Search PubMed⌕ Search

Biomedical subjects

David J Berlowitz

Publications and source records attributed to David J Berlowitz.

6 recordsLinked to original sources
PubMed2006

A retrospective analysis of sleep quality and survival with domiciliary ventilatory support in motor neuron disease.

Previous studies have demonstrated that domiciliary ventilatory support improves survival, quality of life and cognitive function in motor neuron disease (MND). These benefits are partly attributed to better sleep quality and less hypoxia. In a retrospective analysis we compared the effect of non-invasive (NPPV, n = 52), tracheostomy (TPPV, n = 23) and no ventilation (n = 43) on sleep and survival in MND patients over a seven-year period. The TPPV and NPPV groups had more sleep arousals (AI, p = 0.024), more respiratory events (p = 0.001) and more time asleep with an oxygen saturation less than 90% (%TST with SpO2<90%, p = 0.01), than those who were not ventilated. After treatment with TPPV or NPPV, the percentage of rapid eye movement sleep increased (p<0.001) and the %TST with Sp02<90% (p = 0.006) and AI (p = 0.001) decreased. Improvements were larger and more consistent with NPPV. The median survival of those who used TPPV was 41 months, NPPV 32 months and of those not ventilated was 25 months, significantly different four years (p = 0.0497) after symptom onset. In this retrospective cohort of MND patients, ventilation, particularly NPPV, markedly improved sleep and conferred a modest survival advantage.

Aged↗
PubMed2005

A longitudinal evaluation of sleep and breathing in the first year after cervical spinal cord injury.

OBJECTIVES: To establish the incidence of sleep disordered breathing (SDB) after acute tetraplegia and to determine the relation between the Apnea-Hypopnea Index (AHI) score and the previously postulated predictors of SDB in tetraplegia. DESIGN: Inception cohort. We performed full polysomnography immediately after acute tetraplegia and at 2, 4, 13, 26, and 52 weeks postinjury. Spirometry, maximum inspiratory and expiratory pressures, medication usage, and neck and abdominal girth were also assessed. Preinjury SDB was estimated using the multivariate apnea prediction equation. SETTING: Acute care, subacute care, and community. PARTICIPANTS: Consecutive sample with acute tetraplegia. Thirty subjects (25 men) were initially included. Thirteen completed 12 months of follow-up. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: SDB (AHI score >10 events/h) and respiratory function. RESULTS: Three subjects (10%; 95% confidence interval [CI], 2%-28%) had probable SDB before injury. In the first 48 hours after injury, no subject had SDB. At 2 weeks, 60% (95% CI, 26%-88%) had SDB; at 4 weeks, 62% (95% CI, 38%-82%); at 13 weeks, 83% (95% CI, 61%-95%); at 26 weeks, 68% (95% CI, 44%-88%); and at 52 weeks, 62% (95% CI, 32%-86%). No consistent relation was found between the previously postulated predictors and SDB. CONCLUSIONS: SDB is highly prevalent within 4 weeks of acute tetraplegia.

Abdomen↗
PubMed2005

The effect of a post acute respiratory outreach service for patients with chronic obstructive pulmonary disease on hospital readmission rates.

OBJECTIVE: The aim of this study was to investigate the effect of a Post Acute Respiratory Outreach Service (PAROS) for patients with chronic obstructive pulmonary disease (COPD), on hospital utilization. METHODS: A retrospective cohort of patients was examined, using a nested comparison, to test the hypothesis that PAROS would affect hospital utilization in the 12 months following the intervention. Patients admitted with COPD and subsequently enrolled in PAROS were compared with age, sex and diagnosis-matched controls admitted with COPD, who did not receive PAROS. RESULTS: Of 216 patients admitted with COPD during the 1-year study period, 28 were referred to PAROS. A total of 25 suitable controls were identified. Three cases that could not be matched were excluded from the analysis. There were no significant differences in lung function or prior hospitalization between the two groups at baseline. A significant increase in hospital bed days, in the 12 months following the index admission, was observed in the PAROS group (P = 0.046). There was no difference in the number of admissions or emergency department presentations between the groups. CONCLUSIONS: The PAROS program did not lead to a reduction in hospital utilization. This study supports previous findings that respiratory outreach services delivered immediately post discharge increase hospital utilization.

Aged↗
PubMedDate not supplied

The process of implementing a nurse-coordinated multidisciplinary pulmonary rehabilitation program in Melbourne.

In March 2002 The Northern Clinical Research Centre, Epping implemented a six week outpatient based pulmonary rehabilitation program for people with COPD. This paper outlines the establishment, underlying philosophy, marketing, coordination and personnel necessary for a successful program, as identified by the research centre. Barriers to program participation were identified and steps to minimize these were implemented. The longitudinal evaluation of this program in a prospective manner enables the duration of the effect of this adjunctive therapy to be examined in the Australian population. One hundred and thirty six participants have graduated from the research centre's pulmonary rehabilitation program since the program commenced in 2002. This paper reviews the process of implementing a pulmonary rehabilitation program in the northern corridor of Melbourne.

Ambulatory Care↗