ABSTRACT
No disponible
Subject(s)
Humans , Nebulizers and Vaporizers/trends , Asthma/drug therapy , Pulmonary Disease, Chronic Obstructive/drug therapy , Prescription Drug Misuse , Metered Dose Inhalers/trends , Patient Education as Topic/trendsSubject(s)
Nebulizers and Vaporizers , Patient Education as Topic , Asthma/drug therapy , Attitude of Health Personnel , Disease Management , Equipment Design , Equipment Failure , Health Knowledge, Attitudes, Practice , Health Personnel/education , Humans , Medication Adherence , Pulmonary Disease, Chronic Obstructive/drug therapy , Quality Improvement , Respiratory TherapySubject(s)
Humans , Male , Female , Adult , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/therapeutic use , Streptococcus pneumoniae/pathogenicity , Pneumococcal Infections/epidemiology , Pneumonia, Pneumococcal/prevention & control , Community-Acquired Infections/prevention & controlABSTRACT
OBJECTIVES: To evaluate the reliability of home respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome (SAHS) and to compare the cost of this technique with that of nighttime polysomnography performed in a sleep laboratory. PATIENTS AND METHODS: This was a prospective study of a random sample of patients with clinically suspected SAHS in which the participants who underwent both home respiratory polygraphy and nighttime polysomnography were blinded as to the results of their first test. Costs were calculated based on a theoretical population of 1000 individuals. A t test for paired samples, the Pearson correlation coefficient, and a receiver operator characteristic curve were used for the statistical analysis. RESULTS: The study population was composed of 45 patients with a mean (SD) age of 52.3 (11) years of whom 21 (46.6%) were diagnosed with SAHS, defined by an apnea-hypopnea index greater than 10 in nighttime polysomnography. Comparison of the results obtained in both recordings revealed statistically significant correlations for all comparisons. The optimal cutoff in this population was a respiratory disturbance index of 13.7 or more, for which the area under the receiver operating characteristic curve was 87.5% (95% confidence interval, 74.2%-95.4%). The mean cost of home respiratory polygraphy in a patient with suspected SAHS was euro69, whereas that of polysomnography was euro179. CONCLUSIONS: Home respiratory polygraphy is a reliable technique for the diagnosis of SAHS. Using this technique routinely in patients suspected of SAHS will be more economical than using nighttime polysomnography. Uncertain results must be verified by nighttime polysomnography.
Subject(s)
Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/economics , Adolescent , Adult , Aged , Costs and Cost Analysis , Diagnostic Techniques, Respiratory System , Female , Humans , Male , Middle Aged , Prospective Studies , Reproducibility of ResultsABSTRACT
Objetivos: El presente estudio se realizó con los siguientes objetivos: a) valorar la fiabilidad de la poligrafía respiratoria domiciliara (PRD) para el diagnóstico de síndrome de apneas-hipopneas durante el sueño (SAHS), y b) comparar los costes derivados de la realización de PRD con los de la polisomnografía nocturna (PSG) efectuada en el laboratorio de sueño. Pacientes y métodos: Se trata de un estudio prospectivo y ciego. La población de estudio estuvo constituida por una selección aleatoria de pacientes con sospecha clínica de SAHS. A todo paciente incluido en el estudio se le realizaron PRD y PSG sin conocer el resultado de la primera. Para el cálculo de costes se utilizó una población teórica de 1.000 personas. Para el análisis estadístico se emplearon la prueba de la t de Student para muestras emparejadas, el coeficiente de correlación de Pearson y el cálculo de las curvas de eficacia diagnóstica. Resultados: Se estudió a 45 pacientes, con una edad media (± desviación estándar) de 52,3 ± 11 años, de los que se diagnosticó de SAHS (índice de apneas-hipopneas ≥ 10 en la PSG) a 21 (46,6%). Al comparar los valores obtenidos en la PRD y la PSG, las correlaciones fueron significativas para todos los pares relacionados. El punto de corte óptimo en nuestra población fue un índice de acontecimientos respiratorios de 13,7 o mayor, con un área bajo la curva de eficacia diagnóstica del 87,5% (intervalo de confianza del 95%, 74,2-95,4%). La realización de una PRD en un paciente con sospecha de SAHS supone un coste medio de 69 , mientras que el de una PSG es de 179 . Conclusiones: La PRD es un método fiable para el diagnóstico de SAHS. Su realización de forma protocolizada supone un ahorro respecto a la realización de PSG a todos los pacientes con sospecha de SAHS. Por último, los resultados dudosos de la PRD requieren la realización de PSG
Objectives: To evaluate the reliability of home respiratory polygraphy for the diagnosis of sleep apneahypopnea syndrome (SAHS) and to compare the cost of this technique with that of nighttime polysomnography performed in a sleep laboratory. Patients and methods: This was a prospective study of a random sample of patients with clinically suspected SAHS in which the participants who underwent both home respiratory polygraphy and nighttime polysomnography were blinded as to the results of their first test. Costs were calculated based on a theoretical population of 1000 individuals. A t test for paired samples, the Pearson correlation coefficient, and a receiver operator characteristic curve were used for the statistical analysis. Results: The study population was composed of 45 patients with a mean (SD) age of 52.3 (11) years of whom 21 (46.6%) were diagnosed with SAHS, defined by an apneahypopnea index greater than 10 in nighttime polysomnography. Comparison of the results obtained in both recordings revealed statistically significant correlations for all comparisons. The optimal cutoff in this population was a respiratory disturbance index of 13.7 or more, for which the area under the receiver operating characteristic curve was 87.5% (95% confidence interval, 74.2%-95.4%). The mean cost of home respiratory polygraphy in a patient with suspected SAHS was 69, whereas that of polysomnography was 179. Conclusions: Home respiratory polygraphy is a reliable technique for the diagnosis of SAHS. Using this technique routinely in patients suspected of SAHS will be more economical than using nighttime polysomnography. Uncertain results must be verified by nighttime polysomnography
Subject(s)
Humans , Polysomnography/methods , Sleep Apnea Syndromes/diagnosis , Respiratory Function Tests , Cost-Benefit Analysis , Polysomnography/economics , Home Care Services, Hospital-Based/economics , Clinical ProtocolsABSTRACT
La gripe aviar está causada por virus de la gripe tipo A que se presentan de manera natural entre las aves silvestres. La producida por el subtipo H5N1 se está extendiendo en la actualidad y es motivo de preocupación porque afecta a humanos, con brotes altamente mortales sobre todo en Vietnam y Tailandia. La transmisión del virus de las aves a las personas es muy poco eficiente. El mecanismo de transmisión es la vía respiratoria por inhalación de productos procedentes de las aves enfermas. La transmisión de persona a persona se ha dado en muy pocos casos y no se ha propagado más allá de una persona. Hasta el momento se han registrado 252 casos con 148 fallecidos. Los síntomas van desde los típicos de la gripe fiebre, tos, dolor de garganta y dolor muscular hasta la infección ocular, neumonía, distrés respiratorio y otras complicaciones que pueden producir la muerte del paciente. Todos los pacientes presentan signos clínicos y radiológicos de neumonía, con cambios radiológicos tales como infiltrados difusos y consolidaciones lobulares o segmentarias con broncograma aéreo. La mortalidad es elevada. El tratamiento más activo son los inhibidores de la neuraminidasa; entre ellos, el oseltamivir, que ha sido el más empleado, consigue reducir la replicación vírica y mejorar la supervivencia. Los casos humanos han coincidido con epidemias en las aves. La gravedad de esta enfermedad justifica un estrecho seguimiento y estudio (AU)
Avian infuenza is caused by type A influenza virus and occurs naturally among wild birds. Influenza A virus subtype H5N1 is currently spreading and is causing concern due to infection in humans, with highly lethal outbreaks mainly in Vietnam and Thailand. Transmission of the virus from birds to humans is highly inefficient. The mechanism of transmission is through the respiratory tract due to inhalation of products from infected birds. Person-to-person transmission has occurred in only a few cases and infection has not been spread to more than one person. To date, 252 cases have been registered with 148 deaths. The symptoms of avian influenza range from typical influenza symptoms fever, cough, sore throat and muscle ache to eye infection, pneumonia, respiratory distress and other, sometimes fatal, complications. All patients show clinical and radiological signs of pneumonia with radiological alterations that include diffuse infiltrates and lobar or segmentary consolidations on air bronchogram. Mortality is high. The most active treatment consists of neuraminidase inhibitors, among which oseltamivir is the most widely used, achieving a reduction in viral replication and improving survival. Human cases have coincided with epidemics in birds. Because of the severity of this disease, close follow-up and investigation are warranted (AU)
