Journal Club

Question 1

RYRSØ, C.K. et al., 2018. Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis. BMC Pulmonary Medicine, 18(1).
(Ryrsø et al. 2018)

Answer 1

Importance of early supervised PR, 3 weeks post discharge (especially in COPD)

1: PR should be given 3 weeks after discharge from hospital
2: PR can reduce hospital re admissions
3: PR reduces risk of mortality, improve HRQoL and exercise capacity

Question 2

GANE, E.M. et al., 2022. Discharge Planning of Older Persons from Hospital: Comparison of Observed Practice to Recommended Best Practice. Healthcare, 10(2), p. 202.

(Gane et al. 2022)

Answer 2

Best practice for Discharge Planning from hospital of the elderly

1: there needs to be efficenent discharges home from hospital = due to rising elderly population
2: Importance of MDT collaboration and family/ patient in discharge planning
3: Discharges reduces risk of HAI (hosp acquired infect)
4: MDT need clearly defined roles to better health care quality

Question 3

NNATE, D.A., BARBER, D. and ABARAOGU, U.O., 2021. Discharge Plan to Promote Patient Safety and Shared Decision Making by a Multidisciplinary Team of Healthcare Professionals in a Respiratory Unit. Nursing Reports, 11(3), pp. 590–599.
(Nnate, Barber and Abaraogu 2021)

Answer 3

MDT in shared decision making during discharge planning to promote safety

1: Importance of smoking cessation
2: Smoking and home O2 is a contraindication for the patients safety
3: importance of MDT shared decision making when clinical decisions are hard or contradict guidelines

Question 4

PYSZORA, A. and LEWKO, A., 2022. Non-pharmacological Management in Palliative Care for Patients With Advanced COPD. Frontiers in Cardiovascular Medicine, 9.

(Pyszora and Lewko 2022)

Answer 4

Palliative care and non-pharmaceutical management for end COPD
IMPROVING SOB

1: positioning
Forward lean sit improves resp muscles and is effective in COPD
2: Pursed lipped breathing intervention and handheld fan to blow air (relax) for self-manegement
3: blow as you go and pacing for management
4: Walking aids also improve breathlessness - reduce excursion and increase mob and ex to allow sputum clearance
5: anxiety management (mindfulness maybe therapy)
6: diaphragmatic breathing may cause fatigue in end stage COPD with increased WOB

Question 5

O’NEILL, K., O’DONNELL, A.E. and BRADLEY, J.M., 2019. Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis. Respirology, 24(3).

(O’Neill, O’Donnell and Bradley 2019)

Answer 5

ACTs, PR and Sputum clearance

1: ACTs should be persoanalised, and done 2 x a week
2: goal from short term ACT = increase sputum clearance and improve ventilation
3: long term goal of ACTs = decrease further airway damage by stopping viscous cycle of infection
Therefore, reducing exacerbations, hospitalisations and improving QOL
4: ACBT
5: AD
6: PEP devices (CPAP, BIPAP, OCPEP)

Question 6

WESTERDAHL, E., OSADNIK, C. and EMTNER, M., 2019. Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: Physical therapy practice in Sweden. Chronic Respiratory Disease, 16, p. 147997311985586.

(Westerdahl, Osadnik and Emtner 2019)

Answer 6

What ACT to use

1: PEP was prescribed the most and deemed most effective (94% effectiveness at clearing sputum)
2: Treatment lasts around 5 - 20 minutes
3: Huffing and Coughing were second most effective ACT
4) physical exercise (although pt need personalised plans are many barriers)

Question 7

DING, S. and ZHONG, C., 2020. Exercise and Cystic Fibrosis. Advances in Experimental Medicine and Biology, 1228, pp. 381–391.
(Ding and Zhong 2020)

Answer 7

1: PA and ex was seen more effective then drugs and has less risks attached to it and has more benefits eg: bone density in CF
2: Swimming, jogging and tai chi are effective exercise for CF or conditions that cannot exercise vigorously