BackgroundPancreaticoduodenectomy (PD) is often a morbid procedure with a prolonged recovery time. Enhanced recovery after surgery (ERAS) protocols have been shown to improve outcomes at high-volume hepatopancreaticobiliary (HPB) centers, but data on their implementation and reproducibility in moderate-volume institutions remain limited. In 2018, we implemented a standardized ERAS protocol for patients undergoing PD at a Commission on Cancer (CoC)-accredited, moderate-volume teaching hospital with a mean annual PD volume of 30 cases. Components of this pathway included a nurse-led preoperative educational session, nutritional optimization, multimodal pain control, incentive spirometer use, and early ambulation.MethodsA retrospective analysis of 200 patients who underwent PD between January 2015 and December 2022 compared ICU length of stay, overall hospital length of stay, and discharge disposition before and after the implementation of the standardized ERAS protocol. Patient demographics and clinical characteristics were similar between groups.ResultsEnhanced recovery after surgery implementation was associated with significant reductions in ICU stay (mean 3.13 days vs 0.82 days, P < .0001), reductions in hospital length of stay (mean 15.37 vs 11.21 days, P = .0012), and increases in favorable discharge disposition to home (73.1% vs 83.1%, P = .044). No remarkable differences were noted in readmission rates or death within 30 days after surgery.DiscussionImplementation of a standardized ERAS program for PD can be successfully achieved at a moderate-volume institution with results comparable to those reported from specialized high-volume HPB centers. These findings support the broader applicability of ERAS for PD beyond major academic referral centers.

Incentive spirometry is widely used in respiratory rehabilitation to enhance lung expansion and prevent postoperative pulmonary complications. However, conventional devices, including volume-oriented and flow-oriented incentive spirometers, rely on subjective visual interpretation, which may limit measurement accuracy and clinical utility. A digital incentive spirometer (DIS) has been developed to provide objective, real-time measurements of inspiratory volume. This study aimed to evaluate the agreement and reliability between the DIS and a volume-oriented incentive spirometer (VIS) across different age groups. A cross-sectional study was conducted in 150 participants aged 7-80 years, stratified into five age groups with equal sex distribution. Inspiratory volume was measured simultaneously using both devices. Agreement was assessed using Bland-Altman analysis, and reliability was evaluated using intraclass correlation coefficients (ICC). The DIS demonstrated good overall reliability (ICC = 0.868, 95% CI: 0.821-0.903). The mean difference was 48.69 mL, indicating slight overestimation by the DIS. However, the limits of agreement were wide (-469.24 to 566.63 mL), suggesting limited interchangeability. Reliability varied across age groups, with the highest ICC in older adults and the lowest in adolescents. The DIS showed good reliability but limited agreement with the VIS.

Objectives: The aim of this study was to investigate the association between the effect of respiratory muscle strength parameters obtained from endurance athletes and their aerobic capacity levels. Methods: A total of 70 endurance athletes (23 women and 47 men) voluntarily participated in the study. Respiratory muscle strength was measured using a digital spirometer. Maximum VO2 was evaluated using the cardiopulmonary exercise test system (Cosmed K5). Results: As a result of the study, it was determined that in female endurance athletes, Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP) values were related to the End-Tidal Carbon Dioxide Pressure (PETCO2) value at maximum load. In male endurance athletes, it was determined that MEP values were related to PETCO2 values at maximum load, End-Tidal Oxygen Pressure (PETO2) values at maximum load, MaxVO2 values, VO2 values at RCP, and VO2 values at Ventilatory Threshold (VT). In addition, it was determined that in male endurance athletes, the MIP value was related to the VCO2 value at Ventilatory Threshold (RCP) and the VTidal value at maximum load. The other sub-parameters of maximum oxygen consumption (VO2) examined were not found to be related to respiratory muscle strength. Conclusions: The present findings indicate that respiratory muscle strength may be associated with selected cardiopulmonary exercise variables in endurance athletes. However, because this was a cross-sectional study, no causal inference can be made. Prospective and intervention studies are required to clarify these associations.

This protocol describes a standardized, reproducible, multicomponent respiratory guidance and nursing care intervention for elderly patients with chronic obstructive pulmonary disease (COPD). Based on Orem's self-care deficit nursing theory, the method integrates structured breathing training, respiratory muscle training, aerobic exercise, and continuous nursing support. The intervention is delivered by trained respiratory nurses over a 12-week period in inpatient and outpatient settings. The protocol includes procedures for patient selection, group allocation, baseline assessment, and structured implementation of intervention components. Breathing training incorporates guided respiratory exercises and spirometer-assisted techniques, combined with individualized exercise programs, psychological support, and discharge planning. The protocol specifies intervention frequency, duration, supervision, safety monitoring, and adherence tracking to ensure consistency and reproducibility. Standardized outcome assessment procedures are outlined, including pulmonary function testing, arterial blood gas analysis, dyspnea evaluation, functional ability assessment, sleep quality measurement, and quality-of-life evaluation using validated clinical instruments. This protocol provides a practical and structured framework for implementing nonpharmacological respiratory care in elderly patients with COPD across clinical and rehabilitation settings.

This cross-sectional study examined the independent and combined associations of breakfast frequency, forced vital capacity (FVC) and psychological symptoms among Chinese adolescents. A total of 2776 adolescents aged 12-17 years were recruited from three regions of Anhui Province using stratified cluster random sampling. Breakfast frequency was self-reported as days per week over the past month and categorised as low, medium or high. FVC was measured with a standardised electronic spirometer (CSTF-FH) following CNSSCH (Chinese National Student Physical Fitness Survey) protocols. Psychological symptoms were assessed using the Multidimensional Subhealth Assessment Questionnaire for Adolescents (MSQA) and dichotomised according to established cut-offs. Covariates included age, height, weight, grip strength, standing long jump, sleep duration and parental education. Binary logistic regression was used, building three models. The overall prevalence of psychological symptoms was 14 %. Breakfast frequency was inversely correlated with psychological symptoms (P < 0·001). Low breakfast frequency (1-2 d/week) was associated with a higher symptom rate (31 %) than high frequency (5-7 d/week, 12 %) and increased odds of symptoms (OR = 3·34, 95 % CI 2·04, 5·60). No independent association was found between FVC and psychological symptoms. However, adolescents with both low breakfast frequency and low FVC had 4·10 times higher odds of psychological symptoms (95 % CI 1·83, 9·21, P < 0·001) than those with high breakfast frequency and high FVC. These findings suggest that low breakfast frequency is a robust correlate of psychological symptoms in adolescents, and that the combination of low breakfast frequency with low FVC identifies a particularly high-risk group.