Although non-invasive ventilation (NIV) efficacy in the treatment of acute hypercapnic respiratory failure (AHRF) have been previously demonstrated, not all the studies reveal this fact in the same ...degree, with some variability in the results. This study aimed to analyse variables related to NIV outcome for AHRF.
A group of consecutive patients requiring NIV due to AHRF were included in a prospective observational cohort study performed in conventional wards. Variables considered included those reported in the literature, as well as staff problems during the management of the ventilators. The study aimed to include all patients during one year, but after the initial results, it had to be suspended.
Fifteen patients were included in the study: 10 males, mean age 68+/-12. APACHE-II score was 17.6+/-6.5. pH and pCO2 before NIV were 7.22+/-0.11 and 110+/-72 mmHg respectively. pH, corticosteroids use, APACHE score, and EPAP were found to influence outcome. Besides, an inadequate use of NIV due to lack of personnel training was detected in all patients with NIV failure (RR 3.5; 95% CI: 1.08-11.2; p = 0.007). In the light of these results, the study had to be suspended and patients were transferred to the respiratory ward.
NIV is a life-saving respiratory treatment influenced by several factors, of which staff training is a key one. Centres attending acute respiratory patients should have an area in which this requirement is fulfilled.
OBJECTIVE: To analyse the variability of long term oxygen therapy (LTOT) prevalence according to several organisational and population factors.METHODS: Prospective multicentre survey in 29 public ...hospitals (population 6796964) recording data on the organisational structure of the
participating centres and factors related to LTOT prevalence. Official figures were also obtained from local health authorities on the prevalence and cost of LTOT.RESULTS: The overall prevalence of LTOT was 184 per 100000 population (range 71-473). There was a specific unit or staff
member for LTOT supervision in 17 (58.6%) centres, giving a lower prevalence (169 vs. 237/100000; P = 0.03). The altitude of the participating centres (median 92 m, mean 275 m; range 4-848 m) was found to influence LTOT prevalence (r = 0.73; P =
0.005). In the linear regression analysis, the coefficient of determination for altitude was 0.504. Other factors, such as percentage of population aged over 65 years, the attitude of prescribers towards patients with low adherence, current smokers or those with a PaO2 =
61 mmHg, were not related to LTOT prevalence.CONCLUSIONS: Altitude and the existence of a specific unit or staff member for LTOT supervision significantly influence LTOT prevalence.
The evaluation of a 13-month maintenance program (MP) for 39 severe COPD patients with FEV(1)%pred 44(7)% who, as result of two different 8-week leg exercise training (LET) programs, one supervised ...at the hospital (group S; n = 20) and the other self-monitored (SM; n = 19), had achieved different levels of exercise tolerance. After LET, patients in group S had a higher maximal oxygen uptake and endurance time than patients in the SM group O(2)max 1.43(0.30) l. min(-1) vs l.25(0.27) l. min(-1) and endurance-time 16(4) min vs 12 (5) min, respectively). During the MP patients were advised to walk vigorously at least 4 km/day, 4 times/wk. After the MP, while endurance time remained higher than at baseline, it had decreased ( p < 0.01) immediately after LET in both groups and no differences were evident between groups (11(4) min and 10(4), respectively). In contrast, Chronic Respiratory Diseases Questionnaire scores, which had improved significantly after LET in both groups, remained high. Long-term effects of MP were independent of the training strategy or whether physiological improvements had been obtained with the initial LET. SM exercise programs do not seem capable of maintaining physiological improvements in exercise tolerance, though "quality of life" can be maintained.
To understand the function of cortical circuits, it is necessary to catalog their cellular diversity. Past attempts to do so using anatomical, physiological or molecular features of cortical cells ...have not resulted in a unified taxonomy of neuronal or glial cell types, partly due to limited data. Single-cell transcriptomics is enabling, for the first time, systematic high-throughput measurements of cortical cells and generation of datasets that hold the promise of being complete, accurate and permanent. Statistical analyses of these data reveal clusters that often correspond to cell types previously defined by morphological or physiological criteria and that appear conserved across cortical areas and species. To capitalize on these new methods, we propose the adoption of a transcriptome-based taxonomy of cell types for mammalian neocortex. This classification should be hierarchical and use a standardized nomenclature. It should be based on a probabilistic definition of a cell type and incorporate data from different approaches, developmental stages and species. A community-based classification and data aggregation model, such as a knowledge graph, could provide a common foundation for the study of cortical circuits. This community-based classification, nomenclature and data aggregation could serve as an example for cell type atlases in other parts of the body.
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