Chronic obstructive pulmonary disease (COPD) requiring long-term oxygen therapy (LTOT) is an incurable lung disease often complicated by other comorbidities. Research is limited for hospitalized COPD exacerbations with LTOT and palliative care services. The purpose of this quantitative research study was to determine the correlation between palliative care interventions and COPD patient outcomes specific to an intensive care unit (ICU) stay, invasive mechanical ventilator support, physician orders for cardiopulmonary resuscitation (CPR) code status, and hospital discharge to hospice care. The theoretical base for this study was Donabedian's quality improvement theory. The quasi-experimental, nonequivalent groups design divided COPD hospitalized patient sample into 2 groups, those with and those without palliative care, for comparison. An independent-samples t test, one-way MANOVA, and follow-up univariate ANOVAS was done to compare the means of ICU days and ventilator days; a cross tabulation, chi-square test of independence, and Fisher exact test was done to compare code status and place of hospital discharge. The mean number of the ICU days and ventilator days for palliative care patients was significantly higher than patients who did not receive palliative care. A significant interaction was found for palliative care and code status change from CPR to no CPR; however, data relating to palliative care and hospital discharge to hospice was insignificant. In conclusion, palliative care does not reduce costs by limiting the number of days spent in an ICU or the number of days on invasive mechanical ventilation; although, it may have an important role in the code status order change from CPR to no CPR to align with the patient's end of life care preference.

Living with chronic obstructive pulmonary disease stage III or IV has a major impact on a person's everyday life. The aim of this licentiate thesis was to describe the experiences of women living with chronic obstructive pulmonary disease stage III or IV, as well as the experiences as a close relative to women with chronic obstructive pulmonary disease stage III or IV. In both studies, data were collected through individual, semi-structured interviews. The interview texts were then subjected to qualitative content analysis. A purposive sample of 15 women with either stage III or IV chronic obstructive pulmonary disease stage and a total of 9 close relatives participated in the studies. The findings showed that breathlessness restricted women with chronic obstructive pulmonary disease, to live with a breathing and body which they had to wait for. Stabilizing an ever-present breathlessness by restoring strength helped them manage everyday life and adapt to their limited abilities and energy. This restoration required detailed planning and a good knowledge of their breathing and bodies. Women were afraid of contracting life-threatening infections that would cause suffering. Fear led to isolation, and digital media were described as an important means of communication (I). Close relatives were of major importance to women with chronic obstructive pulmonary disease in their everyday life in terms of being flexible to accommodate the women’s needs. They were flexible, available, and on stand-by. The COVID-19 pandemic was experienced by close relatives as a reinforced threat to women with chronic obstructive pulmonary disease. Close relatives raised awareness of their vulnerability to potentially life-threatening infections, leading them to carefully avoid exposure and thus rely more on digital media. A more sedentary life was one effect of living in a gradually, yet controlled everyday life for close relatives. Women with chronic obstructive pulmonary disease stage III or IV and their close relatives expressed that they lacked continuity, participation, and support from healthcare professionals (I, II). In conclusion, the findings of this licentiate thesis show that women with chronic obstructive pulmonary disease stage III or IV and their close relatives experience both health and suffering in their everyday lives. By gaining understanding and insights into the lives of women with chronic obstructive pulmonary disease, as well as the needs and everyday challenges of their close relatives, better health outcomes can be supported. / <p>Vid tidpunkten för seminariet var följande delarbete opublicerat: delarbete 2 inskickat.</p><p>At the time of the licentiate seminar the following paper was unpublished: paper 2 submitted.</p>

Prior to the coronavirus disease-2019 (COVID-19) pandemic people with chronic obstructive pulmonary disease (COPD) were already experiencing social isolation due to the complex intersection of symptoms, and perceptions towards the illness. COPD is a chronic lung illness characterized by progressive shortness of breath, and decreasing lung function, with influenza and other respiratory illnesses more likely to have fatal consequences for this population. Societal beliefs and assumptions around behavioural risk factors, and in particular smoking, contribute to perceptions that COPD diagnosis, outcomes and experiences are self-inflicted and an individual responsibility. This is a perspective that fails to take into the account the complex contextual factors of the social determinants of health, where structural inequities result in higher smoking rates among populations with lower socioeconomic status. Further, these underlying societal values may compound the isolation experienced with COPD in which ongoing stigma towards the illness discourages people from identifying with a COPD diagnosis. The lack of identity may discourage developing a community where people can share experiences and strategies in living with COPD, and form a collective group that can advocate for change. Digital technologies (DTs), such as Facebook and Zoom offer new avenues to support social connectedness. However, little focus has been given on how people with COPD may (or may not) be using DTs to support their illness. This study explored the role DTs could serve in addressing social connectedness and experiences and outcomes for the COPD community. The study was informed by Mertens (2003, 2007) transformative approach where the knowledge of people living with COPD was prioritized in finding out what DTs they may be using to maintain social connectedness and to support their illness. The three stage mixed methods research design consisted of interviews, patient-reported outcome measures, patient-reported experience measures and a DT survey. Bazeley's (2018) approach was used to guide the integrative mixed analysis on data collected across the three stages. The overall findings were: 1) Participants’ experiences in living with COPD had uniquely prepared them for the COVID-19 pandemic, and it was the community that lacked capacity; 2) Dominant discourse around technology may be creating further harms to the COPD population that extend beyond the digital world; 3) Current digital health monitoring strategies for other chronic illnesses do not fully translate to the interests and needs for people living with COPD; 4) People living with COPD are using DTs, but prefer to keep their virtual world separate from their illness world; and 5) Considerations for DTs for COPD should move beyond managing outcomes, and include supporting experiences of living. Conducted between December 2018 and July 2020, and concurrent with the COVID-19 pandemic, the study demonstrated even greater importance with the onset of the pandemic in understanding how DTs may support social connectedness for people living with life-limiting chronic lung conditions. / Graduate / 2022-02-07

Originally Published in: Kazuya Tanimura, Susumu Sato, Yoshinori Fuseya, Koichi Hasegawa, Kiyoshi Uemasu, Atsuyasu Sato, Tsuyoshi Oguma, Toyohiro Hirai, Michiaki Mishima and Shigeo Muro. Quantitative Assessment of Erector Spinae Muscles in Patients with COPD: Novel Chest CT-derived Index for Prognosis. Annals of the American Thoracic Society. [Year];[Volume]:[Pages]. DOI: [Number] Copyright© 2015 by the American Thoracic Society The final publication is available at http://www.atsjournals.org/journal/annalsats/ / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19621号 / 医博第4128号 / 新制||医||1015(附属図書館) / 32657 / 京都大学大学院医学研究科医学専攻 / (主査)教授 福原 俊一, 教授 今中 雄一, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20987号 / 医博第4333号 / 新制||医||1027(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 長船 健二, 教授 一山 智 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13555号 / 論医博第2284号 / 新制||医||1067(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 森信 暁雄, 教授 中本 裕士, 教授 永井 純正 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Pulmonary function testing (PFT) is recommended by guidelines for the diagnosis of chronic obstructive pulmonary disease and the diagnosis and monitoring of asthma. Portable in-office tests offer rural patients and providers information previously more difficult to obtain because of hospital closures, transportation barriers, and cost. This article describes the successful implementation and measurement of in-office PFT in 3 rural primary care offices. Providers were more likely to order a PFT for patients with asthma (33%) than a patient with chronic obstructive pulmonary disease (9.7%). Recommendations include increased staff involvement and repeat education midimplementation.

COPD (Chronic Obstructive Pulmonary Disease) is one of the most widespread lung diseases today and is a growing cause for suffering and mortality worldwide. It is considered to be the third leading cause of death in the near future. Smoking is the most important risk factor for this disease and about 50% of smokers develop COPD. The purpose of this study was to mediate the experience of not being able to stop smoking described by persons diagnosed with mild or moderate COPD. The study involved five women and five men. Data was collected by semi-structured interviews and analyzed using qualitative latent content analysis. The analysis resulted in two themes: Life is governed by a long smoking history that is difficult to break and To be aware of and enlightened, but lacking ability to make a decision, and in five categories: That it is the wrong time in life to stop; To break a lifelong pattern is almost impossible; That plans to stop does not lead to results; Being aware of the consequences of continued smoking and to have received help and support but not liking to be patronized. Participants' lives were governed by a lifelong smoking habit which was difficult to break, although they had knowledge about the harmful effects of smoking. Individuals life situation is very important if the cessation of smoking can be successfully implemented and with lasting results. To have plans to stop smoking is not enough it is also necessary to get motivation and support from the environment and at the right time. Participants that where reluctant to smoking cessation where also critical to the information and support that was given to them. This indicates that health professionals should be more sensitive and provide an individually tailored support when an individual decides to stop smoking. / <p>Validerat; 20110102 (ysko)</p>

Bakgrund Kronisk obstruktiv lungsjukdom (KOL) är en kronisk inflammation i lungorna som förstör lungvävnaden och minskar lungkapaciteten. Sjukdomen går inte att bota. År 2030 beräknas sjukdomen utgöra den tredje största dödsorsaken samt patientgruppen i världen. KOL medför ett stort lidande och försämrad livskvalité för den drabbade. Syfte Syftet med litteraturöversikten är att beskriva personers upplevelser av att leva med kronisk obstruktiv lungsjukdom (KOL). Metod Examensarbetet genomfördes som en strukturerad litteraturöversikt. 13 artiklar från databaserna Cinahl och PsycINFO analyserades och sammanställdes med Fribergs analysmetod. De inkluderade artiklarna var av kvalitativ design. Resultat Resultatet delades in i två huvudkategorier: Förändring av förutsättningar och hantering av förändringarna. De centrala fynden var de fysiska förändringar som upplevdes, att fokus låg på andningen och känslor av att vara begränsad socialt var särskilt framträdande. Känslor av skam och skuld men också kunskapsutbyte och stöd hos andra personer i liknande situation. Att använda fysisk aktivitet som en strategi och ta ansvar för egenvård. Slutsats Resultatet visar att personer med sjukdomen KOL upplever begränsningar i det dagliga livet både gällande den sociala samvaron och fysiska aktiviteter. Hjälpmedel ansågs minska isolering och de dagliga aktiviteterna kunde upprätthållas bättre. Känslor av skuld och skam som har en inverkan på personernas upplevelser av hälsa framträder. Det finns upplevelser om attityder gentemot personer med KOL och att detta kunde leda till att man undvek att söka vård. / Background Chronic obstructive pulmonary disease (COPD) is a chronic inflammation of the lungs that destroys the lung tissue, reduces lung capacity and cannot be cured. In 2023, the disease is estimated to be the third biggest patient group in the world and the third largest cause of death. COPD causes suffering through shortness of breath, limited mobility and are duced quality of life. Aim The purpose of this thesis is to describe people's experiences of living with chronic obstructive pulmonary disease (COPD). Method The thesis was carried out as a structured literature review containing 13 articles from the database CINAHL and PsycINFO. The articles were analyzed and compiled using Friberg´s analysis method. The included articles were of qualitative design. Results The results were divided into two main categories: Change in conditions and management of the changes. The central findings were the physical changes experienced, a focus on breathing and feelings of being socially restricted were particularly prominent. Feelings of shame and guilt but also exchange of knowledge and support from other people in a similar situation. Using physical activity as a strategy and taking responsibility for selfcare. Conclusions The results show that people with the disease COPD experience limitations in daily life both regarding social interaction and physical tasks. The study also reveals feelings of guilt and shame, which are significant for the persons' health. Experiences that there is a certain attitude towards people who suffer from the disease are described.