Bibliographies: 'Respiratory therapists' – Grafiati (2024)

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Abstract:

Background: Reusable elastomeric respirator use in health care may represent one solution to address N95 respirator shortages experienced during infectious disease outbreaks, but cleaning and disinfection requirements may limit their utility. Evidence of respirator cleaning and disinfection behaviors and practices by health care workers may inform guidance on reusable respirator use. Methods: Medical system elastomeric respirator users were surveyed about respirator cleaning and disinfection practices and perceptions via an electronic survey. Respondents were subsequently classified based on reported compliance with their assigned respirator use. To explore whether respirator cleaning and disinfection issues affected compliance with assigned device use, responses were compared between user groups and adjusted for covariates. Results: A total of 432 of 2,024 (21%) eligible elastomeric respirator users completed the survey. Most (>90%) reported that their respirator was clean, but only 52% reported that they always disinfect their respirators after use according to the hospital’s expected practice. Only 40 respondents (9%) reported regularly cleaning the respirator with soap and water, in accordance with manufacturer recommendations. Reporting of suboptimal decontamination practice was not associated with assigned device compliance, however, except among providers and respiratory therapists. Conclusion/Application to Practice: Although perceptions of cleanliness and adherence to expected decontamination practices during routine use did not appear to influence compliance with assigned respirator use overall, this did predict compliance among providers and respiratory therapists, both of whom have nonfixed workstations. Practical and effective strategies to assure easy access to and availability of clean reusable respiratory protective devices are needed to facilitate their use in health care respiratory protection programs.

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Introduction: The purpose of this study was to determine the perceptions of practicing respiratory therapists (RT) and respiratory care educators regarding the role of RTs serving as physician extenders. Methods: The survey instrument was an electronic questionnaire that consisted of 17 questions. Participation was voluntary and participants were selected through random and convenience sampling techniques. Results: Of 506 respondents, 234 were respiratory care educators. Overwhelmingly, the respondents held the Registered Respiratory Therapist credential (92.7%). Respondents were about equally split among three education levels: 31.7% associate degree, 31.7% bachelor’s degree, and 27.3% master’s degree. Of the respondents 62.45% had considered pursing a degree in physician assistant (PA). Respondents expressed a preference for an Advanced Practice Respiratory Therapy (APRT) program (77.9%) rather than a PA program. Nearly two-thirds of the respondents reported they felt that a master’s degree should be the minimum level of education for an APRT. Conclusions: This study suggests that practitioners and educators alike are strongly supportive of advanced practice in the profession of respiratory therapy.

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This mixed-method study investigated the effects of self-directed physiological monitoring on therapists anxiety. Ten therapists participated in a10-week physiological monitoring training sessions while monitoring respiratory sinus arrhythmia (RSA) and heart rate variability (HRV). The participants completed the state-trait anxiety inventory questionnaire after having a first, sixth, or tenth therapy session with a client. This was designed to monitor their state anxiety while working with clients. A series of paired sampled t-tests was conducted to assess changes in HRV, RSA, trait anxiety, and state anxiety. One significant result was found: the RSA of the therapist increased significantly. Correlations existed between the HRV of the therapist increasing and the trait anxiety of the therapist decreasing through RSA training sessions although they were not significant at the .05 level.

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The purpose of this study was to identify the complete scope, cognitive, affective and psychom*otor, of clinical competencies required for the successful practice by entry-level associate degree respiratory care graduates entering the workforce. The study was conducted using a Delphi technique. American Association for Respiratory Care House of Delegates nominated a panel of experts to participate in the study. A total of 55 individuals were nominated and 21 agree to participate in the study. The individuals represented both college-based educators and hospital managers and educators. The initial questionnaire requested that each panel member list those cognitive, affective and psychom*otor clinical competencies that they believed to be required for successful entrylevel practice. The responses from the first round were grouped into like categories and returned to the panel members to be rated on a four-point scale during the second and third rounds of the study. Consensus was achieved with the third round resulting in a final list of 26 cognitive, 20 affective and 28 psychom*otor clinical competencies. The final list of competencies includes the most basic cognitive and psychom*otor skills of the profession and did not include many of the areas listed by the National Board for Respiratory Care exam matrix. The study also lists 20 affective attributes as essential for successful practice. There are no current standardized methods in use to evaluate affective skills. Research will need to continue to clarify the skills needed for competent and successful entry-level practice.
Department of Educational Studies

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This phenomenological study investigated the transition experiences of clinical respiratory therapists who pursued second careers as respiratory faculty. Situated Learning Theory and Workplace Learning Theory were the frameworks for interviews with 11 second career respiratory faculty who had taught fewer than five years in baccalaureate degree programs. The goal of this study was to identify the major themes of their experiences. Thematic analysis revealed five common experiences: under-preparation, challenges, overwhelmed feelings, personal responsibilities, and rewards. The common theoretical framework for all participants was the critical need to understand their communities of practice within their organizations. From this study, respiratory department chairs and administrators may better understand the challenges and needs of clinical therapists as they transition into faculty positions. Positive experiences such as improved orientations and continued effective faculty support may promote a more rewarding and long-term practice.

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Thesis advisor: Babak Momeni
Diseases of the upper respiratory tract encompass a plethora of complex multifaceted etiologies ranging from acute viral and bacterial infections to chronic diseases of the lung and nasal cavity. Due to this inherent complexity, typical treatments often fail in the face of recalcitrant infections and/or severe forms of chronic disease, including asthma. Thus, in order to provide improved standard of care, the mechanisms at play in hard-to-treat etiologies must be better understood. More recently, research has demonstrated a significant association between microbiota and many URT diseases. Previous work has also identified species capable of directly inhibiting standard treatments used to control asthma exacerbations. Despite an exhaustive collection of data characterizing microbiota composition in states of both health and disease, our knowledge of what microbiota profiles are observed in what specific disease etiologies is severely lacking. Yet, gaining these insights is crucial for the translation of such data into application. In this thesis I sought to: 1) identify gut microbiota profiles associated with severe and treatment resistant forms of childhood asthma, and 2) formulate a predictive model to facilitate the restructuring of microbiota for desired therapeutic outcomes. To identify gut microbiota and metabolites enriched in severe and treatment resistant childhood asthma, I looked to an ongoing longitudinal human study on vitamin D and childhood asthma. In this study, I find several fecal bacterial taxa and metabolites associated with more severe (i.e., higher wheeze proportion) and treatment resistant asthma in children at age 3 years. Specifically, several Veillonella species were enriched in children with higher wheeze proportion and in children that responded poorly to inhaled corticosteroid treatment (ICS) (i.e., non-responders). Haemophilus parainfluenzae, a species previously identified as enriched in the airway of adults with ICS-resistant asthma, was also uniquely enriched in children considered ICS non-responders in this study. Several metabolic pathways were also distinctly enriched: histidine metabolism was enriched in children with higher wheeze proportion while sphingolipid metabolism was enriched in ICS non-responders. Both metabolic pathways have been previously identified in association with asthma, further corroborating their role in this disease. Yet, this study is the first to identify these taxa and metabolites in children with preexisting and treatment resistant asthma. In the pursuit of improved treatment outcomes for recalcitrant URT diseases, recent efforts have turned towards microbiota-based therapies. While such treatments have proven successful in the treatment of gastrointestinal infections, these methods have not yet been extended to other conditions. Considering this, I ask whether a predictive model describing microbial interactions can facilitate the restructuring of microbiota for desired therapeutic outcomes. For this, I use a community of nasal microbiota to determine when a simply Lotka-Volterra-like (LV) model is a suitable representation for microbial interactions. I then utilize our LV-like model to examine whether environmental fluctuations have a major influence on community assembly and composition. For this, I looked specifically at pH fluctuations. In this study, I found that LV-like models are most suitable for describing community dynamics in complex low nutrient conditions. I also identified simple in vitro experiments that can reliably predict the suitability of a LV-like model for describing outcomes of a two-species community. When our LV-like model was applied to an in silico community of nasal species to determine the impact of environmental fluctuations, I find that nasal communities are generally robust against pH fluctuations and that, in this condition, facilitative interactions are a stabilizing force, and thus, selected for in in silico enrichment experiments. Overall, this thesis further corroborates the association of microbiota with URT diseases and treatment outcomes while also providing unique insight into their association with specific etiologies in childhood asthma. This thesis also provides a framework for developing models able to facilitate the development of future microbiota-based therapies while also determining how, and when, environmental factors impact community assembly and composition
Thesis (PhD) — Boston College, 2021
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Biology

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Abstract:

Pediatric patients or newborns admitted to Neonatal Intensive Care Units (NICU) receive life support care due to various conditions and pathologies. The physiotherapist controls and applies medicinal gases, institutes and monitors invasive and non-invasive mechanical ventilation, as well as performs weaning, among others. Learning ventilatory management must be appropriate for the age and, therefore, consider different lungs for the proper simulations of compliance and resistance. Although the insertion of physical therapists is relatively recent, there are several postgraduate courses and training in this area. The creation of a mechanical lungthat covers, separately, neonatal and pediatric patients will be a fundamental tool for the learning and training of future professionals who will work in the area. To develop two neonatal and pediatric mechanical lungs, as well as to simulate different elastic and resistive behaviors inherent in clinical practice. Experimental study, bench, divided into two stages: creation of mechanical lungs and evaluation of mechanical characteristics. The lungs will be made on a two-story metallic base: on the upper floor, the pediatric lung and the lower floor, the neonatal. In the second stage, the mechanical lung will be connected to a mechanical ventilator, using its own ventilatory parameters used in both types of patients. For the neonatal, respiratory rate of 35rpm, inspiratory time of 0.45 and endotracheal tube of 3.0 mm. The pediatric lung will be ventilated with a volume between 100-120mL, 20-25 compliance and a 4.5mm orotracheal tube. The construction of the neonatal and pediatric mechanical lung will strongly add the teaching of the Neonatal and Pediatric Intensive Physical Therapy specialty in the Undergraduate and Graduate settings, adding value to the teaching and training of professionals.

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Inhalation therapies are gaining popularity for both respiratory and non-respiratory therapies. However the challenge remains to achieve optimal drug delivery because of the complex interaction between inhaler devices, drug formulations along with patients’ coordination and physiology. In order to lower R&D costs and efforts, and understand better the mechanics of pharmaceutical aerosols, system designers are looking for comprehensive tools enabling them to reproduce virtual inhalation processes. Computational fluid dynamics (CFD) techniques represent a non-invasive way of predicting the fate of inhaled medication from oral or nasal delivery devices. The object of this work is to apply CFD methodology to model the full inhalation mechanism, from the drug dispersion inside the device and delivery to the patient, to its journey within the respiratory tract.

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Lung disease is America’s third largest killer, and responsible for one in seven deaths [1]. Most lung disease is chronic, and respiratory support is essential. Current therapies for the respiratory failure include mechanical ventilation and bed-side extracorporeal membrane oxygenation (ECMO) devices which closely simulate the physiological gas exchange of the natural lung.

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