Predictors for adherence to action plans for self-treatment of COPD exacerbations

Introduction/Aim: A minority of patients with chronic obstructive pulmonary disease (COPD) derives benefit fromself-management interventions that include action plans for self-treatment of COPD exacerbations. The aimof this studywas to identify predictors for adherence to action plans for self-treatment of exacerbations in COPD patients. Methods: Self-reported diary data from a subset of COPD patients who participated in a randomized controlled trial (COPE-II study) in the Netherlands was used to assess adherence to COPD action plans within a self-management intervention. Only patients with exacerbations were included. Successful self-treatment was defined as self-initiating a course of oral steroids/antibiotics within 2 days from the start of an exacerbation. A patient was defined as being adherent when in ≥75% of all exacerbations the self-treatment action plan was followed. Patient-level factors that showed a univariate association (P <0.10) with adherence were included in a multivariate logistic regression model to identify the predictors for adherence toCOPD self-treatment action plans (P <0.05). Results: Data from 66 patients (mean age 63.6 ± 8.0;men 56.1%) showed 387 exacerbations within 2 years of follow-up. Adherence to the action plans was observed in 37.9% of the patients and in 216 COPD exacerbations. Multivariate logistic regression analyses showed that being male (OR: 5.1; 95% CI: 1.5-17.3) and having no walking problems (EQ5D mobility, OR: 4.9; 95%CI: 1.5-16.4) were positively associatedwith being adherent to the action plan for self-treatment of COPD exacerbations. Conclusion: Our study results indicate that being male and having no walking problems are predictors for better adherence to COPD exacerbation action plans. This implies that exploring patients' mobility and offering more support to femaleCOPDpatients who are lessmobilemay positively influence the adherence to COPD exacerbation self-treatment action plans. More research is, however, required to confirm this

Current care services provided for patients with COPD in the Eastern province in Saudi Arabia: a descriptive study

Background: COPD is a leading cause of morbidity and mortality worldwide. The prevalence rate of COPD in the general Saudi population is estimated to be 2.4% and 14.2% among smokers. Not much is known about current health care services for patients with COPD in Saudi Arabia. The objective of this study was to determine the current care services for patients with COPD provided by government hospitals in the Eastern province of Saudi Arabia. Methods: A cross-sectional study was conducted in the Eastern province of Saudi Arabia. Directors of the Department of Internal Medicine from all 22 general government hospitals that are under the responsibility of the Ministry of Health or the Ministry of Higher Education in this region were asked to participate. Data were collected using a questionnaire. Results: The study results indicated that there are limited hospital facilities for patients with COPD: no respiratory departments in any of the included hospitals, no spirometry in 77.3% of the hospitals, no intensive care units in 63.7% of the hospitals, and no pulmonary rehabilitation program in any of the hospitals. Among the included 22 hospitals, 24 respiratory physicians, 29 respiratory therapists, and three physiotherapists were involved in COPD care. Conclusion: In conclusion, current care services provided by government hospitals in the Eastern province of Saudi Arabia for patients with COPD do not meet international recommendations for COPD management. Increased awareness, knowledge, and implementation of COPD guidelines by health care providers will most probably improve COPD management in Saudi Arabia. In addition, the government could improve dissemination of information about COPD management through national programs and by offering specific education regarding respiratory diseases.Mohammed E Alsubaiei, Paul A Cafarella, Peter A Frith, R Doug McEvoy, Tanja W Effin

Unmet needs of patients with chronic obstructive pulmonary disease (COPD): A qualitative study on patients and doctors

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease with repeated exacerbations resulting in gradual debilitation. The quality of life has been shown to be poor in patients with COPD despite efforts to improve self-management. However, the evidence on the benefit of self-management in COPD is conflicting. Whether this could be due to other unmet needs of patients have not been investigated. Therefore, we aimed to explore unmet needs of patients from both patients and doctors managing COPD. Methods: We conducted a qualitative study with doctors and patients in Malaysia. We used convenience sampling to recruit patients until data saturation. Eighteen patients and eighteen doctors consented and were interviewed using a semi-structured interview guide. The interviews were audio-recorded, transcribed verbatim and checked by the interviewers. Data were analysed using a thematic approach. Results: The themes were similar for both the patients and doctors. Three main themes emerged: knowledge and awareness of COPD, psychosocial and physical impact of COPD and the utility of self-management. Knowledge about COPD was generally poor. Patients were not familiar with the term chronic obstructive pulmonary disease or COPD. The word ‘asthma’ was used synonymously with COPD by both patients and doctors. Most patients experienced difficulties in their psychosocial and physical functions such as breathlessness, fear and helplessness. Most patients were not confident in self-managing their illness and prefer a more passive role with doctors directing their care. Conclusions: In conclusion, our study showed that knowledge of COPD is generally poor. There was mislabelling of COPD as asthma by both patients and physicians. This could have resulted in the lack of understanding of treatment options, outcomes, and prognosis of COPD. The misconception that cough due to COPD was contagious, and breathlessness that resulted from COPD, had important physical and psychosocial impact, and could lead to social isolation. Most patients and physicians did not favour self-management approaches, suggesting innovations based on self-management may be of limited benefit

I read it on reddit: Exploring the role of online communities in the 2016 US elections news cycle

Reddit has developed into a significant platform for political discussion among Millennials. In this exploratory study, we examine subscription trends on three political sub-forums on Reddit during the 2016 US presidential elections: /The_Donald, /SandersForPresident, and /HillaryClinton. As a theoretical framework, we draw from work on online communities’ group identity and cohesion. Concretely, we investigate how subscription dynamics relate to positive, negative and neutral news events occurring during the election cycle. We classify news events using a sentiment analysis of event-related news headlines. We observe that users who supported Sanders displayed no consolidation of support for Clinton after she won the Democratic Party’s presidential nomination. Secondly, we show that negative news events affected Sanders and Clintons subscription trends negatively, while showing no effect for Donald Trump. This gives empirical credence to Trump’s controversial claim that he could “stand in the middle of 5th Avenue and shoot somebody and not lose any voters”. We offer a number of explanations for the observed phenomena: the nature of the content of the three subreddits, their cultural dynamics, and changing dynamics of partisanship. We posit that the ‘death of expertise’ expresses itself on Reddit as a switch in persuasion tactics from a policy-based to an emotions-based approach, and that group members’ agreement on policy proved a weak marker for online communities’ group identity and cohesion. We also claim that strong partisanship coupled with weak party affiliation among Millennials contributed to the low levels of Democratic support consolidation after Clinton won the nomination

Counseling for health behavior change in people with COPD: systematic review

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).Counseling has been suggested as a promising approach for facilitating changes in health behavior. The aim of this systematic review of counseling interventions for people with COPD was to describe: 1) counseling definitions, 2) targeted health behaviors, 3) counseling techniques and 4) whether commonalities in counseling techniques were associated with improved health behaviors. Ten databases were searched for original randomized controlled trials which included adults with COPD, used the term “counseling” as a sole or component of a multifaceted intervention and were published in the previous 10 years. Data extraction, study appraisal and coding for behavior change techniques (BCTs) were completed by two independent reviewers. Data were synthesized descriptively, with meta-analysis conducted where possible. Of the 182 studies reviewed as full-text, 22 were included. A single study provided a definition for counseling. Two key behaviors were the main foci of counseling: physical activity (n=9) and smoking cessation (n=8). Six studies (27%) reported underlying models and/or theoretical frameworks. Counseling was the sole intervention in 10 studies and part of a multicomponent intervention in 12. Interventions targeting physical activity included a mean of 6.3 (±3.1) BCTs, smoking cessation 4.9 (±2.9) BCTs and other behaviors 6.5 (±3.9) BCTs. The most frequent BCTs were social support unspecified (n=22; 100%), goal setting behavior (n=11), problem-solving (n=11) and instructions on how to perform the behavior (n=10). No studies shared identical BCT profiles. Counseling had a significant positive effect for smoking cessation and positive but not significant effect for physical activity. Counseling for health behavior change was rarely defined and effectiveness varied by target behavior. Provision of specific details when reporting studies of counseling interventions (definition, BCTs, dosage) would allow clarification of the effectiveness of counseling as an approach to health behavior change in people with COPD

Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review

Exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this prevalent and devastating condition. This review provides a concise, state of the art summary on prevention and management of exacerbations. Considerable new data underpins evidence in support of many preventative interventions, pharmacological and non-pharmacological, that are now available. Challenges remain in developing new approaches, and delivering those that already exist to the right patient at the right time. Management of an exacerbation remains stepwise according to clinical severity, but there is now additional focus on addressing comorbidities and taking the opportunity at acute events to optimise preventative strategies for the future. Ultimately, exacerbations are heterogeneous events in a heterogeneous disease, and an individualised approach is paramount

Non-surgical treatment of hip osteoarthritis. Hip school, with or without the addition of manual therapy, in comparison to a minimal control intervention: Protocol for a three-armed randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Hip osteoarthritis is a common and chronic condition resulting in pain, functional disability and reduced quality of life. In the early stages of the disease, a combination of non-pharmacological and pharmacological treatment is recommended. There is evidence from several trials that exercise therapy is effective. In addition, single trials suggest that patient education in the form of a hip school is a promising intervention and that manual therapy is superior to exercise.</p> <p>Methods/Design</p> <p>This is a randomized clinical trial. Patients with clinical and radiological hip osteoarthritis, 40-80 years of age, and without indication for hip surgery were randomized into 3 groups. The active intervention groups A and B received six weeks of hip school, taught by a physiotherapist, for a total of 5 sessions. In addition, group B received manual therapy consisting of joint manipulation and soft-tissue therapy twice a week for six weeks. Group C received a self-care information leaflet containing advice on "live as usual" and stretching exercises from the hip school. The primary time point for assessing relative effectiveness is at the end of the six weeks intervention period with follow-ups after three and 12 months.</p> <p>Primary outcome measure is pain measured on an eleven-point numeric rating scale. Secondary outcome measures are the hip dysfunction and osteoarthritis outcome score, patient's global perceived effect, patient specific functional scale, general quality of life and hip range of motion.</p> <p>Discussion</p> <p>To our knowledge this is the first randomized clinical trial comparing a patient education program with or without the addition of manual therapy to a minimal intervention for patients with hip osteoarthritis.</p> <p>Trial registration</p> <p>ClinicalTrials <a href="http://www.clinicaltrials.gov/ct2/show/NCT01039337">NCT01039337</a></p

Tectono-stratigraphic response of the Sandino Forearc Basin (N-Costa Rica and W-Nicaragua) to episodes of rough crust and oblique subduction

The southern Central American active margin is a world-class site where past and present subduction processes have been extensively studied. Tectonic erosion/accretion and oblique/orthogonal subduction are thought to alternate in space and time along the Middle American Trench. These processes may cause various responses in the upper plate, such as uplift/subsidence, deformation, and volcanic arc migration/ shut-off. We present an updated stratigraphic framework of the Late Cretaceous– Cenozoic Sandino Forearc Basin (SFB) which provides evidence of sedimentary response to tectonic events. Since its inception, the basin was predominantly filled with deep-water volcaniclastic deposits. In contrast, shallow-water deposits appeared episodically in the basin record and are considered as tectonic event markers. The SFB stretches for about 300 km and varies in thickness from 5 km (southern part) to about 16 km (northern part). The drastic, along-basin, thickness variation appears to be the result of (1) differential tectonic evolutions and (2) differential rates of sediment supply. (1) The northern SFB did not experience major tectonic events. In contrast, the reduced thickness of the southern SFB (5 km) is the result of at least four uplift phases related to the collision/accretion of bathymetric reliefs on the incoming plate: (i) the accretion of a buoyant oceanic plateau (Nicoya Complex) during the middle Campanian; (ii) the collision of an oceanic plateau (?) during the late Danian–Selandian; (iii) the collision/accretion of seamounts during the late Eocene–early Oligocene; (iv) the collision of seamounts and ridges during the Pliocene–Holocene. (2) The northwestward thickening of the SFB may have been enhanced by high sediment supply in the Fonseca Gulf area which reflects sourcing from wide, high relief drainage basins. In contrast, sedimentary input has possibly been lower along the southern SFB, due to the proximity of the narrow, lowland isthmus of southern Central America. Moreover, two phases of strongly oblique subduction affected the margin, producing strike-slip faulting in the forearc basin: (1) prior to the Farallon Plate breakup, an Oligocene transpressional phase caused deformation and uplift of the basin depocenter, triggering shallowing-upward of the Nicaraguan Isthmus in the central and northern SFB; (2) a Pleistocene–Holocene transtensional phase drives the NW-directed motion of a forearc sliver and reactivation of the graben-bounding faults of the late Neogene Nicaraguan Depression. We discuss arguments in favour of a Pliocene development of the Nicaraguan Depression and propose that the Nicaraguan Isthmus, which is the apparent rift shoulder of the depression, represents a structure inherited from the Oligocene transpressional phase