1
|
Cogen JD, Quon BS. Update on the diagnosis and management of cystic fibrosis pulmonary exacerbations. J Cyst Fibros 2024:S1569-1993(24)00047-X. [PMID: 38677887 DOI: 10.1016/j.jcf.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/29/2024]
Abstract
Pulmonary exacerbations in people with cystic fibrosis are associated with significant morbidity and reduced quality of life. Pulmonary exacerbation treatment guidelines, published by an expert panel assembled by the Cystic Fibrosis Foundation nearly 15 years ago, were primarily consensus-based as there were several gaps in the evidence base. In particular, limited evidence existed regarding optimal pulmonary exacerbation treatment strategies, including duration of antibiotic therapy, treatment location, antibiotic selection, and the role of systemic corticosteroids. Over the last decade, results from observational studies and large multi-center randomized controlled trials have begun to answer important questions related to pulmonary exacerbation treatment. This review focuses on the diagnosis, etiology, and changing epidemiology of pulmonary exacerbations, and also summarizes the most recent and up-to-date studies describing pulmonary exacerbation treatment. Finally, this review provides consideration for future pulmonary exacerbation research priorities, particularly in the current highly effective modulator therapy era.
Collapse
Affiliation(s)
- Jonathan D Cogen
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
| | - Bradley S Quon
- Division of Respiratory Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Moger TA, Holte JH, Amundsen O, Haavaag SB, Edvardsen A, Bragstad LK, Hellesø R, Tjerbo T, Vøllestad NK. Associations between outpatient care and later hospital admissions for patients with chronic obstructive pulmonary disease - a registry study from Norway. BMC Health Serv Res 2024; 24:500. [PMID: 38649963 PMCID: PMC11036724 DOI: 10.1186/s12913-024-10975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Although chronic obstructive pulmonary disease (COPD) admissions put a substantial burden on hospitals, most of the patients' contacts with health services are in outpatient care. Traditionally, outpatient care has been difficult to capture in population-based samples. In this study we describe outpatient service use in COPD patients and assess associations between outpatient care (contact frequency and specific factors) and next-year COPD hospital admissions or 90-day readmissions. METHODS Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009-2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and-demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals. RESULTS A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2-3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant. CONCLUSION As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers.
Collapse
Affiliation(s)
- Tron Anders Moger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Jon Helgheim Holte
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Olav Amundsen
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Silje Bjørnsen Haavaag
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Edvardsen
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Line Kildal Bragstad
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
- Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Ragnhild Hellesø
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trond Tjerbo
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Athanazio RA, Bernal Villada L, Avdeev SN, Wang HC, Ramírez-Venegas A, Sivori M, Dreyse J, Pacheco M, Man SK, Noriega-Aguirre L, Farouk H. Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study. BMJ Open Respir Res 2024; 11:e002101. [PMID: 38637115 PMCID: PMC11029392 DOI: 10.1136/bmjresp-2023-002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/16/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION The EXAcerbations of Chronic obstructive lung disease (COPD) and their OutcomeS (EXACOS) International Study aimed to quantify the rate of severe exacerbations and examine healthcare resource utilisation (HCRU) and clinical outcomes in patients with COPD from low-income and middle-income countries. METHODS EXACOS International was an observational, cross-sectional study with retrospective data collection from medical records for a period of up to 5 years. Data were collected from 12 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Hong Kong, Mexico, Panama, Russia and Taiwan. The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU. RESULTS In total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. A statistically significant decrease in mean (SD) FEV1 from baseline to post-baseline was observed in patients with ≥1 severe exacerbation (1.23 (0.51) to 1.13 (0.52) L; p=0.0000). Mean BEC was 0.198 x109 cells/L, with 64.7% of patients having a BEC ≥0.1 x109 cells/L and 21.3% having a BEC ≥0.3 x109 cells/L. The most common comorbidity was hypertension (58.3%). An increasing number of severe exacerbations per year was associated with greater HCRU. DISCUSSION The findings presented here indicate that effective treatment strategies to prevent severe exacerbations in patients with COPD remain a significant unmet need in low-income and middle-income countries.
Collapse
Affiliation(s)
- Rodrigo Abensur Athanazio
- Pulmonology Division, Heart Institute-InCor-Clinical Hospital, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sergey N Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Alejandra Ramírez-Venegas
- Tobacco Smoking and COPD Research Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Martín Sivori
- Pneumology Unit, Dr J M Ramos Mejía Pulmonology University Center, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Jorge Dreyse
- Department of Internal Medicine and Critical Care Center, Clínica Las Condes and School of Medicine Universidad Finis Terrae, Santiago, Chile
| | - Manuel Pacheco
- Internal Medicine Research Group, Universidad Tecnológica de Pereira, Pereira, Colombia
- Fundación Universitaria Visión de las Américas y Respiremos Unidad de Neumología, Pereira, Colombia
| | - Sin Kit Man
- Department of Medicine and Geriatrics, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong Special Administrative Region (HKSAR), Tuen Mun, People's Republic of China
| | - Lorena Noriega-Aguirre
- Center for Diagnosis and Treatment of Respiratory Diseases (CEDITER), Panama City, Panama
| | | |
Collapse
|
4
|
Reis Gomes VM, Pires MC, Delfino Pereira P, Schwarzbold AV, Gomes AGDR, Pessoa BP, Cimini CCR, Rios DRA, Anschau F, Nascimento FJM, Grizende GMS, Vietta GG, Batista JDL, Ruschel KB, Carneiro M, Reis MA, Bicalho MAC, Porto PF, Dos Reis PP, Araújo SF, Nobre V, Marcolino MS. AB 2CO risk score for in-hospital mortality of COVID-19 patients admitted to intensive care units. Respir Med 2024:107635. [PMID: 38641122 DOI: 10.1016/j.rmed.2024.107635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/07/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE To develop a mortality risk score for COVID-19 patients admitted to intensive care units (ICU), and to compare it with other existing scores. MATERIALS AND METHODS It is a retrospective observational study, including consecutive adult patients with laboratory-confirmed COVID-19 admitted to ICUs of 18 hospitals from nine Brazilian cities, from 09/2021 to 07/2022. Potential predictors were selected based on the literature review. Generalized Additive Models were used to examine outcomes and predictors. LASSO regression was used to derive the mortality score. RESULTS From 558 patients, median age was 69 years (IQR 58-78), 56.3% were men, 19.7% required mechanical ventilation (MV), and 44.8% died. The final model comprised six variables: age, pO2/FiO2, respiratory function (respiratory rate or if in MV), chronic obstructive pulmonary disease, and obesity. The AB2CO had an AUROC of 0.781 (95% CI 0.744 to 0.819), good overall performance (Brier score=0.191) and an excellent calibration (slope=1.063, intercept=0.015, p-value=0.834). The model was compared with other scores and displayed better discrimination ability than the majority of them. CONCLUSIONS The AB2CO score is a fast and easy tool to be used upon ICU admission.
Collapse
Affiliation(s)
- Virginia Mara Reis Gomes
- Medical School and University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Magda Carvalho Pires
- Statistics Department, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.
| | - Polianna Delfino Pereira
- Medical School and University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). R. Ramiro Barcelos, 2359, Porto Alegre, Brazil.
| | | | | | - Bruno Porto Pessoa
- Hospital Julia Kubitschek. R. Dr. Cristiano Rezende, 2745, Belo Horizonte, Brazil.
| | | | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor. Av. Francisco Trein, 326, Porto Alegre, Brazil.
| | | | | | | | - Joanna d'Arc Lyra Batista
- Institute for Health Technology Assessment (IATS). R. Ramiro Barcelos, 2359, Porto Alegre, Brazil; Medical School, Federal University of Fronteira Sul, Rod. SC 484 - Km 02, Chapecó, Brazil; Hospital Regional do Oeste. R. Florianópolis, 1448 E, Chapecó, Brazil.
| | | | - Marcelo Carneiro
- Hospital Santa Cruz. R. Fernando Abott, 174, Santa Cruz do Sul, Brazil.
| | - Marco Aurélio Reis
- Hospital Risoleta Tolentino Neves. R. das Gabirobas, 01, Belo Horizonte, Brazil.
| | - Maria Aparecida Camargos Bicalho
- Fundação Hospitalar do Estado de Minas Gerais - FHEMIG. Cidade Administrativa de Minas Gerais, Edifício Gerais - 13º andar, Rod. Papa João Paulo II, 3777, Belo Horizonte, Brazil.
| | - Paula Fonseca Porto
- Hospital Metropolitano Odilon Behrens. R. Formiga, 50, Belo Horizonte, Brazil.
| | | | | | - Vandack Nobre
- Medical School and University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Milena Soriano Marcolino
- Medical School and University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). R. Ramiro Barcelos, 2359, Porto Alegre, Brazil; Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil.
| |
Collapse
|
5
|
Wang X, Lv Y, Zhang C, Mi J, Zhao Q. Status quo and influencing factors of multiprofessional and multidisciplinary teamwork for early mobilization in mechanically ventilated patients in ICUs: A multi-centre survey study. J Adv Nurs 2024. [PMID: 38622988 DOI: 10.1111/jan.16149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/16/2024] [Accepted: 03/02/2024] [Indexed: 04/17/2024]
Abstract
AIM To understand the status quo of multiprofessional and multidisciplinary collaboration for early mobilization of mechanically ventilated patients in Chinese ICUs and identify any factors that may influence this practice. DESIGN A multi-centre cross-sectional survey. METHODS From October to November 2022, the convenience sampling method was used to select ICU multiprofessional and multidisciplinary early mobility members (including physicians, nurses and physiotherapists) from 27 tertiary general hospitals in 14 provinces, cities and autonomous regions of China. They were asked to complete an author-developed questionnaire on the status of collaboration and the Assessment of Inter-professional Team Collaboration Scale. A multiple linear regression model was used to analyse the factors associated with the level of collaboration. RESULTS Physicians, nurses and physiotherapists mostly suffered from the lack of normative protocols, unclear division of responsibilities and unclear multiprofessional and multidisciplinary teams when using a collaborative approach to early activities. Multiple linear regression analysis showed that the number of ICU patients managed, the existence of norms and processes, the attitude of colleagues around them, the establishment of a team, communication methods and activity leaders were significant influences on the level of collaboration among members of the multiprofessional and multidisciplinary early activities. CONCLUSION The collaboration of multiprofessional and multidisciplinary early activity members for mechanically ventilated patients in the ICU remains unclear, and the collaboration strategy needs to be constructed and improved, taking into account China's human resources and each region's economic development level. IMPACT This study investigates the collaboration status of multiprofessional and multidisciplinary activity members from the perspective of teamwork, analyses the reasons affecting the level of collaboration and helps to develop better teamwork strategies to facilitate the implementation of early activities. PATIENT OR PUBLIC CONTRIBUTION The participants in this study were multiprofessional and multidisciplinary medical staff who performed early activities for ICU patients.
Collapse
Affiliation(s)
- Xueqin Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Ying Lv
- Neurosurgery ICU, Affiliated Hospital of Hebei University/School of Clinical Medicine, Baoding, Hebei, People's Republic of China
| | - Chuanlin Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jie Mi
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Qinghua Zhao
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| |
Collapse
|
6
|
Bindayel IA, Alahmad SA. Perception of faculty in the community health sciences colleges towards simulation-based education in clinical nutrition undergraduate practical courses. BMC Med Educ 2024; 24:402. [PMID: 38605334 PMCID: PMC11007933 DOI: 10.1186/s12909-024-05338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Simulation now is widely used for training and education in different fields including healthcare education. Medicine and healthcare students can be trained in a secure, efficient, and engaging setting by Simulation-based Education (SBE). Therefore, this study aimed to assess the perception of faculty members in the community health departments towards SBE to be used in practical subjects for clinical nutrition undergraduate courses. METHOD This cross-sectional survey was conducted among community health sciences faculty members. The perception was assessed using a self-administered questionnaire that included three sections. RESULTS This questionnaire was completed by 125 faculty members, of whom 36 (28.8%) were male and 89 (71.2%) were female. Overall, faculty members had positive perceptions, with a mean score of 3.86 ± 0.74, but a high level of anxiety toward SBE, with a mean score of 3.42 ± 0.75. There was a statistically significant difference between the responses of the faculty members based on the training they received in simulation (P = 0.001). CONCLUSION The study results indicate that community health sciences faculty members' perception of SBE in Saudi Arabia is generally positive. However, the results show high levels of anxiety among faculty members toward SBE.
Collapse
Affiliation(s)
- Iman Abdullah Bindayel
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Shahad Ahmed Alahmad
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
7
|
Warmbein A, Hübner L, Rathgeber I, Mehler-Klamt AC, Huber J, Schroeder I, Scharf C, Gutmann M, Biebl J, Manz K, Kraft E, Eberl I, Zoller M, Fischer U. Robot-assisted early mobilization for intensive care unit patients: Feasibility and first-time clinical use. Int J Nurs Stud 2024; 152:104702. [PMID: 38350342 DOI: 10.1016/j.ijnurstu.2024.104702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Early mobilization is only carried out to a limited extent in the intensive care unit. To address this issue, the robotic assistance system VEMOTION® was developed to facilitate (early) mobilization measures more easily. This paper describes the first integration of robotic assistance systems in acute clinical intensive care units. OBJECTIVE Feasibility test of robotic assistance in early mobilization of intensive care patients in routine clinical practice. SETTING Two intensive care units guided by anesthesiology at a German university hospital. PARTICIPANTS Patients who underwent elective surgery with postoperative treatment in the intensive care unit and had an estimated ventilation time over 48 h. METHODS Participants underwent robot-assisted mobilization, scheduled for twenty-minute sessions twice a day, ten times or one week, conducted by nursing staff under actual operational conditions on the units. No randomization or blinding took place. We assessed data regarding feasible cutoff points (in brackets): the possibility of enrollment (x ≥ 50 %), duration (pre- and post-setup (x ≤ 25 min), therapy duration (x = 20 min), and intervention-related parameters (number of mobilizing professionals (x ≤ 2), intensity of training, events that led to adverse events, errors or discontinuation). Mobilizing professionals rated each mobilization regarding their physical stress (x ≤ 3) and feasibility (x ≥ 4) on a 7 Point Likert Scale. An estimated sample size of at least twenty patients was calculated. We analyzed the data descriptively. RESULTS Within 6 months, we screened thirty-two patients for enrollment. 23 patients were included in the study and 16 underwent mobilization using robotic assistance, 7 dropped out (enrollment eligibility = 69 %). On average, 1.9 nurses were involved per therapy unit. Participants received 5.6 robot-assisted mobilizations in mean. Pre- and post-setup had a mean duration of 18 min, therapy a mean of 21 min. The robot-assisted mobilization was started after a median of 18 h after admission to the intensive care unit. We documented two adverse events (pain), twelve errors in handling, and seven unexpected events that led to interruptions or discontinuation. No serious adverse events occurred. The mobilizing nurses rated their physical stress as low (mean 2.0 ± 1.3) and the intervention as feasible (mean 5.3 ± 1.6). CONCLUSIONS Robot-assisted mobilization was feasible, but specific safety measures should be implemented to prevent errors. Robotic-assisted mobilization requires process adjustments and consideration of unit staffing levels, as the intervention does not save staff resources or time. REGISTRATION clinicaltrials.org TRN: NCT05071248; Date: 2021/10/08; URL https://clinicaltrials.gov/ct2/show/NCT05071248. TWEETABLE ABSTRACT Robot-assisted early mobilization in intensive care patients is feasible and no adverse event occurred.
Collapse
Affiliation(s)
- Angelika Warmbein
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany.
| | - Lucas Hübner
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Ivanka Rathgeber
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany
| | - Amrei Christin Mehler-Klamt
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Jana Huber
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Ines Schroeder
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Christina Scharf
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Marcus Gutmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Johanna Biebl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Kirsi Manz
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Inge Eberl
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Michael Zoller
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Uli Fischer
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
8
|
Gruiskens JRJH, van Hoef LFM, Theunissen MM, Courtens AM, Gidding-Slok AHM, van Schayck OCP, van den Beuken-van Everdingen MMHJ. Recommendations for Improving Chronic Care in Times of a Pandemic Based on Patient Experiences. J Am Med Dir Assoc 2024; 25:623-632.e5. [PMID: 38000443 DOI: 10.1016/j.jamda.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 08/24/2023] [Accepted: 10/14/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic had a profound and pervasive impact on the health of chronic care patients and disrupted care systems worldwide. Our research aimed to assess the impact of the pandemic on chronic care provision and provide recommendations for improving care provision, based on patient experiences. DESIGN Qualitative semi-structured interviews were held among patients with chronic obstructive pulmonary disease (COPD) or heart failure. SETTING AND PARTICIPANTS Using stratified sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. In the summer of 2021, online interviews were conducted. METHODS An iterative process was adopted to analyze the data. Going back and forth through the data and our analytical structure, we first coded the data, and subsequently developed categories, themes, and aggregate dimensions. The data were synthesized in a data structure and a data table, which were analyzed using an interpretative approach. RESULTS We found 3 dimensions through which care might be improved: (1) proactive and adaptive health care organization and use of innovative technologies, (2) assistance in maintaining patient resilience and coping strategies, and (3) health care built on outreaching and person-centered care enabling identification of individual patient needs. Experiences of impaired accessibility to care, altered and unmet care demands and patient needs, and the negative impact of national containment strategies on patient resilience support the need for improvement in these dimensions. CONCLUSIONS AND IMPLICATIONS The in-depth insight gained on the impact of the pandemic on chronic care provision was used to propose recommendations for improving care, supported by not only the what and how but also the why developments require additional efforts made by policymakers and change agents, augmented by structural use and development of innovations. Health care organizations should be enabled to rapidly respond to changing internal and external environments, develop and implement innovations, and match care to patient needs.
Collapse
Affiliation(s)
- Jeroen R J H Gruiskens
- Department of Family Medicine, CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Maastricht, The Netherlands.
| | - Liesbeth F M van Hoef
- Expertise Centre for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Maurice M Theunissen
- Expertise Centre for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Annemie M Courtens
- Expertise Centre for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Annerika H M Gidding-Slok
- Department of Family Medicine, CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Maastricht, The Netherlands
| | | |
Collapse
|
9
|
Burma JS, Griffiths JK, Lapointe AP, Oni IK, Soroush A, Carere J, Smirl JD, Dunn JF. Heart Rate Variability and Pulse Rate Variability: Do Anatomical Location and Sampling Rate Matter? Sensors (Basel) 2024; 24:2048. [PMID: 38610260 PMCID: PMC11013825 DOI: 10.3390/s24072048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024]
Abstract
Wearable technology and neuroimaging equipment using photoplethysmography (PPG) have become increasingly popularized in recent years. Several investigations deriving pulse rate variability (PRV) from PPG have demonstrated that a slight bias exists compared to concurrent heart rate variability (HRV) estimates. PPG devices commonly sample at ~20-100 Hz, where the minimum sampling frequency to derive valid PRV metrics is unknown. Further, due to different autonomic innervation, it is unknown if PRV metrics are harmonious between the cerebral and peripheral vasculature. Cardiac activity via electrocardiography (ECG) and PPG were obtained concurrently in 54 participants (29 females) in an upright orthostatic position. PPG data were collected at three anatomical locations: left third phalanx, middle cerebral artery, and posterior cerebral artery using a Finapres NOVA device and transcranial Doppler ultrasound. Data were sampled for five minutes at 1000 Hz and downsampled to frequencies ranging from 20 to 500 Hz. HRV (via ECG) and PRV (via PPG) were quantified and compared at 1000 Hz using Bland-Altman plots and coefficient of variation (CoV). A sampling frequency of ~100-200 Hz was required to produce PRV metrics with a bias of less than 2%, while a sampling rate of ~40-50 Hz elicited a bias smaller than 20%. At 1000 Hz, time- and frequency-domain PRV measures were slightly elevated compared to those derived from HRV (mean bias: ~1-8%). In conjunction with previous reports, PRV and HRV were not surrogate biomarkers due to the different nature of the collected waveforms. Nevertheless, PRV estimates displayed greater validity at a lower sampling rate compared to HRV estimates.
Collapse
Affiliation(s)
- Joel S. Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.G.); (J.C.); (J.D.S.)
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - James K. Griffiths
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.G.); (J.C.); (J.D.S.)
- Faculty of Biomedical Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | - Ibukunoluwa K. Oni
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Ateyeh Soroush
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Joseph Carere
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.G.); (J.C.); (J.D.S.)
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jonathan D. Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.G.); (J.C.); (J.D.S.)
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jeff F. Dunn
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Faculty of Biomedical Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| |
Collapse
|
10
|
Alhuneafat L, Khalid MU, Jabri A, Deicke MD, Virk S, Jacobs MW, Hsich E, Alqarqaz M, Dunlap ME, Kassis-George H, Link C. Early pandemic in-hospital outcomes and mortality risk factors in COVID-19 solid organ transplant patients. Proc AMIA Symp 2024; 37:414-423. [PMID: 38628349 PMCID: PMC11018036 DOI: 10.1080/08998280.2024.2325310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/14/2024] [Indexed: 04/19/2024] Open
Abstract
Background Solid organ transplant (SOT) recipients with COVID-19 have a higher risk of mortality than those without COVID-19. However, it is unclear how SOT patient outcomes compare to the general population without SOT who contract COVID-19. Methods We used the National Inpatient Sample from January to December 2020 to investigate inpatient outcomes seen in SOT recipients after contracting COVID-19 compared to nontransplant patients. We identified our study sample using ICD-10 CM and excluded those <18 years of age and those with dual organ transplants. Inpatient outcomes were compared in SOT and non-SOT COVID cohorts, and we further evaluated predictors of mortality in the SOT with COVID population. Results Out of the 1,416,445 COVID-19 admissions included in the study, 8315 (0.59%) were single SOT recipients. Our analysis that adjusted for multiple baseline characteristics and comorbidities demonstrated that COVID-19 in SOT patients was associated with higher rates of acute kidney injury (adjusted odds ratio [aOR] 2.34, 95% confidence interval [CI] 1.81-3.02, P < 0.01), lower rates of acute respiratory distress syndrome (aOR 0.68, 95% CI 0.54-0.85, P < 0.01), and similar rates of cardiac arrest, pulmonary embolism, circulatory shock, cerebrovascular events, and in-hospital mortality. Age >65 was associated with mortality in SOT patients. Conclusion In this nationally representative sample, SOT patients presenting with COVID-19 experienced similar rates of mortality compared to those without SOT. SOT patients were more likely to develop acute kidney injury. Further research is needed to understand the complex relationship between transplant patient outcomes and COVID-19.
Collapse
Affiliation(s)
- Laith Alhuneafat
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Muhammad Umar Khalid
- Department of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ahmad Jabri
- Heart and Vascular Center, Henry Ford, Detroit, Michigan, USA
| | - Matthew D. Deicke
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Shiza Virk
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Max W. Jacobs
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Eileen Hsich
- Advanced Heart Failure and Transplant, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Mark E. Dunlap
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Hayah Kassis-George
- Advanced Heart Failure and Transplant, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Christopher Link
- Advanced Heart Failure and Transplant, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
11
|
Gilworth G, Harris K, Morgan TL, Ayis S, Fox-Rushby J, Godfrey E, Hopkinson NS, Lewin S, Lim KK, Spinou A, Taylor SJC, White P. The IMPROVE trial: study protocol for a pragmatic cluster randomised controlled trial to assess the effectiveness of using lay health workers to improve uptake and completion of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Trials 2024; 25:194. [PMID: 38500191 PMCID: PMC10949634 DOI: 10.1186/s13063-024-07998-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is a programme of exercise and education and the most effective treatment for the symptoms and disability associated with chronic obstructive pulmonary disease. However, the benefits of PR are limited by poor uptake and completion. This trial will determine whether using trained volunteer lay health workers, called "PR buddies," improves uptake and completion of PR and is cost-effective. This trial protocol outlines the methods for evaluating effectiveness, cost-effectiveness, and acceptability. METHODS The IMPROVE trial is a pragmatic, open, cluster randomised controlled trial planned in 38 PR services across England and Wales. PR services will be randomised to either intervention arm-offering support from PR buddies to patients with chronic obstructive pulmonary disease-or to usual care as the control arm. PR staff in trial sites randomised to the intervention arm will receive training in recruiting and training PR buddies. They will deliver training to volunteers, recruited from among people who have recently completed PR in their service. The 3-day PR-buddy training programme covers communication skills, confidentiality, boundaries of the PR-buddy role and behaviour change techniques to help patients overcome obstacles to attending PR. An internal pilot will test the implementation of the trial in eight sites (four intervention sites and four in control arm). The primary outcome of the trial is the uptake and completion of PR. A process evaluation will investigate the acceptability of the intervention to patients, PR staff and the volunteer PR buddies, and intervention fidelity. We will also conduct a cost-effectiveness analysis. DISCUSSION Improving outcomes for chronic obstructive pulmonary disease and access to PR are priorities for the UK National Health Service (NHS) in its long-term plan. The trial hypothesis is that volunteer PR buddies, who are recruited and trained by local PR teams, are an effective and cost-effective way to improve the uptake and completion rates of PR. The trial is pragmatic, since it will test whether the intervention can be incorporated into NHS PR services. Information obtained in this trial may be used to influence policy on the use of PR buddies in PR and other similar services in the NHS. TRIAL REGISTRATION ISRCTN12658458. Registered on 23/01/2023.
Collapse
Affiliation(s)
- Gill Gilworth
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Sheffield, UK
| | - Katherine Harris
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Toby L Morgan
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Salma Ayis
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Julia Fox-Rushby
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Emma Godfrey
- School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Simon Lewin
- Department of Health Sciences Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Ka Keat Lim
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Arietta Spinou
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's Centre for Lung Health, King's College London, London, UK
| | - Stephanie J C Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Patrick White
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK.
| |
Collapse
|
12
|
Aldhahir AM, Siraj RA, Alqarni AA, Alqahtani JS, Alyami MM, Majrshi MS, Alwafi H, Alqahtani MM, Monshi SS, Al-Zalabani AH, Alanazi AM. The prevalence and sociodemographic determinants of tobacco and nicotine use among students in healthcare disciplines in Saudi Arabian universities: a cross-sectional survey. Front Public Health 2024; 12:1348370. [PMID: 38515594 PMCID: PMC10954892 DOI: 10.3389/fpubh.2024.1348370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
Background Tobacco smoking is one of the most significant health-related problems worldwide. However, the prevalence and sociodemographic determinants of tobacco and nicotine use among students on healthcare courses in Saudi Arabia are limited. Methods This cross-sectional study used a questionnaire that was distributed via SurveyMonkey between November 2022 and June 2023 to all student universities offering healthcare courses. Data are presented as frequency and percentages. The associated sociodemographic factors with current tobacco and nicotine use were subjected to logistic regression. Results Overall, 5,012, of whom 3,872 (77.25%) were males, responded to the online survey. The prevalence of current tobacco and nicotine use was 3,553 (71%). The majority of users used electronic nicotine delivery systems (1,622: 32.36%). The current use of cigarettes (AOR: 1.75 (1.42 to 2.15)), e-cigarettes (AOR: 1.17 (1.01 to 1.37)), and smokeless tobacco substances (AOR: 1.35 (1.02 to 1.90)) were more pronounced among males compared to female students. However, the current use of a hookah was less among males (AOR: 0.74 (95% CI: 61 to 0.91)). Smoking cigarettes was practiced less among students living in other regions compared to the Central Region. However, smokeless tobacco substances seem to be more prevalent in the Western, Southern, and Northern Regions, (AOR: 1.57 (95% CI: 1.09 to 2.26)), (AOR: 1.43 (95% CI: 1.04 to 1.95)), and (AOR: 1.57 (95% CI: 1.09 to 2.26)), respectively. Conclusion Smoking is prevalent among students in the healthcare disciplines, with electronic nicotine delivery systems being the most used product. Several sociodemographic factors were associated with higher tobacco or nicotine use.
Collapse
Affiliation(s)
- Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Rayan A. Siraj
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdullah A. Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Respiratory Therapy Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Mohammed M. Alyami
- Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia
| | - Mansour S. Majrshi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Mohammed M. Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sarah S. Monshi
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdulmohsen H. Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Abdullah M. Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
13
|
Luján M, Cinesi Gómez C, Peñuelas O, Ferrando C, Heili-Frades SB, Carratalá Perales JM, Mas A, Sayas Catalán J, Mediano O, Roca O, García Fernández J, González Varela A, Sempere Montes G, Rialp Cervera G, Hernández G, Millán T, Ferrer Monreal M, Egea Santaolalla C. Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient. Arch Bronconeumol 2024:S0300-2896(24)00057-7. [PMID: 38521646 DOI: 10.1016/j.arbres.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
Acute respiratory failure due to COVID-19 pneumonia often requires a comprehensive approach that includes non-pharmacological strategies such as non-invasive support (including positive pressure modes, high flow therapy or awake proning) in addition to oxygen therapy, with the primary goal of avoiding endotracheal intubation. Clinical issues such as determining the optimal time to initiate non-invasive support, choosing the most appropriate modality (based not only on the acute clinical picture but also on comorbidities), establishing criteria for recognition of treatment failure and strategies to follow in this setting (including palliative care), or implementing de-escalation procedures when improvement occurs are of paramount importance in the ongoing management of severe COVID-19 cases. Organizational issues, such as the most appropriate setting for management and monitoring of the severe COVID-19 patient or protective measures to prevent virus spread to healthcare workers in the presence of aerosol-generating procedures, should also be considered. While many early clinical guidelines during the pandemic were based on previous experience with acute respiratory distress syndrome, the landscape has evolved since then. Today, we have a wealth of high-quality studies that support evidence-based recommendations to address these complex issues. This document, the result of a collaborative effort between four leading scientific societies (SEDAR, SEMES, SEMICYUC, SEPAR), draws on the experience of 25 experts in the field to synthesize knowledge to address pertinent clinical questions and refine the approach to patient care in the face of the challenges posed by severe COVID-19 infection.
Collapse
Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Oscar Peñuelas
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Medicina Intensiva Hospital Universitario de Getafe, Madrid, Spain
| | - Carlos Ferrando
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Department of Anesthesia and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
| | - Sarah Béatrice Heili-Frades
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario Fundación Jiménez Díaz Quirón Salud, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), CIBERES, REVA Network, Madrid, Spain
| | | | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | | | - Olga Mediano
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Sleep Unit, Pneumology Department. Hospital Universitario de Guadalajara, Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), Universidad de Alcalá, Madrid, Spain
| | - Oriol Roca
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Parc Taulí-I3PT, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Javier García Fernández
- Servicio de Anestesiología, UCI Quirúrgica y U. Dolor. H. U. Puerta de Hierro, Madrid, Spain
| | | | | | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - Teresa Millán
- Servicio de Medicina Intensiva Hospital Universitario Son Espases, Facultad de Medicina de las Islas Baleares, Spain
| | - Miquel Ferrer Monreal
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; UVIIR, Servei de Pneumologia, Institut de Respiratori, Clínic Barcelona, IDIBAPS. Universitat de Barcelona, Barcelona, Spain
| | | |
Collapse
|
14
|
Montserrat-Capdevila J, Fornells-Barberà I, Roso-Llorach A, Olivares-Sanzo P, Romero-Gracia A, Ichart JX. [Impact of COVID-19 on the mental health of the population: Study in primary care]. Aten Primaria 2024; 56:102813. [PMID: 38039619 PMCID: PMC10711385 DOI: 10.1016/j.aprim.2023.102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE To determine the prevalence of COVID-19 and the characteristics of infected patients, as well as the prevalence of mental disorders associated with the infection and the associated risk factors. Secondary: to know the prevalence of the long COVID syndrome and the characteristics of this cohort. DESIGN Incidence study of mental disorder in patients diagnosed with COVID-19 and case-control study of long COVID syndrome in the subsample of patients diagnosed with COVID-19 without a history of mental disorder. SITE: Primary care setting in Lleida. PARTICIPANTS The 46,258 patients diagnosed of COVID-19 without a history of mental disorder were followed for 2 years. MAIN MEASUREMENTS The dependent variable was the mental disorder in the period 03/11/2020 to 03/11/2022; and the independent variables were clinical and social variables. Its association with mental disorder was analyzed by calculating the adjusted hazard ratio using a logistic regression model. RESULTS The average age of 46,258 patients at the beginning of the study was 43±17.9 years. 47% were women. The mental disorder rate for all period was 3.46% (59.20% anxiety). A predictive score was elaborated. The long COVID syndrome was more common in older women, without toxic habits, with obesity and associated comorbidity. CONCLUSIONS COVID-19 has had an impact on the mental health of patients. Knowing the risk factors for developing these mental disorders and the long COVID syndrome would allow the clinician to be able to identify patients at risk in order to establish preventive measures and avoid their appearance.
Collapse
Affiliation(s)
- Josep Montserrat-Capdevila
- Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària (UDMAFIC) Lleida, Lleida, España; Fundació d'Investigació en Atenció Primària Jordi Gol, Institut per a la recerca a l'Atenció Primària de Salut (IDIAP), Barcelona, España; Atenció Primària Lleida, Institut Català de la Salut (ICS), Lleida, España; Facultat de Medicina, Universitat de Lleida (UdL), Lleida, España.
| | - Immaculada Fornells-Barberà
- Equip d'Assessorament i d'Orientació Psicopedagògic (EAP) Ll-02 Segrià (Sector B). Departament d'Educació, Generalitat de Catalunya, España
| | - Albert Roso-Llorach
- Fundació d'Investigació en Atenció Primària Jordi Gol, Institut per a la recerca a l'Atenció Primària de Salut (IDIAP), Barcelona, España; Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, España
| | - Pau Olivares-Sanzo
- Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària (UDMAFIC) Lleida, Lleida, España; Fundació d'Investigació en Atenció Primària Jordi Gol, Institut per a la recerca a l'Atenció Primària de Salut (IDIAP), Barcelona, España; Atenció Primària Lleida, Institut Català de la Salut (ICS), Lleida, España
| | - Albert Romero-Gracia
- Fundació d'Investigació en Atenció Primària Jordi Gol, Institut per a la recerca a l'Atenció Primària de Salut (IDIAP), Barcelona, España; Atenció Primària Lleida, Institut Català de la Salut (ICS), Lleida, España
| | - J Xavier Ichart
- Àrea de Gestió Clínica, Direcció d'Atenció Primària Lleida, Institut Català de la Salut (ICS), Lleida, España; Fundació d'Investigació en Atenció Primària Jordi Gol, Institut per a la recerca a l'Atenció Primària de Salut (IDIAP), Barcelona, España
| |
Collapse
|
15
|
Koch JJ, Beeler PE, Marak MC, Hug B, Havranek MM. An overview of reviews and synthesis across 440 studies examines the importance of hospital readmission predictors across various patient populations. J Clin Epidemiol 2024; 167:111245. [PMID: 38161047 DOI: 10.1016/j.jclinepi.2023.111245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/06/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The scientific literature contains an abundance of prediction models for hospital readmissions. However, no review has yet synthesized their predictors across various patient populations. Therefore, our aim was to examine predictors of hospital readmissions across 13 patient populations. STUDY DESIGN AND SETTING An overview of systematic reviews was combined with a meta-analytical approach. Two thousand five hundred four different predictors were categorized using common ontologies to pool and examine their odds ratios and frequencies of use in prediction models across and within different patient populations. RESULTS Twenty-eight systematic reviews with 440 primary studies were included. Numerous predictors related to prior use of healthcare services (odds ratio; 95% confidence interval: 1.64; 1.42-1.89), diagnoses (1.41; 1.31-1.51), health status (1.35; 1.20-1.52), medications (1.28; 1.13-1.44), administrative information about the index hospitalization (1.23; 1.14-1.33), clinical procedures (1.20; 1.07-1.35), laboratory results (1.18; 1.11-1.25), demographic information (1.10; 1.06-1.14), and socioeconomic status (1.07; 1.02-1.11) were analyzed. Diagnoses were frequently used (in 37.38%) and displayed large effect sizes across all populations. Prior use of healthcare services showed the largest effect sizes but were seldomly used (in 2.57%), whereas demographic information (in 13.18%) was frequently used but displayed small effect sizes. CONCLUSION Diagnoses and patients' prior use of healthcare services showed large effects both across and within different populations. These results can serve as a foundation for future prediction modeling.
Collapse
Affiliation(s)
- Janina J Koch
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland
| | - Patrick E Beeler
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland
| | - Martin Chase Marak
- Currently an Independent Researcher, Previously at Texas A&M University, 400 Bizzell St, College Station, TX 77843, USA
| | - Balthasar Hug
- Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland; Cantonal Hospital Lucerne, Department of Internal Medicine, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Michael M Havranek
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland.
| |
Collapse
|
16
|
Mahfouz HA, Alhazmi NF, Almatrafi MK, Almehmadi SS, Alharbi JK, Qadi LR, Tawakul A. The Influence of Lifestyle on Academic Performance Among Health Profession Students at Umm Al-Qura University. Cureus 2024; 16:e56759. [PMID: 38650788 PMCID: PMC11033961 DOI: 10.7759/cureus.56759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
Background and aim A healthy lifestyle is defined as a way of living that reduces the likelihood of severe illness or early death. Factors required for a healthy lifestyle, such as regular physical activity, better sleep patterns, improved dietary habits, probable caffeine consumption, and decreased feelings of anxiety, are generally assumed to be important for high academic performance. This study aims to investigate the correlation between a healthy lifestyle and academic success among health profession students at Umm Al-Qura University, Saudi Arabia. By doing so, we could potentially lead to the implementation of targeted interventions to support students in achieving their best academic potential. Methods This is an observational cross-sectional study conducted among health profession students at Umm Al-Qura University. An online questionnaire was used to collect data on demographic information and the impact of lifestyle characteristics on academic performance from October to November 2023. Data were analyzed using RStudio (R version 4.3.1). Results A total of 652 students participated in the study. The majority were between the ages of 18 and 25 years (97.2%, n=634). Females constituted the majority of the participants (69.9%, n=456). Regarding the field of study, the College of Medicine had the highest representation (52.9%, n=345). Regarding body mass index, the normal weight category was the most prevalent, encompassing 59.8% (n=390) of the participants. The results show that the participants generally had a good grade point average (GPA) in the range of 3.50 to 4.00. Also, the time spent on social media applications was not correlated with academic performance (P=0.575). Importantly, the majority of participants perceived that lifestyle habits impacted their academic performance. Conclusion This study found that unhealthy lifestyle factors, such as lack of physical activity, inadequate sleep, poor dietary choices, smoking, and mental health issues such as anxiety, have a negative impact on academic performance. Therefore, the dissemination of relevant knowledge is needed to promote the importance of a healthy lifestyle and raise students' awareness.
Collapse
Affiliation(s)
- Huda A Mahfouz
- College of Medicine, Umm Al-Qura University, Al-Qunfudah, SAU
| | | | | | | | | | - Lyan R Qadi
- College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Abdullah Tawakul
- Faculty of Medicine, Department of Medicine, Umm Al-Qura University, Makkah, SAU
| |
Collapse
|
17
|
Oberste M, Asenova T, Ernst A, Shah-Hosseini K, Schnörch N, Buess M, Rosenberger KD, Kossow A, Dewald F, Neuhann F, Hellmich M. Results of the Cologne Corona Surveillance (CoCoS) project- a cross-sectional study: survey data on risk factors of SARS-CoV-2 infection, and moderate-to-severe course in primarily immunized adults. BMC Public Health 2024; 24:548. [PMID: 38383381 PMCID: PMC10882740 DOI: 10.1186/s12889-024-17958-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Amidst the COVID-19 pandemic, vaccination has been a crucial strategy for mitigating transmission and disease severity. However, vaccine-effectiveness may be influenced by various factors, including booster vaccination, as well as personal factors such as age, sex, BMI, smoking, and comorbidities. To investigate the potential effects of these factors on SARS-CoV-2 infection and disease severity, we analyzed data from the third round of the Cologne Corona Surveillance (CoCoS) project, a large cross-sectional survey. METHODS The study was conducted mid-February to mid-March 2022 in Cologne, Germany. A random sample of 10,000 residents aged 18 years and older were invited to participate in an online survey. Information on participants' demographics (age, sex), SARS-CoV-2 infections, vaccination status, smoking, and preexisting medical conditions were collected. The outcomes of the study were: (1) the occurrence of SARS-CoV-2 infection despite vaccination (breakthrough infection) and (2) the occurrence of moderate-to-severe disease as a result of a breakthrough infection. Cox proportional-hazards regression was used to investigate possible associations between the presence/absence of booster vaccination, personal factors and the occurrence of SARS-CoV-2 infection. Associations with moderate-to-severe infection were analyzed using the Fine and Gray subdistribution hazard model. RESULTS A sample of 2,991 residents responded to the questionnaire. A total of 2,623 primary immunized participants were included in the analysis of breakthrough infection and 2,618 in the analysis of SARS-CoV-2 infection severity after exclusions due to incomplete data. The multivariable results show that booster vaccination (HR = 0.613, 95%CI 0.415-0.823) and older age (HR = 0.974, 95%CI 0.966-0.981) were associated with a reduced hazard of breakthrough infection. Regarding the severity of breakthrough infection, older age was associated with a lower risk of moderate-to-severe breakthrough infection (HR = 0.962, 95%CI0.949-0.977). Female sex (HR = 2.570, 95%CI1.435-4.603), smoking (HR = 1.965, 95%CI1.147-3.367) and the presence of chronic lung disease (HR = 2.826, 95%CI1.465-5.450) were associated with an increased hazard of moderate-to-severe breakthrough infection. CONCLUSION The results provide a first indication of which factors may be associated with SARS-CoV-2 breakthrough infection and moderate-to-severe course of infection despite vaccination. However, the retrospective nature of the study and risk of bias in the reporting of breakthrough infection severity limit the strength of the results. TRIAL REGISTRATION DRKS.de, German Clinical Trials Register (DRKS), Identifier: DRKS00024046, Registered on 25 February 2021.
Collapse
Affiliation(s)
- Max Oberste
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Teodora Asenova
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Nadja Schnörch
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | | | - Kerstin Daniela Rosenberger
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Annelene Kossow
- Cologne Health Authority, Cologne, Germany
- Institute of Hygiene, University Hospital of Muenster, University Muenster, Robert-Koch-Straße 49, 48149, Muenster, Germany
| | - Felix Dewald
- Institute of Virology, Medical Faculty and University Hospital of Cologne, University of Cologne, Fürst-Pückler-Straße 56, 50935, Cologne, Germany
| | - Florian Neuhann
- Cologne Health Authority, Cologne, Germany
- Heidelberg Institute of Global Health, University Heidelberg, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany.
| |
Collapse
|
18
|
AlRabeeah SM, Alzahrani EM, Aldhahir AM, Siraj RA, Alqarni AA, AlDraiwiesh IA, Alqahtani AS, Almqati BS, Alharbi TG, Almuntashiri AA, Alghamdi SM, Aljohani FE, Almulhim MA, Alshehri AF, Naser AY, Alwafi H, Alobaidi NY, Hjazi AM, Alsulaimani MA, Oyelade T, Alahmari M, Alanazi TM, Almeshari MA, Alqahtani JS. A population-based study of 15,000 people on Knowledge and awareness of lung cancer symptoms and risk factors in Saudi Arabia. Front Oncol 2024; 14:1295847. [PMID: 38450193 PMCID: PMC10916300 DOI: 10.3389/fonc.2024.1295847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024] Open
Abstract
Background Lung cancer is currently the most fatal form of cancer worldwide, ranking as the fourth most prevalent type in Saudi Arabia, particularly among males. This trend is expected to increase with growing population, lifestyle changes, and aging population. Understanding the awareness of the Saudi population regarding the risk factors and symptoms of lung cancer is necessary to attenuate the predicted increase in cases. Method A cross-sectional, population-based survey was performed using a previously validated questionnaire (Lung CAM). Multiple linear regression analysis was used to assess variables associated with deficiency in knowledge and awareness of risk factors and symptoms of lung cancer. Results Majority of the 15,099 respondents were male (65%), aged between 18 and 30 years (53%), 50% of which were educated up to a bachelor's degree level. Overall awareness of lung cancer signs and symptoms was 53%, with painful cough and coughing up blood being the best-known symptoms. Conversely, persistent shoulder pain (44%) and clubbing fingers (47%) were the least known lung cancer symptoms. Also, 60% of the respondents showed low confidence in identifying the signs and symptoms of lung cancer. The overall awareness of the risk factors for lung cancer development was 74%, with first-hand (74%) and second-hand (68%) smoking being the most known risk factors. However, only ≤ 62% know the other non-smoking risk factors. Awareness of the risk factors and symptoms of lung cancer depended on age, gender, education, marital and employment status (p < 0.001). Conclusion Public awareness of the risk factors and symptoms of lung cancer in Saudi Arabia is inadequate and heavily dependent on education and socio-economic status. Awareness can be improved through campaigns to raise awareness about other lesser-known lung cancer risk factors and symptoms.
Collapse
Affiliation(s)
- Saad M. AlRabeeah
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Eidan M. Alzahrani
- Department of Physical Therapy, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Rayan A. Siraj
- Respiratory Therapy Department, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdullah A. Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ibrahim A. AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdullah S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Badr S. Almqati
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Turki G. Alharbi
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | | | - Saeed M. Alghamdi
- Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Fahad E. Aljohani
- Pediatric Department, Khobar Governmental Hospital, Khobar, Saudi Arabia
| | | | - Ali F. Alshehri
- Preventive Medicine Department, Khobar Primary Health Care Centers, Khobar, Saudi Arabia
| | - Abdallah Y. Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | - Nowaf Y. Alobaidi
- Respiratory Therapy Department, King Saud bin Abdulaziz University for Health Sciences, Alahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Alahsa, Saudi Arabia
| | - Ahmed M. Hjazi
- Department of Medical Laboratory Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mujahid A. Alsulaimani
- Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Tope Oyelade
- University College London (UCL) Division of Medicine, London, United Kingdom
| | - Mushabbab Alahmari
- Department of Respiratory Therapy, University of Bisha, Bisha, Saudi Arabia
| | - Turki M. Alanazi
- Respiratory Therapy Department, King Saud bin Abdulaziz University for Health Sciences, Alahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Alahsa, Saudi Arabia
| | - Mohammed A. Almeshari
- Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| |
Collapse
|
19
|
Bogart M, Leung GYH, Cyhaniuk A, DiRocco K. Inpatient Admissions and Re-Admissions in Medicare Beneficiaries Initiating Umeclidinium/Vilanterol or Tiotropium Therapy. Int J Chron Obstruct Pulmon Dis 2024; 19:439-450. [PMID: 38374817 PMCID: PMC10874883 DOI: 10.2147/copd.s436654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/10/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose Patients with chronic obstructive pulmonary disease (COPD) who are hospitalized are more likely to die from their illness and have increased likelihood of re-admission than those who are not. Subsequent re-admissions further increase the burden on healthcare systems. This study compared inpatient admission rates and time-to-first COPD-related inpatient admission among Medicare beneficiaries with COPD indexed on umeclidinium/vilanterol (UMEC/VI) versus tiotropium (TIO). Patients and Methods This retrospective study used the All-Payer Claims Database to investigate hospital admission and re-admission outcomes in Medicare beneficiaries with COPD with an initial pharmacy claim for UMEC/VI or TIO from 1 January 2015 to 28 February 2020. Inpatient admissions, baseline, and follow-up variables were assessed in patients indexed on UMEC/VI and TIO after propensity score matching (PSM), with time-to-first on-treatment COPD-related inpatient admission as the primary endpoint. Re-admissions were assessed among patients with a COPD-related inpatient admission in the 30- and 90-days post-discharge. Results Post-PSM, 7152 patients indexed on UMEC/VI and 7069 on TIO were eligible for admissions analysis. The mean (standard deviation [SD]) time-to-first COPD-related inpatient admission was 46.71 (87.99) days for patients indexed on UMEC/VI and 44.96 (85.90) days for those on TIO (p=0.06). The mean (SD) number of inpatient admissions per patient was 1.24 (2.92) for patients indexed on UMEC/VI and 1.26 (3.05) for those on TIO (p=0.49). Proportion of patients undergoing re-admissions was similar between treatments over both 30 and 90 days, excluding a significantly lower proportion of patients indexed on UMEC/VI than those indexed on TIO for COPD-related re-admissions for hospital stays of 4-7 days and 7-14 days, and all-cause re-admissions for stays of 4-7 days. Conclusion Patients with COPD using Medicare in the US and receiving UMEC/VI or TIO reported similar time-to-first inpatient admission and similar proportion of re-admissions.
Collapse
Affiliation(s)
- Michael Bogart
- Customer Engagement, Value, Evidence and Outcomes (CEVEO) US Medical Affairs, GSK, Research Triangle Park, NC, USA
| | | | | | | |
Collapse
|
20
|
Guimarães AP, Seidel H, Pires LVDM, Trindade CO, Baleeiro RDS, Souza PMD, Silva FGDE, Coelho DB, Becker LK, Oliveira ECD. GABA Supplementation, Increased Heart-Rate Variability, Emotional Response, Sleep Efficiency and Reduced Depression in Sedentary Overweight Women Undergoing Physical Exercise: Placebo-Controlled, Randomized Clinical Trial. J Diet Suppl 2024:1-15. [PMID: 38321713 DOI: 10.1080/19390211.2024.2308262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Gamma-aminobutyric acid (GABA) serves as a pivotal neurotransmitter implicated in the pathogenesis of stress, anxiety, sleep-related disorders, and heart rate (HR) reactions. Heart-rate variability (HRV), modulated by the sympathetic and parasympathetic branches of the autonomic nervous system (ANS), offers insights into cardiac autonomic control and cardiovascular well-being. The present study aimed to explore the impact of GABA supplementation on emotional metrics, sleep quality, and HRV in sedentary women with overweight or obesity partaking in physical exercise. A randomized, double-blind, placebo-controlled clinical trial was undertaken involving 30 sedentary women with overweight or obesity. Volunteers were assigned randomly to two groups: the intervention group receiving GABA (200 mg) once daily for a total of 90 supplementation doses, and the placebo group. Both groups engaged in physical exercise, while the supplementation regimen spanned 90 days. Assessments were conducted at three intervals: baseline (T0), midway through the study (T45), and study culmination (T90). Following 90 days of GABA supplementation, the intervention group demonstrated enhancements in habitual sleep efficiency, as indicated by reductions in Pittsburgh Sleep Quality Index (PSQI) scores. Moreover, an improved emotional response was observed, characterized by diminished negative affect. GABA supplementation yielded ameliorations in depression scores as per the Depression, Anxiety, and Stress Scale (DASS-21). Notably, an augmented HRV was noted, attributed to heightened parasympathetic autonomic nervous system predominance. GABA supplementation elicited noteworthy enhancements in heart rate variability, emotional response, depression mitigation, and sleep efficiency following a 90-day supplementation.
Collapse
Affiliation(s)
| | - Helen Seidel
- Medicine Department, Medicine School, Federal University of Ouro Preto, Ouro Preto, Brazil
| | | | - Cristina Oliveira Trindade
- Postgraduate Program in Health and Nutrition/PPGSN, Federal University of Ouro Preto, Ouro Preto, Brazil
| | | | | | | | - Daniel Barbosa Coelho
- Postgraduate Program in Health and Nutrition/PPGSN, Federal University of Ouro Preto, Ouro Preto, Brazil
- Physical Education Department, Physical Education School, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Lenice Kappes Becker
- Postgraduate Program in Health and Nutrition/PPGSN, Federal University of Ouro Preto, Ouro Preto, Brazil
- Physical Education Department, Physical Education School, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Emerson Cruz de Oliveira
- Postgraduate Program in Health and Nutrition/PPGSN, Federal University of Ouro Preto, Ouro Preto, Brazil
- Physical Education Department, Physical Education School, Federal University of Ouro Preto, Ouro Preto, Brazil
| |
Collapse
|
21
|
Nishioki T, Sato T, Okajima A, Motomura H, Takeshige T, Watanabe J, Yae T, Koyama R, Kido K, Takahashi K. Impact of the COVID-19 pandemic on COPD exacerbations in Japanese patients: a retrospective study. Sci Rep 2024; 14:2792. [PMID: 38307984 PMCID: PMC10837154 DOI: 10.1038/s41598-024-53389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/31/2024] [Indexed: 02/04/2024] Open
Abstract
Various infection control measures implemented during the coronavirus disease (COVID-19) pandemic have reduced the number of respiratory infections, which are the most common cause of chronic obstructive pulmonary disease (COPD) exacerbations. Here, we investigated whether infectious disease prevention during the COVID-19 pandemic reduced COPD exacerbations and the characteristics of patients exhibiting exacerbations before and during the COVID-19 pandemic. We included outpatients and inpatients with moderate or severe COPD exacerbations who required systemic steroids between April 1, 2018 and March 31, 2022. Their medical records were retrospectively compared and analyzed in 2-year intervals (before and during the COVID-19 pandemic). During the 4-year observation period, 70,847 outpatients and 2,772 inpatients were enrolled; 55 COPD exacerbations were recorded. The number of COPD exacerbations decreased from 36 before to 19 during the COVID-19 pandemic. Regarding the characteristics of patients with exacerbations, the % forced expiratory volume in one second (52.3% vs. 38.6%, P = 0.0224) and body mass index (BMI) (22.5 vs. 19.3, P = 0.0127) were significantly lower during the COVID-19 pandemic than before the pandemic. The number of COPD exacerbations during the pandemic decreased. Additionally, the tendency for a reduction in COPD exacerbation was greatest in patients with preserved lung function or above-standard BMI patients.
Collapse
Affiliation(s)
- Toshihiko Nishioki
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan.
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Tadashi Sato
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Akifumi Okajima
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Hiroaki Motomura
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Tomohito Takeshige
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Junko Watanabe
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Toshifumi Yae
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Ryo Koyama
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Kenji Kido
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| |
Collapse
|
22
|
Seo C, Kaur S, Thornton CS. Bronchiectasis and COVID-19: For Better or for Worse? Ann Am Thorac Soc 2024; 21:208-210. [PMID: 38299923 PMCID: PMC10848909 DOI: 10.1513/annalsats.202312-1018ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Affiliation(s)
| | - Simarpreet Kaur
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Christina S Thornton
- Department of Medicine and
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|
23
|
Siu DCH, Gafni-Lachter L. Addressing Barriers to Chronic Obstructive Pulmonary Disease (COPD) Care: Three Innovative Evidence-Based Approaches: A Review. Int J Chron Obstruct Pulmon Dis 2024; 19:331-341. [PMID: 38317666 PMCID: PMC10843977 DOI: 10.2147/copd.s426050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a preventable yet widespread and profoundly debilitating respiratory condition, exerting substantial personal and global health ramifications alongside significant economic implications. The first objective of this literature review was to identify reviews the barriers to optimal COPD care, categorizing them into personal patient factors, professional awareness and knowledge, patient-professional relationships, and healthcare service models, including access to care that significantly impacts the quality of COPD management. The second objective was to introduce three approaches for enhancing COPD care outcomes: Self-Management Educational Programs, Health Qigong, and Telehealth service provision, each demonstrating positive effects on COPD patients' health status. These evidence-based interventions offer promising avenues for enhancing COPD care and patient outcomes. Integrating these approaches into comprehensive COPD management strategies holds potential for improving the well-being and quality of life of individuals living with this chronic condition.
Collapse
Affiliation(s)
- Damian Chi Hong Siu
- Boston University, Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA
| | - Liat Gafni-Lachter
- Boston University, Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA
| |
Collapse
|
24
|
Poucineau J, Khlat M, Lapidus N, Espagnacq M, Chouaïd C, Delory T, Le Coeur S. Impact of the COVID-19 Pandemic on COPD Patient Mortality: A Nationwide Study in France. Int J Public Health 2024; 69:1606617. [PMID: 38362309 PMCID: PMC10868525 DOI: 10.3389/ijph.2024.1606617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives: We investigated the mortality patterns of chronic obstructive pulmonary disease (COPD) patients in France relative to a control population, comparing year 2020 to pre-pandemic years 2017-2019. Methods: COPD patient and sex, age and residence matched control cohorts were created from the French National Health Data System. Survival was analyzed using Cox regressions and standardized rates. Results: All-cause mortality increased in 2020 compared to 2019 in the COPD population (+4%), but to a lesser extent than in the control population (+10%). Non-COVID-19 mortality decreased to a greater extent in COPD patients (-5%) than in the controls (-2%). Death rate from COVID-19 was twice as high in the COPD population relative to the control population (547 vs. 279 per 100,000 person-years). Conclusion: The direct impact of the pandemic in terms of deaths from COVID-19 was much greater in the COPD population than in the control population. However, the larger decline in non-COVID-19 mortality in COPD patients could reflect a specific protective effect of the containment measures on this population, counterbalancing the direct impact they had been experiencing.
Collapse
Affiliation(s)
- Jonas Poucineau
- Institut National d’Études Démographiques (INED), Paris, France
- Institut de Recherche et Documentation en Économie de la Santé (IRDES), Paris, France
| | - Myriam Khlat
- Institut National d’Études Démographiques (INED), Paris, France
| | - Nathanaël Lapidus
- Faculté de Santé, Sorbonne Université, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1136 Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Hôpital Saint-Antoine, Paris, France
| | - Maude Espagnacq
- Institut de Recherche et Documentation en Économie de la Santé (IRDES), Paris, France
| | - Christos Chouaïd
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955 Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Hospital Center Intercommunal De Créteil, Créteil, France
| | - Tristan Delory
- Institut National d’Études Démographiques (INED), Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1136 Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Centre Hospitalier Annecy Genevois (CH Annecy), Metz-Tessy, France
| | - Sophie Le Coeur
- Institut National d’Études Démographiques (INED), Paris, France
| |
Collapse
|
25
|
Beeh KM, Scheithe K, Schmutzler H, Krüger S. Real-World Effectiveness of Fluticasone Furoate/Umeclidinium/Vilanterol Once-Daily Single-Inhaler Triple Therapy for Symptomatic COPD: The ELLITHE Non-Interventional Trial. Int J Chron Obstruct Pulmon Dis 2024; 19:205-216. [PMID: 38249826 PMCID: PMC10800114 DOI: 10.2147/copd.s427770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose Real-life effectiveness data on once-daily single-inhaler triple therapy (odSITT) with the inhaled corticosteroid fluticasone furoate (FF), the long-acting muscarinic antagonist umeclidinium (UMEC), and the long-acting β2-agonist vilanterol (VI) in patients with chronic obstructive pulmonary disease (COPD) are important to complement evidence from well-controlled randomized clinical trials. Effectiveness of odSITT was quantified by assessing health status and symptoms in usual care. Patients and Methods ELLITHE was a single-country (Germany), multicenter, open-label, non-interventional effectiveness study between 2020 and 2022, evaluating the effect of treatment initiation with FF/UMEC/VI 100/62.5/25 µg once-daily via the ELLIPTA inhaler on improvements in clinical outcomes versus baseline in COPD patients. The primary endpoint was the change in the total COPD Assessment Test (CAT) score between baseline and month 12. Key secondary endpoints included change in CAT score over time, occurrence of exacerbations until month 12, changes in forced expiratory volume in one second (FEV1), inhaler adherence, and safety. Results Nine hundred and six patients were included (age 66.6 years, 55.6% male, mean FEV1 52.6% of predicted, mean CAT 21.5 units, 1.4 exacerbations/year pre-study). About 63.9% of patients were escalated from dual therapies, and 18% were switched from multiple-inhaler triple therapies. Reductions in CAT score at month 12 were statistically significant and above the threshold of clinical importance (-2.6 units; p < 0.0001). CAT score also improved at interim visits. CAT improvements were more pronounced in patients with high baseline scores and better inhaler adherence. Exacerbations during follow-up were rare (0.2 events/year) compared to pre-study (1.4 events/year). FEV1 was improved by 93 mL (p < 0.0001). No new safety effects were observed. Conclusion In usual care, treatment with odSITT resulted in significant and clinically relevant improvements of CAT score and FEV1 in COPD patients, regardless of the occurrence of exacerbations. These findings challenge the current guideline recommendations for SITT only in patients experiencing exacerbations.
Collapse
Affiliation(s)
| | - Karl Scheithe
- Department of Biostatistics, GKM Gesellschaft Für Therapieforschung mbH, Munich, Germany
| | | | - Saskia Krüger
- Medical Department, BERLIN-CHEMIE AG, Berlin, Germany
| |
Collapse
|
26
|
Alqarni AA, Badr OI, Aldhahir AM, Alqahtani JS, Siraj RA, Naser AY, Alghamdi AS, Majrshi M, Alghamdi SM, Alyami MM, Alghamdi SA, Alwafi H. Obesity Prevalence and Association with Spirometry Profiles, ICU Admission, and Comorbidities Among Patients with COPD: Retrospective Study in Two Tertiary Centres in Saudi Arabia. Int J Chron Obstruct Pulmon Dis 2024; 19:111-120. [PMID: 38249824 PMCID: PMC10799648 DOI: 10.2147/copd.s442851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Background Obesity is common among chronic obstructive pulmonary disease (COPD) patients and is associated with an increase in acute exacerbation episodes. However, data on obesity's impact on and association with clinical outcomes among patients with COPD are limited. This study aimed to determine overweight and obesity prevalence and associations with spirometry profiles, intensive care unit (ICU) admission, and comorbidities in patients with COPD. Methods In this retrospective cohort study, we reviewed the electronic health records of adult individuals diagnosed with COPD who visited the studied pulmonary clinics between 1 January 2018 and 31 December 2022 and then collected key demographic variables and relevant clinical outcomes and comorbidities. Results A total of 474 patients with COPD were included in the final analysis, of whom 60% were male. The occurrences of overweight and obesity were 32.7% and 38.2%, respectively. The presence of comorbidities was high in obese patients (78.4%), followed by overweight patients (63.8%) with COPD. Obese and overweight patients had the highest ward admission rates (38.3% and 34.2%, respectively). ICU admissions were higher in obese and overweight patients (16% and 12%, respectively) compared with normal-weight patients (9%). Although no significant correlation was found between body mass index and spirometry parameters, comorbidities and ICU admission were linked to overweight and obesity in COPD patients (AOR: 1.82 95% CI: 1.15 to 2.86 and AOR: 3.34 95% CI 1.35 to 8.22, respectively). Conclusion Our findings imply that obesity in COPD is prevalent and is associated with adverse clinical outcomes including a greater number of comorbidities and higher rates of hospitalization and admission to ICUs although no associations were found between body weight and spirometry parameters. Further studies are needed to assess whether implementing and optimising obesity screening and management at an early stage in COPD can prevent further deterioration.
Collapse
Affiliation(s)
- Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Respiratory Therapy Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Omaima I Badr
- Department of Chest Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Department of Pulmonary Medicine, Al Noor Specialist Hospital, Mecca, Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Rayan A Siraj
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al Ahsa, Saudi Arabia
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Abdulrhman S Alghamdi
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mansour Majrshi
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Saeed M Alghamdi
- Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohammed M Alyami
- Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia
| | - Sara A Alghamdi
- Respiratory Care Department, AlSalama Hospital, Jeddah, Saudi Arabia
| | - Hassan Alwafi
- Department of Clinical Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| |
Collapse
|
27
|
Bitar A, Barakat F, Hawat A, Alsaid B. Dietary and smoking habits during the exam period and their effect on the academic achievement among Syrian medical students. BMC Med Educ 2024; 24:60. [PMID: 38216913 PMCID: PMC10785519 DOI: 10.1186/s12909-023-04950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/07/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Dietary habits are crucial for maintaining overall health and have been shown to impact academic performance. However, little research has been conducted on the specific eating, drinking, and smoking habits during the exam period and their effect on academic performance. Therefore, this study aimed to investigate dietary and smoking habits and their relationship with academic performance among medical students at Damascus University. Findings from this study can inform interventions to improve both dietary habits and academic performance. METHODS A cross-sectional design was used to investigate the association between dietary habits during the exam period and academic performance among 608 medical students. Data were collected using a self-administered paper-based questionnaire that was randomly distributed across multiple classes. The statistical analysis employed Spearman's rank correlation and multiple linear regression to examine the relationship between the different amounts of diet behaviour during the exams and the reported average students' grades from the last two semesters. The regression model was adjusted for age, sex, residency type, and residency partners. RESULTS In both Spearman's rank correlation and multiple linear regression analyses, we observed consistent negative associations between specific dietary habits and self-reported average grades. These included daily consumption of tea (B = -0.334, p = 0.022), instant coffee (B = -0.682, p = 0.001), and weekly fast food consumption (B = -0.583, p = 0.038). Notably, traditional coffee was found to be significant in the Spearman analysis but did not exhibit significance in the regression analysis. Furthermore, the regression analysis revealed a negative association between water pipe consumption and academic performance (B = -0.700, p = 0.049). No significant association was observed between other dietary habits, cigarette smoking, and academic performance. CONCLUSIONS The study highlights a negative, but weak, association between academic achievement and specific dietary habits during the exam period. However, further longitudinal studies are needed to establish causal relationships. Additionally, the study suggests exploring the impact of other habits such as study and sleeping habits, which may have a more significant impact on academic achievement.
Collapse
Affiliation(s)
- Anas Bitar
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Fady Barakat
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Angie Hawat
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Bayan Alsaid
- Laboratory of Anatomy, Faculty of Medicine, Damascus University, Damascus, Syria
| |
Collapse
|
28
|
Waters AB, Bottari SA, Jones LC, Lamb DG, Lewis GF, Williamson JB. Regional associations of white matter integrity and neurological, post-traumatic stress disorder and autonomic symptoms in Veterans with and without history of loss of consciousness in mild TBI. Front Neuroimaging 2024; 2:1265001. [PMID: 38268858 PMCID: PMC10806103 DOI: 10.3389/fnimg.2023.1265001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Background Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) share overlapping symptom presentations and are highly comorbid conditions among Veteran populations. Despite elevated presentations of PTSD after mTBI, mechanisms linking the two are unclear, although both have been associated with alterations in white matter and disruptions in autonomic regulation. The present study aimed to determine if there is regional variability in white matter correlates of symptom severity and autonomic functioning in a mixed sample of Veterans with and without PTSD and/or mTBI (N = 77). Methods Diffusion-weighted images were processed to extract fractional anisotropy (FA) values for major white matter structures. The PTSD Checklist-Military version (PCL-M) and Neurobehavioral Symptom Inventory (NSI) were used to determine symptom domains within PTSD and mTBI. Autonomic function was assessed using continuous blood pressure and respiratory sinus arrythmia during a static, standing angle positional test. Mixed-effect models were used to assess the regional specificity of associations between symptom severity and white matter, with FA, global symptom severity (score), and white matter tract (tract) as predictors. Additional interaction terms of symptom domain (i.e., NSI and PCL-M subscales) and loss of consciousness (LoC) were added to evaluate potential moderating effects. A parallel analysis was conducted to explore concordance with autonomic functioning. Results Results from the two-way Score × Tract interaction suggested that global symptom severity was associated with FA in the cingulum angular bundle (positive) and uncinate fasciculus (negative) only, without variability by symptom domain. We also found regional specificity in the relationship between FA and autonomic function, such that FA was positively associated with autonomic function in all tracts except the cingulum angular bundle. History of LoC moderated the association for both global symptom severity and autonomic function. Conclusions Our findings are consistent with previous literature suggesting that there is significant overlap in the symptom presentation in TBI and PTSD, and white matter variability associated with LoC in mTBI may be associated with increased PTSD-spectra symptoms. Further research on treatment response in patients with both mTBI history and PTSD incorporating imaging and autonomic assessment may be valuable in understanding the role of brain injury in treatment outcomes and inform treatment design.
Collapse
Affiliation(s)
- Abigail B. Waters
- Brain Rehabilitation Research Center, North Florida/South Georgia VAMC, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Sarah A. Bottari
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| | - Laura C. Jones
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| | - Damon G. Lamb
- Brain Rehabilitation Research Center, North Florida/South Georgia VAMC, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| | - Gregory F. Lewis
- Socioneural Physiology Lab, Kinsey Institute, Indiana University, Bloomington, IN, United States
| | - John B. Williamson
- Brain Rehabilitation Research Center, North Florida/South Georgia VAMC, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| |
Collapse
|
29
|
Agustí A, Hughes R, Rapsomaki E, Make B, del Olmo R, Papi A, Price D, Benton L, Franzen S, Vestbo J, Mullerova H. The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohort. ERJ Open Res 2024; 10:00895-2023. [PMID: 38348246 PMCID: PMC10860203 DOI: 10.1183/23120541.00895-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 02/15/2024] Open
Abstract
Background The diagnosis of COPD requires the demonstration of non-fully reversible airflow limitation by spirometry in the appropriate clinical context. Yet, there are patients with symptoms and relevant exposures suggestive of COPD with either normal spirometry (pre-COPD) or preserved ratio but impaired spirometry (PRISm). Their prevalence, clinical characteristics and associated outcomes in a real-life setting are unclear. Methods To investigate them, we studied 3183 patients diagnosed with COPD by their attending physician included in the NOVELTY study (clinicaltrials.gov identifier NCT02760329), a global, 3-year, observational, real-life cohort that included patients recruited from both primary and specialist care clinics in 18 countries. Results We found that 1) approximately a quarter of patients diagnosed with (and treated for) COPD in real life did not fulfil the spirometric diagnostic criteria recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), and could be instead categorised as pre-COPD (13%) or PRISm (14%); 2) disease burden (symptoms and exacerbations) was highest in GOLD 3-4 patients (exacerbations per person-year (PPY) 0.82) and lower but similar in those in GOLD 1-2, pre-COPD and PRISm (exacerbations range 0.27-0.43 PPY); 3) lung function decline was highest in pre-COPD and GOLD 1-2, and much less pronounced in PRISm and GOLD 3-4; 4) PRISm and pre-COPD were not stable diagnostic categories and change substantially over time; and 5) all-cause mortality was highest in GOLD 3-4, lowest in pre-COPD, and intermediate and similar in GOLD 1-2 and PRISm. Conclusions Patients diagnosed COPD in a real-life clinical setting present great diversity in symptom burden, progression and survival, warranting medical attention.
Collapse
Affiliation(s)
- Alvar Agustí
- University of Barcelona, Respiratory Institute – Clinic Barcelona, IDIBAPS, and CIBERES, Barcelona, Spain
- These authors contributed equally
| | - Rod Hughes
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
- These authors contributed equally
| | - Eleni Rapsomaki
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Barry Make
- National Jewish Health and University of Colorado Denver, Denver, CO, USA
| | - Ricardo del Olmo
- Diagnostic and Treatment Department, Hospital de Rehabilitaciόn Respiratoria “Maria Ferrer” and IDIM CR, Buenos Aires, Argentina
| | - Alberto Papi
- University of Ferrara, Department of Translation Medicine, Ferrara, Italy
| | - David Price
- Observational and Pragmatic Research Institute, Singapore and Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Laura Benton
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Stefan Franzen
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Jørgen Vestbo
- University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Hana Mullerova
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| |
Collapse
|
30
|
Balavenkataraman A, Saunders H, Helgeson SA. Trends in outcomes of hospitalizations from acute exacerbations of chronic obstructive pulmonary disease during the COVID-19 pandemic. Lung India 2024; 41:77-79. [PMID: 38160468 PMCID: PMC10883440 DOI: 10.4103/lungindia.lungindia_472_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
|
31
|
Shteinberg M, Sibila O, Stein N, Faner R, Jordan A, Olvera N, Sivapalan P, Jensen JUS, Crichton M, Marrades P, Chalmers JD, Meyer CN, Saliba W. Risk of SARS-CoV-2 Infection and Disease Severity Among People With Bronchiectasis: Analysis of Three Population Registries. Chest 2024; 165:79-83. [PMID: 37574165 DOI: 10.1016/j.chest.2023.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/17/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Michal Shteinberg
- Pulmonary Institute and CF Center, Carmel Medical Center, Haifa, Israel; B. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel.
| | - Oriol Sibila
- Respiratory Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Rosa Faner
- Respiratory Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Alexander Jordan
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nuria Olvera
- Respiratory Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pradeesh Sivapalan
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Ulrik S Jensen
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Megan Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, England
| | - Pau Marrades
- Respiratory Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, England
| | - Christian N Meyer
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Medicine, Respiratory Unit, SUH-Roskilde, Copenhagen, Denmark
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel; B. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
32
|
Waeijen-Smit K, Crutsen M, Keene S, Miravitlles M, Crisafulli E, Torres A, Mueller C, Schuetz P, Ringbæk TJ, Fabbian F, Mekov E, Harries TH, Lun CT, Ergan B, Esteban C, Quintana Lopez JM, López-Campos JL, Chang CL, Hancox RJ, Shafuddin E, Ellis H, Janson C, Suppli Ulrik C, Gudmundsson G, Epstein D, Dominguez J, Lacoma A, Osadnik C, Alia I, Spannella F, Karakurt Z, Mehravaran H, Utens C, de Kruif MD, Ko FWS, Trethewey SP, Turner AM, Bumbacea D, Murphy PB, Vermeersch K, Zilberman-Itskovich S, Steer J, Echevarria C, Bourke SC, Lane N, de Batlle J, Sprooten RTM, Russell R, Faverio P, Cross JL, Prins HJ, Spruit MA, Simons SO, Houben-Wilke S, Franssen FME. Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients. ERJ Open Res 2024; 10:00838-2023. [PMID: 38410700 PMCID: PMC10895439 DOI: 10.1183/23120541.00838-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/16/2023] [Indexed: 02/28/2024] Open
Abstract
Background Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden. The aims of the present study were to explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalisation using an individual patient data meta-analysis (IPDMA) design. Methods A systematic review was performed identifying studies that reported in-hospital mortality, post-discharge mortality and hospital readmission rates following ECOPD-related hospitalisation. Data analyses were conducted using a one-stage random-effects meta-analysis model. This study was conducted and reported in accordance with the PRISMA-IPD statement. Results Data of 65 945 individual patients with COPD were analysed. The pooled in-hospital mortality rate was 6.2%, pooled 30-, 90- and 365-day post-discharge mortality rates were 1.8%, 5.5% and 10.9%, respectively, and pooled 30-, 90- and 365-day hospital readmission rates were 7.1%, 12.6% and 32.1%, respectively, with noticeable variability between studies and countries. Strongest predictors of mortality and hospital readmission included noninvasive mechanical ventilation and a history of two or more ECOPD-related hospitalisations <12 months prior to the index event. Conclusions This IPDMA stresses the poor outcomes and high heterogeneity of ECOPD-related hospitalisation across the world. Whilst global standardisation of the management and follow-up of ECOPD-related hospitalisation should be at the heart of future implementation research, policy makers should focus on reimbursing evidence-based therapies that decrease (recurrent) ECOPD.
Collapse
Affiliation(s)
- Kiki Waeijen-Smit
- Department of Research and Development, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Mieke Crutsen
- Pulmonary Function and Exercise Testing Laboratory, MUMC+, Maastricht, the Netherlands
| | - Spencer Keene
- Department of Research and Development, Ciro, Horn, the Netherlands
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Clinical Pharmacy and Toxicology, MUMC+, Maastricht, the Netherlands
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Ernesto Crisafulli
- Respiratory Medicine Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic of Barcelona and University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer, Institución Catalana de Investigación y Estudios Avanzados, CIBERES, Barcelona, Spain
| | - Christian Mueller
- Cardiovascular Research Institute Base, Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Thomas J Ringbæk
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Fabio Fabbian
- Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Evgeni Mekov
- Department of Occupational Diseases, Medical University Sofia, Sofia, Bulgaria
| | - Timothy H Harries
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - Chung-Tat Lun
- Department of Medicine and ICU, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - Begum Ergan
- Dokuz Eylul University, Faculty of Medicine, Department of Pulmonary and Critical Care, Division of Critical Care, Izmir, Turkey
| | - Cristóbal Esteban
- Respiratory Department, Hospital Galdakao, Galdakao, Spain
- Instituto BioCruces-Bizkaia, Barakaldo, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas, Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud, Bizkaia, Spain
| | - Jose M Quintana Lopez
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas, Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud, Bizkaia, Spain
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Catherina L Chang
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Hancox
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Hollie Ellis
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Gunnar Gudmundsson
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - José Dominguez
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERES, Barcelona, Spain
| | - Alicia Lacoma
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERES, Barcelona, Spain
| | | | - Inmaculada Alia
- Intensive Care Units, Hospital Universitario de Getafe, CIBERES, Getafe, Spain
| | - Francesco Spannella
- Internal Medicine and Geriatrics, Hypertension Excellence Centre of the European Society of Hypertension, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University Politecnica delle Marche, Ancona, Italy
| | - Zuhal Karakurt
- Respiratory Critical Care Unit, University of Health Sciences Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hossein Mehravaran
- Pulmonary and Critical Care Division, Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Cecile Utens
- Libra, Rehabilitation and Audiology, Eindhoven, the Netherlands
| | - Martijn D de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel P Trethewey
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- University of Exeter, Exeter, UK
| | - Alice M Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dragos Bumbacea
- Department of Pneumology and Acute Respiratory Care, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Patrick B Murphy
- Lane Fox Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College, London, UK
| | - Kristina Vermeersch
- Department of Chronic Diseases, Metabolism and Ageing, Research Group BREATHE, KU Leuven, Leuven, Belgium
| | - Shani Zilberman-Itskovich
- Nephrology Division, Assaf-Harofeh (Shamir) Medical Center, Be'er Ya'akov, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - John Steer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, North Tyneside General Hospital, North Shields, UK
| | - Carlos Echevarria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Stephen C Bourke
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, North Tyneside General Hospital, North Shields, UK
| | - Nicholas Lane
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (Fundació Dr Pifarré), Lleida, Spain
- CIBERES, Madrid, Spain
| | - Roy T M Sprooten
- Department of Respiratory Medicine, MUMC+, Maastricht, The Netherlands
| | - Richard Russell
- School of Immunology and Microbial Sciences, Guy's Campus, Kings College, London, UK
| | - Paola Faverio
- School of Medicine and Surgery, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Jane L Cross
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Hendrik J Prins
- Department of PMR, Libra, Rehabilitation and Audiology, Eindhoven, The Netherlands
- Department of PMR, Anna Hospital, Geldrop, The Netherlands
- Department of PMR, Catharina Hospital, Eindhoven, The Netherlands
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | | | - Frits M E Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| |
Collapse
|
33
|
Jones AW, King BE, Cumella A, Hopkinson NS, Hurst JR, Holland AE. Use of infection control measures in people with chronic lung disease: mixed methods study. ERJ Open Res 2024; 10:00403-2023. [PMID: 38259806 PMCID: PMC10801757 DOI: 10.1183/23120541.00403-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/16/2023] [Indexed: 01/24/2024] Open
Abstract
Background The introduction of community infection control measures during the COVID-19 pandemic was associated with a reduction in acute exacerbations of lung disease. We aimed to understand the acceptability of continued use of infection control measures among people with chronic lung disease and to understand the barriers and facilitators of use. Methods Australian adults with chronic lung disease were invited to an online survey (last quarter of 2021) to specify infection control measures they would continue themselves post-pandemic and those they perceived should be adopted by the community. A subset of survey participants were interviewed (first quarter of 2022) with coded transcripts deductively mapped to the COM-B model and Theoretical Domains Framework. Results 193 people (COPD 84, bronchiectasis 41, interstitial lung disease 35, asthma 33) completed the survey. Physical distancing indoors (83%), handwashing (77%), and avoidance of busy places (71%) or unwell family and friends (77%) were measures most likely to be continued. Policies for the wider community that received most support were those during the influenza season including hand sanitiser being widely available (84%), wearing of face coverings by healthcare professionals (67%) and wearing of face coverings by the general population on public transport (66%). Barriers to use of infection control measures were related to physical skills, knowledge, environmental context and resources, social influences, emotion, beliefs about capabilities and beliefs about consequences. Conclusions Adults with chronic lung diseases in Australia are supportive of physical distancing indoors, hand hygiene, and avoidance of busy places or unwell family and friends as long-term infection control measures.
Collapse
Affiliation(s)
- Arwel W. Jones
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
| | - Bill E. King
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
| | | | | | - John R. Hurst
- UCL Respiratory, University College London, London, UK
| | - Anne E. Holland
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| |
Collapse
|
34
|
Fox MT, Butler JI. Rural caregivers' preparedness for detecting and responding to the signs of worsening health conditions in recently hospitalised patients at risk for readmission: a qualitative descriptive study. BMJ Open 2023; 13:e076149. [PMID: 38154900 PMCID: PMC10759104 DOI: 10.1136/bmjopen-2023-076149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/17/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES This study aimed to explore informal rural caregivers' perceived preparedness to detect and respond to the signs of worsening health conditions in patients recently discharged from hospital and at risk for readmission. DESIGN A qualitative descriptive design and semistructured interviews were used. Data were thematically analysed. SETTING Data collection occurred in 2018 and 2019 in rural communities in Southwestern and Northeastern Ontario, Canada. PARTICIPANTS The study included sixteen informal caregivers who were all family members of a relative discharged from hospital at high risk for readmission following hospitalisation mostly for a medical illness (63%). Participants were mostly women (87.5%), living with their relative (62.5%) who was most often a parent (56.3%). RESULTS Three themes were identified: (1) warning signs and rural communities, (2) perceived preparedness, and (3) improving preparedness. The first theme elucidates informal caregivers' view that they needed to be prepared because they were taking over care previously provided by hospital healthcare professionals yet lacked accessible medical help in rural communities. The second theme captures informal caregivers' perceptions that they lacked knowledge of how to detect warning signs and how to respond to them appropriately. The last theme illuminates informal caregivers' suggestions for improving preparation related to warning signs. CONCLUSIONS Informal caregivers in rural communities were largely unprepared for detecting and responding to the signs of worsening health conditions for patients at high risk for hospital readmission. Healthcare professionals can anticipate that informal caregivers, particularly those whose relatives live far from medical help, need information on how to detect and respond to warning signs, and may prioritise their time to this aspect of postdischarge care for these caregivers.
Collapse
Affiliation(s)
- Mary T Fox
- School of Nursing, Centre for Aging Research and Education, York University, Toronto, Ontario, Canada
| | - Jeffrey I Butler
- School of Nursing, Centre for Aging Research and Education, York Univ, Toronto, Ontario, Canada
| |
Collapse
|
35
|
Shakeel I, Ashraf A, Afzal M, Sohal SS, Islam A, Kazim SN, Hassan MI. The Molecular Blueprint for Chronic Obstructive Pulmonary Disease (COPD): A New Paradigm for Diagnosis and Therapeutics. Oxid Med Cell Longev 2023; 2023:2297559. [PMID: 38155869 PMCID: PMC10754640 DOI: 10.1155/2023/2297559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/28/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023]
Abstract
The global prevalence of chronic obstructive pulmonary disease (COPD) has increased over the last decade and has emerged as the third leading cause of death worldwide. It is characterized by emphysema with prolonged airflow limitation. COPD patients are more susceptible to COVID-19 and increase the disease severity about four times. The most used drugs to treat it show numerous side effects, including immune suppression and infection. This review discusses a narrative opinion and critical review of COPD. We present different aspects of the disease, from cellular and inflammatory responses to cigarette smoking in COPD and signaling pathways. In addition, we highlighted various risk factors for developing COPD apart from smoking, like occupational exposure, pollutants, genetic factors, gender, etc. After the recent elucidation of the underlying inflammatory signaling pathways in COPD, new molecular targeted drug candidates for COPD are signal-transmitting substances. We further summarize recent developments in biomarker discovery for COPD and its implications for disease diagnosis. In addition, we discuss novel drug targets for COPD that could be explored for drug development and subsequent clinical management of cardiovascular disease and COVID-19, commonly associated with COPD. Our extensive analysis of COPD cause, etiology, diagnosis, and therapeutic will provide a better understanding of the disease and the development of effective therapeutic options. In-depth knowledge of the underlying mechanism will offer deeper insights into identifying novel molecular targets for developing potent therapeutics and biomarkers of disease diagnosis.
Collapse
Affiliation(s)
- Ilma Shakeel
- Department of Zoology, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002, India
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Anam Ashraf
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Mohammad Afzal
- Department of Zoology, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002, India
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania 7248, Australia
| | - Asimul Islam
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Syed Naqui Kazim
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Md. Imtaiyaz Hassan
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| |
Collapse
|
36
|
Liang Y, Sun Y. Awareness of and attitude toward COVID-19 vaccination among individuals with COPD and the strategies to overcome vaccine hesitation: A mini review. Hum Vaccin Immunother 2023; 19:2286686. [PMID: 38059434 PMCID: PMC10732662 DOI: 10.1080/21645515.2023.2286686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) vaccines have a protective effect on individuals with chronic obstructive pulmonary disease (COPD), preventing them from developing severe illnesses and reducing the risk of hospitalization and mortality. However, the coverage rate of COVID-19 vaccination among this population is not satisfactory, which is associated with their lack of awareness of and negative attitudes toward COVID-19 vaccination, that is, vaccine hesitancy. We reviewed recent literatures on the vaccination status of COPD patients and vaccine hesitancy, described the factors related to vaccine hesitancy among COPD patients, and proposed strategies to improve the vaccine coverage, such as providing accurate and consistent vaccine information to the public, patient health education program, improving self-management capabilities, easy access to vaccination service, etc., which can hopefully help to improve patients' ability to cope with SARS-CoV-2 infection and reduce the COVID-19 related mortality.
Collapse
Affiliation(s)
- Ying Liang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
| |
Collapse
|
37
|
Islam R, Ahmed S, Chakma SK, Mahmud T, Al Mamun A, Islam Z, Islam MM. Smoking and pre-existing co-morbidities as risk factors for developing severity of COVID-19 infection: Evidence from a field hospital in a rural area of Bangladesh. PLoS One 2023; 18:e0295040. [PMID: 38064450 PMCID: PMC10707513 DOI: 10.1371/journal.pone.0295040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
Since August 2020; the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in collaboration with UNICEF has been operating a COVID-19 field hospital at the Teknaf sub-district of Cox's Bazar in Bangladesh. This paper is focused on estimating the effects of a history of tobacco smoking and pre-existing co-morbidities on the severity of COVID-19 infection among adult patients admitted into the aforesaid hospital. We conducted a retrospective data analysis of COVID-19 adult patients hospitalized from August 27, 2020 to April 20, 2022. Based on inclusion criteria; a total of 788 admitted patients were included in the analysis. We conducted a Chi-squared test and Fisher's exact test for the categorical variables to see their associations. Multinomial logistic regression models were performed to explore the risk factors for the severity of COVID-19 infection. Among 788 patients, 18.4%, 18.8%, 13%, 7.1%, 3.4%, and 1.9% have had a history of smoking, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVD), and asthma respectively. Overall, the mean age of the patients was 40.3 ± 16.4 years and 51% were female. In multivariate analysis, history of smoking and co-morbidities were identified as the risk factors for the severity of COVID-19 infection; the history of smoking was found linked with an increase in the risk of developing critical, severe, and moderate level of COVID-19 infection- notably 3.17 times (RRR = 3.17; 95% CI: 1.3-7.68), 2.98 times (RRR = 2.98; 95% CI: 1.87-4.76) and 1.96 times (RRR = 1.96; 95% CI: 1.25-3.08) respectively more than the patients who never smoked. It was evident that patients with at least one of the selected co-morbidities such as hypertension, diabetes, COPD, CVD, and asthma exhibited a significantly higher likelihood of experiencing severe illness of COVID-19 compared to patients without any co-morbidity. History of tobacco smoking and pre-existing co-morbidities were significantly associated with an increased severity of COVID-19 infection.
Collapse
Affiliation(s)
- Rashadul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayem Ahmed
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Samar Kishor Chakma
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tareq Mahmud
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdullah Al Mamun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ziaul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M. Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
38
|
Elshafei AA, Flores SA, Kaur R, Becker EA. Respiratory Interventions, Hospital Utilization, and Clinical Outcomes of Persons with COPD and COVID-19. Int J Chron Obstruct Pulmon Dis 2023; 18:2925-2931. [PMID: 38089539 PMCID: PMC10712260 DOI: 10.2147/copd.s436228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose Coronavirus disease 2019 (COVID-19) impacted outcomes of persons with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). This study investigated the differences in respiratory interventions, hospital utilization, smoking status, and 30-day readmission in those with COPD and COVID-19 based on hospital survival status. Methods A retrospective cross-sectional study was conducted from February 2020 to October 2020 and included persons with COPD and COVID-19 infection. We examined respiratory interventions, hospital utilization and outcomes, and 30-day hospital readmission. Chi-square test analysis was used to assess categorical variables, and t-test or Mann-Whitney was used to analyze continuous data based on normality. Results Ninety persons were included in the study, 78 (87%) were survivors. The most common comorbidity was hypertension 71 (78.9%) (p = 0.003). Twenty-two (24%) persons were intubated, from whom 12 (15%) survived (p < 0.001). There were 25 (32.1%) and 12 (100%), (p < 0.001) persons who required an ICU admission from the survivor and non-survivor groups, respectively. Among the survivor group, fifteen (19%) persons required 30-day hospital readmission. Conclusion Persons with COPD and COVID-19 had a lower mortality rate (13%) compared to other studies in the early pandemic phase. Non-survivors had increased ICU utilization, endotracheal intubation, and more frequent application of volume control mode. Discharging survivors to long-term acute care facilities may reduce 30-day hospital readmissions.
Collapse
Affiliation(s)
- Ahmad A Elshafei
- Department of Quality Operations & Population Health, Advocate Health, Green Bay, WI, USA
- Department of Respiratory Care, Rush University Medical Center Chicago, IL, USA
| | - Stephani A Flores
- Department of Respiratory Care, Rush University Medical Center Chicago, IL, USA
| | - Ramandeep Kaur
- Department of Cardiopulmonary Sciences, Rush University, Chicago, IL, USA
| | - Ellen A Becker
- Department of Cardiopulmonary Sciences, Rush University, Chicago, IL, USA
| |
Collapse
|
39
|
Ho T, Shahzad A, Jones A, Raghavan N, Loeb M, Johnston N. Examining the effect of the COVID-19 pandemic on community virus prevalence and healthcare utilisation reveals that peaks in asthma, COPD and respiratory tract infection occur with the re-emergence of rhino/enterovirus. Thorax 2023; 78:1248-1253. [PMID: 37423763 PMCID: PMC10715522 DOI: 10.1136/thorax-2022-219957] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/30/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Airway disease exacerbations are cyclical related to respiratory virus prevalence. The COVID-19 pandemic has been associated with reduced exacerbations possibly related to public health measures and their impact on non-COVID-19 respiratory viruses. We aimed to investigate the prevalence of non-COVID-19 respiratory viruses during the pandemic compared with prior in Ontario, Canada and healthcare utilisation related to asthma, chronic obstructive pulmonary disease (COPD) and respiratory tract infection. METHODS This is a population-based retrospective analysis of respiratory virus tests, emergency department (ED) visits and hospitalisations between 2015 and 2021 in Ontario. Weekly virus testing data were used to estimate viral prevalence for all non-COVID-19 respiratory viruses. We plotted the %positivity and observed and expected counts of each virus to visualise the impact of the pandemic. We used Poisson and binomial logistic regression models to estimate the change in %positivity, count of positive viral cases and count of healthcare utilisation during the pandemic. RESULTS The prevalence of all non-COVID-19 respiratory viruses decreased dramatically during the pandemic compared with prior. Comparing periods, the incidence rate ratio (IRR) for positive cases corresponded to a >90% reduction for non-COVID-19 respiratory viruses except adenovirus and rhino/enterovirus. Asthma-related ED visits and hospital admissions fell by 57% (IRR 0.43 (95% CI 0.37 to 0.48)) and 61% (IRR 0.39 (95% CI 0.33 to 0.46)). COPD-related ED visits and admissions fell by 63% (IRR 0.37 (95% CI 0.30 to 0.45)) and 45% (IRR 0.55 (95% CI 0.48 to 0.62)). Respiratory tract infection ED visits and admissions fell by 85% (IRR 0.15 (95% CI 0.10 to 0.22)), and 85% (IRR 0.15 (95% CI 0.09 to 0.24)). Rather than the usual peaks in disease condition, during the pandemic, healthcare utilisation peaked in October when rhino/enterovirus peaked. CONCLUSIONS The prevalence of nearly all non-COVID-19 respiratory viruses decreased during the pandemic and was associated with marked reductions in ED visits and hospitalisations. The re-emergence of rhino/enterovirus was associated with increased healthcare utilisation.
Collapse
Affiliation(s)
- Terence Ho
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Abdullah Shahzad
- The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
| | - Aaron Jones
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Natya Raghavan
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Neil Johnston
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
40
|
Kappe NN, Alagem N, Tov N, Stolk J. Governmental Non-Pharmaceutical Interventions during the COVID-19 Pandemic and the COPD Exacerbation and Respiratory Infection Rate in Patients with Alpha-1 Antitrypsin Deficiency. COPD 2023; 20:292-297. [PMID: 37665565 DOI: 10.1080/15412555.2023.2249108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023]
Abstract
During the COVID-19 pandemic the number of hospital admissions due to chronic obstructive pulmonary disease (COPD) exacerbations was significantly reduced. The reason for this decline is not fully understood. Governmental non-pharmaceutical interventions (NPI's), an increase in community treated exacerbations, or healthcare avoidance by patients, are potential reasons. For the current study, the impact of Dutch governmental NPI's on the COPD exacerbations and respiratory infections rate in patients with severe alpha-1 antitrypsin deficiency (AATD) was analyzed. The patients participated in the NCT04204252 study, a randomized controlled trial evaluating the efficacy and safety of inhaled alpha-1 antitrypsin. Data collected in the time-period from March 2020 until February 2022 was analyzed. In this period the Dutch government imposed variable NPI's to contain the spread of SARS-CoV-2. Patients were required to document their daily symptoms in an electronic diary. The strictness of the governmental NPI's was measured by the COVID-19 Stringency Index. 19 patients participated in this study during the analysis period. A total of 40 respiratory infections and COPD exacerbations occurred. The Spearman's correlation coefficient of the monthly average COVID-19 Stringency Index and respiratory infections and COPD exacerbations rate was -0.316 (p = 0.132). When months known for a low respiratory infection rate were excluded, the correlation coefficient was -0.625 (p = 0.010). This study showed a significant negative correlation between the COPD exacerbations and respiratory infection rate and the COVID-19 Stringency Index in patients with AATD related COPD in the autumn-winter months.
Collapse
Affiliation(s)
- Naomi Nanke Kappe
- Department of Pulmonology, Leiden University Medical Center, Member of European Reference Network Lung, Leiden, The Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Jan Stolk
- Department of Pulmonology, Leiden University Medical Center, Member of European Reference Network Lung, Leiden, The Netherlands
| |
Collapse
|
41
|
Chow R, So OW, Im JHB, Chapman KR, Orchanian-Cheff A, Gershon AS, Wu R. Predictors of Readmission, for Patients with Chronic Obstructive Pulmonary Disease (COPD) - A Systematic Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2581-2617. [PMID: 38022828 PMCID: PMC10664718 DOI: 10.2147/copd.s418295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally and is responsible for over 3 million deaths annually. One of the factors contributing to the significant healthcare burden for these patients is readmission. The aim of this review is to describe significant predictors and prediction scores for all-cause and COPD-related readmission among patients with COPD. Methods A search was conducted in Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from database inception to June 7, 2022. Studies were included if they reported on patients at least 40 years old with COPD, readmission data within 1 year, and predictors of readmission. Study quality was assessed. Significant predictors of readmission and the degree of significance, as noted by the p-value, were extracted for each study. This review was registered on PROSPERO (CRD42022337035). Results In total, 242 articles reporting on 16,471,096 patients were included. There was a low risk of bias across the literature. Of these, 153 studies were observational, reporting on predictors; 57 studies were observational studies reporting on interventions; and 32 were randomized controlled trials of interventions. Sixty-four significant predictors for all-cause readmission and 23 for COPD-related readmission were reported across the literature. Significant predictors included 1) pre-admission patient characteristics, such as male sex, prior hospitalization, poor performance status, number and type of comorbidities, and use of long-term oxygen; 2) hospitalization details, such as length of stay, use of corticosteroids, and use of ventilatory support; 3) results of investigations, including anemia, lower FEV1, and higher eosinophil count; and 4) discharge characteristics, including use of home oxygen and discharge to long-term care or a skilled nursing facility. Conclusion The findings from this review may enable better predictive modeling and can be used by clinicians to better inform their clinical gestalt of readmission risk.
Collapse
Affiliation(s)
- Ronald Chow
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olivia W So
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - James H B Im
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Kenneth R Chapman
- University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Andrea S Gershon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert Wu
- University Health Network, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
42
|
Kee YS, Wong CK, Abdul Aziz MA, Zakaria MI, Mohd Shaarif F, Ng KS, Liam CK, Pang YK, Khoo EM. 30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital. Int J Chron Obstruct Pulmon Dis 2023; 18:2623-2631. [PMID: 38022826 PMCID: PMC10658934 DOI: 10.2147/copd.s429108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. Patients and Methods A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. Results The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. Conclusion The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.
Collapse
Affiliation(s)
- Yan Shen Kee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kuan Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Mohd Idzwan Zakaria
- Academic Unit Trauma and Emergency, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fatimah Mohd Shaarif
- Academic Unit Trauma and Emergency, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
43
|
Bhatt SP, Agusti A, Bafadhel M, Christenson SA, Bon J, Donaldson GC, Sin DD, Wedzicha JA, Martinez FJ. Phenotypes, Etiotypes, and Endotypes of Exacerbations of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:1026-1041. [PMID: 37560988 PMCID: PMC10867924 DOI: 10.1164/rccm.202209-1748so] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/04/2023] [Indexed: 08/11/2023] Open
Abstract
Chronic obstructive pulmonary disease is a major health problem with a high prevalence, a rising incidence, and substantial morbidity and mortality. Its course is punctuated by acute episodes of increased respiratory symptoms, termed exacerbations of chronic obstructive pulmonary disease (ECOPD). ECOPD are important events in the natural history of the disease, as they are associated with lung function decline and prolonged negative effects on quality of life. The present-day therapy for ECOPD with short courses of antibiotics and steroids and escalation of bronchodilators has resulted in only modest improvements in outcomes. Recent data indicate that ECOPD are heterogeneous, raising the need to identify distinct etioendophenotypes, incorporating traits of the acute event and of patients who experience recurrent events, to develop novel and targeted therapies. These characterizations can provide a complete clinical picture, the severity of which will dictate acute pharmacological treatment, and may also indicate whether a change in maintenance therapy is needed to reduce the risk of future exacerbations. In this review we discuss the latest knowledge of ECOPD types on the basis of clinical presentation, etiology, natural history, frequency, severity, and biomarkers in an attempt to characterize these events.
Collapse
Affiliation(s)
- Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alvar Agusti
- Institut Respiratori (Clinic Barcelona), Càtedra Salut Respiratoria (Universitat de Barcelona), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-Barcelona), Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), España
| | - Mona Bafadhel
- Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Stephanie A. Christenson
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gavin C. Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Don D. Sin
- Centre for Heart Lung Innovation and
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- St. Paul’s Hospital, Vancouver, British Columbia, Canada; and
| | - Jadwiga A. Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | |
Collapse
|
44
|
Liu G, Haw TJ, Starkey MR, Philp AM, Pavlidis S, Nalkurthi C, Nair PM, Gomez HM, Hanish I, Hsu AC, Hortle E, Pickles S, Rojas-Quintero J, Estepar RSJ, Marshall JE, Kim RY, Collison AM, Mattes J, Idrees S, Faiz A, Hansbro NG, Fukui R, Murakami Y, Cheng HS, Tan NS, Chotirmall SH, Horvat JC, Foster PS, Oliver BG, Polverino F, Ieni A, Monaco F, Caramori G, Sohal SS, Bracke KR, Wark PA, Adcock IM, Miyake K, Sin DD, Hansbro PM. TLR7 promotes smoke-induced experimental lung damage through the activity of mast cell tryptase. Nat Commun 2023; 14:7349. [PMID: 37963864 PMCID: PMC10646046 DOI: 10.1038/s41467-023-42913-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
Toll-like receptor 7 (TLR7) is known for eliciting immunity against single-stranded RNA viruses, and is increased in both human and cigarette smoke (CS)-induced, experimental chronic obstructive pulmonary disease (COPD). Here we show that the severity of CS-induced emphysema and COPD is reduced in TLR7-deficient mice, while inhalation of imiquimod, a TLR7-agonist, induces emphysema without CS exposure. This imiquimod-induced emphysema is reduced in mice deficient in mast cell protease-6, or when wild-type mice are treated with the mast cell stabilizer, cromolyn. Furthermore, therapeutic treatment with anti-TLR7 monoclonal antibody suppresses CS-induced emphysema, experimental COPD and accumulation of pulmonary mast cells in mice. Lastly, TLR7 mRNA is increased in pre-existing datasets from patients with COPD, while TLR7+ mast cells are increased in COPD lungs and associated with severity of COPD. Our results thus support roles for TLR7 in mediating emphysema and COPD through mast cell activity, and may implicate TLR7 as a potential therapeutic target.
Collapse
Affiliation(s)
- Gang Liu
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia
| | - Tatt Jhong Haw
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
| | - Malcolm R Starkey
- Depatrment of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ashleigh M Philp
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Healthcare clinical campus, UNSW, Sydney, Australia
| | - Stelios Pavlidis
- The Airways Disease Section, National Heart & Lung Institute, Imperial College London, London, UK
| | - Christina Nalkurthi
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia
| | - Prema M Nair
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
| | - Henry M Gomez
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
| | - Irwan Hanish
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
- Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Alan Cy Hsu
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
| | - Elinor Hortle
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia
| | - Sophie Pickles
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia
| | | | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Jacqueline E Marshall
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia
| | - Richard Y Kim
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Adam M Collison
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
| | - Joerg Mattes
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
| | - Sobia Idrees
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia
| | - Alen Faiz
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia
| | - Nicole G Hansbro
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia
| | - Ryutaro Fukui
- Division of Innate Immunity, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Shirokanedai, Minatoku, Tokyo, Japan
| | - Yusuke Murakami
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, Musashino University, Nishitokyo-shi, Tokyo, Japan
| | - Hong Sheng Cheng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Nguan Soon Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jay C Horvat
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
| | - Paul S Foster
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
| | - Brian Gg Oliver
- Woolcock Institute of Medical Research, University of Sydney & School of Life Sciences, University of Technology, Sydney, Australia
| | | | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Section of Anatomic Pathology, Università di Messina, Messina, Italy
| | - Francesco Monaco
- Thoracic Surgery, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), Università di Messina, Messina, Italy
| | - Gaetano Caramori
- Pneumologia, Dipartimento BIOMORF and Dipartimento di Medicina e Chirurgia, Universities of Messina and Parma, Messina, Italy
| | - Sukhwinder S Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Ken R Bracke
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Peter A Wark
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia
| | - Ian M Adcock
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Healthcare clinical campus, UNSW, Sydney, Australia
| | - Kensuke Miyake
- Division of Innate Immunity, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Shirokanedai, Minatoku, Tokyo, Japan
| | - Don D Sin
- The University of British Columbia Centre for Heart Lung Innovation, St Paul's Hospital & Respiratory Division, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Camperdown, New South Wales, Australia.
- Immune Healthy &/or Grow Up Well, Hunter Medical Research Institute & University of Newcastle, Callaghan, New South Wales, Australia.
| |
Collapse
|
45
|
Hyams C, Qian G, Nava G, Challen R, Begier E, Southern J, Lahuerta M, Nguyen JL, King J, Morley A, Clout M, Maskell N, Jodar L, Oliver J, Ellsbury G, McLaughlin JM, Gessner BD, Finn A, Danon L, Dodd JW. Impact of SARS-CoV-2 infective exacerbation of chronic obstructive pulmonary disease on clinical outcomes in a prospective cohort study of hospitalised adults. J R Soc Med 2023; 116:371-385. [PMID: 37404021 PMCID: PMC10686205 DOI: 10.1177/01410768231184162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/04/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVES To determine whether acute exacerbations of chronic obstructive pulmonary disease (AECOPD) triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have worse outcomes than AECOPD caused by other infectious agents or non-infective AECOPD (NI-COPD). DESIGN A two-hospital prospective cohort study of adults hospitalised with acute respiratory disease. We compared outcomes with AECOPD and a positive test for SARS-CoV-2 (n = 816), AECOPD triggered by other infections (n = 3038) and NI-COPD (n = 994). We used multivariable modelling to adjust for potential confounders and assessed variation by seasons associated with different SARS-CoV-2 variants. SETTING Bristol UK, August 2020-May 2022. PARTICIPANTS Adults (≥18 y) hospitalised with AECOPD. MAIN OUTCOME MEASURES We determined the risk of positive pressure support, longer hospital admission and mortality following hospitalisation with AECOPD due to non-SARS-CoV-2 infection compared with SARS-CoV-2 AECOPD and NI-COPD. RESULTS Patients with SARS-CoV-2 AECOPD, in comparison to non-SARS-CoV-2 infective AECOPD or NI-COPD, more frequently required positive pressure support (18.5% and 7.5% vs. 11.7%, respectively), longer hospital stays (median [interquartile range, IQR]: 7 [3-15] and 5 [2-10] vs. 4 [2-9] days, respectively) and had higher 30-day mortality (16.9% and 11.1% vs. 5.9%, respectively) (all p < 0.001). In adjusted analyses, SARS-CoV-2 AECOPD was associated with a 55% (95% confidence interval [95% CI]: 24-93), 26% (95% CI: 15-37) and 35% (95% CI: 10-65) increase in the risk of positive pressure support, hospitalisation length and 30-day mortality, respectively, relative to non-SARS-CoV-2 infective AECOPD. The difference in risk remained similar during periods of wild-type, Alpha and Delta SARS-CoV-2 strain dominance, but diminished during Omicron dominance. CONCLUSIONS SARS-CoV-2-related AECOPD had worse patient outcomes compared with non-SARS-CoV-2 AECOPD or NI-AECOPD, although the difference in risks was less pronounced during Omicron dominance.
Collapse
Affiliation(s)
- Catherine Hyams
- Academic Respiratory Unit and Bristol Vaccine Centre, University of Bristol, Bristol, BS15, UK
| | - George Qian
- Engineering Mathematics, University of Bristol, Bristol, Bristol, BS8, UK
| | - George Nava
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, Bristol, BS15, UK
| | - Robert Challen
- Engineering Mathematics, University of Bristol, Bristol, Bristol, BS8, UK
| | - Elizabeth Begier
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Jo Southern
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Maria Lahuerta
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Jennifer L Nguyen
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Jade King
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, Bristol, BS2, UK
| | - Anna Morley
- Academic Respiratory Unit, Southmead Hospital, Bristol, Bristol, BS15, UK
| | - Madeleine Clout
- Bristol Vaccine Centre and Population Health Sciences, University of Bristol, Bristol, BS2, UK
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, Bristol, BS15, UK
| | - Luis Jodar
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Jennifer Oliver
- Bristol Vaccine Centre and Population Health Sciences, University of Bristol, Bristol, BS2, UK
| | | | - John M McLaughlin
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Bradford D Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Adam Finn
- Bristol Vaccine Centre, Cellular and Molecular Medicine and Population Health Sciences, University of Bristol, Bristol, BS2, UK
| | - Leon Danon
- Engineering Mathematics, University of Bristol, Bristol, Bristol, BS8, UK
| | - James W Dodd
- Academic Respiratory Unit and Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, BS15, UK
| | - The Avon CAP Research Group
- Academic Respiratory Unit and Bristol Vaccine Centre, University of Bristol, Bristol, BS15, UK
- Engineering Mathematics, University of Bristol, Bristol, Bristol, BS8, UK
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, Bristol, BS15, UK
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, Bristol, BS2, UK
- Academic Respiratory Unit, Southmead Hospital, Bristol, Bristol, BS15, UK
- Bristol Vaccine Centre and Population Health Sciences, University of Bristol, Bristol, BS2, UK
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth, KT20, UK
- Bristol Vaccine Centre, Cellular and Molecular Medicine and Population Health Sciences, University of Bristol, Bristol, BS2, UK
- Academic Respiratory Unit and Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, BS15, UK
| |
Collapse
|
46
|
Brock JM, Böhmker F, Schuster PU, Eberhardt R, Gompelmann D, Kontogianni K, Dittrich S, Benjamin N, Herth F. Endobronchial lung volume reduction with valves reduces exacerbations in severe emphysema patients. Respir Med 2023; 218:107399. [PMID: 37673413 DOI: 10.1016/j.rmed.2023.107399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/13/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Exacerbations drive the progression of chronic obstructive pulmonary disease (COPD). Endoscopic lung volume reduction (ELVR) with valves is an established treatment option for patients with severe emphysema. Post-interventional exacerbations are observed in 8-17% of cases. Whether the exacerbation rate changes in the medium term after ELVR, is not known. METHODS This is a single-center retrospective analysis of severe emphysema patients with endobronchial valve implantation. The number of exacerbations before and after ELVR was compared, including lung function parameters, exercise capacity and degree of lung volume reduction. The primary endpoint of the study was the number of exacerbations one year after ELVR compared to one year before ELVR. RESULTS 129 patients (mean age 64.1 ± 7.7 years, 57% female, mean FEV1 0.8 ± 0.2 l, mean RV 243.4 ± 54.9 %) with ELVR in the years 2016-2019 and complete exacerbation history were analyzed. Patients experienced a mean of 2.5 ± 2.2 moderate and severe exacerbations in the year before ELVR. The number of exacerbations decreased significantly to 1.8 ± 2.2 exacerbations in the first year after ELVR (p = 0.009). The decrease in exacerbation rate was associated with the development of complete lobar atelectasis (r = 0.228. p = 0.009). Accordingly, in 41 patients with complete lobar atelectasis, the decrease in exacerbation rate was higher from 2.8 ± 2.0 to 1.4 ± 1.8 exacerbations (p < 0.001). CONCLUSIONS ELVR with valves appears promising to reduce the exacerbation rate in COPD patients, especially when the full treatment benefit of complete lobar atelectasis is achieved.
Collapse
Affiliation(s)
- Judith Maria Brock
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.
| | - Felix Böhmker
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | | | - Ralf Eberhardt
- Department of Pneumology and Intensive Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Daniela Gompelmann
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Konstantina Kontogianni
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Susanne Dittrich
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nicola Benjamin
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| |
Collapse
|
47
|
Kang J, Kim HC, Jang Y, Lee JB, Lee JS, Oh YM, Ji HW, Jung JY, Lee SW. Randomised controlled trial of a behavioural intervention to reduce exposure to PM 2.5 in patients with COPD. Environ Int 2023; 181:108286. [PMID: 37918066 DOI: 10.1016/j.envint.2023.108286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/22/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Fine particulate matter (PM2.5) is a well-known risk factor for worse outcomes of chronic obstructive pulmonary disease (COPD). However, evidence-based guidance on effective personal behavioural strategies to minimise the effects of PM2.5 is limited. This study aimed to assess the effectiveness of a behavioural intervention in reducing PM2.5 exposure and improving clinical outcomes in patients with COPD. MATERIALS AND METHODS Participants were 1:1 randomised, and the intervention group received a behavioural intervention consisting of five activities, while the control group received usual care. The participants were followed up for 9 months. The primary outcomes were differences in the score of St. George's Respiratory Questionnaire for patients with COPD (SGRQ-C) and COPD assessment test (CAT) from baseline. RESULTS A total of 106 participants were enrolled and 102 completed the study. At the end of the study, the intervention group showed significant improvements in the primary outcomes compared to the control group, with a group difference of -5.9 in the reduction of total SGRQ-C (-3.4 vs. 2.5; p = 0.049) and -3.8 in the CAT score (-1.2 vs. 2.7; p = 0.001). Participants with good adherence to the intervention demonstrated a greater extent of improvement in CAT score and lower PM2.5 levels compared to those who had poor adherence or were in the control group. Regular checking of air quality forecasts was significantly associated with a reduction in CAT scores among all the intervention activities. CONCLUSION Individual-level behavioural interventions can be an effective strategy for mitigating the health hazards associated with PM2.5. CLINICALTRIALS gov Identifier: NCT04878367.
Collapse
Affiliation(s)
- Jieun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Youngwon Jang
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Bok Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun Woo Ji
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
48
|
Hwang YS, Jo HS. Risks for Readmission Among Older Patients With Chronic Obstructive Pulmonary Disease: An Analysis Using Korean National Health Insurance Service - Senior Cohort Data. J Prev Med Public Health 2023; 56:563-572. [PMID: 38053341 DOI: 10.3961/jpmph.23.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVES The high readmission rate of patients with chronic obstructive pulmonary disease (COPD) has led to the worldwide establishment of proactive measures for identifying and mitigating readmissions. This study aimed to identify factors associated with readmission, as well as groups particularly vulnerable to readmission that require transitional care services. METHODS To apply transitional care services that are compatible with Korea's circumstances, targeted groups that are particularly vulnerable to readmission should be identified. Therefore, using the National Health Insurance Service's Senior Cohort database, we analyzed data from 4874 patients who were first hospitalized with COPD from 2009 to 2019 to define and analyze readmissions within 30 days after discharge. Logistic regression analysis was performed to determine factors correlated with readmission within 30 days. RESULTS The likelihood of readmission was associated with older age (for individuals in their 80s vs. those in their 50s: odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19 to 2.12), medical insurance type (for workplace subscribers vs. local subscribers: OR, 0.84; 95% CI, 0.72 to 0.99), type of hospital (those with 300 beds or more vs. fewer beds: OR, 0.77; 95% CI, 0.66 to 0.90), and healthcare organization location (provincial areas vs. the capital area: OR, 1.66; 95% CI, 1.14 to 2.41). CONCLUSIONS Older patients, patients holding a local subscriber insurance qualification, individuals admitted to hospitals with fewer than 300 beds, and those admitted to provincial hospitals are suggested to be higher-priority for transitional care services.
Collapse
Affiliation(s)
- Yu Seong Hwang
- Department of Health Policy and Management, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Heui Sug Jo
- Department of Health Policy and Management, Kangwon National University School of Medicine, Chuncheon, Korea
| |
Collapse
|
49
|
Fang AP, Edmond MC, Marsh RH, Normil M, Poola N, Michel Payant SJ, Luc PR, Strokes N, Calixte M, Rimpel L, Rouhani SA. Outcomes of Invasive and Noninvasive Ventilation in a Haitian Emergency Department. Ann Glob Health 2023; 89:72. [PMID: 37868710 PMCID: PMC10588490 DOI: 10.5334/aogh.4009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 09/17/2023] [Indexed: 10/24/2023] Open
Abstract
Background Limited data exist on the outcomes of patients requiring invasive ventilation or noninvasive positive pressure ventilation (NIPPV) in low-income countries. To our knowledge, no study has investigated this topic in Haiti. Objectives We describe the clinical epidemiology, treatment, and outcomes of patients requiring NIPPV or intubation in an emergency department (ED) in rural Haiti. Methods This is an observational study utilizing a convenience sample of adult and pediatric patients requiring NIPPV or intubation in the ED at an academic hospital in central Haiti from January 2019-February 2021. Patients were prospectively identified at the time of clinical care. Data on demographics, clinical presentation, management, and ED disposition were extracted from patient charts using a standardized form and analyzed in SAS v9.4. The primary outcome was survival to discharge. Findings Of 46 patients, 27 (58.7%) were female, mean age was 31 years, and 14 (30.4%) were pediatric (age <18 years). Common diagnoses were cardiogenic pulmonary edema, pneumonia/pulmonary sepsis, and severe asthma. Twenty-three (50.0%) patients were initially treated with NIPPV, with 4 requiring intubation; a total of 27 (58.7%) patients were intubated. Among those for whom intubation success was documented, first-pass success was 57.7% and overall success was 100% (one record missing data); intubation was associated with few immediate complications. Twenty-two (47.8%) patients died in the ED. Of the 24 patients who survived, 4 were discharged, 19 (intubation: 12; NIPPV: 9) were admitted to the intensive care unit or general ward, and 1 was transferred. Survival to discharge was 34.8% (intubation: 22.2%; NIPPV: 52.2%); 1 patient left against medical advice following admission. Conclusions Patients with acute respiratory failure in this Haitian ED were successfully treated with both NIPPV and intubation. While overall survival to discharge remains relatively low, this study supports developing capacity for advanced respiratory interventions in low-resource settings.
Collapse
Affiliation(s)
- Anna P. Fang
- Boston Medical Center, Department of Emergency Medicine, One Boston Medical Center Place, Boston, MA, USA
| | - Marie Cassandre Edmond
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Regan H. Marsh
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Manouchka Normil
- Zanmi Lasante, Port-au-Prince, Haiti
- Family Medicine, GHESKIO Centers, Port-au-Prince, Haiti
| | - Nivedita Poola
- Department of Emergency Medicine, SUNY Downstate/King’s County Hospital, Brooklyn, NY, USA
| | - Sherley Jean Michel Payant
- Zanmi Lasante, Port-au-Prince, Haiti
- Family Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Pierre Ricot Luc
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Natalie Strokes
- Family Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Manise Calixte
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Linda Rimpel
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Shada A. Rouhani
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
50
|
Chen F, Matsuda A, Budinger GRS, Sporn PHS, Casalino-Matsuda SM. Hypercapnia increases ACE2 expression and pseudo-SARS-CoV-2 entry in bronchial epithelial cells by augmenting cellular cholesterol. Front Immunol 2023; 14:1251120. [PMID: 37901225 PMCID: PMC10600497 DOI: 10.3389/fimmu.2023.1251120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Patients with chronic lung disease, obesity, and other co-morbid conditions are at increased risk of severe illness and death when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hypercapnia, the elevation of CO2 in blood and tissue, commonly occurs in patients with severe acute and chronic lung disease, including those with pulmonary infections, and is also associated with high mortality risk. We previously reported that hypercapnia increases viral replication and mortality of influenza A virus infection in mice. We have also shown that culture in elevated CO2 upregulates expression of cholesterol synthesis genes in primary human bronchial epithelial cells. Interestingly, factors that increase the cholesterol content of lipid rafts and lipid droplets, platforms for viral entry and assembly, enhance SARS-CoV-2 infection. In the current study, we investigated the effects of hypercapnia on ACE2 expression and entry of SARS-CoV-2 pseudovirus (p-SARS-CoV-2) into airway epithelial cells. We found that hypercapnia increased ACE2 expression and p-SARS-CoV-2 uptake by airway epithelium in mice, and in cultured VERO and human bronchial epithelial cells. Hypercapnia also increased total cellular and lipid raft-associated cholesterol in epithelial cells. Moreover, reducing cholesterol synthesis with inhibitors of sterol regulatory element binding protein 2 (SREBP2) or statins, and depletion of cellular cholesterol, each blocked the hypercapnia-induced increases in ACE2 expression and p-SARS-CoV-2 entry into epithelial cells. Cigarette smoke extract (CSE) also increased ACE2 expression, p-SARS-CoV-2 entry and cholesterol accumulation in epithelial cells, an effect not additive to that of hypercapnia, but also inhibited by statins. These findings reveal a mechanism that may account, in part, for poor clinical outcomes of SARS-CoV-2 infection in patients with advanced lung disease and hypercapnia, and in those who smoke cigarettes. Further, our results suggest the possibility that cholesterol-lowering therapies may be of particular benefit in patients with hypercapnia when exposed to or infected with SARS-CoV-2.
Collapse
Affiliation(s)
- Fei Chen
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Aiko Matsuda
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - G. R. Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, United States
| | - Peter H. S. Sporn
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, United States
| | - S. Marina Casalino-Matsuda
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|