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Dreßler M, Lassmann H, Eichhorn C, Trischler J, Hutter M, Zielen S, Schulze J. Are Questionnaires Helpful To Predict Exercise-Induced Bronchoconstriction (EIB) And Exercise-Induced Laryngeal Obstruction (EILO)? KLINISCHE PADIATRIE 2024; 236:139-144. [PMID: 38286408 DOI: 10.1055/a-2151-2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Exercise induced laryngeal obstruction (EILO) is an important differential diagnosis to exercise induced bronchoconstriction (EIB) and diagnosed via continuous laryngoscopy while exercising (CLE). However, availability of CLE is limited to specialized centres. And without CLE EILO is often misdiagnosed as EIB. Therefore it is essential to carefully preselect potential EILO candidates. Aim of this study was to investigate whether two short questionnaires -Asthma Control Test (ACT) and Dyspnea Index (DI) evaluating upper airway-related dyspnea- can differentiate between EIB and EILO. METHODS Patients with dyspnea while exercising were analysed with an exercise challenge in the cold chamber (ECC) to diagnose EIB in visit 1 (V1), as appropriate a CLE in visit 2 (V2, 4-6 weeks after V1) and ACT and DI in V1 and V2. EIB patients were treated with asthma medication after V1. RESULTS Complete dataset of 36 subjects were gathered. The ACT showed lower values in V2 in EILO compared to EIB patients. A lack of improvement in ACT in V2 after asthma medication of EIB patients is suspicious for additional EILO diagnosis. The DI showed higher values in V1 in EILO compared to EIB patients. A score≥30 can predict a positive CLE reaction. CONCLUSION ACT and DI are valuable tools in preselecting CLE candidates to assure timely diagnostic despite limited diagnostic capabilities.
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Affiliation(s)
- Melanie Dreßler
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Hannah Lassmann
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Celine Eichhorn
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Jordis Trischler
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Martin Hutter
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Stefan Zielen
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Johannes Schulze
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
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Barati Jozan MM, Ghorbani BD, Khalid MS, Lotfata A, Tabesh H. Impact assessment of e-trainings in occupational safety and health: a literature review. BMC Public Health 2023; 23:1187. [PMID: 37340453 DOI: 10.1186/s12889-023-16114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Implementing workplace preventive interventions reduces occupational accidents and injuries, as well as the negative consequences of those accidents and injuries. Online occupational safety and health training is one of the most effective preventive interventions. This study aims to present current knowledge on e-training interventions, make recommendations on the flexibility, accessibility, and cost-effectiveness of online training, and identify research gaps and obstacles. METHOD All studies that addressed occupational safety and health e-training interventions designed to address worker injuries, accidents, and diseases were chosen from PubMed and Scopus until 2021. Two independent reviewers conducted the screening process for titles, abstracts, and full texts, and disagreements on the inclusion or exclusion of an article were resolved by consensus and, if necessary, by a third reviewer. The included articles were analyzed and synthesized using the constant comparative analysis method. RESULT The search identified 7,497 articles and 7,325 unique records. Following the title, abstract, and full-text screening, 25 studies met the review criteria. Of the 25 studies, 23 were conducted in developed and two in developing countries. The interventions were carried out on either the mobile platform, the website platform, or both. The study designs and the number of outcomes of the interventions varied significantly (multi-outcomes vs. single-outcome). Obesity, hypertension, neck/shoulder pain, office ergonomics issues, sedentary behaviors, heart disease, physical inactivity, dairy farm injuries, nutrition, respiratory problems, and diabetes were all addressed in the articles. CONCLUSION According to the findings of this literature study, e-trainings can significantly improve occupational safety and health. E-training is adaptable, affordable, and can increase workers' knowledge and abilities, resulting in fewer workplace injuries and accidents. Furthermore, e-training platforms can assist businesses in tracking employee development and ensuring that training needs are completed. Overall, this analysis reveals that e-training has enormous promise in the field of occupational safety and health for both businesses and employees.
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Affiliation(s)
- Mohammad Mahdi Barati Jozan
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Md Saifuddin Khalid
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Aynaz Lotfata
- School Of Veterinary Medicine, Department Of Veterinary Pathology, University of California, Davis, USA
| | - Hamed Tabesh
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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3
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Ramachandran HJ, Oh JL, Cheong YK, Jiang Y, Teo JYC, Seah CWA, Yu M, Wang W. Barriers and facilitators to the adoption of digital health interventions for COPD management: A scoping review. Heart Lung 2023; 59:117-127. [PMID: 36801546 DOI: 10.1016/j.hrtlng.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Knowledge of the barriers and facilitators in the adoption of digital health interventions (DHI) is sparse yet crucial to facilitate chronic obstructive pulmonary disease (COPD) management. OBJECTIVES This scoping review aimed to summarize patient- and healthcare provider-level barriers and facilitators in the adoption of DHIs for COPD management. METHODS Nine electronic databases were searched from inception up till October 2022 for English language evidence. Inductive content analysis was used. RESULTS This review included 27 papers. Frequent patient-level barriers were poor digital literacy (n = 6), impersonal care delivery (n = 4), and fear of being controlled by telemonitoring data (n = 4). Frequent patient-level facilitators were improved disease understanding and management (n = 17), bi-directional communication and contact with healthcare providers (n = 15), and remote monitoring and feedback (n = 14). Frequent healthcare provider-level barriers were increased workload (n = 5), lack of technology interoperability with existing health systems (n = 4), lack of funding (n = 4), and lack of dedicated and trained manpower (n = 4). Frequent healthcare provider-level facilitators were improved efficiency of care delivery (n = 6) and DHI training programmes (n = 5). CONCLUSION DHIs have the potential to facilitate COPD self-management and improve efficiency of care delivery. However, several barriers challenge its successful adoption. Attaining organizational support in developing user centric DHIs that can be integrated and are interoperable with existing health systems is crucial if we are to witness tangible return on investments at the patient-, healthcare provider- and healthcare system-level.
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Affiliation(s)
- Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore.
| | - Joo Lin Oh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Yue Krystal Cheong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Jun Yi Claire Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Chuen Wei Alvin Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Mingming Yu
- School of Nursing, Peking University, Beijing, China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
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Chalupsky MR, Craddock KM, Schivo M, Kuhn BT. Remote patient monitoring in the management of chronic obstructive pulmonary disease. J Investig Med 2022; 70:1681-1689. [PMID: 35710143 DOI: 10.1136/jim-2022-002430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
Remote patient monitoring allows monitoring high-risk patients through implementation of an expanding number of technologies in coordination with a healthcare team to augment care, with the potential to provide early detection of exacerbation, prompt access to therapy and clinical services, and ultimately improved patient outcomes and decreased healthcare utilization.In this review, we describe the application of remote patient monitoring in chronic obstructive pulmonary disease including the potential benefits and possible barriers to implementation both for the individual and the healthcare system.
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Affiliation(s)
- Megan R Chalupsky
- Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,VA Northern California Health Care System, Mather, California, USA
| | - Krystal M Craddock
- Department of Respiratory Care, University of California Davis Health System, Sacramento, California, USA
| | - Michael Schivo
- Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,VA Northern California Health Care System, Mather, California, USA
| | - Brooks T Kuhn
- Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA .,VA Northern California Health Care System, Mather, California, USA
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5
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Bugajski A, Szalacha L, Rechenberg K, Johnson A, Beckie T, Morgan H. Psychometric Evaluation of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory in the United States. Heart Lung 2021; 51:1-8. [PMID: 34731690 DOI: 10.1016/j.hrtlng.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/30/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND High quality self-care among individuals with chronic obstructive pulmonary disease (COPD) promotes better outcomes, however, there are few validated self-care measures that are psychometrically sound to be used in research. OBJECTIVES The purpose of this study is to examine the psychometric properties of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory (SC-COPDI) in an English-speaking population in the United States. METHODS Factorial validity, construct validity and reliability of the SCCOPDI were examined using components analysis via principal components analysis, hypothesis testing via multivariate linear regression, Cronbach's alpha, and split-half reliability. RESULTS The SCCOPDI demonstrated strong evidence of validity and reliability on par with the SCCOPDI's original construction. Component analysis produced item loadings consistent with the theoretical underpinnings of the instrument. Reliability metrics yielded good internal consistency across all subscales of the SCCOPDI. CONCLUSIONS The SCCOPDI is a valid and reliable instrument to measure self-care in people with COPD.
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Affiliation(s)
- Andrew Bugajski
- Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805.
| | - Laura Szalacha
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
| | - Kaitlyn Rechenberg
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
| | - Ayesha Johnson
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
| | - Theresa Beckie
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
| | - Hailey Morgan
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
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Anan T, Kajiki S, Oka H, Fujii T, Kawamata K, Mori K, Matsudaira K. Effects of an Artificial Intelligence-Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e27535. [PMID: 34559054 PMCID: PMC8501409 DOI: 10.2196/27535] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 07/30/2021] [Indexed: 12/28/2022] Open
Abstract
Background Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem. Objective This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)–assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants’ adherence to exercises. Methods We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone’s chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC). Results We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75%) out of 48 participants in the intervention group and 3 (7%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95% CI 11.25-164.28; P<.001). Conclusions This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program. Trial Registration University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038307.
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Affiliation(s)
- Tomomi Anan
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.,Cenxus Occupational Physicians' Firm, Tokyo, Japan
| | - Shigeyuki Kajiki
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.,Cenxus Occupational Physicians' Firm, Tokyo, Japan.,Advanced Occupational Health Research and Consulting Inc, Tokyo, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Fujii
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Kawamata
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Mori
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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O'Connell S, McCarthy VJ, Savage E. Self-management support preferences of people with asthma or chronic obstructive pulmonary disease: A systematic review and meta-synthesis of qualitative studies. Chronic Illn 2021; 17:283-305. [PMID: 31426658 DOI: 10.1177/1742395319869443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To synthesise findings from qualitative studies on the preferences of people with asthma or chronic obstructive pulmonary disease (COPD) for self-management support. METHODS A thematic synthesis of literature was carried out. Six databases (ASSIA, CINAHL, MEDLINE, PsycINFO, Psychology and the Behavioural Sciences and SSCI) were used to search for qualitative studies eliciting perspectives of adults with asthma and/or COPD on self-management support, published between May 2008 and April 2018. RESULTS A total of 968 articles were retrieved across databases, with 15 articles included in the synthesis. Three themes were identified: Types of Support described the range of supports valued by participants in the studies, particularly education provided by competent healthcare professionals; The Support Relationship highlighted the importance of a collaborative relationship with one's healthcare professional which was characterised by communication, trust and continuity over time and Accessibility identified the considerations of participants relating to physically accessible, prompt support which is provided in a format preferred by the individual. DISCUSSION Increased understanding of patients' preferences may provide insight which can be used to enhance engagement with self-management support. Further research needs to examine self-management support preferences outside the context of evaluating interventions for people with asthma/COPD and needs to address the optimal means of enhancing accessibility.
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Affiliation(s)
- Selena O'Connell
- Catherine McAuley School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Vera Jc McCarthy
- Catherine McAuley School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Eileen Savage
- Catherine McAuley School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
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Dennett EJ, Janjua S, Stovold E, Harrison SL, McDonnell MJ, Holland AE. Tailored or adapted interventions for adults with chronic obstructive pulmonary disease and at least one other long-term condition: a mixed methods review. Cochrane Database Syst Rev 2021; 7:CD013384. [PMID: 34309831 PMCID: PMC8407330 DOI: 10.1002/14651858.cd013384.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition characterised by shortness of breath, cough and recurrent exacerbations. People with COPD often live with one or more co-existing long-term health conditions (comorbidities). People with more severe COPD often have a higher number of comorbidities, putting them at greater risk of morbidity and mortality. OBJECTIVES To assess the effectiveness of any single intervention for COPD adapted or tailored to their comorbidity(s) compared to any other intervention for people with COPD and one or more common comorbidities (quantitative data, RCTs) in terms of the following outcomes: Quality of life, exacerbations, functional status, all-cause and respiratory-related hospital admissions, mortality, pain, and depression and anxiety. To assess the effectiveness of an adapted or tailored single COPD intervention (simple or complex) that is aimed at changing the management of people with COPD and one or more common comorbidities (quantitative data, RCTs) compared to usual care in terms of the following outcomes: Quality of life, exacerbations, functional status, all-cause and respiratory-related hospital admissions, mortality, pain, and depression and anxiety. To identify emerging themes that describe the views and experiences of patients, carers and healthcare professionals when receiving or providing care to manage multimorbidities (qualitative data). SEARCH METHODS We searched multiple databases including the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, and CINAHL, to identify relevant randomised and qualitative studies. We also searched trial registries and conducted citation searches. The latest search was conducted in January 2021. SELECTION CRITERIA Eligible randomised controlled trials (RCTs) compared a) any single intervention for COPD adapted or tailored to their comorbidity(s) compared to any other intervention, or b) any adapted or tailored single COPD intervention (simple or complex) that is aimed at changing the management of people with COPD and one or more comorbidities, compared to usual care. We included qualitative studies or mixed-methods studies to identify themes. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods for analysis of the RCTs. We used Cochrane's risk of bias tool for the RCTs and the CASP checklist for the qualitative studies. We planned to use the Mixed Methods Appraisal tool (MMAT) to assess the risk of bias in mixed-methods studies, but we found none. We used GRADE and CERQual to assess the quality of the quantitative and qualitative evidence respectively. The primary outcome measures for this review were quality of life and exacerbations. MAIN RESULTS Quantitative studies We included seven studies (1197 participants) in the quantitative analyses, with interventions including telemonitoring, pulmonary rehabilitation, treatment optimisation, water-based exercise training and case management. Interventions were either compared with usual care or with an active comparator (such as land-based exercise training). Duration of trials ranged from 4 to 52 weeks. Mean age of participants ranged from 64 to 72 years and COPD severity ranged from mild to very severe. Trials included either people with COPD and a specific comorbidity (including cardiovascular disease, metabolic syndrome, lung cancer, head or neck cancer, and musculoskeletal conditions), or with one or more comorbidities of any type. Overall, we judged the evidence presented to be of moderate to very low certainty (GRADE), mainly due to the methodological quality of included trials and imprecision of effect estimates. Intervention versus usual care Quality of life as measured by the St George's Respiratory Questionnaire (SGRQ) total score may improve with tailored pulmonary rehabilitation compared to usual care at 52 weeks (mean difference (MD) -10.85, 95% confidence interval (CI) -12.66 to -9.04; 1 study, 70 participants; low-certainty evidence). Tailored pulmonary rehabilitation is likely to improve COPD assessment test (CAT) scores compared with usual care at 52 weeks (MD -8.02, 95% CI -9.44 to -6.60; 1 study, 70 participants, moderate-certainty evidence) and with a multicomponent telehealth intervention at 52 weeks (MD -6.90, 95% CI -9.56 to -4.24; moderate-certainty evidence). Evidence is uncertain about effects of pharmacotherapy optimisation or telemonitoring interventions on CAT improvement compared with usual care. There may be little to no difference in the number of people experiencing exacerbations, or mean exacerbations with case management compared with usual care (OR 1.09, 95% CI 0.75 to 1.57; 1 study, 470 participants; very low-certainty evidence). For secondary outcomes, six-minute walk distance (6MWD) may improve with pulmonary rehabilitation, water-based exercise or multicomponent interventions at 38 to 52 weeks (low-certainty evidence). A multicomponent intervention may result in fewer people being admitted to hospital at 17 weeks, although there may be little to no difference in a telemonitoring intervention. There may be little to no difference between intervention and usual care for mortality. Intervention versus active comparator We included one study comparing water-based and land-based exercise (30 participants). We found no evidence for quality of life or exacerbations. There may be little to no difference between water- and land-based exercise for 6MWD (MD 5 metres, 95% CI -22 to 32; 38 participants; very low-certainty evidence). Qualitative studies One nested qualitative study (21 participants) explored perceptions and experiences of people with COPD and long-term conditions, and of researchers and health professionals who were involved in an RCT of telemonitoring equipment. Several themes were identified, including health status, beliefs and concerns, reliability of equipment, self-efficacy, perceived ease of use, factors affecting usefulness and perceived usefulness, attitudes and intention, self-management and changes in healthcare use. We judged the qualitative evidence presented as of very low certainty overall. AUTHORS' CONCLUSIONS Owing to a paucity of eligible trials, as well as diversity in the intervention type, comorbidities and the outcome measures reported, we were unable to provide a robust synthesis of data. Pulmonary rehabilitation or multicomponent interventions may improve quality of life and functional status (6MWD), but the evidence is too limited to draw a robust conclusion. The key take-home message from this review is the lack of data from RCTs on treatments for people living with COPD and comorbidities. Given the variation in number and type of comorbidity(s) an individual may have, and severity of COPD, larger studies reporting individual patient data are required to determine these effects.
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Affiliation(s)
- Emma J Dennett
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | - Sadia Janjua
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | - Elizabeth Stovold
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | | | - Melissa J McDonnell
- Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - Anne E Holland
- Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
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Patel N, Kinmond K, Jones P, Birks P, Spiteri MA. Validation of COPDPredict™: Unique Combination of Remote Monitoring and Exacerbation Prediction to Support Preventative Management of COPD Exacerbations. Int J Chron Obstruct Pulmon Dis 2021; 16:1887-1899. [PMID: 34188465 PMCID: PMC8232856 DOI: 10.2147/copd.s309372] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background COPDPredict™ is a novel digital application dedicated to providing early warning of imminent COPD (chronic obstructive pulmonary disease) exacerbations for prompt intervention. Exacerbation prediction algorithms are based on a decision tree model constructed from percentage thresholds for disease state changes in patient-reported wellbeing, forced expiratory volume in one second (FEV1) and C-reactive protein (CRP) levels. Our study determined the validity of COPDPredict™ to identify exacerbations and provide timely notifications to patients and clinicians compared to clinician-defined episodes. Methods In a 6-month prospective observational study, 90 patients with COPD and frequent exacerbations registered wellbeing self-assessments daily using COPDPredict™ App and measured FEV1 using connected spirometers. CRP was measured using finger-prick testing. Results Wellbeing self-assessment submissions showed 98% compliance. Ten patients did not experience exacerbations and treatment was unchanged. A total of 112 clinician-defined exacerbations were identified in the remaining 80 patients: 52 experienced 1 exacerbation; 28 had 2.2±0.4 episodes. Sixty-two patients self-managed using prescribed rescue medication. In 14 patients, exacerbations were more severe but responded to timely escalated treatment at home. Four patients attended the emergency room; with 2 hospitalised for <72 hours. Compared to the 6 months pre-COPDPredict™, hospitalisations were reduced by 98% (90 vs 2, p<0.001). COPDPredict™ identified COPD-related exacerbations at 7, 3 days (median, IQR) prior to clinician-defined episodes, sending appropriate alerts to patients and clinicians. Cross-tabulation demonstrated sensitivity of 97.9% (95% CI 95.7-99.2), specificity of 84.0% (95% CI 82.6-85.3), positive and negative predictive value of 38.4% (95% CI 36.4-40.4) and 99.8% (95% CI 99.5-99.9), respectively. Conclusion High sensitivity indicates that if there is an exacerbation, COPDPredict™ informs patients and clinicians accurately. The high negative predictive value implies that when an exacerbation is not indicated by COPDPredict™, risk of an exacerbation is low. Thus, COPDPredict™ provides safe, personalised, preventative care for patients with COPD.
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Affiliation(s)
- Neil Patel
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK.,Directorate of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| | - Kathryn Kinmond
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK.,Department of Health & Social care, Staffordshire University, Stoke-on-Trent, Staffordshire, UK
| | - Pauline Jones
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Pamela Birks
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Monica A Spiteri
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
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10
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Márquez Fosser S, Mahmoud N, Habib B, Weir DL, Chan F, El Halabieh R, Vachon J, Thakur M, Tran T, Bustillo M, Beauchamp C, Bonnici A, Buckeridge DL, Tamblyn R. Smart about medications (SAM): a digital solution to enhance medication management following hospital discharge. JAMIA Open 2021; 4:ooab037. [PMID: 34159299 PMCID: PMC8211568 DOI: 10.1093/jamiaopen/ooab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To outline the development of a software solution to improve medication management after hospital discharge, including its design, data sources, intrinsic features, and to evaluate the usability and the perception of use by end-users. Materials and Methods Patients were directly involved in the development using a User Center Design (UCD) approach. We conducted usability interviews prior to hospital discharge, before a user started using the application. A technology acceptance questionnaire was administered to evaluate user self-perception after 2 weeks of use. Results The following features were developed; pill identification, patient-friendly drug information leaflet, side effect checker, and interaction checker, adherence monitoring and alerts, weekly medication schedule, daily pill reminders, messaging service, and patient medication reviews. The usability interviews show a 98.3% total success rate for all features, severity (on a scale of 1–4) 1.4 (SD 0.79). Regarding the self-perception of use (1–7 agreement scale) the 3 highest-rated domains were: (1) perceived ease of use 5.65 (SD 2.02), (2) output quality 5.44 (SD 1.65), and (3) perceived usefulness 5.29 (SD 2.11). Discussion Many medication management apps solutions have been created and most of them have not been properly evaluated. SAM (Smart About Medications) includes the user perspective, integration between a province drug database and the pharmacist workflow in real time. Its features are not limited to maintaining a medication list through manual entry. Conclusion We can conclude after evaluation that the application is usable and has been self-perceived as easy to use by end-users. Future studies are required to assess the health benefits associated with its use.
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Affiliation(s)
- Santiago Márquez Fosser
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Nadar Mahmoud
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Bettina Habib
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Daniala L Weir
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Fiona Chan
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Rola El Halabieh
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Jeanne Vachon
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Manish Thakur
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Thai Tran
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | | | - André Bonnici
- Pharmacy Department, McGill University Health Centre, Montreal, Canada
| | - David L Buckeridge
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montréal, Canada
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11
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Li W, Liu W, Liu S, Li J, Wang W, Li K. Perceptions of patients with chronic obstructive pulmonary disease towards telemedicine: A qualitative systematic review. Heart Lung 2021; 50:675-684. [PMID: 34107391 DOI: 10.1016/j.hrtlng.2021.03.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are some qualitative studies on the views of patients with chronic obstructive pulmonary disease (COPD) on telemedicine, however, there are few related qualitative systematic reviews. OBJECTIVES To systematically review and synthesize qualitative studies involving the perceptions of patients with COPD about telemedicine to understand patients' attitudes and expectations for telemedicine and determine the obstacles and stimulus in the use of telemedicine. METHODS We searched PubMed, Web of Science, MEDLINE, Embase and CINAHL for articles published from January 2000 to December 2020. The data were analysed using thematic synthesis. RESULTS We included 20 articles involving 19 studies and 301 patients, and we identified four themes: perceived ease of use, perceived usefulness, perceived difficulty of use, and perceived uselessness. We found that although patients have different views on telemedicine, most of them have a positive attitude towards it. CONCLUSIONS The synthesis of views will help us determine the factors that promote or hinder the application of telemedicine and guide the design and implementation of telemedicine in the future.
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Affiliation(s)
- Wenshuo Li
- School of Nursing, Jilin University, China
| | - Wei Liu
- Operation Room Department, The First Hospital of Jilin University, China
| | | | - Jing Li
- School of Nursing, Jilin University, China
| | | | - Kun Li
- School of Nursing, Jilin University, China
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12
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Chambers D, Cantrell A, Booth A. Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BackgroundIn 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice.ObjectivesTo map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions.MethodsFor the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA).ResultsA total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights.LimitationsThe research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders.ConclusionsOverall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services.Future workResearch should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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13
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Coventry PA, Blakemore A, Baker E, Sidhu M, Fitzmaurice D, Jolly K. The Push and Pull of Self-Managing Mild COPD: An Evaluation of Participant Experiences of a Nurse-Led Telephone Health Coaching Intervention. QUALITATIVE HEALTH RESEARCH 2019; 29:658-671. [PMID: 30501475 DOI: 10.1177/1049732318809679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Health coaching is a novel population intervention to support self-management but it is untested in people with mild disease. People with chronic obstructive pulmonary disease with mild dyspnea are a population excluded from supported self-management and whose illness might progress without intervention. We explored participants' experiences about how health coaching motivated behavior change. Interviews were conducted with 21 intervention and 10 control participants at 6 months, and 20 intervention participants at 12 months. Participants were identified from a randomized controlled trial of telephone health coaching. Data were analyzed using the framework method. Participants positively enacted behavior change to become more physically active. Participants took advantage of environmental affordances to pull themselves toward activity targets, or relied on being pushed to be more active by the health coach or significant others. Behavior change was maintained where efforts to be more active were built into the everyday lifeworld of participants.
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Affiliation(s)
| | - Amy Blakemore
- 2 The University of Manchester, Manchester, United Kingdom
| | | | | | | | - Kate Jolly
- 3 University of Birmingham, Birmingham, United Kingdom
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14
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Conway CM, Kelechi TJ. Digital Health for Medication Adherence in Adult Diabetes or Hypertension: An Integrative Review. JMIR Diabetes 2017; 2:e20. [PMID: 30291093 PMCID: PMC6238839 DOI: 10.2196/diabetes.8030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/02/2017] [Accepted: 07/02/2017] [Indexed: 01/15/2023] Open
Abstract
Background Optimal management of chronic diseases, such as type 2 diabetes and hypertension, often include prescription medications. Medication adherence (MA) is one component of self-management. Optimization through digital health—eHealth and mHealth—could enhance patient awareness and/or communication between the patient and provider. Objective Medication adherence is a major issue that affects 50%-60% of chronically ill adults. Digital health refers to eHealth and mHealth, collectively, and as these technologies become more accessible, remote health delivery is increasingly available as an adjunct to improve medication adherence; communicate with patients and providers; and provide education to patients, families, and communities. The objective of this integrative review was to examine the types of digital health technologies that targeted medication adherence in the adult population with diabetes or hypertension. Methods An integrative review was conducted using databases within EBSCOhost, PubMed, and Scopus. Eligible studies available as of September 2016 had to be written in English, had to contain digital health interventions to improve medication adherence to prescription medications in adults 18 years or older, and had to focus on diabetes or hypertension. Results Of the 337 located studies, 13 (3.9%) used a digital health intervention for medication adherence to prescribed medications for diabetes or hypertension and were assessed according to the Chronic Care Model. Conclusions The 13 studies included in this review found no conclusive evidence of improved medication adherence using digital health interventions such as interactive voice response (IVR), short message service (SMS) text messaging, telemonitoring, and interactive software technology. Among the 13 studies were digital health interventions that foster medication adherence via one-way communication to the patient or two-way communication between the patient and health care provider for adjunct medication adherence strategies. More research is needed to determine which digital health interventions are most beneficial for individuals with diabetes or hypertension.
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Affiliation(s)
- Cheryl Moseley Conway
- School of Nursing, Western Carolina University, Cullowhee, NC, United States.,College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Teresa J Kelechi
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
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15
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Patel N, Belcher J, Thorpe G, Forsyth NR, Spiteri MA. Measurement of C-reactive protein, procalcitonin and neutrophil elastase in saliva of COPD patients and healthy controls: correlation to self-reported wellbeing parameters. Respir Res 2015; 16:62. [PMID: 26018813 PMCID: PMC4451749 DOI: 10.1186/s12931-015-0219-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/09/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Saliva is increasingly promoted as an alternative diagnostic bio-sample to blood; however its role in respiratory disease requires elucidation. Our aim was to investigate whether C-reactive protein (CRP), procalcitonin (PCT) and neutrophil elastase (NE) could be measured in unstimulated whole saliva, and to explore differences between COPD patients and controls with normal lung function. We also determined the relationship between these salivary biomarkers and self-reported COPD-relevant metrics. METHODS Salivary CRP, PCT and NE levels were measured at each of 3 visits over a 14-day period alongside spirometry and a daily self-assessment dairy in 143 subjects: 20 never-smokers and 25 smokers with normal spirometry; 98 COPD patients [GOLD Stage I, 16; Stage II, 32; Stage III, 39; Stage IV, 11]. Twenty-two randomly selected subjects provided simultaneous blood samples. RESULTS Levels of each salivary biomarker could distinguish between the above cohorts. Significant differences remained for salivary CRP and NE (p < 0.05) following adjustment for age, gender, sampling time, gum disease and total co-morbidities; but not for BMI except for salivary NE, which remained higher in smokers compared to non-smokers and stable COPD subjects (p < 0.001). Patients with acute COPD exacerbations had a median increase in all 3 salivary biomarkers (p < 0.001); CRP: median 5.74 ng/ml, [interquartile range (IQR) 2.86-12.25], PCT 0.38 ng/ml, [IQR 0.22-0.94], and NE 539 ng/ml, [IQR 112.25-1264]. In COPD patients, only salivary CRP and PCT levels correlated with breathing scores (r = 0.14, p < 0.02; r = 0.13, p < 0.03 respectively) and sputum features but not with activities of daily living. Salivary CRP and PCT concentrations strongly correlated with serum counterparts [r = 0.82, (95% CI: 0.72-0.87), p < 0.001 by Spearman's; and r = 0.53, (95% CI: 0.33-0.69), p < 0.006 respectively]; salivary NE did not. CONCLUSIONS CRP, PCT and NE were reliably and reproducibly measured in saliva, providing clinically-relevant information on health status in COPD; additionally NE distinguished smoking status. All 3 salivary biomarkers increased during COPD exacerbations, with CRP and PCT correlating well with patient-derived clinical metrics. These results provide the conceptual basis for further development of saliva as a viable bio-sample in COPD monitoring and exacerbation management.
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Affiliation(s)
- Neil Patel
- Department of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Ground Floor, Trent Building, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK.
| | - John Belcher
- School of Computing and Mathematics, Keele University, Stoke-on-Trent, Staffordshire
| | - Gary Thorpe
- Department of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Ground Floor, Trent Building, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK
| | - Nicholas R Forsyth
- Institute of Science and Technology Medicine, Keele University, Stoke-on-Trent, Staffordshire
| | - Monica A Spiteri
- Department of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Ground Floor, Trent Building, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK
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