Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Clinical guidelines are statements designed to help physicians make decisions about appropriate health care for specific circumstances. The constant rise in the number of published guidelines has been accelerated by the need of healthcare organizations to integrate evidence from clinical research with rational health policy, with the prospect of improving the quality and reducing the costs of health care at a local level. ⋯ Moreover, the evidence on which clinical guidelines are based can change with time and therefore they should be reviewed regularly. The critical approaches to making high-quality guidelines, the value of implementation strategies, and how healthcare organizations and individual physicians can use medical guidelines to enhance clinical effectiveness will be discussed.
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Monaldi Arch Chest Dis · Feb 2002
ReviewTreatment of primary spontaneous pneumothorax by simple talcage under medical thoracoscopy.
Medical thoracoscopy under local anesthesia with simple talc poudrage is a safe and cost-effective technique to prevent recurrences in the case of primary spontaneous pneumothorax. Pathogenesis of primary spontaneous pneumothorax, i.e. a pneumothorax occurring without any underlying lung disease, remains unclear; there is no proof that the air leak leading to air escape into the visceral pleura is located in blebs or bullae visualized during the procedure. ⋯ Pulmonologists doing thoracoscopic talc pleurodesis should learn to better control pain due to thoracoscopic talcage as it has been shown that thoracoscopic talcage is not more painful than a chest tube drainage in patients providing they receive at least some opioids. There is also a debate on the best surgical approach to treat pneumothorax but minithoracotomy with pleurectomy remains the gold standard although more expensive and associated with some morbidity or mortality.
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Monaldi Arch Chest Dis · Feb 2002
Biofilm formation in endotracheal tubes. Association between pneumonia and the persistence of pathogens.
Nosocomial pneumonia is still a common problem, especially in intubated and mechanically ventilated patients. The endotracheal tube contributes substantially to the pathogenesis of pneumonia in these patients, because it facilitates microaspiration and impairs host defences. Common nosocomial pathogens like Pseudomonas aeruginosa are known to produce exopolysaccharide and generate the complex biofilm structure, which allows adhesion to abiotic surfaces and protection against antibiotic action. ⋯ Endotracheal tubes, removed from patients with ventilator-associated pneumonia are covered more frequently with biofilm than those of uninfected controls. It remains unclear whether this represents a source of infection or contamination. Bacterial biofilm, however, may play an important role in recurrent pulmonary infections of the intubated and mechanically ventilated patient.