Respir Care Clin N Am
· 2006 Mar · PMID 16530644
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In addition to overnight polysomnography, there are two special tests with which every sleep technologist should be familiar: the multiple sleep latency test and the maintenance of wakefulness test. These two tests class...In addition to overnight polysomnography, there are two special tests with which every sleep technologist should be familiar: the multiple sleep latency test and the maintenance of wakefulness test. These two tests classify excessive daytime sleepiness using objective data. The role of the sleep technologist is to understand and perform an accurate test so that sleep clinicians can use that data in diagnosing and treating their patients. This article provides step-by-step directions for performing these tests.
Respir Care Clin N Am
· 2006 Mar · PMID 16530643
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Accurate interpretation of a polysomnogram is based on a sleep parameters report generated from the scored sleep stages and clinical events. Understanding the calculations necessary to verify the accuracy of the digitall...Accurate interpretation of a polysomnogram is based on a sleep parameters report generated from the scored sleep stages and clinical events. Understanding the calculations necessary to verify the accuracy of the digitally produced PSG evaluation report ensures that the interpreting physician has the necessary information to formulate an impression and make recommendations. This chapter provides definitions of the sleep report parameters and the calculations to verify accuracy.
Respir Care Clin N Am
· 2006 Mar · PMID 16530642
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The acquisition process for infant and toddler polysomnography requires pediatric-specific equipment and specially trained personnel. Pediatric laboratories must keep in mind the importance of including the parent throug...The acquisition process for infant and toddler polysomnography requires pediatric-specific equipment and specially trained personnel. Pediatric laboratories must keep in mind the importance of including the parent through-out the process. The demand for infant and pediatric polysomnography continues to grow as new research increasingly demonstrates the value of studying physiologic variables collected during the study.
Respir Care Clin N Am
· 2005 Dec · PMID 16303598
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Polysomnographic events comprise a wide variety of phenomena,including episodes of apnea, episodes of hypopnea, leg movements, transient central nervous system arousals, and eye movements. The process of event scoring in...Polysomnographic events comprise a wide variety of phenomena,including episodes of apnea, episodes of hypopnea, leg movements, transient central nervous system arousals, and eye movements. The process of event scoring involves pattern recognition and provides a description of potentially pathophysiologic activity occurring during sleep. The rules for scoring sleep-related events continue to be developed. The rules are precise and must be followed with extreme care. When the polysomnogram is interpreted,the report must include a summary of event scoring and clinical correlation to the sleep complaint. Arousals, periodic limb movements, and respiratory events are significant because they represent pathophysiologies on which final diagnosis largely depends.
Respir Care Clin N Am
· 2005 Dec · PMID 16303597
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Sleep stage scoring is a system-based classification procedure requiring knowledge and understanding of brainwave electrical potentials and their patterns in different cortical areas. Monitoring precise scalp locations r...Sleep stage scoring is a system-based classification procedure requiring knowledge and understanding of brainwave electrical potentials and their patterns in different cortical areas. Monitoring precise scalp locations requires standardized electrode placements. The electroencephalogram is recorded concurrently with eye movement potentials (electro-oculogram) and submentalis muscle activity (electromyogram). The resulting recording is a polysomnogram. This article addresses sleep stage scoring in adults.
Respir Care Clin N Am
· 2005 Dec · PMID 16303596
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Adequate titration of PAP and oxygen therapy depends on intuitive, observant, and highly skilled acquisition technicians. Sleep laboratories must have a variety of equipment to ensure that technicians have adequate resou...Adequate titration of PAP and oxygen therapy depends on intuitive, observant, and highly skilled acquisition technicians. Sleep laboratories must have a variety of equipment to ensure that technicians have adequate resources during manual titrations. Titration policies and procedures must be determined and written by sleep laboratory staff to ensure compliance with third-party payers, provide guidance to technical staff, and enable ongoing quality improvement processes. Methods of PAP and NIPPV are discussed.
Respir Care Clin N Am
· 2005 Dec · PMID 16303595
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Monitoring of respiration during sleep allows the assessment of physiologic variables that are required to characterize SRBD events. The patency of the upper airway, the pattern of breathing, oxygenation, and ventilation...Monitoring of respiration during sleep allows the assessment of physiologic variables that are required to characterize SRBD events. The patency of the upper airway, the pattern of breathing, oxygenation, and ventilation usually can be inferred from simultaneous measurements of airflow, respiratory effort, thoracic volume, and blood gases. As new techniques of respiratory monitoring emerge, the respiratory therapist and sleep technologist must be familiar with the advantages and shortcomings of each modality.
Respir Care Clin N Am
· 2005 Dec · PMID 16303594
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This article presents an overview of common cardiac arrhythmias. Interventions for severe and potentially severe arrhythmias are discussed. Tips for recording and viewing the electrocardiogram as employed in polysomnogra...This article presents an overview of common cardiac arrhythmias. Interventions for severe and potentially severe arrhythmias are discussed. Tips for recording and viewing the electrocardiogram as employed in polysomnography are presented. The focus is on arrhythmias, and as such the information revolves around rhythm, rate, and blocks. The reader is referred to other sources for discussion of topics such as axis, ischemia, and infarct.
Respir Care Clin N Am
· 2005 Dec · PMID 16303593
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A sleep technician who runs a sleep study without understanding the basis of the signals being acquired can spend a lot of time and energy trying to improve poor signal quality without success. Poor signal quality often...A sleep technician who runs a sleep study without understanding the basis of the signals being acquired can spend a lot of time and energy trying to improve poor signal quality without success. Poor signal quality often results in an image that cannot be interpreted or is difficult to interpret, and extensive troubleshooting often results in a very disrupted sleep study. This article addresses trouble-shooting and elimination of artifact in polysomnography.
Respir Care Clin N Am
· 2005 Dec · PMID 16303592
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The field of sleep diagnostics and polysomnography has increased significantly in the past 2 decades, and the need for expertly trained and qualified technologists has never been greater. This article instructs the thera...The field of sleep diagnostics and polysomnography has increased significantly in the past 2 decades, and the need for expertly trained and qualified technologists has never been greater. This article instructs the therapist in the importance of proper patient hookup, reviews the 10-20 international system of electrode placement, considers accurate placement of electrodes and sensors, and discusses the use of various instrumentation.
Respir Care Clin N Am
· 2005 Dec · PMID 16303591
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Daytime sleepiness and inadequate sleep patterns have become a universal issue. The effects of sleep loss are more than just a nuisance; sleep loss can lead to increased mortality. Prudent and responsible clinicians shou...Daytime sleepiness and inadequate sleep patterns have become a universal issue. The effects of sleep loss are more than just a nuisance; sleep loss can lead to increased mortality. Prudent and responsible clinicians should make the sleep assessment a routine part of the health history.
Respir Care Clin N Am
· 2005 Dec · PMID 16303590
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Polysomnographic technology has advanced by exponential degrees since the first sleep studies were conducted by Dement. The basic electrical concepts have remained the same since that time and are an essential element in...Polysomnographic technology has advanced by exponential degrees since the first sleep studies were conducted by Dement. The basic electrical concepts have remained the same since that time and are an essential element in the understanding of polysomnographic equipment. The application of these basic electrical concepts has allowed, however, for an improvement in the acquisition,manipulation, and storage of physiologic data during sleep. This article defines polysomnography in terms of its history and its current status. The basic electrical concepts are presented with their application to polysomnography. A discussion of other basic principles is included with practical application.
Respir Care Clin N Am
· 2005 Dec · PMID 16303589
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Wakefulness, NREM sleep, and REM sleep are three distinct states of existence. Each state has characteristic behavioral and physiologic patterns,and each has specific neurophysiologic mechanisms associated with its gener...Wakefulness, NREM sleep, and REM sleep are three distinct states of existence. Each state has characteristic behavioral and physiologic patterns,and each has specific neurophysiologic mechanisms associated with its generation and control. Structures in the brainstem use various neurotransmitters to influence higher brain structures in the midbrain and cortex. The ARAS provides cholinergic, noradrenergic, and glutaminergic stimulation to the thalamus, hypothalamus, and basal forebrain resulting in cholinergic and glutaminergic excitation of the cortex. An active cortex that exhibits a characteristic pattern of desynchronized EEG manifests wakefulness. Various factors affect the need and timing of sleep onset. These factors influence the nucleus tractus solitarius, causing its noradrenergic projections to midbrain and forebrain structures to inhibit activity in the ARAS, resulting inactivation of inhibitory GABAergic thalamocortical projections to the cor-tex. During a state of decreased activation, the cortex exhibits a pattern of synchronized EEG. Transition between NREM sleep and REM sleep is controlled by noradrenergic neurons in the loci coeruleus and serotoninergic neurons in the raphe called REM-off cells and cholinergic neurons in the nucleus reticularis pontis oralis called REM-on cells. Other brain structures are involved in generation and control of REM sleep-related phenomena, such as eye movement and muscle atonia. During wakefulness, there is increased sympathetic tone and decreased parasympathetic tone that maintains most organ systems in a state of action or readiness. During NREM sleep, there is decreased sympathetic tone and increased parasympathetic activity that creates a state of reduced activity. REM sleep is characterized by increased parasympathetic activity and variable sympathetic activity associated with increased activation of certain brain functions. The states of wakefulness and sleep are characterized as stages that are defined by stereotypical EEG, EMG, and EOG patterns. Wakefulness stage has an EEG pattern predominated by the alpha rhythm. With onset of stage 1 sleep, the alpha rhythm attenuates, and an EEG pattern of relatively low voltage and mixed frequency is seen. Progression to stage 2 sleep is defined by the appearance of sleep spindles or K-complexes. Further progression into the deepest sleep stages 3 and 4 is defined by the occurrence of high-amplitude, low-frequency EEG activity. The progression of sleep stages occurs in cycles of 60 to 120 minutes throughout the sleep period. Various circadian environmental and ontologic factors affect the pattern of sleep stage occurrence.
Respir Care Clin N Am
· 2005 Sep · PMID 16168920
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With diverse training and experience, respiratory therapists enjoy a wide variety of employment opportunities. The profession is moving beyond the traditional acute-care facility, such as a hospital, into extended care,...With diverse training and experience, respiratory therapists enjoy a wide variety of employment opportunities. The profession is moving beyond the traditional acute-care facility, such as a hospital, into extended care, sleep medicine, disease management, patient transport, and even fields beyond health care delivery, such as education and research. Respiratory therapists will survive in these changing times if they possess the ability to recognize change as an opportunity for growth. As the baby boomer generation ages, and the incidence of chronic illness increases, respiratory therapists will be in even greater demand.
Respir Care Clin N Am
· 2005 Sep · PMID 16168919
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In recent years, there has been a paradigm shift in the roles and responsibilities of respiratory therapists. Therapists increasingly are expected to design and implement respiratory care plans within the scope of protoc...In recent years, there has been a paradigm shift in the roles and responsibilities of respiratory therapists. Therapists increasingly are expected to design and implement respiratory care plans within the scope of protocols. Respiratory therapists also are expected to perform greater numbers of advanced procedures such as endotracheal intubation and arterial catheter insertion. The greatest impact on respiratory care practice is likely to be the increasing use of the principles of evidence-based medicine. Each of these factors will affect how respiratory therapists should be trained and educated in the twenty-first century.
Respir Care Clin N Am
· 2005 Sep · PMID 16168918
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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 s...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.
Respir Care Clin N Am
· 2005 Sep · PMID 16168917
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The need for continuing education for respiratory therapists as well as other for health care practitioners is well established. The changing nature and increased volume of medical information, along with the rapid growt...The need for continuing education for respiratory therapists as well as other for health care practitioners is well established. The changing nature and increased volume of medical information, along with the rapid growth of technology related to respiratory care, demand that professionals engage in continuing education. Educational activities may be formal lectures or seminars, or self-directed studies, teleconferences, or video presentations. Recent studies indicate that interactive workshops, alone or in combination with other educational methods, are more likely to be effective that didactic lectures alone. Evaluation methods for continuing education programs have focused on attendees' ratings but should be revised to emphasize the impact of the educational program on beneficial changes in practice.
Respir Care Clin N Am
· 2005 Sep · PMID 16168916
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Problem-based learning has been used in respiratory therapy education for a relatively short time. The purpose of PBL is to produce a graduate who has improved critical thinking and life-long learning skills. On a practi...Problem-based learning has been used in respiratory therapy education for a relatively short time. The purpose of PBL is to produce a graduate who has improved critical thinking and life-long learning skills. On a practical note, another goal is to help the graduate pass the NBRC Clinical Simulation examination. PBL is the use of cases to provide a stimulus for the specification of learning issues, or objectives, which the students research and discuss. The heart of the PBL process is the tutorial group, composed ofa group of five to seven students and a faculty facilitator. Students work through the case, listing facts, testing hypotheses, learning pharmacology,and studying the learning issues of the case. Information is learned in thecontext of the patient case, rather than in isolated classes. Cases are presented in the progressive-disclosure model. Student evaluation consists of written examinations, self- and peer evaluation, and with an independent case study process. Program evaluation has shown that students enjoy the process and think that they are performing clinically better than their non-PBL peers. Pass rates for the Clinical Simulation examination are above the national average. A more in-depth study of program outcomes is indicated.
Respir Care Clin N Am
· 2005 Sep · PMID 16168915
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The capacity to perform critical thinking in respiratory care may be enhanced through awareness and education to improve skills, abilities, and opportunities. The essential skills for critical thinking in respiratory car...The capacity to perform critical thinking in respiratory care may be enhanced through awareness and education to improve skills, abilities, and opportunities. The essential skills for critical thinking in respiratory care include prioritizing, anticipating, troubleshooting, communicating, negotiating, decision making, and reflecting. In addition to these skills, critical thinkers exhibit certain characteristics such as critical evaluation, judgment,insight, motivation, and lifelong learning. The teaching of critical thinking may be accomplished though problem-based learning using an evidenced-based approach to solve clinical problems similar to those encountered in professional practice. Other traditional strategies such as discussion, debate, case study, and case presentations can be used. Web-based curriculum and technologic advances have created opportunities such as bulletin boards, real-time chats, and interactive media tools that can incorporate critical thinking. Many concerns and controversies surround the assessment of critical thinking, and individuals who administer critical thinking tests must be aware of the strengths and limitations of these assessment tools, as well as their relevance to the workplace. The foundational works reported in this article summarize the current status of assessment of critical thinking and can stimulate further investigation and application of the skills, characteristics, educational strategies, and measurement of critical thinking in respiratory care.
Respir Care Clin N Am
· 2005 Sep · PMID 16168914
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This study would not have been possible without the valuable insight of program directors across the country who were willing to share their experience. Although not conclusive, the results of the survey of program direc...This study would not have been possible without the valuable insight of program directors across the country who were willing to share their experience. Although not conclusive, the results of the survey of program directors indicate that online education is being used in a small number of respiratory care education programs. The benefits and difficulties related by these program directors are similar to those found in the larger body of literature in higher education. The authors agree with most survey respondents that online education is a critical long-term strategy for programs of respiratory care education. Further investigation and better understanding of the various issues affecting online learning for respiratory care students are needed, however.