The Experts below are selected from a list of 128646 Experts worldwide ranked by ideXlab platform
Marin H Kollef - One of the best experts on this subject based on the ideXlab platform.
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use of a handheld computer by Respiratory Care practitioners to improve the efficiency of weaning patients from mechanical ventilation
Critical Care Medicine, 2002Co-Authors: Manuel Iregui, Suzanne Ward, Darnetta Clinikscale, Donna Clayton, Marin H KollefAbstract:OBJECTIVE: To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. DESIGN: A prospective before-after study design with consecutive control and intervention time periods. SETTING: A medical intensive Care unit of an urban teaching hospital. PARTICIPANTS: All patients receiving mechanical ventilation in the medical intensive Care unit were eligible for study enrollment. INTERVENTIONS: Weaning of mechanical ventilation during the control period was conducted by Respiratory Care practitioners using a previously published protocol (n = 176). During the intervention period, Respiratory Care practitioners weaned patients using a handheld computer version of the same protocol (n = 176). MEASUREMENTS AND RESULTS: The time for the first spontaneous breathing trial to occur was significantly shorter during the intervention period compared with the control period (49.9 +/- 63.2 hrs vs. 72.5 +/- 86.9 hrs, p=.018). The percentage of patients undergoing a spontaneous breathing trial when first meeting established criteria for a spontaneous breathing trial was significantly greater during the intervention period (89.8% vs. 63.6%, p<.001). Length of stay in the intensive Care unit was also significantly shorter for patients during the intervention period (6.2 +/- 7.1 days vs. 7.7 +/- 8.0 days, p=.018). CONCLUSIONS: This experience suggests that Respiratory Care practitioners employing a weaning protocol programmed on a handheld computer can wean patients from mechanical ventilation more efficiently compared with the use of a paper-based weaning protocol.
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use of a handheld computer by Respiratory Care practitioners to improve the efficiency of weaning patients from mechanical ventilation
Critical Care Medicine, 2002Co-Authors: Manuel Iregui, Suzanne Ward, Darnetta Clinikscale, Donna Clayton, Marin H KollefAbstract:OBJECTIVE: To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. DESIGN: A prospective before-after study design with consecutive control and intervention time periods. SETTING: A medical intensive Care unit of an urban teaching hospital. PARTICIPANTS: All patients receiving mechanical ventilation in the medical intensive Care unit were eligible for study enrollment. INTERVENTIONS: Weaning of mechanical ventilation during the control period was conducted by Respiratory Care practitioners using a previously published protocol (n = 176). During the intervention period, Respiratory Care practitioners weaned patients using a handheld computer version of the same protocol (n = 176). MEASUREMENTS AND RESULTS: The time for the first spontaneous breathing trial to occur was significantly shorter during the intervention period compared with the control period (49.9 +/- 63.2 hrs vs. 72.5 +/- 86.9 hrs, p=.018). The percentage of patients undergoing a spontaneous breathing trial when first meeting established criteria for a spontaneous breathing trial was significantly greater during the intervention period (89.8% vs. 63.6%, p<.001). Length of stay in the intensive Care unit was also significantly shorter for patients during the intervention period (6.2 +/- 7.1 days vs. 7.7 +/- 8.0 days, p=.018). CONCLUSIONS: This experience suggests that Respiratory Care practitioners employing a weaning protocol programmed on a handheld computer can wean patients from mechanical ventilation more efficiently compared with the use of a paper-based weaning protocol.
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the effect of Respiratory therapist initiated treatment protocols on patient outcomes and resource utilization
Chest, 2000Co-Authors: Marin H Kollef, Donna Clayton, Darnetta Clinkscale, Steven D Shapiro, Lisa Cracchiolo, Russ Wilner, Linda HossinAbstract:Context Physicians frequently prescribe Respiratory treatments to hospitalized patients, but the influence of such treatments on clinical outcomes is difficult to assess. Objective To compare the clinical outcomes of patients receiving Respiratory treatments managed by Respiratory Care practitioner (RCP)–directed treatment protocols or physician-directed orders. Design A single center, quasi-randomized, clinical study. Setting Three internal medicine firms from an urban teaching hospital. Patients Six hundred ninety-four consecutive hospitalized non-ICU patients ordered to receive Respiratory treatments. Main outcome measures Discordant Respiratory Care orders, Respiratory Care charges, hospital length of stay, and patient-specific complications. Discordant orders were defined as written orders for Respiratory treatments that were not clinically indicated as well as orders omitting treatments that were clinically indicated according to protocol-based treatment algorithms. Results Firm A patients (n = 239) received RCP-directed treatments and had a statistically lower rate of discordant Respiratory Care orders (24.3%) as compared with patients receiving physician-directed treatments in firms B (n = 205; 58.5%) and C (n = 250; 56.8%; p Conclusions Respiratory Care managed by RCP-directed treatment protocols for non-ICU patients is safe and showed greater agreement with institutional treatment algorithms as compared with physician-directed Respiratory Care. Additionally, the overall utilization of Respiratory treatments was significantly less among patients receiving RCP-directed Respiratory Care.
Manuel Iregui - One of the best experts on this subject based on the ideXlab platform.
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use of a handheld computer by Respiratory Care practitioners to improve the efficiency of weaning patients from mechanical ventilation
Critical Care Medicine, 2002Co-Authors: Manuel Iregui, Suzanne Ward, Darnetta Clinikscale, Donna Clayton, Marin H KollefAbstract:OBJECTIVE: To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. DESIGN: A prospective before-after study design with consecutive control and intervention time periods. SETTING: A medical intensive Care unit of an urban teaching hospital. PARTICIPANTS: All patients receiving mechanical ventilation in the medical intensive Care unit were eligible for study enrollment. INTERVENTIONS: Weaning of mechanical ventilation during the control period was conducted by Respiratory Care practitioners using a previously published protocol (n = 176). During the intervention period, Respiratory Care practitioners weaned patients using a handheld computer version of the same protocol (n = 176). MEASUREMENTS AND RESULTS: The time for the first spontaneous breathing trial to occur was significantly shorter during the intervention period compared with the control period (49.9 +/- 63.2 hrs vs. 72.5 +/- 86.9 hrs, p=.018). The percentage of patients undergoing a spontaneous breathing trial when first meeting established criteria for a spontaneous breathing trial was significantly greater during the intervention period (89.8% vs. 63.6%, p<.001). Length of stay in the intensive Care unit was also significantly shorter for patients during the intervention period (6.2 +/- 7.1 days vs. 7.7 +/- 8.0 days, p=.018). CONCLUSIONS: This experience suggests that Respiratory Care practitioners employing a weaning protocol programmed on a handheld computer can wean patients from mechanical ventilation more efficiently compared with the use of a paper-based weaning protocol.
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use of a handheld computer by Respiratory Care practitioners to improve the efficiency of weaning patients from mechanical ventilation
Critical Care Medicine, 2002Co-Authors: Manuel Iregui, Suzanne Ward, Darnetta Clinikscale, Donna Clayton, Marin H KollefAbstract:OBJECTIVE: To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. DESIGN: A prospective before-after study design with consecutive control and intervention time periods. SETTING: A medical intensive Care unit of an urban teaching hospital. PARTICIPANTS: All patients receiving mechanical ventilation in the medical intensive Care unit were eligible for study enrollment. INTERVENTIONS: Weaning of mechanical ventilation during the control period was conducted by Respiratory Care practitioners using a previously published protocol (n = 176). During the intervention period, Respiratory Care practitioners weaned patients using a handheld computer version of the same protocol (n = 176). MEASUREMENTS AND RESULTS: The time for the first spontaneous breathing trial to occur was significantly shorter during the intervention period compared with the control period (49.9 +/- 63.2 hrs vs. 72.5 +/- 86.9 hrs, p=.018). The percentage of patients undergoing a spontaneous breathing trial when first meeting established criteria for a spontaneous breathing trial was significantly greater during the intervention period (89.8% vs. 63.6%, p<.001). Length of stay in the intensive Care unit was also significantly shorter for patients during the intervention period (6.2 +/- 7.1 days vs. 7.7 +/- 8.0 days, p=.018). CONCLUSIONS: This experience suggests that Respiratory Care practitioners employing a weaning protocol programmed on a handheld computer can wean patients from mechanical ventilation more efficiently compared with the use of a paper-based weaning protocol.
Donna Clayton - One of the best experts on this subject based on the ideXlab platform.
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use of a handheld computer by Respiratory Care practitioners to improve the efficiency of weaning patients from mechanical ventilation
Critical Care Medicine, 2002Co-Authors: Manuel Iregui, Suzanne Ward, Darnetta Clinikscale, Donna Clayton, Marin H KollefAbstract:OBJECTIVE: To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. DESIGN: A prospective before-after study design with consecutive control and intervention time periods. SETTING: A medical intensive Care unit of an urban teaching hospital. PARTICIPANTS: All patients receiving mechanical ventilation in the medical intensive Care unit were eligible for study enrollment. INTERVENTIONS: Weaning of mechanical ventilation during the control period was conducted by Respiratory Care practitioners using a previously published protocol (n = 176). During the intervention period, Respiratory Care practitioners weaned patients using a handheld computer version of the same protocol (n = 176). MEASUREMENTS AND RESULTS: The time for the first spontaneous breathing trial to occur was significantly shorter during the intervention period compared with the control period (49.9 +/- 63.2 hrs vs. 72.5 +/- 86.9 hrs, p=.018). The percentage of patients undergoing a spontaneous breathing trial when first meeting established criteria for a spontaneous breathing trial was significantly greater during the intervention period (89.8% vs. 63.6%, p<.001). Length of stay in the intensive Care unit was also significantly shorter for patients during the intervention period (6.2 +/- 7.1 days vs. 7.7 +/- 8.0 days, p=.018). CONCLUSIONS: This experience suggests that Respiratory Care practitioners employing a weaning protocol programmed on a handheld computer can wean patients from mechanical ventilation more efficiently compared with the use of a paper-based weaning protocol.
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use of a handheld computer by Respiratory Care practitioners to improve the efficiency of weaning patients from mechanical ventilation
Critical Care Medicine, 2002Co-Authors: Manuel Iregui, Suzanne Ward, Darnetta Clinikscale, Donna Clayton, Marin H KollefAbstract:OBJECTIVE: To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. DESIGN: A prospective before-after study design with consecutive control and intervention time periods. SETTING: A medical intensive Care unit of an urban teaching hospital. PARTICIPANTS: All patients receiving mechanical ventilation in the medical intensive Care unit were eligible for study enrollment. INTERVENTIONS: Weaning of mechanical ventilation during the control period was conducted by Respiratory Care practitioners using a previously published protocol (n = 176). During the intervention period, Respiratory Care practitioners weaned patients using a handheld computer version of the same protocol (n = 176). MEASUREMENTS AND RESULTS: The time for the first spontaneous breathing trial to occur was significantly shorter during the intervention period compared with the control period (49.9 +/- 63.2 hrs vs. 72.5 +/- 86.9 hrs, p=.018). The percentage of patients undergoing a spontaneous breathing trial when first meeting established criteria for a spontaneous breathing trial was significantly greater during the intervention period (89.8% vs. 63.6%, p<.001). Length of stay in the intensive Care unit was also significantly shorter for patients during the intervention period (6.2 +/- 7.1 days vs. 7.7 +/- 8.0 days, p=.018). CONCLUSIONS: This experience suggests that Respiratory Care practitioners employing a weaning protocol programmed on a handheld computer can wean patients from mechanical ventilation more efficiently compared with the use of a paper-based weaning protocol.
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the effect of Respiratory therapist initiated treatment protocols on patient outcomes and resource utilization
Chest, 2000Co-Authors: Marin H Kollef, Donna Clayton, Darnetta Clinkscale, Steven D Shapiro, Lisa Cracchiolo, Russ Wilner, Linda HossinAbstract:Context Physicians frequently prescribe Respiratory treatments to hospitalized patients, but the influence of such treatments on clinical outcomes is difficult to assess. Objective To compare the clinical outcomes of patients receiving Respiratory treatments managed by Respiratory Care practitioner (RCP)–directed treatment protocols or physician-directed orders. Design A single center, quasi-randomized, clinical study. Setting Three internal medicine firms from an urban teaching hospital. Patients Six hundred ninety-four consecutive hospitalized non-ICU patients ordered to receive Respiratory treatments. Main outcome measures Discordant Respiratory Care orders, Respiratory Care charges, hospital length of stay, and patient-specific complications. Discordant orders were defined as written orders for Respiratory treatments that were not clinically indicated as well as orders omitting treatments that were clinically indicated according to protocol-based treatment algorithms. Results Firm A patients (n = 239) received RCP-directed treatments and had a statistically lower rate of discordant Respiratory Care orders (24.3%) as compared with patients receiving physician-directed treatments in firms B (n = 205; 58.5%) and C (n = 250; 56.8%; p Conclusions Respiratory Care managed by RCP-directed treatment protocols for non-ICU patients is safe and showed greater agreement with institutional treatment algorithms as compared with physician-directed Respiratory Care. Additionally, the overall utilization of Respiratory treatments was significantly less among patients receiving RCP-directed Respiratory Care.
Dean R Hess - One of the best experts on this subject based on the ideXlab platform.
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executive summary optimal niv mediCare access promotion a technical expert panel report from the american college of chest physicians the american association for Respiratory Care the american academy of sleep medicine and the american thoracic socie
Chest, 2021Co-Authors: Robert L Owens, Dean R Hess, Joshua O Benditt, Richard D Branson, Nicholas S Hill, Lisa F Wolfe, Loutfi S Aboussouan, John M Coleman, Gerard J Criner, Bartolome R CelliAbstract:The current national coverage determinations (NCDs) for noninvasive ventilation for patients with thoracic restrictive disorders, COPD, and hypoventilation syndromes were formulated in 1998. New original research, updated formal practice guidelines, and current consensus expert opinion have accrued that are in conflict with the existing NCDs. Some inconsistencies in the NCDs have been noted, and the diagnostic and therapeutic technology has also advanced in the last quarter century. Thus, these and related NCDs relevant to bilevel positive airway pressure for the treatment of OSA and central sleep apnea need to be updated to ensure the optimal health of patients with these disorders. To that end, the American College of Chest Physicians organized a multisociety (American Thoracic Society, American Academy of Sleep Medicine, and American Association for Respiratory Care) effort to engage experts in the field to: (1) identify current barriers to optimal Care; (2) highlight compelling scientific evidence that would justify changes from current policies incorporating best evidence and practice; and (3) propose suggestions that would form the basis for a revised NCD in each of these 5 areas (thoracic restrictive disorders, COPD, hypoventilation syndromes, OSA, and central sleep apnea). The expert panel met during a 2-day virtual summit in October 2020 and subsequently crafted written documents designed to achieve provision of "the right device to the right patient at the right time." These documents have been endorsed by the participating societies following peer review and publication in CHEST and will be used to inform efforts to revise the current NCDs.
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evidence based Respiratory Care
Respiratory Care, 2021Co-Authors: Dean R HessAbstract:Evidence-based medicine is the integration of individual clinical expertise with the best available research and the patient's values and expectations. The efficient approach to finding the best evidence is to identify systematic reviews or evidence-based clinical practice guidelines. Respiratory therapies that are supported by evidence include lung-protective ventilation and noninvasive ventilation for individuals with COPD. Evidence does not support postoperative incentive spirometry or intermittent mandatory ventilation. The principles of evidence-based medicine are a valuable approach to Respiratory Care practice.
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Respiratory Care year in review 2013 neonatal Respiratory Care pulmonary function testing and pulmonary rehabilitation
Respiratory Care, 2014Co-Authors: Craig D Smallwood, Jeffrey M Haynes, Brian W Carlin, Dean R HessAbstract:Respiratory Care practice includes neonatal Respiratory Care, pulmonary function testing, and pulmonary rehabilitation. The purpose of this paper is to review the recent literature related to these topics in a manner that is most likely to have interest to the readers of Respiratory Care.
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Respiratory Care Year in Review 2013: Airway Management, Noninvasive Monitoring, and Invasive Mechanical Ventilation
Respiratory care, 2014Co-Authors: Charles G. Durbin, Lluis Blanch, Eddy Fan, Dean R HessAbstract:Fundamental to Respiratory Care practice are airway management, noninvasive monitoring, and invasive mechanical ventilation. The purpose of this paper is to review the recent literature related to these topics in a manner that is most likely to have interest to the readers of Respiratory Care.
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Respiratory therapy organizational changes are associated with increased Respiratory Care utilization
Respiratory Care, 2013Co-Authors: Ann M Parker, Xinggang Liu, Anthony D Harris, Carl Shanholtz, Robin L Smith, Dean R Hess, Marty Reynolds, Giora NetzerAbstract:P < .001), chest physiotherapy (7.4% vs 21.6%, P < .001), BALs (24.0% vs 41.4%, P < .001), and lower Respiratory tract cultures (21.5% vs 38.0%, P < .001) in mechanically ventilated patients post-intervention. CONCLUSIONS: A multi-component intervention, including an increase in RT/ patient ratio, improved RT orientation, and establishment of a core staffing model, was associated with increased Respiratory resource utilization and evidence-based practice, specifically BALs and
Suzanne Ward - One of the best experts on this subject based on the ideXlab platform.
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use of a handheld computer by Respiratory Care practitioners to improve the efficiency of weaning patients from mechanical ventilation
Critical Care Medicine, 2002Co-Authors: Manuel Iregui, Suzanne Ward, Darnetta Clinikscale, Donna Clayton, Marin H KollefAbstract:OBJECTIVE: To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. DESIGN: A prospective before-after study design with consecutive control and intervention time periods. SETTING: A medical intensive Care unit of an urban teaching hospital. PARTICIPANTS: All patients receiving mechanical ventilation in the medical intensive Care unit were eligible for study enrollment. INTERVENTIONS: Weaning of mechanical ventilation during the control period was conducted by Respiratory Care practitioners using a previously published protocol (n = 176). During the intervention period, Respiratory Care practitioners weaned patients using a handheld computer version of the same protocol (n = 176). MEASUREMENTS AND RESULTS: The time for the first spontaneous breathing trial to occur was significantly shorter during the intervention period compared with the control period (49.9 +/- 63.2 hrs vs. 72.5 +/- 86.9 hrs, p=.018). The percentage of patients undergoing a spontaneous breathing trial when first meeting established criteria for a spontaneous breathing trial was significantly greater during the intervention period (89.8% vs. 63.6%, p<.001). Length of stay in the intensive Care unit was also significantly shorter for patients during the intervention period (6.2 +/- 7.1 days vs. 7.7 +/- 8.0 days, p=.018). CONCLUSIONS: This experience suggests that Respiratory Care practitioners employing a weaning protocol programmed on a handheld computer can wean patients from mechanical ventilation more efficiently compared with the use of a paper-based weaning protocol.
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use of a handheld computer by Respiratory Care practitioners to improve the efficiency of weaning patients from mechanical ventilation
Critical Care Medicine, 2002Co-Authors: Manuel Iregui, Suzanne Ward, Darnetta Clinikscale, Donna Clayton, Marin H KollefAbstract:OBJECTIVE: To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. DESIGN: A prospective before-after study design with consecutive control and intervention time periods. SETTING: A medical intensive Care unit of an urban teaching hospital. PARTICIPANTS: All patients receiving mechanical ventilation in the medical intensive Care unit were eligible for study enrollment. INTERVENTIONS: Weaning of mechanical ventilation during the control period was conducted by Respiratory Care practitioners using a previously published protocol (n = 176). During the intervention period, Respiratory Care practitioners weaned patients using a handheld computer version of the same protocol (n = 176). MEASUREMENTS AND RESULTS: The time for the first spontaneous breathing trial to occur was significantly shorter during the intervention period compared with the control period (49.9 +/- 63.2 hrs vs. 72.5 +/- 86.9 hrs, p=.018). The percentage of patients undergoing a spontaneous breathing trial when first meeting established criteria for a spontaneous breathing trial was significantly greater during the intervention period (89.8% vs. 63.6%, p<.001). Length of stay in the intensive Care unit was also significantly shorter for patients during the intervention period (6.2 +/- 7.1 days vs. 7.7 +/- 8.0 days, p=.018). CONCLUSIONS: This experience suggests that Respiratory Care practitioners employing a weaning protocol programmed on a handheld computer can wean patients from mechanical ventilation more efficiently compared with the use of a paper-based weaning protocol.
