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Humans , China , Esophageal Neoplasms , Length of Stay , Malnutrition , Mass Screening , Postoperative Complications , ROC Curve , Sensitivity and SpecificityABSTRACT
OBJECTIVE@#To investigate the association of the time of initial diagnosis with the severity of chronic obstructive pulmonary disease (COPD).@*METHODS@#A total of 803 patients who were diagnosed to have COPD for the first time in our hospital between May 2015 to February 2018 were enrolled in this study.The diagnoses of COPD and asthma COPD overlap (ACO) were made according GOLD guidelines and european consensus definition.Lung function of the patients was graded according to the GOLD guidelines.@*RESULTS@#The patients with COPD had a mean age of 61.8±9.9 years,including 726 male and 77 female patients.The course of the patients (defined as the time from symptom onset to the establishment of a diagnosis) was 3(0.5,8) years.Among these patients,85.2% had a moderate disease severity (FEV1%<80%),and 48.3% had severe or very severe conditions (FEV1%<50%);47.0% of them were positive for bronchial dilation test.In the overall patients,295(36.7%) were also diagnosed to have ACO,and the mean disease course of ACO[3(1,9) years]was similar to that of COPD[3(0.5,8) years](>0.05).A significant correlation was found between the disease course and the lung function of the patients.Multiple linear regression analysis showed that an older age and a longer disease course were associated with poorer lung functions and a greater disease severity.@*CONCLUSIONS@#The delay of the initial diagnosis is significantly related to the severity of COPD.
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Aged , Female , Humans , Male , Middle Aged , Age Factors , Asthma , Diagnosis , Delayed Diagnosis , Disease Progression , Lung , Pulmonary Disease, Chronic Obstructive , Diagnosis , Severity of Illness Index , Time FactorsABSTRACT
Objective: The aim of this paper is to identify the basic organizational structure and the key elements of integrated healthcare model of patients with Chronic Obstructive Pulmonary Disease (COPD) and propose an appropriate development strategy.Methods: Based on the literature review of research articles about integrated care on patients with COPD, an analysis was conducted with the help of the Chronic Care Model (CCM) which is a chronic disease management model.Results: From of a total 16 articles about 13 case studies were found.An integrated healthcare of COPD was carried out in 10 hospital-based or community-based care programs.Most of the patients were the elderly and health status were moderately severe or more severe.The components of healthcare programs varied from 4 to 12 included at least two CCM dimension.A coordinator or a case manager was appointed in all healthcare programs and a follow-up plan was made as well.Decision making was supported by clinic guideline and specialist resource in 9 integrated healthcare programs which community facilities involved.All programs included self-management with health education and individualized behavioral support was in 10 programs.The action plan was applied in 8 studies.8 studies using a clinical information system connected health care provider and patients.Conclusions: COPD integrated care program can be constructed according to the management model of chronic disease, and it is suggested that we can organize the COPD integrated care program based on CCM and the program comprises 4 organizational components of at least two CCM dimensions.The key elements of COPD integrated healthcare are to appoint a coordinator, to make a follow-up plan, and the necessity of community participation to support decision making, support self-management by education and individualized behavioral management with an action plan.
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Objective To assess the value of serum amyloid A (SAA) in patients with acute asthma attack. Methods Sixty-four asthmatic patients in acute phase and 20 healthy individuals were included. The asthmatic patients were divided into bacterial infection-induced group and non-bacterial infection-induced group. Lung function test and chest X-rays test were conducted And inflammatory cell counts , serum SAA and CRP levels were measured. SAA were compared among subgroups of asthmatic patients and healthy controls and the diagnostic value of SAA to distinguish bacterial infection-induced asthma was estimated. Results SAA of both asthma subgroups were significantly higher when compared with the healthy individuals, and it was higher in bacterial infection-induced group than that in non-bacterial infection-induced group. In terms of ROC curve , AUC was 0.966 for SAA to distinguish merging bacterium infection, and the cut-off value was 36.67mg/L with sensitivity of 92.3% and specificity of 88.2%. Conclusions SAA increases in patients during acute asthma attack, and particularlymore obviously in bacterial infection-induced patients. It may be used as a reliable biomarker to distinguish merging bacterium infection during acute asthma attack.
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<p><b>OBJECTIVE</b>To establish a high-performance liquid chromatography (HPLC)-based method for determining isoniazide concentration in pleural effusion and plasma of patients with tuberculous pleurisy, and evaluate the permeability of isoniazide from blood into pleural effusion.</p><p><b>METHODS</b>We collected pleural effusion from 15 patients with tuberculous pleurisy 2 h after administration 300 mg isoniazide in the morning of day 1. Pleural effusion and plasma were obtained 2 h after isoniazide administration on day 3. Isoniazide concentration was measured using HPLC, and the penetration rate of isoniazide in pleural effusion was calculated.</p><p><b>RESULTS</b>Isoniazide concentration in the pleural effusion averaged 1.156∓1.190 µg/ml in the 15 patients at 2 h after isoniazide administration on day 1. On day 3, isoniazide concentration was 1.920∓1.294 µg/ml in the pleural effusion and 2.445∓1.463 µg/ml in the plasma, and the mean penetration rate of isoniazide from blood into the pleural effusion was 86.0%.</p><p><b>CONCLUSION</b>As isoniazide has a high penetration rate into the pleural effusion in most patients, continuous oral administration of isoniazid has been sufficient to achieve an effective treatment concentration, and intrapleural injection of isoniazide may seem unnecessary for non-drug-resistant tuberculosis pleurisy.</p>