RESUMO
Normative trachea dimensions and aerodynamic information during development was collected to establish clinical benchmarks and showed that airway development seems to outpace respiratory demands. Infants and toddlers' trachea exhibit higher aerodynamic stress that significantly decreases by teenage years. This implies large airway pathology in younger children may have a more substantial clinical impact.
Assuntos
Resistência das Vias Respiratórias/fisiologia , Simulação por Computador , Hidrodinâmica , Estresse Fisiológico/fisiologia , Traqueia/crescimento & desenvolvimento , Traqueia/fisiopatologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , MasculinoRESUMO
OBJECTIVES/HYPOTHESIS: About 260,000 septoplasties are performed annually in the US to address nasal septal deviation (NSD). Yet, we do not consistently understand what aspects of NSD result in symptoms. STUDY DESIGN: Blinded cohort study. METHODS: Two fellowship-trained surgeons blindly reviewed computerized tomography (CTs) of 10 confirmed NSD patients mixed with 36 healthy controls. All patients were correctly identified, however, 24/36 controls were falsely identified by both surgeons as patients (33.3% specificity), which were grouped as asymptomatic NSD (aNSD), while the remaining controls as non-NSD (healthy). Acoustic rhinometry, rhinomanometry, individual CT-based computational fluid dynamics and nasal sensory testing were applied to address the puzzling questions of why these aNSD had no symptoms and, more fundamentally, what caused symptoms in sNSD patients. RESULTS: aNSD reported no nasal symptoms - Nasal Obstruction Symptom Evaluation score (sNSD: 60.50 ± 13.00; aNSD: 5.20 ± 5.41; non-NSD: 6.66 ± 7.17, P < .05); 22-item Sino-Nasal Outcome Test score (sNSD: 32.60 ± 14.13; aNSD: 10.04 ± 10.10; non-NSD: 9.08 ± 12.42, P < .001). No significant differences in measured nasal resistance, minimum cross-sectional area (MCA), degree of septal deviation, and nasal airflow distributions were found between sNSD and aNSD groups. Only three variables differentiate sNSD versus aNSD: anterior averaged heat flux on deviated side, inferior turbinate peak heat flux on non-deviated side, and nasal cool sensitivity measured by menthol lateralization threshold, with no significant differences among these variables found between the two healthy groups (aNSD vs. non-NSD). These variables by themselves or combined can differentiate sNSD from controls with higher specificity than the physicians (ROC area under the curve = 0.84 with 70% sensitivity and 91.6% specificity). CONCLUSIONS: This study sheds light on the potential mechanisms of NSD symptomatology: distorted nasal cooling due to NSD exacerbated by poorer nasal mucosal sensitivity. It further supports our previous hypothesis that nasal obstruction complaints do not result directly from obstruction, rather from the capacity of our nose to subjectively sense airflow cooling. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:509-517, 2022.
Assuntos
Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/complicações , Estudos de Casos e Controles , Humanos , Septo Nasal/diagnóstico por imagem , Septo Nasal/fisiopatologia , Deformidades Adquiridas Nasais/patologia , Deformidades Adquiridas Nasais/fisiopatologia , Transtornos do Olfato/etiologia , Rinomanometria , Rinometria Acústica , Tomografia Computadorizada por Raios XRESUMO
During March 2006, a series of statewide conferences was held to discuss home care outcomes, with a special emphasis on strategies for retaining home care nurses. Administrators and owners of home care agencies in one state with high staff retention and a low rate of turnover participated in four panel discussions to share best practices. The discussions were sponsored by TMF Health Quality Institute, the Quality Improvement Organization (QIO). In addition to practitioner panels, a review of the home care research literature on recruitment and retention was presented. This article is derived from the combined evidence shared during those meetings. The three most common strategies for retaining nursing staff were the use of case management or primary nursing, management participation in direct patient care, and open lines of communication.
Assuntos
Enfermagem em Saúde Comunitária , Serviços de Assistência Domiciliar , Recursos Humanos de Enfermagem/provisão & distribuição , Seleção de Pessoal/organização & administração , Adulto , Fatores Etários , Atitude do Pessoal de Saúde , Escolha da Profissão , Administração de Caso , Comunicação , Tomada de Decisões Gerenciais , Humanos , Satisfação no Emprego , Pessoa de Meia-Idade , Avaliação das Necessidades , Pesquisa em Administração de Enfermagem , Recursos Humanos de Enfermagem/educação , Recursos Humanos de Enfermagem/psicologia , Avaliação de Resultados em Cuidados de Saúde , Lealdade ao Trabalho , Admissão e Escalonamento de Pessoal , Reorganização de Recursos Humanos/economia , Enfermagem Primária , Texas , Gestão da Qualidade Total , Recursos HumanosRESUMO
A Texas hospital achieves improvement in its readmission rate by implementing Project RED.
Assuntos
Alta do Paciente , Readmissão do Paciente/economia , Centers for Medicare and Medicaid Services, U.S. , Comportamento Cooperativo , Humanos , Readmissão do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Texas , Estados UnidosRESUMO
Approximately 1 in 5 Medicare patients are rehospitalized within 30 days of discharge. The Harlingen Hospital Referral Region, an area defined by the Dartmouth Atlas as 35 ZIP codes in South Texas, reduced 30-day hospital readmission rates and associated costs through its participation in the Centers for Medicare & Medicaid Services Care Transitions project. The project emphasized a community-wide focus on 4 quality improvement areas: (a) the problem of rehospitalization, (b) improving cross-setting collaboration, (c) access to performance data, and (d) implementation of best practice interventions to reduce avoidable hospitalizations.