Resp Care
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"Evidence-based practice" involves applying the best available evidence to the care of individuals. Explicit, systematic methods have developed for determining what is the best available evidence. ⋯ The clinical question is not always how to apply the evidence but whether the available evidence applies to a particular patient. We should always ask whether the right provider is doing the right thing for the right patient at the right time in the right setting with the right resources.
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Determine respiratory care managers' preferences regarding baccalaureate and master's degree education for practicing respiratory therapists (RTs). ⋯ For RTs who plan to complete a baccalaureate degree, majoring in advanced respiratory care practice is potentially valuable. Managers showed preference for hiring experienced RTs with baccalaureate degrees but did not prefer entry-level therapists with baccalaureate degrees. Graduate degrees are supported for managers, clinical specialists, educators, and supervisors. Most managers supported some use of distance learning for graduate degrees.
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Expiratory rib cage compression is a chest physiotherapy technique known as "squeezing" technique in Japan. It has been claimed that rib cage compression effectively treats and/or prevents lung collapse, but no studies have been reported on rib cage compression focused on improving ventilation and/or oxygenation in subjects with collapsed lung. Therefore, we studied whether rib cage compression, with and without prone positioning, improves the ratio of P(aO)(2) to fraction of inspired oxygen (P(aO)(2)/F(IO)(2)), P(aCO)(2), or dynamic compliance of the respiratory system. ⋯ It is unlikely that rib cage compression re-expands collapsed lung. Prone positioning improved oxygenation in rabbits with induced atelectasis.
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The carbon monoxide diffusing capacity test (D(LCO)) is a commonly performed pulmonary function test that requires technical expertise and attention to detail to get acceptable results. With the advent of automated devices and powerful computer programs, D(LCO) measurement has rapidly gained wide clinical acceptance. But there are many subtle aspects to performing the test that can diminish its accuracy and repeatability. ⋯ At least 2 but no more than 5 D(LCO) tests should be conducted, and testing is complete when 2 tests are within 10% or 3 D(LCO) units (mL CO/min/mm Hg) of each other. The reported D(LCO) value is the average of the first 2 tests that meet the reproducibility criteria, but if 5 tests are performed and no 2 meet the reproducibility criteria, the reported value is the average of the 2 tests with the highest inspiratory volumes. These quality controls will help laboratories achieve consistent high D(LCO) accuracy.