ISFAM: THE INFORMATION SECURITY FOCUS AREA MATURITY MODEL

Information security is mainly a topic that is considered to be information technology related. However, to successfully implement information security, an organization´s information security program should reflect the business strategy. Nowadays information security is in many companies enforced by the information technology department, based on what they think should be in place to protect their business from inside and outside threats and risks. Additionally, information security covers many different subjects. This makes it especially hard for small and medium sized organizations to determine how they should design their information security program. \ \ Therefore, we present the Information Security Focus Area Maturity Model (ISFAM). By identifying dependencies between various aspects of information security and representing them coherently in the ISFAM, the model is capable of determining the current information security maturity level. Involving the ISFAM model in the design process of an organization´s information security program enables organizations to set up high level guidelines based on their current status. These guidelines can be used to incrementally and structurally improve information security maturity within the organization. We have successfully evaluated the ISFAM assessment model through a single case study at a medium sized telecommunications organization

Core Outcome Set for pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Pulmonary rehabilitation (PR) is fundamental however, response to this intervention varies among patients with COPD. One of the main reasons for this differential response is the heterogeneity of outcomes used and reported, hindering bench-marking between and within PR centres, the conduction of meta-analysis and the scientific/clinical advance of a vital treatment to respiratory patients. This problem can be overcome with the development of a Core Outcome Set (COS) - minimum set of outcomes that should be consistently measured and reported. Thus, this thesis aims to develop a COS for PR in patients with COPD. It will be developed in stages, according to the Core Outcome Measures in Effectiveness Trials (COMET) initiative methodology: i) identify existing knowledge systematic review of the literature, ii) fill gaps in knowledge if needed observational studies of effects of PR in overlooked outcomes, iii) elicit views about important outcomes in a consensus process qualitative study with interviews and Delphi survey, iv) hold a face to face meeting to finalise the recommended COS. Finally, a review of the clinimetric properties of the most used measures for the core outcomes will be conducted, to recommend not only the core outcomes, but also the core measures. This COS is expected to facilitate consistency among trials, lessen the risk of outcome reporting bias and inform clinical and research practice.publishe

Outcomes and measures of pulmonary rehabilitation in patients with COPD: a systematic review

The magnitude of response to pulmonary rehabilitation (PR) is influenced by the selection of outcomes and measures. Outcome and measure selection depends on various factors which can lead to high heterogeneity of reported outcomes/measures in the literature, hindering bench marking between and within PR centers and an effective evidence synthesis. We aimed to review all outcomes and measures used in clinical trials of PR for patients with COPD. A systematic review was conducted (CRD42017079935) with searches on Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed. Studies reporting on PR of stable patients with COPD and from 2000 onwards were included. Data were extracted into a standardized table. Frequency of reporting for each domain, outcome and measure was synthesized using Microsoft Excel®. 267 studies were included with 43153 patients with COPD. 22 domains, 163 outcomes and 217 measures were found. Several measures were used to assess the same outcome. Exercise capacity (n=218) assessed with the six-minute walk test (n=140), health-related quality of life (n=204) assessed with the Saint George’s respiratory questionnaire (n=99), and symptoms (n=158) assessed with the modified medical research council dyspnoea scale (n=56) were mostly reported. The least reported outcomes were comorbidities, adverse events and knowledge. This systematic review reinforced the need of a core outcome set in this field, as high heterogeneity in reported outcomes and measures was found. Future studies should assess the importance of each outcome for PR according to different stakeholders.publishe

Determinants of polypharmacy and compliance with GOLD guidelines in patients with chronic obstructive pulmonary disease

BACKGROUND: Polypharmacy of respiratory medications is commonly observed in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate determinants of polypharmacy and to study the consistency of actual respiratory drug use with current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in pulmonary rehabilitation candidates with COPD. METHODS: Data were extracted from the records of all patients with a diagnosis of COPD referred for pulmonary rehabilitation to CIRO+ between 2005 and 2009. Use of respiratory medications, self-reported COPD exacerbations, lung function, blood gases, exercise capacity, Medical Research Council (MRC) dyspnea grade, and St George's Respiratory Questionnaire (SGRQ) were recorded as part of assessment of health status. RESULTS: In total, 1859 COPD patients of mean age (+/- standard deviation) 64.3 +/- 9.7 years and with a forced expiratory volume in one second (FEV(1)) of 44.7% +/- 18.2% were included. On average, patients used 3.5 +/- 1.5 respiratory medications; this number increased with increasing GOLD stage, MRC score, and SGRQ scores. FEV(1) (% predicted), SGRQ, and number of recent exacerbations were independent determinants of polypharmacy. Use of long-acting bronchodilators and inhaled corticosteroids was substantial and comparable in all GOLD stages. Use of corticosteroids was not restricted to patients with frequent exacerbations. CONCLUSION: Polypharmacy of respiratory medications is common in COPD patients with persistent symptoms. In addition to severity of disease, health status is an independent predictor of polypharmacy. Actual drug use in COPD patients referred for pulmonary rehabilitation is partially inconsistent with current GOLD guidelines

Outcomes of pulmonary rehabilitation in patients with COPD: a systematic review

Introduction: The magnitude of response to pulmonary rehabilitation (PR) is partially influenced by the selection of outcomes and measures. Overall guidance on such subject is somewhat limited as no comprehensive systematic review has gathered all outcomes and measures used in clinical trials of PR for patients with chronic obstructive pulmonary disease (COPD). We aimed to summarise all previously reported outcomes and measures to further contribute to the development of a core outcome set (COS). Methods: Searches were conducted on Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed. Studies reporting on PR of stable patients with COPD were included. Data were extracted into a pre-developed standardised table. Frequency of reporting for each outcome and measure was synthesised using Microsoft Excel®. Results: 267 studies were included with 43153 patients with COPD. A broad range of outcomes (n=186) was found. PR was mostly conducted in outpatient setting (n=146) 2- 3 days/week (n=150) during 8-12 weeks (n=124). Exercise capacity (n=214) with the sixminute walk test (n=138), health-related quality of life (n=181) with the Saint George’s respiratory questionnaire (n=84), and symptoms (n=96) with the modified medical research council dyspnoea questionnaire (n=41) were mostly reported. Comorbidities and medication with the number of medication (n=1), sleep with the Pittsburgh sleep quality index (n=1) and self-management with the Flinders university PIh scale (n=1) were less reported. Conclusions: This study reinforced the need for a COS for PR in patients with COPD, as high heterogeneity in reported outcomes was found. Researchers and clinicians may now choose to use the most reported outcomes and measures to facilitate comparisons across studies, and/or use less reported outcomes and measures to investigate the effectiveness of PR.publishe

Patients' perspective on pulmonary rehabilitation: experiences of European and American individuals with chronic respiratory diseases

Despite the fact that pulmonary rehabilitation (PR) is the most powerful nonpharmacological intervention to improve the symptoms, exercise capacity and quality of life of people living with chronic lung disease [1], fewer than 2% of eligible patients enrol [2, 3]. While preparing a joint American Thoracic Society (ATS)/European Respiratory Society (ERS) Policy Statement on pulmonary rehabilitation [4], we developed a survey to better understand patients' perspectives on PR, and to identify challenges faced both by patients who have taken part in PR and those who might be eligible but have not had the opportunity. The survey was disseminated via the European Lung Foundation/ERS and ATS Public Advisory Roundtable professional patient networks, and via the COPD Foundation and Pulmonary Fibrosis Foundation to patients with a wide range of chronic lung diseases. The survey was available online from July, 2014 to November, 2014 in 10 languages (Dutch, English, Flemish, French, German, Greek, Italian, Polish, Portuguese and Spanish). Responses were received from 1685 people (73% female) with self-reported chronic lung disease in 29 countries (USA: 71.1%; Europe: 27.4%; others: 1.5%) and were included in the analyses (table 1)

Changes in lower limb muscle function and muscle mass following exercise-based interventions in patients with chronic obstructive pulmonary disease : a review of the English-language literature

Chronic obstructive pulmonary disease (COPD) patients often experience lower limb muscle dysfunction and wasting. Exercise-based training has potential to improve muscle function and mass, but literature on this topic is extensive and heterogeneous including numerous interventions and outcomemeasures. This reviewuses a detailed systematic approach to investigate the effect of this wide range of exercise-based interventions on muscle function and mass. PUBMED and PEDro databases were searched. In all, 70 studies (n = 2504 COPD patients) that implemented an exercise-based intervention and reported muscle strength, endurance, or mass in clinically stable COPD patients were critically appraised. Aerobic and/or resistance training, high-intensity interval training, electrical or magnetic muscle stimulation, whole-body vibration, andwater-based training were investigated. Muscle strength increased in 78%, muscle endurance in 92%, and muscle mass in 88% of the cases where that specific outcome was measured. Despite large heterogeneity in exercise-based interventions and outcome measures used, most exercise-based trials showed improvements in muscle strength, endurance, and mass in COPD patients. Which intervention(s) is (are) best for which subgroup of patients remains currently unknown. Furthermore, this literature review identifies gaps in the current knowledge and generates recommendations for future research to enhance our knowledge on exercise-based interventions in COPD patients

COPD and exercise: does it make a difference?

Physical activity is defined as any bodily movement produced by skeletal muscles which results in energy expenditure. Physical activity in daily life can be categorised into occupational, sports, conditioning, household, or other activities. Exercise is a subset of physical activity that is planned, structured, and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness [1]. According to international guidelines, exercise training, widely regarded as the cornerstone of pulmonary rehabilitation, is the best available means of improving muscle function and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) [2, 3]. It truly makes a difference in the life of patients with COPD. In this review, an overview is provided on the history of exercise training (as standalone intervention or as part of a comprehensive pulmonary rehabilitation programme), the state-of-the-art exercise training, exercise training in comorbid patients with COPD, and the impact of physical activity counselling in a clean air environment

End-of-life care in a COPD patient awaiting lung transplantation: a case report

COPD is nowadays the main indication for lung transplantation. In appropriately selected patients with end stage COPD, lung transplantation may improve quality of life and prognosis of survival. However, patients with end stage COPD may die while waiting for lung transplantation. Palliative care is important to address the needs of patients with end stage COPD. This case report shows that in a patient with end stage COPD listed for lung transplantation offering palliative care and curative-restorative care concurrently may be problematic. If the requirements to remain a transplantation candidate need to be met, the possibilities for palliative care may be limited. Discussing the possibilities of palliative care and the patient's treatment preferences is necessary to prevent that end-of-life care needs of COPD patients dying while listed for lung transplantation are not optimally addressed. The patient's end-of-life care preferences may ask for a clear distinction between the period in which palliative and curative-restorative care are offered concurrently and the end-of-life care period. This may be necessary to allow a patient to spend the last stage of life according to his or her wishes, even when this implicates that lung transplantation is not possible anymore and the patient will die because of end stage COPD