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Fjaellegaard K, Koefod Petersen J, Alstrup G, Skaarup S, Frost Clementsen P, Laursen CB, Bhatnagar R, Bodtger U. Ultrasound in predicting improvement in dyspnoea after therapeutic thoracentesis in patients with recurrent unilateral pleural effusion. Eur Clin Respir J 2024; 11:2337446. [PMID: 38711600 PMCID: PMC11073413 DOI: 10.1080/20018525.2024.2337446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Background In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following drainage may support the management of these patients. This study aimed to assess the association between ultrasound (US) characteristics and a relevant improvement in dyspnoea immediately following drainage. Methods In a prospective, observational study, patients with recurrent unilateral pleural effusion underwent US evaluation of effusion characteristics and diaphragm movement measured by M-mode and the Area method before and right after drainage. The level of dyspnoea was assessed using the modified Borg scale (MBS). A minimal important improvement in dyspnoea was defined as delta MBS ≥ 1. Results In the 104 patients included, 53% had a minimal important improvement in dyspnoea following thoracentesis. We found no association between US-characteristics, including diaphragm shape or movement (M-mode or the Area method), and a decrease in dyspnoea following drainage. Baseline MBS score ≥ 4 and a fully drained effusion were significant correlated with a minimal important improvement in dyspnoea (OR 3.86 (1.42-10.50), p = 0.01 and 2.86 (1.03-7.93), p = 0.04, respectively). Conclusions In our study population, US-characteristics including assessment of diaphragm movement or shape was not associated with a minimal important improvement in dyspnoea immediately following thoracentesis.
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Affiliation(s)
- Katrine Fjaellegaard
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Jesper Koefod Petersen
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Gitte Alstrup
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Søren Skaarup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rahul Bhatnagar
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Uffe Bodtger
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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Twose C, Ferris R, Wilson A, Rahman N, Farquhar M, Mishra E. Therapeutic thoracentesis symptoms and activity: a qualitative study. BMJ Support Palliat Care 2023; 13:e190-e196. [PMID: 33419856 DOI: 10.1136/bmjspcare-2020-002584] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Malignant pleural effusions (MPEs) commonly occur in patients with advanced cancer. Drainage of fluid is used to relieve symptoms and improve quality of life. OBJECTIVE To improve our understanding of how therapeutic aspiration affects symptoms and activities in patients with MPE. METHODS Patients presenting to the Pleural Clinic at Norfolk and Norwich University Hospital with a confirmed or suspected MPE participated in up to three semistructured interviews during their diagnostic/therapeutic pathway. Interviews were analysed using framework analysis by two researchers independently. RESULTS Sixteen patients participated. Symptoms reported before drainage included breathlessness, cough, chest pain, fatigue and anorexia. Symptoms affected their activities, including walking, bending over and socialisation. Patients described anxiety about the underlying diagnosis and fear of over-reliance on others. Expectations of drainage outcome varied, with some hoping for a cure and others hoping for any improvement. After drainage, breathlessness, chest pain and cough improved in some patients. They reported feeling and sleeping better, but fatigue and poor appetite remained. Participants were more active after aspiration, but the duration of improvement was a few days only. Despite this, patients still felt the procedure worthwhile. CONCLUSION Overall health and respiratory symptoms improved following drainage, but constitutional symptoms did not improve. This may be because constitutional symptoms are caused by the underlying cancer. This study suggests that clinicians should consider a range of symptoms, rather than just breathlessness, in planning outcomes for clinical trials. These results are important to inform patients about the potential benefits and duration of symptom improvement after therapeutic aspiration.
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Affiliation(s)
- Chloe Twose
- Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, UK
| | - Rebecca Ferris
- Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, UK
| | - Andrew Wilson
- School of Medicine, University of East Anglia, Norwich, UK
| | - Najib Rahman
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Eleanor Mishra
- Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, UK
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Zhang Z, Zhou J, Conroy TB, Chung S, Choi J, Chau P, Green DB, Krieger AC, Kan EC. Deduced Respiratory Scores on COVID-19 Patients Learning from Exertion-Induced Dyspnea. SENSORS (BASEL, SWITZERLAND) 2023; 23:4733. [PMID: 37430647 DOI: 10.3390/s23104733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/12/2023]
Abstract
Dyspnea is one of the most common symptoms of many respiratory diseases, including COVID-19. Clinical assessment of dyspnea relies mainly on self-reporting, which contains subjective biases and is problematic for frequent inquiries. This study aims to determine if a respiratory score in COVID-19 patients can be assessed using a wearable sensor and if this score can be deduced from a learning model based on physiologically induced dyspnea in healthy subjects. Noninvasive wearable respiratory sensors were employed to retrieve continuous respiratory characteristics with user comfort and convenience. Overnight respiratory waveforms were collected on 12 COVID-19 patients, and a benchmark on 13 healthy subjects with exertion-induced dyspnea was also performed for blind comparison. The learning model was built from the self-reported respiratory features of 32 healthy subjects under exertion and airway blockage. A high similarity between respiratory features in COVID-19 patients and physiologically induced dyspnea in healthy subjects was observed. Learning from our previous dyspnea model of healthy subjects, we deduced that COVID-19 patients have consistently highly correlated respiratory scores in comparison with normal breathing of healthy subjects. We also performed a continuous assessment of the patient's respiratory scores for 12-16 h. This study offers a useful system for the symptomatic evaluation of patients with active or chronic respiratory disorders, especially the patient population that refuses to cooperate or cannot communicate due to deterioration or loss of cognitive functions. The proposed system can help identify dyspneic exacerbation, leading to early intervention and possible outcome improvement. Our approach can be potentially applied to other pulmonary disorders, such as asthma, emphysema, and other types of pneumonia.
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Affiliation(s)
- Zijing Zhang
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Jianlin Zhou
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Thomas B Conroy
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Samuel Chung
- Center for Sleep Medicine at Weill Cornell Medicine, New York, NY 10065, USA
| | - Justin Choi
- Center for Sleep Medicine at Weill Cornell Medicine, New York, NY 10065, USA
| | - Patrick Chau
- Center for Sleep Medicine at Weill Cornell Medicine, New York, NY 10065, USA
| | - Daniel B Green
- Center for Sleep Medicine at Weill Cornell Medicine, New York, NY 10065, USA
| | - Ana C Krieger
- Center for Sleep Medicine at Weill Cornell Medicine, New York, NY 10065, USA
| | - Edwin C Kan
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
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Steinhilber B, Seibt R, Gabriel J, Bär M, Dilek Ü, Brandt A, Martus P, Rieger MA. Influence of Face Masks on Physiological and Subjective Response during 130 Min of Simulated Light and Medium Physical Manual Work-An Explorative Study. Healthcare (Basel) 2023; 11:1308. [PMID: 37174850 PMCID: PMC10178085 DOI: 10.3390/healthcare11091308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Undesirable side effects from wearing face masks during the ongoing COVID-19 pandemic continue to be discussed and pose a challenge to occupational health and safety when recommending safe application. Only few studies examined the effects of continuously wearing a face mask for more than one hour. Therefore, the influence of wearing a medical mask (MedMask) and a filtering facepiece class II respirator (FFP2) on the physiological and subjective outcomes in the course of 130 min of manual work was exploratively investigated. Physical work load and cardiorespiratory fitness levels were additionally considered as moderating factors. METHODS Twenty-four healthy subjects (12 females) from three different cardiorespiratory fitness levels each performed 130 min of simulated manual work with light and medium physical workload using either no mask, a MedMask or FFP2. Heart rate, transcutaneous oxygen and carbon dioxide partial pressure (PtcO2, PtcCO2) as well as perceived physical exertion and respiratory effort were assessed continuously at discrete time intervals. Wearing comfort of the masks were additionally rated after the working period. RESULTS There was no difference in time-dependent changes of physiological outcomes when using either a MedMask or a FFP2 compared to not wearing a mask. A stronger increase over time in perceived respiratory effort occurred when the face masks were worn, being more prominent for FFP2. Physical workload level and cardiorespiratory fitness level were no moderating factors and higher wearing comfort was rated for the MedMask. CONCLUSION Our results suggest that using face masks during light and medium physical manual work does not induce detrimental side effects. Prolonged wearing episodes appeared to increase respiratory effort, but without affecting human physiology in a clinically relevant way.
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Affiliation(s)
- Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Julia Gabriel
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Mona Bär
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Ümütyaz Dilek
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Adrian Brandt
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, Medical Faculty, University Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
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Qureshi M, Thapa B, Muruganandan S. A Narrative Review-Management of Malignant Pleural Effusion Related to Malignant Pleural Mesothelioma. Heart Lung Circ 2023; 32:587-595. [PMID: 36925448 DOI: 10.1016/j.hlc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 03/17/2023]
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive, almost universally fatal cancer with limited therapeutic options. Despite efforts, a real breakthrough in treatment and outcomes has been elusive. Pleural effusion with significant breathlessness and pain is the most typical presentation of individuals with MPM. Although thoracentesis provides relief of breathlessness, most such pleural effusions recur rapidly, and a definitive procedure is often required to prevent a recurrence. Unfortunately, the optimal treatment modality for individuals with recurrent MPM-related effusion is unclear, and considerable variation exists in practice. In addition, non-expandable lung is common in pleural effusions due to MPM and makes effective palliation of symptoms more difficult. This review delves into the latest advances in the available management options (both surgical and non-surgical) for dealing with pleural effusion and non-expandable lung related to MPM. We discuss factors that determine the choice of definitive procedures that need to be tailored to the individual patient.
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Affiliation(s)
- Maryum Qureshi
- Department of Thoracic Surgery, Northern Hospital, Melbourne, Vic, Australia.
| | - Bibhusal Thapa
- Department of Thoracic Surgery, Northern Hospital, Melbourne, Vic, Australia
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Northern Hospital, Melbourne, Vic, Australia; School of Medicine, Health Sciences, Dentistry, University of Melbourne, Vic, Australia
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Mishra EK, Clark A, Laskawiec-Szkonter M, Maskell NA, Rahman NM. Trial Protocol: Reaccumulation rate of pleural effusions after therapeutic aspiration: An observational cohort study to determine baseline factors associated with rate of pleural fluid reaccumulation following therapeutic aspiration in patients with malignant pleural effusion attending a pleural clinic (REPEAT). NIHR OPEN RESEARCH 2023; 3:5. [PMID: 37881455 PMCID: PMC10593318 DOI: 10.3310/nihropenres.13282.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 10/27/2023]
Abstract
Background Malignant pleural effusion (MPE) is the build-up of pleural fluid in the space between the lung and chest wall due to advanced cancer. It is treated initially by large volume drainage (therapeutic aspiration). If the fluid reaccumulates, a definitive procedure is performed. There is wide variation in rate of reaccumulation. Patients with rapid reaccumulation often attend hospital as an emergency. Conversely, patients with slow reaccumulation do not need a definitive procedure and may experience cancelled or unnecessary procedures. This study aims to create and validate a multivariable prediction model to predict how quickly pleural fluid will reaccumulate in patients with MPE following therapeutic aspiration. Research question Can we predict how quickly pleural fluid will reaccumulate in patients with MPEs? Methods A total of 200 patients with known or suspected MPE attending for therapeutic aspiration will be recruited from 5-10 UK hospitals over 20 months. Patients will be enrolled prior to undergoing aspiration. Following this, they will undergo chest X-ray, which will be repeated one week later (treatment as usual). Rate of reaccumulation will be calculated based on change of size of the effusion seen on X-ray. Data will be collected on common clinical biomarkers e.g., size of effusion on pre-aspiration chest X-ray, volume of fluid drained. This data will be analysed to create a clinical score.A further validation cohort of 40 patients will be enrolled in parallel with creation of the score. Anticipated impact The ability to predict rate of reaccumulation of MPE will enable patients and clinicians to make better informed treatment decisions. For patients with predicted rapid reaccumulation, a definitive procedure could be offered as first-line treatment, rather than a therapeutic aspiration. This will prevent emergency hospital admissions and decrease number of procedures. By contrast, patients whose effusions will recur slowly may avoid an unnecessary procedure.
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Affiliation(s)
- Eleanor K. Mishra
- University of East Anglia, Norwich, NR4 7TL, UK
- Norfolk and Norwich University Hospitals NHS, Norwich, UK
| | - Allan Clark
- University of East Anglia, Norwich, NR4 7TL, UK
| | | | | | - Najib M. Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, OX3 7LE, UK
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Factors Affecting Rate of Pleural Fluid Accumulation in Patients with Malignant Pleural Effusions. CURRENT PULMONOLOGY REPORTS 2023. [DOI: 10.1007/s13665-023-00299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Abstract
Purpose of Review
Malignant pleural effusions (MPEs) are initially treated with thoracocentesis but usually reaccumulate. There is wide variation in the rate of recurrence. Those with rapid recurrence could benefit from early definitive treatment, whilst those with slower recurrences may not. Here, we discuss pleural fluid homeostasis, MPE pathophysiology, and factors associated with reaccumulation.
Recent Findings
Few studies have investigated markers of MPE reaccumulation. Suggested features of rapid reaccumulation include lactate dehydrogenase, effusion size, positive cytology, and dyspnoea. Vascular endothelial growth factor (VEGF) correlates with MPE size and treatment response, but its association with reaccumulation rate is unknown. Some anti-VEGF therapies have shown promise in MPE management.
Summary
Further work is needed to validate hypothesised biomarkers of rapid recurrence and to characterise other biomarkers, such as VEGF. The Reaccumulation rate of Malignant Pleural Effusions After Therapeutic Aspiration (REPEAT) study aims to address these gaps in the literature and is currently in recruitment.
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8
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Steinhilber B, Seibt R, Gabriel J, Brountsou J, Muljono M, Downar T, Bär M, Bonsch R, Brandt A, Martus P, Rieger MA. Effects of Face Masks on Physical Performance and Physiological Response during a Submaximal Bicycle Ergometer Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1063. [PMID: 35162087 PMCID: PMC8834111 DOI: 10.3390/ijerph19031063] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023]
Abstract
The ongoing COVID-19 pandemic requires wearing face masks in many areas of our daily life; hence, the potential side effects of mask use are discussed. Therefore, the present study explores whether wearing a medical face mask (MedMask) affects physical working capacity (PWC). Secondary, the influence of a filtering facepiece mask with exhalation valve class 2 (FFP2exhal) and a cotton fabric mask (community mask) on PWC was also investigated. Furthermore, corresponding physiological and subjective responses when wearing face masks as well as a potential moderating role of subjects' individual cardiorespiratory fitness and sex on face mask effects were analyzed. Thirty-nine subjects (20 males, 19 females) with different cardiorespiratory fitness levels participated in a standardized submaximal bicycle ergometer protocol using either a MedMask, FFP2exhal, community mask, or no mask (control) on four days, in randomized order. PWC130 and PWC150 as the mechanical load at the heart rates of 130 and 150 beats per minute were measured as well as transcutaneous carbon dioxide partial pressure, saturation of peripheral capillary oxygen, breathing frequency, blood pressure, perceived respiratory effort, and physical exhaustion. Using the MedMask did not lead to changes in PWC or physiological response compared to control. Neither appeared changes exceeding normal ranges when the FFP2exhal or community mask was worn. Perceived respiratory effort was up to one point higher (zero-to-ten Likert scale) when using face masks (p < 0.05) compared to control. Sex and cardiorespiratory fitness were not factors influencing the effects of the masks. The results of the present study provide reason to believe that wearing face masks for infection prevention during the COVID-19 pandemic does not pose relevant additional physical demands on the user although some more respiratory effort is required.
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Affiliation(s)
- Benjamin Steinhilber
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
| | - Robert Seibt
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
| | - Julia Gabriel
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
| | - Joulia Brountsou
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
| | - Markus Muljono
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
| | - Tomasz Downar
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
| | - Mona Bär
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
| | - Rosina Bonsch
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
| | - Adrian Brandt
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
| | - Peter Martus
- Medical Faculty, Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Monika A. Rieger
- Medical Faculty, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (J.B.); (M.M.); (T.D.); (M.B.); (R.B.); (A.B.); (M.A.R.)
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9
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Zhang Z, Sharma P, Conroy TB, Phongtankuel V, Kan EC. Objective Scoring of Physiologically Induced Dyspnea by Non-Invasive RF Sensors. IEEE Trans Biomed Eng 2022; 69:432-442. [PMID: 34255624 PMCID: PMC8743005 DOI: 10.1109/tbme.2021.3096462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Dyspnea, also known as the patient's feeling of difficult or labored breathing, is one of the most common symptoms for respiratory disorders. Dyspnea is usually self-reported by patients using, for example, the Borg scale from 0 - 10, which is however subjective and problematic for those who refuse to cooperate or cannot communicate. The objective of this paper was to develop a learning-based model that can evaluate the correlation between the self-report Borg score and the respiratory metrics for dyspnea induced by exertion and increased airway resistance. METHODS A non-invasive wearable radio-frequency sensor by near-field coherent sensing was employed to retrieve continuous respiratory data with user comfort and convenience. Self-report dyspnea scores and respiratory features were collected on 32 healthy participants going through various physical and breathing exercises. A machine learning model based on the decision tree and random forest then produced an objective dyspnea score. RESULTS For unseen data as well as unseen participants, the objective dyspnea score can be in reasonable agreement with the self-report score, and the importance factor of each respiratory metrics can be assessed. CONCLUSION An objective dyspnea score can potentially complement or substitute the self-report for physiologically induced dyspnea. SIGNIFICANCE The method can potentially formulate a baseline for clinical dyspnea assessment and help caregivers track dyspnea continuously, especially for patients who cannot report themselves.
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Affiliation(s)
- Zijing Zhang
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Pragya Sharma
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Thomas Bradley Conroy
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Veerawat Phongtankuel
- Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Edwin C. Kan
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
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10
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DeBiasi EM, Feller-Kopman D. Anatomy and Applied Physiology of the Pleural Space. Clin Chest Med 2021; 42:567-576. [PMID: 34774165 DOI: 10.1016/j.ccm.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The unique anatomy and physiology of the pleural space provides tight regulation of liquid within the space under normal physiologic conditions. When this balance is disrupted and pleural effusions develop, there can be significant impacts on the respiratory system. Drainage of effusions can lead to meaningful improvement in symptoms, primarily owing to improvement in the length-tension relationship of the respiratory muscles. Ultrasound examination to evaluate the movement and function of the diaphragm, as well as pleural manometry, have provided a greater understanding of the impact of pleural effusion and thoracentesis.
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Affiliation(s)
- Erin M DeBiasi
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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11
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Reychler G, Beaumont M, Latiers AC, Pieters T, Fremault A. Dyspnea could be accurately assessed by a caregiver in hospitalized patients with respiratory diseases: Interrater reliability and agreement study. Braz J Phys Ther 2021; 25:735-740. [PMID: 34119444 PMCID: PMC8721053 DOI: 10.1016/j.bjpt.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/15/2020] [Accepted: 04/21/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The perception of dyspnea is a subjective feeling typically self-assessed by the patient. However, the assessment by a caregiver is sometimes required. OBJECTIVES The primary aim was to compare patient self-assessment and caregiver assessment of dyspnea (interrater reliability) using the modified Borg and visual analog scale (VAS) in hospitalized patients. The secondary aim was to compare dyspnea assessment between the two scales for patients and caregiver (inter-instrument reliability). METHODS Self-assessment of dyspnea intensity of hospitalized patients with respiratory diseases was compared with caregiver's assessment. Dyspnea intensity was measured using two scales, the modified Borg scale (0-10 scale) and the 10 cm VAS. Mean difference and 95% confidence interval (CI) between assessors (i.e. patient versus caregiver) were calculated for each scale. Inter- and intra-rater reliability was calculated using intraclass correlation coefficients (ICCs). RESULTS A total of 254 patients were recruited. The mean differences between patient and caregiver ratings were 0.31 (95% CI: 0.09, 0.53) for the modified Borg scale and 0.36 (95% CI: 0.06, 0.65) for the VAS scale. Interrater reliability was good for both scales with ICC of 0.79 (95% CI: 0.73, 0.84) for VAS and 0.82 (95% CI: 0.77, 0.86) for the modified Borg scale. The mean differences in scores between scales were 0.93 (95% CI 0.69, 1.17) for patients' ratings and 0.88 (95% CI 0.72, 1.04) for caregiver's rating. The inter-instrument reliability was moderate to good and similar for both assessors. CONCLUSION Dyspnea can be accurately estimated by caregivers when patients with lung diseases cannot self-report. Scores on the VAS to rate dyspnea were higher than the scores on the Borg scale.
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Affiliation(s)
- Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Université Catholique de Louvain, Brussels, Belgium; Service de Pneumologie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium; Secteur de Kinésithérapie et Ergothérapie, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - Marc Beaumont
- Service de Réhabilitation Respiratoire, Centre Hospitalier des Pays de Morlaix, Morlaix, France; EA3878 (GETBO), CHU Brest, Brest, France
| | - Anne-Claire Latiers
- Secteur de Kinésithérapie et Ergothérapie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thierry Pieters
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Université Catholique de Louvain, Brussels, Belgium; Service de Pneumologie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - Antoine Fremault
- Service de Pneumologie, Grand Hôpital de Charleroi, Charleroi, Belgium
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12
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Mercer RM, Varatharajah R, Shepherd G, Lu Q, Castro-Añón O, McCracken DJ, Dudina A, Addala D, Tsikrika S, George V, Banka R, Asciak R, Hassan M, Hallifax R, Bedawi EO, Shute JK, Rahman NM. Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion. BMJ Open Respir Res 2021; 7:7/1/e000701. [PMID: 32963027 PMCID: PMC7509958 DOI: 10.1136/bmjresp-2020-000701] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Current guidelines recommend an initial pleural aspiration in the investigation and management of suspected malignant pleural effusions (MPEs) with the aim of establishing a diagnosis, identifying non-expansile lung (NEL) and, at times, providing a therapeutic procedure. A wealth of research has been published since the guidelines suggesting that results and outcomes from an aspiration may not always provide sufficient information to guide management. It is important to establish the validity of these findings in a 'real world' population. METHODS A retrospective analysis was conducted of all patients who underwent pleural fluid (PF) sampling, in a single centre, over 3 years to determine the utility of the initial aspiration. RESULTS A diagnosis of MPE was confirmed in 230/998 (23%) cases, a further 95/998 (9.5%) were presumed to represent MPE. Transudative biochemistry was found in 3% of cases of confirmed MPE. Positive PF cytology was only sufficient to guide management in 45/140 (32%) cases. Evidence of pleural thickening on CT was associated with both negative cytology (χ2 1df=26.27, p<0.001) and insufficient samples (χ2 1df=10.39, p=0.001). In NEL 44.4% of patients did not require further procedures after pleurodesis compared with 72.7% of those with expansile lung (χ2 1df=5.49, p=0.019). In patients who required a combined diagnostic and therapeutic aspiration 106/113 (93.8%) required further pleural procedures. CONCLUSIONS An initial pleural aspiration does not achieve either definitive diagnosis or therapy in the majority of patients. A new pathway prioritising symptom management while reducing procedures should be considered.
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Affiliation(s)
- Rachel Mary Mercer
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom .,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.,Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, United Kingdom
| | - Rebecca Varatharajah
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Gillian Shepherd
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Qiang Lu
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Olalla Castro-Añón
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom.,Respiratory Division and Sleep Disorders Unit, Lucus Augusti University Hospital, Lugo, Spain
| | - David J McCracken
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Alexandra Dudina
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Dinesh Addala
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Stamatoula Tsikrika
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom.,Pulmonary Division, Department of Critical Care, Medical School, National and Kapodistrian, University of Athens, Evangelismos General Hospital, Athens, Greece
| | - Vineeth George
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Radhika Banka
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Maged Hassan
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom.,Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Robert Hallifax
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Janis Kay Shute
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom.,Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, United Kingdom.,Oxford NIHR Biomedical Research Centre, University of Oxford and Oxford University Hospitals, Oxford, UK
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13
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Lee CH, Kim IH. Aquatic Exercise and Land Exercise Treatments after Total Knee Replacement Arthroplasty in Elderly Women: A Comparative Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:589. [PMID: 34201120 PMCID: PMC8229167 DOI: 10.3390/medicina57060589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Early intensive exercise after total knee replacement arthroplasty (TKRA) has become increasingly popular due to its ability to enhance knee physical function and reduce pain. When implemented exclusively, aquatic exercise (AE) appears to be more advantageous than land exercise (LE), particularly in the early phase after TKRA. Our study aimed to compare the clinical efficacy of AE and LE with respect to their effects on pain and physical function after TKRA. Materials and Methods: Between February 2008 and January 2020, 100 female patients who underwent TKRA were enrolled in this retrospective study. We measured the range of motion (ROM) of the knee, the isokinetic strength of the knee joint (function), and pain both initially and one month after TKRA. Two weeks after TKRA, the participants were enrolled in either the AE or the LE program for a total of two weeks. Two 30 min sessions of intensive ROM and knee strengthening exercises and balance training were provided to the AE and LE groups for 10 days. The home exercise group (HE) only received information on ROM and strengthening exercises. There were 33, 21, and 46 patients allocated to the AE, LE, and HE groups, respectively. Results: The ROM of the side on which surgery was performed improved significantly in all groups, as did the pain scores. In the AE group, the knee flexor strength showed a tendency toward improvement. Contrastingly, there was no significant improvement in the knee extensor strength in the AE group. Conclusions: Overall, the AE and LE groups showed superior outcomes compared with HE. In addition, the AE group demonstrated some improvement in knee muscle strength even with a short hospital stay. Further study with long-term follow-up should be performed to better define the outcomes.
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Affiliation(s)
- Chang-Hyung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea;
| | - In-Hye Kim
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Korea
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14
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Roh J, Ahn HY, Kim I, Son JH, Seol HY, Kim MH, Lee MK, Eom JS. Clinical course of asymptomatic malignant pleural effusion in non-small cell lung cancer patients: A multicenter retrospective study. Medicine (Baltimore) 2021; 100:e25748. [PMID: 34106603 PMCID: PMC8133234 DOI: 10.1097/md.0000000000025748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022] Open
Abstract
The British Thoracic Society guidelines recommend observation for patients with asymptomatic malignant pleural effusion (MPE). However, asymptomatic MPE can become symptomatic. This study examined the clinical course of asymptomatic MPE in patients with non-small cell lung cancer (NSCLC), including the incidence and timing of symptom development of asymptomatic MPE and the associated factors.Retrospective data of 4822 NSCLC patients between January 2012 and December 2017 were reviewed. Symptom development of asymptomatic MPE was defined as the development of symptoms requiring additional treatment, such as insertion of a chest tube, within 1 year in patients who lacked MPE symptoms at the time of diagnosis. Clinical information, pathological parameters, and radiological characteristics were reviewed. Patient data up to 1 year from the initial diagnosis were reviewed.Of 113 patients with asymptomatic MPE, 46 (41%) became symptomatic within 1 year despite appropriate anticancer treatment. The median time to symptom development was 4 months, and 38 patients (83%) developed symptoms within 6 months. Multivariate logistic regression showed that female sex (odds ratio [OR], 0.256; 95% confidence interval [CI], 0.101-0.649; P = .004) and the depth of pleural effusion on initial computed tomography (CT) (OR, 0.957; 95% CI, 0.932-0.982; P = .001) were independently associated with symptom development of asymptomatic MPE.A fraction of 41% of patients with asymptomatic MPE became symptomatic within 1 year. Female sex and larger MPE on initial CT were independently associated with symptom development of asymptomatic MPE.
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Affiliation(s)
- Jiyeon Roh
- Department of Internal Medicine
- Biomedical Research Institute, Pusan National University Hospital
| | - Hyo Yeong Ahn
- Biomedical Research Institute, Pusan National University Hospital
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine
| | - Insu Kim
- Department of Internal Medicine, Dong-A University Hospital, Busan
| | | | - Hee Yun Seol
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | | | | | - Jung Seop Eom
- Department of Internal Medicine
- Biomedical Research Institute, Pusan National University Hospital
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15
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Beltsios ET, Mavrovounis G, Adamou A, Panagiotopoulos N. Talc pleurodesis in malignant pleural effusion: a systematic review and meta-analysis. Gen Thorac Cardiovasc Surg 2020; 69:832-842. [PMID: 33222091 DOI: 10.1007/s11748-020-01549-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Malignant pleural effusion is a severe and common complication in patients with primary or metastatic malignancies of the pleura. Although talc pleurodesis is widely used for managing malignant pleural effusions, there is still controversy in the literature regarding its superiority compared to other approaches. We conducted this meta-analysis to further investigate its efficacy compared to alternative interventions. METHODS We systematically reviewed the PubMed, Cochrane, and Scopus databases to identify studies that fulfilled our inclusion criteria. Study quality was evaluated using validated tools and the pooled Risk Ratio (RR) and confidence interval (CI) were calculated. We performed sensitivity analyses based on the meta-analysis method and type of study. RESULTS Twenty-four studies were included in the current systematic review meta-analysis. Talc pleurodesis was associated with statistically significant higher successful pleurodesis rates when compared with all controls [RR (95% CI) 1.15 (1.00, 1.31); Pz = 0.04], only chemical controls [RR (95% CI) 1.26 (1.13, 1.40); Pz < 0.0001], and bleomycin [RR (95% CI) 1.22 (1.05, 1.42); Pz = 0.008]. The comparison between talc pleurodesis and controls at the > 1-month follow-up time point favored talc pleurodesis [RR (95% CI): 1.62 (1.15, 2.27); Pz = 0.005]. Finally, talc poudrage was associated with a statistically significant higher successful pleurodesis rate when compared with all controls. Sensitivity analyses verified the robustness of our results. CONCLUSION Talc pleurodesis is an effective MPE management approach presenting borderline statistically significant superiority compared to control methods especially compared to bleomycin as well as when pleurodesis success is evaluated later than 1 month postoperatively.
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Affiliation(s)
- Eleftherios T Beltsios
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK. .,Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Biopolis, Greece.
| | - Georgios Mavrovounis
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Biopolis, Greece
| | - Antonis Adamou
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Biopolis, Greece.,Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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16
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Choratas A, Papastavrou E, Charalambous A, Kouta C. Developing and Assessing the Effectiveness of a Nurse-Led Home-Based Educational Programme for Managing Breathlessness in Lung Cancer Patients. A Feasibility Study. Front Oncol 2020; 10:1366. [PMID: 32983967 PMCID: PMC7492635 DOI: 10.3389/fonc.2020.01366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Breathlessness is the most common and refractory symptom in lung cancer patients. Even though various educational programmes have been developed, only a few were intended for implementation in the home setting for its management. Aim: Feasibility of a study for implementing a nurse-led educational programme for breathlessness management of lung cancer patients at home. Method: A randomized feasibility study was undertaken between February 2017 and October 2018. Patients were recruited through referral from oncologists from two oncology centers in Cyprus under certain inclusion and exclusion criteria. Patients were randomized in the intervention or control group via a computer programme, and their named family caregivers (f.c.) were allocated in the same group. Participants were not blinded to group assignment. The intervention consisted of a PowerPoint presentation and implementation of three non-pharmacological interventions. The control group received usual care. Patients were assessed for breathlessness, anxiety, and depression levels, whereas f.c. were assessed for anxiety, depression, and burden levels. F.c. also assessed patients' dyspnea level. The duration of the study process for both the intervention and control group was over a period of 4 weeks. Results: Twenty-four patients and their f.c. (n = 24) were allocated equally in the intervention and control group. Five patients withdrew, and the final sample entered analysis was 19 patients and 19 family caregivers. In the intervention group n = 11 + 11, and in the control group n = 8 + 8. In the intervention group patients' breathlessness and anxiety levels showed improvement and their f.c.s in the anxiety and burden levels. Major consideration was the sample size and the recruitment of the patients by the referring oncologists. Attrition was minor during the study process. No harm was recorded by the participants of the study. Conclusions: The study provided evidence of the feasibility of the implementation of the educational programme. For the future definitive study major consideration should be patients' recruitment method in order to achieve adequate sample size. Moreover, qualitative data should be collected in relation to the intervention and the involvement of f.c. The feasibility study was registered to the Cyprus Bioethics Committee with the registration number 2016/16. There was no funding of the study.
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Affiliation(s)
- Aristides Choratas
- Nursing Department, Cyprus University of Technology, Limassol, Cyprus
- *Correspondence: Aristides Choratas
| | | | - Andreas Charalambous
- Nursing Department, Cyprus University of Technology, Limassol, Cyprus
- Nursing Department, University of Turku, Turku, Finland
| | - Christiana Kouta
- Nursing Department, Cyprus University of Technology, Limassol, Cyprus
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17
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Ozoglu Aytac S, Kilic SP, Ovayolu N. Effect of inhaler drug education on fatigue, dyspnea severity, and respiratory function tests in patients with COPD. PATIENT EDUCATION AND COUNSELING 2020; 103:709-716. [PMID: 31733985 DOI: 10.1016/j.pec.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study was conducted to examine the effect of inhaler drug education on fatigue, dyspnea severity, and respiratory function tests in patients with chronic obstructive pulmonary disease (COPD). METHODS This randomized controlled study was conducted with a total of 85 patients treated at the chest diseases clinic and outpatient clinic of a state hospital. The data were collected using questionnaires, respiratory function tests, and the COPD and Asthma Fatigue Scale (CAFS) and Visual Analogue Scale (VAS-for dyspnea severity). RESULTS It was determined that after 4 weeks of inhaler drug education, the CAFS mean score decreased to 35.32 ± 14.36, the dyspnea severity mean score decreased to 4.76 ± 2.50, and the respiratory function tests mean scores increased to forced expiratory volume in 1 s (FEV1) = 58.83 ± 25.48, forced vital capacity (FVC) = 59.04 ± 19.19, and FEV1/FVC = 88.39 ± 21.59 in the intervention group (p < 0.05). No change was observed in the patients in the control group except for FEV1 and FVC mean scores (p > 0.05). CONCLUSION These results demonstrate that inhaler drug education can improve fatigue, dyspnea severity, and respiratory function tests of patients with COPD. PRACTICE IMPLICATIONS The training by nurses of every patient hospitalized in the clinic regarding inhaler drug therapy, and the regular checking of patients' way of using the inhaled drugs, will contribute to COPD management.
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Affiliation(s)
- Sema Ozoglu Aytac
- Gaziantep University, Şahinbey, Research and Application Hospital, Gaziantep, Turkey
| | - Serap Parlar Kilic
- İnonu University Faculty of Nursing, Department of Internal Medicine Nursing, Battalgazi/Malatya, 44000, Turkey.
| | - Nimet Ovayolu
- Gaziantep University Faculty of Health Sciences, Department of Internal Medicine Nursing, Gaziantep, Turkey
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18
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Grosu HB, Molina S, Casal R, Song J, Li L, Diaz-Mendoza J, Reddy C, Yarmus L, Schiavo D, Simoff M, Johnstun J, Raid AA, Feller-Kopman D, Lee H, Sahetya S, Foley F, Maldonado F, Tian X, Noor L, Miller R, Mudambi L, Saettele T, Vial-Rodriguez M, Eapen GA, Ost DE. Risk factors for pleural effusion recurrence in patients with malignancy. Respirology 2019; 24:76-82. [PMID: 29966171 PMCID: PMC7315912 DOI: 10.1111/resp.13362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/09/2018] [Accepted: 06/07/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The main purpose of treatment in patients with malignant pleural effusion (MPE) is symptom palliation. Currently, patients undergo repeat thoracenteses prior to receiving a definitive procedure as clinicians are not aware of the risk factors associated with fluid recurrence. The primary objective of this study was to identify risk factors associated with recurrent symptomatic MPE. METHODS Retrospective multicentre cohort study of patients who underwent first thoracentesis was performed. The primary outcome was time to fluid recurrence requiring intervention in patients with evidence of metastatic disease. We used a cause-specific hazard model to identify risk factors associated with fluid recurrence. We also developed a predictive model, utilizing Fine-Gray subdistribution hazard model, and externally validated the model. RESULTS A total of 988 patients with diagnosed metastatic disease were included. Cumulative incidence of recurrence was high with 30% of patients recurring by day 15. On multivariate analysis, size of the effusion on chest X-ray (up to the top of the cardiac silhouette (hazard ratio (HR): 1.84, 95% CI: 1.21-2.80, P = 0.004) and above the cardiac silhouette (HR: 2.22, 95% CI: 1.43-3.46, P = 0.0004)), larger amount of pleural fluid drained (HR: 1.06, 95% CI: 1.04-1.07, P < 0.0001) and higher pleural fluid LDH (HR: 1.008, 95% CI: 1.004-1.011, P < 0.0001) were associated with increased hazard of recurrence. Negative cytology (HR: 0.52, 95% CI: 0.43-0.64, P < 0.0001) was associated with decreased hazard of recurrence. The model had low prediction accuracy. CONCLUSION Pleural effusion size, amount of pleural fluid drained, LDH and pleural fluid cytology were found to be risk factors for recurrence.
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Affiliation(s)
- Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sofia Molina
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- School of Medicine and Health Sciences TecSalud, Monterrey, Mexico
| | - Roberto Casal
- Pulmonary Department, Michael DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Chakravarthy Reddy
- Pulmonary Department, University of Utah Health Care, Salt Lake City, UT, USA
| | - Lonny Yarmus
- Pulmonary Department, Johns Hopkins University, Baltimore, MD, USA
| | - Dante Schiavo
- Pulmonary Department, Mayo Clinic, Rochester, MN, USA
| | - Michael Simoff
- Pulmonary Department, Henry Ford Hospital, Detroit, MI, USA
| | - Jared Johnstun
- Pulmonary Department, University of Utah Health Care, Salt Lake City, UT, USA
| | - Abu-Awwad Raid
- Pulmonary Department, Michael DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Hans Lee
- Pulmonary Department, Johns Hopkins University, Baltimore, MD, USA
| | - Sarina Sahetya
- Pulmonary Department, Johns Hopkins University, Baltimore, MD, USA
| | - Finbar Foley
- Pulmonary Department, Mayo Clinic, Rochester, MN, USA
| | | | - Xin Tian
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laila Noor
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Russell Miller
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lakshmi Mudambi
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy Saettele
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Macarena Vial-Rodriguez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gerogie A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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19
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Garske LA, Kunarajah K, Zimmerman PV, Adams L, Stewart IB. In patients with unilateral pleural effusion, restricted lung inflation is the principal predictor of increased dyspnoea. PLoS One 2018; 13:e0202621. [PMID: 30281613 PMCID: PMC6169850 DOI: 10.1371/journal.pone.0202621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The mechanism of dyspnoea associated with pleural effusion is uncertain. A cohort of patients requiring thoracoscopy for unilateral exudative effusion were investigated for associations between dyspnoea and suggested predictors: impaired ipsilateral diaphragm movement, effusion volume and restricted lung inflation. METHODS Baseline Dyspnoea Index, respiratory function, and ultrasound assessment of ipsilateral diaphragm movement were assessed prior to thoracoscopy, when effusion volume was measured. Transitional Dyspnoea Index (change from baseline) was assessed 4 and 8 weeks after thoracoscopy. Pearson product moment assessed bivariate correlations and a general linear model examined how well total lung capacity (measuring restricted lung inflation), effusion volume and impaired diaphragm movement predicted Baseline Dyspnoea Index. Un-paired t tests compared the groups with normal and impaired diaphragm movement. RESULTS 19 patients were studied (14 malignant etiology). Total lung capacity was associated with Baseline Dyspnoea Index (r = 0.68, P = 0.003). Effusion volume (r = -0.138, P = 0.60) and diaphragm movement (P = 0.09) were not associated with Baseline Dyspnoea Index. Effusion volume was larger with impaired diaphragm movement compared to normal diaphragm movement (2.16 ±SD 0.95 vs.1.16 ±0.92 L, P = 0.009). Total lung capacity was lower with impaired diaphragm movement compared to normal diaphragm movement (65.4 ±10.3 vs 78.2 ±8.6% predicted, P = 0.011). The optimal general linear model to predict Baseline Dyspnoea Index used total lung capacity alone (adjusted R2 = 0.42, P = 0.003). In nine participants with controlled effusion, baseline effusion volume (r = 0.775, P = 0.014) and total lung capacity (r = -0.690, P = 0.040) were associated with Transitional Dyspnoea Index. CONCLUSIONS Restricted lung inflation was the principal predictor of increased dyspnoea prior to thoracoscopic drainage of effusion, with no independent additional association with either effusion volume or impaired ipsilateral diaphragm movement. Restricted lung inflation may be an important determinant of the dyspnoea associated with pleural effusion.
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Affiliation(s)
- Luke A. Garske
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Thoracic Medicine, Prince Charles Hospital, Brisbane, Queensland, Australia
- * E-mail:
| | | | - Paul V. Zimmerman
- Department of Thoracic Medicine, Prince Charles Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Lewis Adams
- Allied Health Sciences and Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ian B. Stewart
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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20
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Abstract
PURPOSE OF REVIEW Patients with malignant pleural effusions (MPEs) are heterogenous in their disease course, symptom severity, responses to cancer therapies, fluid recurrence rates, and thus need for definitive fluid control measures. To tailor the most appropriate treatment for individual patients, clinicians need to 'phenotype' the patients and predict their clinical course. This review highlights the recent efforts to develop better predictive tools and knowledge gaps for further research. RECENT FINDINGS The LENT scoring system, which includes pleural fluid lactate dehydrogenase, performance status, serum neutrophil-to-lymphocyte ratio and tumor type, allows prediction of the survival of patients with MPE. Symptomatic response after therapeutic pleural drainage is highly variable; ongoing studies aim to identify those who would derive symptomatic benefit from fluid drainages. Multivariate analysis found that patients with low pleural fluid pH [odds ratio (OR) 37.04], large effusions (OR 3.31), and increasing age (OR 1.02) were more likely to require pleurodesis or indwelling pleural catheter placement for fluid control. Better predictive tools for rate of fluid recurrence and likelihood of successful pleurodesis would help guide clinical decision-making. SUMMARY Phenotyping MPE would guide the formulation of optimal management for individual MPE patients.
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Keshishyan S, Harris K. Asymptomatic malignant pleural effusion: to observe or to manage. J Thorac Dis 2017; 9:S1146-S1147. [PMID: 29214072 DOI: 10.21037/jtd.2017.06.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sevak Keshishyan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, Valhalla, NY, USA
| | - Kassem Harris
- Division of Pulmonary, Critical Care, and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, Valhalla, NY, USA
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Penz E, Watt KN, Hergott CA, Rahman NM, Psallidas I. Management of malignant pleural effusion: challenges and solutions. Cancer Manag Res 2017; 9:229-241. [PMID: 28694705 PMCID: PMC5491570 DOI: 10.2147/cmar.s95663] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Malignant pleural effusion (MPE) is a sign of advanced cancer and is associated with significant symptom burden and mortality. To date, management has been palliative in nature with a focus on draining the pleural space, with therapies aimed at preventing recurrence or providing intermittent drainage through indwelling catheters. Given that patients with MPEs are heterogeneous with respect to their cancer type and response to systemic therapy, functional status, and pleural milieu, response to MPE therapy is also heterogeneous and difficult to predict. Furthermore, the impact of therapies on important patient outcomes has only recently been evaluated consistently in clinical trials and cohort studies. In this review, we examine patient outcomes that have been studied to date, address the question of which are most important for managing patients, and review the literature related to the expected value for money (cost-effectiveness) of indwelling pleural catheters relative to traditionally recommended approaches.
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Affiliation(s)
- Erika Penz
- Division of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, SK
| | - Kristina N Watt
- Division of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, SK
| | - Christopher A Hergott
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Respiratory Trials Unit, Oxford University, Oxford, UK
| | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Respiratory Trials Unit, Oxford University, Oxford, UK
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23
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At-risk and intervention thresholds of occupational stress using a visual analogue scale. PLoS One 2017; 12:e0178948. [PMID: 28586383 PMCID: PMC5460813 DOI: 10.1371/journal.pone.0178948] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/22/2017] [Indexed: 01/15/2023] Open
Abstract
Background The visual analogue scale (VAS) is widely used in clinical practice by occupational physicians to assess perceived stress in workers. However, a single cut-off (black-or-white decision) inadequately discriminates between workers with and without stress. We explored an innovative statistical approach to distinguish an at-risk population among stressed workers, and to establish a threshold over which an action is urgently required, via the use of two cut-offs. Methods Participants were recruited during annual work medical examinations by a random sample of workers from five occupational health centres. We previously proposed a single cut-off of VAS stress in comparison with the Perceived Stress Scale (PSS14). Similar methodology was used in the current study, along with a gray zone approach. The lower limit of the gray zone supports sensitivity (“at-risk” threshold; interpreted as requiring closer surveillance) and the upper limit supports specificity (i.e. “intervention” threshold–emergency action required). Results We included 500 workers (49.6% males), aged 40±11 years, with a PSS14 score of 3.8±1.4 and a VAS score of 4.0±2.4. Using a receiver operating characteristic curve and the PSS cut-off score of 7.2, the optimal VAS threshold was 6.8 (sensitivity = 0.89, specificity = 0.87). The lower and upper thresholds of the gray zone were 5 and 8.2, respectively. Conclusions We identified two clinically relevant cut-offs on the VAS of stress: a first cut-off of 5.0 for an at-risk population, and a second cut-off of 8.2 over which an action is urgently required. Future investigations into the relationships between this upper threshold and deleterious events are required.
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Boshuizen RC, Vd Noort V, Burgers JA, Herder GJM, Hashemi SMS, Hiltermann TJN, Kunst PW, Stigt JA, van den Heuvel MM. A randomized controlled trial comparing indwelling pleural catheters with talc pleurodesis (NVALT-14). Lung Cancer 2017. [PMID: 28625655 DOI: 10.1016/j.lungcan.2017.01.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Symptomatic malignant pleural effusion (MPE) occurs frequently in patients with metastatic cancer. The associated prognosis is poor and the success rate of talc pleurodesis (TP) is low. Indwelling pleural catheters (IPCs) are commonly inserted when TP has been unsuccessful. METHODS We compared talc pleurodesis with the use of an indwelling pleural catheter in patients with recurrent MPE in a multicenter randomized controlled trial (superiority design). The primary endpoint was improvement from baseline in Modified Borg Score (MBS) 6weeks after randomized treatment. Secondary endpoints were hospitalization days, re-interventions, and adverse events. RESULTS Dyspnea improved significantly (p<0.01) after either treatment, but the magnitude of this improvement did not differ significantly between arms (median 3 and 1 for TP:IPC respectively in rest, p=0.16, (TP 13:IPC 16) and 3 and 1 during exercise, p=0.72 (TP 13:IPC 17)). There was no difference in dyspnea during exercise between TP and IPC at week 6 following treatment, while at rest TP patients (n=13) reported less dyspnea than IPC patients (n=18) (median 0 vs 1, p=0.002). Compared to TP, patients with an IPC had significantly less hospital days during randomized treatment (median: 0 vs 5, p<0.0001), and total hospitalizations for all causes (median: 1.6 vs 1.0, p=0.0035). Fewer IPC patients underwent more than one re-intervention (7/45 vs 15/43, p=0.09). The mean number of re-interventions was lower following IPC (0.21 vs 0.53, p=0.05). Equal number of adverse events occurred. CONCLUSIONS IPC was not superior in the primary endpoint, improvement of the modified Borg scale (MBS). However, IPC patients had lower hospital stay, fewer admissions and fewer re-interventions. The IPC is an effective treatment modality in patients with symptomatic malignant pleural effusion.
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Affiliation(s)
- R C Boshuizen
- Dep. of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Dep. of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - V Vd Noort
- Biometrics Dep., The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - J A Burgers
- Dep. of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - G J M Herder
- Dep. of Pulmonary Diseases, St. Antonius Hospital Nieuwegein, The Netherlands.
| | - S M S Hashemi
- Dep. of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands.
| | - T J N Hiltermann
- Dep. of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - P W Kunst
- Dep. of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; Dep. of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands.
| | - J A Stigt
- Dep. of Pulmonolgy, Isala Klinieken, Zwolle, The Netherlands.
| | - M M van den Heuvel
- Dep. of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Puspawati NLPD, Sitorus R, Herawati T. Hand-held Fan Airflow Stimulation Relieves Dyspnea in Lung Cancer Patients. Asia Pac J Oncol Nurs 2017; 4:162-167. [PMID: 28503650 PMCID: PMC5412155 DOI: 10.4103/apjon.apjon_14_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: The main symptom of lung cancer is dyspnea which can lead to depression, anxiety, limited independent activities, and decreased quality of life. The purpose of this study was to identify the effect of airflow stimulation from a hand-held fan as nonpharmacological palliative intervention on dyspnea in patients with lung cancer. Methods: This study used open, randomized, controlled, crossover trial design involved 21 participants. Diaphragmatic breathing technique was used in control arm. Results: Wilcoxon test result showed that airflow stimulation significantly influenced dyspnea scale (P = 0.003) and respiratory rate (RR) (P = 0.008). Combination of airflow stimulation and diaphragmatic breathing can lower both dyspnea scale and RR significantly (P < 0.0001). Conclusions: This combination can be applied on nonhypoxemic dyspneic lung cancer patients.
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Affiliation(s)
| | - Ratna Sitorus
- Medical Surgical Nursing, Faculty of Nursing, University of Indonesia, Depok, Indonesia
| | - Tuti Herawati
- Medical Surgical Nursing, Faculty of Nursing, University of Indonesia, Depok, Indonesia
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Yamaguchi T, Goya S, Kohara H, Watanabe H, Mori M, Matsuda Y, Nakamura Y, Sakashita A, Nishi T, Tanaka K. Treatment Recommendations for Respiratory Symptoms in Cancer Patients: Clinical Guidelines from the Japanese Society for Palliative Medicine. J Palliat Med 2016; 19:925-35. [PMID: 27315488 DOI: 10.1089/jpm.2016.0145] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Respiratory symptoms, dyspnea, cough, and death rattle, are common and distressing in advanced cancer patients. Palliation of respiratory symptoms is important to improve quality of life in cancer patients and their families/caregivers. Currently published clinical guidelines for the management of these respiratory symptoms in cancer patients did not cover the topics comprehensively or were not based on formal process for the development of clinical guidelines. METHODS The Japanese Society for Palliative Medicine (JSPM) decided to develop comprehensive clinical guidelines for the management of respiratory symptoms in cancer patients following the formal guideline developing process. RESULTS This article provides a summary of the recommendations with the rationales, as well as a short summary of the developing process, of the JSPM respiratory symptom management guidelines. We established 26 recommendations and all recommendations are based on the best available evidences and expert consensus. DISCUSSION More future clinical researches and continuous guideline updates are required to improve the quality of respiratory symptom management in cancer patients.
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Affiliation(s)
- Takashi Yamaguchi
- 1 Department of Palliative Medicine, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Sho Goya
- 2 Department of Respiratory Medicine, Kinki Central Hospital , Itami, Japan
| | - Hiroyuki Kohara
- 3 Department of Palliative Medicine, Hiroshima Prefectural Hospital , Hiroshima, Japan
| | - Hiroaki Watanabe
- 4 Department of Palliative Medicine, Komaki Municipal Hospital , Komaki, Japan
| | - Masanori Mori
- 5 Department of Palliative Medicine, Seirei Hamamatsu General Hospital , Hamamatsu, Japan
| | - Yoshinobu Matsuda
- 6 Department of Psycho-somatic Medicine, Kinki-Chuo Chest Medical Center , Sakai, Japan
| | - Yoichi Nakamura
- 7 Department of Surgery, Toho University Ohashi Medical Center , Tokyo, Japan
| | - Akihiro Sakashita
- 8 Department of Palliative Care, Hyogo Prefectural Kakogawa Medical Center , Kakogawa, Japan
| | - Tomohiro Nishi
- 9 Department of Medical Oncology, Kawasaki Municipal Ida Hospital , Kawasaki, Japan
| | - Keiko Tanaka
- 10 Department of Palliative Care, Tokyo Metropolitan Komagome Hospital , Tokyo, Japan
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Abstract
Pleural effusions are common and account for high morbidity and mortality in a range of patients. Thoracentesis can provide significant symptom relief and improvement in physiologic parameters including dyspnea, exercise, and sleep. Recent advances, including the use of ultrasound and dedicated procedural teams, have improved the safety of thoracentesis. This has allowed thoracentesis to be performed on higher-risk individuals including those with elevated bleeding risk and bilateral pleural effusions. This review will summarize recent advances in thoracentesis procedural safety, symptom relief following thoracentesis, and understanding of the physiologic basis for such improvements.
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Affiliation(s)
- Erin M. DeBiasi
- Department of Pulmonary and Critical Care Medicine, Yale University, New Haven, CT, USA
| | - Jonathan Puchalski
- Department of Pulmonary and Critical Care Medicine, Yale University, New Haven, CT, USA
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Kim SK, Ahn YH, Yoon JA, Shin MJ, Chang JH, Cho JS, Lee MK, Kim MH, Yun EY, Jeong JH, Shin YB. Efficacy of Systemic Postoperative Pulmonary Rehabilitation After Lung Resection Surgery. Ann Rehabil Med 2015; 39:366-73. [PMID: 26161342 PMCID: PMC4496507 DOI: 10.5535/arm.2015.39.3.366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/10/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate the efficacy of systemic pulmonary rehabilitation (PR) after lung resection in patients with lung cancer. METHODS Forty-one patients undergoing lung resection were enrolled and classified into the experimental (n=31) and control groups (n=10). The experimental group underwent post-operative systemic PR which was conducted 30 min/day on every hospitalization day by an expert physical therapist. The control group received the same education about the PR exercises and were encouraged to self-exercise without supervision of the physical therapist. The PR group was taught a self-PR program and feedback was provided regularly until 6 months after surgery. We conducted pulmonary function testing (PFT) and used a visual analog scale (VAS) to evaluate pain, and the modified Borg Dyspnea Scale (mBS) to measure perceived respiratory exertion shortly before and 2 weeks, 1, 3, and 6 months after surgery. RESULTS A significant improvement on the VAS was observed in patients who received systemic PR >3 months. Significant improvements in forced vital capacity (FVC) and mBS score were observed in patients who received systemic PR >6 months (p<0.05). Other PFT results were not different compared with those in the control group. CONCLUSION Patients who received lung resection suffered a significant decline in functional reserve and increases in pain and subjective dyspnea deteriorating quality of life (QoL). Systemic PR supervised by a therapist helped improve reduced pulmonary FVC and QoL and minimized discomfort during the postoperative periods in patients who underwent lung resection.
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Affiliation(s)
- Soo Koun Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Young Hyun Ahn
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea. ; Department of Rehabilitation Medicine, Medwill Hospital, Busan, Korea
| | - Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Myung Jun Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. ; Regional Center for Respiratory Diseases, Pusan National University Hospital, Busan, Korea
| | - Jae Hyeok Chang
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jeong Su Cho
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. ; Regional Center for Respiratory Diseases, Pusan National University Hospital, Busan, Korea. ; Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Min Ki Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. ; Regional Center for Respiratory Diseases, Pusan National University Hospital, Busan, Korea. ; Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi Hyun Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. ; Regional Center for Respiratory Diseases, Pusan National University Hospital, Busan, Korea. ; Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun Young Yun
- Department of Biostatistics, Clinical Trial Center, Pusan National University Hospital, Busan, Korea
| | - Jong-Hwa Jeong
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. ; Regional Center for Respiratory Diseases, Pusan National University Hospital, Busan, Korea
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Boshuizen RC, Burgers JA, van den Heuvel MM. Comments on predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion. Chest 2015; 147:e232. [PMID: 26033142 DOI: 10.1378/chest.15-0253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Rogier C Boshuizen
- Department of Thoracic Oncology, The Netherlands Cancer Institute. Amsterdam, The Netherlands.
| | - Jacobus A Burgers
- Department of Thoracic Oncology, The Netherlands Cancer Institute. Amsterdam, The Netherlands
| | - Michel M van den Heuvel
- Department of Thoracic Oncology, The Netherlands Cancer Institute. Amsterdam, The Netherlands
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Egerod I, Nielsen S, Lisby KH, Darmer MR, Pedersen PU. Immediate post-operative responses to transcatheter aortic valve implantation: An observational study. Eur J Cardiovasc Nurs 2014; 14:232-9. [PMID: 24550558 DOI: 10.1177/1474515114525521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/04/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Conventional treatment for patients with severe symptomatic aortic stenosis is surgical aortic valve replacement (SAVR), but transcatheter aortic valve implantation (TAVI) has become a reliable alternative in high-risk patients. AIMS The aim of our study was to describe the post-operative patient response to TAVI on the evening of the procedure and the following day before discharge from the coronary care unit. A secondary aim was to compare responses of patients younger and older than 80 years of age. METHODS A prospective, comparative observational study triangulating nurse assessment and structured interviews on a cohort of 54 Danish patients: 28/26 male/female, 26/28 younger/older than 80. Mean age in the younger/older group was 73/85 years. RESULTS After TAVI pain was experienced by 47 (87%) patients; 29 (62%) were restricted by pain, and 24 (44%) had discomfort at the femoral insertion site. Disturbed sleep/rest were reported by 34 (63%)/29 (55%) patients; nausea/vomiting by 14 (26%)/5 (9%) patients, restricting eating/drinking in 11 (21%)/8 (15%) patients. Sinus rhythm/atrial fibrillation/paced rhythm were observed in 35 (65%)/8 (15%)/21 (39%) patients; bleeding/haematoma/oozing from femoral insertion site in 23 (45%)/10 (19%)/23 (43%) patients. CONCLUSION Patients older than 80 years did as well as the younger patients in our study; the main complaints were post-operative pain and disrupted sleep. Our numbers are small, but most patients experienced considerable pain, predominantly continuous and at rest. We recommend the development of an evidence-based pathway to address the immediate post-operative issues in TAVI patients. Non-pharmacological interventions to prevent pain and promote sleep need to be explored.
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Affiliation(s)
- Ingrid Egerod
- Trauma Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Susanne Nielsen
- Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Karen H Lisby
- Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Mette R Darmer
- Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
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