Canadian Journal of Respiratory Therapy最新文献

Background: Compassionate extubation (CE) refers to withdrawing mechanical ventilation and allowing a patient to die peacefully at the end of life. The primary objective of this pilot study was to quantify the emotional impact of CE on Respiratory Therapists (RT) and Registered Nurses (RNs).

Methods: This pilot survey was conducted between March and April 2021 at an academic medical center among RTs and RNs. It included questions on participants' demographics, work characteristics, and Impact of Events (IES) scale to assess the subjective stress caused by CE. Data were analyzed using descriptive and χ² statistics.

Results: Among 20 participants, 18 (90%) were females, 12 (60%) were in the 20-40-year age group, 12 (60%) were RTs, and 8 (40%) RNs. Around 15 (75%) participants worked day shifts with a weekly average of 3-4 shifts, and 14 (70%) performed/observed CE within 1 month before taking this survey. CE performed/observed in a month was ≤2 among 15 (75%) and 3-5 among 4 (20%) participants. Mean total IES score was 16.7 (12.3) among all participants representing 7 (35%) having low, 6 (30%) moderate, and 7 (35%) high emotional impact when performing CE. Risk of developing post-traumatic stress disorder (PTSD) was present in 6 (30%) participants. A significantly higher number of participants in the low impact group were satisfied with the institutional CE process (p = 0.043) than those in the medium/high impact group.

Conclusion: This pilot study findings reveal that RTs and RNs experience moderate to high levels of subjective stress when performing CE. One-third of the survey participants were at risk of developing PTSD.

Introduction/background: The impacts of racism on the experiences of under-represented minorities in health education programs such as respiratory therapy can impede the ability of these students to succeed in these programs and in the healthcare workplace. This can exacerbate the discrepancy between the racial diversity of the healthcare workforce and that of the population that they intend to serve.

Methods: An integrative literature review was conducted to examine and integrate the published literature that describes how racism is expressed and addressed in health education programs and in healthcare workplaces.

Results: Thirty-one studies were reviewed that included a variety of allied health professions. Racial discrimination in these programs is characterized as racial stereotyping, micro-aggressions, significant cognitive and emotional burdens, socio-economic challenges, and organizational impediments. Individual coping strategies such as confronting racism directly or minimizing its existence and seeking and offering social and cultural supports are reported. At an institutional level, policies to address racism, foster an inclusive culture, and develop programs that enable and support diversity and career progression have been described.

Discussion: A conceptual model that frames the factors that enable racism (both extrinsic/societal and intrinsic/individual) against strategies that mitigate the effects of racism (both institutional and individual) is proposed and applied to respiratory therapy programming.

Conclusion: Respiratory therapy programs must acknowledge, prioritize, and address racism consistently and systemically. Targeted research is required to explore the specific experiences of this profession, and to validate the effectiveness of the strategies described to redress the inequities unmasked by racism.

Background: The severity of disease and mortality due to coronavirus disease (COVID-19) was found to be high among patients with concurrent medical illnesses. Serum biomarkers can be used to predict the course of COVID-19 pneumonia. Data from India are very scarce about predictors of mortality among COVID-19 patients.

Methodology: In the present retrospective study of 65 RT-PCR confirmed COVID-19 patients, we retrieved data regarding clinical symptoms, laboratory parameters, and radiological grading of severity. Further, we also collected data about their hospital course, duration of stay, treatment, and outcome. Data analysis was done to compare the patient characteristics between survivor and non-survivor groups and to assess the predictors of mortality.

Results: The mean age of the study population was 56.23 years (SD, 12.91) and most of them were males (63%); 81.5% of patients survived and were discharged, whereas 18.5% of patients succumbed to the disease. Univariate analysis across both groups showed that older age, diabetes mellitus, higher computed tomogram (CT) severity score, and raised levels of laboratory parameters viz, D-dimer, CPK-MB (creatine kinase), and lactate dehydrogenase (LDH) were associated with increased mortality among hospitalized patients. On multivariate analysis, elevated levels of serum D-dimer (odds ratio, 95% CI: 10.98, 1.13-106.62, p = 0.04) and LDH (odds ratio, 95% CI: 19.15, 3.28-111.87, p = 0.001) were independently associated with mortality.

Conclusion: Older patients, diabetics, and patients with high CT severity scores at admission are at increased risk of death from COVID-19. Serum biomarkers such as D-dimer and LDH help in predicting mortality in COVID-19 patients.

Introduction: There is no standard methodology for outlining the intricacies of allied healthcare education (AHE) or its quality. The profound misconception is that quality assurance (QA) in AHE is used on a "voluntary" basis. Given the absence of statutory regulatory mechanisms such as accreditation, validation, and audit by the peripheral agencies concerning QA, adoption of QA measures in AHE is not consistent, and it results in producing a subpar allied health workforce. This paper analyzes the need to include QA measures as an essential domain in evaluating the effectiveness of allied health professional education programs.

Method: A large database search was performed using pertinent terms, and a blueprint was developed for a meticulous literature review published between 2015 and 2021. Five hundred eighty-two articles were found and screened; a critical appraisal was performed for 22 peer-reviewed articles for relevant information.

Results: The literature review identified the need to use academic domains such as leadership, planning, delivery, and feedback as QA criteria to evaluate the efficiency of education and training in allied health professional education programs. Instructors and facilitators for specific knowledge and skill development and a description of their roles should also be used in QA evaluation.

Conclusion: Resources for effective learning and teaching in the allied healthcare domain are limited. This review highlights the significant need to include a QA system in AHE, considering the pivotal role of these students in supporting humankind, now and in the future. The findings contribute to the research by providing essential insights into current trends and focusing on existing research in AHE quality.

Background: During the current COVID-19 pandemic and increased air pollution levels, wearing a facial mask has been recommended. This study aimed to compare the impact of wearing different masks when performing a submaximal functional activity (six-minute walk test; 6MWT) on respiratory symptoms, oxygen saturation, and functional capacity.

Methods: Twenty-nine subjects (10 men, 19 women; age 22 ± 1 yr.; FEV₁/FVC 0.90 ± 0.01) performed four rounds of 6MWT wearing different masks (surgical (Medima SK, Thailand), handmade cloth, and N95 (3M AuraTM 1870⁺, USA)) and while not wearing a mask. Respiratory symptoms (dyspnea and breathing effort), oxygen saturation, and other physiological parameters were assessed before and after each walking trial.

Results: Six-minute walking distances were comparable between walking trials (P = 0.59). At the end of minute 6, a significant difference between groups was found on dyspnea (P = 0.02) and breathing effort (P < 0.001). Post hoc tests showed that wearing a cloth mask significantly increased dyspnea (P = 0.004) compared to wearing a surgical mask. Wearing a cloth mask also significantly increased breathing effort compared to wearing a surgical mask (P < 0.001) and not wearing a mask (P < 0.001). Likewise, while wearing an N95 mask, breathing effort significantly increased compared to wearing a surgical mask (P = 0.007) and not wearing a mask (P = 0.002).

Conclusions: Wearing different masks while performing submaximal functional activity results in no differences in functional performance, oxygen saturation, heart rate, or blood pressure. However, wearing cloth masks and N95 masks results in higher respiratory symptoms.

Objective: Despite evidence-based guidelines, SpO₂ maintenance-related practices of care providers remain inconsistent. Our aim was to evaluate the impact of interprofessional learning workshops, bedside coaching, and neonatal intensive care unit (NICU) level enablers on targeted behavioral change of NICU staff, focusing on SpO₂ maintenance.

Methods: NICU is a specialized area of the hospital with sophisticated monitors where multidisciplinary staff provide round-the-clock care for sick and preterm infants. As a subset of a quality improvement project to improve SpO₂ maintenance and reduce desaturation events, three targeted evidence-based staff behaviors were deemed as important based on established capability-opportunity-motivation-behavior and theoretical domains framework models: setting SpO₂ alarm limits, using SpO₂ alarm management algorithms, and reporting daily summaries of SpO₂ during rounds. We conducted interprofessional workshops, provided bedside coaching, and altered unit NICU processes (guidelines, automated SpO₂ histogram printouts, defined staff standard work) and measured demonstrable changes in staff reaction, learning, and behaviors by direct observation of behaviors and survey questionnaires.

Results: Two hundred and seventy-five (87%) and 210 (80%) of NICU staff attended workshops and received bedside coaching, respectively. The proportion of staff expressing satisfaction with workshop and bedside coaching was 85% and 82%, respectively. The proportion of staff reporting improvement in their knowledge and confidence related to SpO₂ maintenance increased significantly following the workshop. Targeted behaviors related to SpO₂ maintenance like setting appropriate alarm limits, adhering to SpO₂ management algorithm, and reporting daily SpO₂ summaries during rounds increased from 80% to 96%, 0% to 64%, and 20% to 70%, respectively.

Conclusion: Focused behavioral change interventions aimed at improving staff capability, opportunity, and motivation resulted in a demonstrable change in targeted staff behaviors related to SpO₂ maintenance. Further research is needed to establish ways of optimizing intended staff behaviors while implementing care bundles in a given setting.

Objectives: Emergency intubation is a high-risk procedure in children. Studies describing intubation practices in locations other than pediatric centres are scarce and varied. This study described pediatric intubations in adult-based community emergency departments (EDs) and determined what factors were associated with intubated-related adverse events (AEs) and described outcomes of children transferred to a quaternary care pediatric institution.

Methods: This is a retrospective review of data collected between January 2006 and March 2017 at Lakeridge Health and Hospital for Sick Children (SickKids). Patients were <18 years and intubated in Lakeridge Health EDs; those intubated prior to ED arrival were excluded. Primary outcomes were intubation first-pass success (FPS) and AEs secondary to intubation.

Results: Patients (n = 121) were analyzed, and median (interquartile range (IQR)) age was 3.7 (0.4-14.3) years. There were 76 (62.8%) FPS, with no difference between pediatricians (n = 25, 23%) or anaesthetists (n = 12, 11%), versus all other providers (paramedic n = 13 (12%), ED physician n = 37 (34%), respiratory therapist n = 20 (18%), transfer team n = 2 (2%)). The proportion of AEs was 24 (19.8%, n = 21 minor, n = 3 major), with no significant difference between pediatricians or anaesthetists versus all other providers. Data from 68 children transferred to SickKids were available, with the majority extubated within a short median (IQR) time of admission, 1.2 (0.29-3.8) days.

Conclusions: Pediatric intubations were rare in a Canadian adult-based community hospital system. Most intubations demonstrated FPS with relatively few AEs and no significant differences between health provider type. Future investigations should utilize multi-centred data to inform strategies suited for organizations' unique practice cultures, including training programs.