The cruel journey through the COVID-19 INFERNO.

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Hospital monitoring, setting and training for home non invasive ventilation.

Although in recent years guidelines have been published in order to define indications, applications and delivery of long-term home non invasive mechanical ventilation (HNMV), there is lack of information with regards to in-hospital assessment, planning and training to initiate and prescribe it. Discontinuation and lack of compliance versus HNMV may affect the follow-up of these patients adding a costly burden for care. The present review proposes an operative flow chart for optimisation of HNMV prescription from initial patient's selection to post discharge follow up including; 1. assessment of the correct choice of ventilator, interfaces, ventilation setting. 2. Timing for different physiological monitoring (arterial gases, mechanics, sleep) 3. Timing for clinical evaluation, machine adaptation, carer training and long term follow-up

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

Advanced COPD patients under home mechanical ventilation and/or long term oxygen therapy: italian health care costs.

Introduction. Little information is available on health care costs for patients with very severe chronic obstructive pulmonary disease The aim of the current work was to evaluate Italian health care costs in these patients. Patients and Methods. Prospective 1-year analysis were assessed in three subgroups of patients; non-invasively ventilated (n=30); invasively-ventilated (n=12) and on long-term oxygen therapy (n= 41). Acute costs for care were a sum of fees for doctor\u2019s consultations, admissions to hospital (ward and intensive care unit) and emergency drugs. Chronic costs were the sum of costs for pharmacotherapy and home ventilation and/or oxygen care. Results. Mean cost/day/patient was 96\ub1112 \u20ac (range 9-526 \u20ac), with acute costs accounting for 72% and chronic costs for 28% of the total cost burden, with no significant differences in costs associated with the three subgroups. Acute costs had a non-normally distribution (range 0 to 510 \u20ac) with cost for hospitalization being the highest cost burden with greater than 30 % of acute care costs were attributed to only a small segment of patients. Chronic care costs were also unevenly distributed among the various groups (ANOVA p=0.006), with home oxygen supply being the highest cost burden. Conclusions. The current Health Care System is in urgent need for a reassessment of the high cost burden associated with hospitalizations and home oxygen supply

Early consensus management for non-ICU acute respiratory failure SARS-CoV-2 emergency in Italy : from ward to trenches

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COVID-19 and pulmonary rehabilitation: preparing for phase three.

Considering the expected high burden of respiratory, physical and psychological impairment following the acute phase of COVID-19, a huge number of patients should be referred early to a rehabilitation program. Pulmonary rehabilitation is an evidence-based, well recognized and widely accepted and available to cover these needs

Plan de igualdad del Hotel Biarritz, Playa de Gandia

[ES] Podemos destacar el impacto que en un espacio breve de tiempo han tenido las políticas en materia de igualdad en la población actual y la evolución de la legislación que ha ido favoreciendo y protegiendo los derechos de las mujeres que antes no se contemplaban. Así, en el presente trabajo se realiza un diagnóstico del estado de la igualdad en el Hotel Biarritz a través de la aplicación de técnicas cuantitativas y cualitativas de investigación social. Se analiza las características de la plantilla y sus percepciones sobre la igualdad, y a partir de los resultados se propone un Plan de Igualdad para dicho Hotel. Este plan tiene como eje fundamental corregir las desigualdades detectadas por razón de género en la distribución de los puestos de trabajo: retribuciones salariales, desfeminización de determinados puestos, eliminación de vocabulario sexista, medidas para la conciliación y protocolo contra el acoso sexual, entre otras.[EN] In this TFG is intended to make a diagnosis on equality in a private company in the tourism sector located in the Playa de Gandia (Hotel Biarritz) in order to develop an Equality Plan to correct the weaknesses detected and promote equality of men and women of opportunities in the work environment studied.Vitacca Morales, S. (2019). Plan de igualdad del Hotel Biarritz, Playa de Gandia. http://hdl.handle.net/10251/128236TFG

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

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Tai Chi recreational exercise is not rehabilitation

Not availabl