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Viggers HE, Ingham TR, Chapman RB, Crane J, Currie AB, Davies C, Keall M, Howden-Chapman PL. Impact of a Heating Voucher on Health Outcomes in COPD Patients: A Randomised Controlled Trial. Int J Chron Obstruct Pulmon Dis 2025; 20:1097-1109. [PMID: 40260082 PMCID: PMC12010073 DOI: 10.2147/copd.s483194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 03/07/2025] [Indexed: 04/23/2025] Open
Abstract
Purpose Aotearoa New Zealand (NZ) homes are cold by international standards, with many failing to achieve temperatures recommended by WHO housing and health guidelines. Despite strong evidence of seasonal exacerbations in Chronic Obstructive Pulmonary Disease (COPD), there has been little examination of the effect of household warmth, or housing quality on COPD outcomes. The Warm Homes for Elder New Zealanders (WHEZ) study aimed to see if subsidising electricity costs would improve the health outcomes of older people with COPD. Previous analysis showed a modest, typically 2-10% dependent on prior usage, increase in electricity use among the subsidised households. Patients and Methods Participants aged over 55 with doctor-diagnosed COPD were recruited from three regional centres, and where possible their dwelling was insulated after enrolment. A single-blinded randomised controlled trial of the effect of an electricity voucher (NZ$500) on health care usage during winter was carried out in three locations across New Zealand. The primary outcome was exacerbations treated with antibiotics, and/or corticosteroids. The Clinical Trial Registration is NCT01627418. Of the 520 participants assigned to a wave, partial or better data was achieved for 424; 215 of those were randomised to the early intervention group, and 209 to receive the intervention later. Results Despite the modest increase in energy use by study households, reported previously, there was no significant difference between study arms in the frequency of exacerbation of COPD (0.089, p=0.5875, 95% CI -1.406-1.584) nor hospitalisations. An exploratory analysis suggested a lower mortality among participants assigned to receive the intervention first (OR 0.310, p=0.0175, 95% CI 0.118-0.815). Conclusion This study showed little effect of winter electricity vouchers on exacerbations of COPD. However, such vouchers increased energy use and may have reduced overall mortality. A larger study, particularly with susceptible subpopulations, is recommended to examine this mortality impact further.
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Affiliation(s)
| | | | | | - Julian Crane
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Ann Beatrice Currie
- Community and Public Health, Canterbury District Health Board, Christchurch, New Zealand
| | - Cheryl Davies
- Tū Kotahi Māori Asthma Trust, Lower Hutt, New Zealand
| | - Michael Keall
- Department of Public Health, University of Otago, Wellington, New Zealand
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O'Connor L, Wang B, Ye Z, Behar S, Tarrant S, Stamegna P, Pretz C, Soni A. Evaluation of an Integrated Digital and Mobile Intervention for COPD Exacerbation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.02.13.25322246. [PMID: 39990547 PMCID: PMC11844591 DOI: 10.1101/2025.02.13.25322246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and healthcare utilization, with frequent exacerbations contributing to emergency department visits and hospitalizations. This study evaluates a multimodal, community-based digital health intervention's association with changes in acute care utilization among patients with COPD to develop preliminary estimates of intervention effects. Methods In this decentralized, nonrandomized pilot clinical trial, participants with moderate to severe COPD were offered biometric monitoring, symptom tracking, on-demand MIH services, and a digital pulmonary rehabilitation program. Outcomes were compared between intervention participants and a weighted synthetic control group using full optimal matching. Weighted odds ratios derived from regression models were used to estimate intervention effect size. The primary outcome was hospitalization during the study period. Secondary outcomes included 30 and 90-day readmission rates, emergency department visits, and hospital length of stay. Results In total, 88 participants from the intervention arm (mean age 67, 50% female) were compared to a weighted synthetic control of 14,492 participants (weighted mean age 66, 48.7% female). We observed that participants in the intervention arm had a trend toward decreased hospitalization with an OR of 0.69 (CI 0.44-1.03, p=0.066). The intervention was also associated with 61% decreased odds of 30-day readmission after an index admission compared to controls (OR: 0.39, 95% CI: 0.16-0.95, p = 0.04). Trends toward reductions in ED visits and hospital length of stay were also observed. Conclusions A combined digital and mobile health approach to COPD management was associated with reductions in acute care utilization. These findings support further investigation into hybrid care models to enhance COPD self-management and improve patient outcomes. Future research should evaluate scalability, cost-effectiveness, and long-term clinical impact.
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Voulgareli I, Antonogiannaki EM, Bartziokas K, Zaneli S, Bakakos P, Loukides S, Papaioannou AI. Early Identification of Exacerbations in Patients with Chronic Obstructive Pulmonary Disease (COPD). J Clin Med 2025; 14:397. [PMID: 39860403 PMCID: PMC11765565 DOI: 10.3390/jcm14020397] [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: 12/04/2024] [Revised: 01/05/2025] [Accepted: 01/08/2025] [Indexed: 01/27/2025] Open
Abstract
Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) have a substantial effect on overall disease management, health system costs, and patient outcomes. However, exacerbations are often underdiagnosed or recognized with great delay due to several factors such as patients' inability to differentiate between acute episodes and symptom fluctuations, delays in seeking medical assistance, and disparities in dyspnea perception. Self-management intervention plans, telehealth and smartphone-based programs provide educational material, counseling, virtual hospitals and telerehabilitation, and help COPD patients to identify exacerbations early. Moreover, biomarkers such as blood eosinophil count, fibrinogen, CRP, Serum amyloid A(SAA),together with imaging parameters such as the pulmonary artery-to-aorta diameter ratio, have emerged as potential predictors of exacerbations, yet their clinical utility is limited by variability and lack of specificity. In this review, we provide information regarding the importance of the early identification of exacerbation events in COPD patients and the available methods which can be used for this purpose.
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Affiliation(s)
- Ilektra Voulgareli
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (I.V.); (E.-M.A.); (S.L.)
| | - Elvira-Markela Antonogiannaki
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (I.V.); (E.-M.A.); (S.L.)
| | | | - Stavrina Zaneli
- 1st Respiratory Medicine Department, “Sotiria” Chest Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (S.Z.); (P.B.); (A.I.P.)
| | - Petros Bakakos
- 1st Respiratory Medicine Department, “Sotiria” Chest Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (S.Z.); (P.B.); (A.I.P.)
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, “Attikon” University Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (I.V.); (E.-M.A.); (S.L.)
| | - Andriana I. Papaioannou
- 1st Respiratory Medicine Department, “Sotiria” Chest Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (S.Z.); (P.B.); (A.I.P.)
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Melloul A, Freund O, Tiran B, Perluk TM, Golan N, Kleinhendler E, Gershman E, Unterman A, Elis A, Bar-Shai A. Respiratory Specialist Visits Before Admissions with COPD Exacerbation are Linked to Improved Management and Outcomes. Int J Chron Obstruct Pulmon Dis 2024; 19:2387-2396. [PMID: 39525519 PMCID: PMC11549881 DOI: 10.2147/copd.s491447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024] Open
Abstract
Purpose Exacerbations of COPD (ECOPD) significantly impact disease progression and mortality. Visiting a respiratory specialist (RS) in proximity to the exacerbation may lead to prompt treatment and improved outcomes. We aimed to evaluate the association between an RS visit 30-days before admission and exacerbation outcomes. Patients and methods The prospective study included subjects that were hospitalized with ECOPD between 2017 and 2019 in 13 medical centers. Pre-admission, in-hospital, and 30-day outcomes were assessed and compared between patients with and without a 30-day RS visit, using propensity score matching. A sub-group analysis was performed based on the reason for the RS visit (emergent vs regular follow-up). Results Three hundred and forty-four subjects were included, and 105 (31%) had pre-admission RS visit (RS group). Before matching, indicators of severe COPD were prevalent in the RS group, while after matching there were no differences. RS visits were associated with pre-hospital initiation of short acting bronchodilators (50% vs 36%), antibiotics (30% vs 17%), and systemic steroids (38% vs 22%). The RS group had longer duration between first symptoms to hospital arrival (median 5 vs 3 days, p < 0.01) and shorter hospital length-of-stay (median 4 vs 5 days, p = 0.04). In-hospital and 30-days outcomes were similar between the groups. However, a non-emergent pre-hospital RS visit was associated with improved in-hospital and 30-day outcomes. Conclusion Routine RS visits could lead to correct and early treatment for ECOPD with a potential for improved outcomes. These findings highlight the need for available specialists and higher awareness.
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Affiliation(s)
- Ariel Melloul
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Freund
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Tiran
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Moshe Perluk
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Netanel Golan
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Kleinhendler
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Evgeni Gershman
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Unterman
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishay Elis
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine C, Rabin Medical Center, Petach Tikva, Israel
| | - Amir Bar-Shai
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Choi JY, Ryu EJ. Factors Associated with Non-Adherence to Self-Management Among Patients with Chronic Obstructive Pulmonary Disease: A Survey Using the Delphi Technique and Analytic Hierarchy Process. Int J Chron Obstruct Pulmon Dis 2024; 19:1247-1259. [PMID: 38854589 PMCID: PMC11162182 DOI: 10.2147/copd.s451332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Background The relevant factors and patterns of non-adherence to self-management among patients with chronic obstructive pulmonary disease (COPD) need to be elucidated to improve self-management. Purpose This study was a survey to prioritize the relevance of factors associated with non-adherence to COPD self-management using the Delphi technique and analytic hierarchy process (AHP). Patients and Methods A total of 15 expert panels were established to determine the priority of relevant factors in a three-round Delphi survey and an AHP. To develop the preliminary conceptual framework for non-adherence to COPD self-management, findings from a systematic literature review, a qualitative study using in-depth interviews with COPD patients, and the first round of the Delphi survey were integrated. Based on the preliminary framework, the content validity ratio (CVR) was analyzed to examine the consensus among expert panels in the second and third rounds of the Delphi survey, and the relative weight was determined by pairwise comparisons between alternative factors in the AHP. Results In developing the preliminary conceptual framework, 8 factor categories and 53 factors were identified as relevant to non-adherence to COPD self-management. Of the 53 factors, 22 factors with a CVR of 0.49 or higher were identified in the Delphi survey. A total of 14 of the 53 factors were common to both the Delphi survey and AHP with high weights. The most notable factors were prolonged treatment, experience of treatment failure, and unknown effects of medication. Conclusion Through consensus decision-making by experts, 14 factors were identified as relevant factors associated with non-adherence to COPD self-management. A hierarchical and systematic framework incorporating factors associated with non-adherence to COPD self-management was developed in this study. Further research is needed to develop intervention strategies based on factors associated with non-adherence to COPD self-management.
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Affiliation(s)
- Ja Yun Choi
- College of Nursing, Chonnam National University, Chonnam Research Institute of Nursing Science, Gwangju, Republic of Korea
| | - Eui Jeong Ryu
- Department of Nursing, Dongshin University, Naju, Republic of Korea
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Liao LY, Chen KM, Cheng HR, Hsu HF. Factors of Influence on Diabetes Awareness in Older People With Chronic Obstructive Pulmonary Disease Comorbid With Type 2 Diabetes Mellitus. J Nurs Res 2024; 32:e323. [PMID: 38488165 DOI: 10.1097/jnr.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of mortality in this population. PURPOSE This study was designed to investigate the predictive factors of diabetes awareness (DA), including diabetes knowledge (DK), and diabetes care behaviors (DCB) among older people with both COPD and T2DM. METHODS This was a cross-sectional descriptive correlation study. One hundred thirty-three older-age patients with COPD comorbid with T2DM receiving treatment at a chest hospital were enrolled as participants. Both DK and DCB were utilized to measure DA. The Diabetes Knowledge Questionnaire was utilized to measure DK, and the Summary of Diabetes Self-Care Activities was used to evaluate DCB. RESULTS The average glycated hemoglobin (HbA1c) was 7.68% ( SD = 1.55%), with 74 (55.6%) participants having a level > 7%. The average DA was 46.46% ( SD = 13.34%), the average DK was 53.42% ( SD = 18.91%), and the average DCB was 39.50% ( SD = 16.66%). In terms of demographic variables, age, diabetes education, diabetes shared care, and HbA1c were all significantly associated with DA, DK, and DCB (all p s < .05). The overall variance in DA was significantly explained by diabetes education and HbA1c (all p s < .05). The overall variance in DK was significantly explained by age, diabetes education, and HbA1c. The overall variance in DCB was significantly explained by diabetes education and HbA1c (all p s < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE Our study findings indicate that older adult patients with COPD comorbid with T2DM are at elevated risks of poor glycemic control and low DA. Healthcare professionals should be aware of these issues and develop appropriate DA plans to prevent poor glycemic control in this population. Providing accurate information on diabetes to older adults with COPD comorbid with T2DM is important to improving their DK and promoting better DCB.
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Affiliation(s)
- Lin-Yu Liao
- PhD, RN, Head Nurse, Department of Nursing, Chest Hospital, Ministry of Health and Welfare, Taiwan
| | - Kuei-Min Chen
- PhD, RN, FAAN, Professor, College of Nursing, Center for Long-Term Care Research, Kaohsiung Medical University, and Department of Medical Research, Kaohsiung Medical University Hospital, Taiwan
| | - Hsiu-Rong Cheng
- PhD, RN, Associate Professor, Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Hui-Fen Hsu
- PhD, Postdoctoral Fellow, College of Nursing, Kaohsiung Medical University, Taiwan
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Mekhuri S, Quach S, Barakat C, Sun W, Nonoyama ML. A cross-sectional survey on the effects of ambient temperature and humidity on health outcomes in individuals with chronic respiratory disease. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:256-269. [PMID: 38084109 PMCID: PMC10710831 DOI: 10.29390/001c.90653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/20/2023] [Indexed: 09/16/2024]
Abstract
Rationale Extremes of temperature and humidity are associated with adverse respiratory symptoms, reduced lung function, and increased exacerbations among individuals living with chronic obstructive pulmonary disease (COPD). Objectives To describe the reported effects of temperature and humidity extremes on the health outcomes, health status and physical activity (PA) in individuals living with COPD. Methods A cross-sectional self-reported survey collected the effects on health status (COPD Assessment Test [CAT]), PA, and health outcomes in 1) moderate/ideal (14 to 21°C, 30 to 50% relative humidity [RH]), 2) hot and humid (≥ 25°C, > 50% RH) and 3) cold and dry (≤ 5°C, < 30% RH) weather conditions. Participants were ≥ 40 years old with COPD or related chronic respiratory diseases (e.g., asthma, sleep apnea, interstitial lung disease, lung cancer) and residing in Canada for ≥ 1 year. Negative responders to weather extremes were a priori defined as having a change of ≥ 2 points in the CAT. Main Results Thirty-six participants responded; the mean age (SD) was 65 (11) years, and 23 (64%) were females. Compared to ideal conditions, 23 (66%) and 24 (69%) were negatively affected by cold/dry and hot/humid weather, respectively. Health status was significantly lower, and PA amount and difficulty level were reduced in hot/humid and cold/dry conditions compared with ideal conditions. The number of exacerbations in hot/humid was significantly higher compared to ideal conditions. Conclusions More participants were negatively affected by extremes of weather: health status worsened, PA decreased, and frequency of exacerbations was higher compared to ideal. Future prospective studies should directly and objectively investigate different combinations of extreme temperature and humidity levels on symptoms and PA to understand their long-term health outcomes.
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Affiliation(s)
| | - Shirley Quach
- Respiratory Therapy Department & Child Health Evaluative SciencesHospital for Sick Children
- School of Rehabilitation ScienceMcMaster University
| | | | - Winnie Sun
- Faculty of Health SciencesOntario Tech University
- dvancement for Dementia Care Centre (ADCC)Ontario Shores Centre for Mental Health Sciences
| | - Mika L Nonoyama
- Faculty of Health SciencesOntario Tech University
- Respiratory Therapy Department & Child Health Evaluative SciencesHospital for Sick Children
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Chang EM, Chen LS, Li YT, Chen CT. Associations Between Self-Management Behaviors and Psychological Resilience in Patients With COPD. Respir Care 2023; 68:511-519. [PMID: 36854468 PMCID: PMC10173111 DOI: 10.4187/respcare.10416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND COPD is a common but irreversible disease. Nevertheless, patients with COPD can maintain good quality of life through psychological resilience and effective self-management. However, limited studies have investigated the relationship between self-management behaviors and resilience in patients with COPD. Thus, the present study aimed to determine the factors associated with self-management behaviors and resilience among patients with COPD. METHODS A total of 100 subjects with COPD were recruited from a medical center in northern Taiwan from February 2020 to January 2021. Each subject completed a questionnaire based on the 20-item COPD Self-Management Scale and 25-item Resilience Scale through a face-to-face interview. A multiple linear regression model that controlled for sociodemographic and clinical factors was used to examine the relationship between self-management behaviors and resilience. RESULTS Analysis of our data indicated that differences in educational level, smoking status, religion, modified Medical Research Council dyspnea scale score, degree of COPD impacting wellbeing, number of COPD-related hospitalizations within 1 year, and self-reported comorbidities were associated with differences in self-management and resilience scores. The GOLD (Global Initiative for Chronic Obstructive Lung Disease) D group had the lowest scores for self-management and resilience among GOLD groups A, B, C, and D. Self-management and resilience were positively correlated (r = 0.703, P < .001). In the linear regression model, a better self-management value was associated with a higher resilience score (β = 0.749, P < .001), whereas an increasing resilience score was also associated with a better self-management score (β = 0.461, P < .001). CONCLUSIONS This study revealed that self-management and psychological resilience were positively correlated and associated in our linear regression model. Future work may focus on finding the causative relationship between self-management and resilience among patients with COPD.
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Affiliation(s)
- En-Ming Chang
- Department of Long-Term Care, National Taipei University of Nursing and Health Science, Taipei City, Taiwan
- Department of Respiratory Care, Shin Kong Wu Ho Su Memorial Hospital, Taipei City, Taiwan
| | - Li-Sheng Chen
- Department of Respiratory Therapy, Georgia State University, Atlanta, Georgia
| | - Yang-Tzu Li
- Department of Long-Term Care, National Taipei University of Nursing and Health Science, Taipei City, Taiwan
| | - Chi-Tsung Chen
- Department of Respiratory Care, Shin Kong Wu Ho Su Memorial Hospital, Taipei City, Taiwan.
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Quach S, Veitch A, Zaccagnini M, West A, Nonoyama ML. Underrepresentation of Respiratory Therapists as Experts in Delphi Studies on Respiratory Practices and Research Priorities. Respir Care 2022; 67:1609-1632. [PMID: 36442987 PMCID: PMC9994035 DOI: 10.4187/respcare.10012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Delphi survey techniques are a common consensus method used to collect feedback from an expert panel to inform practices, establish guidelines, and identify research priorities. Collecting respiratory therapists' (RT) expertise and experiences as part of consensus-building methodologies is one way to ensure that they align with RT practices and to better influence respiratory care practice. This narrative review aimed to report the RT representation in expert panels of Delphi studies focused on respiratory therapy practices and research priorities. The research question that guided this review is: to what extent are RTs included as expert participants among published Delphi studies relate to respiratory therapy and research topics? We conducted a structured search of the literature and identified 23 papers that reported Delphi studies related to respiratory care practices and 15 that reported on respiratory-related research priorities. Delphi studies that focused on reporting consensus on respiratory care practices included the following: (1) mechanical ventilation, (2) high-flow nasal cannula therapy, (3) COVID-19 respiratory management, (4) home oxygen therapy, (5) cardiopulmonary monitoring, and (6) disease-specific guidelines. Delphi studies that focused on establishing respiratory research priorities included the following: (1) theory and practice-orientated knowledge gaps, and (2) priority research topics for empirical investigation. The results of this review suggest that RTs were rarely included as expert participants and, when involved, were minimally represented (5% to 33%). Given RTs' diverse and relevant experience in respiratory care, incorporating their perspectives to inform future education, respiratory care practices, and research priorities would allow evidence to better align with knowledge gaps deemed important for the respiratory therapy profession.
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Affiliation(s)
- Shirley Quach
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Respiratory Therapy Department, Hospital of Sick Children, Toronto, Ontario, Canada
| | - Alanna Veitch
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Marco Zaccagnini
- School of Physical and Occupational Therapy, McGill University, Montréal, Quebec, Canada
- Department Respiratory Therapy, McGill University Health Centre, Montréal, Quebec, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, New Brunswick, Canada
| | - Mika L Nonoyama
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.
- Respiratory Therapy Department, Hospital of Sick Children, Toronto, Ontario, Canada
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ten Cate D, Schuurmans MJ, van Eijk J, Bell JJ, Schoonhoven L, Ettema RGA. Factors Influencing Nurses' Behavior in Nutritional Care for Community-Dwelling Older Adults Before, During, and After Hospitalization: A Delphi Study. J Contin Educ Nurs 2022; 53:545-556. [DOI: 10.3928/00220124-20221107-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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de Campos Medeiros J, da Silva ÁC, Corso Pereira M. Monitoring daily symptoms and (self-reported) exacerbations in patients with bronchiectasis: a prospective study. Multidiscip Respir Med 2022; 17:859. [PMID: 36545495 PMCID: PMC9761409 DOI: 10.4081/mrm.2022.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Exacerbations are pivotal events in the natural history of patients with non-cystic fibrosis bronchiectasis (NCFB), since they have a negative impact on the functional evolution of these individuals. The daily symptoms of patients with NCFB show great variability, which negatively affects their self-perception of symptoms and exacerbations. The aim of this study was to identify daily symptoms in patients with NCFB, and to investigate whether there is a correlation between the frequency of self-reported exacerbations and events defined according to the criteria established in the literature to define exacerbation in bronchiectasis. Methods This observational and prospective study was carried out in outpatient clinics of a Brazilian public university hospital. Over 24 weeks, patients completed a diary in which daily symptoms, self-reported exacerbations, and demands for medical care for respiratory symptoms were recorded. The instrument used (diary and symptom scores ranging from 0 to 12) were developed by the researchers. The participants also answered questionnaires mMRC, Leicester's, and St. George's Respiratory (SGRQ). Results Twenty-eight patients returned the diary, their mean age was 54 years, and 50% out of them were classified as mild by the FACED score. Cough (64%) and expectoration (62%) were the most frequent symptoms. Correlations were found between the stability score and the mMRC (r=0.4727, p=0.011) and SGRQ (r=0.6748, p<0.0001) questionnaires. The number of self-perceived exacerbations (24) was significantly lower than exacerbations using the exacerbation consensus (63) (p<0.01). Additionally, no correlation was found between these two criteria. Conclusions There was great variability of symptoms among the individuals sampled, and even for the same individual, over time. Patients had low self-perception of exacerbations, which suggests that strategies aimed at improving this self-perception may contribute to the early detection of exacerbations.
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Affiliation(s)
- Jéssica de Campos Medeiros
- Rua Patativa, número 170 bloco D AP 34, Vila Teixeira, Campinas, SP, CEP 13034810, Brazil. Tel. +55.019.989976074.
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Dang Y, Wang R, Qian K, Lu J, Zhang Y. Clinical and radiomic factors for predicting invasiveness in pulmonary ground‑glass opacity. Exp Ther Med 2022; 24:685. [PMID: 36277144 PMCID: PMC9533109 DOI: 10.3892/etm.2022.11621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with preinvasive or invasive pulmonary ground-glass opacity (GGO) often face different clinical treatments and prognoses. The present study aimed to identify the invasiveness of pulmonary GGO by analysing clinical and radiomic features. Patients with pulmonary GGOs who were treated between January 2014 and February 2019 were included. Clinical features were collected, while radiomic features were extracted from computed tomography records using the three-dimensional Slicer software. Predictors of GGO invasiveness were selected by least absolute shrinkage and selection operator logistic regression analysis, and receiver operating characteristic (ROC) curves were drawn for each prediction model. A total of 194 patients with pulmonary GGOs were included in the present study. The maximum diameter of the solid component, waveletHLL_ngtdm_Coarseness (P=0.03), waveletLHH_firstorder_Maximum (P<0.01) and waveletLLH_glrlm_LongRunEmphasis (P<0.01) were significant predictors of invasive lung GGOs. The area under the ROC curve (AUC) for the prediction models of clinical features and radiomic features was 0.755 and 0.719, respectively, whereas the AUC for the combined prediction model was 0.864 (95% CI, 0.802-0.926). Finally, a nomogram was established for individualized prediction of invasiveness. The combination of radiomic and clinical features can enable the differentiation between preinvasive and invasive GGOs. The present results can provide some basis for the best choice of treatment in patients with lung GGOs.
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Affiliation(s)
- Yutao Dang
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
- Department of Thoracic Surgery, Shijingshan Hospital of Beijing City, Shijingshan Teaching Hospital of Capital Medical University, Beijing 100040, P.R. China
| | - Ruotian Wang
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Kun Qian
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Yi Zhang
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
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Deep Learning-Based Computed Tomography Features in Evaluating Early Screening and Risk Factors for Chronic Obstructive Pulmonary Disease. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5951418. [PMID: 36051929 PMCID: PMC9410847 DOI: 10.1155/2022/5951418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/18/2022]
Abstract
This research aimed to investigate the diagnostic effect of computed tomography (CT) images based on a deep learning double residual convolution neural network (DRCNN) model on chronic obstructive pulmonary disease (COPD) and the related risk factors for COPD. The questionnaire survey was conducted among 980 permanent residents aged ≥ 40 years old. Among them, 84 patients who were diagnosed with COPD and volunteered to participate in the experiment and 25 healthy people were selected as the research subjects, and all of them underwent CT imaging scans. At the same time, an image noise reduction model based on the DRCNN was proposed to process CT images. The results showed that 84 of 980 subjects were diagnosed with COPD, and the overall prevalence of COPD in this epidemiological survey was 8.57%. Multivariate logistic regression model analysis showed that the regression coefficients of COPD with age, family history of COPD, and smoking were 0.557, 0.513, and 0.717, respectively (P < 0.05). The diagnostic sensitivity, specificity, and accuracy of DRCNN-based CT for COPD were greatly superior to those of single CT and the difference was considerable (P < 0.05). In summary, advanced age, family history of COPD, and smoking were independent risk factors for COPD. CT based on the DRCNN model can improve the diagnostic accuracy of simple CT images for COPD and has good performance in the early screening of COPD.
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14
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ALHarbi ER, Wazqar DY, Sofar SM. A quasi-experimental study of the effect of a comprehensive blended health educational program on self-management practices among patients with chronic obstructive pulmonary disease. Heart Lung 2022; 56:133-141. [PMID: 35901603 DOI: 10.1016/j.hrtlng.2022.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence and illness burden of chronic obstructive pulmonary disease (COPD) are both high. Currently, limited guidance is available to support the establishment of effective health programs to increase self-management practices in patients with COPD. OBJECTIVES To explore the effect of a comprehensive blended health education program on self-management practices in patients with mild-to-moderate COPD in Jeddah City, Saudi Arabia. METHODS A quasi-experimental research study was carried out with a convenience sample of 60 discharged or stable patients with COPD following treatment. Participants were divided into an intervention group (n = 30) that received usual hospital care and blended health education program, and a control group (n = 30) that obtained the usual hospital care without involvement in the health education program from May 2021- to August 2021. Data were collected before and three months after the intervention using the COPD Self-Management Scale and patient socio-demographic and clinical information surveys. RESULTS Statistically significant differences were found between the control and intervention groups after three months of the intervention based on total COPD Self-Management Scale scores. There were no statistically significant relationships between the participants' mean COPD Self-Management Scale scores in both groups with their socio-demographic and clinical characteristics before and after the intervention. CONCLUSIONS A nurse-led, comprehensive blended health education program was found to be an effective method for improving COPD patients' self-management practices. COPD nurses and nurse researchers must collaborate to identify the most common interventions with the best cost/benefit ratios and greater positive effects on early COPD patients' self-management practices and general well-being.
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Affiliation(s)
- Eman Rashed ALHarbi
- Graduate Student, Department of Medical Surgical Nursing, Faculty of Nursing, King Abdulaziz University, P. O. Box 24828, Jeddah 21551, Saudi Arabia
| | - Dhuha Youssef Wazqar
- Consultant, Associate Professor of Oncology Nursing and Palliative Care, Department of Medical Surgical Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Samah Mahmoud Sofar
- Assistant Professor of Medical Surgical Nursing Department, Faculty of Nursing, Alexandria University, Egypt.
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15
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Benzo MV, Novotny P, Benzo RP. Adding Granularity of COPD Self-Management to Impact Quality of Life. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:277-284. [PMID: 35259291 PMCID: PMC9166338 DOI: 10.15326/jcopdf.2021.0277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Self-management abilities are a recognized ingredient for living well with chronic obstructive pulmonary disease (COPD), improving all outcomes. Fostering self-management requires a personalized program and patient engagement to make lifestyle decisions. While some self-management practices are proven effective, like the prompt use of a plan for COPD exacerbations, there is a guideline-recognized gap on specific self-management behaviors that can impact particular COPD symptoms and allow for tailored self-management programs. We aimed to investigate the association of well-defined self-management behaviors with the most common COPD symptoms in a large cohort of patients with COPD. METHODS We analyzed baseline data of stable COPD patients who participated in 3 National Institutes of Health-funded studies. Symptoms were defined by the 4 domains of the Chronic Respiratory Questionnaire: dyspnea-fatigue-emotions-mastery. The self-management behaviors were the individual items of the Self-Management Ability Scale-30. Lasso regression models were built to explore the association of behaviors with symptoms, adjusting for lung function and age. RESULTS We analyzed 512 stable COPD patients, 54% female, age mean (standard deviation [SD]) 69.6 (9.9) years and forced expiratory volume in 1 second percent predicted (FEV1%) 42.2 (19.0).Dyspnea was associated with exercising and self-efficacy for self-care. Emotion was associated with good relationships, self-efficacy for self-care, positivity, and participating in agreeable activities. Fatigue was associated with self-efficacy for self-care, doing exercise, and participating in agreeable activities. Mastery was associated with self-efficacy for self-care, positivity, exercising, and participating in agreeable activities. DISCUSSION Our findings provide specific self-management behaviors associated with common COPD symptoms that may inform self-management programs. Positive thinking represents a novel self-management approach to COPD emotions and mastery.
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Affiliation(s)
- Maria V Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Paul Novotny
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States
| | - Roberto P Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
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16
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Care-seeking and delay of care during COPD exacerbations. NPJ Prim Care Respir Med 2022; 32:7. [PMID: 35169140 PMCID: PMC8847354 DOI: 10.1038/s41533-022-00269-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Patients who receive earlier treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) have a better prognosis, including earlier symptom resolution and reduced risk of future emergency-department visits (ED) or hospitalizations. However, many patients delay seeking care or do not report worsening symptoms to their healthcare provider. In this study, we aimed to understand how patients perceived their breathing symptoms and identify factors that led to seeking or delaying care for an acute exacerbation of COPD. We conducted semistructured interviews with 60 individuals following a recent COPD exacerbation. Participants were identified from a larger study of outpatients with COPD by purposive sampling by exacerbation type: 15 untreated, 15 treated with prednisone and/or antibiotics in the outpatient setting, 16 treated in an urgent care or ED setting, and 14 hospitalized. Data were analyzed using inductive content analysis. Participants were primarily male (97%) with a mean age of 69.1 ± 6.9 years, mean FEV1 1.42 (±0.63), and mean mMRC dyspnea of 2.7 (±1.1). We identified 4 primary themes: (i) access and attitudinal barriers contribute to reluctance to seek care, (ii) waiting is a typical response to new exacerbations, (iii) transitioning from waiting to care-seeking: the tipping point, and (iv) learning from and avoiding worse outcomes. Interventions to encourage earlier care-seeking for COPD exacerbations should consider individuals’ existing self-management approaches, address attitudinal barriers to seeking care, and consider health-system changes to increase access to non-emergent outpatient treatment for exacerbations. Clinical Trial Registration NCT02725294
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17
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Auchus RJ, Courtillot C, Dobs A, El-Maouche D, Falhammar H, Lacroix A, Farrar M, O’Donoghue C, Anatchkova M, Cutts K, Taylor N, Yonan C, Lamotte M, Touraine P. Treatment patterns and unmet needs in adults with classic congenital adrenal hyperplasia: A modified Delphi consensus study. Front Endocrinol (Lausanne) 2022; 13:1005963. [PMID: 36465641 PMCID: PMC9717438 DOI: 10.3389/fendo.2022.1005963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is a rare autosomal recessive condition characterized by cortisol deficiency and excess androgen production. The current standard of care is glucocorticoid (GC) therapy, and sometimes mineralocorticoids, to replace endogenous cortisol deficiency; however, supraphysiologic GC doses are usually needed to reduce excess androgen production. Monitoring/titrating GC treatment remains a major challenge, and there is no agreement on assessment of treatment adequacy. This study surveyed expert opinions on current treatment practices and unmet needs in adults with classic CAH. METHODS A modified two-round Delphi process with adult endocrinologists was conducted via online questionnaire. Survey questions were organized into three categories: practice characteristics/CAH experience, GC management, and unmet needs/complications. Anonymized aggregate data from Round 1 were provided as feedback for Round 2. Responses from both rounds were analyzed using descriptive statistics. Consensus was defined a priori as: full consensus (100%, n=9/9); near consensus (78% to <100%, n=7/9 or 8/9); no consensus (<78%, n<7/9). RESULTS The same nine panelists participated in both survey rounds; five (56%) were based in North America and four (44%) in Europe. Most panelists (78%) used hydrocortisone in the majority of patients, but two (22%) preferred prednisone/prednisolone. Panelists agreed (89%) that adequate control is best evaluated using a balance of clinical presentation and androgen/precursor laboratory values; no consensus was reached on optimal timing of collecting samples for androgen testing or laboratory values indicating good control. Despite lack of consensus on many aspects of CAH management, panelists agreed on the importance of many disease- and GC-related complications, and that there is a large unmet need for new treatments. With currently available treatments, panelists reported that 46% of classic CAH patients did not have optimized androgen levels, regardless of GC dose. CONCLUSIONS The limited areas of consensus obtained in this study reflect the variability in treatment practices for adults with classic CAH, even among clinicians with expertise in treating this population. However, all panelists agreed on the need for new treatments for classic CAH and the importance of many disease- and GC-related complications, which are difficult to manage with currently available treatments.
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Affiliation(s)
- Richard J. Auchus
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, MI, United States
- *Correspondence: Richard J. Auchus,
| | - Carine Courtillot
- Department of Endocrinology and Reproductive Medicine, Center for Rare Endocrine and Gynecological Disorders, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Adrian Dobs
- Department of Medicine, Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Diala El-Maouche
- Division of Endocrinology and Metabolism, George Washington University, Washington, DC, United States
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Andre Lacroix
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Mallory Farrar
- Neurocrine Biosciences, Inc., Health Economics and Outcomes Research, San Diego, CA, United States
| | - Conor O’Donoghue
- Neurocrine Biosciences, Inc., New Product Commercialization, San Diego, CA, United States
| | | | - Katelyn Cutts
- Evidera, Patient-Centered Research, Bethesda, MD, United States
| | - Natalie Taylor
- Evidera, Patient-Centered Research, Bethesda, MD, United States
| | - Chuck Yonan
- Neurocrine Biosciences, Inc., Health Economics and Outcomes Research, San Diego, CA, United States
| | - Mark Lamotte
- IQVIA, Global Health Economics and Outcomes Research (HEOR), Zaventem, Belgium
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Center for Rare Endocrine and Gynecological Disorders, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
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18
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Bremond M, Berthelot A, Plantier L, Breton H, Pautrat M. Micro-phenomenological approach to explore the patient experience during an initial spirometry examination to diagnose COPD in general practice in France. BMJ Open 2021; 11:e049121. [PMID: 34215612 PMCID: PMC8256747 DOI: 10.1136/bmjopen-2021-049121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To explore the patient experience of a spirometry test used to confirm chronic obstructive pulmonary disease (COPD) diagnosis in patients with suspected smoking-related COPD. DESIGN This is a qualitative study, performed with open interviews in adults following a routine spirometry test to confirm COPD diagnosis. Data were analysed with a phenomenological-inspired micro-phenomenology approach. PARTICIPANTS Eligible patients were recruited through their general practitioner, 10 were interviewed. SETTING Primary care in Centre-Val-De-Loire area, France, in 2018. RESULTS Participants reported the spirometry test experience as being unfamiliar but gave meaning to the symptoms they experience. Participants expressed a desire to perform the test well and a willingness to confront their state of health. After the spirometry had been completed and the results announced, participants moved through stages of grief from their pre-spirometry self and symptom perception to a state of acceptance. Overall, participants expressed a narrative of an evolving cognitive and corporeal awareness during this spirometry experience. The verbatim quotes describe a cognitive rupture with their chronic illness usually considered as a 'way of life'. CONCLUSIONS A spirometry test goes beyond a diagnostic value, providing patients with an opportunity to gain awareness of their own state of health, reframe their breathlessness-related limitations and thus begin to accept the disease. These awareness gains may be considered as small steps towards health behavioural change. Spirometry may have educative potential and support lifestyle changes.
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Affiliation(s)
- Matthieu Bremond
- Department of Education and Training Sciences, University of Tours, Tours, France
- EA7505 EES, University of Tours, Tours, France
| | | | - Laurent Plantier
- EA7505 EES, University of Tours, Tours, France
- Department of Pulmonology and Functional Respiratory Exploration, CHRU Tours, Tours, France
- INSERM UMR 1100, University of Tours, Tours, France
| | - Hervé Breton
- Department of Education and Training Sciences, University of Tours, Tours, France
- EA7505 EES, University of Tours, Tours, France
| | - Maxime Pautrat
- EA7505 EES, University of Tours, Tours, France
- Faculty of Medicine, University of Tours, Tours, France
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Schrijver J, Effing TW, Brusse-Keizer M, van der Palen J, van der Valk P, Lenferink A. Predictors of patient adherence to COPD self-management exacerbation action plans. PATIENT EDUCATION AND COUNSELING 2021; 104:163-170. [PMID: 32616320 DOI: 10.1016/j.pec.2020.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Identifying patient characteristics predicting categories of patient adherence to Chronic Obstructive Pulmonary Disease (COPD) exacerbation action plans. METHODS Data were obtained from self-treatment intervention groups of two COPD self-management trials. Patients with ≥1 exacerbation and/or ≥1 self-initiated prednisolone course during one-year follow-up were included. Optimal treatment was defined as 'self-initiating prednisolone treatment ≤2 days from the onset of a COPD exacerbation'. Predictors of adherence categories were identified by multinomial logistic regression analysis using patient characteristics. RESULTS 145 COPD patients were included and allocated to four adherence categories: 'optimal treatment' (26.2 %), 'sub optimal treatment' (11.7 %), 'significant delay or no treatment' (31.7 %), or 'treatment outside the actual exacerbation period' (30.3 %). One unit increase in baseline dyspnoea score (mMRC scale 0-4) increased the risk of 'significant delay or no treatment' (OR 1.64 (95 % CI 1.07-2.50)). Cardiac comorbidity showed a borderline significant increased risk of 'treatment outside the actual exacerbation period' (OR 2.40 (95 % CI 0.98-5.85)). CONCLUSION More severe dyspnoea and cardiac comorbidity may lower adherence to COPD exacerbation action plans. PRACTICE IMPLICATIONS Tailored self-management support with more focus on dyspnoea and cardiac disease symptoms may help patients to better act upon increased exacerbation symptoms and improve adherence to COPD exacerbation action plans.
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Affiliation(s)
- Jade Schrijver
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.
| | - Tanja W Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
| | | | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Research Methodology, Measurement, and Data-Analysis, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, the Netherlands
| | - Paul van der Valk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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20
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Wu W, Huo Y, Ding X, Zhou Y, Gu S, Gao Y. Identification of the risks in CAR T-cell therapy clinical trials in China: a Delphi study. Ther Adv Med Oncol 2020; 12:1758835920966574. [PMID: 33149770 PMCID: PMC7580145 DOI: 10.1177/1758835920966574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Aims: Within the past few years, there has been tremendous growth in clinical trials of chimeric antigen receptor (CAR) T-cell therapies. Unlike those of many small-molecule pharmaceuticals, CAR T-cell therapy clinical trials are fraught with risks due to the use of live cell products. The aim of this study is to reach a consensus with experts on the most relevant set of risks that practically occur in CAR T-cell therapy clinical trials. Methods: A Delphi method of consensus development was used to identify the risks in CAR T-cell therapy clinical trials, comprising three survey rounds. The expert panel consisted of principal investigators, clinical research physicians, members of institutional ethics committees, and Good Clinical Practice managers. Results: Of the 24 experts invited to participate in this Delphi study, 20 participants completed Round 1, Round 2, and Round 3. Finally, consensus (defined as >80% agreement) was achieved for 54 risks relating to CAR T-cell clinical trials. Effective interventions related to these risks are needed to ensure the proper protection of subject health and safety. Conclusion: The Delphi method was successful in gaining a consensus on risks relevant to CAR T-cell clinical trials in a geographically diverse expert association. It is hoped that this work can benefit future risk-based quality management in clinical trials and can potentially promote the better development of CAR T-cell therapy products.
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Affiliation(s)
- Weijia Wu
- Department of Clinical Pharmacy and Pharmaceutical Management, School of Pharmacy, Fudan University, Shanghai, China
| | - Yan Huo
- National Institution of Food and Drug Control, National Medical Products Administration, Beijing, China
| | - Xueying Ding
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee
| | - Yuhong Zhou
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengying Gu
- Clinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Gao
- Department of Clinical Pharmacy and Pharmaceutical Management, School of Pharmacy, Fudan University, Pudong District, Shanghai, 200433, China
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21
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Jia C, Zhang C, Fang F, Huang K, Dong F, Gu X, Niu H, Li S, Wang C, Yang T. Enjoying Breathing Program: A National Prospective Study Protocol to Improve Chronic Obstructive Pulmonary Disease Management in Chinese Primary Health Care. Int J Chron Obstruct Pulmon Dis 2020; 15:2179-2187. [PMID: 32982210 PMCID: PMC7501983 DOI: 10.2147/copd.s258479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is prevalent and poses a heavy burden worldwide. However, patients know little about COPD, and primary health care providers have poor therapy capability in China. Enjoying Breathing Program aims to establish a new comprehensive COPD patient management system, including early detection, standardized therapy, and follow-up in China. The goal of the study is to 1) describe the intervention for physicians and patients and 2) to assess the effectiveness of this program. Methods It is the first nationwide trial involving all levels of health care institutions from primary health care institutions to tertiary hospitals. It includes a series of structured but individualized intervention for both health care providers and COPD patients. Primary health care providers from pilot hospitals will take both online and face-to-face courses, including the procedure of COPD patients’ management and prevention, diagnosis and treatment. Once the patients are diagnosed with COPD, they will undertake standard therapy and self-management education program, perform rehabilitation exercises, and be followed up by primary health care providers every 3 months. The primary outcome will be exacerbation-related hospital/emergency admission and the change of patients’ awareness and primary health care providers’ knowledge of COPD within 36 months. Secondary outcome will include the change of pulmonary function test, structured COPD patients’ management, two-way referral, and standardized therapy. Conclusion A comprehensive COPD patient management model to promote the standardized therapy will be established; this will improve COPD patients’ awareness and health quality. Trial Registration Number This study has been registered at www.ClinicalTrials.gov (registration identifier: NCT04318912).
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Affiliation(s)
- Cunbo Jia
- Department of Health Reform and Development, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Chunyu Zhang
- Department of Health Reform and Development, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Fang Fang
- Department of Health Reform and Development, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Fen Dong
- Data Platform, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Xiaoying Gu
- Data Platform, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Hongtao Niu
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Shan Li
- School of Management, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, People's Republic of China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, People's Republic of China
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22
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Öztürk BÖ, Alpaydın AÖ, Özalevli S, Güler N, Cimilli C. Self-Management Training in Chronic Obstructive Lung Disease Improves the Quality of Life. Turk Thorac J 2020; 21:266-273. [PMID: 32687788 DOI: 10.5152/turkthoracj.2019.19015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 08/31/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Management of chronic obstructive pulmonary disease (COPD) includes interventions such as improving skills in coping with the disease. We aimed to examine the effect of self-management training on the quality of life and functional parameters in patients with moderate to severe COPD. MATERIALS AND METHODS Sixty-one consecutive patients with COPD were recruited in the study prospectively. The patients were randomized into two groups: self-management training (n=31) and standard care (n=30). Each patient was evaluated by spirometry, COPD assessment test (CAT), St George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), modified British Medical Research Council (mMRC) dyspnea scale, and short form-36 (SF-36). A team of physiotherapists, psychologists, pulmonary disease specialists, and dietitians provided self-management training and biweekly counseling via phone. At the end of three months, both the groups were re-evaluated using the same assessment parameters. RESULTS We found no significant difference between the baseline demographic characteristics of the self-management training and standard care groups. We observed a reduction in CAT (p<0.001), SGRQ impact (p=0.013), activity subscales (p<0.001) and the total scores (p=0.020), and HADS anxiety (p=0.012) and depression (p=0.014) scores in the self-management training group after the education session. A significant increase in SF-36 physical function score was also observed (p=0.008). No significant improvement in the functional parameters was observed in either group; however, the change in FEV1 was more pronounced in the self-management training group than in the control group (p=0.017). The hospital readmissions and 1-year survival rates were similar for both the groups after receiving education (p>0.05). CONCLUSION Our results suggest that the self-management training of the patients with COPD improves the quality of life and reduces the symptoms of depression and anxiety. Therefore, at the least, self-management training should be done as the first step of pulmonary rehabilitation in patients with COPD who cannot access pulmonary rehabilitation facilities.
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Affiliation(s)
| | - Aylin Özgen Alpaydın
- Department of Pulmonary Diseases, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Sevgi Özalevli
- Department of Pulmonary Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Nurcan Güler
- Department of Pulmonary Diseases, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Can Cimilli
- Department of Psychiatry, Dokuz Eylül University School of Medicine, İzmir, Turkey
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23
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Korpershoek YJG, Hermsen S, Schoonhoven L, Schuurmans MJ, Trappenburg JCA. User-Centered Design of a Mobile Health Intervention to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease (Copilot): Mixed Methods Study. J Med Internet Res 2020; 22:e15449. [PMID: 32538793 PMCID: PMC7324997 DOI: 10.2196/15449] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/12/2019] [Accepted: 01/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. Objective This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. Methods The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. Results The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention—Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. Conclusions By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions.
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Affiliation(s)
- Yvonne J G Korpershoek
- Research Group Chronic Illnesses, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Sander Hermsen
- OnePlanet Research Center, imec NL, Wageningen, Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jaap C A Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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24
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Feiring E, Friis T. Facilitators and barriers to clinicians' use of COPD action plans in self-management support: A qualitative study. PATIENT EDUCATION AND COUNSELING 2020; 103:693-701. [PMID: 31733986 DOI: 10.1016/j.pec.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/04/2019] [Accepted: 11/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Written action plans for patients with chronic obstructive pulmonary disease (COPD) aim at early recognition of exacerbations and self-initiation of interventions. Previous research suggest underuse of COPD action plans. We wanted to 1) examine which factors clinicians in specialist healthcare perceived as influencing clinicians' use of written action plans in COPD-self management support and 2) propose a framework for understanding the factors affecting clinicians' use of action plans in routine practice. METHODS We performed a theory-driven retrospective qualitative study. Documentary data were collected to describe the COPD action plan in context. In-depth interviews with clinicians (n = 8) were carried out. Interview data were thematically analyzed, using a predetermined model for understanding behavior. RESULTS Our study revealed that a number of factors influenced clinicians' use of action plans, including their capabilities (knowledge and skills to identify "the right patient" and to individualize the plan template) and motivations (beliefs, reinforcements, and emotions s.a. frustration, fear, and distrust), together with organizational and social opportunities (resources, patient, and GP preferences). CONCLUSION A multilevel understanding of factors that affect clinicians' use of action plans in self-management support is needed. PRACTICE IMPLICATION The proposed framework can be used to guide future initiatives to promote targeted self-management support.
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Affiliation(s)
- Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Tori Friis
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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25
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Qian S, Golubnitschaja O, Zhan X. Chronic inflammation: key player and biomarker-set to predict and prevent cancer development and progression based on individualized patient profiles. EPMA J 2019; 10:365-381. [PMID: 31832112 PMCID: PMC6882964 DOI: 10.1007/s13167-019-00194-x] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/06/2019] [Indexed: 12/24/2022]
Abstract
A strong relationship exists between tumor and inflammation, which is the hot point in cancer research. Inflammation can promote the occurrence and development of cancer by promoting blood vessel growth, cancer cell proliferation, and tumor invasiveness, negatively regulating immune response, and changing the efficacy of certain anti-tumor drugs. It has been demonstrated that there are a large number of inflammatory factors and inflammatory cells in the tumor microenvironment, and tumor-promoting immunity and anti-tumor immunity exist simultaneously in the tumor microenvironment. The typical relationship between chronic inflammation and tumor has been presented by the relationships between Helicobacter pylori, chronic gastritis, and gastric cancer; between smoking, development of chronic pneumonia, and lung cancer; and between hepatitis virus (mainly hepatitis virus B and C), development of chronic hepatitis, and liver cancer. The prevention of chronic inflammation is a factor that can prevent cancer, so it effectively inhibits or blocks the occurrence, development, and progression of the chronic inflammation process playing important roles in the prevention of cancer. Monitoring of the causes and inflammatory factors in chronic inflammation processes is a useful way to predict cancer and assess the efficiency of cancer prevention. Chronic inflammation-based biomarkers are useful tools to predict and prevent cancer.
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Affiliation(s)
- Shehua Qian
- 1Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
- 2Hunan Engineering Laboratory for Structural Biology and Drug Design, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
- 3State Local Joint Engineering Laboratory for Anticancer Drugs, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
| | - Olga Golubnitschaja
- 4Radiological Clinic, UKB, Excellence Rheinische Friedrich-Wilhelms-University of Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany
- 5Breast Cancer Research Centre, UKB, Excellence Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
- 6Centre for Integrated Oncology, Cologne-Bonn, Excellence Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
| | - Xianquan Zhan
- 1Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
- 2Hunan Engineering Laboratory for Structural Biology and Drug Design, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
- 3State Local Joint Engineering Laboratory for Anticancer Drugs, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
- 7Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People's Republic of China
- 8National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People's Republic of China
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26
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Ko FWS, Chan KP, Hui DSC. Comprehensive care for chronic obstructive pulmonary disease. J Thorac Dis 2019; 11:S2181-S2191. [PMID: 31737345 PMCID: PMC6831924 DOI: 10.21037/jtd.2019.09.81] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common chronic disease worldwide and incurs heavy utilization of healthcare resources. Many COPD patients have comorbidities and experience exacerbations in the course of the disease. Correct diagnosis and appropriate disease assessment are essential for clinical management. Comprehensive care for patients with different severity of disease aims to offer personalized treatment to suit individual needs. Patients with recent exacerbations also need extra care for the post-acute and rehabilitation phases. Comprehensive care consists of self-management and pulmonary rehabilitation and involves multiple healthcare providers working together closely to provide formal structured programmes for patients. The setting, professionals involved, content and the duration of programme vary a lot among different comprehensive care models. Some randomized controlled trials suggested there was improvement in quality of life, exercise capacity and reduced hospital admissions for participants in comprehensive care programmes compared with controls. However, other studies showed that such programmes might not confer benefits and might even bring harm. The reason for the differences in clinical effect of programmes might be due to differences in study design, components and subjects involved in the studies. Careful evaluation of each programme is thus mandatory. Further research is needed to evaluate the safety and effectiveness of comprehensive care management for COPD patients, both at the stable and post-acute exacerbation state.
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Affiliation(s)
- Fanny Wai San Ko
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Pang Chan
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - David Shu Cheong Hui
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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27
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Eap D, Ghasarossian C, Malmartel A. [The GLORI-COPD score: detection of COPD patients at risk of complications]. Rev Mal Respir 2019; 36:468-476. [PMID: 31010752 DOI: 10.1016/j.rmr.2019.02.006] [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: 10/12/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
DEVELOPMENT OF THE GLORI-COPD SCORE GLObal RIsk of severe outcomes in COPD patients. INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a commonly under-diagnosed disease. This study aimed to develop a screening tool for COPD patients with a high risk of complications, taking into account COPD severity and associated co-morbidity. METHODS Two Delphi rounds were conducted to select the items for a preliminary score. Subsequently, this score was submitted to patients with a possible diagnosis of COPD attending for pulmonary function tests in hospital and primary care. Items associated with a diagnosis of COPD and its severity were examined with multivariate logistic regressions. Associated items in our analyses and in the literature were integrated into the score. The score was developed with a factorial analysis and optimized according to ROC curves. RESULTS Fifteen items were selected with the Delphi method, of which six were retained after logistic regression. They were submitted to 64 patients (mean age: 59+/-13.6 years). Factors associated with COPD were smoking ≥10 pack-years and a history of acute exacerbations. Low levels of activity and coughing up sputum were associated with COPD severity. Age ≥40 years and co-morbidities were added to the score. According to the factorial analysis, a two-stage score was developed assessing first the diagnosis of COPD and then the risk of severe outcomes. It showed a sensitivity of 71 %, a specificity of 77 %. The positive and negative predictive value were respectively 28 % and 96 %. CONCLUSION The score was an acceptable screening tool to identify COPD patients with high risk of complications. Nevertheless, validation needs be performed in a larger population to allow its use in primary care.
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Affiliation(s)
- D Eap
- Département de médecine générale, université de médecine Paris Descartes - Site Cochin, 24, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - C Ghasarossian
- Département de médecine générale, université de médecine Paris Descartes - Site Cochin, 24, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - A Malmartel
- Département de médecine générale, université de médecine Paris Descartes - Site Cochin, 24, rue du Faubourg Saint-Jacques, 75014 Paris, France.
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28
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Fergie L, Campbell KA, Coleman-Haynes T, Ussher M, Cooper S, Coleman T. Stop smoking practitioner consensus on barriers and facilitators to smoking cessation in pregnancy and how to address these: A modified Delphi survey. Addict Behav Rep 2019; 9:100164. [PMID: 31193880 PMCID: PMC6543497 DOI: 10.1016/j.abrep.2019.100164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Pregnant women can experience barriers and facilitators towards achieving smoking cessation. We sought consensus from smoking cessation practitioners on how influential pre-identified barriers and facilitators can be on pregnant women's smoking behaviour, and how difficult these might be to manage. Suggestions for techniques that could help overcome the barriers or enhance the facilitators were elicited and consensus sought on the appropriateness for their use in practice. Methods Forty-four practitioners who provided cessation support to pregnant women completed a three-round modified Delphi survey. Round one sought consensus on the ‘influence’ and ‘difficulty’ of the barriers and facilitators, and gathered respondents' suggestions on ways to address these. Rounds two and three sought further consensus on the barriers and facilitators and on ‘appropriateness’ of the respondent-suggested techniques. The techniques were coded for behaviour change techniques (BCTs) content using existing taxonomies. Results Barriers and facilitators considered to be the most important mainly related to the influence of significant others and the women's motivation & self-efficacy. Having a supportive partner was considered the most influential, whereas lack of support from partner was the only barrier that reached consensus as being difficult to manage. Barriers relating to social norms were also considered influential, however these received poor coverage of respondent-suggested techniques. Those considered the easiest to address mainly related to aspects of cessation support, including misconceptions surrounding the use of nicotine replacement therapy (NRT). Barriers and facilitators relating to the women's motivation & self-efficacy, such as the want to protect the baby, were also considered as being particularly easy to address. Fifty of the 54 respondent-suggested techniques reached consensus as being appropriate. Those considered the most appropriate ranged from providing support early, giving correct information on NRT, highlighting risks and benefits and reinforcing motivating beliefs. Thirty-three BCTs were identified from the respondent-suggested techniques. ‘Social support (unspecified)’, ‘Tailor interactions appropriately’ and ‘Problem solving’ were the most frequently coded BCTs. Conclusions Involving partners in quit attempts was advocated. Existing support could be potentially improved by establishing appropriate ways to address barriers relating to pregnant smokers' ‘social norms’. In general, providing consistent and motivating support seemed favourable. Significant others, women's motivation and self-efficacy influence quit attempts. Having an unsupportive partner was considered the most difficult barrier to address. Suggestions on how to address barriers relating to social norms were lacking. Giving consistent support and boosting women's motivation to quit were advocated. Enhancing women's knowledge on NRT use was deemed easy to do and beneficial.
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Affiliation(s)
- Libby Fergie
- Division of Primary Care, School of Medicine, University of Nottingham, UK
| | | | - Tom Coleman-Haynes
- Division of Primary Care, School of Medicine, University of Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, UK.,Institute for Social Marketing, University of Stirling, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, School of Medicine, University of Nottingham, UK
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29
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Murphie P, Little S, Paton R, McKinstry B, Pinnock H. Defining the Core Components of a Clinical Review of People Using Continuous Positive Airway Pressure Therapy to Treat Obstructive Sleep Apnea: An International e-Delphi Study. J Clin Sleep Med 2018; 14:1679-1687. [PMID: 30353812 DOI: 10.5664/jcsm.7372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/19/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Guidelines recommend regular review of individuals using continuous positive airway pressure (CPAP) to treat obstructive sleep apnea but do not agree on the core components and frequency. We aimed to achieve consensus on essential components and frequency of review. METHODS We used an e-Delphi approach, recruiting a multidisciplinary international expert panel to identify components based on a list compiled from guidelines and to score these on a scale 1 to 5 over three rounds. Consensus was defined as ≥ 75% agreement for scores of 4 or higher. Free-text comments were thematically analyzed. RESULTS Forty participants completed 3 rounds scoring 36 potential components. Seventeen components achieved consensus: treatment acceptability, sleep quality, symptom resolution (including reduction in apnea-hypopnea index), assessment of sleepiness (including when driving), technical CPAP issues (mask fit/humidification/cleaning/filters), recording CPAP adherence, and quality of life. Participants suggested 12 to 18 monthly reviews (more frequent when commencing CPAP) or "on demand." Free-text comments highlighted that reviews should be multidisciplinary, flexible (including telehealth), and focus on symptom control. CONCLUSIONS We mapped 17 prioritized components to a suggested template that may support clinical reviews. Reviews should be flexible, frequently in the early stages of commencing CPAP, shifting to "on demand" and/or remote follow-up for maintenance. Our findings may inform future guideline recommendations for reviewing CPAP users.
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Affiliation(s)
- Phyllis Murphie
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, United Kingdom.,Department of Respiratory Medicine, NHS Dumfries and Galloway, United Kingdom
| | - Stuart Little
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, United Kingdom
| | - Robin Paton
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, United Kingdom
| | - Brian McKinstry
- e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, United Kingdom
| | - Hilary Pinnock
- Department of Respiratory Medicine, NHS Dumfries and Galloway, United Kingdom
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30
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Korpershoek YJG, Vervoort SCJM, Trappenburg JCA, Schuurmans MJ. Perceptions of patients with chronic obstructive pulmonary disease and their health care providers towards using mHealth for self-management of exacerbations: a qualitative study. BMC Health Serv Res 2018; 18:757. [PMID: 30286761 PMCID: PMC6172846 DOI: 10.1186/s12913-018-3545-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 09/17/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Self-management of exacerbations in COPD patients is important to reduce exacerbation impact. There is a need for more comprehensive and individualized interventions to improve exacerbation-related self-management behavior. The use of mobile health (mHealth) could help to achieve a wide variety of behavioral goals. Understanding of patients and health care providers perspectives towards using mHealth in promoting self-management will greatly enhance the development of solutions with optimal usability and feasibility. Therefore, the aim of this study was to explore perceptions of COPD patients and their health care providers towards using mHealth for self-management of exacerbations. METHODS A qualitative study using focus group interviews with COPD patients (n = 13) and health care providers (HCPs) (n = 6) was performed to explore perceptions towards using mHealth to support exacerbation-related self-management. Data were analyzed by a thematic analysis. RESULTS COPD patients and HCPs perceived mostly similar benefits and barriers of using mHealth for exacerbation-related self-management. These perceived benefits and barriers seem to be important drivers in the willingness to use mHealth. Both patients and HCPs strengthen the need for a multi-component and tailored mHealth intervention that improves patients' exacerbation-related self-management by determining their health status and providing adequate information, decision support and feedback on self-management behavior. Most importantly, patients and HCPs considered an mHealth intervention as support to improve self-management and emphasized that it should never replace patients' own feelings nor undermine their own decisions. In addition, the intervention should be complementary to regular contact with HCPs, as personal contact with a HCP was considered to be very important. To optimize engagement with mHealth, patients should have a positive attitude toward using mHealth and an mHealth intervention should be attractive, rewarding and safe. CONCLUSIONS This study provided insight into perceptions of COPD patients and their HCPs towards using mHealth for self-management of exacerbations. This study points out that future mHealth interventions should focus on developing self-management skills over time by providing adequate information, decision support and feedback on self-management behavior and that mHealth should complement regular care. To optimize engagement, mHealth interventions should be attractive, rewarding, safe and tailored to the patient needs.
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Affiliation(s)
- Y. J. G. Korpershoek
- Research Group Chronic Illnesses, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS, Utrecht, PO Box 12011-3501, AA The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - J. C. A. Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. J. Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht, The Netherlands
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