Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Monaldi Arch Chest Dis · Sep 2003
Review Practice Guideline Guideline[Guidelines for psychology activities in cardiologic rehabilitation and prevention].
The purpose of these guidelines is to provide specific recommendations in regard to psychological activities in cardiac rehabilitation (CR). Based on scientific evidence and clinical experience, the present guidelines are targeted for psychologists working in the field of cardiac rehabilitation and for the core component of CR, as well as for the health care providers, insurers, policy makers and consumers. In the introduction, the framework of Italian cardiac rehabilitation and psychology as well as the methodology used are defined, in accordance with the recommendations of the National Guidelines Programme of the Italian Health Ministry. ⋯ Section three describes the psychological characterization and the specificity of psychological interventions in different cardiac patients populations: patients with ischemic heart disease, patients after cardiac surgery, patients with chronic heart failure, patients after heart transplantation, patients with chronic peripheral artery disease, patients with pace-maker or implantable cardioverter defibrillator, high risk patients for cardiovascular disease, over 75 years of age and finally end-stage cardiac patients. The last section describes the processes of programme evaluation, audit and patient feedback as the main instruments recommended for continuous improvement of quality of psychological care in cardiac rehabilitation. The appendices contain a flow-chart describing the course of psychological interventions, a summary of recommendations for each cardiac condition and a glossary.
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Monaldi Arch Chest Dis · Jul 2003
ReviewImpact of sleep on ventilation and gas exchange in chronic lung disease.
Sleep has many effects on breathing, all potentially adverse, ranging from the respiratory centre to the lower airways and chest wall. The overall effect is to diminish ventilation with consequent hypoxaemia and hypercapnia. ⋯ Patients with obstructive airway disease are particularly adversely affected during sleep with hypoventilation and reduced tidal volume, whereas patients with interstitial disease maintain overall ventilation although respiratory frequency falls. Sleep-related effects are most pronounced in rapid-eye-movement (REM) sleep and can have significant cardiovascular consequences including sleep-related cardiac arrhythmias and pulmonary hypertension and can also predispose to nocturnal death, particularly during acute exacerbations.
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Monaldi Arch Chest Dis · Apr 2003
ReviewLung protective ventilation in ARDS: role of mediators, PEEP and surfactant.
Lung protective ventilation such as the ARDSnet low tidal volumes strategy can reduce mortality in ARDS patients. The knowledge that an essential therapy such as mechanical ventilation on the intensive care influences patient outcome has given rise to the re-evaluation of current ventilation practices. This review addresses the current state of lung protective strategies and their physiological rationale. ⋯ Furthermore, the role of tidal volume, PEEP, recruitment manoeuvres and surfactant on lung injury is discussed. Finally, we discuss results from clinical studies on mechanical ventilation and elucidate these results with data acquired in experimental studies. Guidelines for future strategies and/or investigations are presented.