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Value-based healthcare analysis of shoulder surgery for patients with symptomatic rotator cuff tears - Calculating the impact of arthroscopic cuff repair. Shoulder Elbow 2022; 14:59-70. [PMID: 35845620 PMCID: PMC9284256 DOI: 10.1177/1758573220928258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical repair of full-thickness rotator cuff tears in symptomatic patients is known to offer significant benefits. Despite this there remains a lack of universal appreciation that such surgery offers high clinical value, with some commissioners even limiting access to it. The value-based healthcare agenda provides a means to design, deliver and measure the impact of healthcare to a defined segment of patients. The aim of this study was to measure the value of surgically repairing primary symptomatic full-thickness rotator cuff tears when outcomes and costs were assessed over an entire care pathway. METHODS A prospective study of patients undergoing rotator cuff tears repair was undertaken. Patients were managed using a standardised integrated care pathway. Subsequent outcomes and costs were measured over the whole care pathway. Outcomes were assessed from both traditional and patient centric re-formatted prisms. RESULTS Significant improvement in clinical outcomes where recognised when assessed from either the traditional or re-formatted prisms. Economic review of this approach revealed the pathway generated a sustainable and notable positive margin. DISCUSSION This study evidences how a well-designed value-based healthcare shoulder approach can be delivered and measured. It demonstrates rotator cuff surgery to be a high value treatment for patients with symptomatic rotator cuff tears.
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Undetected Respiratory Depression in People with Opioid Use Disorder. Drug Alcohol Depend 2022; 234:109401. [PMID: 35306391 DOI: 10.1016/j.drugalcdep.2022.109401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Opioid-related deaths are increasing globally. Respiratory complications of opioid use and underlying respiratory disease in people with Opioid Use Disorder (OUD) are potential contributory factors. Individual variation in susceptibility to overdose is, however, incompletely understood. This study investigated the prevalence of respiratory depression (RD) in OUD treatment and compared this to patients with chronic obstructive pulmonary disease (COPD) of equivalent severity. We also explored the contribution of opioid agonist treatment (OAT) dosage, and type, to the prevalence of RD. METHODS There were four groups of participants: 1) OUD plus COPD ('OUD-COPD', n = 13); 2) OUD without COPD ('OUD', n = 7); 3) opioid-naïve COPD patients ('COPD'n = 13); 4) healthy controls ('HC'n = 7). Physiological indices, including pulse oximetry (SpO2%), end-tidal CO2 (ETCO2), transcutaneous CO2 (TcCO2), respiratory airflow and second intercostal space parasternal muscle electromyography (EMGpara), were recorded continuously over 40 min whilst awake at rest. Significant RD was defined as: SpO2%< 90% for > 10 s, ETCO2 per breath > 6.6 kPa, TcCO2 overall mean > 6 kPa, respiratory pauses > 10 s RESULTS: At least one indicator was observed in every participant with OUD (n = 20). This compared to RD episode occurrence in only 2/7 HC and 2/13 COPD participants (p < 0.05,Fisher's exact test). The occurrence of RD was similar in OUD participants prescribed methadone (n = 6) compared to those prescribed buprenorphine (n = 12). CONCLUSIONS Undetected RD is common in OUD cohorts receiving OAT and is significantly more severe than in opioid-naïve controls. RD can be assessed using simple objective measures. Further studies are required to determine the association between RD and overdose risk.
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38 From theory to clinical practice: lessons learned from the delivery of a breathlessness support service. BMJ Support Palliat Care 2018. [DOI: 10.1136/bmjspcare-2018-mariecurie.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionA single-blind randomised controlled trial demonstrated that an integrated palliative and respiratory care service for patients with advanced disease and chronic breathlessness known as the Breathlessness Support Service (BSS) resulted in improved patient’s mastery in the BSS group compared to standard care (mean difference 0·58 95% CI 0·01–1·15 p=0·048; effect size 0·44).1AimTo describe the clinical aspects of delivering the BSS with regards to; referral sources patient characteristics and interventions provided.MethodSecondary data analysis of all patients that were referred to and completed that BSS intervention as part of the delayed intervention model RCT.1Results105 patients enrolled in the study 86 patients attended the first BSS clinic 75 completed the BSS intervention (two clinic appointments and a physiotherapy-based home visit). 80% of patients had non – malignant disease; respiratory medicine constituted most referrals. The majority (88%) of patients received solely non – pharmacological interventions. 35 (41%) patients reported that the have never accessed Pulmonary Rehabilitation (PR). At the point of discharge the BSS provided on ward referral and/or access to additional services (PR=53% social work=41% palliative care=11%).ConclusionsMajority of referrals were from respiratory medicine and GP practices for patients with chronic breathlessness due to non – malignant disease which highlights the challenges of trying to palliate breathlessness in the generalist setting. The BSS provided patients with access to self-management non – pharmacological interventions delivered by integrated multi-disciplinary team with expertise in breathlessness management which resulted in improved breathlessness mastery.Reference. Higginson IJ, et al.An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: A randomised controlled trial. The Lancet Respiratory Medicine2014;2(12):979–987.
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P214 The prevalence of respiratory symptoms and lung disease in a south london “lung health in addictions” service. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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S23 Neural respiratory drive during sleep at high altitude. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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T6 Randomised sham-controlled trial of transcutaneous electrical stimulation in obstructive sleep apnoea. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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S26 Feasibility and patient tolerability of transcutaneous electrical stimulation in obstructive sleep apnoea. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Comparative study of linear and curvilinear ultrasound probes to assess quadriceps rectus femoris muscle mass in healthy subjects and in patients with chronic respiratory disease. BMJ Open Respir Res 2016; 3:e000103. [PMID: 26835132 PMCID: PMC4716191 DOI: 10.1136/bmjresp-2015-000103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Ultrasound measurements of rectus femoris cross-sectional area (RFCSA) are clinically useful measurements in chronic obstructive pulmonary disease (COPD) and critically ill patients. Technical considerations as to the type of probe used, which affects image resolution, have limited widespread clinical application. We hypothesised that measurement of RFCSA would be similar with linear and curvilinear probes. Methods Four studies were performed to compare the use of the curvilinear probe in measuring RFCSA. Study 1 investigated agreement of RFCSA measurements using linear and curvilinear probes in healthy subjects, and in patients with chronic respiratory disease. Study 2 investigated the intra-rater and inter-rater agreement using the curvilinear probe. Study 3 investigated the agreement of RFCSA measured from whole and spliced images using the linear probe. Study 4 investigated the applicability of ultrasound in measuring RFCSA during the acute and recovery phases of an exacerbation of COPD. Results Study 1 showed demonstrated no difference in the measurement of RFCSA using the curvilinear and linear probes (308±104 mm2 vs 320±117 mm2, p=0.80; intraclass correlation coefficient (ICC)>0.97). Study 2 demonstrated high intra-rater and inter-rater reliability of RFCSA measurement with ICC>0.95 for both. Study 3 showed that the spliced image from the linear probe was similar to the whole image RFCSA (308±103.5 vs 263±147 mm2, p=0.34; ICC>0.98). Study 4 confirmed the clinical acceptability of using the curvilinear probe during an exacerbation of COPD. There were relationships observed between admission RFCSA and body mass index (r=+0.65, p=0.018), and between RFCSA at admission and physical activity levels at 4 weeks post-hospital discharge (r=+0.75, p=0.006). Conclusions These studies have demonstrated that clinicians can employ whole and spliced images from the linear probe or use images from the curvilinear probe, to measure RFCSA. This will extend the clinical applicability of ultrasound in the measurement of muscle mass in all patient groups.
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S47 Neural respiratory drive responses to increases in continuous positive airway pressure in healthy subjects: Abstract S47 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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S30 Nutrition and Exercise Rehabilitation in Obesity Hypoventilation Syndrome (NERO): A Pilot Randomised Controlled Trial. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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S48 Continuous positive airway pressure titration in awake obese subjects with obstructive sleep apnoea and its impact on neural respiratory drive and breathlessness. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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S50 Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P29 Impact Of Respiratory Virtual Clinics In Primary Care On Responsible Respiratory Prescribing And Inhaled Corticosteroid Withdrawal In Patients With Copd: A Feasibility Study. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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S55 Neural Respiratory Drive Using Parasternal Electromyography In Clinically Stable Cystic Fibrosis Patients: A Physiological Marker Of Lung Disease Severity And Exercise Capacity. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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S54 Neural Respiratory Drive Measured Using Parasternal Intercostal Muscle Electromyography In Patients With Interstitial Lung Disease. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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S53 Neural Respiratory Drive And Symptoms Limiting Exercise Capacity In Chronic Obstructive Pulmonary Disease. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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A UK survey of rehabilitation following critical illness: implementation of NICE Clinical Guidance 83 (CG83) following hospital discharge. BMJ Open 2014; 4:e004963. [PMID: 24833691 PMCID: PMC4025447 DOI: 10.1136/bmjopen-2014-004963] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine the implementation of National Institute for Health and Care Excellence guidance (NICE CG83) for posthospital discharge critical illness follow-up and rehabilitation programmes. DESIGN Closed-question postal survey. SETTING Adult intensive care units (ICUs) across the UK, identified from national databases of organisations. Specialist-only and private ICUs were not included. PARTICIPANTS Senior respiratory critical care physiotherapy clinicians. RESULTS A representative sample of 182 surveys was returned from the 240 distributed (75.8% (95% CI 70.4 to 81.2)). Only 48 organisations (27.3% (95% CI 20.7 to 33.9)) offered a follow-up service 2-3 months following hospital discharge, the majority (n=39, 84.8%) in clinic format. 12 organisations reported posthospital discharge rehabilitation programmes (6.8% (95% CI 3.1 to 10.5)), albeit only 10 of these operated on a regular basis. Lack of funding was reported as the most frequent (n=149/164, 90%) and main barrier (n=99/156, 63.5%) to providing services. Insufficient resources (n=71/164, 43.3%) and lack of priority by the clinical management team (n=66/164, 40.2%) were also highly cited barriers to service delivery. CONCLUSIONS NICE CG83 has been successful in profiling the importance of rehabilitation for survivors of critical illness. However, 4 years following publication of CG83 there has been limited development of this clinical service across the UK. Strategies to support delivery of such quality improvement programmes are urgently required to enhance patient care.
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P178 Nocturnal oximetry monitoring to predict hypercapnia in obese patients. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P35 The combined gold assessment, muscle weakness and walking distance: Abstract P35 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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S134 Activity monitoring in intensive care unit survivors: Assessing daily physical activity with objective outcome measures. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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S137 Failure of NICE guidance CG83 implementation: National UK survey of rehabilitation services for survivors of critical illness: Abstract S137 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P78 Physical Inactivity is Associated with Mid-Thigh Intramuscular Fat in Patients with COPD. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P40 Change in Rectus Femoris Cross Sectional Area (RFcsa) Following an Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD): Abstract P40 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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S48 The Effect of Angiotensin-Converting Enzyme Inhibition on Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease: A Randomised Controlled Trial. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P161 Cough Intensity in Voluntary, Induced and Spontaneous Cough: Abstract P161 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P160 Increased cough intensity in patients with chronic cough: Abstract P160 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P36 An Advanced Physiological Monitoring Tool To Detect Treatment Failure In Hospitalised Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease (AECOPD). Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P30 Feasibility of a New Out-Patient Breathlessness Support Service. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P71 Relationship between quadriceps rectus femoris cross-sectional area and health related quality of life in patients following critical illness. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P132 Comparative study of the Curvilinear Ultrasound Probe (CUP) vs the Linear Ultrasound Probe (LUP) to measure Rectus Femoris Cross Sectional Area (RFcsa). Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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S94 Ultrasound measurement of quadriceps wasting in early chronic obstructive pulmonary disease and its relationship with daily physical activity. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054b.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P66 Inter-observer reliability of ultrasound to measure rectus femoris cross-sectional area in critically ill patients. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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S116 Parasternal muscle electromyelography (EMGpara) reflects observed changes in dynamic hyperinflation during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054b.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P72 Relationship between quadriceps rectus femoris anatomical cross-sectional area, physiological cross-sectional area and pennation angle in healthy subjects. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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A physiological model of patient-reported breathlessness during daily activities in COPD. Eur Respir Rev 2011; 18:66-79. [PMID: 20956127 DOI: 10.1183/09059180.00000809] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breathlessness during daily activities has a significant impact on quality of life in chronic obstructive pulmonary disease. Herein, we present a physiological model of patient-reported breathlessness based on the relationship between ventilatory load, respiratory muscle capacity, neural respiratory drive and neuromechanical dissociation during daily activities. This model should facilitate an understanding of the mechanisms driving increased intensity of breathlessness during daily activities and the relief of breathlessness following medical or surgical interventions. The model should also provide a structure on which to base the development of patient-reported outcome instruments to measure the severity of breathlessness during daily activities in chronic obstructive pulmonary disease.
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Neural Respiratory Drive in Patients with COPD during Exercise Tests. Respiration 2011; 81:294-301. [DOI: 10.1159/000317136] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 04/05/2010] [Indexed: 11/19/2022] Open
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S118 Acute hemispheric stroke patients have reduced functional residual capacity and cough flow rates. Thorax 2010. [DOI: 10.1136/thx.2010.150946.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P101 Surface parasternal intercostal electromyogram (sEMGpara) as a monitoring tool in cystic fibrosis. Thorax 2010. [DOI: 10.1136/thx.2010.150987.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P144 Muscle fibre atrophy and aerobic to anaerobic fibre type shift in the quadriceps in COPD. Thorax 2010. [DOI: 10.1136/thx.2010.150987.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P143 NF-kappa B (NF- B) and activator protein-1 (AP-1) DNA binding in the quadriceps of COPD patients. Thorax 2010. [DOI: 10.1136/thx.2010.150987.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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S65 Interim data from a randomised controlled trial of average volume-assured pressure support (AVAPS) versus spontaneous-timed (ST) pressure support in Obesity Hypoventilation Syndrome (OHS). Thorax 2010. [DOI: 10.1136/thx.2010.150938.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Screening for sleep-disordered breathing in neuromuscular disease using a questionnaire for symptoms associated with diaphragm paralysis. Eur Respir J 2010; 37:400-5. [DOI: 10.1183/09031936.00036210] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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