Chest
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To evaluate the role of nebulized opioids in COPD. ⋯ The recently published Global Initiative for Lung Disease guidelines have specifically stated that opioids are contraindicated in COPD management due to the potential respiratory depression and worsening hypercapnia. Nebulized opioids should be discouraged, as current data do not support their use.
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Comparative Study
Transpyloric feeding tube placement in critically ill patients using electromyogram and erythromycin infusion.
Transpyloric feeding is desirable in critically ill patients who often have gastroparesis; however, correct placement is difficult, requiring fluoroscopy, endoscopy, or time-consuming blind attempts. This study evaluated the success rate and time required to place transpyloric tubes using erythromycin infusion and GI electromyogram (EMG) signal. ⋯ Erythromycin infusion and EMG guidance can facilitate rapid transpyloric feeding tube placement in critically ill patients at the bedside.
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Comparative Study
Chest wall kinematics and breathlessness during pursed-lip breathing in patients with COPD.
Pursed-lip breathing (PLB) is a strategy often spontaneously employed by patients with COPD during distress situations. Whether and to what extent PLB affects operational lung volume is not known. Also, conflicting reports deal with PLB capability of decreasing breathlessness. ⋯ Changes in VCWee related to baseline airway obstruction but not to hyperinflation (FRC). By lengthening of TE and TTOT, PLB decreases VCWee and reduces breathlessness.
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Comparative Study
Gender differences in health-related quality of life in patients complaining of chronic cough.
To confirm that more women than men who complain of chronic cough seek medical attention, to determine whether the health-related quality of life (HRQOL) of these women is more adversely affected than men, and to determine whether there are gender differences in the ways that chronic cough adversely affects HRQOL. ⋯ Women with chronic cough were probably more inclined to seek medical attention than men because their HRQOL was more adversely affected and because they were more apt to suffer from physical complaints such as stress incontinence, which provoked psychosocial issues such as becoming embarrassed.
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Comparative Study
Education and experience improve the performance of transbronchial needle aspiration: a learning curve at a cancer center.
Transbronchial needle aspiration (TBNA) is an indispensable part of the pulmonologist's armamentarium, although it continues to be woefully underutilized despite its demonstrated safety and usefulness. We herein review our experience with the procedure. ⋯ TBNA performance was able to be improved over time. Increased specimen yield and sampling sensitivity over a 43-month period suggested the impact of enhanced training interventions and experience. Rapid on-site examination was also indispensable for the promotion of diagnostic accuracy. The progressive acquisition of skills as regards the use of cytology needles for TBNA purposes should precede the use of a histology needle for such biopsy purposes. For selected cases, the use of the 19-gauge histology needle increased the diagnostic yield of TBNA. It is to be hoped that increased experience with the TBNA technique and focused education regarding its performance will enhance its utilization by bronchoscopists and the spread of its acceptance.