Background There is increasing concern about discontinuity of care across transitions (e.g. from home to hospital) and how that might affect appropriate medical management. We examined the changes over time in outpatient to inpatient continuity in individuals hospitalized with advanced lung cancer and its relationship to end of life ICU use. Methods Retrospective analysis of the linked Surveillance, Epidemiology and End Results (SEER) – Medicare database. Subjects were 21,183 Medicare beneficiaries aged 66 years or older diagnosed with Stage IIIB or IV lung cancer between January 1, 1992 and December 31, 2002 who died within a year of diagnosis from 1992 through 2003. Outpatient to inpatient continuity is defined as an inpatient visit by the patient's usual care provider during the last hospitalization. The primary outcome measure is ICU use during the last hospitalization. Results Outpatient to inpatient continuity decreased from 60.1% in 1992 to 51.5% in 2002 (p<0.001). Factors associated with decreased continuity included: male gender, black race, low socioeconomic status, being unmarried, treatment by a hospitalist, and treatment in a teaching hospital. ICU use increased by 5.8% per year from 1993–2002. After adjusting for patient characteristics, patients with outpatient to inpatient continuity had a 25.1% reduced odds of spending time in an ICU during the terminal hospitalization. Conclusion Outpatient to inpatient continuity of care declined during the 1990s and early 2000s. Patients with terminal lung cancer who experienced continuity of care across the outpatient to hospital settings were less likely to spend time in the ICU prior to death.
Objective To evaluate the efficacy and safety of early pulmonary rehabilitation (PR) (ie, <3 days of hospitalization) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Embase, Web of Science, PubMed and Cochrane Library were searched from their inception to 1 April 2021. Randomized controlled trials were included if they observed the efficacy of early PR in AECOPD patients. Study selection, data extraction, risk of bias and quality of evidence were assessed by two researchers independently. Assessment of the risk of bias and eidence quality were evaluated by the Cochrane Collaboration’s tool and Grading of Recommendations, Assessment, Development and Evaluation system, respectively. Results Fourteen trials (829 participants) were identified. Significant improvement was found in the 6-minute walk distance (6MWD; mean difference (MD): 69.64; 95% CI: 40.26 to 99.01; Z = 4.65, P < 0.0001, low quality). In the subgroup analysis, the exercise-training group showed marked improvement (MD: 96.14; 95% CI: 20.24 to 172.04; Z = 2.48, P = 0.001). The Saint George’s Respiratory Questionnaire (SGRQ) total score was low (MD: −12.77; 95% CI: −16.03 to −9.50; Z = 7.67, P < 0.0001, moderate quality). Significant effects were not found for the duration of hospital stay, quadriceps muscle strength or five times sit to stand test. Only one serious adverse event was reported in experimental group, which was not associated with early PR. Conclusion PR initiated <3 days of hospitalization may increase exercise capacity and improve quality of life, but the results should be interpreted prudently and dialectically, and the role of early PR in AECOPD needs further exploration.
Objective This systematic review delineates various exercise‐based pulmonary rehabilitation (PR) designs and quantifies how they may be optimized in pediatric asthma treatment. Design Comprehensive systematic review, network meta‐analysis, and quality analyses using PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Medline searches. Interventions Discrete and combined endurance, respiratory, resistance, strength, and interval training. Main Outcome Measures Forced expiratory volume at 1 s to predicted value ratio (FEV1% pred), forced vital capacity to predicted value ratio (FVC% pred), forced expiratory flow between 25% and 75% of vital capacity ratio (FEF25%–75%), the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and the 6‐min walk test (6MWT). Results Twenty‐four randomized controlled trials (RCTs) involving a combined 1031 patients were included. Endurance training was the most common form of PR (58.3%), typically conducted through outpatient clinics (29.2%). Network meta‐analysis showed that compared with other PR, interval training significantly improved PAQLQ total scores, and activity, symptom, and emotional domains. Interval training also had a significant effect on the 6MWT. No adverse events were reported. Exercise training did not have a significant effect on FEV1% pred; however, combined endurance and respiratory training significantly improved both FVC% pred and FEF25%–75%. Conclusions Exercise‐based PR is safe and effective in childhood asthma treatment. Interval training may be a core component for improving quality of life and exercise capacity in this patient population, while combined respiratory and endurance training may significantly affect lung function. The clinical efficacy of these results should be confirmed through high‐quality RCTs.
Background At present, there is short of effective treatment for acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF). The treatment of IPF with traditional Chinese medicine (TCM) has some advantages. However, the evidence is unclear whether TCM can be recommended as an effective therapy to treat AE-IPF. The purpose of the study is to explore the efficacy and safety of TCM for patients with AE-IPF. Methods A randomized, double-blind, placebo-controlled, exploratory clinical trial will be performed. A total of 80 patients diagnosed with AE-IPF will be randomized into the intervention or control group. In addition to conventional treatment, the intervention group will be treated with Kangxianhuanji granule, and the control group will be given a placebo granule. The administration frequency is 10 g each time and two times daily. After 4 weeks of treatment, the patients were followed up for 12 weeks. The primary outcomes are treatment failure rate and all-cause mortality. Secondary outcome measures will include the length of hospitalization, overall survival, acute exacerbation rate, intubation rate, Modified British Medical Research Council (mMRC) score, the St George’s Respiratory Questionnaire idiopathic pulmonary fibrosis (SGRQ-I) score, and arterial blood gas analysis. Discussion TCM may be beneficial in IPF. However, it has never been evaluated in patients with AE-IPF, who are incredibly prone to respiratory failure and have a high mortality rate. It is the first clinical trial to explore the efficacy and safety of TCM in the treatment of AE-IPF. This result will provide a basis for further study, which provides a high-quality evidence for the treatment of AE-IPF with TCM. Trial registration Chinese Clinical Trial Registry ChiCTR1900026289. Registered on 29 September 2019.
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