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Abstract
IMPORTANCE Pneumonia often leads to functional decline during and after hospitalization and is a leading cause of hospital readmissions. Physical and occupational therapists help improve functional mobility and may be of help in this population. OBJECTIVE To evaluate whether use of physical and occupational therapy in the acute care hospital is associated with 30-day hospital readmission risk or death. DESIGN, SETTING, AND PARTICIPANTS This cohort study included the electronic health records and administrative claims data of 30 746 adults discharged alive with a primary or secondary diagnosis of pneumonia or influenza-related conditions from January 1, 2016, to March 30, 2018. Patients were treated at 12 acute care hospitals in a large health care system in western Pennsylvania. Data for this study were analyzed from September 2019 through March 2020. EXPOSURES Number of physical and occupational therapy visits during the acute care stay categorized as none, low (1-3), medium (4-6), or high (>6). MAIN OUTCOMES AND MEASURES Outcomes were 30-day hospital readmission or death. Generalized linear mixed models were estimated to examine the association of therapy use and outcomes, controlling for patient demographic and clinical characteristics. Subgroup analyses were conducted for patients older than 65 years, for patients with low functional mobility scores, for patients discharged to the community, and for patients discharged to a post-acute care facility (ie, skilled nursing or inpatient rehabilitation facility). RESULTS Of 30 746 patients, 15 507 (50.4%) were men, 26 198 (85.2%) were White individuals, and the mean (SD) age was 67.1 (17.4) years. The 30-day readmission rate was 18.4% (5645 patients), the 30-day death rate was 3.7% (1146 patients), and the rate of either outcome was 19.7% (6066 patients). Relative to no therapy visits, the risk of 30-day readmission or death decreased as therapy visits increased (1-3 visits: odds ratio, 0.98; 95% CI, 0.89-1.08; 4-6 visits: odds ratio, 0.89; 95% CI, 0.79-1.01; >6 visits: odds ratio, 0.86; 95% CI, 0.75-0.98). The association was stronger in the subgroup with low functional mobility and in individuals discharged to a community setting. CONCLUSIONS AND RELEVANCE In this study, the number of therapy visits received was inversely associated with the risk of readmission or death. The association was stronger in the subgroups of patients with greater mobility limitations and those discharged to the community.
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Affiliation(s)
- Janet K. Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aileen Chou
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tracey Euloth
- University of Pittsburgh Medical Center Rehabilitation Services, Pittsburgh, Pennsylvania
| | - Beth Matcho
- University of Pittsburgh Medical Center Rehabilitation Services, Pittsburgh, Pennsylvania
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Shirado K, Wakabayashi H, Maeda K, Nishiyama A, Asada M, Isse H, Saito S, Kakitani C, Momosaki R. Impact of Energy intake at One Week after Hospitalization on Prognosis for Older Adults with Pneumonia. J Nutr Health Aging 2020; 24:119-124. [PMID: 31886818 DOI: 10.1007/s12603-019-1282-y] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study objectives to investigate the influence of average energy intake at 1 week of hospitalization on prognosis for older adults with pneumonia. DESIGN Retrospective observational cohort study. SETTING The Japan Rehabilitation Nutrition Database comprise those with pneumonia in acute care hospitals. PARTICIPANTS The study included 329 pneumonia patients (aged over 65 years) who entered into the Japan Rehabilitation Nutrition Database (JRND) from November 2015 to March 2018. MEASUREMENTS Logistic regression analysis was performed to confirm the relationship of energy intake with the rate of mortality, discharge home, and pneumonia recurrence during hospitalization. Variables included in the multiple regression analysis model were age, sex, Mini Nutritional Assessment-Short Form score (MNA-SF) at hospitalization, A-DROP, Charlson comorbidity index (CCI), and presence or absence of rehabilitation. RESULTS Of 315 patients with pneumonia (median age 85 years), 63.8% were men. 57.7% were assigned to the lack of energy intake (LEI) at 1 week after admission. Patients in the LEI group were older (p = 0.033), had higher A-DROP score (p < 0.001), and showed higher malnutrition rate in MNA-SF at hospitalization (p < 0.001) than those in the control group. Mortality, pneumonia recurrence (p = 0.001), median body mass index (p = 0.012), and low malnutrition in MNA-SF (p < 0.001) at discharge were significantly higher in the LEI group than in the control group. Logistic regression analysis showed that LEI was an independent risk factor for mortality (Odds ratio: 5.07, p = 0.002), discharge home (Odds ratio: 0.33, p = 0.007), and pneumonia recurrence (Odds ratio: 3.26, p = 0.007). CONCLUSIONS LEI at 1 week after hospitalization in older adults with pneumonia was an independent risk factor for mortality, difficult at-home recovery, and pneumonia recurrence. These findings suggest the importance of adequate energy intake from the early days of hospitalization.
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Affiliation(s)
- K Shirado
- Kengo Shirado, R.P.T. Department of Rehabilitation, Aso Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka 820-8505, Japan; Tel: +81-948-29-8038; Fax: +81-948-25-8018,
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Ho CC, Tsai MH, Chen YC, Kuo CC, Lin P. Persistent elevation of blood pressure by ambient coarse particulate matter after recovery from pulmonary inflammation in mice. Environ Toxicol 2019; 34:814-824. [PMID: 30919559 DOI: 10.1002/tox.22749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/19/2018] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
Exposure to ambient particulate matter (PM) is associated with hypertension and cardiovascular diseases. Recently, we reported that exposure to fine and coarse PM caused pulmonary inflammation and pulmonary small arterial remodeling in mice, and osteopontin (OPN) level was elevated following PM exposure. However, in the present study, cotreatment with 5-methoxytryptophan for 4 weeks partially reduced coarse PM-induced pulmonary inflammation without reducing pulmonary OPN secretion or recovery from pulmonary arterial remodeling in mice. Persistent vascular dysfunction may lead to vascular remodeling. Therefore, we further compared the relationship between coarse PM-induced inflammation and vascular dysfunction by exposing mice to PM before and after cessation of PM exposure. Oropharyngeal aspiration of PM for 8 weeks induced pulmonary inflammation and pulmonary small artery remodeling in mice, as well as increased serum C-reactive protein and OPN concentrations and systolic blood pressure (SBP). After the cessation of PM exposure for another 8 weeks, lung inflammation had recovered and vascular remodeling had partially recovered. Elevation of OPN, metalloproteinases (MMPs), and cytokines in bronchioalveolar lavage were significantly reduced. However, PM-induced systemic responses did not recover after the cessation of PM exposure. Notably, not only serum OPN and SBP remained significantly elevated; also, serum endothelin-1, MMP-9, and keratinocyte-derived chemokine concentrations were significantly increased after cessation of PM exposure for another 8 weeks. These data suggested that systemic inflammation and systemic vascular dysfunction might be important in PM-induced elevation of SBP. Furthermore, SBP elevation was persistent after cessation of PM exposure for 8 weeks.
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Affiliation(s)
- Chia-Chi Ho
- National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, 350 Taiwan
| | - Ming-Hsien Tsai
- National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, 350 Taiwan
| | - Yu-Cheng Chen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, 350 Taiwan
- Department of Occupational Safety and Health, China Medical University, Taichung, 404 Taiwan
| | - Cheng-Chin Kuo
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, 350 Taiwan
| | - Pinpin Lin
- National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, 350 Taiwan
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Sawada Y, Sasabuchi Y, Nakahara Y, Matsui H, Fushimi K, Haga N, Yasunaga H. Early Rehabilitation and In-Hospital Mortality in Intensive Care Patients With Community-Acquired Pneumonia. Am J Crit Care 2018; 27:97-103. [PMID: 29496765 DOI: 10.4037/ajcc2018911] [Citation(s) in RCA: 10] [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] [Indexed: 11/01/2022]
Abstract
BACKGROUND Community-acquired pneumonia is one of the most common infectious diseases and can be fatal. The benefits of early rehabilitation in intensive care units are known, but the association between early rehabilitation and in-hospital mortality of patients with community-acquired pneumonia admitted to intensive care units has not been studied. OBJECTIVES To study the association between early rehabilitation and the in-hospital mortality of patients with community- acquired pneumonia admitted to intensive care units, effects of early rehabilitation on unit and hospital lengths of stay, and total costs of hospitalization. METHODS A retrospective observational cohort study using a national inpatient database of patients with community-acquired pneumonia admitted to intensive care units in acute care hospitals in Japan from July 2011 through March 2014. Propensity score-matching analysis was used to compare outcomes between patients with and without early rehabilitation (within 2 days of admission). RESULTS Among 8732 eligible patients, propensity score matching created 972 pairs of patients with and without early rehabilitation. The early rehabilitation group had significantly lower in-hospital mortality than did the group without early rehabilitation (17.9% vs 21.9%, respectively; P = .03). The groups did not differ significantly in intensive care unit or hospital lengths of stay or in total costs of hospitalization. CONCLUSIONS Early rehabilitation within 2 days of admission was associated with reduced in-hospital mortality of patients with community-acquired pneumonia admitted to intensive care units.
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Affiliation(s)
- Yusuke Sawada
- Yusuke Sawada is a senior resident doctor, Yasuo Nakahara is a research associate, and Nobuhiko Haga is a professor, Department of Rehabilitation Medicine, University of Tokyo Hospital, Tokyo, Japan. Yusuke Sasabuchi is a project assistant professor, Department of Health Service Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Hiroki Matsui is an assistant professor and Hideo Yasunaga is a professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo. Kiyohide Fushimi is a professor, Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan
| | - Yusuke Sasabuchi
- Yusuke Sawada is a senior resident doctor, Yasuo Nakahara is a research associate, and Nobuhiko Haga is a professor, Department of Rehabilitation Medicine, University of Tokyo Hospital, Tokyo, Japan. Yusuke Sasabuchi is a project assistant professor, Department of Health Service Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Hiroki Matsui is an assistant professor and Hideo Yasunaga is a professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo. Kiyohide Fushimi is a professor, Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan
| | - Yasuo Nakahara
- Yusuke Sawada is a senior resident doctor, Yasuo Nakahara is a research associate, and Nobuhiko Haga is a professor, Department of Rehabilitation Medicine, University of Tokyo Hospital, Tokyo, Japan. Yusuke Sasabuchi is a project assistant professor, Department of Health Service Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Hiroki Matsui is an assistant professor and Hideo Yasunaga is a professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo. Kiyohide Fushimi is a professor, Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan.
| | - Hiroki Matsui
- Yusuke Sawada is a senior resident doctor, Yasuo Nakahara is a research associate, and Nobuhiko Haga is a professor, Department of Rehabilitation Medicine, University of Tokyo Hospital, Tokyo, Japan. Yusuke Sasabuchi is a project assistant professor, Department of Health Service Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Hiroki Matsui is an assistant professor and Hideo Yasunaga is a professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo. Kiyohide Fushimi is a professor, Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan
| | - Kiyohide Fushimi
- Yusuke Sawada is a senior resident doctor, Yasuo Nakahara is a research associate, and Nobuhiko Haga is a professor, Department of Rehabilitation Medicine, University of Tokyo Hospital, Tokyo, Japan. Yusuke Sasabuchi is a project assistant professor, Department of Health Service Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Hiroki Matsui is an assistant professor and Hideo Yasunaga is a professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo. Kiyohide Fushimi is a professor, Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan
| | - Nobuhiko Haga
- Yusuke Sawada is a senior resident doctor, Yasuo Nakahara is a research associate, and Nobuhiko Haga is a professor, Department of Rehabilitation Medicine, University of Tokyo Hospital, Tokyo, Japan. Yusuke Sasabuchi is a project assistant professor, Department of Health Service Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Hiroki Matsui is an assistant professor and Hideo Yasunaga is a professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo. Kiyohide Fushimi is a professor, Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Yusuke Sawada is a senior resident doctor, Yasuo Nakahara is a research associate, and Nobuhiko Haga is a professor, Department of Rehabilitation Medicine, University of Tokyo Hospital, Tokyo, Japan. Yusuke Sasabuchi is a project assistant professor, Department of Health Service Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Hiroki Matsui is an assistant professor and Hideo Yasunaga is a professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo. Kiyohide Fushimi is a professor, Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan
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Kosai K, Izumikawa K, Imamura Y, Tanaka H, Tsukamoto M, Kurihara S, Takazono T, Morinaga Y, Nakamura S, Miyazaki T, Yanagihara K, Tashiro T, Kohno S. Importance of functional assessment in the management of community-acquired and healthcare-associated pneumonia. Intern Med 2014; 53:1613-20. [PMID: 25088872 DOI: 10.2169/internalmedicine.53.2499] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE In Japan, the number of elderly people who have difficulties performing the activities of daily living (ADLs) is increasing. The objective of this study was to assess the relationship between ADL and the clinical characteristics of pneumonia. METHODS We conducted a retrospective study of 219 adult patients hospitalized due to pneumonia [151 patients with community-acquired pneumonia (CAP) and 68 patients with healthcare-associated pneumonia (HCAP)]. CAP, HCAP, and all the patients were stratified into two groups using a modified version of the Katz index of five ADLs as follows: independent in all ADLs or dependent in one to three ADLs (CAP-A, HCAP-A, and All-A groups) and dependent in four or five ADLs (CAP-B, HCAP-B, and All-B groups). Disease severity, microbiological findings, and mortality were compared between the groups. RESULTS As the ability to perform ADLs declined, A-DROP scores (the CAP severity measurement index) increased significantly in CAP (CAP-A: 1.1±1.1, CAP-B: 2.6±1.1), HCAP (HCAP-A: 2.0±1.0, HCAP-B: 2.8±1.0), and all patients (All-A: 1.3±1.1, All-B: 2.8±1.0). Thirty-day mortality was higher in the CAP-B (23.1%) and All-B (19.2%) groups than in the CAP-A (0.7%) and All-A (1.8%) groups, respectively. A multivariate Cox proportional hazards analysis showed an ADL score ≥ four to be a significant predictor of 30-day mortality in CAP patients [hazard ratio (HR), 19.057; 95% confidence interval (CI), 1.930-188.130] and in all patients (HR, 8.180; 95% CI, 1.998-33.494). CONCLUSION A functional assessment using a modified version of the Katz index is useful for the management of CAP and HCAP patients.
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Badalian AV, Luzhnikov EA, Gol'dfarb IS, Godkov MA, Khvatov VB, Bitkova EE, El'kov AN, Il'iashenko KK, Nikulina VP, Matveev SB. [Homeostasis changes during rehabilitation period after acute chemical poisoning]. Anesteziol Reanimatol 2013:43-50. [PMID: 24340996] [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: 06/03/2023]
Abstract
The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol). Disorders of rheology, haemostasis and endotoxicosis accrued in all groups. These disorders were a signs of the erythrocytes and platelets aggregation developing and viscoelasticity disorder. Homeostasis changes during rehabilitation period need an accurate diagnostics for purposeful treatment of the defined disorders.
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Rassulova MA, Siziakova LA, Aĭrapetova NS. [Effect of naphthalan and therapeutic mud applications on clinical and roentgenological characteristics in patients with protracted pneumonia]. Vopr Kurortol Fizioter Lech Fiz Kult 2009:16-19. [PMID: 19637834] [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: 05/28/2023]
Abstract
The influence of application of naftalan and therapeutic muds on clinical and roentgenological parameters, external respiration function, biochemical and immunological characteristics of the inflammatory process was studied in 82 patients presenting with protracted pneumonia and compared with the outcome of therapy using no physical factors. The application of naftalan and therapeutic muds was shown to reduce activity of inflammatory processes, improve airway patency and the state ofbronchial mucosa. Naftalan produced better therapeutic effect than muds.
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Mayordomo-Colunga J, Medina A, Rey C, Díaz JJ, Concha A, Los Arcos M, Menéndez S. Predictive factors of non invasive ventilation failure in critically ill children: a prospective epidemiological study. Intensive Care Med 2008; 35:527-36. [PMID: 18982307 DOI: 10.1007/s00134-008-1346-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [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: 04/20/2008] [Accepted: 10/19/2008] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Identification of predictive factors for non-invasive ventilation (NIV) failure and determination of NIV characteristics. DESIGN Prospective observational study. SETTING Paediatric Intensive Care Unit in a University Hospital. PATIENTS AND MEASUREMENTS A total of 116 episodes were included. Clinical data collected were respiratory rate (RR), heart rate and FiO(2) before NIV began. Same data and expiratory and support pressures were collected at 1, 6, 12, 24 and 48 h. Conditions precipitating acute respiratory failure (ARF) were classified into two groups: type 1 (38 episodes) and type 2 (78 episodes). Ventilation-perfusion impairment was the main respiratory failure mechanism in type 1, and hypoventilation in type 2. Factors predicting NIV failure were determined by multivariate analysis. RESULTS Most common admission diagnoses were pneumonia (81.6%) in type 1 and bronchiolitis (39.7%) and asthma (42.3%) in type 2. Complications secondary to NIV were detected in 23 episodes (20.2%). NIV success rate was 84.5% (68.4% in type 1 and 92.3% in type 2). Type 1 patients showed a higher risk of NIV failure compared to type 2 (OR 11.108; CI 95%, 2.578-47.863). A higher PRISM score (OR 1.138; CI 95%, 1.022-1.267), and a lower RR decrease at 1 h and at 6 h (OR 0.926; CI 95%, 0.860-0.997 and OR 0.911; CI 95%, 0.837-0.991, respectively) were also independently associated with NIV failure. CONCLUSIONS NIV is a useful respiratory support technique in paediatric patients. Type 1 group classification, higher PRISM score, and lower RR decrease during NIV were independent risk factors for NIV failure.
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Affiliation(s)
- Juan Mayordomo-Colunga
- Departamento de Pediatría, Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain
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Incorvaia C, Riario-Sforza GG, Pravettoni C, Megali R, Yacoub MR, Frati F. Incidence and characteristics of hospital-acquired pneumonia in a pulmonary rehabilitation setting. Med Sci Monit 2008; 14:CR196-CR198. [PMID: 18376347] [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: 05/26/2023] Open
Abstract
BACKGROUND The incidence of Hospital Acquired Pneumonia (HAP) varies according to the setting. It is estimated to be approximately 0.5% to 1% in hospitalized subjects but higher in mechanically ventilated patients in intensive care units. The incidence of HAP in a pulmonary rehabilitation unit has not been investigated. MATERIAL/METHODS Patients with chronic obstructive pulmonary disease (COPD), admitted for pulmonary rehabilitation between January 1 and December 31, 2006, were included. HAP was defined by symptoms, signs, and radiograph imaging of pulmonary infiltrate. Chest radiography allowed us to distinguish HAP from COPD exacerbations. The disease course also was evaluated. RESULTS In total, 143 subjects (85 men, 58 women; mean age, 74.2 years) were enrolled. Nine of them (6.3%; 6 men, 3 women; mean age, 72.8+/-3.2 years) developed HAP. Twenty-four (16.8%) had pneumonia signs and symptoms but no radiologic findings. In these patients, a diagnosis of COPD exacerbation was made. Seven of 9 patients with HAP were successfully treated with empiric antibiotic therapy, while the other 2 required a modification of the antibiotic regimen after resistant Klebsiella pneumoniae and Pseudomonas aeruginosa had been detected in sputum culture. CONCLUSIONS The incidence of HAP in a pulmonary rehabilitation setting was approximately 6%, higher than that previously described in hospitalized subjects. The clinical course of HAP was favorable, no mortality occurred. This could be explained either by patient-related or by environment-related factors.
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Dolgov EN, Gorbachenko AV, Litvinenko VD. [The evaluation of functional state of cardiovascular system in servicemen affected by pneumonia during participation in counter-terrorist operations in the North Caucasus]. Voen Med Zh 2007; 328:13-6. [PMID: 17580471] [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: 05/15/2023]
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Ageeva TS, Zhavoronok TV, Teteneva FF, Krivonogov NG, Riazantseva NV, Zavadovskaia VD, Stepovaia EA, Dubodelova AV, Petina GV, Starikov IV, Danilenko VI. [Extrahospital pneumonias: the clinico-scintigraphic characterization and oxidative balance of cells]. Klin Med (Mosk) 2007; 85:43-8. [PMID: 17882809] [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: 05/17/2023]
Abstract
Ventilation-perfusion pulmonary scintigraphy was carried out in 30 patients with a verified diagnosis of extra-hospital pneumonia (EHP) and 10 healthy subjects; ventilation-perfusion ratio (V/Q), apex-basis ventilation and perfusion gradient, and the condition of alveolar-capillary permeability (ACP) were analyzed. Clinical symptoms during the debut of EHP were more pronounced in patients with an alveolar type of pulmonary infiltrate (PI) vs. patients with interstitial one: they had pulmonary infiltration syndrome, pleural pain, tachypnoe, tachycardia, a fever of higher than 38 degrees C, and leucocytosis more often. During the acute period of EHP, elevated lipid peroxidation in the erythrocyte membrane as well as a decrease in the content of reduced glutathione and the activity of superoxide dismutase and catalase in erythrocytes did not depend on the type of PI. In EHP, independently of PI type, the study revealed an increase in V/Q of higher than 1.0 on the side of lesion and bilateral (including the healthy side) increase in ACP for radioactive aerosol.
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Schultz K, Bergmann KC, Kenn K, Petro W, Heitmann RH, Fischer R, Lang SM. [Effectiveness of inpatient pulmonary rehabilitation (AHB). Results of a multicenter prospective observation study]. Dtsch Med Wochenschr 2006; 131:1793-8. [PMID: 16902901 DOI: 10.1055/s-2006-949155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The value of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD) is well accepted. However, there are no data on the efficacy of in-patient rehabilitation instituted within 14 days after an acute disease episode, as practised in Germany. It was the purpose of this multi-centre prospective study to assess changes in lung function, exercise capacity, symptoms and disease-related quality of life (QoL) in patients discharged from hospital for an episode of worsening COPD or asthma, pulmonary embolism, pneumonia or treatment of lung cancer. PATIENTS AND METHODS 207 patients (mean age 60 13 years) with COPD (n=86), pneumonia (n=42), lung cancer (n=24), asthma (n=14), pulmonary embolism (n=7) or other pulmonary disease (n=34) were included. Measurements of lung function, exercise capacity and disease-related QoL were carried out at the beginning and end of rehabilitation. Socio-economic data and disease-related QoL measurements were recorded again after 2 months. RESULTS Rehabilitation led to a significant improvement of lung function, exercise capacity and QoL. Patients felt rehabilitation was efficacious (95%), to be recommended (99%) and important (100%). Improvement of QoL was maintained at two 2 months and only 16% of previously working patients had applied for retirement. CONCLUSIONS The data demonstrate the clinically relevant benefit of in-patient pulmonary rehabilitation immediately after a period of acute illness. In view of these result and the known morbidity and mortality of patients with COPD after hospitalization for a period of acute illness, this form of pulmonary rehabilitation should be considered as standard treatment for these patients.
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Alvarez Lerma F, Palomar M, Insausti J, Olaechea P, Cerdá E, Sánchez Godoy J, De la Torre MV. [Staphylococcus aureus nosocomial infections in critically ill patients admitted in intensive care units]. Med Clin (Barc) 2006; 126:641-6. [PMID: 16759562 DOI: 10.1157/13087841] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate the frequency of nosocomial infections caused by Staphylococcus aureus in critically ill patients admitted to Spanish intensive care units (ICUs) and to describe the characteristics and outcome of patients in whom this pathogen was isolated. PATIENTS AND METHOD Prospective, observational, and multicenter study. All patients admitted during one or 2 months to the participating ICUs in the National Nosocomial Infection Surveillance Study (ENVIN) between 1997 and 2003 were included. Patients were classified as infected by S. aureus, infected by other microorganisms, and without nosocomial infection. RESULTS A total of 34,914 patients were controlled of whom 3,450 (9.9%) had acquired a nosocomial infection during his/her ICU stay (16.0 infections per 100 patients). In 682 (19.8%) patients, a total of 775 infectious episodes in which one of the microorganisms isolated was S. aureus were documented (cumulative incidence 2.2 episodes of S. aureus infection per 100 patients). There was a predominance of S. aureus infection in patients with pneumonia associated with mechanical ventilation (21.4%) and in patients with catheter-related bacteremia (13%). Independent variables associated with S. aureus infection were male sex (odds ratio [OR] = 1.25; 95% confidence interval [CI], 1.03-1.52) and underlying trauma pathology (OR = 1.72, 95%; 95%CI, 1.26-2.35), whereas an older age has been a protective factor (OR = 0.90; 95%CI, 0.84-0.96). Mortality in patients with S. aureus infection was significantly higher than in infections caused by other microorganisms, and in both cases higher than in patients without infection (34.5%, 30.3%, and 10.7%, respectively). In 208 (30.5%) patients, infections due to methicillin-resistant S. aureus were diagnosed, which in turn had increased significantly over the years (p = 0.001). Mortality in patients with methicillin-resistant S. aureus infection was 35.1% compared with 34.2% in patients with methicillin sensitive S. aureus infections (p = NS). CONCLUSIONS S. aureus was isolated in 19.8% of patients with ICU-acquired infection, particularly in relation to pneumonia in mechanically ventilated patients. Mortality in patients with S. aureus infection was higher than that in patients with infections due to other microorganisms and patients without infection. In contrast, differences in the outcome of patients with infections caused by methicillin-sensitive or methicillin-resistant S. aureus were not found.
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El Solh A, Pineda L, Bouquin P, Mankowski C. Determinants of short and long term functional recovery after hospitalization for community-acquired pneumonia in the elderly: role of inflammatory markers. BMC Geriatr 2006; 6:12. [PMID: 16899118 PMCID: PMC1557854 DOI: 10.1186/1471-2318-6-12] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [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: 04/18/2006] [Accepted: 08/09/2006] [Indexed: 01/08/2023] Open
Abstract
Background Hospitalization for older patients with community-acquired pneumonia (CAP) is associated with functional decline. Little is know about the relationship between inflammatory markers and determinants of functional status in this population. The aim of the study is to investigate the association between tumor necrosis factor (TNF)-α, C-reactive protein (CRP) and Activities of Daily Living, and to identify risk factors associated with one year mortality or hospital readmission. Methods 301 consecutive patients hospitalized for CAP (mean age 73.9 ± 5.3 years) in a University affiliated hospital over 18 month period were included. All patients were evaluated on admission to identify baseline demographic, microbiological, cognitive and functional characteristics. Serum levels for TNF-α and CRP were collected at the same time. Reassessment of functional status at discharge, and monthly thereafter till 3 months post discharge was obtained and compared with preadmission level to document loss or recovery of functionality. Outcome was assessed by the composite endpoint of hospital readmission or death from any cause up to one year post hospital discharge. Results 36% of patients developed functional decline at discharge and 11% had persistent functional impairment at 3 months. Serum TNF-α (odds ratio [OR] 1.12, 95% CI 1.08–1.15; p < 0.001) and the Charlson Index (OR = 1.39, 95% CI 1.14 to 1.71; p = 0.001) but not age, CRP, or cognitive status were independently associated with loss of functionality at the time of hospital discharge. Lack of recovery in functional status at 3 months was associated with impaired cognitive ability and preadmission comorbidities. In Cox regression analysis, persistent functional impairment at 3 months, impaired cognitive function, and the Charlson Index were highly predictive of one year hospital readmission or death. Conclusion Serum TNF-α levels can be useful in determining patients at risk for functional impairment following hospitalization from CAP. Old patients with impaired cognitive function and preexisting comorbidities who exhibit delay in functional recovery at 3 months post discharge may be at high risk for hospital readmission and death. With the scarcity of resources, a future risk stratification system based on these findings might be proven helpful to target older patients who are likely to benefit from interventional strategies.
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Affiliation(s)
- Ali El Solh
- Western New York Respiratory Research Center, 462 Grider Street, Buffalo, NY 14215, USA
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Lilibeth Pineda
- Western New York Respiratory Research Center, 462 Grider Street, Buffalo, NY 14215, USA
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Pam Bouquin
- Western New York Respiratory Research Center, 462 Grider Street, Buffalo, NY 14215, USA
| | - Corey Mankowski
- Western New York Respiratory Research Center, 462 Grider Street, Buffalo, NY 14215, USA
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Abstract
OBJECTIVE To determine the relative frequency and describe the predisposing causes of recurrent pneumonia in infants and children aged between 1 month and 14 years. METHODS We retrospectively reviewed the medical records of a tertiary care pediatric hospital covering a 10-year period, from January 1994 through December 2003. Children with cystic fibrosis were not included in the analysis. Recurrent pneumonia was defined as at least two pneumonia episodes in a 1 year period or at least three episodes over a lifetime. RESULTS Of 1644 children hospitalized with pneumonia, 106 (6.4 %) met the criteria for recurrent pneumonia. An underlying cause was identified in 92 patients (86.7 %). Of these, the underlying cause was diagnosed prior to pneumonia in 67 (72.8 %), during the first episode in 12 (13 %) and during recurrence in 13 (14.1 %). Underlying causes included asthma in 28 patients (30.4 %), congenital cardiac defects in 27 patients (29.3 %), aspiration syndrome in 25 patients (27.1 %), immune disorder in nine patients (9.7 %), pulmonary anomalies in two patients (2.1 %), and anhidrotic ectodermal dysplasia in one patient (1 %). CONCLUSIONS Recurrent pneumonia occurred in 6.4 % of all children hospitalized for pneumonia. The underlying cause was identified in 86.7 % of the children. The most common causes were asthma, congenital cardiac defects, and aspiration syndrome.
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Choi JSP, Jones AYM. Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia. ACTA ACUST UNITED AC 2005; 51:25-30. [PMID: 15748122 DOI: 10.1016/s0004-9514(05)70050-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ventilator-associated pneumonia results from bacterial colonisation of the aerodigestive tract or aspiration of contaminated secretions into the lower airways. As a consequence of infection of the lung parenchyma and alveolitis, accumulation of inflammatory exudates and infiltration of airway mucosa can lead to unfavourable respiratory mechanics in ventilator-associated pneumonia. Tracheal suction is often employed by nursing staff in the management of mechanically ventilated patients with ventilator-associated pneumonia but this technique has the potential to increase respiratory resistance. Manual hyperinflation is used by physiotherapists to improve lung volume and mobilise secretions and has been shown to increase lung compliance. The effect of manual hyperinflation on airway resistance has not been studied. This study aims to demonstrate an additional mechanical benefit to the respiratory system when manual hyperinflation and suction techniques are combined, by comparing the application of manual hyperinflation and suction with suction alone on static lung compliance (C(L)) and inspiratory resistance (R(AW)) in mechanically ventilated patients with ventilator-associated pneumonia. Fifteen adult patients with ventilator-associated pneumonia were recruited and acted as their own controls. Manual hyperinflation followed by suction (manual hyperinflation plus suction) and suction alone were applied consecutively, in random order, on two occasions, four hours apart. Respiratory variables, C(L) and R(AW), were measured five times and the averaged value documented. Data were recorded before, immediately after, and 30 minutes after each intervention protocol. C(L) increased by 22% and R(AW) decreased by 21%, up to 30 minutes after manual hyperinflation plus suction, but not after suction alone. This study suggests that manual hyperinflation in conjunction with suction induces beneficial changes in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia.
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Affiliation(s)
- Jessica Siu-Ping Choi
- Physiotherapy Department, Queen Elizabeth Hospital, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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18
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Martínez-Moragón E, García Ferrer L, Serra Sanchis B, Fernández Fabrellas E, Gómez Belda A, Julve Pardo R. [Community-acquired pneumonia among the elderly: differences between patients living at home and in nursing homes]. Arch Bronconeumol 2005; 40:547-52. [PMID: 15574267 DOI: 10.1016/s1579-2129(06)60373-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The etiology, presentation, and prognosis of community-acquired pneumonia (CAP) among nursing home residents are believed to differ from those of other groups. However, few Spanish studies have confirmed those assumptions or studied regional differences in CAP etiology. PATIENTS AND METHODS A prospective study which included all patients over 65 years of age admitted to our hospital with CAP was carried out over a period of 18 months (2002-2003). We examined clinical, analytical, and radiographic characteristics paying particular attention to functional status--using the Eastern Cooperative Oncology Group (ECOG) scale and Barthel and Karnofsky indices--and comorbidity. Two blood cultures, a Legionella antigen test in urine, and serology for atypical bacteria were used for the etiologic diagnosis; bacterial cultures of respiratory samples were also used in certain cases. RESULTS Ninety-one patients, 25 of whom were nursing home residents, were enrolled. The nursing home residents were older than the other patients (mean [SD] age of 82 [4] compared with 73 [5]; P=.0001) and had greater comorbidity (P=.0001)--with a significantly greater presence of diabetes mellitus, cerebrovascular disease, congestive heart failure, and dementia. They also had a poorer functional status (ECOG, 2.09 [0.9] compared with 0.93 [1.1], P=.001; Barthel Index, 19 [33] compared with 77 [35], P=.001; Karnofsky In-dex, 51 [17] compared with 78 [23], P=.001). Regarding clinical characteristics, significant differences were found for respiratory rate (39 [11] compared with 27 [7] breaths/min; P=.001), blood pressure (69.5 [20] compared with 79.2 [18] mm Hg; P=.029), and temperature (36.6 [1.2] compared with 37.7 [1.1] degrees C; P=.001). CAP patients from nursing homes presented a greater number of affected lobules in chest x-rays (P=.004), more hypoxemia, acidosis, anemia, hypoalbuminemia, and greater scores of urea and creatinine. Fine Scale scores were also greater (134 [26] compared with 95 [28]; P=.001) as was mortality (7/25 compared with 3/66; P=.005). Few patients had an etiologic diagnosis and no significant differences were observed between the groups. The variable that predicted mortality in elderly patients in this series, according to stepwise logistic regression, was urea (adjusted R2=0.452). CONCLUSIONS In our sample population, nursing home residents were older, had greater comorbidity, and severe functional impairment. Under these circumstances the severity of CAP increases and becomes an important cause of mortality despite the fact that the etiologic agents do not appear to differ from those of the other patients.
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Affiliation(s)
- E Martínez-Moragón
- Servicio de Neumología, Hospital de Sagunto, Port Sagunt, Valencia, Spain.
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19
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Sil'vestrov VP. [Principles of rehabilitation of patients with acute pneumonia]. TERAPEVT ARKH 2005; 77:43-8. [PMID: 16206604] [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: 05/04/2023]
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20
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Ruiz de Oña Lacasta JM, Gómez Fernández M, Celdrán Gil J. Edad, comorbilidad y mortalidad en pacientes hospitalizados por neumonía adquirida en la Comunidad (réplica). Rev Clin Esp 2004; 204:563. [PMID: 15456616 DOI: 10.1157/13066188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Abstract
OBJECTIVES To determine if gestational age (GA) is independently associated with hospital resource use and outcomes among infants hospitalized for respiratory syncytial virus (RSV). STUDY DESIGN Analysis of retrospective data from 304 infants (</=1 year) with bronchiolitis or RSV pneumonia admitted to nine children's hospitals from April 1995 to September 1996. Resource use and outcomes examined included admission to the intensive care unit (ICU), intubation, and hospital and ICU length of stay. The Comprehensive Severity Index controlled for severity of illness. RESULTS Two hundred fifteen term infants (GA > or =37 weeks) and 89 infants with GA <37 weeks, divided according to GA into 3 subgroups (< or =32, 33 to 35, and 36 weeks), were compared. Significant differences were found for rate of intubation (P=.002) and ICU and hospital length of stay (P=.021 and P<.0001, respectively), with the highest resource use in 33 to 35 weeks GA infants, which remained significant in multiple regression analyses. CONCLUSIONS Infants 33 to 35 weeks GA had hospital outcomes that were negative or worse than infants < or =32 weeks GA. Data suggest prematurity < or =35 weeks GA significantly increases the risk for severe outcomes among infants hospitalized for RSV. Infants 36 weeks GA had outcomes similar to term infants. No evidence was observed of gradation or inverse linear risk relation between GA and hospital outcomes.
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Affiliation(s)
- Susan D Horn
- Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, Utah 84102-1282, USA.
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22
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Ramsdale H. On illness, convalescence and rehabilitation. Can Respir J 2003; 10:364-5. [PMID: 14571287 DOI: 10.1155/2003/892450] [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: 11/18/2022] Open
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23
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Abstract
OBJECTIVE To determine how often home mechanical ventilation (HMV) is instituted electively in children with respiratory failure from neuromuscular diseases and whether there were opportunities to discuss therapeutic options with patients/families before respiratory failure. METHODS Patients with neuromuscular disease (n = 73) requiring HMV (age, 2 months to 24 years) were studied. Whether HMV was initiated nonelectively because of acute respiratory failure or electively before acute respiratory failure, and opportunities for health care providers to discuss therapeutic options with patients/families before acute respiratory failure (hospitalization with pneumonia, clinic visits for preoperative evaluation, pulmonary function testing [PFT] and/or polysomnography [PSG]) were recorded. RESULTS HMV was initiated electively in 21% of patients with neuromuscular disease; 69% of the nonelective HMV group had HMV initiated after respiratory failure caused by pneumonia. In the nonelective group, opportunities for discussion of therapeutic options with the patients and families could have occurred before respiratory failure during 111 hospitalizations for pneumonia, 13 preoperative evaluations, 43 abnormal PFTs, and 24 abnormal PSGs. CONCLUSIONS Most patients with neuromuscular disease had HMV initiated nonelectively after acute respiratory failure caused by pneumonia. Opportunities for discussing the therapeutic options with patients and families before respiratory failure were missed or ineffective.
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Affiliation(s)
- Suchada Sritippayawan
- Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, California 90027, USA
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24
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Levenson D. Simple measure predicts how pneumonia patients will fare after discharge. Rep Med Guidel Outcomes Res 2002; 13:7-9. [PMID: 12506929] [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: 04/19/2023]
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25
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Bratzler DW. Osteopathic manipulative treatment and outcomes for pneumonia. J Am Osteopath Assoc 2001; 101:427-8. [PMID: 11526874] [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: 02/21/2023]
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26
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Noll DR, Shores JH, Gamber RG, Herron KM, Swift J. Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia. J Am Osteopath Assoc 2000; 100:776-82. [PMID: 11213665] [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: 02/19/2023]
Abstract
While osteopathic manipulative treatment (OMT) is thought to be beneficial for patients with pneumonia, there have been few clinical trials--especially in the elderly. The authors' pilot study suggested that duration of intravenous antibiotic use and length of hospital stay were promising measures of outcome. Therefore, a larger randomized controlled study was conducted. Elderly patients hospitalized with acute pneumonia were recruited and randomly placed into two groups: 28 in the treatment group and 30 in the control group. The treatment group received a standardized OMT protocol, while the control group received a light touch protocol. There was no statistical difference between groups for age, sex, or simplified acute physiology scores. The treatment group had a significantly shorter duration of intravenous antibiotic treatment and a shorter hospital stay.
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Affiliation(s)
- D R Noll
- Division of Medicine, Kirksville College of Osteopathic Medicine, 800 W Jefferson St, Kirksville, MO 63501, USA
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27
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Shamenova SI. [The rehabilitation of patients with acute pneumonia in the convalescence phase by using balneotherapy procedures]. Vopr Kurortol Fizioter Lech Fiz Kult 2000:18-21. [PMID: 11094888] [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: 04/15/2023]
Abstract
Effects of balneotherapy (underwater douche-massage, Gauffe baths, contrast douche) on clinical course of acute pneumonia (AP), external respiration function, cardiohemodynamics, surface activity of pulmonary surfactant, lipid peroxidation were studied in 88 AP convalescents. It was found that underwater douche-massage is indicated in prevailing hemodynamic disorders and moderate obstruction of the large bronchi. The efficacy of the douche was 93.8%. Gauffe baths were preferable (clinical response 88.9%) in marked bronchial obstruction with affection of all the bronchi but in satisfactory cardiovascular function. Contrast douche was not effective in AP convalescents (response--56.9%).
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28
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Matveeva LA, Kuz'menko OV, Kurts IA, Golosova LO. [The use of an aerosol of natural brine and of sinusoidal modulated currents in chronic pneumonias in children]. Vopr Kurortol Fizioter Lech Fiz Kult 1998:12-5. [PMID: 9643136] [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: 02/07/2023]
Abstract
Inhalations of 1% natural brine in combination with SMC electrophoresis of 1% natural brine above the lesion proved to ensure good correction of the defense of respiratory tract mucosa and to prolong remission to 15-18 months. This method can be applied in sanatoria, in rehabilitation centers, in pulmonary disease departments.
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29
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Chumillas S, Ponce JL, Delgado F, Viciano V, Mateu M. Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. Arch Phys Med Rehabil 1998; 79:5-9. [PMID: 9440408 DOI: 10.1016/s0003-9993(98)90198-8] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the efficacy of respiratory rehabilitation in preventing postoperative pulmonary complications (PPC) and to define which patients can benefit. DESIGN A randomized clinical trial. SETTING A public hospital. PATIENTS Eighty-one patients who had upper abdominal surgery were distributed into two homogeneous groups: control (n = 41) and rehabilitation (n = 40). INTERVENTION Breathing exercises in the rehabilitation group. MAIN OUTCOME MEASURES Preoperative and postoperative clinical evaluation, spirometry, arterial gasometry, and simple chest X-rays. RESULTS The incidence of PPC was 7.5% in the rehabilitation group and 19.5% in the control group; the control group also had more radiologic alterations (p = .01). Stratified PPC analysis did not reveal significant differences between groups. However, high- and moderate-risk patients in the rehabilitation group had fewer PPC. Multivariate analysis showed a greater PPC risk associated with pulmonary history (p = .02) and duration of surgery longer than 120 min (p = .03), while rehabilitation exerted a protective effect (p = .06). Significant postoperative decreases in pulmonary volumes and arterial gas values were recorded in both groups, without significant differences. CONCLUSIONS Respiratory rehabilitation protects against PPC and is more effective in moderate- and high-risk patients, but does not affect surgery-induced functional alterations.
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Affiliation(s)
- S Chumillas
- Department of Rehabilitation, Lluis Alcanyís Hospital, Xàtiva, Valencia, Spain
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30
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Leser C, Rothe TB, Karrer WL. [Rehabilitation of cystic fibrosis in adulthood]. Praxis (Bern 1994) 1997; 86:1984-1990. [PMID: 9465725] [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: 05/22/2023]
Abstract
By the example of 2 adult patients with cystic fibrosis (CF) problems of pulmonary manifestation of CF and its complications are discussed. In both patients disease manifested late. Life expectancy of CF-patients has markedly increased over the last decades. In the adult distinct complications appear more often such as exacerbation of bronchitis due to pseudomonas aeruginosa, colonisation of air ways by Burkholderia cepacia or by atypical mycobacteria, development of allergic bronchopulmonary aspergillosis, bronchiectases and spontaneous pneumothorax. Today, even in adults with chronic bronchitis of unknown origin the possibility of CF has to be considered. Optimized treatment under clinical conditions, in combination with a physical training program and a diet rich in calories will ameliorate subjective physical performance as well as objective pulmonary function and work capacity. Regular rehabilitation programs contribute to better compliance. In patients with CF direct transition from pediatric to pneumologic/internistic treatment for adults is mandatory in order to optimize expectancy and quality of life.
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Affiliation(s)
- C Leser
- Luzerner Höhenklinik, Montana
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31
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Björkqvist M, Wiberg B, Bodin L, Bárány M, Holmberg H. Bottle-blowing in hospital-treated patients with community-acquired pneumonia. Scand J Infect Dis 1997; 29:77-82. [PMID: 9112303 DOI: 10.3109/00365549709008669] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A study was carried out to determine whether bottle-blowing has any positive effects in patients with pneumonia. In a prospective open study 145 adults with untreated community-acquired pneumonia requiring hospitalization were randomized to early mobilization (group A), to sit up and take 20 deep breaths on 10 occasions daily (group B), or to sit up and to blow bubbles in a bottle containing 10 cm water through a plastic tube 20 times on 10 occasions daily (group C). Peak expiratory flow (PEF), vital capacity (VC), forced expiratory volume in 1 sec (FEV1) and serum concentration of C-reactive protein (CRP) were determined on admission, and on days 4 and 42. Fever duration and hospital stay were recorded. In a subset of 16 patients, single breath diffusion capacity of carbon monoxide was measured on 3 occasions. The patients in group A were hospitalized for a mean of 5.3 days, group B for 4.6 days and group C for 3.9 days. Treatment was a significant factor (p = 0.037) in a Cox regression model, with group C significantly better than group A (p = 0.01). The number of days with fever was 2.3, 1.7 and 1.6 in groups A, B and C respectively. These differences were not significant (p = 0.28). No significant differences were found between the groups regarding CRP, PEF, VC, FEV1, or diffusion capacity. Intensive bottle-blowing shortens the hospital stay in patients with pneumonia. The underlying mechanism is not clear.
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Affiliation(s)
- M Björkqvist
- Department of Infectious Diseases, Orebro Medical Center Hospital, Sweden
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32
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Shovkun VA, Chernov VN, Useĭnova NN, Nezhivenko MV, Nezhivenko NN, Gulkanian LA, Orlova LN. [The use of magnetic fields in the combined rehabilitation of children with a history of acute pneumonia]. Vopr Kurortol Fizioter Lech Fiz Kult 1996:40-41. [PMID: 8686228] [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: 05/22/2023]
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33
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Iarosh AM, Kurch TK, Eremenko AE, Khalikova NN, Semenova LV. [Changes in the immunity indices of children suffering from inflammatory lung diseases undergoing cold exposures]. Vopr Kurortol Fizioter Lech Fiz Kult 1995:14-6. [PMID: 7660615] [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: 01/26/2023]
Abstract
Cooling and heating the feet in children with pulmonary inflammatory diseases in remission improved immunity. Air baths in addition to stimulating immunity enhanced bactericidal potential of blood neutrophils. Cool and warm showers decreased this potential.
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34
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Iarosh AM, Kurch TK. [The effect of cold exposure on the respiratory function in children suffering from inflammatory lung diseases]. Vopr Kurortol Fizioter Lech Fiz Kult 1995:9-11. [PMID: 7785231] [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: 01/27/2023]
Abstract
Single total (air bath, douche) and local (cooling of the feet with water) exposure to mild cold do not arise noticeable disorders of the respiration function in children suffering from recurrent and asthmatic bronchitis in remission. Local cold procedures improve bronchial patency while the exposure to heat results in its worsening.
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35
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Kirillov MM, Reshetnikov VA, Orlova MM. [Aspects of physical and psychological rehabilitation of patients with severe-course acute pneumonia]. Klin Med (Mosk) 1994; 72:15-18. [PMID: 7898000] [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: 05/22/2023]
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36
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Vorob'ev LP, Busarova GA. [Adaptational reactions in patients with acute pneumonia]. Lik Sprava 1993:47-51. [PMID: 8379138] [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: 05/22/2023]
Abstract
Adaptive reactions were studied in 80 patients with acute pneumonia. In the hospital 94.1% patients showed reactions of stress and incomplete reactions of training and activation. With improvement of the clinical condition the number of stress reactions reduces, while the number of physiological reactions of training and activation increased. The stress reaction is an unfavourable factor as to transition of acute pneumonia into chronic unspecific pulmonary diseases. These studies may be of value for evaluation of the prognosis and care of acute pneumonia.
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37
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Rychkova MA, Darsaliia IA, Zozulia LS, Isakova NN. [The use of sea mud in the combined therapy of patients with acute pneumonia at a hospital]. Vopr Kurortol Fizioter Lech Fiz Kult 1992:22-6. [PMID: 1295214] [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: 12/26/2022]
Abstract
Basing on the observation on 246 patients with acute pneumonia, it is inferred that application of mud can be beneficial since the hospital treatment day 4-5. Compared to conventional, combined treatment with application of mud seems more favourable permitting more rapid attenuation of clinical symptoms and DIC syndrome, promoting active enzyme fibrinolysis and antithrombin-III, x-ray infiltration disappeared 4 days earlier, respiratory reserves and forced expiration grew.
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38
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Kliachkin LM. [Principles of the rehabilitation of patients with bronchopulmonary diseases]. Klin Med (Mosk) 1992; 70:105-9. [PMID: 1507802] [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: 12/27/2022]
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39
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Egorova GI, Kir'ianova VV. [The use of the electrophoresis of mud preparations in bronchopulmonary diseases]. Vopr Kurortol Fizioter Lech Fiz Kult 1991:55-6. [PMID: 1781170] [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: 12/28/2022]
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40
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Moens M, De Neve M. [Respiratory physiotherapy in lung diseases]. Acta Belg Med Phys 1990; 13:53-8. [PMID: 2239013] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- M Moens
- Dienst Fysische Geneeskunde en Revalidatie, Reumatologie, Electromyografie en B.M.C., A.Z. Stuivenberg, Antwerpen
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41
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Knysh VI, Taranukha VK. [The rehabilitative treatment of servicemen at a polyclinic]. Voen Med Zh 1990:27-9. [PMID: 2345970] [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: 12/31/2022]
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42
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Asauliuk IK. [The rehabilitation of young patients with a history of acute pneumonia]. Vrach Delo 1989:53-5. [PMID: 2800499] [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: 01/02/2023]
Abstract
The author reports data on 1120 patients with acute pneumonia. Age of the patients varied from 19 to 23 years. Complex treatment resulted in 52.7% of patients in normalization of clinico-roentgenological, laboratory findings and ventilation capacity of the lungs while 30.3% retained asthenic syndrome within 2-3 weeks after discharge from the hospital, 17% showed moderate disorders of the ventilatory pulmonary function before discharge from the hospital. For normalization of pulmonary ventilation rehabilitation measures were carried in out-patient conditions from 3 to 10 months. Determination of spirographic rates and spirographic bicycle ergometry are valuable criteria in assessment of the functional rehabilitation of the above category of patients.
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Krupennikov AI. [Impulse decimeter-wave therapy of patients with chronic nonspecific lung diseases at the medical rehabilitation stage]. Vopr Kurortol Fizioter Lech Fiz Kult 1989:39-43. [PMID: 2711634] [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: 01/02/2023]
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44
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Kreĭmer AI, Klimov VV. [Thermovibrotherapy in the combined rehabilitation of children with a history of acute pneumonia]. Vopr Kurortol Fizioter Lech Fiz Kult 1989:43-5. [PMID: 2711635] [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: 01/02/2023]
Abstract
A clinical response and the effect on local bronchopulmonary immunity have been assessed for thermotherapy and vibrotherapeutics used in convalescent young children who had acute pneumonia. The clinical and immunological appearance of the children was found to improve due to combined rehabilitation measures involving thermovibrotherapy.
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Krupennikov AI. [Low-frequency magnetotherapy in the rehabilitative treatment of patients with nonspecific lung diseases]. Vopr Kurortol Fizioter Lech Fiz Kult 1988:26-31. [PMID: 3245139] [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: 01/04/2023]
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46
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Mal'tsev LM, Kobzev VP, Boliasov NA. [Rehabilitative treatment of patients with acute pneumonia]. Voen Med Zh 1988:23-6. [PMID: 3206830] [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: 01/04/2023]
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47
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Polozhentsev SD, Lebedev MF. [Assessment of the effectiveness of the medical rehabilitation of patients with acute pneumonia]. Voen Med Zh 1988:49-50. [PMID: 3206838] [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: 01/04/2023]
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48
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Simonova OI, Savel'ev BP, Markov BA. [Effectiveness of therapeutic and rehabilitation complexes in the treatment of children with chronic bronchopulmonary diseases and mucoviscidosis]. Vopr Kurortol Fizioter Lech Fiz Kult 1988:23-5. [PMID: 3212958] [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: 01/04/2023]
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49
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Rychkova MA, Endakova EA, Novgorodtseva TP, Levagina NM. [Value of therapeutic mud on the activity of lysosomal enzymes in patients with nonspecific lung diseases]. Vopr Kurortol Fizioter Lech Fiz Kult 1988:25-7. [PMID: 3376433] [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: 01/05/2023]
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50
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Barkov VA, Komiachilova AS, Smirnova GI, Namestnikov VV, Rogozina TV. [Treatment of abscessing pneumonia by using combination physiotherapy]. Vopr Kurortol Fizioter Lech Fiz Kult 1987:13-6. [PMID: 3604115] [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: 01/06/2023]
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