Bulletin of the New York Academy of Medicine
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Violence--homicides, suicides, injuries caused by youth or family acts--continues in the United States. Firearms are involved in most incidents. The Centers for Disease Control and Prevention addresses the problem using the traditional tools of public health: epidemiologic data, individual and societal interventions based on the data, and ongoing evaluations to assess the effects of the interventions and change them if necessary. Examples of interventions are presented.
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Manual and mechanical exsufflation are important but underutilized ways to clear airway secretions. These methods are especially useful when used in concert with noninvasive intermittent positive airway pressure ventilatory assistance to facilitate extubation and ventilator weaning. This can be used as much as 24 hours a day as an alternative to tracheostomy ventilation or body ventilator use for patients with paralytic restrictive ventilatory insufficiency. ⋯ Noninvasive intermittent positive airway pressure ventilatory assistance or body ventilator use can rest the respiratory muscles of patients with advanced chronic obstructive pulmonary disease. This and pulmonary rehabilitation programs geared to exercise reconditioning are therapeutic options that significantly improve the quality of life of these patients. For both paralytic restrictive and obstructive pulmonary patients, these techniques decrease cost and frequency of hospitalizations.