scholarly journals Integrating care between an NHS hospital, a community provider and the role of commissioning: the experience of developing an integrated respiratory service

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040267
Author(s):  
Jonathan Banks ◽  
Tracey Stone ◽  
James Dodd
Keyword(s):  
Hospital Staff ◽  
Chronic Obstructive ◽  
Working Relationships ◽  
Obstructive Pulmonary Disease ◽  
For Profit ◽  
Community Provider ◽  
Service Staff ◽  
Shared Information ◽  
Negative Perceptions ◽  
The Relationship

ObjectivesAn integrated respiratory service was commissioned in 2016 in a UK region to support patients with chronic obstructive pulmonary disease. The service brought together the respiratory department of a National Health Service hospital and a not-for-profit community provider. This paper evaluates: (1) the perceived efficacy of integrated working between the organisations from the perspective of staff and (2) the relationship between commissioning and integration of the services.DesignSemistructured interviews with staff from the three organisations involved in the integrated respiratory service. Staff were purposefully sampled. The interviews were audio recorded, transcribed and analysed thematically.SettingSecondary care respiratory unit; community provider of respiratory care; and a clinical commissioning group.ParticipantsNineteen interview participants: nine from the community provider; eight from the hospital and two from the clinical commissioning group.ResultsStaff identified lack of integration between the organisations characterised by: poor communication, lack of trust, absence of shared information technology and ineffective integrative initiatives. The commissioning process created barriers to integration including: contractual limitations which prevented pathway development, absence of agreed clinical governance arrangements and lack of recognition of community work undertaken by hospital staff. Positive working relationships were established over time as staff recognised the skills that each had to offer.ConclusionsThe commissioning process underpinned the relationship between the organisations and contributed to distrust and negative perceptions of the ‘other’. Commissioning an integrated service should incorporate dialogue with stakeholders as early as possible and before the contract is finalised to develop a bedrock of trust.

scholarly journals THE RELATIONSHIP OF NT PRO BNP AND ECHOCARDIOGRAPHIC FEATURES OF RIGHT VENTRICLE DISFUNCTION WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT HAJI ADAM MALIK GENERAL HOSPITAL MEDAN

2020 ◽  
Vol 7 (12) ◽  
pp. 49-50
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Cardiovascular Complications ◽  
Chronic Obstructive ◽  
Pathological Findings ◽  
Obstructive Pulmonary Disease ◽  
The Relationship ◽  
Severe Copd

Background: Cardiovascular complications caused by Chronic Obstructive Pulmonary Disease (COPD) will affect structure and function of heart’s normal anatomy. This study aims to determine the relationship between the abnormality of NT Pro BNP levels and echocardiographic features of right ventricular (RV) dysfunction in COPD. Method: A cross-sectional study to assess the association between the abnormality of NT Pro BNP levels and echocardiographic features of right ventricular dysfunction in COPD in the outpatient unit of the Integrated Heart Center H. Adam Malik Hospital Medan. COPD patients were grouped based on GOLD criteria from spirometry examination into severe COPD (GOLD III) and very severe COPD (GOLD IV). Subjects then performed NT pro BNP and echocardiography examination to assess pathological changes in cardiac. Result: NT Pro BNP was higher in GOLD IV. Cut off value of NT Pro BNP > 172 pg/nl is the initial parameter of right ventricular dysfunction. Pulmonary hypertension was found in 93% of cases. The most common cardiac pathological findings were RV hypertrophy (71%), RV dysfunction (86.7%) and pulmonary regurgitation (87.5%). Pathological findings on echocardiography were more common in the GOLD IV group. COPD severity was associated with NT Pro BNP abnormalities (p <0.001) and associated with pathologic echocardiographic findings (p <0.001). Conclusion: Severe COPD is associated with increased NT pro-BNP abnormalities and pathological findings on echocardiography. Echocardiography facilitates early detection of cardiovascular complications in patients with severe and very severe COPD (GOLD III and IV).

Assessment of Health Impacts of PM2.5 by AirQ+ Software in the City of Sanandaj, Iran (2018-2019)

2021 ◽  
Vol 9 (1) ◽  
pp. 45-56
Author(s):  
Ghorban Asgari ◽  
◽  
Ramin Khoshniyat ◽  
Farhad Karimi ◽  
Kamal Ebrahimi ◽  
...  
Keyword(s):  
Air Pollution ◽  
Environmental Protection Agency ◽  
Health Effect ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Hourly Data ◽  
Baseline Incidence ◽  
Brain Stroke ◽  
The Relationship ◽  
Airq Software

Background: Particulate or particle mattes in term of air pollution are particles with a diameter of 2.5 μm or less (PM2.5). PM2.5 is a natural source of air pollution and has harmful effects on citizens in Sanandaj City, located in the west of Iran. Methods: In this study, the hourly data of concentration of PM2.5 were taken from the Kurdistan Environmental Protection Agency. During the study period (2018-2019), the 24-hour concentration of PM2.5 exceeded 339 times the average level. By AirQ+ software, the relationship between data and Relative Risk (RR), Baseline Incidence (BI), and Attributable Proportion (AP) were estimated. Then chronic obstructive pulmonary disease, lung cancer, ischemic heart disease, and brain stroke in the range of over 30 years were estimated. Results: The main target of this study was to survey the relationship between PM2.5 concentration and the death rate of citizens of this non-industrial city. The long-term health effect (more than 6 months) of PM2.5 caused 326 deaths on average (except for accidents and poisoning). Conclusion: Increase the concentration of PM2.5 is one factor that affects a high percentage of mortality rate.

scholarly journals The Relationship Between Cough Reflex Sensitivity and Exacerbation Frequency in Chronic Obstructive Pulmonary Disease

Lung ◽  
2020 ◽  
Vol 198 (4) ◽  
pp. 617-628
Author(s):  
Peter S. P. Cho ◽  
Hannah V. Fletcher ◽  
Richard D. Turner ◽  
Irem S. Patel ◽  
Caroline J. Jolley ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Cough Reflex Sensitivity ◽  
Obstructive Pulmonary Disease ◽  
Cough Reflex ◽  
Exacerbation Frequency ◽  
The Relationship

Day-to-day variability of forced oscillatory mechanics for early detection of acute exacerbations in COPD

2020 ◽  
Vol 56 (3) ◽  
pp. 1901739 ◽  
Author(s):  
Sabine C. Zimmermann ◽  
Jacqueline Huvanandana ◽  
Chinh D. Nguyen ◽  
Amy Bertolin ◽  
Joanna C. Watts ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Standard Deviation ◽  
Early Detection ◽  
Pulmonary Disease ◽  
Repeated Measures ◽  
Chronic Obstructive ◽  
Forced Oscillation Technique ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbations ◽  
The Relationship

BackgroundTelemonitoring trials for early detection of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have provided mixed results. Day-to-day variations in lung function measured by the forced oscillation technique (FOT) may yield greater insight. We evaluated the clinical utility of home telemonitoring of variability in FOT measures in terms of 1) the relationship with symptoms and quality of life (QoL); and 2) the timing of variability of FOT measures and symptom changes prior to AECOPD.MethodsDaily FOT parameters at 5 Hz (resistance (R) and reactance (X); Resmon Pro Diary, Restech Srl, Milan, Italy), daily symptoms (COPD Assessment Test (CAT)) and 4-weekly QoL data (St George's Respiratory Questionnaire (SGRQ)) were recorded over 8–9 months from chronic obstructive pulmonary disease (COPD) patients. Variability of R and X was calculated as the standard deviation (sd) over 7-day running windows and we also examined the effect of varying window size. The relationship of FOT versus CAT and SGRQ was assessed using linear mixed modelling, daily changes in FOT variability and CAT prior to AECOPD using one-way repeated measures ANOVA.ResultsFifteen participants with a mean±sd age of 69±10 years and a % predicted forced expiratory volume in 1 s (FEV1) of 39±10% had a median (interquartile range (IQR)) adherence of 95.4% (79.0–98.8%). Variability of the inspiratory component of X (indicated by the standard deviation of inspiratory reactance (SDXinsp)) related to CAT and weakly to SGRQ (fixed effect estimates 1.57, 95% CI 0.65–2.49 (p=0.001) and 4.41, 95% CI −0.06 to 8.89 (p=0.05), respectively). SDXinsp changed significantly on the same day as CAT (1 day before AECOPD, both p=0.02) and earlier when using shorter running windows (3 days before AECOPD, p=0.01; accuracy=0.72 for 5-day windows).ConclusionsSDXinsp from FOT telemonitoring reflects COPD symptoms and may be a sensitive biomarker for early detection of AECOPD.

Periodontitis Is Associated with Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 98 (5) ◽  
pp. 534-540 ◽  
Author(s):  
K. Takeuchi ◽  
K. Matsumoto ◽  
M. Furuta ◽  
S. Fukuyama ◽  
T. Takeshita ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Population Attributable Fraction ◽  
Community Dwelling ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
Severe Periodontitis ◽  
The Relationship

Although they are known to share pathophysiological processes, the relationship between periodontitis and chronic obstructive pulmonary disease (COPD) is not fully understood. The aim of the present study was to test the hypothesis that periodontitis is associated with a greater risk of development of COPD, when smoking is taken into account. The analysis in a 5-y follow-up population-based cohort study was based on 900 community-dwelling Japanese adults (age: 68.8 ± 6.3 [mean ± SD], 46.0% male) without COPD aged 60 or older with at least 1 tooth. Participants were classified into 3 categories according to baseline periodontitis severity (no/mild, moderate, and severe). COPD was spirometrically determined by a fixed ratio of <0.7 for forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and by FEV1/FVC below the lower limit of normal. Poisson regression was used to calculate the relative risk (RR) of developing COPD according to the severity of periodontitis. The population attributable fraction (PAF) was also calculated. During follow-up, 22 (2.4%) subjects developed COPD. Compared with no/mild periodontitis subjects, a significantly increased risk of COPD occurred among severe periodontitis subjects (RR = 3.55; 95% confidence interval [CI], 1.18 to 10.67), but no significant differences were observed between the no/mild and moderate categories (RR = 1.48; 95% CI, 0.56 to 3.90). After adjustment for potential confounders, including smoking intensity, the relationship between severe periodontitis and risk of COPD remained significant (RR = 3.51; 95% CI, 1.15 to 10.74). Likewise, there was a positive association of periodontitis severity with risk of COPD ( P for trend = 0.043). The PAF for COPD due to periodontitis was 22.6%. These data highlight the potential importance of periodontitis as a risk factor for COPD.

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