643 research outputs found
ACT-ONE - ACTION at last on cancer cachexia by adapting a novel action beta-blocker
Novel action beta-blockers combine many different pharmacological effects. The espindolol exhibits effects through ÎČ and central 5-HT1α receptors to demonstrate pro-anabolic, anti-catabolic, and appetite-stimulating actions. In the ACT-ONE trial, espindolol reversed weight loss and improved handgrip strength in patients with cachexia due to non-small cell lung cancer or colorectal cancer. With this trial, another frontier of cachexia management is in sight. Nonetheless, more efficacy and safety data is needed before new therapeutic indications for novel action beta-blockers can be endorsed
Chronic obstructive pulmonary disease patient journey: hospitalizations as window of opportunity for extra-pulmonary intervention.
PURPOSE OF REVIEW: Hospitalizations due to exacerbation of chronic pulmonary disease (COPD) are a major burden for patient and healthcare Extra-pulmonary needs and resulting interventions are poorly FINDINGS: COPD induces nutritional issues, body composition changes and patient exercise capacity. The COPD patient journey can be accelerated exacerbations during which disease-related detrimental factors such as inflammation, hypoxia, inactivity, and glucocorticosteroid treatment intensify, which acutely and often irreversibly worsens patient Specific needs during exacerbations reach beyond the respiratory system, clinicians should comprehensively evaluate patients and identify potent feasible metabolic and anabolic intervention targets. General and nutritional support appear feasible and with potential to cover for the bodily requirements during exacerbation. Adjunctive physical exercise or neuromuscular electrical stimulation may prevent the muscle loss. Hospitalizations should be considered as a window of opportunity for patient assessment and implementation of tailored extra-pulmonary strategies with long-term implications. Nutritional assessment and well as physical exercise appear promising but should be investigated in adequately designed and conducted trials
Health-related behaviour among managers of Slovenian hospitals and institutes of public health
Aim: Behavioural risk factors have a significant impact on health. We aimed to assess health-related behaviour, health status, and use of healthcare services among managers of Slovenian hospitals and institutes of public health.
Methods: This was a cross-sectional study which included management (directors, scientific directors, directorsâ deputies) of Slovenian hospitals and institutes of public health (63 respondents; 57% women; overall mean age: 51±7 years; response rate: 74%). Data were obtained using an anonymous self-administered questionnaire.
Results: About 35% of respondents were directors. More than half of the respondents were overweight or obese (52%), the majority were not sufficiently physically active (59%) and overloaded with stress (87%). Hypercholesterolemia (36%), spinal disease (17%), and arterial hypertension (16%) were most common chronic diseases. Whilst only few participants visited their general practitioner due their health complaints, blood pressure (76%), cholesterol (51%), and glucose (54%) were measured within last year in most of the respondents.
Conclusion: Our findings point to a high prevalence of overweight and obesity as well as workplace-related stress among Slovenian public health managers. Therefore, effective preventive strategies should be focused on stress management along with promotion of healthy behavioural patterns
The obesity paradox in chronic disease: facts and numbers
Body size, particularly large, is a matter of concern among the lay public. Whether this is justified depends upon the state of health and should be judged individually. For patients with established chronic disease, there is sufficient evidence to support the benefits of large body size, i.e., the obesity paradox. This uniform finding is shared over a variety of cardiovascular, pulmonary, and renal diseases and is counterintuitive to the current concepts on ideal body weight. The scientific community has to increase the awareness about differences for optimal body size in health and disease. Simultaneously, clinicians have to be aware about body weight dynamics implications and should interpret the changes in the context of an underlying disease in order to implement the best available management
Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis
Objectives
To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. Design
A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all Englishâlanguage articles published between 1990 and April 2016. Setting
Hospital or skilled nursing facility. Participants
Older adults with informal caregivers discharged to a community setting. Measurements
Readmission rates, length of and time to postâdischarge rehospitalizations, costs of postdischarge care. Results
Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62â0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64â0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. Conclusion
For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission
Neurological and endocrinological disorders: orphans in chronic obstructive pulmonary disease
SummaryPatients with chronic obstructive pulmonary disease (COPD) are often characterised by a range of characteristic co-morbidities that interfere with their pulmonary disease. In addition to a mere association with co-morbidities, a complex pathophysiological interaction and mutual augmentation occurs between COPD and its co-morbidities that may result in disease progression and increased morbidity and mortality. An interdisciplinary approach is required both for diagnosis and treatment to target co-morbidities early in the course of the disease. This review summarizes the current knowledge of the interaction with cerebrovascular disease and endocrinological co-morbidities in COPD patients. There is growing evidence that COPD is an independent risk factor for ischemic stroke, increasing the risk about twofold. Stroke risk in COPD patients increases with the severity of the disease as measured by the degree of airflow limitation. The presence of cardiovascular risk factors is of particular importance for stroke prevention in COPD patients. Endocrinological co-morbidities are also important and many are associated with increased cardiovascular risk. Impaired glucose metabolism ranges from insulin resistance to overt diabetes mellitus, which is a frequent finding and is associated with worse outcome
To eat or not to eat? Indicators for reduced food intake in 91,245 patients hospitalized on nutritionDays 2006-2014 in 56 countries worldwide: A descriptive analysis
Background: Inadequate nutrition during hospitalization is strongly associated with poor patient outcome, but ensuring adequate food intake is not a priority in clinical routine worldwide. This lack of priority results in inadequate and unbalanced food intake in patients and huge amounts of wasted food. Objectives: We evaluate the main factors that are associated with reduced meal intake in hospitalized patients and the differences between geographical regions. Design: We conducted a descriptive analysis of data from 9 consecutive, annual, and cross-sectional nutritionDay samples (2006-2014) in a total of 91,245 adult patients in 6668 wards in 2584 hospitals in 56 countries. A general estimation equation methodology was used to develop a model for meal intake, and P-value thresholding was used for model selection. Results: The proportion of patients who ate a full meal varied widely (24.7-61.5%) across world regions. The factors that were most strongly associated with reduced food intake on nutritionDay were reduced intake during the previous week (OR: 0.20; 95% CI: 0.17, 0.22), confinement to bed (OR: 0.49; 95% CI: 0.44, 0.55), female sex (OR: 0.53; 95% CI: 0.5, 0.56), younger age (OR: 0.74; 95% CI: 0.64, 0.85) and older age (OR: 0.80; 95% CI: 0.74; 0.88), and low body mass index (OR: 0.84; 95% CI: 0.79, 0.90). The pattern of associated factors was homogenous across world regions. Conclusions: A set of factors that are associated with full meal intake was identified and is applicable to patients hospitalized in any region of the world. Thus, the likelihood for reduced food intake is easily estimated through access to patient characteristics, independent of world regions, and enables the easy personalization of food provision
Impact of chronic inflammatory airway disease on stroke severity and long-term survival after ischemic stroke - a retrospective analysis
Background Chronic inflammatory airway disease (CIAD) has emerged as
independent risk factor for cardiovascular mortality and ischemic stroke but
the impact of co-existing CIAD in patients with ischemic stroke is less clear.
Methods We retrospectively analyzed 1013 patients with acute ischemic stroke
who were consecutively admitted to the Department of Neurology, Charité -
UniversitÀtsmedizin Berlin, Germany within one year. Mean follow-up was 80
months (IQR 32â85 months). Using multivariable regression models we analyzed
the impact of CIAD (defined as chronic obstructive pulmonary disease or asthma
bronchiale) on stroke severity and outcome. Results Co-existing CIAD was
evident in 7.1 % (nâ=â72) of all patients with acute ischemic stroke. Baseline
characteristics of stroke patients with CIAD did not differ significantly from
ischemic stroke patients without CIAD. Age (OR 1.17 [95 % CI 1.03-1.37] per
decade), atrial fibrillation (OR 3.43 [95 % CI 2.47-4.78]) and coronary artery
disease (OR 1.51 [95 % CI 1.07â2.14]) but not a history of CIAD (pâ=â0.30)
were associated with severe stroke (NIHSSâ„11) on hospital admission. Age (HR
1.70 [95 % CI 1.53-1.87] per decade), peripheral artery disease (HR 1.91 [95 %
CI 1.35-2.7]), stroke severity at hospital admission (NIHSS per point HR 1.08
[95 % CI 1.06-1.10]), and history of CIAD (HR 1.43 [95 % CI 1.02-2.00]) were
independently associated with mortality during long-term follow-up. However,
CIAD was not significantly associated with short-term mortality after stroke.
Conclusion Co-existing CIAD showed no significant association with stroke
severity at hospital admission and early mortality after ischemic stroke. CIAD
was negatively associated with long-term survival after ischemic stroke
Iohexol clearance is superior to creatinine-based renal function estimating equations in detecting short-term renal function decline in chronic heart failure
Aim To compare the performance of iohexol plasma clearance
and creatinine-based renal function estimating equations
in monitoring longitudinal renal function changes in
chronic heart failure (CHF) patients, and to assess the effects
of body composition on the equation performance.
Methods Iohexol plasma clearance was measured in 43
CHF patients at baseline and after at least 6 months. Simultaneously,
renal function was estimated with five creatinine-
based equations (four- and six-variable Modification
of Diet in Renal Disease, Cockcroft-Gault, Cockcroft-Gault
adjusted for lean body mass, Chronic Kidney Disease Epidemiology
Collaboration equation) and body composition
was assessed using bioimpedance and dual-energy x-ray
absorptiometry.
Results Over a median follow-up of 7.5 months (range
6-17 months), iohexol clearance significantly declined
(52.8 vs 44.4 mL/[min Ă1.73 m2], P = 0.001). This decline
was significantly higher in patients receiving mineralocorticoid
receptor antagonists at baseline (mean decline
-22% of baseline value vs -3%, P = 0.037). Mean serum creatinine
concentration did not change significantly during
follow-up and no creatinine-based renal function estimating
equation was able to detect the significant longitudinal
decline of renal function determined by iohexol clearance.
After accounting for body composition, the accuracy
of the equations improved, but not their ability to detect
renal function decline.
Conclusions Renal function measured with iohexol plasma
clearance showed relevant decline in CHF patients,
particularly in those treated with mineralocorticoid receptor
antagonists. None of the equations for renal function
estimation was able to detect these changes
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