[Perceived self-efficacy and respiratory rehabilitation]. / L'autoefficacia percepita e la riabilitazione respiratoria.

AIMS: To analyse if rehabilitation treatment can enhance perceived self-efficacy in performance of daily living activities in patients affected by chronic respiratory diseases (prevalently over 65 years of age and living in a poor socio-cultural context). METHODS. One-hundred and fifteen inpatients undergoing rehabilitation in hospital were administered two questionnaires: the A-D scale which evaluates state anxiety and depressive symptoms, and the Self-Efficacy and Independent Daily Living (SEIDL) questionnaire which evaluates expected self-efficacy in performing daily living activities. SEIDL was re-administered by phone after patients' discharge home, asking about their perceived actual self-efficacy in that moment. RESULTS: Subjects showed significantly higher scores on the A-D scale compared to the Italian normative sample. Females had lower expectations of self-efficacy than males (p = 0.000) and had a lower perception of their effective self-efficacy at follow-up (p = 0.01). State anxiety and depressive symptoms showed a significant negative correlation with expected self-efficacy and perceived self-efficacy at follow-up. CONCLUSIONS: Adequate psychological assessment is necessary before the start of rehabilitation treatment, as emotional disturbances can cancel the beneficial effects of rehabilitation. The creation of community day-centres would also be opportune, to support people affected by chronic respiratory diseases who may experience increased emotional disturbances when family support is lacking or insufficient.

Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods.

OBJECTIVE: To compare the short-term effects of postural drainage (PD), oscillating positive expiratory pressure (using the FLUTTER device), and expiration with the glottis open in the lateral posture (ELTGOL) on oxygen saturation, pulmonary function, and sputum production in patients with an acute exacerbation of chronic bronchitis. DESIGN: A prospective, randomized study. SETTING: A clinical ward. PATIENTS: Ten patients with chronic bronchitis exacerbation received PD, FLUTTER, and ELTGOL by the same respiratory therapist at about the same time of day on separate days and in random order. MAIN OUTCOME MEASURES: Oxygen saturation and pulmonary function were measured before, immediately after, and 15 minutes and 1 hour after each treatment. Improvement in sputum production was measured by total sputum wet weight immediately after and for 1 hour after treatment. INTERVENTIONS: PD consisted of positioning the patients in a posture that allows bronchial drainage by gravity. FLUTTER is a device that is claimed to combine oscillating positive expiratory pressure with oscillations of the airflow. ELTGOL is an airway clearance technique that uses lateral posture and different lung volumes to control expiratory flow rate to avoid airway compression. The total time spent for treatments was 30 minutes. RESULTS: All techniques were well tolerated, and oxygen saturation and pulmonary function did not change significantly during and after treatments. Thirty minutes after the beginning of treatment, sputum production increased significantly with all techniques, but during the 1 hour after the end of treatment, it was significantly larger with FLUTTER (from 15.0 +/- 8.6g to 19.0 +/- 9.3g, p < .01) and ELTGOL (from 17.0 +/- 7.0g to 20.6 +/- 6.9g, p < .02) than with PD (from 15.5 +/- 4.0g to 17.5 +/- 3.7g, NS). CONCLUSIONS: All three treatments were safe and effective in removing secretions without causing undesirable effects on oxygen saturation, but FLUTTER and ELTGOL techniques were more effective in prolonging secretion removal in chronic bronchitis exacerbation than was the PD method.

Controlled resuscitation for uncontrolled hemorrhagic shock.

OBJECTIVE: To test the hypothesis that controlled resuscitation can lead to improved survival in otherwise fatal uncontrolled hemorrhage. METHODS: Uncontrolled hemorrhage was induced in 86 rats with a 25-gauge needle puncture to the infrarenal aorta. Resuscitation 5 minutes after injury was continued for 2 hours with lactated Ringer's solution (LR), 7.3% hypertonic saline in 6% hetastarch (HH), or no fluid (NF). Fluids infused at 2 mL x kg(-1) x min(-1) were turned on or off to maintain a mean arterial pressure (MAP) of 40, 80, or 100 mm Hg in six groups: NF, LR 40, LR 80, LR 100, HH 40, and HH 80. Blood loss was measured before and after 1 hour of resuscitation. RESULTS: Survival was improved with fluids. Preresuscitation blood loss was similar in all groups. NF rats did not survive 4 hours. After 72 hours, LR 80 rats (80%) and HH 40 rats (67%) showed improved survival over NF rats (0%) (p < 0.05). Rebleeding increased with MAP. Attempts to restore normal MAP (LR 100) led to increased blood loss and mortality. CONCLUSION: Controlled resuscitation leads to increased survival compared with no fluids or standard resuscitation. Fluid type affects results. Controlled fluid use should be considered when surgical care is not readily available.

The management of blast injury.

The unique physiologic and medical consequences of blast injuries are often unrecognized and frequently poorly understood. The medical consequences, including pulmonary, gastrointestinal and auditory injury, have a defined and unique set of physiologic sequelae. Understanding the mechanism of injury, treatment issues and the potential long-term morbidity of primary blast injuries will enhance survival.

Human gammaglobulin use in the treatment of severe thrombocytopenia associated with sarcoidosis.

Thrombocytopenia associated with sarcoidosis is an uncommon, yet potentially lethal, complication. The traditional treatment for the thrombocytopenia has been steroid therapy followed by splenectomy if steroid therapy fails. The use of human immunoglobulin as a potential therapy in a patient afflicted with thrombocytopenia and sarcoidosis is reviewed.

Exertional rhabdomyolysis and acute renal failure following the Army Physical Fitness Test.

Rhabdomyolysis and myoglobinuric acute renal failure may occur following strenuous exercise and may be more common in less physically conditioned persons. A case of moderately severe acute renal failure after the exercise involved in a routine Army Physical Fitness Test (APFT) is described. This level of exertion, which is universally applied to Army personnel, should be recognized as a potential etiology of rhabdomyolysis. Prospective studies may help define the exact risk to renal function provided by the APFT.