Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial

Background: Chronic obstructive pulmonary disease (COPD) generates a high burden on health care, and hospital admissions represent a substantial proportion of the overall costs of the disease. Integrated care (IC) has shown efficacy to reduce hospitalisations in COPD patients at a pilot level. Deployment strategies for IC services require assessment of effectiveness at the health care system level. Aims: The aim of this study was to explore the effectiveness of a community-based IC service in preventing hospitalisations and emergency department (ED) visits in stable frail COPD patients. Methods: From April to December 2005, 155 frail community-dwelling COPD patients were randomly allocated either to IC (n=76, age 73 (8) years, forced expiratory volume during the first second, FEV1 41(19) % predicted) or usual care (n=84, age 75(9) years, FEV1 44 (20) % predicted) and followed up for 12 months. The IC intervention consisted of the following: (a) patient’s empowerment for self-management; (b) an individualised care plan; (c) access to a call centre; and (d) coordination between the levels of care. Thereafter, hospital admissions, ED visits and mortality were monitored for 6 years. Results: IC enhanced self-management (P=0.02), reduced anxiety–depression (P=0.001) and improved health-related quality of life (P=0.02). IC reduced both ED visits (P=0.02) and mortality (P=0.03) but not hospital admission. No differences between the two groups were seen after 6 years. Conclusion: The intervention improved clinical outcomes including survival and decreased the ED visits, but it did not reduce hospital admissions. The study facilitated the identification of two key requirements for adoption of IC services in the community: appropriate risk stratification of patients, and preparation of the community-based work force

Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial

Background: Chronic obstructive pulmonary disease (COPD) generates a high burden on health care, and hospital admissions represent a substantial proportion of the overall costs of the disease. Integrated care (IC) has shown efficacy to reduce hospitalisations in COPD patients at a pilot level. Deployment strategies for IC services require assessment of effectiveness at the health care system level. Aims: The aim of this study was to explore the effectiveness of a community-based IC service in preventing hospitalisations and emergency department (ED) visits in stable frail COPD patients. Methods: From April to December 2005, 155 frail community-dwelling COPD patients were randomly allocated either to IC (n=76, age 73 (8) years, forced expiratory volume during the first second, FEV1 41(19) % predicted) or usual care (n=84, age 75(9) years, FEV1 44 (20) % predicted) and followed up for 12 months. The IC intervention consisted of the following: (a) patient's empowerment for self-management; (b) an individualised care plan; (c) access to a call centre; and (d) coordination between the levels of care. Thereafter, hospital admissions, ED visits and mortality were monitored for 6 years. Results: IC enhanced self-management (P=0.02), reduced anxiety-depression (P=0.001) and improved health-related quality of life (P=0.02). IC reduced both ED visits (P=0.02) and mortality (P=0.03) but not hospital admission. No differences between the two groups were seen after 6 years. Conclusion: The intervention improved clinical outcomes including survival and decreased the ED visits, but it did not reduce hospital admissions. The study facilitated the identification of two key requirements for adoption of IC services in the community: appropriate risk stratification of patients, and preparation of the community-based work force

The efficacy of psychologically based interventions to improve anxiety, depression and quality of life in COPD: a systematic review and meta-analysis

This article comprises a systematic review and meta-analysis looking at the efficacy of psychological intervention in improving anxiety, depression and quality of life in respiratory disease.Objective: To systematically evaluate the efficacy of psychologically based interventions for addressing psychological outcomes in patients with chronic obstructive pulmonary disease (COPD). Methods: Electronic databases, key journals and reference lists of included studies were scrutinised for inclusion; in addition authors were contacted for potential unpublished research. Nine studies were identified for inclusion. Data was extracted by two reviewers independently using a standardised extraction sheet and a series of meta-analyses completed for measures of anxiety, depression and quality of life. Results: Eight studies evaluated a cognitive behavioural- or psychotherapeutically based intervention and one study evaluated taped progressive muscle relaxation. The studies revealed some evidence for the interventions’ impact on anxiety, but, taken together interventions had limited effectiveness. The meta-analyses that were conducted revealed a small effect for anxiety only. Conclusion: The results are discussed considering the limitations of the research and previous work in this area. A systematic evaluation of psychological interventions on psychological co-morbidity in patients with COPD is recommended. Practice implications: There is some evidence that psychological interventions impact anxiety and this should be explored further and more interventions should target quality of life

Need and baseline for harmonising nursing education in respiratory care: preliminary results of a global survey

Background: The COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum. Method: A 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries. Results: 30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content. Conclusion: Survey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice

ARTICLE Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial

BACKGROUND: Chronic obstructive pulmonary disease (COPD) generates a high burden on health care, and hospital admissions represent a substantial proportion of the overall costs of the disease. Integrated care (IC) has shown efficacy to reduce hospitalisations in COPD patients at a pilot level. Deployment strategies for IC services require assessment of effectiveness at the health care system level. AIMS: The aim of this study was to explore the effectiveness of a community-based IC service in preventing hospitalisations and emergency department (ED) visits in stable frail COPD patients. METHODS: From April to December 2005, 155 frail community-dwelling COPD patients were randomly allocated either to IC (n = 76, age 73 (8) years, forced expiratory volume during the first second, FEV 1 41(19) % predicted) or usual care (n = 84, age 75(9) years, FEV 1 44 (20) % predicted) and followed up for 12 months. The IC intervention consisted of the following: (a) patient's empowerment for self-management; (b) an individualised care plan; (c) access to a call centre; and (d) coordination between the levels of care. Thereafter, hospital admissions, ED visits and mortality were monitored for 6 years. RESULTS: IC enhanced self-management (P = 0.02), reduced anxiety-depression (P = 0.001) and improved health-related quality of life (P = 0.02). IC reduced both ED visits (P = 0.02) and mortality (P = 0.03) but not hospital admission. No differences between the two groups were seen after 6 years. CONCLUSION: The intervention improved clinical outcomes including survival and decreased the ED visits, but it did not reduce hospital admissions. The study facilitated the identification of two key requirements for adoption of IC services in the community: appropriate risk stratification of patients, and preparation of the community-based work force

Need and baseline for harmonising nursing education in respiratory care: preliminary results of a global survey

Background: The COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum.Method: A 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries.Results: 30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content.Conclusion: Survey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice

Need and baseline for harmonising nursing education in respiratory care: preliminary results of a global survey

Background: The COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum.Method: A 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries.Results: 30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content.Conclusion: Survey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice

Other title: Title from page 2: Dynamic and static load testing : bridge no. HAM-75-1292 Shepherd Lane over I-75 static load test; Other title: Bridge no. HAM-75-1292 Shepherd Lane over I-75 static load test; Other title: Bridge HAM-75-1292, Static load test report

"PID 82288."; "HAM-75-12.60, Hamilton County, Ohio."; "February 2020, final draft report."; "Prepared in cooperation with the Ohio Department of Transportation (ODOT) and the U.S. Department of Transportation, Federal Highway Administration"--Page 2; Includes bibliographical references; Final reportA static load test was performed at the foundation for the north pier of proposed Bridge No. HAM-75-1292 in Cincinnati, Ohio. The bridge carries Shepherd Lane over I-75. The piles are 14-inch diameter pipe piles, driven with a plate covering the pile tip and then filled with concrete. The ultimate bearing value (UBV) is 226 kips. This corresponds to the nominal pile resistance for Load and Resistance Factor Design or the ultimate pile capacity in Allowable Stress Design. The pile was instrumented with vibrating-wire strain gages which were encased in concrete within the pile. The pile was tested to a maximum test load of 454 kips, which was the capacity of the steel reaction frame. The results of the static load test indicated a nominal side resistance of at least 255 kips, a nominal tip resistance of at least 199 kips, and a total nominal resistance of at least 454 kips. The load-displacement curve did not cross the Davisson criteria line, so the full resistance of the test pile was not mobilized under the maximum test load. Therefore, the nominal test pile resistance is greater than the maximum test load of 454 kip

The relationship of physiological status, coping, and hardiness to patient outcomes in chronic illness

Nurses caring for the chronically ill are confronted with the enigma of disparate outcomes among patients having the same clinical diagnosis and similar physiological status. The purpose of this study was to examine the relationships of physiological status, coping, and hardiness to patient outcomes in chronic illness. Hardiness and coping strategies were viewed as mediating variables between physiological status and patient outcomes. Chronic Obstructive Pulmonary Disease (COPD) was the prototypic chronic illness under study because of its insidious onset, slow progression, advanced stage symptoms, and associated high mortality. The Institute of Medicine (IOM) model for stress research, consistent with Lazarus\u27 theory of stress and coping, provided a framework for the study. The physiological status of 104 adults (85 men, 19 women) with COPD was measured using standardized Pulmonary Function Testing (PFT). Subjects completed the Health Related Hardiness Scale (HRHS), the Ways of Coping (WCQ) Questionnaire with three additional open-ended questions, a Pulmonary Impact Profile Scale (PIPS), and a 12-minute measured walk (12MD). After psychometric evaluation of the PIPS, data were analyzed by descriptive statistics, Analysis of Variance (ANOVA), and Pearson Correlation coefficients. Predictor variables for patient outcomes were examined using Multiple Regression Analysis. Coping strategies did not relate to outcomes (12MD: F =.509, p =.603; PIPS: F =.019, p =.982). Patients with COPD incorporated both problem-focused and emotion-focused strategies. Open-end responses identified coping in terms of problem solving and positive reappraisal strategies; the problems most frequently identified were adjustment to limitations and shortness of breath . Commitment (r =.18) and challenge (r =.21) components of hardiness had significant correlations (p $\u3c$.05) with 12MD, whereas control did not. High hardy individuals used Planful Problem Solving strategies significantly more often (F = 7.772, p =.006) than low hardy subjects. Physiological status and hardiness explained a greater amount of variance in distance walked (R\sp2 =.187, p $\u3c$.0001) than in the PIPS score (R\sp2 =.090, p =.008). Coping strategies did not contribute significantly to either PIPS or 12MD outcomes. Face validity of the PIPS was supported by qualitative data depicting perceived problem areas of dyspnea, activity limitations, and emotional adjustment

Noise barrier foundation design

Final report; "July 2022."; Additional project information from email: SJN 136124; PID 111439; Sponsored by the Ohio Department of Transportation, Office of Statewide Planning & Research; State job no. 34652; No content included for Appendix A or Appendix B, cover pages only; Includes bibliographical references (page 18); OTP 1.23/7:2022-19The Ohio Department of Transportation (ODOT) wishes to develop a design method for drilled shaft foundations of noise barriers, using the software program LPILE. To accomplish this task, the research team performed the following activities: 1) Determine appropriate design loads and design criteria, 2) Review and evaluate soil strength correlations for incorporation into the design method, 3) Develop the proposed design method, and 4) Compare the proposed design method to existing ODOT design tables. Using wind loads from the AASHTO LRFD Bridge Design Specifications (AASHTO, 2020), the p-y method of analysis for laterally loaded piles was used to determine the drilled shaft length for all the different cases that are included in the current noise barrier foundation design tables in the Bridge Design Manual (ODOT, 2022a). The comparison of results to the existing design tables generally found very good agreement for granular soils. In the majority of cases the difference is only 0.5 foot. However, for the cohesive soils, there are some significant differences. For soft cohesive soils with N=0-1 the existing design table appears to be unconservative when compared to the results from the current study. In some cases, the drilled shaft lengths should be increased by up to 3 feet. While for stiffer cohesive soils the existing design table is much more conservative than the results from the current study. Also considered was the effect that varying the axial load and the addition of ice loads had on the shear, moment, and percent deflection for a noise barrier foundation located in a granular soil with N=10-19 and the maximum panel spacing (24 ft) and barrier height (20 ft). The increase in axial load slightly increases the shear and moment in the foundation. The small moment created by the off-center ice loads does not have a significant effect on the shear and moment in the noise barrier foundation. The addition of ice load does show an increase in the percent deflection of the noise barrier. The proposed design method may also be used to design a noise barrier foundation that falls outside the limits of the design tables in the ODOT Bridge Design Manual. The proposed design method has been adapted for this purpose and described in a white paper. The white paper describes the loading, design procedure, and the method of interpreting the results. It is intended for ODOT design consultants to use when the standard design tables do not appl