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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] [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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de Decker L, Beauchet O, Gouraud-Tanguy A, Berrut G, Annweiler C, Le Conte P. Treatment-limiting decisions, comorbidities, and mortality in the emergency departments: a cross-sectional elderly population-based study. J Nutr Health Aging 2012; 16:914-8. [PMID: 23208032 DOI: 10.1007/s12603-012-0414-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Older adults experience a higher risk of death in the emergency departments (EDs), in part, as a result of their comorbidities. A treatment-limiting decision is often reported for older adults who die in the EDs. The Charlson Comorbidity Index (CCI) is a validated method for the scoring of comorbidities. Whether an association between the CCI and treatment-limiting decisions exists remains unknown. OBJECTIVE To determine whether the CCI was associated with the treatment-limiting decisions made for older patients who die in the EDs. METHODS A total of 2,095 patients ≥65 years old who died in the EDs in France and Belgium were prospectively included between 2004 and 2005. The recorded data included: 1) the CCI score; 2) patient age; 3) gender; 4) living in senior housing facilities; 5) hospitalizations occurring in the previous year; 6) presence of functional limitations (according to the Knaus classification); 7) chronic diseases; and 8) presence of organ failure(s). A treatment-limiting decision was defined as a predetermined choice not to implement therapies that would otherwise be required to sustain life. RESULTS A treatment-limiting decision was identified in 993 (47%) patients. Fully-adjusted logistic regression model showed that a CCI ≥ 5 (OR=25.56 with P=0.037), age ≥85years (OR=20.33 with P<0.001), living in an institution (OR=0.15 with P=0.017), hematologic (OR=6.92 with P=0.020) and respiratory disease (OR=0.17 with P=0.046), and neurologic causes (OR=0.20 with P=0.010) of organ failure were significantly associated with treatment-limiting decisions. CONCLUSION An elevated CCI score (≥5) was associated with a treatment-limiting decision in elderly patients evaluated in the EDs. Further research is needed to corroborate this finding.
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Jacquemin B, Kauffmann F, Pin I, Le Moual N, Bousquet J, Gormand F, Just J, Nadif R, Pison C, Vervloet D, Künzli N, Siroux V. Air pollution and asthma control in the Epidemiological study on the Genetics and Environment of Asthma. J Epidemiol Community Health 2012; 66:796-802. [PMID: 21690606 PMCID: PMC3943770 DOI: 10.1136/jech.2010.130229] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The associations between exposure to air pollution and asthma control are not well known. The objective of this study was to assess the association between long-term exposure to NO(2), O(3) and PM(10) and asthma control in the follow-up of the Epidemiological study on the Genetics and Environment of Asthma (EGEA2) (2003-2007). METHODS Modelled outdoor NO(2), O(3) and PM(10) estimates were linked to each residential address using the 4 km grid air pollutant surface developed by the French Institute of Environment in 2004. Asthma control was assessed in 481 subjects with current asthma using a multidimensional approach following the 2006-2009 Global Initiative for Asthma guidelines. Multinomial and ordinal logistic regressions were conducted adjusted for sex, age, body mass index, education, smoking and use of inhaled corticosteroids. The association between air pollution and the three domains of asthma control (symptoms, exacerbations and lung function) was assessed. ORs are reported per IQR. RESULTS Median concentrations (in micrograms per cubic metre) were 32 (IQR 25-38) for NO(2) (n=465), 46 (41-52) for O(3) and 21 (18-21) for PM(10) (n=481). In total, 44%, 29% and 27% had controlled, partly controlled and uncontrolled asthma, respectively. The ordinal ORs for O(3) and PM(10) with asthma control were 1.69 (95% CI 1.22 to 2.34) and 1.35 (95% CI 1.13 to 1.64), respectively. When including both pollutants in the same model, both associations persisted. Associations were not modified by sex, smoking status, use of inhaled corticosteroids, atopy, season of examination or body mass index. Both pollutants were associated with each of the three main domains of control. CONCLUSIONS The results suggest that long-term exposure to PM(10) and O(3) is associated with uncontrolled asthma in adults, defined by symptoms, exacerbations and lung function.
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Yabuki H, Tabata T, Sugawara T, Mitomo H, Miyamoto A, Fujimura S. [Examination using multivariate analysis of the risk factors by surgical approach in elderly intractable pneumothorax]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2012; 65:761-768. [PMID: 22868458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE In this study, we evaluated the risk factors for postoperative complications in elderly patients with intractable pneumothorax and constructed a risk assessment model. MATERIALS AND METHODS Between January 2004 and December 2011, 83 elderly patients( age, 75 years or older) underwent an operation at our hospital for intractable pneumothorax. Preoperative factors of these cases were assessed to clarify which is contributory to the development of postoperative complications by using univariate analysis and multivariate logistic regression analysis. RESULTS Thirty-five patients (42.2%) developed postoperative complications. In univariate analysis, total protein, albumin level, blood urea nitrogen, creatinine level, Paco2, body mass index, performance status, and preoperative respiratory complications showed statistically significant associations with the occurrence of postoperative complications. In the multivariate analysis, the performance status showed a statistically significant association( 95% confidence interval, 1.17〜4.44;odds ratio, 2.28;p=0.0157). CONCLUSION The results suggested that the preoperative examinations were useful in predicting postoperative complications in the elderly patients with intractable pneumothorax. Poor performance status, low nutrition, respiratory failure, and preoperative respiratory complications are risk factors for postoperative complications in elderly patients with intractable pneumothorax.
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Watanabe M, Baba H. [Esophageal cancer surgery for patients with chronic respiratory diseases]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2012; 65:749-752. [PMID: 22868441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Esophageal cancer frequently occurs in the elderly and many of the patients have smoking history. Therefore, some of them have pulmonary comorbidity such as chronic respiratory diseases. As postoperative pulmonary complications after esophagectomy can be a cause of hospital death, careful evaluation is needed before the decision of the indication for surgery. In order to prevent postoperative pulmonary complications in patients with pulmonary comorbidities, modifications in the surgical procedures are needed. Even for cases who can tolerate standard esophagectomy, both the bronchial arteries and pulmonary branches of the vagal nerve should be preserved as far as possible. For patients who cannot tolerate the thoracotomy, transhiatal esophagectomy or non-surgical treatment should be selected. Postoperatively, airway cleansing using a bronchoscopy or mini-tracheostomy should be performed for cases with difficulty in sputum excretion. An enhanced recovery program by multidisciplinary team is effective to prevent postoperative pulmonary complications. Perioperative use of corticosteroid and sivelestat may reduce the incidence of pulmonary complications. As aspiration pneumonia is sometimes fatal in patients after esophagectomy, care to avoid aspiration is needed. Respiratory care is essential during the follow-up period as well as perioperative period in esophagectomized patients with pulmonary comorbidities.
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Horo K, Brou-Godé VC, Ahui BJM, Kouassi BA, Diouf AF, Konaté-Koné F, Motsebo FS, Ouattara K, Bemba ELP, Foutoupouo K, Meless T, N'Gom SA, Koffi BN, Aka-Danguy E. [Dynamic of respiratory pathology in a service of pneumology in black Africa in the context of HIV infection from 1998 to 2007]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:180-184. [PMID: 22677108 DOI: 10.1016/j.pneumo.2011.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Revised: 07/02/2011] [Accepted: 07/17/2011] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The pneumology in developing countries is practiced in a singular context: population mostly younger, endemic tuberculosis, high prevalence of HIV infection and growing pollution. OBJECTIVE The aim of this study is to present respiratory pathology evolution in hospitalization of pneumology department in black Africa. METHODOLOGY Our study is retrospective and descriptive. We consulted the register of hospitalization activities from January 1998 to December 2007. RESULTS The age group of 20-49 years represents 78.36% of all patients. Tuberculosis (TB) remains the first affection from 1998 to 2007 with a frequency varying between 38.2% and 45.2%. The cases of pneumonia are in regression since 2001, but cases of febrile alveolar interstitial pneumonia (FAIP) increase. The pathologies bound to tobacco addiction are rare. HIV infection is associated to TB (82.86%), to pneumonia (77.22%), to FAIP (92.23%). On 832 cases of death recorded, 46.15% of deaths are assigned to TB, 15.98% to pneumonia and 14.66% to FAIP. The global lethality of the TB and the pneumonia is respectively 20.1% and 17.6%. The one of FAIP is 32.5%. Mortality attributable to TB and pneumonia decreases progressively but the one attributable to FAIP remains important. CONCLUSION Respiratory pathology is dominated by TB, pneumonia and FAIP. These pathologies associated to HIV infection cause a strong mortality.
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Bylka W, Witkowska-Banaszczak E, Studzińska-Sroka E, Matławska I. [Phytotherapy of respiratory tract diseases]. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2012; 65:124-131. [PMID: 23289257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Herbal medicines have been used in cough due to their antitussive and expectorant activity. Antitussives act either centrally on the cough center of the brain or peripherally on the cough receptors in the respiratory passages. The antitussive effect of many herbs results from the content of mucilage, which exerts protective and demulcent activity. The activity of expectorant herbs results primarily from their influence on the gastric mucose (saponins and ipec alkaloids). This proves reflex stimulation which leads to an increase in the secretion of bronchial glands. Volatile-oil type expectorant herbs exert a direct stimulatory effect on the bronchial glands by means of local irritation with antibacterial activity. In colds and flu, herbs containing volatile oil can be used; also, volatile oils are ingredients of syrups and liquids as well as external phytomedicines in the form of liniments, ointments, and inhalations. The paper shows the herbs and phytomedicines present on the Polish market used for the treatment of respiratory tract diseases.
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Azarpazhooh A, Tenenbaum HC. Separating fact from fiction: use of high-level evidence from research syntheses to identify diseases and disorders associated with periodontal disease. JOURNAL (CANADIAN DENTAL ASSOCIATION) 2012; 78:c25. [PMID: 22436432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Correlations with periodontitis have been reported for several diseases, although the biological mechanisms that might lead to these putative correlations are generally unclear. This paper describes the most robust of these associations, on the basis of an evaluation of research syntheses (meta-analyses and systematic reviews) available up to June 2011. This high-level evidence indicates that individuals with periodontitis have a significantly higher risk of various other problems, including cardiovascular disease, diabetes mellitus, respiratory disease and preterm low-birth-weight deliveries. For some conditions, treatment of periodontitis leads to a reduction in the rates of the other disease, lending further support to the concept that the association is reversible. An understanding of these correlations is important to allow dental health care providers to inform patients with periodontitis of their increased risks and to counsel such patients to seek additional medical assessment or intervention, as indicated.
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Tsai SS, Chen PS, Yang YH, Liou SH, Wu TN, Sung FC, Yang CY. Air pollution and hospital admissions for myocardial infarction: are there potentially sensitive groups? JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2012; 75:242-51. [PMID: 22352332 DOI: 10.1080/15287394.2012.641202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Recent studies showed that air pollution is a risk factor for hospitalization for myocardial infarction (MI). However, there is limited evidence to suggest which subpopulations are at higher risk for MI arising from air pollution. This study was undertaken to examine the modifying effects of specific secondary cardiovascular diagnosis (including hypertension, diabetes, congestive heart failure, and arrhythmias) on the relationship between hospital admissions for MI and exposure to ambient air pollutants. Hospital admissions for MI and ambient air pollution data for Taipei were obtained for the period 1999-2009. The relative risk of hospital admissions for MI was estimated using a case-crossover approach. None of the secondary diagnosis examined showed significant evidence of effect modification. It would appear that the correlation between air pollutant exposure and MI occurrence is not affected by predisposing factors present in other cardiovascular diseases.
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Murakami M, Maruoka S, Miura K. [Application and indication of psychotropic drugs for respiratory diseases]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 2012; 70:78-83. [PMID: 22413497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Respiratory symptoms are induced not only by the organic stimulation of air tract but also by emotional irritation. Symbolic respiratory reactions and symptoms like a cough and dyspnea may develop when human's eomotion is affected by a psychosocial stressor. It is important to differentiate so-called psychosomatic disorders of respitratory system because it may easily take the chronic course and may become difficult to improve unless a precise diagnosis and treatment is not performed. Anxiety disorder and depressive state often merges the condition, and the patients with respiratory diseases sometimes may benefit from a antianxiety agents and antidepressant therapy when significant depressive symptoms are present. Specific psychotherapy may be applicable when symptom is aggravated by remarkable psychologic factors.
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Azarpazhooh A, Tenenbaum HC. Periodontitis: a syndromic condition. JOURNAL (CANADIAN DENTAL ASSOCIATION) 2012; 78:c27. [PMID: 22507279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Gonzalez LP, Pignaton W, Kusano PS, Módolo NSP, Braz JRC, Braz LG. Anesthesia-related mortality in pediatric patients: a systematic review. Clinics (Sao Paulo) 2012; 67:381-7. [PMID: 22522764 PMCID: PMC3317253 DOI: 10.6061/clinics/2012(04)12] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 12/05/2011] [Indexed: 12/02/2022] Open
Abstract
This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.
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Izmerov NF, Kuz'mina LP, Koliaskina MM, Lazarashvili NA. [Molecular genetic studies in occupational medicine]. GIGIENA I SANITARIIA 2011:10-14. [PMID: 22184992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
DNA diagnostic techniques aimed at elaborating informative criteria for assessment of the risk for occupational, occupationally induced diseases are extensively used to study the molecular mechanisms involved in the development of occupational diseases in labor medicine. Patients with different forms of occupational bronchopulmonary diseases have been found to have matrix metalloproteinase-1 (MMP-1) gene mutations. In some individuals, a combination of polymorphic variants of MMP-1 and alpha1-proteinase inhibitor genes is characterized by the presence of clinical complications and the concurrence of bronchopulmonary and skin diseases. GSTM1 gene mutation is noted for the earlier onset (up to 5 years), severity, and poor prognosis of allergic dermatoses.
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Aissa I, Rachdi I, Ben Miled K, Ghedira H. [Incidence of venous thromboembolism in men admitted to a pneumology unit for acute respiratory disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:129-135. [PMID: 21665075 DOI: 10.1016/j.pneumo.2010.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 02/15/2010] [Accepted: 04/27/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major source of morbidity and mortality all over the world. It is one of the complications arising in a hospital environment. The main aim of this study is to estimate the incidence of VTE in respiratory inpatients. METHOD The authors carried out a prospective study on acute respiratory disease inpatients. A medical analytical index card was used. An echo-venous Doppler of lower limbs was practiced on D1 and D10 of hospitalization. The Wells scored was used to estimate the clinical probability of the occurrence of VTE. RESULTS Seven of 100 patients studied developed VTE (95% CI : 2-12%), four of which presented a pulmonary embolism. The patients with VTE are 60-years-old±11.67. The incidence of VTE includes 20% (95% CI : 12.2-27.8%) of the patients hospitalized for bronchial cancer, 7.14% (95% CI : 2.1-12.18) of the patients presenting pulmonary tuberculosis and 4.54% (95% CI : 0.46-8.62%) of the patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). The duration of hospitalization was prolonged for the treatment of VTE (21±4.41 days for these patients compared with 12±5 days in the absence of VTE (P<0.001)). The analysis of the various risk factors shows that a Performance Status>2 (P=0.005) and lung cancer (P=0.028) are the factors most incriminated in the occurrence of VTE. It is associated with a mortality of 2%. CONCLUSION VTE is a reality which is necessary to prevent in respiratory inpatients in situations at risk, especially in patients with lung cancer and with a PS>2.
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Mariscal A, Medrano IH, Cánovas AA, Lobo E, Loinaz C, Vela L, Espiga PGR, Castrillo JCM. [Perioperative management of Parkinson's disease]. Neurologia 2011; 27:46-50. [PMID: 21470721 DOI: 10.1016/j.nrl.2010.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 12/01/2010] [Indexed: 11/17/2022] Open
Abstract
One of the particular characteristics of Parkinson's disease (PD) is the wide clinical variation as regards the treatment that can be found in the same patient. This occurs with specific treatment for PD, as well as with other drug groups that can make motor function worse. For this reason, the perioperative management of PD requires experience and above all appropriate planning. In this article, the peculiarities of PD and its treatment are reviewed, and a strategy is set out for the perioperative management of these patients.
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Henkin S, Tucker KL, Gao X, Falcon LM, Qawi I, Brugge D. Association of depression, psycho-social stress and acculturation with respiratory disease among Puerto Rican adults in Massachusetts. J Immigr Minor Health 2011; 13:214-23. [PMID: 20012203 PMCID: PMC4871150 DOI: 10.1007/s10903-009-9307-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To assess associations between acculturation, depression, and self-reported stress score with reported diagnosis of respiratory disease (RD) in Puerto Rican adults, participants (N = 1,168) were identified from areas of high Hispanic density in the Boston, MA metropolitan area. Eligible participants were interviewed in the home by bilingual interviewers in either Spanish or English. Scales included topics ranging from general background to depressive symptomatology. Respiratory disease was self-reported and checked against prescribed medication. More than one-third (37.8%) of subjects reported doctor-diagnosed RD. A final binary logistical regression model (N = 850), which was adjusted for potential confounders (sex, age, education, poverty) showed that RD was significantly associated with psychological acculturation (OR = 1.97, P = 0.005), depressive symptomatology (OR = 1.52, P = 0.03) high perceived stress score (OR = 1.97, P = 0.009), and current smoking (OR = 1.61, P = 0.03). Significant inverse associations included a high level of language acculturation (OR = 0.65, P = 0.03), light (OR = 0.67, P = 0.01) and moderate to heavy physical activity versus sedentary physical activity (OR = 0.40, P = 0.03). We found self reported physician diagnosed RD was associated with high perceived stress and depression, as well as higher levels of psychological acculturation. Longitudinal research is needed to determine if there is a causal pathway for these associations.
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O'Sullivan AK, Sullivan J, Higuchi K, Montgomery AB. Health care utilization & costs for cystic fibrosis patients with pulmonary infections. MANAGED CARE (LANGHORNE, PA.) 2011; 20:37-44. [PMID: 21428129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To examine patterns of health care utilization and costs among cystic fibrosis (CF) patients with pulmonary infections. DESIGN Retrospective administrative claims database analysis. METHODOLOGY We used administrative claims data (including both medical and pharmacy claims) to examine health care utilization and costs among CF patients with pulmonary infections over one year. We conducted a subgroup analysis in which we examined selected outcome measures among patients with tobramycin for inhalation (TIS) prescriptions by the number of TIS prescriptions filled. PRINCIPAL FINDINGS Among 1,064 CF patients identified with pulmonary infections, 80% had at least one CF-related office visit, 34% had a CF-related hospital stay, and 95% filled at least one prescription over one year. Total annual CF-related health care costs averaged $29,000 plus $20,000 for prescription drugs. In the subgroup analysis, there was a trend towards longer lengths of stay and higher inpatient costs with fewer numbers of TIS prescriptions filled. CONCLUSION CF patients with pulmonary infections have substantial levels of health care utilization and costs.
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Deng L, Yin GQ, Xie ZW. [The related manifestations of bronchoscope examination in pediatric congenital malformations with airway lesions (I)]. ZHONGHUA ER KE ZA ZHI = CHINESE JOURNAL OF PEDIATRICS 2010; 48:956-959. [PMID: 21215194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Qian LL, Liu CQ, Guo YX, Jiang YJ, Ni LM, Xia SW, Liu XH, Zhuang WZ, Xiao ZH, Wang SN, Zhou XY, Sun B. Current status of neonatal acute respiratory disorders: a one-year prospective survey from a Chinese neonatal network. Chin Med J (Engl) 2010; 123:2769-2775. [PMID: 21034580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND We conducted a prospective, multicenter investigation of incidence, management and outcome of neonatal acute respiratory disorders (NARD), and evaluated related perinatal risk factors and efficacy of respiratory therapies in neonatal intensive care units (NICUs) in a Chinese neonatal network. METHODS Data were prospectively collected in 2004 - 2005 from infants with NARD defined as presence of respiratory distress and oxygen requirement during the first 3 days of life. RESULTS A total of 2677 NARD was classified (20.5% of NICU admissions). There were 711 (5.44%) with respiratory distress syndrome (RDS), 589 (4.51%) pulmonary infection, 409 (3.13%) meconium aspiration syndrome, 658 (5.03%) aspiration of amniotic fluid and 239 (1.83%) transient tachypnoea. Meconium aspiration syndrome had the highest rate with fetal distress, transient tachypnoea from cesarean section, and RDS with maternal disorders. Assisted mechanical ventilation was applied in 53.4% of NARD, and in above five disorders with 84.7%, 52.3%, 39.8%, 24.5%, and 53.6%, respectively. Corresponding mortality in these disorders was 31.4%, 13.6%, 17.8%, 4.1% and 5.0%, respectively. Surfactant was provided to 33.9% of RDS. In all RDS infants, the survival rate was 78.8% if receiving surfactant, and 63.4% if not (P < 0.001). CONCLUSIONS This study provided NICU admission-based incidence and mortality of NARD, reflecting efficiency of advanced respiratory therapies, which should be a reference for current development of respiratory support in NICU at provincial and sub-provincial levels, justifying efforts in upgrading standard of care in emerging regions through a collaborative manner.
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Fuiano N, Riario-Sforza GG, Incorvaia C. [Update on eosinophilic airway disorders]. RECENTI PROGRESSI IN MEDICINA 2010; 101:406-412. [PMID: 21137578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Eosinophilic disorders of the airways affect the nose and paranasal sinuses, the bronchi and the lungs. Involvement of the nose includes the well known non allergic rhinitis with eosinophilia syndrome and new disorders characterized by co-participation of mast cells and neutrophils. Eosinophilic bronchitis must be distinguished from asthma, on the basis of some functional findings and a different cytokine profile. Eosinophilic pneumonia comprises acute and chronic forms, Churg-Strauss syndrome, hypereosinophilic syndrome, and eosinophilic granuloma, as well as secondary pneumonia such as Loeffler's syndrome.The treatment is mainly based on corticosteroids and the prognosis is variable, depending upon the development of acute respiratory failure (acute eosinophilic pneumonia, eosinophilic granuloma) or of vasculitis with multi-organ organ involvement in Churg-Strauss syndrome.
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Abstract
OBJECTIVES Although mild stress hyperglycemia in pediatric illness is common, severe hyperglycemic responses (≥300 mg/dL [16.7 mmol/L]) to stress are unusual. We sought to determine the incidence and course of extreme stress hyperglycemia (ESH) in acute pediatric illness, including whether it is a marker of increased mortality or associated with subsequent development of diabetes mellitus (DM). METHODS We retrospectively reviewed a cohort of 55,120 consecutive visits over 6 years to a pediatric emergency department at which blood glucose concentrations were measured and report on visits with laboratory glucose 300 mg/dL (16.7 mmol/L) or greater without DM. RESULTS There were 72 cases of ESH (incidence of 0.13%). Median age was 8.8 years; 63% were male. The most common diagnoses were respiratory illness (49%), trauma (15%), and seizure (8%), and 65% of patients had received glucose-influencing interventions before evaluation. Eighty-five percent were ill appearing, 60% were admitted to the intensive care unit, and half had acidemic pH values. The overall mortality rate was 22%. Despite treatment of hyperglycemia in only 8 patients, glucose concentrations decreased to 150 mg/dL (8.3 mmol/L) or less within 48 hours in 67% and before discharge or death in 85% of patients. Preceding symptoms and concurrent laboratory results were helpful to exclude diabetes, and none of the surviving patients with follow-up available went on to develop type 1 or 2 DM. CONCLUSIONS Although rare, ESH (≥300 mg/dL [16.7 mmol/L]) does occur in acute pediatric illness, in most cases is at least partially iatrogenic, and is a marker of severe illness and high mortality. Normoglycemia is typically restored quickly with treatment of the primary illness. No association was found with a subsequent diagnosis of DM.
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97
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That nagging cough. HARVARD MEN'S HEALTH WATCH 2010; 15:3-7. [PMID: 20941870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Ueki M, Maekawa N. [Preoperative evaluation, management and outcome in the elderly patient]. MASUI. THE JAPANESE JOURNAL OF ANESTHESIOLOGY 2010; 59:1133-1137. [PMID: 20857668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Two principles should be kept in mind when performing preoperative evaluation of the elderly patient. First, we should suspect the disease processes commonly associated with aging. Second, we should assess the degree of functional reserve of specific, pertinent organ systems. Preoperative risk assessment is focused on detailed review from anamnesis and physical examination together with the assessment of functional status. Especially, it is important to examine the cardiovascular and respiratory functions in the elderly patient. Further, this also includes assessment of consumed drugs, physiological function, cognitive function, competency, availability of social support, and sign of depression. Surgical risk and outcome in the elderly patient depend primarily on four factors: age, the patient's physiological status and coexisting disease, whether the surgery is elective or urgent, and the type of procedures.
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99
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Pelkonen AS, Kotaniemi-Syrjänen A, Malmström K, Malmberg LP, Mäkelä MJ. Clinical findings associated with abnormal lung function in children aged 3-26 months with recurrent respiratory symptoms. Acta Paediatr 2010; 99:1175-9. [PMID: 20219027 DOI: 10.1111/j.1651-2227.2010.01790.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate whether there are any associations between parentally reported symptoms, clinical findings and lung function in young children with recurrent lower respiratory tract symptoms. METHODS In 2000-2003, 148 children, aged 3-26 months, with recurrent lower respiratory tract symptoms underwent physical examination, investigation of a chest radiograph, whole body plethysmography and skin prick testing to common food and inhalant allergens. RESULTS Lung function was considered abnormal (i.e. functional residual capacity z-score of > or =1.65 and/or specific conductance z-score of < or =-1.65) in 83 (56%) children. Findings of increased work of breathing (p < 0.001) and nonspecific noisy breathing sounds (p < 0.001) in the physical examination, as well as an abnormal chest radiograph (p = 0.028) were independently associated with abnormal lung function, explaining up to 34% of the variation in lung function. In contrast, parentally reported respiratory symptoms, environmental exposures or atopic trait were not associated with lung function abnormalities. CONCLUSION The results of this study emphasize the importance of the meticulous clinical examination in the evaluation of early childhood respiratory disorders. As physical examination alone cannot predict lung function abnormalities reliably in preschool children with troublesome respiratory symptoms, lung function testing may be considered in such patients to obtain additional objective information.
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100
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Huang W, Kan H, Kovats S. The impact of the 2003 heat wave on mortality in Shanghai, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2010; 408:2418-20. [PMID: 20219235 DOI: 10.1016/j.scitotenv.2010.02.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 02/01/2010] [Accepted: 02/03/2010] [Indexed: 04/15/2023]
Abstract
In 2003, Shanghai recorded the hottest summer in over 50years. We investigated the impact on the mortality of a heat wave in 2003 in Shanghai. We calculated excess mortality and rate ratios (RRs) during the heat wave (July 19-August 6, 2003) compared to a reference (non-heatwave) period (June 28-July 9, and August 16-August 22). During the heat wave, the RR of total mortality was 1.13 (95% CI: 1.06-1.20), and the impact was greatest for cardiovascular (RR=1.19, 95% CI: 1.08-1.32) and respiratory (RR=1.23, 95% CI: 1.02-1.48) mortality. Gender did not make a statistically significant difference for the heat-wave impact. Elderly people (over 65years) were most vulnerable to the heat wave. Our analysis showed that the 2003 heat wave had a substantial effect on mortality in Shanghai. Public health programs should be implemented to prevent heat wave-related health problems in the city.
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