Chronic Obstructive Disease Patients Research Articles

Palliative Care Consultation Reduces 30-Day Readmission Rates for Hospitalized Patients with End-Stage Chronic Obstructive Pulmonary Disease (FR440C)

•List the rates and causes for hospital readmission in patients with end-stage chronic obstructive disease, with and without palliative care services.•Provide the outcomes in end-stage chronic obstructive disease patients, with and without palliative care consultation. End-stage chronic obstructive disease (COPD) has a high level of symptom burden, requirement for long-term oxygen therapy and frequent exacerbations that require hospitalization. Research to date is limited regarding the delivery and impact of palliative care services in patients with end-stage COPD. Determine the relationship between in-hospital palliative consultation on hospital readmission in patients with end-stage COPD in the United States. A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for 2014. Adults (≥ 18 years) with a diagnosis of end-stage COPD that received an in-hospital palliative consultation were identified using ICD-9 codes described in literature. The primary outcome was rate of readmission within 30-days of discharge. Secondary outcomes were reasons for readmission, and mortality and morbidity rates. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for readmission were identified using Cox's proportional hazards model. In total, 233,184 hospital admissions with a diagnosis of end-stage COPD were identified, of which 6.87% (16,038) received in-hospital palliative care consultation. PS matching was performed based on age, gender, hospital status, and Charlson comorbidity score. The overall 30-day rate of readmission in patients with end-stage COPD was 16.9%. Palliative care consultation was an independent predictor associated with a lower risk of readmission (Hazard Ratio 0.521, CI 0.398-0.682, p <0.001). The most common cause for readmission was sepsis (8.46%), followed by COPD (7.29%). Those readmitted had a significantly higher rate of death in hospital than those for index admissions (8.44% vs 5.52 %, p < 0.001). In-hospital palliative care consultation in patients with end-stage COPD reduces hospital readmission.

Effect of Pulmonary Rehabilitation on Quality of Life among the Chronic Obstructive Disease Patients Admitted at Pravara Rural Hospital, Loni (Bk)

Effect of Pulmonary Rehabilitation on Quality of Life among the Chronic Obstructive Disease Patients Admitted at Pravara Rural Hospital, Loni (Bk)

A Putative ABC Transporter Permease Is Necessary for Resistance to Acidified Nitrite and EDTA in Pseudomonas aeruginosa under Aerobic and Anaerobic Planktonic and Biofilm Conditions.

Pseudomonas aeruginosa (PA) is an important airway pathogen of cystic fibrosis and chronic obstructive disease patients. Multiply drug resistant PA is becoming increasing prevalent and new strategies are needed to combat such insidious organisms. We have previously shown that a mucoid, mucA22 mutant PA is exquisitely sensitive to acidified nitrite (, pH 6.5) at concentrations that are well tolerated in humans. Here, we used a transposon mutagenesis approach to identify PA mutants that are hypersensitive to . Among greater than 10,000 mutants screened, we focused on PA4455, in which the transposon was found to disrupt the production of a putative cytoplasmic membrane-spanning ABC transporter permease. The PA4455 mutant was not only highly sensitive to , but also the membrane perturbing agent, EDTA and the antibiotics doxycycline, tigecycline, colistin, and chloramphenicol, respectively. Treatment of bacteria with plus EDTA, however, had the most dramatic and synergistic effect, with virtually all bacteria killed by 10 mM , and EDTA (1 mM, aerobic, anaerobic). Most importantly, the PA4455 mutant was also sensitive to in biofilms. sensitivity and an anaerobic growth defect was also noted in two mutants (rmlC and wbpM) that are defective in B-band LPS synthesis, potentially indicating a membrane defect in the PA4455 mutant. Finally, this study describes a gene, PA4455, that when mutated, allows for dramatic sensitivity to the potential therapeutic agent, as well as EDTA. Furthermore, the synergy between the two compounds could offer future benefits against antibiotic resistant PA strains.

Chronic respiratory patient control by multivariate charts

This article seeks to explain how to monitor the chronic obstructive disease patient and control any complications so that timely treatment can be applied. Control charts and statistical process control (SPC) theory were used on chronic respiratory patient follow-up and control. Controlling several variables simultaneously, using univariate charts, can be misleading, more so when there are correlated variables, so multivariate and univariate control charts were studied. One-sided control charts are preferable when the aim is to detect changes in the mean solely in one direction. Thus, one-sided, univariate and multivariate charts were built, which identified previously undetected out-of-control events. The study's main limitation is its retrospective nature. However, following-up individual patients can highlight medical therapy effects. The article concludes that control charts, in particular one-sided ones, are a valuable tool for monitoring chronic respiratory patients, thus contributing to medical decision making. The article highlights control chart application to chronic respiratory patient follow-up, permitting a global view of patient evolution over time.

Physiological changes during low- and high-intensity noninvasive ventilation

In a physiological randomised cross-over study performed in stable hypercapnic chronic obstructive disease patients, we assessed the short-term effects of two settings of noninvasive ventilation. One setting was aimed at maximally reducing arterial carbon dioxide tension (P(a,CO(2))) (high-intensity (Hi) noninvasive positive pressure ventilation (NPPV)): mean ± SD 27.6 ± 2.1 cmH(2)O of inspiratory positive airway pressure, 4 ± 0 cmH(2)O of expiratory positive airway pressure and respiratory rate of 22 breaths · min(-1). The other was performed according to the usual parameters used in earlier studies (low-intensity (Li)-NPPV): 17.7 ± 1.6 cmH(2)O of inspiratory positive airway pressure, 4 ± 0 cmH(2)O of expiratory positive airway pressure and respiratory rate of 12 breaths · min(-1). Both modes of ventilation significantly improved gas exchange compared with spontaneous breathing (SB), but to a greater extent using Hi-NPPV (P(a,CO(2)) 59.3 ± 7.5, 55.2 ± 6.9 and 49.4 ± 7.8 mmHg for SB, Li-NPPV and Hi-NPPV, respectively). Similarly, Hi-NPPV induced a greater reduction in the pressure-time product of the diaphragm per minute from 323 ± 149 cmH(2)O · s · min(-1) during SB to 132 ± 139 cmH(2)O · s · min(-1) during Li-NPPV and 40 ± 69 cmH(2)O · s · min(-1) during Hi-NPPV, while in nine out of 15 patients, it completely abolished SB activity. Hi-NPPV also induced a marked reduction in cardiac output (CO) measured noninvasively with a Finometer PRO (Finapres Medical Systems BV, Amsterdam, the Netherlands) compared with Li-NPPV. We conclude that while Hi-NPPV is more effective than Li-NPPV in improving gas exchange and in reducing inspiratory effort, it induces a marked reduction in CO, which needs to be considered when Hi-NPPV is applied to patients with pre-existing cardiac disease.

Relationship between whole blood base excess and CO 2 content in vivo

Empirical relationships are demonstrated for whole blood base excess (BE) and CO 2 content (C co 2 ), both calculated from in vivo measurements of P co 2 , pH, hemoglobin concentration and O 2 saturation. Comparisons are provided by measurements from three separate studies: (1) supine exercise (arterial and mixed venous samples); (2) chronic obstructive disease patients (arterial samples) breathing air and 100% O 2; and (3) maximal seated exercise on a bicycle ergometer with and without added inspired CO 2 (arterial samples before, during and after). Two standardized values of C co 2 (vol.%) are derived which closely relate to BE (mmol/l). The C co 2 at a P co 2 of 40 mmHg [C co 2 (40)] for all samples ( n = 220) demonstrated a curvilinear relationship: C co 2 (40) = 45.37 + 1.48(BE) + 0.0156(BE) 2, r = +0.996, SEE = 0.88 vol.%. The C co 2 at a pH of 7.4 [C co 2 (7.4)] gave a linear relationship: C co 2 (7.4) = 45.09 + 2.58 (BE), r = +0.998, SEE = 1.19 vol.%. Empirical computations for the Haldane factor from studies 1 and 2 gave values of 0.285 in terms of C co 2 (vol.%/vol.%) and 0.266 for BE (mmol/l/mmol reduced Hb). The BE values can serve as useful estimates of lactate concentrations during exercise and the excellent relationships between standardized C co 2 and BE demonstrate their equivalency and either can be utilized, depending on whether quantification of the CO 2 dissociation curve or acid-base status is desired.