The goal of this thesis is to analyze and understand the risks of Chronic Obstructive Pulmonary Disease (COPD) and lung cancer with respect to the provinces of Turkey according to the results of spatial analysis. The insurance sector of the country needs that kind of analysis to make more precise pricing in insurance products. Especially in health and life insurance products, morbidities like COPD and lung cancer may aect the life expectancy as much as the premiums. COPD and lung cancer prevalence may exhibit spatial autocorrelation due to spatial similarity of provinces. Hence understanding of spatial pattern of COPD and lung cancer prevalence may provide better actuarial decisions. In this research, common risk factors of COPD and lung cancer are considered to be tobacco sales, air pollution, urbanization, gross schooling rate, life expectancy, median age and GDP per capita of the provinces. The spatial patterns of these factors in Turkey as well as their correlations to COPD and lung cancer prevalence are explored in this study. The raw data of the morbidities (COPD and lung cancer) are collected from the Social Seiv curity Institution (SGK) and the useful data are selected in these raw data. The data of the independent variables are collected and derived from the Turkish Statistical Institute (TUIK) and Tobacco and Alcohol Market Regulatory Authority (TAPDK). First of all, COPD prevalence ratios and lung cancer prevalence ratios are grouped by 81 provinces of Turkey and every morbidity is separated by gender. Then, it needs to be decided the variables which define prevalence of COPD and that of lung cancer. Age, gender, socio-economic status, urbanization, schooling rate, life expectancy, tobacco sales and air quality may be some of the random variables which are categorized by provinces for both morbidities. After data collection spatial analysis is applied with visualization, explanatory analysis and modeling by using Geographic Information Systems (GIS). In visualization, general spatial patterns are identified for morbidities and variables. In explanatory analysis part, proximity matrices are used to evaluate Moran&rsquo / s I values for understanding the spatial autocorrelation. Then, these Moran&rsquo / s I values are used for plotting correlograms in order to follow the spatial dependence better. After identifying spatial dependence of the variables, Ordinary Linear Regression and Spatial Regression models are established and compared. Finally, as a result of those findings in the analysis, actuarial risk assessments are found for both two morbidities with respect to provinces and gender. The risk assessments are mapped and compared with the explanatory variables in the models which are found in the previous part and the relations between risks and variables are observed. As a result, the parameters show spatial autocorrelation which means that / financial risk assessments of COPD and lung cancer should be taken into account when deciding the pricing of some actuarial products such as health insurance. Generally, spatial correlation is ignored in this kind of calculations, but due to the high autocorrelation the results may indicate serious change. From the actuarial perspective, the results of the analysis are suggested to be used in health insurance premium pricing. Since the analysis could not have been made on the basis of individuals, and financial burden of morbidities for insurance companies are not given clearly, it is not possible to calculate any health insurance product premium, but it is more appropriate to consider the importance of these risk results in the calculations of health insurance products.

BAKGRUND: KOL är en sjukdom som drabbar allt fler personer världen över och anses bli den tredje vanligaste dödsorsaken i världen år 2020. Det finns inget botemedel mot KOL men genom omfattande omvårdnad kan patienten och anhöriga uppleva välbefinnande trots sjukdomen. Andningssvårigheterna påverkar patientens vardagliga liv och livskvalitet negativt både psykiskt och fysiskt. SYFTE: Syftet med denna studie var att belysa hur sjuksköterskor kan underlätta vid andningssvårigheter för patienter med sjukdomen KOL med utgångspunkt från både patienters önskemål och sjuksköterskors erfarenheter. METOD: Studien var en litteraturöversikt baserad på redan vetenskapligt framforskat datamaterial. Datamaterialet inom ämnet som format resultatet begränsades till nio vetenskapliga artiklar, både av kvalitativ- och kvantitativ karaktär. RESULTAT: Det framstår tre teman; kontinuerligt utbyte av kunskaper, spara på patientens krafter samt ge stöd och trygghet. Kontinuerligt utbyte av kunskaper innebär det kunskapsutbyte som sker mellan patienter och sjuksköterskor i omvårdnaden. Det andra temat beskriver hur patienters andning påverkas genom planering av vardagen och det sista temat visar på de psykiska aspekterna. DISKUSSION: Denna studie visar på vikten av en god relation mellan sjuksköterskor och patienter för att omvårdnaden ska bli av bästa kvalitet. Med en god relation skapas trygghet och tillförlitlighet vilket är det viktigaste för patienter med KOL. / BACKGROUND: COPD is a disease that increasingly affects more patients around the world; by 2020 is it is projected to be the third most common cause of death. There is no cure against COPD. Moreover, difficulty breathing affects the patient’s quality of life physically and mentally. However, with extensive care patients and their relatives can experience wellbeing in spite of the illness. PURPOSE: The aim of this study is to illustrate how nurses can ease the suffering of patients with COPD with a starting point from the patient’s wishes and the nurse’s experience. METHOD: The study was a literature review based on existing researched data material based on nine scientific articles of qualitative and quantitative nature. RESULT: Three themes emerged: the continuously exchange of knowledge; saving the patients strength; and give security and support. The continuously exchange of knowledge refers to knowledge exchange between nurse and patient during the caring process. The second theme describes how the patient’s breathing is affected by the planning of everyday life. The last theme illustrates the mental aspects. CONCLUSION: This study shows a good relationship between patient and nurse is important to create security and support which are the most important things for patients suffering from COPD.

Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with chronic obstructive pulmonary disease (COPD). The main objective of this thesis was to describe balance impairment and fall risk in individuals with COPD and to examine interventions for improving balance and reducing fall risk in the context of pulmonary rehabilitation. The first study of this thesis showed that falls are common in patients with COPD and that fallers are characterized by impairments in standard clinical balance measures, such as the Berg Balance Scale and Timed Up and Go. In the second study, we found that the exercise component of conventional pulmonary rehabilitation has only modest effects on balance and fall risk in COPD, highlighting the need to examine the role of balance-specific training for these patients. The third study of this thesis identified the postural control subsystems most responsible for the observed balance deficits in COPD. Compared with age-matched controls, individuals with COPD demonstrated reductions in all balance control subsystems and slower reaction times in response to external perturbations. In this study, we also showed that deficits in balance in patients with COPD were associated with peripheral muscle weakness and reduced physical activity levels. These results informed the design of the final study of this thesis, a randomized controlled trial evaluating the addition of specific balance training to pulmonary rehabilitation for improving balance in patients with COPD. Preliminary results from this study suggest that the addition of thrice weekly balance exercises to a conventional pulmonary rehabilitation program is effective for optimizing gains in measures of functional balance and fall risk. The findings from the four studies included in this thesis support the need for incorporating balance assessment and treatment for at-risk patients with COPD, as part of their comprehensive management.

No description available.

Syftet med studien var att jämföra livskvalitet, kunskap om KOL och antal patienter som inlett ett rökstopp där en grupp erhöll standard vård och en annan grupp förutom standard vård även fick ett strukturerat omhändertagande på en distriktssköterskeledd KOL- mottagning med undervisning i egenvård.Studien genomfördes med kvasiexperimentell design. Urvalet var 52 patienter från primärvården med diagnosen KOL. Patienterna matchades utifrån kön, sjukdomens svårighetsgrad och slumpades sen till två grupper, en interventionsgrupp och en jämförandegrupp. Jämförandegruppen erhöll standardvård medan interventionsgruppen utöver standardvård erhöll två utbildningsbesök i egenvård hos astma KOL-sjuksköterskan på en vårdcentral i mellansverige.Som datainsamlingsmetod har två enkäter använts. En enkät som innehöll frågor om kön, ålder, civilstånd, utbildning, upplevd kunskap om KOL och rökstatus samt en enkät som hade till syfte att ge information om hur andningsbesvären påverkar patientens livskvalitet. Båda grupperna har svarat på enkäterna vid två tillfällen, vid det första besöket och vid det sista besöket efter tre månader. Interventionsgruppen har däremellan fått två utbildningsbesök.Resultaten visade statistiskt säkerställda skillnader mellan grupperna gällande livskvalitet, rökstopp och kunskaper om KOL. Interventionsgruppen hade fått minskade andningsbesvär, hade ökat sin fysiska aktivitet och fått en bättre psykosocial hälsa. Medan jämförande gruppen hade försämrats något i alla dessa avseenden. I interventionsgruppen hade sex av sexton rökande patienter slutat att röka, medan ingen hade slutat av de fjorton rökande patienterna i jämförandegruppen. Patienterna i interventions- gruppen hade också väsentligen större kunskaper om sin sjukdom jämfört med patienterna i jämförandegruppen.

No description available.

Syfte: Att beskriva hur olika former av fysisk aktivitet kunde påverka patienter med sjukdomen KOL och vilka faktorer som inverkade på dessa patienters möjligheter att vara fysiskt aktiva, samt att beskriva hur sjuksköterskan genom patientutbildning kunde hjälpa patienter till ökad fysisk aktivitet. Metod: Studien har genomförts i form av en systematisk litteraturstudie. Till resultatet har använts 16 kvantitativa och en kvalitativ artikel. Resultat: Resultatet visade att träning både i grupp och individuellt förbättrade livskvalitet, fysisk förmåga och andnöd. Träning motverkade också kakexi och minskade risken för depression. Både konditionsträning och styrketräning var värdefulla träningsformer. Efter en intensivare träningsperiod var det viktigt att bibehålla resultatet, detta kunde ske genom fortsatt träning på hemorten efter rehabilitering och genom att träna regelbundet men inte lika ofta. Faktorer som kunde påverka träning positivt var tillgång till syrgas, även för patienter med saturation över 88 procent, samt ett adekvat näringsintag som var viktigt för att orka träna. Det var värdefullt för sjuksköterskan att notera graden av fysisk aktivitet i omvårdnadsplanen för varje patient, eftersom detta gav information om hur patienten mådde. Det var också viktigt att lyssna till patientens tankar, eftersom fysisk aktivitet hade olika betydelse för olika individer. Genom undervisning kunde sjuksköterskan hjälpa patienten att bli mer fysiskt aktiv. Dels genom att förklara hur den nedåtgående aktivitetsspiralen påverkar, men också genom att stärka patientens självtillit, för att våga vara fysiskt aktiv. En kombination av träning, undervisning och andningsteknik tycktes vara särskilt värdefullt för personer med diagnosen KOL

Abstract Objective: Readmission is a big part of health care expenditure and recent studies suggested that hospital readmissions can be applied as an important indicator of quality of care within health care system. Furthermore elderly population usually costs the large amount health care expenses and is the main group in readmission. Moreover readmission is usually attributed to chronic diseases. Nevertheless, evaluations of hospital readmissions under universal health care coverage areas were not well-studied in Taiwan. Therefore this study aims to explore the associations between initial hospitalizations and probability of hospital readmissions in details. Research method: Patients aged 65 or older with primary clinical diagnosis of asthma or COPD based on ICD-9-CM for hospital admissions and readmissions in Taiwan.National claims of these two diseases were collected and analyzed from year 2000 to 2004. Population-based descriptive analyses of related health care utilizations were estimated. Multivariate logistic regressions were conducted to predict the probability of hospital readmissions. Controlled variables included patient factors, medical institutions¡¦ characteristics, urbanizations, and air quality indicators. Result: Among asthma and COPD elderly patients, more health care utilizations were observed in the hospital readmissions than initial admissions. Multivariate logistic regressions indicated that age, gender, disease severity, hospital characteristics, and air quality were significant predictors of the probability of hospital readmission. Meanwhile, age, disease severity, and hospital characteristics also significantly affected the time interval between initial admission and readmission. In addition, longer length of stay in the initial admission will significantly shorten the time interval between initial admission and readmission (P<0.001). Conclusion: For Asthma and COPD elderly patients, longer length of stay in the initial admission will significantly shorten the time interval between initial admission and readmission and have higher probability of hospital readmission. This study provides the evidence of reducing the health care expenditure by controlling readmission rate. With more understandings of factors affecting hospital readmissions, we can improve the health care delivery and reduce unplanned readmissions in the future. Key words: Asthma, COPD, hospital readmission, health care utilization, length of stay, admission fees

Walden University College of Health Sciences This is to certify that the doctoral study by Maureen Barta has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Cheryl Holly, Committee Chairperson, Health Services Faculty Dr. Eric Anderson, Committee Member, Health Services Faculty Dr. Vincent Hall, University Reviewer, Health Services Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 â?? Increasing Knowledge About Alpha-1 Antitrypsin Deficiency in the Chronic Obstructive Pulmonary Disease Population by Maureen Ann Wentink Barta MSN, Pacific Lutheran University, 1996 BSN, Pacific Lutheran University, 1992 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2015 â?? The purpose of the project was to increase awareness about alpha-1 antitrypsin deficiency (AATD) in chronic obstructive pulmonary disease (COPD), particularly among those with a familial history of genetic factor AATD; an additional goal was to understand its relationship to COPD. COPD is the third leading cause of death in the United States, with more than half of COPD patients experiencing significant disabilities. Major causes for COPD include smoking, air pollution, secondary smoke, upper respiratory infections, hereditary factors, occupational factors, environmental factors, and socioeconomic factors. Genetic factors, however, also play a significant role in early onset COPD and in those who smoke and have the genetic factor related to COPD (AATD), symptoms are more severe and exacerbations more frequent. Undiagnosed AATD can result in under treatment and lack of planning for preventing COPD onset and exacerbation in these patients. COPD clients of a local pharmacy (n =31) were invited to complete a Likert survey and given materials on COPD exacerbation prevention and information on AATD. Results indicated that 38.7% of respondents had early onset symptoms, positive family history, and no improvement in symptoms with smoking cessation. The results support that targeting those family members with COPD and providing information on genetic factors for this condition could decrease the frequency and severity of exacerbations. This is in keeping with the health belief model that guided this study in that a perceived risk for harm has the potential to improve the use of preventative health measures in individuals.

Many respiratory patients misuse their inhaler. Although training improves their inhaler technique, patients do forget the correct inhaler use with time. In the current work, three clinical studies investigated novel tools designed with feedback mechanisms to ensure patients use the correct inhalation method when using their inhaler. Research Ethics Committee approval was obtained and all the participants signed an informed consent form. In the first study, the recruited asthmatic children (n=17) and adults (n=39) had their metered dose inhaler (MDI) technique assessed. Those who attained the recommended inhalation flow rate (IFR) of < 90 l/min through their MDI formed the control group. Whilst those who had a poor MDI technique with an IFR ≥ 90 l/min were randomized into either the verbal counselling (VC) group; or the 2ToneTrainer (2TT) group that, in addition to the verbal training, received the 2ToneTrainer MDI technique training device equipped with an audible feedback mechanism of correct inhalation flow. All the participants were assessed on two occasions (6 weeks apart) for their inhalation flow rate, asthma control and quality of life. The study showed that the 2ToneTrainer tool was as efficient as verbal training in improving and maintaining the asthmatic patients' MDI technique, particularly using the recommended slow inhalation flow through the MDI. Although statistically insignificant, potential improvement in quality of life was demonstrated. The 2ToneTrainer tool has the advantage of being available to the patients all the time to use when they are in doubt of their MDI technique. In the second research study, the inhalation profiles of asthmatic children (n=58) and adults (n=63), and of COPD patients (n=63) were obtained when they inhaled through the novel Spiromax dry powder inhaler (DPI) which was connected to an electronic pressure change recorder. From these inspiratory profiles; the peak inhalation flow, inhalation volume and inhalation acceleration rate were determined. The variability (23%-58%) found in these inhalation profile parameters among various patient groups would be expected in all DPIs. The effect of the inhalation acceleration rates and volumes on dose emission characteristics from DPIs should be investigated. Attention, though, should be paid to the patients' realistic inhalation profile parameters, rather than the recommended Pharmacopoeial optimal inhalation standard condition, when evaluating the in-vitro performance of DPIs. Finally, in preschool asthmatic children, the routine use of the current AeroChamber Plus spacer (n=9) was compared with that of a novel version; the AeroChamber Plus with Flow-Vu spacer (n=10) over a 12-week period. The Flow-Vu spacer has a visual feedback indicator confirming inhalation and tight mask-face seal. The study showed that the new AeroChamber Plus with Flow-Vu spacer provided the same asthma control as the AeroChamber Plus in preschool children and maintained the same asthma-related quality of life of their parents. However, the parents preferred the new Flow-Vu spacer because its visual feedback indicator of inhalation reassured them that their asthmatic children did take their inhaled medication sufficiently.