Respiratory care
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Inhaled nitric oxide (INO) has been used with heated and humidified high-flow nasal cannula (HFNC), nasal CPAP and several forms of noninvasive ventilation (NIV). This study was designed to evaluate the delivered dose of INO, level of NO2 generation, and effect of net gas delivery (addition of INO to the ventilator circuit--gas removed for sampling) on lung pressure at different NO doses during noninvasive respiratory support. ⋯ Clinicians cannot always assume that the set INO level results in a similar lung dose when using all forms of neonatal noninvasive support. Clinical decisions regarding ways to improve INO delivery may need to include changing settings or placing patients on a different form of noninvasive support. The NO2 level delivered to the patient could be greater than the value recorded by the INO delivery system.
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Editorial Comment
Therapist-directed protocols designed with health-care reform in mind.
There is no doubt that therapist-directed protocols are an effective way of providing therapy to patients in need of respiratory care. Therapist-directed protocols have been shown to provide the right therapy to the right patients in an effective and efficient manner. The current investigation presents us with an additional reason for promoting the use of therapist-directed protocols by suggesting a reduced readmission rate in the therapist-directed care group. Respiratory therapists must advocate for the continued or expanded use of these therapist-driven protocols as a way of assisting their institutions to potentially reduce COPD readmissions and minimize CMS reimbursement reductions.
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Various aspects of medication adherence and health-related quality of life (HRQOL) have been studied in subjects with COPD. Nevertheless, little is known about the association between these factors. The aim of this study was to undertake a systematic review of the published literature focusing on the relationship between medication adherence and HRQOL in COPD. ⋯ The relationship between medication adherence and HRQOL may be dual. The effect of medication adherence on HRQOL might be a consequence of the effectiveness of therapy and the negative effects (ie, side effects, daily life limitation of therapy, social stigma) that it can generate. HRQOL might also influence the patterns of patients' drug use, as an increased HRQOL might trigger non-adherence. The dynamics between adherence and HRQOL might differ over time, as the negative effects of medication non-adherence might become dominant in the long term.