Kroonilise obstruktiivse kopsuhaiguse ravi: aeg on üle vaadata raviskeem

Krooniline obstruktiivne kopsuhaigus (KOK) on krooniline hingamisteede progresseeruv haigus, mis põhjustab nii töövõimetust kui ka järjest suurenevaid tervishoiukulutusi. Viimase paari aasta jooksul on arusaam haigusest ning seega KOKi käsitlus ja ravi muutunud. Lisandunud on uued pikatoimelised kombineeritud bronhodilataatorid ja nii on ravivõimalused laienenud ning ka paranenud.Ülevaates on käsitletud KOKi peamisi ravivõtteid ja arutletud inhaleeritavate pikatoimeliste β2 - agonistide ja antikolinergiliste fikseeritud kombinatsioonravimite rolli üle erineva raskusastmega KOKi-haigete raviskeemis. Käsitletud on ka inhaleeritavate kortikostreroidide näidustusi ja kõrvaltoimeid KOKi ravis.Eesti Arst 2016; 95(5):315–32

Töötamise muutunud vormid ja nende õiguslik reguleerimine

https://www.ester.ee/record=b5245280~S

Roadmap for Societal Engagement for Higher Education Institutions

Publicación derivada del siguiente Proyecto Europeo: Higher Education Institution for Societal Engagement. HEISE. http://www.mapsi.eu/heise/Higher education institutions (HEIs) play a key role in educating young people to understand the underlying values in societies and cultures, which create crucial abilities to foster social integration. To succeed in this, the teachers and students of HEIs need novel ways to increase intercultural understanding and social inclusion. Hence, in the project we aim to create a comprehensive educational model grounded in experiential and challenge based learning to increase the higher education institutions’ societal engagement (HEISE).This study was co-funded by the Erasmus+ programme of the European Union within the Strategic Partnership for Higher Education (grant no. 2016-1-EE01-KA203-017334; HEISE project)

Managing art projects with societal impact : study book for students, stakeholders and researchers

This publication is an outcome of a joint co-writing effort created together with several researchers: Riikka Anttonen, Victoria Ateca-Amestoy, Kaisa Holopainen, Tanja Johansson, Annukka Jyrämä, Anne Karkkunen, Kaari-Kiitsak Prikk, Kristina Kuznetsova-Bogdanovitš, Mervi Luonila, Juko-Mart Kõlar, Beatriz Plaza, Kätlin Pulk, Tiina Pusa, Anna Ranczakowska-Ljutjuk, Marge Sassi, Ira Stiller and Anne Äyväri. We have each contributed to the building and commenting on the chapters, not only within our fields of expertise but conjointly and collectively throughout the Study Book. The book is based on our joint activities within Managing Art Projects with Societal Impact (MAPSI) – project in EU Erasmus+ Lifelong learning –programme (201-32016). MAPSI joins five organizations that each bring into the project their special expertise; Estonian Academy of Theatre and Music, Estonian Business School, Laurea University of Applied Sciences, Sibelius Academy of the University of the Arts Helsinki and Universidad del País Vasco / Euskal Herriko Unibertsitatea UPV/EHU (for more information about the project please see http://www.mapsi.eu/). During the project we have learnt to question each other, reflect together, and jointly create new knowledge across the different fields of experiences. The Study Book highlights this process way of working. The aims of MAPSI project were: • To create a specialization module in master programs in management of artistic projects with societal impact • To create an international network focusing on educating cultural managers and facilitators to manage and mediate artistic and cultural projects with societal impact. • Create an innovative field of specialization in the context of art/cultural management master’s programmes that train the future managers and mediators for artistic projects with societal impact • Develop new teaching materials and content of high quality that contribute to the European arts/cultural management education • Build up a conception of new integrated models for interactive study and internships This Study Book is one way to respond to these aims. The book is particularly called a ‘study book’, aiming not to give direct answers, but to open avenues for students and practitioners to reflect and learn to create their own way of managing art project with societal impact. The book provides analysis of the current practices, skills and the competences need for successful interaction between art and society. It contains multiple cases and examples as well as theoretical perspectives and tools for managers to build up their knowledge, competences and skills to manage art projects with societal impact. Yet, as we firmly believe that there is never only one right way to do 4 this, we do not provide only one way or a model to apply, but various perspectives to create one’s own model or models that could work in some specific contexts and circumstances. The key target group of the Study Book is students in arts management, social studies, arts, or economics interested in the field where art is used for societal engagement. We also believe that it contributes to the people already working or aiming to work in art projects or organizations with societal impact. We hope that our readers will not only acquire answers but also new questions; new knowledge and new perspectives building further the content of the book

Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial

Rationale: Early detection of COPD exacerbations using tele-monitoring of physiological variables might reduce the frequency of hospitalisation. Objectives: To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique (FOT) and cardiac parameters in older COPD patients with co-morbidities. Methods: This multicentre, randomized clinical trial recruited 312 GOLD grade II-IV COPD patients (median age 71 years [IQR:66-76], 49.6% grade II, 50.4% grade III-IV), with a history of exacerbation in the previous year and at least one non-pulmonary co-morbidity. Patients were randomised to usual care (n=158) or tele-monitoring (n=154) and followed for 9 months. All tele-monitoring patients self-assessed lung mechanics daily and in a subgroup with congestive heart failure (n=37) cardiac parameters were also monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions. Measurements and Main results: Primary outcomes were time to first hospitalisation (TTFH) and change in EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescriptions, hospitalisation, CAT, PHQ-9 and MLHF questionnaire scores, quality-adjusted life years and healthcare costs. Tele-monitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate and questionnaire scores. In an exploratory analysis, tele-medicine was associated with fewer repeat hospitalizations (-54%, p=0.017). Conclusions: In older COPD patients with co-morbidities remote monitoring of lung function by FOT and cardiac parameters did not change TTFH and EQ-5D. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01960907

Perspectives on Mentorship – Reinventing Mentoring in Arts and Creative Industries Management.

The book Perspectives on Mentorship – Reinventing Mentoring in Arts and Creative Industries Management offers a holistic view with multiple perspectives to the topic of mentorship in arts and cultural context. It can be used as a course book for mentorship programmes, providing further knowledge for anyone working in mentorship or planning to build a mentorship programme in the context of arts management education within art or cultural institutions. It provides a unique exploration of this subject by presenting different perspectives, raising thought provoking questions, and examining ways to manage a mentoring programme. It is important to remember that mentoring does not happen by itself, and that it requires management and intervention in order to be sustainable. University students interested in arts management will find the book invaluable in obtaining a better understanding of how mentoring could be approached and help them in the development of their professional identity. It does not present one universal truth or method, but instead is about sharing experiences. From the academic perspective, the book encourages readers to approach mentoring with an open mind, offering tools to reflect on the process of building programmes around the core of mentoring – a dynamic human relationship which affects the identity of both parties – and then to build on the different layers around that foundation. The book seeks to provide insights into the different layers that are created during the mentoring process. It poses a variety of questions that can apply to specific programmes and helps readers understand how to effectively manage and sustain mentorship relationships.EUROPEAN COMMISSION–EACEA 2020: Ref. 2020-1-EE01-KA203-078003. Reinventing Mentoring in Arts Management. (2020-2023

Randomised controlled trial of telemonitoring with addition of daily forced oscillation in older people with COPD and co-morbidity

Evidence of clinical benefit and cost-effectiveness from daily symptom and simple telemonitoring in COPD is unproven. The CHROMED study explored the effect of telemonitoring in older people with COPD and significant co-morbidity who performed daily forced oscillation measurements via RESMON PRO DIARY to identify early physiological change associated with an exacerbation. Six centres in 5 countries randomised 312 people to 9 months telemonitoring (154) or daily symptom questionnaires (158). Each day the monitored group recorded symptoms, pulse, BP, oxygen saturation and airway resistance and reactance. An alert was generated if results exceeded pre-determined parameters and the participant was contacted by their local clinical centre to consider additional treatment. Baseline characteristics were evenly matched: mean age 71 years, FEV1 1.3L (50% predicted) and SGRQ score 49. 61% of subjects had 2+ exacerbations and 42% had been hospitalised in the previous year. Time to first hospitalisation did not differ albeit the monitoring group had fewer hospitalisations (79 vs 103; p=ns) and days in hospital (329 vs. 650; p=ns). However, subjects hospitalized with an AE COPD in the previous year (n=128) had a lower hospitalisation rate (p<0.04). Quality of life (EQ-5D) and health status (CAT) did not differ between groups. Mean cost in the monitored group was marginally lower (€4,615 vs €4,831; p=ns). Telemonitoring including daily forced oscillation impacted neither time to first hospitalisation nor health status. Reduction in hospitalisation rate in subjects with previous hospitalisation suggests these individuals may benefit from telemonitoring and earlier treatment

Lung function assessed by home forced oscillation and self reported symptoms during COPD exacerbations

CHROMED (clinical trials for elderly people with multiple diseases, www.chromed.eu) is an EU-funded project involving 9 partners from 7 European countries aimed at evaluating the impact of a new home care approach to reduce costs and improve quality of life in elderly patients with COPD and comorbidity. The trial involves 300 patients with a prior history of exacerbations randomly assigned to a monitoring or observational arm. Monitored patients performed daily self-assessment of lung mechanics with a FOT (Forced Oscillation Technique) device (RESMON PRO DIARY, Restech srl, Italy) and completed a symptom diary card on touchscreen device (HOME PATIENT MONITOR, EBM srl, Italy). Any detected worsening in lung mechanics generated an alert triggering a phone interview directed at verifying the patient's status and optimizing treatment. By the end of March 2015, 70 monitored patients had completed the trial resulting in 16198 measurements with an adherence of 90.1%. Based on lung mechanics, 311 worsening events were detected, resulting in 0.65±0.3 alerts/patient/month. At least one major symptom (dyspnea, sputum purulence and volume) was reported in 70% of events and 41% were associated with an exacerbation according to diary cards (Seemungal et al., Am J Respir Crit Care Med 1998). A total of 77 exacerbations were confirmed during the phone interview and treated, but 48% of them were not associated with an exacerbation defined by diary cards only. These results suggest that a significant percentage of exacerbations cannot be identified by diary cards only. Self-assessment of lung mechanics using FOT provides complementary information which can be useful to manage COPD patients at home