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Cardiorespiratory Physiotherapy around the Clock: Experience at a University Hospital.

ABSTRACT: Purpose: To document and describe the use of a hospital-wide, 24-hour cardiorespiratory physiotherapy service run by an intensive care unit (ICU) team of physiotherapists. Methods: We prospectively collected data on all non-ICU hospital patients who used the 24-hours-per-day cardiorespiratory physiotherapy service over a 1-year period between July 2013 and June 2014. The ICU physiotherapists documented the reason, origin of referral, time of call, and type and frequency of treatment of each patient. Results: Over the 1-year period, the ICU physiotherapists administered 2,192 out-of-hours cardiorespiratory physiotherapy treatments (n=685 patients) outside the ICU. Most referrals originated from the emergency department (25%), the cardiopulmonary transplant unit (20%), and the pulmonology department (16%). Referrals were from a physiotherapist in 49% of cases, from a nurse in 32%, and from a physician in 19%. Of these, 89% were made between 4:00 p.m. and 8:00 a.m., and sputum retention was the most frequent reason (86%). Conclusion: Although proving its cost effectiveness is difficult, organizing a 24-hours-per-day, 7-days-per-week cardiorespiratory physiotherapy service in a large hospital is feasible.

SUBMITTER: Devroey M

PROVIDER: S-EPMC5125462 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Cardiorespiratory Physiotherapy around the Clock: Experience at a University Hospital.

Devroey Marianne M Buyse Catherine C Norrenberg Michelle M Ros Anne-Marie AM Vincent Jean-Louis JL

Physiotherapy Canada. Physiotherapie Canada 20160101 3

Purpose: To document and describe the use of a hospital-wide, 24-hour cardiorespiratory physiotherapy service run by an intensive care unit (ICU) team of physiotherapists. Methods: We prospectively collected data on all non-ICU hospital patients who used the 24-hours-per-day cardiorespiratory physiotherapy service over a 1-year period between July 2013 and June 2014. The ICU physiotherapists documented the reason, origin of referral, time of call, and type and frequen ...[more]

PMID: 27909374

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Project description:Management of noncommunicable diseases requires the adoption of multidisciplinary interventions that targets the modification of risk factors. Cardiovascular and respiratory diseases are amongst the four main killers of noncommunicable diseases. Physiotherapists specializing in cardiorespiratory physiotherapy are in a critical position in the management of health behaviors associated with noncommunicable diseases. However, the current context of health service in Jordan does not provide sufficient support and recognition for the delivery of specialized physiotherapy services. Objectives. The primary aim of this study was to describe cardiorespiratory physiotherapy service in Jordan. The secondary aims of this study were to: (i) Identify benchmarks from international contexts and guidelines for the delivery of cardiorespiratory physiotherapy service. (ii) Identify gaps and areas for development in the current delivery of cardiorespiratory physiotherapy service. Methods. This two phase study included a survey and a conceptual review with benchmarking. Following ethics approval, a cross sectional survey of physiotherapists practicing in Jordan was conducted. In phase 1, a survey was developed to describe the relevant dimensions of cardiorespiratory physiotherapy service. In phase 2 a conceptual review of the literature was performed to identify domains of service delivery and criteria required for optimal delivery of cardiorespiratory physiotherapy service. In the discussion we integrated the results of the survey within the benchmarks that emerged from the conceptual review of literature in order to identify gaps and areas for development in the current delivery of cardiorespiratory physiotherapy service. Results. Phase 1: Data emerging from the survey suggests that Physiotherapists in Jordan lack training and autonomy, preventing them from acquiring advanced roles particularly cardiorespiratory physiotherapy that requires specialised knowledge and skills. The current delivery of the service is limited to acute interventions, and is based on limited, unstructured referral from physicians depriving the patients from the service. The context of health service in Jordan does not provide sufficient recognition for physiotherapy; neither does it support the delivery of multidisciplinary interventions by appropriate regulations and policies. Phase 2: The following three domains emerged from the literature and were used for describing cardiorespiratory physiotherapy in Jordan: people, scope of practice, and context of practice. Conclusion. Advancing practice requires developing competencies relevant to cardiorespiratory physiotherapy particularly diagnosis, health promotion, and prevention. It is recommended that health authorities should develop regulations and policies that promote the recognition and integration of physiotherapists in the healthcare system, as well as facilitating the implementation of patient centred, multidisciplinary interventions.

Project description:Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that is increasingly being used to treat early rectal cancer (T1/T2). We studied the outcomes of TEM for rectal cancer at our institution looking at the indication, recurrence rate, need for further radical surgery, 30-day and 12-month mortality and complication rate. We performed a retrospective analysis of prospectively collected data of cases between 2008 and 2012: 110 TEM procedures were performed during this period: 40 were confirmed rectal cancers and 70 were benign. We analysed the data for the 40 patients with confirmed rectal cancer. Thirty (75 %) of the subjects were male with a mean age of 71 ± 10 years (range 49-90 years) and 19 (48 %) patients were ASA 3 and 4. Nineteen (48 %) of cancers were pT1, eighteen (45 %) were pT2, two (5 %) were pT3 and one was yPT0. Mean specimen size was 66 ± 20 mm (range 33-120 mm) with a mean polyp size of 41 ± 24 mm (range 18-110 mm). The mean cancer size was 24 ± 13 mm (range 2-50 mm). Average distance from the anal verge was 70 ± 37 mm (range 10-150 mm), and the mean operating time was 72 ± 22 min (range 40-120 min), with an average blood loss of 28 ± 15 ml (range 10-50ml). Median hospital stay was 2 ± 1 days (range 1-7 days). Complete excision (R0) was achieved in 37 (93 %) patients. Minor post-operative complications included urinary retention in two and pyrexia in three patients. There were no 30-day or 12-month mortalities. Mean follow-up was 13 ± 11 months, range (3-40 months) Local recurrence occurred in two (5 %) patients, both underwent redo TEM. Twelve (30 %) patients underwent laparoscopic radical resections (seven AR and five APER) post-TEM. Post-operative histology confirmed pT0N0 in 7/12 patients. Three were lymph node-positive (T0N1), one was pT3N1 and the fifth was pT3N2. TEM is associated with quicker recovery, shorter hospital stay and fewer complications than radical surgery. It is a good alternative to radical surgery in early rectal cancer, especially for high-risk patients. Recurrent tumours can be treated with redo TEM.

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Cardiorespiratory Physiotherapy around the Clock: Experience at a University Hospital.

Publications

Cardiorespiratory Physiotherapy around the Clock: Experience at a University Hospital.

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