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PF dysfunction affects the adult CF population, with PF symptoms limiting the ability of up to one in three patients to participate in physiotherapy management.

Aim: As we move into a new phase of the COVID-19 pandemic, cardiac and pulmonary services are considering how to sustain telehealth modalities long term. It is important to learn from services that had greater telehealth adoption and determine factors that support sustained use. We aimed to describe how telehealth has been used to deliver cardiac and pulmonary rehabilitation services across Queensland, Australia. Methods and Results Semi-structured interviews (n = 8) and focus groups (n = 7) were conducted with 27 cardiac and pulmonary clinicians and managers from health services across Queensland between June-August 2021. Interview questions were guided by Greenhalgh’s Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Hybrid inductive/deductive framework analysis elicited six main themes: 1. Variable levels of readiness; 2. Greater telehealth uptake in pulmonary versus cardiac rehabilitation; 3. Safety and risk management; 4. Client willingness - targeted support required; 5. Equity and access; and, 6. New models of care. We found sustained integration of telehealth in cardiac and pulmonary rehabilitation will require contributions from all stakeholders: consumers (e.g., co-design), clinicians (e.g. shared learning), health services (e.g., increasing platform functionality), and the profession (e.g., sharing resources). Conclusions There are opportunities for telehealth programs servicing large geographic areas, and to increase program participation rates more broadly. Centralised models of care serving large geographic areas could maximise sustainability with current resource limitations; however, realising the full potential of telehealth will require additional funding for supporting infrastructure and workforce. Individuals and organisations both have roles to play in sustaining telehealth in cardiac and pulmonary services.

Routine tracheostomy care in children maintains airway patency, minimizes infection, and ensures skin integrity around the tracheostomy stoma to prevent complications. Using evidence-based recommendations for care of the mature tracheostomy limits variation in practice and leads to better patient outcomes in all care settings. Incorporating evidence-based care into practice is especially important because children with tracheostomies are at high risk for morbidity and mortality. The purpose of this review is to summarize the most current, evidence-based literature for pediatric tracheostomy care, including stoma care and tracheostomy suctioning. Rehabilitation nurses can then include these best practices when caring for children with tracheostomies and when educating caregivers who provide tracheostomy care to children at home.

Mine water geothermal energy could provide sustainable heating, cooling and storage to assist in the decarbonisation of heat and achieving Net Zero carbon emissions. However, mined environments are highly complex and we currently lack the understanding to confidently enable a widespread, cost-effective deployment of the technology. Extensive and repeated use of the mined subsurface as a thermal source/store and the optimisation of operational infrastructure encompasses a range of scientific and technical challenges that require broad partnerships to address. We present emerging results of a pioneering multidisciplinary collaboration formed around an at-scale mine water geothermal research infrastructure in Glasgow, United Kingdom. Focused on a mined, urban environment, a range of approaches have been applied to both characterise the environmental change before geothermal activities to generate “time zero” datasets, and to develop novel monitoring tools for cost-effective and environmentally-sound geothermal operations. Time zero soil chemistry, ground gas, surface water and groundwater characterisation, together with ground motion and seismic monitoring, document ongoing seasonal and temporal variability that can be considered typical of a post-industrial, urban environment underlain by abandoned, flooded coal mine workings. In addition, over 550 water, rock and gas samples collected during borehole drilling and testing underwent diverse geochemical, isotopic and microbiological analysis. Initial results indicate a connected subsurface with modern groundwater, and resolve distinctive chemical, organic carbon and stable isotope signatures from different horizons that offer promise as a basis for monitoring methods. Biogeochemical interactions of sulphur, carbon and iron, plus indications of microbially-mediated mineral oxidation/reduction reactions require further investigation for long term operation. Integration of the wide array of time zero observations and understanding of coupled subsurface processes has significant potential to inform development of efficient and resilient geothermal infrastructure and to inform the design of fit-for-purpose monitoring approaches in the quest towards meeting Net Zero targets.

What is the impact of including an allied health assistant (AHA) role on physiotherapy service delivery in an acute respiratory service? A pragmatic pre-post design study examined physiotherapy services across two 3-month periods: current service delivery [P1] and current service delivery plus AHA [P2]. Clinical and non-clinical activity quantified as number, type and duration (per day) of all staff activity categorised for skill level (AHA, junior, senior). Physiotherapy service delivery increased in P2 compared to P1 (n = 4730 vs n = 3048). Physiotherapists undertook fewer respiratory (p < 0.001) and exercise treatments (p < 0.001) but increased reviews for inpatients (p < 0.001) and at multidisciplinary clinics in P2 (56% vs 76%, p < 0.01). The AHA accounted for 20% of all service provision. AHA activity comprised mainly non-direct clinical care including oversight of respiratory equipment use (e.g. supply, set-up, cleaning, loan audits) and other patient-related administrative tasks associated with delegation handovers, supervision and clinical documentation (72%), delegated supervision of established respiratory (5%) and exercise treatments (10%) and delegated exercise tests (3%). The AHA completed most of the exercise tests (n = 25). AHA non-direct clinical tasks included departmental management activities (11%). No adverse events were reported. AHA inclusion in an acute respiratory care service changed physiotherapy service provision. The AHA completed delegated routine clinical and non-clinical tasks. Physiotherapists increased clinic activity and annual reviews. Including an AHA role offers sustainable options for enhancing physiotherapy service provision in acute respiratory care.