this patient subset, overreliance on Wells' prediction rules as the solo decision making tool should be cautioned.
View details for DOI 10.1097/MBC.0b013e328356926e
View details for Web of Science ID 000309552200008
View details for PubMedID 22885764
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A systematic review and meta-analysis of the effects of infliximab on the rate of colectomy and post-operative complications in patients with inflammatory bowel disease
ARCHIVES OF MEDICAL SCIENCE
2011; 7 (6): 1000-1012
Abstract
Use of biological therapies may reduce or delay the surgical procedures in patients with inflammatory bowel disease (IBD). The aim of this meta-analysis and systematic review was to determine the impact of pre-operative infliximab (IFX) use on the rate of surgical interventions in patients with IBD and also the effect of preoperative IFX therapy on post-surgical complications.Literature was searched for studies that investigated the efficacy of IFX on the rate of colectomy and post-operative complications/side effects in patients with IBD between 1966 and February 2011.Twelve articles were included in the meta-analysis. In comparison to control groups, patients who received IFX had a relative risk (RR) of 1.17 (p = 0.65) for the rate of colectomy, odds ratio of 3.34 (p = 0.09) in seven observational studies and RR of 0.74 (p = 0.79) in clinical trials for mortality. Summary RR of hospitalization was 0.61 (p = 0.005). Infections and anastomotic leak, pouch-related complications, sepsis and thrombotic events were more common in the patients under IFX therapy but post-operational hospitalization was lower. The patients with IBD who were under IFX therapy were most of the times refractive to other therapies and their disease was more severe.Although IFX does not decrease the rate of colectomy in patients with IBD, it would not increase most of the post-operational side effects in the patients.
View details for DOI 10.5114/AOMS.2011.26612
View details for Web of Science ID 000298831300014
View details for PubMedID 22328883
View details for PubMedCentralID PMC3264992
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Chest physicians' knowledge of appropriate thromboprophylaxis: insights from the PROMOTE study
BLOOD COAGULATION & FIBRINOLYSIS
2011; 22 (8): 667-672
Abstract
Venous thromboembolism (VTE) is a major cause of in-hospital mortality. Several international guidelines provide thromboprophylaxis recommendations; however, guidelines adherence is missing worldwide. We evaluated the chest physicians' knowledge regarding VTE prophylaxis, using a systematically developed questionnaire. The Prophylaxis-foR-venOus-throMbOembolism-assessmenT-questionnairE (PROMOTE) questionnaire was developed using an algorithm encompassing the most important VTE prophylaxis topics and included 13 clinical scenarios. Responses were evaluated with reference to the eighth edition of American College of Chest Physicians guidelines for VTE prevention to assess thromboprophylaxis appropriateness. The questionnaires were distributed during the fourth International Congress on Pulmonary Disease, Intensive Care and Tuberculosis. From the 88 received questionnaires (response rate: 39.8%), 82 were acceptable (62 men, 20 women). The most commonly cited VTE risk factors were immobility (79.2%), surgery (68.2%), and cancer (60.9%). The mean correct response ratio to the questions was 67% [95% confidence interval (CI) 64-70%] with highest appropriateness ratios amongst cardiologists (77.1 ± 5.8%) and lowest ratios among thoracic surgeons (59.2 ± 5%). Physicians' specialty had a significant effect on the overall appropriateness (P = 0.04) and most of appropriateness subcategories. Thoracic surgeons had the lowest rate of over-prophylaxis (P = 0.02). Years passed from graduation were inversely associated with overall appropriateness (P = 0.006). Physicians with academic engagements had a higher overall appropriateness (P = 0.04). We found a wide gap between the guideline recommendations and the responses. PROMOTE is the first systematically developed questionnaire that addresses chest physicians' thromboprophylaxis knowledge and could be useful to strategies to improve VTE prophylaxis. Because of the dissimilar prophylaxis pitfalls of different specialists, distinct educational programs seem necessary to improve their knowledge of proper VTE prophylaxis.
View details for DOI 10.1097/MBC.0b013e32834ad76d
View details for Web of Science ID 000297138400007
View details for PubMedID 21986466
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Association of Wells' Prediction Rules' risk groups with incidence of Pulmonary Embolism in NRITLD DVT Registry Participants
BIOMED CENTRAL LTD. 2011: 108-109
View details for Web of Science ID 000215871400274
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A Systematic Review and Meta-analysis of the Efficacy and Adverse Events of Infliximab in Comparison to Corticosteroids and Placebo in Active Ulcerative Colitis
INTERNATIONAL JOURNAL OF PHARMACOLOGY
2011; 7 (3): 325-332
View details for DOI 10.3923/ijp.2011.325.332
View details for Web of Science ID 000294652000003