Search for small-bowel capsule diagnostic yield optimization conducted through observational analysis. / Búsqueda de optimización de la cápsula endoscópica mediante análisis observacional.

OBJECTIVES: To search for parameters susceptible to optimization when performing capsule endoscopy (CE) in a third level hospital with high volume and experience in this test. PATIENTS AND METHODS: Retrospective observational study, including 1325 CEs performed between 2017 and 2022. Overall diagnostic yield, effective diagnostic yield, by indication, place of request and waiting list, as well as complete examination rate and cleansing degree were analyzed. RESULTS: The overall diagnostic yield was 70.99%, while the effective diagnostic yield was 72.7%. Diagnostic yields varied between 60.2% and 77.9% depending on the indication and between 64.7% and 74.3% depending on the requesting center. The mean waiting list was 101.15 days, with a tendency to worse results when the waiting list was longer. A total of 77.8% of the examinations were complete. Completion rates were lower in patients >70 years of age (p=0.001), as well as in those with gastric transit >60minutes (p=0.000). A total of 77.3% were clean, with debris that did not impede diagnosis being found in 16.9% and debris that did impede diagnosis in 5.8%. There was a relationship, although not significant, between cleansing degree and age. CONCLUSIONS: The diagnostic yields of CE in our center are in line with those previously reported. Differences were found according to the place of request. Waiting list could also influence diagnostic yield. Completion rates are lower in >70 years of age and when gastric transit is >60minutes. Cleansing degree achieved is acceptable.

Efficacy of pulmonary rehabilitation in patients with moderate chronic obstructive pulmonary disease: a randomized controlled trial.

BACKGROUND: Pulmonary Rehabilitation for moderate Chronic Obstructive Pulmonary Disease in primary care could improve patients' quality of life. METHODS: This study aimed to assess the efficacy of a 3-month Pulmonary Rehabilitation (PR) program with a further 9 months of maintenance (RHBM group) compared with both PR for 3 months without further maintenance (RHB group) and usual care in improving the quality of life of patients with moderate COPD.We conducted a parallel-group, randomized clinical trial in Majorca primary health care in which 97 patients with moderate COPD were assigned to the 3 groups. Health outcomes were quality of life, exercise capacity, pulmonary function and exacerbations. RESULTS: We found statistically and clinically significant differences in the three groups at 3 months in the emotion dimension (0.53; 95%CI0.06-1.01) in the usual care group, (0.72; 95%CI0.26-1.18) the RHB group (0.87; 95%CI 0.44-1.30) and the RHBM group as well as in fatigue (0.47; 95%CI 0.17-0.78) in the RHBM group. After 1 year, these differences favored the long-term rehabilitation group in the domains of fatigue (0.56; 95%CI 0.22-0.91), mastery (0.79; 95%CI 0.03-1.55) and emotion (0.75; 95%CI 0.17-1.33). Between-group analysis only showed statistically and clinically significant differences between the RHB group and control group in the dyspnea dimension (0.79 95%CI 0.05-1.52). No differences were found for exacerbations, pulmonary function or exercise capacity. CONCLUSIONS: We found that patients with moderate COPD and low level of impairment did not show meaningful changes in QoL, exercise tolerance, pulmonary function or exacerbation after a one-year, community based rehabilitation program. However, long-term improvements in the emotional, fatigue and mastery dimensions (within intervention groups) were identified. TRIAL REGISTRATION: ISRCTN94514482.

[Efficacy of respiratory rehabilitation on patients with moderate COPD in primary care and maintenance of benefits at 2 years]. / Eficacia de la rehabilitación respiratoria en pacientes con EPOC moderada en atención primaria y mantenimiento de los beneficios a los 2 años.

OBJECTIVES: To assess the efficacy of a pulmonary rehabilitation programme lasting 24 months and carried out at primary care health centres in improving the quality of life of patients with moderate COPD, compared with a programme of 12 weeks pulmonary rehabilitation with the usual care. Secondary aims include the assessment of the effects of the programme on dyspnoea, exercise capacity, reduction of crises, hospital admissions and length of time in hospital. DESIGN: Randomised clinical trial, with 3 groups in parallel and with blind evaluation. The control group will continue with the customary care. SUBJECT: Patients attended at primary health care centres with a diagnosis, based on GOLD criteria, of moderate COPD. Patients will be recruited from 5 health centres. 56 patients per group are needed (allowing for 20% drop-outs) to detect the minimum clinically meaningful differences between treatments, with an alpha error of 0.005 and statistical power of 80%. INTERVENTION: All eligible patients with signed informed consent will be randomised into the following groups: a) pulmonary rehabilitation for 12 weeks and programme maintenance for 24 months; b) pulmonary rehabilitation for 12 weeks without maintenance programme; c) control group continuing with customary care. Pulmonary rehabilitation will include educational sessions, respiratory physiotherapy and low-intensity physical exercise. Follow-ups will be at the end of the rehabilitation programme, and at one and 2 years. MEASUREMENTS: Quality of life with the Chronic Respiratory Questionnaire, 6-minute walking test, Borg Dyspnoea Scale, Medical Research Council Dyspnoea Score, Lung Function Tests, and intervention group.

Eficacia de la rehabilitación respiratoria en pacientes con EPOC moderada en atención primaria y mantenimiento de los beneficios a los 2 años / Efficacy of respiratory rehabilitation on patients with moderate COPD in primary care and maintenance of benefits at 2 years

Objetivos. Establecer la eficacia de un programa de rehabilitación pulmonar de 24 meses de duración llevado a cabo en centros de salud de atención primaria, en la mejora de la calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) moderada, respecto a un programa de 12 semanas de duración y a los cuidados habituales. Como objetivos secundarios planteamos analizar el efecto del programa en cuanto a la mejora de la disnea, de la capacidad para el ejercicio, la disminución de las exacerbaciones, los ingresos hospitalarios y los días de estancia en hospital. Diseño. Ensayo clínico aleatorizado, paralelo, de 3 grupos, con evaluación a ciegas. El grupo control seguirá con el tratamiento habitual. Sujetos del estudio. Pacientes atendidos en atención primaria con diagnóstico de EPOC moderada según criterios GOLD. Se seleccionarán en 5 centros de salud. Se necesitan 56 pacientes por grupo (contando un 20% de pérdidas) para detectar mínimas diferencias clínicamente relevantes entre tratamientos, con un error alfa de 0,005 y una potencia del 80%. Intervención. Todos los pacientes elegibles (que cumplan criterios de inclusión) y que han firmado el consentimiento informado serán asignados aleatoriamente a uno de los siguientes grupos: a) rehabilitación pulmonar durante 12 semanas y mantenimiento de éste hasta 24 meses (RHBM); b) rehabilitación pulmonar durante 12 semanas sin programa de mantenimiento (RHB), y c) el grupo control que seguirá con los cuidados habituales (CH). La rehabilitación pulmonar incluirá sesiones educativas, fisioterapia respiratoria y ejercicio físico de baja intensidad. El seguimiento se hará al finalizar el programa de rehabilitación pulmonar, al año y a los 24 meses. Mediciones. Calidad de vida con el Chronic Respiratory Questionnaire, test de la marcha de 6 min, escala de disnea de Borg, puntuación de disnea del Medical Research Council, pruebas de función pulmonar y grupo de intervención

Objectives. To assess the efficacy of a pulmonary rehabilitation programme lasting 24 months and carried out at primary care health centres in improving the quality of life of patients with moderate COPD, compared with a programme of 12 weeks pulmonary rehabilitation with the usual care. Secondary aims include the assessment of the effects of the programme on dyspnoea, exercise capacity, reduction of crises, hospital admissions and length of time in hospital. Design. Randomised clinical trial, with 3 groups in parallel and with blind evaluation. The control group will continue with the customary care. Subject. Patients attended at primary health care centres with a diagnosis, based on GOLD criteria, of moderate COPD. Patients will be recruited from 5 health centres. 56 patients per group are needed (allowing for 20% drop-outs) to detect the minimum clinically meaningful differences between treatments, with an alpha error of 0.005 and statistical power of 80%. Intervention. All eligible patients with signed informed consent will be randomised into the following groups: a) pulmonary rehabilitation for 12 weeks and programme maintenance for 24 months; b) pulmonary rehabilitation for 12 weeks without maintenance programme; c) control group continuing with customary care. Pulmonary rehabilitation will include educational sessions, respiratory physiotherapy and low-intensity physical exercise. Follow-ups will be at the end of the rehabilitation programme, and at one and 2 years. Measurements. Quality of life with the Chronic Respiratory Questionnaire, 6-minute walking test, Borg Dyspnoea Scale, Medical Research Council Dyspnoea Score, Lung Function Tests, and intervention group