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Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation and Non- Invasive Ventilation organized by Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom Team Members: Ms. VONG Yonny PTI NDH Mr. CHAN Clement SPT RHTSK Mr. CHAN Geoffrey PTI PYNEH Mr. LAM Patrick PTI PWH Ms. POON Pauline SPT QMH Hospital Authority Convention 2014 8 May 2014 at the Hong Kong Convention & Exhibition Centre

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Page 1: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Corporate Scholarship Program

Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation and Non-Invasive Ventilation organized by Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom

Team Members: Ms. VONG Yonny PTI NDH Mr. CHAN Clement SPT RHTSK Mr. CHAN Geoffrey PTI PYNEH Mr. LAM Patrick PTI PWH Ms. POON Pauline SPT QMH

Hospital Authority Convention 2014 8 May 2014 at the Hong Kong Convention & Exhibition Centre

Page 2: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

A. Clinical Visit/ Attachment

1. Guys’ and St. Thomas (GST) Hospital Lane Fox Respiratory Unit (LFRU)

2. Daily Consultant Ward Round, Multidisciplinary Meeting in the LFRU

3. Physiotherapy Service in the LFRU

4. Neuromuscular Service in the LFRU

5. LFRU Outreach (Intermediate care / home visit) Service for Home Mechanical Ventilation

6. Ambulatory Oxygen Assessment Physio-led Clinic

7. Pulmonary Rehabilitation

8. Intensive Care Unit (ICU)

Program Content 5 to 16 Nov 2012

Page 3: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

B. Practical and Workshop

9. Continuous Positive Airway Pressure (CPAP) and Non Invasive Ventilation (NIV) -Interface, Setup, Titration, Protocols and Troubleshooting

10. Negative Pressure Ventilation (Cuirass, Iron Lung)

11. Cough Assist

12. Overnight Oximetry , Capnography

13. Sleep Disorders including Obstructive Sleep Apnoea

(OSA) and Obesity Hypoventilation Syndrome (OHS)

14. Respiratory Muscle and Cough Strength Measurement

Program Content 5 to 16 Nov 2012

Page 4: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

0.67M

0.16M

0.65M

0.17M

Facts and Figures

Page 5: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Setting / Referral • 14 Critical Care Beds, 2 Out-patient Rooms

Professional Staff Medical (1 shift + oncall)

• 4 Respiratory Consultants (Respiratory, Critical Care & Sleep) • 2 Registrars • 1 Intensivist • Research Fellows and Consultants

Nursing (3 shifts)

• 1 Ward Manager • 48 Nurses (3 shifts) • 1 Outreach Sister & 1 Outreach Senior Nurse

Therapists (1 shift + oncall)

• 2 Senior / Respiratory Physiotherapy Specialist • 1 Physiotherapist • 1 Neuromuscular Transitional Care Co-ordinator (Respiratory Physiotherapy Specialist) • 0.1 Rehabilitation Physiotherapy Specialist • 1 Senior Occupational Therapist

Technical (1 shift + oncall)

• 5 Technicians/Engineers

Medical

Nursing

Therapies

Technical

24/7 coverage

Lane Fox Respiratory Unit (LFRU)

Organization Structure

Page 6: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

LFRU

Target Disease & Condition

Chronic Respiratory Failure

Weaning from Invasive Tracheostomy Ventilation

• Airway disease

• Neuromuscular disease

• Chest wall abnormalities

• Obesity

Domiciliary NIV for Chronic Respiratory Failure

Obstructive Sleep Apnoea

Post polio syndrome

Page 7: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

CRF Patients

Longterm Respiratory Support

Acute Respiratory Support

Emergency Admission To Lane Fox Unit

Respiratory Assessment Sleep Studies

Regular Reviews

Non-Invasive Ventilation (>150 episodes per year)

Pre-op Assessment Post-op Support

Nutritional Assessment PEG Insertion

Liaise with AICU & PICU

(>70 cases / yr)

Respiratory Physiotherapy Support

Establish & Service HMV

(>150 cases / yr; >1100 cases in total)

Assess for Cough Assist Device

Liaise with Local Hospital

Weaning from Ventilation/ Removal of Tracheostomy

(>70 cases / yr)

ICU Admission Tracheostomy

EOLC

Progressive Neuromuscular Disease

Clinical Support and Remote Weaning

Page 8: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

LFRU

Service Partners

General Practitio-

ner

Local Hospitals

Highly Dependent Nursing Home

Clinical Excellence

Educational Excellence

Research Excellence

Page 9: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Consultant PT / Physician – led 24/7 Acute NIV Service (covering A&E, Emergency Ward, HDU, LFU)

Page 10: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Consultant PT / Physician – lead 24/7 Acute NIV Service (covering A&E, Emergency Ward, HDU, LFU)

46%

26%

11%

4%

13%

Diagnosis

COPD

Pneumonia

LVF

OSA

Others

52%

11%

22%

10%

5%

Referral Source

A&E

Admission Ward

Critical Care

Other Wards

Others

(n=149) (n=149)

Page 11: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Assessment

Peak Cough Flow Arterial blood gas sampling and interpretation

Page 12: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Assessment

• Allow continuous monitoring, which has been shown to be useful in the initiation and titration of NIV and ventilator for the treatment of acute and chronic respiratory failure

• The use of the combined PCO2 /SpO2 sensor has been validated against measurements on ABG samples repeatedly drawn from indwelling arterial lines

• Measurements between ABG and TcPCO2

were highly correlated (for PCO2 between 5 to 22kPa) on arrival in the HDU (r=0.99, p<0.001) and 1 hour (r=0.99, p<0.001) and 4 hours (r=0.98, p<0.001) after commencing NIV.

Respiratory Physiotherapist Roles and Responsibilities

Transcutaneous pCO2 (TcPCO2)

Source: Cox et al. Non-invasive monitoring of CO2 levels In patients using NIV for AECOPD. Thorax 2006, 61(4), 364-365 Hazenberg et al. Validation of a Transcutaneous CO2 Monitor in Adult Patients with Chronic Respiratory Failure. Respiration 2011;81:242-246. Carter R. Transcutaneous CO2 and O2 Monitoring in the Adult Patient. The Buyers Guide to Respiratory Care Products 102-109. (http://dev.ersnet.org/uploads/Document/2c/WEB_CHEMIN_2560_1194522858.pdf)

Page 13: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Sputum Clearance

Page 14: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Airway Clearance

Recombinant Human Deoxyribonuclease (DNAse)

Respiratory Physiotherapist Roles and Responsibilities

• Intratracheal administration of DNAse 30 mins before chest physiotherapy to facilitate sputum clearance

Source: Malcolm King and Bruce K Rubin. Pharmacological approaches to discovery and development of new mucolytic agents. Advanced Drug

Delivery Reviews 2002, 54(11) 1475–1490. Hill and Webber. Physiotherapy for airway clearance in adults. Eur Respir J 1999;14:1418-1424.

Page 15: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Weaning from Mechanical Ventilation to NIV

Page 16: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Outreach Program • Home assessment • Home tracheostomy

ventilation • Critical care • Weaning from invasive

Mechanical Ventilation • Intermediate care • Acute care home • Palliative Care

Page 17: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Abbreviations: PSG = nocturnal polysomnography; ODI = oxygen desaturation index, CPAP=continuous positive airway pressure.

Assessment Overnight Oximetry (OSA/OHS/CSA/Overlap)

Page 18: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Ambulatory Oxygen Physio-led Clinic

Page 19: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Pulmonary Rehabilitation

Page 20: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Respiratory Physiotherapist Roles and Responsibilities

Training Support: To safely manage patients requiring acute NIV, PT in the GSTT undergo a

clinical competencies acquisition process. During the training process, PT shall be formally assessed on their clinical competencies

Page 21: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Overseas Corporate Scholarship Program for Allied Health Professionals Attachment Program for Physiotherapists in Advancement of

Respiratory Rehabilitation and Non-Invasive Ventilation

Potential Opportunity of Respiratory Physiotherapy Service in HA

1. Physiotherapy in Acute NIV Service

2. Community Physiotherapy (CPT) in NIV

Service

3. Ambulatory Oxygen Therapy Clinic

Page 22: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Overseas Corporate Scholarship Program for Allied Health Professionals Attachment Program for Physiotherapists in Advancement of

Respiratory Rehabilitation and Non-Invasive Ventilation

Potential Opportunity of Respiratory Physiotherapy Service in HA

1. Physiotherapy in Acute NIV Service

2. Community Physiotherapy in NIV Service

3. Ambulatory Oxygen Therapy Clinic

Page 23: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Physiotherapy in Acute NIV Service

Learning Points from UK

Multidisciplinary team uses standardized evidence-based guidelines and protocols.

Comprehensive care-giver training and competency assessment Continuing support after discharge and emergency support during crisis.

Physiotherapists provide 24/7 service on NIV setup, titration and troubleshooting in Accident and Emergency Department (AED) Clinical competencies acquisition in NIV management for Physiotherapists

through training and assessment to ensure an effective and safe management to patients

Active research allows continuous evaluation and development of the NIV

service

Page 24: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Physiotherapy in Acute NIV Service Physiotherapy Service Improvement

Guidelines Development and Staff Training

• Service guideline on ‘Physiotherapy Management of COPD patients with Non-invasive Ventilation’ was developed and endorsed by PTCOC.

• In-service trainings were conducted among PWH, QMH, PYNEH, TWEH and NDH with more than 150 attendance.

• Multidisciplinary Journal Club Sharing in Medicine and Rehabilitation Team of TWEH: 5PT, 3 OT, 5 nurse, 1 Consultant, 3 Associate Consultant and 1 Physician.

• Physiotherapy Commissioned Training Program 2013/2014 : ‘Advances in NIV and Home Mechanical Ventilation (HMV) for Physiotherapist’, held from 17 to 20 Jan 2014 with more than 200 participants

Ensure Service Quality and Safety Enhance Clinical Risk Management

Improve Clinical Practice

Page 25: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Physiotherapy in Acute NIV Service New HA Service Development:

NIV Program Development and Evaluation

• To improve service quality and safety, a

multidisciplinary COPD NIV Program involving physician, physiotherapist and nurse has been implemented in 5 pilot hospitals (PWH, PMH, POH, QMH and UCH) since mid to late 2013.

• A physiotherapist baseline database is constructing for evaluation and further planning.

Ensure Service Quality and Safety Enhance Clinical Risk Management

Improve Clinical Practice

Page 26: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Physiotherapy in Acute NIV Service New Physiotherapy Service Development:

5 Pilot Hospitals Experience:

• Early mobilization with NIV therapy

• Bronchial hygiene therapy enhanced with cough assist machine and manual assisted coughing technique

• Titration of parameters during exercise and bronchial hygiene therapy to optimize outcome if necessary

Ensure Service Quality and Safety Enhance Clinical Risk Management

Improve Clinical Practice

Page 27: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Physiotherapy in Acute NIV Service New Physiotherapy Service Development:

5 Pilot Hospitals Experience (cont’d)

• Proactive discussion with Respiratory physician and nurse to facilitate better NIV management including fitting, weaning and parameters adjustment.

• Supporting weaning process of long-term tracheostomy

>> cuff-down + NIV therapy

Ensure Service Quality and Safety Enhance Clinical Risk Management

Improve Clinical Practice

Page 28: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Overseas Corporate Scholarship Program for Allied Health Professionals Attachment Program for Physiotherapists in Advancement of

Respiratory Rehabilitation and Non-Invasive Ventilation

Potential Opportunity of Respiratory Physiotherapy Service in HA

1. Physiotherapy in Acute NIV Service

2. Community Physiotherapy (CPT)

in NIV Service

3. Ambulatory Oxygen Therapy Clinic

Page 29: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Community Physiotherapy and NIV Service

Learning Points from UK Multidisciplinary team backup with standardized evidence-based guidelines

and protocols. Well-established Outreach program including proactive case management with crisis intervention planning to prevent avoidable hospital readmission

CPT provide regular community visits to patients on NIV or home

tracheostomy, those residing at acute care home as well as NMD patients in chronic respiratory failure. Comprehensive care-giver training and competency assessment.

PT conducted objective measurement (transcutaneous PCO2 and ABG) on the PCO2 level of hypercapnic or NIV patients

PT titrate the NIV setting of patients in the community, according to the protocol and guidelines, to facilitate timely intervention

Page 30: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Community Physiotherapy in NIV Service Potential Opportunity in HA

1. Standardization of documentation of NIV assessment and intervention.

2. With reference to the Community PT experience for NIV users in NDH, PMH and QEH. It is recommended to:

• explore the possibility of implementing similar service in other clusters to facilitate early discharge and prevent unplanned hospital re-admission of respiratory failure patients with NIV.

• explore the feasibility of assessing PaCO2 level in the community by PT to facilitate early, safe and effective intervention for patient residing in the community

Better Manage Growing Service Demand Increase Efficiency, Reduce Demand

Page 31: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Community Physiotherapy in NIV Service New Physiotherapy Service Development North District Hospital (NDH) Experience:

Proactive case management and collaboration

SaO2 80%

24/ 11/ 2014 Telemonitoring data: Mean SaO2 80%, <88% 10 hr 28 min (79.1%) on 3.5 LO2/min NC

Case Mr. Mak

CPT trigger Crisis Management

suggesting NIV initiation

Respiratory Consultation

Clinical Admission with NIV initiated

& decrease O2 support

SaO2 90%

21/12/2014 Telemonitoring data: Mean SaO2 92%, <88% 19min

(Nocturnal BIPAP, ST mode, RR 12, IPAP 20, EPAP 12 RT: 1; Insp time: 1.0, 1 LO2)

Page 32: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Community Physiotherapy in NIV Service Physiotherapy Service Improvement NDH Experience: Transcutaneous PCO2 measurement

Page 33: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Overseas Corporate Scholarship Program for Allied Health Professionals Attachment Program for Physiotherapists in Advancement of

Respiratory Rehabilitation and Non-Invasive Ventilation

Potential Opportunity of Respiratory Physiotherapy Service in HA

1. Physiotherapy in Acute NIV Service

2. Community Physiotherapy (CPT) in NIV

Service

3. Ambulatory Oxygen Therapy Clinic

Page 34: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Ambulatory Oxygen Therapy (AOT) Clinic

Learning Points from UK

• PT led AOT clinic provides thorough assessment

to ensure best understanding of

respiratory condition and equipment

selection for optimization of patient daily life

activity.

• Detailed and up-dated assessment

report for Physician to facilitate further

investigation and management.

Page 35: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Ambulatory Oxygen Therapy (AOT) Clinic Potential Opportunity in HA

• To consult relevant stakeholders to explore the feasibility of

establishing AOT clinic in out-patient or

extended care setting.

• NDH has incorporated portable oxygen concentrator

therapy for NIV users to enhance their physical activities

and oxygen compliance.

• To improve patients’ symptoms, exercise

tolerance and physical independence.

Ensure Service Quality and Safety Improve Clinical Practice

Page 36: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Ambulatory Oxygen Therapy (AOT) Clinic Physiotherapy Service Improvement

NDH Experience- O2 empowerment pilot study

(O2 cylinder and Portable Oxygen Concentrator)

Increase oxygen compliance

Facilitate Pulmonary Rehabilitation Program

Safe pursuit of outdoor activities

Increase Physical endurance

Empower Physical activities

Page 37: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Overseas Corporate Scholarship Program for Allied Health Professionals Attachment Program for

Physiotherapists in Advancement of Respiratory Rehabilitation and Non-Invasive Ventilation

Conclusion

• This attachment program has inspired the advancement of physiotherapists’ role in NIV service and pulmonary rehabilitation. Further training of more PT is recommended.

• Apart from the current service in HA, PT service for respiratory patients and NIV users could be enhanced for better care and reduction in unplanned readmission, via multidisciplinary collaboration and continuing professional training

• With management’s support, effective resource allocation and continuing professional training in HA,

we believe a higher level of care for chronic respiratory patients can be attained.

Page 38: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Reference

1. Carter R. Transcutaneous CO2 and O2 Monitoring in the Adult Patient. The Buyers Guide to Respiratory Care Products 2012, 102-109. (http://dev.ersnet.org/uploads/Document/2c/WEB_CHEMIN_2560_1194522858.pdf)

2. Cox et al. Non-invasive monitoring of CO2 levels In patients using NIV for AECOPD. Thorax 2006, 61(4), 364-365

3. Department of Health (2012). Health Facts of Hong Kong. (http://www.dh.gov.hk/english/statistics/statistics_hs/files/Health_Statistics_pamphlet_E.pdf)

4. Dixon Anna and Robinson Ray (2002). “The United Kingdom” Healthcare systems in eight countries; trends and challenges. European Observatory on Health Systems. Health Trends Review, HM Treasury.

5. Food and Health Bureau of the Hong Kong Special Administration Region Government (2008). Synopsis of Healthcare Financing Studies - Healthcare System and Financing: Overseas Experience.

Page 39: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Reference 6. Fried Bruce and Gaydos Laura (2002). “The United Kingdom” World

Health System: Challenges and Perspectives: Eds. Bruce Fried and Laura Gaydos. Chicago: Health Administration Press.

7. Ham Chris (1997). “The United Kingdom.” Healthcare Reform: Learning from International Experience. Ed. C. Ham OUP.

8. Harker Rachael (2011). NHS Funding and Expenditure (http://www.nhshistory.net/parlymoney.pdf)

9. Hazenberg et al. Validation of a Transcutaneous CO2 Monitor in Adult Patients with Chronic Respiratory Failure. Respiration 2011;81:242-246.

10. Hill and Webber. Physiotherapy for airway clearance in adults. Eur Respir J 1999;14:1418-1424.

11. Kaiser (2009). An online health policy resource for faculty and students. http://www.kaiseredu.org/topics_im_ihs.asp?imID=1&parentID=61

12. Malcolm King and Bruce K Rubin. Pharmacological approaches to discovery and development of new mucolytic agents. Advanced Drug Delivery Reviews 2002, 54(11) 1475–1490.

Page 40: Corporate Scholarship Program - Hospital Authority · 2014-06-09 · Corporate Scholarship Program Attachment Program for Physiotherapists in Advancement of Respiratory Rehabilitation

Acknowledgement LFRU, Guy’s and St. Thomas’ NHS Foundation Trust,

London, United Kingdom Respiratory Team and Physiotherapy Department of

NDH, PMH, POH, PWH, PYNEH, QMH, RHTSK, TWEH and UCH

Thank you

Q&A