CCQ Scores Research Articles

Promoting leadership and communication skills in emergency medicine residents: the role of High-Fidelity Simulation

The residency program in Emergency Medicine should include formal training in Non-Technical Skills (NTS). We evaluated the effectiveness of a program based on High-Fidelity Simulation (HFS) to improve the leadership and communication skills of residents in Emergency Medicine. In this prospective observational study, we performed 6 simulation sessions, each with 3 scenarios about the management of the critically ill. In the second to the fifth session, participants received specific training about: the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach, leadership, communication, and situation awareness, one topic per session. Technical Skills (TS) were measured as the percentage of critical actions correctly performed by participants during the primary examination. NTS were rated by the Leadership Behavior Description Questionnaire (LBDQ), Communication Competence Questionnaire (CCP), and Clinical Teamwork Scale (CTS). The trend over the following sessions was evaluated. We examined 90 scenarios, 15 scenarios per session (three scenarios repeated 5 times). The LBDQ score reached in the fifth and sixth sessions (fifth: 25 [20-30]; sixth: 25 [22-29]), was significantly higher than that obtained in the first, second, and third ones (first: 23 [18-24]; second: 22 [16-26]; third: 20 [14-26], all p<0.05). The percentage of correctly performed actions during ABCDE assessment (10 [7-14] vs. 17 [15-19]), as well as CCQ scores (46 [42-48] vs. 51 [47-52]) and CTS scores (82 [64-88] vs. 94 [91-101], all p<0.01), increased significantly between the first and the last session. HFS confirmed to be an effective instrument to allow Emergency Medicine residents to acquire NTS skills in a safe environment.

Treatment Adherence and Health Status of Patients With COPD Under Treatment With Salmeterol/Fluticasone via the Elpenhaler® Device: The AHEAD Study.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous progressive lung condition characterized by long-term respiratory symptoms and airflow limitation. Appropriate bronchodilation is the cornerstone of COPD treatment, leading to better health status as well as benefits in prognosis and mortality. In the current open, noninterventional, observational study, 716 patients diagnosed with COPD of variable severity were administered a fixed-dose combination (FDC) of fluticasone propionate and salmeterol (500 + 50 mcg) through the Elpenhaler® device. The patients' adherence to treatment (based on the MMAS-8 [8-item Morisky Medication Adherence Scale]) and health status (based on the CCQ [Clinical COPD Questionnaire]) were assessed at the beginning of the study and at the end of the 3-month follow-up period. The mean ± SD MMAS-8 score at 1 and 3 months was 6.12 ± 1.89 and 6.45 ± 1.80, respectively, indicating medium adherence overall; however, there was a statistically significant increase of 0.33 units in the MMAS-8 score at the end of the follow-up (paired t-test p < 0.0001), suggestive of an improvement in adherence throughout the study. Higher adherence was associated with better health status at baseline, which further improved by the end of the follow-up. Moreover, we observed a statistically significant decrease of 1.07 points (p < 0.0001) in the mean CCQ total score from the baseline (CCQ score = 2.2 ± 1.00) until the end of the study follow-up (CCQ score = 1.13 ± 0.67). Similar conclusions were also drawn in the mean domain scores regarding symptoms (score equal to 1.36 ± 0.72, decrease by 1.18) as well as functional and mental state (scores equal to 0.86 ± 0.73 and 1.20 ± 0.88, decrease by 1.04 and 1.00, respectively, p < 0.0001). Similarly, when patients were stratified into subgroups with and without comorbidities, the former group showed an increase of 7% in the patients with medium to high adherence during the course of the study. In the same patient subgroup, there was a notable decrease in CCQ score by 1.18 points (p < 0.0001) during the study. The administration of FDC of fluticasone propionate and salmeterol, (500 + 50 mcg) via the Elpenhaler® device for COPD, resulted in a well-maintained or slight increase in treatment adherence and a subsequent benefit in health status, which further persisted after 3 months of treatment.

SYSTEMATIC LONG COVID SYMPTOMS ASSESSMENT IN HYPERTENSIVE AND NON-HYPERTENSIVE INDIVIDUALS DURING THE 12-MONTHS FOLLOW-UP AFTER HOSPITAL DISCHARGE

Objective: To study the impact of hypertension on the dynamics of physical, emotional and cognitive symptoms during the 12-months follow-up after hospitalization for COVID-19. Design and method: 212 patients hospitalized for COVID-19 (50% hypertensive, 53% female, mean age 53,4±13,6 years) underwent comprehensive questionnaire survey evaluating physical (CAT, CCQ and mMRC dyspnea scales for respiratory and EFTER-COVID for other related symptoms), emotional (HADS) and cognitive well-being (Memory, Thinking and Communication subscale of SBQ-LC questionnaire, MTC-SBQ-LC) that was performed pre-discharge and repeated after 1, 3, and 12 months. Results: Despite being older (57,8±11,8 vs 50,7±13,9, p&lt;0,001) and having higher BMI (31,7±5,3 vs 27,4±4,4 kg/m2, p&lt;0,001), hypertensive patrticipants had similar baseline summary scores of symptoms severity but slightly higher mMRC dyspnea score (2,7±1,1 vs 2,3±1,1, p = 0,023), and no significant difference in trends of summary scores have been detected by ANOVA (see graphic abstract). Non-hypertensive subjects had worse baseline limitation of everyday activity, cough and sputum production by respective CAT and CCQ sections that were characterized by better dynamics during follow-up. The residual level of respiratory-related symptoms at 12 months was higher in hypertensive cohort (CAT score 8,1±5,1 vs 5,8±5,0, p = 0,003, CCQ score 7,5±6,1 vs 4,5±5,1, p&lt;0,001, mMRC dyspnea score 1,57±0,63 vs 1,27±0,54, p&lt;0,001), most likely due to more frequent concomitant obesity and diastolic dysfunction. The most striking data was obtained in the MTC-SBQ-LC: yonger and healthier non-hypertensive participants displayed similar trends of most cognitive symptoms to the hypertensive cohort, but had persistently worse brain fog, difficulties in understanding others’ speech, planning, concentrating, and word-finding, that resulted in significantly higher summary score at 12 months after discharge (1,71±2,36 vs 0,96±1,30, p = 0,010). No differences were detected in anxiety and depression levels as assessed by HADS. Conclusions: Hypertensive patients that had been hospitalized for COVID-19 displayed similar trends of resolving physical, emotional and cognitive symptoms throughout the 12-month follow-up but had higher levels of residual respiratory-related symptoms and dyspnoea compared to the non-hypertensive participants, whereas the latter were characterized by significantly higher level of cognitive dysfunction as assessed by the dedicated SBQ-LC subscale.

A cross sectional pilot study to assess the role of phthalates on respiratory morbidity among patients with chronic obstructive pulmonary disease

BackgroundChronic Obstructive Pulmonary Disease (COPD) affects ∼16 million U.S. adults. Phthalates, synthetic chemicals in consumer products, may adversely impact pulmonary function and airway inflammation; however, their role on COPD morbidity remains unknown. ObjectiveWe examined associations between phthalate exposures and respiratory morbidity among 40 COPD patients who were former smokers. MethodsWe quantified 11 phthalate biomarkers in urine samples collected at baseline in a 9-month prospective cohort study in Baltimore, Maryland. COPD baseline morbidity measures included: health status and quality of life measures (CAT: COPD Assessment Test, CCQ: Clinical COPD Questionnaire, SGRQ: St. George's Respiratory Questionnaire; mMRC: Modified Medical Research Council Dyspnea Scale), and lung function. Information on prospective exacerbation data was monitored monthly during the 9-month longitudinal follow-up period. To examine associations between morbidity measures and phthalate exposures, we used multivariable linear and Poisson regression models for continuous and count outcomes, respectively, adjusting for age, sex, race/ethnicity, education, and smoking pack-years. ResultsHigher mono-n-butyl phthalate (MBP) concentrations were associated with increased CAT(β, 2.41; 95%CI, 0.31–4.51), mMRC (β, 0.33; 95%CI 0.11–0.55), and SGRQ (β, 7.43; 95%CI 2.70–12.2) scores at baseline. Monobenzyl phthalate (MBzP) was also positively associated with CCQ and SGRQ scores at baseline. Higher concentrations of the molar sum of Di (2-ethylhexyl) phthalate (DEHP) were associated with increased incidence of exacerbations during the follow-up period (incidence rate ratio, IRR = 1.73; 95%CI 1.11, 2.70 and IRR = 1.94; 95%CI 1.22, 3.07, for moderate and severe exacerbations, respectively). MEP concentrations were inversely associated with incidence of exacerbations during the follow-up period. ConclusionsWe found that exposure to select phthalates was associated with respiratory morbidity among COPD patients. Findings warrant further examination in larger studies given widespread phthalate exposures and potential implications for COPD patients should relationships observed be causal.

Clinical Characteristics, Treatment Patterns and Economic Burden of COPD in Kyrgyzstan: A FRESH AIR Study.

BackgroundCOPD prevalence and mortality in Kyrgyzstan are high. Data on clinical and economic impact of COPD in Kyrgyzstan are scarce. This study was part of the FRESH AIR research project that focused on prevention, diagnosis and treatment of chronic lung diseases in low-resource settings.AimWe aimed to evaluate the clinical characteristics, treatment patterns and economic burden of COPD in Kyrgyzstan.MethodsA representative sample of patients with a spirometry-confirmed diagnosis of COPD was included. All patients were registered in one of the five major hospitals in Kyrgyzstan. Patients were surveyed on COPD risk factors, health-care utilization and patient reported outcomes (CCQ, MRC). Associations with high symptom burden (MRC score ≥4) and cost were assessed using logistic regression analyses.ResultsA total of 306 patients were included with mean age 62.1 (SD: 11.2), 61.4% being male, mean BMI 26.9 (SD: 5.2) and mean monthly income $85.1 (SD: 75.4). Biomass was used for heating and cooking by 71.2% and 52.0%. Current and ex-smokers accounted 14.1% and 32%. Mean FEV1 was 46% (SD: 12.8), 71.9% had COPD GOLD III–IV and most frequent co-morbidities were hypertension (25.2%), diabetes (5.6%) and heart diseases (4.6%). Mean CCQ score was 2.0 (SD: 0.9) and MRC score 3.7 (SD: 0.9). Yearly mean number of hospital days due to COPD was 10.1 (SD: 3.9). Total annual per-patient costs of reimbursed health-care utilization ($107) and co-payments ($224, ie, 22% of patients’ annual income) were $331. We found that only GOLD IV and hypertension were significantly associated with high symptom burden. Exacerbations and hypertension were significantly associated with high cost.ConclusionThe clinical and economic burden of COPD on patients and the government in Kyrgyzstan is considerable. Notably, almost half of interviewed patients were current or ex-smokers and biomass exposure was high.

The effect of dual bronchodilatory therapy on the clinical control of chronic obstructive pulmonary disease in real clinical practice

Today, achieving clinical control in patients with chronic obstructive pulmonary disease (COPD) remains relevant. Thus, the results of a large multicenter study of clinical efficacy of dual bronchodilatory therapy in real practice conducted in Eastern Europe, including the Russian Federation, are of great interest.Aim. Assessment of changes in the clinical control in patients with COPD receiving treatment with LABA/LAMA combination (tiotropium/olodaterol 5/5 μg via the Respimat® inhaler) in real clinical practice.Methods. The study included patients (n = 1 476) with COPD older than 40 years who were prescribed tiotropium/olodaterol 5/5 μg via the Respimat® inhaler according to the current Russian and foreign clinical guidelines. The observation period was 6 weeks. The clinical control of COPD was assessed by the CCQ questionnaire, the patient’s general condition, the severity of dyspnea according to the mMRC scale, the incidence of using short-acting bronchodilators to relieve symptoms. The criterion for therapeutic success was a 0.4 point decrease in the CCQ score, the minimal clinically important differenceResults. The treatment with tiotropium/olodaterol 5/5 μg was successful, i.e., led to a decrease in the number of CCQ points by more than 0.4 points, in 89.84% of patients (95% CI 88.2 – 91.3 %; p &lt; 0.0001). On average, the overall CCQ score between the first and second visit decreased by 1.31 ± 0.97 points, the severity of symptoms – by 1.39 ± 1.03 points, the functional state – by 1.2 ± 1.1 points, the mental condition – by 1.38 ± 1.31 CCQ points. Achievement of clinical control did not depend on comorbid pathology, disease severity, patient age, and the previous therapy.Conclusion. The results obtained on a wide sample of patients from real practice confirmed the high clinical efficacy of tiotropium/olodaterol 5/5 μg in achieving clinical control of COPD.

The Effects of Low Pressure Domiciliary Non-Invasive Ventilation on Clinical Outcomes in Patients with Severe COPD Regardless Having Hypercapnia.

BackgroundThe effectiveness of non-invasive home ventilation in patients with severe chronic obstructive pulmonary disease (COPD) is lacking. Non-invasive home ventilation might be more effective when high ventilator settings are used. However, high ventilator settings might reduce patient adherence. We have developed a multidisciplinary approach (ventilation practitioners, 24 hours support of respiratory nurses, physicians) to non-invasive ventilation aimed at optimizing patient adherence using low ventilator settings in severe COPD patients with high disease burden irrespectively having hypercapnia.MethodsWe included in a proof of concept, prospective interventional study, 48 GOLD stage III–IV COPD patients with a high disease burden (≥2 exacerbations in a year, and Medical Research Council dyspnea scores ≥3). Outcome measures included hospital admissions, capillary pCO2, Medical Research Council dyspnea scores (MRC), Clinical COPD Questionnaire scores (CCQ) and Hospital Anxiety and Depression Scale (HADS).ResultsAfter 1 year 32 patients could be evaluated. Hospital admissions decreased by 1.0 admission (mean difference ± SD: 1.0 ± 1.48; p = 0.001). In-hospital days decreased by 10.0 days (10.0 ± 15.48; p = 0.001). Capillary pCO2 decreased by 0.33 kPa (0.33 ± 0.81: p = 0.03). The MRC dyspnea score decreased by 0.66 (0.66 ± 1.35; p = 0.02). The CCQ score decreased by 0.59 (0.59 ± 1.39; p = 0.03). The HADS anxiety score decreased by 1.64 (1.64 ± 3.12; p = 0.01). The HADS depression score decreased by 1.64 (1.64 ± 3.91; p = 0.04).ConclusionA proof of concept multidisciplinary approach, using low pressure domiciliary non-invasive ventilation, aimed at optimizing patient adherence in severe COPD patients regardless having hypercapnia, reduced hospital admissions and improved symptoms and quality of life measures. This may imply that severe COPD patients with high disease burden, irrespective being hypercapnic, are candidates to be treated with low pressure domiciliary non-invasive ventilation.

Long-Term Auscultation in Chronic Obstructive Pulmonary Disease: Renaissance of an Ideograph of Medical Care

Background: Electronic auscultation technology has advanced dramatically in the last few years. Therefore, long-term pulmonary auscultation could provide additional information about respiratory system by monitoring acute chronic obstructive pulmonary disease (AECOPD) exacerbations or by identifying wheezing phenotypes amongst stable COPD patients. Objectives: Comparison of respiratory sounds in stable versus AECOPD patients recorded with a portable respiratory sound monitor over a period of 24 h. Methods: This prospective trial evaluated cough and wheezing events using an auscultation monitor specially developed for this purpose with 4 integrated highly sensitive microphones, in stable and severely AECOPD patients for a period of 24 h in an inpatient setting. Results: Twenty stable COPD patients (12 male, 60%) and 20 severely exacerbated COPD patients (14 male, 70%) were analyzed. In AECOPD patients, long-term auscultation revealed a significantly higher number of wheezing epochs than stable COPD patients (591 [IQR: 145–1,645] vs. 152 [IQR: 90–400]; p = 0.021). Conversely, cough epochs did not differ between AECOPD and stable COPD patients (213 [IQR: 140–327] vs. 162 [IQR: 123–243]; p = 0.256). The Borg-dyspnea scale, CAT score, and total CCQ score each showed no correlation with wheezing frequency, while CAT and CCQ scores did correlate with coughing frequency. Conclusion: Wheezing, but not coughing, occurs more frequently in AECOPD patients than in stable COPD patients, indicating that severe wheezing is an important clinical sign of exacerbation, while coughing is not. Therefore, the patterns of wheezing and coughing, as assessed by long-term auscultation, differ in stable versus exacerbated COPD patients.

Effectiveness of Characteristic Keynote Prescription of Homeopathic Medicines in Acute Nasopharyngitis in Paediatric Age Group - A Prospective, Longitudinal Observational Study

Acute Nasopharyngitis is a common upper respiratory tract infection caused by adenoviruses, influenza, rhinovirus, parainfluenza or respiratory syncytial viruses. This prospective, longitudinal, observational study was conducted at SKHMC, Jaipur for a period of 1 year (April 2018 to March 2019), aiming to ascertain the effectiveness of characteristic keynote prescription of homoeopathic medicines in the cases of Acute Nasopharyngitis in paediatric age group. In this study, 59 cases of Acute Nasopharyngitis were treated with homoeopathic medicines prescribed on the basis of totality of the symptoms along with characteristic keynote symptoms. Treatment outcomes were assessed using Common Cold Questionnaire. Out of 59 patients, 36 patients (61.0%) were improved; 15 patients (25.5%) were at status quo, and 08 patients (13.5%) became worse. Maximum patients were found to be in the age group of School Age children (n=27; 45.8%) and Pre-School children (n=21; 35.6%). Males were observed to be affected more as compared to females. Paired ttest was conducted on the CCQ scores obtained before and after treatment and the result showed that p value was &lt; 0.05 &amp; t = 8.404, which was statistically significant which concluded that characteristic keynote prescription of homoeopathic medicines was effective in cases of Acute Nasopharyngitis. Keywords Homeopathy; Common Cold; School age children; Observational study

Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis

Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.

Validation of the St George’s respiratory questionnaire and risks factors affecting the quality of life of Lebanese COPD and asthma patients

Objective: We aimed to validate the Arabic version of the St George’s Respiratory Questionnaire (SGRQ) for use in Lebanese Chronic obstructive pulmonary disease (COPD) and asthma patients and to identify risk factors that might affect the quality of life in these patients. Methods: COPD (n = 90) and asthma patients (n = 124) were recruited from the outpatient clinics of the Pulmonology department of a university hospital and a medical center in Beirut. They filled out a standardized questionnaire. The total SGRQ score and the component scores (symptoms, activity and impacts) were calculated. To confirm the SGRQ validity in the Lebanese population, factor analyses were applied for the whole sample, only asthma and only COPD patients, respectively. The associations between the total SGRQ score and FEV1% predicted, CCQ score and MRC scale were assessed. Multiple linear regression models were used to evaluate the association between the total SGRQ scores and the socio-demographics and the diseases risk factors. Results: COPD patients had a higher SGRQ total and subscales scores compared to asthma patients. A high Cronbach’s alpha was found for the whole sample (0.802), only COPD patients (0.833) and only asthma patients (0.734). A significant negative correlation was found between FEV1% predicted and the total SGRQ scores. Occupational exposure, BMI and previous waterpipe smoking were among the factors that significantly and positively influenced a higher SGRQ score. Conclusions: The Lebanese version of the SGRQ emerges as a good health-related quality of life evaluative instrument that is reasonable to be used in COPD and asthma patients in Lebanon.

The cutoff point of clinical chronic obstructive pulmonary disease questionnaire for more symptomatic patients

BackgroundAn adequate threshold for the Clinical Chronic Obstructive Pulmonary Disease (COPD) Questionnaire (CCQ) defining more symptomatic COPD patients has not been determined. We aimed to determine the efficacy of the CCQ and the appropriate CCQ threshold for more symptomatic COPD patients.MethodsCOPD patients aged > 40 years who smoked/had smoked ≥10 packs/year were prospectively enrolled over 1 year from three South Korean hospitals (n = 126). Correlations between the CCQ and St. George’s Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), the modified Medical Round Council (mMRC) scale, lung function, and exercise capacity were evaluated. “More symptomatic patients” were those with an SGRQ score ≥ 25. Area under the receiver operating curve and classification and regression tree analyses were performed to determine the CCQ threshold equivalent to an SGRQ score ≥ 25.ResultsThe CCQ significantly correlated with the SGRQ, CAT, and mMRC scale (r = 0.76, 0.69, and 0.53, respectively). A CCQ cutoff of 1.4 predicted an SGRQ score of 25 better than others. A CCQ score of 1.4 was a significant determinant of an SGRQ score ≥ 25 even after adjusting for potential confounders.ConclusionsThe CCQ was correlated with other symptom indicators, lung function, and exercise capacity. A CCQ cutoff of 1.4 agreed better than CCQ cutoff of 1.0, suggested by guideline, and this cutoff value may identify more symptomatic COPD patients well.Trial registrationClinicalTrials.gov Identifier: NCT02527486. Date of registration: December 19, 2014, retrospectively registered.

Effectiveness of case management in the prevention of COPD re-admissions: a pilot study

BackgroundChronic obstructive pulmonary disease (COPD) exacerbations are associated with high disease burden and costs, especially in the case of hospitalizations. The overall number of hospital admissions due to exacerbations of COPD has increased. It is remarkable that re-admissions account for a substantial part of these hospitalizations. This pilot study investigates the use of case management to reduce re-admissions due to COPD.MethodsCOPD patients with more than one hospitalization per year due to an exacerbation were included. The participants (n = 10) were closely monitored and intensively coached for 20 weeks after hospitalization. The case manager provided care in a person-focused manner. The case manager informed and supported the patient, took action when relapse threatened, coordinated and connected primary and secondary care. Data of 12 months before and after start of the intervention were compared. Primary outcome was the difference in number of hospitalizations. Secondary outcomes were health-related quality of life (measured by the Clinical COPD Questionnaire, CCQ) and dyspnoea (measured by the MRC Dyspnoea Scale).ResultsThe incidence rate of hospitalizations was found to be 2.25 times higher (95% confidence interval [CI] 1.3–3.9; P = 0.004) 12 months before compared with 12 months after the start of case management. COPD patients had a mean CCQ score of 3.3 (95% CI 2.8–3.8) before and 2.4 (95% CI 1.9–2.8) after 20 weeks of case management; a difference of 1.0 (95% CI 0.4–1.6; P = 0.001). The mean MRC scores showed no significant differences before (4.3; 95% CI 3.7–4.9) and after the case management period (3.9; 95% CI 3.2–4.6); a difference of 0.4 (95% CI − 0.1 to 0.9; P = 0.114).ConclusionsThis pilot study shows that the number of COPD hospital re-admissions decreased significantly after the introduction of a case manager. Moreover, there was an improvement in patient-reported health-related quality of life.

Effect of add-on valproate on craving in methamphetamine depended patients: A randomized trial.

Background:Methamphetamine dependence lead to the compulsive use, loss of control, and social and occupational dysfunctions. This study aimed to compare the effect of valproate in reducing the craving in methamphetamine dependents.Materials and Methods:This is a randomized, double-blind, controlled clinical trial on 40 men of 18–40 years old referred to Noor Hospital during December 2012–September 2013 in Isfahan, Iran. The subjects participated in matrix program and randomly were divided into two groups of valproate and placebo. A 4-months program of intervention with valproate or placebo was arranged for each group. The rate of craving to methamphetamine and positive methamphetamine urine tests were evaluated in both groups every 2 weeks using cocaine craving questionnaire-brief (CCQ-Brief) and urine test. After the 4 months (active treatment with valproate and placebo), the drug was tapered and discontinued within 10 days, and patients were introduced to self-help groups and monitored regularly on a weekly basis over another 3 months. Collected data were analyzed with SPSS 20 using analysis of covariance repeated measure, Chi-square, and t-test.Results:CCQ score of the intervention group was significantly less than the placebo group (P < 0.001), except on weeks 1, 3, and 28. The ratio of a positive urine test for methamphetamine in the intervention group was significantly lower than the control group in all screenings except weeks 3 and 28.Conclusion:Adding valproate to matrix program in the treatment of methamphetamine dependence showed significant effect on the reduction of the craving to methamphetamine.

Mapping the Clinical Chronic Obstructive Pulmonary Disease Questionnaire onto Generic Preference-Based EQ-5D Values

ObjectivesTo develop a model to predict EuroQol five-dimensional questionnaire (EQ-5D) values from clinical chronic obstructive pulmonary disease (COPD) questionnaire (CCQ) scores. MethodsWe used data from three clinical trials (the Randomized Clinical Trial on Effectiveness of Integrated COPD Management in Primary Care [RECODE], the Assessment Of Going Home Under Early Assisted Discharge [GO-AHEAD], and the Health Status Guided COPD Care [MARCH]). Data were randomly split into an estimation sample and a validation sample. The conceptual similarity between patient-reported CCQ and preference-based EQ-5D scores was assessed using correlation and principal-component analysis. Different types of models were estimated with increasing complexity. We selected the final models on the basis of mean absolute error and root mean square error when comparing predicted and observed values from the same population (internal validity) and from different trial populations (external validity). We also developed models for different country-specific EQ-5D value sets. ResultsThe principal-component analysis showed that the CCQ domains functional state and mental state are associated with four dimensions of the EQ-5D. The EQ-5D dimension pain/discomfort formed a separate construct on which no CCQ item loaded. The mean observed EQ-5D values were not significantly different from the mean predicted EQ-5D values in internal validation samples but did significantly differ in external validation samples. The models underestimated EQ-5D values in milder health states and overestimated them in more severe health states. The predictive ability of the models was similar across different EQ-5D value sets. ConclusionsThe models can predict mean EQ-5D values that are similar to observed mean values in a similar population. The overestimating/underestimating of the low/high EQ-5D values, however, limits its use in Markov models. Therefore, mapping should be used cautiously.

자아탄력-자아통제 수준에 따른 청소년의 기질 및 성격 특성

Objectives:The purpose of present study is to identify the differences between temperament and character traits among ado- lescents classified by ego resilience and ego control level. Methods:A Junior Temperament and Character Inventory (TCI) was performed on participants, and a California Child Q- Test (CCQ) was tested for by the parents of the adolescent participants. Results:The result of the factor analysis and discriminant analysis show that the participants are classified into three different groups based on CCQ score and item response patterns. The three groups are named the ego resilience group, the undercon- trolled group, and the overcontrolled group. The ego resilience group indicates that they have a high level of interest and curiosi- ty but yet they are not easily tempered. Moreover, they behave proactively with a reasonable level of responsibility in order to improve themselves. In contrast, among the undercontrolled group, it is observed that, although the group shows even higher level of interest, curiosity and honesty, they are careless, more impulsive, and have a lack of delayed gratification and shame. Conclusions:The overcontrolled group shows that they are the most cautious and reflective group among the three but also show emotional instability such as strong criticism and passive-aggressiveness. In this study, implications and limitations are dis- cussed.

Tolerability and efficacy of inhaled AZD4818, a CCR1 antagonist, in moderate to severe COPD patients

This study evaluated the tolerability and efficacy of inhaled AZD4818, a CCR1 antagonist, in patients with COPD. This double-blind, placebo-controlled study (NCT00629239) randomised patients with moderate to severe COPD to AZD4818 300mug or placebo twice daily via Turbuhaler((R)) for 4 weeks. Safety, lung function, functional capacity and health status measures were measured. Plasma concentrations of AZD4818 were measured after the first dose and after 2 and 4 weeks' treatment. Sixty-five patients (47 male; median age 65.6 years) received AZD4818 (n=33) or placebo (n=32). There was no statistically significant difference between AZD4818 and placebo in change from baseline to endpoint for FEV(1) (AZD4818-placebo: 0.026L, p=0.69), morning PEF (-6L/min, p=0.23), or other lung function measures. There was no difference between treatment groups in the 6-min walk test, MMRC dyspnoea index, BODE index and CCQ scores. Plasma concentrations indicated that patients were exposed to AZD4818 as expected. AZD4818 was well tolerated: 27 treatment-related adverse events (13 with AZD4818, 14 with placebo), 2 serious adverse events (both AZD4818: exacerbation [considered not treatment-related] and deep vein thrombosis [considered treatment-related]) and 11 discontinuations (7 with AZD4818). Inhaled AZD4818 was well tolerated at 300mug twice daily for 4 weeks in patients with COPD; however, there was no indication of a beneficial treatment effect despite exposure as expected. These findings in COPD are in line with other studies reporting a lack of clinical efficacy with CCR1 antagonists in other therapy areas.

Validation of the Clinical COPD questionnaire in Italian language

BackgroundThe development and validation study of the Clinical Chronic Obstructive Disease (COPD) Questionnaire (CCQ) has recently been published in this journal. The CCQ is the first questionnaire that incorporates both clinician and patient guideline goals in the clinical control evaluation of patients with COPD in general clinical practice. The aim of this study is the validation of the CCQ questionnaire in Italian, in specific pulmonary disease clinical practice.MethodsValidity was tested on a population of healthy subjects and patients with COPD, using the Italian validated version of the Short Form Health Survey (SF-36) and guideline recommended routine measurement in COPD patients (FEV1, FVC, BMI and functional dyspnoea). Test-retest reliability was tested by re-administering the CCQ after 2 weeks. Responsiveness was tested by re-administering the CCQ after three weeks of hospital pulmonary rehabilitation. Distance walked and Borg breathlessness rating were measured at the end of the six-minute walking test (6 MWT), before and after rehabilitation.ResultsCross-sectional data were collected from 175 subjects (55 healthy; 40 mild-moderate, 50 severe and 25 very severe COPD). Cronbach's alpha was high (0.89). The CCQ scores in patients were significantly worse than in healthy subjects. The CCQ total score in patients with COPD was significantly worse in those with BMI < = 21. Significant correlations were found between the CCQ total score and domains of the SF-36 (rho = -0.43 to rho = -0.72). The correlation between the CCQ and FEV1 % predicted was rho = -0.57. The correlation between the CCQ and MRC was rho = 0.63. Test-retest reliability was determined in 112 subjects over a period of two weeks (Intra Class Coefficient = 0.99). Forty-six patients with COPD showed significant improvement in CCQ scores, distance-walked and Borg breathlessness rating after 3 weeks of pulmonary rehabilitation, indicating CCQ responsiveness.ConclusionsThe CCQ is self-administered and has been specially developed to measure clinical control in patients with COPD. Data support its validity, reliability and responsiveness in Italian and in specific pulmonary disease clinical practice.