General practice and primary care最新文献_第8页

Withdrawal of high-dose inhaled corticosteroids in COPD patients with mild or moderate airflow limitation: a feasibility study in primary care 轻度或中度气流受限的COPD患者停用大剂量吸入皮质类固醇:一项初级保健的可行性研究

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5007

P. White, G. Gilworth, M. Thomas, C. Corrigan, Patrick J. Murphy, N. Hart, Leslie A. Hamilton, T. Harries

{"title":"Withdrawal of high-dose inhaled corticosteroids in COPD patients with mild or moderate airflow limitation: a feasibility study in primary care","authors":"P. White, G. Gilworth, M. Thomas, C. Corrigan, Patrick J. Murphy, N. Hart, Leslie A. Hamilton, T. Harries","doi":"10.1183/13993003.congress-2019.pa5007","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa5007","url":null,"abstract":"Background: High-dose inhaled corticosteroids (HD-ICS) are prescribed frequently outside guidelines in COPD, especially with mild or moderate airflow limitation. The acceptability and safety of withdrawal of HD-ICS in these patients is unknown. Aim: Feasibility study of a trial of the safe withdrawal of HD-ICS prescribed outside guidelines in COPD patients with mild or moderate airflow limitation. Method: COPD patients with mild or moderate airflow limitation using HD-ICS were invited to participate by their GPs. The challenges of identifying those suitable for inclusion have been described elsewhere. Participants were randomised to withdrawal from or continued use of HD-ICS. Impact of withdrawal was assessed through measures of lung function, quality of life, exacerbations, cellular and molecular biomarkers and neural respiratory drive. Measures were repeated at 3 and 6 months. Results: 61 patients attended. All agreed to undertake HD-ICS withdrawal. 21 patients were excluded due to: FEV1 reversibility (49%), severe airflow limitation (29%), no airflow obstruction (10%), frequent exacerbations in past year (4%), hospital admission for exacerbation (4%), BMI >35 (4%). 40 patients were recruited to the feasibility study. 20 were randomised to withdraw from HD-ICS use, 20 to continue HD-ICS use. Among the withdrawal arm, 5 resumed HD-ICS because of a decline in lung function or patient choice. Conclusions: A trial of the withdrawal of HD-ICS is feasible and acceptable to eligible patients responding to invitation. Of priority are identification of suitable patients and careful monitoring to detect a decline in lung function following withdrawal.","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122574193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prospective multicenter observational study comparing ambulatory management of spontaneous pneumothorax versus hospital care: PNEUMOPECO study 前瞻性多中心观察性研究:比较自发性气胸的门诊治疗与医院护理:PNEUMOPECO研究

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa721

A. Angibaud, Y. Bazin, A. Salé, L. Sohier, C. Gangloff, E. Antone, W. Trzepizur, L. Chemery, S. Guinard, T. Guy, C. Gut-Gobert, C. Bernier, B. Delatour, S. Jouneau

引用次数: 0

Quality of life in German GP-Patients with COPD– a longitudinal study 德国gp - COPD患者的生活质量——一项纵向研究

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa704

C. Klett-Tammen, H. Lingner, A. Kuhlmann, T. Schmidt, J. Lutter, J.-M. von der Schulenburg, M. Kreuter, T. Welte

引用次数: 0

Effect of screening for undiagnosed COPD on respiratory hospitalisation and mortality; 4 year follow up of the TargetCOPD trial 未确诊COPD筛查对呼吸道住院率和死亡率的影响TargetCOPD试验的4年随访

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.oa5147

P. Adab, D. Fitzmaurice, James Martin, A. Sitch, K. Cheng, A. Daley, A. Dickens, A. Enocson, S. Greenfield, K. Jolly, S. Jowett, Martin R Miller, R. Riley, S. Siebert, R. Stockley, A. Turner, Shamil Haroon, R. Jordan

引用次数: 0

STOP-BANG: a method to detect obstructive sleep apnea and discriminate for severity in primary care STOP-BANG:一种在初级保健中检测阻塞性睡眠呼吸暂停和区分严重程度的方法

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.oa255

Marta Plana Pes, Eric Rojas Calvera, Anna Torrente Nieto, Susana Mota Casals, Immaculada Castellà i Dagà, Anton Obrador I Legares, Mercè Salvans Sagué, Emilio Marco Segarra, Xavier Espuña Capote, María Buxó Pujolràs, Daniela Soledad Torres Scianca, R. Blanes, Ramon Orriols Martínez

{"title":"STOP-BANG: a method to detect obstructive sleep apnea and discriminate for severity in primary care","authors":"Marta Plana Pes, Eric Rojas Calvera, Anna Torrente Nieto, Susana Mota Casals, Immaculada Castellà i Dagà, Anton Obrador I Legares, Mercè Salvans Sagué, Emilio Marco Segarra, Xavier Espuña Capote, María Buxó Pujolràs, Daniela Soledad Torres Scianca, R. Blanes, Ramon Orriols Martínez","doi":"10.1183/13993003.congress-2019.oa255","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.oa255","url":null,"abstract":"Introduction: A STOP-BANG questionnaire (SBQ) score of ≥3 may detect obstructive sleep apnea (OSA) but is not well studied in primary care (PC) Aims and Objectives: Assess the ability of SBQ to predict OSA severity in PC Methods: 30 to 70 year-olds attending any of 4 PC centres in a 22-month period were randomly selected. PC physician did the SBQ. A home respiratory polygraphy (HRP) was done when scores of ≥3 were found and an attended polysomnography (PSG) when apnea-hypopnea index (AHI) was Results: Of included patients (565), 38.2% had SBQ≥3. Of these, 93.1% were diagnosed with OSA (Figure 1). All cases with SBQ≥6 had an AHI≥5/h. SBQ discriminated patients with severe OSA (AHI≥30/h)(n=70, AUC=0.697, 95% CI:0.621-0.773): moderate in women (n=23, AUC=0.733, 95% CI:0.605-0.860) and lower in men (n=47, AUC=0.679, 95% CI:0.583-0.766). In these cases, SBQ≥5 in women had a sensitivity (Sn) of 52.2%, specificity (Sp) of 85.7%, positive likelihood ratio (LR+) of 3.65 and negative likelihood ratio (LR-) of 0.56; and SBQ≥6 in men gave Sn of 44.7%, Sp of 86.7%, LH+ of 3.35 and LH- of 0.64 Conclusions: SB≥3 may adequately screen for OSA in PC. Scores of SB≥5 in women and ≥6 in men could be good opportunistic predictors of severe OSA in PC.","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123913794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Developing a patient-centred template for asthma reviews: an IMP2ART implementation strategy 制定以患者为中心的哮喘审查模板:IMP2ART实施战略

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3996

K. McClatchey, Aimee Sheldon, E. Steed, Stephanie J. C. Taylor, H. Pinnock, C. Ridgway, Oliver Taylor, V. Carter, F. Appiagyei, D. Price

{"title":"Developing a patient-centred template for asthma reviews: an IMP2ART implementation strategy","authors":"K. McClatchey, Aimee Sheldon, E. Steed, Stephanie J. C. Taylor, H. Pinnock, C. Ridgway, Oliver Taylor, V. Carter, F. Appiagyei, D. Price","doi":"10.1183/13993003.congress-2019.pa3996","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3996","url":null,"abstract":"Introduction: Computer templates are used in consultation to review long-term conditions such as asthma. Templates aim to improve adherence to key functions, but risk overriding the patient agenda. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme, aimed to develop an asthma review template to enhance patient-centred care, and promote supported self-management in primary care. Methods: Building on current guidelines, recommendations of an Asthma UK and Royal College of Physicians workshop, patient-centred literature, and behaviour change theory, the multidisciplinary team (clinicians, health psychologists, technical experts) developed a prototype template. A professional advisory group of asthma-interested GPs and nurses (n=17), provided insights into item inclusions and advised on feasibility within primary care. Results: Key features of the prototype template include: an opening question to establish the patient’s agenda such that patients concerns and goals can be addressed; a reduction in extensive data collection e.g. by using different tabs for spirometry; considerations for poorly controlled asthma; links to access a range of external information sources for patients; and a closing question to confirm the patient’s agenda has been addressed. The template highlights patient-centredness, encourages action plan provision, and supports patients to self-manage their asthma. Conclusions: Our prototype template is designed to promote patient-centred care and overcome the risk of reducing asthma reviews to ‘tick-box’ exercises. We will now seek feedback on the utility of the template from professionals and patients. Funding: NIHR PGfAR (RP-PG-1016-20008).","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":"17 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120813797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Withdrawal of inhaled corticosteroids in COPD patients with mild or moderate airflow limitation: who is suitable for a trial of withdrawal? 轻度或中度气流受限的COPD患者停药:谁适合停药试验?

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5005

T. Harries, G. Gilworth, M. Thomas, C. Corrigan, P. Murphy, N. Hart, Leslie A. Hamilton, P. White

{"title":"Withdrawal of inhaled corticosteroids in COPD patients with mild or moderate airflow limitation: who is suitable for a trial of withdrawal?","authors":"T. Harries, G. Gilworth, M. Thomas, C. Corrigan, P. Murphy, N. Hart, Leslie A. Hamilton, P. White","doi":"10.1183/13993003.congress-2019.pa5005","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa5005","url":null,"abstract":"Background: Inappropriate use of high-dose inhaled corticosteroids (HD-ICS) increases pneumonia risk and other complications in patients with COPD. The main indication for prescription of HD-ICS is frequent exacerbations with symptomatic disease. There is a need to identify those patients who are inappropriately prescribed HD-ICS. Aim: Identify COPD patients with mild or moderate airflow limitation suitable for withdrawal of HD-ICS. Method: Electronic records search in UK primary care identified COPD patients (asthma excluded) recently prescribed HD-ICS with no recorded severe airflow limitation in the past year. Before assessment with a view to HD-ICS withdrawal each record was scrutinised. Patients were excluded if prescription of HD-ICS was justified. Eligible patients invited by their family doctor for COPD review. Results: 392 suitable records were identified by electronic search from a COPD patient population of 2967. Frequent inconsistencies in diagnosis and recording of exacerbations were seen in patient notes, often with inability to assign prescription (rescue packs) of antibiotics and prednisolone to exacerbation occurrence. 243 patients excluded from withdrawal as HD-ICS justified. Predominant exclusion factors were: moderate or severe exacerbations (35%), severe airflow obstruction (27%), airflow reversibility (6%), active lung cancer (4%), dementia (3%). 149 patients invited for COPD review. 61 attended, 27 declined in writing, 61 not contactable or refused on the telephone. Conclusion: The determinants of suitability for HD-ICS prescription in primary care records are inconsistently recorded, difficult to identify and challenging to apply.","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127773723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Deprescribing of inhaled corticosteroids in patients with COPD with mild or moderate airflow limitation: what do patients think? 轻度或中度气流受限慢性阻塞性肺病患者吸入糖皮质激素处方的解除:患者怎么看?

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5009

G. Gilworth, T. Harries, M. Thomas, C. Corrigan, Patrick J. Murphy, N. Hart, Leslie A. Hamilton, P. White

{"title":"Deprescribing of inhaled corticosteroids in patients with COPD with mild or moderate airflow limitation: what do patients think?","authors":"G. Gilworth, T. Harries, M. Thomas, C. Corrigan, Patrick J. Murphy, N. Hart, Leslie A. Hamilton, P. White","doi":"10.1183/13993003.congress-2019.pa5009","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa5009","url":null,"abstract":"Background: GOLD guidelines support the prescription of high-dose inhaled corticosteroids (HD-ICS) in symptomatic COPD patients with frequent or severe exacerbations. HD-ICS are frequently prescribed outside guidelines with the risk of side effects. No investigation of patients’ views of HD-ICS withdrawal have been conducted. Aim: To assess the views of COPD patients with mild or moderate airflow limitation to the staged withdrawal of HD-ICS prescribed outside guidelines with a view to a trial in primary care. Methods: One-to-one semi-structured qualitative interviews exploring COPD patients’ opinions and feelings about using HD-ICS prescribed outside guidelines and their attitudes to proposed withdrawal. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was completed. Results: Seventeen eligible COPD patients were interviewed. Twenty six expressed interest. 7 did not meet spirometry eligibility criteria. Two were unable due to illness. Many participants were not aware they were using a HD-ICS or of the risk of side effects. Some were unconcerned by what they perceived as low individual risk. Others expressed fears of worsening symptoms on withdrawal. Most with mild or moderate airflow limitation would have been willing to attempt withdrawal or titration to a lower dose of HD-ICS if advised by their clinician especially if a reasoned explanation was offered. Conclusions: Attitudes to discontinuing HD-ICS use are varied and likely to be complex. Proposed deprescribing requires detailed conversations between patients and respiratory healthcare professionals including acknowledgement of possible limited understanding of the medication.","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127593790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incidence and risk factors of frequent asthma exacerbations in a multinational, multidatabase cohort study 一项跨国、多数据库队列研究中频繁哮喘发作的发生率和危险因素

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa702

E. Baan, M. de Ridder, M. Engelkes, E. Svensson, D. Prieto-Alhambra, F. Lapi, C. Giaquinto, G. Picelli, F. Albers, E. Bradford, G. Brusselle, M. V. Van Dyke, P. Rijnbeek, K. Verhamme

引用次数: 0

Does d-dimer level predict pulmonary thromboembolism diagnosis in patients with lung cancer? d-二聚体水平能预测肺癌患者肺血栓栓塞的诊断吗?

General practice and primary care Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5011

Zeynep Ummu Tursun, D. Tatar, N. Aksel, A. Ayrancı, A. Erbaycu, Y. Varol

{"title":"Does d-dimer level predict pulmonary thromboembolism diagnosis in patients with lung cancer?","authors":"Zeynep Ummu Tursun, D. Tatar, N. Aksel, A. Ayrancı, A. Erbaycu, Y. Varol","doi":"10.1183/13993003.congress-2019.pa5011","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa5011","url":null,"abstract":"Aim: In our study, we aimed to determine the diagnostic contribution of d-dimer level in patients with lung cancer, suspected pulmonary thromboembolism(PTE). Materials and Methods: The cases followed-up with lung cancer diagnosis between 2012-2017 were examined retrospectively. A total of 126 cancer patients diagnosed with PTE were included in the study. A total of 101 lung cancer patients without PTE formed control group. Results: A total of 227 lung cancer patients were included in the study. In the group with PTE, consisting of 126 cases, 102 cases were male (81%), 24 were female (19%) and mean age was 61,5 (± 8,91) years. In control group, consisting of 101 cases, 84 of cases were male (83,2%), 17 were female (16,8%) and mean age was 62,5 (±8,72) years. No statistically significant difference was identified between groups with regard to age, sex, cancer stage and comorbidity. While mean level of d-dimer was 4910,67± 5665 ng/dl in PTE group (median 2916; min. 169- max. 45000 ng/dl), mean level was 1917,78± 2122 ng/dl in control group (median 1196; min. 44- max. 1000 ng/dl) (p Conclusion: Although d-dimer values were higher in lung cancer patients, who developed PTE, no “cut off” value was determined as predictive for diagnosis of PTE.","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122403718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0