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 · Apr 2003
The role of prophylactic brain irradiation in small cell lung cancer treatment.
To review the effectiveness and safety of prophylactic cranial irradiation (PCI) in patients with small-cell lung cancer (SCLC). ⋯ PCI improves both overall and disease free survival and decreases the risk for brain relapse in SCLC patients in complete remission. PCI should be applied early, and useful and safe doses may be 30-36 GY in 2-3 Gy fractions, though future studies may further illuminate the optimal dose, fractionation and timing.
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Monaldi Arch Chest Dis · Mar 2003
Practice Guideline Guideline[Recommendations for cardiovascular rehabilitation in the very elderly].
Cardiac rehabilitation has gained widespread acceptance as an integral component in the management of patients with several forms of cardiac disease. Nevertheless, the benefits deriving from cardiac rehabilitation, and the most appropriate modalities of delivering this treatment, are still uncertain in patients older than 75 years who, beyond a high morbidity and mortality from ischemic heart disease, are characterized by frequent comorbidities, disability, psychological and emotional abnormalities, and cognitive impairment. All these conditions may concur to limit physical exercise capacity, are frequent causes of physical disability and deteriorated quality of life, and are a barrier to enrolling older patients into standardized rehabilitation programs. ⋯ Indeed, the presence of comorbidity or of significant functional limitations should imply the design of alternative rehabilitation programs, which should be based on strongly individualized modalities as well as intensity and duration of physical exercise training. In summary, this article is intended to encourage and help the cardiological community to recruit even the oldest old into cardiac rehabilitation programs, through an adjustment and individualization process of the rehabilitative pathway that should be based on the enclosed recommendations and guidelines. This could reduce the otherwise high exclusion rate of older patients, who are frequently deprived of the potential benefits from cardiac rehabilitation consisting, at least, in improved functional capacity, neuropsychological and emotional profile, and quality of life.
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Monaldi Arch Chest Dis · Mar 2003
Practice Guideline Guideline[Guidelines on psychological intervention in cardiac rehabilitation- methodological process].
The development and the role of cardiac rehabilitation in healthcare programs related to cardiovascular diseases has led to the growth of knowledge, experience and specific technical, scientific, organizational and cultural skills on the part of the different health professionals engaged with the cardiologist in the management of rehabilitation programs. The need to define the characteristics of the psychological intervention in cardiac rehabilitation programs on the basis of scientific evidence encouraged the Board of the Italian Group of Cardiac Rehabilitation and Prevention [Gruppo Italiano di Cardiologia Riabilitativa e Preventiva (GICR)] to set up a working group (WG), composed of psychologists chosen on the basis of their proven specific experience in clinical research, with the task of defining the state-of-the-art of the psychological intervention in cardiac rehabilitation on the basis of documented efficacy, as a first step to formulating Guidelines on Psychological Intervention in Cardiac Rehabilitation. The methodology adopted by the WG was in line with the recommendations of the National Guidelines Program of the Italian Ministry of Health; the WG chose, in addition, to exploit a detailed critical review of clinical psychology practice in order to provide systematic evidence for recommendations and clinical approaches at present supported only by expert opinion. ⋯ In the course of the first 4 months of 2003 the document produced will be discussed and reviewed jointly by the WG, the Cardiologic Scientific Board instituted by the GICR enlarged to include a delegate of the patient and volunteer no-profit worker associations. The following phases will include the publication by mid 2003 of a position-paper. The final draft of the Guidelines on Psychological Intervention in Cardiac Rehabilitation will be submitted to the Commission of the National Guidelines Program.
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Monaldi Arch Chest Dis · Oct 2002
ReviewNon invasive mechanical ventilation in cystic fibrosis: physiological effects and monitoring.
Chronic respiratory insufficiency in cystic fibrosis (CF) is characterised by an increase in respiratory load, which leads to alveolar hypoventilation with the preservation of respiratory muscle strength. Non-invasive mechanical ventilation (NIMV) is able to improve alveolar ventilation and thus gas exchange and allow the the respiratory muscles to rest in patients with cystic fibrosis with variable severity of lung disease. ⋯ After a successful evaluation, the monitoring of patients starting NIMV can be performed with simple, non invasive parameters such as gas exchange, tidal volume, respiratory rate, minute ventilation and comfort. In the long term however, studies are warranted to assess the benefit of NIMV in terms of lung function, quality of sleep and most importantly, quality of life.