Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease characterized by persistent airway obstruction that is only partially reversible. It is the fourth leading cause of death and is predicted to be the third by 2030. The progression of the disease involves chronic inflammation, oxidative stress, excess protease activity, increased lung cell apoptosis and accelerated lung aging, but the exact pathogenesis is still unclear. The major cause of COPD is cigarette smoking(CS). Although COPD is associated with increasing social and economical burden, there have been few advances in pharmacological therapy of COPD. Mesenchymal stem cells (MSCs) are fibroblast-like multipotent stem cells which can be isolated from a broad range of sources including bone marrow (BM) and adipose tissue. Administration of BM-derivedMSCs (BM-MSC) or adipose tissue-derived MSCs was reported to attenuate CS-induced emphysema in murine models. Induced pluripotent stem cell-derived MSC (IPSC-MSC) are MSCs differentiated from induced pluripotent stem cells(IPSCs), which are pluripotent cells generated by somatic cell reprogramming in vitro. IPSC-MSCs have several advantages over BM-MSC, including more abundant sources and high capacity of doubling without loss of differentiation potency. A general exploration and comparison on the effects of human IPSC-MSC and BM-MSC treatments were carried out in a 56-day CS-exposed rat model. Compared to BM-MSC, IPSC-MSC showed a higher capacity to reside in lung tissue. The two treatments shared similar efficacy to attenuate CS-induced lung cell apoptosis, to restore CS-induced reduction of lungIL-10and to alleviate CS-induced elevation of systemic TGF-β1. In addition, IPSC-MSC was found to cause reduction in CS-induced elevation of systemic oxidative stress and reversal of CS-induced reduction of lung adiponectin. Furthermore, in order to understand the possible paracrine mechanism involved, human airway epithelial cells were treated with IPSC-MSC or BM-MSC-conditioned medium in a cell culture system in the presence of cigarette smoke medium (CSM). Potentiation rather than attenuation of CSM-induced release of pro-inflammatory cytokine IL-8, MCP-1 and IL-6 was observed with IPSC-MSC or BM-MSC conditioned medium. It is currently unknown whether cultured IPSC-MSCs or BM-MSCs will release pro-inflammatory mediators into the conditioned medium or not. In order to study CS-induced oxidative stress and inflammation in a short time frame, anacute (5-day) CS-exposed rat model was established in juvenile and adult groups. An age-dependent alteration of CS-induced oxidative and inflammatory responses was demonstrated in this model. In summary, our in vivo rat model provides a platform for elucidating the effects of stem cell treatment in CS-induced oxidative stress and inflammation, leading to lung damage. Our findings suggest that treatment of IPSC-MSC or BM-MSC might be able to slow down CS-induced disease progression, possibly through anti-oxidant, anti-inflammatory and anti-apoptotic properties. However, caution should be taken as our in vitro data revealed that conditioned medium from MSCs may provoke pro-inflammatory responses. Further studies on the regulation of the activity of MSCs in vivo will be needed before developing IPSC-MSC into cell therapies for COPD to halt the progression over time. / published_or_final_version / Medicine / Master / Master of Philosophy

Hospital readmission rates are considered to be an important indicator of quality of care because they may be a consequence of actions of commission or omission made during the initial hospitalization of the patient, or as a consequence of poorly managed transition of the patient back into the community. The negative impact on patient quality of life and huge burden on healthcare system have made reducing hospital readmissions a central goal of healthcare delivery and payment reform efforts. In this project, we will focus on COPD (Chronic Obstructive Pulmonary Disease) which is one of the leading causes of disability and mortality worldwide. This project will design and develop a prognostic COPD healthcare management system which is a sustainable clinical decision-support system to reduce the number of readmissions by identifying those patients who need preventive interventions to reduce the probability of being readmitted. Based on patient’s clinical records and discharge summary, our system would be able to determine the readmission risk profile of patients treated for COPD. Suitable interventions could then be initiated with the objective of providing quality and timely care that helps prevent avoidable readmission. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Interventions are needed to improve health outcomes by increasing the practice of evidence based medicine ( EBM ). Patient mediated interventions have been little studied but hold promise : they target identified barriers to EBM and particular types of patient mediated intervention have shown success. Furthermore, consumers are now being given information about evidence but the effects of this on EBM have yet to be properly assessed. The aim of this study was to show whether informing patients about research evidence leads to improved application of that evidence in their medical care. The study trialed a relatively low cost manual, developed using current best practice, which summarised Cochrane Reviews of evidence. The study focused on chronic obstructive pulmonary disease ( COPD ), a high - cost, high - burden chronic disease, showing a large gap between evidence and clinical practice. The study comprised a controlled before - and - after trial and a process evaluation. The trial assessed the success of this manual in changing medical practice for three indicator treatments ( influenza vaccination, bone density testing and pulmonary rehabilitation ) and in changing patient quality of life, knowledge, communication with doctor, satisfaction with information and anxiety. Results were analysed by median split of socioeconomic disadvantage. At 3 months the manual was associated with lower anxiety for participants with lowest socioeconomic disadvantage. At 12 months the manual was associated with higher pulmonary rehabilitation enrolment for participants with greatest socioeconomic disadvantage. Other outcome measures showed no significant change. Limitations included loss of power from unexpectedly good baseline care and adjustments for baseline differences. The process evaluation showed that the manual was read more than a control pamphlet at both 3 and 12 months but a minority of manual recipients reported talking to their doctor about topics from the manual. Very little treatment change was reported. Patient attitudes to evidence and doctor / patient communication norms appeared to be barriers for this patient group. New protocols for the design of behavioural interventions provide a framework for overcoming these barriers in future interventions. / Thesis (Ph.D.)--School of Medicine, 2006.

University of Macau / Institute of Chinese Medical Sciences