193 research outputs found
The complexity of managing COPD exacerbations: a grounded theory study of European general practice
No full textObjectives To understand the concerns and challenges faced by general practitioners (GPs) and respiratory physicians about primary care management of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD).Design 21 focus group discussions (FGDs) were performed in seven countries with a Grounded Theory approach. Each country performed three rounds of FGDs.Setting Primary and secondary care in Norway, Germany, Wales, Poland, Russia, The Netherlands, China (Hong Kong).Participants 142 GPs and respiratory physicians were chosen to include urban and rural GPs as well as hospital-based and out patient-clinic respiratory physicians.Results Management of acute COPD exacerbations is dealt with within a scope of concerns. These concerns range from ‘dealing with comorbidity’ through ‘having difficult patients’ to ‘confronting a hopeless disease’. The first concern displays medical uncertainty regarding diagnosis, medication and hospitalisation. These clinical processes become blurred by comorbidity and the social context of the patient. The second concern shows how patients receive the label ‘difficult’ exactly because they need complex attention, but even more because they are time consuming, do not take responsibility and are non-compliant. The third concern relates to the emotional reactions by the physicians when confronted with ‘a hopeless disease’ due to the fact that most of the patients do not improve and the treatment slows down the process at best. GPs and respiratory physicians balance these concerns with medical knowledge and practical, situational knowledge, trying to encompass the complexity of a medical condition.Conclusions Knowing the patient is essential when dealing with comorbidities as well as with difficult relations in the consultations on exacerbations. This study suggests that it is crucial to improve the collaboration between primary and secondary care, in terms of, for example, shared consultations and defined work tasks, which may enhance shared knowledge of patients, medical decision-making and improved management planning
Multidisciplinary, Multisite Evaluation of Alternative Sagebrush Steppe Restoration Treatments: The SageSTEP Project
No full textThis special issue presents short-term ecological effects of restoration treatments imposed as part of the Sagebrush Steppe Treatment Evaluation Project (SageSTEP), and summarizes public attitude survey results related to restoration efforts. Funded by the US Joint Fire Science Program (JFSP; 2005–2011), the Bureau of Land Management (BLM; 2011 to present), the National Interagency Fire Center (2011 to present), and the US Fish and Wildlife Service (2010), SageSTEP was designed and implemented to provide treatment-related information to managers concerned about the rapidly changing condition of sagebrush steppe ecosystems in the US Interior West (McIver et al. 2010). At lower elevations, cheatgrass has become more dominant at the expense of native perennial bunchgrasses, in some locations shifting fire return intervals from &spigt;50–100 yr to &spilt; 20 yr, and greatly increasing mean fire size (Whisenant 1990; Miller et al. 2011; Balch et al. 2012). At higher elevations, piñon pine and juniper woodlands have expanded and displaced sagebrush and other shrubs, in some places shifting fire return intervals from 10–50 yr to &spigt;&spigt; 50 yr, and significantly increasing mean fire severity (Miller and Heyerdahl 2008)
BMC Public Health
No full textBackgroundDespite it is costly, slow and non-reproducible process, physician review (PR) is a commonly used method to interpret verbal autopsy data. However, there is a growing interest to adapt a new automated and internally consistent method called InterVA. This study evaluated the level of agreement in determining causes of death between PR and the InterVA model.MethodsVerbal autopsy data for 434 cases collected between September 2009 and November 2012, were interpreted using both PR and the InterVA model. Cohen\u2019s kappa statistic (\u3ba) was used to compare the level of chance corrected case-by-case agreement in the diagnosis reached by the PR and InterVA model.ResultsBoth methods gave comparable cause specific mortality fractions of communicable diseases (36.6\ua0% by PR and 36.2\ua0% by the model), non-communicable diseases (31.1\ua0% by PR and 38.2\ua0% by the model) and accidents/injuries (12.9\ua0% by PR and 10.1\ua0% by the model). The level of case-by-case chance corrected concordance between the two methods was 0.33 (95\ua0% CI for \u3ba\u2009=\u20090.29\u20130.34). The highest and lowest agreements were seen for accidents/injuries and non-communicable diseases; with \u3ba\u2009=\u20090.75 and \u3ba\u2009=\u20090.37, respectively.ConclusionIf the InterVA were used in place of the existing PR process, the overall diagnosis would be fairly similar. The methods had better agreement in important public health diseases like; TB, perinatal causes, and pneumonia/sepsis; and lower in cardiovascular diseases and neoplasms. Therefore, both methods need to be validated against a gold-standard diagnosis of death.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2032-7) contains supplementary material, which is available to authorized users.5U22/PS022179_10/PS/NCHHSTP CDC HHS/United State
Glob Health Action
No full textBackgroundIn Ethiopia, most deaths take place at home and routine certification of cause of death by physicians is lacking. As a result, reliable cause of death (CoD) data are often not available. Recently, a computerized method for interpretation of verbal autopsy (VA) data, called InterVA, has been developed and used. It calculates the probability of a set of CoD given the presence of circumstances, signs, and symptoms reported during VA interviews. We applied the InterVA model to describe CoD in a rural population of Ethiopia.ObjectiveVA data for 436/599 (72.7%) deaths that occurred during 2010\u20132011 were included. InterVA-4 was used to interpret the VA data into probable cause of death. Cause-specific mortality fraction was used to describe frequency of occurrence of death from specific causes.ResultsInterVA-4 was able to give likely cause(s) of death for 401/436 of the cases (92.0%). Overall, 35.0% of the total deaths were attributed to communicable diseases, and 30.7% to chronic non-communicable diseases. Tuberculosis (12.5%) and acute respiratory tract infections (10.4%) were the most frequent causes followed by neoplasms (9.6%) and diseases of circulatory system (7.2%).ConclusionInterVA-4 can produce plausible estimates of the major public health problems that can guide public health interventions. We encourage further validation studies, in local settings, so that InterVA can be integrated into national health surveys.5U22/PS022179_10/PS/NCHHSTP CDC HHS/United StatesWellcome Trust/United Kingdo
Het vergelijken van krommen m.b.v. splinefunkties bij fotogrammetrische detailmeting
No full textCivil Engineering and Geoscience
Primary and secondary care clinicians' views on self-treatment of COPD exacerbations: a multinational qualitative study.
No full textOBJECTIVE: To explore clinicians' views on antibiotic and/or steroid 'rescue packs' used as self-treatment for patients with exacerbations of COPD. METHODS: 21 focus groups conducted in 7 countries--Netherlands, Russia, Norway, China (Hong Kong), Wales, Germany and Poland involving 142 primary care clinicians and pulmonologists. RESULTS: We found wide variation in reported use of and attitudes to self-treatment among GPs and pulmonologists in the participating countries. Clinicians highlighted the importance of identifying patients who were most likely to benefit (those with more severe disease) and most likely to use the treatment appropriately (demonstrated by previous behaviour), and the importance of adequate patient education and ongoing communication in regard to use of self-treatment packs. Clinicians recognised patient empowerment and facilitating prompt treatment as potential benefits of self-treatment. However, many felt they did not have the time or resources for appropriate patient selection and education. CONCLUSION: Clinicians do not feel it is appropriate to offer self-treatment rescue packs to all patients routinely without careful consideration of patient understanding of their illness and their capacity for self-management. PRACTICE IMPLICATIONS: Adequate resources and continuity of patient care are required for clinicians to feel confident in the safe and effective implementation of this strategy
PLoS One
No full textBackgroundOver the last fifty years the world has seen enormous decline in mortality rates. However, in low-income countries, where vital registration systems are absent, mortality statistics are not easily available. The recent economic growth of Ethiopia and the parallel large scale healthcare investments make investigating mortality figures worthwhile.MethodsLongitudinal health and demographic surveillance data collected from September 11, 2009 to September 10, 2012 were analysed. We computed incidence of mortality, overall and stratified by background variables. Poisson regression was used to test for a linear trend in the standardized mortality rates. Cox-regression analysis was used to identify predictors of mortality. Households located at <2300 meter and 652300 meter altitude were defined to be midland and highland, respectively.ResultsAn open cohort, with a baseline population of 66,438 individuals, was followed for three years to generate 194,083 person-years of observation. The crude mortality rate was 4.04 (95% CI: 3.77, 4.34) per 1,000 person-years. During the follow-up period, incidence of mortality significantly declined among under five (P<0.001) and 5\u201314 years old (P<0.001), whereas it increased among 65 years and above (P<0.001). Adjusted for other covariates, mortality was higher in males (hazard ratio (HR)\u200a=\u200a1.42, 95% CI: 1.22, 1.66), rural population (HR\u200a=\u200a1.74, 95% CI: 1.32, 2.31), highland (HR\u200a=\u200a1.20, 95% CI: 1.03, 1.40) and among those widowed (HR\u200a=\u200a2.25, 95% CI: 1.81, 2.80) and divorced (HR\u200a=\u200a1.80, 95% CI: 1.30, 2.48).ConclusionsOverall mortality rate was low. The level and patterns of mortality indicate changes in the epidemiology of major causes of death. Certain population groups had significantly higher mortality rates and further research is warranted to identify causes of higher mortality in those groups.20145U22/PS022179_05/PS/NCHHSTP CDC HHS/United States24675840PMC39680551023
Tuberculosis treatment outcome and predictors in northern Ethiopian prisons: A five-year retrospective analysis
No full textBackground: The prison situations are notorious for causing interruptions of tuberculosis (TB) treatment and occurrence of unfavorable outcomes. In Ethiopian prisons, though TB treatment programs exist, treatment outcome results and factors contributing to unsuccessful outcome are not well documented. In this study, we assessed the treatment outcome of TB cases and identified risk factors for unsuccessful outcome in northern Ethiopian prisons.
Methods: A retrospective record review was conducted for all prisoners diagnosed with TB between September 2011 and August 2015. Outcome variables were defined following WHO guidelines.
Results: Out of the 496 patients, 11.5% were cured, 68% completed treatment, 2.5% were lost to follow-up, 1.6% were with a treatment failure, 1.4% died, and 15% were transferred out. All transferred out or released prisoners were not appropriately linked to health facilities and might be lost to treatment follow-up. The overall treatment success rate (TSR) of the 5 years was 94% among the patients who were not transferred out. The odds of unsuccessful outcome were 4.68 times greater among re-treatment cases compared to the newly treated cases. The year of treatment was also associated with variations in TSR; those treated during the earlier year were more likely to have unsuccessful outcome. Sputum non-conversion at the second-month check-up was strongly associated with unsuccessful outcome among the smear-positive cases.
Conclusions: The mean TSR of the prisoners in the study prisons was quite satisfactory when gauged against the target level set by the End TB Strategy. However, the lack of appropriate linkage and tracking systems for those prisoners transferred or released before their treatment completion would have a negative implication for the national TB control program as such patients might interrupt their treatment and develop drug-resistant TB. Being in a re-treatment regimen and sputum non-conversion at the second-month check-up were significantly associated with unsuccessful treatment outcome among the all forms of and smear-positive TB cases, respectively
Why do physicians lack engagement with smoking cessation treatment in their COPD patients? A multinational qualitative study
No full textSmoking cessation is the only effective intervention to slow down the accelerated decline in lung function in smokers with chronic
obstructive pulmonary disease. Nevertheless, physicians often do not routinely provide evidence-based smoking cessation
treatment to their patients. To understand underlying reasons, we explored how physicians engage in smoking cessation treatment
in their chronic obstructive pulmonary disease patients. In total, 21 focus group discussions were held with general practitioners
and pulmonologists in seven different countries in Europe and Asia. We generated three themes, whereby some of the issues
concerned smokers in general: first, ‘physicians’ frustration with chronic obstructive pulmonary disease patients who smoke’. These
frustrations interfered with the provision of evidence-based treatment and could result in this group of patients being treated
unequally. Second: ‘physicians’ limited knowledge of, and negative beliefs about, smoking cessation treatment’. This hindered
treating smokers effectively. Third: ‘healthcare organisational factors that influence the use of smoking cessation treatments’.
Money and time issues, as well as the failure to regard smoking as a disease, influenced how physicians engaged in smoking
cessation treatment. Our results indicate that there is a number of barriers to the provision of effective smoking cessation treatment
in patients with chronic obstructive pulmonary disease and smokers in general. Introducing an informative smoking cessation
programme, including communication skills and ethical issues, in the vocational and postgraduate medical training may help to
address these barriers. This is important in order to increase engagement with smoking cessation treatment and to improve quality
of chronic obstructive pulmonary disease care
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