Resp Care
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Review Comparative Study
Center-based vs patient-based diagnosis and therapy of sleep-related respiratory disorders and the role of the respiratory care practitioner.
Unlike center-based laboratories that follow prescribed technical standards, patient-based studies lack technical standardization. Whereas center-based studies are usually performed by technicians who have met certain professional criteria, patient-based studies can be performed by anyone, even those without clinical training. Although guidelines are currently being developed to direct the use of unattended monitoring in the home, a need exists for specific guidelines that delineate professional qualifications for those who initiate and titrate therapy for patients with sleep-related respiratory disorders. ⋯ A need exists for multicenter, peer-reviewed, controlled studies to establish standard recording variables and machine specifications for unattended monitoring devices. Also, the role and cost-benefit ratio of unattended monitoring in healthcare delivery need to be defined. Therefore, with the demand for technology-oriented research, clinical outcome studies, and professional standards, more respiratory care practitioners have the opportunity to expand their practice into the field of sleep medicine.
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Review Comparative Study
Novel strategies for delivering oxygen: reservoir cannula, demand flow, and transtracheal oxygen administration.
Oxygen-conserving devices can decrease costs because less oxygen is used. However, they may also add costs due to the more complex equipment involved (ie, device and catheter replacement). Oxygen is relatively expensive. ⋯ By promoting mobility and improving adherence to continuous oxygen therapy, oxygen-conserving systems may increase the amount of oxygen used, thus offsetting savings. It is shortsighted to focus only on reducing the costs of oxygen administration. Attention also needs to be directed to patient outcomes such as functional status, use of healthcare services, and quality of life.
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Healthcare policymakers, governmental and private alike, are now faced with an enormous challenge. Demands for improved access to cost-effective and high quality healthcare are emanating from all segments of our society. Clearly, the traditional model of admitting patients to an acute care hospital as a first-line intervention is losing favor. ⋯ Home respiratory equipment and supplies, while an important component of managing chronic respiratory disease, are only effective if used safely, properly, and in compliance with the prescribing physician's intentions. The use of skilled and dedicated home respiratory therapists to train patients, monitor and assess outcomes, and communicate with the prescribing physician ensures optimum results. It is time for reimbursement policies to recognize this vital role played by home respiratory therapists.