The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelinesare used to guide clinical practices for treating Chronic Obstructive Pulmonary Disease (COPD). GOLD focuses heavily on stable COPD patients, limiting its use fornon-stable COPD patients such as those with severe, acute exacerbations of COPD (AECOPD) that require hospitalization. Although AECOPD can be heterogeneous, it can lead to deterioration of health and early death. Electronic health records (EHRs) can be used to analyze patient data for understanding disease progression and generating guideline evidence for AECOPD patients. However, because of its structure and representation, retrieving, analyzing, and properly interpreting EHR data can be challenging, and existing tools do not provide granular analytic capabil-ities for this data.<div><br></div><div>This dissertation presents, develops, and implements a novel approach that systematically captures the effect of interventions during patient medical encounters, and hence may support evidence generation for clinical guidelines in a systematic and principled way. A conceptual framework that structures components, such as data storage, aggregation, extraction, and visualization, to support EHR data analytics for granular analysis is introduced. We develop a software framework in Python based on these components to create longitudinal representations of raw medical data extracted from the Medical Information Mart for Intensive Care (MIMIC-III) clinical database. The software framework consists of two tools: Patient Aggregated Care Events (PACE), a novel tool for constructing and visualizing entire medical histories of both individual patients and patient cohorts, and Mark SIM, a Markov Chain Monte Carlo modeling and simulation tool for predicting clinical outcomes through probabilistic analysis that captures granular temporal aspects of aggregated, clinicaldata.<br></div><div><br></div><div>We assess the efficacy of antibiotic treatment and the optimal time of initiationfor in-hospitalized AECOPD patients as an application to probabilistic modeling. We identify 697 AECOPD patients of which 26.0% were administered antibiotics. Our model simulations show a 50% decrease in mortality rate as the number of patients administered antibiotics increase, and an estimated 5.5% mortality rate when antibiotics are initially administrated after 48 hours vs 1.8% when antibiotics are initially administrated between 24 and 48 hours. Our findings suggest that there may be amortality benefit in initiation of antibiotics early in patients with acute respiratory failure in ICU patients with severe AECOPD.<br></div><div><br></div><div>Thus, we show that it is feasible to enhance representation of EHRs to aggregate patients’ entire medical histories with temporal trends and support complex clinical questions to drive clinical guidelines for COPD.<br></div>

No description available.

The full text will be available at the end of the embargo period: 5th Nov 2021

Syfte: Att utvärdera vilken rökavvänjnings metod som är mest effektiv vid kronisk obstruktiv lungsjukdom. Det som undersöktes var de förbättringar i patientresultatet av de olika rökavvänjnings metoderna. Mål: Databassökning samt identifiering av relevant litteratur.Bedömning av kvaliteten på de inkluderade studierna ochsammanställning och sammanfattning av dokumentationen respektive resultat. Studie typer: Sammanställningar och systematiska sammanställningar. Källor: MEDLINE, CINAHL och Cochrane Bibliotek. Metoder: Litteratursökning utfördes, sammanställningarna bedömdes med AMSTAR 2 och PRISMA formulären. Informationen sammanställdes i tabell som sammanfattade resultaten. Resultat: 10 systematiska sammanställningar med medel till hög PRISMA och AMSTAR 2 poäng samlades med en variation av 370 – 13000 KOL-patienter. Dödlighet, sjuklighet och livskvalité visade positiva resultat, andel personer som slutade röka visade också signifikanta siffror.Slutsats: Det finns bevis av interventioner som har positiv effekt på KOL-patienter att sluta röka. Intensiv farmakoterapi rådgivning och motiverande samtal visade bästa resultat för en KOL-patient. / Purpose: To evaluate which smoking cessation method is most effective in chronic obstructive pulmonary disease. What was investigated were the improvements in the patient result of different smoking cessation methods. Objective: Database search and identification of relevant literature.Assessment of quality of the included studiescompilation and summary of the documentation and the result. Studies: Reviews and systematic reviews. Sources: MEDLINE, CINAHL and Cochrane Library. Methods: Literature search was performed, the reviews were assessed with AMSTAR 2 and PRISMA. The information was extracted in tables.Results: 10 systematic reviews with high PRISMA and AMSTAR 2 score were collected with a variety of 370-13000 COPD patients. Mortality, morbidity and quality of life showed positive results, the proportion of people who quit smoking also showed significant numbers. Conclusion: There is evidence of interventions that have a positive effect on COPD patients to quit smoking. Intensive pharmacotherapy counseling and motivational interviewing showed the best results for a COPD patient.

Early avoidable 30-day post discharge readmission among patients diagnosed with chronic obstructive pulmonary disease (COPD) is associated with poor transition care processes. The purpose of this project was to analyze organizational system processes for admission and discharge transition care of patients diagnosed with COPD to identify key intervention strategies that could decrease the rate of 30-day post-discharge readmission by 1%. The project used the transitional care model as the framework to target specific care transition needs and create patient-centered, supportive, evidence-based relationships among the patient, the providers, the community, and the health care system to identify key intervention strategies for implementation. A retrospective chart review was conducted of transitional care management and care coordination practices of providers of patients diagnosed with COPD. Analysis of the data revealed that the local regional organization used a single, generic, computerized discharge planning and care transition process for patients diagnosed with COPD. As a result, missed opportunities to target a patient's specific care needs led to higher rates of readmission. The implications of the findings of this project for social change include identification of evidence-based recommendations and practices that could influence clinician practices and improve patient outcomes and the quality of health care delivery.

Background and Objective: Comorbidity and especially cardiovascular diseases are common among patients with chronic obstructive pulmonary disease (COPD). The primary purpose of this study was to identify drugs for the treatment of cardiovascular diseases in COPD patients. The secondary purpose was to analyze whether the use of cardiovascular drugs differs between patients with mild and severe COPD symptoms.     Method: The study was a retrospective cross-sectional study of 421 COPD patients whose drug lists were analyzed and cardiovascular drugs were identified. These drugs were then divided into eight drug groups, based on the drug's ATC (Anatomic Therapeutic Chemical classification system) codes. Only patients with reported cardiovascular diseases were included in the analysis. Patients with mild and severe COPD symptoms were identified. Thereafter, the patients were divided into two groups based on the COPD symptoms. Chi-squared test was performed to see if the use of cardiovascular drugs differs between patients with mild and severe COPD symptoms.  Setting: Primary and secondary care patients with COPD in Gävle and Dalarna.  Main outcome measures: Identify and analyze the use of cardiovascular drugs in COPD patients with mild and severe symptoms.  Results: The results of the survey showed that cardiovascular drugs were used by 274 (65%) of the COPD patients. Among them, 66 % with severe COPD symptoms and 34 % with mild symptoms. The use of the eight cardiovascular drug groups were similar between patients with mild and severe COPD symptoms. There wasn’t any statistically significant difference in the use of cardiovascular drugs between patients with mild and severe COPD symptoms (p= 0,893).   Conclusions: There wasn’t any difference in the use of cardiovascular drugs among patients with mild and severe COPD symptoms. However, this result needs to be substantiated with a follow-up study with a larger study population and longer study time to be generalizable.

Bakgrund Kronisk obstruktiv lungsjukdom är ett pågående folkhälsoproblem som främst drabbar personer som röker. Det finns även andra faktorer, som passiv rökning samt exponering för luftföroreningar, som kan öka risken att framskrida sjukdomen. Egenvård är mycket viktigt i detta tillstånd, eftersom det i nuläget inte finns något botemedel mot sjukdomen. Syfte Syftet är att belysa patienters upplevelse av att leva med kronisk obstruktiv lungsjukdom. Metod Litteraturöversikt som baserades på tio kvalitativa vetenskapliga artiklar från Cinahl och PubMed. Resultat Resultatet visade att KOL påverkar människor på olika sätt, både psykiskt och fysiskt. Patienterna kan uppleva trötthet och andnöd i vardagen. Sjukdomen kan orsaka känslor som skuld, skam och ensamhet, vilket har visat sig leda till isolering. Slutsats På grund av att KOL är en kronisk sjukdom som varar livet ut är det viktigt att behandlingen effektivt hanterar patientens symtom. Sjuksköterskans uppgift är att identifiera samt förstå patientens unika behov och skräddarsy behandlingen utifrån dennes behov. Sammantaget är vårdens kvalitet en nyckelfaktor som formar relationen mellan sjuksköterska och patient. / Background Chronic obstructive pulmonary disease is an ongoing public health issue primarily affecting individuals who smoke. There are other factors, such as passive smoking and exposure to air pollution, which can also increase the risk of developing the disease. Self-care is crucial in this condition as there is currently no cure for the disease. Aim The aim is to illuminate individuals’ experience of living with chronic obstructive pulmonary disease. Method A literature review based on ten qualitative studies from Cinahl and PubMed. Results The results showed that COPD affects people in various ways, both mentally and physically. Patients may experience fatigue and shortness of breath in their daily lives. The disease can trigger emotions such as guilt, shame, and loneliness, which has been found to lead to isolation. Conclusions Due to COPD being a chronic disease that lasts a lifetime, it is crucial for treatment to effectively manage the patient’s symptoms. The nurse’s responsibility is to identify and comprehend the patient’s unique needs and tailor the treatment accordingly. Overall, the quality of care is a key factor that shapes the relationship between the nurse and the patient.

Bakgrund: Kronisk obstruktiv lungsjukdom(KOL) är en långsiktig sjukdom som tar tid innan den visar symtom. När patienten kommer och vill ha information och åtgärder för sina symtom har sjukdomsförloppet redan pågått ett tag. Eftersom den är långdragen är omvårdnadsåtgärderna olika beroende på vart i tiden man ligger i sjukdomen. År 2020 kommer denna patientgrupp vara den tredje största i världen, finns det omvårdnadsåtgärder som ökar livskvalitén för denna patientgrupp? Syfte: Syftet med litteraturstudien var att sammanställa resultat avseende forskning om omvårdnad vid kronisk obstruktiv lungsjukdom som leder till förbättrad livskvalité. Metod: Litteratur studie. Resultat: Kunskapsutbytet mellan patient och sjuksköterska: Hur viktigt det är med en klar och tydlig information vid möte mellan sjuksköterska och patient. Att ge stöd och trygghet: Viktigt att sjuksköterskan finns tillgänglig för patienten, underlätta för patienten: Sjuksköterskan har en viktig roll hos patienter med KOL för att förbättra deras förutsättningar för god livskvalité. Slutsats: Viktigt att skapa en tillit mellan sjuksköterskan och patienten, detta skapar trygghet och resulterar till en god fysisk omvårdnad. När trygghet och tillit har byggts upp mellan sjuksköterskan och patienten blir kommunikationen god och man kan tillsammans komma fram till den bästa lösningen för varje enskild patient. / Background: Chronic obstructive pulmonary disease (COPD) is a long term disease that takes time before it shows symptoms. When the patient comes and want information and measures for their symptoms, the disease process has already been going on for a while. Because it is lengthy nursing actions different depending on where in time lying in the disease. In the year of 2020 this will be the third largest patient group in the world, are there any nursing interventions that can increase quality of life? Aim: The purpose of this study was to compile results concerning research on nursing care in chronic obstructive pulmonary disease that leads to improve quality of life. Method: Literature. Results: Knowledge exchange between patient and nurse: How important it is with a clear and transparent information at the meeting between the nurse and patient. To provide support and trust: Important that the nurse is available for the patient. Facilitating patient: The nurse has an important role in patients with COPD to improve their conditions for a god quality of life. Conclusion: Important to create trust between the nurse and patient, this creates confidence and results to good physical care. When trust and confidence has been built between nurse and patient communication becomes good and we can together arrive at the best solution for each individual patient.

Cardiovascular disease is common in Chronic Obstructive Pulmonary Disease (COPD), and forced expiratory volume in one second (FEV1) independently predicts cardiovascular morbidity and mortality. Pathological changes in the systemic vasculature have been proposed as potential mechanisms linking COPD to cardiovascular disease, and patients with COPD may be at increased risk of acute myocardial infarction during acute exacerbations. Notwithstanding causation, FEV1 may be a useful prognostic marker in patients undergoing cardiac surgery. This thesis examined these three aspects of cardiovascular co-morbidity in relation to COPD and FEV1. In 2,241 consecutive cardiac surgery patients, FEV1 was associated with length of hospital stay (p<0.001) and mortality (p<0.001) adjusting for age, sex, height, body mass index, socioeconomic status, smoking, cardiovascular risk factors, chronic pulmonary disease, and type/urgency of surgery. In a survey of Scottish Respiratory Consultants there was no consensus regarding the investigation and management of acute coronary syndrome in exacerbation of COPD. In a case-series of 242 patients with exacerbations 2.5% (95% CI 1.0 to 5.6%) had chest pain, raised serum troponin and serial electrocardiogram changes suggestive of acute coronary syndrome. However, over half reported chest pain, while raised troponin was not associated with chest pain or serial ECG changes. Carotid-radial pulse wave velocity (PWV), aortic distensibility, and aortic calcification were measured to assess the relationship of the systemic vasculature to FEV1 and emphysema severity on CT. In adjusted analyses, emphysema was associated with PWV in patients with COPD (p = 0.006) and, in population based samples, with extent of distal aortic calcification (p=0.02) but not with aortic distensibility (p=0.60). This thesis found that FEV1 was associated with mortality and length of hospital stay in patients undergoing cardiac surgery, and that chest pain and raised troponin were common but unrelated in exacerbation of COPD. In the vascular studies distal but not proximal vascular pathology was associated with FEV1, and if COPD is truly related to systemic arterial disease, the distal arterial tree is implicated.

Bakgrund Kronisk obstruktiv lungsjukdom är en sjukdom som är irreversibel och påverkar andningen negativt hos dem som lider av den och visar sig genom ett stort antal symtom. Sjukdomen skapar stort lidande och försvårar förmågan att leva ett normalt liv med hög livskvalité. Det beräknas vara den tredje största dödsorsaken i världen 2030 enligt världshälsoorganisationen. Syfte Att beskriva personers erfarenheter av att leva med Kronisk obstruktiv lungsjukdom  Metod Studien utgörs av en litteraturstudie med fjorton artiklar. Artiklarnas resultat sammanfattades och gick från delarna till en ny helhet. En kvalitetsgranskning och analys utfördes för att skapa resultatet. Resultat Resultatet presenterades med fyra huvudkategorier: Att inte få luft, Förändrad livssituation, Beroende av stöd och Information och hantering. Till huvudkategorierna skapades följande tio underkategorier: Andnöd/andfåddhet, Ångest, Trötthet, Förluster, Skam, Miljöanpassning, Anhöriga, Hjälpmedel, Undervisning och information och Hantering och strategier. Konklusion Litteraturstudien visade att en stor dimension av symtom påverkar personer som lever med Kronisk obstruktiv lungsjukdom. Det behövs vidare forskning angående personers erfarenhet av sjukdomen men denna litteraturstudie har gett en inblick i några av de erfarenheter personerna lever med. / Background Chronic obstructive pulmonary disease is an irreversible disease and it’s effecting the breathing in a negative way for those suffering by the disease and it’s shown by many different symptoms. The disease creates big suffering and obstructs the ability to live a normal life with high quality of life. It is expected to be the third largest cause of death worldwide in 2030, according to the World Health Organization. Aim To describe people's experiences of living with chronic obstructive lung disease. Method The study is a literature study with fourteen articles. The result from the articles were summarized and went from parts into a new whole. An inspection of quality and analysis was performed to create the result. Result The result were presented with four main categories: Unable to breathe, Change of way of life, Depending on support, Information and management. To the main categories were ten under categories created:  Shortness of breath/breathlessness, Anxiety, Fatigue, Losses, Adaptation to environment, Relatives, Utilities, Education and information and Management and strategies. Conclusion The literature study showed that there’s a major dimension of symptoms affecting people living with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease. The literature review showed that a large dimension of symptoms are affecting people living with chronic obstructive pulmonary disease. We need further research on people's experience of the disease, but this study has provided an insight into some of the experiences people are living with.