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Short term abstinence from smoking: its place in preoperative preparation.

Newer pulmonary function instruments make measurement of small airway function possible as a routine, inexpensive part of preoperative preparation of patients with obstructive lung disease. Patients with early stages of chronic obstructive lung disease have maldistribution of ventilation and perfusion producing an increased A-a oxygen gradient. If the disease is at a reversible stage, early diagnosis and treatment should be helpful in preventing postoperative complications. Five volunteer heavy smokers stopped smoking for one week without any improvement in small airway function. A longer period of abstinence and other therapeutic modalities for these patients is needed prior to surgery to reduce the postoperative impact of this pathology.

Adult↗

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Modification of the Bennett MA-1 ventilator for use with intermittent mandatory ventilation.

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Humans↗

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Intermittent mandatory ventilation: an alternative weaning technic. A case report.

Many variations of measurement have been proposed for determining when a patient may be weaned from artificial ventilation. The present case report describes successful use of intermittent mandatory ventilation for weaning a patient when measurements had indicated weaning would not be possible.

Acid-Base Equilibrium↗

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The AHCPR guidelines on heart failure: comparison of a family medicine and an internal medicine practice with the guidelines and an educational intervention to modify behavior.

OBJECTIVES: The objectives of this study were to apply the Agency for Health Care Policy and Research (AHCPR) guideline for heart failure to the measurement of quality of care in the ambulatory setting, to compare the results for two large practices and to design an educational intervention for the two practices being studied. METHODS: A retrospective chart review was conducted on a random sample of 50 patients with heart failure selected from each of two outpatient practices: the general internal medicine practice and the family medicine practice at a large academic medical center. Five medical review criteria were developed from the AHCPR guideline for heart failure to compare the two practices with each other and the guidelines. An educational intervention was developed to modify physician behavior in regard to compliance with guidelines. RESULTS: Assessment of left ventricular function occurred in 79% of all cases. Of eligible patients, 68% were treated with angiotensin-converting enzyme inhibitors (ACE-Is). Of those patients treated with enalapril and captopril, 30% and 12%, respectively, were receiving the target dose as defined in the AHCPR guidelines. Of patients not eligible for treatment with ACE-Is, none were treated with hydralazine and nitrates. When the ejection fraction was less than or equal to 40%, 81% of eligible patients were treated with ACE-Is, whereas 59% were treated with ACE-Is when the ejection fraction was greater than 40%. Calcium channel blockers were used in the treatment of 42% of patients. A statistical difference (P = .05) was found between the two practices for documentation of left ventricular function, the use of ACE-Is for patients with ejection fraction less than or equal to 40%, and the use of calcium channel blockers and beta blockers. CONCLUSIONS: In the practices studied, there is underutilization of the documentation of left ventricular function, ACE-Is in eligible patients, target doses of ACE-Is, and the use of hydralazine and nitrates for ineligible patients. A higher proportion of patients receive ACE-I therapy when the ejection fraction is less than or equal to 40%. There may be inappropriate use of calcium channel blockers in some patients. There is unexplained clinical variation between the two practices studied.

Adrenergic beta-Antagonists↗

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