Access to pulmonary rehabilitation: perspectives of patients, loved ones and healthcare professionals

Introduction: Improving access to pulmonary rehabilitation (PR) is an international priority, but due to several constraints, healthcare professionals are often faced with the challenge of having to prioritise patients. Evidence from quantitative research suggests that symptoms, functional and health status and not lung function should guide referrals to pulmonary rehabilitation (PR). Whether these criteria are corroborated by the opinions of different stakeholders remains unknown. This qualitative study explored criteria, barriers and facilitators to access PR from the perspectives of people with chronic respiratory disease (CRD), loved ones and healthcare professionals. Methods: An exploratory, cross-sectional qualitative study was carried out. Focus groups were conducted separately with people with CRD, loved ones and healthcare professionals; transcribed verbatim and analysed thematically. All participants had previous experience with PR. Results: Seven focus groups were conducted: four with people with CRD (24 with chronic obstructive pulmonary disease and 5 with interstitial lung disease, 75.9% male, 68.4 ± 7.5 years); one with loved ones (n = 5, 100% female, 66.6 ± 7.7 years) and two with healthcare professionals (n = 16, 25% male, 38 ± 9.2 years). Perspectives among stakeholders were mostly consensual and organised in three themes: all people with CRD should have access to PR and as early as possible “Universal access”; if prioritisation is needed then priority should be given to those motivated, with high symptom burden and impaired functional status “Priority to those struggling and motivated”; and education about PR and continuity and communication between care settings and professionals are lacking to improve access to PR “Communication, dissemination and organisation as main keys”. Conclusions: Our findings corroborate previous evidence and provide new and complementary in-depth understanding to design interventions to improve access to PR in line with the perspectives of different stakeholders.publishe

Long-term maintenance strategies after pulmonary rehabilitation: perspectives of people with chronic respiratory diseases, informal carers and healthcare professionals

No abstract available.publishe

Management of Locally Advanced Esthesioneuroblastoma in a Pregnant Woman

Esthesioneuroblastoma (ENB) is a rare malignant tumor that commonly develops in the upper nasal cavity. Standard treatment is not established, especially in locally advanced disease which portends the worse prognosis. Hereby, we report a case of a 27-year-old, 23-week pregnant woman, with a 2-month history of progressively growing right cervical lymphadenopathy, nasal obstruction, anosmia, frequent episodes of epistaxis, and right frontal headache. Imagiological evaluation revealed a lesion with 7×5,2×3,2 cm in the nasal fossae with extension to the ethmoidal complex and right olfactive fend and invasion of the endocranial compartment associated with lymphadenopathy. The biopsy revealed a high-grade EBN. Neoadjuvant chemotherapy with cisplatin and etoposide was administrated during pregnancy and continued after delivery up to 6 cycles of treatment with partial response. Radiotherapy followed, with complete response. This case report is intended to highlight that a high grade of suspicion should be kept in the presence of nonspecific symptoms of nasal obstruction, anosmia, facial pain, and/or headache and focus that chemotherapy is an important component of a combined-treatment modality for locally advanced ENB that can be used during pregnancy in a lifesaving situation.info:eu-repo/semantics/publishedVersio

Pulmonary telerehabilitation: an international call for action

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Pulmonary rehabilitation in primary health care: an effective intervention even with minimal resources

No abstract available.publishe

Bringing pulmonary rehabilitation closer to the community and keeping its effectiveness

Background: Pulmonary Rehabilitation (PR) is a key evidence-based intervention in the management of chronic respiratory diseases. Nevertheless, it is still highly inaccessible and underutilised by patients, as most PR programmes are directed to patients with advanced disease and/or held on a hospital-basis. There is an urgent need to increase access to PR and therefore, new intervention models that can be more inclusive and closer to patients' homes have been recommended. Purpose: To evaluate the effects of a community-based PR programme in patients with chronic respiratory diseases. Methods: A quasi-experimental study was conducted. Patients were recruited from primary health care centres. Patients enrolled in a 12- week community-based PR programme of exercise training, twice a week, and education and psychosocial support, once every other week. Outcome measures used to assess effectiveness of the programme were collected pre/post PR. Dyspnoea during activities was collected with the modified medical research council-dyspnoea scale (mMRC); anxiety and depression symptoms with the Hospital Anxiety and Depression Scale (HADS); health-related quality of life with the Saint George's Respiratory Questionnaire (SGRQ); quadriceps muscle strength (QMS) with a handheld dynamometer; functionality with the 1-minute sit-to-stand (1-minSTS); exercise tolerance with the sixminute walk test (6MWT) and functional balance with the Brief Balance Evaluation System Test (Brief-BESTest). Differences were examined using the Student's t-test or the Wilcoxon test, according to data normality, and effect sizes (ES) were calculated. For the measures with an established minimal clinically important difference (MCID), an analysis of the number of patients that improved above that value was conducted. Results: Fifty-six patients (36 male; 67.0±10.3years; 56.8±3.2% FEV %predicted) with COPD (n=37), asthma (n=11), asthma-COPD overlap syndrome (n=2), interstitial lung disease (n=2), pneumonitis (n=2), pulmonary fibrosis (n=1), lung transplant due to COPD (n=1) and bronchiectasis (n=1) participated. After the PR programme, significant improvements were observed in the mMRC (2[0-4] vs. 1[0-3]; p≤0.001; ES=-0.49; 22 (39,3%) patients above the MCID); HADS Anxiety (6.5±3.5 vs. 5.7±3.4;p=0.042; ES=-0.23; 23 (41,1%) patients above the MCID) and HADS Depression (6.6±4.1 vs. 5.8±3.8; p=0.113; ES=-0.19; 23 (41,1%) patients above the MCID); SGRQ total score (46.5±19.0 vs. 38.4±16.5; p≤0.001; ES=-0.45; 35 (62,5%) patients above the MCID); QMS (29.3±7.5 vs. 32.9±7.6Kgf; p≤0.001; ES=0.48); 1-minSTS (26±10 vs. 30±11 repetitions; p≤0.001; ES=0.38; 26 (46,4%) patients above the MCID), 6MWT (400.8±116.9 vs. 455.8±118.5m; p≤0.001; ES=0.47; 40 (71,4%) patients above the MCID), Brief-BESTest (17.2±5.0 vs. post 20.2±3.3; p≤0.001; ES=0.70; 13 (23,2%) patients above the MCID). Conclusion(s): Community-based PR programmes are feasible and effective to conduct in patients with chronic respiratory diseases, providing similar benefits for symptoms, health-related quality of life, lower limb muscle strength, functionality, exercise tolerance and balance to those well-established for PR programmes carried out in hospital outpatient settings. Implications: Community-based PR programmes are a feasible and effective way of increasing access to a fundamental intervention for patients with chronic respiratory diseases.publishe

Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.info:eu-repo/semantics/publishedVersio

Enhancing the assessment of cardiorespiratory fitness using field tests

Objective: To establish normative values and reference equations of the 6-minute walk test (6MWT), incremental shuttle walk test (ISWT) and unsupported upper limb exercise test (UULEX) for Portuguese adults. Design: Cross-sectional study. Descriptive statistics and differences between age decades and genders were explored using univariate general linear models to compute reference values. Reference equations were established with a forward stepwise multiple regression. Setting: General community. Participants: In total, 645 adult volunteers without disabilities [43% male, mean age 55.1 (standard deviation 23.6) years] were recruited from the university campus and surrounding community. Intervention: Not applicable. Main outcome measures: Data on age, gender, height, weight, body mass index and smoking status were collected using a structured questionnaire. Physical activity was evaluated using the Brief Physical Activity Assessment Tool. Participants performed two repetitions of the 6MWT, ISWT and UULEX, and the best repetition was used for analysis. Results: Overall, performance was better in males than in females, and decreased with age. Participants’ performance was significantly reduced after the sixth decade of life compared with the other decades (P < 0.001). Reference equations were: 6MWT = 226.93 − (5.00 × age) + (360.41 × height), R2 = 71%; ISWT = 393.81 − (17.98 × age) + (185.64 × gender) + (775.88 × height), R2 = 83%; and UULEX = 16.71 − (0.14 × age) + (2.66 × gender), R2 = 57%. Conclusion: Leg or arm exercise field tests are affected significantly by age and gender. These results will aid health professionals to interpret the results of field tests obtained from healthy or diseased adult populations.publishe

El tránsito de los propósitos a los efectos en la evualuación masiva de la Educación Superior

In the frame of evaluation policies on education quality, the application of quality tests to college education, –ECAES– based on the concept of competence, has already started in Colombia. Such a strategy recognizes its own limitation to draw conclusions about college education by itself. Therefore, the possible uses of its results must neither ignore the previous remark, nor be conclusive in operating against or in favor of individuals or institutions evaluated. After understanding the meanings of massive evaluation and, in order to anticipate possible effects of its application, it is acknowledged that these effects are related both to the instrument and the model of analysis applied, more that to the objectives prescribed for the test. Both the construction of the test as a tool, and the model of analysis, show the stance adopted to conceive educative and evaluative actions. For that reason, to question such perspectives allows to get close to the understanding of the effects of those assumptions.En el marco de la política de evaluación de la calidad de la educación, comienza en el país la aplicación de los exámenes de calidad de la educación superior –ECAES– orientados desde el concepto de competencias. Dicha estrategia reconoce su limitación para concluir, por si misma, acerca de la calidad de la educación superior. Porlo tanto, los usos posibles de los resultados no pueden ni abstraerse de tal consideración ni ser concluyentes para operar en contra o a favor de los sujetos e instituciones evaluados. Al desentrañar los sentidos de la evaluación masiva, para anticipar los posibles efectos de su uso, se reconoce que estos están en relación, más que con los propósitos desde los cuales se propone la prueba, con el instrumento y el modelo de análisis aplicado. La construcción del instrumento de prueba y del modelo de análisis reflejan la postura desde la cual se concibe el accionar educativo y evaluativo. De allí que problematizar sobre dichas posturas permita acercarse a la comprensión de los efectos de dichos supuestos

Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies

Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.info:eu-repo/semantics/publishedVersio