Chronic respiratory disease
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The stigma of non-communicable respiratory diseases (NCRDs), whether perceived or otherwise, can be an important element of a patient's experience of his/her illness and a contributing factor to poor psychosocial, treatment and clinical outcomes. This systematic review examines the evidence regarding the associations between stigma-related experiences and patient outcomes, comparing findings across a range of common NCRDs. Electronic databases and manual searches were conducted to identify original quantitative research published to December 2015. ⋯ No studies adequately met all criteria for methodological rigor. The inter-connectedness of stigma-related experiences to other aspects of patient experiences highlight that an integrated approach is needed to address this important issue. Future studies should adopt more rigorous methodology, including streamlining measures, to provide robust evidence.
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At least 5% of all intensive care unit patients require prolonged respiratory support. Multiple factors have been suggested as possible predictors of successful respiratory weaning so far. We sought to verify whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) can predict freedom from prolonged mechanical ventilation (PMV) in patients treated in a regional weaning centre. ⋯ APACHE II failed to predict freedom from mechanical ventilation (area under the receiver-operating characteristic curve [AUROC] = 0.534; 95% confidence interval [CI]: 0.439-0.628; p = 0.65) and tracheostomy tube removal (AUROC = 0.527; 95% CI: 0.431-0.621; p = 0.63). Weaning outcome was unrelated to the aetiology of respiratory failure on admission ( p = 0.41). APACHE II cannot predict weaning outcome in patients requiring PMV.