Chest
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Randomized Controlled Trial Comparative Study
Impact of a disease management program upon caregivers of chronically critically ill patients.
Few studies have examined the effects of caregiving on the caregivers of chronically critically ill (CCI) patients, and no one has examined the impact of a disease management program (DMP) on physical and psychological outcomes for the caregivers of CCI patients. The purposes of this study of caregivers of CCI patients were as follows: (1) to describe the characteristics of CCI patients and caregivers and to examine the frequency of depression, subjective burden, and physical health; (2) to examine factors related to depression after hospital discharge; and (3) to examine the effects of a DMP on the physical health, depression, and burden of caregivers 2 months post-hospital discharge. ⋯ Two months after hospital discharge, approximately 25% of caregivers were classified as depressed with 16.7% of the depressed group classified as moderately or severely depressed. The caregivers of CCI patients are at risk for post-hospital discharge depression, and the caregivers of institutionalized CCI patients are at highest risk of long-term negative effects from caregiving.
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Comparative Study
A multidimensional grading system (BODE index) as predictor of hospitalization for COPD.
We hypothesized that the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index would better predict hospitalization for COPD than FEV1 alone, and the purpose of this study was to test this hypothesis in a cohort of patients with COPD. ⋯ The BODE staging system, which includes in addition to FEV1 other physiologic and clinical variables, helps to better predict hospitalization for COPD.
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Despite major advances in our understanding of the pathophysiologic processes leading to pulmonary arterial hypertension and recent developments in therapeutic approaches, the long-term prognosis for patients with pulmonary arterial hypertension remains unsatisfactory. Early detection and adequate clinical classification of the disease, better assessment of patients' prognosis, and improved therapeutic strategies are important challenges for clinicians in coming years.
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Comparative Study
Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia.
Traditionally, pneumonia developing in patients outside the hospital is categorized as community acquired, even if these patients have been receiving health care in an outpatient facility. Accumulating evidence suggests that health-care-associated infections are distinct from those that are truly community acquired. ⋯ The present analysis justified HCAP as a new category of pneumonia. S aureus was a major pathogen of all pneumonias with higher rates in non-CAP pneumonias. Compared with CAP, non-CAP was associated with more severe disease, higher mortality rate, greater LOS, and increased cost.
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Comparative Study
Nontuberculous mycobacterial infection: CT scan findings, genotype, and treatment responsiveness.
The purpose of this study was to compare the imaging findings of nontuberculous mycobacterial (NTM) infection in patients with normal and abnormal cystic fibrosis (CF) genotypes, and normal and abnormal alpha1-antitrypsin (AAT) phenotypes. ⋯ In patients with NTM infection, the CT scan findings show only minor differences according to phenotype and genotype. Initial CT scan findings do not predict change on follow-up CT scan evaluation. However, on follow-up CT scan, patients with CF mutations are less likely to improve, while those with AAT phenotype appear to have a radiographic outcome similar to those with normal phenotype.