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Betancourt-Peña J, Vidal V, Zapata-Jiménez D, Ávila-Valencia JC, Benavides-Córdoba V. [Pulmonary rehabilitation effects in patients with COPD according to GOLD 2020 classification in Cali, Colombia]. Rehabilitacion (Madr) 2024; 58:100815. [PMID: 37862778 DOI: 10.1016/j.rh.2023.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/13/2023] [Accepted: 02/14/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease has a guide in charge of prevention and treatment, called the Global Initiative for Chronic Lung Disease, which is annually updated and catalogs pulmonary rehabilitation, within the treatment options. OBJECTIVE To describe the effects on clinical variables, functional capacity, anxiety/depression and health-related quality of life in patients with chronic obstructive pulmonary disease, after a pulmonary rehabilitation program, according to the GOLD 2020 classification in a Cali clinic. MATERIALS AND METHODS Descriptive, longitudinal study where 79 patients divided into 3 groups were included (B, C and D). RESULTS The mean age was 70 years, 69% men. The number of hospitalized days was greater for groups C and D with an average of 8 and 13 days, respectively (p≤0.000). The functional capacity showed a greater distance in group C (421m) and the shortest distance for group D (328m), p≤0.006. In anxiety and depression, group D managed to obtain improvements as well as in the quality of life questionnaire. CONCLUSION Group C presented greater functional capacity and better quality of life, group B had better results in clinical variables, and group D had worse clinical condition, functional capacity and quality of life. At the end of pulmonary rehabilitation, group D presented greater changes in functional capacity and quality of life.
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Affiliation(s)
- J Betancourt-Peña
- Facultad de Salud y Rehabilitación Institución Universitaria Escuela Nacional del Deporte, Facultad de Salud, Escuela de Rehabilitación Humana, Universidad del Valle, Cali, Colombia.
| | - V Vidal
- Clínica Palma Real, Cali, Colombia
| | | | - J C Ávila-Valencia
- Facultad de Salud y Rehabilitación Institución Universitaria Escuela Nacional del Deporte, Clínica de Occidente S. A., Cali, Colombia
| | - V Benavides-Córdoba
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Cali, Colombia
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Madiraca J, Lindell K, Coyne P, Miller S. Palliative Care Interventions in Advanced Chronic Obstructive Pulmonary Disease: An Integrative Review. J Palliat Med 2023. [PMID: 36862125 DOI: 10.1089/jpm.2022.0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD), the sixth leading cause of death in the United States, is associated with higher mortality rates in women. Women also experience tremendous symptom burden, including dyspnea, anxiety, and depression, in comparison to men with COPD. Palliative care (PC) provides symptom management and addresses advanced care planning for serious illness, but little is known about the use of PC in women with COPD. Objective: The purpose of this integrative review was to identify known PC interventions in advanced COPD and to understand the problem of gender and sex disparities. Methods: Whittemore and Knafl's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to guide this integrative review, and the quality of the articles was appraised using the Mixed Methods Appraisal Tool2018 version. A database search was conducted in PubMed, SCOPUS, ProQuest, and CINAHL complete between 2009 and 2021. Results: Application of search terms yielded 1005 articles. After screening 877 articles, 124 met inclusion criteria, resulting in a final sample of 15 articles. Study characteristics were evaluated for common concepts and synthesized using the Theory of Unpleasant Symptoms influencing factors (physiological, situational, and performance). All 15 studies discussed PC interventions with the focus on dyspnea management or improvement in quality of life. None of the studies identified in this review focused specifically on women with advanced COPD receiving PC, despite the significant impact that this illness has on women. Conclusion: It remains unknown if any intervention is more beneficial than another for women with advanced COPD. Future research is needed to provide an understanding of the unmet PC needs of women with advanced COPD.
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Affiliation(s)
- Jessica Madiraca
- Medical University of South Carolina, School of Nursing, Geriatrics, and Palliative Care, Charleston, South Carolina, USA
| | - Kathleen Lindell
- Medical University of South Carolina, School of Nursing, Geriatrics, and Palliative Care, Charleston, South Carolina, USA
| | - Patrick Coyne
- Division of Genera Internal Medicine, Geriatrics, and Palliative Care, Charleston, South Carolina, USA
| | - Sarah Miller
- Medical University of South Carolina, School of Nursing, Geriatrics, and Palliative Care, Charleston, South Carolina, USA
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Pyszora A, Lewko A. Non-pharmacological Management in Palliative Care for Patients With Advanced COPD. Front Cardiovasc Med 2022; 9:907664. [PMID: 35924211 PMCID: PMC9339631 DOI: 10.3389/fcvm.2022.907664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disabling condition associated with progressive airflow limitation and lung tissue damage; its main symptoms are breathlessness, fatigue, cough, and sputum production. In the advanced stage of the disease, these symptoms may severely impact on a person's physical and psychological functioning, with some also developing chronic respiratory failure, associated with blood gas abnormalities. Non-pharmacological interventions can improve quality of life and functioning in the management of people living with advanced COPD. This article will provide an overview of common non-pharmacological methods used in the symptomatic management of severe COPD, including: breathlessness and fatigue management strategies, anxiety management, pulmonary rehabilitation (PR) and physical activity (PA), neuromuscular electrical stimulation (NMES), airway clearance techniques (ACTs), nutrition and non-invasive ventilation (NIV). The importance of a holistic and multi-disciplinary approach to people living with COPD will be discussed.
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Affiliation(s)
- Anna Pyszora
- Palliative Care Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
- *Correspondence: Anna Pyszora
| | - Agnieszka Lewko
- Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
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Cabal Escandóna V, Montes Monsalve LA, Celis Sarmiento NS, Ortiz Mahecha AL. Grupo de síntomas de enfermedad pulmonar obstructiva crónica y cuidados paliativos: una revisión sistemática. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2022. [DOI: 10.11144/javeriana.ie24.gsep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
La enfermedad pulmonar obstructiva crónica (EPOC) es una entidad patológica que se caracteriza por una serie de manifestaciones físicas persistentes como tos, fatiga, disnea y producción de esputo; síntomas que generan malestar en el paciente desde el momento del diagnóstico y que, al ser una enfermedad irreversible por el daño tisular que causa, progresivamente va incidiendo de manera negativa en la calidad de vida. De otra parte, se ha reportado presencia de síntomas psicológicos como depresión, inseguridad, ansiedad y alteraciones emocionales en los pacientes diagnosticados con EPOC. Así mismo, los pacientes con este diagnóstico tienden a desarrollar comportamientos que alteran sus relaciones sociales familiares y laborales, por cuanto tienden a aislarse debido a la sintomatología, especialmente física.
La situación planteada genera la necesidad de desarrollar un trabajo de investigación con el objetivo de reconocer el clúster de síntomas físicos, psicológicos y sociales de los pacientes diagnosticados con EPOC, e identificar si se plantea un abordaje desde la atención paliativa. El estudio se desarrolló mediante una revisión sistemática de literatura en la que se identificaron 1776 artículos, de los que se evaluaron 41 para la identificación del clúster de síntomas. Se identificó el binomio disnea y tos, fatiga y expectoración como el clúster de síntomas físicos; la depresión y la ansiedad constituyen el clúster de síntomas psicológicos, y el impacto en la calidad de vida y la percepción de aislamiento o exclusión social.
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Systematic review of effectiveness and quality assessment of patient education materials and decision aids for breathlessness. BMC Pulm Med 2022; 22:237. [PMID: 35725454 PMCID: PMC9208236 DOI: 10.1186/s12890-022-02032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Around 10% of adults suffer from clinically significant breathlessness. High quality and actionable patient education materials (PEMs) and patient decision aids (PDAs) have an important role for shared decision making and patient self-management. OBJECTIVE To systematically assess the effectiveness of patient education materials (PEMs) and patient decision aids (PDAs) on clinical outcomes. Secondly, to assess the quality of PEMs and PDAs for breathlessness that are accessible online. METHODS A systematic review of PEM or PDA intervention for breathlessness published between 1 January 2010 and November 2020 was conducted. An environmental scan and quality assessment of publicly available PEMs and PDAs was also conducted. RESULTS Out of 2985 records, five studies were eligible for inclusion in this systematic review. Results of two randomised controlled trials suggest potential effectiveness of PEMs to improve patient reported outcomes and reduce healthcare utilization. In the environmental scan, 88 materials were included. Minimum reading age for most was high (Grade 10) and PEMs scored an average of 87% for understandability and 67% for actionability. Based on the DISCERN tool only 10 were classified as high quality. CONCLUSION There is a paucity of evidence on the effectiveness of PEMs and PDAs for improvement in breathlessness. There is a need to develop higher quality PEMs for breathlessness.
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Schloesser K, Bergmann A, Eisenmann Y, Pauli B, Hellmich M, Oberste M, Hamacher S, Tuchscherer A, Frank KF, Randerath W, Herkenrath S, Simon ST. Only I Know Now, of Course, How to Deal With it, or Better to Deal With it: A Mixed Methods Phase II Study of a Cognitive and Behavioral Intervention for the Management of Episodic Breathlessness. J Pain Symptom Manage 2022; 63:758-768. [PMID: 34793948 DOI: 10.1016/j.jpainsymman.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
CONTEXT Episodic breathlessness is characterized by increased breathlessness intensity, and it is burdensome for patients. A vicious cycle of breathlessness-anxiety/panic-breathlessness leads to emergencies that can rarely be alleviated by drugs. Non-pharmacological interventions seem to be beneficial: Can a brief cognitive and behavioral intervention help patients to better manage episodic breathlessness? OBJECTIVES To evaluate the feasibility, safety, acceptability, and potential effects of a brief cognitive and behavioral intervention for the management of episodic breathlessness. METHODS Between February 2019 and February 2020, 49 patients with life-limiting diseases suffering from episodic breathlessness were enrolled in the single-arm phase II study. The baseline assessment was followed by the one- to two-hour intervention. In weeks two, four, and six after the intervention, the outcomes (main outcome of potential effects: mastery of breathlessness) were assessed, and in week six, a qualitative interview, and the final assessment took place. A mixed-methods approach was used to evaluate mainly the feasibility, including interviewing informal carers. RESULTS 46/49 patients (24 female; 36 with COPD; mean age: 66.0 years) participated in the baseline assessment, 38 attended the intervention, 32 completed the final assessment, and 22 were interviewed. Study procedures and the intervention were feasible and mainly well accepted and patients did not experience burdens caused by it (28/32). In the interviews, patients described a positive change in their competencies in managing episodic breathlessness and feelings of anxiety during the episode. Mastery of breathlessness improved after the intervention. CONCLUSION The brief cognitive and behavioral intervention and the study procedures are feasible, safe, and well accepted. We can describe a change for better management of episodic breathlessness in patients after the intervention, still, this needs to be evaluated in a Phase III trial for inclusion in the management of episodic breathlessness.
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Affiliation(s)
- Karlotta Schloesser
- Department of Palliative Medicine, Faculty of Medicine and University Hospital (K.S., Y.E., B.P., S.T.S.), University of Cologne, Cologne, Germany
| | - Anja Bergmann
- Department of Nursing Science, Faculty of Medicine and University Hospital (A.B.), University of Cologne, Cologne, Germany
| | - Yvonne Eisenmann
- Department of Palliative Medicine, Faculty of Medicine and University Hospital (K.S., Y.E., B.P., S.T.S.), University of Cologne, Cologne, Germany
| | - Berenike Pauli
- Department of Palliative Medicine, Faculty of Medicine and University Hospital (K.S., Y.E., B.P., S.T.S.), University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital (M.H., M.O., S.H.), University of Cologne, Cologne, Germany
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital (M.H., M.O., S.H.), University of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital (M.H., M.O., S.H.), University of Cologne, Cologne, Germany
| | - Armin Tuchscherer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital (A.T.), University of Cologne, Cologne, Germany
| | - Konrad F Frank
- Department III of Internal Medicine, Section Pneumology, Faculty of Medicine and University Hospital (K.F.F.), University of Cologne, Cologne, Germany
| | - Winfried Randerath
- Center for Sleep Medicine and Respiratory Care, Clinic for Pneumology and Allergology, Bethanien Hospital, Solingen, Germany and Institute for Pneumology at the University of Cologne (W.R., S.H.), Cologne, Germany
| | - Simon Herkenrath
- Center for Sleep Medicine and Respiratory Care, Clinic for Pneumology and Allergology, Bethanien Hospital, Solingen, Germany and Institute for Pneumology at the University of Cologne (W.R., S.H.), Cologne, Germany
| | - Steffen T Simon
- Center for Integrated Oncology, Faculty of Medicine and University Hospital, University of Cologne (S.T.S.), Cologne, Germany.
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Huang JY, Steele P, Dabscheck E, Smallwood N. Nasal High Flow Therapy For Symptom Management in People Receiving Palliative Care. J Pain Symptom Manage 2022; 63:e237-e245. [PMID: 34600084 DOI: 10.1016/j.jpainsymman.2021.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
For patients with chronic non-malignant lung disease, severe chronic breathlessness can significantly impact quality of life, causing significant disability, distress, social isolation, and recurrent hospital admissions. Caregivers for people with challenging symptoms, such as severe breathlessness, are also profoundly impacted. Despite increasing research focused on breathlessness over recent years, this symptom remains extremely difficult to manage, with no effective treatment that completely relieves breathlessness. A new potential treatment for relieving breathlessness in patients at home is nasal high flow (NHF) therapy. NHF therapy is a respiratory support system that delivers heated, humidified air (together with oxygen if required) with flows of up to 60 L/min. This case describes a patient with very severe chronic obstructive pulmonary disease who received domiciliary NHF therapy (approximately 8 hours/day, flow rate of 20 L/min) over twelve months with good effect for the relief of severe chronic breathlessness. We discuss the management principles for severe chronic breathlessness, the physiological effects of NHF therapy and the evidence for long-term use in the community setting. With the support of respiratory and palliative care clinicians together, domiciliary NHF therapy has great potential for improving current symptom management approaches in people with life-limiting illnesses.
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Affiliation(s)
- Joanna Yilin Huang
- Department of Respiratory Medicine (J.Y.H., E.D., N.S.), Alfred Hospital, Melbourne, Victoria, Australia
| | - Patrick Steele
- Department of Palliative Care (P.S.), Royal Melbourne Hospital, , Melbourne, Victoria, Australia; Department of Palliative Care, Peter MacCallum Cancer Centre (P.S.), Parkville, Melbourne, Victoria, Australia; Department of Palliative Care (P.S.), Monash Health, Clayton Road, Clayton, Victoria, Australia; Palliative Care South East (P.S.), Sladen Street, Cranbourne, Victoria, Australia
| | - Eli Dabscheck
- Department of Respiratory Medicine (J.Y.H., E.D., N.S.), Alfred Hospital, Melbourne, Victoria, Australia; Central Clinical School (Alfred Hospital) (E.D.), Monash University, Melbourne, Victoria, Australia
| | - Natasha Smallwood
- Department of Respiratory Medicine (J.Y.H., E.D., N.S.), Alfred Hospital, Melbourne, Victoria, Australia; Department of Immunology & Respiratory Medicine, Central Clinical School (Alfred Hospital) (N.S.), Monash University, Melbourne, Victoria, Australia.
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Campbell ML, Donesky D, Sarkozy A, Reinke LF. Treatment of Dyspnea in Advanced Disease and at the End of Life. J Hosp Palliat Nurs 2021; 23:406-420. [PMID: 33883525 DOI: 10.1097/njh.0000000000000766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dyspnea is a subjective experience of breathing discomfort that consists of qualitatively distinct sensations, varies in intensity, and can only be known through the patient's report. Dyspnea is akin to suffocation and is one of the most distressing symptoms experienced by patients with advanced illness and at the end of life. Common approaches to dyspnea management, such as pulmonary rehabilitation, breathing strategies, or supplemental oxygen, have become accepted through pragmatic use or because studies do not include dyspnea as a measured outcome. Patients and clinicians urgently need evidence-based treatments to alleviate this frightening symptom. To fill this gap, a group of dyspnea researchers with expertise to conduct a literature review of evidence-based interventions for dyspnea in patients with serious illness produced these guidelines. We present the evidence from the strongest recommendations for practice to the weakest recommendations and include practical considerations for clinical nurses.
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Rubio-Rask SE, Farver-Vestergaard I, Hilberg O, Løkke A. Sexual health communication in COPD: The role, contents and design of patient information leaflets. Chron Respir Dis 2021; 18:14799731211020322. [PMID: 34189938 PMCID: PMC8252346 DOI: 10.1177/14799731211020322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Understanding need for support and information among people with COPD is important for the delivery of patient-centred care. Especially regarding intimacy matters, many people wish to remain sexually active but may be struggling to find out how, as information and communication regarding sexual health is scarce. This is especially true when it comes to people with chronic obstructive pulmonary disease (COPD). The present review seeks to provide an overview of the role, contents and design of patient information leaflets (PILs) and discuss their application in sexual health communication for COPD. Based on the literature, a number of key points in the design of high-quality PILs are suggested, and important areas for the improvement of patients-clinician communication are highlighted. While PILs is a commonly used format to provide information in healthcare, other formats, e.g. video and podcasts, could be explored. Prioritizing the development of material to support communication in the future is necessary to address the needs of both patients and caregivers and to support clinicians in initiating conversations about sexual health and intimacy matters.
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Affiliation(s)
| | | | - Ole Hilberg
- Department of Medicine, Vejle Hospital, Vejle, Denmark
| | - Anders Løkke
- Department of Medicine, Vejle Hospital, Vejle, Denmark
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Broese JMC, de Heij AH, Janssen DJA, Skora JA, Kerstjens HAM, Chavannes NH, Engels Y, van der Kleij RMJJ. Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review. Palliat Med 2021; 35:486-502. [PMID: 33339466 PMCID: PMC7975862 DOI: 10.1177/0269216320981294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although guidelines recommend palliative care for patients with chronic obstructive pulmonary disease, there is little evidence for the effectiveness of palliative care interventions for this patient group specifically. AIM To describe the characteristics of palliative care interventions for patients with COPD and their informal caregivers and review the available evidence on effectiveness and implementation outcomes. DESIGN Systematic review and narrative synthesis (PROSPERO CRD42017079962). DATA SOURCES Seven databases were searched for articles reporting on multi-component palliative care interventions for study populations containing ⩾30% patients with COPD. Quantitative as well as qualitative and mixed-method studies were included. Intervention characteristics, effect outcomes, implementation outcomes and barriers and facilitators for successful implementation were extracted and synthesized qualitatively. RESULTS Thirty-one articles reporting on twenty unique interventions were included. Only four interventions (20%) were evaluated in an adequately powered controlled trial. Most interventions comprised of longitudinal palliative care, including care coordination and comprehensive needs assessments. Results on effectiveness were mixed and inconclusive. The feasibility level varied and was context-dependent. Acceptability of the interventions was high; having someone to call for support and education about breathlessness were most valued characteristics. Most frequently named barriers were uncertainty about the timing of referral due to the unpredictable disease trajectory (referrers), time availability (providers) and accessibility (patients). CONCLUSION Little high-quality evidence is yet available on the effectiveness and implementation of palliative care interventions for patients with COPD. There is a need for well-conducted effectiveness studies and adequate process evaluations using standardized methodologies to create higher-level evidence and inform successful implementation.
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Affiliation(s)
- Johanna MC Broese
- Public Health & Primary care, Leiden
University Medical Centre, Leiden, The Netherlands
- Lung Alliance Netherlands, The
Netherlands
- Johanna MC Broese, Department of Public
Health and Primary Care, Leiden University Medical Centre, Post zone V0-P,
Postbus 9600, Leiden 2300 RC, The Netherlands.
| | - Albert H de Heij
- Centre of Expertise for Palliative Care,
University of Groningen and University Medical Centre Groningen, Groningen, The
Netherlands
| | - Daisy JA Janssen
- Department of Research &
Development, CIRO, Horn, The Netherlands
- Department of Health Services Research,
Care and Public Health Research Institute, Faculty of Health, Medicine and Life
Sciences, Maastricht University, The Netherlands
| | - Julia A Skora
- Public Health & Primary care, Leiden
University Medical Centre, Leiden, The Netherlands
| | - Huib AM Kerstjens
- department of Respiratory Medicine &
Tuberculosis, and Groningen Research Institute for Asthma and COPD (GRIAC),
University of Groningen and University Medical Centre Groningen, Groningen, The
Netherlands
| | - Niels H Chavannes
- Public Health & Primary care, Leiden
University Medical Centre, Leiden, The Netherlands
| | - Yvonne Engels
- Anaesthesiology, Pain & Palliative
Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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Abstract
PURPOSE OF REVIEW Breathlessness is a common yet complex symptom of advanced disease. Effective management will most likely draw upon the skills of multiple disciplines and professions. This review considers recent advances in the management of chronic breathlessness with regards to interdisciplinary working. RECENT FINDINGS There are growing data on interventions for chronic breathlessness that incorporate psychosocial mechanisms of action, for example, active mind-body treatments; and holistic breathlessness services that exemplify interprofessional working with professionals sharing skills and practice for user benefit. Patients value the personalized, empathetic and understanding tenor of care provided by breathlessness services, above the profession that delivers any intervention. Workforce training, decision support tools and self-management interventions may provide methods to scale-up these services and improve reach, though testing around the clinical effects of these approaches is required. SUMMARY Chronic breathlessness provides an ideal context within which to realize the benefits of interdisciplinary working. Holistic breathlessness services can commit to a comprehensive approach to initial assessment, as they can subsequently deliver a wide range of interventions suited to needs as they are identified.
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Chen X, Treanor D, Le B, Smallwood N. Gaps in Opioid Prescription for Severe Breathlessness in Hospitalized Patients With Chronic Obstructive Pulmonary Disease or Interstitial Lung Disease. J Pain Symptom Manage 2020; 60:e36-e39. [PMID: 32446973 DOI: 10.1016/j.jpainsymman.2020.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Xinye Chen
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Darran Treanor
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Brian Le
- Department of Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Natasha Smallwood
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
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Nicholls AR, Levy AR, Meir R, Sanctuary C, Jones L, Baghurst T, Thompson MA, Perry JL. The Susceptibles, Chancers, Pragmatists, and Fair Players: An Examination of the Sport Drug Control Model for Adolescent Athletes, Cluster Effects, and Norm Values Among Adolescent Athletes. Front Psychol 2020; 11:1564. [PMID: 32754092 PMCID: PMC7366030 DOI: 10.3389/fpsyg.2020.01564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Abstract
Although there are few high-profile cases of adolescent athletes being caught doping, up to a third of young athletes may dope. In order to generate a more accurate understanding of why adolescent athletes dope, it is important to validate models that help to explain this behavior. The aims of this study were 3-fold: firstly, to test the Sport Drug Control Model for Adolescent Athletes (SDCM-AA); secondly, to generate athlete profiles that would help quantify the proportion of athletes who are at risk of doping; and thirdly, to create norm values for the Adolescent Sport Doping Inventory (ASDI), which would allow national doping organizations, sporting organizations, and clubs to benchmark the scores of their athletes for key psycho-social variables linked to doping. A total of 2208 adolescent athletes from the United Kingdom, Australia, Hong Kong, and the United States completed the ASDI. The data presented an appropriate fit to the SDCM-AA model, in which 54% of the variance in susceptibility to doping was explained in the model, and 44.8% of attitudes toward doping was accounted for. Four distinct clusters of athletes emerged: the Susceptibles (i.e., identified with the benefits of doping, were willing to cheat, and viewed little threat), the Chancers (i.e., identified with the benefits of doping, scored high on willingness to cheat, and were highly influenced by their reference group, but had an average score for threat, self-esteem, and legitimacy), the Pragmatists (i.e., did not engage with any aspects of doping, but were more susceptible than the fair players), and Fair Players (i.e., high levels of sportspersonship, unwilling to cheat, and viewed doping as a threat). The revised SDCM-AA appears a valid model that helps explain the factors associated with doping attitudes and doping susceptibility. Adolescent athletes can be classified into one of four clusters, in relation to doping. Their cluster group could influence the content of the anti-doping education they receive.
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Affiliation(s)
- Adam R. Nicholls
- Department of Sport, Health and Exercise Science, University of Hull, Hull, United Kingdom
| | - Andrew R. Levy
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Rudi Meir
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Colin Sanctuary
- School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | - Leigh Jones
- Hong Kong Rugby Foot-Ball Union, Hong Kong, Hong Kong
| | - Timothy Baghurst
- College of Education, Florida State University, Tallahassee, FL, United States
| | - Mark A. Thompson
- Department of Sport, Health and Exercise Science, University of Hull, Hull, United Kingdom
| | - John L. Perry
- Department of Psychology, Mary Immaculate College, Limerick, Ireland
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Ambrosino N, Fracchia C. Strategies to relieve dyspnoea in patients with advanced chronic respiratory diseases. A narrative review. Pulmonology 2019; 25:289-298. [PMID: 31129045 DOI: 10.1016/j.pulmoe.2019.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The management of symptoms in patients with advanced chronic respiratory diseases needs more attention. This review summarizes the latest evidence on interventions to relieve dyspnoea in these patients. METHODS We searched randomised controlled trials, observational studies, systematic reviews, and meta-analyses published between 1990 and 2019 in English in PubMed data base using the keywords. Dyspnoea, Breathlessness AND: pharmacological and non pharmacological therapy, oxygen, non invasive ventilation, pulmonary rehabilitation, alternative medicine, intensive care, palliative care, integrated care, self-management. Studies on drugs (e.g. bronchodilators) or interventions (e.g. lung volume reduction surgery, lung transplantation) to manage underlying conditions and complications, or tools for relief of associated symptoms such as pain, are not addressed. RESULTS Relief of dyspnoea has received relatively little attention in clinical practice and literature. Many pharmacological and non pharmacological therapies are available to relieve dyspnoea, and improve patients' quality of life. There is a need for greater knowledge of the benefits and risks of these tools by doctors, patients and families to avoid unnecessary fears which might reduce or delay the delivery of appropriate care. We need services for multidisciplinary care in early and late phases of diseases. Early integration of palliative care with respiratory, primary care, and rehabilitation services can help patients and caregivers. CONCLUSION Relief of dyspnoea as well as of any distressing symptom is a human right and an ethical duty for doctors and caregivers who have many potential resources to achieve this.
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Affiliation(s)
- N Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Istituto di Montescano, Pneumologia Riabilitativa, Montescano (PV), Italy.
| | - C Fracchia
- Istituti Clinici Scientifici Maugeri IRCCS, Istituto di Montescano, Pneumologia Riabilitativa, Montescano (PV), Italy
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Upham JW. Contemporary Concise Review 2018: Asthma and chronic obstructive pulmonary disease. Respirology 2019; 24:693-699. [PMID: 30945412 DOI: 10.1111/resp.13553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- John W Upham
- Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
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Celli BR. Targeting dyspnoea in patients with very severe COPD: Practical precision medicine. Respirology 2018; 23:1086-1087. [PMID: 29943514 DOI: 10.1111/resp.13359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 11/28/2022]
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