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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. Exploring the barriers and facilitators for the use of digital health technologies for the management of COPD: a qualitative study of clinician perceptions. QJM 2020; 113:163-172. [PMID: 31545374 DOI: 10.1093/qjmed/hcz241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Received: 06/05/2019] [Revised: 08/23/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Digital health technology (DHT) promises to support patients and healthcare professionals (HCPs) to optimize the management of chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence demonstrating the effectiveness of DHT for the management of COPD. One reason for this is the lack of user-involvement in the development of DHT interventions in COPD meaning their needs and preferences are rarely accounted for in the design phase. Although HCP adoption issues have been identified in relation to DHT, little is known about the challenges perceived by HCPs providing care to COPD patients. Therefore, this study aims to qualitatively explore the barriers and facilitators HCPs perceive for the use of DHT in the management of COPD. METHODS Participants (n = 32) were recruited using snowball sampling from two university hospitals and several general practitioner clinics. A semi-structured interview was conducted with each participant. NVivo 12 software was used to complete thematic analysis on the data. RESULTS Themes identified include: data quality; evidence-based care; resource constraints; and digital literacy presented as barriers; and facilitators include the following themes: digital health training and education; improving HCP digital literacy; and Personalized prescribing. Patient-centered approaches, such as pulmonary rehabilitation and shared decision-making were suggested as implementation strategies to ease the adoption of digital health for the management of COPD. CONCLUSION These findings contribute new insights about the needs and preferences of HCPs working in COPD regarding DHT. The findings can be used to help mitigate user-experience issues by informing the design of person-centered implementation and adoption strategies for future digital health interventions in COPD.
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Affiliation(s)
- P Slevin
- From the The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - T Kessie
- From the The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - J Cullen
- Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - M W Butler
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - S C Donnelly
- Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - B Caulfield
- From the The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Khan F, Mat A, Hogan AE, Kent BD, Eigenheer S, Corrigan MA, O'Shea D, Butler MW. Preliminary asthma-related outcomes following glucagon-like peptide 1 agonist therapy. QJM 2017; 110:853-854. [PMID: 28673015 DOI: 10.1093/qjmed/hcx125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 06/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Khan
- From the Respiratory Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
- Respiratory Department, University College Dublin, Dublin, Ireland
| | - A Mat
- Endocrine Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - A E Hogan
- Endocrine Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - B D Kent
- From the Respiratory Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - S Eigenheer
- From the Respiratory Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - M A Corrigan
- Endocrine Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - D O'Shea
- Endocrine Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
- Endocrine Department, University College Dublin, Dublin, Ireland
| | - M W Butler
- From the Respiratory Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
- Respiratory Department, University College Dublin, Dublin, Ireland
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Stahlschmidt ZR, French SS, Ahn A, Webb A, Butler MW. A Simulated Heat Wave Has Diverse Effects on Immune Function and Oxidative Physiology in the Corn Snake (Pantherophis guttatus). Physiol Biochem Zool 2017; 90:434-444. [DOI: 10.1086/691315] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brady D, Lavelle LP, McEvoy SH, Murphy DJ, Gallagher A, Gibney B, Butler MW, Shortt F, McMullan M, Fabre A, Lynch DA, Abbara S, Donnelly SC, Dodd JD. Assessing fibrosis in pulmonary sarcoidosis: late-enhanced MRI compared to anatomic HRCT imaging. QJM 2016; 109:257-64. [PMID: 26537956 DOI: 10.1093/qjmed/hcv200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/05/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- D Brady
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - L P Lavelle
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S H McEvoy
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D J Murphy
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A Gallagher
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - B Gibney
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - M W Butler
- Department of Respiratory Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - F Shortt
- Department of Radiology, St Vincent's Private Hospital, Elm Park, Dublin 4, Ireland
| | - M McMullan
- Department of Radiology, St Vincent's Private Hospital, Elm Park, Dublin 4, Ireland
| | - A Fabre
- Department of Pathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - S Abbara
- Department of Radiology, UT Southwestern, Dallas, TX, USA
| | - S C Donnelly
- Department of Respiratory Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J D Dodd
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Walsh SM, Gallagher A, Gallagher R, Barnes E, Doherty GA, Dodd JD, Butler MW. First do no harm: nasogastric tube placement and confirmation. QJM 2016; 109:219. [PMID: 26319701 DOI: 10.1093/qjmed/hcv160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S M Walsh
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - A Gallagher
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - R Gallagher
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - E Barnes
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - G A Doherty
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - J D Dodd
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - M W Butler
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
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Nicholson TT, Franciosi A, Landers S, Butler MW. Assessing potential risks of treatment with long-term azithromycin in COPD patients: long-term oxygen users beware? Ir J Med Sci 2015; 185:993-997. [PMID: 26502012 DOI: 10.1007/s11845-015-1372-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/21/2015] [Accepted: 10/10/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Long-term daily azithromycin therapy reduces the frequency of exacerbations in chronic obstructive pulmonary disease (COPD) in a randomized controlled clinical trial setting. Concerns exist regarding arrhythmic and auditory toxicities from chronic use in the real-world setting. We hypothesized that risk factors for adverse drug reactions to azithromycin would be more frequent than previously reported, that certain specific subgroups would have different frequencies of these risk factors and that the whispered voice test would be a useful test with which to test for hearing deficits. METHODS Following ethical approval, 47 consecutive hospital-based patients with a mean age 69 years ± 8.2, and with physician-diagnosed COPD (mean FEV1 45.1 ± 18 % predicted), were screened for subjective hearing impairment (screening questions and whispered voice test) and by electrocardiogram for prolonged QTc. Other potential risk factors and contraindications to long-term daily azithromycin were sought. RESULTS In total, 38 patients (80.9 %) had at least one risk factor or contraindication to azithromycin treatment. 19 patients (40.4 % of total) had subjective hearing impairment. 17 (36.1 %) had prolonged QTc intervals. 4 patients (8.51 %) had contraindicating co-morbidities. Those on long-term oxygen therapy were significantly more likely to have at least one risk factors or contraindications to azithromycin (p = 0.0025). CONCLUSION In a COPD population who would otherwise potentially be candidates for long-term daily azithromycin therapy, over 80 % had risk factors for complications from long-term daily azithromycin. Preventative treatment with long-term daily azithromycin may be appropriate for fewer COPD patients than previously thought, especially in those on long-term oxygen therapy.
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Affiliation(s)
- T T Nicholson
- Department of Respiratory Medicine, St. Vincent's University Hospital and University College Dublin, Dublin 4, Ireland
| | - A Franciosi
- Department of Respiratory Medicine, St. Vincent's University Hospital and University College Dublin, Dublin 4, Ireland
| | - S Landers
- Department of Respiratory Medicine, St. Vincent's University Hospital and University College Dublin, Dublin 4, Ireland
| | - M W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital and University College Dublin, Dublin 4, Ireland.
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Butler MW, Hackett NR, Salit J, Strulovici-Barel Y, Omberg L, Mezey J, Crystal RG. Glutathione S-transferase copy number variation alters lung gene expression. Eur Respir J 2011; 38:15-28. [PMID: 21349909 DOI: 10.1183/09031936.00029210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The glutathione S-transferase (GST) enzymes catalyse the conjugation of xenobiotics to glutathione. Based on reports that inherited copy number variations (CNVs) modulate some GST gene expression levels, and that the small airway epithelium (SAE) and alveolar macrophages (AMs) are involved early in the pathogenesis of smoking-induced lung disease, we asked: do germline CNVs modulate GST expression levels in SAE and AMs? Microarrays were used to survey GST gene expression and determine CNVs genotypes in SAE and AMs obtained by bronchoscopy from current smokers and nonsmokers. 26% of subjects were null for both GSTM1 alleles, with reduced GSTM1 mRNA levels seen in both SAE and AMs. 30% of subjects had homozygous deletions of GSTT1, with reduced mRNA levels in both tissues. Interestingly, GSTT2B exhibited homozygous deletion in the blood of 27% of subjects and was not expressed in SAE in the remainder of subjects, but was expressed in AMs of heterozygotes and wild-type subjects, proportionate to genotype. These data show a germline CNV-mediated linear relationship of genotype with expression level, suggesting minimal compensation of gene expression levels in heterozygotes, consistent with GST polymorphisms playing a role in the risk of smoking-associated, xenobiotic-induced lung disease.
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Affiliation(s)
- M W Butler
- Dept of Genetic Medicine, Weill Cornell Medical College, New York, NY 10065, USA
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Miller SDW, Butler MW, Meagher F, Costello RW, McElvaney NG. Team Objective Structured Bedside Assessment (TOSBA): a novel and feasible way of providing formative teaching and assessment. Med Teach 2007; 29:156-9. [PMID: 17701626 DOI: 10.1080/01421590701287889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
It can be challenging to teach and assess medical students successfully in the setting of a hospital ward using real patients. We describe a novel method of providing weekly formative clinical assessment and teaching to final year students on an acute medical ward: The Team Objective Structured Bedside Assessment (TOSBA). The TOSBA involves three groups of five students rotating through three ward-based stations (each station consists of an inpatient and facilitator). Each group spends 25 minutes at a bedside station where the facilitator asks consecutive students to perform one of five clinical tasks. Every student receives a standardised grade and is provided with educational feedback at each of the three stations. We report our 15-month experience using the TOSBA format to assess and teach a large number of medical students on a weekly basis. We discuss the advantages and potential drawbacks of our approach.
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Affiliation(s)
- S D W Miller
- Dept. of Clinical Teaching, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Butler MW, Saaidin N, Sheikh AA, Fennell JS. Dissatisfaction with Do Not Attempt Resuscitation Orders: A nationwide study of Irish consultant physician practices. Ir Med J 2006; 99:208-10. [PMID: 16986566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The legal/ethical status of Do Not Attempt Resuscitation (DNAR) orders in Ireland has not been clarified, nor have national policies been formulated. We questioned 298 consultant physicians in the Republic of Ireland about DNAR orders. 173 replies were received (58%). 85 expressed unsatisfactory understanding of issues relating to Irish DNAR orders (49%). 116 physicians felt that alert patients preferred not to discuss their own resuscitation (67%). 55 physicians felt that if a competent adult patient is the subject of a DNAR order without the patient's knowledge, the reasons for this decision are "almost never" documented in the patient's medical record (32%). 75 consultants "almost never" had advance discussion of resuscitation preferences with the patient (43%). 47 physicians had experienced advance directives for Irish patients (27%). 102 physicians felt that both they and the patient's next of kin had joint responsibility for deciding resuscitation status for an incapacitated patient with no advance directive (59%). 37 respondents described a formal resuscitation policy in their place of work (21%). We feel that physicians require greater national guidance regarding DNAR order-making, and we advocate more widespread use of resuscitation policies.
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Affiliation(s)
- M W Butler
- Dept. of Medicine, St. Columcille's Hospital, Loughlinstown, Dublin
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Butler MW, O'Mahony MJ, Donnelly SC, McDonnell TJ. Managing exacerbations of COPD: room for improvement. Ir Med J 2004; 97:108-10. [PMID: 15200219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major cause of hospital admissions. Because of the consequent morbidity, mortality and burden on hospital resources, COPD management guidelines have been formulated. We reviewed 62 consecutive patients with AECOPD admitted from September 1st to December 18th 2000 in St. Vincents University Hospital, Ireland, including 3 months follow-up data, to evaluate the quality of care and in particular to assess the care of such patients by respiratory and non-respiratory physicians. There was a frequent failure to objectively confirm the diagnosis of COPD by spirometry (completed in 39 of the 51 patients who, at admission, had been previously labelled with COPD (76%), and in 53 out of 62 patients (85%) at the end of the study period), or to estimate severity by quantifying the FEV1 as a percentage of the normal predicted range (estimated in only 21 of the 39 patients who had spirometry previously performed (53%)). Those patients managed with input from respiratory physicians were more likely to have their diagnosis of COPD confirmed with spirometry (p < 0.05). They were also more likely to have out-patient follow-up arranged at discharge (p < 0.05). There was a trend towards the more frequent prescribing of oxygen to hypoxic patients in "respiratory" than in "non-respiratory" managed cases (p = 0.182) and a shorter hospital stay (0.1 < p < 0.5). 4 out of 11 severely hypoxaemic patients at admission (PO2 < 7.3kPa) were not screened at discharge for possible long term oxygen therapy (36%). 20 patients received combination antibiotic therapy with no infiltrate on CXR (32%). Pulmonary rehabilitation was offered to 12 patients (19%). 5 out of 18 current smokers had documented smoking cessation advice (28%) and none received smoking cessation pharmacotherapy. Finally we noted that the Hospital In-Patient Enquiry (HIPE) data and casualty department admission books were frequently misleading or medical records unlocatable (in 30 out of 92 cases (33%)). We conclude that the management of AECOPD at St. Vincent's University Hospital is frequently suboptimal, and may be managed better with respiratory physician involvement. In particular, there could be more frequent spirometric confirmation of the diagnosis of COPD, better screening for long term oxygen therapy and more conservative use of antibiotics. Audit is complicated by difficulty accessing relevant data.
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Affiliation(s)
- M W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4
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Abstract
BACKGROUND Hydatid disease is rare in Ireland and its incidence and prevalence are unknown. Most cases are diagnosed by a combination of clinical findings, morphological features on imaging and by serological testing. AIMS We describe an Irish case of pulmonary hydatid disease detected at bronchoscopy by bronchoalveolar lavage, and discuss the diagnosis and treatment of the disorder. CONCLUSION The diagnosis of this rare disease requires a high index of suspicion. Treatment is primarily surgical, with a role for antihelminthic agents.
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Affiliation(s)
- M W Butler
- Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
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Abstract
BACKGROUND Quinolones have traditionally had limited application in the area of community-acquired respiratory tract infections due to poor cover against Streptococcus pneumoniae. This trend is changing with the broader spectrum of newer fluoroquinolones. A rare serious side effect of fluoroquinolones is tendinopathy. AIMS This study describes two cases of levofloxacin-associated tendinopathy in patients with severe chronic obstructive pulmonary disease (COPD) and the implications and mechanisms involved are discussed. CONCLUSIONS The finding of two cases of levofloxacin-induced tendinopathy in our patients suggests that the problem may be more frequent than previously considered. Patients with COPD treated with fluoroquinolones may have other risk factors for tendinopathy such as advanced age, corticosteroid use and renal impairment and merit vigilance for signs of tendonitis.
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Affiliation(s)
- M W Butler
- Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
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Butler MW, Lazar EL, Smerling AJ, Stolar CJ. Differential effects of inhaled nitric oxide on normoxic and hypoxic isolated in situ neonatal pig lungs perfused by extracorporeal membrane oxygenation. J Pediatr Surg 1994; 29:275-8; discussion 279. [PMID: 8176605 DOI: 10.1016/0022-3468(94)90332-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 01/29/2023]
Abstract
Inhaled nitric oxide (NO) is effective as a selective pulmonary vasodilator, but its effects on uninjured lungs subjected to normoxia and hypoxia have not been fully studied. The authors sought the response of pulmonary vascular resistance (PVR) to inhaled NO in piglet lungs devoid of ischemic injury in a model of reversible pulmonary hypertension. If the changes were dose-responsive, the authors asked whether the PVR changes were related to normoxia or hypoxia, and hypothesized that the change would be more pronounced for hypoxia than normoxia. In situ isolated piglet lungs were prepared by occlusive tracheostomy and ligation of the ductus arteriosus and aorta. Cannulae positioned in the left atrium and pulmonary artery were connected to a standard extracorporeal membrane oxygenation (ECMO) circuit, and flow was increased to approximate cardiac output. After stabilization, piglets (aged 5 to 14 days, weighing 3.2 to 6.4 kg) were divided into two groups of four each: normoxic (FIO2 0.30, normal PVR) and hypoxic (FIO2 0.07, increased PVR). NO was administered at 10 to 80 parts per million (ppm) in increments of 10 ppm, for 5 minutes at each concentration, with a return to baseline before each new dose. Flow, pulmonary arterial (PA) and left atrial (LA) pressures were continuously monitored, from which PVR was calculated (PVR = [PPA - PLA]/flow) and expressed as log delta PVR. Data were analyzed statistically by repeated measures of analysis of variance, comparing log delta PVR to baseline at each dose of NO, and comparing log delta PVR for normoxic and hypoxic lungs at each dose of NO.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M W Butler
- Division of Pediatric Surgery, Columbia University, College of Physicians and Surgeons, New York, NY
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Abstract
Despite advances in infant transport and intensive care, congenital diaphragmatic hernia (CDH) still poses a serious threat to life during the neonatal period. Only with the introduction of extracorporeal membrane oxygenation (ECMO) has mortality declined significantly. Understanding the pathophysiology of CDH and its devastating effect on the lungs' bronchial and vascular development assists the clinician in rational management during the perioperative period. Successful treatment demands prompt diagnosis, informed preoperative assessment and preparation, carefully timed surgical repair, and aggressive postoperative intensive care with a thorough understanding of the role of ECMO. Improvements in ventilatory support and pharmacologic management of pulmonary hypertension have allowed surgeons to delay repair until circulatory hemodynamics, electrolytes, and oxygenation can be optimized, even resorting to preoperative ECMO in selected cases if needed. Patients with severe bilateral pulmonary hypoplasia pose serious dilemmas in terms of selection for ECMO, as well as for surgical repair. Long-term follow-up of patients after CDH repair reveals persistent hypoperfusion of the involved lung but no debilitating pulmonary disease. Future therapies may include early fetal intervention or lung transplantation, although these areas remain controversial and experimental, and clinical experience is limited.
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Affiliation(s)
- M W Butler
- Division of Pediatric Surgery, Babies Hospital, Columbia-Presbyterian Medical Center, New York, New York 10032
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