Beyond FEV1 in COPD: a review of patient-reported outcomes and their measurement

Abstract: Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms and pathological consequences. Although primarily viewed as a respiratory disease, COPD has both pulmonary and extrapulmonary effects, which have an impact on many aspects of physical, emotional, and mental well-being. Traditional assessment of COPD relies heavily on measuring lung function, specifically forced expiratory volume in 1 second (FEV1). However, the evidence suggests that FEV1 is a relatively poor correlate of symptoms such as breathlessness and the impact of COPD on daily life. Furthermore, many consequences of the disease, including anxiety and depression and the ability to perform daily activities, can only be described and reported reliably by the patient. Thus, in order to provide a comprehensive view of the effects of interventions in clinical trials, it is essential that spirometry is accompanied by assessments using patient-reported outcome (PRO) instruments. We provide an overview of patient-reported outcome concepts in COPD, such as breathlessness, physical functioning, and health status, and evaluate the tools used for measuring these concepts. Particular attention is given to the newly developed instruments emerging in response to recent regulatory guidelines for the development and use of PROs in clinical trials. We conclude that although data from the development and validation of these new PRO instruments are emerging, to build the body of evidence that supports the use of a new instrument takes many years. Furthermore, new instruments do not necessarily have better discriminative or evaluative properties than older instruments. The development of new PRO tools, however, is crucial, not only to ensure that key COPD concepts are being reliably measured but also that the relevant treatment effects are being captured in clinical trials. In turn, this will help us to understand better the patient's experience of the disease

The effect of cultural orientation and leadership style on self- versus other-oriented organizational citizenship behavior in Turkey and the Netherlands

This paper investigated the effects of a paternalistic and empowering leadership style on organizational citizenship behaviour (OCB) in an experimental design using 100 Turkish and 100 Dutch students who held part-time jobs. Confirming our expectations, a paternalistic leadership style had a more positive effect on job dedication and organizational support in Turkey than in the Netherlands. Contradicting our expectations, an empowering leadership style did not have a more positive effect on any of the OCB dimensions in the Netherlands than it did in Turkey. However, in the Netherlands an empowering leadership style had a stronger effect on interpersonal facilitation, job dedication, and organizational support than a paternalistic leadership style. Paternalistic and empowering leadership styles both had positive effects on OCB dimensions in Turkey. As expected, collectivism moderated the relationship between paternalistic leadership style and other oriented OCB (i.e., interpersonal facilitation). Specifically, people who had more collectivistic tendencies were more positively influenced by a paternalistic leader than people who had low collectivistic tendencies in both countries. However, individualism did not have any moderating effects on the relationship between empowering leadership style and self-oriented OCB (i.e., job dedication). Our findings are relevant for understanding the effects of leadership styles and cultural orientations on self- versus other-oriented OCB in Turkey and the Netherlands

Bulk and Surface Nucleation Processes in Ag2S Conductance Switches

We studied metallic Ag formation inside and on the surface of Ag2S thin films, induced by the electric field created with a STM tip. Two clear regimes were observed: cluster formation on the surface at low bias voltages, and full conductance switching at higher bias voltages (V > 70mV). The bias voltage at which this transition is observed is in agreement with the known threshold voltage for conductance switching at room temperature. We propose a model for the cluster formation at low bias voltage. Scaling of the measured data with the proposed model indicates that the process takes place near steady state, but depends on the STM tip geometry. The growth of the clusters is confirmed by tip retraction measurements and topography scans. This study provides improved understanding of the physical mechanisms that drive conductance switching in solid electrolyte memristive devices.Comment: In press for PR

Relationship between guideline treatment and health-related quality of life in asthma

The aim of this study was to compare the health-related quality of life (HRQL) of asthma patients treated according to the 1997 National Institute of Health (NIH) international asthma guideline and that of asthmatics receiving non-guideline treatment. The suitability of 146 asthmatics' medication regimes was determined according to the 1997 NIH asthma guideline. Quality of life was assessed on a seven-point scale using the Asthma Quality of Life questionnaire. Just over half of the patients were not currently using the treatment considered necessary for controlling their asthma. Patients treated according to the guideline (n=72) had a significantly higher overall HRQL than patients with non-guideline treatment (5.7 versus 5.3). The differences were also significant for the subscales measuring symptoms and environmental exposure, but not for activities or emotional function. An association between non-guideline treatment and a poorer health-related quality of life in asthma patients treated in general practice was observed. This study supports the role of evidence-based guidelines in daily practice. Further studies are needed to determine if guideline treatment is responsible for the increase in health-related quality of life observed in this work

The use of humour in diversional therapy

Humour is a natural phenomenon that every human being possesses. But humour is often not fully utilized and often taken for granted. It is only recently that there has been an upsurge in research in the area of humour that has began to highlight and prove the many benefits that come from its effective utilization. Although humour is a natural phenomenon, there are times in our lives when humour needs to be formally initiated such as in times of illness. Diversional Therapists because of the nature of their work, have ample opportunities to initiate humour. Humour is one of the many tools diversional therapists can use to increase the effectiveness of their activities programmes. This paper examines the definitions of humour and laughter, the beneficial functions of humour, why the use of humour is important in diversional therapy practice and the applications of humour in practice. The paper aims to give diversional therapists background information about humour, highlight the many benefits of humour and give some practical ideas of how humour can be formally incorporated into their diversional therapy programmes. It is envisaged that this paper will increase diversional therapists knowledge of humour, encourage the use of formal humour programmes with clients and encourage diversional therapists to research the various ways of using humour in their practice