COPD patients rarely receive pulmonary rehabilitation despite its health benefits

Only a tiny fraction of patients hospitalized for COPD, or chronic obstructive pulmonary disease, participate in a pulmonary rehabilitation program following hospitalization, even though such programs are recommended and Medicare covers their cost, according to new research published online in the Annals of the American Thoracic Society.

In “Participation in Pulmonary Rehabilitation Following Hospitalization for COPD among Medicare Beneficiaries,” Kerry A. Spitzer, Ph.D., MPA, and co-authors report that in 2012 only 1.9 percent of COPD patients nationally started a pulmonary rehabilitation within six months of being hospitalized for a COPD exacerbation. This despite the fact that two years earlier Medicare’s policy changed to provide coverage for pulmonary rehabilitation services, effectively offering pulmonary rehabilitation to millions of U.S. patients for the first time.

COPD is a chronic disease and the fourth leading cause of death in the U.S. Pulmonary rehabilitation provides exercise training, self-management advice, nutrition counseling and emotional support. Despite its proven benefits, an ATS-commissioned survey by Wakefield Research found that 62 percent of people diagnosed with COPD have never heard of pulmonary rehabilitation.

The patient-tailored intervention has been shown to improve physical and psychological well-being and quality of life. Other studies have shown that pulmonary rehabilitation reduces COPD exacerbations that often lead to hospitalization. Clinical guidelines recommend that patients begin pulmonary rehabilitation within three weeks following discharge from the hospital.

According to study senior author Peter Lindenauer, MD, MSc, a hospitalist at Baystate Medical Center and director of the Institute for Healthcare Delivery and Population Science at the University of Massachusetts Medical School, there has been growing recognition of the benefits of pulmonary rehabilitation.

As hospitals and health systems, like ours, increase efforts to keep patients with COPD healthy and out of the hospital, we have prioritized enrolling patients into our rehabilitation program prior to hospital discharge,” Dr. Lindeauer said. “As a result, we are seeing improvements in readmission rates among patients with COPD.”

After reviewing the records of 223,832 patients hospitalized for COPD in 2012, the researchers found:

  • 4,225 (1.9 percent) received pulmonary rehabilitation within six months of being discharged from the hospital.
  • 6,111 (2.7 percent) received pulmonary rehabilitation within one year of being discharged from the hospital.
  • Whites, males, younger patients and those on home oxygen were more likely to receive pulmonary rehabilitation.
  • Smokers and those living farther than 10 miles away from a pulmonary rehabilitation program, belonging to lower socioeconomic groups and coping with additional chronic diseases and prior hospitalizations were less likely to receive pulmonary rehabilitation.
  • Among those who started pulmonary rehabilitation, more than half completed at least 16 sessions. Medicare will typically pay for up to 36 sessions.

Study limitations include the fact that researchers could not determine whether the low rates of pulmonary rehabilitation utilization were due to lack of physician referrals, patients choosing not to attend or a combination of the two factors.Dr. Spitzer, the lead study author and senior clinical research coordinator at Baystate, believes more research is needed to understand why patients are not receiving pulmonary rehabilitation.

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Witch hazel: Uses, benefits, and side effects

Witch hazel is a small tree native to the east coast of North America. Many people use it as a decorative outdoor plant.

In this article, learn about the possible benefits of witch hazel, as well as how to use it and whether there are any side effects.

Uses and benefits

Witch hazel is an astringent. People commonly use it topically, meaning they apply it directly to the skin.

Witch hazel may help treat the following conditions:

Hemorrhoids

Witch hazel may help heal hemorrhoids, which are dilated veins in the anus or rectum. Hemorrhoids can cause irritation, bleeding, and discomfort.

While there is not enough evidence to prove it is effective, some people get relief by adding witch hazel to a bath. This may be due to its anti-inflammatory properties.

Similarly to sunburn, bug bites and stings can cause swelling and inflammation. Applying witch hazel to the bite may reduce itching and discomfort.

Sunburn

Witch hazel has anti-inflammatory properties, which may help reduce discomfort from sunburn.

People can use a cloth or cotton ball to apply witch hazel directly to sunburn.

It may be especially soothing if a person mixes witch hazel with aloe vera, which is another plant and anti-inflammatory agent.

Stretch marks

Some people apply witch hazel to pregnancy stretch marks in an effort to lighten them and make them less noticeable. However, there is no research to support this use.

Bleeding

The astringent properties of witch hazel cause the skin to tighten and small blood vessels to constrict, which may help stop bleeding from minor cuts or nosebleeds.

Side effects

Witch hazel is safe for most people to use as an at-home treatment for some common skin issues.

Some people may have an allergic reaction to witch hazel, so it is best to test it first on a small patch of skin and monitor it for 24 hours. If there is no redness, itching, or irritation, it should be safe to apply to a larger area.

Takeaway

Witch hazel can be a great addition to an at-home medicine cabinet and is usually well-tolerated. It is safe for most people to use for certain skin conditions, even if the research has not yet proven its effectiveness scientifically.

However, using home remedies such as witch hazel cannot replace advice from a doctor or other healthcare provider.

If using witch hazel as a remedy does not work or the condition gets worse, it is vital that people consult their doctor for further advice.

Witch hazel is available in some pharmacies, health food stores, and online.

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Aseptic technique: Purpose, benefits, and types

Aseptic technique is a standard healthcare practice that helps prevent the transfer of germs to or from an open wound and other susceptible areas on a patient’s body.

This article will explain different types of aseptic technique, how it differs from clean technique, and how to use it at home.

Purpose and benefits of aseptic technique

The skin is the body’s first line of defense against germs. A person is vulnerable to infection as soon as there is a break in their skin, regardless of whether it occurs as a result of an accidental injury or a surgical incision.

Aseptic technique helps prevent healthcare-associated infections (HCAIs). An HCAI is an infection that a person acquires as a result of treatment from a healthcare professional.

According to the Centers for Disease Control and Prevention (CDC), one in every 31 hospital patients will have at least one HCAI.

Common HCAIs include:

  • catheter-associated urinary tract infection
  • central line-associated bloodstream infection
  • Clostridium difficile infection
  • surgical site infection
  • ventilator-associated pneumonia

These types of infection are a significant concern in the healthcare community. HCAIs can lead to severe health complications for affected individuals and disciplinary consequences for medical facilities.

Additionally, HCAIs have a significant economic impact. According to the Center for Disease Dynamics, Economics & Policy, the five most common HCAIs cost the United States approximately $9.8 billion a year.

Aseptic techniques range from simple practices, such as using alcohol to sterilize the skin, to full surgical asepsis, which involves the use of sterile gowns, gloves, and masks.

Healthcare professionals use aseptic technique practices in hospitals, surgery rooms, outpatient care clinics, and other healthcare settings.

Using aseptic technique prevents the spread of infection by harmful germs. Healthcare professionals use aseptic technique when they are:

  • performing surgical procedures
  • performing biopsies
  • dressing surgical wounds or burns
  • suturing wounds
  • inserting a urinary catheter, wound drain, intravenous line, or chest tube
  • administering injections
  • using instruments to conduct a vaginal examination
  • delivering babies

People working in a variety of healthcare settings use aseptic technique. Aseptic technique is not the same as surgical asepsis, also known as sterile technique, which refers to a set of infection control practices that it is necessary to use in operating rooms.

According to the U.S. Joint Commission, there are several different aspects of aseptic technique practices:

  • barriers
  • patient and equipment preparation
  • environmental controls
  • contact guidelines

We discuss each of these below.

Barriers

Barriers prevent the transfer of germs between healthcare professionals, patients, and the environment. Aseptic barriers include:

  • sterile gloves
  • sterile gowns
  • sterile masks
  • sterile drapes
  • protective wrappers on sterilized instruments

Patient and equipment preparation

Healthcare professionals must thoroughly prepare both the patient and the equipment before a medical procedure takes place.

Aseptic preparation may involve:

  • disinfecting a patient’s skin using antiseptic wipes
  • sterilizing equipment and instruments before a procedure
  • keeping sterilized instruments inside plastic wrappers to prevent contamination before use

Environmental controls

Healthcare professionals also have to consider the patient’s immediate surroundings. It is essential to maintain an aseptic environment before and during procedures. The designated procedural area is also called an aseptic field.

Maintaining an aseptic field involves:

  • keeping doors closed
  • minimizing movement in and out of the aseptic field
  • limiting entry to necessary personnel only
  • permitting only one patient per aseptic field

Contact guidelines

Once a healthcare professional has washed their hands and donned their sterile barriers, they must follow sterile-to-sterile contact guidelines. These guidelines prohibit any contact between sterile and nonsterile items.

At this point, healthcare professionals can only touch sterile objects and surfaces, and they must avoid touching nonsterile items and surfaces at all costs.

The same guidelines apply to sterile devices. If a sterile instrument falls on the ground and the wrapper sustains damage, a healthcare professional must remove the instrument and re-sterilize it before use.

The proper execution of aseptic technique requires training. If a person needs to use aseptic technique in their home, a trained healthcare professional can demonstrate the proper practices to them.

Anyone performing aseptic techniques at home will need to have sterile gloves and special dressing kits at hand.

While aseptic technique requires proper training and the use of specialist equipment, clean technique is much easier to achieve at home. Clean technique involves thoroughly washing the hands, wearing gloves, and maintaining a clean environment.

Takeaway

Aseptic technique is a standard set of healthcare practices that aim to eliminate the transfer of germs. The proper use of aseptic technique should prevent HCAIs, which are a significant healthcare concern that can lead to consequences for both patients and healthcare facilities.

Healthcare professionals receive specialized training in aseptic technique practices. However, a person can also receive aseptic technique training if they need to use these practices at home.

Clean technique is much easier for untrained individuals to achieve, and it involves limiting the number of germs in a patient’s vicinity. Clean technique does not require the use of sterile instruments and equipment. Instead, the aim of using this technique is to avoid directly contaminating instruments and materials that will come into contact with the patient.

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