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Selzler AM, Lee L, Brooks D, Kohli R, Rose L, Goldstein R. Exploring factors affecting the timely transition of ventilator assisted individuals in Ontario from acute to long-term care: Perspectives of healthcare professionals. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:223-231. [PMID: 37927454 PMCID: PMC10622171 DOI: 10.29390/001c.89103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
Rationale Ventilator Assisted Individuals (VAIs) frequently remain in intensive care units (ICUs) for a prolonged period once clinically stable due to a lack of transition options. These VAIs occupy ICU beds and resources that patients with more acute needs could better utilize. Moreover, VAIs experience improved outcomes and quality of life in long-term and community-based environments. Objective To better understand the perspectives of healthcare providers (HCPs) working in an Ontario ICU regarding barriers and facilitators to referral and transition of VAIs from the ICU to a long-term setting. Methods We conducted semi-structured interviews with ten healthcare providers involved in VAI transitions. Main Results Perceived barriers included long wait times for long-term care settings, insufficient bed availability at discharge locations, medical complexity of patients, long waitlists, and a lack of transparency of waitlists. Facilitators included strong partnerships and trusting relationships between referring and discharge locations, a centralized referral system, and utilization of community partnerships across care sectors. Conclusions Insufficient resourcing of long-term care is a key barrier to transitioning VAIs from ICU to long-term settings; strong partnerships across care sectors are a facilitator. System-level approaches, such as a single-streamlined referral system, are needed to address key barriers to timely transition.
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Affiliation(s)
| | | | - Dina Brooks
- West Park Healthcare Centre
- McMaster University
- Departments of Medicine & Physical Therapy University of Toronto
| | | | - Louise Rose
- Florence Nightingale Faculty of Nursing King's College London
| | - Roger Goldstein
- West Park Healthcare Centre
- Departments of Medicine & Physical Therapy University of Toronto
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Giberson CE, Cheshier SH, Poree LR, Saulino MF. Diaphragm Pacing: A Safety, Appropriateness, Financial Neutrality, and Efficacy Analysis of Treating Chronic Respiratory Insufficiency. Neuromodulation 2023; 26:490-497. [PMID: 36609087 DOI: 10.1016/j.neurom.2022.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study aimed to evaluate the safety and applicability of treating chronic respiratory insufficiency with diaphragm pacing relative to mechanical ventilation. MATERIALS AND METHODS A literature review and analysis were conducted using the safety, appropriateness, financial neutrality, and efficacy principles. RESULTS Although mechanical ventilation is clearly indicated in acute respiratory failure, diaphragm pacing improves life expectancy, increases quality of life, and reduces complications in patients with chronic respiratory insufficiency. CONCLUSION Diaphragm pacing should be given more consideration in appropriately selected patients with chronic respiratory insufficiency.
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Spinou A. A Review on Cough Augmentation Techniques: Assisted Inspiration, Assisted Expiration and Their Combination. Physiol Res 2020; 69:S93-S103. [DOI: 10.33549/physiolres.934407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cough is an important mechanism of airway clearance. In patients who present weak and ineffective cough, augmentation techniques aim to assist or simulate the maneuver. These techniques target different phases of the cough cycle, mainly the inspiratory and expiratory phases, through assisted inspiration, assisted expiration and their combination. They include the manual hyperinflation, ventilator hyperinflation, glossopharyngeal breathing, manually assisted cough and mechanical insufflator-exsufflator, each applied individually or in different combinations. The aim of this review is to investigate the effectiveness and safety of cough augmentation techniques. Findings support that all commonly used techniques can theoretically improve airway clearance, as they generate higher cough peak flows compared to unassisted cough. Still, the studies assessing cough augmentation present considerable limitations and the direct comparison of different techniques is challenging. Current evidence indicate that cough peak flow shows higher increase with the combination of assisted inspiration and expiration, and improvement is greater in patients with lower unassisted values. Associated adverse events are infrequent.
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Affiliation(s)
- A. Spinou
- Population Health Sciences, Faculty of Life Sciences and Medicine, King’s College London, United Kingdom.
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Rose L, Watling L, Kohli R, Bautista C, Renzetti D, Avendano M, Goldstein R. Transition program for ventilator assisted individuals from acute care to home. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2019. [DOI: 10.1080/24745332.2018.1514674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Louise Rose
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, United Kingdom
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Michael Garron Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Laura Watling
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Raj Kohli
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | | | | | - Monica Avendano
- West Park Healthcare Centre, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Roger Goldstein
- West Park Healthcare Centre, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- NSA Chair in Respiratory Rehabilitation Research, Toronto, Ontario, Canada
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Ambrosino N, Fracchia C. The role of tele-medicine in patients with respiratory diseases. Expert Rev Respir Med 2017; 11:893-900. [PMID: 28942692 DOI: 10.1080/17476348.2017.1383898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Tele-medicine is a clinical application connecting a patient with specialized care consultants by means of electronic platforms, potentially able to improve patients' self-management and allow for the care of patients with limited access to health services. This article summarizes the use of tele-medicine as a tool in managing patients suffering from some pathological respiratory conditions. Areas covered: We searched papers published between 1990 and 2017 dealing with tele-medicine and respiratory diseases, chronic obstructive pulmonary disease, asthma, interstitial lung disease, chronic respiratory failure, neuromuscular diseases, critical illness, home mechanical ventilation, and also legal and economic issues. Controlled trials report different results on feasibility, cost-effectiveness, and safety of tele-medicine. Expert commentary: Progress in tele-medicine widens the horizons in respiratory medicine: this tool may potentially reduce health care costs by moving some medical interventions from centralized locations in to patient's home, also allowing for the delivery of care in countries with limited access to it. Legal, safety, and privacy problems, as well as reimbursement issues, must still be defined and solved. At present time, we still need much more evidence to consider this modality as a real option in the management of these patients.
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Affiliation(s)
- Nicolino Ambrosino
- a Istituti Clinici Scientifici Maugeri, Istituto di Montescano IRCCS , Pneumologia Riabilitativa , Montescano (PV) , Italy
| | - Claudio Fracchia
- a Istituti Clinici Scientifici Maugeri, Istituto di Montescano IRCCS , Pneumologia Riabilitativa , Montescano (PV) , Italy
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Ambrosino N, Makhabah DN, Sutanto YS. Tele-medicine in respiratory diseases. Multidiscip Respir Med 2017; 12:9. [PMID: 28435672 PMCID: PMC5397786 DOI: 10.1186/s40248-017-0090-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/29/2017] [Indexed: 11/23/2022] Open
Abstract
Information and Communication Technologies applied to health care and advances in sensor and data transmission technology allowed tele-medicine based programs of care also for patients with respiratory diseases. Different sensors, transmission devices and interventions are used in tele-medicine for some indications. Patients suffering from Chronic Obstructive Pulmonary Disease, asthma, neuromuscular diseases, ventilator assisted individuals and those undergoing pulmonary rehabilitation programs may benefit from this approach. The legal problems are still unsolved. Economic advantages for health care systems, though potentially high, are still poorly investigated. Despite the hopes, we need more evidence before this modality can be considered as a real progress in the management of patients with respiratory diseases. On one hand, these technologies can improve the care of patients with difficult access to services, particularly those in rural/remote areas, on the other hand, there is the risk that they will be used only to reduce standard services in health systems of developed countries.
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Affiliation(s)
| | - Dewi Nurul Makhabah
- Pulmonary and Respiratory Medicine Department, Medical Faculty Sebelas Maret University, Solo, Central Jawa Indonesia
| | - Yusup Subagio Sutanto
- Pulmonary and Respiratory Medicine Department, Medical Faculty Sebelas Maret University, Solo, Central Jawa Indonesia
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Ambrosino N, Vitacca M, Dreher M, Isetta V, Montserrat JM, Tonia T, Turchetti G, Winck JC, Burgos F, Kampelmacher M, Vagheggini G. Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement. Eur Respir J 2016; 48:648-63. [DOI: 10.1183/13993003.01721-2015] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/10/2016] [Indexed: 12/13/2022]
Abstract
The estimated prevalence of ventilator-dependent individuals in Europe is 6.6 per 100 000 people. The increasing number and costs of these complex patients make present health organisations largely insufficient to face their needs. As a consequence, their burden lays mostly over families. The need to reduce healthcare costs and to increase safety has prompted the development of tele-monitoring for home ventilatory assistance.A European Respiratory Society Task Force produced a literature research based statement on commonly accepted clinical criteria for indications, follow-up, equipment, facilities, legal and economic issues of tele-monitoring of these patients.Many remote health monitoring systems are available, ensuring safety, feasibility, effectiveness, sustainability and flexibility to face different patients' needs. The legal problems associated with tele-monitoring are still controversial. National and European Union (EU) governments should develop guidelines and ethical, legal, regulatory, technical, administrative standards for remote medicine. The economic advantages, if any, of this new approach must be compared to a “gold standard” of home care that is very variable among different European countries and within each European country.Much more research is needed before considering tele-monitoring a real improvement in the management of these patients.
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Building a Comprehensive System of Services to Support Adults Living with Long-Term Mechanical Ventilation. Can Respir J 2016; 2016:3185389. [PMID: 27445527 PMCID: PMC4904516 DOI: 10.1155/2016/3185389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background. Increasing numbers of individuals require long-term mechanical ventilation (LTMV) in the community. In the South West Local Health Integration Network (LHIN) in Ontario, multiple organizations have come together to design, build, and operate a system to serve adults living with LTMV. Objective. The goal was to develop an integrated approach to meet the health and supportive care needs of adults living with LTMV. Methods. The project was undertaken in three phases: System Design, Implementation Planning, and Implementation. Results. There are both qualitative and quantitative evidences that a multiorganizational system of care is now operational and functioning in a way that previously did not exist. An Oversight Committee and an Operations Management Committee currently support the system of services. A Memorandum of Understanding has been signed by the participating organizations. There is case-based evidence that hospital admissions are being avoided, transitions in care are being thoughtfully planned and executed collaboratively among service providers, and new roles and responsibilities are being accepted within the overall system of care. Conclusion. Addressing the complex and variable needs of adults living with LTMV requires a systems response involving the full continuum of care.
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