Yes, the spring 2014 Diagnostics bulletin is now online. 

The spring issue of the Bulletin features an article by Danielle Bonagura, RRT, from the Yale New Haven Hospital pediatric pulmonary laboratory, offering tricks-of-the-trade for obtaining quality data from a pediatric population. Our 2013 Specialty Practitioner of the Year, Balamurugan Panneerselvam, BS, RST, RPSGT, CPFT, returns with the second installment of his article on nasal nitric oxide testing. 

There is also a review of the basic maintenance of the Morgan Scientific plethysmography system and the introduction of a new feature to the Bulletin: “The Quarterly Case Report.” The Quarterly Case Report will feature an interesting graphic or short case report of patient testing or an equipment troubleshooting scenario. I am hopeful that the readership will find the Quarterly Case Report interesting to read and that it may provide insights to affect clinical practice.

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Despite the myriad of settings RTs have worked; we have not always been keen on embracing change, particularly when it has been driven by new payment systems or reengineering to reduce operational expense.  Respiratory Therapists (RTs) are specialized professionals that help to improve the health and well-being of patients with respiratory illness. RTs have provided clinical services in acute care hospitals, long-term acute care and skilled nursing facilities, home care (skilled under Part A and durable medical equipment (DME) providers under Part B); as well as pulmonary rehabilitation, in medical groups alongside primary care physicians and have demonstrated value in meeting the complex needs of patients.  In the era of The New Healthcare Normal, RTs are poised to be at the forefront of change and distinguish the profession as paramount in creating solutions under the Affordable Care Act (ACA) by serving in various roles in Accountable Care Organizations (ACOs).  
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The demand for Home Medical Equipment (HME) will increase according to an independent study conducted by a Texas based company (See Medtrade Monday Article).  The firm recently conducted market research on the HME industry and forecasts an 8.2% increase, resulting in an industry that will tout well over $12.6 billion by 2018.  Industry leaders lauded the report as evidence on the value of the medical device focused meetings to support education and training on new and emerging medical devices. Additionally, noted the importance regarding the role of medical devices in meeting the needs of patients in low cost environments - the home.

While this is in part true based on the acute care shift; what is lacking currently with regards to medical device education is the evidence on the clinical utility to determine the effect on health outcomes and cost reduction.  This is the crux of the issue with the HME industry and the reason for the challenges that exists today under the competitive bidding program. Value Based Health Care (VBHC) is where the industry must focus its efforts to establish the role of HME providers as essential in the continuum of care.  The equipment is integral to patient care but the focus must be the patient; not the equipment (
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Health care has changed at a rapid pace over the past five years.  While we're fully aware of the changes occurring under the Affordable Care Act (Act), Respiratory Therapists (RTs) are very familiar with change.  We've seen departments in the hospitals go from centralized to decentralized just  to go back to a centralized model; coverage under the 'Medicare Part A' benefit in skilled nursing facilities (SNFs) for RT services discontinued under the Balanced Budget Act (BBA) during the Clinton administration, and now the role of the RT being eliminated altogether at certain organizations. (see The KentuckyOne Case)  We've embarked on an era that I call "The New Healthcare Normal", in which Value Based Health Care (1, 2) is central and the products and services (inputs) are measured based on the relative value of the outputs (improved health
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I've been following tweets about the "doc-fix" bill and comments about the replacement of Centers for Medicare and Medicaid Services’ (CMS’) Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) competitive acquisition program [aka competitive bidding]; with the Market Pricing Program (MPP) and have been perplexed by the ongoing focus on equipment.

Value Based Healthcare is the way in which healthcare is delivered now in our country; the inputs (resources or products used) don’t matter but the outputs (better outcomes at reduced costs) are most important. The DME industry must focus its efforts on providing Value Based Healthcare.

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Reflect for a moment about the changes in healthcare over the past five years.  Now think about the transition from filling the inpatient beds and increasing overall volumes for surgical cases to reducing the length of stays and performing more procedures in same day centers or through robotics and minimally invasive methods. 

Then consider the methods and madness surrounding reimbursement for services and products under the Medicare Part B benefit; and the increased level of scrutiny and vigilance with utilization of resources relative to medical necessity.  No matter how you are affected, it is plain to see that things have definitely changed. Some may argue for the better because we are now charged with demonstrating value by improving health outcomes while reducing costs; while others may say things have changed too drastically and the patient will suffer as a result of the shift to value based healthcare.  
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Hi Bill,
Here are two of my concerns when I'm running a support group, or if I'm the speaker.
1) Keep a positive spin on all discussion.  It's real easy for folks with disabilities to focus on the 'dis'!
2) You, the leader, need to stay in charge so that no one person monopolizes the conversation.  
You as facilitator need to know how to redirect conversation, for many different reasons.
Most importantly, have fun and help folks connect with their world.
Happy trails,
Betsy Thomason, RRT
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You ask an interesting question. I have a support group in Sun City, Arizona that has been around for close to 30 years without much advertising, I generally have about 20 people show up. Our Pulmonary Rehabilitation Program really talks it up and some individuals tell me that after diagnosis, they simply called the hospital or the Lung Association to find a group. 
When I started working in another area, I felt there was nothing for people here but found it difficult to get it going in an area that is not a retirement community. It is a Better Breathers Club through the Lung Association. The Lung Association has been the best advertisement. A Pulmonary Physician offered his office after hours to meet and now we have some activity but still slow. Community Centers are a good place to advertise if you plan to meet right there or your group is close to it. I have not gotten any individuals attending from local hospitals the flyers were provided to. If you are affiliated with a hospital it might be a good time to offer your support group to the discharge planning team that is working on the 30 day hospital readmission plan. I have just been invited to attend one of these meetings to prevent COPD readmission.
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Laura & Brian are hitting Capitol Hill Tuesday!
Please send your last minute letters in to congress right now!
Montana has been mentioned several times in our who's who of respiratory care meeting already so let's keep them talking about us by sending in even more letters!
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Recent news reports about the layoffs of respiratory therapists in Kentucky and the concomitant fervor that’s followed on some social media sites prompts me to address some of the most vocal of claims. The beauty of social media is that those types of forums allow individuals to express their "opinions," but in a rational world, we all must have the foresight and knowledge to understand that opinions are not facts.


Here’s what we know --

MythKentuckyOne is eliminating all RTs from their health system.

That is not true. "We have spoken with the media, with RTs involved, the Kentucky Society for Respiratory Care and the Kentucky Board for Respiratory Care to get all the details. The health system has removed RTs from three stand-alone ED's (one of which is completely closing altogether). KentuckyOne still employs RTs in their hospitals and ICUs to perform ventilator management and other care for patients with respiratory diseases. While I disagree with removing RTs from the stand-alone EDs, that is a far claim from wiping them off the map.

MythNurses do not perform physical therapy like they perform respiratory therapy.

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It's March and that means that a lot of respiratory care students are looking to make the transition from student to graduate to professional. Even though I graduated a long, long time ago (in a galaxy far, far away), I remember the uncertainty of that transition. Will I pass my finals? Where will I get a job? How do I know I'm taking care of my patients properly? And...drum roll, please...will I pass my NBRC board exams?

"Mind what you have learned. Save you, it can." ~Yoda

First, it is important that you take a deep breath and remember your education. You've spent countless hours studying, learning, and practicing your skills in the lab and clinic environments. Don't discount your experiences and the skills you've developed. To be an effective and safe practitioner, you must learn to trust yourself and your education...and to never be afraid to ask for help. We're all in this together.

In a very close second is to remember that you are not done learning. Too many times, graduates leave their respiratory care program thinking that they have learned everything there is to know about respiratory therapy. The sheer volume of knowledge for respiratory therapists is far too vast to learn in 18-24 months. I guarantee you will learn at least one new thing every day from your peers, your mentors, your allied health/nursing/physician colleagues, and (most importantly, I would argue) your patients.
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In the Boston area all just use standard nebulizers for tTOBI treatments. Never heard of using 50 psi and not sure what one would connect to it
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I don't know if any one has seen this in the news ~ 2 weeks ago?

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Also wondering what people think & if they have experienced similar cuts in their departments.  
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Respiratory Therapist are making differences throughout all aspects of medical care. One of the key issues leading today’s medical needs is Autism having little to no support from federal, state or legislative governments. Children, Young Adults and Families are impacted every day with growing need for education, research and support.

Some of you may not know what Autism is. That is OK. This blog is intended to educate you in this and introduce you to a field that needs Respiratory Therapist. It can combine with Neurological, Behavioral and Cognitive conditions with ongoing research implementing sustainment of daily living and care for most of these kids needs. We are changing our roles from Acute care to Chronic Care sustainment and we all must be aware of different situational disorders. Having been afflicted with this in our family, I am making an effort to express how important this condition must be exposed. Children need our help and this is important.

Autism Speaks, 2014 states that  "Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. With the May 2013 publication of the

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While I am not much of a blogger, I will give it a shot periodically on current topics that I see from my rocking chair on the porch.....

As many had expected, the healthcare arena and climate is going through many adjusts and readjusts as the rules of the game have change. While as healthcare clinicians, our primary goal has always been to serve as an expert and advocate for the patient with cardiopulmonary disease. While some of these changes have set the stage for a positive impact on patients, while in the same light many of these changes have placed obstacles and challenges to providing the care we believe is right for patients.

So what are the 5 "hot" trends that currently are taking place in the healthcare literature that are having a direct impact on the respiratory care department? My biased opinion is the following:

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Standing orders have been a part of the RT's work life for a very long time. Have asthma? Standing order for Q2 albuterol x 24 hours. Just have surgery? IS Q2 hours and PRN until discharge. I am a total advocate for standardizing care across the continuum but we can't forget that the "asthmatic" is really an individual and that surgical patients have unique challenges that can't be addressed by a standing order. Now, don't get me wrong...I'm a big fan of protocols. But a standing order isn't a protocol. A standing order is a set of orders that direct care for all individuals admitted with a certain diagnosis with no room for individualization.

How do we individualize care, then? First, we can't forget to assess the patient on a regular basis. Does the patient wheeze? It might not hurt to try a bronchodilator. But we can't simply administer a medication and not look at outcomes. Did it improve patient condition? Does the patient feel better? Are we achieving our desired clinical outcomes? Is the answer yes? Great! Let's continue the therapy. Is the answer no? Then let's stop this therapy and find something else that works.

Second, we have to know the evidence. It would help my patient if I were to find evidence that showed other patients with similar conditions responded well (or didn't respond) to certain therapies. But where do I find that evidence? As a respiratory therapist, my first step should be the AARC clinical practice guidelines webpage. Some CPGs are related to condition, some are related to therapy. CPGs "are statements that includes recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options" (Institutes of Medicine, 2011). Basically, these recommendations are based entirely on the evidence available. A good, trustworthy CPG is based on the systematic review, considers all patient groups, manages conflicts of interest, and has a transparent process.
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Program Committee chair Ira Cheifetz invites AARC members into "Mission Control" where planning for AARC Congress 2014 took place in early February. Dr. Cheifetz gives people a sneak peak as to what they can expect at the 60th International Respiratory Convention & Exhibition in Las Vegas, NV (Dec. 9-12). And don't forget...this year's meeting will be held at an entirely new venue at the Mandalay Bay Resort & Casino; the 5th largest convention center in the United States.

Check out Dr. Cheifetz's video and don't forget to visit the AARC Channel on Youtube where you'll find vignettes for all AARC Specialty Sections.

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Welcome to the future of Medicare Homecare .
Medicare competetive bidding has decimated the homecare industry so badly. The insanity of this so called system has left so many of our seniors and disabled without proper Homecare it is tragic. This example you gave is happening all across the country. The moronic reasoning is to save Medicare money. The sad result is increased ER and hospital stays. How is it possible this saves money!?
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Congratulations to CVS! The national pharmacy chain announced today that it will cease all tobacco sales by October 1, 2014, because "it's the right thing to do."

Read all about their decision to align product sales with company values at their official page. News coverage has expanded to a CNN article and a Washington Post article regarding why, in the long run, this is also a profitable decision.

Also, read this letter from the AARC to the CVS leadership team.

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I started working with the Drive4COPD in 2010 as the Missouri D4C captain. For 3 years, I attended/supported/organized so many Drive4COPD events in Missouri that I could recite the 5 question survey in my sleep. When I joined the AARC, my participation in the D4C was put on hold as I learned my new job and settled into a new area.

Two days ago, I got back in the swing of things. Working with Jason Moury, D4C coordinator, I helped with an event in downtown Dallas at the national Greyhound headquarters. With my colleagues Doug Laher and Steve Nelson and my new RT friend Deirdre Farahani, we screened over 120 people for risk factors for COPD. However, the great part wasn't so much the screening of these was the interaction we were able to initiate. We had several discussions with folks who have loved ones with COPD and who have lost loved ones with COPD. We had tobacco cessation discussions with those who still smoke and are struggling with quitting. We engaged in discussions about the role of the respiratory therapist, what we do, and how we can help the community.

The attendees of this health fair were fantastic. The Greyhound corporation leadership visited with us and told us about their commitment to employee wellness. They even, with Jason's help, sent out a series of emails to their employees leading up to the health fair about COPD, risk factors, the screener, and tips for lung health. Many attendees told us that they learned a great deal about COPD from the emails and decided to visit with our booth to learn more. It was a fantastic day for all of us involved.
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