Pulmonary & Respiratory Medicine

Objectives: Prior studies have shown that patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have a high hospital readmission rate and that close outpatient follow-up may reduce the need for hospital readmission. The objective of this study is to analyze the effect of scheduled 7-day post-hospital follow-up appointments on 30-day readmission in patients hospitalized with AECOPD.

Methods: A quasi-experimental, multicenter, prospective cohort design with retrospective observation as part of the Integrated Michigan Patient- Centered Alliance in Care Transitions (I-MPACT) was used. Each of the four participating hospitals in Michigan selected AECOPD as their target intervention and were incentivized to increase overall rates of scheduled 7-day post-hospital follow-up for all patients discharged in this target population using a pay-for-performance system. A random sample of patients discharged with AECOPD was included and patients were excluded if discharged or transferred to another hospital, left against medical advice, died during initial hospitalization, were known to have died within 30 days of discharge without readmission, or were discharged to a skilled nursing facility. Analyses were done using Pearson chi-square and multivariate logistic regression modeling.

Results: Of the 686 patients with a diagnosis of AECOPD, 29.5% (N=202) received a scheduled follow-up while 70.65% (N=484) did not. The sample was 57% female, 73% White, and 13% on Medicaid with a mean age of 66 years. Based on a risk-adjusted model, patients who received a 7-day post-hospital follow-up appointment had a 43% lower likelihood of readmission compared to patients who did not receive an appointment (OR=0.57; p=0.03). Additionally, patients who received a scheduled follow-up with a Primary Care Provider had a 53% lower likelihood of readmission compared to patients who did not receive a scheduled appointment (OR=0.47; p=0.01).

Conclusion: For patients hospitalized for AECOPD, scheduling outpatient follow-up appointments within 7 days of hospital discharge was associated with a reduction in 30-day hospital readmissions. Scheduling early post-hospital follow-up appointments for patients with AECOPD may reduce readmission rates.

The aim is to examine the effects of cannabis use on pain, trauma, and obstructive sleep apnea in adolescents regarding sleep patterns. With the recent legalization of cannabis as well as my role as a clinical sleep therapist for nearly a decade, I strongly believe there is a connection between both topics, and I strive to showcase the positive influence that cannabis can have on sleep patterns. This literature review strives to highlight the benefits on sleep that may be provided to those with pain, trauma, OSA as well as adolescent use. I have selected a wide variety of current literature to share the potential benefits of cannabis in relation to sleep.

Climate change and the associated decrease in air quality have led to profound effects on the widespread presence of respiratory diseases and allergens. Urbanized lifestyles and growing transportation emissions have shown to have a negative impact on the environment. Predominantly, increased average temperatures, CO2 and NO emissions, allergen and mold production, harsh weather conditions and Volatile Organic Compound (VOC) release from vegetation. Based on a review of past literature; the present study provides an overview of the link between the prevalence of respiratory diseases and allergies in response to anthropogenic factors that have induced global climate change. There are an abundance of factors that are contributing to climate change that can be correlated to respiratory diseases and allergies. Respiratory disorders that correspond to climate change include: allergic respiratory disorders, asthma, exacerbations of chronic obstructive lung disease, and decrease in lung function. Increase in vehicle emissions over the years has been shown to have a direct relationship with respiratory allergies. Increase in respiratory allergies has also been linked to people who live in industrialized areas. These results indicate that climate change is affecting the respiratory health of a wide variety of people. There are many disorders, including an increase in allergies and different diseases that correspond to climate change and the factors causing climate change. This information is important and very relevant due to the drastic changes that have happened to our Earth in the past 10 years. In the past 10 years carbon dioxide emissions have increased 10%, sea levels have risen 1.6 inches, and average temperature has increased by 0.22 degrees Celsius.