Angiotensin II Modulates Podocyte Glucose Transport

Podocytes play a central role in the maintenance of the glomerular filtration barrier and are cellular targets of angiotensin II (AngII). Non-hemodynamic pathways of AngII signaling regulate cellular function and mediate podocyte abnormalities that are associated with various glomerulopathies, including diabetic kidney disease. In this study we investigated the capacity of AngII to modulate glucose uptake in mouse podocytes expressing the human AT1 receptor (AT1R+) after 5 days of exposure to normal (NG, 5.6 mmol/L) or to high (HG, 30 mmol/L) glucose. Short (30 min) as well as long-term (24 h) incubations with AngII markedly enhanced glucose transport in both NG and HG cells. In podocytes cultured under NG conditions, AngII inhibited insulin-stimulated glucose uptake. Regardless of the presence or absence of AngII, no effect of insulin on glucose uptake was observed in HG cells. Stimulation of glucose transport by AngII was mediated by protein kinase C and by phosphoinositide 3-kinase. Glucose dependent surface expression of the glucose transporters GLUT1, GLUT2, and GLUT4 was modulated by AngII in a time and glucose concentration dependent manner. Furthermore, despite its inhibitory effect on insulin's action, AngII elevated the number of podocyte insulin receptors in both NG and HG cultured cells. These findings demonstrate that AngII modulates podocyte basal, as well as insulin-dependent glucose uptake by regulating glucose transporters and insulin signaling

Simulation-based education within respiratory physiotherapy training:a scoping review

Objective The aim of this scoping review is to provide respiratory physiotherapists with guidance on the implementation of simulation-based education Introduction In recent years there has been a widespread rise in the adoption of simulation-based education. A scoping review was decided upon by the ACPRC Editorial Board to focus on any new evidence or guidance in the field. Inclusion criteria 1) Studies investigating the use of simulation-based education within respiratory physiotherapy 2) Meta-analyses, systematic reviews, scoping reviews, randomised controlled trials and observational studies. Methods A literature search was developed and refined through testing. Nine databases were searched between 01/01/2014 and 31/10/2022. Data regarding study design, population, intervention, comparator and control were extracted into a data extraction table. Results were grouped by study design, intervention or context. Results 141 sources were retrieved from the searches. After initial screening 27 sources were included and after full-text review, 25 were included. Sources included: meta-analyses and systematic review and studies considering pre-registration education, interprofessional learning, part-task trainers and postgraduate education. Conclusion There is increasing research output in the simulation-based education field for respiratory physiotherapy. The evidence continues to focus on learner experience. More resources and support are required to increase access to simulation-based education for respiratory physiotherapists

A core syllabus for post-graduate training in respiratory physiotherapy

Physiotherapy contributes significantly to improving quality of life for patients with respiratory disease. Physiotherapists specialised in dealing with respiratory pathology and its associated problems are not only central in the delivery of pulmonary rehabilitation but also provide strategies and techniques for exercise testing, airway clearance, breathlessness management, mobility and function improvement and pain management. Published evidence-based recommendations have paved the way for standardised practice while also unravelling the extended scope of responsibilities of the respiratory physiotherapist. The breakdown of traditional roles and allocation of new responsibilities is not confined to the respiratory physiotherapist within healthcare systems. Team-based healthcare and interprofessional treatment of patients is prevalent in the provision of care across the globe. New methods of healthcare delivery indicate that tasks are entrusted to those deemed competent to perform them. It has therefore been necessary to train allied health professionals to take over parts of clinical care

Position statement and considerations for remotely delivered pulmonary rehabilitation services.

Statement and methods of development The challenge of access to pulmonary rehabilitation (PR) and meeting associated service demand is certainly not new. However, the COVID-19 pandemic set an unprecedented challenge evoking rapid adaptation of services. An inherent spotlight has been placed on remotely delivered services. As we look beyond the height of this pandemic, it is important to reflect and consider what has been learnt, and emerging perspectives on the future of PR service delivery. This document updates the ‘ACPRC statement and considerations for the remote delivery of pulmonary rehabilitation services during the COVID-19 pandemic’ (1) and seeks to provide pragmatic practical guidance for remotely delivered models of PR for healthcare professionals that should be used alongside local guidance. The recommendations provided are for guidance only, and may be updated in response to further national guidelines and new evidence. An online survey of PR healthcare professionals (ACPRC pulmonary rehabilitation provision during COVID-19 and beyond!) was conducted in the development of this document to scope current practice in PR services across the U.K. Informed by queries received by the ACPRC, the survey was first conducted in 2020 and repeated in July 2021 with the aim of capturing a snapshot of practice, one-year post onset of the COVID-19 pandemic. The survey was publicised and disseminated via Twitter using the @theACPRC handle, with request that one team member completed on behalf of their service. A summary of the 21 responses can be found in Appendix 1 which served to inform the content of this document. A literature review was undertaken to identify and integrate relevant published trials since the 2021 Cochrane review of telerehabilitation for people with chronic respiratory disease (2). Details of the search strategy can be found in Appendix 2 and summary of study characteristics and outcomes in Appendix 3. Anonymous feedback from four PR services was collated and analysed to identify common themes in experiences of remotely delivered PR services. A summary of this process and collated feedback can be found in Appendix 4. Key terms Remotely delivered models – the delivery of pulmonary rehabilitation services at a distance; the interaction between healthcare professional and participant using communication and information technologies, that may take place in real-time (synchronously) or asynchronously (1). It may be delivered by a virtual platform, an online web application or programme, or referred to as telerehabilitation (note: this terminology is used where studies have reported it). Field walking tests are commonly employed to evaluate exercise capacity, prescribe exercise, and evaluate treatment response in chronic respiratory diseases (3). The most valid, reliable and responsive ones are the six-minute walk test (6MWT), incremental (ISWT) and endurance walk test (ESWT). NACAP – the National Asthma and COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP), as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), and currently covers England and Wales. The programme is led by the Royal College of Physicians (RCP) and includes a pulmonary rehabilitation workstream. PRSAS – the Pulmonary Rehabilitation Services Accreditation Scheme was launched in April 2018, and is run by the Royal College of Physicians (RCP)

Association of Chartered Physiotherapists in Respiratory Care scoping review: Post-operative physiotherapy in people undergoing thoracic surgery

Introduction This scoping review was produced by the ACPRC editorial board. Following a preliminary scoping day, surgery was considered 1 of 5 key priorities for review. Surgery was subsequently separated into specialities. Objective The objective of this scoping review was to report the extent and methodological type of evidence associated with post-operative physiotherapy in people who underwent thoracic surgery. Inclusion criteria Studies with adult patients undergoing thoracic surgery and published between 2014 and 2020 were included. The thoracic procedure undertaken required post-operative physiotherapy intervention as part of the recovery process. Method Searches were undertaken in PEDro, CINAHL, EMBASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Article titles and abstracts were screened by one reviewer, and full text articles appraised by two reviewers. Quality was assessed and data was extracted using the relevant tools dependent on study methodology. Results Initially, 1809 articles were retrieved from which 28 articles were included in this scoping review, including a total of 6265 participants. Studies were randomised control trials (n = 10), observational studies (n = 7) and systematic review or meta-analysis (n = 5). The quality of the articles was good with the studies having structured protocols and blinding of subjects where appropriate, however there were some methodical flaws, including being underpowered. The variability in clinical physiotherapy practice between countries was highlighted. Included studies explored respiratory physiotherapy (n = 13), mobilisation (n = 10), combined respiratory and mobilisation (n = 3), kinesiology taping (n = 1) and outcomes (n = 1). Early and intensive mobilisation as part of an ERAS programme demonstrated statistically significant reduction in length of stay, post-operative pulmonary complications, and morbidity. The level of patients’ pre-operative mobility impacted on their post-operative outcomes and risk of developing post-operative pulmonary complications (PPC). Conclusion The scoping review included 28 studies with a range of methodologies providing evidence that supports post-operative physiotherapy intervention in people who undergo thoracic surgery. Future research should aim to clarify which respiratory physiotherapy techniques impact recovery and expand the diversity of methodologies to include more qualitative research

Association of Chartered Physiotherapists in Respiratory Care scoping review: Post-operative physiotherapy in people undergoing thoracic surgery

Introduction This scoping review was produced by the ACPRC ed- itorial board. Following a preliminary scoping day, surgery was considered 1 of 5 key priorities for review. Surgery was subsequently separated into specialities. Objective The objective of this scoping review was to report the extent and methodological type of evidence associ- ated with post-operative physiotherapy in people who underwent thoracic surgery. Inclusion criteria Studies with adult patients undergoing thoracic sur- gery and published between 2014 and 2020 were in- cluded. The thoracic procedure undertaken required post-operative physiotherapy intervention as part of the recovery process. Method Searches were undertaken in PEDro, CINAHL, EM- BASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Article titles and abstracts were screened by one reviewer, and full text articles appraised by two reviewers. Quality was assessed and data was extracted using the relevant tools dependent on study methodology. Results Initially, 1809 articles were retrieved from which 28 articles were included in this scoping review, including a total of 6265 participants. Studies were randomised control trials (n = 10), observational studies (n = 7) and systematic review or meta-analysis (n = 5). The quality of the articles was good with the studies having structured protocols and blinding of sub- jects where appropriate, however there were some methodical flaws, including being underpowered. The variability in clinical physiotherapy practice be- tween countries was highlighted. Included studies explored respiratory physiotherapy (n = 13), mobilisation (n = 10), combined respiratory and mobilisation (n = 3), kinesiology taping (n = 1) and outcomes (n = 1). Early and intensive mobilisation as part of an ERAS programme demonstrated statistically significant reduction in length of stay, post-operative pulmonary complications, and morbidity. The level of patients’ pre-operative mobility impacted on their post-operative outcomes and risk of developing post-operative pulmonary complications (PPC). Conclusion The scoping review included 28 studies with a range of methodologies providing evidence that supports post-operative physiotherapy intervention in people who undergo thoracic surgery. Future research should aim to clarify which respiratory physiotherapy tech- niques impact recovery and expand the diversity of methodologies to include more qualitative research