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The one-minute sit-to-stand test: A practical tool for assessing functional exercise capacity in patients with COPD in routine clinical practice. 一分钟坐立测试:在常规临床实践中评估慢性阻塞性肺病患者功能锻炼能力的实用工具。
IF 3.5 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/14799731241291530
Paulien Mellaerts, Heleen Demeyer, Astrid Blondeel, Tim Vanhoutte, Sofie Breuls, Marieke Wuyts, Iris Coosemans, Lode Claes, Nele Vandenbergh, Kaat Beckers, Lucas Vanden Bossche, Dimitri Stylemans, Wim Janssens, Stephanie Everaerts, Thierry Troosters

Background: Chronic obstructive pulmonary disease (COPD) is associated with a reduced exercise capacity. Although several field tests for exercise capacity have been modified for non-standard settings, i.e. outside the hospital clinic or pulmonary rehabilitation center, their uptake remains limited. Objectives: To assess the test-retest reliability, constuct validity and responsiveness of the one-minute sit-to-stand test (1'STST) adopted in clinical practice among patients with COPD and to confirm the earlier established minimal important difference (MID) of three repetitions. Methods: Patients with COPD performed two 1'STSTs, two 6-minute walk tests (6MWT), an isometric quadriceps force (QF) measurement, a cardiopulmonary exercise test (CPET), and a seven-day physical activity (PA) measurement before and after three months of pulmonary rehabilitation (PR). An Intraclass Correlation Coefficient (ICC) evaluated the agreement between two 1'STSTs. Pearson Correlation examined the association between the 1'STST and other physical measurements, and their changes following PR. A receiver operating characteristic (ROC) curve was constructed using a 30-meter increment in the 6MWT as cut-off to identify responders. Results: The 1'STST demonstrated good reliability (Δ0.9 ± 4.0 repetitions, p = .13; ICC = 0.79). The 1'STST was moderately correlated with the 6MWT (r = 0.57, p < .0001), VO2max (r = 0.50, p = .0006) and maximal work rate (r = 0.52, p = .0003). Weak correlations were observed with QF (r = 0.33, p = .03) and step count (r = 0.38, p = .013). The 1'STST improved after PR (∆ = 3.6 ± 6.4 repetitions, p = .0013) and changes correlated moderately with changes in the 6MWT (r = 0.57, p = .002), QF (r = 0.48, p = .003) and VO2max (r = 0.41, p = .014). A cut-off of three repetitions demonstrated a 71% accuracy in identifying responders to a rehabilitation program. Conclusion: The 1'STST is a valuable alternative to evaluate exercise capacity in patients with COPD when more expensive and time-consuming tests are unavailable.

背景:慢性阻塞性肺病(COPD)与运动能力下降有关。尽管针对非标准环境(即医院诊所或肺康复中心以外)对几种运动能力现场测试进行了修改,但其使用率仍然有限。研究目的评估慢性阻塞性肺病患者在临床实践中采用的一分钟坐立测试(1'STST)的重复测试可靠性、持续有效性和响应性,并确认早先确定的三次重复的最小重要差异(MID)。方法:慢性阻塞性肺病患者进行两次 1'STST 测试:慢性阻塞性肺病(COPD)患者在接受肺康复治疗(PR)三个月前后分别进行了两次 1'STST 测试、两次 6 分钟步行测试(6MWT)、等长股四头肌力(QF)测量、心肺运动测试(CPET)和七天体力活动(PA)测量。类内相关系数(ICC)评估了两个 1'STST 之间的一致性。皮尔逊相关性检验了 1'STST 与其他体能测量值之间的关联,以及它们在肺康复后的变化。以 6MWT 的 30 米增量为分界点,构建了接收者操作特征曲线 (ROC),以识别应答者。结果显示1'STST 表现出良好的可靠性(Δ0.9 ± 4.0 次,p = .13;ICC = 0.79)。1'STST与6MWT(r = 0.57,p < .0001)、最大容氧量(r = 0.50,p = .0006)和最大工作率(r = 0.52,p = .0003)呈中度相关。与 QF(r = 0.33,p = .03)和步数(r = 0.38,p = .013)的相关性较弱。PR 后,1'STST 有所改善(Δ = 3.6 ± 6.4 次,p = .0013),其变化与 6MWT 的变化(r = 0.57,p = .002)、QF(r = 0.48,p = .003)和 VO2max(r = 0.41,p = .014)呈中度相关。以三次重复为临界值,在确定康复计划响应者方面的准确率为 71%。结论:1'STST在无法进行更昂贵、更耗时的测试时,1'STST 是评估慢性阻塞性肺病患者运动能力的一种有价值的替代方法。
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引用次数: 0
The impact of bronchoalveolar lavage on the diagnosis of undifferentiated interstitial lung disease alongside a multidisciplinary discussion. 支气管肺泡灌洗对未分化间质性肺病诊断的影响及多学科讨论。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1177/14799731231196581
Wafa B Khan, Harry M Gallagher, Dilip Jayasimhan, Michael Dray, Catherina L Chang

Background and objective: Cellular analysis of bronchoalveolar lavage (BAL) fluid may aid diagnosis in patients with undifferentiated interstitial lung disease (ILD). The utility of this test in the diagnostic process in conjunction with a multidisciplinary discussion (MDD) is not known. We aim to assess and compare interobserver agreement and diagnostic confidence before and after presenting BAL results in an ILD-MDD.

Methods: Patients undergoing investigations for ILD at Waikato Hospital were recruited. At the ILD-MDD two respiratory physicians and one respiratory radiologist participated in the discussion, and their diagnosis and diagnostic confidence were assessed at four sequential time points. Assessors were blinded to each others diagnosis and diagnostic confidence scores. The four sequential time points were (1) after clinical and radiology presentation; (2) after subsequent MDD; (3) after reviewing BAL results; (4) after final MDD with all results. Interobserver agreements were calculated using Fleiss κ statistic.

Results: 36 patients were recruited, and 77.8% were male. In the first step, the interobserver agreement was substantial κ = 0.622 (95% CI 0.47-0.77), improving in step 2 following MDD to κ = 0.78 (95% CI 0.624-0.935), in step 3 κ = 0.776 (95% CI 0.614-0.937) and step 4 achieved almost perfect agreement of κ = 0.969 (95% CI 0.828-1.11). The diagnostic confidence for individual and group diagnosis increased with the presentation of BAL with and without multidisciplinary MDD.

Conclusion: We found that BAL cellular analysis improves interobserver agreement and confidence in diagnosis following MDD, thus aiding decision-making in cases with undifferentiated ILD.

背景与目的:支气管肺泡灌洗液的细胞分析有助于诊断未分化间质性肺病(ILD)。该测试在诊断过程中与多学科讨论(MDD)结合使用的效用尚不清楚。我们的目的是评估和比较在ILD-MDD中呈现BAL结果前后观察者之间的一致性和诊断置信度。方法:招募在怀卡托医院接受ILD调查的患者。在ILD-MDD,两名呼吸科医生和一名呼吸科放射科医生参与了讨论,并在四个连续的时间点评估了他们的诊断和诊断可信度。评估者对彼此的诊断和诊断置信度得分视而不见。四个连续的时间点是(1)在临床和放射学表现之后;(2) 在随后的MDD之后;(3) 在审查BAL结果之后;(4) 在最终MDD之后,所有结果。使用Fleissκ统计量计算观察者之间的一致性。结果:36例患者为男性,占77.8%。在第一步中,观察者之间的一致性为κ=0.622(95%CI 0.47-0.77),在MDD后的第二步中改善为κ=0.78(95%CI 0.624-0.935),在步骤3κ=0.76(95%CI 0.614-0.937)和步骤4中,κ=0.969(95%CI 0.828-1.11)几乎完全一致。个体和组诊断的诊断置信度随着伴有和不伴有多学科MDD的BAL的出现而增加。结论:我们发现BAL细胞分析提高了观察者对MDD诊断的一致性和信心,从而有助于未分化ILD病例的决策。
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引用次数: 0
Acute severe asthma and its predictors of mortality in rural Southwestern Nigeria: a-five year retrospective observational study. 尼日利亚西南部农村地区急性严重哮喘及其死亡率预测因素:一项为期五年的回顾性观察研究
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1177/14799731221151183
Azeez Oyemomi Ibrahim, Shuaib Kayode Aremu, Babatunde Adeola Afolabi, Gbadebo Oladimeji Ajani, Fasanmi Tolulope Kolawole, OlufunmilayoAdenike Oguntoye

Objectives: There is an observed paucity of data regarding the predictors of asthma mortality in Nigeria. This study aimed to ascertain the clinical presentations and predictors of acute severe asthma mortality in rural Southwestern Nigeria.

Methods: A retrospective observational study using a data form and a standardized questionnaire was used to review the 124 patients admitted at Emergency Department between January 2015 and December 2019. The data were analyzed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Binary logistic regression analysis was used to determine the predictors of asthma mortality and a p-value <.05 was considered statistically significant.

Results: A total of 124 patients were studied. The acute severe asthma mortality was 4.8% and its predictors were older age (Crude odds Ratio (COR), 14.857; 95% CI: 2.489-88.696, p < .001), Tobacco smoking (COR, 6.741; 95% CI: 1.170-38.826, p = .016), more than three co-morbidities (COR, 2.750; 95% CI: 1.147-26.454, p = 0.012), diabetes mellitus (COR, 13.750; 95% CI: 2.380-79.433, p < .001), Human Immunodeficiency virus (COR, 117.000; 95% CI: 9.257-1479.756, p < .001), ≥2 days before presentation (COR, 7.440; 95% CI: 1.288-42.980, p = .039), and Short-acting-B2-agonists overuse (COR, 7.041; 95% CI: 1.005-62.165, p = .044).

Conclusion: The mortality rate was 4.8% and its predictors were older age patients, tobacco smoking, multiple co-morbidities, diabetes mellitus, HIV, SP02 <90%, delay presentation, and Short-acting-B2-agonists over use, The study showed that there is high prevalence of asthma mortality in rural Southwestern Nigeria. The findings may be used to plan for asthma preventions and control programs in rural settings, and may also provide an impetus for prospective research on these outcomes.

目的:观察到尼日利亚哮喘死亡率预测因素的数据缺乏。本研究旨在确定尼日利亚西南部农村急性严重哮喘死亡率的临床表现和预测因素。方法:采用回顾性观察研究,采用数据表和标准化问卷对2015年1月至2019年12月在急诊科收治的124例患者进行回顾性分析。数据分析采用SPSS Version 22.0。结果以描述性和表格形式呈现。采用二元logistic回归分析确定哮喘死亡率的预测因素并确定p值。结果:共研究了124例患者。急性重症哮喘病死率为4.8%,预测因素为年龄较大(粗优势比(COR), 14.857;95% CI: 2.489-88.696, p < .001),吸烟(COR, 6.741;95% CI: 1.170-38.826, p = 0.016),超过3例合并症(COR, 2.750;95% CI: 1.147-26.454, p = 0.012),糖尿病(COR, 13.750;95% CI: 2.380-79.433, p < 0.001),人类免疫缺陷病毒(COR, 117.000;95% CI: 9.257-1479.756, p < .001),就诊前≥2天(COR, 7.440;95% CI: 1.288-42.980, p = 0.039),短效b2激动剂过度使用(COR, 7.041;95% CI: 1.005-62.165, p = 0.044)。结论:死亡率为4.8%,预测因素为高龄患者、吸烟、多种合并症、糖尿病、HIV、SP02
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引用次数: 1
Risk factors and clinical characteristics of breathlessness in Australian adults: Data from the BOLD Australia study. 澳大利亚成年人呼吸困难的风险因素和临床特征:来自澳大利亚 BOLD 研究的数据。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1177/14799731231221820
Yijun Zhou, Maria R Ampon, Michael J Abramson, Alan L James, Graeme P Maguire, Richard Wood-Baker, David P Johns, Guy B Marks, Helen K Reddel, Brett G Toelle

Background: Breathlessness is a common symptom related to a significant health burden. However, the association of breathlessness with clinical characteristics, especially objective pulmonary test results is scarce. We aimed to identify the characteristics independently associated with breathlessness in Australian adults.

Method: The analysis used data from BOLD Australia, a cross-sectional study that included randomly selected adults aged ≥40 years from six sites in Australia. Clinical characteristics and spirometry results were compared for breathlessness (modified Medical Research Council [mMRC] grade ≥2).

Results: Among all respondents (n = 3321), 252 participants (7.6%) reported breathlessness. The main univariate associations were obesity, chronic respiratory diseases, heart diseases and being Indigenous Australians (odds ratios [ORs] = 2.78, 5.20, 3.77 and 4.38, respectively). Participants with breathlessness had lower pre-and post-bronchodilator lung function than those without. Impaired spirometry results including FVC or FEV1 below 80% predicted, or FEV1/FVC < LLN were independently associated with breathlessness (adjusted ORs = 2.66, 2.94 and 2.34, respectively).

Conclusions: Breathlessness is common among Australian adults and is independently associated with obesity, chronic respiratory diseases, heart diseases, being Indigenous Australians, and impaired spirometry. Multi-disciplinary assessment and comprehensive investigation is needed in clinical practice to address the many factors associated with breathlessness in the population.

背景:呼吸困难是一种常见症状,对健康造成很大负担。然而,呼吸困难与临床特征,尤其是客观肺部测试结果之间的关联却很少。我们旨在确定与澳大利亚成年人呼吸困难独立相关的特征:分析采用了澳大利亚 BOLD 研究的数据,这是一项横断面研究,包括从澳大利亚六个地点随机挑选的年龄≥40 岁的成年人。比较了呼吸困难的临床特征和肺活量测定结果(修改后的医学研究委员会[mMRC]等级≥2):在所有受访者(n = 3321)中,有 252 人(7.6%)报告有呼吸困难。肥胖、慢性呼吸系统疾病、心脏病和澳大利亚土著人是主要的单变量关联因素(几率比 [OR] 分别为 2.78、5.20、3.77 和 4.38)。与没有呼吸困难的人相比,有呼吸困难的人使用支气管扩张剂前后的肺功能较低。肺活量测定结果受损,包括 FVC 或 FEV1 低于 80% 预测值,或 FEV1/FVC < LLN,均与呼吸困难独立相关(调整后 ORs 分别为 2.66、2.94 和 2.34):呼吸困难在澳大利亚成年人中很常见,并与肥胖、慢性呼吸系统疾病、心脏病、澳大利亚土著居民和肺活量受损等因素密切相关。临床实践中需要进行多学科评估和综合调查,以解决与呼吸困难有关的诸多因素。
{"title":"Risk factors and clinical characteristics of breathlessness in Australian adults: Data from the BOLD Australia study.","authors":"Yijun Zhou, Maria R Ampon, Michael J Abramson, Alan L James, Graeme P Maguire, Richard Wood-Baker, David P Johns, Guy B Marks, Helen K Reddel, Brett G Toelle","doi":"10.1177/14799731231221820","DOIUrl":"10.1177/14799731231221820","url":null,"abstract":"<p><strong>Background: </strong>Breathlessness is a common symptom related to a significant health burden. However, the association of breathlessness with clinical characteristics, especially objective pulmonary test results is scarce. We aimed to identify the characteristics independently associated with breathlessness in Australian adults.</p><p><strong>Method: </strong>The analysis used data from BOLD Australia, a cross-sectional study that included randomly selected adults aged ≥40 years from six sites in Australia. Clinical characteristics and spirometry results were compared for breathlessness (modified Medical Research Council [mMRC] grade ≥2).</p><p><strong>Results: </strong>Among all respondents (<i>n</i> = 3321), 252 participants (7.6%) reported breathlessness. The main univariate associations were obesity, chronic respiratory diseases, heart diseases and being Indigenous Australians (odds ratios [ORs] = 2.78, 5.20, 3.77 and 4.38, respectively). Participants with breathlessness had lower pre-and post-bronchodilator lung function than those without. Impaired spirometry results including FVC or FEV<sub>1</sub> below 80% predicted, or FEV<sub>1</sub>/FVC < LLN were independently associated with breathlessness (adjusted ORs = 2.66, 2.94 and 2.34, respectively).</p><p><strong>Conclusions: </strong>Breathlessness is common among Australian adults and is independently associated with obesity, chronic respiratory diseases, heart diseases, being Indigenous Australians, and impaired spirometry. Multi-disciplinary assessment and comprehensive investigation is needed in clinical practice to address the many factors associated with breathlessness in the population.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A qualitative study of the sources of chronic obstructive pulmonary disease-related emotional distress. 慢性阻塞性肺疾病相关情绪困扰来源的定性研究
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1177/14799731231163873
Diana Zanolari, Daniela Händler-Schuster, Christian Clarenbach, Gabriela Schmid-Mohler

Objective: The aim of this study is to identify the sources of illness-related emotional distress from the perspective of individuals living with mild to severe chronic obstructive pulmonary disease (COPD).

Methods: A qualitative study design with purposive sampling was applied at a Swiss University Hospital. Eleven interviews were conducted with individuals who suffered from COPD. To analyze data, framework analysis was used, guided by the recently presented model of illness-related emotional distress.

Results: Six main sources for COPD-related emotional distress were identified: physical symptoms, treatment, restricted mobility, restricted social participation, unpredictability of disease course and COPD as stigmatizing disease. Additionally, life events, multimorbidity and living situation were found to be sources of non-COPD-related distress. Negative emotions ranged from anger, sadness, and frustration to desperation giving rise to the desire to die. Although most patients experience emotional distress regardless of the severity of COPD, the sources of distress appear to have an individual manifestation.

Discussion: There is a need for a careful assessment of emotional distress among patients with COPD at all stages of the disease to provide patient-tailored interventions.

目的:本研究旨在从轻至重度慢性阻塞性肺疾病(COPD)患者的角度确定疾病相关情绪困扰的来源。方法:采用有目的抽样的定性研究设计。对患有慢性阻塞性肺病的个人进行了11次访谈。为了分析数据,采用框架分析,以最近提出的疾病相关情绪困扰模型为指导。结果:确定了COPD相关情绪困扰的六个主要来源:躯体症状、治疗、活动受限、社会参与受限、病程不可预测性和COPD作为污名化疾病。此外,生活事件、多重疾病和生活状况也被发现是非copd相关窘迫的来源。消极情绪包括愤怒、悲伤、沮丧和绝望,这些情绪会引发对死亡的渴望。尽管大多数患者无论COPD的严重程度如何都会经历情绪困扰,但困扰的来源似乎有个体表现。讨论:有必要仔细评估COPD患者在疾病各个阶段的情绪困扰,以提供适合患者的干预措施。
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引用次数: 2
The arrival ward requiring help by wheelchair or medical cart, arterial oxygenation index, age, albumin and neutrophil count score: Predicting in-hospital mortality in Chinese patients with acute exacerbations of chronic obstructive pulmonary disease. 需要轮椅或医疗车帮助的到达病房、动脉氧合指数、年龄、白蛋白和中性粒细胞计数评分:预测中国慢性阻塞性肺病急性加重患者的住院死亡率。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1177/14799731231197226
Dawei Chen, Caimei Chen, Pan Zhang, Feng Zhang, Hao Zhang, Qing Sun, Jian Sun, Yan Tan, Binbin Pan, Xin Wan

Background: In this study, we will derive and validate a prognostic tool to predict in-hospital death based on Chinese acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.

Methods: Independent predictors of in-hospital death were identified by logistic regression analysis and incorporated into a clinical prediction tool.

Results: The clinical prediction model was developed with data from 1121 patients and validated with data from 245 patients. The five predictors of in-hospital death from the development cohort (Arrival ward requiring help by wheelchair or medical cart, Arterial oxygenation index, Age, Albumin and Neutrophil count) were combined to form the AAAAN Score. The AAAAN Score achieved good discrimination (AUC = 0.85, 95% CI 0.81-0.89) and calibration (Hosmer-Lemeshow chi-square value was 3.33, p = 0.65). The AAAAN Score, which underwent internal bootstrap validation, also showed excellent discrimination for mortality (AUC = 0.85, 95% CI 0.81 to 0.89) and performed more strongly than other clinical prediction tools. Patients were categorized into 3 risk groups based on the scores: low risk (0-2 points, 0.7% in-hospital mortality), intermediate risk (3-4 points, 4.1% in-hospital mortality), and high risk (5-7 points, 23.4% in-hospital mortality). Predictive performance was confirmed by external validation.

Conclusions: The AAAAN Score is a prognostic tool to predict in-hospital death in Chinese AECOPD patients.

背景:在这项研究中,我们将推导并验证一种基于中国慢性阻塞性肺病急性加重期(AECOPD)患者的预测住院死亡的预后工具。方法:通过逻辑回归分析确定住院死亡的独立预测因素,并将其纳入临床预测工具。结果:临床预测模型是用1121名患者的数据开发的,并用245名患者的资料进行了验证。将来自发展队列的住院死亡的五个预测因素(需要轮椅或医疗车帮助的到达病房、动脉氧合指数、年龄、白蛋白和中性粒细胞计数)结合起来形成AAAAN评分。AAAAN评分实现了良好的区分(AUC=0.85,95%CI 0.81-0.89)和校准(Hosmer Lemeshow卡方值为3.33,p=0.65)。经过内部引导验证的AAAAN评分也显示出良好的死亡率区分(AUC=0.85,95%CI为0.81至0.89),并且比其他临床预测工具表现得更强。根据评分将患者分为3个风险组:低风险组(0-2分,住院死亡率0.7%)、中风险组(3-4分,住院死亡4.1%)和高风险组(5-7分,住院病死率23.4%)。预测性能已通过外部验证得到确认。结论:AAAAN评分是预测中国AECOPD患者住院死亡的预后工具。
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引用次数: 0
Implementation and maintenance of an enhanced pulmonary rehabilitation program in a single centre: An implementation study. 在单一中心实施和维护强化肺部康复计划:一项实施研究。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1177/14799731231179105
Kim van der Braak, Joshua Wald, Catherine M Tansey, Thais Paes, Maria Sedeno, Anne-Marie Selzler, Michael K Stickland, Jean Bourbeau, Tania Janaudis-Ferreira

Background: Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). An enhanced PR program was developed with a self-management education intervention. The objective of our study was to evaluate the implementation of the enhanced PR program into a single centre.

Methods: Pre-post implementation study consisted of two evaluation periods: immediately after implementation and 18 months later. Guided by the RE-AIM framework, outcomes included: Reach, Effectiveness, Adoption, Implementation and Maintenance.

Results: Reach: 70-75% of referred patients agreed to a PR program (n = 26). Effectiveness: Clinically important improvements occurred in some patients in functional exercise capacity (64% of the patients achieved clinical important difference in 6-min walk test in the first evaluation period and 44% in the second evaluation period), knowledge, functional status, and self-efficacy in both evaluation periods. Adoption: All healthcare professionals (HCPs) involved in PR (n = 8) participated. Implementation: Fidelity for the group education sessions ranged from 76 to 95% (first evaluation) and from 82 to 88% (second evaluation). Maintenance: The program was sustained over 18 months with minor changes. Patients and HCPs were highly satisfied with the program.

Conclusions: The enhanced PR program was accepted by patients and HCPs and was implemented and maintained at a single expert center with good implementation fidelity.

背景:肺康复(PR)对慢性阻塞性肺病(COPD)患者有很大的益处。通过自我管理教育干预,制定了一项强化的公关计划。我们研究的目的是评估强化公共关系计划在单个中心的实施情况。方法:实施前后研究包括两个评估期:实施后立即和18个月后。在RE-AIM框架的指导下,结果包括:达到、有效性、采用、实施和维护。结果:达到:70-75%的转诊患者同意PR计划(n=26)。有效性:在两个评估期内,一些患者在功能锻炼能力(64%的患者在第一个评估期的6分钟步行测试中取得了临床重要差异,44%的患者在第二个评估期取得了临床显著差异)、知识、功能状态和自我效能方面都有了重要改善。采用:参与PR的所有医疗保健专业人员(HCP)(n=8)都参与了。实施:团体教育课程的忠诚度在76%至95%(第一次评估)和82%至88%(第二次评估)之间。维护:该计划持续了18个多月,但有一些小的变化。患者和HCP对该计划非常满意。结论:强化PR计划被患者和HCP接受,并在一个专家中心实施和维护,具有良好的实施保真度。
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引用次数: 1
How can the findings of the EMAX trial on long-acting bronchodilation in chronic obstructive pulmonary disease be applied in the primary care setting? EMAX关于慢性阻塞性肺病长效支气管扩张的试验结果如何应用于初级保健环境?
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1177/14799731231202257
Edward M Kerwin, Paul W Jones, Leif H Bjermer, François Maltais, Isabelle H Boucot, Ian P Naya, David A Lipson, Chris Compton, Lee Tombs, Claus F Vogelmeier

This review addresses outstanding questions regarding initial pharmacological management of chronic obstructive pulmonary disease (COPD). Optimizing initial treatment improves clinical outcomes in symptomatic patients, including those with low exacerbation risk. Long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) dual therapy improves lung function versus LAMA or LABA monotherapy, although other treatment benefits have been less consistently observed. The benefits of dual bronchodilation in symptomatic patients with COPD at low exacerbation risk, and its duration of efficacy and cost effectiveness in this population, are not yet fully established. Questions remain on the impact of baseline symptom severity, prior treatment, degree of reversibility to bronchodilators, and smoking status on responses to dual bronchodilator treatment. Using evidence from EMAX (NCT03034915), a 6-month trial comparing the LAMA/LABA combination umeclidinium/vilanterol with umeclidinium and salmeterol monotherapy in symptomatic patients with COPD at low exacerbation risk who were inhaled corticosteroid-naïve, we describe how these findings can be applied in primary care.

这篇综述解决了关于慢性阻塞性肺病(COPD)初始药物治疗的悬而未决的问题。优化初始治疗可以改善有症状患者的临床结果,包括那些病情恶化风险较低的患者。与LAMA或LABA单药治疗相比,长效毒蕈碱拮抗剂/长效β2-拮抗剂(LAMA/LABA)双重治疗可改善肺功能,尽管其他治疗益处尚未得到一致观察。双重支气管扩张在低恶化风险的COPD症状患者中的益处,以及在该人群中的有效期和成本效益,尚未完全确定。基线症状严重程度、既往治疗、支气管扩张剂的可逆性程度和吸烟状况对双支气管扩张剂治疗反应的影响仍存在疑问。使用来自EMAX(NCT03034915)的证据,我们描述了这些发现如何应用于初级保健。EMAX是一项为期6个月的试验,比较了LAMA/LABA组合umeclidinium/vilantol与umeclidinium和沙美特罗单药治疗吸入皮质类固醇的低恶化风险COPD症状患者。
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引用次数: 0
Prevalence and assessment of frailty in interstitial lung disease - a systematic review and meta-analysis. 间质性肺病虚弱的患病率和评估——一项系统综述和荟萃分析。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1177/14799731231196582
Angela Weber, Ilena Müller, Annina E Büchi, Sabina A Guler

Background: Frailty is a multisystem dysregulation that challenges homeostasis and increases vulnerability towards stressors. In patients with interstitial lung diseases (ILD) frailty is associated with poorer lung function, greater physical impairment, and higher symptom burden. Our understanding of the prevalence of frailty in ILD and consequently its impact on the ILD population is limited.

Objective and methods: We aimed to systematically review frailty assessment tools and to determine frailty prevalence across different ILD cohorts. Meta-analyses were used to calculate the pooled prevalence of frailty in the ILD population.

Results: We identified 26 studies (15 full-texts, 11 conference abstracts) including a total of 4614 patients with ILD. The most commonly used frailty assessment tools were the Fried Frailty Phenotype (FFP), the Short Physical Performance Battery (SPPB), and the cumulative Frailty Index (FI). Data allowed for meta-analyses of FFP and SPPB prevalence. The pooled prevalence of frailty was 35% (95% CI 25%-45%) by FFP, and 19% (95% CI 12%-28%) by SPPB.

Conclusions: Frailty is common in ILD, with considerable variability of frailty prevalence depending on the frailty assessment tool used. These findings highlight the importance of frailty in ILD and the need for a standardized approach to frailty assessment in this population.

背景:虚弱是一种多系统失调,挑战体内平衡,增加对压力源的脆弱性。在间质性肺病(ILD)患者中,虚弱与肺功能较差、身体损伤更大和症状负担更高有关。我们对ILD中虚弱的患病率及其对ILD人群的影响的了解是有限的。目的和方法:我们旨在系统地回顾虚弱评估工具,并确定不同ILD队列的虚弱患病率。荟萃分析用于计算ILD人群中虚弱的合并患病率。结果:我们确定了26项研究(15篇全文,11篇会议摘要),包括4614名ILD患者。最常用的虚弱评估工具是油炸虚弱表型(FFP)、短期物理性能电池(SPPB)和累积虚弱指数(FI)。允许对FFP和SPPB患病率进行荟萃分析的数据。FFP和SPPB的虚弱综合患病率分别为35%(95%CI 25%-45%)和19%(95%CI 12%-28%)。结论:虚弱在ILD中很常见,根据使用的虚弱评估工具,虚弱患病率有很大的可变性。这些发现强调了虚弱在ILD中的重要性,以及对该人群进行虚弱评估的标准化方法的必要性。
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引用次数: 0
Experiences and perceptions of receiving and prescribing rehabilitation in adults with cystic fibrosis undergoing lung transplantation. 囊性纤维化成人肺移植患者接受和处方康复治疗的经验和看法。
IF 4.1 3区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1177/14799731221139293
Lisa Wickerson, Rajan Grewal, Lianne G Singer, Cecilia Chaparro

Background: Rehabilitation is prescribed to optimize fitness before lung transplantation (LTx) and facilitate post-transplant recovery. Individuals with cystic fibrosis (CF) may experience unique health issues that impact participation.

Methods: Patient and healthcare provider semi-structured interviews were administered to explore perceptions and experiences of rehabilitation before and after LTx in adults with CF. Interviews were analyzed via inductive thematic analysis.

Results: Eleven participants were interviewed between February and October 2021 (five patients, median 28 (IQR 27-29) years, one awaiting re-LTx, four following first or second LTx) and six healthcare providers. Rehabilitation was delivered both in-person and virtually using a remote monitoring App. Six key themes emerged: (i) structured exercise benefits both physical and mental health, (ii) CF-specific physiological impairments were a large barrier, (iii) supportive in-person or virtual relationships facilitated participation, (iv) CF-specific evidence and resources are needed, (v) tele-rehabilitation experiences during the COVID-19 pandemic resulted in preferences for a hybrid model and (vi) virtual platforms and clinical workflows require further optimization. There was good engagement with remote data entry alongside satisfaction with virtual support.

Conclusions: Structured rehabilitation provided multiple benefits and a hybrid model was preferred going forward. Future optimization of tele-rehabilitation processes and increased evidence to support exercise along the continuum of CF care are needed.

背景:在肺移植(LTx)前进行康复是为了优化体能,促进移植后的恢复。患有囊性纤维化(CF)的个体可能会经历影响参与的独特健康问题。方法:采用半结构化访谈法,探讨成人CF患者LTx前后对康复的认知和体验。访谈采用归纳主题分析法进行分析。结果:11名参与者在2021年2月至10月期间接受了采访(5名患者,中位28 (IQR 27-29)岁,1名等待重新LTx, 4名首次或第二次LTx)和6名医疗保健提供者。康复治疗包括面对面和虚拟的远程监控应用程序。出现了六个关键主题:(i)有组织的锻炼有益于身心健康;(ii) cf特有的生理障碍是一个很大的障碍;(iii)支持性的面对面或虚拟关系促进了参与;(iv)需要cf特有的证据和资源;(v) COVID-19大流行期间的远程康复经验导致对混合模式的偏好;(vi)虚拟平台和临床工作流程需要进一步优化。与远程数据输入的良好接触以及对虚拟支持的满意。结论:有组织的康复治疗有多种益处,今后首选混合模式。未来需要远程康复过程的优化和更多的证据来支持CF治疗的连续性。
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引用次数: 0
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Chronic Respiratory Disease
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