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Kaiser G Lim

Publications and source records attributed to Kaiser G Lim.

8 recordsLinked to original sources
PubMed2005

Internal medicine resident education in the medical intensive care unit: the impact on education and patient care of a scheduling change for didactic sessions.

OBJECTIVE: Modifications in residency educational programs are needed to comply with the work-hour limitations introduced by the Accreditation Council for Graduate Medical Education. The objective of this study was to determine the impact of rescheduling critical care didactic sessions on medicine residents' education during their medical intensive care unit (MICU) rotation and on outcomes. DESIGN: A pilot program of nonrandomized design. SETTING: A graduate school of medicine. PATIENTS: All patients admitted during the study periods who authorized their medical records to be reviewed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We instituted a pilot program that replaced the daily traditional 1-hour post-rounds didactic session with an 8:00 am 30-min session, conducted before work rounds, on weekdays from July 2003 through December 2003. The residents' end-of-rotation examination scores were used to assess the impact on education. The pilot period residents' examination results were compared with the examination results from July 2002 through December 2002. To evaluate the effect on patient care, the Acute Physiology Score, Acute Physiology and Chronic Health Evaluation III score, and predicted and observed lengths of MICU and hospital stay of all patients during these two study periods were abstracted and compared. Forty-eight residents were included in each period of the study. The residents' performance on the examination at the end of MICU rotation improved when the didactic session was moved to 8:00 am (67.9 +/- 13.8 vs. 73.9 +/- 12.1; p = .0270). The statistically significant improvement was limited to the first-year residents. There were 751 and 903 patients, respectively, admitted to the MICU during the 2002 and 2003 study periods. There were no significant differences in Acute Physiology Score and Acute Physiology and Chronic Health Evaluation III score between patients admitted during the two study periods. The observed hospital mortality rate was lower during the second period. There were no statistically significant differences in the adjusted length of MICU and hospital stay between the two periods. CONCLUSION: Early morning didactic sessions improve the educational experience of internal medicine residents rotating in the MICU without compromising patient care.

Adult↗
PubMed2004

Agnogenic myeloid metaplasia with pleural extramedullary leukemic transformation.

Agnogenic myeloid metaplasia (AMM) is one of the myeloproliferative disorders, and is usually accompanied by extramedullary hematopoiesis (EMH) in various organs, mainly in the liver, spleen and lymph nodes. Extramedullary hematopoiesis and/or leukemic transformation of EMH in the pleura is a rare occurrence and is usually asymptomatic. Pleural involvement is usually diagnosed on postmortem examination. Herein we describe a 71-year-old man with newly diagnosed agnogenic myeloid metaplasia who was evaluated for progressively worsening dyspnea, pulmonary hypertension and bilateral pleural effusions. EMH involving the lungs and pleura was suspected. A sulfur colloid technetium 99m bone marrow scan performed to detect extramedullary hematopoiesis was negative. The diagnostic thoracentesis yielded bloody fluid that contained a large population of myeloblasts, indicating pleural leukemic transformation. The patient received 100 cGy to the whole lung for treatment of pulmonary hypertension due to EMH. This was followed by 1500 cGy total dose of radiation to the left lung for pleural extramedullary leukemic transformation. Pleural effusions resolved and repeat echocardiography showed reduction of the pulmonary artery pressure. Three months later he had leukemic transformation involving the skin and lymph nodes. Four months after radiation therapy, he had full-blown acute myeloid leukemia. He received 2 cycles of Gemtuzumab ozogamicin (Mylotarg), allopurinol and hydroxyurea. Three months after initiation of chemotherapy, he deteriorated and received salvage chemotherapy of prednisone, VP-16 and imatinib mesylate (Gleevec). He was hospitalized for neutropenic fever and was diagnosed to have pulmonary aspergillosis. He died of multisystem failure 8 1/2 months after being diagnosed with AMM.

Aged↗
PubMed2004

Chyloptysis in adults: presentation, recognition, and differential diagnosis.

Chyloptysis is a rare finding, and the accompanying respiratory symptoms are usually nonspecific. The recognition of the chylous nature of the sputum is requisite for proper diagnosis, especially if chyloptysis is not accompanied by chylous pleural effusion. The key to the differential diagnosis of chyloptysis is to consider illnesses that can induce reflux of chyle into the bronchial tree. There are two mechanisms postulated: the first requires the presence of an abnormal communication between the bronchial tree and the lymphatic channels, and the second requires a bronchopleural fistula in the context of a chylous pleural effusion. Chyloptysis in adults should prompt assessment for evidence of lymphatic obstruction from trauma, radiation, and malignancy, and to exclude diseases with known association with chyloptysis, ie, lymphangioleiomyomatosis, yellow nail syndrome, or thoracic lymphangiectasis. A lymphangiogram is recommended to define the abnormality. In the case of lymphangiectasis, patients respond to either dietary modification and/or ligation of the thoracic duct.

Adult↗
PubMed2004

The clinical utility of flexible bronchoscopy in the evaluation of chronic cough.

STUDY OBJECTIVES: To assess the clinical utility of flexible bronchoscopy (FB) in the evaluation of patients with chronic cough and normal or nonlocalizing chest radiographic findings. DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Forty-eight patients with chronic cough and no other clinical or radiographic indications for FB who underwent the procedure from 1996 to 2001. RESULTS: Before FB, 45 patients had a chest radiograph and 21 patients had a chest CT performed. On visual inspection, 37 of 48 of the FB findings (82%) were normal, 9 were consistent with "bronchitis," one patient had a "small tracheal plaque," and one patient had "minimal arytentoid redundancy." Three of the 27 patients who had a microbiologic assessment performed during their FB demonstrated potentially pathogenic organisms. Antibiotic treatment based on culture data did not result in improvement in cough. Cytologic examination was performed in specimens from 33 patients; 1 patient was noted to have reactive squamous atypia, and the remainder were normal. The patient noted to have minimal arytenoid redundancy and the patient with a tracheal plaque each had another etiology for their cough identified, the treatment of which resulted in cough improvement. CONCLUSIONS: FB adds little to the diagnosis of chronic cough in the context of normal or nonlocalizing chest radiographic or CT findings. FB did not result in successful treatment alteration, nor did it contribute to the identification of the cough etiology.

Adult↗
PubMed2004

Mild persistent asthma. Traits, treatment set it apart from mild intermittent asthma.

Mild persistent asthma has greater airway hyperresponsiveness than mild intermittent asthma and may also have more persistent respiratory symptoms and more severe consequences. By other measures, the two conditions are not always easy to differentiate. Nevertheless, primary care physicians need to be able to recognize and treat mild persistent asthma in order to reduce the number of severe exacerbations, and even fatalities, that can occur if it is not properly managed. In this article, Dr Lim discusses how to differentiate mild persistent asthma from mild intermittent asthma and explores the best options for pharmacologic treatment.

Administration, Inhalation↗
PubMed2004

Chronic cough.

Explore the source record for details and available documents.

Chronic Disease↗
PubMed2002

Management of persistent symptoms in patients with asthma.

The main goals of asthma therapy are to control symptoms, prevent acute attacks, and maintain lung function as close to normal as possible. Customizing the regimen to relieve the patient's symptoms and control airway inflammation is important. If asthma is not well controlled, an initial inhaled corticosteroid boost will treat the underlying heightened airway inflammation, and the addition of a long-acting beta2-adrenergic agonist or leukotriene receptor antagonist will rapidly control symptoms. Most patients do not require prolonged treatment with expensive combination or additive agents. Exercise-induced bronchoconstriction is a common source of symptoms. Treatments for scheduled and unscheduled exercises differ. Inhaled corticosteroids prevent frequent and severe asthma exacerbations. When patients have persistent symptoms despite a pharmacological regimen, environmental factors and nonpharmacological interventions must be considered before medication is increased. When an inhaled corticosteroid is being considered, issues of compliance, drug delivery device, and proper inhaler techniques are as important as issues of potency, clinical efficacy, and adverse effects. The new hydrofluoroalkane preparations offer more lung deposition and may be important in treating inflammation of the small airways in patients with asthma.

Administration, Inhalation↗