Quality of life changes in patients with chronic obstructive pulmonary disease after hospitalization due to acute exacerbation

Exacerbations of Chronic Obstructive pulmonary Disease (COPD) are a leading cause of admission to hospital and have a great impact on health care expenditure. The magnitude and time course of effect of an acute COPD exacerbation on health status are not known. Moreover the factors causing exacerbations are largely unknown. Objective: The objectives of this study were twofold: 1) to characterize the time course of recovery of health status over a 6 month period following initial presentation with an exacerbation, and 2) to determine predictive factors for readmission to hospital after the initial hospitalization for acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Methods: This study was a prospective collection of data between October 2003 and April 2005 in patients with COPD. The patients who were included in this study, were hospitalised for an acute exacerbation of COPD at the pneumonology clinic of the Amalia Fleming General Hospital after a first evaluation at the emergency department of the hospital and were followed up for six months. The health related quality of life (HRQOL) measured by St George’s respiratory questionnaire (SGRQ) scores was used as an outcome indicator for the assessment of the time course of recovery of the patients after their initial hospitalization. Information on potential risk factors including the health related quality of life (HRQOL), standard clinical measurements as spirometry and arterial blood gases (ABG’s) and patient characteristics were collected, as well, at the admission and first follow up visit. Results: Seventy two patients (72) completed the follow up visits. During the 6 months follow up period 65 exacerbations were recorded, 28 patients (39%) needed hospitalization due to acute COPD exacerbation, Anthonisen type I, and 6 patients (8,5%) died. At presentation, during an exacerbation the questionnaire scores were worse (total score difference 4,7 units, p=0,054) in patients with subsequent exacerbation and rehospitalization. The greatest improvement in patient’s quality of life occurred within the first month. In patients without readmission the difference in SGRQ scores was 19,2 units and in patients with a readmission it was 16,4 units (difference in total scores of the two groups 7,7 units in, p=0,01). Subsequently, scores improved more rapidly in patients without readmission. The difference between the two groups at the three months follow up was 12,6 units, p=0,001 and at the six months follow up was 11 units, p=0,002. In patients without readmission the improvement in SGRQ scores during the first three months of the follow up was bigger than 4 units, which is the minimum clinically significant change. Multivariate logistic regression showed that lower SGRQ total score is a risk factor for readmission to hospital after an initial hospitalization due to acute COPD exacerbation (OR=1,06, 95%CI=1,01 to 1,11, p=0,039). Age and admissions in the previous year were significantly related with readmissions in the simple logistic regression but did not remain in the final multiple regression models. On the other hand, surprisingly, factors quite important for the clinical management of COPD patients such as smoking habit, and clinical measurements such as FEV1, PO2 and PCO2 were not related with the risk of readmission. Conclusions: An acute COPD exacerbation has a sustained effect on patient’s health status. The recovery period is long and exceeds the three months, even in patients who have no further admissions to hospital due an exacerbation. A second episode within six months limits recovery markedly. On the other hand, the usual clinical measurements for the evaluation of a COPD patient are not associated with the risk of readmission to hospital. Reversely, the assessment of health related quality of life seems to be a valid prognostic indicator of future COPD exacerbations and hospitalizations.Οι παροξύνσεις της Χρόνιας Αποφρακτικής Πνευμονοπάθειας (ΧΑΠ) είναι μία από τις κυριότερες αιτίες εισαγωγής για νοσηλεία στο νοσοκομείο και έχουν μεγάλη επίδραση στο κόστος της φροντίδας υγείας. Η σημασία και η χρονική διάρκεια της επίδρασης μιας οξείας παρόξυνσης ΧΑΠ στην κατάσταση υγείας των αρρώστων δεν είναι γνωστές. Επιπλέον οι παράγοντες που προκαλούν τις παροξύνσεις είναι σε μεγάλη έκταση άγνωστοι. Σκοπός: Ο σκοπός της παρούσας μελέτης ήταν διπλός: 1)να περιγράψει την χρονική πορεία ανάρρωσης της κατάστασης υγείας μετά από παρόξυνση και 2)να προσδιορίσει προγνωστικούς παράγοντες επανεισαγωγής στο νοσοκομείο μετά από νοσηλεία για Παρόξυνση Χρόνιας Αποφρακτικής Πνευμονοπάθειας. Υλικό - Μέθοδος: Πρόκειται για προοπτική μελέτη, η συλλογή των στοιχείων της οποίας πραγματοποιήθηκε μεταξύ Οκτωβρίου 2003 και Απριλίου 2005 σε αρρώστους με ΧΑΠ. Οι άρρωστοι που συμπεριλήφθηκαν τελικά στη μελέτη, νοσηλεύθηκαν για Οξεία Παρόξυνση ΧΑΠ στην Πνευμονολογική Κλινική του Γ. Ν. Αμαλία Φλέμινγκ μετά από αξιολόγησή τους στο Τμήμα Επειγόντων Περιστατικών του Νοσοκομείου και παρακολουθήθηκαν για έξι μήνες μετά τη νοσηλεία τους. Η σχετιζόμενη με την υγεία ποιότητα ζωής, όπως μετρήθηκε με το ερωτηματολόγιο του St George, χρησιμοποιήθηκε ως δείκτης για τον προσδιορισμό της πορείας ανάρρωσης των αρρώστων μετά την αρχική τους εισαγωγή. Επίσης, συλλέχθηκαν στοιχεία για πιθανούς παράγοντες κινδύνου επανεισαγωγής όπως η σχετιζόμενη με την υγεία ποιότητας ζωής, κλινικές μετρήσεις, όπως σπιρομέτρηση και αέρια αρτηριακού αίματος και δημογραφικά χαρακτηριστικά των αρρώστων. Αποτελέσματα: Εβδομήντα δύο (72) άρρωστοι ολοκλήρωσαν όλα τα στάδια παρακολούθησης της μελέτης. Καταγράφηκαν συνολικά 65 παροξύνσεις εντός ενός εξαμήνου από την αρχική τους νοσηλεία για παρόξυνση ΧΑΠ. 28 άρρωστοι (39%) χρειάστηκαν νοσηλεία λόγω παρόξυνσης τύπου Ι κατά Anthonisen, ενώ 6 (8,5%) απεβίωσαν. Κατά την αρχική εισαγωγή η βαθμολογία του ερωτηματολογίου ήταν χειρότερη (διαφορά διάμεσων συνολικής βαθμολογίας 4,7 μονάδες, p=0,054) στους αρρώστους με επανεισαγωγή. Η μεγαλύτερη βελτίωση στην ποιότητα ζωής των αρρώστων, δηλαδή η μεγαλύτερη μείωση στη βαθμολογία του ερωτηματολογίου, καταγράφηκε κατά τον πρώτο μήνα μετά την αρχική νοσηλεία για παρόξυνση ΧΑΠ. Στους αρρώστους χωρίς επανεισαγωγή ήταν 19,2 μονάδες, ενώ στους αρρώστους με επανεισαγωγή ήταν 16,4 στη συνολική βαθμολογία (διαφορά μέσων συνολικής βαθμολογίας 7,7 μονάδες, p=0,01). Στους μήνες που ακολούθησαν οι βαθμολογίες βελτιώθηκαν ταχύτερα στους αρρώστους χωρίς περαιτέρω παρόξυνση. Στους τρεις μήνες η διαφορά των μέσων ήταν 12,6 μονάδες, p=0,001 και στους έξι μήνες η διαφορά των μέσων ήταν 11 μονάδες, p= 0,002. Στους αρρώστους χωρίς επανεισαγωγή, η μείωση στη συνολική βαθμολογία του ερωτηματολογίου κατά τους τρεις πρώτους μήνες ήταν μεγαλύτερη από τέσσερις μονάδες που είναι το όριο για κλινικά σημαντική μεταβολή. Η πολλαπλή λογιστική παλινδρόμηση έδειξε στατιστικά σημαντική σχέση μεταξύ της πιθανότητας επανεισαγωγής και της συνολικής βαθμολογίας του ερωτηματολογίου ποιότητας ζωής SGRQ (OR=1,06, 95%ΔΕ=1,01 έως 1,11, p=0,039). Η ηλικία και οι προηγούμενες εισαγωγές για παρόξυνση είχαν σημαντική συσχέτιση με τις επανεισαγωγές στη διμεταβλητή ανάλυση, αλλά δεν διατήρησαν τη στατιστική σημαντικότητα τους στην πολλαπλή λογιστική παλινδρόμηση. Αντίθετα παράγοντες σημαντικοί για την παθογένεια της νόσου, όπως το κάπνισμα, και για την εκτίμηση της κλινικής εικόνας των αρρώστων, όπως ο FEV1, PO2 και PCO2, δεν αποδείχθηκε να σχετίζονται με τον κίνδυνο επανεισαγωγών σε νοσοκομείο. Συμπέρασμα: Οι παροξύνσεις της ΧΑΠ έχουν παρατεταμένη επίδραση στην κατάσταση υγείας των αρρώστων. Η περίοδος ανάρρωσης είναι μακρά και ξεπερνά τους τρεις μήνες ακόμη και στους αρρώστους που δεν επανεισάγονται, λόγω νέας παρόξυνσης, στο νοσοκομείο. Ένα νέο επεισόδιο παρόξυνσης εντός έξι μηνών από το αρχικό περιορίζει σημαντικά την ανάρρωση. Επιπλέον, οι συνήθεις κλινικές και εργαστηριακές μέθοδοι αξιολόγησης της κλινικής κατάστασης των αρρώστων δεν αποτελούν προγνωστικούς παράγοντες για επανεισαγωγή στο νοσοκομείο. Αντίθετα η αξιολόγηση της σχετιζόμενης με την υγεία ποιότητας ζωής των αρρώστων αποτελεί σημαντικό και αξιόπιστο προγνωστικό δείκτη μελλοντικών παροξύνσεων και πιθανής νοσηλείας σε νοσοκομείο λόγω παρόξυνσης ΧΑΠ

The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of “Institute for Healthcare Improvement Ventilator Bundle”, i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the “IHI Ventilator Bundle” combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle’s compliance should be the gold standard combination

Surgical anatomy of double pyramidal lobe on total thyroidectomy: a rare case report

Double pyramidal lobe is a scarce anatomical variation of the thyroid gland. Its presence impinges on the completeness of total and subtotal thyroidectomy and the postoperative treatment. Surgeons should be always aware of this variation in order to perform sufficient resection of the thyroid gland and minimize the possibility of recurrence of benign and malignant thyroidopathies

The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of “Institute for Healthcare Improvement Ventilator Bundle”, i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the “IHI Ventilator Bundle” combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle’s compliance should be the gold standard combination

Estimation of the optimal time needed for weaning of Intensive Care Unit tracheostomized patients on mechanical ventilation. A prospective observational study

Background and aim: Determining the time that is required for weaning, as well as the factors that influence it can be used for the appropriate planning of patient's medical and nursing care. The aim of this study is to estimate the optimal time an Intensive Care Unit (ICU) patient with tracheostomy needs to wean from mechanical ventilation. Methods: This prospective observational study was conducted on 162 patients from two general hospitals in Athens, Greece.  A specially designed recording form was created to conduct the study. The Statistical Package for the Social Sciences (SPSS) v.25 for Windows was used to record and analyze the data. The level of statistical significance was set at α=5%. Results: Results were found after comparing and associating the demographic and clinical characteristics and medical history of patients with the duration of weaning, the length of post-tracheostomy ICU stay and the time from intubation to tracheostomy. Conclusions: According to the results of our study, there are various factors that affect success and duration of weaning. More specifically, there seems to be an association between duration of weaning and age, number of closure attempts, success of closure, time from intubation to tracheostomy, length of the patient's post-tracheostomy ICU stay and diagnosis upon admission. The shorter the duration of weaning, the greater the benefits for the patients themselves, such us avoiding respiratory damage, reduction of mortality and morbidity and preventing of length of patient's ICU stay

COVID-19 Vaccine Uptake among Healthcare Workers: A Systematic Review and Meta-Analysis

The vaccine-induced immunity of healthcare workers (HCWs) is crucial to controlling the COVID-19 pandemic. Therefore, we conducted a systematic review and meta-analysis to assess the COVID-19 vaccine uptake among HCWs worldwide and to identify predictors of vaccination. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL, and medRxiv up to 25 August 2022. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We found 25 studies including 491,624 vaccinated HCWs, while the full sample included 555,561 HCWs. The overall proportion of vaccinated HCWs was 77.3%. Vaccine uptake for studies that were conducted in North America (85.6%) was higher than the proportion for studies that were conducted in Asia (79.5%), Europe (72.8%), and Africa (65.6%). The overall prevalence of COVID-19 vaccine uptake was 83.6% and 77.4% for physicians and nurses, respectively. Older age, white race, physicians’ profession, seasonal influenza vaccine, direct COVID-19 patient care, and confidence in COVID-19 vaccine safety and effectiveness were positive predictors of vaccine uptake, while history of SARS-CoV-2 infection was a negative predictor. Deep understanding of the factors that influence HCWs’ decisions to receive a COVID-19 vaccine is critical to implementing tailored communication strategies for HCWs who are at risk for not getting vaccinated

First COVID-19 Booster Dose in the General Population: A Systematic Review and Meta-Analysis of Willingness and Its Predictors

The emergence of breakthrough infections and new highly contagious variants of SARS-CoV-2 threaten the immunization in individuals who had completed the primary COVID-19 vaccination. This systematic review and meta-analysis investigated, for the first time, acceptance of the first COVID-19 booster dose and its associated factors among fully vaccinated individuals. We followed the PRISMA guidelines. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL and medrxiv from inception to 21 May 2022. We found 14 studies including 104,047 fully vaccinated individuals. The prevalence of individuals who intend to accept a booster was 79.0%, while the prevalence of unsure individuals was 12.6%, and the prevalence of individuals that intend to refuse a booster was 14.3%. The main predictors of willingness were older age, flu vaccination in the previous season, and confidence in COVID-19 vaccination. The most important reasons for decline were adverse reactions and discomfort experienced after previous COVID-19 vaccine doses and concerns for serious adverse reactions to COVID-19 booster doses. Considering the burden of COVID-19, a high acceptance rate of booster doses could be critical in controlling the pandemic. Our findings are innovative and could help policymakers to design and implement specific COVID-19 vaccination programs in order to decrease booster vaccine hesitancy

Predictors of Willingness of the General Public to Receive a Second COVID-19 Booster Dose or a New COVID-19 Vaccine: A Cross-Sectional Study in Greece

Given the concerns of waning immunity from the primary COVID-19 vaccines and the first booster dose, we conducted an online cross-sectional study in May 2022 to investigate willingness to receive a second COVID-19 booster dose or a new COVID-19 vaccine and its associated factors. Overall, 62% of the participants were willing to be vaccinated, 25.8% were unsure, and 12.3% were unwilling to be vaccinated. The main reasons against accepting a second COVID-19 booster dose/new COVID-19 vaccine were concerns about the side effects and the effectiveness and the opinion that further vaccination is unnecessary. Males, younger individuals, participants without a previous COVID-19 diagnosis, and those with good/very good self-perceived physical health were significantly more frequently willing to receive a second COVID-19 booster dose or a new COVID-19 vaccine. Additionally, increased fear of the COVID-19, increased trust in COVID-19 vaccinations, and decreased fear of a second booster dose or a new COVID-19 vaccine was associated with increased willingness. Our results show some hesitancy and unwillingness toward further COVID-19 vaccination and indicate that the fear of COVID-19 and trust in COVID-19 vaccination affects public opinion