ABSTRACT
BACKGROUND: Pulmonary rehabilitation (PR) is mandatory before bronchoscopy lung volume reduction (BLVR); there is scant information about its efficacy post-BLVR. We retrospectively evaluated pulmonary function (PF) and disability in patients pre/post-BLVR and its additive effect on an intensive PR program post-BLVR vs matched non-BLVR controls. We analyzed changes within BLVR patients according to presence or not of atelectasis. METHODS: We compared PF and exercise tolerance (6-min walk test, 6MWT) in 39 BLVR patients (FEV1% pred. 28.9⯱â¯1.5; RV% pred. 236.1⯱â¯7.7) pre-/post-BLVR, and vs. 32 controls (FEV1% pred. 32.7⯱â¯1.5; RV % pred. 217.8⯱â¯8.3) before and after PR. RESULTS: BLVR patients showed a greater improvement than controls in PF (difference between groups: 3.8 for FEV1% pred., pâ¯=â¯0.043; -20.5 for RV % pred., pâ¯=â¯0.02) and 6MWT response rate (12/39 vs. 1/39 subjects, pâ¯=â¯0.003). Both groups further improved significantly 6MWT after PR without a significant difference between groups. Atelectasis after BLVR mainly accounted for the improvement in FEV1% pred, RV% pred. and 6MWT compared to both BLVR without atelectasis and controls. CONCLUSION: BLVR improves PF (particularly RV) and exercise tolerance, patients with lobar exclusion being the best improvers. PR following BLVR yields a further improvement in exercise tolerance in both (atelectasis and non-atelectasis) subgroups.
Subject(s)
Bronchoscopy , Emphysema/rehabilitation , Emphysema/surgery , Lung/physiopathology , Pneumonectomy/methods , Respiratory Function Tests , Aged , Case-Control Studies , Exercise Tolerance , Female , Humans , Male , Outcome Assessment, Health Care , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
Within telehealth there are a number of domains relevant to pulmonary care: telemonitoring, teleassistance, telerehabilitation, teleconsultation and second opinion calls. In the last decade, several studies focusing on the effects of various telemanagement programs for patients with chronic obstructive pulmonary disease (COPD) have been published but with contradictory findings. From the literature, the best telemonitoring outcomes come from programs dedicated to aged and very sick patients, frequent exacerbators with multimorbidity and limited community support; programs using third-generation telemonitoring systems providing constant analytical and decisionmaking support (24 h/day, 7 days/week); countries where strong community links are not available; and zones where telemonitoring and rehabilitation can be delivered directly to the patient's location. In the near future, it is expected that telemedicine will produce changes in work practices, cultural attitudes and organization, which will affect all professional figures involved in the provision of care. The key to optimizing the use of telemonitoring is to correctly identify who the ideal candidates are, at what time they need it, and for how long. The time course of disease progression varies from patient to patient; hence identifying for each patient a 'correct window' for initiating telemonitoring could be the correct solution. In conclusion, as clinicians, we need to identify the specific challenges we face in delivering care, and implement flexible systems that can be customized to individual patients' requirements and adapted to our diverse healthcare contexts.
Subject(s)
Delivery of Health Care, Integrated/methods , Practice Patterns, Physicians' , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Medicine/methods , Telemedicine/methods , Clinical Decision-Making , Delivery of Health Care, Integrated/organization & administration , Humans , Prognosis , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Medicine/organization & administration , Severity of Illness Index , Telemedicine/organization & administrationSubject(s)
Amyloid Neuropathies, Familial/diagnosis , Diagnostic Errors , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/diagnosis , Radiculopathy/diagnosis , Spinal Stenosis/diagnosis , Adult , Aged , Aged, 80 and over , Amyloid Neuropathies, Familial/pathology , Biopsy , Delayed Diagnosis , Diagnostic Techniques, Neurological , Female , Humans , Immunoglobulin Light-chain Amyloidosis/complications , Immunoglobulin Light-chain Amyloidosis/diagnosis , Immunoglobulin Light-chain Amyloidosis/pathology , Logistic Models , Lumbar Vertebrae , Male , Middle Aged , Multivariate Analysis , Neural Conduction , Paraproteinemias/complications , Paraproteinemias/diagnosis , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/etiology , Peripheral Nervous System Diseases/pathology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/pathology , Prealbumin/genetics , Radiculopathy/etiology , Retrospective Studies , Spinal Puncture , Spinal Stenosis/complicationsABSTRACT
This study in healthy subjects examined the effects of a system delivering focal microvibrations at high frequency (Equistasi®) on tonic vibration stimulus (TVS)-induced inhibition of the soleus muscle H reflex. Highfrequency microvibrations significantly increased the inhibitory effect of TVS on the H reflex for up to three minutes. Moreover, Equistasi® also significantly reduced alpha-motoneuron excitability, as indicated by the changes in the ratio between the maximumamplitude H reflex (Hmax reflex) and the maximumamplitude muscle response (Mmax response); this effect was due to reduction of the amplitude of the H reflex because the amplitude of muscle response remained unchanged. The present findings indicate that Equistasi® has a modulatory effect on proprioceptive reflex circuits. Therefore, Equistasi® might interfere with some mechanisms involved in both physiological and pathophysiological control of movement and of posture.
