Pulmonary rehabilitation: is it cost effective?

The purpose of the study was to evaluate number of hospitalizations, length of stay, exercise routine, and patient satisfaction following attendance at a pulmonary rehabilitative program. A retrospective chart review and survey conducted on 72 subjects with chronic obstructive pulmonary disease showed a significant decrease in number of hospitalizations and length of stay following attendance at the program. In addition, 72% of the subjects continued to carry out an exercise routine and 99% indicated that the rehabilitation program had met their expectations. This study suggests that the pulmonary rehabilitative program was cost-effective.     

The challenge of valvular heart disease: when is it time to operate?

In patients with valve disease, operating too soon exposes them to unnecessary surgical risk, but waiting too long may lead to cardiac damage and poor outcome. When to refer a patient for surgery depends on which valve is involved, the type of defect (stenosis or regurgitation), the degree of the defect, and the degree of symptoms or functional impairment.     

Films or fabrics: is it time to re-appraise postoperative dressings?

Post-operative wounds healing by primary intention are often seen as the simplest areas of modern wound care. However, have we overlooked the problems that can exist and are we really looking at postoperative dressing selection with the same vigour we attach to other areas of wound care? This article outlines the development of modern post operative dressings, both fabric and film-based and raises the question 'if postoperative wound infection is a problem should we consider more effective barrier dressings?'     

Current assessment of risk-benefit by regulators: is it time to introduce decision analyses?

Regulatory risk-benefit assessments may overweight small but serious risks relative to benefits. Using terfenadine and torsade de pointes as an exemplar, we illustrate how a different decision may result when outcomes are assessed using quality-adjusted life-years within a decision-analytical framework. The adoption of common measures of health outcome and the use of decision analyses, which will allow uncertainty to be characterized and evidence to be compiled from disparate sources, may inform complex risk-benefit decisions and should be used in conjunction with qualitative assessments.     

Community-acquired pneumonia: is it time to shorten the antibiotic treatment?

Evaluation of: Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am. J. Med. 120, 783–790 (2007).

Guidelines for community-acquired pneumonia (CAP) treatment have been published since 1993. Currently, the guidelines developed under the auspices of the Infectious Diseases Society of America and the American Thoracic Society are used. Empirical antibiotic recommendations reported in the current guidelines have not changed significantly from those reported previously concerning the choice of antibiotics, whereas the treatment duration is generic. Actually, in clinical practice, it seems that patients with mild-to-moderate CAP are overtreated for 7–10 days. The concern regarding adverse drug interactions, drug costs and, especially, increasing antimicrobial resistance have led to attempts to shorten the duration of therapy for CAP.     

Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?

Cold therapy has been used regularly as an immediate treatment to induce analgesia following acute soft-tissue injuries, however, a prolonged ice application has proved to delay the start of the healing and lengthen the recovery process. Hyperbaric gaseous cryotherapy, also known as neurocryostimulation, has shown the ability to overcome most of the limitations of traditional cold therapy, and meanwhile promotes the analgesic and anti-inflammatory effects well, but the current existing studies have shown conflicting results on its effects. Traditional cold therapy still has beneficial effect especially when injuries are severe and swelling is the limiting factor for recovery after soft-tissue injuries, and therefore no need to be entirely put out to pasture in the rehabilitation practice. Strong randomized controlled trials with good methodological quality are still needed in the future to evaluate the effects of different cryotherapy modalities.     

Social roles and long-term illness: is it time to rehabilitate convalescence?

The total extent of sickness in the population has increased while disease has decreased. Being sick is a role that offers the patient many advantages both directly, in terms of being absolved from undertaking many daily activities if necessary, and indirectly, through additional financial and other resources that may be offered. Because of these advantages, it is usual for any persistent sickness to be validated by health care professionals. Moreover sick people are expected to make every effort to leave the sick state, especially to make every effort using offered advice and resources such as rehabilitative treatments. However some people are sick longer than anticipated or apparently justified. The sick role developed based on assumptions that may no longer be valid, and the extended World Health Organization's International Classification of Functioning (WHO ICF) model of illness provides a new analysis of the problem, emphasizing that sometimes sickness is caused or perpetuated by factors other than disease. Among other factors, the lack of a way out of the sick role might be one reason for increasing sickness. Therefore re-establishing convalescence as a role might facilitate people in leaving the sick role, and rehabilitation should consider promoting convalescence.     

Sedation practice: is it time to wake up and embrace change?

Recommendations for sedation regimes in the intensive care unit (ICU) have evolved over the last decade based on findings that relate the clinical approach to improved patient outcomes. Martin and co-workers conducted two surveys into German sedation practice covering the time period during which these changes occurred and as such provide an insight into how these recommendations are being incorporated into everyday clinical practice.