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1
Wijesinghe, Meme. "Oxygen therapy in respiratory disorders." Thesis, Queen Mary, University of London, 2012. http://qmro.qmul.ac.uk/xmlui/handle/123456789/2511.
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Oxygen therapy remains a cornerstone of medical practice and is generally regarded as being safe. However, there is a lack of clinical evidence to support the routine use of oxygen therapy, and in certain conditions, injudicious oxygen may cause harm. In this thesis, I will present two audits and three randomised controlled trials of oxygen therapy. Methods A prospective audit of the prescription and use of oxygen therapy before and after the introduction of an oxygen prescription section on a drug chart A retrospective audit of ambulance oxygen administration, in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) Two randomised controlled trials of high flow versus titrated oxygen in 150 patients with community acquired pneumonia and 106 patients with acute severe asthma A randomised controlled trial of 24 subjects with obesity hypoventilation syndrome (OHS) comparing 100% oxygen with air Results Oxygen prescription is suboptimal in hospital inpatients. Whilst an oxygen prescription section improved prescription, this intervention did not improve clinical practice Over 70% of patients presenting with AECOPD received high flow oxygen prior to presentation to the emergency department. The risk of adverse outcomes increased progressively with increased PaO2 High concentration oxygen leads to a rise in PaCO2 compared to titrated oxygen, when administered to patients presenting with asthma or pneumonia Breathing 100% oxygen leads to a rise in PaCO2 in patients with OHS Conclusion This series of studies has shown that further measures are warranted to ensure the safe practice of oxygen therapy in the pre-hospital and hospital setting. In addition, the findings suggest that the potential for high concentration oxygen therapy to increase PaCO2 is not limited to COPD but may occur in other respiratory conditions in which abnormal gas exchange or respiratory drive are present.
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Bradley, Kimberley Anne. "Respiratory therapy for speech in multiple sclerosis." Thesis, University College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264909.
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Else, Liana. "Lived experiences of professional nurses caring for mechanically ventilated patients." Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/8295.
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Critical care nursing is a speciality that continues to evolve and transform. Critical care nurses of the 21st century routinely care for the complex, critically ill patient, integrating sophisticated technology with the accompanying psychosocial challenges and the ethical conflicts associated with critical illness – while, at the same time, addressing the needs and concerns of the family. Providing nursing care in such a dynamic and fast-track unit can pose various challenges for the critical care nurse. Professional nurses are the backbone of any health-care system. The quality of nursing directly affects the patients’ outcomes, and nursing care must therefore be rendered meticulously. Mechanical ventilator support is routinely needed for critically ill adults in these care units and is also a common therapy in sub-acute and long-term care settings. The care of the mechanically ventilated patient is the core of a professional nurse`s practice in the critical care unit. The mechanically ventilated patient presents many challenges for the professional nurse, while the critical care unit poses as a stressful environment for the professional nurse as well as the patient. The objectives of this study therefore were to explore and describe the lived experiences of professional nurses while caring for mechanically ventilated patients, and to develop recommendations to support professional nurses while caring for mechanically ventilated patients. A qualitative, explorative, descriptive and contextual research design was utilised. Data was collected by means of semi-structured interviews and analysed according to the framework provided by Tesch. Purposive sampling was used to select a sample of professional nurses working in a critical care environment. Guba’s model was utilised to verify data and to ensure trustworthiness of the study. Ethical principles were adhered to throughout this research study. With the analysed data, recommendations were to support professional nurses while caring for mechanically ventilated.
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Perrin, Kyle Gareth. "High concentration oxygen therapy in acute respiratory disease." Thesis, University of Canterbury. Health Sciences Centre, 2010. http://hdl.handle.net/10092/5079.
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Uncontrolled oxygen is often administered to breathless patients regardless of whether hypoxaemia is present. In acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) this may result in carbon dioxide (CO2) retention and worsening respiratory failure in some patients. In AECOPD the main mechanism is the release of hypoxic pulmonary vasoconstriction and an increase in the physiological dead space to tidal volume ratio (VD/VT). Acute asthma and pneumonia have features in common with AECOPD, namely significant ventilation – perfusion mismatch; and there is the potential for CO2 retention to occur if uncontrolled high concentration oxygen is given. There have been no randomised controlled trials of oxygen therapy in pneumonia and only one in asthma. The potential mechanisms of any change in arterial CO2 that may occur with oxygen therapy in respiratory disorders other than COPD remain uncertain.
This thesis presents work from three clinical studies. In two randomised controlled trials, high concentration oxygen was compared to titrated oxygen therapy in patients with either acute severe asthma and suspected community acquired pneumonia. Oxygen was administered for one hour in conjunction with standard medical treatment. Transcutaneous CO2 (PtCO2) was continuously monitored and the number of patients with pre-specified increases in PtCO2 were calculated. The proportion of patients with a rise in PtCO2 4 mmHg was significantly higher in the high concentration oxygen groups of both studies. In the pneumonia study 36/72 (50.0%) vs 11/75 (14.7%) met this endpoint, with a relative risk of 3.4 (95% CI 1.9 to 6.2; P <0.001), and in the asthma study 22/50 (44%) vs 10/53 (18.9%) met this endpoint, with a relative risk of 2.3 (95% CI 1.2 to 4.3; P=0.009). Similarly, a rise in PtCO2 8 mmHg was more common with high concentration oxygen. In the pneumonia study 11/72 (15.3%) vs 2/75 (2.7%) of patients met this endpoint, with a relative risk of 5.7 (95% CI 1.3 to 25.0; P=0.007), and 10/50 (20%) vs 3/53 (5.7%) of asthma patients met this endpoint, with a relative risk of 3.6 (95% CI 1.1 to 12.3; P=0.03). A third study measured the physiological response to 20 minutes of 100% oxygen in chronic severe asthma, with comparison to a group of negative controls (normal subjects) and positive controls (COPD patients). There was a significant rise in PtCO2 of similar magnitude in the asthma and COPD groups compared with the normal controls. The mechanism of the PtCO2 rise was similar in asthma and COPD, with an increase in VD/VT but no change in minute ventilation.
These studies demonstrate than uncontrolled high concentration oxygen has the potential to cause CO2 retention in respiratory diseases other than COPD, and that in asthma the mechanism of hypercapnia is similar to that in AECOPD. In acute asthma and community-acquired pneumonia oxygen should be administered only to those patients with evidence of arterial hypoxaemia in a dose that relieves hypoxaemia without causing hyperoxia, thereby achieving the benefits of oxygen therapy while reducing the potential for harm.
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Alfadhel, Munerah. "Phage-based therapy for nasal and respiratory infections." Thesis, University of Strathclyde, 2013. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=23059.
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The adoption of therapy based on bacteriophage for the reduction of harboured pathogens is limited by a lack of understanding regarding their formulation as medicines. The product must able to efficiently deliver phage without deterioration and since oral delivery results in the destruction of the lytic activity, a nasal delivery system was investigated. This thesis first describes the formulation of lyophilised nasal inserts carrying a bacteriophage selective for S. aureus, for the eradication of MRSA resident in the nose. Lyophilization of bacteriophages in 1 mL of 1-2% (w/v) hydroxypropyl methylcellulose (HPMC) with or without the addition of 1% (w/v) mannitol yielded nasal inserts composed of a highly porous leaflet-like matrix. The bacteriophage titre fell following lyophilization to 108 pfu per insert, then reduced 100- to 1000-fold over 6 to 12 months storage at 4 oC. The second part of this thesis presented a new phage bioprocess method which involved co-precipitation of a n aqueous mixture of phage and a crystallisable carrier (glutamine or glycine) is described. Inclusion of albumin or trehalose at 5% w/w during co-precipitation provided additional stabilization of the phage. In the third part of this thesis, a lipid vehicle (LamellasomesTM) as a carrier in pulmonary delivery for antibiotics and/or bacteriophage was characterised. We further investigated the potential for co-formulation of antibiotics or bacteriophage by dispersion into LMS and nebulization of aerosolized droplets. Patients with cystic fibrosis (CF) may harbour antibiotic-resistant, mucoid strains of Pseudomonas aeruginosa in the lung. Bacteriophages were carried with the bulk fraction, rather than being selectively carried in larger or smaller aerosols. Dilution of colistin or tobramycin into LMS increased the nebulized drug fraction deposited into stages 2-5. This suggests that the surface activity of the LMS facilitates the generation of smaller aerosol droplets during nebulization. In conclusion, the work reported in this thesis suggests that bacteriophages can be formulated in a stable preparation and therefore have a potential as an alternative therapeutic agent for treatment of resistant bacterial infection on mucous surfaces.
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Slater, Mariel. "Predicting response to Azithromycin therapy in asthma." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/14428/.
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Macrolide antibiotics, including Azithromycin (AZM), can improve clinical symptoms in asthma regardless of infection status. Mechanisms underlying these beneficial effects are yet to be fully elucidated. Asthma is associated with a defective airway epithelium with reduced expression of structural proteins and aberrant repair responses. In vitro, AZM has shown anti-inflammatory and anti-viral actions, as well as enhancement of airway cell barrier integrity. Therefore, it was hypothesised that the beneficial effects of AZM in asthma may involve barrier reinforcement. The main aims were to determine the effects of AZM on airway epithelial function in vitro, in vivo and ex vivo. Primary normal human bronchial epithelial cells (HBEC) were differentiated in vitro through an air liquid interface. Severe asthma patients were administered 250mg daily AZM for 6 weeks, with clinical outcome measures and bronchoscopy pre- and post-AZM. Addition of AZM to HBEC in vitro enhanced the development of a differentiating epithelial barrier over 14 days, which was accompanied by reduced permeability, increased thickness, reduced mucin expression and suppressed endogenous release of MMP-9. Importantly, MMP-9 levels inversely correlated with barrier integrity, providing a putative mechanism. Clinical measures from 10 asthma patients were heterogeneous both pre- and post-AZM. Overall, symptoms, lung function and inflammation did not significantly alter and there was no association between clinical measures and the epithelial barrier of bronchial biopsies. The current findings suggest that AZM aids in HBEC barrier formation in vitro. This novel finding may relate to the beneficial effects of AZM reported in vivo e.g. through reducing susceptibility to damage and inflammation during re-epithelisation. This could not be confirmed in vivo due to the low number of samples obtained. The current findings add further evidence towards the beneficial non-antibacterial effects of AZM and may have implications for the prospective targeting of the epithelium for clinical benefit in asthma.
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Hixon, Sally J. "An investigation of the psychometric properties of a clinical simulation examination for respiratory care practitioners /." The Ohio State University, 1985. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487261919111437.
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McHenry, Kristen L. "New Faculty Mentoring in Respiratory Care." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5444.
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McHenry, Kristen L. "Respiratory Therapists as Physician Extenders: Perceptions of Practitioners and Educators." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/2542.
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Donne, Adam. "Investigations into recurrent respiratory papillomatosis and the evaluation of current therapy." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.678786.
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Giroux, Matthieu. "Patient-specific biomechanical model of the respiratory system for radiation therapy." Thesis, Lyon, 2018. http://www.theses.fr/2018LYSE1205.
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La Radio/Hadron-thérapie consiste à déposer une dose létale de rayonnement dans la tumeur tout en réduisant l'impact de cette dose sur les tissus sains. Les mouvements internes, en particulier ceux engendrés par la respiration modifient la forme, la position et la densité des organes, source d'erreur et d'incertitude sur la position du dépôt de dose. Lorsque la tumeur se trouve sur un organe en mouvement, la dificulté majeure est de cibler la tumeur pendant le traitement. Cette incertitude sur la position rend indispensable la mise en place d'une stratégie permettant la prédiction du mouvement tumoral. Ceci permet en eet de guider le faisceau de rayons ionisants de sorte qu'il suive les mouvements tumoraux. De plus, le traitement par hadronthérapie nécessite également l'accès à une description précise de la densité de l'ensemble des organes traversés par le faisceau, car la position du dépôt maximal de l'énergie véhiculée par les ions (le pic de Bragg) en dépend. Malheureusement, le mouvement respiratoire est complexe et sa prédiction n'est pas une tâche simple – en particulier, la respiration est commandée par l'action indépendante des muscles de la cage thoracique et du diaphragme. Les techniques actuelles basées sur l'imagerie, telles que le Cone-Beam ou le recalage dé- formable d'images, tentent de prédire la position des tumeurs pulmonaires. Ces méthodes font l'hypothèse d'un mouvement reproductible de l'appareil respiratoire dans le temps. D'autres techniques basées sur l'emploi de deux caméras à rayons X (cyberknife, tracking mis au point par l'équipe du Centre carbone d'Heildelberg [HIT]) peuvent permettre la pré- diction de la position des tumeurs, quand leur segmentation et leur contourage automatique en temps réel est possible. Cependant, ces méthodes sont, si ce n'est risquées, invasives, et elles ne permettent pas de calculer l'évolution des organes environnants, une information indispensable pour déterminer la position du pic de Bragg. Ainsi déduire le mouvement de la tumeur à partir de seules séries d'images médicales apparaît comme insuffisant. Une solution peut alors résider dans le développement d'un modèle biomécanique patient-spécifique du système respiratoire intégrant la variabilité du mouvement respiratoire. Pour que ce modèle soit précis, il doit comprendre la modélisation de la cage thoracique, du diaphragme et des poumons. Il est tout aussi important que ce modèle puisse être piloté par des paramètres mesurés en externe (capteurs 3D, spiromètre, etc.) an de préserver un caractère non-invasif et de corréler le mouvement externe du thorax et de l'abdomen, ainsi que le ux d'air échangé avec les mouvements internes. Les changements de propriétés mécaniques des milieux traversés par le faisceau doivent également être modélisés an de satisfaire les besoins de l'hadronthérapieThe 4D computational patient specic of the respiratory system could be potentially used in various medical contexts; for diagnosis, treatment planning, laparoscopic, dose computation or the registration between online imaging systems such as positron emission tomography (PET), computed-tomography (CT) as well as high delity and precise computer-based training simulators. The main novelty of this PhD project lies in the context of radiation therapy; we have developed a patient-specic biomechanical model of the respiratory system enabling the correlation of the internal organs motion with respiratory surrogate signal(s) during the treatment. This permits to take into account the respiratory motion variabilities. The deformation of the dierent structures is controlled and driven by simulated rib cage (mimic the external intercostal muscles) and diaphragm actions. For the diaphragm, we have applied the radial direction of muscle forces, and simple homogeneous dirichlet boundary condition is applied to the lower part of the diaphragm, which is attached to the rib cage. For each rib a rigid transformation is calculated automatically by nite helical axis method (rigid translation and rotation) and used to dene displacement boundary conditions. The resulting widening of the thoracic cavity forces the lungs to expand due to an applied negative pressure in the pleural cavity. Other novelty of the PhD project, that the amplitude of the lung pressure and diaphragm force are patient-specic, and determined at dierent respiratory states by an optimization framework based on inverse FE analysis methodology, by minimizing the volume lungs errors, between the respiratory volume (calculated from CT scan images at each state) and the simulated volume (calculated by biomechanical simulation). All other structures are linked to each other, but feature dierent deformation behavior due to the assigned material properties. Our results are quite realistic compared to the 4D CT scan images and the proposed physically-based FE model is able to predict correctly the respiratory motion
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Fayad, Hadi. "Respiratory motion modeling for use in diagnostic imaging and radiation therapy." Brest, 2011. http://www.theses.fr/2011BRES2058.
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Les déformations associées au mouvement respiratoire sont l’un des paramètres principaux réduisant la sensibilité et la spécificité au niveau thoracique et abdominal. En outre, le mouvement respiratoire diminue la précision dans la fusion d’images acquises en utilisant un système combiné tomographie à émission de positron / tomodensitométrie (TEP/TDM). Les solutions existantes à jour incluent l’acquisition des images TDM et TEP synchronisées avec la respiration. Cependant, les différences entre l'acquisition 4D TEP et 4D TDM, dues aux conditions de respiration différentes pour ces deux modalités, limitent ce processus. De plus, la dose élevée nécessaire à l’acquisition 4D TDM n’est pas justifiable pour tous les patients. Le premier objectif de cette thèse était alors de générer des images dynamiques TDM à partir d’une image TDM de référence et des matrices de déformation obtenues en utilisant un recalage élastique des données 4D TEP non corrigées pour l’atténuation. Une telle approche élimine, d’une part la nécessité d’une acquisition 4D TDM, et assure d’autre part la bonne correspondance entre les images 4D TDM et 4D TEP. En conséquence, le deuxième objectif de cette thèse était de développer et évaluer dans un premier temps des modèles de mouvement respiratoire spécifiques à chaque patient et dans un deuxième temps des modèles génériques du mouvement respiratoire. Ces modèles relient le mouvement interne aux mouvements externes caractérisés par des signaux respiratoires 1D ou des surfaces externes du patient. Finalement, les deux modèles développés ont été validés et appliqués dans le cadre de la correction du mouvement respiratoire et de l’atténuation en TEP et pour la radiothérapieOne of the most important parameters reducing the sensitivity and specificity in the thoracic and abdominal areas is respiratory motion and associated deformations which represent today an important challenge in medical imaging. In addition, respiratory motion reduces accuracy in image fusion from combined positron emission tomography computed tomography (PET/CT) systems. Solutions presented to date include respiratory synchronized PET and CT acquisitions. However, differences between acquired 4D PET and corresponding CT image series have been reported due to differences in respiration conditions during PET and CT acquisitions. In addition, the radiation dose burden resulting from a 4D CT acquisition may not be justifiable for every patient. The first objective of this thesis was to generate dynamic CT images from one reference CT image; based on deformation matrices obtained from the elastic registration of 4D non attenuation corrected PET images. Such an approach eliminates, on one hand the need for the acquisition of dynamic CT, while at the same time ensuring the good matching between CT and PET images. The second objective was to develop and evaluate methods of building patient specific respiratory motion models and at as a second step more developed generic respiratory motion models. These models relate the internal motion to the parameters of an external surrogate signal (PET respiratory signal or patient's surface) that can be acquired during data acquisition and treatment delivery. Finally, the two developed models were validated and used in the PET respiratory motion and attenuation correction and in radiation therapy applications
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Abdelhamid, S. "Respiratory motion modelling and predictive tracking for adaptive radiotherapy." Thesis, Coventry University, 2010. http://curve.coventry.ac.uk/open/items/f135cb12-e9f9-1e4f-9c57-6de2fc378069/1.
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External beam radiation therapy (EBRT) is the most common form of radiation therapy (RT) that uses controlled energy sources to eradicate a predefined tumour volume, known as the planning target volume (PTV), whilst at the same time attempting to minimise the dose delivered to the surrounding healthy tissues. Tumours in the thoracic and abdomen regions are susceptible to motion caused mainly by the patient respiration and movement that may occur during the treatment preparation and delivery. Usually, an adaptive approach termed adaptive radiation therapy (ART), which involves feedback from imaging devices to detect organ/surrogate motion, is considered. The feasibility of such techniques is subject to two main problems. First, the exact position of the tumour has to be estimated/detected in real-time and second, the delay that can arise from the tumour position acquisition and the motion tracking compensation. The research work described in this thesis is part of the European project entitled ‘Methods and advanced equipment for simulation and treatment in radiation oncology’ (MAESTRO), see Appendix A. The thesis presents both theoretical and experimental work to model and predict the respiratory surrogate motion. Based on a widely investigated clinical internal and external respiratory surrogate motion data, two new approaches to model respiratory surrogate motion were developed. The first considers the lung as a bilinear model that replicates the motion in response to a virtual input signal that can be seen as a signal generated by the nervous system. This model and a statistical model of the respiratory period and duty cycle were used to generate a set of realistic respiratory data of varying difficulties. The aim of the latter was to overcome the lack of test data for a researcher to evaluate their algorithms. The second approach was based on an online polynomial function that was found to adequately replicate the breathing cycles of regular and irregular data, using the same number of parameters as a benchmark sinusoidal model.
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Villiger, Carmel G. "Investigations into transient respiratory control using the work rate of breathing and a non-linear breather." Thesis, This resource online, 1991. http://scholar.lib.vt.edu/theses/available/etd-02132009-170901/.
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McHenry, Kristen L. "Respiratory Compromise in the ALS Patient." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/2536.
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Davreux, Christopher J. "Antioxidant therapy for the management and prevention of adult respiratory distress syndrome." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape16/PQDD_0003/MQ34060.pdf.
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Serpa-Lopez, Marco A. "Suitability of Tumour Tracking For The Verification of Respiratory Gated Radiation Therapy." Thesis, University of Canterbury. Physics and Astronomy, 2011. http://hdl.handle.net/10092/6597.
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External beam radiotherapy (RT) is the primary treatment modality for patients with inoperable lung tumours. Respiration-induced motion and related intra-/interfractional variations present a series of limitations to the success of existing conventional treatment modalities for lung cancer. Subsequently, to minimise the effects of respiration different management techniques have been proposed and are available. Respiratory gated radiotherapy (RGRT) holds promise to improve dose conformity, reduce the normal tissue control probability while increasing the tumour control probability. Its effectiveness depends on precise tumour localisation and targeting during dose delivery. In this thesis, the suitability of RGRT for the compensation of breathing induced motion was investigated by means of phantom studies and film dosimetry. Both regular and irregular trajectories were simulated during gated dose delivery and their effects on dose distributions analysed. Respiration-induced motion led to dose blurring and hence to less conformal dose distributions, which resulted overall in underdose of the treatment planning volume and an overdose of healthy surrounding tissue. Compared to non-gated dose delivery, RGRT improved dose conformity by enabling steeper dose gradients, resulting in an increased sparing of healthy tissue, at the expenses of increased delivery times. In the presence of irregular motion paths the dosimetric advantages of RGRT were observed to decrease. In the absence of a clinical tool for treatment verification such irregularities may pass unnoticeable and may lead to poor treatment outcomes.
Investigations of the suitability of a software tool for tracking lung tumours in portal images during RGRT demonstrated that it is possible to determine and track tumour motion during gated treatment. Both the residual tumour motion inside the gating window as well as the probability density function were used as measures to quantify tumour position and variability. Tracking information was sufficient to quantify residual motion and variability. Baseline drifts as well as sudden fluctuations in tumour positions were detected and quantified, which led to considerable variations in residual motion which in turn may result in marginal miss. Although this was a retrospective analysis of motion data, the tool showed a great potential for verification of the tumour position during RGRT and may possibly be useful for adaptation of the gating window.
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Baker, Cathy Sue. "Rationale for surfactant replacement therapy in patients with acute lung injury." Thesis, Imperial College London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243281.
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Oppermann, Rebecca. "Improving Critical Thinking Skills of Undergraduate Respiratory Therapy Students Through the Use of a Student-Developed, Online, Respiratory Disease Management Database." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1468942315.
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McHenry, Kristen L. "Professional and Ethical Standards in Respiratory Care." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/2538.
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Chakraborty, Chandrani. "Quantification of respiratory motion in PET/CT and its significance in radiation therapy." Oklahoma City : [s.n.], 2008.
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Johnson, Kimberly Lynn. "The Structure and Implementation of Respiratory Therapy Orientation for Clinical Staff in Acute Care Hospitals." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1316123707.
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Massie, Michael Todd. "Respiratory-Gated IMRT Quality Assurance with Motion in Two Dimensions." Wright State University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=wright1284726606.
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McHenry, Kristen L. "Safe Practice." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/2535.
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Kwilas, Anna R. "Respiratory Syncytial Virus Based Vectors for the Treatment of Cystic Fibrosis." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1284384649.
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Scott, David M. "The importance of multiskilled training and workplace basic competencies as perceived by Missouri hospital nursing executives and nursing instructors /." free to MU campus, to others for purchase, 1999. http://wwwlib.umi.com/cr/mo/fullcit?p9953891.
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Remera, Jeanne Manywa. "Perceptions among caregivers and physiotherapists on the importance of chest physiotherapy in asthmatic children attending hospitals in Kigali, Rwanda." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
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Childhood asthma is one of the commonest chronic respiratory conditions in developed communities. Chest physiotherapy has traditionally been one of the interventions used mainly after an attack and for a relatively short-period on an outpatient basis. The purpose of the study was to determine the perceptions of physiotherapists and caregivers about the importance of chest physiotheraphy in asthmatic children in Kigali. To achieve this aim the author attempted to identify the perceived benefits of chest physiotherapy for asthmatic children among caregiversto determine the perception of physiotherapists about the importance of chest physiotherapy for asthmatic children and
to identify the physiotherapists experiences with doctors referrals and the caregivers compliance in the management of asthmatic children.
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Liddil, Jessica Marie. "The Impact of a Service-Learning Experience on Respiratory Therapy Students and the Community." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1373579884.
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Camprubí, Rimblas Marta. "Nebulized anti-coagulants as a therapy for acute lung injury and acute respiratory distress syndrome." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/663961.
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La síndrome de distrés respiratori agut (ARDS) és una insuficiència respiratòria aguda amb una incidència global a Europa de 17,9 per cada 100.000 persones-any. Tot i els avenços en el tractament de suport dels pacients amb ARDS, la mortalitat continua sent alta (40%) i els pacients que sobreviuen presenten seqüeles persistents. Actualment no existeix un tractament efectiu.
La fisiopatologia de l’ARDS es caracteritza per l’activació de la coagulació i la inflamació a nivell pulmonar, juntament amb el trencament de la barrera alveolar-capil·lar. Això comporta la formació d’edema proteic, la infiltració dels neutròfils cap al compartiment alveolar i l'activació dels macròfags cap a un fenotip pro-inflamatori.
Estudis previs en models pre-clínics de lesió pulmonar aguda (ALI) i en pacients amb ARDS han demostrat els efectes beneficiosos del anti-coagulants, tot i que aquests efectes positius es veuen contrarestats pel risc d’hemorràgia sistèmica. Els anti-coagulants podrien ser efectius gràcies a la seva activitat anti-inflamatòria a més de les seves propietats anti-coagulants. Atesa l’estreta interacció entre aquestes vies i la seva influència en la permeabilitat, els anti-coagulants també podrien restaurar la barrera alveolar-capil·lar. La nebulització dels anti-coagulants directament al compartiment alveolar podria augmentar l'eficàcia local i disminuir el risc d'hemorràgia sistèmica.
La hipòtesi d'aquesta tesi és que l'heparina nebulitzada i/o antitrombina (ATIII) limitaran la resposta pro-inflamatòria i pro-coagulant pulmonar després de la LPA, promovent, també, la restauració de la barrera alveolar-capil·lar. La co-administració dels anti-coagulants directament als pulmons mitjançant nebulització produirà un efecte sinèrgic que potenciarà les propietats de l'heparina i l’ATIII, reduint la lesió pulmonar i evitant el risc d'hemorràgia sistèmica.
Com a part d’aquesta tesi es mostren els resultats de l'acció de l'heparina o l’ATIII específicament en poblacions pulmonars primàries de cèl·lules humanes lesionades i l'administració directa d'heparina i/o ATIII als pulmons per nebulització en un model de rata d’ALI.
La nebulització d'heparina i/o d’ATIII atenuen la inflamació i coagulació pulmonar sense produir hemorràgia sistèmica en el model d’ALI. El tractament amb heparina nebulitzada modula els macròfags alveolars mitjançant la reducció dels efectors de TGF-β i NF-κB i la via de coagulació i disminueix el reclutament de neutròfils a l'espai alveolar. L'administració local d'ATIII augmenta els efectes beneficiosos en la coagulació, mentre que la combinació d'ATIII i heparina tenen un major impacte en la reducció de la permeabilitat i la disminució de la infiltració de macròfags en el compartiment alveolar. En estudiar l'acció translacional en humans d'ambdós anti-coagulants en poblacions cel·lulars humanes lesionades aïllades de biòpsies pulmonars, l'heparina disminueix l'expressió de marcadors proinflamatoris en els macròfags alveolars i desactiva la via NF-κB en cèl·lules alveolars tipus II; disminuint l'expressió dels seus mediadors i efectors. D’altra banda, l'ATIII redueix els nivells de mediadors proinflamatoris i augmenta les unions estretes en les cèl·lules alveolars tipus II lesionades.
Els estudis actuals demostren que l'heparina nebulitzada i l'ATIII poden ser un tractament potencial per a la ARDS, ja que actuen en diferents vies i processos de la fisiopatologia d’aquesta síndrome. L'administració local d'anti-coagulants atenua la lesió pulmonar disminuint la inflamació, la coagulació i proveeix millores en la permeabilitat sense causar hemorràgia sistèmica.Acute respiratory distress syndrome (ARDS) is an acute respiratory failure with a global incidence in Europe of 17.9 per 100,000 person-year. Although significant advances have been performed in supportive care of patients with ARDS, mortality remains high (40%) and survivors present persistent sequelae. An effective pharmacological therapy for this syndrome is not available yet. ARDS pathophysiology involves pulmonary activated coagulation and inflammation together with the breakdown of the alveolar-capillary barrier. This leads to proteinaceous edema, neutrophils infiltration into the alveolar compartment and the activation of macrophages towards a pro-inflammatory phenotype. Beneficial effects of anti-coagulants have been proved in pre-clinical models of acute lung injury (ALI) and in ARDS patients, although systemic bleeding offset its positive effects. Anti-coagulants could be effective for their anti-inflammatory activity in addition to their anti-coagulant properties. Moreover, given the cross talk of these pathways and their influence on permeability, anti-coagulants could also restore the alveolar-capillary barrier. Nebulization of anti-coagulants directly into the alveolar compartment might increase local efficacy and decrease the risk of systemic bleeding. The hypothesis of this thesis is that nebulized heparin and/or antithrombin (ATIII) limit the pro-inflammatory and pro-coagulant response in the lungs after ALI, also promoting the restoration of the alveolar-capillary barrier. The co-administration of both anti-coagulants directly into the lungs via nebulization produces a synergistic effect enhancing the properties of heparin and ATIII, reducing lung injury and avoiding the risk of systemic bleeding. As part of this thesis we are showing the results of the action of heparin or ATIII in specific primary human injured cell lung populations and the direct administration of heparin and/or ATIII into the lungs by nebulization in a rat model of ALI. Nebulized heparin and/or ATIII attenuated pulmonary inflammation and coagulation and did not produce systemic bleeding in the model of ALI. Treatment with nebulized heparin modulated alveolar macrophages through reducing TGF-β and NF-κB effectors and the coagulation pathway and decreased the recruitment of neutrophils into the alveolar space. Local administration of ATIII alone increased beneficial effects in coagulation, while combined ATIII and heparin had a higher impact reducing permeability and decreasing the infiltration of macrophages into the alveolar compartment. The translational action into humans of both anti-coagulants was also studied. In injured human cell lung populations isolated from lung biopsies, heparin diminished the expression of pro-inflammatory markers in alveolar macrophages and deactivated the NF-κB pathway in alveolar type II cells; decreasing the expression of its mediators and effectors. Also, ATIII decreased levels of pro-inflammatory mediators and increased levels of tight junctions in injured alveolar type II cells. The current studies prove that nebulized heparin and ATIII might be a potential treatment for ARDS, as they act in different pathways and processes of the pathophysiology of this syndrome. Local administration of anti-coagulants attenuates lung injury decreasing inflammation, coagulation and proving ameliorations on permeability without causing systemic bleeding.
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Ray, Christin. "Effects of Respiratory Muscle Strength Training in Classically Trained Singers." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1405505205.
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Bergh, Alison. "The effect of passive thoracic flexion-rotation movement on the total static compliance of the respiratory system and respiratory responses in ventilated patients." Thesis, Link to the online version, 2007. http://hdl.handle.net/10019/408.
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Almasoudi, Bandar M. "Problem-Based Learning as a Teaching Method Versus Lecture-Based Teaching in Respiratory Therapy Education." Digital Archive @ GSU, 2012. http://digitalarchive.gsu.edu/rt_theses/13.
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ABSTRACT
BACKGROUND: Although Problem-based learning (PBL) approach is a common teaching technique in medical education, its use in the field of respiratory therapy is somewhat controversial. With so many programs adopting PBL strategies, it is important to examine whether there are differences between PBL and traditional teaching approaches in regards to learning outcomes. Therefore, the purpose of this study was to investigate if there are any significant differences between PBL and lecture-based program students in their cognitive abilities in mechanical ventilation.
METHODS: Two universities with BS programs in respiratory therapy were chosen—one uses PBL (15 participants) and on uses lecture-based method (24 participants). All 39 participants were given10 multiple-choice questions related to mechanical ventilation derived from the NBRC RRT written exam forms (C & D) as a pre and a post test.
RESULTS: The dependent t-test showed a significant difference between the pre and post test of the lecture-based and the PBL groups, resulting in a p value of 0.006 and 0.025 respectively. The independent t-test showed a significant difference in the pre-test favoring the lecture-based group (p = 0.039). However, the independent t-test showed no significant difference in the post-test (p=0.085)
CONCLUSIONS: PBL is increasing in popularity despite the fact that studies of its efficacy have been thus far inconclusive. This study has shown PBL to be effective, but not significantly more effective than traditional lecture-based methods in regards to objective test scores.
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Felix, Moscoso Monica, Galvan Jack Denegri, Loayza Fernando Ortega, and Adrian V. Hernandez. "Respiratory Therapy in Chronic Heart Failure Patients Complicated With Sleep-Disordered Breathing: Potential Study Bias." Journal of the Japanese Circulation Society, 2016. http://hdl.handle.net/10757/611825.
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Demingo, Xavier Preston. "Professional nurses' knowledge regarding weaning the critically ill patient from the mechanical ventilation." Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/1323.
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Mechanical ventilation (MV) is one of the most frequently used treatment modalities in the intensive care unit (ICU) (Burns, 2005:14). Up to 90% of critically ill patients in ICUs globally are connected to a mechanical ventilator. Although mechanical ventilation is a lifesaving intervention, it is expensive and is associated with diverse complications (Mclean, Jensen, Schroeder, Gibney & Skjodt, 2006: 299). Ventilator-associated pneumonia (VAP) accounts for 25% of all infections in ICU, with global crude mortality figures estimated at 20-70% (Craven, 2006:251). Minimising the time that a patient is connected to a mechanical ventilator to the absolute minimum can have considerable benefits in terms of decreased mortality and morbidity, as well as a decreased length of ICU stay and lower hospital costs. Critically ill patients therefore need to be weaned from the mechanical ventilator as soon as their condition that warranted the need for mechanical ventilation is stabilized. The process of weaning the critically ill patient from mechanical ventilation constitutes a significant proportion of total ventilator time. As professional nurses attend to the mechanically ventilated patient 24 hours a day, they have a vital role to play in the collaborative management of the patient requiring weaning from mechanical ventilation. The objectives of this study were to explore and describe the professional nurses’ knowledge regarding weaning the critically ill patient from mechanical ventilation. Based on the results, recommendations in the form of a protocol were made in order to improve the professional nurses’ knowledge and enhance the care of the mechanically ventilated patient. A quantitative design, which was exploratory, descriptive and contextual in nature, was utilised for the study. The data collection instrument of choice was a self-administered questionnaire. Convenience, non-probability sampling was the sampling method chosen for the purpose of this study. Collected data were analysed with the assistance of a statistician using descriptive and inferential statistics. Results were displayed in the form of graphs and tables. The results obtained in the study, combined with data from the literature review, were used to develop recommendations to enhance vi professional nurses’ knowledge regarding weaning the critically ill patient from mechanical ventilation. The recommendations were presented in the form of a protocol based on the available evidence. Ethical principles as they relate to conducting research were adhered to throughout the study.
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Patel, Mitesh Dilipkumar Kantilal. "Efficacy and safety of maintenance and reliever combination budesonide/formoterol therapy in asthma patients at risk of severe exacerbations : a randomised controlled trial." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/13591/.
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The Single combination budesonide/formoterol inhaler as Maintenance And Reliever Therapy (SMART) regimen reduces severe asthma exacerbations, but it is uncertain whether it increases the risk of adverse effects due to high corticosteroid and beta-agonist doses with both short-term and cumulative exposure in patients at risk of severe exacerbations. The primary hypothesis was that the SMART regimen would reduce the risk of beta-agonist overuse. Secondary aims were to investigate whether patients treated with the SMART regimen were less likely to seek medical review in the setting of beta-agonist overuse and to determine whether any reduction in severe asthma exacerbations would be at a cost of a higher systemic corticosteroid burden. This 24-week, open-label, parallel-group, multicentre randomised controlled trial randomised 303 asthma patients with a recent exacerbation to combination 200/6µg budesonide/formoterol metered dose inhaler (MDI) according to the SMART regimen (two actuations twice daily as maintenance with one extra actuation as-needed for relief of symptoms) or a fixed-dose regimen (two actuations twice daily as maintenance) with one to two actuations of 100µg salbutamol MDI as-needed for relief of symptoms (the ‘Standard’ regimen), with electronic monitoring to measure actual medication use. The use of electronic monitoring allowed beta-agonist overuse to be applied as a marker of the risk of life-threatening asthma. The primary outcome was the proportion of participants with at least one high beta-agonist use episode (more than eight actuations per day of budesonide/formoterol in addition to the four maintenance doses in the SMART group or more than 16 actuations per day of salbutamol in the Standard group). There was no significant difference between groups in the proportion of participants with at least one high use episode: SMART 84/151 (55.6%) versus Standard 68/152 (44.7%), relative risk (95% CI) 1.24 (0.99 to 1.56), p=0.058. There were fewer days of high use in the SMART group [mean (SD) 5.1 days (14.3) versus 8.9 days (20.9), relative rate (95% CI) 0.58 (0.39 to 0.88), p=0.01]. Of the participants who had at least one high use episode, those in the SMART group had fewer days of high use without medical review [mean (SD) 8.5 days (17.8) versus 18.3 days (24.8), relative rate (95% CI) 0.49 (0.31 to 0.75), p=0.001]. The SMART regimen resulted in higher inhaled corticosteroid exposure [mean (SD) 943.5µg budesonide per day (1502.5) versus 684.3µg budesonide per day (390.5), ratio of means (95% CI) 1.22 (1.06 to 1.41), p=0.006], but reduced oral corticosteroid exposure [mean (SD) 77.5mg prednisone (240.5) versus 126.6mg prednisone (382.1), p=0.011], with no significant difference in composite systemic corticosteroid exposure [mean (SD) 793.7mg prednisone equivalent per year (893.1) versus 772.1mg prednisone equivalent per year (1062.7), ratio of means (95% CI) 1.03 (0.86 to 1.22), p=0.76]. Participants in the SMART group had fewer severe asthma exacerbations [35 (weighted mean rate per year 0.53) versus 66 (0.97), relative rate (95% CI) 0.54 (0.36 to 0.82), p=0.004]. The SMART regimen has a favourable risk/benefit profile in patients at risk of severe asthma exacerbations. Funding This study was funded by the Health Research Council of New Zealand, a government funding organisation.
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Xu, Qianyi. "Towards Intelligent Tumor Tracking and Setup Verification in Radiation Therapy For Lung Cancer." Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/195222.
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Lung cancer is the most deadly cancer in the United States. Radiation therapy uses ionizing radiation with high energy to destroy lung tumor cells by damaging their genetic material, preventing those cells from reproducing. The most challenging aspect of modern radiation therapy for lung cancer is the motion of lung tumors caused by patient breathing during treatment. Most gating based radiotherapy derives the tumor motion from external surrogates and generates a respiratory signal to trigger the beam. We propose a method that monitors internal diaphragm motion, which can provide a respiratory signal that is more highly correlated to lung tumor motion compared to the external surrogates. We also investigate direct tracking of the tumor in fluoroscopic video imagery. We tracked fixed tumor contours in fluoroscopic videos for 5 patients. The predominant tumor displacements are well tracked based on optical flow. Some tumors or nearby anatomy features exhibit severe nonrigid deformation, especially in the supradiaphragmatic region. By combining Active Shape Models and the respiratory signal, the deformed contours are tracked within a range defined in the training period. All the tracking results are validated by a human expert and the proposed methods are promising for applications in radiotherapy. Another important aspect of lung patient treatment is patient setup verification, which is needed to reduce inter- and intra-fractions geometry uncertainties and ensure precise dose delivery. Currently, there is no universally accepted method for lung patient verification. We propose to register 4DCT and 2D x-ray images taken before treatment to derive the couch shifts necessary for precise radiotherapy. The proposed technique leads to improved patient care.
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Parikh, Bhairavi Rajiv. "The design and development of a direct and continuous sensor for the measurement of inhaled nitric oxide concentrations." Link to electronic version, 2000. http://www.wpi.edu/Pubs/ETD/Available/etd-0830100-001359/.
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Rowley, Janet M. "Development and evaluation of a self-efficacy scale for people with breathing pattern disorders a dissertation submitted in partial fulfilment for the degree of Master of Health Science at Auckland University of Technology, 2004." Full dissertation. Abstract, 2004. http://puka2.aut.ac.nz/ait/theses/RowleyJ.pdf.
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Diniz, Nayara Otaviano. "Evaluation of membership, complexity index of drugs and devices for use techniques in patients with pulmonary inhalational chronic obstructive." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=11990.
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CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel SuperiorChronic obstructive pulmonary disease is a common, avoidable and treatable disease characterized by persistent obstruction of the airways and lungs. This disease is usually progressive and associated with a chronic inflammatory response set off by noxious particles or gases. Patients with chronic obstructive pulmonary disease, represents a great impact on the increase of clinical care, as well as the economic health spending to provide better quality of life. This study characterizes the pharmacoepidemiological profile, adherence to drug therapy, pharmacotherapy complexity and performance of using inhalation devices in outpatientâs subjects of a referral hospital for treatment of pulmonary diseases. This is a descriptive, exploratory and transversal study. 83 individuals were interviewed, with a predominance of males, a mean age of 68.22 years, and low schooling. The average number of medications per patient was 5.58, characterizing the polypharmacy, and 81.9% had some type of comorbidity. The founded prevalence was mean adherence rate (45.8%). The most frequent response among the questions asked to measure adherence was related to forgettings (38.6%). The complexity therapy had a mean value of 15.9 points, a high score that reveals the difficulties in following the treatment. After evaluation of inhalation devices was found that as the use of dry powder inhaler Aerolizer, the technique was considered good in 62.5% of patients, the use of Respimat  inhaler was "good" in 70.96% of cases and the use of metered-dose aerosol showed to be regular in 64.7%. The evaluation of the use of the devices found flaws in several steps considered essential for their proper management. From these data, are needed strategies that aimed at enhancing actions to improve adherence to therapy and ongoing evaluation of inhalation devices, minimizing complications for the patient.
A DoenÃa pulmonar obstrutiva crÃnica, à uma doenÃa comum, evitÃvel e tratÃvel, caracterizada por obstruÃÃo persistente das vias aÃreas e dos pulmÃes, geralmente progressiva e associada a uma resposta inflamatÃria crÃnica desencadeada por partÃculas ou gases nocivos. Os pacientes portadores de DoenÃa pulmonar obstrutiva crÃnica representam um grande impacto no aumento dos atendimentos clÃnicos, assim como nos gastos econÃmicos com a saÃde para proporcionar melhor qualidade de vida. Este trabalho caracteriza o perfil farmacoepidemiolÃgico, a adesÃo à terapia medicamentosa, complexidade da farmacoterapia e o desempenho do uso de dispositivos inalatÃrios em indivÃduos atendidos em um ambulatÃrio de um hospital de referÃncia em tratamento de doenÃas pulmonares. Trata-se de um estudo descritivo, exploratÃrio e transversal. Foram entrevistados 83 indivÃduos, com predominÃncia do sexo masculino, idade mÃdia de 68,22 anos e baixa escolaridade. A mÃdia do nÃmero de medicamentos por paciente foi de 5,58, caracterizando a polifarmÃcia, e 81,9% tinham algum tipo de comorbidade. A prevalÃncia encontrada foi de mÃdia adesÃo (45,8%). A resposta mais frequente entre as perguntas realizadas para mensurar a adesÃo foi a referente aos esquecimentos dos pacientes em tomarem seus medicamentos diariamente (38,6%). A complexidade terapÃutica teve valor mÃdio de 15,9 pontos, um escore elevado que revela as dificuldades existentes no seguimento do tratamento. ApÃs avaliaÃÃo dos dispositivos inalatÃrios constatou-se que quanto ao uso de inaladores de pà seco Aerolizer a tÃcnica foi considerada boa em 62,5% dos pacientes, o uso de inalador Respimat foi âbomâ em 70,96% dos casos e o uso de aerossol dosimetrado mostrou-se regular em 64,7%. A avaliaÃÃo do uso dos dispositivos encontrou falhas em vÃrias etapas consideradas essenciais para o seu manejo adequado. A partir destes dados, se fazem necessÃrias estratÃgias que visem potencializar aÃÃes para melhorar a adesÃo à terapia e uma avaliaÃÃo contÃnua do uso dos dispositivos inalatÃrios, minimizando complicaÃÃes para o paciente.
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Waller, Michael David. "The behaviour of the cystic fibrosis respiratory epithelium and its response to multidose CFTR gene therapy." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/41881.
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Cystic fibrosis (CF) is a clinical syndrome resulting from inherited mutations to the cystic fibrosis transmembrane conductance regulator (CFTR) protein, whose absent or reduced function results in abnormal epithelial ion transport and an abnormal transepithelial potential difference (PD), leading to downstream epithelial dysfunction and a pathognomonic clinical phenotype. Most treatments to date manage the disease sequelae of airway mucus and infection, but correction of the underlying defect for all patients is the ultimate aim. Gene therapy offers the potential as a universal treatment to ameliorate CFTR function, leading to clinical benefit. This thesis will centre on the recently completed Multidose Trial (MDT) - the repeated application of non-viral CFTR gene therapy in patients with cystic fibrosis. The trial was undertaken during the entirely of this PhD, and recruited 136 patients (aged ≥12) with CF, and randomised to receive 12, monthly nebulised doses of a cationic-lipid (pGM169/GL67A), or placebo. The hypothesis of the study was that repeated administration of non-viral gene therapy would produce vector-specific epithelial CFTR, leading to demonstrable improvements in lung function and measureable de novo chloride ion transport in the upper (nasal) and lower (bronchial) airway. The study reports stability in lung function with gene therapy (n=62) at 48 weeks compared to a decline in the placebo group (n=54), concluding a significant treatment effect of a relative improvement of 3.7% (p=0.046) in percent-predicted forced expiratory volume in 1 second (FEV1) at follow-up; other clinical parameters further support a treatment benefit, however a reduction in the frequency of pulmonary exacerbations was not detected. A post hoc analysis identified a significant treatment benefit of 6.4% in patients with more severe airways disease (ppFEV1 50-70%), however failed to detect a treatment effect in patients with less severe disease (ppFEV1 70-90%). Individual patients demonstrated de novo chloride transport in the nasal and lower airway, as measured by epithelial potential difference, with a significant difference being measured in the lower airway in response to gene therapy (-4.4 mV, p=0.03); no difference was identified in the upper airway in response to active treatment. The thesis will next explore the relationships of epithelial PD between the nasal and lower airway with measurements of lung function at baseline, and in response to treatment with gene therapy. At baseline, trends between sodium transport in the nasal epithelium and FEV1 and a lung clearance index (LCI) (p=0.01) were identified; no relationship was identified between chloride indices, or with any measurement from the lower airway. No relationship between the electrophysiology of the upper and lower airway epithelium was detected. The author will present a novel method used to maintain blinding whilst performing nasal PD (NPD) measurements during the MDT, using a 2-operator technique. This technique is reported as not inferior to the standard NPD method and supports its validity of its use for future studies, but provides caution that this method may take longer to perform and that more data may be excluded owing to poor NPD trace quality. The thesis concludes by describing two studies designed to further understand the performance and interpretation of PD measurements, and discussing the overall usefulness of airway PD as a clinical trial outcome. The first study investigates the amount of total chloride secretion (in healthy (non-CF) volunteers (n=18)) in the nasal epithelium by perfusing 'standard nasal' (with amiloride) and 'lower airway' (sans amiloride) solutions, reporting that more (approximately 50%) chloride is secreted in the presence of amiloride-containing solutions, and when the duration of perfusion was extended. The final study aimed to define the minimum period for performing sequential NPDs in the same (CF) patient, reporting that 4/8 (50%) CF patients basal PD had returned after 30 min, and that basal PD had returned by 60 min in all patients, concluding that repeated measurements could be made over a short timeframe for clinical and research studies.
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Espinosa, Frank F. (Frank Francis). "Exogenous surfactant transport through the pulmonary airways : improving surfactant replacement therapy for neonatal respiratory distress syndrome." Thesis, Massachusetts Institute of Technology, 1996. http://hdl.handle.net/1721.1/10974.
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Freislederer, Philipp [Verfasser], and Katia [Akademischer Betreuer] Parodi. "Optimization strategies for respiratory motion management in stereotactic body radiation therapy / Philipp Freislederer ; Betreuer: Katia Parodi." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2020. http://d-nb.info/1221061984/34.
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Askie, Lisa. "A randomised controlled trial of oxygen therapy on growth and development of preterm infants." Connect to full text, 2003. http://hdl.handle.net/2123/599.
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Thesis (Ph. D.)--University of Sydney, 2003.Includes tables and questionnaires. Title from title screen (viewed Apr. 28, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Centre for Perinatal Health Services Research, School of Public Health. Includes bibliography. Also available in print form.
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Kiessig, Michael, and Michael Kiessig. "The effect of "fusafungine" on the incidence of upper respiratory tract symptoms in ultradistance runners." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/25545.
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Fusafungine is an antibiotic of fungal origin with a potent local anti-inflammatory action (German-Fattal, 1995; German-Fattal, 1996). It is administered locally to the nasal and pharyngeal mucosa by spray. It can be hypothesised that the anti-inflammatory action of fusafungine may decrease the development of mucosa! inflammation in such a manner that the incidence of symptoms of upper respiratory tract infection may be reduced if it is administered before, during and after completion of an ultramarathon. Furthermore, fusafungine could also reduce the risk of secondary bacterial infection. The potential value of fusafungine in reducing the symptoms of upper respiratory tract infections or the development of bacterial upper respiratory infection is the focus of this thesis.
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Keene, Shane, Kristen L. McHenry, Randy L. Byington, and Mark Washam. "Respiratory Therapists as Physician Extenders: Perceptions of Practitioners and Educators." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/2548.
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Introduction: The purpose of this study was to determine the perceptions of practicing respiratory therapists (RT) and respiratory care educators regarding the role of RTs serving as physician extenders. Methods: The survey instrument was an electronic questionnaire that consisted of 17 questions. Participation was voluntary and participants were selected through random and convenience sampling techniques. Results: Of 506 respondents, 234 were respiratory care educators. Overwhelmingly, the respondents held the Registered Respiratory Therapist credential (92.7%). Respondents were about equally split among three education levels: 31.7% associate degree, 31.7% bachelor’s degree, and 27.3% master’s degree. Of the respondents 62.45% had considered pursing a degree in physician assistant (PA). Respondents expressed a preference for an Advanced Practice Respiratory Therapy (APRT) program (77.9%) rather than a PA program. Nearly two-thirds of the respondents reported they felt that a master’s degree should be the minimum level of education for an APRT. Conclusions: This study suggests that practitioners and educators alike are strongly supportive of advanced practice in the profession of respiratory therapy.
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Dunn, Melinda Carol Cox. "Inhibition of Respiratory Syncytial Virus In Vitro and In Vivo by the Experimental Immunosuppressive Agent Leflunomide." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1269449453.
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Pater, Piotr. "A method for in-treatment measurement of residual respiratory motion of organs for stereotactic body radiation therapy." Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=32606.
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Stereotactic Body Radiation Therapy is a radical treatment method for small lesions in the body where a surgical dose of radiation is given to attempt to sterilize the lesion. One of its limitations lays in the respiratory motion of the target during treatment. For this technique, high precision and accuracy on the dose delivered to the target is critical. This work produced a measurement method for the target's position and motion, during treatment, without giving extra dose to the patient. This method is based on a statistical analysis of the position of implanted metallic markers, visible on treatment portal images. The method was implanted in a software written entirely in Real Basic (Real Software, Texas, USA) code. The software was tested with images of a respiratory phantom of known motion. The motion statistics detected by the software corresponded to the measured values. Results show that the software can be applied on clinical patient data. Some studies of patient data are presented to demonstrate the software's possibilities.La radiothérapie stéréotactique extracérébrale est une méthode de traitement radicale, où une forte dose de radiation est donnée à une petite lésion dans le corps, pour tenter de la stériliser. Une des limites de cette thérapie réside dans la difficulté d'irradier la cible précisément et exactement à la dose prescrite, puisqu'elle est constamment induite en mouvement par la respiration du patient durant le traitement. Ce travail a permis de concevoir une méthode de mesure de la position et du mouvement de la cible, durant le traitement, sans donner de dose additionnelle au patient. Cette méthode est basée sur une analyse statistique de la position de marqueurs métalliques implantés chirurgicalement près de la cible et visibles sur des images portales prises durant le traitement. Un logiciel codé en Real Basic (Real Software, Texas, USA) intégrant la méthode a été écrit. Le logiciel a été testé avec un fantôme respiratoire de déplacement connu. Les statistiques du mouvement obtenues par le logiciel correspondaient aux valeurs mesurées sur le fantôme. Les résultats montrent que le logiciel peut-être utile pour l'analyse du mouvement dans des cas cliniques de patients. Quelques exemples d'études cliniques sur des images de patients sont présentés pour démontrer les possibilités du logiciel et de la méthode utilisée.
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Jones, Andrew Thomas. "Regional pulmonary perfusion using electron beam computed tomography." Thesis, Imperial College London, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391623.
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Baril, Jacinthe. "Interaction between circulatory and respiratory exercise adaptation in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF)." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97901.
Full textAbstract:
Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients show a marked reduction in exercise capacity compared to that of healthy age-matched individuals. While inadequate gas exchange and resulting hypoxemia appears as the primary factor in COPD, an impaired cardiac output is the predominant explanation for the reduced oxygen delivery in CHF. However, the extent of the contributions of other systemic factors remains unclear. In light of the potential interactions between cardiac output (Qc) and pulmonary hyperinflation, there is surprisingly little data thus far on ventilatory constraints in CHF and on the role of blood flow delivery in COPD which may further limit the exercise capacity. Thus, the purpose of this study was to compare the slope of the Qc versus oxygen uptake (VO2) response through several submaximal cycling loads in patients with moderately severe COPD and with that of moderate to severe CHF patients as well as age-matched healthy control subjects (CTRL). Also examined was the possibility that ventilatory constraints such as dynamic hyperinflation contribute to an abnormal stroke volume response in both diseases. Cardiac output was measured using the CO 2-rebreathing equilibrium technique during baseline conditions and cycling at 20, 40 and 65% of peak power in 17 COPD (Age: 64 +/- 8 yrs; FEV 1/FVC: 37 +/- 11%; FEV1: 41 +/- 15 % predicted), 10 CHF (Age: 57+/- 10 yrs; FEV1/FVC: 73.8 +/- 5.6%; FEV 1: 93 +/- 13% predicted) and 10 age-matched CTRL subjects. Inspiratory capacity (IC) was also measured for the determination of dynamic hyperinflation during the steady state exercise bouts. The results indicate that while the absolute Qc values are lower in COPD and in CHF than in CTRL during 65% peak power cycling (11.30 +/- 2.38 vs 12.40 +/- 2.08 vs 15.63 +/- 2.15 L•min-1 respectively, p < 0.01), likely due to their lower exercise metabolic demand. The Qc/VO2 response to increasing levels of exercise intensity was lower or normal in CHF patients compared to CTRL, while normal or hyperdynamic in most COPD patients. Indeed, the majority of patients with COPD exhibited Qc/VO2 slopes greater than 7.0, which may be indicative of a peripheral muscle bioenergetic disturbance that may drive the need for greater oxygen delivery, and thus result in an exaggerated central circulatory response.
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Morton, Natasha Elizabeth. "Improving thoracic imaging for radiation therapy: The development and translation of patient adaptive computed tomography." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/28950.
Full textAbstract:
Radiotherapy is a lifesaving cancer treatment using radiation to kill cancer cells. Effective treatment requires accuracy and precision, directing radiation to the cancer while avoiding healthy tissue. As such, in-depth knowledge of the cancer’s size, location and surroundings is required for planning radiation delivery. For regions under motion, such as the thorax, spatial-temporal imaging (4D CT) is required to gain an understanding of how the anatomy will move during treatment. Current 4D CT techniques fail to adapt to a changing patient, resulting in inaccurate images and reduced confidence in treatment planning.
This thesis presents the development and implementation of the next generation of 4D CT, patient adaptive CT imaging. Adaptive CT is a software solution that adapts the 4D CT imaging process to patient motion signals (respiratory changes and cardiac function), with the goal of improving image accuracy.
There are three main studies around which this body of work focuses. The first outlines steps towards the clinical translation of adaptive CT, comparing adaptive CT to standard 4D CT imaging techniques.
The second outlines the development for future applications and improvements of adaptive CT. Delving into limitations of the system itself, an in-silico analysis of the system and scanner parameters on image quality is detailed. The universality of the system is discussed and techniques for inter-brand compatibility are explored.
The third details the expansion of adaptive CT for emerging radiation therapy indications. Cardiac motion is incorporated into the adaptive CT software and a detailed feasibility study is presented with implications for centrally located lung cancer and non-invasive cardiac radioablation treatments.
Overall, this body of work presents the advancement of patient adaptive CT imaging, providing superior images for radiation therapy treatment planning and opening up 4D CT imaging for new treatment paradigms.