CPAP-Applikation bei der Thorakozentese: Pleuralen Druckabfall mindern und Komplikationen verhindern

2020 ◽  
Vol 8 (1) ◽  
pp. 28-29
Author(s):  
Thomas Lesser

Background: Excessive drop of pleural pressure (Ppl) during therapeutic thoracentesis may be related to adverse events and/or to repeated procedures due to incomplete drainage. Objective: This was a pilot study of the impact of the application of continuous positive airway pressure (CPAP) at +5 cm H2O upon the Ppl profile during thoracentesis. Methods: This was a prospective, controlled study of 49 consecutive adults who underwent thoracentesis. Enrollment was via alternation on a one-to-one basis. Pleural manometry was used to compare serial Ppl in patients using CPAP at +5 cm H2O (CPAP group) with Ppl in patients without CPAP (control group). Results: Mean volumes drained were comparable between CPAP and control groups (1,380 vs. 1,396 mL). Patients in the CPAP group had a significantly greater change in volume per centimeter water column pressure (p = 0.0231, 95% confidence interval 6.41-82.61). No patient in the CPAP group had a Ppl less than -20 cm H2O at termination of the procedure, while 8 (33%) control group patients developed a pressure lower than -20. No patient in either group developed re-expansion pulmonary edema. Conclusion: The application of CPAP at +5 cm H2O mitigates the decreases in Ppl caused by thoracentesis via an increase in pleural compliance. The clinical implications of this finding merit study.

2021 ◽  
Vol 10 (4) ◽  
pp. 720
Author(s):  
Adam Benjafield ◽  
Liesl Oldstone ◽  
Leslee Willes ◽  
Colleen Kelly ◽  
Carlos Nunez ◽  
...  

There are currently few data on the impact of mask resupply on longer-term adherence to positive airway pressure (PAP) therapy. This retrospective analysis investigated the effects of mask/mask cushion resupply on the adherence to PAP versus no resupply. Deidentified patient billing data for PAP supply items were merged with telemonitoring data from Cloud-connected AirSense 10/AirCurve 10 devices via AirViewTM (ResMed). Eligible patients started PAP between 1 July 2014 and 17 June 2016, had ≥360 days of PAP device data, and achieved initial U.S. Medicare adherence criteria. Patients who received a resupply of mask systems/cushions (resupply group) were propensity-score-matched with those not receiving any mask/cushion resupply (control group). A total of 100,370 patients were included. From days 91 to 360, the mean device usage was 5.6 and 4.5 h/night in the resupply and control groups, respectively (p < 0.0001). The proportion of patients with a mean device usage ≥4 h/night was significantly higher in the resupply group versus the control group (77% vs. 59%; p < 0.0001). The therapy termination rate was significantly lower in the resupply group versus the control group (14.7% vs. 31.9%; p < 0.0001); there was a trend toward lower therapy termination rates as the number of resupplies increased. The replacement of mask interface components was associated with better longer-term adherence to PAP therapy versus no resupply.


PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0256950
Author(s):  
Jayme Marques dos Santos Neto ◽  
Clístenes Cristian de Carvalho ◽  
Lívia Barboza de Andrade ◽  
Thiago Gadelha Batista Dos Santos ◽  
Rebeca Gonelli Albanez da Cunha Andrade ◽  
...  

Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2–6 years with ASA I–II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188–368) in the CPAP group and 124 s (95% CI: 92–157) in the control group (median difference: 154 s; 95% CI: 58–249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14–0.48; p<0.001). The median for T2 was 21 s (95% CI: 13–29) and 29 s (95% CI: 22–36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.


Author(s):  
Behnam Behforouz ◽  
Anca Daniela Frumuselu

This paper investigates the efficiency of text messaging as an English as a Foreign Language (EFL) instructional tool to enhance learner autonomy and perception at the Islamic Azad University-South Tehran Branch, Iran. The study considers seventy-four learners to participate in the study after the administration of an Oxford Placement Test to measure their proficiency level. Participants are randomly assigned in experimental and control groups, including 37 participants each. A questionnaire is used as a pretest and posttest to measure learners` autonomy. Participants from the experimental group use text messaging (the treatment) to receive instructions, whereas those from the control group receive traditional classroom instructions in a face-to-face channel. A semi-structured interview is also used to collect date on experimental group participants` perception in using MALL in classrooms. The results reveal remarkable differences between the experimental and control groups’ means on their learner autonomy scores. However, the impact of the independent samples t-test has shown that there is no statistically meaningful gender difference among the learners regarding their autonomy scores. The findings based on the semi-structured interview showed complimentary views on MALL. The current study is beneficial since its outcomes could be relevant for EFL curriculum developers and English language teachers in the use of mobile learning and text messaging in the English classroom.


2002 ◽  
Vol 87 (8) ◽  
pp. 3667-3671 ◽  
Author(s):  
G. E. Krassas ◽  
N. Pontikides ◽  
V. Deligianni ◽  
K. Miras

The aim of this prospective controlled study was to ascertain the effect of hyperthyroidism on sperm quality and composition. We studied 23 thyrotoxic male patients, aged 43.8 ± 2.4 yr (mean ± sem), and 15 healthy male controls of approximately the same age (42.2 ± 2.2 yr). Two semen analyses at intervals of 2–3 wk were obtained before and about 5 months after euthyroidism was achieved either by methimazole alone (14 patients) or 131I plus methimazole (9 patients). Total fructose, zinc (Zn), and magnesium (Mg) were also measured in seminal plasma in 16 patients, because 7 had semen volume less than 2 ml. In the control group semen analysis was performed only once. Mean (±sem) semen volume was within normal range both in patients (3.3 ± 0.2 ml) and controls (3.5 ± 0.4 ml; P = NS). Mean sperm density was lower in patients, although the difference compared with controls did not reach statistical significance (35.7 ± 5.3 vs. 51.5 ± 6.1 × 106/ml; P = 0.062). The same was found with sperm morphology (68 ± 7% vs. 78 ± 8%; P = NS). Finally, mean motility was lower in thyrotoxic males than in controls (28 ± 8% vs. 57 ± 7%; P &lt; 0.01). After treatment, sperm density and motility improved [35.7 ± 5.3 vs. 43.3 ± 6.5 × 106/ml (P = NS) and 28 ± 8% vs. 45 ± 7% (P &lt; 0.05), respectively], but sperm morphology did not change (68 ± 7% vs. 70 ± 6%; P = NS). Mean values for fructose, Zn, and Mg did not differ between controls and patients either before or after achievement of euthyroidism [9.2 ± 0.7, 3.0 ± 0.5, and 4.2 ± 0.7 nmol/liter vs. 8.6 ± 0.9, 3.0 ± 0.5, and 4.7 ± 0.8 nmol/liter (patients before) and 9.1 ± 0.7, 3.1 ± 0.6, and 4.5 ± 0.9 nmol/liter (patients after treatment) for fructose, Zn, and Mg, respectively]. Moreover, according to the treatment given, no statistically significant differences were found before or after treatment. Finally, seminal plasma fructose, Zn, and Mg levels did not correlate with sperm parameters or with pretreatment thyroid hormone levels. In conclusion, the results of our study indicate that male patients with hyperthyroidism have abnormalities in seminal parameters, mainly sperm motility. These abnormalities improve or normalize when the patients become euthyroid. Restoration of sperm parameters was independent of the treatment provided for the hyperthyroid syndrome. Moreover, seminal plasma elements, such as fructose, Zn, and Mg, did not correlate with sperm density, motility, or morphology.


2020 ◽  
Vol 17 (11) ◽  
pp. 1179-1183
Author(s):  
Geeta Sharma ◽  
Tom Stewart ◽  
Scott Duncan

Background: Curriculum-integrated dance programs are a promising but relatively under-researched strategy for increasing children’s physical activity (PA). The aim of this study was to determine the impact of a curriculum-integrated dance program on children’s PA. Methods: A total of 134 primary children aged 7–9 years from 4 New Zealand schools were assigned to either a dance group (n = 78) or a control group (n = 56). The dance group participated in a 6-week curriculum-integrated dance program during school time. Although the dance program focused on curricular learning, fitness and coordination were embedded in the dance sessions. Intensity of PA varied according to the focus of each dance session. PA was measured at baseline and postintervention using a waist-mounted ActiGraph GT3X+ accelerometer for 8 consecutive days. Results: There were no significant intervention effects on PA levels between the dance and control groups postintervention. Conclusion: Dance-embedded learning did not increase overall levels of PA in this study. Future studies may consider assessing longer term effects of a dance-based intervention, or programs that place more focus on PA promotion.


2019 ◽  
Vol 31 (2) ◽  
pp. 166-191 ◽  
Author(s):  
Aurik Gustomo ◽  
Hary Febriansyah ◽  
Henndy Ginting ◽  
Imelia Martinovita Santoso

PurposeEmployee engagement has been directly linked to organizational outcomes, and at present, improving employee engagement has increasingly been a main focus for organizations. However, studies evaluating the impact of storytelling interventions on increasing the level of employee engagement are limited. Storytelling is one of the intervention methods that can provide cognitive stimulus to employees, which in turn could change their attitudes toward work including employee engagement. The purpose of this study is to determine the effectiveness of storytelling as an intervention tool for increasing employee engagement in one of the state-owned enterprises (SOEs) in West Java, Indonesia.Design/methodology/approachThis study uses a quantitative method. Employees from a West Java branch of large SOEs were randomly assigned into experimental and control groups. The research design used a pretest and a post-test with an expressive writing method to identify the extent of employee engagement by comparing participant groups and measuring the increase of employee engagement as a result of the storytelling intervention. The experimental group participated in three storytelling sessions that had been set up by panels of experts, while the control group was not given any treatment. The expressive writing analysis was conducted using software that has been developed and tested for validity and reliability. Furthermore, statistical analysis was used to test the results of expressive writing scoring to determine the impact of storytelling interventions.FindingsDirect storytelling is proven to be one of the most effective methods of increasing employee engagement in one of the SOEs in the West Java region. The results of this study showed that there were differences between the experiment and control groups after experiencing a direct storytelling intervention where there was a significant increase in the dimensions of employee engagement. Participants in experimental group had higher scores than participants in control group in most of the employee engagement dimensions. Additionally, expressive writing methods are also proven to be able to provide a stimulus for employees in expressing thoughts, perceptions and motivations for employee engagement in the company.Research limitations/implicationsAs direct storytelling has not been frequently used, especially to improve employee engagement, more studies should be conducted in various settings, with different measurement tools, and in a more controlled environment to confirm the effects of the intervention.Practical implicationsThis paper provides insight into how companies can use direct storytelling to improve the dimensions of employee engagement. Additionally, this research can also be used as a reference by companies in Indonesia, especially SOEs, for applying the same method in an effort to improve work-related attitudes, such as employee satisfaction and organizational commitment.Social implicationsThis study raises social implications in which employees enthusiasm increases in improving personal relationships between employees and storytellers, who are middle or upper management employees. In addition, employees also more appreciate their struggles when starting their careers, so they care more about increasing their role and involvement in the company.Originality/valueThis paper provides resources and information for companies and organizations to improve employee engagement through the implementation of direct storytelling. The focus of this paper is to gain information on the role of direct storytelling in improving employee engagement within a company or organization.


2004 ◽  
Vol 122 (6) ◽  
pp. 252-258 ◽  
Author(s):  
Tathiana Pagano ◽  
Luciana Akemi Matsutani ◽  
Elisabeth Alves Gonçalves Ferreira ◽  
Amélia Pasqual Marques ◽  
Carlos Alberto de Bragança Pereira

CONTEXT: Fibromyalgia is a syndrome characterized by chronic, diffuse musculoskeletal pain, and by a low pain threshold at specific anatomical points. The syndrome is associated with other symptoms such as fatigue, sleep disturbance, morning stiffness and anxiety. Because of its chronic nature, it often has a negative impact on patients' quality of life. OBJECTIVE: To assess the quality of life and anxiety level of patients with fibromyalgia. TYPE Of STUDY: Cross-sectional. SETTING: Rheumatology outpatient service of Hospital das Clínicas (Medical School, Universidade de São Paulo). METHODS: This study evaluated 80 individuals, divided between test and control groups. The test group included 40 women with a confirmed diagnosis of fibromyalgia. The control group was composed of 40 healthy women. Three questionnaires were used: two to assess quality of life (FIQ and SF-36) and one to assess anxiety (STAI). They were applied to the individuals in both groups in a single face-to-face interview. The statistical analysis used Student's t test and Pearson's correlation test (r), with a significance level of 95%. Also, the Pearson chi-squared statistics test for homogeneity, with Yates correction, was used for comparing schooling between test and control groups. RESULTS: There was a statistically significant difference between the groups (p = 0.000), thus indicating that fibromyalgia patients have a worse quality of life and higher levels of anxiety. The correlations between the three questionnaires were high (r = 0.9). DISCUSSION: This study has confirmed the efficacy of FIQ for evaluating the impact of fibromyalgia on the quality of life. SF-36 is less specific than FIQ, although statistically significant values were obtained when analyzed separately, STAI showed lower efficacy for discriminating the test group from the control group. The test group showed worse quality of life than did the control group, which was demonstrated by both FIQ and SF-36. Even though STAI was a less efficient instrument, it presented significant results, showing that fibromyalgia patients presented higher levels of anxiety, both on the state and trait scales. Thus, patients with fibromyalgia had higher levels of tension, nervousness, preoccupation and apprehension, and higher propensity towards anxiety. CONCLUSION: The three instruments utilized showed efficiency in evaluating fibromyalgia patients. FIQ was found to be the most efficient instrument for discriminating and assessing the impact of fibromyalgia on their quality of life. It can be concluded that such patients have a worse quality of life and higher levels of anxiety.


2009 ◽  
Vol 26 (3) ◽  
pp. 259-273 ◽  
Author(s):  
Erin R. Mazzoni ◽  
P. Lynn Purves ◽  
Julie Southward ◽  
Ryan E. Rhodes ◽  
Viviene A. Temple

The impact of a six-week indoor wall climbing on the perceptions of self for children with special needs aged 6–12 years was explored. Participants (n = 46) were randomly assigned to the intervention (girls, n = 4; boys, n = 19) and control groups (girls, n = 5; boys, n = 18). Belayers’ and children’s perceptions of efficacy were measured using specifically designed questionnaires and perceptions of competence and global self-worth were measured using Harter’s (1985) Self-Perception Profile for Children for participants with an adaptive age of 8 years or higher. Children’s self-efficacy and belayers’ ratings of children’s efficacy improved significantly, t(21) = 3.9, p = .001, d = .84 and F(2, 44) = 30.03, p < .001, respectively. The children’s judgments of their athletic and social competence and global self-worth, however, did not change over time or differ from the wait-listed control group (p > .05). These results suggest that it is likely that many experiences that enhance self-efficacy may be needed to improve self-perceptions.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4591-4591
Author(s):  
Selim Corbacioglu ◽  
Simone Cesaro ◽  
Maura Faraci ◽  
Bernd Gruhn ◽  
Jaap J Boelens ◽  
...  

Background Acute GvHD (aGvHD) remains one of the most significant complications of allogeneic hematopoietic stem cell transplantation (HSCT) with a persistently high incidence despite a plethora of prophylactic approaches. The medical need for effective drugs to prevent aGvHD remains substantial. Methods A prospective, randomized, open-label controlled study has been conducted in 356 children at high-risk for hepatic VOD post-HSCT to demonstrate efficacy of prophylaxis with defibrotide (DF) to reduce the incidence of VOD (180 in the DF arm and 176 in the control arm [Corbacioglu, Lancet 2012]). A secondary objective of the study was to analyze the impact of DF prophylaxis on the incidence and severity of aGvHD. Among children undergoing allogeneic HSCT (allo-subset) 122 patients received DF prophylaxis and 117 were in the control arm. Results Demographic and baseline characteristics were similar in the DF and control arm of the allo-subset. Mean age (± SD) was 6.47±5.28 and 6.54±5.49 in DF arm and in the controls respectively, with 29% and 30% being <2 years; 64% and 58%, respectively, were males. Busulfan was used in conditioning in 62% and 64% of patients in the two arms, and melphalan in 60% and 53%, respectively. Grafts were from related donors in 40% and 30%, respectively, in DF and control arm. Prophylaxis with DF was shown to significantly reduce the occurrence and severity of aGvHD. At day+100 post-HSCT the incidence of aGvHD was 47% in the DF arm vs. 65% in the control group (p=0.0046). DF did not seem to affect the incidence of aGvHD grade I (25% vs 28%, respectively). However, Defibrotide showed a consistent reduction of the more severe grade II–IV aGvHD from 37% to 22% (p=0.0130). Of note the use of corticosteroids was significantly lower in patients receiving DF prophylaxis (37% vs 48% in control arm, p=0.0363), likely reflecting the lower incidence of aGvHD in the DF arm. This has also previously been observed in the treatment studies [Richardson, ASH 2012]. Standard GvHD prophylaxis was allowed according to best practice and was generally comparable (cyclosporine A: 81% vs. 89%; methotrexate: 46% vs. 56%; in DF and control arm, respectively). However, there was a difference in patients who received antithymocyte globulin (ATG) in the DF arm compared to controls (55% vs 70%). Exploratory analysis performed adjusting for ATG as covariate confirmed the significant effects of defibrotide [Adjusted Risk Difference (DF vs control) for aGvHD grade II–IV: -0.1470 (95%CI: -0.2618; -0.0322), p =0.0121]. Defibrotide did not seem to interfere with a graft-versus-leukemia effect. Relapse rates of combined leukemias were 8% (ALL 1.5%, AML 5%, others 1.5%) in DF group compared with 10% (ALL 3%, AML 7%) in controls by day +100; while 10% (ALL 1.5%, AML 7%, others 1.5%) patients in DF group relapsed by day +180 compared with 13% (ALL 8%, AML 5%) in the control arm. Conclusions The study shows that DF prophylaxis can reduce the incidence and severity of aGvHD in children undergoing allogeneic HSCT. This reduction observed with defibrotide is additional to standard GvHD prophylaxis that was fully implemented in these patients. Defibrotide has been reported to protect endothelial cells from damage as well as to downregulate heparanase activity. These clinical data would therefore suggest a benefit of defibrotide to reduce the incidence and severity of aGvHD. Further studies may be conducted to strengthen preclinical and clinical evidence for the role of defibrotide in aGvHD prevention. Ref: Corbacioglu S et al, Lancet 2012; 379:1301-9. Richardson PG et al, Blood 2012; 120:738. Disclosures: Corbacioglu: Gentium : Consultancy. Cesaro:Pfizer SpA: Honoraria; Gilead: Honoraria; Merck: Honoraria. Tudone:Gentium : Employment. Ballabio:Gentium : Employment. Heringa:Gentium S.p.A.: Employment.


2020 ◽  
Vol 9 (1) ◽  
pp. 193 ◽  
Author(s):  
Jong Eun Park ◽  
Tae Gun Shin ◽  
Ik Joon Jo ◽  
Kyeongman Jeon ◽  
Gee Young Suh ◽  
...  

Sepsis is a common cause of delirium in the intensive care unit (ICU). Recently, vitamin C and thiamine administration has been gaining interest as a potential adjunct therapy for sepsis. We investigated the impact of early vitamin C and thiamine administration on ICU delirium-free days among critically ill patients in septic shock. We performed a single-center, retrospective study of patients who visited the emergency department (ED) from January 2017 to July 2018. We categorized patients into a treatment (received vitamin C and thiamine) and control group. We compared delirium-free days within 14 days after ICU admission using propensity score matching. Of 435 patients with septic shock, we assigned 89 propensity score-matched pairs to the treatment and control groups. The median delirium-free days did not differ between treatment (11, interquartile range [IQR] 5–14 days) and control (12, IQR 6–14 days) groups (p = 0.894). Secondary outcomes were not different between the two groups, including delirium incidence and 28-day mortality. These findings were consistent after subgroup analysis for patients who met the sepsis-3 definition of septic shock. Vitamin C and thiamine administration showed no association with ICU delirium-free days among patients in septic shock.


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