Delayed Gastric Emptying Post-Esophagectomy: A Single-Institution Experience

2020 ◽  
Vol 15 (6) ◽  
pp. 547-554
Author(s):  
Allison B. Frederick ◽  
William R. Lorenz ◽  
Stella Self ◽  
Christine Schammel ◽  
William D. Bolton ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Gastric Emptying ◽  
Pulmonary Disease ◽  
Delayed Gastric Emptying ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Postoperative Course ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
Definition Of

Objective Delayed gastric emptying (DGE) is a common functional disorder after esophagectomy in patients with esophageal carcinoma. Management of DGE varies widely and it is unclear how comorbidities influence the postoperative course. This study sought to determine factors that influence postoperative DGE. Methods This retrospective study evaluates patients who underwent esophagectomy with gastric pull-up between 2007 and 2019. The cohort was stratified in various ways to determine if postoperative care and outcomes differed, including patient demographics, comorbidities, intraoperative and postoperative procedures. Results During the study period, 149 patients underwent esophagectomy and 37 had diabetes. Overall incidence of DGE, as defined in this study, was 76.5%. Surgery type was significantly different between DGE and normal emptying cohorts ( P = 0.005). Comparing diabetic and nondiabetic patients, there was no significant difference noted in DGE ( P = 0.25). Additionally, there was no difference in presence of DGE for patients who underwent any intraoperative pyloric procedure compared to those who did not ( P = 0.36). Of significance, all 16 patients with chronic obstructive pulmonary disease had a delay in gastric emptying ( P = 0.01). Conclusions A higher proportion of patients with DGE post-esophagectomy were identified compared to the literature. There is little consensus on a true definition of DGE, but we believe this definition identifies patients suffering in the immediate postoperative period and in follow-up. There is no evidence to support a different postoperative course for patients with diabetes, but the link between chronic obstructive pulmonary disease and DGE warrants further investigation.

scholarly journals Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) Comorbidities in Lithuanian National Database: A Cluster Analysis

2022 ◽  
Vol 19 (2) ◽  
pp. 970
Author(s):  
Elena Jurevičienė ◽  
Greta Burneikaitė ◽  
Laimis Dambrauskas ◽  
Vytautas Kasiulevičius ◽  
Edita Kazėnaitė ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Kidney Diseases ◽  
Screening Tools ◽  
National Database ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
The Impact

Various comorbidities and multimorbidity frequently occur in chronic obstructive pulmonary disease (COPD), leading to the overload of health care systems and increased mortality. We aimed to assess the impact of COPD on the probability and clustering of comorbidities. The cross-sectional analysis of the nationwide Lithuanian database was performed based on the entries of the codes of chronic diseases. COPD was defined on the code J44.8 entry and six-month consumption of bronchodilators. Descriptive statistics and odds ratios (ORs) for associations and agglomerative hierarchical clustering were carried out. 321,297 patients aged 40–79 years were included; 4834 of them had COPD. A significantly higher prevalence of cardiovascular diseases (CVD), lung cancer, kidney diseases, and the association of COPD with six-fold higher odds of lung cancer (OR 6.66; p < 0.0001), a two-fold of heart failure (OR 2.61; p < 0.0001), and CVD (OR 1.83; p < 0.0001) was found. Six clusters in COPD males and five in females were pointed out, in patients without COPD—five and four clusters accordingly. The most prevalent cardiovascular cluster had no significant difference according to sex or COPD presence, but a different linkage of dyslipidemia was found. The study raises the need to elaborate adjusted multimorbidity case management and screening tools enabling better outcomes.

scholarly journals Effect of Pharmacy Counseling on Readmissions in Patients with Acute Exacerbations of COPD: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Narachai Prasungriyo ◽  
Nungruthai Sooksai
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Direct Costs ◽  
Disease Assessment ◽  
Chronic Obstructive ◽  
P Value ◽  
Intervention Period ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
Acute Exacerbations

Objective: To investigate the effects of pharmacy counseling on clinical and economic outcomes in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients.Material and Methods: The outcomes consisted of 28-day hospital readmissions related to AECOPD, direct costs, medication adherence calculated by proportion of days covered (PDC), and health-related quality of life (HRQoL) measured by chronic obstructive pulmonary disease assessment test (CAT). The data derived from the intervention group, for which pharmacy counseling was provided, was compared with that obtained from the control group provided with usual pharmaceutical care. The study also drew comparisons between the PDC and CAT scores of pre- and postintervention periods.Results: Forty-four patients (23 intervention and 21 control) were included in the analysis. There were no significant differences in the readmission rate (13% vs 19%, p-value>0.050), nor the number of readmitted patients (3 vs 3, p-value >0.050). A decrease in direct costs did not reach statistical significance (p-value>0.050). In addition, no difference between the PDC scores was found (96.67 vs 100.00, p-value>0.050). Intervention patients obtained significantly lower CAT scores than the control patients did (9 vs 19, p-value<0.050). Compared with the pre-intervention period, PDC scores were identical; however, CAT scores measured during the post-intervention period were significantly different.Conclusion: Pharmacy counseling for AECOPD patients could enhance HRQoL. Drug therapy and pulmonary rehabilitation may cause such improvement. Further work, which has adequate participants, is required to detect a significant difference in readmissions between the two groups.

Chronic Obstructive Pulmonary Disease

2014 ◽  
pp. 334-345 ◽  
Author(s):  
John J. Reilly
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Differential Diagnosis ◽  
Pulmonary Disease ◽  
Airflow Obstruction ◽  
Health Care Practitioner ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Definition Of ◽  
The U.S

Virtually every health care practitioner who provides care to adults will encounter individuals with chronic obstructive pulmonary disease (COPD). Current estimates of the prevalence of the condition vary based on the method of ascertainment: most surveys show that approximately 6% of adults report a doctor's diagnosis of COPD but that approximately 25% have airflow obstruction when assessed by spirometry. COPD is common, morbid, mortal, and expensive: estimates are that 〉20 million U.S. adults have COPD and that it is responsible for 〉120,000 deaths annually with a cost to the U.S. economy of more than $38 billion. This chapter describes the definition of COPD, presenting clinical symptomatology and evaluation, natural history, differential diagnosis, current concepts of pathogenesis, therapeutic options, and the evaluation of a patient with known or suspected COPD considering surgery.

scholarly journals Hospital-Based Clinical Pharmacy Services to Improve Ambulatory Management of Chronic Obstructive Pulmonary Disease

2016 ◽  
Vol 33 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Amber Lanae Smith ◽  
Valerie Palmer ◽  
Nada Farhat ◽  
James S. Kalus ◽  
Krishna Thavarajah ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Ambulatory Care ◽  
Pulmonary Disease ◽  
Clinical Pharmacy ◽  
Chronic Obstructive ◽  
Pharmacy Services ◽  
Obstructive Pulmonary Disease ◽  
Clinical Pharmacy Services ◽  
Significant Difference ◽  
The Impact

Background: No systematic evaluations of a comprehensive clinical pharmacy process measures currently exist to determine an optimal ambulatory care collaboration model for chronic obstructive pulmonary disease (COPD) patients. Objective: Describe the impact of a pharmacist-provided clinical COPD bundle on the management of COPD in a hospital-based ambulatory care clinic. Methods: This retrospective cohort analysis evaluated patients with COPD managed in an outpatient pulmonary clinic. The primary objective of this study was to assess the completion of 4 metrics known to improve the management of COPD: (1) medication therapy management, (2) quality measures including smoking cessation and vaccines, (3) patient adherence, and (4) patient education. The secondary objective was to evaluate the impact of the clinical COPD bundle on clinical and economic outcomes at 30 and 90 days post–initial visit. Results: A total of 138 patients were included in the study; 70 patients served as controls and 68 patients received the COPD bundle from the clinical pharmacist. No patients from the control group had all 4 metrics completed as documented, compared to 66 of the COPD bundle group ( P < .0001). Additionally, a statistically significant difference was found in all 4 metrics when evaluated individually. Clinical pharmacy services reduced the number of phone call consults at 90 days ( P = .04) but did not have a statistically significant impact on any additional pre-identified clinical outcomes. Conclusion: A pharmacist-driven clinical COPD bundle was associated with significant increases in the completion and documentation of 4 metrics known to improve the outpatient management of COPD.

scholarly journals System of control in the organization of pulmonary rehabilitation of persons with chronic obstructive pulmonary disease

2019 ◽  
Vol 5 (3) ◽  
pp. 69 ◽  
Author(s):  
K.A. Tymruk-Skoropad ◽  
Iu.O. Pavlova ◽  
M.A. Mazepa
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Control System ◽  
Physical Therapy ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Current Control ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
Clinically Significant

<p><strong>The aim</strong><strong>: </strong>to substantiate the structural components of the control system aimed at improving the physical therapist’s work during pulmonary rehabilitation (PR) of COPD persons.</p><p><strong>Materials and methods. </strong>Analysis and generalization of the data of the special scientific and methodological literature on the issues of physical therapy of patients with chronic obstructive pulmonary disease; method of analysis of medical records; elaboration of Internet sources, including databases of evidence based medical literature.<strong></strong></p><p><strong>Results. </strong>The control system, which is reasonable to be implemented at three stages (preliminary, current, final) of the process of physical therapy (PT) and PR of patients with COPD, is substantiated.</p><p>The control system within the competence of the physical therapist provides for rehabilitation examination (preliminary control), monitoring (current control) and final evaluation of certain indicators. There were 5 groups of main indicators: quality of life/ activity and participation, disease course, body functions, body structures, educational competence. For the selected groups of indicators, the selection of measuring instruments was made, the features of their application at different stages were outlined, the values of the minimum clinically significant difference for the selected indicators were given.</p><p><strong>Conclusions. </strong>The process of pulmonary rehabilitation of people with COPD needs to be evaluated and monitored for its effectiveness in accordance with the expected results.</p><p>The monitoring system allows to track all changes in the patient's health and functioning, regulate the intervention and its intensity, evaluate both the individual physical therapy session and the effectiveness of the entire program.</p><p>One of the criteria of the control system is the effectiveness of PT and PR, which is evaluated on the basis of the dynamics and direction of changes of the studied indicators, their compliance with the expected result and taking into account the values of the minimal clinically significant difference for the evaluated indicators.</p>

scholarly journals Iron deficiency in non-anemic chronic obstructive pulmonary disease in a predominantly male population: an ignored entity

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Vidushi Rathi ◽  
Pranav Ish ◽  
Gulvir Singh ◽  
Mani Tiwari ◽  
Nitin Goel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Iron Deficiency ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Male Population ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Iron Deficient ◽  
Significant Difference

Non-anemic iron deficiency has been studied in heart failure, but studies are lacking in chronic obstructive pulmonary disease (COPD). The potential clinical implications of association of iron deficiency with the severity of COPD warrant research in this direction. This was an observational, cross-sectional study on patients with COPD to compare disease severity, functional status and quality of life in non-anemic patients with COPD between two groups - iron deficient and non-iron deficient. Stable non-anemic COPD with no cause of bleeding were evaluated for serum iron levels, ferritin levels, TIBC, 6MWD, SGRQ, spirometry, and CAT questionnaire. The study patients were divided into iron replete (IR) and iron deficient (ID) groups. A total of 79 patients were studied, out of which 72 were men and seven were women. The mean age was 61.5±8.42 years. Of these, 36 (45.5%; 95% CI, 34.3-56.8%) had iron deficiency. Mean 6-minute-walk distance was significantly shorter in ID (354.28±82.4 meters vs 432.5±47.21 meters; p=0.001). A number of exacerbations in a year were more in ID group (p=0.003), and more patients in ID had at least two exacerbations of COPD within a year (p=0.001). However, the resting pO2, SaO2, and SpO2 levels did not differ significantly between the two groups (p=0.15 and p=0.52, respectively). Also, there was no significant difference in the distribution of patients of a different class of airflow limitations between the two groups. Non-anemic iron deficiency (NAID) is an ignored, yet easily correctable comorbidity in COPD. Patients with iron deficiency have a more severe grade of COPD, had lesser exercise capacity and more exacerbations in a year as compared to non-iron deficient patients. So, foraying into the avenue of iron supplementation, which has shown promising results in improving functional capacity in heart failure and pulmonary hypertension, may well lead to revolutionary changes in the treatment of COPD.

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