Welshcoughlin4259

The Spearman correlation coefficient was used to determine the correlation between sEAdi and tEAdi. Agreement was calculated by using Bland-Altman statistics. RESULTS Fifteen subjects were included. The tEAdi detected 3,675 breathing efforts, of which 3,162 (86.0%) were also detected by sEAdi. A statistically significant temporal correlation (r = 0.95, P less then .001) was found between sEAdi and tEAdi in stable recordings. The mean difference in the time intervals between both techniques was 10.1 ms, with limits of agreement from -410 to 430 ms. CONCLUSIONS Analysis of our results showed that sEAdi was not reliable for breathing effort detection in subjects who were invasively ventilated compared with tEAdi. In stable recordings, however, sEAdi and tEAdi had excellent temporal correlation and good agreement. With optimization of signal stability, sEAdi may become a useful monitoring tool. Copyright © 2020 by Daedalus Enterprises.BACKGROUND Medication adherence in asthma and COPD is notoriously low. To intervene effectively, family physicians need to assess adherence accurately, which is a challenging endeavor. In collaboration family physicians and individuals with asthma or COPD, we aimed to explore the barriers and facilitators of assessing medication adherence in clinical practice (exploratory phase), and to develop a novel web-based tool (e-MEDRESP) that will allow physicians to monitor adherence using pharmacy claims data (development phase). METHODS We used qualitative research methods and a framework inspired by user-centered design principles. Five focus groups were held 2 with subjects (n = 15) and 3 with physicians (n = 20), and 10 individual interviews were conducted with physicians. In the exploratory phase, data were analyzed using thematic networks. In the development phase, we identified components to be included in an e-MEDRESP prototype through an iterative approach. The web-based e-MEDRESP tool was constructed by apnting e-MEDRESP in clinical practice. It would be relevant to develop strategies that could facilitate the sharing of information presented in e-MEDRESP among primary care health professionals. Copyright © 2020 by Daedalus Enterprises.BACKGROUND In the modern era, many devices exist to support patients with respiratory insufficiency. There is currently no way to depict changes in the degree of support a patient is receiving over time. METHODS We enrolled 4,889 subjects undergoing 5,732 cardiac surgical visits between 2011 and 2017 and extracted data elements related to respiratory support from the electronic medical record. We created an algorithm to use these data to categorize a subject's respiratory support type and to calculate an empirically derived respiratory support score (RSS) at each postoperative minute; the RSS is scored on a scale of 0 to 100. The RSS was then used to identify the timing and incidence of nonprocedural re-intubations, which were electronically verified against secondary verification fields (eg, nursing extubation note). Rates of nonprocedural re-intubations and noninvasive ventilation were compared between surgical mortality risk scores (STAT scores). RESULTS Computerized assignment of RSS was performed for 3 million subject time points. Mechanical ventilation duration varied significantly by STAT score (P less then .001). Nonprocedural re-intubations increased nonsignificantly with increasing STAT score (P = .059, overall 4.3%); time to nonprocedural re-intubation did not (P = .53). Noninvasive ventilation use was more common and was prolonged with increasing STAT score (P less then .001). CONCLUSIONS Elements of respiratory support can be automatically extracted and transformed into a numerical RSS for visualization of respiratory course. The RSS provides a clear visual depiction of respiratory care over time, particularly in subjects with a complex ICU course. The score also allows for the automated adjudication of meaningful end points, including timing of extubation and incidence of nonprocedural re-intubation. Copyright © 2020 by Daedalus Enterprises.BACKGROUND Postoperative respiratory complications are often severe and associated with a high risk of mortality in patients who undergo open abdomen (OA) management following emergency damage-control surgery. The causes of postoperative respiratory complications remain unknown. Therefore, we evaluated postoperative factors associated with respiratory complications in nontrauma patients who had undergone OA management using propensity score matching, with a focus on OA-related risk factors. METHODS This retrospective analysis included subjects who underwent OA management during a 4-y study period. Age, body mass index, and smoking history were selected as covariates. After propensity score matching, we compared postoperative factors (ie, first operative time, duration of OA, initial 3-d fluid balance, length of ICU stay, and in-hospital mortality) in 2 groups of subjects those who had post-OA respiratory complications (PORCs) and those who did not. RESULTS 60 subjects (33 men and 27 women) were identified; 38.3% of these subjects had PORCs. After propensity score matching, 18 subjects were matched. The 3-d fluid balance was significantly higher in subjects with PORCs than in those without PORCs (3,513 mL vs 1,087 mL; P = .027). learn more CONCLUSIONS To our knowledge, this is the first study to examine factors associated with respiratory complications following OA in nontrauma subjects. After adjusting for known co-factors associated with postoperative respiratory complications, the 3-d fluid balance was identified as a significant risk factor for PORCs in subjects who had undergone OA. Clinicians should pay attention to the incidence of PORCs in OA subjects with a positive fluid balance after emergency abdominal surgery. Copyright © 2020 by Daedalus Enterprises.BACKGROUND Survivors of prolonged ICU admissions are bedridden and immobilized for an extended period of time. These patients often are discharged to long-term acute care hospitals (LTACHs) for continued medical care and rehabilitation. Early ambulation has been associated with improved functional outcomes and lower readmission rates in hospitalized patients. The aim of this study was to determine the association between ambulatory status and discharge disposition in survivors of prolonged ICU stays who were admitted to an LTACH. METHODS We performed a retrospective cohort study of 285 survivors of prolonged ICU stays who were admitted to a university-affiliated LTACH facility from 2010 to 2013. Outcomes of interest included comparing the relationship between ambulatory status and disposition status (ie, home vs acute rehabilitation facility, nursing home, readmission to an ICU, or death). RESULTS The mean age of our cohort was 59.0 ± 15.3 y, with 129 (45%) males, 148 (52%) African-American, 123 (43%) white, and 14 (5%) of subjects other races.