Primary Care Respiratory Journal最新文献

{"title":"Poor reporting may infer poor science: lessons learned from asthma trials.","authors":"Jasper V Been, Daniel Kotz, Onno C P van Schayck","doi":"10.4104/pcrj.2013.00095","DOIUrl":"10.4104/pcrj.2013.00095","url":null,"abstract":"after real-life data suggests that ‘unplanned’ quit attempts are more successful than ‘planned’ ones. Hence the \"catastrophe theory,\" where smokers have varying levels of motivational \"tension\" to stop, and then \"triggers\" in the environment result in a sudden switch in motivational state; if that switch involves immediate renunciation of cigarettes, this can signal a more complete transformation. Tailoring a visual tool to trigger a “catastrophic switch” may yield more benefits. Other visual tools could be developed for those who can’t or won’t immediately quit, which may be just as effective as abrupt quit dates. This pilot should be likened to a Phase 1 trial. Almost anything needing new skills and precious consultation time will encounter some resistance. This did not happen here, with a similar duration of counselling sessions and similar GPs’ ratings on practicability and usefulness. This is the crux of the study. The additional tool was well used. Like any good research, it opens up more questions and opportunities. It has passed Phase 1, so now is the time for Phase 2 and onwards. Their tool could be tried instead of the IPCRG tool. They could develop aids based on other prevalent illnesses, or aids for less motivated or difficult-to-reach smokers (those with mental illness, pregnant smokers, manual workers and ethnic minorities) where smoking rates and health inequalities continue to grow. NeunerJehle’s team needs to continue this work. As former Australian Health Minister Nicola Roxon has said, “We are killing people by not acting.”","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"388-90"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31897437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' perceptions of the potential of breathing training for asthma: a qualitative study.","authors":"Emily Arden-Close,&nbsp;Emma Teasdale,&nbsp;Sarah Tonkin-Crine,&nbsp;Natasha Pitre,&nbsp;Mark Stafford-Watson,&nbsp;Denise Gibson,&nbsp;Anne Bruton,&nbsp;Mike Thomas,&nbsp;Lucy Yardley","doi":"10.4104/pcrj.2013.00092","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00092","url":null,"abstract":"<p><strong>Background: </strong>Poor symptom control is common in asthma. Breathing training exercises may be an effective adjunct to medication; it is therefore important to understand facilitators and barriers to uptake of breathing training exercises.</p><p><strong>Aims: </strong>To gain insight into patients' perceptions of breathing training exercises designed to help control asthma symptoms.</p><p><strong>Methods: </strong>Semi-structured think-aloud interviews were conducted with 29 people with asthma about their views of a booklet on breathing training exercises.</p><p><strong>Results: </strong>Thematic analysis showed breathing training exercises were seen as acceptable in principle because they were viewed as nonpharmacological, holistic, unobtrusive, and likely to increase patient confidence in managing symptoms. Anticipated disadvantages included the time required and perceived irrelevance for those with well-controlled asthma. These views were influenced by prior experience of changing breathing, wanting to self-manage asthma, negative views of medication, and perceived asthma control/severity. Anticipated barriers to carrying out the exercises included difficulties with nose breathing, remembering to do them, and persevering with them. Anticipated facilitators included monitoring tools and social support.</p><p><strong>Conclusions: </strong>The idea of breathing training was viewed positively as an acceptable non-pharmacological treatment that patients can do discreetly to help them breathe more easily and reduce their reliance on medication. Uptake of breathing training may be greater among those who perceive their asthma as severe and/or have negative views of medication. To enhance uptake, it might be helpful to present breathing training exercises as holistic skills that can also benefit those with mild symptoms.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"449-53"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31861788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The debated problem of community-acquired pneumonia diagnosis: many guidelines, any guideline?","authors":"Antonio Infantino, Ruben Infantino","doi":"10.4104/pcrj.2013.00096","DOIUrl":"10.4104/pcrj.2013.00096","url":null,"abstract":"","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"383-5"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31897438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journalwatch@pcrj","authors":"","doi":"10.4104/pcrj.2013.00101","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00101","url":null,"abstract":"Here's the best of the rest: summary reviews of relevant papers from the top respiratory and general medical journals worldwide. Journalwatch@pcrj is produced by the PCRJ Editors-in-Chief — reviews were selected and written by Dr Paul Stephenson and edited by Professor Aziz Sheikh. Each summary contains the name of the first author, the title of the paper, the Vancouver reference and/or doi number, and a link to the abstract of the paper. In the majority of cases these are subscription journals, so to view the full text you will need to subscribe to the journal or pay to view on an individual article basis. These reviews were originally published by the Doctors.net.uk Journal Watch service, which covers other specialties as well as respiratory medicine. Doctors.net.uk is the largest network of GMC-registered doctors in the UK. To find out about membership, click on Doctors.net.uk. The opinions expressed herein may not necessarily reflect the views of the authors of the original articles.","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"206 1","pages":"477 - 481"},"PeriodicalIF":0.0,"publicationDate":"2013-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79545132","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}

{"title":"Selected abstracts from the PCRS-UK National Primary Care Respiratory Conference, Telford, October 2013","authors":"","doi":"10.4104/pcrj.2013.00105","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00105","url":null,"abstract":"Selected abstracts from the PCRS-UK National Primary Care Respiratory Conference, Telford, October 2013 A1 PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org http://dx.doi.org/10.4104/pcrj.2013.00105 1. Patient reported satisfaction of a proactive post hospital discharge telephone service in patients with Chronic Obstructive Pulmonary Disease Bahadur KJ, Chauhan D, McDonnell L, Osman L Physiotherapy Department, Guy’s and St. Thomas’ NHS Foundation Trust (GSTFT), London, UK Aim: Background: Although post hospital discharge telephone support (PHDTS) is a common feature of many clinical services there is little published evidence evaluating the benefits in patients admitted with an exacerbation of chronic obstructive pulmonary disease (ECOPD). Recently GSTFT introduced proactive telephone support as part of routine post-discharge care in the community for patients admitted with an ECOPD. PHDTS was provided weekly for the first month and monthly for two months thereafter. Aim: To evaluate a pro-active PHDTS service by determining patient satisfaction. Method: A patient satisfaction survey was developed with the Patient Experience Team. A convenience sample of 22 patients who received PHDTS during December 2011 was used. Patients were contacted by a single member of the Integrated Respiratory Team (IRT) and the survey completed over the telephone. Results: 21/22 (95%) patients completed the patient survey. 70% rated it “very useful” and 25% “good”. Patients reported that calls were made at convenient times, appropriate frequencies and that regular contact with staff was useful. 67% of patients thought that PHDTS helped to prevent them from visiting hospital. 71% of patients thought that PHDTS decreased their need to contact their GP. Conclusion: Patient satisfaction was high. PHDTS may augment selfmanagement strategies which can help to improve outcome. This survey suggests that pro-active PHDTS is effective in the management of patients with COPD. This could potentially reduce primary and secondary care attendances and healthcare utilisation. Conflict of interest and funding: Nil Corresponding author: Mr Kristopher Bahadur Email: kris.bahadur@gstt.nhs.uk Phone: 07967707472 Institution: Guy's and St. Thomas' NHS Foundation Trust Westminster Bridge Road London United Kingdom SE1 7EH 2. Step-down of well-controlled paediatric asthma patients in primary care: A pharmacist led primary care service Bhalla MK, Abdalla H Walsall Medicines Management, Walsall Clinical Commissioning Group (CCG) Brief outline of context: A pharmacist independent prescriber undertook a pilot project in two practices to identify well-controlled paediatric asthma patients and safely step-down their treatments Brief outline of problem: Accurately diagnosing asthma in children can be difficult leading to some receiving inappropriate diagnoses. Moreover, many young asthmatics outgrow their condition. Nevertheless, a structured step-down is seldom offered to these patients. Assessment o","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"70 1","pages":"A1 - A12"},"PeriodicalIF":0.0,"publicationDate":"2013-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90365721","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}

{"title":"Sensitisation patterns and association with age, gender, and clinical symptoms in children with allergic rhinitis in primary care: a cross-sectional study.","authors":"Cindy M A de Bot,&nbsp;Esther Röder,&nbsp;David H J Pols,&nbsp;Patrick J E Bindels,&nbsp;Roy Gerth van Wijk,&nbsp;Johannes C van der Wouden,&nbsp;Heleen Moed","doi":"10.4104/pcrj.2013.00015","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00015","url":null,"abstract":"<p><strong>Background: </strong>Polysensitisation is a frequent phenomenon in patients with allergic rhinitis. However, few studies have investigated the characteristics of polysensitised children, especially in primary care.</p><p><strong>Objectives: </strong>This analysis describes the patterns of sensitisation to common allergens and the association with age, gender, and clinical symptoms in children in primary care diagnosed with allergic rhinitis.</p><p><strong>Methods: </strong>Cross-sectional data from two randomised double-blind placebo-controlled studies were used to select children aged 6-18 years (n=784) with a doctor's diagnosis of allergic rhinitis or use of relevant medication for allergic rhinitis in primary care. They were assessed for age, gender, specific IgE (type and number of sensitisations), nasal and eye symptom scores.</p><p><strong>Results: </strong>In 699 of the 784 children (89%) with a doctor's diagnosis or relevant medication use, a positive IgE test for one or more allergens was found. Polysensitisation (>2 sensitisations) was found in 69% of all children. Sensitisation was more common in children aged 9-13 than in younger children aged 5-8 years (p=0.03). Monosensitisation and polysensitisation were not significantly different in girls and boys. The severity of clinical symptoms did not differ between polysensitised and monosensitised children, but symptoms were significantly lower in non-sensitised children.</p><p><strong>Conclusions: </strong>Polysensitisation to multiple allergens occurs frequently in children with allergic rhinitis in general practice. Overall, clinical symptoms are equally severe in polysensitised and monosensitised children. Treatment decisions for allergic rhinitis should be made on the basis of a clinical history and allergy testing.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"155-60"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31372725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of patients with symptoms of chronic lung disease in primary care.","authors":"Guy B Marks","doi":"10.4104/pcrj.2013.00054","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00054","url":null,"abstract":"s presented elsewhere will be accepted MERGED Editorials 2 web 29/5/13 17:23 Page 9","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"145-7"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31456942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the DOSE index to predict changes in health status of patients with COPD: a prospective cohort study.","authors":"Myrte Rolink,&nbsp;Wouter van Dijk,&nbsp;Saskia van den Haak-Rongen,&nbsp;Willem Pieters,&nbsp;Tjard Schermer,&nbsp;Lisette van den Bemt","doi":"10.4104/pcrj.2013.00033","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00033","url":null,"abstract":"<p><strong>Background: </strong>The severity of chronic obstructive pulmonary disease (COPD) should not be based on the level of airflow limitation alone. A multicomponent index such as the DOSE index (dyspnoea score (D), level of airflow obstruction (O), current smoking status (S), and exacerbations (E)) has the potential to predict important future outcomes in patients with COPD more effectively than the forced expiratory volume in one second. Health status deterioration should be prevented in COPD patients.</p><p><strong>Aims: </strong>To investigate whether the DOSE index can predict which patients are at risk of a clinically relevant change in health status.</p><p><strong>Methods: </strong>A prospective cohort study was performed using data from primary and secondary care. The DOSE score was determined at baseline and the 2-year change in the Clinical COPD Questionnaire (CCQ) score was calculated. Linear regression analysis was performed for the effect of a high DOSE score (≥ 4) on the change in CCQ score.</p><p><strong>Results: </strong>The study population consisted of 209 patients (112 patients from primary care). Overall, a high DOSE score was a significant predictor of a change in CCQ score after 2 years (0.41, 95% CI 0.13 to 0.70), particularly in primary care patients.</p><p><strong>Conclusions: </strong>A DOSE score of ≥ 4 has the ability to identify COPD patients with a greater risk of future worsening in health status.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":" ","pages":"169-74"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40231629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of severity predictive rules for hospitalised nursing home-acquired pneumonia in Korea: a retrospective observational study.","authors":"Jong-Chan Lee,&nbsp;Hee-Jin Hwang,&nbsp;Yo-Han Park,&nbsp;Jun-Hyeon Joe,&nbsp;Jae-Ho Chung,&nbsp;Sang-Hwan Kim","doi":"10.4104/pcrj.2013.00011","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00011","url":null,"abstract":"<p><strong>Background: </strong>Nursing home-acquired pneumonia (NHAP) is the leading cause of death among long-term care residents.</p><p><strong>Aims: </strong>To compare current scoring indices (NHAP model score, Pneumonia Severity Index (PSI), CURB-65 (confusion, urea nitrogen, respiratory rate, blood pressure, age >65 years) and SOAR (systolic blood pressure, oxygenation, age, respiratory rate)) in predicting mortality and admission to the intensive care unit (ICU) in patients with NHAP.</p><p><strong>Methods: </strong>This retrospective observational study was conducted between July 2008 and June 2011 using data from the Korean Nursing Home Networks. Two hundred and eight nursing home residents were hospitalised with pneumonia in one general hospital. The primary outcome measure was 30-day all-cause mortality. Secondary outcome measures were intensive respiratory or vasopressor support (IRVS), and severe pneumonia (ICU admission or IRVS).</p><p><strong>Results: </strong>PSI class V showed the highest Youden index (0.45), specificity (66.7%), positive predictive value (PPV, 40.0%), negative predictive value (NPV, 91.5%), and area under the curve (AUC, 0.73) for 30-day mortality. For severe pneumonia, PSI class V showed the highest Youden index (0.40), specificity (72.8%), PPV (62.2%), NPV (77.1%), and AUC (0.70). Similarly, PSI class V showed the highest Youden index (0.35), specificity (68.3%), PPV (51.1%), NPV (80.5%), and AUC (0.69) for IRVS.</p><p><strong>Conclusions: </strong>The PSI has superior discriminatory power in predicting all three clinical outcomes (30-day mortality, severe pneumonia, and IVRS) compared with the NHAP model score, CURB-65 and SOAR.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"149-54"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31308154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding nurse practice in COPD: is it key to providing high quality, effective and safe patient care?","authors":"Monica J Fletcher,&nbsp;Birthe H Dahl","doi":"10.4104/pcrj.2013.00044","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00044","url":null,"abstract":"<p><p>The prevalence of chronic obstructive pulmonary disease (COPD), a common and preventable chronic disease, is on the increase, and so are the financial and social burdens associated with it. The management of COPD is particularly challenging, as patients have complex health and social needs requiring life-long monitoring and treatment. In order to address these issues and reduce the burden imposed by COPD, the development of innovative disease management models is vital. Nurses are in a key position to assume a leading role in the management of COPD since they frequently represent the first point of contact for patients and are involved in all stages of care. Although evidence is still limited, an increasing number of studies have suggested that nurse-led consultations and interventions for the management of COPD have the potential to impact positively on the health and quality of life of patients. The role of nurses in the management of COPD around the world could be significantly expanded and strengthened. Providing adequate educational opportunities and support to nurses, as well as addressing funding issues and system barriers and recognising the importance of the expanding roles of nurses, is vital to the well-being of patients with long-term medical conditions such as COPD and to society as a whole, in order to reduce the burden of this disease.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"230-3"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31423947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}