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Educational programmes in COPD management interventions: A systematic review.

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Educational programmes in COPD management interventions: A systematic review.

Respir Med. 2013 Sep 4;

Authors: Stoilkova A, Janssen DJ, Wouters EF

Abstract
BACKGROUND: According to practice guidelines, educational programmes for patients with COPD should address several educational topics. Which topics are incorporated in the existing programmes remains unclear.
OBJECTIVES: To delineate educational topics integrated in current COPD management interventions; and to examine strengths, weaknesses, and methods of delivery of the educational programmes.
DATA SOURCES: A systematic literature search was performed using MEDLINE/PubMed, Cochrane Central Registry of Controlled Clinical Trials, and Web of Science. The authors of included studies were contacted for additional information.
STUDY SELECTION: Studies that contained educational programmes incorporated in COPD management interventions were included.
DATA EXTRACTION: Data were extracted using a pre-designed data form. The Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework was used for evaluating the strengths and weaknesses of the programmes.
DATA SYNTHESIS: In total, 81 articles, describing 67 interventions were included. The majority (53.8%) of the studies incorporated 10 or more educational topics. The following topics were frequently addressed: smoking cessation (80.0%); medication (76.9%); exercise (72.3%); breathing strategies (70.8%); exacerbations (69.2%); and stress management (67.7%). Printed material and/or brochure (90.5%) and demonstrations and practice (73.8%), were the predominant tool and method, respectively. Nurses (75.8%), physicians (37.9%) and physiotherapists (34.8%) were the most involved healthcare professionals.
CONCLUSIONS: Heterogeneity and wide variation in the content and the method of delivery of educational interventions were present. Alignment between educational topics incorporated in the existing programmes and those recommended by the COPD guidelines, involvement of various professionals and combined use of methods should be emphasised.

PMID: 24012387 [PubMed - as supplied by publisher]

Activity monitoring reflects cardiovascular and metabolic variations in COPD patients across GOLD Stages II to IV.

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We investigated whether activity monitoring reliably reflects variations in oxygen transport and utilization during walking in COPD patients.

Forty two patients (14 in each GOLD stage II, III and IV) performed an incremental treadmill protocol to the limit of tolerance. Breath-by-breath gas exchange, central hemodynamic variables and activity monitoring were simultaneously recorded. Physiological variables and accelerometer outputs rose linearly with walking speeds.

Strong correlations (r[interquartile range, IQR]) were found between treadmill walking intensity (WI: range0.8 to 2.0m(.)sec(-2)) and oxygen consumption (0.95 [IQR 0.87 to 0.97]), (range7.6 to 15.5ml(.)kg(-1.)min(-1)); minute ventilation (0.95 [IQR 0.86 to 0.98]),(range 20 to 37 l(.)min(-1)); cardiac output (0.89 [IQR 0.73 to 0.94]), (range 6.8 to 11.5 l(.)min(-1)) and arteriovenous oxygen concentration difference (0.84 [IQR 0.76 to 0.90]),(range 7.7 to 12.1ml O2(.)100 ml(-1)). Correlations between walking WI and gas exchange or central hemodynamic parameters were not different across GOLD stages.

In conclusion, central hemodynamic, respiratory and muscle metabolic variations during incremental treadmill exercise are tightly associated to changes in walking intensity as recorded by accelerometry across GOLD stages II to IV. Interestingly, the magnitude of these associations is not different across GOLD stages.

A multidisciplinary intervention to reduce antibiotic duration in lower respiratory tract infections.

Prolonged antibiotic courses are common in patients with lower respiratory tract infections (LRTIs) and contribute to antibiotic resistance and side effects. This study describes a multidisciplinary intervention to reduce antibiotic duration in LRTI patients.

METHODS: This was a prospective before-and-after intervention study conducted from November 2011 to December 2012. Antibiotic duration was recorded for 6 months for all LRTI admissions (pneumonia, exacerbation of chronic obstructive pulmonary disease, exacerbation of asthma, and other LRTIs), followed by the introduction of an intervention intended to reduce the duration of antibiotic treatment. The intervention incorporated an antibiotic duration based on the CURB65 score, automatic stop dates and pharmacist feedback to prescribers.

RESULTS: Two hundred and eighty-one patients were included in the pre-intervention group and 221 in the post-intervention group. The intervention resulted in a reduction in the duration of antibiotic treatment from 8.3 to 6.8 days (P < 0.001, 18.1% relative reduction). The rate of antibiotic-related adverse effects reduced from 31% to 19% (P = 0.03, 39.3% relative reduction). There was no increase in mortality or length of stay

CONCLUSIONS: A simple intervention can significantly reduce antibiotic duration and antibiotic-related side effects.

Sleep-induced hypoxaemia in patients with chronic obstructive pulmonary disease.

Patients with moderate or severe chronic obstructive pulmonary disease run a high risk of developing sleep-induced hypoxaemia, because of alveolar hypoventilation and ventilation-perfusion mismatch. This article looks at the prevalence, significance and treatment of sleep-induced hypoxaemia in chronic obstructive pulmonary disease.

Management of non-small-cell lung cancer: recent developments.

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Management of non-small-cell lung cancer: recent developments.

Lancet. 2013 Aug 24;382(9893):709-19

Authors: Reck M, Heigener DF, Mok T, Soria JC, Rabe KF

Abstract
Non-small-cell lung cancer is one of the leading causes of deaths from cancer worldwide. Therefore, improvements in diagnostics and treatments are urgently needed. In this review, we will discuss the evolution of lung cancer staging towards more non-invasive, endoscopy-based, and image-based methods, and the development of stage-adapted treatment. A special focus will be placed on the role of novel surgical approaches and modern radiotherapy strategies for early stages of disease, the effect of multimodal treatment in locally advanced disease, and ongoing developments in the treatment of patients with metastatic disease. In particular, we will include an emphasis on targeted therapies, which are based on the assumption that a treatable driver mutation or gene rearrangement is present within the tumour. Finally, the position of lung cancer treatment on the pathway to personalised therapy will be discussed.

PMID: 23972814 [PubMed - indexed for MEDLINE]

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