Co-morbidities as predictors of airflow limitation among smokers in England

The prevalence of co-morbidities among patients with Chronic Obstructive Pulmonary Disease (COPD) is well documented in the literature. Therefore, this pilot study aimed to identify whether co-morbidities screening would enhance COPD case-finding. Smoking patients were approached at Croydon University Hospital and two local community pharmacies (CPs). Their co-morbidities, respiratory symptoms, smoking pack-years and exercise capacity were collected. Airflow limitation was determined using handheld spirometry (COPD-6) device. The prevalence of airflow limitation was 42% (n = 21/50). The main identified predictors of airflow limitation were: co-morbidities (OR = 9, CI: 1.04–77.81, p = 0.025), respiratory symptoms (OR = 33.54, CI: 1.06–11.77, p = 0.039) and smoking history of ≥20 pack-years (OR = 3.94, CI: 1.13–13.64, p = 0.029). CPs were the main location for case-finding. This study demonstrated the need to screen for co-morbidities for COPD case-finding within CPs

COPD care delivery pathways in five European Union countries: mapping and health care professionals’ perceptions

Background: COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. Objective: The aim of this study was to compare COPD patients’ care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals’ (HCPs) perceptions about the current pathways. Methods: HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. Results: Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers. Conclusion: Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients’ engagement could optimize current care pathways resulting in a better integrated system. Keywords: COPD, comorbidities, care delivery pathway, comparative analysi

WELCOME project: What do stakeholders want? In depth analysis of COPD patients, carers and healthcare professional views

Chronic obstructive pulmonary disease is a growing health concern worldwide. Telehealth can facilitate integrated COPD care by providing an opportunity for remote monitoring, early diagnosis and clinical intervention. A design for a telehealth-based system called Wearable Sensing and Smart Cloud Computing for Integrated Care to COPD Patients with Co-morbidities (WELCOME) has been proposed. This study identifies patients', informal carers' and HCPs' acceptance of and requirements for the WELCOME system in four European countries: the United Kingdom (UK), Ireland, Greece and Netherlands

Shared decision making and experiences of patients with long-term conditions : has anything changed?

Background Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. Methods A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. Results The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. Conclusion Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals

Modulation of airway inflammation in COPD

COPD is a preventable, treatable, slowly progressive condition, associated with an abnormally amplified inflammatory response, characterised by an accelerated decline in lung function, punctuated by exacerbations. Exacerbations cause considerable mortality, morbidity, and cost. Airway inflammation in COPD is mainly neutrophilic although eosinophilic airway inflammation plays an important role, particularly during exacerbations. Inflammation in foregut derivatives outside the lung may contribute to amplification of airway inflammation. I have shown that a management strategy aiming to minimise eosinophilic airway inflammation as well as symptoms is associated with a significant 62% reduction in the frequency of severe exacerbations of COPD. This strategy was associated with no overall increase in corticosteroid treatment; there was evidence that increased corticosteroid therapy was targeted to patients with eosinophilic airway inflammation and benefit was largely confined to these patients. I have shown an association between the sputum differential neutrophil count and airway bacterial load, and showed that a one week course of Levofloxacin significantly reduced both the % neutrophil count and bacterial load in patients with stable state COPD and bacterial load > 10^6 cfu/ml. I have shown that the prevalence of peptic ulcer disease increases progressively with increasing severity of COPD in miners with homogeneous risk factors for development of COPD, and that peptic ulceration was a strong and independent predictor of a low FEV_1% predicted and FEV_1\bigFVC ratio. In another population I showed that H. Pylori seropositivity was more common in patients with COPD compared to healthy smokers matched for age and occupation. We have shown that TREM-1 can be measured from induced sputum and is potentially a novel marker of bacterial infection and neutrophilic airway inflammation during exacerbations. Further work is required to ensure that measurement and modulation inflammation of airway results in improved clinical outcomes, and is made more clinically viable

RTG-system i Pampusterminalens containerdepå - En studie om hanteringssystemets effekter och förutsättningar

Norrköpings Hamn och Stuveri AB står inför en stor utmaning då verksamheterna i Norrköping delvis ska konsolideras till Pampusterminalen på Händelö på grund av det nya stadsdelsprojektet i Inre hamnen. Tillkommande verksamhet kommer göra anspråk på terminalyta, något som idag inte finns tillgängligt i Pampusterminalen. Dessutom är visionen för containerterminalen att den årligen hanterade volymen ska öka till 154 000 TEU år 2025 från dagens årligen 70 000 TEU. Det har i det här examensarbetet undersökts för de fysiska möjligheterna att ersätta dagens hanteringssystem där Reachstackers används, med ett modernare och mer hållbart elektriskt RTG-system, samt hur RTG-systemet skulle påverka containerhanteringen. Dessutom har en investeringskalkyl upprättats för att reda ut de ekonomiska effekterna av ett byte. Med hjälp av ett antal kapacitetsberäkningsmodeller har det visat sig att NHS i ett NHS i ett framtida skede bör ha möjlighet att hantera 154 000 containrar med cirka 1 400 TGS och fyra RTG-kranar. De totala inköps- och installationskostnaderna för fyra RTG-kranar skulle uppgå till cirka 60 000 000 kronor. Investeringskalkylen resulterade i ett nettonuvärde på 20 905 550 kr vilket är att betrakta som lönsamt. Baserat på insamlat underlag till den här undersökningen är det därför rekommenderat att NHS går vidare med planerna på att byta hanteringssystem för containerdepån

COPD care delivery pathways in five European Union countries: mapping and health care professionals' perceptions

BACKGROUND: COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. OBJECTIVE: The aim of this study was to compare COPD patients’ care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals’ (HCPs) perceptions about the current pathways. METHODS: HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. RESULTS: Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers. CONCLUSION: Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients’ engagement could optimize current care pathways resulting in a better integrated system