Milk intake in kits: not only the total amount matters

[EN] The aim of this work was to identify milk intake variation patterns in kits throughout lactation, to evaluate their permanent maternal component and their relationships with the performance of kits before and after weaning. To achieve this goal, we used 73 rabbit does, controlled between the 1st and the 4th lactation, which kindled 229 litters with a total of 2225 kits. The daily milk intake records per young rabbit were analysed using a principal component analysis (PCA). We found that 72.3% of the variability was explained by the first 3 principal components (PCs). PC1 explained 46.4% of the total variability, was associated with the total amount of milk intake during lactation and presented a repeatability of 0.27 (P0.05). This component was little related to performance traits. Therefore, it seems that milk plays 2 different roles at the beginning of feed intake; the most important would affect development of the kits and thus is related with high intake. The second one, for a given total amount of milk intake during lactation, would create a kind of competition between milk and feed intake at the end of lactation. The effects of both components still persist during the growing period and seem to be moderately affected by the mother.This study was supported by the Interministerial Commission for Science and Technology (CICYT) of the Spanish Government (AGL2014-53405-C2-1-P). The authors thank Juan Carlos Moreno for his technical support. Grant for Alberto Arnau from the Ministry of Economy and Finance (BES-2012-052345) is also gratefully acknowledged.Bonachera, AA.; Cervera, C.; Martínez-Paredes, E.; Ródenas, L.; Pascual, JJ.; Blas, E. (2017). Milk intake in kits: not only the total amount matters. World Rabbit Science. 25(2):159-166. https://doi.org/10.4995/wrs.2017.6707SWORD15916625

New GOLD classification: Longitudinal data on group assignment

Rationale: Little is known about the longitudinal changes associated with using the 2013 update of the multidimensional GOLD strategy for chronic obstructive pulmonary disease (COPD). Objective: To determine the COPD patient distribution of the new GOLD proposal and evaluate how this classification changes over one year compared with the previous GOLD staging based on spirometry only. Methods: We analyzed data from the CHAIN study, a multicenter observational Spanish cohort of COPD patients who are monitored annually. Categories were defined according to the proposed GOLD: FEV1%, mMRC dyspnea, COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), and exacerbations-hospitalizations. One-year follow-up information was available for all variables except CCQ data. Results: At baseline, 828 stable COPD patients were evaluated. On the basis of mMRC dyspnea versus CAT, the patients were distributed as follows: 38.2% vs. 27.2% in group A, 17.6% vs. 28.3% in group B, 15.8% vs. 12.9% in group C, and 28.4% vs. 31.6% in group D. Information was available for 526 patients at one year: 64.2% of patients remained in the same group but groups C and D show different degrees of variability. The annual progression by group was mainly associated with one-year changes in CAT scores (RR, 1.138; 95%CI: 1.074-1.206) and BODE index values (RR, 2.012; 95%CI: 1.487-2.722). Conclusions: In the new GOLD grading classification, the type of tool used to determine the level of symptoms can substantially alter the group assignment. A change in category after one year was associated with longitudinal changes in the CAT and BODE index

Distribution and outcomes of a phenotype-based approach to guide COPD management: Results from the CHAIN cohort

Rationale: The Spanish guideline for COPD (GesEPOC) recommends COPD treatment according to four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphysema (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator phenotype with emphysema (FEE) or frequent exacerbator phenotype with chronic bronchitis (FECB). However, little is known on the distribution and outcomes of the four suggested phenotypes. Objective: We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes. Methods: We followed a cohort of well-characterized patients with COPD up to one-year. Baseline characteristics, health status (CAT), BODE index, rate of exacerbations and mortality up to one year of follow-up were compared between the four phenotypes. Results: Overall, 831 stable COPD patients were evaluated. They were distributed as NE, 550 (66.2%); ACOS, 125 (15.0%); FEE, 38 (4.6%); and FECB, 99 (11.9%); additionally 19 (2.3%) COPD patients with frequent exacerbations did not fulfill the criteria for neither FEE nor FECB. At baseline, there were significant differences in symptoms, FEV1 and BODE index (all p<0.05). The FECB phenotype had the highest CAT score (17.1±8.2, p<0.05 compared to the other phenotypes). Frequent exacerbator groups (FEE and FECB) were receiving more pharmacological treatment at baseline, and also experienced more exacerbations the year after (all p<0.05) with no differences in one-year mortality. Most of NE (93%) and half of exacerbators were stable after one year. Conclusions: There is an uneven distribution of COPD phenotypes in stable COPD patients, with significant differences in demographics, patient-centered outcomes and health care resources use

Clinical Audits in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Workflow

Objectives: Previous clinical audits for chronic obstructive pulmonary disease (COPD) have provided valuable information on the clinical care delivered to patients admitted to medical wards because of COPD exacerbations. However, clinical audits of COPD in an outpatient setting are scarce and no methodological guidelines are currently available. Based on our previous experience, herein we describe a clinical audit for COPD patients in specialized outpatient clinics with the overall goal of establishing a potential methodological workflow.Methods: A pilot clinical audit of COPD patients referred to respiratory outpatient clinics in the region of Andalusia, Spain (over 8 million inhabitants), was performed. The audit took place between October 2013 and September 2014, and 10 centers (20% of all public hospitals) were invited to participate. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The usefulness of formally scheduled regular follow-up visits was assessed. Two different databases (resources and clinical database) were constructed. Assessments were planned over a year divided by 4 three-month periods, with the goal of determining seasonal-related changes. Exacerbations and survival served as the main endpoints.Conclusions: This paper describes a methodological framework for conducting a clinical audit of COPD patients in an outpatient setting. Results from such audits can guide health information systems development and implementation in real-world settings.This study was financially supported by an unrestricted grant from Laboratorios Menarini, SA (Barcelona, Spain)

Determinants for changing the treatment of COPD: a regression analysis from a clinical audit

Jose Luis L&oacute;pez-Campos,1,2 Mar&iacute;a Abad Arranz,1 Carmen Calero Acu&ntilde;a,1,2 Fernando Romero Valero,3 Ruth Ayerbe Garc&iacute;a,4 Antonio Hidalgo Molina,3 Ricardo I Aguilar Perez-Grovas,4 Francisco Garc&iacute;a Gil,5 Francisco Casas Maldonado,6 Laura Caballero Ballesteros,5 Mar&iacute;a S&aacute;nchez Palop,6 Dolores P&eacute;rez-Tejero,7 Alejandro Segado,7 Jose Calvo Bonachera,8 B&aacute;rbara Hern&aacute;ndez Sierra,8 Adolfo Dom&eacute;nech,9 Macarena Arroyo Varela,9 Francisco Gonz&aacute;lez Vargas,10 Juan J Cruz Rueda10 1Unidad M&eacute;dico-Quir&uacute;rgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Roc&iacute;o/Universidad de Sevilla, Seville, 2Centro de Investigaci&oacute;n Biom&eacute;dica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, 3Hospital Universitario Puerta del Mar, C&aacute;diz, 4Hospital Juan Ram&oacute;n Jim&eacute;nez, Huelva, 5Hospital Universitario Reina Sof&iacute;a, C&oacute;rdoba, 6Hospital Universitario San Cecilio, Granada, 7Hospital Infanta Margarita, Cabra, C&oacute;rdoba, 8Hospital Torrec&aacute;rdenas, Almer&iacute;a, 9Hospital Regional Universitario de M&aacute;laga, 10Hospital Universitario Virgen de las Nieves, Granada, Spain Introduction: This study is an analysis of a pilot COPD clinical audit that evaluated adherence to guidelines for patients with COPD in a stable disease phase during a routine visit in specialized secondary care outpatient clinics in order to identify the variables associated with the decision to step-up or step-down pharmacological treatment.Methods: This study was a pilot clinical audit performed at hospital outpatient respiratory clinics in the region of Andalusia, Spain (eight provinces with over eight million inhabitants), in which 20% of centers in the area (catchment population 3,143,086 inhabitants) were invited to participate. Treatment changes were evaluated in terms of the number of prescribed medications and were classified as step-up, step-down, or no change. Three backward stepwise binominal multivariate logistic regression analyses were conducted to evaluate variables associated with stepping up, stepping down, and inhaled corticosteroids discontinuation.Results: The present analysis evaluated 565 clinical records (91%) of the complete audit. Of those records, 366 (64.8%) cases saw no change in pharmacological treatment, while 99&nbsp;patients (17.5%) had an increase in the number of drugs, 55 (9.7%) had a decrease in the number of drugs, and 45 (8.0%) noted a change to other medication for a similar therapeutic scheme. Exacerbations were the main factor in stepping up treatment, as were the symptoms themselves. In contrast, rather than symptoms, doctors used forced expiratory volume in 1&nbsp;second and previous treatment with long-term antibiotics or inhaled corticosteroids as the key determinants to stepping down treatment.Conclusion: The majority of doctors did not change the prescription. When changes were made, a number of related factors were noted. Future trials must evaluate whether these therapeutic changes impact clinically relevant outcomes at follow-up. Keywords: quality of care, outpatient care, treatment strategies, follow-up, respiratory diseases, airway disease

Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit

Jose Luis L&oacute;pez-Campos,1,2 Maria Abad Arranz,1 Carmen Calero-Acu&ntilde;a,1,2 Fernando Romero-Valero,3 Ruth Ayerbe-Garc&iacute;a,4 Antonio Hidalgo-Molina,3 Ricardo I Aguilar-P&eacute;rez-Grovas,4 Francisco Garc&iacute;a-Gil,5 Francisco Casas-Maldonado,6 Laura Caballero-Ballesteros,5 Mar&iacute;a S&aacute;nchez-Palop,6 Dolores P&eacute;rez-Tejero,7 Alejandro Segado Soriano,7 Jose Calvo-Bonachera,8 B&aacute;rbara Hern&aacute;ndez-Sierra,8 Adolfo Dom&eacute;nech,9 Macarena Arroyo-Varela,9 Francisco Gonz&aacute;lez-Vargas,10 Juan J Cruz-Rueda10 1Unidad M&eacute;dico-Quir&uacute;rgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Roc&iacute;o/Universidad de Sevilla, Seville, 2CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, 3Secci&oacute;n de Neumolog&iacute;a, Hospital Puerta del Mar, C&aacute;diz, 4Servicio de Neumolog&iacute;a, Hospital Juan Ram&oacute;n Jim&eacute;nez, Huelva, 5Servicio de Neumolog&iacute;a, Hospital Universitario Reina Sof&iacute;a, C&oacute;rdoba, 6Servicio de Neumolog&iacute;a, Hospital Universitario San Cecilio, Granada, 7Secci&oacute;n de Neumolog&iacute;a, Hospital Infanta Margarita, Cabra, C&oacute;rdoba, 8Servicio de Neumolog&iacute;a, Hospital Torrec&aacute;rdenas, Almer&iacute;a, 9Servicio de Neumolog&iacute;a, Hospital Regional Universitario de M&aacute;laga, M&aacute;laga, 10Servicio de Neumolog&iacute;a, Hospital Universitario Virgen de las Nieves, Granada,&nbsp;Spain Objectives: Clinical practice in chronic obstructive pulmonary disease (COPD) can be influenced by weather variability throughout the year. To explore the hypothesis of seasonal variability in clinical practice, the present study analyzes the results of the 2013&ndash;2014 Andalusian COPD audit with regard to changes in clinical practice according to the different seasons.Methods: The Andalusian COPD audit was a pilot clinical project conducted from October 2013 to September 2014 in outpatient respiratory clinics of hospitals in Andalusia, Spain (8&nbsp;provinces with more than 8 million inhabitants) with retrospective data gathering. For the present analysis, astronomical seasons in the Northern Hemisphere were used as reference. Bivariate associations between the different COPD guidelines and the clinical practice changes over the seasons were explored by using binomial multivariate logistic regression analysis with age, sex, Charlson comorbidity index, type of hospital, and COPD severity by forced expiratory volume in 1 second as covariates, and were expressed as odds ratio (OR) with 95% confidence intervals (CIs).Results: The Andalusian COPD audit included 621 clinical records from 9 hospitals. After adjusting for covariates, only inhaler device satisfaction evaluation was found to significantly differ according to the seasons with an increase in winter (OR, 3.460; 95% CI, 1.469&ndash;8.151), spring (OR, 4.215; 95% CI, 1.814&ndash;9.793), and summer (OR, 3.371; 95% CI, 1.391&ndash;8.169) compared to that in autumn. The rest of the observed differences were not significant after adjusting for covariates. However, compliance with evaluating inhaler satisfaction was low.Conclusion: The various aspects of clinical practice for COPD care were found to be quite homogeneous throughout the year for the variables evaluated. Inhaler satisfaction evaluation, however, presented some significant variation during the year. Inhaler device satisfaction should be evaluated during all clinical visits throughout the year for improved COPD management. Keywords: COPD, seasons, clinical practice, quality of car