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Biomedical subjects

B J Make

Publications and source records attributed to B J Make.

26 records · Page 2Linked to original sources
PubMed1986

Pulmonary rehabilitation for the elderly.

The elements of a pulmonary rehabilitation program require a variety of different skills. However, the number of people involved in a rehabilitation program will vary with the clinical setting and the number of patients served. In a large program, a physician, respiratory nurse, physical and occupational therapist, psychologist, social worker, respiratory therapist, and dietitian might all be involved on a full- or part-time basis. In other settings, two or three individuals, mostly working part-time, may be the entire team. Pulmonary rehabilitation may be performed on an outpatient basis, in a group practice setting, or in an inpatient hospital unit. Whatever its size, a system must be developed that allows for thorough initial evaluation of patients, formation of rational goals with the patient, adequate time for patient education and training, ongoing re-enforcement to consolidate and maintain gains, and an appropriate means of intervention when the patient experiences an exacerbation of his disease. It should also be recognized that in many areas of the country, there are too few patients and scarce medical resources to mount an intensive pulmonary rehabilitation program. In such instances, referral can be made to larger medical centers. More importantly, the individual practitioner can successfully incorporate many of the elements of pulmonary rehabilitation into his practice by taking the time and effort necessary to ascertain how illness affects the daily lives of the patient with COPD and then addressing patient concerns in an ongoing, comprehensive manner.

Activities of Daily Living↗
PubMed1986

Pulmonary rehabilitation: myth or reality?

Pulmonary rehabilitation is an art of medical practice incorporating many therapeutic modalities with the goal of improving the patient's functional ability. The gains to be realized and the basis for improvement following pulmonary rehabilitation are detailed in this article.

Breathing Exercises↗
PubMed1986

Rehabilitation and home care for ventilator-assisted individuals.

An increasing number of patients with chronic irreversible respiratory disorders are receiving mechanical ventilation in the home. Rehabilitation prior to hospital discharge allows improved independence and mobility in the home for these individuals.

Home Care Services↗
PubMed1986

Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation.

We studied risk factors for nosocomial pneumonia and fatality in 233 intensive care unit patients requiring continuous mechanical ventilation. Ventilator-associated pneumonia was diagnosed in 49 (21%) of the 233 patients. Of the 8 risk factors univariately associated with the development of pneumonia, only the presence of an intracranial pressure monitor (p less than 0.002), treatment with cimetidine (p less than 0.01), hospitalization during fall-winter seasons (p less than 0.04), and mechanical ventilator circuit changes every 24 h rather than every 48 h (p less than 0.02) remained significant after stepwise logistic regression. The overall fatality rate for the 49 patients who developed ventilator-associated pneumonia was 55%. Ventilator-associated pneumonia was 1 of 18 variables univariately associated with overall patient fatality, but it was not among the 7 variables present after multivariate analysis. The data delineate risk factors associated with the development of nosocomial pneumonia and fatality in patients receiving continuous mechanical ventilation.

Adult↗
PubMed1984

Contaminated medication nebulizers in mechanical ventilator circuits. Source of bacterial aerosols.

The contamination rates of medication nebulizers inserted into mechanical ventilator circuits were studied. Semiquantitative techniques were used to sample the reservoir fluid from in-line nebulizers during the first 24 hours after a circuit change. In the initial survey, high levels of contamination (organism concentrations above 10(3)/ml) were present in 13 (68 percent) of the 19 nebulizer reservoirs, and bacterial aerosols were produced by 10 (71 percent) of 14 nebulizers. Gram-negative bacilli were the predominant organisms isolated. Nebulizer contamination originated primarily from reflux of contaminated condensate in the ventilator circuit. When nebulizers were cleaned after each treatment, a reduced rate of contamination was found. Small bacterial aerosols (less than 3 microns in size) were produced in vitro after inoculation of nebulizers with gram-negative bacilli in concentrations isolated from in-use nebulizers. Contaminated in-line medication nebulizers generate small-particle bacterial aerosols that may increase the risk of ventilator-associated pneumonia and therefore should be cleaned or disinfected after each treatment rather than every 24 hours.

Aerosols↗
PubMed1984

Contaminated condensate in mechanical ventilator circuits. A risk factor for nosocomial pneumonia?

We studied ventilator circuit colonization and condensate formation in 30 mechanical ventilators during the first 24 h after a circuit change. Parts of the circuit nearest the patient were more frequently contaminated and had the highest levels of colonization. There was rapid colonization of tubing after a circuit change; 33% of the ventilators were colonized at 2 h, 64% at 12 h, and 80% at 24 h. The median level of colonization at 24 h was 7 X 10(4) organisms/ml. Water condensate collected in the ventilator circuits at a mean rate of 30 ml/h (range, 10 to 60 ml/h). At 24 h, 80% of the condensate samples were contaminated at a median level of 2 X 10(5) organisms/ml. The bacteria isolated from the condensate usually correlated with organisms previously isolated from the patient's sputum, suggesting that the patient's oropharyngeal flora is the primary source of circuit colonization. Highly contaminated condensate in the ventilator circuit may be a significant risk factor for nosocomial pneumonia. We suggest that circuit condensate be emptied regularly, handled as infectious waste, and that special efforts be taken to prevent contaminated condensate from inadvertently washing into the patient's tracheobronchial tree.

Bacterial Infections↗
PubMed1982

The use of learning resource centers in the teaching of pulmonary medicine.

Learning resource centers (LRC) are areas designed for individual study which contain a variety of self-instructional materials. To evaluate the use of LRC in teaching pulmonary medicine, a survey was conducted of medical school pulmonary sections; responses were obtained from 30 sections with an NHLBI pulmonary Academic Award (PAA groups), and 21 sections without PAA (non-PAA group). LRC were established in 77 percent of the PAA group but only 14 percent of the non-PAA group. A higher percentage of pulmonary fellows than students used the resource center and student use was higher when the LRC was formally integrated into the curriculum. Textbooks and journals were more heavily used than materials utilizing audiovisual educational techniques. The results of this study suggest that pulmonary LRC use is modest, LRC cost is high, and LRC educational value may not be superior to general medical libraries.

Academic Medical Centers↗