888 research outputs found
Respiratory sequelae of COVID-19: pulmonary and extrapulmonary origins, and approaches to clinical care and rehabilitation
Although the exact prevalence of post-COVID-19 condition (also known as long COVID) is unknown, more than a third of patients with COVID-19 develop symptoms that persist for more than 3 months after SARS-CoV-2 infection. These sequelae are highly heterogeneous in nature and adversely affect multiple biological systems, although breathlessness is a frequently cited symptom. Specific pulmonary sequelae, including pulmonary fibrosis and thromboembolic disease, need careful assessment and might require particular investigations and treatments. COVID-19 outcomes in people with pre-existing respiratory conditions vary according to the nature and severity of the respiratory disease and how well it is controlled. Extrapulmonary complications such as reduced exercise tolerance and frailty might contribute to breathlessness in post-COVID-19 condition. Non-pharmacological therapeutic options, including adapted pulmonary rehabilitation programmes and physiotherapy techniques for breathing management, might help to attenuate breathlessness in people with post-COVID-19 condition. Further research is needed to understand the origins and course of respiratory symptoms and to develop effective therapeutic and rehabilitative strategies
Causality, Information and Biological Computation: An algorithmic software approach to life, disease and the immune system
Biology has taken strong steps towards becoming a computer science aiming at
reprogramming nature after the realisation that nature herself has reprogrammed
organisms by harnessing the power of natural selection and the digital
prescriptive nature of replicating DNA. Here we further unpack ideas related to
computability, algorithmic information theory and software engineering, in the
context of the extent to which biology can be (re)programmed, and with how we
may go about doing so in a more systematic way with all the tools and concepts
offered by theoretical computer science in a translation exercise from
computing to molecular biology and back. These concepts provide a means to a
hierarchical organization thereby blurring previously clear-cut lines between
concepts like matter and life, or between tumour types that are otherwise taken
as different and may not have however a different cause. This does not diminish
the properties of life or make its components and functions less interesting.
On the contrary, this approach makes for a more encompassing and integrated
view of nature, one that subsumes observer and observed within the same system,
and can generate new perspectives and tools with which to view complex diseases
like cancer, approaching them afresh from a software-engineering viewpoint that
casts evolution in the role of programmer, cells as computing machines, DNA and
genes as instructions and computer programs, viruses as hacking devices, the
immune system as a software debugging tool, and diseases as an
information-theoretic battlefield where all these forces deploy. We show how
information theory and algorithmic programming may explain fundamental
mechanisms of life and death.Comment: 30 pages, 8 figures. Invited chapter contribution to Information and
Causality: From Matter to Life. Sara I. Walker, Paul C.W. Davies and George
Ellis (eds.), Cambridge University Pres
Guidelines for the management of pregnancy in women with cystic fibrosis
Women with cystic fibrosis (CF) now regularly survive into their reproductive years in good health and wish to have a baby. Many pregnancies have been reported in the literature and it is clear that whilst the outcome for the baby is generally good and some mothers do very well, others find either their CF complicates the pregnancy or is adversely affected by the pregnancy. For some, pregnancy may only become possible after transplantation. Optimal treatment of all aspects of CF needs to be maintained from the preconceptual period until after the baby is born. Clinicians must be prepared to modify their treatment to accommodate the changing physiology during pregnancy and to be aware of changing prescribing before conception, during pregnancy, after birth and during breast feeding. This supplement offers consensus guidelines based on review of the literature and experience of paediatricians, adult and transplant physicians, and nurses, physiotherapists, dietitians, pharmacists and psychologists experienced in CF and anaesthetist and obstetricians with experience of CF pregnancy. It is hoped they will provide practical guidelines helpful to the multidisciplinary CF teams caring for pregnant women with CF
How do Cochrane authors conduct web searching to identify studies? Findings from a cross-sectional sample of Cochrane Reviews
This is the final version. Available on open access from Wiley via the DOI in this recordBACKGROUND: Searching the World Wide Web using search engines and websites can be conducted to identify studies for systematic reviews. When searching to support systematic reviews, the searcher faces challenges in using the basic search interfaces of most search engines and websites. OBJECTIVES: To describe and evaluate current practice of web searching in a cross-sectional sample of Cochrane Reviews. The study also describes the stated aims of web searching, i.e. the identification of published or unpublished studies or both. METHODS: A six-month cross-sectional sample of Cochrane Reviews was identified via the Cochrane Library. Reviews were inspected for detail about web searching. Findings were described and evaluated using a framework of key principles for web searching. RESULTS: 423 Cochrane Reviews published August 2016-January 2017 were identified of which 61 (14%) reported web searching. Web searches were typically simplified versions of the bibliographic database search. Advanced and iterative approaches were not widely used. Google Search and Google Scholar were the most popular search engines. Most reports stated identification of grey literature as their aim. CONCLUSION: Basic web search interfaces necessitate simple searches. However, there is scope to use more diverse search features and techniques and a greater variety of search engines
Short-term Airway Clearance Management in people with stable Bronchiectasis
Introducción La expectoración crónica es uno de los síntomas respiratorios más prevalentes en personas con bronquiectasias y se asocia con un peor estado clínico y un fuerte impacto en la vida social. A pesar de que el uso de técnicas de drenaje de secreciones (DS) y agentes hiperosmolares es recomendado para facilitar el manejo diario de la tos productiva en pacientes con bronquiectasias, la calidad de su evidencia es todavía bajamoderada y su grado de recomendación varía de débil a fuerte. Por este motivo, se requiere evaluar en profundidad nuevos enfoques terapéuticos a corto plazo que faciliten el DS y que no hayan sido investigados hasta la fecha, para poder diseñar futuros ensayos clínicos a largo plazo con mayor nivel de garantía. Por consiguiente, el objetivo de esta tesis fue investigar que enfoque terapéutico a corto plazo facilita en mayor medida el DS en personas adultas diagnosticadas de bronquiectasias en periodo de estabilidad clínica, al igual que averiguar cómo interpretar correctamente los beneficios clínicos de estas intervenciones.Métodos Dos ensayos clínicos aleatorizados y cruzados se llevaron a cabo para comparar la efectividad a corto plazo de tres técnicas espiratorias lentas de DS (drenaje autógeno, espiración lenta con glotis abierta en decúbito infralateral [ETLGOL] y presión espiratoria positiva temporal [TPEP]) y tres soluciones salinas para inhalar (suero hipertónico [SH], suero hipertónico con ácido hialurónico [SH+AH] y suero isotónico [SI]) en personas con bronquiectasias. El objetivo primario en ambos ensayos clínicos fue el peso húmedo de la cantidad de esputo expectorada durante las sesiones. Además, se realizó un análisis ad‐hoc utilizando las muestras de esputo de ambos ensayos clínicos para examinar la fiabilidad de la cantidad de esputo durante 24 horas, así como la diferencia importante mínima (DIM) después de una sesión de DS en bronquiectasias. Finalmente, se examinó mediante un estudio de viabilidad/factibilidad el potencial uso de los ruidos respiratorios adventicios analizados de forma computacional como herramienta de evaluación de los efectos a corto plazo del DS en pacientes con bronquiectasias.Resultados (1) Las técnicas de drenaje autógeno y ELTGOL favorecieron en mayor grado la expectoración durante las sesiones que la técnica TPEP en personas con bronquiectasias en estabilidad clínica; siendo el drenaje autógeno la técnica preferida por los participantes; (2) la solución SH+AH fue tan efectiva como la solución de SH y mejor que la solución de SI facilitandola expectoración; sin embargo presentó un mejor perfil de seguridad que el SH en personas conbronquiectasias en periodo de estabilidad clínica y por esto fue la técnica de elección por los participantes; (3) el peso húmedo de la cantidad de esputo expectorada durante 24 horas presentó una fiabilidad aceptable; sin embargo su nivel de concordancia fue ligeramente amplio, especialmente para niveles de expectoración elevados. Además, se estimó que una reducción de al menos 6,4 g. en la cantidad de esputo expectorada durante las 24 horas posteriores a una intervención de DS, o un cambio relativo de alrededor del ‐17% con respecto al nivel basal, es la DIM; (4) el uso de los ruidos respiratorios adventicios analizados de forma computacional fue una herramienta viable/factible y parece ser que el número de crujidos espiratorios graves es la mejor variable para utilizar en futuros estudios.Conclusión Los hallazgos de esta tesis resaltan cuáles son los enfoques terapéuticos de DS a corto plazo más efectivos en personas con bronquiectasias en periodo de estabilidad clínica. Por lo tanto, el próximo paso es diseñar y realizar ensayos clínicos a largo plazo que analicen los efectos de estos enfoques terapéuticos en personas con bronquiectasias.Background Daily sputum expectoration is one of the most common respiratory symptoms in people with bronchiectasis. It is associated with poor health outcomes and negative impacts on social life. Although the use of airway clearance techniques (ACTs) and hyperosmolar agents is recommended to more easily manage chronic productive cough, the quality of evidence is still low-moderate and the level of recommendation ranges from weak to strong in bronchiectasis. However, there is a need to evaluate in-depth the short-term effects of airway clearance therapeutic approaches that are so far under-investigated in bronchiectasis in order to design optimal long-term future trials in this field. Therefore, the aims of this thesis were to investigate what is the short-term effectiveness of airway clearance therapeutic approaches in adults with clinically stable bronchiectasis and how to correctly interpret the clinical benefits observed after these interventions. Methods Two randomised, three-way crossover trials were conducted to compare the short-term effectiveness of three slow-expiratory ACTs (autogenic drainage, slow-expiration with glottis opened in lateral posture [ELTGOL] and temporary positive expiratory pressure [TPEP]) and three inhaled saline solutions (hypertonic saline [HS], hyaluronic acid + HS [HA + HS] and isotonic saline [IS]) in people with bronchiectasis. Wet sputum weight during sessions was selected as the primary outcome in both trials. Moreover, an ad hoc analysis was performed using the sputum samples of both studies to evaluate the reliability of 24-hour sputum weight and the minimal important difference (MID) after short-term airway clearance sessions in bronchiectasis. Finally, a feasibility study was conducted to examine the potential use of computerised adventitious respiratory sounds (ARS) as an outcome measure to assess the short-term effects of airway clearance sessions in bronchiectasis. <br /
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