Pub Date : 2023-05-19DOI: 10.1080/24745332.2023.2205608
L. Boulet, M. Boulay, Laurent Lecours, A. Kaplan, J. Bourbeau, Emily Horvat, A. Côté, S. Field, Myriam Gagné, Samir Gupta, Pierre-Alexis Lépine, I. Satia
Abstract RATIONALE Cough is one of the most common causes for medical consultation. However, we do not know whether its management is optimal in Canada. Although guidelines are available, awareness of these and implementation of their recommendations are uncertain. OBJECTIVE The objective of this research was to evaluate the diagnostic approach and management of cough, as well as knowledge of cough guidelines in Canada. METHODS A cross-sectional online survey of general practitioners (GPs), specialists (SPs) and allied health professionals (AHPs) was conducted anonymously in Canada. Participants answered multiple-choice questions on etiology, diagnosis, follow-up and treatment (only physicians) of cough and knowledge and application of cough guidelines. MEASUREMENTS AND MAIN RESULTS A total of 248 respondents completed the survey (43 GPs, 27 SPs, and 178 AHPs). In the investigation of a patient with chronic cough, a chest radiograph was the most common test ordered by physicians (GPs: 51.2%, SPs: 59.3%) and spirometry with bronchodilator reversibility (61.2%) by AHPs. GPs most often treated cough of unknown etiology with combined inhaled corticosteroid (ICS)-long-acting β2-agonist (LABA) (25.8%) and SPs with a nasal corticosteroid (NCS)(29.8%). NCS was also the most often prescribed treatment for cough considered originating in the upper respiratory tract (GPs: 60.4%, SPs: 76.2%). When cough was believed to be due to asthma or gastroesophageal reflux disease, treatment was appropriate in most cases. Awareness of current cough guidelines content was poor in all groups (GPs: 14.0%, SPs: 51.9%, AHPs: 26.6%). CONCLUSIONS Physicians and AHPs’ knowledge and application of guidelines for the management of chronic cough remains poor. RÉSUMÉ JUSTIFICATION La toux est l'une des causes les plus fréquentes de consultation médicale. Cependant, nous ne savons pas si sa prise en charge est optimale au Canada. Bien que des lignes directrices soient disponibles, la connaissance de celles-ci et la mise en œuvre de leurs recommandations sont incertaines. OBJECTIF Évaluer l'approche diagnostique et la prise en charge de la toux, ainsi que la connaissance des lignes directrices sur la toux au Canada. MÉTHODES Un sondage en ligne transversal auprès des omnipraticiens, des spécialistes et des professionnels de la santé apparentés a été mené de façon anonyme au Canada. Les participants ont répondu à des questions à choix multiples sur l'étiologie, le diagnostic, le suivi et le traitement (uniquement les médecins) de la toux, ainsi que sur la connaissance et l'application des lignes directrices sur la toux. MESURES ET PRINCIPAUX RÉSULTATS Au total, 248 répondants ont répondu à l'enquête (43 omnipraticiens, 27 spécialistes et 178 autres professionnels de la santé). Dans le cadre de l'investigation d'un patient souffrant de toux chronique, une radiographie thoracique était le test le plus couramment prescrit par les médecins (omnipraticiens : 51,2 %, spécialistes : 59,3 %)
咳嗽是求医问诊最常见的原因之一。然而，我们不知道它的管理是否在加拿大是最佳的。虽然有指导方针，但对这些指导方针的认识和对其建议的执行情况并不确定。目的本研究的目的是评估加拿大咳嗽的诊断方法和管理，以及咳嗽指南的知识。方法在加拿大匿名对全科医生(gp)、专科医生(SPs)和联合卫生专业人员(AHPs)进行横断面在线调查。参与者回答多项选择题，内容涉及咳嗽的病因、诊断、随访和治疗(仅限医生)以及咳嗽指南的知识和应用。测量和主要结果共有248名受访者完成了调查(43名全科医生，27名SPs和178名ahp)。在慢性咳嗽患者的调查中，胸片是医生最常要求的检查(全科医生51.2%，专科医生59.3%)，ahp最常要求的是肺活量测定和支气管扩张剂可逆性(61.2%)。全科医生最常使用吸入皮质类固醇(ICS)-长效β2激动剂(LABA)联合治疗病因不明的咳嗽(25.8%)和SPs联合鼻用皮质类固醇(NCS)(29.8%)。NCS也是被认为起源于上呼吸道的咳嗽最常用的处方治疗方法(全科医生:60.4%，SPs: 76.2%)。当咳嗽被认为是由于哮喘或胃食管反流疾病时，治疗在大多数情况下是适当的。所有组对现行咳嗽指南内容的认识都较差(全科医生:14.0%，SPs: 51.9%， AHPs: 26.6%)。结论医师和ahp对慢性咳嗽治疗指南的知识和应用仍然较差。RÉSUMÉ辩护:La toux est l'une des causes les + frsamquentes de consultation msamdicale。因此，现在的新鲜肉已经成为加拿大的最佳选择。关于一次性用品的管理，关于电池的管理，关于电池的管理，关于电池的管理，关于电池的管理，关于电池的管理。目的:Évaluer诊断方法与诊断方法与诊断方法的关系，以及加拿大诊断方法与诊断方法的关系。MÉTHODES在加拿大，综合医疗人员、医疗人员、医疗人员和医疗人员的横向医疗机构似乎是医疗人员和医疗人员的横向医疗机构。3 .与会者不参加下列问题:1 .疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡疡。措施ET PRINCIPAUX RÉSULTATS总共有248人接受了培训(43名全科医生、27名培训人员和178名职业培训人员)。在干部de l 'investigation d一个病人souffrant de toux chronique,一个radiographie thoracique一测试le + couramment prescrit组织par莱斯(omnipraticiens: 51岁的2%,要如何:59岁,3%)等一个spirometrie测试de reversibilite然后bronchodilatateur(61年2%)票面变量来完成de la桑特。全科医生治疗的le + souvent la toux d' samtiologie inconcone与corticostéroïde inhal联合使用bêta-2阿格尼斯特(agoniste)联合使用的延长型samete(25.8%)和Les spsametologie (corticostéroïde鼻)(29.8%)。Le corticostéroïde鼻腔内的呼吸道内的呼吸道内的空气内的呼吸道内的空气内的空气内的空气外的空气内的空气外的空气内的空气内的空气内的空气(全科医生:60.04%，全科医生:76.2%)。Lorsque l'on croyait que la toux ，因为你' astme you au reflux gastrostro -œsophagien, le traitement ，因为你的身体不适，所以你的身体不适。根据不同群体的实际情况，对不同的职业人士(全科医生:14.0%，特殊职业人士:51.9%，职业医生:26.6%)进行管理和管理。结论Les connaissances et l 'application des行准线倒拉撬en电荷de la toux chronique组织par莱斯等变量来完成de la桑特restent平庸。
{"title":"Management of cough in Canadian primary care and specialty practices: A survey of current knowledge of clinicians and allied health professionals","authors":"L. Boulet, M. Boulay, Laurent Lecours, A. Kaplan, J. Bourbeau, Emily Horvat, A. Côté, S. Field, Myriam Gagné, Samir Gupta, Pierre-Alexis Lépine, I. Satia","doi":"10.1080/24745332.2023.2205608","DOIUrl":"https://doi.org/10.1080/24745332.2023.2205608","url":null,"abstract":"Abstract RATIONALE Cough is one of the most common causes for medical consultation. However, we do not know whether its management is optimal in Canada. Although guidelines are available, awareness of these and implementation of their recommendations are uncertain. OBJECTIVE The objective of this research was to evaluate the diagnostic approach and management of cough, as well as knowledge of cough guidelines in Canada. METHODS A cross-sectional online survey of general practitioners (GPs), specialists (SPs) and allied health professionals (AHPs) was conducted anonymously in Canada. Participants answered multiple-choice questions on etiology, diagnosis, follow-up and treatment (only physicians) of cough and knowledge and application of cough guidelines. MEASUREMENTS AND MAIN RESULTS A total of 248 respondents completed the survey (43 GPs, 27 SPs, and 178 AHPs). In the investigation of a patient with chronic cough, a chest radiograph was the most common test ordered by physicians (GPs: 51.2%, SPs: 59.3%) and spirometry with bronchodilator reversibility (61.2%) by AHPs. GPs most often treated cough of unknown etiology with combined inhaled corticosteroid (ICS)-long-acting β2-agonist (LABA) (25.8%) and SPs with a nasal corticosteroid (NCS)(29.8%). NCS was also the most often prescribed treatment for cough considered originating in the upper respiratory tract (GPs: 60.4%, SPs: 76.2%). When cough was believed to be due to asthma or gastroesophageal reflux disease, treatment was appropriate in most cases. Awareness of current cough guidelines content was poor in all groups (GPs: 14.0%, SPs: 51.9%, AHPs: 26.6%). CONCLUSIONS Physicians and AHPs’ knowledge and application of guidelines for the management of chronic cough remains poor. RÉSUMÉ JUSTIFICATION La toux est l'une des causes les plus fréquentes de consultation médicale. Cependant, nous ne savons pas si sa prise en charge est optimale au Canada. Bien que des lignes directrices soient disponibles, la connaissance de celles-ci et la mise en œuvre de leurs recommandations sont incertaines. OBJECTIF Évaluer l'approche diagnostique et la prise en charge de la toux, ainsi que la connaissance des lignes directrices sur la toux au Canada. MÉTHODES Un sondage en ligne transversal auprès des omnipraticiens, des spécialistes et des professionnels de la santé apparentés a été mené de façon anonyme au Canada. Les participants ont répondu à des questions à choix multiples sur l'étiologie, le diagnostic, le suivi et le traitement (uniquement les médecins) de la toux, ainsi que sur la connaissance et l'application des lignes directrices sur la toux. MESURES ET PRINCIPAUX RÉSULTATS Au total, 248 répondants ont répondu à l'enquête (43 omnipraticiens, 27 spécialistes et 178 autres professionnels de la santé). Dans le cadre de l'investigation d'un patient souffrant de toux chronique, une radiographie thoracique était le test le plus couramment prescrit par les médecins (omnipraticiens : 51,2 %, spécialistes : 59,3 %)","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"104 1","pages":"124 - 132"},"PeriodicalIF":0.8,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80463324","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}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2177213
W. Michaelchuk, T. Colella, R. Goldstein, D. Brooks
Abstract RATIONALE: Individuals with chronic obstructive pulmonary disease (COPD) exhibit reduced physical activity (PA) and increased sedentary behavior (SB), both of which are independent predictors of mortality. Wearable technology providing vibration movement prompts may be effective in decreasing SB. This study aimed to assess the feasibility and perceptions of a vibration based FitBit™ SB change strategy in individuals with COPD. METHODS Individuals with stable COPD wore a FitBit™ with movement prompts enabled and disabled for one week each (order randomized). Feasibility and perceptions of the wearable device were assessed in each condition. A validated activity monitor (ActivPAL4™) was used to measure PA and SB. MAIN RESULTS: Of the 28 participants connected with, 19 (68%) expressed interest. A total of 18 of the 19 (95%) interested were eligible to participate, and 15 of 28 (54%) enrolled. All 15 participants completed the study with no dropouts. Nine (64%) participants identified the device as affordable. Perceptions toward the devices were generally positive or agreeable and were unaffected by the device condition (with or without prompts; P > 0.05). Responses to additional open-ended questions revealed that participants thought the device was helpful for breaking up sitting time, the timing of vibration reminders was perceived as confusing by some, and accessibility of the devices and individual preferences are important considerations. CONCLUSIONS The wearable device SB reduction strategy was feasible and participants had positive perceptions toward using it. Individualization and accessibility of device are important considerations.
{"title":"Wearable device for sedentary behavior change in chronic obstructive pulmonary disease is feasible and acceptable","authors":"W. Michaelchuk, T. Colella, R. Goldstein, D. Brooks","doi":"10.1080/24745332.2023.2177213","DOIUrl":"https://doi.org/10.1080/24745332.2023.2177213","url":null,"abstract":"Abstract RATIONALE: Individuals with chronic obstructive pulmonary disease (COPD) exhibit reduced physical activity (PA) and increased sedentary behavior (SB), both of which are independent predictors of mortality. Wearable technology providing vibration movement prompts may be effective in decreasing SB. This study aimed to assess the feasibility and perceptions of a vibration based FitBit™ SB change strategy in individuals with COPD. METHODS Individuals with stable COPD wore a FitBit™ with movement prompts enabled and disabled for one week each (order randomized). Feasibility and perceptions of the wearable device were assessed in each condition. A validated activity monitor (ActivPAL4™) was used to measure PA and SB. MAIN RESULTS: Of the 28 participants connected with, 19 (68%) expressed interest. A total of 18 of the 19 (95%) interested were eligible to participate, and 15 of 28 (54%) enrolled. All 15 participants completed the study with no dropouts. Nine (64%) participants identified the device as affordable. Perceptions toward the devices were generally positive or agreeable and were unaffected by the device condition (with or without prompts; P > 0.05). Responses to additional open-ended questions revealed that participants thought the device was helpful for breaking up sitting time, the timing of vibration reminders was perceived as confusing by some, and accessibility of the devices and individual preferences are important considerations. CONCLUSIONS The wearable device SB reduction strategy was feasible and participants had positive perceptions toward using it. Individualization and accessibility of device are important considerations.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"22 1","pages":"79 - 85"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73599628","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}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2176798
S. Alsubheen, C. Ellerton, R. Goldstein, D. Brooks
Abstract BACKGROUND The psychometric properties of loneliness measures have not been reported in individuals with chronic obstructive pulmonary disease (COPD). This study aimed to assess the validity and reliability of the University of California and Los Angeles Loneliness Scale (UCLA-LS) version 3 for use in this population. METHODS The UCLA-LS was administered at baseline and again after 1 to 2 weeks for test-retest reliability assessment. Intraclass Correlation Coefficient (ICC) was used to assess reliability and estimate minimal detectable change (MDC). Construct validity was established by assessing known groups, and convergent and divergent validity. RESULTS Of the 47 individuals included in this study, 40 persons (87%) reported moderate to high loneliness levels. The UCLA-LS discriminated (p < 0.03) between groups based on marital status, with higher loneliness levels for single (mean difference [MD] = 8 points) and widowed (MD = 7 points) compared to married individuals. The scale had moderate to strong associations with measures of depression (ρ = 0.69-0.72; p < 0.001), anxiety (ρ = 0.46-0.52; p < 0.03), and quality of life (Chronic respiratory questionnaire [CRQ]-Fatigue: ρ = −0.51-−0.53; CRQ-Emotional function: ρ = −0.59-−0.57; CRQ-Mastery: ρ = −0.43-−0.46; p < 0.003). The UCLA-LS showed excellent test-retest reliability with ICC values of 0.96. To detect a change in version 3 UCLA-LS, the MDC score should equal or exceed 7.8 points. CONCLUSION UCLA-LS demonstrated excellent known groups, convergent and divergent validity, and test-retest reliability. These findings may help improve the interpretability of loneliness levels in individuals with COPD.
{"title":"Validity and reliability of the University of California and Los Angeles Loneliness Scale in individuals with chronic obstructive pulmonary disease","authors":"S. Alsubheen, C. Ellerton, R. Goldstein, D. Brooks","doi":"10.1080/24745332.2023.2176798","DOIUrl":"https://doi.org/10.1080/24745332.2023.2176798","url":null,"abstract":"Abstract BACKGROUND The psychometric properties of loneliness measures have not been reported in individuals with chronic obstructive pulmonary disease (COPD). This study aimed to assess the validity and reliability of the University of California and Los Angeles Loneliness Scale (UCLA-LS) version 3 for use in this population. METHODS The UCLA-LS was administered at baseline and again after 1 to 2 weeks for test-retest reliability assessment. Intraclass Correlation Coefficient (ICC) was used to assess reliability and estimate minimal detectable change (MDC). Construct validity was established by assessing known groups, and convergent and divergent validity. RESULTS Of the 47 individuals included in this study, 40 persons (87%) reported moderate to high loneliness levels. The UCLA-LS discriminated (p < 0.03) between groups based on marital status, with higher loneliness levels for single (mean difference [MD] = 8 points) and widowed (MD = 7 points) compared to married individuals. The scale had moderate to strong associations with measures of depression (ρ = 0.69-0.72; p < 0.001), anxiety (ρ = 0.46-0.52; p < 0.03), and quality of life (Chronic respiratory questionnaire [CRQ]-Fatigue: ρ = −0.51-−0.53; CRQ-Emotional function: ρ = −0.59-−0.57; CRQ-Mastery: ρ = −0.43-−0.46; p < 0.003). The UCLA-LS showed excellent test-retest reliability with ICC values of 0.96. To detect a change in version 3 UCLA-LS, the MDC score should equal or exceed 7.8 points. CONCLUSION UCLA-LS demonstrated excellent known groups, convergent and divergent validity, and test-retest reliability. These findings may help improve the interpretability of loneliness levels in individuals with COPD.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"9 1","pages":"70 - 78"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84591186","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}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2178039
Aditi S. Shah, R. Jen, I. Laher, J. Leung, A. Allen, Stephan Van Eden, N. Ayas
Abstract PURPOSE: The purpose of this study was to characterize the associations between inflammatory and oxidative stress biomarkers, demographic, polysomnographic and spirometric parameters in patients with suspected obstructive sleep apnea (OSA) and/or obstructive airway disease. METHODS: This was a cross-sectional exploratory study of patients referred to the University of British Columbia Sleep Clinic who had a diagnostic polysomnogram for suspected OSA. All patients had samples collected for measurements of IL-10, IL-6, e-selectin, endostatin, VCAM-1, ICAM-1, PDGF, thrombospondin-2, 8-OHdG, 8-isoprostane and superoxide dismutase. Spearman correlation and multiple linear regression were used to identify predictors of biomarkers. RESULTS: A total of 63 patients were included: 65% male, mean age 53 years and body mass index (BMI) 33 kg/m2. Inflammatory biomarkers were associated with female sex (IL-6, coefficient 0.51, p = 0.032), FEV1 (IL-6, coefficient −0.02, p = 0.013) and BMI (VCAM-1, coefficient 0.009, p = 0.051). The oxidative stress marker, 8-OHdG, was associated with hypoxemia in rapid eye movement (REM) sleep (coefficient 0.006, p = 0.02). Age and BMI were both independently associated with percentage of time spent below SpO2 90%. REM sleep and patients with overlap conditions and OSA had greater degree of REM and nonrapid eye movement (NREM) sleep hypoxemia than control group. Lastly, there were no differences in oxidative or inflammatory biomarkers between control, OSA, obstructive airway disease and overlap groups though the number of patients in each group were small. CONCLUSION: Female sex, lower FEV1 and increased BMI were independent predictors of increased inflammatory biomarker levels. The oxidative stress marker 8-OHdG was associated with hypoxemia indices of REM. Larger studies are warranted to delineate biomarker profiles in patients with overlap conditions.
{"title":"Biomarkers in patients with suspected obstructive sleep apnea and obstructive lung disease: Associations among polysomnographic, demographic and spirometric parameters","authors":"Aditi S. Shah, R. Jen, I. Laher, J. Leung, A. Allen, Stephan Van Eden, N. Ayas","doi":"10.1080/24745332.2023.2178039","DOIUrl":"https://doi.org/10.1080/24745332.2023.2178039","url":null,"abstract":"Abstract PURPOSE: The purpose of this study was to characterize the associations between inflammatory and oxidative stress biomarkers, demographic, polysomnographic and spirometric parameters in patients with suspected obstructive sleep apnea (OSA) and/or obstructive airway disease. METHODS: This was a cross-sectional exploratory study of patients referred to the University of British Columbia Sleep Clinic who had a diagnostic polysomnogram for suspected OSA. All patients had samples collected for measurements of IL-10, IL-6, e-selectin, endostatin, VCAM-1, ICAM-1, PDGF, thrombospondin-2, 8-OHdG, 8-isoprostane and superoxide dismutase. Spearman correlation and multiple linear regression were used to identify predictors of biomarkers. RESULTS: A total of 63 patients were included: 65% male, mean age 53 years and body mass index (BMI) 33 kg/m2. Inflammatory biomarkers were associated with female sex (IL-6, coefficient 0.51, p = 0.032), FEV1 (IL-6, coefficient −0.02, p = 0.013) and BMI (VCAM-1, coefficient 0.009, p = 0.051). The oxidative stress marker, 8-OHdG, was associated with hypoxemia in rapid eye movement (REM) sleep (coefficient 0.006, p = 0.02). Age and BMI were both independently associated with percentage of time spent below SpO2 90%. REM sleep and patients with overlap conditions and OSA had greater degree of REM and nonrapid eye movement (NREM) sleep hypoxemia than control group. Lastly, there were no differences in oxidative or inflammatory biomarkers between control, OSA, obstructive airway disease and overlap groups though the number of patients in each group were small. CONCLUSION: Female sex, lower FEV1 and increased BMI were independent predictors of increased inflammatory biomarker levels. The oxidative stress marker 8-OHdG was associated with hypoxemia indices of REM. Larger studies are warranted to delineate biomarker profiles in patients with overlap conditions.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"39 1","pages":"86 - 92"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90157174","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}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2176797
S. Desai, Wei Zhang, J. Sutherland, Joel Singer PhD, Xingzuo Zhou, B. Quon
Abstract RATIONALE: Cystic fibrosis (CF) is a progressive multi-organ disease with significant morbidity placing extensive demands on the health care system. No recent estimate of CF health care costs in a Canadian context exists. OBJECTIVES: Provide up-to-date direct cost estimates of the economic burden of CF from the perspective of a Canadian health care system. METHODS: A longitudinal study of retrospective data was completed in British Columbia by linking the Canadian CF Registry with provincial health care administrative databases for the period between 2007 and 2017. MEASUREMENTS: Health care spending (in constant 2017 Canadian dollars) for CF outpatient services, inpatient hospitalizations, medications, and emergency department visits were included. Generalized estimating equations approach for repeated annual cost data over time was used to estimate health care costs. MAIN RESULTS: The overall total direct annual health care spending for CF care in BC increased from $10.6M to $17.2M from 2007 to 2017 ($2017, mean costs per CF patient increased from $31.7K to $42.2K; Cost ratio: 1.33, 95%CI: 1.12-1.57). Outpatient medications, inpatient hospitalizations, outpatient services, and emergency department visits were responsible for 56%, 36%, 7.4% and 0.5% of total costs, respectively. CF adults also showed substantial increases in costs over time (Cost ratio from 2017 relative to 2007: 1.61, 95%CI: 1.17-2.22). CONCLUSIONS: The economic burden of CF increased from 2007 to 2017 driven by rising outpatient medication costs primarily in adults with CF. With approximately 75% of the population eligible for highly effectively cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the economic burden of CF is expected to increase at unprecedented rates.
{"title":"Economic burden of cystic fibrosis care in British Columbia","authors":"S. Desai, Wei Zhang, J. Sutherland, Joel Singer PhD, Xingzuo Zhou, B. Quon","doi":"10.1080/24745332.2023.2176797","DOIUrl":"https://doi.org/10.1080/24745332.2023.2176797","url":null,"abstract":"Abstract RATIONALE: Cystic fibrosis (CF) is a progressive multi-organ disease with significant morbidity placing extensive demands on the health care system. No recent estimate of CF health care costs in a Canadian context exists. OBJECTIVES: Provide up-to-date direct cost estimates of the economic burden of CF from the perspective of a Canadian health care system. METHODS: A longitudinal study of retrospective data was completed in British Columbia by linking the Canadian CF Registry with provincial health care administrative databases for the period between 2007 and 2017. MEASUREMENTS: Health care spending (in constant 2017 Canadian dollars) for CF outpatient services, inpatient hospitalizations, medications, and emergency department visits were included. Generalized estimating equations approach for repeated annual cost data over time was used to estimate health care costs. MAIN RESULTS: The overall total direct annual health care spending for CF care in BC increased from $10.6M to $17.2M from 2007 to 2017 ($2017, mean costs per CF patient increased from $31.7K to $42.2K; Cost ratio: 1.33, 95%CI: 1.12-1.57). Outpatient medications, inpatient hospitalizations, outpatient services, and emergency department visits were responsible for 56%, 36%, 7.4% and 0.5% of total costs, respectively. CF adults also showed substantial increases in costs over time (Cost ratio from 2017 relative to 2007: 1.61, 95%CI: 1.17-2.22). CONCLUSIONS: The economic burden of CF increased from 2007 to 2017 driven by rising outpatient medication costs primarily in adults with CF. With approximately 75% of the population eligible for highly effectively cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the economic burden of CF is expected to increase at unprecedented rates.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"20 1","pages":"60 - 69"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72517151","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}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2191534
R. Leigh
{"title":"President’s message","authors":"R. Leigh","doi":"10.1080/24745332.2023.2191534","DOIUrl":"https://doi.org/10.1080/24745332.2023.2191534","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"75 1","pages":"49 - 51"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88960560","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}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2184431
F. Gabrysz-Forget, C. Poirier
Abstract This case presents a patient with severe pulmonary alveolar microlithiasis, a rare genetic condition affecting the sodium-dependent co-transporter of the type II pneumocytes. As the disease progress, calcium-phosphate microlithiases accumulate within the alveoli. This leads to a severe diffuse interstitial disease with classic sand-like calcifications on chest radiography. Lung transplantation remains the only cure.
{"title":"Severe pulmonary alveolar microlithiasis","authors":"F. Gabrysz-Forget, C. Poirier","doi":"10.1080/24745332.2023.2184431","DOIUrl":"https://doi.org/10.1080/24745332.2023.2184431","url":null,"abstract":"Abstract This case presents a patient with severe pulmonary alveolar microlithiasis, a rare genetic condition affecting the sodium-dependent co-transporter of the type II pneumocytes. As the disease progress, calcium-phosphate microlithiases accumulate within the alveoli. This leads to a severe diffuse interstitial disease with classic sand-like calcifications on chest radiography. Lung transplantation remains the only cure.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"53 1","pages":"119 - 120"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79544800","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}
Pub Date : 2023-02-15DOI: 10.1080/24745332.2022.2150722
Nourhan Kotb, L. Barreto, T. Janaudis-Ferreira
Abstract Post COVID-19 condition is defined as the illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months. The most common symptoms of people with post-COVID condition are symptoms of fatigue, dyspnea, brain fog and post-exertional malaise (PEM). International guidelines on the management of COVID-19 highlight the importance of screening patients for PEM before rehabilitation interventions and carefully monitoring symptoms in response to physical activity to avoid flare-ups. We sought to determine how PEM is being considered in the context of rehabilitation for COVID-19 by reviewing the published literature and registries of clinical trials.
{"title":"Post-exertional malaise in pulmonary rehabilitation after COVID-19: Are we not giving enough attention?","authors":"Nourhan Kotb, L. Barreto, T. Janaudis-Ferreira","doi":"10.1080/24745332.2022.2150722","DOIUrl":"https://doi.org/10.1080/24745332.2022.2150722","url":null,"abstract":"Abstract Post COVID-19 condition is defined as the illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months. The most common symptoms of people with post-COVID condition are symptoms of fatigue, dyspnea, brain fog and post-exertional malaise (PEM). International guidelines on the management of COVID-19 highlight the importance of screening patients for PEM before rehabilitation interventions and carefully monitoring symptoms in response to physical activity to avoid flare-ups. We sought to determine how PEM is being considered in the context of rehabilitation for COVID-19 by reviewing the published literature and registries of clinical trials.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"30 1","pages":"93 - 118"},"PeriodicalIF":0.8,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82560369","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}
Pub Date : 2023-02-07DOI: 10.1080/24745332.2023.2165462
Matthew P Munan, Zoe Hsu, J. Bakal, E. MacIntyre
Abstract INTRODUCTION Patients requiring Prolonged Mechanical Ventilation (PMV) are a small but important subset of critically ill patients treated in an Intensive Care Unit (ICU). The purpose of this study is to identify and characterize the PMV population in Alberta, Canada over a period of 10 years and to determine mortality, discharge disposition and healthcare cost. METHODS A search of the Alberta Health Services Enterprise Data Warehouse was performed to characterize all patients with 7 days or more of mechanical ventilation in an acute care hospital in Alberta from 2009-2019. Data linkages were performed to identify survival up to 2 years and Healthcare cost was estimated using resource intensity weight (RIW) score. RESULTS The search identified 11,739 patients ventilated for ≥7 days from 2009-2019. In this cohort, 59% of patients were ventilated for 7-13 days, 20% for 14-20 days and 21% for 21 days or more. The in-hospital survival rate was 68% and the one-year survival from initiation of ventilation was 61%. Of the patients discharged alive, 93% were discharged to community and 7% were discharged to a continuing care center. The median healthcare cost for index hospital admission was $119,627 ($70,549-$200,036) CONCLUSION PMV users require a significant duration of mechanical ventilation, a prolonged stay in the ICU and hospital and high healthcare resource utilization. The majority of these patients survive their index admission and are discharged to community.
{"title":"Prolonged mechanical ventilation in Alberta: A 10 year historical cohort study","authors":"Matthew P Munan, Zoe Hsu, J. Bakal, E. MacIntyre","doi":"10.1080/24745332.2023.2165462","DOIUrl":"https://doi.org/10.1080/24745332.2023.2165462","url":null,"abstract":"Abstract INTRODUCTION Patients requiring Prolonged Mechanical Ventilation (PMV) are a small but important subset of critically ill patients treated in an Intensive Care Unit (ICU). The purpose of this study is to identify and characterize the PMV population in Alberta, Canada over a period of 10 years and to determine mortality, discharge disposition and healthcare cost. METHODS A search of the Alberta Health Services Enterprise Data Warehouse was performed to characterize all patients with 7 days or more of mechanical ventilation in an acute care hospital in Alberta from 2009-2019. Data linkages were performed to identify survival up to 2 years and Healthcare cost was estimated using resource intensity weight (RIW) score. RESULTS The search identified 11,739 patients ventilated for ≥7 days from 2009-2019. In this cohort, 59% of patients were ventilated for 7-13 days, 20% for 14-20 days and 21% for 21 days or more. The in-hospital survival rate was 68% and the one-year survival from initiation of ventilation was 61%. Of the patients discharged alive, 93% were discharged to community and 7% were discharged to a continuing care center. The median healthcare cost for index hospital admission was $119,627 ($70,549-$200,036) CONCLUSION PMV users require a significant duration of mechanical ventilation, a prolonged stay in the ICU and hospital and high healthcare resource utilization. The majority of these patients survive their index admission and are discharged to community.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"53 1","pages":"52 - 59"},"PeriodicalIF":0.8,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86039756","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}
Pub Date : 2023-01-02DOI: 10.1080/24745332.2023.2167414
R. Leigh
{"title":"President’s message","authors":"R. Leigh","doi":"10.1080/24745332.2023.2167414","DOIUrl":"https://doi.org/10.1080/24745332.2023.2167414","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"9 1","pages":"1 - 3"},"PeriodicalIF":0.8,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78530210","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}
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