Reliability of home CPAP titration with different automatic CPAP devices

<p>Abstract</p> <p>Background</p> <p>CPAP titration may be completed by automatic apparatus. However, differences in pressure behaviour could interfere with the reliability of pressure recommendations. Our objective was to compare pressure behaviour and effective pressure recommendations between three Automatic CPAP machines (Autoset Spirit, Remstar Auto, GK 420).</p> <p>Methods</p> <p>Sixteen untreated obstructive sleep apnea patients were randomly allocated to one of the 3 tested machines for a one-week home titration trial in a crossover design with a 10 days washout period between trials.</p> <p>Results</p> <p>The median pressure value was significantly lower with machine GK 420 (5.9 +/- 1.8 cm H₂O) than with the other devices both after one night and one week of CPAP titration (7.4 +/- 1.3 and 6.6 +/- 1.9 cm H₂O). The maximal pressure obtained over the one-week titration was significantly higher with Remstar Auto (12.6 +/- 2.4 cm H₂O, Mean +/- SD) than with the two other ones (10.9 +/- 1.0 and 11.0 +/- 2.4 cm H₂O). The variance in pressure recommendation significantly differed between the three machines after one night and between Autoset Spirit and the two other machines after 1 week.</p> <p>Conclusion</p> <p>Pressure behaviour and pressure recommendation significantly differ between Auto CPAP machines both after one night and one week of home titration.</p

Specialist clinics - definition: proposal for the discussion from the ad hoc committee on care structures by the Association of the Scientific Medical Societies in Germany (AWMF) for the reform of hospital care

Specialist clinics play an important role in inpatient care in the German healthcare system. They are characterized by a high degree of specialization and expertise and are described in numerous medical disciplines. However, a generally accepted legal definition of specialist clinics has so far been lacking. The ad hoc committee of the Association of the Scientific Medical Societies in Germany (AWMF) for the reform of hospital care in Germany, therefore, presents proposals for a definition, a description of quality characteristics, and an allocation to care levels. In the opinion of the committee, three aspects are necessary for the definition of specialist clinics: a high total number of patients treated, a high proportion of the disease entities attributable to the specialist area according to diagnosis and services, and structural characteristics. The definition proposed here is intended to help the political decision-makers in the federal and state governments to standardize according to medical-scientific criteria.Fachkliniken spielen in der stationären Versorgung im deutschen Gesundheitswesen eine wesentliche Rolle. Sie zeichnen sich durch eine hohe Spezialisierung und Expertise aus und werden in zahlreichen medizinischen Disziplinen beschrieben. Allerdings fehlt bisher eine allgemein akzeptierte Legaldefinition von Fachkliniken. Die Ad-hoc-Kommission der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) zur Reform der Krankenhausversorgung in Deutschland legt daher Vorschläge für eine Definition, die Beschreibung von Qualitätsmerkmalen und die Zuordnung zu Versorgungsebenen vor. Drei Aspekte sind zur Definition von Fachkliniken nach Ansicht der Kommission notwendig: eine hohe Gesamtzahl von behandelten Patientinnen und Patienten, ein hoher Anteil der auf das Fachgebiet entfallenden Krankheitsentitäten nach Diagnose und Leistungen sowie Strukturmerkmale. Die hier vorgeschlagene Definition soll den politischen Entscheidungsträgern in Bund und Ländern helfen, eine Vereinheitlichung nach medizinisch-wissenschaftlichen Kriterien festzulegen

Cheyne-stokes respiration in patients with heart failure: prevalence, causes, consequences and treatments

Cheyne-Stokes respiration (CSR) is characterized by a pattern of cyclic oscillations of tidal volume and respiratory rate with periods of hyperpnea alternating with hypopnea or apnea in patients with heart failure. CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges. CSR impairs the quality of life and increases cardiac mortality in patients with heart failure. Thus, CSR should actively be pursued in patients with severe heart failure. When CSR persists despite optimal therapy of heart failure, noninvasive adaptive servoventilation is currently the most promising treatment