Evolución del uso de la ventilación mecánica no invasiva en enfermedad pulmonar obstructiva crónica en una región española, 1997-2010

Introduction

Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).

Subjects and methods

A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression.

Results

We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC] = −3.4, 95% CI: − 4.8; −2.0, P <.05) and in the group without ventilatory intervention (APC = −4.2%, −5.6; −2.8, P <.05); upward trend in the use of NIV (APC = 16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC = −4.5%, −10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC = 0.5, −1.3; 2.4) and in the group without intervention (APC = 0.1, −1.6; 1.9); downward trend with statistical significance in the NIV group (APC = −7.1, −11.7; −2.2, P <.05) and not statistically significant in the IMV group (APC = −0,8, −6, 1; 4.8). The mean stay did not change substantially.

Conclusions

The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay.     

Efficacy and safety of plasma exchange: an 11-year single-center experience of 2730 procedures in 317 patients

We reviewed retrospectively 317 patients who received 2730 plasma exchange (PE) procedures. According to guidelines published by the American Society for Apheresis (ASFA) in 2013, there were 220 (69%), 55 (17%), 32 (9%), and 7 (4%) patients who were treated with PE for a disease or condition considered as category I, II, III, and IV, respectively. Overall, 73%, 72%, and 69% of the patients showed an improvement of the underlying disease or condition at the end of the PE, and at 3 months and at 6 months after finishing the PE, respectively. We observed adverse effects in 90 (3%) PEs.     

Evolution of the Use of Noninvasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease in a Spanish Region, 1997–2010

IntroductionNoninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).Subjects and methodsA retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through JoinPoint regression.ResultsWe identified 30 027 hospital discharges. JoinPoint analysis: downward trend in attendance (annual percentage change [APC]=?3.4, 95% CI: ?4.8 to ?2.0, P<.05) and in the group without ventilatory intervention (APC=?4.2%, ?5.6 to ?2.8, P<.05); upward trend in the use of NIV (APC=16.4, 12.0–20.9, P<.05), and downward trend that was not statistically significant in IMV (APC=?4.5%, ?10.3 to 1.7). We observed an upward trend without statistical significance in overall mortality (APC=0.5, ?1.3 to 2.4) and in the group without intervention (APC=0.1, ?1.6 to 1.9); downward trend with statistical significance in the NIV group (APC=?7.1, ?11.7 to ?2.2, P<.05) and not statistically significant in the IMV group (APC=?0.8, ?6, 1–4.8). The mean stay did not change substantially.ConclusionsThe introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay.     

Trasplante de progenitores hematopoyéticos con intensidad reducida en enfermedades genéticas. Experiencia del grupo GETMON (Grupo Español de Trasplante de Médula Ósea en Niños)

Introduction

Haematopoietic stem cell transplantation (HSCT) involves implanting cellular elements capable of generating a new and healthy haematopoietic system. Reduced intensity conditioning (RIC) consists of an immunosuppressive treatment to facilitate a progressive implant with lower morbidity. This type of conditioning can also lead to myelosuppression, which is potentially reversible over time.Reduced intensity conditioning enables HSCT to be performed on patients with genetic diseases for whom added comorbidity is undesirable due to the high doses of chemotherapy that accompanies conventional myeloablative regimens.

A Survey of Online and Mobile Technology Use at Peer Support Agencies

Understanding how individuals with mental illness who receive services at peer support agencies use technology can inform the development of online and mobile health interventions tailored for users in these non-traditional mental health settings. The purpose of this study was to assess the use of technology among individuals with mental illness at peer support agencies. A survey delivered within peer support agencies (PSAs) in one state assessed technology use among individuals ages 18 and over with a self-identified mental illness receiving services at these agencies. In total, 195 individuals from 10 PSAs completed the survey. Eighty-two percent of respondents used the internet, with 63% of respondents connected to the internet at the PSAs. Eighty one percent of respondents owned a cell phone, 70% used text messaging, 58% owned smartphones, 61% used mobile applications, and 72% used social media. PSA users under age 55 were significantly more likely to own a smartphone than PSA users age 55 and older. Among internet users, 71% had searched for health information online and 57% had searched for mental health information online. Many individuals who receive services at PSAs have access to online and mobile technologies. These technologies may be leveraged to expand the reach of evidence-based health and mental health programs to individuals in these non-traditional mental health settings. Future research should explore the feasibility of intervention strategies that involve PSAs as a resource for linking people with mental illness to online and mobile support for their health and wellness goals.     

End-user views of an electronic encounter decision aid linked to routine depression screening

Objective

Our aim was to gather community stakeholder input to inform the development of a digital system linking depression screening to decision support.

The relationship between conformity to male and female gender norms and depression during pregnancy

Archives of Women's Mental Health - To analyze whether there is an association between conformity to male and female gender norms and the Edinburgh Postnatal Depression Scale (EPDS) score as an...