Differentiating Upper from Lower Airway Compromise in Neonates

1985 ◽  
Vol 94 (5) ◽  
pp. 509-515 ◽  
Author(s):  
Seth M. Pransky ◽  
Kenneth M. Grundfast
Keyword(s):  
Decision Making ◽  
Very Low Birth Weight ◽  
Upper Airway ◽  
Respiratory Physiology ◽  
Lower Airway ◽  
Respiratory Care ◽  
Multiple Factors ◽  
Airway Problem ◽  
Therapeutic Decision Making ◽  
Therapeutic Alternatives

Technologic advancements and improvements in supportive care have resulted in increased survival of very low birth weight and premature infants. With salvage of these high risk newborns, many difficult management problems arise. Respiratory distress of the newborn is the most common airway problem that affects these patients and subglottic edema or stenosis may frequently complicate management of the airway. Decision-making in airway maintenance and respiratory care can be problematic due to multiple factors that must be considered. The otolaryngologist is often consulted when upper airway obstruction is suspected. Relevant respiratory physiology is reviewed in order to help direct therapeutic decision-making. Parameters of assessment are enumerated and methods for choosing among therapeutic alternatives are presented. A paradigm to aid in differential diagnosis is described.

The shift in the indications for the tracheotomy between 1940 and 1955: an historical review

1999 ◽  
Vol 113 (7) ◽  
pp. 624-627 ◽  
Author(s):  
K. Graamans ◽  
W. Pirsig ◽  
K. Biefel
Keyword(s):  
World War Ii ◽  
Beneficial Effect ◽  
Upper Airway ◽  
Historical Review ◽  
Second World War ◽  
Respiratory Physiology ◽  
Lower Airway ◽  
World War ◽  
The 19Th Century ◽  
Second World

AbstractIn the period between 1940 and 1955 the indications for tracheotomy were extended. For centuries tracheotomies were performed to treat obstructive diseases of the upper airway (hypopharynx, larynx, trachea). With the end of the second World War tracheotomy was indicated more and more for the therapy of lower airway disturbances.Medical empiricism is thought to be responsible for the gradual shift in the indications during that period from upper to lower airway disturbances. Knowledge about the underlying principles of respiratory physiology was, however, already present at the end of the 19th century, but the shift in the indications did not occur until relatively recently. For many victims of World War II the discovery of the beneficial effect of a tracheotomy in a variety of traumatic disorders may have come too late.

Uso de propulsor mandibular fixo Flex Developer como recurso no tratamento da Classe II em paciente não colaborador

2020 ◽  
Vol 13 (52) ◽  
pp. 40-51
Author(s):  
Renato Barcellos Rédua
Keyword(s):  
Upper Airway ◽  
Class Ii ◽  
Class Ii Malocclusion ◽  
Skeletal Class ◽  
Advantages And Disadvantages ◽  
Skeletal Class Ii ◽  
High Incidence ◽  
Therapeutic Alternatives ◽  
Smile Aesthetics ◽  
Treatment Alternatives

Class II malocclusion has a high incidence in the population, which may compromise smile aesthetics, occlusion function and stability. Skeletal Class II may affect facial aesthetics and upper airway volume. Class II malocclusion is routinely associated with skeletal Class II condition, having as treatment alternatives the use of Extra Buccal Appliance (EBA) or removable or fixed propulsor appliance. This article describes a case of a patient who did not accept the use of EBA and so it was fitted a Flex Developer propulsor for Class II correction and discussed the advantages and disadvantages of therapeutic alternatives for Class II correction.

scholarly journals Factors associated with the decision to prescribe and administer antipsychotics for older people with delirium: a qualitative descriptive study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047247
Author(s):  
Emily J Tomlinson ◽  
Helen Rawson ◽  
Elizabeth Manias ◽  
Nicole (Nikki) M Phillips ◽  
Peteris Darzins ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Health Professionals ◽  
Acute Care Hospital ◽  
Nursing Workload ◽  
Care Hospital ◽  
Antipsychotic Medications ◽  
Factors Associated ◽  
Multiple Factors ◽  
Qualitative Descriptive

ObjectivesTo explore factors associated with decision-making of nurses and doctors in prescribing and administering as required antipsychotic medications to older people with delirium.DesignQualitative descriptive.SettingTwo acute care hospital organisations in Melbourne, Australia.ParticipantsNurses and doctors were invited to participate. Semi-structured focus groups and individual interviews were conducted between May 2019 and March 2020. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis.ResultsParticipants were 42 health professionals; n=25 nurses and n=17 doctors. Themes relating to decisions to use antipsychotic medication were: safety; a last resort; nursing workload; a dilemma to medicate; and anticipating worsening behaviours. Nurses and doctors described experiencing pressures when trying to manage hyperactive behaviours. Safety was a major concern leading to the decision to use antipsychotics. Antipsychotics were often used as chemical restraints to ‘sedate’ a patient with delirium because nurses ‘can’t do their job’. Results also indicated that nurses had influence over doctors’ decisions despite nurses being unaware of this influence. Health professionals’ descriptions are illustrated in a decision-making flowchart that identifies how nurses and doctors navigated decisions regarding prescription and administration of antipsychotic medications.ConclusionsThe decision to prescribe and administer antipsychotic medications for people with delirium is complex as nurses and doctors must navigate multiple factors before making the decision. Collaborative support and multidisciplinary teamwork are required by both nurses and doctors to optimally care for people with delirium. Decision-making support for nurses and doctors may also help to navigate the multiple factors that influence the decision to prescribe antipsychotics.

scholarly journals Integrating multiple fuzzy expert systems under restricting requirements 

2012 ◽  
Vol 52 (No. 4) ◽  
pp. 187-196
Author(s):  
S. Aly ◽  
I. Vrana
Keyword(s):  
Decision Making ◽  
Expert Systems ◽  
Business Processes ◽  
New Product ◽  
Decision Problems ◽  
Food Chains ◽  
Problem Context ◽  
Multiple Factors ◽  
Decision Consistency ◽  
Fuzzy Expert Systems

The multiple, different and specific expertises are often needed in making YES-or-NO (YES/NO) decisions for treating a variety of business, economic, and agricultural decision problems. This is due to the nature of such problems in which decisions are influenced by multiple factors, and accordingly multiple corresponding expertises are required. Fuzzy expert systems (FESs) are widely used to model expertise due to its capability to model real world values which are not always exact, but frequently vague, or uncertain. In addition, they are able to incorporate qualitative factors. The problem of integrating multiple fuzzy expert systems involves several independent and autonomous fuzzy expert systems arranged synergistically to suit a varying problem context. Every expert system participates in judging the problem based on a predefined match between problem context and the required specific expertises. In this research, multiple FESs are integrated through combining their crisp numerical outputs, which reflect the degree of bias to the Yes/No subjective answers. The reasons for independency can be related to maintainability, decision responsibility, analyzability, knowledge cohesion and modularity, context flexibility, sensitivity of aggregate knowledge, decision consistency, etc. This article presents simple algorithms to integrate multiple parallel FES under specific requirements: preserving the extreme crisp output values, providing for null or non-participating expertises, and considering decision-related expert systems, which are true requirements of a currently held project. The presented results provides a theoretical framework, which can bring advantage to decision making is many disciplines, as e.g. new product launching decision, food quality tracking, monitoring of suspicious deviation of the business processes from the standard performance, tax and customs declaration issues, control and logistic of food chains/networks, etc. 

The Prescription as Final Common Pathway

1995 ◽  
Vol 11 (3) ◽  
pp. 384-390 ◽  
Author(s):  
Jerry Avorn
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Health Economics ◽  
Medical Care ◽  
Clinical Medicine ◽  
Decision Science ◽  
Therapeutic Decision ◽  
Common Pathway ◽  
Final Common Pathway ◽  
Therapeutic Decision Making

AbstractThere is an informational void about Pharmaceuticals in the training of most doctors, despite the importance of the prescription in medical care. The writing of the prescription is the final common pathway in therapeutic decision making, which involves such diverse forces and disciplines as anthropology, decision science, health economics, ethics, and politics, as well as pharmacology and clinical medicine. Programs to improve the precision and cost-effectiveness of doctors' prescribing must consider all of these factors if pharmacotherapeutics are to be used optimally.

scholarly journals Changes in the Upper and Lower Pharyngeal Airway Spaces Associated with Rapid Maxillary Expansion

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Fitin Aloufi ◽  
Charles B. Preston ◽  
Khalid H. Zawawi
Keyword(s):  
Orthodontic Treatment ◽  
Upper Airway ◽  
Rapid Maxillary Expansion ◽  
Lower Airway ◽  
Control Group ◽  
Maxillary Expansion ◽  
Pharyngeal Airway ◽  
Significant Difference ◽  
And Gender ◽  
Maxillary Constriction

Objectives. The primary objectives of this retrospective study were first to compare the upper and lower pharyngeal airway spaces between orthodontic patients with and without maxillary constriction and second to evaluate the effect of rapid maxillary expansion (RME) on these airway spaces. A secondary objective was to compare the mode of breathing between groups. Materials and Methods. The experimental (RME) group consisted of 30 patients (mean age, years, 16 boys and 14 girls) with maxillary constriction who were treated with hyrax-type RME. The control group comprised the records of age- and gender matched patients (mean age, years, 16 boys and 14 girls) with no maxillary constriction but requiring nonextraction comprehensive orthodontic treatment. Cephalometric measurements in the sagittal dimension of upper and lower airway spaces for the initial and final records were recorded. Mode of breathing and length of treatment were also compared. Results. The sagittal dimension of the upper airway increased significantly in the RME group ( mm) compared to the control group ( mm), . However, there was no significant difference in the lower pharyngeal airway measurement between the RME group () and the control group (), . There was no significant difference with respect to mode of breathing between the two groups (). Conclusion. Rapid maxillary expansion (RME) during orthodontic treatment may have a positive effect on the upper pharyngeal airway, with no significant change on the lower pharyngeal airway.

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