Estudos recentes têm sugerido que doença pulmonar obstrutiva crônica (DPOC) possa ser um fator de risco para aspergilose invasiva (AI), particularmente no contexto de ventilação mecânica e uso de esteróides. Neste trabalho, realizamos estudo de coorte prospectivo multicêntrico (2009-2010) em três unidades de terapia intensiva no Sul do Brasil. Foram incluídos no estudo pacientes com DPOC que apresentassem novo infiltrado pulmonar enquanto em ventilação mecânica e sob uso de corticosteróides. Para estes pacientes, foram realizados os seguintes testes, em amostras respiratórias (maioria aspirado traqueal): exame micológico direto, cultura quantitativa para fungos, pesquisa de antígeno galactomanana (GM) (Platelia Aspergillus) e PCR em tempo real para Aspergillus. O DNA das amostras respiratórias foi extraído utilizando-se o kit de extração MycXtra (Myconostica, UK), sendo a amplificação feita com dois kits comerciais de q-PCR: Aspergillus spp q-PCR Alert kit (Nanogen, Itália) e MycAssayTM Aspergillus kit (Myconostica, UK). Foi também obtido soro destes pacientes, onde foi testada GM, precipitinas para Aspergillus e IgE total. O estudo foi aprovado no comitê de ética dos dois hospitais. Foram incluídos no estudo 47 pacientes (40,4% do sexo masculino), sendo a idade média de 68,6 anos (±9,9). A maioria (72,8%) dos pacientes possuía DPOC grave (GOLD III/IV). A dosagem de esteróides (equivalentes de prednisona) variou de 100-4125 mg (mediana: 900 mg). Exame micológico (direto e cultivo) foi positivo para Aspergillus seção Fumigatti em apenas dois pacientes (4,2%). Outros fungos identificados foram Scedosporium apiospermum (n=1) e Histoplasma capsulatum (n=1). Precipitinas para Aspergillus foram positivas em três pacientes, com títulos baixos (<1:2). Os níveis de IgE variaram de 2 a >3000 UI/ml (mediana de 74 UI/ml). Em sua grande maioria, os índices de GM no soro foram <0,5, enquanto que nas amostras respiratórias, os índices de GM foram >0,5, >1,0 e >1,5 em 74,5%, 40,5% e 21,3%, respectivamente. PCR da Myconostica foi positivo em 10 pacientes, enquanto PCR Nanogen detectou apenas um paciente. A mortalidade geral foi de 53,2%. Este estudo prospectivo multicêntrico mostrou uma baixa incidência (4,2%) de AI em pacientes com DPOC. A determinação de GM mostrou altos índices nas amostras analisadas (50% com índices ópticos >1,3), possivelmente necessitando um maior ponto de corte para excluir resultados falso-positivos. A combinação de PCR e GM para o diagnóstico de AI em amostras respiratórias merece investigação adicional, devido à baixa sensibilidade dos métodos de cultivo observados nos estudos clínicos realizados. / Recent data have suggested that chronic obstructive pulmonary disease (COPD) may be an important risk factor for invasive aspergillosis (IA), particularly in the context of mechanical ventilation (MV) and therapy with corticosteroids. Here we present the results of a prospective multicentric study (2009-2010) conducted in three intensive care units (ICUs) in Southern Brazil. COPD patients on steroids showing a new lung infiltrate while on mechanical ventilation were included and the following tests were performed in respiratory samples (mostly tracheal aspirates): microscopy, quantitative fungal culture, galactomannan (GM) (Platelia Aspergillus EIA) and real-time PCR to detect Aspergillus DNA. DNA was extracted using MycXtra kit (Myconostica, UK) and amplification was performed using two q-PCR commercial kits: Aspergillus spp q-PCR Alert kit (Nanogen, Italy) and MycAssayTM Aspergillus kit (Myconostica, UK). Serum was also obtained and tested for Aspergillus precipitins, GM and total IgE levels. Ethical approval was obtained in each of the participant hospitals. A total of 47 patients were enrolled in the study (male 59.6%). Mean age was 68.6 years-old (± 9.9). Most patients had severe COPD (GOLD stages III/IV in 72.8%). Steroid dosage (prednisone equivalent) ranged from 100-4125 mg (median 900 mg). Microscopy and culture were positive for Aspergillus section Fumigatti in only 2 patients (4.2%). Other fungi included H. capsulatum (n=1) and S. apiospermum (n=1). Aspergillus precipitins were positive for three patients, at low titers (<1:2). IgE levels ranged from 2 to >3,000 IU/ml (median 74 IU/ml). All serum GM indexes were <0.5 and respiratory samples, GM indexes of >0.5, >1.0 and >1.5 were observed in 74.5%, 40.5%, and 21.3%, respectively. Myconostica PCR was positive in 10 patients, while Nanogen PCR detected only one patient. Overall mortality was 53.2%. This prospective multicenter study showed a low incidence (4.2%) of IA in critically ill patients with COPD. High optical indices were observed when GM was tested in respiratory samples (50% of the results showed indices of >1.3). Therefore, the test did not discriminate IA and a a higher cutoff would be needed to exclude false-positive results. The combination of PCR and GM for the diagnosis of IA in respiratory samples deserves further investigation due to the low diagnostic sensitivity of the classical mycology methods.

Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) are conditions that represent significant and ongoing medical costs, including frequent emergency department (ED) visits, hospitalizations, work absences, and disability. This retrospective cross-sectional study, examined the effects of the frequent ED visits due to COPD and CHF on the beneficiaries of Medicare and Medicaid in Maryland. The goal was to identify the factors that led these patients to visit the ED, the impact of these visits on Medicare utilization and costs across Maryland, and preventative intervention strategies to control this population's costs of care. Secondary data were analyzed from 2010-2012 using the Administrative Claims Data in Chronic Condition Warehouse (CCW). The results for the first research question revealed that an increase in the number of primary care physicians was correlated with a decrease in ED visits; thus, persons living in areas with higher PCPs also had lower ED visits therefore the first null hypothesis was rejected (Ï?2 = 3.85, p=.05) . The results for the second research question revealed that ED visits had no significant relationship with death in a given year; thus, patients may be diverted to less expensive care sites to minimize cost and ED overcrowding, therefore the second null hypothesis was not rejected (Ï?2 = 0, p=.98). In both cases, the confounding variables of gender, age, and race had significant effects upon the relationship. Health Professionals and policy makers may use the findings to develop strategies to increase supply of PCPs, adapt patient centered interventions and modify existing chronic disease care strategies to minimize or prevent lifestyle and environmental factors that affect chronic disease outcomes. Such improvements could contribute to positive social change by eliminating or reducing the overcrowding that occurs in emergency departments in Maryland and other states.

<p>Validerat; 20101217 (root)</p>

<p> </p><p> </p><p><strong> </strong></p><h1><strong> </strong></h1><p>Abstract</p><p>The aim of the study was to describe factors of nurse’s experiences when they give NIV treatment to patients with acute respiratory failure in a lung department. Semi structured interview questions about how nurses experience to give NIV treatment on a ordinary lung department was done on 10 nurses, who work in a lung department were NIV treatment is given. Data were analyzed with content analysis. In the result there was shown two themes. The two themes were knowledge and cooperation during NIV treatment and time and support accomplish NIV treatment easier to give. The first themes were knowledge and cooperation during NIV treatment. The theme was created by four categories: “specific knowledge about NIV treatment”, “cooperation with doctors” ”documentation about the treatment”, and ”teamwork between nurses”.  The theme time and support accomplish NIV treatment easier to give, was also created by four categories:” support for next of kin” satisfaction when the treatment is helping, “the patients need of support” and “time for the patient”. NIV treatment is a treatment that is god but in need of development, according to the nurses on the lung department, but there is a lot around the treatment that could be better. For example: getting more time with the patient and further educate doctors and nurses, so that NIV treatment can be given under assured requirements and to more patients.<strong> </strong></p><p> </p><p><strong>Key words</strong>: nurses, experiences, NIV treatment, COPD patients, technological equipment</p> / <p>Sammanfattning</p><p>Syftet med studien var att beskriva allmänsjuksköterskors upplevelser av att ge noninvasiv ventilation (NIV) behandling till patienter med akut andningssvikt på en lungavdelning.<strong> </strong>Halvstrukturerade intervjufrågor ställdes till tio allmänsjuksköterskor som arbetade på en lungavdelning där NIV behandling bedrivs. Intervjuerna analyserades med kvalitativ innehållsanalys. I resultatet framkom två teman: ”Kunskap och samarbete underlättar NIV behandling” och ”Tid och stöd till patienten underlättar NIV behandling”. Det första temat ”kunskap och samarbete underlättar NIV behandling” bildades av fyra kategorier; ”specifika kunskaper om NIV behandling”, ”samarbete med läkare”, ”dokumentation om behandlingen” och ”teamarbete mellan sjuksköterskor”. Temat ”tid och stöd till patienten underlättar genomförandet av NIV behandling” bildades också av fyra kategorier; ”anhörigstöd till patienten”, ” tillfredsställelse när behandlingen hjälper”, ”patientens behov av stöd” och ”tid för patienten”. NIV behandling är en behandling som är bra men behöver utvecklas enligt sjuksköterskorna på avdelningen, mycket runt om kring behandlingen behövde bli bättre t.ex. att få mer tid till patienten och mer utbildning för både läkare och sjuksköterskor så att behandlingen kan ges under tryggare förutsättningar och till fler patienter.</p><p> </p><p><strong>Nyckelord</strong>: sjuksköterskor, upplevelser, NIV behandling, KOL patienter, teknologisk utrustning</p><h1><strong> </strong></h1>

遠距醫療的概念，就是基於信息和通信技術為基礎的醫學和健康服務，經過多年實踐，遠距醫療技術的進展和應用的程序雖未能符合當前醫療的需求。但在新興技術與新科技醫療器材(Medical Device)逐漸改變了傳統的醫學行為。尤其在全球微波互通存取及智慧醫療平台的架構下(Worldwide Interoperability for Microwave Access, WiMAX), 新興的行動遠距醫療進展已逐漸縮短醫生與病患的差距。遠距醫療在慢性阻塞性肺病的應用已廣泛的在歐洲及北美使用。不僅是超越地理障礙。更可改善病人治療成效與降低醫療及社會成本。台灣醫療資源的不平衡，過多的資源放在人口密集的城市，相對於偏鄉離島，則需付出更多的社會經濟成本，但卻獲得不足的照護。本研究是藉由高速寬帶的無線通信，將胸腔暨重症專科醫師的知識與經驗，協同當地的醫生與護士，執行對慢性阻塞性病患的遠距醫療照護，以達到病人可以在任何時間與任何地方都可獲得無縫式的醫療照護。本研究根據遠距醫療照護產業文獻，整理遠距醫療照護之應用，並深入分析急病個案醫療管理模式，期望提供未來有意進入遠距照護產業之業者或後續研究者參考。

Fatigue is a distressing, complex, and multidimensional sensation, that is common in individuals with chronic obstructive pulmonary disease (COPD), and impacts negatively on their functioning and quality of life. Limited research has been conducted to examine how various factors may influence the different dimensions of subjective fatigue experienced in these individuals. Four dimensions of subjective fatigue including: emotional, behavioural, cognitive, and physical, were examined in a convenience sample of 42 participants with COPD who attended an outpatient pulmonary rehabilitation program. The primary purpose of this feasibility study was to determine the proportion of individuals experiencing the four dimensions of fatigue, and to examine the relationships between these dimensions of fatigue and various influencing factors (dyspnea, depression, anxiety, sleep quality, activity limitation, heart rate, and oxygen saturation). The secondary purpose was to compare the four dimensions of fatigue by sex, supplemental oxygen use, smoking status, and severity of dyspnea, and to examine the relationships between the four dimensions of fatigue and age, the number of co-morbidities, and the amount of pulmonary rehabilitation received. Self-report questionnaires were used to measure fatigue (Multidimensional Fatigue Inventory MFI), anxiety and depression (Hospital Anxiety and Depression Scale HADS), and sleep quality (Pittsburgh Sleep Quality Index PSQI). Pulmonary rehabilitation health records were accessed to collect data on the remaining variables. The majority of the participants (61.9% - 81.0%) experienced moderate levels of subjective fatigue in all four dimensions. Moderate to severe levels of physical fatigue were experienced in 95.3% of the participants. The only significant relationship was between anxiety and emotional fatigue; all other relationships were statistically insignificant. There were no significant differences between sex, supplemental oxygen use, smoking status, and severity of dyspnea on the four dimensions of subjective fatigue. Many of the participants had probable presence of clinical anxiety (42.9%), where the prevalence of anxiety was nearly twice as high as depression (21.4%). Findings from this study can be used by healthcare professionals to gain a better understanding of fatigue in individuals with COPD who attend pulmonary rehabilitation, and help in developing effective interventions for reducing the distressing effects of fatigue.

Patienter med kronisk obstruktiv lungsjukdom (KOL) upplever ofta oro relaterat till dyspné. Syftet med studien var att undersöka vilka icke-farmakologiska åtgärder som kan vidtas för att lindra patienters oro relaterat till dyspné vid KOL.  En litteraturstudie genomfördes där vetenskapliga artiklar granskades och sammanställdes. Resultatet visade att det finns ett flertal icke-farmakologiska åtgärder så som andningstekniker, fysisk träning, avledning, nutrition och kommunikation som sjuksköterskan kan undervisa och informera om för att lindra oro relaterad till dyspné. Åtgärderna bör vara individanpassade, eftersom varje patient är unik. Sjuksköterskan bör själv eller tillsammans med andra vårdinstanser försäkra sig om att patienten får den information och utbildning om sin sjukdom som krävs för att lindra patientens oro i möjligast mån. Informationen och utbildningen bör vara omfattande, för att patienten ska kunna finna de strategier och hjälpmedel som hjälper just dem vid oro. Lungrehabiliteringsprogram visade sig vara av betydelse för patienternas möjlighet att finna strategier för att lindra oro relaterad till dyspné. Ytterligare forskning men även utbildning av sjuksköterskor behövs angående specifika icke-farmakologiska åtgärder som kan lindra oro relaterad dyspné. Det behövs även forskning om vilka icke-farmakologiska åtgärder som bör ingå i ett lungrehabiliteringsprogram. / Patients with chronic obstructive pulmonary disease (COPD) often experience anxiety related to dyspnea. The purpose of this study was to investigate the non-pharmacological interventions that can be performed to alleviate patients' anxiety related dyspnea. A literature review was conducted and scientific articles were reviewed and summarized. The results showed that there are several non-pharmacological interventions that nurses can conduct to relieve anxiety related dyspnea, such as breathing techniques, physical exercise, diversion, nutrition and communication. Every patient is unique and therefore should the nurse interventions be individualized. It is the nurse task together with other health care professionals to ensure that the patients receives and understands the information that is given. The information and education should be extensive so that the patient will be able to find the right strategies that will help them to alleviate their anxiety. Pulmonary rehabilitation programs proved to be of great importance to patients' ability to find strategies to relieve anxiety related to dyspnea. Further research and education to nurses are needed on specific non- pharmacological interventions that can relieve anxiety related dyspnea. Research is also needed on which non-pharmacological interventions that should be part of a pulmonary rehabilitation program.

Fatigue is a distressing, complex, and multidimensional sensation, that is common in individuals with chronic obstructive pulmonary disease (COPD), and impacts negatively on their functioning and quality of life. Limited research has been conducted to examine how various factors may influence the different dimensions of subjective fatigue experienced in these individuals. Four dimensions of subjective fatigue including: emotional, behavioural, cognitive, and physical, were examined in a convenience sample of 42 participants with COPD who attended an outpatient pulmonary rehabilitation program. The primary purpose of this feasibility study was to determine the proportion of individuals experiencing the four dimensions of fatigue, and to examine the relationships between these dimensions of fatigue and various influencing factors (dyspnea, depression, anxiety, sleep quality, activity limitation, heart rate, and oxygen saturation). The secondary purpose was to compare the four dimensions of fatigue by sex, supplemental oxygen use, smoking status, and severity of dyspnea, and to examine the relationships between the four dimensions of fatigue and age, the number of co-morbidities, and the amount of pulmonary rehabilitation received. Self-report questionnaires were used to measure fatigue (Multidimensional Fatigue Inventory MFI), anxiety and depression (Hospital Anxiety and Depression Scale HADS), and sleep quality (Pittsburgh Sleep Quality Index PSQI). Pulmonary rehabilitation health records were accessed to collect data on the remaining variables. The majority of the participants (61.9% - 81.0%) experienced moderate levels of subjective fatigue in all four dimensions. Moderate to severe levels of physical fatigue were experienced in 95.3% of the participants. The only significant relationship was between anxiety and emotional fatigue; all other relationships were statistically insignificant. There were no significant differences between sex, supplemental oxygen use, smoking status, and severity of dyspnea on the four dimensions of subjective fatigue. Many of the participants had probable presence of clinical anxiety (42.9%), where the prevalence of anxiety was nearly twice as high as depression (21.4%). Findings from this study can be used by healthcare professionals to gain a better understanding of fatigue in individuals with COPD who attend pulmonary rehabilitation, and help in developing effective interventions for reducing the distressing effects of fatigue.

The aim of the study To investigate relationship between inflammation of the airways (bronchi) and pulmonary function. Objectives 1. To examine the levels of peripheral blood cytokines of patients suffering from COPD during exacerbation and remission, in order to detect non-invasive marker/markers of COPD that will enable us to differentiate infectious origin of exacerbation from non-infectious. 2. To investigate relationship between radiology changes of the lungs and respiratory function in patients suffering from chronic obstructive pulmonary disease. 3. To find out whether it is possible to evaluate changes of airway inflammation using classical inflammation and bacterial markers in patients suffering from COPD. To evaluate dependence of these markers on COPD clinical phase. 4. To evaluate the count of regulatory T lymphocytes (CD4+CD25+), as cells, possibly decreasing inflammation, in blood of the patients suffering from COPD and compare the results with results obtained from the group of patients who are not suffering from COPD. 5. To examine the amount of cells with CD25+ marker in mucosa of bronchi of patients suffering from COPD and compare this result with the result obtained in the control groups of non-smokers and smokers who are not suffering from COPD. Scientific novelty In practical work, the problem of timely diagnosis of exacerbation of the disease remains still important, despite significant achievements in research and treatment of COPD. The search of... [to full text] / Tyrimo tikslas: ištirti kvėpavimo takų (bronchų) uždegimo sąsajas su plaučių funkcija. Tyrimo uždaviniai 1. Ištirti asmenų, sergančių LOPL, periferinio kraujo citokinų koncentraciją ligos paūmėjimo ir remisijos metu, tikintis rasti neinvazinį LOPL paūmėjimo žymenį (žymenis), leisiantį atskirti infekcinę paūmėjimo kilmę nuo neinfekcinės. 2. Ištirti radiologinių plaučių pokyčių ir kvėpavimo funkcijos rodiklių sąsajas sergant lėtine obstrukcine plaučių liga. 3. Ištirti, ar apie kvėpavimo takų uždegimo pokyčius sergant LOPL galima spręsti iš klasikinių uždegimo ir bakterijų žymenų pokyčių kraujyje. Įvertinti šių kraujo žymenų priklausomybę nuo LOPL klinikinės fazės. 4. Nustatyti T reguliacinių limfocitų (CD4+CD25+), kaip galimai uždegimą slopinančių ląstelių, kiekį LOPL sergančių ligonių kraujyje ir palyginti su LOPL nesergančių asmenų grupe. 5. Ištirti CD25+ žymenį turtinčių ląstelių kiekį LOPL sergančių ligonių bronchų gleivinėje ir palyginti jį su LOPL nesergančių rūkančių ir nerūkančių asmenų kontrolinėmis grupėmis. Mokslinė darbo reikšmė ir naujumas. Nežiūrint didelių pasiekimų tiriant ir gydant LOPL, praktiniame darbe iki šiol išlieka savalaikio ligos paūmėjimo nustatymo problema. Nuolat ieškoma potencialių neinvazinių žymenų, kurie galėtų padėti laiku diagnozuoti LOPL paūmėjimą ir galimai nustatyti jo kilmę (bakterinis ar imuninis). Daug tikimasi iš citokinų, kaip potencialių LOPL paūmėjimo žymenų. Nors pavieniuose darbuose tirta IL-10 ir TNF-α koncentracija LOPL... [toliau žr. visą tekstą]

Tyrimo tikslas: ištirti kvėpavimo takų (bronchų) uždegimo sąsajas su plaučių funkcija. Tyrimo uždaviniai 1. Ištirti asmenų, sergančių LOPL, periferinio kraujo citokinų koncentraciją ligos paūmėjimo ir remisijos metu, tikintis rasti neinvazinį LOPL paūmėjimo žymenį (žymenis), leisiantį atskirti infekcinę paūmėjimo kilmę nuo neinfekcinės. 2. Ištirti radiologinių plaučių pokyčių ir kvėpavimo funkcijos rodiklių sąsajas sergant lėtine obstrukcine plaučių liga. 3. Ištirti, ar apie kvėpavimo takų uždegimo pokyčius sergant LOPL galima spręsti iš klasikinių uždegimo ir bakterijų žymenų pokyčių kraujyje. Įvertinti šių kraujo žymenų priklausomybę nuo LOPL klinikinės fazės. 4. Nustatyti T reguliacinių limfocitų (CD4+CD25+), kaip galimai uždegimą slopinančių ląstelių, kiekį LOPL sergančių ligonių kraujyje ir palyginti su LOPL nesergančių asmenų grupe. 5. Ištirti CD25+ žymenį turtinčių ląstelių kiekį LOPL sergančių ligonių bronchų gleivinėje ir palyginti jį su LOPL nesergančių rūkančių ir nerūkančių asmenų kontrolinėmis grupėmis. Mokslinė darbo reikšmė ir naujumas. Nežiūrint didelių pasiekimų tiriant ir gydant LOPL, praktiniame darbe iki šiol išlieka savalaikio ligos paūmėjimo nustatymo problema. Nuolat ieškoma potencialių neinvazinių žymenų, kurie galėtų padėti laiku diagnozuoti LOPL paūmėjimą ir galimai nustatyti jo kilmę (bakterinis ar imuninis). Daug tikimasi iš citokinų, kaip potencialių LOPL paūmėjimo žymenų. Nors pavieniuose darbuose tirta IL-10 ir TNF-α koncentracija LOPL... [toliau žr. visą tekstą] / The aim of the study To investigate relationship between inflammation of the airways (bronchi) and pulmonary function. Objectives 1. To examine the levels of peripheral blood cytokines of patients suffering from COPD during exacerbation and remission, in order to detect non-invasive marker/markers of COPD that will enable us to differentiate infectious origin of exacerbation from non-infectious. 2. To investigate relationship between radiology changes of the lungs and respiratory function in patients suffering from chronic obstructive pulmonary disease. 3. To find out whether it is possible to evaluate changes of airway inflammation using classical inflammation and bacterial markers in patients suffering from COPD. To evaluate dependence of these markers on COPD clinical phase. 4. To evaluate the count of regulatory T lymphocytes (CD4+CD25+), as cells, possibly decreasing inflammation, in blood of the patients suffering from COPD and compare the results with results obtained from the group of patients who are not suffering from COPD. 5. To examine the amount of cells with CD25+ marker in mucosa of bronchi of patients suffering from COPD and compare this result with the result obtained in the control groups of non-smokers and smokers who are not suffering from COPD. Scientific novelty In practical work, the problem of timely diagnosis of exacerbation of the disease remains still important, despite significant achievements in research and treatment of COPD. The search of... [to full text]