Home Treatment Of Patients Research Articles

Long-term Efficiency of Home Nasal Mask Ventilation in Patients With Diffuse Bronchiectasis and Severe Chronic Respiratory Failure: A Case-Control Study

The aim of this study was to evaluate long-term efficacy and tolerance of nasal mask ventilation (NMV) in a comparative case-control study. Fourteen patients with diffuse bronchiectasis and severe chronic respiratory failure (CRF), treated by long-term oxygen-therapy (LTO) and NMV, were case matched with 14 patients with diffuse bronchiectasis and severe CRF treated with only LTO. Patients and control subjects were compared based on the following parameters: blood gases, FEV1, vital capacity, hospitalizations, and survival. Symptoms, Karnofsky function score, and clinical evolution were also monitored in patients. Three subgroups may be identified according to outcome: two early deaths (subgroup 1), six patients with initial improvement and subsequent deterioration (subgroup 2), and six patients whose conditions remained improved for >2 years (subgroup 3). PaO2 decrease slope was slighter in this last subgroup than subgroup 2. The days of hospitalization were significantly reduced after institution of NMV in the patient group. Comparison between patients and control subjects did not show any difference on PaO2 evolution and on the overall median survival (46 and 40 months in NMV and control group, respectively). Long-term tolerance and compliance remained satisfactory for 11 patients. These results suggest that NMV is feasible as a long-term home treatment in patients with diffuse bronchiectasis. Although our results may have failed to prove a long-term efficiency on the course of blood gases and survival, a beneficial effect is observed with reduction of hospitalizations and improvement of functional status. This study warrants further investigation, in a prospective series, with a larger number of patients.

Programa de detección precoz de insuficiencia respiratoria en la enfermedad de Duchenne: resultados preliminares

Noninvasive mechanical ventilation through a nasal mask is a recently introduced therapeutic tool that represents a noteworthy advance in home treatment for patients with respiratory insufficiency secondary to ventilatory pump failure. We present the preliminary results of a program for early detection of respiratory insufficiency in patients with Duchenne's disease. Sixteen patients (mean age 15.8 years) with this disease were evaluated between January 1994 and January 1995. Mean lung function parameters were FVC 1,440 ml (46.7%), PO2 87.3 mmHg, PCO2 40.8 mmHg, PIM 40.1 cmH2O (30.6%), and PEM 41 cmH2O (25%). Two patients had abnormal pulse oximetry readings at night and abnormal gasometric readings during the day and were started on mechanical ventilation through nasal masks. These 2 patients were older, more hypoxemic and hypercapnic, had lower FVC values and showed greater deterioration of inspiratory and expiratory muscle pressures.

P81 A trial evaluating the home treatment of patients with acute proximal deep vein thrombosis (DVT)

P81 A trial evaluating the home treatment of patients with acute proximal deep vein thrombosis (DVT)

P81 A trial evaluating the home treatment of patients with acute proximal deep vein thrombosis (DVT)

P81 A trial evaluating the home treatment of patients with acute proximal deep vein thrombosis (DVT)

Haemophilia A home therapy in the United Kingdom 1975-6.

Data on home treatment for patients with haemophilia A (factor VIII deficient haemophilia) were compiled for 1975 and 1976 from questionnaires answered by directors of haemophilia centres throughout the United Kingdom. There were 48 haemophilia centres in 1975 and 71 in 1976. The number of patients on or in training for home treatment increased from 267 to 488 in the two years, and a further 241 haemophiliacs were considered suitable for home therapy by the end of 1976. Apart from a small (but increasing) number of haemophiliacs on prophylactic treatment, most patients were on low-dose (250-500 units) on-demand regimens, using a mean of 20 000 factor VIII units per patient per year in 1976. An estimated 55% of the blood product used for home therapy in the UK in 1976 was imported from commercial sources. Despite the fact that the numbers of patients on home treatment have increased, so that about 60% of the potential population were receiving or being considered for home treatment in 1976, inadequacies in the service still remain. In some centres follow-up is clearly inadequate; about 15% of patients still rely on cryoprecipitate; and too little money has been invested in making the NHS self-sufficient in factor VIII production.

Intensive psychiatric training for visiting nurses.

S EVERAL YEARS AGO the Visiting Nurse Association of Erie County, New York, arranged for a grant from a local philanthropic organization to obtain psychiatric training for its staff nurses and asked the department of psychiatry at Edward J. Meyer Memorial Hospital in Buffalo to organize the training program. Tilat seemed like a useful community service, but at the outset we were not aware of the potential the program held for teaching our own hospital staff about the community. The Visiting Nurse Association selected two nurses for the training, and I served as the coordinator and supervising psychiatrist. Tile training program began with a one-week orientation period to familiarize the nurses with all aspects of our 100-bed psychiatric service, which serves as an acute receiving facility for the 1,200,000 people of Erie County. The orientation consisted primarily of meetings and discussions with key hospital staff members. At the same time the nurses were enrolled in the class in psychodynamics and psychopathology for sophomore medical students. It met for four hours a week through the entire academic year, and offered lectures, case demonstra tions, and supervised patient interviews. One of tile nurses came to work and study at the hospital for the first six months of the year and the other for the second six months. The hospital experience was divided into two parts. The first was a six-week assignment to a treatment team on the women’s inpatient service. During that time the nurse became familiar with the workings of the psychiatric ward, and had an opportunity to see representative types of psychopathology. She also participated in ward rounds, and met twice a week with me to discuss specific cases. During her remaining four and half months at the hospital she worked directly under my supervision, and attended daily rounds on the inpatient service to maintain contact with referring physicians and nurses. She began accepting referrals for home treatment of patients being discharged from the inpatient