Partial cricotracheal resection for pediatric subglottic stenosis: long-term outcome in 57 patients.

OBJECTIVE: We sought to assess the long-term outcome of 57 pediatric patients who underwent partial cricotracheal resection for subglottic stenosis. METHODS: Eighty-one pediatric partial cricotracheal resections were performed in our tertiary care institution between 1978 and 2004. Fifty-seven patients had a minimal follow-up time of 1 year and were included in this study. Evaluation was based on the last laryngotracheal endoscopy, the responses to a questionnaire, and a retrospective review of the patient's data. The following parameters were analyzed: decannulation rates, breathing, voice quality, and deglutition. RESULTS: A single-stage partial cricotracheal resection was performed in 38 patients, and a double-stage procedure was performed in 19 patients. Sixteen patients underwent an extended partial cricotracheal resection (ie, partial cricotracheal resection combined with another open procedure). At a median follow-up time of 5.1 years, the decannulation rates after a single- or double-stage procedure were 97.4% and 95%, respectively. Two patients remained tracheotomy dependent. One patient had moderate exertional dyspnea, and all other patients had no exertional dyspnea. Voice quality was found to improve after surgical intervention for 1 +/- 1.34 grade dysphonia (P < .0001) according to the adapted GRBAS grading system (Grade, Roughness, Breathiness, Asthenia, and Strain). CONCLUSIONS: Partial cricotracheal resection provides good results for grades III and IV subglottic stenosis as primary or salvage operations. The procedure has no deleterious effects on laryngeal growth and function. The quality of voice significantly improves after surgical intervention but largely depends on the preoperative condition.

Optimisation de la cryo microscopie électronique pour les études des minicercles d'ADN

RESUME : Bien que les propriétés physiques de la structure de l'ADN aient été intensivement étudiées pendant plus de 50 ans il y a encore beaucoup de questions importantes qui attendent des réponses. Par exemple, qu'arrive-t-il à la structure de la double hélice d'ADN nue (sans protéines liées) lorsqu'elle est fortement courbée, de la même manière que dans les nucléosomes? Cet ADN nu est-il facilement plié (il reste dans le régime élastique) ou réduit-il la contrainte de flexion en formant des sites hyperflexibles «kinks» (il sort du régime élastique en cassant l'empilement des paires de bases à certains endroits) ? La microscopie électronique peut fournir une réponse à cette question par visualisation directe des minicercles d'ADN de la longueur d'un tour de nucléosome (environ 90 paires de bases). Pour que la réponse soit scientifiquement valide, on doit observer les molécules d'ADN lorsqu'elles sont en suspension dans la solution d'intérêt et sans que des colorations, produits chimiques ou fixatifs n'aient été ajoutés, étant donné que ceux-ci peuvent changer les propriétés de l'ADN. La technique de la cryo-microscopie électronique (cryo-EM) développée par le groupe de Jacques Dubochet au début des années 80, permet la visualisation directe des molécules d'ADN suspendues dans des couche minces vitrifiées de solutions aqueuses. Toutefois, le faible contraste qui caractérise la cryo-EM combinée avec la très petite taille des minicercles d'ADN rendent nécessaire l'optimisation de plusieurs étapes, aussi bien dans la préparation des échantillons que dans le processus d'acquisition d'images afin d'obtenir deux clichés stéréo qui permettent la reconstruction 3-D des minicercles d'ADN. Dans la première partie de ma thèse, je décris l'optimisation de certains paramètres pour la cryoEM et des processus d'acquisition d'image utilisant comme objets de test des plasmides et d'autres molécules d'ADN. Dans la deuxième partie, je .décris comment j'ai construit les minicercles d'ADN de 94 bp et comment j'ai introduit des modifications structurelles comme des coupures ou des lacunes. Dans la troisième partie, je décris l'analyse des reconstructions des rninicercles d'ADN. Cette analyse, appuyée par des tests biochimiques, indique fortement que des molécules d'ADN sont capables de former de petites molécules circulaires de 94 bp sans dépasser les limites d'élasticité, indiquant que les minicercles adoptent une forme circulaire régulière où la flexion est redistribuée le long la molécule. ABSTRACT : Although physical properties of DNA structure have been intensively studied for over 50 years there are still many important questions that need to be answered. For example, what happens to protein-free double-stranded DNA when it is strongly bent, as in DNA forming nucleosomes? Is such protein-free DNA smoothly bent (i.e. it remains within elastic limits of DNA rigidity) or does it release its bending stress by forming sharp kinks (i.e. it exits the elastic regime and breaks the stacking between neighbouring base-pairs in localized regions)? Electron microscopy can provide an answer to this question by directly visualizing DNA minicircles that have the size of nucleosome gyres (ca 90 bp). For the answer to be scientifically valid, one needs to observe DNA molecules while they are still suspended in the solution of interest and no staining chemicals or fixatives have been added since these can change the properties of the DNA. CryoEM techniques developed by Jacques Dubochet's group beginning in the 1980's permit direct visualization of DNA molecules suspended in cryo-vitrified layers of aqueous solutions. However, a relatively weak contrast of cryo-EM preparations combined with the very small size of the DNA minicircles made it necessary to optimize many of the steps and parameters of the cryo-EM specimen preparation and image acquisition processes in order to obtain stereo-pairs of images that permit the 3-D reconstruction of the observed DNA minicircles. In the first part of my thesis I describe the optimization of the cryo-EM preparation and the image acquisition processes using plasmid size DNA molecules as a test object. In the second part, I describe how I formed the 94 by DNA minicircles and how I introduced structural modifications like nicks or gaps. In the third part, I describe the cryo-EM analysis of the constructed DNA minicircles. That analysis, supported by biochemical tests, strongly indicates that DNA minicircles as small as 94 by remain within the elastic limits of DNA structure, i.e. the minicircles adopt a regular circular shape where bending is redistributed along the molecules.

Basal insulin and cardiovascular and other outcomes in dysglycemia.

BACKGROUND: The provision of sufficient basal insulin to normalize fasting plasma glucose levels may reduce cardiovascular events, but such a possibility has not been formally tested. METHODS: We randomly assigned 12,537 people (mean age, 63.5 years) with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes to receive insulin glargine (with a target fasting blood glucose level of ≤95 mg per deciliter [5.3 mmol per liter]) or standard care and to receive n-3 fatty acids or placebo with the use of a 2-by-2 factorial design. The results of the comparison between insulin glargine and standard care are reported here. The coprimary outcomes were nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes and these events plus revascularization or hospitalization for heart failure. Microvascular outcomes, incident diabetes, hypoglycemia, weight, and cancers were also compared between groups. RESULTS: The median follow-up was 6.2 years (interquartile range, 5.8 to 6.7). Rates of incident cardiovascular outcomes were similar in the insulin-glargine and standard-care groups: 2.94 and 2.85 per 100 person-years, respectively, for the first coprimary outcome (hazard ratio, 1.02; 95% confidence interval [CI], 0.94 to 1.11; P=0.63) and 5.52 and 5.28 per 100 person-years, respectively, for the second coprimary outcome (hazard ratio, 1.04; 95% CI, 0.97 to 1.11; P=0.27). New diabetes was diagnosed approximately 3 months after therapy was stopped among 30% versus 35% of 1456 participants without baseline diabetes (odds ratio, 0.80; 95% CI, 0.64 to 1.00; P=0.05). Rates of severe hypoglycemia were 1.00 versus 0.31 per 100 person-years. Median weight increased by 1.6 kg in the insulin-glargine group and fell by 0.5 kg in the standard-care group. There was no significant difference in cancers (hazard ratio, 1.00; 95% CI, 0.88 to 1.13; P=0.97). CONCLUSIONS: When used to target normal fasting plasma glucose levels for more than 6 years, insulin glargine had a neutral effect on cardiovascular outcomes and cancers. Although it reduced new-onset diabetes, insulin glargine also increased hypoglycemia and modestly increased weight. (Funded by Sanofi; ORIGIN ClinicalTrials.gov number, NCT00069784.).

Interpretation of partial fingermarks using an automated fingerprint identification system

Abstract : In the subject of fingerprints, the rise of computers tools made it possible to create powerful automated search algorithms. These algorithms allow, inter alia, to compare a fingermark to a fingerprint database and therefore to establish a link between the mark and a known source. With the growth of the capacities of these systems and of data storage, as well as increasing collaboration between police services on the international level, the size of these databases increases. The current challenge for the field of fingerprint identification consists of the growth of these databases, which makes it possible to find impressions that are very similar but coming from distinct fingers. However and simultaneously, this data and these systems allow a description of the variability between different impressions from a same finger and between impressions from different fingers. This statistical description of the withinand between-finger variabilities computed on the basis of minutiae and their relative positions can then be utilized in a statistical approach to interpretation. The computation of a likelihood ratio, employing simultaneously the comparison between the mark and the print of the case, the within-variability of the suspects' finger and the between-variability of the mark with respect to a database, can then be based on representative data. Thus, these data allow an evaluation which may be more detailed than that obtained by the application of rules established long before the advent of these large databases or by the specialists experience. The goal of the present thesis is to evaluate likelihood ratios, computed based on the scores of an automated fingerprint identification system when the source of the tested and compared marks is known. These ratios must support the hypothesis which it is known to be true. Moreover, they should support this hypothesis more and more strongly with the addition of information in the form of additional minutiae. For the modeling of within- and between-variability, the necessary data were defined, and acquired for one finger of a first donor, and two fingers of a second donor. The database used for between-variability includes approximately 600000 inked prints. The minimal number of observations necessary for a robust estimation was determined for the two distributions used. Factors which influence these distributions were also analyzed: the number of minutiae included in the configuration and the configuration as such for both distributions, as well as the finger number and the general pattern for between-variability, and the orientation of the minutiae for within-variability. In the present study, the only factor for which no influence has been shown is the orientation of minutiae The results show that the likelihood ratios resulting from the use of the scores of an AFIS can be used for evaluation. Relatively low rates of likelihood ratios supporting the hypothesis known to be false have been obtained. The maximum rate of likelihood ratios supporting the hypothesis that the two impressions were left by the same finger when the impressions came from different fingers obtained is of 5.2 %, for a configuration of 6 minutiae. When a 7th then an 8th minutia are added, this rate lowers to 3.2 %, then to 0.8 %. In parallel, for these same configurations, the likelihood ratios obtained are on average of the order of 100,1000, and 10000 for 6,7 and 8 minutiae when the two impressions come from the same finger. These likelihood ratios can therefore be an important aid for decision making. Both positive evolutions linked to the addition of minutiae (a drop in the rates of likelihood ratios which can lead to an erroneous decision and an increase in the value of the likelihood ratio) were observed in a systematic way within the framework of the study. Approximations based on 3 scores for within-variability and on 10 scores for between-variability were found, and showed satisfactory results. Résumé : Dans le domaine des empreintes digitales, l'essor des outils informatisés a permis de créer de puissants algorithmes de recherche automatique. Ces algorithmes permettent, entre autres, de comparer une trace à une banque de données d'empreintes digitales de source connue. Ainsi, le lien entre la trace et l'une de ces sources peut être établi. Avec la croissance des capacités de ces systèmes, des potentiels de stockage de données, ainsi qu'avec une collaboration accrue au niveau international entre les services de police, la taille des banques de données augmente. Le défi actuel pour le domaine de l'identification par empreintes digitales consiste en la croissance de ces banques de données, qui peut permettre de trouver des impressions très similaires mais provenant de doigts distincts. Toutefois et simultanément, ces données et ces systèmes permettent une description des variabilités entre différentes appositions d'un même doigt, et entre les appositions de différents doigts, basées sur des larges quantités de données. Cette description statistique de l'intra- et de l'intervariabilité calculée à partir des minuties et de leurs positions relatives va s'insérer dans une approche d'interprétation probabiliste. Le calcul d'un rapport de vraisemblance, qui fait intervenir simultanément la comparaison entre la trace et l'empreinte du cas, ainsi que l'intravariabilité du doigt du suspect et l'intervariabilité de la trace par rapport à une banque de données, peut alors se baser sur des jeux de données représentatifs. Ainsi, ces données permettent d'aboutir à une évaluation beaucoup plus fine que celle obtenue par l'application de règles établies bien avant l'avènement de ces grandes banques ou par la seule expérience du spécialiste. L'objectif de la présente thèse est d'évaluer des rapports de vraisemblance calcul és à partir des scores d'un système automatique lorsqu'on connaît la source des traces testées et comparées. Ces rapports doivent soutenir l'hypothèse dont il est connu qu'elle est vraie. De plus, ils devraient soutenir de plus en plus fortement cette hypothèse avec l'ajout d'information sous la forme de minuties additionnelles. Pour la modélisation de l'intra- et l'intervariabilité, les données nécessaires ont été définies, et acquises pour un doigt d'un premier donneur, et deux doigts d'un second donneur. La banque de données utilisée pour l'intervariabilité inclut environ 600000 empreintes encrées. Le nombre minimal d'observations nécessaire pour une estimation robuste a été déterminé pour les deux distributions utilisées. Des facteurs qui influencent ces distributions ont, par la suite, été analysés: le nombre de minuties inclus dans la configuration et la configuration en tant que telle pour les deux distributions, ainsi que le numéro du doigt et le dessin général pour l'intervariabilité, et la orientation des minuties pour l'intravariabilité. Parmi tous ces facteurs, l'orientation des minuties est le seul dont une influence n'a pas été démontrée dans la présente étude. Les résultats montrent que les rapports de vraisemblance issus de l'utilisation des scores de l'AFIS peuvent être utilisés à des fins évaluatifs. Des taux de rapports de vraisemblance relativement bas soutiennent l'hypothèse que l'on sait fausse. Le taux maximal de rapports de vraisemblance soutenant l'hypothèse que les deux impressions aient été laissées par le même doigt alors qu'en réalité les impressions viennent de doigts différents obtenu est de 5.2%, pour une configuration de 6 minuties. Lorsqu'une 7ème puis une 8ème minutie sont ajoutées, ce taux baisse d'abord à 3.2%, puis à 0.8%. Parallèlement, pour ces mêmes configurations, les rapports de vraisemblance sont en moyenne de l'ordre de 100, 1000, et 10000 pour 6, 7 et 8 minuties lorsque les deux impressions proviennent du même doigt. Ces rapports de vraisemblance peuvent donc apporter un soutien important à la prise de décision. Les deux évolutions positives liées à l'ajout de minuties (baisse des taux qui peuvent amener à une décision erronée et augmentation de la valeur du rapport de vraisemblance) ont été observées de façon systématique dans le cadre de l'étude. Des approximations basées sur 3 scores pour l'intravariabilité et sur 10 scores pour l'intervariabilité ont été trouvées, et ont montré des résultats satisfaisants.

High bi-atrial organization in patients with long-standing persistent atrial fibrillation terminated within the left atrium

Sustained atrial fibrillation (AF) is maintained by sites displaying high dominant frequency (DF). In patients (pts) with long-standing persistent AF (LS-pAF), their spatial distribution and the presence of a left-to-right atrial DF gradient remain poorly known. We hypothesized that the pre-ablation bi-atrial frequency characteristics of LS-pAF pts terminated within the left atrium (LT) are different from that of non terminated (NT) ones. Methods: 23 consecutive pts (59±7y, LS-pAF duration 19±12m) underwent stepwise catheter ablation (step-CA) consisting in pulmonary veins isolation, left atrial (LA) defragmentation, and right atrial (RA) ablations for non terminated AF. A quadripolar catheter (CAT) was placed into the RA appendage (RAA), a decapolar CAT into the coronary sinus (CS) and a duodecapolar CAT into the LA divided into 8 segments. For each segment, 20-sec of bipolar recording was acquired. The DF was defined as the largest peak in the power spectrum (3-15 Hz). The inter-atrial DF gradient was defined as the DF difference between LA and RA appendages. Results: LS-pAF was terminated in 83% (19/23) of the pts: 17 LT, 2 during RA ablation and 4 NT. The figure shows that before ablation bi-atrial DF values of LT pts are significantly lower than that of NT pts for each LA segment as well as for the RAA (p < 0.05). No significant LA-to-RA DF gradient was observed both for LT (0.3±0.5 Hz, p=ns) and NT (0.5±0.03 Hz, p=ns) pts. No significant difference in DF values was observed between LA segments. Conclusions: The lower DF of LT pts is suggestive of a higher organization within both atria compared to NT pts. Our findings suggest that low bi-atrial DF values, but not inter-atrial DF gradient, might be of interest for selecting LS-pAF candidates for sinus rhythm restoration by step-CA.

Long-term health-related quality of life and walking capacity of lung recipients with and without bronchiolitis obliterans syndrome.

BACKGROUND: Outcome after lung transplantation (LTx) is affected by the onset of bronchiolitis obliterans syndrome (BOS) and lung function decline. Reduced health-related quality of life (HRQL) and physical mobility have been shown in patients developing BOS, but the impact on the capacity to walk is unknown. We aimed to compare the long-term HRQL and 6-minute walk test (6MWT) between lung recipients affected or not by BOS Grade > or =2. METHODS: Fifty-eight patients were prospectively followed for 5.6 +/- 2.9 years after LTx. Assessments included the St George's Respiratory Questionnaire (SGRQ) and the 6MWT, which were performed yearly. Moreover, clinical complications were recorded to estimate the proportion of the follow-up time lived without clinical intercurrences after transplant. Analyses were performed using adjusted linear regression and repeated-measures analysis of variance. RESULTS: BOS was a significant predictor of lower SGRQ scores (p < 0.01) and reduced time free of clinical complications (p = 0.001), but not of 6MWT distance (p = 0.12). At 7 years post-transplant, results were: 69.0 +/- 21.8% vs 86.9 +/- 5.6%, p < 0.05 (SGRQ); 58.5 +/- 21.6% vs 88.7 +/- 11.4%, p < 0.01 (proportion of time lived without clinical complications); and 82.2 +/- 10.9% vs 91.9 +/- 14.2%, p = 0.27 (percent of predicted 6MWT), respectively, for patients with BOS and without BOS. CONCLUSIONS: Despite significantly less time lived without clinical complications and progressive decline of self-reported health status, the capacity to walk of patients affected by BOS remained relatively stable over time. These findings may indicate that the development of moderate to severe BOS does not prevent lung recipients from walking independently and pursuing an autonomous life.

Long-Stay Activity Report 2001

This report presents data collected through a survey of long-stay units in 2001. The aim of the survey is to provide statistics on the number of beds available for long-term care, how the beds are used and the types of patients who occupy these beds. In order to present the data this report has been divided into a number of sections. This introductory section examines how data was collected and analysed and gives a summary of the results. Download document here

Long-Stay Activity Report 2002

Long-Stay Activity Report 2002 This report presents data collected through a survey of long-stay units in 2002. The aim of the survey is to provide statistics on the number of beds available for long-term care, how the beds are used and the types of patients who occupy these beds. Click here to download PDF 420kb

Long-Stay Activity Report 2002

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Dynamics of the recruitment of lateral amygdala neurons following successive fear learning to different conditional stimuli

In fear conditioning, an animal learns to associate an unconditioned stimulus (US), such as a shock, and a conditioned stimulus (CS), such as a tone, so that the presentation of the CS alone can trigger conditioned responses. Recent research on the lateral amygdala has shown that following cued fear conditioning, only a subset of higher-excitable neurons are recruited in the memory trace. Their selective deletion after fear conditioning results in a selective erasure of the fearful memory. I hypothesize that the recruitment of highly excitable neurons depends on responsiveness to stimuli, intrinsic excitability and local connectivity. In addition, I hypothesize that neurons recruited for an initial memory also participate in subsequent memories, and that changes in neuronal excitability affect secondary fear learning. To address these hypotheses, I will show that A) a rat can learn to associate two successive short-term fearful memories; B) neuronal populations in the LA are competitively recruited in the memory traces depending on individual neuronal advantages, as well as advantages granted by the local network. By performing two successive cued fear conditioning experiments, I found that rats were able to learn and extinguish the two successive short-term memories, when tested 1 hour after learning for each memory. These rats were equipped with a system of stable extracellular recordings that I developed, which allowed to monitor neuronal activity during fear learning. 233 individual putative pyramidal neurons could modulate their firing rate in response to the conditioned tone (conditioned neurons) and/or non- conditioned tones (generalizing neurons). Out of these recorded putative pyramidal neurons 86 (37%) neurons were conditioned to one or both tones. More precisely, one population of neurons encoded for a shared memory while another group of neurons likely encoded the memories' new features. Notably, in spite of a successful behavioral extinction, the firing rate of those conditioned neurons in response to the conditioned tone remained unchanged throughout memory testing. Furthermore, by analyzing the pre-conditioning characteristics of the conditioned neurons, I determined that it was possible to predict neuronal recruitment based on three factors: 1) initial sensitivity to auditory inputs, with tone-sensitive neurons being more easily recruited than tone- insensitive neurons; 2) baseline excitability levels, with more highly excitable neurons being more likely to become conditioned; and 3) the number of afferent connections received from local neurons, with neurons destined to become conditioned receiving more connections than non-conditioned neurons. - En conditionnement de la peur, un animal apprend à associer un stimulus inconditionnel (SI), tel un choc électrique, et un stimulus conditionné (SC), comme un son, de sorte que la présentation du SC seul suffit pour déclencher des réflexes conditionnés. Des recherches récentes sur l'amygdale latérale (AL) ont montré que, suite au conditionnement à la peur, seul un sous-ensemble de neurones plus excitables sont recrutés pour constituer la trace mnésique. Pour apprendre à associer deux sons au même SI, je fais l'hypothèse que les neurones entrent en compétition afin d'être sélectionnés lors du recrutement pour coder la trace mnésique. Ce recrutement dépendrait d'un part à une activation facilité des neurones ainsi qu'une activation facilité de réseaux de neurones locaux. En outre, je fais l'hypothèse que l'activation de ces réseaux de l'AL, en soi, est suffisante pour induire une mémoire effrayante. Pour répondre à ces hypothèses, je vais montrer que A) selon un processus de mémoire à court terme, un rat peut apprendre à associer deux mémoires effrayantes apprises successivement; B) des populations neuronales dans l'AL sont compétitivement recrutées dans les traces mnésiques en fonction des avantages neuronaux individuels, ainsi que les avantages consentis par le réseau local. En effectuant deux expériences successives de conditionnement à la peur, des rats étaient capables d'apprendre, ainsi que de subir un processus d'extinction, pour les deux souvenirs effrayants. La mesure de l'efficacité du conditionnement à la peur a été effectuée 1 heure après l'apprentissage pour chaque souvenir. Ces rats ont été équipés d'un système d'enregistrements extracellulaires stables que j'ai développé, ce qui a permis de suivre l'activité neuronale pendant l'apprentissage de la peur. 233 neurones pyramidaux individuels pouvaient moduler leur taux d'activité en réponse au son conditionné (neurones conditionnés) et/ou au son non conditionné (neurones généralisant). Sur les 233 neurones pyramidaux putatifs enregistrés 86 (37%) d'entre eux ont été conditionnés à un ou deux tons. Plus précisément, une population de neurones code conjointement pour un souvenir partagé, alors qu'un groupe de neurones différent code pour de nouvelles caractéristiques de nouveaux souvenirs. En particulier, en dépit d'une extinction du comportement réussie, le taux de décharge de ces neurones conditionné en réponse à la tonalité conditionnée est resté inchangée tout au long de la mesure d'apprentissage. En outre, en analysant les caractéristiques de pré-conditionnement des neurones conditionnés, j'ai déterminé qu'il était possible de prévoir le recrutement neuronal basé sur trois facteurs : 1) la sensibilité initiale aux entrées auditives, avec les neurones sensibles aux sons étant plus facilement recrutés que les neurones ne répondant pas aux stimuli auditifs; 2) les niveaux d'excitabilité des neurones, avec les neurones plus facilement excitables étant plus susceptibles d'être conditionnés au son ; et 3) le nombre de connexions reçues, puisque les neurones conditionné reçoivent plus de connexions que les neurones non-conditionnés. Enfin, nous avons constaté qu'il était possible de remplacer de façon satisfaisante le SI lors d'un conditionnement à la peur par des injections bilatérales de bicuculline, un antagoniste des récepteurs de l'acide y-Aminobutirique.

Long-Stay Activity Report 2003

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Long Stay Activity Report 1997

This report presents data collected through a survey of long-stay units in 1997. The aim of the survey is to provide statistics on the number of beds available for long-term care, how the beds are used and the types of patients who occupy these beds Download the Report here

Long Stay Activity Report 1998

This report presents data collected through a survey of long-stay units in 1998. The aim of the survey is to provide statistics on the number of beds available for long-term care, how the beds are used and the types of patients who occupy these beds Download the Report here

A Framework for Quality in Long-Term Residential Care for Older People in Ireland

The National Council on Ageing and Older People has long been concerned about the quality of long-term residential care for older people in Ireland. In 1986, its predecessor, the National Council for the Aged published “It’s Our Home”. The Quality of Life in Private and Voluntary Nursing Homes. In 1999 the Council commissioned a postal survey of all long-term residential care facilities in the country to determine whether facilities had quality initiatives in operation; providers’ views and aspirations for future provision of long-term care; providers’ views on the introduction of a national quality monitoring policy Download the Report here

Long-term azithromycin therapy in patients with severe chronic obstructive pulmonary disease and repeated pulmonary exacerbations

L’objectiu es determinar si el tractament amb azitromicina a llarg termini redueix la freqüència d’exacerbacions respiratòries en pacients amb malaltia pulmonar obstructiva crònica (MPOC) greu. Estudi retrospectiu observacional que avalua els beneficis clínics del tractament amb azitromicina a llarg termini (500 mg per via oral tres vegades per setmana) durant 12 mesos en pacients amb MPOC greu amb un mínim de 4 exacerbacions agudes (EAMPOC) per any o colonitzats per Pseudomonas aeruginosa. Es comparen amb els 12 mesos previs a l’introducció de l’azitromicina: nombre de EAMPOC, hospitalitzacions i dies d'estada hospitalària. L’azitromicina a llarg termini s’associa a una reducció significativa de EAMPOC, hospitalitzacions i dies d’estada hospitalària en pacients amb EPOC greu independentment de la colonització basal.