Respiratory care clinics of North America
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Respir Care Clin N Am · Mar 1998
ReviewThe ABCs of patient and rehabilitation specialist training and education.
In this article the authors consider patient training and education from the perspective of training the rehabilitation specialist. Specialist training is a process that will enable the specialist to aid the patient and caregiver in the acquisition of knowledge, skills, understanding, and a positive outlook as they pertain to the management of the patient's medical condition. The ultimate goals are to encourage patient and family to participate more fully in health care and to allow a more collaborative effort between the health care provider and the patient.
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The measurement of outcomes of therapy is becoming ever more important as part of the overall management of an individual patient. This is particularly true when considering pulmonary rehabilitation for a patient with chronic lung disease. Health, clinical, and behavioral domains should be assessed when evaluating the effectiveness of pulmonary rehabilitation. This assessment of outcomes can be easily made using currently available tools.
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Respir Care Clin N Am · Mar 1998
ReviewPulmonary rehabilitation in the acute inpatient rehabilitation hospital.
In closing, pulmonary rehabilitation in an inpatient rehabilitation hospital is not a new idea, but is now becoming more popular as the burden of care shifts away from the acute care hospital. Pulmonary rehabilitation has been demonstrated to be cost-effective, improve quality of life, and decrease the number of future hospital days for the patient. A few surveys have shown, however, that only 5% of pulmonary rehabilitation programs serviced inpatients in a rehabilitation hospital, and only 1% of 283 programs had a physiatrist as the medical director of the pulmonary rehabilitation program. ⋯ The spectrum of pulmonary rehabilitation will continue to evolve into the twenty-first century, and clearly the rehabilitation hospital will be part of that change. Whether caring for very elderly COPD patients who are too debilitated to return home from the acute care hospital or managing ventilator-dependent patients with COPD, spinal cord injury, or neuromuscular disease, the IPR team and the rehabilitation hospital will have to demonstrate cost-effective outcomes. Physiatrists should play a major role in this evolution, on both a patient-benefit level and legislative level, to increase awareness of pulmonary rehabilitation.
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A successful comprehensive pulmonary rehabilitation program depends on these key pieces: thorough planning, an experienced coordinator who is a patient advocate, a dedicated and supportive medical director, enthusiastic and committed team members, the use of program graduates as volunteers, and providing the essential components of pulmonary rehabilitation, which consist of assessment, patient training, exercise, psychosocial intervention, and follow-up. The patients are the most important members of the team. Their courage, dedication, and determination to make their quality of life the best it can be is truly an inspiration to all of us.
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Resistance measurements are the most useful parameters for assessing acute changes in airway caliber associated with bronchodilation or bronchial provocation. Used in addition to spirometry, Raw can provide a better differentiation of the causes of airflow impairment as well as the presence of concurrent processes. A simple, noninvasive Raw measurement can provide definitive answers in the absence of other changes. Finally, the addition of practical, nonplethysmographic measurements opens a new application for bedside, office, and home monitoring.