The Integrative Physiology of Exercise Training in Patients with COPD.

The Integrative Physiology of Exercise Training in Patients with COPD. COPD. 2019 May 16;:1-14 Authors: Neder JA, Marillier M, Bernard AC, James MD, Milne KM, O'Donnell DE Abstract Supervised exercise training (EXT) as part of pulmonary rehabilitation is arguably the most effective intervention for improving exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). In the current review, we focus on the physiological rationale for EXT and the expected physiological benefits that can be achieved in patients who can be exposed to sufficiently high training stimuli. Thus, after a brief consideration of the mechanisms of exercise limitation and their sensory consequences, we expose the potential beneficial effects of EXT on respiratory mechanical and peripheral muscular adaptations to exercise. The available evidence indicates that changes in exertional ventilation, breathing pattern, operating lung volumes and static respiratory muscle strength after EXT are modest and often inconsistent. Inspiratory muscle training may have a role in patients showing inspiratory weakness pre-rehabilitation. Beneficial changes in peripheral muscles can be seen in those who can tolerate higher training intensity, particularly using combined resistance and dynamic (including interval) exercise. It should be recognised, however, that it might not be feasible to reach meaningful physiological training effects in many frail elderly patients with advanced r...
Source: COPD: Journal of Chronic Obstructive Pulmonary Disease - Category: Respiratory Medicine Tags: COPD Source Type: research

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CONCLUSIONS: Multimorbid patients with ACS are at a greater risk for worse outcomes than their nonmultimorbid counterparts. Lack of consistent measurement makes interpretation of the impact of multimorbidity challenging and emphasizes the need for more research on multimorbidity's effects on postdischarge healthcare utilization. PMID: 32925234 [PubMed - as supplied by publisher]
Source: The Journal of Cardiovascular Nursing - Category: Nursing Authors: Tags: J Cardiovasc Nurs Source Type: research
CONCLUSION: This research identified important risk factors for failure of primary healing and need for re-amputation at the TM and TT level. If considering a TM amputation, caution should be exercised in patients with diabetes, in particular those with an abnormal ABI and/or renal failure. At the TT level, caution should be exercised in those who smoke. PMID: 32800475 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research
This study aimed to investigate the predictive significance of C ‐reactive protein/albumin ratio for postoperative atrial fibrillation occurrence in patients who were underwent coronary artery bypass graft surgery.MethodsAmong 830 patients who underwent coronary artery bypass grafting with cardiopulmonary bypass between January 2016 and February 2020, 137 patients with no prior arrhythmia history were included in this cross sectional study.ResultsOne hundred and thirty ‐seven (16.5%) patients developed atrial fibrillation in postoperative period. Patients who experienced postoperative atrial fibrillation were more like...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
CONCLUSION: ICHRON predicted ChrD diagnosis at 3-years among an external, geographically distant validation cohort. These findings show the value of ICHRON for primary care patients in distinct locales. Additionally, electronic calculation of ICHRON empowers the clinical use of this tool to identify and differentially manage and treat high-risk patients. PMID: 32563688 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
ABSTRACTIntroductionThe development of new pharmacological treatments for chronic obstructive pulmonary disease (COPD) has improved health ‐related quality of life of patients. However, suboptimal adherence may limit its potential.ObjectiveThe aim of the present study was to assess the adherence to free triple inhaled therapy and to investigate poor adherence determinants among primary care patients.MethodsData were derived from a primary care database in Italy. Patients aged 40+ affected by COPD and prescribed with inhaled corticosteroids, long ‐acting beta agonists and long‐acting muscarinic antagonists (N = 3177) ...
Source: The Clinical Respiratory Journal - Category: Respiratory Medicine Authors: Tags: ORIGINAL ARTICLE Source Type: research
CONCLUSION: Smoking cessation rates varied substantially at the practitioner, practice site, and health system levels. It is likely that individual physician approaches to smoking cessation impact patients' likelihood of quitting. PMID: 32561440 [PubMed - as supplied by publisher]
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
Spontaneous coronary artery dissection (SCAD), an acute disruption of the inner surface of the coronary artery resulting in a false vascular lumen, is a well-established cause of acute coronary syndromes (ACS). SCAD has been traditionally considered a rare condition, affecting almost exclusively young women in the peripartum period. Thanks to the improved diagnosis and management of ACS, it has become recently clear that SCAD can affect both genders and patients of all ages. Compared with ACS secondary to atherosclerotic disease, SCAD seems to have a higher incidence in patients with arterial hypertension, chronic kidney d...
Source: International Journal of Cardiology - Category: Cardiology Authors: Source Type: research
An 80 year old male presented to the emergency department after an episode of gross hematuria four hours prior. Review of systems at the emergency department was positive for dysuria and chronic obstructive urinary symptoms while negative for fevers, chills, or flank pain. Of note, his past medical history includes atrial fibrillation on rivaroxaban anticoagulation, left bundle branch block, coronary artery disease (status post drug eluting stent placement to the left circumflex artery in 2003 and drug eluting stent placement to the left anterior descending artery in 2013), peripheral vascular disease (status post bilatera...
Source: Urology - Category: Urology & Nephrology Authors: Tags: Grand Rounds Source Type: research
AbstractPurposeTo investigate risk factors for severe bleeding during warfarin treatment, including the influence of sex, age, comorbidity and co-medication on bleeding risk.MethodsPatients initiating warfarin treatment between 2007 and 2011 were identified in the nationwide Swedish Prescribed Drug Register, and diagnoses of severe bleeding were retrieved from the National Patient Register. Hazard ratios (HR) with 95% confidence intervals (CI) for severe bleeding were estimated using multiple Cox regression adjusting for indications and including covariates age, sex, comorbidities and co-medications. Interactions between s...
Source: European Journal of Clinical Pharmacology - Category: Drugs & Pharmacology Source Type: research
ConclusionsThe 85% of enrolled patients showed poor adherence to free triple inhaled therapy. Co ‐morbidities, such as heart failure (OR 1.78, 95%CI 1.19‐2.75), depression (OR 1.41, 95%CI 1.06‐1.88), and peripheral vascular disease (OR 1.32, 95%CI 1.01‐1.74) were associated with poor adherence. Former (OR 0.52, 95%CI 0.34‐0.78) or current smokers (OR 0.61, 95%CI 0.41‐0.93) and patie nts with more severe airways obstruction or history of severe exacerbations (OR 0.64, 95%CI 0.52‐0.79) were less likely to exhibit poor adherence. Real‐world adherence to triple inhaled therapy with different inhalers is general...
Source: The Clinical Respiratory Journal - Category: Respiratory Medicine Authors: Tags: ORIGINAL ARTICLE Source Type: research
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