Assessing the global impact of chronic obstructive pulmonary disease (COPD) on a patient’s life can be difficult to perform in the clinical setting due to time constraints and workflow challenges. The primary objective of this study was to compare disease impact ratings between patient selfadministered COPD Assessment Test (CAT) and physician standard office assessment. This prospective study was conducted at a family medicine residency clinic in northeast Tennessee. The study included two study groups: 1) adult patients seen at the clinic during the 3-month study period with an active diagnosis of COPD, and 2) their physicians. Physicians’ assessment of the impact of COPD on their patients’ daily lives was compared to patients’ self-administered CAT assessments. Physician assessment of COPD impact and patient ssessment of CAT categories significantly differed (χ2 =11.0, P=0.012). There was very poor agreement between patient and physician ratings (κ=0.003), with 42.9% of physician ratings underestimating the impact, 28.6% overestimating the impact, and 28.6% orrectly estimating the impact COPD had on their patients’ lives. These findings support the use of validated assessment tools to help providers understand the symptom burden for patients with COPD.

Denna rapport utvärderar företag och verksamheter med telemedicinska produkter som finns på den svenska marknaden inom hemsjukvård för områdena Kronisk Obstruktiv Lungsjukdom, neonatalsjukvård samt hjärtsvikt. Även säkerhetsaspekter, verifierad nytta samt områdeskvantifiering för funna produkter behandlas. Detta genomfördes genom en avsökning av marknaden där säkerhetsaspekter och underlag för verifierad nytta undersöktes. Med telemedicin kan sjukhus och patienter trådlöst kommunicera och överföra mätdata, trots långa avstånd. Detta ger vinster för samhälle, miljö och patient. Avsökningen av marknaden erhöll resultatet: sju verksamma företag med telemedicinska lösningar och fem verksamheter med forsknings- och utvecklingsprojekt.   Sammanfattningsvis blir det tydligt att många telemedicinska projekt fortfarande är i utvecklingsstadiet. Orsaker till detta är att teknikutveckling är dyrt och kräver utbildning, något som kan bortprioriteras om det redan finns fungerande och implementerade system i samhället. Slutsatsen är att telemedicin har stor potential att minska antalet sjukhusbesök per patient och att majoriteten av produkterna på den svenska marknaden finns i norra delen av landet, där glesbygden är som störst. / This report investigates companies and businesses with telemedicine products on the Swedish market within home care regarding Chronical Obstructive Pulmonary Disease (COPD), neonatal care and heart failure. Safety issues, verified benefits and classification of the products were focus points for the investigation. Key components investigated were safety aspects and if the products had proven benefits. With the use of telemedicine, hospitals and patients can wirelessly communicate and transfer data, despite long distances. Benefits can be seen for the society, the environment and the patient. Seven companies with solutions in telemedicine and five businesses with projects in research and development within the telemedicine market, were found from the investigation.   Many of the telemedicine products are still in the development phase. Development is expensive and requires education and might therefore be unprioritized due to already existing solutions in the society. The conclusion of this report is that telemedicine has a big potential to reduce the need to stay at the hospital and that the majority of the products on the Swedish market are located in the northern part of the country, due to the sparsely populated area.

Chronic obstructive pulmonary disease is the fourth largest cause of death worldwide and the prevalence is predicted to increase even further to make it the third largest cause of death by 2020. The main cause of the disease is exposure to tobacco smoke. COPD is a complex disease and there is a strong need of better understanding of the pathogenetic mechanisms in order to come up with novel therapeutic interventions and preventive strategies. The golden standard to image the lungs today is to use computed tomography (CT) which is an imaging modality that involves ionizing radiation and could thus harm the patient, especially with repeated exposure. New techniques in the image acquisition of magnetic resonance imaging (MRI), an imaging modality that does not involve ionizing radiation, has emerged that allows for lung imaging. The work included segmentation of the lungs, image registration and partitioning of the lungs inorder to perform regional analysis. The results indicate that the mean value of the T1-parameter in the left and right lung is not affected to the same degree, where the left lung showed a greater decrease. The results also showed that the anterior parts of the lungs are not showing any statistically significant changes but the changes were instead seen in the center and posterior parts. Both lungs also showed results that indicate that the mean T1-value is recovered at the end of the longitudinal study, a phenomenon that couldn’t be explained and further studies have to be performed.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global problem with about 251 million people affected globally in the year 2016. There are many risk factors that can lead to the development of COPD, with smoking and old age being the most common risk factors. Chronic Obstructive Pulmonary Disease wholly affects the persons live accompanied by symptoms such as difficulty in breathing, anxiety, coughing, increment in the production of phlegm, and tiredness. Aim: the aim of the study was to describe the experiences of people living with Chronic Obstructive Pulmonary Disease. Methodology: A literature-based study was conducted with ten qualitative articles obtained from the database CINAHL and PUBMED. The studies were subjected to a quality analysis and Friberg’s step analysis. Article searches were conducted between 2020 and 2021. Results: The results of the articles were interpreted into a new result describing the daily struggles of people living with COPD. A main theme “when everyday life becomes a struggle for survival” and four subthemes were identified. Conclusion: COPD effects the persons live in a lot of ways. People experience many limitations in their lives with the experience of guilt and shame being the strongest. To be able to minimize the suffering of people with COPD in the future, there is a much needed development in the nursing field and in the health sector on what it is like for people to live with COPD.

Background: This systematic review evaluates the oral health-related quality of life (OHRQoL) of patients with chronic respiratory diseases. Methods: A systematic literature search was performed based on the PubMed, Medline, Web of Science, and Scopus, using the search terms: “oral health-related quality of life” and “respiratory disease” or “lung” and “oral health-related quality of life.” Full-text articles published until June 30, 2021 and reporting any OHRQoL measurement in children or adults with a chronic respiratory disease or condition were included and analyzed qualitatively. Results: A total of seven out of 44 studies were included, of which four studies examined adults and three studies investigated children. The respective diseases were chronic obstructive pulmonary disease (COPD) (n = 2), sleep apnea (n = 2), severe asthma (n = 1), cystic fibrosis (n = 1), and lung transplantation (n = 1). Four studies confirmed a worse OHRQoL in the respiratory diseased group compared to healthy controls. The overall OHRQoL was reduced in the included studies. Oral health, healthrelated quality of life, and disease-related parameters were rarely examined with regard to OHRQoL. Conclusion: Patients with chronic respiratory diseases show a reduced OHRQoL. Oral health should be fostered in these individuals to support their OHRQoL.

This thesis discusses military operations planning and methodology by reviewing two of NATO’s planning documents, i.e. the ‘Allied Joint Doctrine for Operational-Level Planning’ (AJP 5) and the ‘Comprehensive Operations Planning Directive’ (COPD), and defends the following claim. Parts of the description of NATO’s Operational-Level Planning Process (OLPP), as described in the AJP 5 and the COPD, is methodologically inconsistent (contradictory), due to epistemic and practical implications of methodology. As such, the thesis discusses three topics: approaches to Operational Art, planning heuristics and implications of methodology. The thesis also intertwines military operations planning, methodology and military problem-solving. This thesis consists of two published papers and an introduction. The introduction explains and further discusses operations planning as well as terms and concepts stated within the two papers. Paper I focuses on the AJP 5 and discusses the methodological distinction between two approaches within Operational Art, denoted the ‘Design’ and the ‘Systemic’ approach. The distinction between these approaches is vague and paper I states one epistemic and one practical implication of methodology. Paper II focuses on the COPD and discusses two specific planning heuristics. The first relates to the Systemic approach and the second heuristic relates to the third approach denoted the ‘Causalist’ approach within Operational Art. A methodological contradiction exists between these specific heuristics and paper II states one epistemic and three practical implications of methodology. Briefly, this thesis implies that parts of NATO’s description of the OLPP suffers from a methodological contradiction. Hence, a suggestion is to revise parts of the AJP 5 and the COPD. The thesis also suggest the development of a “NATO handbook of methodology” to better explain methodological implications on military operations planning and the “how to” of military problem-solving. / <p>QC 20170403</p>

<p> The cellular, molecular, and genetic mechanisms underlying the pathogenesis of Chronic Obstructive Pulmonary Disease (COPD) are not well understood. The purpose of this thesis was to address the hypothesis that microbial infection is important for the development and/or progression of COPD through investigation of how cigarette smoke alters the response to a bacterial challenge in a mouse model of cigarette smoke-exposure. To this end, in chapter 2 of this thesis we tested the hypothesis that cigarette smoke-exposure attenuates the ability of alveolar macrophages to sense microbial antigens through innate pattern recognition receptors. The central point of this study was the observation that alveolar macrophages isolated from cigarette smoke-exposed mice had attenuated expression of typical inflammatory cytokines following microbial stimulation. Building on this main observation, in chapter 3 we questioned what the consequences of this would be to an in vivo bacterial challenge with nontypeable Haemophilus influenzae. We demonstrated that cigarette smoke-exposure resulted in chronic inflammation, this inflammation was exacerbated following bacterial challenge, and perhaps most importantly, the nature of the inflammatory response was altered. Interestingly, an observation from the study in chapter 3 indicated that exacerbated inflammation in cigarette smoke-exposed mice may be beneficial for clearance of the bacteria, but may come at the expense of damage to the lungs. Consequently, in chapter 4 we questioned the strain and dose/ frequency stringencies of cigarette smoke-exposure on the observation of accelerated bacterial clearance. We demonstrated a role for antibodies in bacterial clearance. Collectively, this thesis provides insight into our understanding of COPD by demonstrating that cigarette smoke-exposure alters the pulmonary immune/ inflammatory response to a microbial challenge, which has a detrimental impact on the lungs. </p> / Thesis / Doctor of Philosophy (PhD)

No description available.

No / Context. The End of Life Care Strategy for England highlights effective communication between patients and professionals as key to facilitating patient involvement in advance care planning. The strategy emphasizes that, currently, communication in patients with noncancer life-limiting conditions is likely to be inadequate, and research has identified that patients with chronic obstructive pulmonary disease and heart failure have a poor understanding of their condition. Objectives. To identify existing interventions of patient-professional communication developed for life-limiting conditions and explore the applicability of interventions developed within a cancer framework to other diagnostic groups. Methods. A comprehensive literature review of studies describing communication interventions for patients receiving end-of-life care was undertaken. Ten electronic databases were searched. Inclusion criteria were all English language studies relating to patient-professional communication interventions for patients with life-limiting conditions receiving end-of-life care. Results. Of the 755 articles initially identified, 16 met the inclusion criteria. Three core themes emerged from the synthesis of the literature: using education to enhance professional communication skills, using communication to improve patient understanding, and using communication skills to facilitate advance care planning. Conclusion. Although limited, evidence relating to the development and evaluation of communication interventions for patients with life-limiting illnesses would suggest that a successful intervention should include combined components of training, patient discussion, and education. In a context of limited resources and an increasing number of patients living and dying with chronic life-limiting conditions, the need for appropriate and effective communication strategies should be seen as a priority for both research and policy.

Bakgrund: kronisk obstruktiv lungsjukdom (KOL) är en långvarig sjukdom och kännetecknas av att luftvägarna blir trånga och luftflödet minskar, vilket gör andningen mer ansträngd och leder till dyspné och andnöd. För att ge en individanpassad vård är det avgörande för sjuksköterskor att ta hänsyn till personers upplevelse av sjukdom och stödja dem i deras egenvård. Syfte: att beskriva personers upplevelse av att leva med KOL. Metod: En literatursöversikt utfördes baserad på Fribergs metod och inkluderade 10 orginalartiklar från Cinahl Complete och Pubmed. Resultat: Resultatet handlar om två huvudteman från analysen av tio kvalitativa artiklar om personers upplevelser av KOL. Dessa teman inkluderar utmaningar med att leva med KOL, uppdelat i fysiska och psykiska hinder, samt upplevelser av stöd, indelat i brist på stöd och stöd från vården. Dessa teman ger en inblick i de komplexa utmaningar som personer med KOL möter i sin vardag. Slutsats: Denna litteraturöversikt visar att personer med KOL påverkas inte bara av fysiska hälsoproblem utan också av emotionella och psykologiska utmaningar. Vårdpersonal bör ta hänsyn till dessa aspekter för att erbjuda en helhetstäckande och effektiv vård, vilket förbättrar livskvaliteten och välbefinnandet hos personer med KOL. En personcentrerad vård kräver empati, lyhördhet och en holistisk syn för att möta personernas behov. / Background: chronic obstructive pulmonary disease (COPD) is a long-term condition characterized by narrowed airways and reduced airflow, leading to labored breathing and resulting in dyspnea and shortness of breath. To provide personalized care, it is crucial for nurses to consider people’s experiences of the disease and support them in their self-care. Aim: To describe the people’s experience of living with COPD. Method: A literature review was conducted based on Friberg's method, incorporating ten original articles from Cinahl Complete and PubMed. Results: The findings are centered around two main themes from the analysis of ten qualitative articles on people’s experiences with COPD. These themes include the challenges of living with COPD, divided into physical and psychological hurdles, and experiences of support, categorized into social and healthcare support. These themes provide insight into the complex challenges that COPD people face in their daily lives. Conclusion: This literature review demonstrates that people with COPD are affected not only by physical health problems but also by emotional and psychological challenges. Healthcare professionals should account for these aspects to provide comprehensive and effective care, thereby enhancing the quality of life and well-being of people with COPD. Person-centered care requires empathy, attentiveness, and a holistic approach to meet the needs of people.