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41.
Cristina Lalmolda Hector Prados Georgina Mateu Mariona Noray Xavier Pomares Manel Luján 《Archivos de bronconeumologia》2019,55(5):246-251
IntroductionThe aim of this study was to assess several air-pressure settings for MI–E to determine their effect on peak cough flow (PCF), and to compare the best pressures with those are more common used in the literature (±40 cmH2O) in patients with neuromuscular disorders (NMD).MethodsAdults with NMD in whom MI–E was indicated were recruited. Assisted PCF was measured by an external pneumotachograph. The protocol included 9 PCF measures per patient: 1 baseline (non-assisted), 4 with increasing inspiratory pressures without negative pressure (10, 20, 30 and 40 cmH2O or maximum tolerated), and then 4 adding expiratory pressures (?10, ?20, ?30 and ?40 cmH2O or maximum tolerated) with maximum inspiratory pressure previously achieved.ResultsTwenty one patients were included, 61% with amyotrophic lateral sclerosis (ALS). Mean PCFs with recommended pressures (±40 cmH2O) were lower than the scored in the individualized steps of the titration protocol (197.7 ± 67 l/min vs 214.2 ± 60 l/min, p < 0.05). Regarding subgroups, mean PCFmax values in ALS patients with bulbar symptoms were significantly higher than those achieved with recommended pressures (163.6 ± 80 vs 189 ± 66 l/min, p < 0.05).ConclusionThe PCFmax obtained with the protocol did not always match the recommended settings. It may be advisable to perform MI–E titration assessed by non-invasive PCF monitoring in patients with NMD, especially in ALS with bulbar involvement to improve the therapy detecting airway collapse induced by high pressures. 相似文献
42.
Kathryn H. Bowles Sarah J. Ratcliffe John H. Holmes Sue Keim Sheryl Potashnik Emilia Flores Diane Humbrecht Christina R. Whitehouse Mary D. Naylor 《Journal of the American Medical Directors Association》2019,20(4):408-413
Objectives
Although hospital clinicians strive to effectively refer patients who require post-acute care (PAC), their discharge planning processes often vary greatly, and typically are not evidence-based.Design
Quasi-experimental study employing pre-/postdesign. Aimed at improving patient-centered discharge processes, we examined the effects of the Discharge Referral Expert System for Care Transitions (DIRECT) algorithm that provides clinical decision support (CDS) regarding which patients to refer to PAC and to what level of care (home care or facility).Setting and participants
Conducted in 2 hospitals, DIRECT data elements were collected in the pre-period (control) but discharging clinicians were blinded to the advice and provided usual discharge care. During the postperiod (intervention), referral advice was provided within 24 hours of admission to clinicians, and updated twice daily. Propensity modeling was used to account for differences between the pre-/post patient cohorts.Measures
Outcomes compared between the control and the intervention periods included PAC referral rates, patient characteristics, and same-, 7-, 14-, and 30-day readmissions or emergency department visits.Results
Although 24%–25% more patients were recommended for PAC referral by DIRECT algorithm advice, the proportion of patients receiving referrals for PAC did not significantly differ between the control (3302) and intervention (5006) periods. However, the characteristics of patients referred for PAC services differed significantly and inpatient readmission rates decreased significantly across all time intervals when clinicians had DIRECT CDS compared with without. There were no differences observed in return emergency department visits. Largest effects were observed when clinicians agreed with the algorithm to refer (yes/yes).Conclusions/Implications
Our findings suggest the value of timely, automated, discharge CDS for clinicians to optimize PAC referral for those most likely to benefit. Although overall referral rates did not change with CDS, the algorithm may have identified those patients most in need, resulting in significantly lower inpatient readmission rates. 相似文献43.
Jessica T Goodwin Chantelle DeCroff Emilia Dauway Amelia Sybenga Raman C Mahabir 《CANADIAN JOURNAL OF PLASTIC SURGERY》2013,21(4):226-228
Reduction mammoplasty is one of the most commonly performed procedures in plastic surgery. Occasionally, there are findings reported by pathologists that are unfamiliar to the treating surgeon. The aim of the present study was to determine the types of pathologies encountered in reduction mammoplasty specimens. From this list of diagnoses, a best practice guideline for management will be organized to better assist plastic surgeons in the management of patients with incidental findings on pathology reports. A total of 441 pathology reports from patients who underwent bilateral or unilateral reduction mammoplasty in the past three years were identified. A list of 21 different pathologies was generated from the pathology reports, along with supplemental data from recent texts and articles. Occult carcinomas were encountered in two cases (0.45%) and high-risk lesions were found in three cases (0.68%) at the authors’ institution. An algorithm was then constructed to organize the pathologies according to risk of malignancy and assign them to a management guideline. There are many different lesions encountered incidentally in reduction mammoplasty specimens that may or may not confer some cancer risk. It is important for plastic surgeons to know which lesions need closer follow-up to provide the best care for their patients. 相似文献
44.
Fabio Gaetano Santeramo Marco Tappi Emilia Lamonaca 《Health policy (Amsterdam, Netherlands)》2021,125(8):995-1001
The fast-moving coronavirus disease 2019 (COVID-19) called for a rapid response to slowing down the viral spread and reduce the fatality associated to the pandemic. Policymakers have implemented a wide range of non-pharmaceutical interventions to mitigate the spread of the pandemic and reduce burdens on healthcare systems. An efficient response of healthcare systems is crucial to handle a health crisis. Understanding how non-pharmaceutical interventions have contributed to slowing down contagions and how healthcare systems have impacted on fatality associated with health crisis is of utmost importance to learn from the COVID-19 pandemic. We investigated these dynamics in Italy at the regional level. We found that the simultaneous introduction of a variety of measures to increase social distance is associated with an important decrease in the number of new infected patients detected daily. Contagion reduces by 1% with the introduction of lockdowns in an increasing number of regions. We also found that a robust healthcare system is crucial for containing fatality associated with COVID-19. Also, proper diagnosis strategies are determinant to mitigate the severity of the health outcomes. The preparedness is the only way to successfully adopt efficient measures in response of unexpected emerging pandemics. 相似文献
45.
Emilia Modolo Pinto Sheila A. C. Siqueira Priscilla Cukier Maria C. B. V. Fragoso Chin Jia Lin Berenice Bilharinho de Mendonca 《Pituitary》2011,14(4):400-404
Nelson’s syndrome (NS) is characterized by the appearance and/or progression of ACTH-secreting pituitary macroadenomas in
patients who had previously undergone bilateral adrenalectomy for the treatment of Cushing’s disease. Such corticotroph macroadenomas
respond poorly to currently available therapeutic options which include surgery, radiotherapy and chemotherapy. P53 protein
accumulation may be detected by immunohistochemistry in pituitary corticotroph adenomas and it has been suggested that it
might be causally related to tumor development. Wild type P53 protein plays an important role in the cellular response to
ionizing radiation and other DNA damaging agents and is mutated in many human tumors. In this study we report an adult male
patient with NS who underwent both transsphenoidal and transcranial pituitary surgeries, conventional and stereotaxic radiotherapy
and brachytherapy. Despite of the efforts to control tumor mass and growth, this macroadenoma displayed relentless growth
and aggressive behavior. DNA extracted from the first two surgical samples, as well as DNA from peripheral blood leukocytes
disclosed normal p53 sequence. DNA extracted from tumor samples obtained at surgeries performed after pituitary irradiation carried a somatic
heterozygous mutation, consisting of a deletion of four cytosines between nucleotides 12,144–12,149 in exon 4 of the p53 gene. This frameshift mutation creates a stop codon in exon 4 excluding the expression of a functional protein from the defective
allele. These data demonstrate a possible association between the P53 protein loss of function induced by radiotherapy and
the aggressive course of the disease in this patient. 相似文献
46.
Nikolaos Samaras Dimitrios Samaras Pierre-Olivier Lang Alexandre Forster Claude Pichard Emilia Frangos Patrick Meyer 《Maturitas》2013,74(3):213-219
Age related male hypogonadism, or “andropause”, is increasingly recognized as of frequent occurrence in older patients. Diagnosis requires both the presence of clinical symptoms and low testosterone levels. However, diagnosing andropause in this age group may be challenging since symptoms are frequently non specific and testosterone levels are influenced by a multitude of parameters such as lifestyle factors and chronic diseases. In this article we discuss the pathophysiology, definition and diagnostic difficulties of andropause in geriatric patients. Moreover, we review the relation between testosterone levels and frequent geriatric syndromes such as falls, osteoporosis, cognitive and mood disorders, anemia and cardiovascular disease. Finally, we examine the potential benefits and risks of testosterone replacement therapy in this age group. 相似文献
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