Use of volume-targeted non-invasive bilevel positive airway pressure ventilation in a patient with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease in which most patients die of respiratory failure. Although volume-targeted non-invasive bilevel positive airway pressure (BPAP) ventilation has been studied in patients with chronic respiratory failure of various etiologies, its use in ALS has not been reported. We present the case of a 66-year-old woman with ALS and respiratory failure treated with volume-targeted BPAP ventilation for 15 weeks. Weekly data downloads showed that disease progression was associated with increased respiratory muscle weakness, decreased spontaneous breathing, and increased use of non-invasive positive pressure ventilation, whereas tidal volume and minute ventilation remained relatively constant.     

Effect of handling breaks on estimation of heart rate responses to bouts of physical activity among young women: An accelerometer research issue

BackgroundOne of the research interests with regard to accelerometry is the evaluation of physical activity bout under free-living conditions.Research questionThis study aimed to examine the effect of treatment interruption on the estimation of heart rate (HR) response to moderate-to-vigorous intensity physical activity (MVPA) bout.MethodsTwenty-five young women performed at least 30 min of MVPA during 24 h while wearing a uniaxial accelerometer on their waist and a portable HR monitor on their chest simultaneously. Based on the time series data, MVPA bout was defined as physical activity that was maintained at no less than 3 metabolic equivalents (METs) for >10 min without or with interruption, i.e., a 1-, 2-, or 3-min interruption.ResultsThe frequency and duration of MVPA bout significantly increased with interruption (p < 0.01). The HR and estimated MET value for an MVPA bout with interruption were significantly lower than those without interruption (p < 0.01), and the difference gradually increased depending on the duration of the interruptions (p < 0.01).SignificanceThese findings indicate that treatment interruptions could influence the estimation of cardiorespiratory response to MVPA bout under free-living conditions, and interruptions could result in an overestimation of the actual intensity of an MVPA bout.     

Analysis of the relationship between deep venous catheter-related infection and post-operative complications in patients receiving minimally invasive esophagectomy

Objective The aim of the study was to evaluate catheter-related infection rate(CRIR)for patients receiving minimally invasive esophagectomy(MIE),to identify the optimal catheterization approach and relationship between CRIR and post-operative complications.Methods In total,168 patients with esophageal carcinoma and undergoing MIE combined with preoperative deep venous catheterization(DVC)were analyzed in our institution(Qingdao Municipal Hospital,China),from 2014 to 2018.After completing DVC,catheter-tips together with intraductal venous blood samples were sent to the microbiology lab for bacterial strain culture.CRIR was statistically evaluated for the following clinical variables:gender,age,smoking status,drinking status,past history,tumor location,histologic grade,pathological T,N,and M category,anastomotic location,anastomotic leakage,anastomotic stricture,chylothorax,pneumonia,recurrent laryngeal nerve(RLN)injury,reflux esophagitis,catheterization site,and catheter-locking days.Results Among the 144 patients recruited in our study,105 catheters were inserted into the jugular vein and 39 catheters into the subclavian vein.The median age of these patients was 63 years(range:42–79 years),and the median catheter-locking period was seven days(range:4–21 days).Four catheters were identified with three types of strain colonizations,including Staphylococcus epidermidis,Staphylococcus aureus and Blastomyces albicans.Statistical data showed that patients diagnosed with catheter-related infection were likely to incur anastomotic leakage(66.67%,P<0.001)and pneumonia(27.27%,P<0.001);features such as tumors located in the upper esophagus(13.6%,P=0.003),and over seven catheterlocking days(10.00%,P<0.001)were attributed to a high CRIR.Conclusion Although both jugular and subclavian veins can be catheterized for patients with MIE,DVC is associated with more than seven catheter-locking days and upper esophagectomy,due to high CRIR.Furthermore,catheter-related infection is related to anastomotic leakage and pneumonia.     

A Clinical Validation Study of Impaired Physical Mobility of Patients Submitted to Cardiac Catheterization

PURPOSE: To conduct a Fehring model‐based clinical validation of the defining characteristics of the nursing diagnosis of impaired physical mobility in a sample of 250 patients. METHOD: Cross‐sectional study. FINDINGS: Three of the 11 NANDA‐International defining characteristics assessed in this study were validated: limited range of motion, limited ability to perform gross motor skills, and difficulty turning. Although discomfort was not validated due to the rarity of occurrence, there was excellent interrater agreement as to its relevance (kappa coefficient). CONCLUSIONS: In this setting, three characteristics were validated. IMPLICATIONS FOR NURSING PRACTICE: Validation studies are important for advancing evidence‐based practice.     

Abnormal electrocardiogram in a patient with amyotrophic lateral sclerosis mimicking myocardial ischaemia

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that almost exclusively involves motor neurons although autonomic dysfunction has also been reported. We present an 84-year-old female with no documented history of heart disease, who was admitted with negative T waves in the electrocardiogram precordial leads mimicking myocardial ischaemia. No other abnormalities were shown in the rest of the cardiologic evaluation, suggesting autonomic nervous system dysfunction. A neurophysiological study demonstrated acute and chronic denervation in multiple muscles with normal nerve conduction studies, confirming ALS diagnosis. Previous studies have shown that subclinical sympathetic hyperfunction and parasympathetic hypofunction might result in cardiovascular dysfunction in ALS patients. It is important to detect disturbances of autonomic cardiac control because this dysfunction may influence survival and quality of life, leading to a decrease in life expectancy in ALS patients. This Case Report may support the impairment of cardiac autonomic control in patients with ALS.     

Current Use of Fractional Flow Reserve: A Nationwide Survey

Major medical society guidelines recommend the measurement of fractional flow reserve (FFR) as an aid in choosing percutaneous coronary intervention in patients with stable coronary artery disease. We investigated the measurement of FFR among interventionalists, analyzing operators'' attributes and decision-making processes to reveal differences in their applications of FFR and the reasons for those differences. An electronic survey study of 1,089 interventionalists was performed from 2 February through 6 March 2012, yielding 255 responses. Most respondents were >45 years old (58%), worked primarily in a community hospital (59%), and performed 10 to 30 cases per month (52%). More than half (145/253, 57%) used FFR measurement in less than one third of cases, and 39 of 253 (15%) never used it. There were no differences in use of FFR by age, practice location, or angiogram volume (P >0.05 for all). Respondents used FFR measurement more frequently than intravascular ultrasonography (73% vs 60%) to help guide the decision to stent (P <0.01). Operators reported that their primary reasons for not using FFR were lack of availability (47%) and problems with reimbursement (39%). There was no difference in FFR use by operator age, practice setting, or case volume.     

“五位一体”的健康教育模式在PICC置管患者中的应用

目的 探讨“五位一体”的健康教育模式在PICC置管患者中的应用效果.方法 将772例需进行PICC置管的化疗患者随机分为实验组和对照组,各386例.对照组实施常规PICC护理,实验组在此基础上实施“五位一体”的健康教育模式.比较两组患者的并发症发生率、非计划拔管率、导管留置时间及患者的满意度.结果 实验组患者的并发症发生率及非计划拔管率依次为6.99％、1.30％,低于对照组的35.5％、11.92％(P＜0.05)；实验组的导管留置时间为(139.74±20.56)d,对照组为(116.95±30.21)d,两组比较有统计学意义(P＜0.01)；实验组患者的满意度高于对照组(P＜0.05).结论 系统完善的健康教育模式能减少PICC带管期间的并发症发生率,提高患者满意度.