Objective: Hospital-outreach pulmonary rehabilitation (PR) can improve health status and reduce health-care utilization by patients with chronic obstructive pulmonary disease (COPD). However, its long-term effects and costs versus benefits are still not clear. This study was conducted to develop, deliver, and evaluate the effects and monetary savings of a hospital-outreach PR program for patients with COPD. Methods: A randomized controlled trial was conducted. Patients with COPD (n=208) were randomly assigned to the hospital-outreach PR program (treatment) or treatment as usual (control). The treatment group received a 3-month intensive intervention, including supervised physical exercise, smoking cessation, self-management education, and psychosocial support, followed by long-term access to a nurse through telephone follow-up and home visits up to 24 months. The control group received routine care, including discharge education and a self-management education brochure. Main outcomes were collected at 3, 6, 12, and 24-months postrandomization. Primary outcomes included health-care utilization (ie, readmission rates, times, and days, and emergency department visits) and medical costs. Secondary outcomes included lung function (ie, FEV 1 , FEV 1 % predicted, FVC), dyspnea (mMCR), exercise capacity (6MWD), impact on quality of life (CAT), and self-management (CSMS). Results: At the end of 24 months, 85 (81.7%) in the treatment group and 89 (85.6%) in the control group had completed the whole program. Compared with the control group, patients in the treatment group had lower readmission rates, times, and days at 6 and 12 months and during 12-24 months. Regarding costs during the 2 years, the program achieved CN¥3,655.94 medical savings per patient per year, and every ¥1 spent on the program led to ¥3.29 insavings. Patients in the treatment group achieved improvements in FEV 1 , FEV 1 % predicted, exercise capacity, and self-management. It also achieved relief of dyspnea symptoms and improvement in COPD's impact on quality of life. Conclusion: The hospital-outreach PR program for patients with COPD achieved reductions in health-care utilization, monetary savings, and improvements in patient health outcomes. The effects of the program were sustained for at least 2 years. Trial Registration: This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-TRC-14005108).
Background Although evidences showed that sleep disorder is common in patient with end stage renal disease (ESRD), less is known about their sleep quality after early post-kidney transplantation (kTx) especially in Intensive Care Unite (ICU). Thus, the purpose of this study is to investigate sleep quality of kTx recipients in ICU and explore factors related poor sleep, second, to measure the correlation of subjective sleep quality and sleep architecture assessed by PSG in kTx recipients. Methods This study recruited participants from ESRD patients registered in transplantation waiting list at the third xiangya hospital of central south university in China. Participants required to complete the Pittsburgh sleep quality index(PSQI) and demographic questionnaire as baseline data and received one night of Polysomnography (PSG) in the ICU within 96 hours of surgery, during which time sound and light data were monitored. After that Richards Campbell sleep questionnaires (RCSQ) also need completed.Results 26 participants self-reported sleep quality and sleep efficiency based on RCSQ was at middle level (49.2 ± 25.6mm), and 14/26(53.8%) kTx recipients in ICU were poor sleepers defined by RCSQ <50. PSG showed that most kTx recipients in ICU had shallow sleep with mainly stage 2 sleep time (80.90 ±70.10 min), lower total sleep time (136.50 ±86.41 min), higher awakening frequency after sleep onset (8.87 ±5.92 times) and long awaken time (94.67 ±75.09 min) when a sleep disruption occured. multiple linear regression analysis showed that self-reported noise and pain were the significant factor affecting sleep(P < 0.05).Conclusion Subjective sleep quality based on RCSQ scored better than objective one measured by PSG in kTx recipients, sleep disruption always remained a substantial problem and affected by selfreported noise and pain.
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