Pulmonary Unit

Trieste, Italy

Pulmonary Unit

Trieste, Italy
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Devine D.A.,Medical Surgical Nursing Services | Wenger B.,Nursing Innovation and Outcomes | Krugman M.,Nursing Innovation and Outcomes | Zwink J.E.,Medical Surgical Nursing Services | And 4 more authors.
Journal of Nursing Administration | Year: 2015

An academic hospital used Transforming Care at the Bedside (TCAB) principles as the framework for generating evidence-based recommendations for the design of an expansion of the current hospital. The interdisciplinary team used the table of evidence-based data to advocate for a patient- and family-centered, safe, and positive work environment. A nurse project manager acted as liaison between the TCAB design team, architects, and facilities and design consultants. Part 2 of this series describes project evaluation outcomes. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Mitchison H.M.,University College London | Schmidts M.,University College London | Loges N.T.,University Hospital Muenster | Freshour J.,New York University | And 14 more authors.
Nature Genetics | Year: 2012

Primary ciliary dyskinesia most often arises from loss of the dynein motors that power ciliary beating. Here we show that DNAAF3 (also known as PF22), a previously uncharacterized protein, is essential for the preassembly of dyneins into complexes before their transport into cilia. We identified loss-of-function mutations in the human DNAAF3 gene in individuals from families with situs inversus and defects in the assembly of inner and outer dynein arms. Knockdown of dnaaf3 in zebrafish likewise disrupts dynein arm assembly and ciliary motility, causing primary ciliary dyskinesia phenotypes that include hydrocephalus and laterality malformations. Chlamydomonas reinhardtii PF22 is exclusively cytoplasmic, and a PF22-null mutant cannot assemble any outer and some inner dynein arms. Altered abundance of dynein subunits in mutant cytoplasm suggests that DNAAF3 (PF22) acts at a similar stage as other preassembly proteins, for example, DNAAF2 (also known as PF13 or KTU) and DNAAF1 (also known as ODA7 or LRRC50), in the dynein preassembly pathway. These results support the existence of a conserved, multistep pathway for the cytoplasmic formation of assembly competent ciliary dynein complexes. © 2012 Nature America, Inc. All rights reserved.

Price D.,University of Aberdeen | Yawn B.,Olmsted Medical Center | Brusselle G.,Ghent University | Rossi A.,Pulmonary Unit
Primary Care Respiratory Journal | Year: 2013

While the pharmacological management of chronic obstructive pulmonary disease (COPD) has evolved from the drugs used to treat asthma, the treatment models are different and the two diseases require clear differential diagnosis in order to determine the correct therapeutic strategy. In contrast to the almost universal requirement for anti-inflammatory treatment of persistent asthma, the efficacy of inhaled corticosteroids (ICS) is less well established in COPD and their role in treatment is limited. There is some evidence of a preventive effect of ICS on exacerbations in patients with COPD, but there is little evidence for an effect on mortality or lung function decline. As a result, treatment guidelines recommend the use of ICS in patients with severe or very severe disease (forced expiratory volume in 1 second <50% predicted) and repeated exacerbations. Patients with frequent exacerbations - a phenotype that is stable over time - are likely to be less common among those with moderate COPD (many of whom are managed in primary care) than in those with more severe disease. The indiscriminate use of ICS in COPD may expose patients to an unnecessary increase in the risk of side-effects such as pneumonia, osteoporosis, diabetes and cataracts, while wasting healthcare spending and potentially diverting attention from other more appropriate forms of management such as pulmonary rehabilitation and maximal bronchodilator use. Physicians should carefully weigh the likely benefits of ICS use against the potential risk of side-effects and costs in individual patients with COPD. © 2013 Primary Care Respiratory Society UK. All rights reserved.

Marchese S.,Respiratory Intensive Care Unit | Corrado A.,Respiratory Intensive Care Unit | Scala R.,Pulmonary Unit | Corrao S.,University of Palermo | And 2 more authors.
Respiratory Medicine | Year: 2010

Background: Tracheostomy is increasingly performed in intensive care units (ICU), with many patients transferred to respiratory ICU (RICU). Indications/timing for closing tracheostomy are discussed. Aim and Method: We report results of a one-year survey evaluating: 1) clinical characteristics, types of tracheostomy, complications in patients admitted to Italian RICU in 2006; 2) clinical criteria and systems for performing decannulation, and outcome of patients undergoing tracheostomy (number decannulated; number non-decannulated/non-ventilated; number non-decannulated/ventilated; dead/lost patients). Results: 22/32 RICUs replied. There were 846 admissions of 719 patients (Mean age 64,3 (±14.2) years, 489 (68%) males). Causes of admission were: acute respiratory failure with underlying chronic co-morbidities 176 (24.4%); exacerbation of Chronic Obstructive Pulmonary Disease 222 (34.4%); neuromuscular diseases 200 (27.8%); surgical patients 77 (10.7%); thoracic dysmorphism 28 (3.8%); obstructive sleep apnea syndrome 16 (2.2%). Percutaneous tracheostomies were 65.9%. Major complications after tracheostomy were 2%. 427 tracheostomies were evaluated for decannulation: 96 (22.5%) were closed; 175 patients (41%) were discharged with home mechanical ventilation; 114 patients (26.5%) maintained the tracheostomy despite weaning from mechanical ventilation and 42 patients (10%) died or lost. The clinical criteria chosen for decannulation were: stability of respiratory conditions, effective cough, underlying diseases and ability to swallow. The systems for evaluating feasibility of decannulation were: closure of tracheostomy tube; laryngo-tracheoscopy; use of tracheal button and down-sizing. Conclusions: There were few major complications of tracheostomy. A substantial proportion of patients maintain the tracheostomy despite not requiring mechanical ventilation. There was no agreement on indications and systems for closing tracheostomy.

Weiler Z.,Pulmonary Unit | zeldin Y.,Allergy and Immunology Unit | Magen E.,Barzilai Medical Center | Zamir D.,Barzilai Medical Center | Kidon M.I.,Allergy and Immunology Unit
Respiratory Medicine | Year: 2010

Background: At the population level, asthma has been associated with chronic systemic inflammation as well as adverse cardiovascular outcomes. Objectives: The aim of this study was to investigate peripheral vascular hemodynamic variables of arterial stiffness (AS) and their relationship to pulmonary function tests in asthmatic patients. Methods: Young asthmatic patients from the tertiary center for pulmonary diseases at the Barzilai Medical Center underwent pulmonary function evaluation and non-invasive radial artery hemodynamic profiling, pre- and post-exercise. Results were compared to age matched, non-asthmatic controls. Results: 23 young asthmatics and 41 controls, completed all evaluation points. Pulmonary flow parameters were significantly reduced in the asthma group at all points. There were no differences between groups in BMI, blood pressure, pulse rate or measurements of AS at baseline or after bronchodilation. The % predicted forced expiratory volume in the first second at baseline (FEV1%) in asthmatics was positively correlated with the small arteries elasticity index (SAEI) and negatively correlated with the systemic vascular resistance (SVR) in these patients. These correlations were not observed in non-asthmatic controls. In multifactorial regression FEV1 remained the major factor associated with measurements of AS in asthmatic patients, while gender was the only significant factor in non-asthmatic controls. Conclusions: Significant correlations between measurements of AS and FEV1 in young asthmatics, suggest the presence of a common systemic, most likely inflammatory pathway involving both the cardiovascular and respiratory systems. © 2009.

PubMed | Pulmonary Unit, University of Verona, University Pompeu Fabra, University of Bergen and 8 more.
Type: Comparative Study | Journal: The European respiratory journal | Year: 2015

We compared risk factors and clinical characteristics, 9-year lung function change and hospitalisation risk across subjects with the asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), asthma or COPD alone, or none of these diseases.Participants in the European Community Respiratory Health Survey in 1991-1993 (aged 20-44years) and 1999-2001 were included. Chronic airflow obstruction was defined as pre-bronchodilator forced expiratory volume in 1s (FEV1)/forced vital capacity

Corrado A.,University of Florence | Renda T.,University of Florence | Polese G.,Pulmonary Unit | Rossi A.,University of Verona
Respiratory Medicine | Year: 2013

Background several studies suggest that many asthmatic subjects have uncontrolled asthma. The control of asthma is now considered the major goal of therapy. Objectives to ascertain the level of asthma control, by Asthma Control Test (ACT), in "real-life" clinical practice and the potential risk factors for uncontrolled disease in patients treated with inhaled corticosteroids (ICS) and long-acting beta-adrenergic agonists (LABA). Methods SERENA is a multi-centre, cross-sectional, 6-month observational, non-interventional study carried out in 16 Pulmonary Units in Italy. Asthmatic outpatients aged over 18, undergoing treatment with ICS at medium-high daily doses associated with LABA, were enrolled. The patients were divided in 3 subgroups according to the level of asthma control by ACT score (25:controlled; 20-24:partly controlled; <20: uncontrolled). Results Out of a total of 548 patients, 396 met the inclusion criteria. Only 9.1% of patients had asthma controlled, while partly controlled and uncontrolled asthma accounted for 39.6% and 51.3% respectively. The mean age was 54.5 ± 15.8 and the mean duration of asthma was 16.1 ± 14.1 years. There were more females than males (63% vs 37%) and females had highest prevalence of uncontrolled asthma (63.1%). The mean values of FEV1% predicted were lower in the uncontrolled group (p < 0.001). The percentage of patients with at least 1 exacerbation, unscheduled visit and/or admissions was lower in controlled (22.2%, 8.3%, 8.3%) than in partly controlled (50%, 38.6%, 9.2%) and uncontrolled (83.2%, 66.2%, 27.8%) groups (p < 0.0001). The multivariate ordinal logistic regression analysis identified female sex, FEV1 and exacerbations as the strongest independent factors associated with the uncontrolled disease. Conclusion This study highlights the importance in clinical practice of a periodic assessment by a validated asthma control instrument and exacerbations/health care contacts during previous year. Clinicians should be aware that a significant proportion of patients can have uncontrolled asthma, despite regular pharmacological treatment. © 2013 Elsevier Ltd. All rights reserved.

Mor Z.,Public Health Services | Leventhal A.,Hebrew University of Jerusalem | Weiler-Ravell D.,Pulmonary Unit | Peled N.,Lady Davis Carmel Medical Center | Lerman Y.,Tel Aviv University
Respiratory Care | Year: 2012

BACKGROUND: Chest x-ray (CXR) is widely used for diagnosing and screening pulmonary tuberculosis (PTB), yet its validity is debatable and its costs are relatively high. This study aimed to determine the validity of CXR screening in detecting radiological findings compatible with active PTB or with old healed tuberculosis (OHTB). METHODS: All Ethiopian immigrants to Israel between 2001 and 2005 were radiographed before emigration. Immigrants whose CXR demonstrated PTB or OHTB were evaluated, treated, and followed for one year after arrival. The end point of this historical cohort study was a diagnosis of active pulmonary disease within the study period. RESULTS: CXR was performed on 13,379 immigrants. Changes suggesting PTB were identified in 150 (1.1%) of those, and 46 were diagnosed with active PTB. Sensitivity, specificity, and positive predictive value of a CXR suggesting PTB were 80.1%, 99.2%, and 31%, respectively. As PTB prevalence in this cohort is 0.4%, post-test odds for CXR suggestive of PTB were 75.5. Changes suggesting OHTB were identified in 257 (1.9%) immigrants. Of those, 15 (5.8%) developed active PTB within one year following arrival. Sensitivity, specificity, and positive predictive value of CXR suggestive of OHTB were 17.2%, 98.2%, and 5.8%, respectively, when active PTB during the first year was the end point. In this study, 291 CXR were required to detect one active PTB patient, costing $5,802. CONCLUSIONS: CXR is a valid and cost-saving tool for screening active PTB in immigrants originating in high-burden countries, and is beneficial in detecting OHTB in immigrants who are at a higher risk for developing active PTB. © 2012 Daedalus Enterprises.

Decramer M.,University Hospitals | Rossi A.,Pulmonary Unit | Lawrence D.,Novartis | McBryan D.,Novartis
Respiratory Medicine | Year: 2012

Background: Recent findings of rapid lung function decline in younger patients with moderate COPD severity suggest the need for effective early treatment. Aim: To evaluate the effectiveness of indacaterol as maintenance therapy in COPD patients not receiving other maintenance treatments. Methods: Pooled data from three randomised, placebo-controlled studies provided a population of patients with moderate-to-severe COPD not receiving maintenance treatment at baseline and who received once-daily, double-blind treatment with indacaterol 150 μg, indacaterol 300 μg or placebo. Data from an open-label tiotropium treatment arm in one study were available for comparison. Efficacy evaluations included trough FEV1, dyspnoea (transition dyspnoea index, TDI) and health status (St George's Respiratory Questionnaire, SGRQ) at 6 months and risk of COPD exacerbations. Results: The maintenance-naïve population comprised 232 (indacaterol 150 μg), 220 (indacaterol 300 μg) and 325 (placebo) patients, plus 156 (tiotropium) (30% of overall study population). Patients treated with indacaterol 150 and 300 μg had statistically significant improvements relative to placebo (p < 0.05) in trough FEV1 (170 and 180 mL), TDI total score (1.27 and 1.04 points), rescue use and SGRQ total score (-6.1 and -2.5 units) at 6 months. Patients receiving tiotropium had statistically significant improvements versus placebo (p < 0.05) in trough FEV1 (130 mL) and TDI total score (0.69 points). Exacerbations were rare and not significantly reduced by any treatment. Treatments were well tolerated. Conclusions: Indacaterol, given to patients with moderate-to-severe COPD not receiving other maintenance treatments, provided effective bronchodilation with significant, clinically relevant improvements in dyspnoea and health status compared with placebo. © 2012 Elsevier Ltd. All rights reserved.

Shteinberg M.,Pulmonary Unit
Harefuah | Year: 2012

Actinomyces infections are rare infections, involving the head and neck, abdominal cavity, and the lung. We report a case of a 66 year old woman with shortness of breath and a pleural effusion from which Actinomyces meyeriwas cultured. The diagnosis was confirmed by the polymerase chain reaction technique. The infection was successfully treated with a combination of ampicillin and surgical decortication. Due to their rarity, Actinomyces infections are not often suspected. These infections are difficult to diagnose due to specific microbiologic requirements for isolation of Actinomyces. In many reviewed cases of Actinomyces infection, patients underwent surgery for presumed cancer but were eventually diagnosed as being infected with actinomycosis. Due to lack of improvement of our patient, surgical decortication was performed, which led to a successful outcome.

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