RESUMEN
OBJECTIVES: To assess effects on patient outcomes when care for patients with stable chronic obstructive pulmonary disease (COPD) is transferred from respiratory care physician to respiratory nurse. METHODS: A randomized controlled trial was used with a follow-up period of 9 months. Of 720 patients from the respiratory outpatient clinic of the general and teaching hospital in Alkmaar (The Netherlands), 187 were eligible for randomization and gave informed consent. Ninety-three patients received care from the nurse, and 87 received usual care. Outcomes measured were: clinical parameters, health status, self-care behaviour (including knowledge), patient satisfaction, and consultations with key care providers. RESULTS: The respiratory nurse reported more consultations than the respiratory care physician [mean (standard deviation)]: number of consultations 3.1 (0.7) by nurse and 2.0 (0.9) by physician (p = 0.007). Patients cared for by the nurse showed worsening in mean forced vital capacity [-5.5% (13.3%) v. +2.9% (18.2%) with physician; p = 0.004], and no difference in self-assessed condition, while improvements were found for subjective knowledge (p = 0.017), self-assessed rate for coping with COPD (p = 0.045), overall satisfaction (p = 0.003), and the majority of individual indicators of satisfaction. Groups showed no differences for forced expiratory volume in 1 s, body mass index, smoking status, health status, objective knowledge, other items of self-care behaviour, and consultations with key care providers. DISCUSSION: Assignment of care for outpatients with stable COPD to the respiratory nurse, working under a protocol, seems to be justified in terms of patient outcomes.
Asunto(s)
Continuidad de la Atención al Paciente , Rol de la Enfermera , Evaluación de Resultado en la Atención de Salud , Rol del Médico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Anciano , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Autocuidado , Espirometría , Encuestas y CuestionariosRESUMEN
BACKGROUND: A study was undertaken to investigate the clinical practice, yield, and costs of preoperative staging in patients with suspected NSCLC and to obtain baseline data for prospective studies on the cost effectiveness of (18)F-fluorodeoxyglucose positron emission tomography in the management of these patients. METHODS: A retrospective study of the medical records of all patients with suspected NSCLC was performed during a 2 year interval (1993-4) in an academic and a large community hospital. RESULTS: Three hundred and ninety five patients with suspected NSCLC were identified; 58 were deemed to be medically inoperable and 337 patients proceeded to the staging process. Staging required a mean (SD) of 5.1 (1.5) diagnostic tests per patient (excluding thoracotomy) carried out over a median period of 20 days (IQR 10-31). Many of the tests (including both invasive and non-invasive) were done because previous imaging tests had suggested metastases, and in most cases the results of initial tests proved to be false positives. After clinical staging, 168 patients were considered to be resectable (stage I/II) and 144 patients underwent surgery with curative intent. At surgery 33 patients (23% of those who underwent surgery) were found to have irresectable lesions and 19 (13%) had a benign lesion. Surgery was also considered to be futile in 22 patients (15%) who developed metastases or local recurrence within 12 months following radical surgery. Hospital admission was responsible for most of the costs. CONCLUSION: In many patients staging involved considerable effort in terms of the number of diagnostic tests, the duration of the staging period and the cost, with limited success in preventing futile surgery. Failures relate to the quality of diagnostic preparation at every level of the TNM staging system.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/economía , Neoplasias Pulmonares/economía , Estadificación de Neoplasias/economía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Femenino , Fluorodesoxiglucosa F18/economía , Estudios de Seguimiento , Costos de Hospital , Hospitales Comunitarios/economía , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Inutilidad Médica , Persona de Mediana Edad , Recurrencia Local de Neoplasia/economía , Estadificación de Neoplasias/métodos , Estadificación de Neoplasias/normas , Países Bajos , Cuidados Posoperatorios/economía , Estudios Prospectivos , Radiofármacos/economía , Estudios Retrospectivos , Tomografía Computarizada de Emisión/economía , Tomografía Computarizada de Emisión/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: Evaluation of clinical management in patients suspected of pulmonary embolism as compared with the Dutch consensus for diagnosing pulmonary embolism. DESIGN: Retrospective. SETTING: Medical Centre Alkmaar. METHOD: Retrospective analysis of clinical management in patients subjected to ventilation-perfusion scintigraphy on suspicion of pulmonary embolism. RESULTS: In 55 (24%) of the 225 patients included a high-probability scan was found, in 68 (30%) a non-high-probability scan and in 102 (45%) a normal scan. The clinical management in all patients with a normal or high-probability scan was according to the consensus. In the 68 patients with a non-high-probability scan the consensus was completely followed in 16%, partially in 18% and not at all in 66%. CONCLUSION: Clinical management of patients with a non-high-probability scan in the vast majority of cases was not according to the consensus. The consensus was followed in all patients with a normal or high-probability scan.
Asunto(s)
Protocolos Clínicos , Embolia Pulmonar/diagnóstico por imagen , Anticoagulantes/uso terapéutico , Humanos , Valor Predictivo de las Pruebas , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/fisiopatología , Cintigrafía , Estudios Retrospectivos , Tromboflebitis/diagnóstico por imagen , Ultrasonografía , Relación Ventilacion-PerfusiónAsunto(s)
Carcinoma Broncogénico/cirugía , Neoplasias Pulmonares/cirugía , Radiografías Pulmonares Masivas , Anciano , Carcinoma Broncogénico/diagnóstico por imagen , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Países Bajos , Pronóstico , Estudios RetrospectivosRESUMEN
The effect of the beta 1-selective adrenoceptor blocker, metoprolol, on ventilatory function was studied in eight asthmatic patients in relation to the plasma level of the agent following its administration in ordinary and slow-release tablets. Metoprolol causes a slight decrease in ventilatory function as compared with placebo. The effect was most pronounced after administration of 200 mg in ordinary tablets, which induced the highest plasma levels. After administration of 200 mg in slow-release tablets the plasma levels were lower and the ventilatory effect was less marked. The bronchial obstruction largely improved after administration of the beta 2-receptor stimulating agent terbutaline. This study indicates, that when a larger dose of metoprolol is used in patients with obstructive lung disease, slow-release durules are to be preferred to ordinary tablets.