Made available in DSpace on 2014-06-11T19:22:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-29Bitstream added on 2014-06-13T19:08:19Z : No. of bitstreams: 1 moreira_gl_me_prud.pdf: 458066 bytes, checksum: 0ca2abc500e5cd73db10163c69dbcb12 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Verificar a validade de constructo e reprodutibilidade de uma versão em português do Chronic Respiratory Questionnaire (CRQ, ou Questionário sobre Doenças Respiratórias Crônicas) em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC). Métodos: A versão em português do CRQ fornecida pela Universidade de McMaster, detentora dos direitos do questionário, foi aplicada a 50 pacientes portadores de DPOC (32 homens; 70±8 anos; VEF1 47±18% previsto) em dois momentos, com intervalo de uma semana. O CRQ tem 4 domínios (dispnéia, fadiga, função emocional e autocontrole) e foi aplicado em formato de entrevista. O Questionário Saint George na Doença Respiratória (SGRQ), já validado em português, foi utilizado como critério de validação. A espirometria e o teste da caminhada de seis minutos (TC6min) foram realizados para análise das correlações com os valores do CRQ. Resultados: Não foram observadas diferenças significativas entre a aplicação e reaplicação do CRQ (p>0.05 para todos os domínios). O coeficiente de correlação intraclasse entre a aplicação e reaplicação foi de 0,98; 0,97; 0,98 e 0,95 para dispnéia, fadiga, função emocional e autocontrole, respectivamente. O coeficiente alfa de Cronbach para os domínios dispnéia, fadiga, função emocional e autocontrole foi de 0,86; 0,78; 0,81 e 0,70 respectivamente... / To verify the construct validity and reproducibility of a Portuguese version of the Chronic Respiratory Questionnaire (CRQ) in patients with chronic obstructive pulmonary disease (COPD). Methods: The Portuguese version of the CRQ provided by McMaster University (Hamilton, Ontario- Canada), the holder of the questionnaire copyrights, was applied to 50 patients with COPD (32 men; 70±8 years; FEV1 47±18% of predicted) on two occasions, 1-week apart. The CRQ is composed of 20 questions divided into four domains (dyspnea, fatigue, emotional function, and mastery) and was applied as an interviewer-administered instrument. The Saint George´s Respiratory Questionnaire (SGRQ), already validated in Portuguese language, was used as the criterion for validation. Spirometry and the 6-minute walk test (6MWT) were performed to analyze the correlations with the CRQ scores domains. Results: There were no significant differences between test... (Complete abstract click electronic access below)

Orientador: Ercy Mara Cipulo Ramos / Banca: José Roberto Jardim / Banca: Dionei Ramos / Resumo: Verificar a validade de constructo e reprodutibilidade de uma versão em português do Chronic Respiratory Questionnaire (CRQ, ou Questionário sobre Doenças Respiratórias Crônicas) em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC). Métodos: A versão em português do CRQ fornecida pela Universidade de McMaster, detentora dos direitos do questionário, foi aplicada a 50 pacientes portadores de DPOC (32 homens; 70±8 anos; VEF1 47±18% previsto) em dois momentos, com intervalo de uma semana. O CRQ tem 4 domínios (dispnéia, fadiga, função emocional e autocontrole) e foi aplicado em formato de entrevista. O Questionário Saint George na Doença Respiratória (SGRQ), já validado em português, foi utilizado como critério de validação. A espirometria e o teste da caminhada de seis minutos (TC6min) foram realizados para análise das correlações com os valores do CRQ. Resultados: Não foram observadas diferenças significativas entre a aplicação e reaplicação do CRQ (p>0.05 para todos os domínios). O coeficiente de correlação intraclasse entre a aplicação e reaplicação foi de 0,98; 0,97; 0,98 e 0,95 para dispnéia, fadiga, função emocional e autocontrole, respectivamente. O coeficiente alfa de Cronbach para os domínios dispnéia, fadiga, função emocional e autocontrole foi de 0,86; 0,78; 0,81 e 0,70 respectivamente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To verify the construct validity and reproducibility of a Portuguese version of the Chronic Respiratory Questionnaire (CRQ) in patients with chronic obstructive pulmonary disease (COPD). Methods: The Portuguese version of the CRQ provided by McMaster University (Hamilton, Ontario- Canada), the holder of the questionnaire copyrights, was applied to 50 patients with COPD (32 men; 70±8 years; FEV1 47±18% of predicted) on two occasions, 1-week apart. The CRQ is composed of 20 questions divided into four domains (dyspnea, fatigue, emotional function, and mastery) and was applied as an interviewer-administered instrument. The Saint George's Respiratory Questionnaire (SGRQ), already validated in Portuguese language, was used as the criterion for validation. Spirometry and the 6-minute walk test (6MWT) were performed to analyze the correlations with the CRQ scores domains. Results: There were no significant differences between test... (Complete abstract click electronic access below) / Mestre

Purpose: The aim of the systematic review was to explore the role that anxiety plays in hospital admissions for those with Chronic Obstructive Pulmonary Disease (COPD). The empirical study aimed to examine whether the frequency of COPD related admissions is related to psychological factors (anxiety, depression, catastrophising, and mindfulness), disease severity, perceived disability and demographic factors. It also sought to examine whether cognitive factors (mindfulness and catastrophising) may explain unique variance in predicting anxiety and COPD-related admissions when other relevant factors are controlled for. Methods: The literature was systematically searched for research related to the predictive power of anxiety in relation to COPD related hospital admissions. A postal cross-sectional survey of 54 people with COPD examined the psychological profile of those who are admitted to hospital for COPD, and if mindfulness and catastrophising can predict anxiety and COPD hospital admissions. Correlations and multiple regressions were utilised to explore these hypotheses. Results: Fourteen studies met inclusion criteria for the systematic review, demonstrating mixed results regarding whether anxiety plays a role in COPD related hospital admissions. Findings from the empirical study suggest that a significant relationship exists between disease severity and number of COPD hospital admissions and catastrophising and overall mindfulness predicted 16.3% of variance in COPD hospital admissions (non-significant). Anxiety scores were significantly correlated with breathlessness, depression, catastrophising and mindfulness with catastrophising and mindfulness predicting 22.3% of variance in anxiety (significant). Conclusions: Further research with robust measures of anxiety and hospital utilization are needed to aid our understanding of the role of anxiety in COPD related admissions. Further research is necessary to determine if mindfulness and catastrophising are useful constructs in predicting anxiety levels and hospital admissions in those with COPD. This will help to inform future psychological interventions with this population.

Chronic Obstructive Pulmonary Disease (COPD) is the fifth leading cause of death in the United States. COPD is a highly heterogeneous disease, and patients with COPD experience varying degrees of respiratory findings (lung function decline, chronic bronchitis, and emphysema). However, the molecular changes underlying this heterogeneity are not well understood. For my dissertation research I used bronchial airway gene expression to develop a signature of lung function decline, evaluate a molecule for potential anti-COPD properties, and develop a gene expression-based classification of COPD subtypes. Genome-wide gene expression generated from bronchial epithelial brushings of ever smokers with and without COPD were used to identify differences in gene expression associated with the rate of subsequent lung function decline. I validated this lung function decline signature in an independent set of COPD patients and determined that this signature may be driven by changes in the activity of the transcription factor XBP1. I next identified gene expression changes in human derived bronchial epithelial cells (HBECS) when exposed to a potential novel anti-COPD compound. I performed an in silico analysis to determine if these gene expression changes were related to COPD-associated gene expression differences observed in independent datasets of COPD patients. Lastly, I performed unbiased gene expression clustering on bronchial brushings to identify novel molecular COPD subtypes. I then examined these gene expression changes in independent datasets of COPD. Together, these works may lead to better understanding and treatment of COPD. The signature of lung function decline could be used as an intermediary endpoint in studies evaluating COPD therapies, or for patient stratification. Characterizing the relationship between the gene expression changes associated with COPD and those induced by the novel anti-COPD compound helps inform choices around its development as a potential medication. Lastly, the molecular subtypes of COPD may lead to a better understanding of molecular heterogeneity in the pathogenesis of COPD and ultimately more patient-specific treatments that are targeted to these molecular differences. / 2023-05-25T00:00:00Z

Yes / The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a pilot randomised controlled trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. Methods: A two-arm pragmatic pilot RCT was conducted comparing the standard service with a Telehealth-supported service and assessed the potential for progressing into a full RCT. The co-primary outcome measures were the proportion of COPD patients readmitted to hospital and changes in patients’ self-reported quality of life. The objectives were to assess the suitability of the methodology, produce a sample size calculation for a full RCT, and to give an indication of cost-effectiveness for both pathways. Results: Sixty three participants were recruited (n = 31 Standard; n = 32 Telehealth); 15 participants were excluded from analysis due to inadequate data completion or withdrawal from the Telehealth arm. Recruitment was slow with significant gaps in data collection, due predominantly to an unanticipated 60% reduction of staff capacity within the clinical team. The sample size calculation was guided by estimates of clinically important effects and COPD readmission rates derived from the literature. Descriptive analyses showed that the standard service group had a lower proportion of patients with hospital readmissions and a greater increase in self-reported quality of life compared to the Telehealth-supported group. Telehealth was cost-effective only if hospital admissions data were excluded. Conclusions: Slow recruitment rates and service reconfigurations prevented progression to a full RCT. Although there are advantages to conducting an RCT with data collection conducted by a frontline clinical team, in this case, challenges arose when resources within the team were reduced by external events. Gaps in data collection were resolved by recruiting a research nurse. This study reinforces previous findings regarding the difficulty of undertaking evaluation of complex interventions, and provides recommendations for the introduction and evaluation of complex interventions within clinical settings, such as prioritisation of research within the clinical remit.

No / Dear Editor In undertaking studies of palliative care in heart failure and chronic obstructive pulmonary disease (COPD) in the UK, we identified procedural, conceptual and ethical challenges that may arise from one feature of The End of Life Care Strategy for England.1 The strategy presents the question, ‘Would I be surprised if the person in front of me was to die in the next six months or one year?’ as a prompt to initiate discussion of endof-life care needs and preferences (paragraph 3.23). We believe this question is inappropriate in heart failure and COPD and its use will inhibit the initiation of a palliative care approach with these patients.

Chronic obstructive pulmonary disease (COPD) has been recognized as a leading cause of mortality in older adults involving acute exacerbations as life-threatening events that lead to frequent hospitalization for care. Informal caregivers have been essential to helping older adults with COPD during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A lack of empirical knowledge exists regarding the experience of informal caregivers of older adults with AECOPD in situation awareness for recognizing, understanding, and responding to an AECOPD in an emergent situation. This qualitative descriptive study explored situation awareness and its components of perception, comprehension and projection of next steps, including the caregiver’s confidence level during the AECOPD event. Fifteen informal caregivers, ages 31-77 years (mean age 48), who provided care for older adults with COPD were interviewed from an underserved community health center. The overarching theme derived from this study was something was wrong and something needed to be done. Subthemes emerged as a heightened sense of awareness, caregiver tipping point, planning next steps, caregiver confidence, and caregiver commitment. This study utilized situation awareness theory as a relevant guiding framework in exploring the experience of lay informal caregivers caring for older adults with AECOPD events. Study findings provided a description of the complex processes involved, including confidence level, for informal caregiver’s in situation awareness to recognize and respond to an AECOPD event in the older adult. Future targeted interventions need to address strategies to enhance individualized care for older adults with AECOPD events for managing care at home.

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.

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.

Η τηλεϊατρική στηρίζεται στην εφαρμογή της σύγχρονης τεχνολογίας των τηλεπικοινωνιών,της πληροφορικής και τον ηλεκτρονικών υπολογιστών για παροχή υπηρεσιών υγείας, σε απομακρυσμένες περιοχές. Συνδυάζει δηλαδή την τεχνολογία με την ιατρική θέτοντας τις δυνατότητες της πρώτης στην διάθεση της δεύτερης. / The telemedicine is supported in the application of modern technology of telecommunications, information technology and computers for benefit of services of health, in removed regions. It combines that is to say the technology with the medicine placing the possibilities first in the disposal second.