Respiratory care
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Multicenter Study
Development and Validation of a Chronic Obstructive Pulmonary Disease Self-Management Scale.
Although self-management reportedly can improve the health and quality of life of patients with COPD, there is no validated instrument for evaluating the status of the self-management of patients with COPD. ⋯ The CSMS is reliable, valid, and sensitive for evaluating the self-management status of COPD patients. To our knowledge, it is the first dedicated scale for evaluating the self-management status of COPD patients, and will serve as an important instrument for assessing and improving the self-management of COPD patients, particularly, those in the Hunan region of China.
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Multicenter Study
High Resource Utilization Does Not Affect Mortality in Acute Respiratory Failure Patients Managed with Tracheostomy.
Tracheostomy practice in patients with acute respiratory failure (ARF) varies greatly among institutions. This variability has the potential to be reflected in the resources expended providing care. In various healthcare environments, increased resource expenditure has been associated with a favorable effect on outcome. ⋯ We were unable to demonstrate a positive relationship between resource expenditure and outcome in ARF patients managed with tracheostomy.
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There are few studies of the epidemiology and clinical outcomes of patients with in-hospital cardiac arrest (IHCA) in a general hospital ward. ⋯ Witnessed IHCAs in the general ward had a higher rate of survival to hospital discharge; however, monitored cases had a lower rate of survival to hospital discharge. Respiratory insufficiency was a major preventable cause of IHCA. In consideration of the preventable IHCAs, further studies should be performed on monitoring practices in general wards.
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Closed pleural biopsy (CPB) in patients with malignant pleural effusion is less sensitive than cytology. Ultrasound-assisted CPB allows biopsies to be performed in the lower thoracic parietal pleura, where secondary spread from pleural metastases is initially more likely to be found. We analyzed whether choosing the point of entry for CPB with thoracic ultrasound assistance influences the diagnostic yield in malignant pleural effusion. ⋯ Selecting the point of entry for CPB using thoracic ultrasound increases the likelihood of obtaining pleural tissue and the diagnostic yield, but without statistical significance. We recommend ultrasound-assisted CPB to investigate pleural effusion, since the diagnostic yield of a pleural biopsy with an Abrams needle increased by > 17% in subjects with malignant pleural effusion.
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Comparative Study
Effects of Condensate in the Exhalation Limb of Neonatal Circuits on Airway Pressure During Bubble Continuous Positive Airway Pressure.
Bubble CPAP is frequently used in spontaneously breathing infants with lung disease. Often bubble CPAP systems lack pressure alarms and pressure-release valves. We observed a large volume of condensate in the exhalation limb of a patient circuit and conducted a series of experiments to test the hypothesis that accumulated condensate could affect delivered pressures. ⋯ Condensate in the exhalation limb of the patient circuit during bubble CPAP can significantly increase pressure delivered to the patient. The back and forth movement of this fluid causes oscillations in airway pressure that are much greater than the oscillations created by gas bubbling out the exhalation tube into the water bath. We recommend continuously monitoring pressure at the nasal airway interface, placing an adjustable pressure-relief valve in the circuit, set to 5 cm H2O above the desired mean pressure, and emptying fluid from the exhalation limb every 2-3 hours.