scholarly journals Clinical Significance of Cough Peak Flow and Its Non-Contact Measurement via Cough Sounds: A Narrative Review

2020 ◽  
Vol 10 (8) ◽  
pp. 2782
Author(s):  
Yasutaka Umayahara ◽  
Zu Soh ◽  
Kiyokazu Sekikawa ◽  
Toshihiro Kawae ◽  
Akira Otsuka ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Foreign Bodies ◽  
Clinical Evidence ◽  
Peak Flow ◽  
Prediction Method ◽  
Extubation Failure ◽  
Narrative Review ◽  
Related Factors ◽  
Contact Measurement ◽  
Cough Strength

Coughing is the primary defence mechanism against foreign bodies in the central airways and can quantitatively be assessed by cough peak flow (CPF). We conducted a narrative review of the literature on CPF, which is most commonly used for evaluating cough strength. This review regards the method for measurement of CPF, the cough-related factors influencing CPF, the clinical significance of CPF evaluation, and a novel cough strength prediction method using cough sounds. Furthermore, this review presents various cutoff thresholds that predict extubation failure in patients on mechanical ventilation, acute respiratory failure, and aspiration risk. The published clinical evidence of CPF demonstrates reasonable diagnostic accuracy, predictive power, and validity, although additional studies on the non-contact measurement of CPF via cough sounds with better-quality methodologies are required.

scholarly journals Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jun Duan ◽  
Xiaofang Zhang ◽  
Jianping Song
Keyword(s):  
Predictive Power ◽  
Peak Flow ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Extubation Failure ◽  
Diagnostic Odds Ratio ◽  
Manual Search ◽  
Cough Strength ◽  
Sensitivity Specificity

Abstract Background The predictive power of extubation failure diagnosed by cough strength varies by study. Here we summarise the diagnostic power of extubation failure tested by cough strength. Methods A comprehensive online search was performed to select potentially eligible studies that evaluated the predictive power of extubation failure tested by cough strength. A manual search was also performed to identify additional studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the predictive power of extubation failure. Results A total of 34 studies involving 45 study arms were enrolled, and 7329 patients involving 8684 tests were analysed. In all, 23 study arms involving 3018 tests measured cough peak flow before extubation. The pooled extubation failure was 36.2% and 6.3% in patients with weak and strong cough assessed by cough peak flow, respectively. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.76 (95% confidence interval [CI]: 0.72–0.80), 0.75 (0.69–0.81), 2.89 (2.36–3.54), 0.37 (0.30–0.45), 8.91 (5.96–13.32), and 0.79 (0.75–0.82), respectively. Moreover, 22 study arms involving 5666 tests measured the semiquantitative cough strength score (SCSS) before extubation. The pooled extubation failure was 37.1% and 11.3%, respectively, in patients with weak and strong cough assessed by the SCSS. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.53 (95% CI: 0.41–0.64), 0.83 (0.74–0.89), 2.50 (1.93–3.25), 0.65 (0.56–0.76), 4.61 (3.03–7.01), and 0.74 (0.70–0.78), respectively. Conclusions Weak cough is associated with increased extubation failure. Cough peak flow is superior to the SCSS for predicting extubation failure. However, both show moderate power for predicting extubation failure.

scholarly journals Clinical significance of smell and taste dysfunction and other related factors in COVID-19

2021 ◽  
Author(s):  
Esra Kavaz ◽  
Emel Tahir ◽  
Heval Can Bilek ◽  
Özgür Kemal ◽  
Aydın Deveci ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Related Factors ◽  
Taste Dysfunction

scholarly journals Advances in dietary pattern analysis in nutritional epidemiology

2021 ◽  
Author(s):  
Christina-Alexandra Schulz ◽  
Kolade Oluwagbemigun ◽  
Ute Nöthlings
Keyword(s):  
Synergistic Effects ◽  
Hybrid Approach ◽  
Transformation Method ◽  
Narrative Review ◽  
Nutritional Epidemiology ◽  
Food Groups ◽  
Related Factors ◽  
Exploratory Approach ◽  
Recent Developments ◽  
Dietary Pattern Analysis

Abstract Background and Purpose It used to be a common practice in the field of nutritional epidemiology to analyze separate nutrients, foods, or food groups. However, in reality, nutrients and foods are consumed in combination. The introduction of dietary patterns (DP) and their analysis has revolutionized this field, making it possible to take into account the synergistic effects of foods and to account for the complex interaction among nutrients and foods. Three approaches of DP analysis exist: (1) the hypothesis-based approach (based on prior knowledge regarding the current understanding of dietary components and their health relation), (2) the exploratory approach (solely relying on dietary intake data), and (3) the hybrid approach (a combination of both approaches). During the recent past, complementary approaches for DP analysis have emerged both conceptually and methodologically. Method We have summarized the recent developments that include incorporating the Treelet transformation method as a complementary exploratory approach in a narrative review. Results Uses, peculiarities, strengths, limitations, and scope of recent developments in DP analysis are outlined. Next, the narrative review gives an overview of the literature that takes into account potential relevant dietary-related factors, specifically the metabolome and the gut microbiome in DP analysis. Then the review deals with the aspect of data processing that is needed prior to DP analysis, particularly when dietary data arise from assessment methods other than the long-established food frequency questionnaire. Lastly, potential opportunities for upcoming DP analysis are summarized in the outlook. Conclusion Biological factors like the metabolome and the microbiome are crucial to understand diet-disease relationships. Therefore, the inclusion of these factors in DP analysis might provide deeper insights.

Silent Venous Thrombosis Revealed by Impedance and 125I-Fibrinogen

1975 ◽  
Author(s):  
M. Hume
Keyword(s):  
At Risk ◽  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Clinical Significance ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Clinical Evidence ◽  
Impedance Plethysmography ◽  
Patients At Risk ◽  
Lung Scan

100 post-operative subjects were observed following total hip replacement using 125I-fibrinogen (125I-Fg) and impedance plethysmography (IPG) with thigh cuff. Phlebo-grams were obtained if these tests indicated venous thrombosis. Also, lung scan was obtained if clinical evidence of pulmonary embolism developed. Sustained significant isotope localization occurred in 40. 32 of these had abnormal IPG. Four patients had minor pulmonary embolism, which was associated with abnormality of either 125I-Fg or IPG. All major obstructive venous thrombosis and all moderately extensive thrombosis was associated with abnormal IPG. Only minute thrombi were not correctly classified by IPG. The following conclusions are supported by this experience. 1) If prospectively applied in patients at risk, the combination of both techniques (125I-Fg, IPG) is capable of detecting all silent venous thrombosis even minute thrombi of negligible significance. 2) IPG is capable of detecting all major obstructive and all moderately extensive thrombi, that is, all thrombosis of clinical significance arising in the leg. 3) Minute thrombi will not be detected by IPG alone and small emboli resulting from detachment of such minute thrombi would be unheralded unless monitoring includes 125I-Fg.

Effects of sleep intervention on glucose control: A narrative review of clinical evidence

2021 ◽  
Author(s):  
Ranjit Tiwari ◽  
Dao Ngoc Hien Tam ◽  
Jaffer Shah ◽  
Michiko Moriyama ◽  
Joseph Varney ◽  
...  
Keyword(s):  
Glucose Control ◽  
Clinical Evidence ◽  
Narrative Review

P0786CLINICAL SIGNIFICANCE AND RELATED FACTORS OF GFR SLOPE IN A LARGE MULTICENTER OBSERVATIONAL STUDY IN JAPAN

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yuji Kamijo ◽  
Koji Hashimoto ◽  
Yosuke Yamada ◽  
Makoto Harada ◽  
Masatsugu Aida ◽  
...  
Keyword(s):  
Linear Regression ◽  
Least Squares ◽  
Clinical Significance ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Surrogate Marker ◽  
Hazard Ratio ◽  
Related Factors ◽  
Ckd Stage ◽  
Egfr Decline

Abstract Background and Aims Recently, glomerular filtration rate (GFR) slope has attracted attention as an important surrogate marker for the prognosis of chronic kidney disease (CKD), with a reduction in slope of eGFR decline by 0.75 mL/min/1.73 m2 per year reportedly having clinical significance. As few large clinical studies on Japanese CKD patients exist, this investigation addresses the clinical significance of GFR slope and its related factors. Method To evaluate the clinical impact of GFR slope, we conducted a prognostic investigation of CKD patients in Japan by means of a large, multicenter, retrospective, observational study. Patients with CKD who were seen at among 15 general hospitals between January and March 2014 were surveyed using medical records. The selection criteria were age ≥20 years, estimated GFR (eGFR) <60 mL/min/1.73 m2, and receiving medical treatment for CKD. Baseline patient characteristics, eGFR changes, and hard endpoints (death or end-stage kidney disease requiring renal replacement therapy) during observation were analysed. We calculated GFR slope using GFR data of 2 years following the observation start point by 2 calculation methods, the linear mixed model and least squares linear regression, and examined the relationship of GFR slope with the hazard ratio of the composite hard endpoints. The factors related to GFR slope were also assessed by multiple regression analysis. Results Among a total of 11233 collected patients, we analyzed the data of 7490 CKD G3 and G4 patients whose GFR data during 2 years could be obtained (60% male, mean age: 71 years, CKD G3a: 55%, G3b: 30%, G4: 15%, mean eGFR: 44.1 mL/min/1.73 m2, urine protein positive: 51%, diabetes mellitus: 49%, use of RAS inhibitors: 57%). The mean observation period was 1040 days. Hard endpoints after the GFR slope measurement period occurred in 301 subjects. The GFR slope of the cohort was -0.948 mL/min/1.73 m2 per year (95% confidence interval [CI] -1.016, -0.880) in the linear mixed model and -0.982 mL/min/1.73 m2 per year (95% CI -1.075, -0.889) according to least squares linear regression. Both calculated GFR slopes were significantly related to the hazard ratio of the composite hard endpoints. Hazard ratio decreased by 0.85 (linear mixed model) and 0.9 (least squares linear regression) times in case of a reduction in slope of eGFR decline by 0.75 mL/min/1.73 m2 per year. Multiple regression analysis revealed strongly significant associations for GFR slope with urine protein and CKD stage and undetectable relationships for GFR slope with diabetes and age. Conclusion This study demonstrated the clinical significance of GFR slope as a surrogate marker for renal prognosis in Japanese CKD patients. In order to reduce slope of eGFR decline, active intervention for proteinuria before the progression to an advanced CKD stage appears to be effective.

scholarly journals Predictors of Blood Pressure in Iranian Women- A Narrative Review

2020 ◽  
Author(s):  
Maryam Etaat ◽  
Zohre Tabatabaye ◽  
Samaneh Motamed Jahromi ◽  
Poneh Yosefi ◽  
Sadegh Sedigh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Stress ◽  
Narrative Review ◽  
Iranian Women ◽  
Related Factors ◽  
Factors Affecting ◽  
Waist Size ◽  
Age Related ◽  
Diet And Exercise ◽  
Important Health

Introduction: hypertension is one of the most important health problems in the world and in developing countries, including Iran. The prevalence of hypertension among Iranian women is higher than men. This study aimed to investigate the predictive causes of hypertension among Iranian women. This study was a narrative review that was conducted by searching related studies and resources in databases of Google Scholar, SID, Pubmed, Magiran, Web of Science, and Scopus. Finally, 49 qualified articles were analyzed and the texts were reviewed. Based on the obtained data, the predictors of hypertension among Iranian women included the underlying factors of obesity (diet and exercise), psychosocial factors (stress, occupation and addiction) and age-related factors. Conclusion:  Obesity and increased waist size had a greater role in high blood pressure in Iranian women. After obesity, age and factors affecting them, lack of exercise, high stress, occupational factors, education, and addiction can also influence high blood pressure.As a result, it can be predicted that by identifying the risk factors, hypertension can be reduced among Iranian women; by teaching the causes and methods of preventing hypertension to the Iranian women as well as screening for timely diagnose and treatment, hypertension could be decreased among Iranian women.

scholarly journals Molecular structure, pharmacokinetics and clinical evidence of brolucizumab: a narrative review

2021 ◽  
Vol 0 ◽  
pp. 0-0
Author(s):  
Francesco Pignatelli ◽  
Alfredo Niro ◽  
Fedele Passidomo ◽  
Giuseppe Addabbo
Keyword(s):  
Molecular Structure ◽  
Clinical Evidence ◽  
Narrative Review

scholarly journals Building cohesion in distributed telemedicine teams: Findings from the Department of Veterans Affairs National Telestroke Program

2020 ◽  
Author(s):  
Himalaya Patel ◽  
Teresa M. Damush ◽  
Edward J. Miech ◽  
Nicholas A. Rattray ◽  
Holly A. Martin ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Veterans Affairs ◽  
Team Cohesion ◽  
Case Conference ◽  
Department Of Veterans Affairs ◽  
Related Factors ◽  
Shared Identity ◽  
Assessment And Treatment ◽  
National Infrastructure ◽  
Interview Transcript

Abstract Background: As telemedicine adoption increases, so does the importance of building cohesion among physicians in telemedicine teams. For example, in acute telestroke services, stroke specialists provide rapid remote stroke assessment and treatment to patients at hospitals without stroke specialty care. In the National Telestroke Program (NTSP) of the U.S. Department of Veterans Affairs, a virtual (distributed) hub of stroke specialists throughout the country provides 24/7 consultations nationwide. We examined how these specialists adapted to distributed teamwork, and we identified cohesion-related factors in program development and support. Methods: We studied the virtual hub of stroke specialists employed by the NTSP. Semi-structured, confidential interviews with stroke specialists in the virtual hub were recorded and transcribed. We explored the extent to which these specialists had developed a sense of shared identity and team cohesion, and we identified factors in this development. Using a qualitative approach with constant comparison methods, two researchers coded each interview transcript independently using a shared codebook. We used matrix displays to identify themes, with special attention to team cohesion, communication, trust, and satisfaction. Results: Of 13 specialists with at least 8 months of NTSP practice, 12 completed interviews; 7 had previously practiced in telestroke programs in other healthcare systems. Interviewees reported high levels of trust and team cohesion, sometimes even more with their virtual colleagues than with co-located colleagues. Factors facilitating perceived team cohesion included a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and support from the NTSP leadership. Although lack of in-person contact was associated with lower cohesion, annual in-person NTSP meetings helped mitigate this issue. Despite technical challenges in establishing a new telehealth system within existing national infrastructure, providers reported high levels of satisfaction with the NTSP. Conclusion: A virtual telestroke hub can provide a sense of team cohesion among stroke specialists at a level comparable with a standard co-located practice. Engaging in transparent discussion of challenging cases, reviewing new clinical evidence, and contributing to program improvements may promote cohesion in distributed telemedicine teams.

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