Role of clinical questionnaires in optimizing everyday care of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a leading cause of disability in all its stages, and death in patients with moderate or severe obstruction. At present, COPD is suboptimally managed; current health is often not measured properly and hardly taken into account in management plans, and the future risk for patients with regard to health status and quality of life is not being evaluated. This review addresses the effect of COPD on the lives of patients and examines ways in which existing assessment tools meet physicians’ needs for a standardized, simple method to measure consistently the full impact of COPD on patients in routine clinical practice. Current assessment of COPD severity tends to focus on airflow limitation, but this does not capture the full impact of the disease and is not well correlated with patient perception of symptoms and health-related quality of life. Qualitative studies have demonstrated that patients usually consider COPD impact in terms of frequency and severity of symptoms, and physical and emotional wellbeing. However, patients often have difficulty expressing their disease burden and physicians generally have insufficient time to collect this information. Therefore, it is important that methods are implemented to help generate a more complete understanding of the impact of COPD. This can be achieved most efficiently using a quick, reliable, and standardized measure of disease impact, such as a short questionnaire that can be applied in daily clinical practice. Questionnaires are precision instruments that contribute sensitive and specific information, and can potentially help physicians provide optimal care for patients with COPD. Two short, easy-to-use, specific measures, ie, the COPD Assessment Test and the Clinical COPD Questionnaire, enable physicians to assess patients’ health status accurately and improve disease management. Such questionnaires provide important measurements that can assist primary care physicians to capture the impact of COPD on patients’ daily lives and wellbeing, and improve long-term COPD management

Modelling survival and connectivity of Mnemiopsis leidyi in the south-western North Sea and Scheldt estuaries

Three different models were applied to study the reproduction, survival and dispersal of Mnemiopsis leidyi in the Scheldt estuaries and the southern North Sea: a high-resolution particle tracking model with passive particles, a low-resolution particle tracking model with a reproduction model coupled to a biogeochemical model, and a dynamic energy budget (DEB) model. The results of the models, each with its strengths and weaknesses, suggest the following conceptual situation: (i) the estuaries possess enough retention capability to keep an overwintering population, and enough exchange with coastal waters of the North Sea to seed offshore populations; (ii) M. leidyi can survive in the North Sea, and be transported over considerable distances, thus facilitating connectivity between coastal embayments; (iii) under current climatic conditions, M. leidyi may not be able to reproduce in large numbers in coastal and offshore waters of the North Sea, but this may change with global warming; however, this result is subject to substantial uncertainty. Further quantitative observational work is needed on the effects of temperature, salinity and food availability on reproduction and on mortality at different life stages to improve models such as used here

Numerical modelling of physical processes governing larval transport in the southern North Sea

A three-dimensional hydrodynamic model (GETM) was coupled with a particle tracking routine (GITM) to study the inter-annual variability in transport paths of particles in the North Sea and English Channel. For validation, a comparison with observed drifter trajectories is also presented here. This research investigated to what extent variability in the hydrodynamic conditions alone (reflecting passive particle transport) contributed to inter-annual variability in the transport of eggs and larvae. In this idealised study, no a priori selection of specific spawning grounds or periods was made and no active behaviour (vertical migration) or mortality was included. In this study, egg and larval development towards coastal nursery areas was based solely on sea water temperature, while settlement areas were defined by a threshold water depth. Results showed strong inter-annual variability in drift direction and distance, caused by a combination of wind speed and direction. Strong inter-annual variability was observed both in absolute amount of settlement in several coastal areas, and in the relative importance of the different areas. The effects of wind and temperature variability are minor for settlement along the western shores of the North Sea and in the English Channel, but have a very significant impact on settlement along the eastern shores of the North Sea. Years with strong south-westerly winds across the Dover Straight resulted in higher settlement figures along its eastern shores of the North Sea (standard deviation 37% of the mean annual settlement value). Settlement in the western Dutch Wadden Sea did not only show inter-annual variability, but patterns were also variable within each year and revealed seasonal changes in the origin of particles: during winter, stronger currents along with colder temperatures generally result in particles originating from further away

Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study

BACKGROUND: This study examined the attitudes and actions of 3415 physician-recruited adults aged ≥ 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting β(2)-agonists. METHODS: Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma. RESULTS: Despite being prescribed regular maintenance therapy, 74% of patients used short-acting β(2)-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting β(2)-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening. CONCLUSION: Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity

Identifying user preferences for a digital educational solution for young seniors with diabetes

The Eindhoven Diabetes Education Simulator project was initiated to develop an educational solution that helps diabetes patients understand and learn more about their diabetes. This article describes the identification of user preferences for the development of such solutions. Young seniors (aged 50-65 years) with type 2 diabetes were chosen as the target group because they are likely to have more affinity with digital devices than older people and because 88% of the Dutch diabetes population is > 50 years of age. Data about the target group were gathered through literature research and interviews. The literature research covered data about their device use and education preferences. To gain insight into the daily life of diabetes patients and current diabetes education processes, 20 diabetes patients and 10 medical experts were interviewed. The interviews were analyzed using affinity diagrams. Those diagrams, together with the literature data, formed the basis for two personas and corresponding customer journey maps. Literature showed that diabetes prevalence is inversely correlated to educational level. Computer and device use is relatively low within the target group, but is growing. The interviews showed that young seniors like to play board, card, and computer games, with others or alone. Family and loved ones play an important role in their lives. Medical experts are crucial in the diabetes education of young senior diabetes patients. These findings are translated into a list of design aspects that can be used for creating educational solutions

Seeing the world through different lenses:activity registration differs between two validated accelerometers

Although accelerometers are extensively validated to estimate energy expenditure in patients with COPD, they show significant differences in non-worn time and type of activity registration http://bit.ly/32fa7WR