scholarly journals The Impact of COPD Exacerbations in the Year Following Pulmonary Rehabilitation: Secondary Analysis of a Randomised Controlled Trial

2020 ◽  
Vol Volume 15 ◽  
pp. 3423-3431
Author(s):  
Bruna Wageck ◽  
Narelle S Cox ◽  
Christine F McDonald ◽  
Angela T Burge ◽  
Ajay Mahal ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Copd Exacerbations ◽  
Randomised Controlled ◽  
The Impact

scholarly journals Appropriateness of general practitioner imaging requests for transient ischaemic attack patients: secondary analysis of a cluster randomised controlled trial

2017 ◽  
Vol 9 (2) ◽  
pp. 131 ◽  
Author(s):  
Annemarei Ranta ◽  
Mark Weatherall ◽  
John Gommans ◽  
Murray Tilyard ◽  
Des Odea ◽  
...  
Keyword(s):  
Decision Support ◽  
Randomised Controlled Trial ◽  
Transient Ischaemic Attack ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Electronic Decision Support ◽  
Investigation Methods ◽  
Ischaemic Attack ◽  
Randomised Controlled ◽  
The Impact

Abstract AIMS Many transient ischaemic attack (TIA) patients receive initial assessments by general practitioners (GPs). In a randomised controlled trial (RCT) we showed that BPAC Inc. TIA/stroke electronic decision support (EDS) for GPs improves patient outcomes and guideline adherence. This secondary analysis assesses the impact of trial associated enhanced GP access to radiological investigation. METHODS Post-hoc analysis of a multi-centre, single blind, parallel group, cluster RCT comparing TIA/stroke EDS guided GP management with usual care to assess whether imaging requests and their appropriateness differed between study groups. RESULTS GPs requested 15/291 (5.2%) carotid ultrasounds and 19/291 (6.5%) computed tomography (CT) head scans. Scans were obtained more frequently in the intervention group (ultrasound cluster adjusted OR (95% CI) 1.41 (0.44 to 4.49), P = 0.56 and CT 13.8 (1.7 to 110.7), P < 0.001). All CTs were clinically appropriate. More ultrasounds were appropriate in the EDS group (cluster adjusted OR (95% CI) of 8.4 (0.39 to 92.3), P = 0.18). Overall investigation costs did not differ between groups (P = 0.83). Some apparent avoidable imaging duplication occurred where patients were subsequently assessed by secondary services. CONCLUSION In the setting of a RCT assessing GP electronic decision support, frequency of GP initiated imaging requests was low and largely appropriate especially in the setting of EDS use. Thus enhanced GP imaging access as part of the EDS tool did not result in inappropriate or excessive GP imaging requests. However, some duplication occurred and practitioners need to ensure that test referrals and results are adequately communicated between sectors.

Survival after inpatient or outpatient pulmonary rehabilitation in patients with fibrotic interstitial lung disease: a multicentre retrospective cohort study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-217361
Author(s):  
Sabina Anna Guler ◽  
Seo Am Hur ◽  
Michael K Stickland ◽  
Patrick Brun ◽  
Luc Bovet ◽  
...  
Keyword(s):  
Cohort Study ◽  
Interstitial Lung Disease ◽  
Randomised Controlled Trial ◽  
Lung Disease ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Time To Death ◽  
Risk Of Death ◽  
Randomised Controlled ◽  
The Impact

BackgroundThe impact of pulmonary rehabilitation (PR) on survival in patients with fibrotic interstitial lung disease (ILD) is unknown. Given the challenges conducting a large randomised controlled trial, we aimed to determine whether improvement in 6-minute walk distance (6MWD) was associated with better survival.MethodsThis retrospective, international cohort study included patients with fibrotic ILD participating in either inpatient or outpatient PR at 12 sites in 5 countries. Multivariable models were used to estimate the association between change in 6MWD and time to death or lung transplantation accounting for clustering by centre and other confounders.Results701 participants (445 men and 256 women) with fibrotic ILD were included. The mean±SD ages of the 196 inpatients and 505 outpatients were 70±11 and 69±12 years, respectively. Baseline/changes in 6MWD were 262±128/55±83 m for inpatients and 358±125/34±65 m for outpatients. Improvement in 6MWD during PR was associated with lower hazard rates for death or lung transplant on adjusted analysis for both inpatient (HR per 10 m 0.94, 95% CI 0.91 to 0.97, p<0.001) and outpatient PR (HR 0.97, 95% CI 0.95 to 1.00, p=0.042). Participation in ≥80% of planned outpatient PR sessions was associated with a 33% lower risk of death (95% CI 0.49% to 0.92%).ConclusionsPatients with fibrotic ILD who improved physical performance during PR had better survival compared with those who did not improve performance. Confirmation of these hypothesis-generating findings in a randomised controlled trial would be required to definitely change clinical practice, and would further support efforts to improve availability of PR for patients with fibrotic ILD.

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