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The Pancreas and the Periampullary Area
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
The preoperative preparation of the patient for the Whipple procedure or total pancreatectomy is of utmost importance. The patient should be carefully evaluated and blood elements should be given to the patient for replacements. Albumin and fresh frozen plasma may be administered if so needed. The patient should be well hydrated and the serum electrolytes should be corrected. The serum creatinine and blood urea nitrogen should be checked to ensure good functioning kidneys. Fat soluble vitamins should be given freely as these patients are usually deficient in this category. In addition, cardiac status should be evaluated and pulmonary hygiene instituted in preparation for a major surgery. Large bowel prep is essential in case the tumor extends and involves a segment of the large bowel or one of its vessels such as the middle colic. The availability of percutaneous cholangiography and drainage either intraduodenally or externally is of great value. It has been shown that patients who have elevated serum bilirubin to 10 mg percent have a 12% mortality rate due to renal failure, sepsis, and hemorrhage. In addition, patients with a serum bilirubin of 20 mg percent have double the morbidity and mortality rates.10 Therefore, percutaneous drainage during preoperative preparation is ideal in the severely jaundiced patient.
Community-Based Pulmonary Rehabilitation of the Patient with Chronic Obstructive Pulmonary Disease
Published in Mary C. Singleton, Eleanor F. Branch, Advances in Cardiac and Pulmonary Rehabilitation, 2018
SUMMARY. In 1984 a community-based pulmonary rehabilitation program was initiated at Duke University Medical Center. A multi-disciplinary group planned the program to meet the rehabilitation needs of the pulmonary patient who was not acutely ill. Musculoskeletal and respiratory evaluative procedures were chosen and a comprehensive exercise and pulmonary hygiene program was designed. An individualized treatment regime is planned for the participant who enrolls in each five week course. With approximately 300 patients having completed the Duke program, the need has surfaced to initiate a “graduate program” to provide an organized maintenance exercise routine for those who have been through the intensive rehabilitation course.
Open thoracic aortic aneurysm repair
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
Arnoud V. Kamman, Bo Yang, Himanshu J. Patel
Major complications can be prevented with adequate postoperative management. Respiratory failure after open repair is most commonly observed. Predictors of this complication include active smoking, COPD (even more in patients with significant reduction of forced expiratory volume in 1 second) and cardiac, renal, or bleeding complications. Pulmonary hygiene is paramount throughout postoperative care. Smoking cessation is essential in all patients; additional bronchodilator therapy for COPD patients can be prescribed to increase the chances of an acceptable outcome.
Association between anticholinergic medication uses and the risk of pneumonia in elderly adults: a meta-analysis and systematic review
Published in Annals of Medicine, 2023
Mindan Wu, Zhixuan Li, Wenchuan Zheng, Jia Zhuang, Shuhan Wu, Qipeng Zhou, Junfu Cai, Houzhen Zheng, Guixing Zeng, Weilin Zhang, Shengbin Zhang, Maohuang Lin, Xianyang Zhong, Qichuan Zhang
Anticholinergic drugs have some adverse effects including central (e.g. cognitive, drowsiness, sedation, delirium, confusion) and peripheral (e.g. dry mouth, constipation) adverse effects. Several potential hypotheses were made to explain the increased risk of pneumonia with anticholinergic medication uses based on adverse effects [20]. Firstly, dryness of mouth could impair oropharyngeal and oesophageal bolus transport which may result in aspiration pneumonia [6,9,21,22]. Second, low levels of thick mucosal secretion could increase the bacterial growth. Depression of mucociliary transport could prolong bacterial stay in the lungs. Both of them may finally lead to respiratory infection [23]. Third, low oesophageal sphincter pressure might lead to acid reflux which could cause aspiration [24]. At last, sedation and altered mental status, one of the anticholinergic drugs central adverse effects, were related with poor pulmonary hygiene, atelectasis and aspiration which might contribute to pneumonia [25]. However, the possible mechanisms still remain speculate with regard to molecular mechanisms.
Community exercise for individuals with spinal cord injury with inspiratory muscle training: A pilot study
Published in The Journal of Spinal Cord Medicine, 2021
Jessica M. Leathem, Martha Macht-Sliwinski, Sarah Boak, Aubrey Courville, Michelle Dearwater, Sneha Gazi, Allison Scott
In addition to regular exercise, IMT can provide additional benefit for individuals with SCI.8,9,15 To decrease risk for respiratory complications, resistive respiratory training (RRT) can be included in an exercise program to potentially decrease secondary health complications.20 RRT has been shown to be effective when included in inpatient rehabilitation for improving respiratory function in patients with SCI,21,22 and other neuromuscular disorders.23–25 This is important, as people with impaired neuromuscular control of respiratory muscles have more difficulty maintaining pulmonary hygiene.26–28 Changes that occur with SCI can impact inspiratory and expiratory neuromuscular control resulting in altered inspiration mechanics,28,29 paradoxical breathing patterns,30,31 and increased reliance on accessory muscles.31,32 Impaired efficiency of respiration increases the risk for respiratory complications13,22,32 supporting the need for continued RRT through the continuum of care. IMT specifically targets inspiratory muscles, providing progressive resistance to the diaphragm, intercostals, and accessory muscles to improve lung volume utilization,33–35 and can improve cardiovascular health, blood pressure regulation,34 and overall respiratory health.36–39
Best practices protocol for the evaluation of bulbar dysfunction: summary recommendations from the NEALS bulbar subcommittee symposium
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2018
Gary L. Pattee, Emily K. Plowman, Benjamin R. Brooks, James D. Berry, Nazem Atassi, Jennifer L. Chapin, Kendrea Garand, Yana Yunusova, Courtney E. Mcilduff, Eufrosina Young, John M. Costello, Eric A. Macklin, Eduardo R. Locatelli, Vincenzo Silani, Daragh Heitzman, James Wymer, Stephen A. Goutman, Deborah F. Gelinas, Richard Smith, Bridget Perry, Paige Nalipinski, Kaila Stipancic, Meghan O'Brien, Stacey L. Sullivan, Jordan Green
The Augmentative communication assessment should focus on communication participation across a variety of functions, proactive introduction of voice and message banking, early consideration of low tech/quick access strategies, and exploring functional use of telephone, texting, keyboarding, internet access, including standard methods of face to face and distance communication. The Swallowing section advocated objective assessment in each of the following upper aerodigestive domains: dietary/oral intake, airway defense physiologic capacity, swallow safety screen, patient-reported swallow-related outcomes, oral sensorimotor exam, and pulmonary function. Specific objective testing and outcome suggestions for each domain were established. Important practice parameters included patient education concerning: dietary modifications, compensatory swallow strategies, oral hygiene, feeding tubes, pulmonary hygiene with airway clearance, and basic life saving techniques. Defining the use and optimal timing of instrumental assessment of swallowing physiology (e.g. videofluoroscopy) remains underway.