151
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Hubert D. [CYSTIC FIBROSIS: CARE OF THE LUNG DISEASE]. Rev Prat 2015; 65:1095-1099. [PMID: 26749716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
(Rh-DNase) and/or hydration (hypertonic saline) nebulisations, Moreover, treatment with inhaled antibiotics is indicated (tobramycin, colistine or aztreonam lysine) for chronic lung infection with Pseudomonas aeruginosa (PA). The treatment regimen also includes bronchodilators for bronchospasms and azithromycin. Regular physical activity is recommended. A treatment potentiating the CFTR protein, ivacaftor, is now indicated for patients with a class 3 mutation. Initial bronchial infection with PA must be treated as soon as possible in order to eradicate the pathogen. Pulmonary exacerbations require antibiotic courses, either orally or intravenously for PA infection. Complications require hospitalisation, with thoracic chest tube placement for a pneumothorax or bronchial artery embolisation for massive hemoptysis. Oxygen therapy and non-invasive ventilation with a nasal mask become necessary when respiratory insufficiency progresses, justifying the initiation of the lung transplant process. Lung disease affects the prognosis of cystic fibrosis, therefore its management in cystic fibrosis centres is of utmost importance. Maintenance treatment mainly relies on daily chest physiotherapy, which can be facilitated by mucolytic
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152
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Guo W, Zeng Y, Su Z, Zhai Y, Zhong C, Li S. [Refractory pulmonary alveolar proteinosis treated with inhaled granulocyte macrophage colony stimulating factor: a case report and review of the literatures]. Zhonghua Jie He He Hu Xi Za Zhi 2015; 38:751-755. [PMID: 26703942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To observe the efficacy of granulocyte macrophage colony stimulating factor inhalation therapy for pulmonary alveolar proteinosis (PAP) patients and to improve the understanding of the therapy. METHODS The clinical data of a patient with autoimmune PAP treated with inhaled granulocyte macrophage colony stimulating factor were described and the literatures were reviewed. RESULTS This 70-year-old female patient was diagnosed with autoimmune PAP and had been treated with whole lung lavage for 10 times, but only achieved short-term symptomatic relief after each operation. Inhalation of granulocyte macrophage colony stimulating factor was then used after the recurrence of PAP, and a significant improvement in oxygenation and clinical symptoms were abserved. The patient remained stable 4 month after the therapy. CONCLUSION Treatment with inhalation of granulocyte macrophage colony stimulating factor is safe, effective and economic for patients with PAP, and would be the first choice for the recurrence of autoimmune PAP after whole lung lavage.
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Affiliation(s)
- Wenliang Guo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yunxiang Zeng
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Zhuquan Su
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yanping Zhai
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Changhao Zhong
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;
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153
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Handa Y, Harada H, Yamashita Y. [A Resected Case Whose Poor Pulmonary Function was Improved through Preoperative Comprehensive Respiratory Rehabilitation]. Kyobu Geka 2015; 68:850-853. [PMID: 26329630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 70-years-old man was diagnosed as having primary lung adenocarcinoma (cT1aN0M0, cStage I A) in the left lingula. Because of poor pulmonary function [vital capacity (VC):1,840 ml, forced expiratory volume (FEV)1.0:790 ml],we thought he could not tolerate the surgery and should be treated by chemoradiation therapy. However,by his strong hope for surgical treatment,comprehensive pulmonary rehabilitation by nutritional therapy and physiotherapy of breathing was started and was continued for about 1 month. As the value of pulmonary function test was improved (VC:2,010 ml,FEV1.0:1,040 ml), we did left lingulectomy. Postoperative complications did not occur and the patient shows a favorable condition without respiratory failure 18 months postoperation.
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Affiliation(s)
- Yoshinori Handa
- Department of Respiratory Surgery, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
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154
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Smid DE, Wilke S, Jones PW, Muris JWM, Wouters EFM, Franssen FME, Spruit MA. Impact of cardiovascular comorbidities on COPD Assessment Test (CAT) and its responsiveness to pulmonary rehabilitation in patients with moderate to very severe COPD: protocol of the Chance study. BMJ Open 2015; 5:e007536. [PMID: 26198426 PMCID: PMC4513521 DOI: 10.1136/bmjopen-2014-007536] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Patients with COPD are characterised by a reduced health status, which can be easily assessed by the COPD Assessment Test (CAT). Previous studies show that health status can be worsened by the presence of comorbidities. However, the impact of cardiovascular comorbidities on health status as assessed with CAT is not sufficiently investigated. Therefore, the current study has the following objectives: (1) to study the clinical, (patho)physiological and psychosocial determinants of the CAT, and impact of previously established and/or newly diagnosed cardiovascular comorbidities on health status in tertiary care patients with COPD; (2) to assess the effects of pulmonary rehabilitation on CAT scores in patients with COPD; (3) to develop reference values for the CAT in Dutch elderly patients without COPD; and (4) to validate the CAT in a broad sample of Dutch patients with COPD. METHODS AND ANALYSIS The COPD, Health status and Comorbidities (Chance) study is a monocentre study consisting of an observational cross-sectional part and a longitudinal part. Demographic and clinical characteristics will be assessed in primary care, secondary care and tertiary care patients with COPD, and in patients without COPD. To assess health status, the CAT, Clinical COPD Questionnaire (CCQ) and St George's Respiratory Questionnaire (SGRQ) will be used. The longitudinal part consists of a comprehensive pulmonary rehabilitation programme in 500 tertiary care patients. For the cross-sectional part of the study, 150 patients without COPD, 100 primary care patients and 100 secondary care patients will be assessed during a single home visit. ETHICS AND DISSEMINATION The Medical Ethical Committee of the Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands (METC 11-3-070), has approved this study. The study has been registered at the Dutch Trial Register (NTR 3416).
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Affiliation(s)
- Dionne E Smid
- Department of Research & Education, CIRO, Horn, The Netherlands
| | - Sarah Wilke
- Department of Research & Education, CIRO, Horn, The Netherlands
| | - Paul W Jones
- Division of Clinical Science, St George's University of London, London, UK
| | - Jean W M Muris
- Department of Family Medicine, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frits M E Franssen
- Department of Research & Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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155
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Capasso L, Cerullo J, Bucci L, Borrelli AC, Caiazzo R, Raimondi F. Respiratory management of ELGA infants in a region of Southern Italy. Acta Biomed 2015; 86 Suppl 1:11-15. [PMID: 26135949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
The distribution of births in many regions of Southern Italy is scattered among a high number of level I centers, many of which still count less than 500 deliveries per year. Campania, the region around Naples, is no exception and this excessive fragmentation results in a high number of neonatal transports, many of which for respiratory distress. In the present paper, we review three different regional peculiarities relevant to the respiratory management of extremely low gestational age babies.
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Affiliation(s)
- Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II, Naples, Italy.
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156
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Altenburg J, Wortel K, van der Werf TS, Boersma WG. Non-cystic fibrosis bronchiectasis: clinical presentation, diagnosis and treatment, illustrated by data from a Dutch Teaching Hospital. Neth J Med 2015; 73:147-154. [PMID: 25968285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This review article describes the epidemiology, clinical presentation, diagnostic workup and treatment options in adult non-cystic fibrosis (non-CF) bronchiectasis (widening of mainly small and medium-sized bronchi as seen on chest computed tomography (CT) scan). We illustrate evidence from the literature with our own data retrieved from chart review, involving 236 adult patients with recurrent lower respiratory tract infections and high-resolution CT-proven non-CF bronchiectasis, who visited the outpatient clinic for respiratory diseases of a large Dutch teaching hospital between 2000 and 2010. Non-CF bronchiectasis can be described as a final common pathway of a vicious cycle of excessive bronchial inflammation, bacterial colonisation and infection. Non-CF bronchiectasis may arise from several causes, headed by infection and immunodeficiency, and is clinically characterised by a chronic, productive cough and infectious exacerbations. Once non-CF bronchiectasis is diagnosed using high-resolution CT scanning, a protocol-driven work-up to identify the underlying cause is recommended. Non-medicinal treatment options are primarily directed at clearance of bronchial secretions, which can further be improved by inhalation of hyperosmolar agents. Antibiotic treatment of exacerbations is a cornerstone medicinal treatment in bronchiectasis management. Patients with frequent exacerbations can be considered for long-term low-dose macrolide treatment, supported by robust evidence. Inhaled antibiotics might be beneficial in selected patients colonised with Pseudomonas aeruginosa. Important developments in the last decade include the introduction of international guidelines and the proposal for a validated scoring system for disease severity. Bronchiectasis patients are encountered by physicians in diverse medical professions and the disease itself is still underdiagnosed. The authors aim to increase awareness of the condition and provide practical tools for diagnosis and treatment.
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Affiliation(s)
- J Altenburg
- Department of Pulmonary Diseases, Medical Centre Alkmaar, Alkmaar, the Netherlands
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157
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Moret M, Darbellay P, Lebowitz D, Alves C, Sabeh N, Carballo S. [Internal medicine in the hospital setting]. Rev Med Suisse 2015; 11:187-192. [PMID: 25831611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Management of all pathologies, and in particular that of the most frequent ones, should whenever possible be based on robust evidence and arguments. New studies published this year enable rationalizing of screening in certain clinical situations, more adequate treatment of others, and open the way for novel and apparently very effective treatments. Whether it be the screening of carotid stenosis, the treatment of pericarditis, of heart failure, of chronic obstructive lung disease or spontaneous bacterial peritonitis, paradigm changes are conceivable. This selective review of the literature summarizes certain studies published this year.
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158
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Nania JJ, Skinner J, Wilkerson K, Warkentin JV, Thayer V, Swift M, Schaffner W, Talbot TR. Exposure to Pulmonary Tuberculosis in a Neonatal Intensive Care Unit: Unique Aspects of Contact Investigation and Management of Hospitalized Neonates. Infect Control Hosp Epidemiol 2015; 28:661-5. [PMID: 17520537 DOI: 10.1086/517975] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 10/04/2006] [Indexed: 11/03/2022]
Abstract
Objective.We describe the investigation of a tuberculosis (TB) exposure in which a neonatal intensive care unit (NICU) respiratory therapist was the index patient, as well as the rationale by which exposed infants were managed and possible explanations for the lack of transmission to these patients.Design.Description of an exposure investigation.Setting.Academic, level IV NICU of a tertiary care children's hospital.Participants.Contacts of a respiratory therapist with pulmonary TB disease, including household members, healthcare coworkers, and infant patients.Results.In addition to 5 household contacts, 248 healthcare coworkers and 180 infant patients were identified as possibly exposed during the 24 days that the index patient worked between December 3, 2004, and January 30, 2005. Tuberculin skin tests (TSTs) were performed for 233 of the 235 contacts with the greatest degree of exposure (household and coworker contacts) who had a previously documented negative TST result or whose TST status was unknown prior to the investigation. No cases of latent tuberculosis infection or TB disease were identified. Because of characteristics of the index case, the exposure duration and setting, the infants' small lung volumes, and lack of evidence of transmission to higher-risk contacts, infants were not clinically evaluated or empirically treated for TB disease. Surveillance for subsequent illness was carried out by primary healthcare providers and parents. No TB disease or unexplained illness in these infants was reported in the 20 months following the exposure.Conclusion.After limited hospital exposure to a healthcare worker with pulmonary TB disease who is not highly contagious, neonates can be safely managed without specific evaluation for TB disease or empirical treatment.
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Affiliation(s)
- Joseph Jacob Nania
- Division of Pediatric Infectious Diseases and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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159
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Kostrzon M, Czarnobilski K, Czarnobilska E. The influence of pulmonary rehabilitation in the Wieliczka Salt Mine on asthma control--preliminary results. Przegl Lek 2015; 72:716-720. [PMID: 27024946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
According to asthma treatment guidelines the main goal of pulmonary rehabilitation is optimum asthma control. The Asthma Control Test (ACT) is a standardised five-item questionnaire for the assessment of asthma control. The study compares the pre- and post-treatment (subterraneotherapy) ACT score with other conventional respiratory parameters. The study included 21 patients with bronchial asthma who underwent a 3-week long subterraneotherapy programme in the 'Wieliczka' Salt Mine. The patients completed the ACT questionnaire before and 2 weeks after subterraneotherapy. At the same time, they underwent testing for concentration of nitric oxide in exhaled breath (FENO), peak expiratory flow (PEF) and spirometry. Subterraneotherapy influenced significantly the change of MEF75 (p = 0.03255) and improvement of ACT score (N = 21, p = 0.0016). The differences in other parameters were not statistically important, but in the case of FEV1 and VC parameters, the differences found were close to the statistical significance (0.05 < p < 0.10). The differences of results before and after subterraneotherapy were higher in the group assigned as patient with poor or moderate asthma control (ACT score < 20, N = 10) than in the group with good control of asthma (ACT score ≥ 20, N = 11). For parameters FEV1, VC, MEF75 and ACT score the improvement was significantly higher in the poor control group. The pulmonary rehabilitation programme combined with subterraneotherapy helps to control asthma especially in patients suffering from poorly or moderate controlled asthma.
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160
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Mitchell PH, Kirkness C, Blissitt PA. Chapter 5 cerebral perfusion pressure and intracranial pressure in traumatic brain injury. Annu Rev Nurs Res 2015; 33:111-183. [PMID: 25946385 DOI: 10.1891/0739-6686.33.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Nearly 300,000 children and adults are hospitalized annually with traumatic brain injury (TBI) and monitored for many vital signs, including intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Nurses use these monitored values to infer the risk of secondary brain injury. The purpose of this chapter is to review nursing research on the monitoring of ICP and CPP in TBI. In this context, nursing research is defined as the research conducted by nurse investigators or research about the variables ICP and CPP that pertains to the nursing care of the TBI patient, adult or child. A modified systematic review of the literature indicated that, except for sharp head rotation and prone positioning, there are no body positions or nursing activities that uniformly or nearly uniformly result in clinically relevant ICP increase or decrease. In the smaller number of studies in which CPP is also measured, there are few changes in CPP since arterial blood pressure generally increases along with ICP. Considerable individual variation occurs in controlled studies, suggesting that clinicians need to pay close attention to the cerebrodynamic responses of each patient to any care maneuver. We recommend that future research regarding nursing care and ICP/CPP in TBI patients needs to have a more integrated approach, examining comprehensive care in relation to short- and long-term outcomes and incorporating multimodality monitoring. Intervention trials of care aspects within nursing control, such as the reduction of environmental noise, early mobilization, and reduction of complications of immobility, are all sorely needed.
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161
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Megías MC, Albarrán OG, Vasco PG, Ferreiro AL, Carro LM. Influence of macrolides, nutritional support and respiratory therapies in diabetes and normal glucose tolerance in cystic fibrosis. A retrospective analysis of a cohort of adult and younger patients. Diabetes Metab Syndr 2015; 9:1-6. [PMID: 25450813 DOI: 10.1016/j.dsx.2014.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM The development of cystic fibrosis related diabetes is associated with increased morbidity and mortality, worse nutritional status and lung function decline. It is known that patients with cystic fibrosis have a chronic inflammation status and that β pancreatic cells are very sensitive to oxidative stress. So these inflammatory mediators could contribute to the onset of progressive pancreatic fibrosis and, hence, to impair glucose metabolism. So, it could be hypothesized that the treatment with macrolides would protect and preserve β-cell function by decreasing pro-inflammatory cytokines and free oxidative radicals. METHODS We retrospectively analyzed a cohort of 64 patients affected of cystic fibrosis, older than 14 years, by using the first pathological 2-h oral glucose tolerance test; peripheral insulin resistance was calculated using the homeostasis model assessment for insulin resistance (HOMA - IR) and pancreatic β-cell function was estimated according to Wareham. The influence of macrolides, microbiological colonization, nutritional support and related clinical parameters were analyzed. RESULTS Comparing CFRD without FPG and NGT, and after adjustment for microbial colonization, the significance of the use of macrolides was lost (p=0.1), as a risk or protective factor for any of the studied groups. Non-significative associations were found in the use of macrolides, inhaled corticosteroids and nutritional support therapies within the different disorders of carbohydrate metabolism. CONCLUSIONS The anti-inflammatory and immunomodulating effect of macrolides did not seem to affect the β cell function or insulin resistance in patients with cystic fibrosis. The use of inhaled corticosteroids or nutritional supplements have not any influence in the carbohydrate metabolism. Further prospective studies are needed to analyze a potential protective role of macrolides in the development of carbohydrate metabolism alterations in cystic fibrosis.
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Affiliation(s)
- Marta Cano Megías
- Endocrinology Department, University hospital Ramón y Cajal. Ctra, Colmenar Viejo 9,1 Km, C.P. 28034 Madrid, Spain.
| | - Olga González Albarrán
- Endocrinology Department, University hospital Ramón y Cajal. Ctra, Colmenar Viejo 9,1 Km, C.P. 28034 Madrid, Spain.
| | - Pablo Guisado Vasco
- Internal Medicine Department, Hospital Quirón San Camilo, C/ Juan Bravo no 39, C.P. 2006 Madrid, Spain.
| | - Adelaida Lamas Ferreiro
- Paediatrics Department, Cystic Fibrosis Unit, University hospital Ramón y Cajal. Ctra, Colmenar Viejo 9,1 Km, C.P. 28034 Madrid, Spain.
| | - Luis Maiz Carro
- Pneumology Department, University hospital Ramón y Cajal. Ctra, Colmenar Viejo 9, 1 Km, C.P. 28034 Madrid, Spain.
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162
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Ghannem M, Bulvestre M, Jaunet N, Lepretre PM. [Muscle retraining or aerobic endurance training? What will improve the aerobic capacity of patients with coronary disease in the only 4 weeks?]. Ann Cardiol Angeiol (Paris) 2014; 63:445-50. [PMID: 25450993 DOI: 10.1016/j.ancard.2014.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effects of 4 weeks of CT and AT, which training impulse (total external workload and perceived exertion), are similar on power associated at VO2 peak (pVO2 peak) and cardiorespiratory responses of patient with CAD. METHOD Eighteen male with CAD (62 ± 7 years, 175 ± 2 cm, 84 ± 16 kg, fraction of ejection = 0.49 ± 0.16) performed 4 weeks of CT (n = 9) or AT (n = 9). pVO2 peak, maximal and first ventilatory threshold values of oxygen uptake (VO2 peak, VO2-vt) and heart rate (HRmax, HR-vt) were measured before and after training session. Total training impulse (exercise rehabilitation and other paramedical actions) were evaluated and harmonized between AT and CT according to Foster et al. formula (1996) RESULTS: No significant difference were found in training impulse between AT and CT (3650 ± 220 vs 3497 ± 190 U, P = NS). VO2 pic increased after AT (16.9 ± 4.4 vs 18.9 ± 4.9 mL O2/min/kg, P < 0.05) and remained unchanged after CT (17.7 ± 7.8 vs 17.8 ± 7.2, P = NS). Four weeks of training induced significant increase in pVO2 peak, VO2-vt and FC-vt, expressed in absolute or relative value (P < 0,05), without any difference between AT and CT modalities (P = NS). CONCLUSIONS Improving pVO2 pic following an exercise training does not necessarily preclude an improvement in coronary VO2 pic. pVO2 peak was not improved with the same cardiorespiratory adaptations between AT and CT. Thus, there seems important to measure gas exchanges of subject with CAD during the incremental test and identify the respective part of muscular and cardiorespiratory functions in exercise exhaustion.
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Affiliation(s)
- M Ghannem
- Unité de cardiologie interventionnelle, centre de prévention et de réadaptation cardiovasculaire Léopold-Bellan d'Ollencourt, hôpital de Gonesse, 38, route de Choisy, 60170 Tracy-le-Mont, France
| | - M Bulvestre
- Centre de prévention et de réadaptation cardiovasculaire Léopold-Bellan d'Ollencourt, 38, route de Choisy, 60170 Tracy-le-Mont, France
| | - N Jaunet
- Unité de cardiologie interventionnelle, centre de prévention et de réadaptation cardiovasculaire Léopold-Bellan d'Ollencourt, hôpital de Gonesse, 38, route de Choisy, 60170 Tracy-le-Mont, France
| | - P M Lepretre
- Laboratoire de recherche « adaptations physiologiques à l'exercice et réadaptation à l'effort », EA-3300, UFR-STAPS, université de Picardie Jules-Verne, allée Paschal-Grousset, 80025 Amiens cedex, France.
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163
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Schultz K. [COPD - non - pharmacological management and pulmonary rehabilitation]. MMW Fortschr Med 2014; 156 Spec no 2:44-50. [PMID: 25552019 DOI: 10.1007/s15006-014-3486-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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164
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Barsky E. [Chronic obstructive pulmonary disease, three suggestions by the Ministry of Health]. Soins 2014:10. [PMID: 25619086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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165
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Jin Y, Yao M, Li W, Chang H, Xu H, Zhang C, Xia J. [Pulmonary rehabilitation therapy of pneumoconiosis patients]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2014; 32:849-850. [PMID: 25579035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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166
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Araujo ASG, Klamt JG, Vicente WVDA, Garcia LV. Pain and cardiorespiratory responses of children during physiotherapy after heart surgery. Braz J Cardiovasc Surg 2014; 29:163-6. [PMID: 25140465 PMCID: PMC4389451 DOI: 10.5935/1678-9741.20140024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/19/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of the present study was to determine the occurrence of pain and changes in blood pressure, heart rate, respiratory rate, and arterial oxygen saturation associated with physiotherapy in children undergoing cardiac surgery. METHODS Eighteen extubated children were assessed for the presence of pain using the face, legs, activity, cry, consolability scale, and blood pressure, heart rate, respiratory rate and arterial oxygen saturation were simultaneously recorded. The physiological parameters were measured at the following time periods: immediately before physiotherapy, five and 10 minutes after the beginning of physiotherapy, and five minutes after its end. Pain was assessed immediately before physiotherapy, ten minutes after the beginning of physiotherapy and five minutes after its end. Pain and physiological changes were assessed by the Friedman test and the correlation between the physiological parameters and the pain scores was assessed by the Spearman test. RESULTS Pain increased during physiotherapy and decreased significantly after it compared to pre-physiotherapy scores. Systolic blood pressure and heart rate increased significantly after 10 minutes of the beginning of physiotherapy. Arterial oxygen saturation tended to decrease during physiotherapy and to increase after it, although without significance. The correlation between pain scores and the physiological variables was significant only for systolic blood pressure and heart rate ten minutes after the beginning of physiotherapy. CONCLUSION Manipulation after the beginning of physiotherapy seems to be accompanied by significant pain and by important associated cardiovascular changes. Apparent analgesia and improved respiratory function were observed after respiratory physiotherapy.
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Affiliation(s)
| | - Jyrson Guilherme Klamt
- Correspondence address: Jyrson Guilherme Klamt, Hospital das Clínicas
da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Av. dos
Bandeirantes, 3900 - Monte Alegre (Campus da USP), Ribeirão Preto, SP, Brazil - Zip
code: 14048-900. E-mail:
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167
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Willson J, Bateman ED, Pavord I, Lloyd A, Krivasi T, Esser D. Cost effectiveness of tiotropium in patients with asthma poorly controlled on inhaled glucocorticosteroids and long-acting β-agonists. Appl Health Econ Health Policy 2014; 12:447-459. [PMID: 24974107 DOI: 10.1007/s40258-014-0107-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND A considerable proportion of patients with asthma remain uncontrolled or symptomatic despite treatment with a high dose of inhaled glucocorticosteroids (ICSs) and long-acting β2-agonists (LABAs). Tiotropium Respimat(®) added to usual care improves lung function, asthma control, and the frequency of non-severe and severe exacerbations, in a population of adult asthma patients who are uncontrolled despite treatment with ICS/LABA. OBJECTIVE This study estimated the cost effectiveness of tiotropium therapy as add-on to usual care in asthma patients that are uncontrolled despite treatment with ICS/LABA combination from the perspective of the UK National Health Service (NHS). METHODS A Markov model was developed which considers levels of asthma control and exacerbations. The model analysed cost and quality-adjusted life-years (QALYs); sensitivity and scenario analyses were also conducted to test the robustness of the base case outcomes. All costs are given at 2012 prices. RESULTS The model found that in this category of asthma with unmet need, add-on tiotropium therapy generated an incremental 0.24 QALYs and £5,238 costs over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of £21,906 per QALY gained. Sensitivity analysis suggested that findings were most dependent on the costs of managing uncontrolled asthma and the cost of treatment with tiotropium. CONCLUSION In this modelled analysis of two clinical trials, tiotropium was found to be cost effective when added to usual care in patients who remain uncontrolled despite treatment with high-dose ICS/LABA. Further research should investigate the long-term treatment effectiveness of tiotropium.
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Affiliation(s)
- Jenny Willson
- Health Economics and Outcomes Research, Real-World Evidence Solutions, IMS Health, 210 Pentonville Road, London, N1 9JY, UK
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Gas when breathing through a tracheal stoma. Respir Care 2014; 59:i. [PMID: 25233525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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169
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Takahashi M, Yamanaka A, Asanuma C, Asano H, Satou T, Koike K. Anxiolytic-like effect of inhalation of essential oil from Lavandula officinalis: investigation of changes in 5-HT turnover and involvement of olfactory stimulation. Nat Prod Commun 2014; 9:1023-1026. [PMID: 25230519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Essential oil extracted from Lavandula officinalis (LvEO) has a long history of usage in anxiety alleviation with good evidence to support its use. However, findings and information regarding the exact pathway involved and mechanism of action remain inconclusive. Therefore, we aimed to (1) reveal the influence of olfactory stimulation, and (2) determine whether the serotonergic system is involved in the anxiolytic effect of LvEO when it is inhaled. To this end, we first compared the anxiety-related behaviors of normosmic and anosmic mice. LvEO inhalation caused notable elevation in anxiety-related parameters with or without olfactory perception, indicating that olfactory stimulation is not necessarily required for LvEO to be effective. Neurochemical analysis of the serotonin (5-HT) turnover rate, accompanied by EPM testing, was then performed. LvEO significantly increased the striatal and hippocampal levels of 5-HT and decreased turnover rates in accordance with the anxiolytic behavioral changes. These results, together with previous findings, support the hypothesis that serotonergic neurotransmission plays a certain role in the anxiolytic properties of LvEO.
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170
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Abstract
The first patient I went to visit during my time working with the respiratory team was a man who had chronic obstructive pulmonary disease (COPD). He was frightened of his breathlessness, felt that clinicians had 'given up on him' and thought nothing could be done to help.
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171
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Abstract
Anxiety and depression are common yet under-treated in respiratory care, says Karen Heslop-Marshall, nurse consultant in the Respiratory Cognitive Behavioural Therapy (CBT) Team at Newcastle upon Tyne Hospitals NHS Foundation Trust.
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172
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Huby G, Harris FM, Powell AE, Kielman T, Sheikh A, Williams S, Pinnock H. Beyond professional boundaries: relationships and resources in health services' modernisation in England and Wales. Sociol Health Illn 2014; 36:400-415. [PMID: 24266800 DOI: 10.1111/1467-9566.12067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article draws on theories of social capital to understand ways in which the negotiation of professional boundaries among healthcare professionals relates to health services change. We compared reconfiguration of respiratory services in four primary care organisations (PCOs) in England and Wales. Service development was observed over 18 months during a period of market-based reforms. Serial interviews with key clinicians and managers from hospital trusts and PCOs followed progress as they collaborated around, negotiated and contested developments. We found that professionals work to protect and expand their claims to work territory. Remuneration and influence was a catalyst for development and was also necessary to establish professional boundaries that underpinned novel service arrangements. Conflict and contest was less of a threat to change than a lack of engagement in boundary work because this engagement produced relationships based on forming shifting professional allegiances across and along boundaries, and these relationships mediated the social capital needed to accomplish change. However, this process also (re)produced inequalities among professions and prevented some groups from participation in service change.
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Affiliation(s)
- Guro Huby
- School of Health in Social Science, University of Edinburgh and Faculty of Health and Social Studies, University College Østfold, Norway
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173
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Abstract
Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease in the world, and its associated health burdens and costs are mounting. Until recently, it was generally accepted that targeting the diagnosis of COPD early in its course was a relatively fruitless effort, since treatments other than already ubiquitous smoking-cessation efforts were unlikely to alter its course. However, there is strong evidence to suggest that the majority of patients with objective COPD are not aware of their condition, and this leads to a significant delay in diagnosis, more aggressive smoking-cessation intervention, and potential treatment. Novel methods of diagnostic testing, community health programs, and primary-care provider recommendations hold promise to expand the recognition of COPD in its incipient stages - where recent evidence suggests a rapid decline in lung function occurs and may be prevented if acted upon. This review explores the evidence to support the efforts to justify programs aimed at early diagnosis, alternative diagnostic strategies that may augment traditional spirometry, therapeutic modalities that could potentially be used in the future to alter early lung-function decline, and emphasizes the necessary cooperative role that physicians, patients, communities, and governments need to play to realize the significant health impact that stands to be gained.
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Affiliation(s)
- Nicholas G Csikesz
- Warren Alpert Medical School of Brown University, Division of Pulmonary, Critical Care, and Sleep Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI, USA
| | - Eric J Gartman
- Warren Alpert Medical School of Brown University, Division of Pulmonary, Critical Care, and Sleep Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI, USA
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174
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Abstract
Inhaled antibiotics are not usually considered outside the setting of cystic fibrosis or Pneumocystis jiroveci prophylaxis. However, because they deliver high drug concentrations at the site of infection with negligible systemic absorption and toxicity, they are logical compliments to standard intravenous therapy for severe nosocomial pneumonias -- particularly those caused by multiresistant organisms. Older studies that have shown marginal or no benefit have either applied inhaled antibiotics indiscriminately to low risk populations, or have used crude delivery systems, such as hand atomizers or poured it into the endotracheal tube. Although inhaled antibiotics cannot be recommended for prevention of nosocomial pneumonia at this time, a few studies involving prophylaxis have shown promising trends, particularly in high-risk patients with predisposing conditions. The greatest potential of inhaled antibiotics lies in the treatment of severe healthcare-associated pneumonia caused by a multiresistant organism. The method of delivery is extremely important. Trials that have shown the most benefit, even against pathogens most difficult to eradicate and in damaged lungs, have used optimized delivery systems. Most authorities recommend using ultrasonic or vibrating disk nebulizers to generate particle sizes between 1 and 5 microm that are crucial for deposition in terminal bronchioles and alveoli. Inhaled liposomal amphotericin has also demonstrated encouraging results in animal trials. Recently, inhaled phytochemicals were successfully employed in the treatment of a patient with primary pulmonary tuberculosis. When used selectively in high-risk patients, or in the treatment of established pneumonia, inhaled antibiotics have not been associated with development of resistant organisms.
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Affiliation(s)
- Emil Lesho
- Walter Reed Army Medical Center, Infectious Diseases, 611 Forest Glen Road, Silver Spring, MD 20901, USA.
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175
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Canares TL, Tucker C, Garro A. Going with the flow: respiratory care in the pediatric emergency department. R I Med J (2013) 2014; 97:23-26. [PMID: 24400308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Providers in pediatric emergency departments (ED) frequently encounter a variety of life-threatening respiratory illnesses. This article reviews current updates on the management and unique adjuncts for 3 common respiratory illnesses. Discussed first is bronchiolitis and the impact of high flow nasal cannula on reducing the need for intubation. Next, the current therapy for croup and the adjunctive use of Heliox and finally, the ED approach to asthma and treatment with breath actuated nebulizers.
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Affiliation(s)
- Therese L Canares
- affiliated with Hasbro Children's Hospital/The Warren Alpert Medical School of Brown University, Providence, RI
| | - Craig Tucker
- affiliated with Hasbro Children's Hospital/The Warren Alpert Medical School of Brown University, Providence, RI
| | - Aris Garro
- Assistant Professor, The Warren Alpert Medical School of Brown University, and Pediatric Emergency Medicine Attending, Hasbro Children's Hospital, Providence, RI
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Zen'ko MY, Rybnikova YA, Glushchenko TS. [Expression of BDNF neurotrophin in the hippocampus and neocortex of rats during the development of post-stress anxiety and its correction by hypoxic postconditioning]. Morfologiia 2014; 146:14-18. [PMID: 25823283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Using quantitative immunohistochemistry, changes in the expression of the BDNF (Brain-Derived Neurotrophic Factor) were studied in the hippocampus and neocortex of 24 male Wistar rats during the development of post-stress-related anxiety state in the experimental model of posttraumatic stress disorder, and its correction by hypoxic postconditioning (PC). For the induction of anxiety state, combined severe psychoemotional stress was applied (immobilization, forced swimming, ether stress followed 7 days later by repeated immobilization - restress). Correction of the anxiety state was achieved by application of hypoxic PC, which included three sessions of mild hypobaric hypoxia (360 mm Hg, 2 h, daily). The formation of the anxiety pathology was accompanied by a significant reduction in the expression of immunoreactive BDNF in dorsal (CA1) and ventral (dentate gyrus) hippocampus and neocortex, while hypoxic PC resulted in partial (hippocampus) or complete (neocortex) restoration of BDNF expression. The results indicate that the neurotrophic factors, and BDNF in particular, seem to play an important role in the pathogenesis of the anxiety-depressive disorders as well as in mechanisms of proadaptive and neuroprotective effects of hypoxic PC.
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Vázquez-Cárdenas NA, Ibarra-Hernández F, López-Hernández LB, Escobar-Cedillo RE, Ruano-Calderón LA, Gómez-Díaz B, García-Calderón N, Carriedo-Dávila MF, Rojas-Hurtado LG, Luna-Padrón E, Coral-Vázquez RM. [Diagnosis and treatment with steroids for patients with Duchenne muscular dystrophy: experience and recommendations for Mexico. Administración del Patrimonio de la Beneficencia Pública. Asociación de Distrofia Muscular de Occidente]. Rev Neurol 2013; 57:455-462. [PMID: 24203668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Duchenne muscular dystrophy is a severe, debilitating and progressive disease that affects 1 in 3,500 live male births in the world. The diagnosis should be confirmed by genetic testing to identify the mutation in the DMD gene or muscle biopsy and immunostaining to demonstrate the absence of dystrophin. Although up to now continues to be an incurable disease, this does not mean it has no treatment. Treatment should be multidisciplinary, looking for the functionality of the patient and avoiding or correcting complications, mainly cardio-respiratory and skeletal. Many proposals have been evaluated and implemented with the aim of improving the quality of life for these patients. The long-term steroids have shown significant benefits, such as prolonging ambulation, reduce the need for spinal surgery, improve cardiorespiratory function and increase survival and the quality of life. This document presents the recommendations based on the experience of the working group and experts worldwide on the diagnosis and treatment with steroids for patients with Duchenne muscular dystrophy.
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178
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Park YC, Jin M, Kim SH, Kim MH, Namgung U, Yeo Y. Effects of inhalable microparticle of flower of Lonicera japonica in a mouse model of COPD. J Ethnopharmacol 2013; 151:123-130. [PMID: 24211495 DOI: 10.1016/j.jep.2013.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/14/2013] [Accepted: 10/03/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Flower of Lonicera japonica (FLJ) is a traditional herbal medicine widely used in East Asia as an anti-inflammatory and anti-oxidative agent. The purpose of this study is to develop an inhalable powder formulation of FLJ and to evaluate its biological effects in a mouse model of chronic obstructive pulmonary disease (COPD). METHODS Inhalable dry powder containing FLJ was produced by spray-drying with leucine as an excipient. Its aerodynamic properties and anti-inflammatory activities were evaluated using the Anderson cascade impactor (ACI) and a mouse model of COPD, respectively. RESULTS FLJ microparticle (FLJmp) had a hollow spherical shape in electron microscopy and showed aerodynamic properties suitable for inhalation (fine particle fraction of 54.0 ± 4.68% and mass median aerodynamic diameter of 4.6 ± 0.34μm). FLJmp decreased TNF-α and IL-6 expression in RAW264.7 cells activated by lipopolysaccharide (LPS). In mice challenged with LPS and cigarette smoke solution (CSS) to develop COPD, FLJmp decreased the levels of TNF-α and IL-6 in bronchoalveolar fluidas well as the number of inflammatory cells including neutrophils in peripheral blood. In addition, FLJmp induced recovery of elastin and collagen distribution, reduction of caspase-3 expression in lung tissues of COPD mice. CONCLUSIONS Inhalational delivery of FLJ using a microparticle system is a promising strategy for the treatment of COPD.
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Affiliation(s)
- Yang-Chun Park
- College of Oriental Medicine, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea; East-West Biological Science Institute, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea
| | - Mirim Jin
- College of Oriental Medicine, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea; East-West Biological Science Institute, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea
| | - Seung-Hyung Kim
- College of Oriental Medicine, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea; East-West Biological Science Institute, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea
| | - Min-Hee Kim
- College of Oriental Medicine, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea; East-West Biological Science Institute, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea
| | - Uk Namgung
- College of Oriental Medicine, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea; East-West Biological Science Institute, Daejeon University, 96-3 Yongwun-dong, Daejeon 300-716, South Korea
| | - Yoon Yeo
- College of Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.
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179
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Jakobsen AS, Laursen LC, Østergaard B, Rydahl-Hansen S, Phanareth KV. Hospital-admitted COPD patients treated at home using telemedicine technology in The Virtual Hospital Trial: methods of a randomized effectiveness trial. Trials 2013; 14:280. [PMID: 24139548 PMCID: PMC3766220 DOI: 10.1186/1745-6215-14-280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/27/2013] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary disease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality of life. However, the studies are few and only involve COPD patients who are in a stable phase or in-patients who are ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine solutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute exacerbation of COPD at home as compared to conventional hospital treatment measured according to first treatment failure, which is defined as readmission due to COPD within 30 days after discharge. METHODS COPD patients with acute exacerbation who fulfilled the eligibility criteria and were from two university hospitals in Denmark were randomized (1:1) by computer-generated tables that allocated treatments in blocks of four to receive either standard treatment at the hospital or the same standard treatment at home using telemedicine technology (that is, a video conference system with a touch screen and webcam and monitoring equipment (spirometer, thermometer, and pulse oximeter)). Patients treated in the telemedicine group were backed up by an organizational setting securing 24/7/365 online access to the hospital, as well as access to oxygen, nebulizer therapy, oral medical therapy and surveillance of vital parameters from home monitoring devices. Patients in both groups were discharged when clinically stable and when fulfilling five pre-specified discharge criteria. Follow-up was performed at 1, 3 and 6 months after discharge. RESULTS Enrollment of patients started in June 2010 and ended in December 2011. Follow-up ended in May 2012. Results were analyzed in 2013. CONCLUSIONS The results may have implications on future hospital treatment modalities for patients with severe exacerbations in COPD where telemedicine may be used as an alternative to conventional admission. TRIAL REGISTRATION Clinical Trials NCT01155856.
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Affiliation(s)
- Anna Svarre Jakobsen
- Research Unit of Clinical Nursing, Bispebjerg & Frederiksberg University Hospital, Bispebjerg Bakke 23a, DK 2400, Copenhagen, NV, Denmark
| | - Lars C Laursen
- Medical Department O, Herlev University Hospital, Herlev Ringvej 75, DK 2730, Herlev, Denmark
| | - Birte Østergaard
- Research Unit of Nursing, Institute of Clinical Research, University of Southern Denmark, Campusvej 55, DK 5230, Odense M, Denmark
| | - Susan Rydahl-Hansen
- Research Unit of Clinical Nursing, Bispebjerg & Frederiksberg University Hospital, Bispebjerg Bakke 23a, DK 2400, Copenhagen, NV, Denmark
| | - Klaus V Phanareth
- Medical Department M, Frederiksberg University Hospital, Nordre Fasanvej 57, DK 2000, Frederiksberg, Denmark
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Sigalet E, Donnon T, Cheng A, Cooke S, Robinson T, Bissett W, Grant V. Development of a team performance scale to assess undergraduate health professionals. Acad Med 2013; 88:989-96. [PMID: 23702524 DOI: 10.1097/acm.0b013e318294fd45] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Interprofessional simulation-based team training is strongly endorsed as a potential solution for improving teamwork in health care delivery. Unfortunately, there are few teamwork evaluation instruments. The present study developed and tested the psychometric characteristics of the newly developed KidSIM Team Performance Scale checklist. METHOD A quasi-experimental research design engaging a convenience sample of 196 undergraduate medical, nursing, and respiratory therapy students was completed in the 2010-2011 academic year. Multidisciplinary student teams participated in a simulation-based curriculum that included the completion of two acute illness management scenarios, resulting in 282 independent reviews by evaluators from medicine, nursing, and respiratory therapy. The authors investigated the underlying factors of the performance checklist and examined the performance scores of an experimental and a control team-training-curriculum group. RESULTS Participation in the supplemental team training curriculum was related to higher team performance scores (P < .001). All teams at Time 2 achieved higher scores than at Time 1 (P < .05). The reliability coefficient for the total performance scale was α = 0.90. Factor analysis supported a three-factor solution (accounting for 67.9% of the variance) with an emphasis on roles and responsibilities (five items) and communication (six items) subscale factors. CONCLUSIONS When simulation is used in acute illness management training, the KidSIM Team Performance Scale provides reliable, valid score interpretation of undergraduates' team process based on communication effectiveness and identification of roles and responsibilities. Implementation of a supplementary team training curriculum significantly enhances students' performance in multidisciplinary simulation-based scenarios at the undergraduate level.
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Affiliation(s)
- Elaine Sigalet
- Department of Pediatrics, Faculty Medicine, University of Calgary, Calgary, Alberta, Canada
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Bossaer JB, Gray JA, Miller SE, Enck G, Gaddipati VC, Enck RE. The use and misuse of prescription stimulants as "cognitive enhancers" by students at one academic health sciences center. Acad Med 2013; 88:967-971. [PMID: 23702522 DOI: 10.1097/acm.0b013e318294fc7b] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Prescription stimulant use as "cognitive enhancers" has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. METHOD Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. RESULTS Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). CONCLUSIONS Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., "cognitive enhancement"), educational quality, and patient safety or health care quality.
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Affiliation(s)
- John B Bossaer
- Department of Pharmacy Practice, Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA.
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182
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Wang CS, Wang XD, Zhang L. [An introduction of inhalation therapy]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 48:609-613. [PMID: 24313217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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183
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Área de asma de SEPAR, Área de enfermería de SEPAR, Departamento de asma ALAT. [SEPAR-ALAT consensus for inhaled therapies]. Arch Bronconeumol 2013; 49 Suppl 1:2-14. [PMID: 23967487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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184
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Editor's commentary. Respir Care 2013; 58:737. [PMID: 23625892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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185
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Respiratory care. Editor's commentary. Respir Care 2013; 58:569. [PMID: 23564872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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186
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Sato H, Ogawa K, Kojo Y, Kawabata Y, Mizumoto T, Yamada S, Onoue S. Development of cyclosporine A-loaded dry-emulsion formulation using highly purified glycerol monooleate for safe inhalation therapy. Int J Pharm 2013; 448:282-9. [PMID: 23528280 DOI: 10.1016/j.ijpharm.2013.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/13/2013] [Accepted: 03/14/2013] [Indexed: 12/28/2022]
Abstract
The main objective of this study was to improve the safety and oxidative stability of glycerol monooleate (GMO)-based dry-emulsion (DE) formulation containing cyclosporine A (CsA) for inhalation therapy. GMO or highly purified GMO (hpGMO) was used as surfactant for the DE formulations (GMO/DE or hpGMO/DE), the toxicological and physicochemical properties of which were characterized with a focus on oxidative stability, in vitro/in vivo toxicity, and dissolution property. Incubation of GMO at oxidation accelerating conditions for 10 days at 60°C resulted in the formation of lipid peroxides as evidenced by increased malondialdehyde (111 μmol/mg); however, hpGMO samples exhibited increase of only 20.7 μmol/mg in malondialdehyde level. No significant acute cytotoxicity was observed in rat alveolar L2 cells exposed to hpGMO (0.28mM), and intratracheal administration of hpGMO powder in rats did not cause an increase of the plasma LDH level. The hpGMO/DE exhibited marked improvement in dissolution behavior of CsA, and stable fine micelles with a mean diameter of 320 nm were formed when suspended in water. A respirable powder formulation of hpGMO/DE (hpGMO/DE-RP) was newly prepared, and its in vitro inhalation property and in vivo efficacy were also evaluated. The hpGMO/DE-RP exhibited high dispersibility in laser diffraction analysis and significantly improved potency to attenuate recruitment of inflammatory cells into airway and thickening of airway wall in an animal model. Thus, the strategic use of hpGMO would improve oxidative stability and local toxicity compared with a GMO-based DE formulation, and its application to RP formulation could be a promising approach for effective inhalation therapy.
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Affiliation(s)
- Hideyuki Sato
- Department of Pharmacokinetics and Pharmacodynamics, School of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
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Commentary on the March 2013 issue. Respir Care 2013; 58:409. [PMID: 23443281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Armagan O, Serin DK, Calisir C, Dokumacioglu A, Ozgen M, Oner S, Alatas O. Inhalation therapy of calcitonin relieves osteoarthritis of the knee. J Korean Med Sci 2012; 27:1405-10. [PMID: 23166425 PMCID: PMC3492678 DOI: 10.3346/jkms.2012.27.11.1405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 08/27/2012] [Indexed: 01/15/2023] Open
Abstract
This study was conducted to determine if nasal salmon calcitonin has additional beneficial effects on clinical symptoms, serum NO, IL-1β, matrix metalloproteinase 3, urinary C-terminal telopeptide type II collagen (CTX-II) levels and MRI findings in knee osteoarthritis (OA) when used concomitantly with exercise therapy. Fifty female patients with knee OA were randomized into two groups. The first group (n = 30) received 200 IU/day nasal salmon calcitonin and a home exercise program; the second group (n = 20) received a home exercise program for 6 months. Compared with baseline,while significant improvements were observed in visual analogue scale (VAS), WOMAC pain, physical function scores, 20-m walking time (P < 0.001) and WOMAC stiffness score (P = 0.041) in the first group, walking and resting VAS, and WOMAC physical function scores were improved (P = 0.029) in the second group after treatment. Significantly increased levels of serum NO and urinary CTX-II (P < 0.001) and significant improvements in the area of medial femoral condyle (P < 0.05) were noted only in the first group. There were significant differences in VAS activation values (P = 0.032) and NO levels (P < 0.001) in the favor of the first group. In conclusion, nasal salmon calcitonin may have possible chondroprotective effects besides its known effects on symptoms in patients with knee OA.
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Affiliation(s)
- Onur Armagan
- Department of Physical Therapy and Rehabilitation, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey.
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189
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Vehring R, Lechuga-Ballesteros D, Joshi V, Noga B, Dwivedi SK. Cosuspensions of microcrystals and engineered microparticles for uniform and efficient delivery of respiratory therapeutics from pressurized metered dose inhalers. Langmuir 2012; 28:15015-15023. [PMID: 22985189 DOI: 10.1021/la302281n] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Engineered porous phospholipid microparticles with aerodynamic diameters in the respirable range of 1-2 μm were cosuspended in 1,1,1,2-tetrafluoroethane, a propellant, with microcrystals of glycopyrrolate, formoterol fumarate dihydrate, or Mometasone furoate-three drugs with different solubilities in the propellant, and different physical, chemical, and pharmacological attributes. The drug microcrystals were added individually, in pairs, or all three together to prepare different cosuspensions, contained in a pressurized metered dose inhaler (pMDI). The drug microcrystals irreversibly associated with the porous particles, and the resultant cosuspensions possessed greatly improved suspension stability compared with suspensions of drug microcrystals alone. In general, all cosuspensions showed efficient dose delivery of the drugs, with fine particle fractions of more than 60% for a wide range of doses, including those as low as 300 ng per inhaler actuation. In the cosuspension pMDIs, comparable fine particle fractions were delivered for all tested drugs, whether or not they were emitted from an inhaler containing one, two, or three drugs. We demonstrate that the cosuspension approach solves at least three long-standing problems in the clinical development of pMDI-based products: (1) dose and drug dependent delivery efficiency, (2) inability to formulate dose strengths below 1 μg to fully explore drug efficacy and safety, and (3) combination suspensions delivering a different fine particle fraction than individual drug suspensions.
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Affiliation(s)
- Reinhard Vehring
- Pearl Therapeutics, Inc., Redwood City, California 94063, United States
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190
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Tsai MJ, Huang JY, Wei PJ, Wang CY, Yang CJ, Wang TH, Hwang JJ. Outcomes of the patients in the respiratory care center are not associated with the seniority of the caring resident. Kaohsiung J Med Sci 2012; 29:43-9. [PMID: 23257256 DOI: 10.1016/j.kjms.2012.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/02/2012] [Indexed: 11/20/2022] Open
Abstract
Although many studies show that the experience level of physicians is significantly associated with the outcomes of their patients, little evidence exists to show whether junior residents provide worse care than senior residents. This study was conducted to analyze whether the experience level of residents may affect the outcomes of patients cared for in a well-organized setting. We conducted a 7-year retrospective study utilizing statistical data from a respiratory care center (RCC) in a medical center between October 2004 and September 2011. In addition to the two medical residents who had been trained in the intensive care unit (ICU), the RCC team also included attending physicians in charge, a nurse practitioner, a case manager, a dietitian, a pharmacist, a social worker, registered respiratory therapists, and nursing staff. Weaning from mechanical ventilation was done according to an established weaning protocol. The 84 months analyzed were classified into five groups according to the levels of the two residents working in the RCC: R2 + R1, R2 + R2, R3 + R1, R3 + R2, and R3 + R3. The monthly weaning rate and mortality rate were the major outcomes, while the mean ventilator days, rate of return to the ICU, and nosocomial infection incidence rate were the minor outcomes. The groups did not differ significantly in the monthly weaning rate, mortality rate, mean ventilator days, rate of return to the ICU, or nosocomial infection incidence rate (p > 0.1). Further analysis showed no significant difference in the monthly weaning rate and mortality rate between months with a first-year resident (R1) and those with two senior residents (p > 0.2). Although the weaning rate in the RCC gradually improved over time (p < 0.001), there was no significant difference in the monthly weaning rate between the groups after adjusting for time and disease severity (p > 0.7). Thus, we concluded that in a well-organized setting, the levels (experiences) of residents did not significantly affect patient outcomes. This result may be attributed to the well-developed weaning protocol and teamwork processes in place, which avoid a large effect from any single factor and provide stable and high-quality care to the patients.
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Affiliation(s)
- Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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191
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Pelerin L. [Chest congestion and respiratory therapy in the elderly]. Soins Gerontol 2012:42-43. [PMID: 22852504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In geriatrics, the usual approach is "primum non nocere":"first do no harm". Physiotherapists must adapt the techniques and exercises they use to the clinical situation of each patient. Close collaboration with the doctor enables care to be modified in accordance with the development of the symptomatology and the therapeutic objectives.
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192
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Abstract
The mechanisms of COPD exacerbation are complex. Respiratory viruses (in particular rhinovirus) and bacteria play a major role in the causative etiology of COPD exacerbations. In some patients, noninfective environmental factors may also be important. Data recently published from a large observational study identified a phenotype of patients more susceptible to frequent exacerbations. Many current therapeutic strategies can reduce exacerbation frequency. Future studies may target the frequent exacerbator phenotype, or those patients colonized with potential bacterial pathogens, for such therapies as long-term antibiotics, thus preventing exacerbations by decreasing bacterial load or preventing new strain acquisition in the stable state. Respiratory viral infections are also an important therapeutic target for COPD. Further work is required to develop new anti-inflammatory agents for exacerbation prevention, and novel acute treatments to improve outcomes at exacerbation.
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Affiliation(s)
- Alex J Mackay
- Academic Unit of Respiratory Medicine, Royal Free Campus, UCL Medical School, London, UK.
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193
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Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction that is only partly reversible, inflammation in the airways, and systemic effects or comorbities. The main cause is smoking tobacco, but other factors have been identified. Several pathobiological processes interact on a complex background of genetic determinants, lung growth, and environmental stimuli. The disease is further aggravated by exacerbations, particularly in patients with severe disease, up to 78% of which are due to bacterial infections, viral infections, or both. Comorbidities include ischaemic heart disease, diabetes, and lung cancer. Bronchodilators constitute the mainstay of treatment: β(2) agonists and long-acting anticholinergic agents are frequently used (the former often with inhaled corticosteroids). Besides improving symptoms, these treatments are also thought to lead to some degree of disease modification. Future research should be directed towards the development of agents that notably affect the course of disease.
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Affiliation(s)
- Marc Decramer
- Respiratory Division, University Hospital, University of Leuven, Leuven, Belgium.
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Guimarães FS, Moço VJR, Menezes SLS, Dias CM, Salles REB, Lopes AJ. Effects of ELTGOL and Flutter VRP1® on the dynamic and static pulmonary volumes and on the secretion clearance of patients with bronchiectasis. Rev Bras Fisioter 2012; 16:108-113. [PMID: 22481696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Although respiratory physical therapy is considered fundamental in the treatment of hypersecretive patients, there is little evidence of its physiological and therapeutic effects in bronchiectasis patients. OBJECTIVE To evaluate the acute physiological effects of ELTGOL and Flutter VRP1® in dynamic and static lung volumes in patients with bronchiectasis and, secondarily, to study the effect of these techniques in sputum elimination. METHODS Patients with clinical and radiological diagnosis of bronchiectasis were included. Patients underwent three interventions in a randomized order and with a one-week washout interval between them. Before all interventions patients inhaled two puffs of 100 mcg of salbutamol. There was a cough period of five minutes before and after the control protocol and the interventions (ELTGOL and Flutter VRP1®). After each cough series patients underwent assessments of dynamic and static lung volumes by spirometry and plethysmography. The expectorated secretions were collected during the interventions and during the second cough series, and quantified by its dry weight. RESULTS We studied 10 patients, two males and eight females (mean age: 55.9±18.1 years). After using Flutter VRP1®and ELTGOL there was a significant decrease in residual volume (RV), functional residual capacity (FRC) and total lung capacity (TLC) (p<0.05). There was a higher sputum production during ELTGOL compared with Control and Flutter VRP1® (p<0.05). CONCLUSION The ELTGOL and Flutter VRP1® techniques acutely reduced lung hyperinflation, but only the ELTGOL increased the removal of pulmonary secretions from patients with bronchiectasis.
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Affiliation(s)
- Fernando S Guimarães
- Serviço de Pneumologia, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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195
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Black SJ, Carson EM, Doughty A. How much and where: assessment of knowledge level of the application of cricoid pressure. J Emerg Nurs 2012; 38:370-4. [PMID: 22421316 DOI: 10.1016/j.jen.2011.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/28/2011] [Accepted: 11/20/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Application of cricoid pressure is a frequently used technique in both rapid sequence intubation in multiple settings and in a more controlled setting in the operating room. In a survey of emergency department personnel performed at the University of Michigan, it was found that there is a knowledge deficit in the recommended force and the anatomic localization of cricoid pressure. Participants in the original study, which included emergency nurses, medical residents, and attending physicians, rated their training in cricoid pressure as poor or nonexistent. A review of the literature shows that, although cricoid pressure is used during endotracheal intubation to protect against regurgitation of gastric contents, many people applying cricoid pressure do not have a good knowledge of where to apply the pressure or how much pressure to apply to be effective. Because cricoid pressure is applicable in areas other than the emergency department, our study surveys personnel in emergency medical services/flight crew; emergency, intensive care unit, and operating room nurses; and respiratory therapists. Even though the use of cricoid pressure is no longer recommended, it is still routinely used. Although applying cricoid pressure is a simple procedure, persons using it must be thoroughly trained and retrained to prevent complications. METHODS When we replicated the University of Michigan study at a 254-bed tertiary care facility, a potential of 325 staff members were given access to an online survey using the questions in the original survey. Staff were assigned to a HealthStream module and sent an invitation through their employee e-mail account. The module included a link to the questionnaire, and demographic data were gathered. The module was optional and results confidential. RESULTS Operating room nurses were most likely to receive supervised instruction on anesthetized patients. These operating room nurses also showed the highest overall knowledge level about the application technique of cricoid pressure. DISCUSSION There continues to be a lack of knowledge about the application of cricoid pressure during intubation. There is an opportunity for collaboration between staff and academic educators to allow for additional theoretical as well as hands-on practice.
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196
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Nayak RP. Latest in cystic fibrosis. Mo Med 2012; 109:127-132. [PMID: 22675793 PMCID: PMC6181745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cystic Fibrosis (CF) is a genetic disease affecting multiple organs. There are about 30,000 patients with CF in the United States, resulting from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, as well as its protein product. The life expectancy of CF patients has increased steadily over recent years, with the current expectation being for them to live into their late 30s. This is due to increased understanding, and therapeutic advances in the CF treatment armamentarium.
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Affiliation(s)
- Ravi P Nayak
- Division of Pulmonary, Critical Care, and Sleep Medicine, Saint Louis University School of Medicine, USA.
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197
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Lougheed MD, Lemiere C, Ducharme FM, Licskai C, Dell SD, Rowe BH, FitzGerald M, Leigh R, Watson W, Boulet LP. Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults. Can Respir J 2012; 19:127-64. [PMID: 22536582 PMCID: PMC3373283 DOI: 10.1155/2012/635624] [Citation(s) in RCA: 207] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and⁄or gaps in the previous guidelines. METHODS Four clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS⁄long-acting beta(2)-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations. RESULTS The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified. CONCLUSIONS The present clinical practice guideline is the first update of the CTS Asthma Guidelines following the Canadian Respiratory Guidelines Committee's new guideline development process. Tools and strategies to support guideline implementation will be developed and the CTS will continue to regularly provide updates reflecting new evidence.
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[Physical training is a universal method of pulmonary rehabilitation of patients with chronic obstructive pulmonary disease]. TERAPEVT ARKH 2012; 84:17-21. [PMID: 22708417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To study systemic effects of chronic obstructive pulmonary disease (COPD) of stage III-IV and to assess their response to pulmonary rehabilitation method physical training (PT). MATERIAL AND METHODS The study enrolled 112 patients aged 46-72 years (mean age 64.3 years) with severe and extremely severe COPD. Of them, 57 patients received standard pharmacotherapy, exercise training and training with respiratory trainers. The control group of 55 patients received only pharmacotherapy. At the start and in the end of the study the following parameters were examined: 6-min walk, inspiratory and expiratory muscles performance (Pi, Pe), functional changes in the lungs, quality of life by MOS SF-36 questionnaire, depressive alterations by CES-D questionnaire, markers of systemic inflammation (TNF-alpha, IL-6, IL-1 beta. C-reactive protein, testosterone). RESULTS At the start of the study all the examinees had low exercise tolerance according to 6-min walk test (266,7 M), inspiratory and expiratory muscles performance (Pi 54,8 cm of water, Pe 75,3 cm of water). Patients from the PT group improved the above parameters: pulmonary function, 6-min walk by 80 m, Pi--to 77.2 cm. Pe--to 89.8 cm, functional residual capacity reduced by 14%, residual pulmonary volume--by 30%, CRP--by 8.1 mg/l, IL-6 by 8.3 pkg/ml, depression regressed, testosterone rose. Patients from the control group improved the above parameters insignificantly. CONCLUSION PT is a universal method of pulmonary, rehabilitation having a positive action on various COPD systemic effects.
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200
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Solache-Carranco A, Sánchez-Bringas MG. Evaluation of a respiratory rehabilitation program in children with scoliosis. CIR CIR 2012; 80:11-17. [PMID: 22472147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Thoracic scoliosis is a lateral curvature of the spine associated with restrictive lung defects, manifested by a decrease in respiratory function tests. We undertook this study to evaluate the effect of a respiratory rehabilitation program over lung function in children with scoliosis. METHODS We carried out a prospective and deliberate intervention study including 25 consecutive patients, aged 6 to 18 years, diagnosed with thoracic scoliosis. The respiratory rehabilitation program was structured into two phases: institutional and private residence. Statistical analysis was carried out using descriptive parameters and paired t-test and Wilcoxon signed-ranks test. Spearman correlation was used to measure intensity of association among variables. Statistical significance was considered when p <0.05. RESULTS Idiopathic scoliosis was present in 52% of patients, with right dorsal curvature in 72%. Cobb angle average was 50.6° ± 29.7°. Most importantly, we found a negative correlation between this angle on left curvature and lung function. Initially, the main respiratory symptoms were dyspnea with poor effort tolerance in 52%. After treatment, 88% of patients were asymptomatic and only 4% presented poor effort tolerance. Oxygen saturation and forced vital capacity percentage had a significant increment after the program. CONCLUSION Respiratory rehabilitation has a positive effect on increasing pulmonary function of children with scoliosis.
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Affiliation(s)
- Angela Solache-Carranco
- Servicio de Rehabilitación Pulmonar, Instituto Nacional de Rehabilitación, México, DF, Mexico.
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