Breathing Easier When a Lung-Health Outpatient Team Has Your Back

Purpose: The goal of this program is to improve the quality of life in COPD patients. An outpatient resource center provides post-discharge follow-up in order to facilitate continuum of care. Background: Frequent readmissions are common in the COPD patient population and have become a focus of the CMS value based measures. Research has shown a 7.1% 30-day readmission rate for a principal diagnosis of COPD and a 20.5% for all-cause 30-day readmission. Patients often do not have a resource which guides them through the continuum of care from inpatient to home. Knowledge deficits regarding medication administration and regimen can lead to poor-compliance and therefore worse outcomes. Understanding the disease process and progression is key if patients are to receive the maximum benefit from their medications. Many of these patients suffer from more than one chronic medical condition which leads to complicated medication regimens. The GOLD recommendation for post hospital discharge to lessen exacerbation-related readmissions is an early follow-up process. However, upon discharge, many of these patients are not back to their baseline and often are unclear about their treatment regimen. According to the Institute for Safe Medication Practices (ISMP), 94% of patients with COPD and asthma use their inhalers incorrectly which can lead to a reduction of efficacy and poor outcomes. Intensive outpatient monitoring, evaluation, and education are needed to prevent readmissions. COPD patients often do not have a resource center that follows up within 1 week of discharge to evaluate their condition, provide intervention, and guide them through the continuum of care from inpatient to outpatient status. Methods: A Lung Health Outpatient Resource Center was assembled using the resources of a multidisciplinary team. The team facilitates to progress patients through the continuum of care with the goal of improving the quality of life and decrease readmissions. Prevention strategies are initiated after an exacerbation; both pharmacologic and non-pharmacologic interventions are used to complement the individual’s treatment goals. The multi-disciplinary team was headed by the Respiratory Department and included: a nurse practitioner (ARNP), respiratory therapist (RT), registered nurse (RN), social work (SW), physicians, and pharmacy. Prior to a COPD patient discharge, an appointment is scheduled at the Lung Health Outpatient Resource Center. During the appointment, the ARNP, RT, and RN evaluate the patient and provides treatment as needed. Education about the COPD disease process and self-management are provided by the multidisciplinary team. The team helps identify and reduce exposure to internal and external risk factors. If further interventions are indicated, the patient’s pulmonologist is contacted for further treatment options. Results: The program started in June of 2017 and data was collected until February of 2018, (9 months). A total of 56 patients were seen in the outpatient clinic and out of the 56, 5 were readmitted for all cause diagnosis and zero cases were admitted for COPD exacerbation. Conclusion: A multidisciplinary Lung Health Outpatient Resource Center made a significant impact in the reduction of COPD readmission rates

Sustainability and Impact of a Lung Health Outpatient Resource Center

BACKGROUND: According to the Worldwide Health Organization, worldwide, it is estimated hundreds of millions of people are affected by chronic respiratory diseases. COPD is a leading cause of death in the United States, and imposes an enormous financial burden on our nation\u27s health care system (COPD. NIH.GOV). COPD patients with severe exacerbations requiring emergency visits or hospitalizations per year are at higher risk for all- cause mortality (Soler-Cataluna JJ, et al. Thor-ax.200,60:925-931 ). A multidisciplinary Lung Health Outpatient Resource Center was established as a continuum of care to support our COPD population post discharge. Patients seen in the center showed successful outcomes, which have led to decreasing readmissions and improved cost savings. Therefore, the center expanded its services to include other chronic pulmonary diseases including pneumonia and pleurisy, asthma, bronchitis, and other respiratory infections. METHODS: The multidisciplinary team was headed by the Respiratory Department in con-junction with the Outpatient clinic and included; nurse practitioners (ARNP), respiratory therapist (RT), registered nurses (RN), social worker (SW), pulmonologist and pharmacy. The center incorporates weekly follow up visits during the acute phase post discharge where symptom management, individualized action plans, interpersonal psychosocial and emotional support is provided and created with the patient and family. Pharmacological and non-pharmacological interventions are utilized to optimize the individual\u27s treatment goal. RESULTS: The Lung Health Outpatient Resource Center was established in June 2017. Data was collected from June 2017 to March 2019. Total population referred was 304 patients. Patients seen in the center (150) had an 8% readmission rate, and those not seen (154) had a 12.9% readmission rate. The estimated average variable cost savings for patients seen was of $1,217,206.90 CONCLUSION: Through utilizing an outpatient resource center and adherence to plan of care, hospital readmission rates were decreased and variable cost savings improved. Sustainability by expanding our services to other chronic pulmonary diseases has been shown

A comparison of Sinogram Affirmed Iterative Reconstruction and filtered back projection on image quality and dose reduction in paediatric head CT: a phantom study

Background: Computed tomography (CT) is one of the most used modalities for diagnostics in paediatric populations, which is a concern as it also delivers a high patient dose. Research has focused on developing computer algorithms that provide better image quality at lower dose. The iterative reconstruction algorithm Sinogram-Affirmed Iterative Reconstruction (SAFIRE) was introduced as a new technique that reduces noise to increase image quality. Purpose: The aim of this study is to compare SAFIRE with the current gold standard, Filtered Back Projection (FBP), and assess whether SAFIRE alone permits a reduction in dose while maintaining image quality in paediatric head CT. Methods: Images were collected using a paediatric head phantom using a SIEMENS SOMATOM PERSPECTIVE 128 modulated acquisition. 54 images were reconstructed using FBP and 5 different strengths of SAFIRE. Objective measures of image quality were determined by measuring SNR and CNR. Visual measures of image quality were determined by 17 observers with different radiographic experiences. Images were randomized and displayed using 2AFC; observers scored the images answering 5 questions using a Likert scale. Results: At different dose levels, SAFIRE significantly increased SNR (up to 54%) in the acquired images compared to FBP at 80kVp (5.2-8.4), 110kVp (8.2-12.3), 130kVp (8.8-13.1). Visual image quality was higher with increasing SAFIRE strength. The highest image quality was scored with SAFIRE level 3 and higher. Conclusion: The SAFIRE algorithm is suitable for image noise reduction in paediatric head CT. Our data demonstrates that SAFIRE enhances SNR while reducing noise with a possible reduction of dose of 68%

The impact of Sinogram-Affirmed Iterative Reconstruction on patient dose and image quality compared to filtered back projection: a narrative review

Objective: Summarize all relevant findings in published literature regarding the potential dose reduction related to image quality using Sinogram-Affirmed Iterative Reconstruction (SAFIRE) compared to Filtered Back Projection (FBP). Background: Computed Tomography (CT) is one of the most used radiographic modalities in clinical practice providing high spatial and contrast resolution. However it also delivers a relatively high radiation dose to the patient. Reconstructing raw-data using Iterative Reconstruction (IR) algorithms has the potential to iteratively reduce image noise while maintaining or improving image quality of low dose standard FBP reconstructions. Nevertheless, long reconstruction times made IR unpractical for clinical use until recently. Siemens Medical developed a new IR algorithm called SAFIRE, which uses up to 5 different strength levels, and poses an alternative to the conventional IR with a significant reconstruction time reduction. Methods: MEDLINE, ScienceDirect and CINAHL databases were used for gathering literature. Eleven articles were included in this review (from 2012 to July 2014). Discussion: This narrative review summarizes the results of eleven articles (using studies on both patients and phantoms) and describes SAFIRE strengths for noise reduction in low dose acquisitions while providing acceptable image quality. Conclusion: Even though the results differ slightly, the literature gathered for this review suggests that the dose in current CT protocols can be reduced at least 50% while maintaining or improving image quality. There is however a lack of literature concerning paediatric population (with increased radiation sensitivity). Further studies should also assess the impact of SAFIRE on diagnostic accuracy

Safety and feasibility of oral immunotherapy to multiple allergens for food allergy

BACKGROUND: Thirty percent of children with food allergy are allergic to more than one food. Previous studies on oral immunotherapy (OIT) for food allergy have focused on the administration of a single allergen at the time. This study aimed at evaluating the safety of a modified OIT protocol using multiple foods at one time. METHODS: Participants underwent double-blind placebo-controlled food challenges (DBPCFC) up to a cumulative dose of 182 mg of food protein to peanut followed by other nuts, sesame, dairy or egg. Those meeting inclusion criteria for peanut only were started on single-allergen OIT while those with additional allergies had up to 5 foods included in their OIT mix. Reactions during dose escalations and home dosing were recorded in a symptom diary. RESULTS: Forty participants met inclusion criteria on peanut DBPCFC. Of these, 15 were mono-allergic to peanut and 25 had additional food allergies. Rates of reaction per dose did not differ significantly between the two groups (median of 3.3% and 3.7% in multi and single OIT group, respectively; p = .31). In both groups, most reactions were mild but two severe reactions requiring epinephrine occurred in each group. Dose escalations progressed similarly in both groups although, per protocol design, those on multiple food took longer to reach equivalent doses per food (median +4 mo.; p < .0001). CONCLUSIONS: Preliminary data show oral immunotherapy using multiple food allergens simultaneously to be feasible and relatively safe when performed in a hospital setting with trained personnel. Additional, larger, randomized studies are required to continue to test safety and efficacy of multi-OIT. TRIAL REGISTRATION: Clinicaltrial.gov NCT0149017