The cruel journey through the COVID-19 INFERNO.

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Does timing of initiation influence acceptance and adherence to NIV in patients with ALS

Background: The role of nocturnal non invasive ventilation (NIV) to prolong tracheostomy-free survival, is still controversial in amyotrophic lateral sclerosis (ALS) patients and the best timing to initiate NIV is unclear. Objective: As NIV acceptance and adherence can be influenced by many factors, we aimed to compare immediate acceptance and short-term NIV adherence between NIV initiated very early and NIV initiated later. Methods: This is a post hoc analysis of our previous cohort retrospective study of 88 ALS patients: 53 under later NIV (late group – LG) (forced vital capacity [FVC] 80%). We compared hours of NIV use as immediate acceptance of NIV (use ≥4 h/night) and dherence at 4 months post-initiation (defined as use ≥4 h/night or 120 h/month). Results: No differences were found between VEG and LG in use of NIV (>5 h/night in both groups), immediate acceptance (85.7% vs. 85.0%, p = 0.927) and short-term adherence (81.3% vs. 87.2%, p = 0.469); 39.7% of patients increased their NIV use (35% by >60 min/night). A decline in adherence was observed in 12.5% of patients irrespective of group affiliation. Conclusions: In ALS patients, initiation of very early NIV does not reduce its immediate acceptance or the short-term adherence. However, at least 1 in 10 patients may be at risk of reducing their adherence irrespective of early or late NIV prescription. As still under debate and not conclusive, further literature on early NIV benefit is welcomed. Keywords: Home mechanical ventilation, ALS, Motoneuron disease, NI

Hidden biases in clinical decision-making: potential solutions, challenges, and perspectives

Every day, we must make decisions that range from simple and risk-free to difficult and risky. Our cognitive sources' limitations, as well as the need for speed, can frequently impair the quality and accuracy of our reasoning processes. Indeed, cognitive shortcuts lead us to solutions that are sufficiently satisfying to allow us to make quick decisions. Unfortunately, heuristics frequently misguide us, and we fall victim to biases and systematic distortions of our perceptions and judgments. Because suboptimal diagnostic reasoning processes can have dramatic consequences, the clinical setting is an ideal setting for developing targeted interventions to reduce the rates and magnitude of biases. There are several approaches to bias mitigation, some of which may be impractical. Furthermore, advances in information technology have given us powerful tools for addressing and preventing errors in health care. Recognizing and accepting the role of biases is only the first and unavoidable step toward any effective intervention proposal. As a result, our narrative review aims to present some insights on this contentious topic based on both medical and psychological literature

Physiological responses to arm exercise in difficult to wean patients with chronic obstructive pulmonary disease

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Physical activity in patients with chronic obstructive pulmonary disease on long-term oxygen therapy: a cross-sectional study

Background and aim: There are few studies evaluating physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT). Aim: To assess PA in hypoxemic COPD patients on LTOT. Methods: In this cross-sectional study, we compared lung function, arterial blood gases, respiratory and peripheral muscle strength, 6-min walking distance (6MWD), daily energy expenditure and steps, and health-related quality of life (HRQL) in COPD patients on LTOT (LTOT group) versus two groups of control patients not needing LTOT: with (HYPOX) and without (COPD) exercise-induced desaturations. Results: Groups did not differ as regards demographics, anthropometrics, peripheral or respiratory muscle strength. Compared to the other groups, LTOT patients had more severe airway obstruction and lung hyperinflation, greater number and severity of comorbidities, shorter 6MWD, as well as lower mean SpO2 during 6MWD and worse quality of life. LTOT patients had a lower daily energy expenditure, shorter time spent > 3.0 METs and longer sedentary time compared to the COPD group, and less daily steps compared to the other groups. No significant difference in any parameter of PA was found between COPD and HYPOX. In LTOT patients, daily steps showed a strong correlation with 6MWD, and a moderate correlation with airway obstruction, level of oxygenation, comorbidities and quality of life but not with peripheral and respiratory muscle strength. In COPD and HYPOX patients, daily steps were strongly correlated with 6MWD and level of oxygenation as assessed by PaO2/FiO2. There was no significant correlation between mean SpO2 and 6MWD in any group. Conclusion: COPD patients on LTOT perform less physical activity than patients not needing LTOT, both with and without exercise-induced desaturations. Patients with exercise-induced desaturations do not perform less physical activity than those without

A Pulmonary Rehabilitation Decisional Score to Define Priority Access for COPD Patients

This retrospective study aimed to evaluate, through an ad hoc 17-item tool, the Pulmonary Rehabilitation Decisional Score (PRDS), the priority access to PR prescription by respiratory specialists. The PRDS, scoring functional, clinical, disability, frailty, and participation parameters from 0 = low priority to 34 = very high priority for PR access, was retrospectively calculated on 124 specialist reports sent to the GP of subjects (aged 71 \ub1 11 years, FEV1%\u2009\u200951 \ub1 17) consecutively admitted to our respiratory outpatient clinic. From the specialist's report the final subject's allocation could be low priority (LP) (>60 days), high priority (HP) (30-60 days), or very high priority (VHP) (<30 days) to rehabilitation. The PRDS calculation showed scores significantly higher in VHP versus LP (p < 0.001) and significantly different between HP and VHP (p < 0.001). Comparing the specialist's allocation decision and priority choice based on PRDS cut-offs, PR prescription was significantly more appropriate in VHP than in HP (p = 0.016). Specialists underprescribed PR in 49% of LP cases and overprescribed it in 46% and 30% of the HP and VHP prescriptions, respectively. A multicomprehensive score is feasible being useful for staging the clinical priorities for PR prescription and facilitating sustainability of the health system

Telemedicine and home care: controversies and opportunities

Summary This review focuses on the prospects, and possible drawbacks, of a new innovative instrument of care known as "home telehealth", "telecare" or "telemedicine". The main results from utilising telemedicine in respiratory diseases (asthma and chronic obstructive pulmonary disease (COPD) as the illustrative conditions) are presented. A principal goal of telemedicine is to improve access to healthcare services. During this process, savings in time and travel costs should be achieved, thereby rationalising access to medical care. The field of telemedicine is relatively new and expanding. In order to establish evidencebased guidelines for the design and implementation of disease management plans that employ telemedicine, further research is required. Telemedicine is not simply "technology" but an innovative medical approach (based more on a dedicated healthcare team than on high-tech instruments) that will help the medical team to care for patients and their families. In the future, it is hoped that telemedicine will form a valuable part of the disease management process, because, when used intelligently, home telehealth should supplement conventional delivery techniques and not replace them

the new frontiers of rehabilitation medicine in people with chronic disabling illnesses

Abstract Because of the demographic shift and the increased proportion of patients surviving acute critical illnesses, the number of people living with severely disabling chronic diseases and, consequently, the demand for rehabilitation are expected to increase sharply over time. As underscored by the World Health Organization, there is substantial evidence that the provision of inpatient rehabilitation in specialized rehabilitation units to people with complex needs is effective in fostering functional recovery, improving health-related quality of life, increasing independence, reducing institutionalization rate, and improving prognosis. Recent studies in the real world setting reinforce the evidence that patients with ischemic heart disease or stroke benefit from rehabilitation in terms of improved prognosis. In addition, there is evidence of the effectiveness of rehabilitation for the prevention of functional deterioration in patients with complex and/or severe chronic diseases. Given this evidence of effectiveness, rehabilitation should be regarded as an essential part of the continuum of care. Nonetheless, rehabilitation still is underdeveloped and underused. Efforts should be devoted to foster healthcare professional awareness of the benefits of rehabilitation and to increase referral and participation

Rehabilitative practice in Europe: roles and competencies of physiotherapists. Are we learning something new from COVID-19 pandemic?

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The degree of arm elevation impacts the endurance and cardiopulmonary adaptations of COPDpatients performing upper-limb exercise: A cross-over study

In Chronic Obstructive Pulmonary Disease (COPD), upper limb exercise is widely recommended. However, how the degree of shoulder flexion may influence the exercise response is unknown