1,721,090 research outputs found
Hospitalized acute exacerbations of chronic obstructive pulmonary disease: which patients may have a negative clinical outcome?
No full textN/
Series "novelties in pulmonary rehabilitation": Determinants of success
No full textIn chronic obstructive pulmonary disease (COPD) patients, pulmonary rehabilitation is a nonpharmacological intervention aimed at improving physical exercise tolerance, dyspnoea and perceived quality of life. However, identifying predictors of clinical response and which patients achieve benefit remains a difficult question to answer with no conclusive data available. Baseline characteristics of COPD patients, such as degree of breathlessness, body weight and arterial partial pressure of oxygen, generally appear to be too direct to have a correlation with improvement of post-rehabilitation outcomes. Furthermore, some additional benefits of patients treated with rehabilitation are simply not detected by usual measures (social interaction, sleep quality and confidence). Although there are some data suggesting that some medical conditions frequently associated with COPD (osteoporosis, metabolic syndrome and heart diseases) may negatively influence rehabilitation outcomes, at present the evidence is contradictory
ICU acquired neuropathy and myopathy
No full textPatients admitted to intensive care often develop complications. Among these, acquired difficulties with neuromuscular function are widely recognised as potential causes of clinical worsening and delayed recovery in these individuals. Critical Illness Pofineuropathy and Critical Illness Myopathy are the most commonly recognised disorders which often occur simultaneously in the critically ill patients. Incidence of both Critical Illness Polineuropathy (from 2 to 80%) and Critical Illness Myopathy (from 1 to 7%) vary consistently according to the patients' selection, being diagnosis mainly addressed by clinical signs and electromyography test. Awareness among health care professionals, early recognition and diagnosis, patient's education about outcome and long-term prognosis, streamlining rehabilitation perspectives are considered short- and long-term key aspects which may optimise care in these patients. This short review will provide the main aspects dealing with definitions, epidemiology, risk factors, and clinical management of acquired difficulties with neuromuscular function in the critical care area
Non-invasive ventilation in chronic obstructive pulmonary disaese (chapter 23). In: Elliott M, Nava S, Schonhofer B. (eds) Non-inavsive Ventilation and Weaning: principles and practice.
No full textAdvanced chronic obstructive pulmonary disease (COPD) is associated with peripheral and respiratory muscular weakness with nocturnal and daytime arterial blood gases abnormalities (including hypercapnia) leading to chronic respiratory failure (CRF). At present, long-term oxygen-therapy (LTOT) is the only recognized long-term treatment that has been shown to significantly improve survival in these patients. An alternative therapeutic approach proposed, especially in patients with worsening hypercapnia, is nocturnal non-invasive ventilation (NIV). The three main theories that explain the efficacy of NIV, as applied by positive pressure (NIPPV), in these patients are:opportunity for resting of fatigued respiratory muscles, improvement in thoracic-pulmonary mechanics, and the ‘resetting’ of the central respiratory drive. In contrast with the strong evidence favouring the use of NIV in acute exacerbation of COPD, many studies performed in severe but stable patients have shown inconsistent and conflicting results. In the short term, NIV has been shown to reduce the rate of hospitalization, as well as to improve both the patient’s quality of life and their functional status. However, long-term assessments did not find any effect on survival and the strongest outcomes were not affected by the use of NIPPV even when added to LTOT.Recommendations of an international consensus conference published in 1999 provided the basis for NIV prescription in stableadvanced COPD patients – nocturnal hypoventilation, sleep fragmentation and daytime arterial hypercapnia; which are stillconsidered the optimal indications for domiciliary NIV, in particular in the presence of severe-progressive deterioration of the clinical condition and instability of respiratory function
Non-invasive ventilation in chronic obstructive pulmonary disease
No full textAdvanced chronic obstructive pulmonary disease (COPD) is associated with peripheral and respiratory muscular weakness with nocturnal and daytime arterial blood gas abnormalities (including hypercapnia) leading to chronic respiratory failure (CRF). At present, long-term oxygen therapy (LTOT) is the only recognized long-term treatment that has been shown to significantly improve survival in these patients. An alternative therapeutic approach proposed, especially in patients with worsening hypercapnia, is nocturnal non-invasive ventilation (NIV). The three main theories that explain the efficacy of NIV, as applied by positive pressure (NIPPV), in these patients are: opportunity for resting of fatigued respiratory muscles, improvement in thoracic-pulmonary mechanics, and the ‘resetting’ of the central respiratory drive. In contrast with the strong evidence favouring the use of NIV in acute exacerbation of COPD, many studies performed in severe but stable patients have shown inconsistent and conflicting results. In the short term, NIV has been shown to reduce the rate of hospitalization, as well as to improve both the patient’s quality of life and their functional status. However, long-term assessments did not find any effect on survival and the strongest outcomes were not affected by the use of NIPPV even when added to LTOT. Recommendations of an international consensus conference published in 1999 provided the basis for NIV prescription in stable advanced COPD patients – nocturnal hypoventilation, sleep fragmentation and daytime arterial hypercapnia – which are still considered the optimal indications for domiciliary NIV, in particular in the presence of severe-progressive deterioration of the clinical condition and instability of respiratory function
When Two Drugs Are Better than Three: Re-Modulating the Therapeutic Plan of a Chronic Obstructive Pulmonary Disease Patient
No full textWe present the case of a 77-year-old man diagnosed with chronic obstructive pulmonary disease (COPD) stage D with emphysema phenotype and treated with triple therapy (salmeterol, fluticasone propionate, and tiotropium) for 1 year without relevant improvements in exertional dyspnea and disease impact. After switching to combination therapy with a long-acting beta(2)-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) (indacaterol/glycopyrronium), we observed, in a 3-month period, a substantial reduction of the modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) scores. Moreover, the patient reported a reduction of dynamic hyperinflation and an improvement of ventilatory response to exercise. (C) 2018 S. Karger AG, Base
COPD 2017: A Year in Review
No full textIn this review, we focused on original manuscripts published in the 2017 that provided additional information on the clinical and therapeutic features of the chronic obstructive pulmonary disease (COPD). We have chosen eight of these studies, collected in four topics concerning the pharmacological treatment (tiotropium) of mild-moderate patients, the pharmacological (fluticasone furoate/vilanterol/umeclidinium) and non-pharmacological treatment (non-invasive mechanical ventilation) of severe patients, the etiology of acute exacerbation of COPD involving seasonal airway pathogens and the role of eosinophils with particular interest to the monoclonal antibody directed against interleukin-5 (mepolizumab). For each topic, we report a brief description of studies, take-home messages, and brief comments
Corpoluce di Fabrizio Crisafulli e Alessandra Cristiani: un teatro di fenomeni
No full textNel giugno 2019 a “La Stanza”, uno spazio per l’arte contemporanea a Narni, il regista teatrale Fabrizio Crisafulli e la performer Alessandra Cristiani hanno presentato, per la prima volta in vent’anni di collaborazione, un’opera ideata congiuntamente: Corpoluce. La performance, strutturata a partire da un serrato scambio tra i movimenti di Alessandra Cristiani e una tecnica di luce particolare ideata da Crisafulli, ha rivelato diversi livelli di comunione delle modalità creative dei due autori, in particolare sui piani della genesi del lavoro, della concezione del luogo e della tensione scenica. Il risultato è un’opera incendiaria e complessa, sviluppata in maniera innovativa su vari livelli, ricca di visioni immaginifiche e di poetici riferimenti
La letteratura distopica. Da Butler a Orwell
No full textCon la definizione della distopia come genere letterario e un'ampia panoramica storico-formale della produzione distopica inglese, questo capitolo risolve una lacuna dei manuali precedenti, dando una collocazione coerente e motivata a tutta una serie di opere prima attribuite in maniera disparata e in parte arbitraria ad altri generi letterari.
Nel primo paragafo - "Un genere romantico" - si definisce la distopia come 'gotico sociale' infivuduandone gli antecedenti nel romanzo giacobino degli anni novanta del Settecento (Godwin, Hays, Wollstonecraft).
Nel secondo paragrafo - "Tra trasgessione e fantascienza" - si traccia un quadro dello sviluppo del genere nella seconda metà dell'Ottocento, individuando i due grandi filoni della letteratura distopica: quello che s'ispira all'atteggiamento critico ed impegnato di William Morris e quello 'borghese' di H.G.Wells, il padre della Fantascienza del Novecento. Il capitolo si sofferma sulle figure più rappresentative ed attuali dei due filoni: Aldous Huxley e Anthony Burgess da un lato e Margaret Oliphant. E.M. Forster, George Orwell dall'altro. L'attualità dei loro 'warnings' viene spiegata sotto vari aspetti ed in particolare in rapporto all'acuirsi nell'inconscio collettivo contemporaneo del mito di Frankenstein (la creatura che minaccia di distruggere il creatore) sopratutto nella versione di Samuel Butler nel suo "Book of Machines"
Letitia Elizabeth Landon's The Improvisatrice: the Fatal Combination of Gender and Genre
No full text"Romantic Women Poets: Genre and Gender" focuses on the part played by women poets in the creation of the literary canon in the Romantic period in Britain. Its thirteen essays enrich our panoramic view of an age that is traditionally dominated by male authors such as Wordsworth, Coleridge, Byron, Shelley, Keats and Scott. Instead the volume concentrates on the poetical theory and practice of such extraordinary and fascinating women as Joanna Baillie, Charlotte Smith, Anna Laetitia Barbauld, Dorothy Wordsworth, Helen Maria Williams, Lady Morgan, Ann Radcliffe, Mary Shelley, Letitia Elizabeth Landon, Anna Seward, and Lady Caroline Lamb. Female and male poets, gender and genres, literary forms and poetic modes are extensively discussed together with the diversity of behavior and personal responses that the individual women poets offered to their age and provoked in their readers. There have been several important collections of essays in this particular area of study in the last few years, but this volume reflects and complements much of this earlier critical work with specific strengths of its own
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