American journal of respiratory and critical care medicine · 2019
Francesco Mojoli、Bélaid Bouhemad、Silvia Mongodi 等
Point-of-care ultrasound is increasingly used at the bedside to integrate the clinical assessment of the critically ill; in particular, lung ultrasound has greatly developed in the last decade. This review describes basic lung ultrasound signs and focuses on their applications in critical care. Lung semiotics are composed of artifacts (derived by air/tissue interface) and real images (i.e., effusions and consolidations), both providing significant information to identify the main acute respiratory disorders. Lung ultrasound signs, either alone or combined with other point-of-care ultrasound techniques, are helpful in the diagnostic approach to patients with acute respiratory failure, circulatory shock, or cardiac arrest. Moreover, a semiquantification of lung aeration can be performed at the bedside and used in mechanically ventilated patients to guide positive end-expiratory pressure setting, assess the efficacy of treatments, monitor the evolution of the respiratory disorder, and help the weaning process. Finally, lung ultrasound can be used for early detection and management of respiratory complications under mechanical ventilation, such as pneumothorax, ventilator-associated pneumonia, atelectasis, and pleural effusions. Lung ultrasound is a useful diagnostic and monitoring tool that might in the near future become part of the basic knowledge of physicians caring for the critically ill patient.
Canadian Geriatrics Journal · 2023
Angela G. Juby、Christopher J. Davis、Suglo Minimaana 等
Background Sarcopenia is associated with increased morbidity and mortality. Clinically, sarcopenia can be overlooked, especially in obesity. Sarcopenia diagnostic criteria include muscle mass (MM) and function assessments. Muscle function can be readily assessed in a clinic setting (grip strength, chair stand test). However, MM requires dual-energy X-ray absorptiometry (DXA) Body Composition (BC) or other costly tools, not readily available. Methods Observational cohort pilot study of independently mobile, community dwelling older adults, comparing MM using two office-based, direct-to-consumer bioimpedance (BIA) scales (Ozeri® [manufactured in China] and OMRON® [OMRON HBF-510® Full Body Sensor, Shiokoji Horikawa, Kyoto, Japan] to DXA. The OMRON differs from the Ozeri scale because the OMRON also includes hand sensors. The European Working Group on Sarcopenia in Older People (EWGSOP) DXA or BIA low MM diagnostic cut-offs were used to classify participants as having low or normal MM. Results Fifty participants: 11 men, 39 women. Forty-two completed DXA. Age 75.8 yrs [67–90]. 81% obese based on body fat cut-offs. With DXA [ASM/height2], 15 had low MM. Using BIA [mmass/height2], 7 with Ozeri, and 27 with OMRON, had low MM. Positive predictive value for low MM versus DXA (as the gold standard) for Ozeri was 73.3% and OMRON was 92.8%. Good correlation between BIA scales and DXA for body fat estimates. Conclusions OMRON captured all low MM participants identified by DXA plus all on DXA diagnostic borderline. Prevalence of obesity was high. Clinically, sarcopenic obese is the most difficult phenotype, as obesity masks low muscle mass. Low cost, readily available, direct-to-consumer BIA BC scales, especially with hand sensors, provide immediate, reliable information on muscle and fat mass. This can prompt appropriate investigation and/or intervention for sarcopenia or sarcopenic obesity.
Current opinion in endocrinology, diabetes, and obesity · 2025
Khushboo Agarwal、Lakshmi Nagendra、Saptarshi Bhattacharya
PURPOSE OF REVIEW: Premenopausal osteoporosis, characterized by low bone mass and fractures, is rare but poses long-term skeletal risks. Unlike postmenopausal osteoporosis, it often stems from inadequate peak bone mass accrual or secondary causes such as systemic diseases, medications, or lifestyle factors. This review explores contemporary approaches to defining, diagnosing, and treating low bone mass and osteoporosis in premenopausal women. RECENT FINDINGS: Prevalence varies according to ethnicity and is further influenced by the diagnostic criteria, with higher risks in Caucasian and Asian women. Key determinants of peak bone mass achieved by the late 20 s include genetics (60-80% of variability), nutrition (calcium, vitamin D, and protein), lifestyle (exercise, smoking, and alcohol), and occupational exposures (e.g., heavy metals and sedentary work). Pregnancy and lactation-associated osteoporosis also cause transient bone loss, particularly in high-risk individuals. Bone mineral density by dual-energy X-ray absorptiometry is the gold standard for diagnosis despite of certain limitations. Additionally, emerging technologies like radiofrequency echographic multi spectrometry show promise. Management focuses on optimizing bone health through adequate nutrition, weight-bearing exercises, and addressing secondary causes, when present like rheumatoid arthritis, long-term glucocorticoid use, hypogonadism, etc. Pharmacological options such as bisphosphonates and teriparatide can be considered in high-risk cases, but evidence on their safety and efficacy in premenopausal women is limited, and concerns about teratogenicity remain. SUMMARY: Early identification and intervention are critical to reduce fracture risk, emphasizing the need for better diagnostic tools and individualized treatment strategies.
Journal of Bone and Mineral Metabolism · 2026
Deniz Apalan、Bulent Yildiz、Ozlem Polat 等
暂无摘要
Medical decision making : an international journal of the Society for Medical Decision Making · 1991
D G Fryback、J R Thornbury
The authors discuss the assessment of the contribution of diagnostic imaging to the patient management process. A hierarchical model of efficacy is presented as an organizing structure for appraisal of the literature on efficacy of imaging. Demonstration of efficacy at each lower level in this hierarchy is logically necessary, but not sufficient, to assure efficacy at higher levels. Level 1 concerns technical quality of the images; Level 2 addresses diagnostic accuracy, sensitivity, and specificity associated with interpretation of the images. Next, Level 3 focuses on whether the information produces change in the referring physician's diagnostic thinking. Such a change is a logical prerequisite for Level 4 efficacy, which concerns effect on the patient management plan. Level 5 efficacy studies measure (or compute) effect of the information on patient outcomes. Finally, at Level 6, analyses examine societal costs and benefits of a diagnostic imaging technology. The pioneering contributions of Dr. Lee B. Lusted in the study of diagnostic imaging efficacy are highlighted.
Journal of nursing care quality · 2024
Kristi Webster、Jeanne Hlebichuk、Lillian Jensen 等
BACKGROUND: Bedside shift report improves patient satisfaction, peer accountability, communication, and decreases safety events. LOCAL PROBLEM: Clinical practice of bedside report varied prior to the pandemic. Due to limited personal protective equipment and exposure risk, bedside report was halted during the pandemic. APPROACH: The Iowa Model of Evidence-Based Practice was used to guide this project. To standardize communication during bedside report, safety data and literature were reviewed and grouped by themes. The acronym COAST was developed, consisting of code status, oxygen, access, safety, and tubes/drains. These elements were to be discussed at the bedside during handoff. RESULTS: Compliance with completing elements of COAST increased during the pilot, 9- and 12-month sustainment periods. Additional safety-related outcomes of cardiopulmonary resuscitation wristband application, falls, and good catches improved. Notably, overtime declined. CONCLUSIONS: A bedside report with standardized communication focusing on safety elements can improve compliance with adoption and patient safety outcomes.
Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy · 2025
Lei Zhang、Yulu Sun、Yiran Zhao 等
Purpose The fat-to-muscle mass ratio (FMR) is an innovative metric that integrates fat and muscle constituents. The aim of this study was to examine the efficacy of FMR in predicting non-alcoholic fatty liver disease (NAFLD) in individuals with T2DM. Methods This cross-sectional study enrolled 307 hospitalized patients aged 50 years and older with T2DM. NAFLD was identified during ultrasound examination. Fat mass and muscle mass were quantified using dual-energy X-ray absorptiometry (DXA), with FMR calculated as fat mass (kg) divided by muscle mass (kg). Results FMR was markedly elevated in the NAFLD patient group compared to the healthy control group (p<0.001). Sex-specific analysis demonstrated notable sex differences in the diagnostic efficacy of this indicator for fatty liver: the area under the curve (AUC) of the subject’s work characteristics was significantly greater in females compared to males (0.860 vs 0.805), and the optimal threshold was also significantly elevated in females relative to males (0.563 vs 0.363). FMR was established as an independent predictor of fatty liver through multifactorial regression modeling, revealing a risk ratio of 28.171 (95% CI 7.008–113.248, p<0.001) in males, while the risk ratio for females was 3.259 (95% CI 1.221–8.700, p=0.018), indicating higher predictive value in males. Conclusions FMR was significantly and independently linked to an increased risk of NAFLD in middle-aged and elderly individuals with T2DM, a discovery that underpins the rationale for enhancing targeted interventions and prognostic management for patients with diabetes mellitus and fatty liver disease.
American journal of physiology. Lung cellular and molecular physiology · 2020
Larissa A Shimoda、Rory E Morty
暂无摘要
BMC Geriatrics · 2026
Woo Chul Son、Kyung Cheon Seo、Miji Kim 等
Background Sarcopenia, defined by the age-related loss of skeletal muscle mass and function, is associated with increased risk of falls, disability, and mortality in older adults. However, the strength of the relationship between sarcopenia and falls varies across studies, largely due to differences in diagnostic criteria. This study aimed to examine the associations between four widely used sarcopenia definitions and fall incidence, and to identify which components of these definitions are most predictive of falls in community-dwelling older adults. Methods We analyzed data from 1,991 participants (aged 70–84 years; 999 men, 992 women) enrolled in the Korean Frailty and Aging Cohort Study. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 (AWGS 2019), European Working Group on Sarcopenia in Older People 2 (EWGSOP2), International Working Group on Sarcopenia (IWGS), and Foundation for the National Institutes of Health (FNIH) criteria. Appendicular lean mass was measured using dual-energy X-ray absorptiometry, muscle strength by handgrip strength (HGS), and physical performance by gait speed, five-times sit-to-stand test (5STS), and Short Physical Performance Battery (SPPB). Fall incidence was self-reported over a two-year follow-up. Results Of the total participants, 399 (20.0%) reported at least one fall during follow-up. Fallers demonstrated significantly poorer 5STS and SPPB performance in both sexes, and lower HGS and slower gait speed in women, whereas muscle mass showed no significant association with falls in either sex. In quintile-based normalization unadjusted analyses, 5STS and SPPB remained significantly associated with falls in both sexes, and gait speed remained significant in women. Among the diagnostic criteria, slow gait speed in both sexes was significantly associated with fall risk in the unadjusted analysis. Conclusion Sarcopenia diagnostic criteria that include physical performance measures—particularly gait speed—showed stronger associations with fall risk than those based mainly on muscle mass in unadjusted analyses. Although these associations were attenuated and became non-significant after adjustment, slow gait speed may still serve as a simple and practical indicator to screen older adults who could be at increased risk of falling. These findings suggest a potential role for physical performance assessments in sarcopenia-related fall risk evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-025-06835-3.
Annals of the rheumatic diseases · 2018
Lennart Jans、Isabelle De Kock、Nele Herregods 等
暂无摘要
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