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Biomedical subjects

W J O'Donohue

Publications and source records attributed to W J O'Donohue.

At least 19 recordsLinked to original sources
PubMed2000

Hypoxemia during sleep in patients with chronic obstructive pulmonary disease: significance, detection, and effects of therapy.

NOD is a common event in patients with symptomatic COPD who are not hypoxemic while awake. Up to 45% of these patients may have significant oxyhemoglobin desaturation during sleep, and most have evidence of pulmonary arterial hypertension. Although intuitively it would seem that supplemental oxygen during sleep should be of medical benefit in COPD patients with NOD, studies to data have not substantiated this idea. Medicare requirements for prescribing nocturnal oxygen are relatively liberal and there is the possibility of misuse, which would cause a substantial increase in the cost of home health care. A well designed multicenter study is needed to provide appropriate indications and guidelines for therapy in these patients.

Home Care Services↗
PubMed1999

Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis.

Limited data exist to guide physicians in the cost-effective treatment of acute exacerbation of chronic bronchitis (AECB). Therefore, the main objective of this study was to determine the antimicrobial efficacy and related costs for patients with AECB. A retrospective review of 60 outpatient medical records with a diagnosis of chronic obstructive pulmonary disease (COPD) and chronic bronchitis episodes from a pulmonary clinic of a teaching institution was undertaken. The participating patients had a total of 224 episodes of AECB requiring antibiotic treatment. Before review, empirical antibiotic choices were divided into first-line (amoxycillin, co-trimoxazole, tetracyclines, erythromycin), second-line (cephradine, cefuroxime, cefaclor, cefprozil) and third-line (co-amoxiclav, azithromycin, ciprofloxacin) agents. Patients receiving first-line agents failed significantly more frequently than third-line agents (19% vs 7%, P < 0.05). Additionally, patients prescribed first-line agents were hospitalized significantly more often for AECB within 2 weeks of outpatient treatment as compared with patients prescribed third-line agents (18.0% vs 5.3% third-line agents; P < 0.02). Time between subsequent AECB episodes requiring treatment was significantly longer for patients receiving third-line agents compared with first-line and second-line agents (P < 0.005). Pharmacy costs were lowest with first-line agents (first-line US$10.30 +/- 8.76; second-line US$24.45 +/- 25.65; third-line US$45.40 +/- 11.11; P < 0.0001), but third-line agents showed a trend towards lower mean total costs of AECB treatment (first-line US$942 +/- 2173; second-line, US$563 +/- 2296; third-line, US$542 +/- 1946). The use of third-line antimicrobials, co-amoxiclav, ciprofloxacin or azithromycin, significantly reduced the failure rate and need for hospitalization, prolonged the time between AECB episodes, and showed a lower total cost for the management of AECB. Prospective studies are needed to confirm these findings.

Acute Disease↗
PubMed1997

Home oxygen therapy.

Home oxygen therapy has well-established benefits for patients with chronic obstructive pulmonary disease and resting hypoxemia. The indications for therapy have been clearly defined in the United States by the Health Care Financing Administration (HCFA), and these guidelines have been accepted by most third-party payers. Controversies regarding the use of oxygen during sleep and exercise when daytime hypoxemia is not present have important therapeutic and financial implications. HCFA has recently proposed a substantial reduction in reimbursement for home oxygen which could have a major adverse effect if done on a global, across-the-board, basis. Some of the new technological developments in oxygen delivery systems are presented in this article.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1996

Home oxygen therapy.

Both the efficacy and the indications for LTOT have been well defined. Most of the studies performed have focused on patients with hypoxemia caused by COPD, and the benefits observed are assumed to apply to all patients with correctable hypoxemia. For Medicare patients, oxygen is reimbursed under a prospective payment system with all delivery systems considered to be cost and therapeutically equal. Because there are, in fact, substantial clinical differences in the medical indications for individual oxygen delivery systems, it is imperative that the prescribing physician be prepared to order the therapy that is most appropriate for each patient. Most home oxygen therapy is now being ordered by primary care physicians, often functioning as gatekeepers in managed care organizations. Education of primary care physicians in this area is often inadequate, and decisions for therapy should not be delegated to the equipment suppliers. If the study of home oxygen therapy conducted by the Office of the Inspector General were repeated today, less misuse of home oxygen would probably be found because of more clearly defined indications and requirements for therapy, but it is likely that the study would find that the level of knowledge of the prescribing physician has not maintained pace with the advances in technology. Continuing education for primary care physicians in this area of respiratory care is essential for appropriate medical management now and in the future.

Humans↗
PubMed1996

Guidelines for the use of nebulizers in the home and at domiciliary sites. Report of a consensus conference. National Association for Medical Direction of Respiratory Care (NAMDRC) Consensus Group.

Guidelines for the use of nebulizers outside of the hospital were developed at the request of the Health Care Financing Administration (HCFA) to assist in the preparation of Medicare criteria for reimbursement. The National Association for Medical Direction of Respiratory Care (NAMDRC) convened a consensus conference in Leesburg, Va, with physician representatives from the major medical organizations involved in adult and pediatric respiratory care. Members of the health-care industry also were invited to participate. After review of the pertinent references, members of the faculty were preassigned topics for presentations during the first day of the meeting. Three workshops were organized to address segments of the consensus statement and to develop written reports. Each report was reviewed by the entire group and then finalized. The Consensus Conference recommends that a metered-dose inhaler (MDI) with reservoir chamber is the preferred mode of aerosol therapy for patients outside of the hospital. The circumstances under which a small-volume nebulizer (SVN) may be appropriate are described. The medications that may be administered by SVN are identified with recommendations as to the usual doses to be prescribed. A cost analysis of the various modes of aerosol therapy is presented. These guidelines should be of value to physicians who are prescribing aerosol therapy in the home and also to policy makers who are developing guidelines for reimbursement.

Ambulatory Care↗
PubMed1996

A case of unilateral bronchiolitis obliterans organizing pneumonia (BOOP).

A patient with unilateral bronchiolitis obliterans organizing pneumonia (BOOP) is described in this report. The disease responded well to glucocorticoid therapy, as is characteristic. Although BOOP is being more frequently recognized as bilateral disease to the best of our knowledge, only three previous cases of unilateral disease have been recognized and reported.

Anti-Inflammatory Agents↗
PubMed1992

Postoperative pulmonary complications. When are preventive and therapeutic measures necessary?

Relevant clinical and physiologic data are available to help guide decision making in the management of patients who are at risk for or already have postoperative pulmonary complications. Prophylactic measures should be simple and focused. Inexpensive treatment methods should be tried before resorting to more individual-intensive and expensive measures. Proper treatment of postoperative atelectasis requires adequate patient assessment and knowledge of the therapeutic options. Costs, measured in dollars as well as in patient morbidity and mortality, are substantially greater when physicians fail to recognize and treat reversible disease before elective surgery and when effective postoperative therapy is not provided in accordance with individual needs.

Breathing Exercises↗
PubMed1992

Prescribing home oxygen therapy. What the primary care physician needs to know.

Physicians who prescribe home oxygen therapy often find it difficult and time-consuming to complete the required certification of medical necessity because of a lack of in-depth knowledge concerning the Medicare requirements and treatment options. The Health Care Financing Administration (HCFA) now mandates that the physician or an employee of the physician complete the form to certify medical necessity (form HCFA-484); otherwise, the home oxygen supplier cannot be reimbursed for equipment and service. Since long-term oxygen therapy is essential to increase survival and to improve the quality of life for patients with hypoxemia due to chronic pulmonary disease, it is imperative that the primary care physician understand the indications and requirements for therapy and be able to order the most appropriate equipment for the therapeutic needs. This article is intended to provide the physician with the information needed to properly prescribe home oxygen therapy.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Resources for medical decision-making in situations of high uncertainty.

The high standards of medical practice rest on the assumption that a physician's competence equips him or her to act on a patient's behalf. The conundrum created by medical uncertainty regarding the patient's diagnosis or the appropriate course of treatment seldom receives attention in the medical literature. This article highlights how the age-old medical ideal of beneficence, the modern concept of probabilities, the added dimension of treatment modification based on patients' preferences, and a compassionate disposition operate as competence-supporting tools in high uncertainty medical situations.

Aged↗
PubMed1992

Transtracheal oxygen: a step beyond the nasal cannula for long-term oxygen therapy.

Transtracheal oxygen represents an important advance in the technology of long-term oxygen therapy. As an oxygen conserving technique, it allows increased physical activity with smaller ambulatory and portable units and facilitates the management of patients with refractory hypoxemia outside of the hospital. There is increasing evidence that transtracheal oxygen therapy provides significant physiologic benefits beyond those achieved with the nasal cannula because of tighter control of oxygen therapy and fewer episodes of hypoxemia as a result of uninterrupted 24-hour oxygen therapy. Transtracheal oxygen therapy should be viewed as a program for long-term oxygen administration and not simply as a procedure that involves the insertion of a catheter into the tracheal. Careful patient screening and patient education is important to avoid complications. The program is best administered through regional centers with a team approach to patient care.

Administration, Intranasal↗
PubMed1991

Effect of oxygen therapy on increasing arterial oxygen tension in hypoxemic patients with stable chronic obstructive pulmonary disease while breathing ambient air.

Recertification for long-term oxygen therapy (LTOT) has been recommended for patients who are clinically unstable when home oxygen therapy is begun. Periods of observation for clinical stability have ranged from three weeks to three months in large multicenter clinical trials. There is concern, however, that an increase in arterial oxygen tension occurring after three months may be related to the beneficial effects of oxygen rather than to continued changes in clinical stability. In a review of 20 patients receiving transtracheal oxygen (TTO2) therapy, it was found that four (20 percent) did not qualify for oxygen therapy at the end of six months because the PaO2 breathing ambient air had increased to levels above 55 mm Hg. All patients were clinically stable at the time of insertion of the transtracheal catheter and all had been receiving nasal oxygen for at least seven months (mean, 25.8 months) before entering the study. A retrospective analysis of data published by Weitzenblum et al disclosed that four (25 percent) of 16 patients had a similar increase in PaO2 when reexamined after one year of oxygen therapy. All of the patients had been studied at least one year before oxygen therapy was initiated and each had three consecutive arterial blood gas measurements done monthly to ensure clinical stability. The increase in PaO2 to levels above 55 mm Hg observed in patients receiving TTO2 therapy was associated with a reduction in alveolar-arterial oxygen gradient; however, arterial oxygen desaturation with walking persisted. The specific mechanisms for improvement in PaO2 during oxygen therapy require further study. Any recommendation for recertification of LTOT must recognize that an increase in PaO2 after three months may be due to the beneficial effects of the oxygen therapy and does not provide prima facie justification for termination of therapy.

Aged↗