Myocard Infarct en Cerebrovasculair Accident keten (MICK) studie

For patients with acute coronary syndrome (ACS) and stroke prompt diagnosis and treatment is essential. Before a patient reaches the hospital he may have had contact with a general practitioner (GP), a GP cooperative (GPC), ambulance service, or Emergency Department. Optimal use and efficient functioning of the acute health care chain is imperative. The aim of the MICK study is to obtain insight into circumstances in which symptoms of patients occur, medical contacts throughout the acute care chain, delays, door-to-balloon and door-to-needle time. This is a prospective observational study including 202 patients suspected of having ACS and 239 suspected of ischemic stroke. Patients filled out a questionnaire and additional data was obtained using registries.\ud Over 40% of all patients suspected of ACS waited more than 6 hours before contacting a health care provider and over 30% of all patients suspected of having a stroke waited more than 4 hours. Patients reached the hospital through many different health care chains. Once a care provider was contacted, 45% of all patients with ACS were hospitalized within 90 minutes at the CCU and 65% of patients with stroke within 4 hours at the stroke unit.\ud Most patients first contacted the GP or GPC. For patients who immediately called 112 time to hospitalization was the shortest.\ud Overall are noticeable the long patient delays in seeking care, the various chains through which patients reach the CCU or stroke unit and the different throughput times

Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations

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Post-stroke self-management interventions: a systematic review of effectiveness and investigation of the inclusion of stroke survivors with aphasia

Purpose: To systematically review self-management interventions to determine their efficacy for people with stroke in relation to any health outcome and to establish whether stroke survivors with aphasia were included. Method: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, The Cochrane Library, and IBSS and undertook gray literature searches. Randomized controlled trials were eligible if they included stroke survivors aged 18 + in a “self-management” intervention. Data were extracted by two independent researchers and included an assessment of methodological quality. Results: 24 studies were identified. 11 out of 24 reported statistically significant benefits in favor of self-management. However, there were significant limitations in terms of methodological quality, and meta-analyses (n= 8 studies) showed no statistically significant benefit of self-management upon global disability and stroke-specific quality of life at 3 months or ADL at 3 or 6 months follow-up. A review of inclusion and exclusion criteria showed 11 out of 24 (46%) studies reported total or partial exclusion of stroke survivors with aphasia. Four out of 24 (17%) reported the number of stroke survivors with aphasia included. In nine studies (38%) it was unclear whether stroke survivors with aphasia were included or excluded. Conclusions: Robust conclusions regarding the effectiveness of poststroke self-management approaches could not be drawn. Further trials are needed, these should clearly report the population included. •Implications for rehabilitation •There is a lack of evidence to demonstrate the effectiveness of self-management approaches for stroke survivors. •It is unclear whether self-management approaches are suitable for stroke survivors with aphasia, particularly those with moderate or severe aphasia. •Further research is needed to understand the optimal timing for self-management in the stroke pathway and the format in which self-management support should be offered

Non-pharmacological Interventions for Breathlessness in Cancer

Introduction: Breathlessness is a common and distressing symptom in people with advanced cancer of all etiologies, often co-existing with cough and fatigue. Its incidence and severity increase as death approaches. Growing evidence suggests that non-pharmacological interventions, delivered as a complex intervention, can increase quality of life of those living with cancer-related breathlessness, and those closest to them. It is clear that these evidence-based treatments are not yet consistently available to patients and families, leading to significant avoidable suffering. Breathlessness interventions may not always reduce the absolute level of the symptom. They may reduce the individual’s awareness of their breathlessness, or increase self-efficacy or knowledge of how to manage it, i.e. they have an effect on its central perception

Unravelling self-management for patients with COPD: long-term effects of the COPE-II study

Chronic obstructive pulmonary disease (COPD) is a chronic and usually progressive disease. Besides symptoms of dyspnoea, sputum production and chronic cough, patients with COPD often have impaired exercise capacity and a decreased physical activity level. Despite optimal pharmacological treatment, patients still experience symptoms and may have difficulties to cope with their disease. In view of this, self-management is increasingly recognised to be important in the treatment of COPD. Scientific evidence on long-term effectiveness of self-management programmes remains scarce. Moreover, it is uncertain what the contribution of independent components of self-management is to its effectiveness. To assess the current state of evidence on the effectiveness of self-management for patients with COPD, we have updated the Cochrane review on this topic. Meta-analyses showed that self-management interventions in patients with COPD are associated with improved health-related quality of life and a reduction in hospital admission. Additionally, the long-term (i.e. after two years of follow-up) effectiveness of two frequently used self-management components, self-treatment of exacerbations and a community-based exercise programme, were evaluated using a randomised controlled trial. Data showed that patients with COPD clearly benefit from self-treatment of exacerbations guided by an action plan as regards the duration and severity of exacerbations. Also, self-treatment reduced healthcare utilisation leading to considerable cost savings. The community-based exercise programme was effective in achieving a behavioural change reflected by a sustained increase in daily physical activity level, but this was not accompanied by a sustained increase in maximal exercise capacity in patients with COPD after two years of follow-up. Based on these results, recommendations for current clinical practice and future research were made