Outcomes associated with comorbid diabetes among patients with COPD exacerbation: findings from the ACURE registry

Abstract Background Diabetes is a common comorbidity among patients with exacerbation of chronic obstructive pulmonary disease (AECOPD). Diabetes has been reported to be associated with length of stay (LOS), death, and cost among AECOPD patients. However, most studies are retrospective or have small sample sizes. The association for cost has not been researched using diabetes as a main analytic factor. This study aimed to fill gaps mentioned above, to compare basic characteristics between the diabetic and non-diabetic group, and to detect associations between diabetes and clinical outcomes among patients hospitalized with AECOPD. Methods A total of 5334 AECOPD patients, classified into diabetic and non-diabetic group, were included from a prospective multicenter patient registry study. Generalized linear regression and logistic regression were separately used for the association between diabetes and direct hospitalization cost and the association between diabetes and LOS. Results Generally, diabetic patients had a more severe profile, including being older, more overweight or obese, having more former smokers, more emergency room visits in the past 12 months, and more comorbidities occurrence. Diabetic patients also had worse clinical outcomes, including higher cost and longer LOS. Additionally, the generalized linear regression indicated that the marginal mean cost difference between diabetic and non-diabetic patients was RMB (¥) 775.7. Conclusions AECOPD patients with comorbid diabetes had a more severe profile and higher direct hospitalization cost. Diabetes screening and integrated care programs might help reduce the heavy comorbidity and economic burden. Moreover, corticosteroids and metformin could be considered in the treatment of these patients. Trial registration Clinicaltrials.gov with the identifier NCT0265752.

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A Critical Review of Multimodal Interventions for Cachexia

Advances in Nutrition ◽

10.1093/advances/nmaa111 ◽

2020 ◽

Cited By ~ 1

Author(s):

Clare McKeaveney ◽

Peter Maxwell ◽

Helen Noble ◽

Joanne Reid

Keyword(s):

Body Composition ◽

Sample Size ◽

Small Sample ◽

Cochrane Library ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Treatment Groups ◽

Small Sample Sizes

ABSTRACT Currently, there are no standardized treatments for cachexia or severe wasting. There is a growing consensus advocating multimodal interventions to address the complex pathogenesis and metabolic alterations in these conditions. This review examined multimodal treatments intended to alleviate and/or stabilize cachexia and severe wasting. The objectives of this review were to 1) identify multimodal interventions for the treatment of cachexia or associated wasting syndromes in patients with a chronic illness, 2) assess the quality of these studies, and 3) assess the effectiveness of multimodal interventions. Electronic databases including PubMed, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, CINAHL, PEDro, OpenGrey, and clinicaltrials.org were systematically searched using both text words and MeSH (medical subject heading) terms. The literature revealed a dearth of large, well-conducted trials in this area. Fourteen trials (n = 5 cancer, n = 5 chronic obstructive pulmonary disease, n = 4 chronic kidney disease) were included in this review. A total of 1026 patients were included across all studies; sample size ranged between 21 and 138 patients. Baseline and follow-up data were collected between 6 wk and 24 mo. All demonstrated some improvement in favor of the treatment groups, in relevant measures of body composition, nutrition, biomarkers, and functionality; however, caution should be applied due to the heterogenous nature of the interventions and small sample sizes. Overall, the evidence from this review supports the role of multimodal interventions in the treatment of severe wasting. However, randomized controlled trials with a powered sample size and sufficiently lengthy interaction period are necessary to assess if multimodal interventions are effective forms of therapy for improving body composition and nutritional and physical status in patients with cachexia and wasting. The protocol for this review is registered with Prospero (ID: CRD42019124374).

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Tai Chi as an Alternative and Complementary Therapy for Patients With Asthma and Chronic Obstructive Pulmonary Disease

Journal of Evidence-Based Complementary & Alternative Medicine ◽

10.1177/2156587213478174 ◽

2013 ◽

Vol 18 (3) ◽

pp. 209-215 ◽

Cited By ~ 4

Author(s):

Manoj Sharma ◽

Taj Haider

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

English Language ◽

Tai Chi ◽

Complementary Therapy ◽

Small Sample ◽

Chronic Obstructive ◽

Attrition Rates ◽

Obstructive Pulmonary Disease ◽

Small Sample Sizes

Chronic obstructive pulmonary disease and asthma are the third ranking cause of death worldwide. A systematic review was conducted to determine the efficacy of tai chi as a therapy to relieve symptoms of chronic obstructive pulmonary disease and/or asthma. Inclusion criteria were ( a) published in the English language, ( b) between the period January 2008 and July 2012, ( c) included tai chi or any form of modified tai chi as a therapy in an intervention, ( d) used any quantitative study design, and ( e) measured chronic obstructive pulmonary disease and/or asthma as an outcome. A total of 5 interventions from 6 studies met these criteria. Tai chi as an effective therapy for asthma and chronic obstructive pulmonary disease is still difficult to determine, although the result listed here are promising. Limitations include small sample sizes, high attrition rates, and short intervention durations.

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Impact of pharmacist-led or co-led medication education groups on patient outcomes: A literature review

Mental Health Clinician ◽

10.9740/mhc.n117932 ◽

2012 ◽

Vol 2 (4) ◽

pp. 86-90 ◽

Cited By ~ 4

Author(s):

Sarah Norman ◽

Erica Davis ◽

Lisa W. Goldstone

Keyword(s):

Medication Compliance ◽

Cardiac Risk ◽

Pharmacist Intervention ◽

Small Sample ◽

Chronic Obstructive ◽

Healthcare Outcomes ◽

Obstructive Pulmonary Disease ◽

Patients With Diabetes ◽

Small Sample Sizes ◽

Education Groups

Introduction: Psychiatric pharmacists lead groups for patients with mental health disorders in a variety of locations. It is unknown whether these groups are effective in increasing patient knowledge and adherence or reducing negative healthcare outcomes. It is also unclear whether certain modalities of pharmacist-led medication education groups are more effective than others. Methods: A literature search using MEDLINE and PsycINFO was performed using the search terms “medication,” “patient education,” “pharmacy” or “pharmacist,” and “psychiatric” or “behavioral” or “mental.” Full text articles of randomized controlled trials or those with a pre-post study design that reported outcomes of a pharmacist-led or coled medication group were included. Results: Six studies were included in the review, many of which were limited by small sample sizes and confounding factors. These studies suggest that pharmacist-led group medication education can improve cardiac risk factors in patients with diabetes, increase inhaler medication compliance in patients with asthma or chronic obstructive pulmonary disease, and improve the ability of pediatric patients and their parents to manage asthma. Elderly patients' ability to manage their medications improved in one study, but was only shown to be significant for patients using four or more medications in another study. Appropriate medication use by psychiatric outpatients was significantly improved with a pharmacist intervention while decreasing total drug and salary costs. Discussion: Group interventions provided by pharmacists can be successful in improving patient care outcomes for a variety of disease states in diverse patient populations such as pediatrics and geriatrics. Further research is needed to evaluate the full impact of pharmacist-led medication education groups on outcomes such as patient attitudes, knowledge, patient ability to self-manage medications, adherence, and utilization of health care resources.

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Average volume-assured pressure support

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v6i22.438 ◽

2018 ◽

Vol 6 (22) ◽

pp. 29-37

Author(s):

Abdurahim Aloud

Keyword(s):

Pressure Support ◽

Neuromuscular Disorders ◽

Small Sample ◽

Chronic Obstructive ◽

Average Volume ◽

Obstructive Pulmonary Disease ◽

Bilevel Positive Airway Pressure ◽

Obstructive Sleep ◽

Small Sample Sizes ◽

Hypoventilation Syndrome

Average volume-assured pressure support (AVAPS) is a relatively new mode of noninvasivepositive pressure ventilation (NiPPV); only a few studies have been done tocompare its effectiveness and safety to bilevel positive airway pressure (BiPAP) in chronicrespiratory failure secondary to obesity hypoventilation syndrome, obstructive sleep apnea,chronic obstructive pulmonary disease, and neuromuscular disorders with respiratory muscleweakness. Only six studies were found in PubMed, and these studies had many limitations,especially small sample sizes. This review provides detailed summaries of these studies.These devices require more investigation.

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Clinical outcomes of cancer patients with COVID-19: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18600 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18600-e18600

Author(s):

Maryam Alasfour ◽

Salman Alawadi ◽

Malak AlMojel ◽

Philippos Apolinario Costa ◽

Priscila Barreto Coelho ◽

...

Keyword(s):

Mortality Rate ◽

Cancer Patients ◽

Clinical Outcomes ◽

Meta Analysis ◽

Small Sample ◽

Prediction Intervals ◽

Invasive Ventilation ◽

Newcastle Ottawa Scale ◽

Small Sample Sizes ◽

Meta Analyses

e18600 Background: Patients with coronavirus disease 2019 (COVID-19) and cancer have worse clinical outcomes compared to those without cancer. Primary studies have examined this population, but most had small sample sizes and conflicting results. Prior meta-analyses exclude most US and European data or only examine mortality. The present meta-analysis evaluates the prevalence of several clinical outcomes in cancer patients with COVID-19, including new emerging data from Europe and the US. Methods: A systematic search of PubMED, medRxiv, JMIR and Embase by two independent investigators included peer-reviewed papers and preprints up to July 8, 2020. The primary outcome was mortality. Other outcomes were ICU and non-ICU admission, mild, moderate and severe complications, ARDS, invasive ventilation, stable, and clinically improved rates. Study quality was assessed through the Newcastle–Ottawa scale. Random effects model was used to derive prevalence rates, their 95% confidence intervals (CI) and 95% prediction intervals (PI). Results: Thirty-four studies (N = 4,371) were included in the analysis. The mortality prevalence rate was 25.2% (95% CI: 21.1–29.7; 95% PI: 9.8-51.1; I 2 = 85.4), with 11.9% ICU admissions (95% CI: 9.2-15.4; 95% PI: 4.3-28.9; I 2= 77.8) and 25.2% clinically stable (95% CI: 21.1-29.7; 95% PI: 9.8-51.1; I 2 = 85.4). Furthermore, 42.5% developed severe complications (95% CI: 30.4-55.7; 95% PI: 8.2-85.9; I 2 = 94.3), with 22.7% developing ARDS (95% CI: 15.4-32.2; 95% PI: 5.8-58.6; I 2 = 82.4), and 11.3% needing invasive ventilation (95% CI: 6.7-18.4; 95% PI: 2.3-41.1; I 2 = 79.8). Post-follow up, 49% clinically improved (95% CI: 35.6-62.6; 95% PI: 9.8-89.4; I 2 = 92.5). All outcomes had large I 2 , suggesting high levels of heterogeneity among studies, and wide PIs indicating high variability within outcomes. Despite this variability, the mortality rate in cancer patients with COVID-19, even at the lower end of the PI (9.8%), is higher than the 2% mortality rate of the non-cancer with COVID-19 population, but not as high as what other meta-analyses conclude, which is around 25%. Conclusions: Patients with cancer who develop COVID-19 have a higher probability of mortality compared to the general population with COVID-19, but possibly not as high as previous studies have shown. A large proportion of them developed severe complications, but a larger proportion recovered. Prevalence of mortality and other outcomes published in prior meta-analyses did not report prediction intervals, which compromises the clinical utilization of such results.

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