ABSTRACT
BACKGROUND: In the process of medical rehabilitation muscular endurance training is the main focus. Unfortunately, outpatient rehabilitation opportunities are limited and specialized pulmonary exercise groups ("lung sport groups") rarely available. Therefore we developed an outpatient endurance sports program for patients with respiratory diseases and evaluated its effectiveness. METHODS: In this feasibility study 31 patients (50â±â15 years) with diverse respiratory diseases were included. By professional functional exercise testing (incl. CPET and lactate measurement according to the standards of DGP and DGSP) the patients optimal training zone was determined and an individualized 12 week lasting aerobic endurance training with ≥â3 sessions of 20â-â60âmin/week realized. RESULTS: After completion of the exercise training program a significant improvement in dyspnoea (Borg-Scale: 65.7â±â12.2 vs. 62.2â±â12.6, pâ=â0.013), body constitution (BMI: 25.7â±â3.3 vs. 24.3â±â3.2âkg/m(2), pâ=â0.018; portion of body fat: 24.8â±â5.8 vs. 23.8â±â6.4â%, pâ=â0.043) as well as physical capacity (VO2 at 4âmmol/l Laktat: 24.2â±â6.9 vs. 26.5â±â7.6âml/min/kg, pâ<â0.01; performance at 4âmmol/l Laktat: running/walking (nâ=â14)â+â1.1âkm/h, pâ=â0.018 and biking/bicycle ergometer (nâ=â17)â+â8.7 Watt, pâ=â0.019) was recorded. These positive developments were also observed in mental and physical quality of life (quality of life questionnaire SF-36: physical score +â9.7 points, mental score +â4.5 points). CONCLUSION: The evaluated exercise program can easily be trained by the patient in a self-dependent setting and was seen to be an effective sports medical treatment in patients with diverse pulmonary diseases.
Subject(s)
Ambulatory Care/methods , Exercise Therapy/methods , High-Intensity Interval Training/methods , Physical Endurance , Respiration Disorders/rehabilitation , Sports , Feasibility Studies , Female , Humans , Lactic Acid/blood , Male , Middle Aged , Physical Conditioning, Human/methods , Pulmonary Medicine/methods , Respiration Disorders/blood , Respiration Disorders/diagnosis , Respiratory Function Tests , Self Care/methods , Sports Medicine/methods , Treatment OutcomeABSTRACT
BACKGROUND: Cryoprobes with flexible catheters are an additional important tool for endobronchial interventional therapy and histologic diagnosis. Different studies compared the diagnostic effectiveness and complications to the forceps as a standard. However, routine endoscopic procedures require a combined use of different methods in order to achieve the highest diagnostic yield. We investigated the impact of cryotechnique in comparison with combined diagnostic tools during routine diagnostics of malignant tumors. PATIENTS AND METHODS: A consecutive series of patients undergoing routine diagnostic for lung cancer was included over a 30 months period (n = 469). The use of the cryotechnique, the complication rates and diagnostic value were prospectively documented. Cryotechnique was used on top of conventional technologies. RESULTS: A histologic proof of tumor by cryotechnique in centrally located tumors was delivered more frequently compared to forceps biopsies alone (81.4 versus 59.9% and 66.2 versus 37.7% in peripheral lesions). However, when the other non-cryotechniques were taken into account, the value was reduced in central probes (7.4%; p = 0.02), but remained high for peripheral findings (19.3%; p < 0.002). The frequency of complications seemed unchanged, however severe bleeding occurred. CONCLUSION: The cryotechnique bears high diagnostic potential beside its therapeutic value, also in routine investigations. The changed complication profile of this technology needs to be addressed in the informed consent and secured airway management may be helpful.
Subject(s)
Bronchoscopy/adverse effects , Bronchoscopy/methods , Cryotherapy/methods , Hemorrhage/etiology , Hemorrhage/prevention & control , Lung Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Idiopathic pulmonary fibrosis is a fatal lung disease with a variable and unpredictable natural history and limited treatment options. Since publication of the ATS-ERS statement on IPF in the year 2000 diagnostic standards have improved and a considerable number of randomized controlled treatment trials have been published necessitating a revision. In the years 2006 - 2010 an international panel of IPF experts produced an evidence-based guideline on diagnosis and treatment of IPF, which was published in 2011. In order to implement this evidence-based guideline into the German Health System a group of German IPF experts translated and commented the international guideline, also including new publications in the field. A consensus conference was held in Bochum on December 3rd 2011 under the protectorate of the "Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)" and supervised by the "Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften" (AWMF). Most recommendations of the international guideline were found to be appropriate for the german situation. Based on recent clinical studies "weak negative" treatment recommendations for pirfenidone and anticoagulation were changed into "weak positive" for pirfenidone and "strong negative" for anticoagulation. Based on negative results from the PANTHER-trial the recommendation for the combination therapy of prednisone plus azathiorpine plus N-acetlycsteine was also changed into strong negative für patients with definite IPF. This document summarizes essential parts of the international IPF guideline and the comments and recommendations of the German IPF consensus conference.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Idiopathic Pulmonary Fibrosis/diagnosis , Idiopathic Pulmonary Fibrosis/therapy , Practice Guidelines as Topic , Pulmonary Medicine/standards , Tomography, X-Ray Computed/methods , Germany , Humans , Idiopathic Pulmonary Fibrosis/blood , InternationalityABSTRACT
The data on the quality of care of patients with lung cancer in Germany are insufficient. Although the National Lung Cancer Guideline from 2010 provides a good scientific basis for the management of the frequently complex pathways, no evidence exists showing how the relevant guideline recommendations are implemented nationwide or which treatment options generally are chosen in a tumour entity with one of the poorest prognoses. As part of the National Cancer Plan 2008, specific targets have been formulated for the systematic improvement of cancer care in Germany. As a main goal, the national re-organisation and harmonisation of tumor documentation and quality assurance are required for a sustainable improvement in the quality of care. This review article first describes the relevant terms and then examines how the specific targets of the National Cancer Plan have been implemented so far with regard to lung cancer care.
Subject(s)
Delivery of Health Care/standards , Documentation/standards , Lung Neoplasms/therapy , Practice Guidelines as Topic , Quality Assurance, Health Care/organization & administration , Registries/standards , Standard of Care/standards , Germany , Humans , Quality Assurance, Health Care/methodsABSTRACT
BACKGROUND: In order to counter the rapidly developing loss of function especially in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) the concept "early geriatric rehabilitation in acute inpatient pneumology" was developed. An essential aspect of the project was a targeted approach making use of multi-professional expertise and standards. METHODS: This 1-year feasibility study included a total of 58 patients with AE-COPD in advanced age (mean: 74.8 ± 6.8 years) with typical geriatric multimorbidity and necessity for acute medical as well as rehabilitation treatment. The results of the early geriatric rehabilitation by a multi-professional rehabilitation team were analyzed in a prospective study approach using standardized assessments. RESULTS: The early geriatric rehabilitation started on median day 3 (range: 1st - 22nd) and lasted in median 16 days (range: 9 - 29). It achieved a significant improvement, particularly in mobility [timed up-and-go, median 19 (range: 10 - 150) vs. 15 (range: 7 - 120) seconds, p < 0.0001], self-help ability [Barthel index, median 73 (range: 5 - 95) vs. 95 (range: 45 - 100) points, p < 0.0001] and social care. CONCLUSIONS: Early geriatric rehabilitation in a cohort of AE-COPD patients is feasible and can be integrated in an acute inpatient pulmonary care system.
Subject(s)
Health Services for the Aged/organization & administration , Pulmonary Disease, Chronic Obstructive/rehabilitation , Recovery of Function , Rehabilitation/organization & administration , Aged , Female , Humans , Male , Treatment OutcomeABSTRACT
BACKGROUND: The care of lung cancer patients in Germany has not been systematically evaluated yet. The aim of this article is to give an overview on the current state of lung cancer care on the basis of existing data. METHODS: In April and May 2010, a literature search was performed in order to collect relevant information concerning epidemiology as well as diagnostic, therapeutic (systemic therapy, radiotherapy, surgery, palliative therapy), and interdisciplinary structures in lung cancer treatment. RESULTS: The published database on lung cancer care in Germany is overall deficient. Treatment of lung cancer patients is mainly located in hospitals, particularly in chest clinics or specialised departments. The access of hospitals for an outpatient treatment as provided per § 116 b SGB V has not yet been realised in all German states. CONCLUSIONS: A systematic and prospective evaluation of lung cancer care is necessary in order to better allocate resources in the future.
