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Prospective multicenter observational study comparing ambulatory management of spontaneous pneumothorax versus hospital care: PNEUMOPECO study 前瞻性多中心观察性研究:比较自发性气胸的门诊治疗与医院护理:PNEUMOPECO研究
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa721
A. Angibaud, Y. Bazin, A. Salé, L. Sohier, C. Gangloff, E. Antone, W. Trzepizur, L. Chemery, S. Guinard, T. Guy, C. Gut-Gobert, C. Bernier, B. Delatour, S. Jouneau
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引用次数: 0
Suboptimal asthma control among over-the-counter reliever purchasers in the community pharmacy 社区药房非处方药购买者的次优哮喘控制
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa709
Elizabeth Azzi, M. Peters, V. Kritikos, D. Price, Pamela Srour, B. Cvetkovski, S. Bosnic-Anticevich
{"title":"Suboptimal asthma control among over-the-counter reliever purchasers in the community pharmacy","authors":"Elizabeth Azzi, M. Peters, V. Kritikos, D. Price, Pamela Srour, B. Cvetkovski, S. Bosnic-Anticevich","doi":"10.1183/13993003.congress-2019.pa709","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa709","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115394975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality of life in German GP-Patients with COPD– a longitudinal study 德国gp - COPD患者的生活质量——一项纵向研究
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa704
C. Klett-Tammen, H. Lingner, A. Kuhlmann, T. Schmidt, J. Lutter, J.-M. von der Schulenburg, M. Kreuter, T. Welte
{"title":"Quality of life in German GP-Patients with COPD– a longitudinal study","authors":"C. Klett-Tammen, H. Lingner, A. Kuhlmann, T. Schmidt, J. Lutter, J.-M. von der Schulenburg, M. Kreuter, T. Welte","doi":"10.1183/13993003.congress-2019.pa704","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa704","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121035385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of screening for undiagnosed COPD on respiratory hospitalisation and mortality; 4 year follow up of the TargetCOPD trial 未确诊COPD筛查对呼吸道住院率和死亡率的影响TargetCOPD试验的4年随访
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.oa5147
P. Adab, D. Fitzmaurice, James Martin, A. Sitch, K. Cheng, A. Daley, A. Dickens, A. Enocson, S. Greenfield, K. Jolly, S. Jowett, Martin R Miller, R. Riley, S. Siebert, R. Stockley, A. Turner, Shamil Haroon, R. Jordan
{"title":"Effect of screening for undiagnosed COPD on respiratory hospitalisation and mortality; 4 year follow up of the TargetCOPD trial","authors":"P. Adab, D. Fitzmaurice, James Martin, A. Sitch, K. Cheng, A. Daley, A. Dickens, A. Enocson, S. Greenfield, K. Jolly, S. Jowett, Martin R Miller, R. Riley, S. Siebert, R. Stockley, A. Turner, Shamil Haroon, R. Jordan","doi":"10.1183/13993003.congress-2019.oa5147","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.oa5147","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122792560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
STOP-BANG: a method to detect obstructive sleep apnea and discriminate for severity in primary care STOP-BANG:一种在初级保健中检测阻塞性睡眠呼吸暂停和区分严重程度的方法
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.oa255
Marta Plana Pes, Eric Rojas Calvera, Anna Torrente Nieto, Susana Mota Casals, Immaculada Castellà i Dagà, Anton Obrador I Legares, Mercè Salvans Sagué, Emilio Marco Segarra, Xavier Espuña Capote, María Buxó Pujolràs, Daniela Soledad Torres Scianca, R. Blanes, Ramon Orriols Martínez
Introduction: A STOP-BANG questionnaire (SBQ) score of ≥3 may detect obstructive sleep apnea (OSA) but is not well studied in primary care (PC) Aims and Objectives: Assess the ability of SBQ to predict OSA severity in PC Methods: 30 to 70 year-olds attending any of 4 PC centres in a 22-month period were randomly selected. PC physician did the SBQ. A home respiratory polygraphy (HRP) was done when scores of ≥3 were found and an attended polysomnography (PSG) when apnea-hypopnea index (AHI) was Results: Of included patients (565), 38.2% had SBQ≥3. Of these, 93.1% were diagnosed with OSA (Figure 1). All cases with SBQ≥6 had an AHI≥5/h. SBQ discriminated patients with severe OSA (AHI≥30/h)(n=70, AUC=0.697, 95% CI:0.621-0.773): moderate in women (n=23, AUC=0.733, 95% CI:0.605-0.860) and lower in men (n=47, AUC=0.679, 95% CI:0.583-0.766). In these cases, SBQ≥5 in women had a sensitivity (Sn) of 52.2%, specificity (Sp) of 85.7%, positive likelihood ratio (LR+) of 3.65 and negative likelihood ratio (LR-) of 0.56; and SBQ≥6 in men gave Sn of 44.7%, Sp of 86.7%, LH+ of 3.35 and LH- of 0.64 Conclusions: SB≥3 may adequately screen for OSA in PC. Scores of SB≥5 in women and ≥6 in men could be good opportunistic predictors of severe OSA in PC.
前言:STOP-BANG问卷(SBQ)得分≥3分可以检测阻塞性睡眠呼吸暂停(OSA),但在初级保健(PC)中尚未得到很好的研究。目的和目的:评估SBQ预测阻塞性睡眠呼吸暂停(OSA)严重程度的能力方法:随机选择22个月期间在4个PC中心就诊的30至70岁的老年人。PC医生做了SBQ。结果:在565例患者中,38.2%的患者SBQ≥3。当患者的评分≥3时,进行家庭呼吸测谎(HRP),当患者的呼吸暂停低通气指数(AHI)≥3时,进行随访的多导睡眠图(PSG)。其中93.1%被诊断为OSA(图1)。所有SBQ≥6的患者AHI均≥5/h。SBQ区分重度OSA患者(AHI≥30/h)(n=70, AUC=0.697, 95% CI:0.621-0.773),女性为中度(n=23, AUC=0.733, 95% CI:0.605-0.860),男性为较低(n=47, AUC=0.679, 95% CI:0.583-0.766)。在这些病例中,女性SBQ≥5的敏感性(Sn)为52.2%,特异性(Sp)为85.7%,阳性似然比(LR+)为3.65,阴性似然比(LR-)为0.56;SBQ≥6的男性Sn为44.7%,Sp为86.7%,LH+为3.35,LH-为0.64。结论:SB≥3可充分筛查阻塞性睡眠呼吸暂停综合征。女性SB≥5分、男性SB≥6分可作为PC患者重度OSA的良好预测指标。
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引用次数: 1
Developing a patient-centred template for asthma reviews: an IMP2ART implementation strategy 制定以患者为中心的哮喘审查模板:IMP2ART实施战略
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3996
K. McClatchey, Aimee Sheldon, E. Steed, Stephanie J. C. Taylor, H. Pinnock, C. Ridgway, Oliver Taylor, V. Carter, F. Appiagyei, D. Price
Introduction: Computer templates are used in consultation to review long-term conditions such as asthma. Templates aim to improve adherence to key functions, but risk overriding the patient agenda. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme, aimed to develop an asthma review template to enhance patient-centred care, and promote supported self-management in primary care. Methods: Building on current guidelines, recommendations of an Asthma UK and Royal College of Physicians workshop, patient-centred literature, and behaviour change theory, the multidisciplinary team (clinicians, health psychologists, technical experts) developed a prototype template. A professional advisory group of asthma-interested GPs and nurses (n=17), provided insights into item inclusions and advised on feasibility within primary care. Results: Key features of the prototype template include: an opening question to establish the patient’s agenda such that patients concerns and goals can be addressed; a reduction in extensive data collection e.g. by using different tabs for spirometry; considerations for poorly controlled asthma; links to access a range of external information sources for patients; and a closing question to confirm the patient’s agenda has been addressed. The template highlights patient-centredness, encourages action plan provision, and supports patients to self-manage their asthma. Conclusions: Our prototype template is designed to promote patient-centred care and overcome the risk of reducing asthma reviews to ‘tick-box’ exercises. We will now seek feedback on the utility of the template from professionals and patients. Funding: NIHR PGfAR (RP-PG-1016-20008).
简介:计算机模板用于会诊,以审查长期条件,如哮喘。模板旨在提高对关键功能的依从性,但有压倒患者议程的风险。实施改进的哮喘自我管理作为常规(IMP2ART)计划,旨在制定哮喘审查模板,以加强以患者为中心的护理,并促进初级保健中的支持性自我管理。方法:多学科团队(临床医生、健康心理学家、技术专家)基于目前的指南、英国哮喘协会和皇家医师学院研讨会的建议、以患者为中心的文献和行为改变理论,开发了一个原型模板。一个由对哮喘感兴趣的全科医生和护士组成的专业咨询小组(n=17)提供了对项目纳入的见解,并就初级保健的可行性提出了建议。结果:原型模板的主要特征包括:一个开放式问题,以建立患者的议程,使患者的关注点和目标可以得到解决;减少大量的数据收集,例如使用不同的肺活量测定标签;控制不良哮喘的注意事项;为患者提供访问一系列外部信息源的链接;最后一个问题来确认病人的日程安排已经解决了。该模板强调以患者为中心,鼓励提供行动计划,并支持患者自我管理哮喘。结论:我们的原型模板旨在促进以患者为中心的护理,并克服将哮喘评估减少为“打勾”练习的风险。我们现在将从专业人员和患者那里寻求对模板效用的反馈。资助:NIHR PGfAR (RP-PG-1016-20008)。
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引用次数: 0
Withdrawal of inhaled corticosteroids in COPD patients with mild or moderate airflow limitation: who is suitable for a trial of withdrawal? 轻度或中度气流受限的COPD患者停药:谁适合停药试验?
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5005
T. Harries, G. Gilworth, M. Thomas, C. Corrigan, P. Murphy, N. Hart, Leslie A. Hamilton, P. White
Background: Inappropriate use of high-dose inhaled corticosteroids (HD-ICS) increases pneumonia risk and other complications in patients with COPD. The main indication for prescription of HD-ICS is frequent exacerbations with symptomatic disease. There is a need to identify those patients who are inappropriately prescribed HD-ICS. Aim: Identify COPD patients with mild or moderate airflow limitation suitable for withdrawal of HD-ICS. Method: Electronic records search in UK primary care identified COPD patients (asthma excluded) recently prescribed HD-ICS with no recorded severe airflow limitation in the past year. Before assessment with a view to HD-ICS withdrawal each record was scrutinised. Patients were excluded if prescription of HD-ICS was justified. Eligible patients invited by their family doctor for COPD review. Results: 392 suitable records were identified by electronic search from a COPD patient population of 2967. Frequent inconsistencies in diagnosis and recording of exacerbations were seen in patient notes, often with inability to assign prescription (rescue packs) of antibiotics and prednisolone to exacerbation occurrence. 243 patients excluded from withdrawal as HD-ICS justified. Predominant exclusion factors were: moderate or severe exacerbations (35%), severe airflow obstruction (27%), airflow reversibility (6%), active lung cancer (4%), dementia (3%). 149 patients invited for COPD review. 61 attended, 27 declined in writing, 61 not contactable or refused on the telephone. Conclusion: The determinants of suitability for HD-ICS prescription in primary care records are inconsistently recorded, difficult to identify and challenging to apply.
背景:不适当使用大剂量吸入皮质类固醇(HD-ICS)可增加COPD患者肺炎风险和其他并发症。HD-ICS处方的主要适应症是伴有症状性疾病的频繁加重。有必要确定那些不适当地开了HD-ICS的患者。目的:确定适合退出HD-ICS的轻度或中度气流受限的COPD患者。方法:在英国初级保健中检索电子记录,确定最近使用HD-ICS的COPD患者(哮喘除外),在过去一年中没有记录严重的气流限制。在评估HD-ICS撤销之前,每个记录都经过仔细审查。如果处方HD-ICS是合理的,则排除患者。由家庭医生邀请的符合条件的患者进行COPD复查。结果:通过电子检索从2967例COPD患者人群中确定了392例合适的记录。在患者病历中,诊断和病情加重的记录经常不一致,通常无法分配抗生素和强的松龙的处方(救援包)以应对病情加重。243例患者因HD-ICS被排除在停药之外。主要排除因素为:中度或重度加重(35%)、严重气流阻塞(27%)、气流可逆性(6%)、活动性肺癌(4%)、痴呆(3%)。149例患者被邀请进行COPD审查。61人参加了会议,27人以书面形式拒绝,61人无法联系或拒绝电话。结论:初诊记录中HD-ICS处方适宜性的决定因素记录不一致,难以识别且具有挑战性。
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引用次数: 0
Deprescribing of inhaled corticosteroids in patients with COPD with mild or moderate airflow limitation: what do patients think? 轻度或中度气流受限慢性阻塞性肺病患者吸入糖皮质激素处方的解除:患者怎么看?
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5009
G. Gilworth, T. Harries, M. Thomas, C. Corrigan, Patrick J. Murphy, N. Hart, Leslie A. Hamilton, P. White
Background: GOLD guidelines support the prescription of high-dose inhaled corticosteroids (HD-ICS) in symptomatic COPD patients with frequent or severe exacerbations. HD-ICS are frequently prescribed outside guidelines with the risk of side effects. No investigation of patients’ views of HD-ICS withdrawal have been conducted. Aim: To assess the views of COPD patients with mild or moderate airflow limitation to the staged withdrawal of HD-ICS prescribed outside guidelines with a view to a trial in primary care. Methods: One-to-one semi-structured qualitative interviews exploring COPD patients’ opinions and feelings about using HD-ICS prescribed outside guidelines and their attitudes to proposed withdrawal. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was completed. Results: Seventeen eligible COPD patients were interviewed. Twenty six expressed interest. 7 did not meet spirometry eligibility criteria. Two were unable due to illness. Many participants were not aware they were using a HD-ICS or of the risk of side effects. Some were unconcerned by what they perceived as low individual risk. Others expressed fears of worsening symptoms on withdrawal. Most with mild or moderate airflow limitation would have been willing to attempt withdrawal or titration to a lower dose of HD-ICS if advised by their clinician especially if a reasoned explanation was offered. Conclusions: Attitudes to discontinuing HD-ICS use are varied and likely to be complex. Proposed deprescribing requires detailed conversations between patients and respiratory healthcare professionals including acknowledgement of possible limited understanding of the medication.
背景:GOLD指南支持高剂量吸入皮质类固醇(HD-ICS)用于频繁或严重加重的有症状的COPD患者。HD-ICS经常在指南之外使用,有副作用的风险。未对患者对HD-ICS停药的看法进行调查。目的:评估轻度或中度气流受限的COPD患者对指南外处方的HD-ICS分阶段停药的看法,以期在初级保健中进行试验。方法:一对一半结构化定性访谈,探讨COPD患者对使用外部指南规定的HD-ICS的看法和感受,以及他们对建议退出的态度。采访录音并逐字抄写。专题分析完成。结果:17例符合条件的COPD患者接受了访谈。26人表示有兴趣。7例不符合肺活量测定合格标准。两人因病不能参加。许多参与者并不知道他们正在使用HD-ICS或副作用的风险。一些人对他们所认为的低个人风险并不关心。其他人则表示担心戒断后症状会恶化。大多数轻度或中度气流受限的患者在临床医生的建议下,特别是在有合理解释的情况下,会愿意尝试停药或滴定至较低剂量的HD-ICS。结论:对停止使用HD-ICS的态度是多种多样的,可能是复杂的。建议开处方需要患者和呼吸保健专业人员之间进行详细的对话,包括承认可能对药物的理解有限。
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引用次数: 0
Incidence and risk factors of frequent asthma exacerbations in a multinational, multidatabase cohort study 一项跨国、多数据库队列研究中频繁哮喘发作的发生率和危险因素
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa702
E. Baan, M. de Ridder, M. Engelkes, E. Svensson, D. Prieto-Alhambra, F. Lapi, C. Giaquinto, G. Picelli, F. Albers, E. Bradford, G. Brusselle, M. V. Van Dyke, P. Rijnbeek, K. Verhamme
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引用次数: 0
Does d-dimer level predict pulmonary thromboembolism diagnosis in patients with lung cancer? d-二聚体水平能预测肺癌患者肺血栓栓塞的诊断吗?
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5011
Zeynep Ummu Tursun, D. Tatar, N. Aksel, A. Ayrancı, A. Erbaycu, Y. Varol
Aim: In our study, we aimed to determine the diagnostic contribution of d-dimer level in patients with lung cancer, suspected pulmonary thromboembolism(PTE). Materials and Methods: The cases followed-up with lung cancer diagnosis between 2012-2017 were examined retrospectively. A total of 126 cancer patients diagnosed with PTE were included in the study. A total of 101 lung cancer patients without PTE formed control group. Results: A total of 227 lung cancer patients were included in the study. In the group with PTE, consisting of 126 cases, 102 cases were male (81%), 24 were female (19%) and mean age was 61,5 (± 8,91) years. In control group, consisting of 101 cases, 84 of cases were male (83,2%), 17 were female (16,8%) and mean age was 62,5 (±8,72) years. No statistically significant difference was identified between groups with regard to age, sex, cancer stage and comorbidity. While mean level of d-dimer was 4910,67± 5665 ng/dl in PTE group (median 2916; min. 169- max. 45000 ng/dl), mean level was 1917,78± 2122 ng/dl in control group (median 1196; min. 44- max. 1000 ng/dl) (p Conclusion: Although d-dimer values were higher in lung cancer patients, who developed PTE, no “cut off” value was determined as predictive for diagnosis of PTE.
目的:在我们的研究中,我们旨在确定d-二聚体水平在肺癌疑似肺血栓栓塞(PTE)患者中的诊断作用。材料与方法:回顾性分析2012-2017年肺癌诊断随访病例。共有126名被诊断为PTE的癌症患者参与了这项研究。101例无PTE的肺癌患者作为对照组。结果:共纳入227例肺癌患者。PTE组126例,其中男性102例(81%),女性24例(19%),平均年龄61.5(±8.91)岁。对照组101例,其中男性84例(83.2%),女性17例(16.8%),平均年龄62.5(±8.72)岁。在年龄、性别、癌症分期和合并症方面,各组之间没有统计学上的显著差异。PTE组d-二聚体平均水平为4910,67±5665 ng/dl(中位2916;最小169-最大169。45000 ng/dl),对照组平均为1917,78±2122 ng/dl(中位数1196;最小44-最大。结论:虽然d-二聚体在发生PTE的肺癌患者中较高,但没有确定“切断”值作为PTE诊断的预测值。
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引用次数: 0
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General practice and primary care
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