Pulmonary rehabilitation before lung cancer resection.

描述（由申请人提供）：本K23提案的目的是为候选人做好准备，使其成为一名独立研究者，能够设计、实施高质量的临床试验，专注于衡量和改善慢性阻塞性肺疾病（COPD）和肺癌患者的结局和护理质量。在建议的学习期间，职业发展活动将包括(1)一对一的指导，(2)开发和实施一个研究项目，(3)展示和发表研究成果，以及(4)完成流行病学硕士学位的课程。候选人提出一个研究项目，将重点展示一种新的方法来减少肺癌切除术后的肺部并发症和住院时间，这是发病率和死亡率的主要原因。降低术后肺部并发症（PPC）的发生率将使更多的患者能够安全地接受手术并从手术中恢复，手术是目前肺癌最有效的治疗方法。目前，唯一能降低术后肺部并发症发生率的干预措施是戒烟。肺切除术后肺部并发症的独立预测因素都是COPD的后果。80%的肺癌患者患有慢性阻塞性肺病。肺康复（PR）已被证明可以有效地减少慢性阻塞性肺病的症状、恶化和住院时间。该K奖的研究计划和具体目标包括一项随机对照试验（运动与常规护理），该试验将检查术前四周的上肢和下肢耐力训练对COPD和中高手术风险患者术后肺并发症和住院时间的影响。它将在出院后三个月评估功能能力。据推测，与常规护理相比，术前四周的运动训练将(1)减少住院天数，(2)显著减少重症监护和呼吸机天数，(3)减少术后主要肺部并发症的发生率，包括肺炎、呼吸衰竭、机械通气时间延长、肺不张，(4)改善恢复正常生活。

DESCRIPTION (provided by applicant): The purpose of this K23 proposal is to prepare the candidate to become an independent investigator, able to design, conduct, and acquire funding for, high-quality clinical trials that focus on measuring and improving outcomes and quality of care for patients with Chronic Obstructive Pulmonary Disease (COPD) and Lung Cancer. During the proposed study period, career development activities will include (1) one-on-one mentoring, (2) development and conduct of a research project, (3) presentation and publication of research findings, and (4) course work leading to a Masters degree in epidemiology. The candidate proposes a research project that will focus on demonstrating a novel approach for decreasing pulmonary complications and hospital stay after lung cancer resection, a major cause of morbidity and mortality. Decreasing the incidence of postoperative pulmonary complications (PPC) will allow more patients to safely undergo and recover from surgery, currently the most effective treatment for lung cancer. Currently, the only intervention shown to decrease the incidence of post-operative pulmonary complications is smoking cessation. Independent predictors of pulmonary complications after lung resection are all consequences of COPD. Eighty percent of patients with lung cancer have COPD. Pulmonary rehabilitation (PR) has been shown to effectively reduce symptoms, exacerbations and duration of hospitalization in COPD. The research proposal and specific aim of this K award includes a randomized controlled trial (exercise versus usual care) that will examine the effects of four weeks of preoperative upper and lower extremity endurance training on postoperative pulmonary complications and hospital stay after lung cancer resection in patients with COPD and moderate to high operative risk. It will evaluate functional capacity three month after discharge. It is hypothesized that four weeks of preoperative exercise training, when compared to usual care, will (1) decrease the number of hospital days, (2) result in significantly fewer intensive care and ventilator days, (3) decrease the incidence of major postoperative pulmonary complications, including pneumonia, respiratory failure, prolonged mechanical ventilation, atelectasis, and (4) improve recovery to active life.