Attitudes and preferences of home mechanical ventilation users from four European countries: an ERS/ELF survey

Home mechanical ventilation is increasingly used by people with chronic respiratory failure. However, there are few reports on attitudes towards treatment. A web-based survey in eight languages was disseminated across 11 European countries to evaluate the perception of home mechanical ventilation provision in ventilator-assisted individuals and caregivers. Out of 787 responders from 11 European countries, 687 were patients and 100 were caregivers. 95% of patients and 94% of caregivers were from only 4 countries (Germany, the Netherlands, Italy, Spain). The majority of respondents were male and aged 46-65\u2005years. Obstructive lung diseases were proportionally more represented among respondent patients (46%), and neuromuscular diseases (65%) were more represented among patients of respondent caregivers. About 20% of respondent patients and caregivers were not sure of the modality of ventilation. Different interfaces were used, with a minority of respondents in all countries using invasive home mechanical ventilation by tracheostomy. These results may be useful for healthcare providers and policy makers to improve the quality of patients' daily lives

Pneumothorax as a complication of lung volume recruitment

Lung volume recruitment involves deep inflation techniques to achieve maximum insufflation capacity in patients with respiratory muscle weakness, in order to increase peak cough flow, thus helping to maintain airway patency and improve ventilation. One of these techniques is air stacking, in which a manual resuscitator is used in order to inflate the lungs. Although intrathoracic pressures can rise considerably, there have been no reports of respiratory complications due to air stacking. However, reaching maximum insufflation capacity is not recommended in patients with known structural abnormalities of the lungs or chronic obstructive airway disease. We report the case of a 72-year-old woman who had poliomyelitis as a child, developed torsion scoliosis and post-polio syndrome, and had periodic but infrequent asthma attacks. After performing air stacking for 3 years, the patient suddenly developed a pneumothorax, indicating that this technique should be used with caution or not at all in patients with a known pulmonary patholog

Quality of life of adult men with Duchenne muscular dystrophy in the Netherlands: implications for care

To assess quality of life of adults with Duchenne muscular dystrophy in the Netherlands and to identify domains and major problems influencing quality of life. Cross-sectional. Seventy-nine men aged ≥ 20 years with Duchenne muscular dystrophy. The Medical Outcome Study Short Form-36 (SF-36), World Health Organization Quality of Life - BREF (WHOQOL-BREF) and an interview were used to assess quality of life and problems. Compared with Dutch general population reference values, the SF-36 domains scores were lower on all domains except mental health and role limitations due to emotional problems. On the WHOQOL-BREF the social relationships domain score was lower. Main problems were intimate relationships, work, leisure, transport and meaningfulness of life. Seventy-three percent stated overall quality of life as "(very) good". The SF-36 domains mental health (rs 0.53, p  < 0.001) and vitality (rs 0.49, p  < 0.001) had the strongest associations with overall quality of life. Adult men with Duchenne muscular dystrophy assess their health status as low in the physical, but not in the mental, domains. Experienced problems are mainly in the area of participation. They are generally satisfied with their overall quality of lif

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement.

The estimated prevalence of ventilator-dependent individuals in Europe is 6.6 per 100 000 people. The increasing number and costs of these complex patients make present health organisations largely insufficient to face their needs. As a consequence, their burden lays mostly over families. The need to reduce healthcare costs and to increase safety has prompted the development of tele-monitoring for home ventilatory assistance.A European Respiratory Society Task Force produced a literature research based statement on commonly accepted clinical criteria for indications, follow-up, equipment, facilities, legal and economic issues of tele-monitoring of these patients.Many remote health monitoring systems are available, ensuring safety, feasibility, effectiveness, sustainability and flexibility to face different patients' needs. The legal problems associated with tele-monitoring are still controversial. National and European Union (EU) governments should develop guidelines and ethical, legal, regulatory, technical, administrative standards for remote medicine. The economic advantages, if any, of this new approach must be compared to a "gold standard" of home care that is very variable among different European countries and within each European country.Much more research is needed before considering tele-monitoring a real improvement in the management of these patients

Prevalência de Salmonella sp em suínos abatidos em frígoríficos do Rio Grande do Sul Prevalence of Salmonella sp. carrier pigs in slaughterhouses of Rio Grande do Sul, Brazil

Este estudo foi realizado com o objetivo de determinar a prevalência de Salmonella sp em suínos abatidos em frigoríficos sob inspeção federal no Rio Grande do Sul. Amostras de fezes e linfonodos foram coletadas em três diferentes frigoríficos no Estado. A partir da análise microbiológica das amostras de 300 animais, encontrou-se uma prevalência de Salmonella sp de 55,66%, com 17,6% de isolamentos a partir dos linfonodos, 18,3% das fezes e 19,6% em ambos os materiais. Foram identificados 26 sorovares diferentes em 226 isolados de Salmonella sp. Os sorovares mais prevalentes foram: Typhimurium (24,3%), Agona (19,9%), Derby (13,2%) e Bredeney (12%). Estes resultados indicam a necessidade de implementar programas de controle com o objetivo de diminuir a prevalência de animais portadores ao abate.<br>This study aimed to determine the prevalence of Salmonella positive pigs at slaughterhouses under federal inspection in Rio Grande do Sul, Brazil. Samples of feces and lymph nodes of 300 animals were collected in three different slaughterhouses, and submitted to bacteriological analysis. The prevalence of Salmonella carrier animals was 55.66%, being 17.6% of the animals Salmonella positive in lymph nodes, 18.3% in feces and 19.6% in both materials. Twenty-six different serovars were identified among 226 Salmonella isolates. The most prevalent serovars were: Typhimurium (24.3%), Agona (19.9%), Derby (13.2%) e Bredeney (12%). These results point out the need of control programs to reduce the prevalence of carrier pigs at slaughter