Search

Background: Epinephrine autoinjector (EAI) is prescribed to prevent a fatal outcome in the case of a repeated anaphylactic reactions. We wanted to determine how adult patients who received their first prescription as part of an urgent treatment of an anaphylactic reaction or at their family physician were instructed on the use of EAI. Methods: Nurses assessing patients’ knowledge asked the patient to demonstrate how to use the EAI training device. Patients who performed the critical steps correctly in 1 min were labelled as competent. Results: Forty-one patients (24% women, 46 ± 5 years) came for the allergy examination 116 ± 145 days after receiving a prescription for EAI. When prescribing, the doctor or nurse explained the instructions for the use of EAI to 63.4% patients, and 31.7 patients practiced the use of EAI using a training device. At the pharmacy, 22% received explanation and 7% also practiced using a training device. Fifty-four percent of patients were able to effectively administer EAI adrenaline within 1 min. Higher education level was associated with sufficient knowledge about the use of EAI (p = 0.026). At the time of the visit to the allergy specialist clinic, 61% of patients had EAI with them. The shelf life of EAI was known to 63% of patients. Conclusions: The activities to increase the prescription rate of EAI immediately after treatment of anaphylactic episode are not sufficient to prevent severe outcome after the repeated episodes of anaphylaxis as nearly a half of patients are not able to use EAI correctly.

Introduction/Objective. Allergic reactions to insect stings are medical emergencies that could be prevented by venom immunotherapy (VIT). The main purpose of VIT is to prevent fatal or life-threatening reactions. We aimed to show the rapidity with which patients experience the benefits of VIT and estimate the number of emergency treatments that are prevented. Methods. We reviewed the medical files of patients who started VIT between 2010 and 2014. We calculated the costs of treatment of the sting reactions, the costs of immunotherapy, and estimated the costs of prevented allergic reactions. Results. In a cohort of 514 patients (40.9% female, age 47.2 ? 14.4 years), the cost of treatment of the index sting reaction was 180.4 ? 166.8 euros. During VIT, 195 patients experienced 446 field stings. In 86.3% of patients, stings were well tolerated, and only one patient experienced a severe reaction (grade III, according to Mueller). A total of 20.4% of VIT treated patients were stung during the first year of VIT and 57% during five years of VIT. The expenditure for five years of VIT was 2,886 euros per patient, which corresponded to an average of 16 emergency treatments for systemic reactions. Conclusion. Emergency situations are prevented in a substantial number of venom-allergic patients and a beneficial effect was already observed during the first year of VIT.

Background We aimed to assess the relationship between echocardiographic characteristics and mortality in patients with chronic obstructive pulmonary disease (COPD). Methods We prospectively studied 154 patients (mean age 71 ± 10 years, 71% male) with COPD. All patients underwent transthoracic Doppler echocardiography within 48 hours of hospital admission. Primary endpoint was all-cause mortality during a median period of 22 months. Results Mildly elevated tricuspid regurgitation pressure and mitral E/e′ ratio were the most commonly encountered echocardiographic abnormalities, observed in 60% and 56% of patients, respectively. In Kaplan-Meier analysis of survival, left atrial enlargement, E/e′ ratio > 8, right atrial enlargement, right ventricular dilation, decreased tricuspid annular plane systolic excursion, decreased tricuspid annular systolic velocity, and elevated tricuspid regurgitation velocity were associated with all-cause mortality (p < 0.05 for all). In the Cox proportional hazards analysis, the mitral E/e′ ratio (hazard ratio 1.048; 95% confidence interval 1.001–1.096) remained an independent echocardiographic predictor of survival after adjustment for age, COPD severity, and other baseline echocardiographic parameters. Conclusions Among patients with COPD, an abnormal mitral E/e′ ratio was an independent echocardiographic predictor of all-cause mortality. Echocardiographic evaluation of structural and functional cardiac abnormalities provides important prognostic information and should be used routinely in the assessment of patients with COPD. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound, 2016

Introduction: To achieve a better quality of life in patients with chronic obstructive pulmonary disease, these patients should be informed about the characteristics of the disease and measures for its effective selfmanagement. The aim of the study was to determine the frequency and type of written instructions regarding lifestyle and self-management of the disease in hospital documentation of patients with chronic obstructive pulmonary disease.Methods: A retrospective quantitative study that reviewed all the hospital’s documents (therapy forms, nursing forms, archives of health education programmes, letters of discharge) was conducted including 253 patients with chronic obstructive pulmonary disease. The results were described in terms of descriptive statistics; chisquare test and ordinal logistic regression were used.Results: On average, hospital records of patients with chronic obstructive pulmonary disease showed less than 4 instructions (x = 3.8, s = 5.1) about life style and disease self-management. Half of chronic obstructive pulmonary disease patients received letters of discharge (x = 0.5, s = 0.9) which contained less guidance about lifestyle and self-management of the disease than their hospital records (x2 = 33.455, p < 0.001). Nurses recorded the instructions five times more frequently than doctors.Discussion and conclusion: The study showed a low number of written instructions about the life style and self-management of the disease given to chronic obstructive pulmonary disease patients during hospitalization. It is necessary to raise awareness about the importance of documenting health education instructions and design tools to improve inter-professional communication.

We aimed to assess the relationship between echocardiographic characteristics and mortality in patients with chronic obstructive pulmonary disease (COPD).We prospectively studied 154 patients (mean age 71 ± 10 years, 71% male) with COPD. All patients underwent transthoracic Doppler echocardiography within 48 hours of hospital admission. Primary endpoint was all-cause mortality during a median period of 22 months.Mildly elevated tricuspid regurgitation pressure and mitral E/e' ratio were the most commonly encountered echocardiographic abnormalities, observed in 60% and 56% of patients, respectively. In Kaplan-Meier analysis of survival, left atrial enlargement, E/e' ratio8, right atrial enlargement, right ventricular dilation, decreased tricuspid annular plane systolic excursion, decreased tricuspid annular systolic velocity, and elevated tricuspid regurgitation velocity were associated with all-cause mortality (p0.05 for all). In the Cox proportional hazards analysis, the mitral E/e' ratio (hazard ratio 1.048; 95% confidence interval 1.001-1.096) remained an independent echocardiographic predictor of survival after adjustment for age, COPD severity, and other baseline echocardiographic parameters.Among patients with COPD, an abnormal mitral E/e' ratio was an independent echocardiographic predictor of all-cause mortality. Echocardiographic evaluation of structural and functional cardiac abnormalities provides important prognostic information and should be used routinely in the assessment of patients with COPD. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:211-221, 2017.

Purpose In chronic obstructive pulmonary disease (COPD), cardiovascular system is involved but less is known about role of specific cardiac biomarkers. We aimed to investigate associations between N-terminal pro B-type natriuretic peptide (NT-proBNP) and troponin T during hospitalisation with 6-month outcome. Methods This was a prospective study conducted in consecutive patients hospitalized for an acute exacerbation of COPD. On admission, and at discharge, NT-proBNP and troponin T were measured, and echocardiography was performed. Hospitalisations and mortality were recorded for 6months after discharge. Results We included 127 patients (70±10years, 70% men, GOLD III/IV 87%). Left ventricular dysfunction was detected in 70 (55%) patients and diastolic dysfunction was the most common type (53 patients–42%). NT-proBNP and troponin T were elevated on admission in 60% and 36%, and at discharge in 28% and 19% of patients. During follow-up, 53 (42%) patients were hospitalized and 17 (13%) patients died. In Kaplan Meier analysis of survival curves, NT-proBNP on admission distinguished between deceased and surviving patients (p=0.011) whilst troponin T at discharge separated hospitalized and non-hospitalized patients (p=0.017). The adjusted Cox proportional hazard model confirmed these findings: discharge troponin T predicted hospitalisations (hazard ratio 2.89, 95% confidence interval 1.13–7.36) and admission NT-proBNP predicted mortality (hazard ratio 4.20, 95% confidence interval 1.07–14.01). Conclusions Elevated NT-proBNP at discharge and troponin T on admission predict outcome in patients hospitalized for an acute exacerbation of COPD.

Summary Background Chronic obstructive pulmonary disease (COPD) follows a slowly progressive natural course that can be accelerated by acute exacerbations, which frequently trigger admissions to hospital. Specific healthcare professional profiles such as that of discharge coordinator have been successful in reducing numbers of hospitalizations and need for medical care in patients with various chronic diseases, but data for COPD are sparse and inconclusive. This study was conceived to test whether coordinated discharge and post-discharge care could reduce re-hospitalizations and use of resources in patients with COPD. Methods/Design This ongoing single-center randomized controlled clinical trial, which began in November 2009, is enrolling COPD patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages II IV, hospitalized because of acute exacerbation. Patients are randomized in a 1:1 fashion to the intervention group, which has care organized by a discharge coordinator, and a control group receiving the usual care. The primary endpoint of the study is the number of patients hospitalized because of worsening of COPD. Data are collected at baseline, at the time of hospital discharge, and at the following time-points after discharge: 48 hours, 7 10 days, 30 days, 90 days, and 180 days. Discussion In COPD patients requiring hospital admission, coordinated discharge appears a feasible option for improving patient and healthcare system-related outcomes. This study will provide evidence on the effectiveness of a discharge coordinator in patients hospitalized because of acute exacerbation of COPD and may give relevant guidance for implementation in clinical practice. Clinical trial registration number: NCT01225627

Introduction: A timely and coordinated preparation for hospital discharge improves a patient's quality of life and decreases the number of hospitalisations. A cross-sectional epidemiologic survey was performed in order to assess the satisfaction of chronic obstructive pulmonary disease patients with a hospital discharge coordinator at the University Clinic Golnik. Methods: The anonymous survey was carried out with a structured questionnaire which was sent via conventional postal delivery services to 107 patients who had been hospitalised due to chronic obstructive pulmonary disease exacerbation between 2 November 2009 and 6 December 2011 and managed by a discharge coordinator. 60 patients returned the questionnaire. The data collected were analysed with descriptive statistics, factor analysis, the linear regression model and multiple linear regression. Results: Factor analysis shows that the general influence of three factors (communication, disease self-management and experiencing disease or symptoms) can explain 84.02 % of patient satisfaction with a hospital discharge coordinator. Satisfaction is primarily influenced by communication, followed by experiencing disease or symptoms. Discussion and conclusion: The patients are satisfied with the activities of the discharge coordinator, as confirmed by other authors. According to the research results, a discharge coordinator should be included in the hospital treatment of chronic obstructive pulmonary disease patients. The assessment of patient satisfaction is a useful quality indicator, as it shows opportunities for improving our work from the patients' perspective.

Diagnosing heart failure with preserved ejection fraction (HFpEF) in patients with chronic obstructive pulmonary disease (COPD) is difficult due to overlapping pathophysiological pathways, risk factors and clinical presentations. We investigated the prevalence and prognostic implications of coexisting HFpEF in patients hospitalized for acute exacerbation of COPD. A total of 116 consecutive patients with an acute exacerbation of COPD were evaluated for HFpEF and followed for an average period of 22 ± 9 months for the occurrence of death from any cause. HFpEF was diagnosed in 22 (19 %) patients with COPD, who were older, and also had higher LV mass, left atrial size, and mitral E/Ea ratio than those without HFpEF (p

At certain points during lifetime one needs to take a break and anniversaries seem to be made for that. This is chance for a thoughtful look back, to separate the grain from the chaff, and maybe to reconcile with the spirits of the past; all this to get the things done better in the future. Already at its foundation, Sanatorium for tuberculosis Golnik, nowadays University Clinic of Respiratory and Allergic Diseases Golnik, was sized for whole country and even beyond; the heritage still to follow in current days. The visionary way was felt at that time as addressing public health problems was in-house doctrine. This has translated to a long history of acknowledging the importance of not only up-to-date diagnostic and therapeutic service but also of preventive approach. In ancient Greece, these two approaches were epitomized by the daughters of Aesculapius, Panacea and Hygieia, goddess of healing and of health. 1 It is therefore not a mere chance that Aesculapius’

Objectives To test whether coordination of discharge from hospital reduces hospitalizations in patients with chronic obstructive pulmonary disease (COPD). Design Randomized controlled clinical trial. Setting Specialized pulmonary hospital. Participants Patients hospitalized for an acute exacerbation of COPD. Intervention Care as usual included routine patient education, supervised inhaler use, respiratory physiotherapy, and disease-related communication. The discharge coordinator intervention added assessment of patient situation and homecare needs. Patients and caregivers were actively involved and empowered in the discharge planning process, which was communicated with community medical professionals to provide continuity of care at home. Measurements The primary end-point of the study was the number of patients hospitalized because of worsening COPD. Key secondary end-points were time-to-COPD hospitalization, all-cause mortality, all-cause hospitalization, days alive and out of hospital, and health-related quality of life. Results Of 253 eligible patients (71 ± 9 years, 72% men, 87% GOLD III/IV), 118 were assigned to intervention and 135 to usual care. During a follow-up of 180 days, fewer patients receiving intervention were hospitalized for COPD (14% versus 31%, P = .002) or for any cause (31% versus 44%, P = .033). In time-to-event analysis, intervention was associated with lower rates of COPD hospitalizations (P = .001). A Cox model of proportional hazards, adjusted for sex, age, GOLD stage, heart failure, malignant disease, and long-term oxygen treatment, demonstrated that intervention reduced the risk of COPD hospitalization (hazard ratio 0.43, 95% confidence interval 0.24–0.77, P = .002). Conclusion Among patients hospitalized for acute COPD exacerbation, discharge coordinator intervention reduced both COPD hospitalizations and all-cause hospitalizations.