A valid academic path to promote respiratory physiotherapy

A one- year post- graduate Master in Physiotherapy and Pulmonary Rehabilitation has been offered within the University of Milan Medical School in collaboration with Associaz ione Italiana Riabilitatori dell\u2019Insufficienz a Respiratoria (ARIR). The aim is to cover a gap in Italian Physiotherapy academic curricula offering a course with theoretical and practical teaching that make students capable of using different techniques and procedures in respiratory physiotherapy. After the recognition by the International Education Recognition System (IERS), ARIR wanted to investigate if and how this course has affected students'attitude and their profession. METHODS A structured questionnaire made up of 15 multiple- choices items (8 on perceived quality of education and 7 on professional change) was sent by email to all physiotherapists who graduated in the previous four editions of the Master. One month was given for completion. Age, gender, year of degree and year of Master where considered as background variables. RESULTS We had a 78% response rate with 57 out of 73 physiotherapists sending the questionnaire back. Mean age was 37 years (23- 60) and women were the majority (78%). Forty- two students (74%) worked in the respiratory field at the time of application but only 15 (36%) dealt with respiratory patients only. Expectations were completely met at the end of Master for 71% of physiotherapists. 96% reported greater professional and clinical skills after the master with a 67% saying working team relationship has improved. 28% improved their job position thanks to the master degree and physiotherapy working in the respiratory field increased by 22%. CONCLUSIONS This course seems to meet students expectations and offer a solid knowledge to better work within the field of respiratory physiotherapy. It is also a way to promote the profession of respiratory physiotherapy in Italy

NIV feasibility during PEG tube placement in bulbar ALS patients: our experience

Background: Percutaneous Endoscopic Gastrostomy (PEG) is the most widely used procedure for feeding dysphagia in ALS patients with respiratory muscle impairment (RMI). Several studies show that it improves survival. NIV may reduce respiratory complications in ALS patients with forced vital capacity (FVC) less than 50% predicted. Moreover, patients and caregiver\u2019s psychological well-being could decline and some distressing symptoms could occur. Aim: We report our experience of PEG tube placement (PEGTP) with NIV in patients with ALS.Methods: This prospective study was performed between December 2012 and September 2014 in our HD Respiratory Rehabilitation Unit. Data was also retrieved through validated questionnaires considering the following psychological factors: anxiety, depression and Quality of Life. PEGTP was performed during pressure-support/assist-control mode NIV through a nasal mask (nNIV) by a Respiratory Therapist (RT). Mechanical Insufflation-Exsufflation (MI-E) was applied before PEGTP if needed. The RT performed trainings before the PEGTP, with nNIV in patients who were not ventilated at home and who were already ventilated via oronasal mask; The effectiveness of nNIV was checked through patient subjective tolerance, for example, through clinical and gasometric response. In the Endoscopy Unit, sedoanalgesia with midazolam was initiated and biological variables (SpO2, heart rate, respiratory rate, and blood pressure) were monitored continuously.Results:nNIV training required a mean of 3.56 days. Two patients (8%) presented a desaturation during PEGTP. After two months of PEGTP, one patient (4%) died. Conclusions:Our results support the mandatory use of NIV during PEGTP in ALS bulbar onset patients and RMI, and it is associated with minimal peri and post-procedural complications. Therefore, we can conclude that PEGTP in patients with ALS and RMI is safe for the management of NIV and MI-E before PEGTP,with RT support