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Vanfleteren MJ, Koopman M, Spruit MA, Pennings HJ, Smeenk F, Pieters W, van den Bergh JJ, Michels AJ, Wouters EF, Groenen MT, Franssen FM, Vanfleteren LE. Effectiveness of Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease With Different Degrees of Static Lung Hyperinflation. Arch Phys Med Rehabil 2018; 99:2279-2286.e3. [PMID: 29906421 DOI: 10.1016/j.apmr.2018.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/31/2018] [Accepted: 05/07/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH). DESIGN Retrospective cohort study. SETTING PR network. PARTICIPANTS A cohort of 1981 patients with COPD (55% men; age: 66.8±9.3y; forced expiratory volume in the first second%: 50.7±19.5; residual volume [RV]%: 163.0±49.7). INTERVENTION An interdisciplinary PR program for patients with COPD consisting of 40 sessions. MAIN OUTCOME MEASURES Participants were stratified into 5 quintiles according to baseline RV and were evaluated on the basis of pre- and post-PR 6-minute walk distance (6MWD), constant work rate test (CWRT), and Saint George's Respiratory Questionnaire (SGRQ), among other clinical parameters. RESULTS With increasing RV quintile, patients were younger, more frequently women, had lower forced expiratory volume in the first second%, lower body mass index and fat-free mass index, shorter 6MWD, shorter CWRT, and worse SGRQ scores (P<.01). All RV strata improved after PR in all 3 outcomes (P<.001). Nevertheless, higher, compared to lower RV categories, had lower ΔCWRT (P<.01) but similar Δ6MWD (P=.948) and ΔSGRQ (P=.086) after PR. CONCLUSIONS LH in COPD is related to younger age, female sex, lower body weight, worse exercise capacity and health status, but did not prevent patients from benefitting from PR. LH, however, influences walking and cycling response after PR differently.
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Affiliation(s)
- Michiel J Vanfleteren
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
| | - Maud Koopman
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands
| | - Herman-Jan Pennings
- Department of Respiratory Medicine, St. Laurentius Hospital, Roermond, the Netherlands
| | - Frank Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Willem Pieters
- Department of Respiratory Medicine, Elkerliek Hospital, Helmond, the Netherlands
| | - Jan J van den Bergh
- Department of Respiratory Medicine, St. Jans Gasthuis, Weert, the Netherlands
| | - Arent-Jan Michels
- Department of Respiratory Medicine, St Anna Hospital, Geldrop, the Netherlands
| | - Emiel F Wouters
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Miriam T Groenen
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands
| | - Frits M Franssen
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Lowie E Vanfleteren
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; COPD Center, Sahlgrenska University Hospital, Göteborg, Sweden
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Pieters W, Wojciechowicz K, Cantelli E, Delzenne-Goette E, De Konink C, Drost L, Te Riele H. PO-005 Prevention strategies for intestinal cancer development in lynch syndrome. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Spruit MA, Augustin IML, Vanfleteren LE, Janssen DJA, Gaffron S, Pennings HJ, Smeenk F, Pieters W, van den Bergh JJAM, Michels AJ, Groenen MTJ, Rutten EPA, Wouters EFM, Franssen FME. Differential response to pulmonary rehabilitation in COPD: multidimensional profiling. Eur Respir J 2015; 46:1625-35. [PMID: 26453626 DOI: 10.1183/13993003.00350-2015] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/28/2015] [Indexed: 11/05/2022]
Abstract
The aim of the present study was to profile a multidimensional response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Dyspnoea, exercise performance, health status, mood status and problematic activities of daily life were assessed before and after a 40-session pulmonary rehabilitation programme in 2068 patients with COPD (mean forced expiratory volume in 1 s of 49% predicted). Patients were ordered by their overall similarity concerning their multidimensional response profile, which comprises the overall response on MRC dyspnoea grade, 6MWD, cycle endurance time, Canadian Occupational Performance Measure performance and satisfaction scores, Hospital Anxiety and Depression Scale anxiety and depression, and St George's Respiratory Questionnaire total score, using a novel non-parametric regression technique.Patients were clustered into four groups with distinct multidimensional response profiles: n=378 (18.3%; "very good responder"), n=742 (35.9%; "good responder"), n=731 (35.4%; "moderate responder"), and n=217 (10.5%; "poor responder"). Patients in the "very good responder" cluster had higher symptoms of dyspnoea, number of hospitalisations <12 months, worse exercise performance, worse performance and satisfaction scores for problematic activities of daily life, more symptoms of anxiety and depression, worse health status, and a higher proportion of patients following an inpatient PR programme compared to the other three clusters.A multidimensional response outcome needs to be considered to study the efficacy of pulmonary rehabilitation services in patients with COPD, as responses to regular outcomes are differential within patients with COPD.
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Affiliation(s)
- Martijn A Spruit
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Ingrid M L Augustin
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Lowie E Vanfleteren
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Daisy J A Janssen
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | | | - Herman-Jan Pennings
- Dept of Respiratory Medicine, St. Laurentius Hospital, Roermond, The Netherlands
| | - Frank Smeenk
- Dept of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Willem Pieters
- Dept of Respiratory Medicine, Elkerliek Hospital, Helmond, The Netherlands
| | | | - Arent-Jan Michels
- Dept of Respiratory Medicine, St Anna Hospital, Geldrop, The Netherlands
| | - Miriam T J Groenen
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Erica P A Rutten
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F M Wouters
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), The Netherlands
| | - Frits M E Franssen
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
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Pieters W, Padget J, Dechesne F, Dignum V, Aldewereld H. Effectiveness of qualitative and quantitative security obligations. Journal of Information Security and Applications 2015. [DOI: 10.1016/j.jisa.2014.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rolink M, van Dijk W, van den Haak-Rongen S, Pieters W, Schermer T, van den Bemt L. Using the DOSE index to predict changes in health status of patients with COPD: a prospective cohort study. Prim Care Respir J 2014; 22:169-74. [PMID: 23538702 PMCID: PMC6442782 DOI: 10.4104/pcrj.2013.00033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: 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. Aims: To investigate whether the DOSE index can predict which patients are at risk of a clinically relevant change in health status. Methods: 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. Results: 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. Conclusions: A DOSE score of ≥4 has the ability to identify COPD patients with a greater risk of future worsening in health status.
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Affiliation(s)
- Myrte Rolink
- Radboud University Nijmegen Medical Centre, Department of Primary and Community Care Nijmegen, The Netherlands
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Schermer TR, Akkermans RP, Crockett AJ, van Montfort M, Grootens-Stekelenburg J, Stout JW, Pieters W. Effect of e-learning and repeated performance feedback on spirometry test quality in family practice: a cluster trial. Ann Fam Med 2011; 9:330-6. [PMID: 21747104 PMCID: PMC3133580 DOI: 10.1370/afm.1258] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Spirometry has become an indispensable tool in primary care to exclude, diagnose, and monitor chronic respiratory conditions, but the quality of spirometry tests in family practices is a reason for concern. Aim of this study was to investigate whether a combination of e-learning and bimonthly performance feedback would improve spirometry test quality in family practices in the course of 1 year. METHODS Our study was a cluster trial with 19 family practices allocated to intervention or control conditions through minimization. Intervention consisted of e-learning and bimonthly feedback reports to practice nurses. Control practices received only the joint baseline workshop. Spirometry quality was assessed by independent lung function technicians. Two outcomes were defined, with the difference between rates of tests with 2 acceptable and repeatable blows being the primary outcome and the difference between rates of tests with 2 acceptable blows being the secondary outcome. We used multilevel logistic regression analysis to calculate odds ratios (ORs) for an adequate test in intervention group practices. RESULTS We analyzed 1,135 tests. Rate of adequate tests was 33% in intervention and 30% in control group practices (OR = 1.3; P=.605). Adequacy of tests did not differ between groups but tended to increase with time: OR = 2.2 (P = .057) after 3 and OR = 2.0 (P = .086) in intervention group practices after 4 feedback reports. When ignoring test repeatability, these differences between the groups were slightly more pronounced: OR = 2.4 (P = .033) after 3 and OR=2.2 (P = .051) after 4 feedback reports. CONCLUSIONS In the course of 1 year, we observed a small and late effect of e-learning and repeated feedback on the quality of spirometry as performed by family practice nurses. This intervention does not seem to compensate the lack of rigorous training and experience in performing spirometry tests in most practices.
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Affiliation(s)
- Tjard R Schermer
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Pieters W, Consoli L. Vulnerabilities and responsibilities: dealing with monsters in computer security. Journal of Information, Communication and Ethics in Society 2009. [DOI: 10.1108/14779960911004499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to analyze information security assessment in terms of cultural categories and virtue ethics, in order to explain the cultural origin of certain types of security vulnerabilities, as well as to enable a proactive attitude towards preventing such vulnerabilities.Design/methodology/approachVulnerabilities in information security are compared to the concept of “monster” introduced by Martijntje Smits in philosophy of technology. The applicability of different strategies for dealing with monsters to information security is discussed, and the strategies are linked to attitudes in virtue ethics.FindingsIt is concluded that the present approach can form the basis for dealing proactively with unknown future vulnerabilities in information security.Research limitations/implicationsThe research presented here does not define a stepwise approach for implementation of the recommended strategy in practice. This is future work.Practical implicationsThe results of this paper enable computer experts to rethink their attitude towards security threats, thereby reshaping their practices.Originality/valueThis paper provides an alternative anthropological framework for descriptive and normative analysis of information security problems, which does not rely on the objectivity of risk.
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Van der Molen T, Pieters W, Bellamy D, Taylor R. Measuring the success of treatment for chronic obstructive pulmonary disease--patient, physician and healthcare payer perspectives. Respir Med 2002; 96 Suppl C:S17-21. [PMID: 12199487 DOI: 10.1016/s0954-6111(02)80030-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The success of treatments for chronic obstructive pulmonary disease (COPD) is evaluated by measuring the impact on a range of health outcomes. However, outcome measures differ in their relative importance to the various stakeholder groups. Patients are most interested in the impact on quality of life and on mortality, while physicians also value information about the effect of treatments on lung function and disease progression. In contrast to patients and physicians, healthcare payers take a population perspective, and need to balance the health gains achieved and the costs of treatment. If the management of COPD is to be improved, it is important, first, to understand the outcomes of importance to each relevant stakeholder group, and then second, to refocus the measures in terms that all stakeholders can value.
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Affiliation(s)
- T Van der Molen
- Department of General Practice, University Hospital Groningen, The Netherlands
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