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Understanding the lived experience of idiopathic pulmonary fibrosis and how this shapes views on home-based pulmonary rehabilitation in Delhi, India. 了解印度德里特发性肺纤维化患者的生活经历,以及这种经历如何影响人们对家庭肺康复的看法。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1177/14799731241258216
Humaira Hanif, Obaidullah Ahmed, James Manifield, Rubia Ishrat, Ilaria Pina, Zahira Ahmed, Mohd Shibli, Dominic Malcolm, Deepak Talwar, Sally J Singh, Mark W Orme

Objectives: Pulmonary Rehabilitation (PR) is a high-impact intervention for individuals with idiopathic pulmonary fibrosis (IPF) but access is limited in India. PR barriers include distance to travel, lack of service provision and lack of healthcare professionals to deliver PR, thus it is disproportionate to the immense burden of IPF in India. We explored the lived experiences of people living with IPF, family caregivers (CGs) and healthcare workers (HCWs) as well as their views towards home-based PR (HBPR) in Delhi, India.

Methods: A qualitative study using semi-structured interviews with individuals with IPF (n = 20), CGs (n = 10) and HCWs (n = 10) was conducted. Data were analysed using codebook thematic analysis.

Results: Three major themes were generated: (i) Health impact, which included pathophysiological changes, range of symptoms experienced, disease consequences and impact of comorbidities; (ii) Disease management, which described strategies to control the progression and overall management of IPF, such as medications and exercises; (iii) Mode of Pulmonary Rehabilitation, which described perceptions regarding HBPR, comparisons with centre-based programmes, and how HBPR may fit as part of a menu of PR delivery options.

Conclusion: People living with IPF, family caregivers and healthcare workers were positive about the potential implementation of HBPR and suggested the development of a paper-based manual to facilitate HBPR over digital/online approaches. The content of HBPR should be sensitive to the additional impact of non-IPF health issues and challenges of reduced interactions with healthcare professionals.

目的:肺康复(PR)是针对特发性肺纤维化(IPF)患者的一种高效干预措施,但在印度却很有限。肺康复的障碍包括路途遥远、缺乏服务和提供肺康复服务的医疗保健专业人员,因此与印度 IPF 的巨大负担不成比例。我们探讨了印度德里的 IPF 患者、家庭照顾者 (CG) 和医护人员 (HCW) 的生活经历以及他们对居家 PR (HBPR) 的看法:采用半结构式访谈法对 IPF 患者(20 人)、CG(10 人)和医护人员(10 人)进行了定性研究。采用编码本主题分析法对数据进行分析:结果:产生了三大主题:(i) 健康影响,包括病理生理变化、所经历的症状范围、疾病后果和合并症的影响;(ii) 疾病管理,描述了控制 IPF 进展和整体管理的策略,如药物和锻炼;(iii) 肺康复模式,描述了对 HBPR 的看法、与基于中心的计划的比较,以及 HBPR 如何作为 PR 交付选项菜单的一部分:IPF 患者、家庭护理人员和医护人员对 HBPR 的潜在实施持积极态度,并建议开发纸质手册,以促进 HBPR 而非数字/在线方法的实施。HBPR 的内容应考虑到非 IPF 健康问题的额外影响以及与医护人员互动减少所带来的挑战。
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引用次数: 0
Motivations for completing pulmonary rehabilitation - A qualitative analysis. 完成肺康复的动机--定性分析。
IF 3.5 3区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1177/14799731241264789
Jennifer Harvey, Karen Ingram, George Edwards, Timothy O Jenkins, Gina Gardener, Suhani Patel, William D-C Man, Ruth E Barker

Background: Previous studies have focused on demographic factors that might predict non-completion of pulmonary rehabilitation (PR). We aimed to identify key modifiable factors that promote completion of PR. Methods: A mixed methods survey was offered to participants completing a discharge assessment following PR. Descriptive statistics and inductive thematic analysis were used to analyse the survey responses, with investigator triangulation. Results: 62 of 187 (33%) patients attending a PR discharge assessment between November 2022 and April 2023 returned the anonymised survey. Desire to improve health and wellbeing was the main reason for both initially committing to a course and for continuing with PR past transient thoughts of leaving. The positive impact of staff was the second most common reason. The enjoyment of the PR programme, being held accountable to attend classes, and the importance of other group members were other key themes identified. Conclusions: In conclusion, our findings suggest PR services need to implement strategies which ensure regular promotion and reinforcement of the health benefits of PR as well as implementation of PR modalities which best monopolise on the positive impact skilled staff have on motivating patients to complete PR.

背景:以前的研究主要关注可能预测未完成肺康复(PR)的人口统计学因素。我们的目的是找出促进完成肺康复的关键可改变因素。研究方法我们向完成肺康复后出院评估的参与者提供了一项混合方法调查。采用描述性统计和归纳主题分析法对调查回答进行分析,并对调查者进行三角测量。结果在 2022 年 11 月至 2023 年 4 月期间参加 PR 出院评估的 187 名患者中,有 62 人(33%)返回了匿名调查问卷。希望改善健康和福祉是最初承诺参加课程以及在短暂的离开想法之后继续参加 PR 的主要原因。员工的积极影响是第二个最常见的原因。PR 课程的乐趣、参加课程的责任感以及其他小组成员的重要性也是其他主要原因。结论:总之,我们的研究结果表明,公共关系服务需要实施相应的策略,确保定期宣传和强化公共关系对健康的益处,并实施最能充分发挥技术熟练的工作人员对激励患者完成公共关系的积极影响的公共关系模式。
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引用次数: 0
Development and initial validation of the ILD-Anxiety-Questionnaire (IAQ): A new instrument for assessing disease specific fears in interstitial lung disease. 间质性肺病焦虑问卷(IAQ)的开发和初步验证:用于评估间质性肺病特定疾病恐惧的新工具。
IF 3.5 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/14799731241274785
Nikola M Stenzel, Nina Piel, Klaus Kenn, Michael Kreuter

Introduction: Multiple studies focusing on chronic lung diseases (i.e. COPD), have indicated that the quality of life (QoL) can be impacted by disease-related fears. In the context of Interstitial Lung Diseases (ILD), however, these have never been systematically examined. Therefore, the aim of the present study was to develop and evaluate an appropriate measuring tool, and to investigate the influence of disease-related anxieties on QoL in ILD.

Method: N = 166 ILD patients participated in the study and completed an itempool on disease-related fears, based on the COPD-Anxiety-Questionnaire (CAF-R) and expert assessments. Further, demographic and psychological variables were assessed (anxiety: GAD-7, QoL: K-BILD; Beliefs about Health: KKG). Psychometric properties were analyzed (factor structure, reliability, validity). Regression analyses were used to calculate the differential predictive power of disease-related anxieties on QoL.

Results: The factor structure was confirmed (Scales: Fear-of-Dependence-and-Progression, Fear-of-Social-Exclusion-and-Isolation, Fear-of-Physical-Activity, Fear-of-Dyspnea, and Sleep-related- Complaints). The Scales showed satisfying reliabilities (α = 0.68 to 0.89) and good validity. Disease-related anxieties proved to be differential predictors for different scales of the K-BILD (ß = -0.15 to ß = -0.58, all ps < .01).

Conclusions: The ILD-Anxiety-Questionnaire (IAQ) is an easy-to-use, valid measurement tool for assessing disease-related anxieties. These vary in their impact on different aspects of QoL. Therefore, it might aid in specifying the indication for potential psychological supplementary interventions. Additional long-term studies are required to investigate how specific anxieties affect both overall and condition-specific QoL in diverse situations.

引言多项针对慢性肺部疾病(如慢性阻塞性肺病)的研究表明,生活质量(QoL)会受到与疾病相关的恐惧的影响。然而,对于间质性肺病(ILD),这些研究还从未进行过系统的研究。因此,本研究旨在开发和评估一种适当的测量工具,并调查疾病相关焦虑对 ILD 患者 QoL 的影响:方法:166 名 ILD 患者参与了研究,并根据慢性阻塞性肺病焦虑问卷(CAF-R)和专家评估完成了与疾病相关的恐惧项目库。此外,还评估了人口统计学和心理变量(焦虑:GAD-7;QoL:K-BILD;健康信念:KKG)。对心理测量特性进行了分析(因子结构、信度、效度)。回归分析用于计算疾病相关焦虑对 QoL 的不同预测能力:结果:因子结构得到了证实(量表结果:因子结构得到确认(量表:害怕依赖和倒退、害怕社会排斥和孤立、害怕体力活动、害怕呼吸困难和与睡眠相关的抱怨)。量表显示出令人满意的信度(α = 0.68 至 0.89)和良好的效度。与疾病相关的焦虑被证明是K-BILD不同量表的不同预测因子(ß = -0.15 to ß = -0.58,所有PS < .01):ILD-焦虑问卷(IAQ)是一种易于使用、有效的测量工具,可用于评估与疾病相关的焦虑。这些焦虑对 QoL 不同方面的影响各不相同。因此,它可以帮助确定潜在心理辅助干预的适应症。还需要进行更多的长期研究,以调查特定的焦虑在不同情况下如何影响整体和特定疾病的 QoL。
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引用次数: 0
Participant-selected music listening during pulmonary rehabilitation in people with chronic obstructive pulmonary disease: A randomised controlled trial. 慢性阻塞性肺病患者在肺康复期间聆听由参与者选择的音乐:随机对照试验。
IF 3.5 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/14799731241291065
Annemarie L Lee, Stacey J Butler, Peter Jung, Imogen N Clark, Jeanette Tamplin, Roger S Goldstein, Dina Brooks

To evaluate the impact of participant-selected music listening as an adjunct to pulmonary rehabilitation (PR) in people with COPD. Adults with COPD referred to PR were randomly assigned to participant-selected music listening (intervention group, [IG]) or usual care (control group [CG]) during an 8-weeks PR program. Prior to training, the IG completed an interview with a registered music therapist to identify music preferences. IG participants listened to an individualised playlist; CG participants had usual care. Primary outcomes included end-6-min walk test symptoms (dyspnoea and exertion) and dyspnoea (Multidimensional Dyspnoea Profile [MDP]), measured pre and post PR and 6-months follow-up. 58 participants, FEV1 52.4 (25.9)% pd) were recruited. There were no between-group differences following the intervention (p > .05 for all outcomes at all time points). Within-group differences following PR were significant for MDP sensory quality: IG mean difference [95% CI] -2.2 [-3.3 to -1.2]; CG -1.5 [-2.5 to -0.5] points; MDP emotional response: IG -3.2 [-4.2 to -2.3]; CG -2.2 [-3.2 to -1.3] points). Participant-selected music listening during PR offered no greater benefit to symptoms of dyspnoea or exertion compared to usual care. With the study limited by COVID-19 restrictions, the role of this adjunct remains to be clarified.

目的:评估参与者自选音乐聆听作为慢性阻塞性肺病患者肺康复(PR)辅助疗法的影响。在为期 8 周的肺康复计划中,被转介到肺康复计划的慢性阻塞性肺病成人被随机分配到参与者自选音乐聆听组(干预组 [IG])或常规护理组(对照组 [CG])。在培训之前,干预组完成了与注册音乐治疗师的访谈,以确定音乐偏好。IG 参与者聆听个性化播放列表;CG 参与者接受常规护理。主要结果包括 6 分钟步行终点测试症状(呼吸困难和用力)和呼吸困难(多维呼吸困难档案 [MDP]),在 PR 前后和 6 个月的随访中进行测量。共招募了 58 名参与者(FEV1 52.4 (25.9)% pd)。干预后无组间差异(所有时间点所有结果的 p > .05)。在 MDP 感觉质量方面,PR 后的组内差异显著:IG 平均差异 [95% CI] -2.2 [-3.3 to -1.2]; CG -1.5 [-2.5 to -0.5] 分;MDP 情绪反应:IG-3.2[-4.2至-2.3];CG-2.2[-3.2至-1.3]分)。与常规护理相比,参与者在 PR 期间选择听音乐对呼吸困难或劳累症状并无更大益处。由于该研究受到 COVID-19 的限制,该辅助疗法的作用仍有待明确。
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引用次数: 0
Out-of-pocket costs associated with chronic respiratory diseases in Korean adults. 韩国成年人与慢性呼吸系统疾病相关的自付费用。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1177/14799731241233301
Jun Su Park, Bomgyeol Kim, Yejin Kim, Sang Gyu Lee, Tae Hyun Kim

Objectives: Chronic respiratory diseases (CRDs) are a burden on both individuals and society. While previous literature has highlighted the clinical burden and total costs of care, it has not addressed patients' direct payments. This study aimed to estimate the incremental healthcare costs associated with patients with CRDs, specifically out-of-pocket (OOP) costs.

Methods: We used survey data from the 2019 Korea Health Panel Survey to estimate the total OOP costs of CRDs by comparing the annual hospitalizations, outpatient visits, emergency room visits, and medications of patients with and without CRDs. Generalized linear regression models controlled for differences in other characteristics between groups.

Results: We identified 222 patients with CRDs, of whom 166 were aged 65 years and older. Compared with the non-CRD group, CRD patients spent more on OOP costs (238.3 USD on average). Incremental costs were driven by outpatient visits and medications, which are subject to a coinsurance of 30% or more and may include items not covered by public insurance. Moreover, CRD patients aged 50-64 years incurred the highest incremental costs.

Discussion: The financial burden associated with CRDs is significant, and outpatient visits and medications constitute the largest components of OOP spending. Policymakers should introduce appropriate strategies to reduce CRD-associated burdens.

目的:慢性呼吸系统疾病(CRD)是个人和社会的负担。以往的文献强调了临床负担和医疗总成本,但并未涉及患者的直接支付。本研究旨在估算与 CRD 患者相关的增量医疗成本,特别是自付(OOP)成本:我们使用了 2019 年韩国健康小组调查的调查数据,通过比较有 CRD 和没有 CRD 患者的年度住院、门诊就诊、急诊就诊和用药情况,估算了 CRD 的自付费用总额。广义线性回归模型控制了组间其他特征的差异:我们发现了 222 名 CRD 患者,其中 166 人年龄在 65 岁及以上。与非 CRD 组相比,CRD 患者的 OOP 费用更高(平均 238.3 美元)。增加的费用主要来自门诊和药物,这些费用的共同保险比例为 30% 或更高,而且可能包括公共保险不承保的项目。此外,50-64 岁的慢性阻塞性肺病患者的增量成本最高:讨论:与 CRD 相关的经济负担十分沉重,而门诊就诊和药物治疗是 OOP 支出的最大组成部分。政策制定者应采取适当的策略来减轻与 CRD 相关的负担。
{"title":"Out-of-pocket costs associated with chronic respiratory diseases in Korean adults.","authors":"Jun Su Park, Bomgyeol Kim, Yejin Kim, Sang Gyu Lee, Tae Hyun Kim","doi":"10.1177/14799731241233301","DOIUrl":"10.1177/14799731241233301","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic respiratory diseases (CRDs) are a burden on both individuals and society. While previous literature has highlighted the clinical burden and total costs of care, it has not addressed patients' direct payments. This study aimed to estimate the incremental healthcare costs associated with patients with CRDs, specifically out-of-pocket (OOP) costs.</p><p><strong>Methods: </strong>We used survey data from the 2019 Korea Health Panel Survey to estimate the total OOP costs of CRDs by comparing the annual hospitalizations, outpatient visits, emergency room visits, and medications of patients with and without CRDs. Generalized linear regression models controlled for differences in other characteristics between groups.</p><p><strong>Results: </strong>We identified 222 patients with CRDs, of whom 166 were aged 65 years and older. Compared with the non-CRD group, CRD patients spent more on OOP costs (238.3 USD on average). Incremental costs were driven by outpatient visits and medications, which are subject to a coinsurance of 30% or more and may include items not covered by public insurance. Moreover, CRD patients aged 50-64 years incurred the highest incremental costs.</p><p><strong>Discussion: </strong>The financial burden associated with CRDs is significant, and outpatient visits and medications constitute the largest components of OOP spending. Policymakers should introduce appropriate strategies to reduce CRD-associated burdens.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10893827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reviewer thank you. 审查员 谢谢。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1177/14799731241233394
{"title":"Reviewer thank you.","authors":"","doi":"10.1177/14799731241233394","DOIUrl":"10.1177/14799731241233394","url":null,"abstract":"","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10943743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140139978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of a respiratory and neurological rehabilitation treatment plan in post Covid-19 affected university students. Randomized clinical study. 呼吸和神经康复治疗计划对受 Covid-19 影响后大学生的影响。随机临床研究。
IF 3.5 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/14799731241255967
Zacarías Sánchez Milá, David Rodríguez Sanz, Ana Martín Nieto, Ana Jiménez Lobo, Manuel Ramos Hernández, Angélica Campón Chekroun, Raúl Frutos Llanes, José Manuel Barragán Casas, Jorge Velázquez Saornil

Background: COVID-19 demonstrated the possibility of neurological complications such as loss of sense of smell and taste, together with respiratory problems. Respiratory training and rehabilitation of neurological sequelae are essential to improve respiratory function and thus quality of life, and the aim of this study is to evaluate the efficacy of a pulmonary and neurological rehabilitation program.

Objectives: To apply a treatment to reduce dyspnea, increase exertional capacity, increase vital capacity and respiratory muscle strength, together with an increase in olfactory and gustatory sensitivity in post-SARS-CoV-2 patients.

Methods: A randomised controlled experimental study was conducted in 220 patients with a medical diagnosis of COVID-19 and more than 5 months of evolution, dyspnoea or perceived fatigue, including olfactory and gustatory perception problems, of whom 200 patients completed the study. 100 patients were randomly assigned to the intervention group, consisting of an inspiratory training treatment plan (Powerbreathe Plus®) combined with aerobic exercise and olfactory gustatory treatment for 31 days, and 100 patients to the control group, for 31 days without any type of therapy.

Results: The study was conducted in post-Covid-19 patients for 5 months. Two hundred patients were divided into an intervention group (n = 100) and a control group (n = 100). The comparison between the groups showed significant differences in spirometric variables; forced vital capacity (p < .001; Eta2 (0.439); Mean: 0,6135), the ratio between both FEV1/FVC (p < 0.01; Eta2 (0.728); Mean:9,313), peak inspiratory pressure (p < 0.01; Eta2 (0.906); Mean:4,526); changes were observed in dyspnoea measured with the modified Borg scale (p < 0.01; Eta2 (0.811); Mean:1,481) and the modified Medical Research Council scale (p < 0.01; Eta2 (0.881); Mean: 0.777); finally, changes were found in neurological variables, in the questions of the Singapore Smell and Taste Questionnaire, How was your sense of smell after treatment? (p < 0.01; Eta2 (0.813); Mean: 1,721) and How is your sense of taste after treatment? (p < 0.01; Eta2 (0.898); Mean: 1,088).

Conclusion: The implementation of a respiratory rehabilitation treatment plan with the Powerbreathe Plus® device, aerobic exercise and neurorehabilitation with olfactory and gustatory training, is a therapeutic option against respiratory and neurological sequelae in patients who have suffered such sequelae due to the SARS-CoV-2 virus. Clinicaltrials.gov: NCT05195099. First posted 18/01/2022; Last Update Posted 29/06/2022.

背景:COVID-19显示了神经系统并发症(如嗅觉和味觉丧失)和呼吸系统问题的可能性。呼吸训练和神经系统后遗症的康复对于改善呼吸功能从而提高生活质量至关重要,本研究旨在评估肺部和神经系统康复计划的疗效:目的:对 SARS-CoV-2 后遗症患者进行治疗,以减轻呼吸困难、提高用力能力、增加生命容量和呼吸肌力量,同时提高嗅觉和味觉灵敏度:对 220 名医学诊断为 COVID-19 并有 5 个月以上进化、呼吸困难或感觉疲劳(包括嗅觉和味觉问题)的患者进行了随机对照实验研究,其中 200 名患者完成了研究。100名患者被随机分配到干预组,包括吸气训练治疗计划(Powerbreathe Plus®)、有氧运动和嗅觉味觉治疗,为期31天;100名患者被分配到对照组,为期31天,不接受任何类型的治疗:这项研究在科维德-19 后患者中进行,为期 5 个月。200 名患者被分为干预组(100 人)和对照组(100 人)。两组间的比较显示,两组在肺活量测量变量方面存在显著差异;肺活量(P < .001;Eta2 (0.439);平均值:0.6135)、肺活量(P < .001;Eta2 (0.439);平均值:0.61350.6135)、FEV1/FVC 之间的比率(P < 0.01;Eta2 (0.728);平均值:9313)、吸气峰压(P < 0.01;Eta2 (0. 906);平均值:4.906);平均值:4526);用改良博格量表测量的呼吸困难(p < 0.01;Eta2(0.811);平均值:1481)和改良医学研究委员会量表(p < 0.01;Eta2(0.881);平均值:0.777)观察到了变化;最后,用改良博格量表测量的呼吸困难(p < 0.01;Eta2(0.728);平均值:0.777)观察到了变化:0.777);最后,在新加坡嗅觉和味觉问卷的问题 "治疗后您的嗅觉如何?(p < 0.01; Eta2 (0.813); Mean:1,721)和治疗后您的味觉如何?(p < 0.01; Eta2 (0.898); Mean:结论结论:使用 Powerbreathe Plus® 设备实施呼吸康复治疗计划、有氧运动和神经康复治疗,并进行嗅觉和味觉训练,是预防 SARS-CoV-2 病毒导致的呼吸系统和神经系统后遗症的一种治疗方法。临床试验:NCT05195099。首次发布时间:2022年1月18日;最后更新时间:2022年6月29日。
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引用次数: 0
Independent effect of the triglyceride-glucose index on all-cause mortality in critically ill patients with chronic obstructive pulmonary disease and asthma: A retrospective cohort study. 甘油三酯-葡萄糖指数对慢性阻塞性肺病和哮喘重症患者全因死亡率的独立影响:一项回顾性队列研究。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1177/14799731241245424
Wen-Qiang Zhou, Xin Song, Wei-Hua Dong, Zhi Chen

Background: The triglyceride-glucose (TyG) index serves as a reliable proxy for insulin resistance (IR). IR has been linked to heightened incidence, prevalence, or severity of chronic obstructive pulmonary disease (COPD) and asthma. Prior research indicates that critically ill patients are prone to developing IR. Nevertheless, few studies have delved into the correlation between IR and all-cause mortality in critically ill patients with COPD and asthma. Therefore, the aim of this study is to explore the association between the TyG index and all-cause mortality in patients with COPD and asthma, with the goal of assessing the impact of IR on the prognosis of this patient population.

Methods: This is a retrospective study, and all data are from the Medical Information Mart for Intensive Care IV (MIMIC-IV) critical care database. This study included 684 ICU patients with COPD and asthma and divided them into quartiles based on TyG index levels. The primary outcomes of this study were all-cause mortality during follow-up, encompassing mortality at 30 days, 90 days, and 180 days. The Kaplan-Meier analysis was used to compare all-cause mortality among the above four groups. Cox proportional hazards analyses were performed to examine the association between TyG index and all-cause mortality in critically ill patients with COPD and asthma. Restricted cubic spline analysis was used to assess potential nonlinear association between the TyG index and the primary outcome.

Results: A total of 684 patients (53.9% female) were included. The 90-days all-cause mortality rate and 180-days all-cause mortality were 11.7% and 12.3%, respectively. Kaplan-Meier analysis revealed a significant association between the TyG index and both 90-days all-cause mortality (log-rank p = .039) and 180-days all-cause mortality (log-rank p = .017). Cox proportional hazards analysis revealed a significant association between the TyG index and 90-days all-cause mortality in both the unadjusted model (HR, 1.30 [95% CI 1.08-1.57] p = .005) and the model adjusted for age, gender, and diabetes (HR, 1.38 [95% CI 1.15-1.67] p < .001). Similarly, the TyG index was associated with 180-days all-cause mortality in the unadjusted model (HR, 1.30 [95% CI 1.09-1.56] p = .004) and the model adjusted for age, sex, and diabetes (HR, 1.38 [95% CI 1.15-1.66] p < .001). The restricted cubic splines (RCS) regression model indicated a significant nonlinear association between the TyG index and both 90-days and 180-days all-cause mortality. Specifically, TyG index >4.8 was associated with an increased risk of mortality at both 90 days and 180 days.

Conclusions: In summary, our results extend the utility of the TyG index to critically ill patients with COPD and asthma. Our study shows that the TyG index is a potential predictor of all-cause mortality in critically ill patients wi

背景:甘油三酯-葡萄糖(TyG)指数是胰岛素抵抗(IR)的可靠替代指标。胰岛素抵抗与慢性阻塞性肺病(COPD)和哮喘的发病率、流行率或严重程度的增加有关。先前的研究表明,重症患者很容易出现 IR。然而,很少有研究深入探讨慢性阻塞性肺病和哮喘重症患者的 IR 与全因死亡率之间的相关性。因此,本研究旨在探讨慢性阻塞性肺病和哮喘患者的 TyG 指数与全因死亡率之间的关系,以评估 IR 对这一患者群体预后的影响:这是一项回顾性研究,所有数据均来自重症监护医学信息市场(MIMIC-IV)重症监护数据库。该研究纳入了 684 名患有慢性阻塞性肺病和哮喘的重症监护病房患者,并根据 TyG 指数水平将其分为四分位。该研究的主要结果是随访期间的全因死亡率,包括 30 天、90 天和 180 天的死亡率。Kaplan-Meier 分析用于比较上述四组患者的全因死亡率。对慢性阻塞性肺病和哮喘重症患者的TyG指数与全因死亡率之间的关系进行了Cox比例危险度分析。限制立方样条分析用于评估TyG指数与主要结果之间的潜在非线性关系:共纳入 684 名患者(53.9% 为女性)。90天全因死亡率和180天全因死亡率分别为11.7%和12.3%。Kaplan-Meier分析显示,TyG指数与90天全因死亡率(log-rank p = .039)和180天全因死亡率(log-rank p = .017)之间存在显著关联。Cox比例危险分析显示,在未调整模型(HR,1.30 [95% CI 1.08-1.57] p = .005)和根据年龄、性别和糖尿病调整的模型(HR,1.38 [95% CI 1.15-1.67] p < .001)中,TyG指数与90天全因死亡率均有显著相关性。同样,在未经调整的模型(HR,1.30 [95% CI 1.09-1.56] p = .004)和根据年龄、性别和糖尿病调整的模型(HR,1.38 [95% CI 1.15-1.66] p < .001)中,TyG 指数与 180 天全因死亡率相关。限制性三次样条(RCS)回归模型表明,TyG指数与90天和180天全因死亡率之间存在显著的非线性关系。具体而言,TyG指数>4.8与90天和180天的死亡风险增加有关:总之,我们的研究结果将TyG指数的实用性扩展到了慢性阻塞性肺病和哮喘重症患者。我们的研究表明,TyG 指数是慢性阻塞性肺病和哮喘重症患者全因死亡率的潜在预测指标。此外,TyG 指数超过 4.8 的患者死亡风险更高。测量TyG指数有助于对慢性阻塞性肺病和哮喘重症患者进行风险分层和预后预测。我们需要进一步的前瞻性研究来证实我们的发现。
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引用次数: 0
A shared decision-making intervention for individuals living with chronic obstructive pulmonary disease who are considering the menu of pulmonary rehabilitation treatment options; a feasibility study. 为正在考虑肺康复治疗方案的慢性阻塞性肺病患者提供共同决策干预;可行性研究。
IF 4.1 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/14799731241238428
A C Barradell,G Doe,H L Bekker,L Houchen-Wolloff,N Robertson,S J Singh
OBJECTIVESShared Decision Making (SDM) has potential to support Pulmonary Rehabilitation (PR) decision-making when patients are offered a menu of centre- and home-based options. This study sought to evaluate the feasibility and acceptability of a three-component PR SDM intervention for individuals with Chronic Obstructive Pulmonary Disease (COPD) and PR healthcare professionals.METHODSParticipants were recruited from Dec 2021-Sep 2022. Healthcare professionals attended decision coaching training and used the consultation prompt during consultations. Individuals received the Patient Decision Aid (PtDA) at PR referral. Outcomes included recruitment capability, data completeness, intervention fidelity, and acceptability. Questionnaires assessed patient activation and decisional conflict pre and post-PR. Consultations were assessed using Observer OPTION-5. Optional interviews/focus groups were conducted.RESULTS13% of individuals [n = 31, 32% female, mean (SD) age 71.19 (7.50), median (IQR) MRC dyspnoea 3.50 (1.75)] and 100 % of healthcare professionals (n = 9, 78% female) were recruited. 28 (90.32%) of individuals completed all questionnaires. SDM was present in all consultations [standardised scores were mean (SD) = 36.97 (21.40)]. Six healthcare professionals and five individuals were interviewed. All felt consultations using the PtDA minimised healthcare professionals' bias of centre-based PR, increased individuals' self-awareness of their health, prompted consideration of how to improve it, and increased involvement in decision-making.DISCUSSIONResults indicate the study processes and SDM intervention is feasible and acceptable and can be delivered with fidelity when integrated into the PR pathway.
目的当患者可在中心和家庭进行选择时,共享决策(SDM)有可能为肺康复(PR)决策提供支持。本研究旨在评估由三部分组成的肺康复 SDM 干预对慢性阻塞性肺病(COPD)患者和肺康复医护人员的可行性和可接受性。医护人员参加了决策指导培训,并在咨询过程中使用了咨询提示。患者在转诊时会收到患者决策辅助工具(PtDA)。结果包括招募能力、数据完整性、干预忠实性和可接受性。问卷调查评估了患者转诊前和转诊后的积极性和决策冲突。使用观察者 OPTION-5 对会诊情况进行评估。结果13%的个体[n = 31,32% 为女性,平均(标清)年龄 71.19 (7.50),MRC 呼吸困难中位数(IQR)3.50 (1.75)]和 100% 的医护人员(n = 9,78% 为女性)被招募。28人(90.32%)完成了所有问卷。所有会诊中均存在 SDM [标准化评分的平均值(标准差)= 36.97 (21.40)]。六名医护人员和五名患者接受了访谈。结果表明,研究过程和 SDM 干预是可行的、可接受的,在整合到公关路径中时可以忠实地实施。
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引用次数: 0
A history of home mechanical ventilation: The past, present and future. 家用机械通风的历史:过去、现在和未来。
IF 3.5 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/14799731241240776
Rebecca F D'Cruz, Nicholas Hart

This state-of-the-art review provides an overview of the history of home mechanical ventilation (HMV), including early descriptions of mechanical ventilation from ancient and Renaissance perspectives and the mass development of ventilators designed for long-term use during the poliomyelitis epidemic. Seminal data from key clinical trials supports the application of HMV in certain patients with chronic obstructive pulmonary disease, neuromuscular disease and obesity-related respiratory failure. Innovative engineering coupled with refined physiological understanding now permits widespread delivery of home mechanical ventilation to a global population, using portable devices with advanced ventilatory modes and telemonitoring capabilities. Exponential growth in digital technology continues, and ongoing research is needed to understand how to harness clinical and physiological data to benefit patients and healthcare services in a clinically- and cost-effective manner.

这篇最新综述概述了家用机械通气(HMV)的历史,包括古代和文艺复兴时期对机械通气的早期描述,以及脊髓灰质炎流行期间为长期使用而设计的呼吸机的大规模开发。关键临床试验的重要数据支持家用机械通气在某些慢性阻塞性肺病、神经肌肉疾病和肥胖相关呼吸衰竭患者中的应用。创新的工程技术加上对生理机能的深入了解,现在可以利用具有先进通气模式和远程监控功能的便携式设备,为全球人口广泛提供家庭机械通气服务。数字技术仍在飞速发展,我们需要不断开展研究,以了解如何利用临床和生理数据,以符合临床和成本效益的方式造福患者和医疗服务。
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引用次数: 0
期刊
Chronic Respiratory Disease
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