Vibration response imaging: protocol for a systematic review

Abstract Background: The concept of lung sounds conveying information regarding lung physiology has been used extensively in clinical practice, particularly with physical auscultation using a stethoscope. Advances in computer technology have facilitated the construction of dynamic visual images derived from recorded lung sounds. Arguably, the most significant progress in this field was the development of the commercially available vibration response imaging (VRI) (Deep Breeze Ltd, Or-Akiva, Israel). This device provides a non-invasive, dynamic image of both lungs constructed from sounds detected from the lungs using surface sensors. In the literature, VRI has been utilized in a multitude of clinical and research settings. This systematic review aims to address three study questions relating to whether VRI can be used as an evaluative device, whether the images generated can be characterized, and which tools and measures have been used to assess these images

A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes

Background Reducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service. Methods/Design A randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial. Discussion This paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services

An observational study of sitting out of bed in tracheostomised patients in the intensive care unit

Objective: To define the number of occasions of sitting out of bed in patients in the intensive care unit (ICU) following tracheostomy formation. Design: Descriptive observational study. Setting: ICU, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, UK. Participants: Convenience sample of 30 mechanically ventilated patients requiring a tracheostomy. Main outcome measures: The number of occasions of sitting out of bed and/or sitting on the edge of the bed during the patient’s stay on the ICU, the number of occasions that patients did not sit out of bed or sit on the edge of the bed as defined due to being ‘medically unwell’ or ‘other’, and ICU outcome. Results: This preliminary work demonstrated that 63% (19/30) of patients sat out of bed during their ICU stay. The median number of occasions of sitting out of bed was two. Thirty-seven percent (11/30) of patients did not sit out of bed and demonstrated a higher mortality rate than the patients who did sit out of bed during their ICU stay. There was no significant difference in age, gender, Apache II scores or length of ICU stay between patients that did and did not sit out of bed. Conclusions: This study found that a culture of patient mobilisation exists on the ICU at St. Thomas’ Hospital, but its frequency of delivery is reduced by the construct that patients are considered too unwell for it to be indicated at times. The effects, risks and benefits of early mobility within the ICU environment require further exploration in order to add to the literature and develop clinical practice