Assessment of accuracy and applicability of a portable electronic diary card spirometer for asthma treatment

AbstractA pocked-sized turbine flowmeter and spirometer device, integrated with an electronic diary card (EDC-spirometer, Micro Medical, U.K.), was tested with a mechanical calibrator, in an outpatient clinic and in the home situation. A screen pneumotachometer was used as flow and volume reference.Ten devices were tested; interdevice variability was small with a mean variation coefficient of 1·1% for both forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) (sd 0·5 and 0·4, respectively) for eight settings of the calibrator. Mean difference from reference was −0·131 (sd 0·04) for FEV1 (range 0·38–3·16) and 0·091 s−1 (sd 0·09) for PEF (range 4·2–11·7). No significant deviation from linearity was present.Results obtained in the outpatient clinic confirmed the accuracy of FEV1 and PEF data obtained with the calibrator. However, linear regression analysis showed a mean underestimation of 0·451 (sd of estimate 0·29) for forced vital capacity over the whole measurement range, probably due to a restricted integration time.In 10 optimally-treated chronic obstructive pulmonary disease patients in a family practice, PEF measurements were done in the home situation, both with the EDC spirometer and a mini-Wright peak flow meter. No significant differences in the diurnal variation of PEF were found. The PEF data from the mini-Wright meter were corrected for earlier reported flow-dependent systematic deviations. In the home situation, patients preferred the EDC spirometer. It is concluded that this device is applicable in the follow-up and treatment of asthma at home

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Background Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Results Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusions After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease