Comment prévenir les chutes chez les personnes âgées vivant à domicile: revue Cochrane pour le praticien. [How to prevent falls among elderly living at home]

Free fulltex: http://www.res_franco.cochrane.org/Files/ResumesRMS2009/Chutespersagees.pdf

Influence of compliance to respiratory weaning consensus conference criteria on respiratory outcome within 48h after planned extubation

INTRODUCTION. A two-step assessment (readiness to wean (RW) followed by spontaneousbreathing trial (SBT)) of predefined criteria is recommended before planned extubation(PE)1.OBJECTIVES. We aimed to evaluate if compliance to all guideline criteria was associatedwith better respiratory outcome within 48 h after PE.METHODS. The data (extracted from our clinical information system) of 458 consecutivepatients who underwent PE after C48 h of invasive ventilation in our medico-surgical ICUwere analyzed. We evaluated compliance with guidelines [1] regarding respiratory rate, tidalvolume, PaO2, FiO2, PEEP, PaCO2, pH, heart rate, systolic arterial pressure and arrhythmiaduringRWand SBT assessment (RW and SBT within 2 h). A patient was classified as RW+ ifallRWcriteria were fulfilled andRW-if at least 1 criterion was violated. The same approachwas used to define SBT+ and SBT- patients. During the 48 h following PE, we assessed theoccurrence of post-PE respiratory failure (PRF) (defined as the presence of at least 1 consensuscriterion of respiratory failure [1]), reintubation (after NIV failure or because of immediateintubation criteria) and cumulative duration of post-PE ventilation (PPEV = Post-PE invasive+ non-invasive ventilation). ICU mortality was recorded. Comparisons for variousoutcomes were performed by Chi-square and t tests.RESULTS. All consensus criteria were fulfilled in 77.3% of the patients during RW and in68.1% of the patients during SBT.[Compliance to weaning criteria and outcome]N = 458 PRF (%) Reintubation (%) PPEV (min) ICU mortality (%)All patients 53.5 10.0 542 ± 664 6.1RW+ 50.0 9.3 490 ± 626 5.4RW- 65.4* 12.5 718 ± 757** 8.7SBT+ 52.6 8.0 498 ± 594 6.7SBT- 55.5 14.4*** 637 ± 788**** 4.8Occurrence of PRF only was not associated with increased ICU mortality: 4.2 versus 7.8%,p = 0.11. By contrast, ICU mortality was significantly increased in patients requiring reintubation:21.7 versus 4.4%. p\0.001; * p = 0.006 RW+ versus RW-; ** p = 0.003RW+ versus RW-; *** p = 0.035 SBT+ versus SBT-; **** p = 0.030 SBT+ versusSBTCONCLUSIONS.In our ICU, compliance to all criteria of the two-step published approach ofrespiratory weaning was not optimal but reintubation rate was comparable to published data.Compliance with consensus conference guidelines was associated with lower reintubation rateand shorter PPEV but not with ICU mortality. As mortality was increased by reintubation,more sensitive and specific criteria to predict the risk of reintubation are probably needed.REFERENCE. Boles JM, et al. Eur Respir J 2007;29:1033-56.

Công bằng Nha cửa và Bạn,

(In Vietnamese)Familial status, or presence of children in the home, protects families with children under 18 years of age. Also protected are families seeking custody of a child or expecting the birth of a child. There is only a narrow exception to this part of the law: units designated as “housing for older persons.” Property owners are required by the law to allow reasonable modifications to a property (at the tenant’s expense) and to make reasonable accommodations in policies in order to accommodate the needs of persons with disabilities.

Fair Housing and You

Familial status, or presence of children in the home, protects families with children under 18 years of age. Also protected are families seeking custody of a child or expecting the birth of a child. There is only a narrow exception to this part of the law: units designated as “housing for older persons.” Property owners are required by the law to allow reasonable modifications to a property (at the tenant’s expense) and to make reasonable accommodations in policies in order to accommodate the needs of persons with disabilities.

Report on the Iowa Veterans Home and the Iowa Department of Veterans Affairs for the year ended June 30, 2011

Report on the Iowa Veterans Home and the Iowa Department of Veterans Affairs for the year ended June 30, 2011

Factors associated with infant low birth weight among Medicaid reimbursed births in Iowa, 2010

The purpose of the fact sheet is to highlight the characteristics of Iowa women who gave birth to low birth weight infants during 2010 and to guide decision makers in implementing programs that improve the health outcomes of the mothers and infants who rely on Medicaid coverage.

2010 Iowa Medicaid – Birth Certificate – Barriers to Prenatal Care Project Match Report Summary of Findings for Medicaid Reimbursed Births

The purpose of the fact sheet is to summarize the Iowa Barriers to Prenatal Care Project’s survey results for women with Medicaid reimbursed births during 2010. This information will be used to guide decision makers in implementing programs that improve the health outcomes of the women and infants who rely on Medicaid coverage.

Birth Certificate Match Report Comparison of Maternal Demographic Characteristics Medicaid vs. Non-Medicaid Reimbursed Births – 2010 Iowa Medicaid

The purpose of the fact sheet is to highlight the characteristics of Iowa women who gave birth in Iowa during calendar year 2010, with a focus on women with labor and delivery costs reimbursed by Medicaid compared to women with labor and delivery costs not reimbursed by Medicaid. This information will be used to guide decision makers in implementing programs that improve the health outcomes of the women and infants who rely on Medicaid coverage.

Report on the Iowa Veterans Home and the Iowa Department of Veterans Affairs for the year ended June 30, 2012

Report on the Iowa Veterans Home and the Iowa Department of Veterans Affairs for the year ended June 30, 2012

European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring

This document summarizes the available evidence and provides recommendations on the use of home blood pressure monitoring in clinical practice and in research. It updates the previous recommendations on the same topic issued in year 2000. The main topics addressed include the methodology of home blood pressure monitoring, its diagnostic and therapeutic thresholds, its clinical applications in hypertension, with specific reference to special populations, and its applications in research. The final section deals with the problems related to the implementation of these recommendations in clinical practice.