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https://www.readbyqxmd.com/read/28715848/patient-outcomes-in-dose-reduction-or-discontinuation-of-long-term-opioid-therapy-a-systematic-review
#1
Joseph W Frank, Travis I Lovejoy, William C Becker, Benjamin J Morasco, Christopher J Koenig, Lilian Hoffecker, Hannah R Dischinger, Steven K Dobscha, Erin E Krebs
Background: Expert guidelines recommend reducing or discontinuing long-term opioid therapy (LTOT) when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed. Purpose: To synthesize studies of the effectiveness of strategies to reduce or discontinue LTOT and patient outcomes after dose reduction among adults prescribed LTOT for chronic pain. Data Sources: MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library from inception through April 2017; reference lists; and expert contacts...
July 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28600754/substance-use-disorder-treatment-following-clinician-initiated-discontinuation-of-long-term-opioid-therapy-resulting-from-an-aberrant-urine-drug-test
#2
Shannon M Nugent, Steven K Dobscha, Benjamin J Morasco, Michael I Demidenko, Thomas H A Meath, Joseph W Frank, Travis I Lovejoy
BACKGROUND: It is unclear whether substance use disorder (SUD) treatment is offered to, or utilized by, patients who are discontinued from long-term opioid therapy (LTOT) following aberrant urine drug tests (UDTs). OBJECTIVE: To describe the proportion of patients who were referred to, and engaged in, SUD treatment following LTOT discontinuation and to examine differences in SUD treatment referral and engagement based on the substances that led to discontinuation...
June 9, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28565787/clinical-observation-of-umbilical-cord-mesenchymal-stem-cell-treatment-of-severe-idiopathic-pulmonary-fibrosis-a-case-report
#3
Chunyu Zhang, Xiaoguang Yin, Jinghan Zhang, Qiang Ao, Yongquan Gu, Ying Liu
Idiopathic pulmonary fibrosis (IPF) is a degenerative disease characterized by fibrosis. Cell therapy has been considered within the therapeutic options for IPF. In this study, we explored the potential benefits of human umbilical cord-derived mesenchymal stem cell (HUC-MSC) intravenous infusion in the management of IPF. We describe a case of a 56-year-old man with IPF who was receiving long-term oxygen therapy (LTOT). The patient underwent HUC-MSC intravenous infusion and was followed up for 12 months. Clinical and motor tests, as well as questionnaires assessing quality of life, were performed prior to and following the transplantation...
May 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28508494/high-dose-prednisolone-after-intravenous-methylprednisolone-improves-prognosis-of-acute-exacerbation-in-idiopathic-interstitial-pneumonias
#4
Toru Arai, Kazunobu Tachibana, Chikatoshi Sugimoto, Yasushi Inoue, Sayoko Tokura, Tomohisa Okuma, Masanori Akira, Masanori Kitaichi, Seiji Hayashi, Yoshikazu Inoue
BACKGROUND AND OBJECTIVE: Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) (AE-IPF) is a poor prognostic disorder. AE is also reported to occur in other idiopathic interstitial pneumonias (IIPs). There are limited data available regarding the effectiveness of treatment for AE-IIPs. The objective of this study was to clarify the prognostic impact of the initial dose of prednisolone (PSL) for treating AE-IIPs. METHODS: Eighty-five patients with AE-IIPs, diagnosed according to the criteria of the Japanese Respiratory Society, were enrolled in this study (IPF/non-IPF: 63/22 patients) from 2004 to 2013...
May 15, 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28506089/long-term-oxygen-therapy-in-copd-patients-who-do-not-meet-the-actual-recommendations
#5
Begum Ergan, Stefano Nava
Chronic respiratory failure due to chronic obstructive pulmonary disease (COPD) is an increasing problem worldwide. Many patients with severe COPD develop hypoxemic respiratory failure during the natural progression of disease. Long-term oxygen therapy (LTOT) is a well-established supportive treatment for COPD and has been shown to improve survival in patients who develop chronic hypoxemic respiratory failure. The degree of hypoxemia is severe when partial pressure of oxygen in arterial blood (PaO2) is ≤55 mmHg and moderate if PaO2 is between 56 and 69 mmHg...
June 2017: COPD
https://www.readbyqxmd.com/read/28454510/home-oxygen-therapy-evidence-versus-reality
#6
F S Magnet, J H Storre, W Windisch
LTOT is a well-established treatment option for hypoxemic patients. Scientific evidence for its benefits of LTOT dates back to the 1980s, when two randomized controlled trials showed prolonged survival in COPD-patients undergoing LTOT for at least 15 hours/day. In contrast, the potential benefits of LTOT in non-COPD-patients has not been well researched and the recommendations for its application are primarily extrapolated from trials on COPD-patients. Recently, a large trial confirmed that COPD-patients who don't meet classic indication criteria, and have moderate desaturation at rest or during exercise, do not benefit from oxygen therapy...
June 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28353374/prediction-of-poor-short-term-prognosis-and-unmet-needs-in-advanced-chronic-obstructive-pulmonary-disease-use-of-the-two-minute-walking-distance-extracted-from-a-six-minute-walk-test
#7
Han-Yee Neo, Hui-Ying Xu, Huei-Yaw Wu, Allyn Hum
OBJECTIVES: Prognostic challenges hinder the identification of patients with advanced chronic obstructive pulmonary disease (COPD) for timely palliative interventions. We postulate that a two-minute derivative (two-minute walking distance [2MWD]) of a standard six-minute walk test (6MWT) can identify frail subjects with poorer survival for early palliative intervention. The primary outcome of interest is mortality at 18 months. Secondary objectives include evaluation of the relationship between the 2MWD and ability to self-care, dyspnea-related disabilities, nutrition, forced expiratory volume in first second (FEV1), quality of life (QoL), and comorbidity burden...
March 29, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28340165/attitudes-toward-opioids-and-risk-of-misuse-abuse-in-patients-with-chronic-noncancer-pain-receiving-long-term-opioid-therapy
#8
Grisell Vargas-Schaffer, Jennifer Cogan
Objectives.:  To determine the attitudes of patients toward long-term opioid therapy (LtOT) and the potential risk of misuse/abuse in patients with chronic noncancer pain (CNCP). Design.:  Prospective, descriptive epidemiological study. Setting.:  Multidisciplinary tertiary care pain center within the Montreal University Health Center. Subjects.:  Patients who had had at least one visit at least one year prior to the invitation...
March 7, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28192376/reasons-for-discontinuation-of-long-term-opioid-therapy-in-patients-with-and-without-substance-use-disorders
#9
Travis I Lovejoy, Benjamin J Morasco, Michael I Demidenko, Thomas H A Meath, Joseph W Frank, Steven K Dobscha
Several factors may accelerate opioid discontinuation rates, including lack of information about the long-term effectiveness of opioids for chronic pain, heightened awareness about opioid-related adverse events, closer monitoring of patients for opioid-related aberrant behaviors, and greater restrictions around opioid prescribing. Rates of discontinuation may be most pronounced in patients deemed to be at "high risk." The purpose of this study was to compare reasons for discontinuation of long-term opioid therapy (LTOT) between patients with and without substance use disorder (SUD) diagnoses receiving care within a major U...
March 2017: Pain
https://www.readbyqxmd.com/read/28142139/long-term-oxygen-therapy-comparison-of-the-german-and-british-guidelines
#10
Friederike Sophie Magnet, Sarah Bettina Schwarz, Jens Callegari, Carl-Peter Criée, Jan Hendrik Storre, Wolfram Windisch
BACKGROUND: The German guideline on long-term oxygen therapy (LTOT) was published in 2008 by the German Respiratory Society (DGP), while the British Thoracic Society (BTS) published their most recent guideline in 2015. OBJECTIVES: The aim of the present article was to highlight the major areas of consensus and disagreement in the recently published BTS and DGP guidelines on LTOT. METHODS: The BTS and DGP guidelines were directly compared in terms of congruencies and differences...
2017: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/28123292/burn-injury-during-long-term-oxygen-therapy-in-denmark-and-sweden-the-potential-role-of-smoking
#11
Hanan A Tanash, Thomas Ringbaek, Fredrik Huss, Magnus Ekström
BACKGROUND: Long-term oxygen therapy (LTOT) increases life expectancy in patients with COPD and severe hypoxemia. Smoking is the main cause of burn injury during LTOT. Policy regarding smoking while on LTOT varies between countries. In this study, we compare the incidence of burn injury that required contact with a health care specialist, between Sweden (a country with a strict policy regarding smoking while on LTOT) and Denmark (a country with less strict smoking policy). METHODS: This was a population-based, cohort study of patients initiating LTOT due to any cause in Sweden and Denmark...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28116924/oxygen-therapy-devices-and-portable-ventilators-for-improved-physical-activity-in-daily-life-in-patients-with-chronic-respiratory-disease
#12
REVIEW
Karina Couto Furlanetto, Fabio Pitta
Patients with hypoxemia and chronic respiratory failure may need to use oxygen therapy to correct hypoxemia and to use ventilatory support to augment alveolar ventilation, reverse abnormalities in blood gases (in particular hypercapnia) and reduce the work of breathing. Areas covered: This narrative review provides an overview on the use of oxygen therapy devices or portable ventilators for improved physical activity in daily life (PADL) as well as discusses the issue of lower mobility in daily life among stable patients with chronic respiratory disease who present indication for long-term oxygen therapy (LTOT) or home-based noninvasive ventilation (NIV)...
February 2017: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/28069009/multi-center-randomized-placebo-controlled-trial-of-nocturnal-oxygen-therapy-in-chronic-obstructive-pulmonary-disease-a-study-protocol-for-the-inox-trial
#13
Yves Lacasse, Sarah Bernard, Frédéric Sériès, Van Hung Nguyen, Jean Bourbeau, Shawn Aaron, François Maltais
BACKGROUND: Long-term oxygen therapy (LTOT) is the only component of the management of chronic obstructive pulmonary disease (COPD) that improves survival in patients with severe daytime hypoxemia. LTOT is usually provided by a stationary oxygen concentrator and is recommended to be used for at least 15-18 h a day. Several studies have demonstrated a deterioration in arterial blood gas pressures and oxygen saturation during sleep in patients with COPD, even in those not qualifying for LTOT...
January 9, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/27993558/higher-prescription-opioid-dose-is-associated-with-worse-patient-reported-pain-outcomes-and-more-health-care-utilization
#14
Benjamin J Morasco, Bobbi Jo Yarborough, Ning X Smith, Steven K Dobscha, Richard A Deyo, Nancy A Perrin, Carla A Green
Some previous research has examined pain-related variables on the basis of prescription opioid dose, but data from studies involving patient-reported outcomes have been limited. This study examined the relationships between prescription opioid dose and self-reported pain intensity, function, quality of life, and mental health. Participants were recruited from 2 large integrated health systems, Kaiser Permanente Northwest (n = 331) and VA Portland Health Care System (n = 186). To be included, participants had to have musculoskeletal pain diagnoses and be receiving stable doses of long-term opioid therapy...
April 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/27983876/risk-factors-of-poor-outcomes-after-admission-for-a-copd-exacerbation-multivariate-logistic-predictive-models
#15
Juan Luis García-Rivero, Cristina Esquinas, Miriam Barrecheguren, Marc Bonnin-Vilaplana, Patricia García-Sidro, Alberto Herrejón, Carlos Martinez-Rivera, Rosa Malo de Molina, Pedro Jorge Marcos, Sagrario Mayoralas, Elsa Naval, Jose Antonio Ros, Manuel Valle, Marc Miravitlles
The aim of this study was to identify a multivariate model to predict poor outcomes after admission for exacerbation of chronic obstructive pulmonary disease (COPD).  We performed a multicenter, observational, prospective study. Patients admitted to hospital for COPD were followed up for 3 months. Relevant clinical variables at admission were selected. For each variable, the best cut-offs for the risk of poor outcome were identified using receiver operating characteristic (ROC) curves. Finally, a stepwise logistic regression model was performed...
December 16, 2016: COPD
https://www.readbyqxmd.com/read/27886372/oxygen-for-breathlessness-in-patients-with-chronic-obstructive-pulmonary-disease-who-do-not-qualify-for-home-oxygen-therapy
#16
REVIEW
Magnus Ekström, Zainab Ahmadi, Anna Bornefalk-Hermansson, Amy Abernethy, David Currow
BACKGROUND: Breathlessness is a cardinal symptom of chronic obstructive pulmonary disease (COPD). Long-term oxygen therapy (LTOT) is given to improve survival time in people with COPD and severe chronic hypoxaemia at rest. The efficacy of oxygen therapy for breathlessness and health-related quality of life (HRQOL) in people with COPD and mild or no hypoxaemia who do not meet the criteria for LTOT has not been established. OBJECTIVES: To determine the efficacy of oxygen versus air in mildly hypoxaemic or non-hypoxaemic patients with COPD in terms of (1) breathlessness; (2) HRQOL; (3) patient preference whether to continue therapy; and (4) oxygen-related adverse events...
November 25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27799763/prescription-of-opioids-for-breathlessness-in-end-stage-copd-a-national-population-based-study
#17
Zainab Ahmadi, Eva Bernelid, David C Currow, Magnus Ekström
BACKGROUND: Low-dose opioids can relieve breathlessness but may be underused in late-stage COPD due to fear of complications, contributing to poor symptom control. OBJECTIVES: We aimed to study the period prevalence and indications of opioids actually prescribed in people with end-stage COPD. METHODS: The study was a longitudinal, population-based study of patients starting long-term oxygen therapy (LTOT) for COPD between October 1, 2005 and June 30, 2009 in Sweden...
2016: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/27649490/long-term-oxygen-therapy-24-vs-15-h-day-and-mortality-in-chronic-obstructive-pulmonary-disease
#18
Zainab Ahmadi, Josefin Sundh, Anna Bornefalk-Hermansson, Magnus Ekström
Long-term oxygen therapy (LTOT) ≥ 15 h/day improves survival in hypoxemic chronic obstructive pulmonary disease (COPD). LTOT 24 h/day is often recommended but may pose an unnecessary burden with no clear survival benefit compared with LTOT 15 h/day. The aim was to test the hypothesis that LTOT 24 h/day decreases all-cause, respiratory, and cardiovascular mortality compared to LTOT 15 h/day in hypoxemic COPD. This was a prospective, observational, population-based study of COPD patients starting LTOT between October 1, 2005 and June 30, 2009 in Sweden...
2016: PloS One
https://www.readbyqxmd.com/read/27610580/the-effect-of-substance-use-disorders-on-the-association-between-guideline-concordant-long-term-opioid-therapy-and-all-cause-mortality
#19
Julie R Gaither, Joseph L Goulet, William C Becker, Stephen Crystal, E Jennifer Edelman, Kirsha Gordon, Robert D Kerns, David Rimland, Melissa Skanderson, Amy C Justice, David A Fiellin
OBJECTIVE: Patients with substance use disorders (SUDs) prescribed long-term opioid therapy (LtOT) are at risk for overdose and mortality. Prior research has shown that receipt of LtOT in accordance with clinical practice guidelines has the potential to mitigate these outcomes. Our objective was to determine whether the presence of a SUD modifies the association between guideline-concordant care and 1-year all-cause mortality among patients receiving LtOT for pain. METHODS: Among HIV+ and HIV- patients initiating LtOT (≥90 days opioids) between 2000 and 2010 as part of the Veterans Aging Cohort Study, we used time-updated Cox regression and propensity-score matching to examine-stratified by SUD status-the association between 1-year all-cause mortality and 3 quality indicators derived from national opioid-prescribing guidelines...
November 2016: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/27408629/self-fill-oxygen-technology-benefits-for-patients-healthcare-providers-and-the-environment
#20
REVIEW
Phyllis Murphie, Nick Hex, Jo Setters, Stuart Little
UNLABELLED: "Non-delivery" home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK)...
June 2016: Breathe
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