European journal of internal medicine
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Eur. J. Intern. Med. · Feb 2014
Acute effects of autoadjusting and fixed continuous positive airway pressure treatments on cardiorespiratory coupling in obese patients with obstructive sleep apnea.
Treatment with positive airway pressure devices improved signs and symptoms of obstructive sleep apnea syndrome (OSA); however, auto-adjusting positive pressure (APAP) device was not as effective as continuous positive airway pressure (CPAP) in reducing arterial blood pressure and insulin resistance. The role played by autonomic cardiac regulation remains to be clarified. We aimed to test the effects of CPAP and APAP on autonomic regulation and cardiorespiratory coupling during sleep. ⋯ APAP treatment was characterized by a greater sympathetic activation and it was associated with a lower cardio-respiratory coupling compared with CPAP. This might account for the different effects on cardiovascular risk factors induced by the two treatments.
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Eur. J. Intern. Med. · Feb 2014
In-hospital mortality of acutely ill medical patients admitted to a resource poor hospital in sub-Saharan Africa and to a Canadian regional hospital compared using the abbreviated VitalPAC Early Warning Score.
the development of validated early warning scores that only require the measurement of vital signs at the bedside has provided for the first time a practical and affordable method of comparing the outcomes of similar patients admitted to hospital in the developed and developing world. ⋯ the in-hospital mortality of patients with the same abbreviated ViEWS on hospital admission is similar in TBRHSC and Kitovu Hospital.
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Eur. J. Intern. Med. · Feb 2014
Trends in specialized palliative care for non-cancer patients in Germany--data from the national hospice and palliative care evaluation (HOPE).
The proportion of non-cancer patients (NCs) admitted to palliative care (PC) services increases steadily. Nevertheless, little is known not only about their specific problems, needs that have to be met, but also about improvements that have taken place already. This analysis focuses on developments seen in NC management concerning end-of-life care. ⋯ Despite the continuously growing number of patients with non-malignant diseases, their number in PC services is still low. As small steps in the right direction have been taken, integrating PC ideas earlier into treatment of chronic diseases to improve quality of life of NCs during the final stages of their diseases will continue to challenge the health care system in terms of workload, need of more staff and further training of medical professionals dealing with NCs in the future.
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Eur. J. Intern. Med. · Feb 2014
Bleeding and venous thromboembolism arising in acutely ill hospitalized medical patients. Findings from the Spanish national discharge database.
There is scarce evidence to identify which acutely ill medical patients might benefit from prophylaxis against venous thromboembolism (VTE). ⋯ A risk score based on variables documented at admission can identify patients with different ratios (near 1.0; about 2.0; and >6.0) between the rate of bleeding and of VTE.
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Eur. J. Intern. Med. · Feb 2014
Observational StudyPlasmapheresis as treatment for hyperlipidemic pancreatitis.
Severe hypertriglyceridemia with an accumulation of chylomicrons and triglyceride figures >1000 mg/dL can cause acute pancreatitis, a potentially fatal complication. The option of rapid reduction in triglyceride concentrations is attractive and possible with plasmapheresis. ⋯ Our results, together with a review of the literature, confirm the need for a randomized clinical trial to compare conventional treatment vs. plasmapheresis in patients with severe hypertriglyceridemic pancreatitis.