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https://www.readbyqxmd.com/read/29157888/quality-measurement-affecting-surgical-practice-utility-versus-utopia
#1
REVIEW
Leonard R Henry, Urs W von Holzen, Michael J Minarich, Ashley N Hardy, Wilbur A Beachy, M Susan Franger, Roderich E Schwarz
The Triple Aim: improving healthcare quality, cost and patient experience has resulted in massive healthcare "quality" measurement. For many surgeons the origins, intent and strengths of this measurement barrage seems nebulous-though their shortcomings are noticeable. This article reviews the major organizations and programs (namely the Centers for Medicare and Medicaid Services) driving the somewhat burdensome healthcare quality climate. The success of this top-down approach is mixed, and far from convincing...
November 11, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29155102/targeting-of-rac1-prevents-bronchoconstriction-and-airway-hyperresponsiveness
#2
Gwennan André-Grégoire, Florian Dilasser, Julie Chesné, Faouzi Braza, Antoine Magnan, Gervaise Loirand, Vincent Sauzeau
BACKGROUND: The molecular mechanisms responsible for airway smooth muscle cells (aSMC) contraction and proliferation in airway hyperresponsiveness (AHR) associated with asthma are still largely unknown. The small GTPases of the Rho family (RhoA, Rac1 and Cdc42) play a central role in SMC functions including migration, proliferation and contraction. OBJECTIVE: The objective of this study is to identify the role of Rac1 in aSMC contraction and to investigate its involvement in AHR associated with allergic asthma...
November 15, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29151936/multiple-guided-technologies-based-on-radial-probe-endobronchial-ultrasound-for-the-diagnosis-of-solitary-peripheral-pulmonary-lesions-a-single-center-study
#3
Huang Haidong, Ning Yunye, Zhang Wei, Paul Zarogoulidis, Wolfgang Hohenforst-Schmidt, Yan-Gao Man, Yang Yuguang, Dong Yuchao, Bai Chong
Objective To evaluate the value of multiple guided technologies based on radial probe endobronchial ultrasound (R-EBUS) in the application of the diagnosis of solitary pulmonary peripheral lesions (PPLs). Methods Analysis of diagnostic yield in 4 groups patients with different combined multiple guided technologies based on R-EBUS, 94 patients with 94 solitary PPLs from Mar, 2013 to Nov, 2014 in Changhai Hospital. Results The overall diagnostic yield was 75% (70/94), the diagnostic yield of Group A (R-EBUS) was 62%(16/26), Group B (R-EBUS with guided sheath, EBUS-GS) was 76% (34/45), Group C (EBUS-GS with fluoroscopy) was 82% (9/11), Group D (virtual bronchoscopic navigation guided EBUS-GS with fluoroscopy) was 92% (11/12)...
2017: Journal of Cancer
https://www.readbyqxmd.com/read/29151314/effect-of-inhaled-steroids-on-clinical-and-inflammatoryparameters-in-children-with-cystic-fibrosis
#4
Zeynep Seda Uyan, Göksenin Ünlügüzel Üstün, Goncagül Haklar, Erkan Çakır, Sedat Oktem, Refika Ersu, Bülent Taner Karadağ, Fazilet Karakoç, Elif Dağlı
Background/aim: The effectiveness of inhaled corticosteroids (ICSs) in cystic fibrosis (CF) is controversial. The aim of this study was to investigate the effect of an ICS on bronchial hyperreactivity (BHR), oxidative status, and clinical and inflammatory parameters in CF patients. Materials and methods: CF patients were randomized to receive either 2 mg/day nebulized budesonide or 0.9% normal saline as placebo for 8 weeks. Results: Twenty-nine CF patients (mean age: 10.5 ± 2.9 years) were enrolled in the study...
November 13, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/29149776/effect-of-nebulized-3-hypertonic-saline-with-salbutamol-on-management-of-acute-asthma-in-outpatient-adults-a-double-blind-randomized-clinical-trial-in-emergency-department
#5
Arash Forouzan, Kambiz Masoumi, Ali Delirrooyfard, Ali Asgari Darian, Laaya Mokhtar Gandomani
Asthma is one of the most common disorders of respiratory tract, management of which still remains as a serious health problem. This study aimed to compare the efficacy of 3% hypertonic saline (HS) plus salbutamol with solely salbutamol on management of acute adults' asthma based on peak flow meter findings. In this double-blind randomized clinical trial, 340 adult patients with acute asthma attacks admitted to emergency department of Ahvaz Golestan and Emam hospitals were enrolled during 2014-2015. The patients were allocated randomly to intervention group (nebulized 2...
October 2017: Iranian Journal of Allergy, Asthma, and Immunology
https://www.readbyqxmd.com/read/29142373/a-pilot-study-of-nebulized-heparin-for-prevention-of-ventilator-induced-lung-injury-comparative-effects-with-an-inhaled-corticosteroid
#6
Farzin Ghiasi, Mohsen Sadeghian, Mohammad Emami, Babak Ali Kiaie, Sarah Mousavi
Background: Ventilator-induced lung injury (VILI) is a side effect of mechanical ventilation. Lung inflammation and pulmonary activation of coagulation are induced by mechanical stress. Clinical and preclinical studies show that heparin possesses anti-inflammatory properties. Therefore, we assessed the effects of nebulized heparin in VILI. Methods: Sixty critically ill adult patients who require mechanical ventilation for more than 48 h were included in this prospective, nonrandomized controlled study...
October 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29140072/novel-aerosol-phase-extraction-method-for-the-determination-of-ca-k-mg-and-na-in-biodiesel-through-inductively-coupled-plasma-atomic-emission-spectrometry
#7
Raquel Sanchez, Salvador Maestre, Maria Soledad Prats Moya, José Luis Todoli
A novel extraction method was developed, optimized and validated for the elemental analysis of organic samples. The method, called aerosol phase extraction (APE), was based on the nebulization of the extracting aqueous solution (0.1 mol L-1 nitric acid) on the sample. The extraction was performed at the interface of each generated extractant droplets as they entered in contact with the samples. Afterwards, the phases were allowed to separate and Ca, K, Na and Mg were determined in aqueous phase by means of inductively coupled plasma optical emission spectroscopy (ICP-OES)...
November 15, 2017: Analytical Chemistry
https://www.readbyqxmd.com/read/29132498/perspectives-from-practice-complexities-of-personal-care-workers
#8
Julie-Anne Martyn, Sally Zanella, Adele Wilkinson
Personal care workers (PCWs) make up the bulk of the workforce in residential and community care services. The knowledge and skill set needed for safe and effective practice in care settings is extensive. A diverse range of registered training organisations (RTOs) offering Certificate III and IV in Individual Support (aging, home and community) are tasked with producing job-ready PCWs. However, the curricula of these programs vary. Additionally, a national code of conduct for healthcare workers became effective in October 2015 as a governance framework for PCWs...
November 14, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/29127842/budesonide-facilitates-weaning-from-mechanical-ventilation-in-difficult-to-wean-very-severe-copd-patients-association-with-inflammatory-mediators-and-cells
#9
Seyed Mohammadreza Hashemian, Esmaeil Mortaz, Hamidreza Jamaati, Leila Bagheri, Seyed Amir Mohajerani, Johan Garssen, Masoud Movassaghi, Peter J Barnes, Nicholas S Hill, Ian M Adcock
INTRODUCTION: Mechanical ventilatory support is life-saving therapy for patients with respiratory failure in intensive care units (ICU) but is linked to ventilator-associated pneumonia and other nosocomial infections. Interventions that improve the efficiency of weaning from mechanical ventilation may improve patient outcomes. OBJECTIVE: To determine whether inhaled budesonide decreases time-to-weaning in COPD stage 4 difficult-to-wean patients and reduces the release of pro-inflammatory cytokines in ICU patients...
October 31, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29125918/in-vitro-characterization-of-the-eflow-closed-system-nebulizer-with-glycopyrrolate-inhalation-solution
#10
Stephen Pham, Gary T Ferguson, Edward Kerwin, Thomas Goodin, Alistair Wheeler, Andrea Bauer
BACKGROUND: Glycopyrrolate administered by a novel, investigational eFlow(®) Closed System (CS) nebulizer (eFlow CS) is being evaluated for the maintenance treatment of chronic obstructive pulmonary disease (COPD). The eFlow CS is a hand-held, vibrating membrane nebulizer optimized to deliver 1 mL of glycopyrrolate solution into the lung in <3 minutes. Clinical studies have shown improvements in lung function of subjects treated with nebulized glycopyrrolate. METHODS: The aerosol performance of the eFlow CS nebulizer was characterized by delivered dose, aerodynamic droplet size distribution and nebulization time...
November 10, 2017: Journal of Aerosol Medicine and Pulmonary Drug Delivery
https://www.readbyqxmd.com/read/29123862/management-of-maternal-anaphylaxis-in-pregnancy-a-case-report
#11
Yasunobu Tsuzuki, Mitsuo Narita, Masayuki Nawa, Urara Nakagawa, Toshiaki Wakai
Case: A 26-year-old woman (gravida 2, para 1) at 25 weeks' gestation was brought to the emergency department because of anaphylactic symptoms. She reported eating Japanese soba and developed symptoms of dyspnea, generalized itchy rash, abdominal pain, and severe uterine contractions within 15-30 min of eating. She was immediately treated by normal saline infusion, two injections of epinephrine (intramuscularly), and a nebulized short-acting β2-receptor agonist, followed by H1-antihistamine and methylprednisolone...
April 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29122414/the-effect-of-hydration-on-voice-quality-in-adults-a-systematic-review
#12
REVIEW
Maxine Alves, Esedra Krüger, Bhavani Pillay, Kristiane van Lierde, Jeannie van der Linde
OBJECTIVES: We aimed to critically appraise scientific, peer-reviewed articles, published in the past 10 years on the effects of hydration on voice quality in adults. STUDY DESIGN: This is a systematic review. METHODS: Five databases were searched using the key words "vocal fold hydration", "voice quality", "vocal fold dehydration", and "hygienic voice therapy". The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed...
November 6, 2017: Journal of Voice: Official Journal of the Voice Foundation
https://www.readbyqxmd.com/read/29116676/salvage-therapy-with-topical-posaconazole-in-lung-transplant-recipients-with-invasive-scedosporium-infection
#13
Amparo Solé, Ana A García-Robles, Carlos Jordá, Enrique Cases Viedma, Nuria Mancheño, José Luis Poveda-Andrés, Juan Pablo Reig Mezquida, Javier Pemán
Scedosporium is an important pathogen in cystic fibrosis (CF) and post-transplant, but it rarely causes invasive infection. Treatment remains challenging, particularly due to the inherent resistance to multiple antifungal agents. We present three complicated invasive tracheobronchial and lung Scedosporium apiospermum infections following lung transplant. In two of three cases, the infection was clinically and radiologically cured with frequent cleansing bronchoscopies, combining triazole with terbinafine therapy and nebulized posaconazole...
November 8, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/29114011/albuterol-delivery-efficiency-in-a-pediatric-model-of-noninvasive-ventilation-with-double-limb-circuit
#14
Jeanne Velasco, Ariel Berlinski
BACKGROUND: Noninvasive ventilation (NIV) is used to treat respiratory failure in patients with concomitant need for aerosol delivery. Limited pediatric data are available on aerosol delivery efficiency, and none at all regarding aerosol delivery efficiency with a double-limb circuit. We compared the effect of position in the double-limb ventilator circuit, types of nebulizer, and ventilator settings on aerosol delivery efficiency in a pediatric model of NIV. We hypothesized that placing a vibrating mesh nebulizer at the ventilator and using the highest inspiratory pressures would increase aerosol delivery efficiency...
November 7, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29107308/dyspnea
#15
REVIEW
Margaret L Campbell
Dyspnea is a subjective experience of breathing discomfort that can only be known through a patient's report. Numeric rating or visual analog scales allow assessment of intensity when the patient can self-report. The Respiratory Distress Observation Scale is a valid, reliable tool for estimating distress when self-report cannot be elicited. Treating dyspnea begins with managing the underlying condition. Other dyspnea-specific evidence-based interventions include morphine and fentanyl, upright positioning, oxygen, invasive and noninvasive ventilation, and balancing rest with activity...
December 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/29098998/the-emergence-of-multidrug-resistant-pseudomonas-aeruginosa-in-cystic-fibrosis-patients-on-inhaled-antibiotics
#16
Atqah AbdulWahab, Khalid Zahraldin, Mazen A Sid Ahmed, Sulieman Abu Jarir, Mohammed Muneer, Shehab F Mohamed, Jemal M Hamid, Abubaker A I Hassan, Emad Bashir Ibrahim
INTRODUCTION: Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is an important and growing issue in the care of patients with cystic fibrosis (CF), and a major cause of morbidity and mortality. OBJECTIVE: The objective of the study was to describe the frequency of MDR-PA recovered from the lower respiratory samples of pediatric and adult CF patients, and its antibiotic resistance pattern to commonly used antimicrobial agents including β-lactams, aminoglycosides, and fluoroquinolones...
November 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/29098280/a-method-to-administer-agents-to-the-larynx-in-an-awake-large-animal
#17
Abigail Durkes, M Preeti Sivasankar
Purpose: This research note describes an adapted experimental methodology to administer an exogenous agent to the larynx and upper airway of awake animals. The exogenous agent could be a perturbation. In the current study, the agent was isotonic saline. Isotonic saline was selected because it is safe, of similar composition to extracellular fluid, and used in voice studies. The described approach allowed large animals such as pigs to be comfortably restrained without chemical sedation or anesthesia for extended periods while receiving the agent...
November 9, 2017: Journal of Speech, Language, and Hearing Research: JSLHR
https://www.readbyqxmd.com/read/29096627/a-28-day-randomized-double-blind-placebo-controlled-parallel-group-study-of-nebulized-revefenacin-in-patients-with-chronic-obstructive-pulmonary-disease
#18
Krishna K Pudi, Chris N Barnes, Edmund J Moran, Brett Haumann, Edward Kerwin
BACKGROUND: Revefenacin is a once-daily long-acting muscarinic antagonist (LAMA) in clinical development for the treatment of patients with chronic obstructive pulmonary disease (COPD). In a dose-ranging study, nebulized once-daily revefenacin had a long duration of action in patients after 7 days' administration of doses up to 700 μg. In this multiple-dose study, the bronchodilation efficacy and adverse events profile were characterized in patients administered nebulized revefenacin once daily for 28 days...
November 2, 2017: Respiratory Research
https://www.readbyqxmd.com/read/29095656/fabrication-of-eudragit-polymeric-nanoparticles-using-ultrasonic-nebulization-method-for-enhanced-oral-absorption-of-megestrol-acetate
#19
Seo Young Dai, Su-Eon Jin, Daehyun Kim, Don Haeng Lee, Su-Geun Yang
Megestrol acetate (MGA) is used as a progestagen to treat advanced cancers in the breast or uterus and anorexia-cachexia syndrome in cancer patients. Due to its low solubility (BCS class II), MGA bioavailability needs to be enhanced for efficacy and safety. We developed MGA-encapsulated Eudragit(®) L100 (EUD) nanoparticles (MGA-EUD (1:1) and MGA-EUD (2:1)) using an ultrasonic nebulization method. MGA-EUD (1:1) and MGA-EUD (2:1) consisted of MGA and EUD at the mass ratios of 1:1 and 2:1. Their physicochemical properties, i...
November 2, 2017: Pharmaceutical Development and Technology
https://www.readbyqxmd.com/read/29094511/a-comparison-of-nanoparticullate-cpg-immunotherapy-with-and-without-allergens-in-spontaneously-equine-asthma-affected-horses-an-animal-model
#20
John Klier, Sabine Geis, Jeanette Steuer, Katharina Geh, Sven Reese, Sebastian Fuchs, Ralf S Mueller, Gerhard Winter, Heidrun Gehlen
INTRODUCTION: New therapeutic strategies to modulate the immune response of human and equine allergic asthma are still under extensive investigation. Immunomodulating agents stimulating T-regulatory cells offer new treatment options beyond conventional symptomatic treatment or specific immunotherapy for human and equine allergic airway diseases, with the goal of a homoeostatic T-helper cell balance. The aim of this study was to evaluate the effects of a nebulized gelatin nanoparticle-CpG formulation (CpG-GNP) with and without specific allergens for the treatment of spontaneous allergic equine asthma as a model for human asthma...
November 1, 2017: Immunity, Inflammation and Disease
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