Dr. Roger S. Goldstein

Biographical Sketch

Professional Qualifications
M.B.Ch.B., Victoria University of Manchester, Manchester, U.K. (1972)
FRCP(C) Internal Medicine (1978), FRCP(C), Respiratory Medicine (1978), FRCP (UK) (1990)

ECFMG (1973), LMCC (1976), FLEX (1978), VQE (1978), MRCP(UK) (1975), American Board of Internal Medicine (1978)

Licensure
U.K. (1972), Ontario (1976)

University Appointments

June 1986 - Present, Graduate Faculty, Institute of Medical Science, University of Toronto.

Division of Respiratory Medicine
1994 - present, Director, Divisional Program in Respiratory Rehabilitation, Division of Respiratory Medicine, Department of Medicine.
1999 - present, Member Division of Physiatry, University of Toronto.

Hospital Appointments

July 1979 - present: Respirologist West Park Hospital, Toronto.
July 1979 - present: Respirologist, Toronto General Hospital, Toronto.
July 1982 - present: Respirologist Mount Sinai Hospital, Toronto.
July 1981 - present, Associate Medical Staff, Toronto Rehabilitation Institute (Queen Elizabeth Hospital), Toronto.

Educational Activities

Undergraduate medical education (extract)

1993 - present: Year I medical students. Undergraduate teaching tutorials in Problem Based Learning - Structure and Function (Cardio-respiratory). Tutorials of 6-8 students. 14 sessions of approximately 2 hours duration with 1.5 hours of additional activities/session = 49 hours/year.

Postgraduate medical education (extract)

1987 - present: Subspecialty trainees in respiratory medicine rotate through the rehabilitation program for 6-8 weeks. There are usually 4 trainees/year. In addition, subspecialty trainees in physical medicine and rehabilitation (physiatry) rotate on an elective basis for 6-8 weeks.

Trainees participate in weekly multidisciplinary clinical and bedside teaching rounds (24 hours/year), office based ambulatory (24 hours/year) and more formalized weekly topic reviews (20 hours/year).

Current Local, Provincial, National and International Activities

Executive Committee Member - International COPD Coalition, 2004 - present

Canadian COPD Alliance (CCA), Founding Chair 1999 -present

American College of Chest Physicians; Marketing Committee,1998-present

Ontario Ministry of Health, Assistive Devices Branch; Senior Medical Advisor for Complex Cases - Home Oxygen & Mechanical Ventilation, 1994 - present.

Ontario Ministry of Health, Assistive Devices Branch, Member, Home Oxygen Program Standing Committee, 1994 - present.

Post-Polio Health International [formerly: Gazette International Networking Institute (GINI)], 1990 - present.

International Respiratory Care Club (IRCC). Canadian Representative, 1994 - present.

Industry Scientific Advisory Boards: National Respiratory Advisory - Boehringer-Ingelheim 1999-present, Regional Respiratory Advisory Glaxo Smith Kline 1999-present, Regional Respiratory Advisory AstraZeneca 2000-present, Byk Pharmaceuticals 2002.

Research Interests

The research interests of the respiratory unit have been closely associated with the development of the clinical program.

Initial studies reflected a need to better understand the mechanisms and management of hypoxia (Delivery of oxygen from standard face masks. Lancet 1982; Effect of oxygen during sleep in COPD. NEJM 1984; Arterial desaturation during exercise and sleep. Chest 1989; Chest 1990). More recently these interests have been extended to include studies on the appropriate use of domiciliary oxygen (Chest 2000), protocols for oximetry testing (AJRCCM 2001) and International approaches to the prescription of oxygen (ERJ 2001).

Studies on the scientific basis of respiratory rehabilitation (Randomised controlled trial of respiratory rehabilitation. Lancet 1994, Meta-analysis of respiratory rehabilitation, Lancet 1996, Summary of systematic reviews, Gerontology 1997) and its components (Inspiratory muscle training. Chest 1989; Ventilatory response to arm elevation. Chest 1993; Components of rehabilitation-a systematic overview. Chest 1997), as well as the role of nutritional interventions (Chest 2000, Chest 2002). There was also a need to develop a better understanding of the clinical importance of statistically significant outcome measures (When small differences mean little. Chest 1996; Minimal important difference in symptoms. J Clin Epidem 1996; Health Status measures in COPD CRJ 1997;) and the influence of rehabilitation on resource utilization (Economic analysis of rehabilitation, Chest 1997; Interpreting treatment effects, BMJ 1998; Generic and specific measures of quality of life, J Clin Epi 1999). On-going studies include evaluating trends in COPD (Pulmonary rehabilitation in Canada, CRJ 1999, Trends in epidemiology of COPD, Chest 1999; Appraisal of practice guidelines, Archives Internal Medicne 2001) and maintenance strategies to promote compliance with health care interventions (Post rehabilitation programs, ERJ 2002; Effect of a rollator, Chest 2002).

For patients with non-obstructive conditions a need to better understand the management of nocturnal hypoventilation (Negative pressure ventilation. Am Rev Respir Dis 1987; Rocking bed. Chest 1987; Non-invasive positive pressure ventilation. Chest 1991) has been an important support to the teaching and clinical care clinical program in home ventilation (Respiratory function among polio survivors. Eur Resp J 1992; Home ventilation demographics and user perspectives. Chest 1995). In turn these studies have led to an interest in evaluating newer ventilators (External chest wall oscillation on gas exchange. Chest 1995; External chest wall oscillation during sleep. Chest 1996; Proportional assist ventilation in patients with COPD. Chest 1997). Ongoing studies include the long term follow-up of mechanics, gas exchange and quality life in individuals receiving home ventilation (Long term follow-up, CRJ 2002).

Recent research has included combined medical/surgical management of COPD by Lung Volume Reduction (submitted 2002), an innovative approach currently under evaluation in a multicentre randomized controlled trial.

In conjunction with Carleton and McMaster Universities and the Ontario Home Oxygen Program (MOH) we have developed an alternate service delivery model for home oxygen which will be piloted in Ontario in 2001-2002.

Current Grant Support

2003 - 2006. Aaron S, Fitzgerald JM, Balter M, Bourbeau J, O-Donnell D, Goldstein RS, Ferguson D, Maltais F. Optimal therapy of COPD to prevent exacerbations and improve quality of life. A randomized, double-blind, placebo-controlled trial. CIHR (Co-principle Investigator) $1,464,139

2004 - 2005. Goldstein RS, Brooks D. Individualized pulmonary rehabilitation (PR) after acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD). Ontario Thoracic Society (Co-Principle Investigator) $30,649.00

2006-2007. Goldstein RS. Chronic Obstructive Pulmonary Disease (COPD) Demonstration Project. Ontario Ministry of Health and Long Term Care, $270,000

Selected Recent Publications

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Chapters and Monographs

Goldstein, R.S. "The effect of isocapnic hypoxia on lung mechanics in man." Mechanisms of airway obstruction in human respiratory disease. De Cock, M.A., Nadel, J.A., Lewis, C.M. and Balkema, A.A. (Eds). Rotterdam, 1979.

Moldofsky, H., Goldstein, R.S., McNicholas, W.T., Lue, F.A., Zamel, N., Phillipson, E.A. "Disordered breathing during sleep and overnight intellectual deterioration in patients with pathological aging." Sleep/wake disorders - Natural history, epidemiology and long term evolution. Guilleminault, C. and Lugaresi, E. (Eds). Raven Press (New York), 143-150, 1983.

Goldstein, R.S. Breathing disorders in sleep. "Hypoventilation, neuromuscular and chest wall disorders." Clinics in Chest Medicine. Phillipson, E.A. and Bradley, T.D. (Eds). Saunders (Philadelphia), 13(3):507-521, 1992.

Goldstein, R.S., Avendano, M.A. "Components of pulmonary rehabilitation program - Candidate evaluation." Principles and practice of pulmonary medicine. Casaburi, R. and Petty, T.L. (Eds). Saunders (Philadelphia), 23:317-321, 1993.

Goldstein, R.S. "Domiciliary ventilation." Therapeutic Approaches, Thorax, Second Edition, 85(3):2501-2520. Roussos, C. and Lenfant, C. (Eds). Marcel Dekker Inc. (New York), 1993.

Goldstein, R.S. "Supplemental oxygen in chronic respiratory disease." Pulmonary Rehabilitation: The Obstructive and Paralytic Conditions. Bach, J.R. (Ed). Hanley and Belfus Inc., 6:65-83, 1996.

Goldstein, R.S., Hall, M.J. "Pulmonary rehabilitation before and after lung transplantation." Respiratory Rehabilitation. Fishman, A. (Ed). Marcel Dekker 91(32):739-766, 1996.

Goldstein, R.S., Avendano, M.A. "Model program development and outcomes in chronic obstructive pulmonary disease." Physical Medicine and Rehabilitation. Clinics of North America. Bach, J.R. and Haas, F. (Eds). W.B. Saunders., 7(2):353-365, 1996.

Van Der Schans, C.P., Goldstein, R.S., Bach, J.R. "Airway secretion management and oxygen therapy." Physical Medicine and Rehabilitation. Clinics of North America. 7(2):277-298, 1996.

Goldstein, R.S. "Ventilatory muscle training." Pulmonary Rehabilitation. Simmons, A.K., Muir, J.F., Pierson, D.J. (Eds). British Medical Journal Publishing Group. London. 46-66, 1996.

Goldstein, R.S. "Evaluating the end-stage patient for appropriate oxygen delivery system and identifying appropriate candidates for home ventilation." Management of End-Stage Pulmonary Disease. Maurer JR (Ed). Seminars of Respiratory and Critical Care Medicine, 6:477-489, 1996.

Goldstein, R.S. "Inspiratory muscle training." Practical Pulmonary Rehabilitation. Morgan, M. and Singh, S. (Eds). Chapman and Hall U.K., 99-115, 1997.

Goldstein, R.S. ?The Canadian Perspective?. International Approach to Pulmonary Rehabilitation. Hodgkin, Connors and Celli (Eds). Lippincott, Williams & Wilkins, Philadelphia, USA., 34(6), 1999.

Lacasse, Y., Donner, C., Goldstein, R.S. Clinical Trials of Respiratory Rehabiliation in Chronic Obstructive Pulmonary Disease - Past, Present and Future. Advances in Rehabilitation: Topics in Pulmonary Rehabilitation. Eds Ambrosino N, Donner C.F., Rampulla C. Maugeri Foundation Books, Pavia, Italy 1999.

Lacasse Y, Wong E, Guyatt G, Goldstein RS. Health-status measurement instruments in patients with chronic obstructive pulmonary disease. In: Jobin J, Maltais F, LeBlanc P, Simard C. (eds.). Advances in Cardiopulmonary rehabilitation. Human Kinetics, 2000: 228-246.

Avendaño M, Goldstein RS, Güell R. Lung Biology in Health and Disease. Long Term Mechanical Ventilation. "Rehabilitation of long term mechanically ventilated patients". C. Lenfant, N. Hill (Eds). 2000: Vol. 152;449-470.

Goldstein RS, Brooks D. The Canadian Perspective. International Approach to Pulmonary Rehabilitation: Guidelines to Success 3rd Edition. Lippincott Williams and Wilkins. Hodkin JE, Celli BR, Connors GL (eds). 2000; 34.

Goldstein RS, Guell R. Long term oxygen therapy. In: Harrison?s Principles of Internal Medicine - Harrison?s Online. 2001

Goldstein RS, Brooks D, Davis L. Sleep in patients with neuromuscular and chest wall disorders. In: Breathing Disorders in Sleep. McNicholas & Phillipson (eds). 23:310-322, 2001.

Goldstein RS. Exercise training in patients with COPD. Comprehensive Management of COPD. Bourbeau J (ed). BC Decker Inc. 2002.

Goldstein RS, Lacasse Y. New trends in epidemiology of lung diseases and socio-economic implications. In: Pulmonary Rehabilitation: Efficacy and Scientific Basis. Donner CF, Ambrosino N & Goldstein RS (eds) 2002.

Goldstein RS. Oxygen in COPD Rehabilitation. In: Advancing the Frontiers of Cardiopulmonary Rehabilitation. Jobin J, Maltais F, Poirier P, LeBlanc P & Simard C (eds) Human Kinetics 2002.

Goldstein RS, ZuWallack R. Long term compliance post COPD rehabilitation. In: Pulmonary Rehabilitation: Efficacy and Scientific Basis. Donner C & Ambrosino N (eds). (in press - 2005)