Correction: A quality improvement initiative for COPD patients: A cost analysis.

[This corrects the article DOI: 10.1371/journal.pone.

A quality improvement initiative for COPD patients: A cost analysis.

The objective of this analysis was to evaluate and report on the economic impact of implementing an integrated, quality, and operational improvement program on chronic obstructive pulmonary disease (COPD) care from acute through post-acute care settings. This initiative was established in a cohort of 12 hospitals in Alabama and sought to address COPD readmission through improved workflows pertaining to early diagnosis, efficient care transitions, and patient visibility across the entire care episode. Implementation of the initiative was influenced by lean principles, particularly cross-functional agreement of workflows to improve COPD care delivery and outcomes.

Cost Savings from Reduced Hospitalizations with Use of Home Noninvasive Ventilation for COPD.

Background: Although evidence suggests significant clinical benefits of home noninvasive ventilation (NIV) for management of severe chronic obstructive pulmonary disease (COPD), economic analyses supporting the use of this technology are lacking.

Objectives: To evaluate the economic impact of adopting home NIV, as part of a multifaceted intervention program, for severe COPD.

Methods: An economic model was developed to calculate savings associated with the use of Advanced NIV (averaged volume assured pressure support with autoexpiratory positive airway pressure; Trilogy100, Philips Respironics, Inc.

An electrocardiogram-based analysis evaluating sleep quality in patients with obstructive sleep apnea.

Objective: The study compares polysomnography (PSG) and cardiopulmonary coupling (CPC) sleep quality variables in patients with (1) obstructive sleep apnea (OSA) and (2) successful and unsuccessful continuous positive airway pressure (CPAP) response.

Patients/methods: PSGs from 50 subjects (32 F/18 M; mean age 48.4 ± 12.

Effects of the melatonin MT-1/MT-2 agonist ramelteon on daytime body temperature and sleep.

Study Objectives: A reduction in core temperature and an increase in the distal-proximal skin gradient (DPG) are reported to be associated with shorter sleep onset latencies (SOL) and better sleep quality. Ramelteon is a melatonin MT-1/MT-2 agonist approved for the treatment of insomnia. At night, ramelteon has been reported to shorten SOL.

Medical disorders and their effects on sleep.

Disturbances of sleep can be encountered in many medical disorders. Conversely, sleep impairment can adversely affect the symptoms of a variety of medical conditions, including respiratory, cardiac, gastrointestinal, renal, rheumatologic, and infectious disorders. More than one sleep pathology may be present in a particular patient, and these disorders may interact to increase the severity or prolong the duration of sleep disturbance.

Monitoring respiration during sleep.

Monitoring of respiration during sleep allows the assessment of physiologic variables that are required to characterize SRBD events. The patency of the upper airway, the pattern of breathing, oxygenation, and ventilation usually can be inferred from simultaneous measurements of airflow, respiratory effort, thoracic volume, and blood gases. As new techniques of respiratory monitoring emerge, the respiratory therapist and sleep technologist must be familiar with the advantages and shortcomings of each modality.

Pulmonary hypertension and cor pulmonale in COPD.

Pulmonary artery hypertension (PAH) is the primary cardiovascular complication encountered in chronic obstructive pulmonary disease (COPD). Cor pulmonale can range clinically from mild changes in right ventricular function to frank right heart failure. The prevalence of PAH increases as COPD worsens, and the development of PAH and cor pulmonale appears to affect survival of patients with COPD.

Medical treatment of obstructive sleep apnea.

A variety of treatment options are available for the treatment of obstructive sleep apnea in addition to positive pressure therapy and surgery. These modes of treatment might be employed in patients who cannot tolerate positive pressure therapy despite aggressive measures to improve compliance. These options include weight reduction, sleep hygiene, positional therapy, and oxygen therapy.

Parasomnias and other sleep-related movement disorders.

Parasomnias are common clinical complaints. Formal sleep evaluation including PSG is indicated for parasomnias that are violent and potentially injurious; disruptive to the bed partner or other household members; accompanied by excessive daytime sleepiness; or associated with medical,psychiatric, or neurologic symptoms or findings [2]. Multiple sleep latency testing should be considered for patients who have complaints of excessive daytime sleepiness.

Monitoring respiration during sleep.

The sleep-related breathing disorders have been categorized in various ways. The most basic schema divides them into obstructive or central apneic events. An American Academy of Sleep Medicine (AASM) Task Force Report published in 1999 defined four separate syndromes associated with abnormal respiratory events during sleep among adults, namely, obstructive sleep apnea-hypopnea syndrome (OSAHS), central sleep apnea-hypopnea syndrome, Cheyne-Stokes breathing syndrome, and sleep hypoventilation syndrome.

Heatstroke and other heat-related illnesses.

Preview Victims of high heat and humidity may be young and healthy or old and debilitated. In either case, severe heatstroke may present a life-threatening situation if treatment is delayed. In this article, the authors examine the various therapeutic options, including physical cooling methods and supportive measures.