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The American College of Chest Physicians, Oct. 28-Nov. 1

The 83rd Annual Meeting of the American College of Chest Physicians

The annual meeting of the American College of Chest Physicians was held from Oct. 28 to Nov. 1 in Toronto and attracted approximately 6,000 participants from around the world, including specialists and heath care professionals focused on pulmonary, critical care, and sleep medicine. The conference featured presentations focused on clinical updates and advances in chest medicine.

In one study, Aaron Holley, M.D., of John Hopkins Medicine in Bethesda, Maryland, and colleagues evaluated the impact of weight and renal function on the rate of venous thromboembolism (VTE) in patients receiving prophylaxis with low-molecular-weight or unfractionated heparin.

"Obesity is not associated with VTE, so no dose adjustment of prophylaxis is required. Acute renal injury is associated with an elevated risk of VTE, but admission serum creatinine level is not," said Holley. "Physicians need to be cognizant of renal function throughout the hospitalization and consider adjusting prophylaxis for VTE, although in fairness, we're not sure how to do this."

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In another study, Margaret Zambon, M.D., of Lahey Hospital and Medical Center in Burlington, Massachusetts, and colleagues evaluated their institution's lung cancer screening program database of over 5,000 patients to determine whether differences exist in screening status, smoking status, cancer history, and time from initial contact to follow-up.

"Of those patients who met high-risk criteria who were appropriate for screening, we found that a significantly lower proportion of females than males followed through with having their baseline screening CT scan done," said Zambon.

When the investigators looked at some possible reasons for not having the scan done (financial reasons, going to another institution to have follow-up, no longer eligible for screening, noncompliance), there were no differences identified by gender.

"Most of the women who did not have their baseline CT scan were referred to the program by their primary care physician, so this may represent an opportunity to improve the shared decision making between a PCP and the patient to better discuss risks and benefits of screening and to address patient concerns," said Zambon.

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In a subgroup analysis of the ETHICS study, Joseph Varon, M.D., of Texas Medical Center in Houston, and colleagues reviewed data from 10,106 surveys sent to health care providers at 174 institutions in 40 countries around the world.

"The study instrument was completely anonymous, and questions were asked as to how comfortable health care providers were caring for homosexual patients and whether they had changed the way they care about a patient once they found they were homosexual," said Varon.

In addition, the specific religion of each health care provider was recorded and analyzed using a t-test statistical analysis.

"A large number of health care professionals felt uncomfortable treating homosexual patients. Moreover, many of them had changed the way they cared about a patient based on the sexual preferences of such patient," said Varon. "The leading religions that had changed the way they care about these patients were Jehovah's Witnesses and Hindus."

Some clinicians who practice other religions, including Muslims, Jews, and non-Catholic-Christians, also felt uncomfortable caring for these patients.

"At least one out of five health care providers feels uncomfortable caring for homosexual patients. Many religions alter the way they treat patients based on their sexual preferences," said Varon. "It is clear that health care providers have an obligation to their patients regardless of gender, race, or sexual preferences. Caring for patients in an unequal manner is unethical and has potential clinical repercussions. Further studies are necessary to ascertain the impact of these findings."

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