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Biomedical subjects

David C Shelledy

Publications and source records attributed to David C Shelledy.

6 recordsLinked to original sources
PubMed2005

Education and credentialing in respiratory care: where are we and where should we be headed?

Respiratory care is indeed at a crossroads. The profession will continue to develop by advancing the education and credentialing needed to function as physician extenders-true cardiopulmonary physician's assistants. As such, the respiratory therapist of the future will focus on patient assessment,care plan development, protocol administration, disease management and rehabilitation, and patient and family education, including tobacco education and smoking cessation. Respiratory therapists, through primary, secondary, and tertiary prevention activities, can positively affect peoples'quality of life. This advanced level professional will work in the intensive-and acute-care settings, applying sophisticated cardiopulmonary technologies, as well in clinics, physician offices, home care, long-term and rehabilitation facilities, industry, educational institutions, and research facilities. The alternative to this advanced practice is for the profession to remain a task-oriented technical field, focused on procedures and the technical aspects of oxygen and aerosol therapy, mechanical ventilatory support, and related diagnostic and monitoring techniques. Although there is a dignified and important role for the provision of the technical aspects of respiratory care, the authors believe that the future role of the respiratory specialist is that of physician extender. Higher-order performance will result in higher-order contributions to health care. This role will require increased numbers of baccalaureate and graduate degree programs in respiratory care and increased numbers of respiratory therapists who hold higher degrees,including the master's degree in respiratory care and doctoral degrees in related fields. Community colleges, 4-year colleges, and universities should be encouraged to develop effective articulation agreements and mechanisms to offer the bachelor of science degree in respiratory care to the community college student. Professional associations and accrediting agencies should promote the development of additional baccalaureate and master's degree programs in respiratory care. Education is best defined as positive behavior change. Amplified education can only improve the ability of respiratory therapists to contribute to the cardiopulmonary health of people worldwide.

Allied Health Personnel↗
PubMed2005

Delivered oxygen concentrations using low-flow and high-flow nasal cannulas.

INTRODUCTION: Nasal cannulas are commonly used to deliver oxygen in acute and chronic care settings; however, there are few data available on delivered fraction of inspired oxygen (F(IO(2))). The purposes of this study were to determine the delivered F(IO(2)) on human subjects using low-flow and high-flow nasal cannulas, and to determine the effects of mouth-closed and mouth-open breathing on F(IO(2)). METHODS: We measured the pharyngeal F(IO(2)) delivered by adult nasal cannulas at 1-6 L/min and high-flow nasal cannulas at 6-15 L/min consecutively in 10 normal subjects. Oxygen was initiated at 1 L/min, with the subject at rest, followed by a period of rapid breathing. Gas samples were aspirated from a nasal catheter positioned with the tip behind the uvula. This process was repeated at each liter flow. Mean, standard deviation, and range were calculated at each liter flow. F(IO(2)) during mouth-open and mouth-closed breathing were compared using the dependent test for paired values, to determine if there were significant differences. RESULTS: The mean resting F(IO(2)) ranged from 0.26-0.54 at 1-6 L/min to 0.54-0.75 at 6-15 L/min. During rapid breathing the mean F(IO(2)) ranged from 0.24-0.45 at 1-6 L/min to 0.49-0.72 at 6-15 L/min. The mean F(IO(2)) increased with increasing flow rates. The standard deviation (+/- 0.04-0.15) and range were large, and F(IO(2)) varied widely within and between subjects. F(IO(2)) during mouth-open breathing was significantly (p < 0.05) greater than that during mouth-closed breathing. CONCLUSIONS: F(IO(2)) increased with increasing flow. Subjects who breathed with their mouths open attained a significantly higher F(IO(2)), compared to those who breathed with their mouths closed.

Administration, Intranasal↗
PubMed2004

An assessment of the appropriateness of respiratory care delivered at a 450-bed acute care Veterans affairs hospital.

INTRODUCTION: Respiratory care is expensive and time-intensive, inappropriate care wastes resources, and failure to provide necessary and appropriate respiratory care may adversely affect patient outcomes. OBJECTIVE: To determine the appropriateness of basic respiratory care delivered at a 450-bed Veterans Affairs hospital during a 3-month interval. METHODS: We determined (1) the percentage of delivered respiratory care that was not indicated (based on standardized clinical practice guidelines), (2) the percentage of respiratory care that was indicated but not ordered (based on standardized clinical practice guidelines), and (3) the labor cost and potential savings of protocol-based respiratory care at our hospital. We selected 5 assessment days, occurring at 2-week intervals. All patients who received basic respiratory care underwent a complete respiratory care assessment, including medical records review, patient interview, physical assessment, and measurement of blood oxygen saturation (via pulse oximetry) and inspiratory capacity. Intensive care patients were excluded from the study. The assessment instrument provided a standardized format based on American Association for Respiratory Care clinical practice guidelines. RESULTS: We assessed 75 patients. A mean of 24.8% of the delivered respiratory therapies reviewed were not indicated. The percentages of ordered but not indicated therapies were: oxygen 17.7%; all categories of aerosolized medications (bronchodilators, mucolytics, anti-inflammatory agents) 32.4%; chest physiotherapy 37.5%; lung expansion therapy 7.7%. A mean of 11.8% of the patients assessed were not receiving respiratory care that was indicated. The percentages of indicated but not ordered therapies were: oxygen 5.3%; bronchodilator 5.3%; lung expansion therapy 36%. CONCLUSION: A mean of 24.8% of the basic respiratory care procedures delivered were not indicated and 11.8% of patients were not receiving care that was indicated. Inappropriate utilization of respiratory care services may increase costs and adversely affect morbidity, mortality, and duration of stay. We believe that implementation of respiratory care assessment protocols based on nationally accepted clinical practice guidelines can reduce unnecessary care, optimize care delivered, and may reduce costs and improve outcomes.

Administration, Inhalation↗
PubMed2004

How to make an effective poster.

Poster presentations given at scientific meetings are widely used in medicine, nursing, and allied health professions to communicate research findings. A good poster presentation can be an effective way to share the results of your research with your peers, in a collegial and non-threatening atmosphere. Feedback received during a poster session can be invaluable in refining your research and preparing for publication in a peer reviewed journal. A typical poster presentation follows the same format as a scientific paper. Poster sections include a title banner, the abstract, introduction, method, results, discussion, conclusions, and tables and figures. Technical details of poster production include decisions on what materials and methods to use to print and display your poster, font size, whether to use a professional graphics department for production, and cost. Presentation of your research at a professional meeting can be a rewarding experience, and is a useful step toward publishing your research in a respected science journal.

Biomedical Research↗
PubMedDate not supplied

The effect of a pediatric asthma management program provided by respiratory therapists on patient outcomes and cost.

OBJECTIVE: The objective was to determine whether a pediatric asthma disease management program (ADMP) provided by respiratory therapists can improve patient outcomes and reduce cost. DESIGN: This was a pre-and post-intervention observational study. METHODS: Hospitalizations, non-intensive care unit (ICU) hospital days, ICU days, emergency department visits, doctor's office visits, school days missed, and associated costs were collected on 18 children with moderate to severe asthma, ages 3 to 18 years, 12 months before and after implementation of the ADMP. The ADMP consisted of eight home visits for assessment, environmental review, and patient education. RESULTS: There were significant reductions (P < .05) in hospitalizations, hospitalization cost, ICU days, non-ICU days, length of stay, emergency department visits and cost, physician office visits and cost, and school days missed. CONCLUSIONS: A pediatric in-home ADMP provided by respiratory therapists can improve outcomes and reduce cost in patients with moderate to severe asthma.

Adolescent↗