Clinics
Time: Alternate Thursdays 9:00-11:30 |
Purpose: This is a multi-disciplinary clinic, accredited by the Canadian Cystic Fibrosis Foundation. Adults with cystic fibrosis receive comprehensive care from a team of health care progessionals with expertise in CF care. |
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Location: C.O.P.C Hotel Dieu Hospital Kingston, ON K7L 3N6 |
Contact: For referrals and appointments Lisa Smith Phone: 613 544 3400 ext 3147 |
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Staff: Diane Lougheed, MD MSc FRCPC, Respirologist Lisa Smith, RN, Nurse Coordinator Kristy Brundage, BScPT, MSc, Physiotherapist Julie Nedvedek, BASc, RD, Registered Dietician Monica Stary Stein, MSW, RSW, Social Worker |
Instructions to Patients: Please bring a list of your current medications to clinic. Check with the nurse coordinator at the time your appointment is mafde to find out if you need to go for breathing tests, an x-ray or bloodwork before your appointment. |
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Purpose: The regular clinic sees patients with asthma. |
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The Division of Respirology at KHSC provides the vast majority of bronchoscopy services in the Southeastern Ontario health region. KHSC performs an average of 400 bronchoscopies per year, including close to 300 EBUS (Endobronchial Ultrasound) in addition to cryobiospy procedures.
Details of these procedures are summarized below:
Flexible Bronchoscopy
Flexible bronchoscopy is a procedure that allows physicians to examine the airways of the lungs. It is most commonly performed as a diagnostic procedure to find out more about a problem with the lungs but can also be used as a therapeutic procedure to treat a problem in the lungs.
Common reasons for performing bronchoscopy include: 1) diagnosis of symptoms related to the chest by examining the airways and taking samples of tissue (biopsies) or fluid to examine for infection or cancer; 2) examining lung collapse (atelectasis) which may reveal a blockage from thick mucous, a foreign body, or a tumour, at which point the physician can attempt to relieve the blockage; 3) facilitate special procedures in the lungs, such as performing biopsies for the evaluation of lung cancer or lung inflammation and scarring.
Endobronchial Ultrasound (EBUS)
Endobronchial ultrasound (EBUS) combines bronchoscopy with ultrasound to enhance the definition of mediastinal structures and aid in visualization of the lung and surrounding mediastinal structures. This equipment has emerged as a highly effective and minimally invasive technique for sampling peribronchial, mediastinal, and lung masses and lymph nodes for pathologic examination. It has been shown to be significantly cost-effective compared with prior gold standard techniques.
More specifically, EBUS plays a significant role in the diagnosis and staging of lung cancer, and is considered the standard of care for patients undergoing evaluation for a lung mass with mediastinal or hilar adenopathy. EBUS is also essential in the diagnostic evaluation of endobronchial lesions as well as hilar and mediastinal adenopathy for patients with malignant and non-malignant diagnoses, which can include sarcoidosis and infectious etiologies. It provides higher diagnostic yield than routine flexible bronchoscopy and is less invasive and resource intensive than mediastinoscopy. As medical diagnosis and therapy move towards less-invasive procedures that provide results equal or superior to those of more invasive procedures, EBUS has become the standard of care and the EBUS program has grown exponentially since its launch in 2014.
Cryobiopsy
Cryobiopsy is an advanced bronchoscopic procedure for obtaining lung tissue for the diagnosis of diffuse parenchymal lung disease, such as interstitial lung disease. It involves the bronchoscopic placement of a flexible cryoprobe inside the lung parenchyma, freezing the probe, and shearing out the lung tissue frozen around the tip. KHSC is one of only a few sites in North America providing this service.
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Time: Alternate Tuesday 9:00-11:30 |
Purpose: Patients are investigated and managed, who have a cough for more than 2 months duration. |
Location: Fraser Armstrong Patient Centre, Level 4 South Kingston General Hospital 76 Stuart Street Kingston, ON |
Contact: For referrals and appointments: Fraser Armstrong Patient Centre Booking Office Phone: 613 548 2342 Fax: 613 549 1459 |
Staff: Diane Lougheed, MD MSc FRCPC |
Instructions to patients: Please bring your medication, including inhalers, and any x-rays, CT scans or breathing test results done at other institutions to your clinic appointments. |
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Contact: For referrals and appointments: Fraser Armstrong Patient Centre Booking Office Phone: 613. 548. 2342 Fax: 613. 549.1459 |
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Instructions to Patients: Please bring your medication, including inhalers, and any x-rays, CT scans or breating test results done at other institutions to your clinic appointments. |
What is the ILD Clinic:
The ILD clinic was created in May, 2013 by Dr. Onofre Moran-Mendoza, with the support and approval of Dr. Michael Fitzpatrick, then Head of the Division of Respirology and Critical Care Medicine. Before the creation of the ILD clinic, no such clinic was in existence.
This clinic was created due to the demand for a specialty clinic for patients suffering with interstitial lung disease (ILD) for diagnosis and management of these complex diseases.
In 2014, the ILD clinic rapidly evolved into an Interstitial Lung Disease Program that now includes:
- ILD Clinic
- ILD Nurse
- ILD Multidisciplinary Rounds
- ILD Fellowship Program
- ILD Research Program
- ILD Program Collaborators
ILD Clinic Protocol Creation:
The ILD clinics are currently held at Hotel Dieu Hospital on Thursdays and Mondays. In order to better understand the approach and procedures for the ICD clinic, Dr. Moran Mendoza attended the ILD Program at the University of Toronto to learn the approach and procedures used by Dr. Shane Shapera, Director of their ILD program.
All diagnostic and management protocols used in the ILD clinic are in compliance with the Guidelines for the Diagnosis and Management of Idiopathic Pulmonary Fibrosis (IPF), published by the American Thoracic Society (ATS, European Respiratory Society (ERS), Japanese Respiratory Society (JRS), and Asociacion Latino Americana de Torax (ALAT) as well as the International Guidelines for the Diagnosis of Idiopathic Interstitial Lung Diseases and the Guidelines on Bronchoalveolar Lavage (BAL) in ILDs.
The ILD clinic works collaboratively with Chest Radiology, Thoracic Surgery, Rheumatology, Palliative Care and Pulmonary Rehabilitation and several protocols for patient assessment and referrals have been created and implemented.
Patient Flow in ILD Clinic:
All patients attending the ILD clinic undergo the following standardized assessments to properly investigate the most common groups of ILDs: Hypersensitivity pneumonitis, Connective Tissues Diseases (CTD), and drugs, as per guidelines:
Questionnaires:
As per the ILD protocol, patients with either clinical or laboratory abnormalities suggestive of a connective tissues disease are referred to Dr. Clements-Baker in the Division of Rheumatology who assess the ILD patients within 2-4 weeks to determine if their ILD is related to a CTD.
Patients who have, as per the American College of Chest Physicians questionnaire, environmental exposures associated with hypersensitivity pneumonitis or have exposure to drugs reported to cause ILD, are routinely offered bronchoscopy with bronchealveolar lavage +/- transbronchial biopsies.
Once diagnosis is established, if anti-fibrotic treatment is required, patients are re-scheduled in clinic to discuss pros and cons of treatment, as well as the need to refer them to:
- Dyspnea Clinic to be assessed and managed by Dr. Ingrid Harle, Palliative Care, who has agreed to collaborate with the ILD clinic and manage the dyspnea patient population.
- Pulmonary Rehabilitation Program with Dr. Denis O’Donnell, to assess suitability for enrollment in the rehabilitation program at Providence Care.
- Lung Transplant Programin Toronto: Eligible patients diagnosed with IPF or with another advanced or progressive ILD despite treatment are referred to the lung transplant program in Toronto
After diagnosis and treatment are established, ILD patients are followed by the clinic every 3-6 months depending on the severity of their disease or presentation and progression.
Nursing Support for the ILD Clinic:
In 2015 the ILD clinic hired nursing support (Mrs. Lynda McCarthy).
Roles of the ILD Nurse:
- Before each appointment the ILD nurse ensures patients have the appropriate chest CT, Pulmonary Function Tests, and blood work.
- As patients arrive to clinic the ILD nurse collects information from all questionnaires that have been mailed to patients before their appointment, reviews all tests, updates medication lists etc.
- Post-appointment the nursing support enters all clinically relevant information into an electronic research database
- The ILD nurse also provides patients with the ILD Clinic Patient Recommendations form and anti-gastroesophageal reflux disease measures. The patient recommendations address environmental exposures of risk that patients should avoid, as well as the monitoring and proper titration of their oxygen (if applicable).
To refer to the ILD Clinic please fax your referral to: 613 549-1459
Purpose:
This program coordinates the care for patients being worked up for possible lung malignancies. This includes patients who are being assessed for possible lung cancer and those with diagnosed lung cancer for whom treatment or further diagnostic decisions are made.
Contact:
Lung Diagnostic Assessment Program (LDAP) Referral Form
Please fax completed form and CT chest report along with any other pertinent information (i.e. other imaging, PFTs, blood work)
Patient Navigator: Christine Noseworthy, RN
Tel: 613.544.3400 ext 2474
Toll Free: 855.544.3400 ext 2474
Fax: 613.546.8225
Email: Christine.Noseworthy@KingstonHSC.ca
DAP Administrative Assistant: Abigail Murano
Admin Tel: 613.544.3400 ext 2410
Toll Free: 855.544.3400 ext 2410
Fax: 613.546.8225
Email: Abigail.Murano@KingstonHSC.ca
Instructions to Patients:
The LDAP Patient Navigator, Christine Noseworthy, will be in contact with you. If you have not been contacted, please contact her at 1 (613) 544-3400 ext 2474
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Staff: Dr.Christine D'Arsigny Email: cld1@queensu.ca Phone: 613. 548. 2371 Fax: 613. 549. 1459 |
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Clinical Programs
The Asthma Program is a comprehensive disease management program which includes diagnostic, therapeutic, educational and research components. The clinical program encompasses ambulatory, emergency and inpatient clinical care. Ambulatory services include multi-disciplinary Asthma Clinics, staffed by respirologists and a nationally certified asthma nurse educator, an Asthma Education Centre, and Pulmonary Function and Allergy Skin Testing Service. Inpatient services include a Collaborative Care Plan for the care of adult asthma patients in the Emergency Department and Inpatient settings, a spirometry service for asthma patients in the Emergency Department, Respirology consultation service for adult asthma inpatients, and Asthma Nurse Educator consultation for adults and parents of pediatric asthma inpatients. The Asthma Research Unit conducts research in asthma symptom perception and lung mechanics, asthma epidemiology, asthma management (clinical trials and asthma education), and asthma guidelines dissemination. The Asthma Research Unit is also affiliated with the hospital’s Clinical Research Centre.
Patients aged 16 years or older may be referred by a physician to the Asthma Clinic, Urgent Asthma Clinic or Asthma Education Centre for assessment. The Asthma Clinic assessments are completed by an asthma specialist (physician) and asthma nurse. Patients may require additional investigations, such as pulmonary function or allergy skin tests. Patients with confirmed asthma will be enrolled in the Asthma Education Program also. The Asthma Education Centre provides education to patients aged 16 years or older, or parents of children with asthma, referred by family physicians, emergency physicians or other specialists. Following an initial assessment by a certified asthma nurse educator, the person with asthma will receive asthma education tailored to their individual needs.
Contacts:
Ms. Jennifer Olajos-Clow, Asthma Nurse Phone: 613 549 6666 ext 3779 Fax: 613 549 1459 Email: olajosj@kgh.kari.net |
Dr. D. Lougheed, Medical Director Phone: 613 548 2348 |
Asthma Research Unit Phone: 613 549-6666 ext 2645 |
Pulmonary Function and Allergy Skin Testing Phone: 613 549 6666 ext 2439 Fax: 613 547 2069 |
Links:
Asthma Education Centre:
http://www.kgh.on.ca/kgh/asthma%20education/ae_Home.htm
Asthma Guidelines:
http://www.asthmaguidlines.com/
Asthma Action Program:
http://www.on.lung.ca/asthmaaction/asthmaaction.html
Living with Asthma:
http:///www.lung.ca/asthma/index.html
Respirology: Dr. D. Lougheed |
Respiratory Therapy: Ms. Cathy Muir |
Nursing: Ms. Jennifer Olajos-Clow Ms. Patti Moyse Ms. Nicola Thomas |
Research: Mr. Thomas Fisher Ms. Janice Minard Ms. Patti Moyse |
The Cystic Fibrosis (CF) Program is a multi-disciplinary program which provides comprehensive care to patients with CF. The team includes a pediatrician (pediatric program) and respiratory physician (adult program), nurse coordinator, physiotherapist, dietician, social worker, pharmacist, pulmonary function technologist and (for the pediatric program) a child life worker. The CF Program provides ambulatory care in separate Pediatric and Adult Clinics, provides inpatient services for hospitalized patients, and participates in CF research. The CF Clinics are accredited by the Canadian Cystic Fibrosis Foundation.
Patients with suspected cystic fibrosis may be referred directly to the appropriate physician for evaluation. Patients with confirmed CF are enrolled in the CF Program and followed regularly by all members of the team in either the Pediatric or Adult CF Clinic, in keeping with current practice guidelines. Patients typically enter the Adult Clinic at about age 18. Routine follow-up visits occur approximately every 3 months. Patients may be seen between regularly scheduled appointments for acaute illnesses. Consultative services are provided to hospitalized patients as required. Patients in the CF Program may be invited to participate in ongoing research studies. Currently, we are participating in several multi-centre CCFF-funded studies, including a genetics study (children and adults) and osteoporosis study (adults only).
Contacts:
Dr. R. van Wylik, Pediatric Clinic Director Phone: 613. 544. 3400 ext 3359 Fax: 613. 544. 3559 Email: vanwylir@hdh.kari.net |
Dr. D. Lougheed, Adult Clinic Director Phone: 613. 548. 2348 Fax: 613. 549. 1459 Email: mdl@queensu.ca |
Ms. Lisa Smith, Nurse Coordinator Phone: 613. 544. 3400 ext 3347 Email: smithl@hdh.kari.net |
Ms. Kristy Brundage, Physiotherapist Phone: 613. 544. 3400 ext 3187 Fax:613. 544. 8320 Email: brundagk@hdh.kari.net |
Ms. Julie Nedvedik, Dietician Phone: 613. 544. 3400 ext 2170 Fax: 613. 544. 1661 Email: nedvidej@hdh.kari.net |
Ms. Mary Wilson, Pharmacist Phone: 613. 544. 3400 ext 2159 Fax: 613. 531. 8260 Email: wilsonm@hdh.kari.net |
Ms. Monica Stary Stein, Social Worker Phone: 613. 544. 3400 ext 3157 Fax: 613. 544. 1661 Email: starystm@hdh.kari.net |
Ms. Cathy Muir, Pulmonary Function Lab Phone: 613. 548. 3232 ext 2439 Fax: 613. 547. 2069 Email: muirc@hdh.kari.net |
Links:
Canadian Cystic Fibrosis Foundation
http://www.ccff.ca
Cysctic Fibrosis Foundation:
http://www.ccff.org
The Lung Diagnostic Assessment Program (LDAP) is a patient- and family-centred program, developed to improve the experience of diagnostic care for patients with suspected lung cancer.
Patients who are referred to the Lung DAP are first triaged by the Nurse Navigator, in preparation for their first clinic visit with either Respirology or Thoracic Surgery. The Nurse Navigator support the patient throughout the course of the diagnostic work-up, provides ongoing care and education. Referrals to the LDAP are accepted by a central fax (1 (613) 546-8225). Respirologists and Thoracic Surgeons see patients at the Hotel Dieu Hospital or Kingston General Hospital, and the Oncologists see patients at the Cancer Centre of Southeastern Ontario. The LDAP coordinates diagnostic investigations, maintains contact with the patient and the clinician’s/ consultant’s office for discussions about the diagnosis and related issues. The LDAP also oversees timely staging investigations and/or referral to surgery or oncology.
The Lung Disease Site Group meets weekly as the Lung Multidisciplinary Cancer Conference (Dr. R. Gregg, chair; Dr. K. Reid, co-chair) to discuss patient cases, treatment, diagnostic and therapeutic issues.
Contacts:
Christine Noseworthy, Lung DAP Nurse Navigator
Phone: 613.544.3400 x2474
Fax: 1.613.546.8225
Links
Cancer Care Ontario (CCO):
http://www.cancercare.on.ca
Cancer Care Ontario (CCO): Diagnostic Assessment Programs
https://www.cancercare.on.ca/pcs/diagnosis/diagprograms/
Cancer Care Ontario (CCO): Lung Disease Pathway Management
https://www.cancercare.on.ca/cms/One.aspx?portalId=1377&pageId=253765
Canadian Cancer Society:
http://www.cancer.ca
American Cancer Society:
http://www.cancer.org/docroot/home/index.asp
Respirology: |
Oncology: |
Thoracic Surgery: Lung Diagnostic Assessment Program: |
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This is a supervised, multidisciplinary rehabilitation program for patients with ventilatory insufficiency. Patient referrals are accepted from physicians and the COPD Education Centre. Typical patients for referral include those who remain symptomatic despite pharmacotherapy, who do not have significant co-morbid illness interfering with their ability to exercise (i.e., who do not have significant ischemic heart disease or musculoskeletal problems that limit their ability to participate), who preferably are non-smoking (although exceptions are made), and who are able to arrange transportation to this multi-modality exercise endurance training program. The 3 week inpatient program is for patients who meet entry criteria, but who are geographically displaced. The outpatient program is an 8 week program where patients attend clinic on three afternoons a week (Monday, Wednesday and Friday), and begin a customized, individualized exercise training program of various exercises including walking stair climbing, treadmill exercise, stationery bicycle, strength training, breathing exercises, stretching, etc. There is also an educational component, which comprises of eight lectures.
The aim of the program is to maximize functional capacity in patients with respiratory impairment so as to improve shortness of breath, exercise performance, and quality of life. Patients leaving the program enter a home-based program where they will continue regular exercises. Multidisciplinary services are also available for selected individuals, i.e., psychology, nutritional support, social work, pharmacy, as well as instruction from specialized COPD educators. This rehab program interfaces with the Better Breathing program, which helps people to continue home-based training, as well as avail of the exercise facilities at St. Mary’s of the Lake Hospital.
Contacts:
Dr. O'Donnell Phone: 613. 548. 2339 Fax: 613. 549. 1459 Email: odonnell@queensu.ca |
Physiotherapist: Phone: 613. 548. 7222 ext 2245 Fax: 613. 544. 1023 |
Physiotherapists: Lorelei Samis Jennifer Patelli Linda Lefevere |
Physiotherapist Assistants: Karon Warren Sally Dawe Judy Gray Charlie Popovic |
Occupational Therapists: Heather Faris |
Patients are referred to the Kingston General Hospital, Sleep Disorders Office via fax (613-549-1459) from their Family doctor, medical specialist or from a medical doctor at a walk-in clinic or ER.
SLEEP REFERAL FORM - http://deptmed.queensu.ca/assets/Sleep Referral Feb2013.pdf
The referrals are prioritized by a sleep specialist. Typically, patients are scheduled to be seen in clinic by a sleep specialist physician at Hotel Dieu Hospital (HDH) before being scheduled for an overnight sleep study at Kingston General Hospital, Sleep lab. Appointments are mailed to patients from the Sleep Disorders Office or may be scheduled by phone.
The Sleep Disorders Laboratory has six private bedrooms and is located at KGH on Kidd 6, Rm 22-6-005. Sleep studies are conducted by registered polysomnographic technologists (RPSGT). Overnight sleep study appointments are for arrival times between 8 PM and 11 PM with departure in the morning usually between 6 AM and 7 AM. When ordered by a sleep specialist, daytime test may be conducted either immediately after the overnight study, or for 8 AM arrival time.
Contact:
Secretary: Maureen Obreiter Phone: 613-548-2382 and Fax: 613-549-1459
Sleep Technologists at the KGH Sleep Laboratory Phone: 613-549-6666 x3347
Department of Medicine, Division of Respirology SLEEP DISORDERS PROGRAM Physicians: Sleep Specialists and Respirologists: Dr. Michael Fitzpatrick Dr. Effie Fanaras Dr. Nicholas Vozoris Sleep Specialist and Neurologist: Dr. Lysa Boisse Lomax |
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Sleep Disorders Laboratory KGH Kidd 6, Room 22-6-005 Medical Director: Dr. Michael Fitzpatrick Co-ordinator: Dr. Helen Driver, PhD, RPSGT, DABSM |
Sleep Disorders Education Centre (SDEC) Hotel Dieu Hospital M4A-008 Co-ordinators: Nancy Farr and Alison Devlin Hours: Monday-Thursday 8:00 am to 4:00 pm Phone: 613-548-2478 Fax: 613-548-1359 |