Chronic Pulmonary Heart Research Articles

Implementation of a breathlessness management programme with an incentive handheld fan as a nonpharmacological approach in dyspnoea management in patients with advanced chronic obstructive pulmonary disease and chronic heart failure

Implementation of a breathlessness management programme with an incentive handheld fan as a nonpharmacological approach in dyspnoea management in patients with advanced chronic obstructive pulmonary disease and chronic heart failure

Barriers and facilitators to mainstreaming telehealth in the community – exploring staff views and roles at the implementation and delivery phase

Background: The future large-scale deployment of Assisted Living Technologies crucially depends on establishing patient benefit at scale. This entails overcoming barriers to uptake, and devising viable service and business models. This current project, MALT: Overcoming Barriers to Mainstreaming Assisted Living Technologies, funded by the Technology Strategy Board through the Assisted Living Innovation Platform, aims to explore these issues with a focus on the delivery of telehealth for people with chronic obstructive pulmonary disease and chronic heart failure. Aim: To explore the barriers and facilitators to telehealth across four sites currently delivering community based services in the Yorkshire and Humber region. In particular, this paper focuses on the perceptions and roles of frontline staff at the implementation and delivery phases of telehealth, which are identified as both potential barriers and facilitators to mainstreaming telehealth successfully. Methods: This first phase of the study involved qualitative interviews with samples of frontline nursing staff; managers, commissioners and other key stakeholders; and patients and carers from each site. Drawing on the existing literature, the data were analysed thematically to identify the barriers and facilitators to successful telehealth implementation and delivery. Results: Staff views of telehealth as a new tool for practice range from resistance and scepticism, to acceptance and enthusiasm, and there are varying opinions about the overall rationale for using telehealth in the community and the patient groups most likely to benefit. Where initial perceptions about telehealth are negative and the availability of training, support and encouragement limited, acceptance of telehealth among frontline staff can be low. Staff engagement at the implementation phase is also influenced by other factors such as workload and working practices; rapid organisational change; and existing information systems and technology. ‘Local champions’ who promote, encourage and support staff, and share their positive experiences of using telehealth can help to counteract these barriers and persuade staff to introduce telehealth for their patients. Other facilitators were also found to be important, including clear and robust systems for installation, technical support and patient monitoring; and user-friendly and appropriate equipment. International Congress on Telehealth and Telecare 2013, London, July 01-03, 2013. 2 International Journal of Integrated Care –Volume 13, 20 November –URN:NBN:NL:UI:10-1-115694– http://www.ijic.org/ Conclusions: Effective service implementation hinges on the acceptance of frontline staff who assume responsibility for promoting the use of telehealth; selecting and referring patients for telehealth; installing and maintaining telehealth equipment; monitoring patients and managing alerts; supporting users of telehealth and meeting their health and related needs; and case managing patients. For some staff telehealth is only one aspect of their wider role, and where perceptions are initially negative, sharing positive stories about using telehealth can encourage staff to challenge these views and learn more about the potential benefits of using telehealth, both for their patients and themselves. However, sharing best practice can be difficult at the implementation phase due to the range of services and staff groups involved in delivering telehealth, and because success stories are not always immediately available.

An examination of social support influences on participation for older adults with chronic health conditions

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs.Implications for RehabilitationVarying types of social support can improve participation in older adults with chronic health conditions.Tangible support and positive social interaction support are the strongest predictors of participation.Creating networks for companionship may be equally as important as providing support for daily living needs.

Symptom Burden

Symptom Burden

2013 SYR Accepted Poster Abstracts

SYR 2013 Accepted Poster abstracts: 1. Benefits of Yoga as a Wellness Practice in a Veterans Affairs (VA) Health Care Setting: If You Build It, Will They Come? 2. Yoga-based Psychotherapy Group With Urban Youth Exposed to Trauma. 3. Embodied Health: The Effects of a Mind-Body Course for Medical Students. 4. Interoceptive Awareness and Vegetable Intake After a Yoga and Stress Management Intervention. 5. Yoga Reduces Performance Anxiety in Adolescent Musicians. 6. Designing and Implementing a Therapeutic Yoga Program for Older Women With Knee Osteoarthritis. 7. Yoga and Life Skills Eating Disorder Prevention Among 5th Grade Females: A Controlled Trial. 8. A Randomized, Controlled Trial Comparing the Impact of Yoga and Physical Education on the Emotional and Behavioral Functioning of Middle School Children. 9. Feasibility of a Multisite, Community based Randomized Study of Yoga and Wellness Education for Women With Breast Cancer Undergoing Chemotherapy. 10. A Delphi Study for the Development of Protocol Guidelines for Yoga Interventions in Mental Health. 11. Impact Investigation of Breathwalk Daily Practice: Canada-India Collaborative Study. 12. Yoga Improves Distress, Fatigue, and Insomnia in Older Veteran Cancer Survivors: Results of a Pilot Study. 13. Assessment of Kundalini Mantra and Meditation as an Adjunctive Treatment With Mental Health Consumers. 14. Kundalini Yoga Therapy Versus Cognitive Behavior Therapy for Generalized Anxiety Disorder and Co-Occurring Mood Disorder. 15. Baseline Differences in Women Versus Men Initiating Yoga Programs to Aid Smoking Cessation: Quitting in Balance Versus QuitStrong. 16. Pranayam Practice: Impact on Focus and Everyday Life of Work and Relationships. 17. Participation in a Tailored Yoga Program is Associated With Improved Physical Health in Persons With Arthritis. 18. Effects of Yoga on Blood Pressure: Systematic Review and Meta-analysis. 19. A Quasi-experimental Trial of a Yoga based Intervention to Reduce Stress and Promote Health and Well-being Among Middle School Educators. 20. A Systematic Review of Yoga-based Interventions for Objective and Subjective Balance Measures. 21. Disparities in Yoga Use: A Multivariate Analysis of 2007 National Health Interview Survey Data. 22. Implementing Yoga Therapy Adapted for Older Veterans Who Are Cancer Survivors. 23. Randomized, Controlled Trial of Yoga for Women With Major Depressive Disorder: Decreased Ruminations as Potential Mechanism for Effects on Depression? 24. Yoga Beyond the Metropolis: A Yoga Telehealth Program for Veterans. 25. Yoga Practice Frequency, Relationship Maintenance Behaviors, and the Potential Mediating Role of Relationally Interdependent Cognition. 26. Effects of Medical Yoga in Quality of Life, Blood Pressure, and Heart Rate in Patients With Paroxysmal Atrial Fibrillation. 27. Yoga During School May Promote Emotion Regulation Capacity in Adolescents: A Group Randomized, Controlled Study. 28. Integrated Yoga Therapy in a Single Session as a Stress Management Technique in Comparison With Other Techniques. 29. Effects of a Classroom-based Yoga Intervention on Stress and Attention in Second and Third Grade Students. 30. Improving Memory, Attention, and Executive Function in Older Adults with Yoga Therapy. 31. Reasons for Starting and Continuing Yoga. 32. Yoga and Stress Management May Buffer Against Sexual Risk-Taking Behavior Increases in College Freshmen. 33. Whole-systems Ayurveda and Yoga Therapy for Obesity: Outcomes of a Pilot Study. 34. Women's Phenomenological Experiences of Exercise, Breathing, and the Body During Yoga for Smoking Cessation Treatment. 35. Mindfulness as a Tool for Trauma Recovery: Examination of a Gender-responsive Trauma-informed Integrative Mindfulness Program for Female Inmates. 36. Yoga After Stroke Leads to Multiple Physical Improvements. 37. Tele-Yoga in Patients With Chronic Obstructive Pulmonary Disease and Heart Failure: A Mixed-methods Study of Feasibility, Acceptability, and Safety. 38. Effects of an Ashtanga Yoga-based Health and Wellness Curriculum on Physical and Emotional Well-being, Engagement Toward School, and Academic Performance of K-6 Students. 39. Yoga as a Facilitator for Participation Following an 8-week Yoga for Individuals With Chronic Stroke. 40. Standardization of Design and Reporting of Yoga Interventions for Musculoskeletal Conditions: A Delphi Approach. 41. Creating S.P.A.C.E. Through Yoga: Africa Yoga Project Teachers Promote Personal Transformation, Peaceful Communities, and Purpose-filled Service.

Mission possible: Helping patients get the medications they need

system,” said Ransom. “The care we provide during this transition phase links inpatient services and outpatient services. It’s a collaborative effort among the different [health professions] in the continuum of care.” In addition to improving markers of clinical care, such as A1C (glycosylated hemoglobin) and blood pressure, the MAP program has reduced the number of hospitalizations and decreased hospital length of stay for uninsured patients at Mission Health. Meeting a need With as many as 44 million Americans without insurance and as many as 17.1 million Americans underinsured, there is a critical need to help patients obtain the medications they need after hospital discharge. Based in Asheville, NC, Mission Health’s MAP began in the late 1990s as a way to help seniors with medication access. The program evolved and expanded to include patients discharged from the hospital with no prescription coverage. Around 2006, the program’s focus evolved once again to where pharmacists and other health professionals help patients aged 18 to 64 years who are uninsured gain access to medications. The MAP team most often counsels patients with depression, diabetes, chronic obstructive pulmonary disorder, heart failure, hypertension, and hyperlipidemia. Uninsured and underinsured patients who need medication assistance or are at high risk for readmission based on their medication history are referred to the MAP after hospital discharge. These patients often face complex situations and barriers to accessing health care, such as transportation challenges and low health literacy. The multidisciplinary MAP team includes two pharmacists, two pharmacy technicians, a licensed clinical social worker, two prescription assistance coordinators, and administrative support. Ransom has been with the MAP program for the past 6 years and has held a leadership role for the past year. He meets with patients one-on-one after they were recently discharged. He also helps with chronic disease management, supports pharmacy operations, and maintains grant application and tracking processes.

Giant Lambl’s excrescence: a rare incidental finding at autopsy

An 88 year old man collapsed unexpectedly while being transported to a medical examination due to suspected bronchopulmonary infection. Additionally, he had complained of diffuse abdominal pain several hours prior to his death. Resuscitation efforts were unsuccessful and he was pronounced dead at the scene. Due to the unexpected nature of his death, the deceased was referred for postmortem evaluation. His past medical history included chronic obstructive pulmonary disease and ischemic heart disease. Postmortem examination showed unremarkable external findings, except for palpably fractured ribs caused by closed chest compressions performed during attempted resuscitation. Internal examination revealed segmental intestinal infarction secondary to acute occlusion of the superior mesenteric artery by thrombus superimposed upon severe atherosclerosis. Macroscopically, the infarcted section of the intestine appeared gangrenous, edematous, and diffusely dark-purple in color. Sectioning of the heart revealed a small, sea anemone-like structure on the surface of the tricuspid valve measuring 1.2 cm in diameter (Figs. 1, 2). In addition, further autopsy findings included diffuse peritonitis and mild intraperitoneal hemorrhage. Microscopic examination of the aforementioned endocardial structure with hematoxylin-eosin (Fig. 3a, b), Movat’s pentachrome (Fig. 3c), and Masson’s trichrome stains showed fragments of gelatinous, arborescent tissue covered by hyperplastic endothelial cells. All of these structures were composed predominantly of a myxoid stroma with occasional elastic fibers and small amounts of collagen, typical of a papillary fibroelastoma. The cause of death was transmural intestinal necrosis caused by acute arterial thrombotic occlusion sustained as the result of severe mesenteric atherosclerosis.

Home Care Safety Markers: A Scoping Review

Safety in home care is a new research frontier, and one in which demand for services continues to rise. A scoping review of the home care literature on chronic obstructive pulmonary disease and congestive heart failure was thus completed to identify safety markers that could serve to develop our understanding of safety in this sector. Results generated seven safety markers: (a) Home alone; (b) A fixed agenda in a foreign language; (c) Strangers in the home; (d) The butcher, the baker, the candlestick maker; (e) Medication mania; (f) Out of pocket: The cost of caring at home; and (g) My health for yours: Declining caregiver health.

Obesity Affects Severity of Symptoms and Quality of Life in Patients with Fibromyalgia

Copyright: © 2013 Oh TH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Fibromyalgia is a chronic pain condition affecting 2-6% of the US population [1,2], and is characterized by widespread pain, tenderness, and various associated features, including fatigue, morning stiffness, unrefreshing sleep, and cognitive symptoms and physical and psychological impairment. Fibromyalgia has a major impact on quality of life (QOL). It has been shown that women with fibromyalgia have QOL below the general population and comparably lower than patients with other chronic conditions such as rheumatoid arthritis, osteoarthritis, permanent ostomy, chronic obstructive pulmonary disease, insulin-dependent diabetes, advanced cancer, or congestive heart failure [3].

Can Peak Expiratory Flow Measurements Differentiate Chronic Obstructive Pulmonary Disease from Congestive Heart Failure?

Dyspneic patients are commonly encountered by Emergency Medical Service (EMS). Frequent causes include Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). Measurement of peak expiratory flow rate (PEFR) has been proposed to help differentiate COPD from CHF. This prospective, cohort, pilot study was conducted to determine if PEFR in patients with an exacerbation of COPD were significantly different than CHF. Included were patients presenting with dyspnea plus a history of COPD and/or CHF. A PEFR was measured, values were compared to predicted average, and a percentage was calculated. Twenty-one patients were enrolled. Six had a diagnosis of COPD, 12 CHF; 3 had other diagnoses. Mean percentage of predicted PEFR with COPD was 26.36%, CHF 48.9% (P = 0.04). Patients presenting with acute COPD had significantly lower percentage of predicted PEFR than those with CHF. These results suggest that PEFR may be useful in differentiating COPD from CHF. This study should be expanded to the prehospital setting with a larger number of subjects.

Un cas rare d’aspergillome volumineux développé au sein d’une lésion de fibrose pulmonaire secondaire à une sclérodermie systémique chez une malade immunocompétente à Madagascar

We report a rare case of a huge aspergilloma developed within a bronchiectasis due to pulling by a pulmonary fibrosis of systemic scleroderma. The patient is a 58-year-old woman presenting a deterioration of the general state associated with repeating hemoptysis, dyspnea, dysphagia, sclérodactylia, generalized cutaneous sclerosis and Raynaud’s phenomenon. There was no antecedent pulmonary tuberculosis. The patient had a pulmonary arterial hypertension complicated by a chronic pulmonary heart at the stage of right cardiac decompensation. Aspergillosis serology was positive and the immunological assessment confirmed scleroderma. The computed tomography showed a huge oblong opacity in a small round bell shape (“signe du grelot”, Monad’s sign) in the left upper lobe developed within a bronchiectasis, and a bilateral pulmonary fibrosis. Although surgery remains the recommended treatment of an aspergilloma, the management of our patient was medical in front of contra-indication for surgery. The evolution was marked by repeating hemoptysis and stability of the pulmonary lesions 2 years later. The management of this entity remains difficult and complicated; the prognosis is in general unfavourable and depends at the same time on the evolution of scleroderma and the aspergilloma infection.

Health Outcomes Associated with Lung Function Decline and Respiratory Symptoms and Disease in a Community Cohort

Background: In workplace respiratory disease prevention, a thorough understanding is needed of the relative contributions of lung function loss and respiratory symptoms in predicting adverse health outcomes. Methods: Copenhagen City Heart Study respiratory data collected at 4 examinations (1976–2003) and morbidity and mortality data were used to investigate these relationships. With 15 or more years of follow-up for a hospital diagnosis of chronic obstructive pulmonary disease (COPD) morbidity, COPD or coronary heart disease (CHD) mortality, and all-cause mortality, risks for these outcomes were estimated in relation to asthma, chronic bronchitis, shortness of breath, and lung function level at examination 2 (1981–1983) or lung function decline established from examinations 1 (1976–1978) to 2 using 4 measures (FEV1 slope, FEV1 relative slope, American College of Occupational and Environmental Medicine's Longitudinal Normal Limit [LNL], or a limit of 90 milliliters per year [ml/yr]). These risks were estimated by hazard ratios (HR) and 95% confidence intervals (CI) adjusted for age, height-adjusted baseline forced expiratory volume in 1 second (FEV1/height2), and height. Results: For COPD morbidity, the increasing trend in the HR (95% CI) by quartiles of the FEV1 slope reached a maximum of 3.77 (2.76–5.15) for males, 6.12 (4.63–8.10) for females, and 4.14 (1.57–10.90) for never-smokers. Significant increasing trends were also observed for mortality, with females at higher risk. Conclusion: Lung function decline was associated with increased risk of COPD morbidity and mortality emphasizing the need to monitor lung function change over time in at-risk occupational populations.

Khronicheskoe legochnoe serdtse:klassifikatsiya, klinika, diagnostika,lechenie. Chast' I

Summary. In the first part of this review both domestic and foreign data from clinical and experimental researches relating to modern views on the definition, classification, clinical and morphological picture, as well as approaches to the treatment of chronic pulmonary heart (CPH) are presented. The CPH classification in stages and functional classes depending on the level of pulmonary failure, arterial oxygen saturation, right ventricular hypertrophy and heart failure are given. Modern methods of diagnosing CPH are introduced as well.

Bronchial provocation tests in clinical practice

Bronchial hyperresponsiveness, which consists of an exaggerated response of the airways to bronchoconstrictor stimuli, is one of the main characteristics of asthma, presented in nearly all asthmatic patients. Bronchial hyperresponsiveness may also be present in other diseases, such as allergic rhinitis, chronic obstructive pulmonary disease, cystic fibrosis, heart failure and respiratory infection, and with some medications, such as β-blockers. Bronchial provocation tests (also known as bronchial challenges) are used to evaluate bronchial responsiveness. These tests have become increasingly used over the last 20 years, with the development and validation of accurate, safe and reproducible tests, and with the publication of well-detailed protocols. Several stimuli can be used in a bronchial challenge, and they are classified as direct and indirect stimuli. There are many indications for a bronchial challenge. In this review, we discuss the main differences between direct and indirect stimuli, and the use of bronchial challenges in clinical practice, especially for confirming diagnoses of asthma, exercise-induced bronchoconstriction and cough-variant asthma, and for use among elite-level athletes.

Inspiratory muscle training in difficult to wean patients: work it harder, make it better, do it faster, makes us stronger

Weaning from prolonged mechanical ventilation is a complex, time-consuming process that involves the loss of force/generating capacity of the inspiratory muscle. In their study 'Inspiratory muscle strength training improves the outcome in failure to wean patients: a randomized trial', Martin and colleagues showed that the use of an inspiratory muscle strength program increased the maximal inspiratory pressure and improved weaning success compared to a control group. The study was performed mainly in post-surgical patients, however, and the results, therefore, may not be generalizable to other subsets of patients, such as those with chronic obstructive pulmonary disease or congestive heart failure. Indeed, the study applied so-called 'strength training' and not 'endurance training', which may be more appropriate in certain circumstances.

Quetiapine Not Quiet-a-pine—Not a Sleeper

The vast majority of quetiapine prescriptions in long-term care facilities are for low doses between 12.5 and 100 mg, mostly given at bedtime. In a retrospective chart review of 2231 nursing home residents from 4 states, the authors determined that the primary indications for quetiapine were behavioral disturbances associated with dementia. However, it is common to find quetiapine given as needed (PRN) and frequently for night-time administration in a variety of health care settings and for patients who may have been prescribed quetiapine for underlying psychiatric and nonpsychiatric illnesses. Insomnia is a chief complaint in older adults, especially females, with prevalence ranging from 20% to 40%. Initiating and maintaining sleep is difficult in older persons and can be characterized as nocturnal waking, insomnia, daytime napping, trouble falling asleep, waking too early, and waking not feeling rested. Underlying illnesses common in long-term care residents, such as chronic obstructive pulmonary disease, dementia, heart failure, pain, mood and anxiety disorders, depression, obstructive sleep apnea, Parkinson Disease, and inactivity, as well as medications and environmental factors, contribute to insomnia. In addition to treating the underlying condition and discontinuing contributingmedications when possible, the AmericanMedical Directors Association (AMDA) Clinical Practice Guidelines for Sleep Disorders in Long Term Care recommends nonpharmacologic approaches such as sleep hygiene counseling, bright light therapy, and cognitive-behavioral therapy for improving sleep before pharmacologic options are considered. Quetiapine is not recommended for sleep disorders by AMDA or other insomnia guidelines. Quetiapine is an atypical antipsychotic indicated for treatment of schizophrenia, acute manic or mixed episodes associated with bipolar

Palliativmedizin und fortgeschrittene, nicht heilbare Erkrankungen

Advanced incurable and life-threatening diseases of internal organs such as chronic obstructive pulmonary disease (COPD), heart failure, and terminal kidney failure are associated with considerable burden for the patients caused by pronounced symptoms (e.g., dyspnea, anxiety, depression) and unmet psychosocial needs. Nevertheless, in Germany addressing palliative medicine in the context of these disorders and co-treatment of these patients by cross-sector partnership with specialized palliative care physicians are not very developed. Against the background of an international perspective and current guidelines, general aspects of palliative care needs (symptom control, communication, advance care planning, etc.) are discussed together with the resultant implications for potential cooperation between internal medicine and palliative care as well as special aspects of the individual diseases (e.g., prognosis or implications of certain treatment options such as "automatic implantable cardioverter-defibrillator", AICD). Timely involvement of the specific expertise of palliative care medicine can ensure that the workload of the primary providers (and their teams) is reduced and better cross-sector management (hospital and home) of the severely ill patients and their families is achieved.

Heart failure and COPD: Partners in crime?

Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are both common diseases with major impact and seem to coexist more frequently than expected from their separate population prevalences. However, estimates of combined prevalence must be interpreted carefully because of imperfections and difficulties in assessment of both diseases. This review aims to highlight HF prevalence in patients with COPD and vice versa, with a critical analysis of studies performed. First, definition, diagnosis, and prevalence of COPD and of HF will be discussed. Subsequently, an overview of important studies concerning combined prevalence with their limitations will be presented. Finally, pathogenic mechanisms and diagnostic considerations in clinical practice will be discussed.

Noninvasive Ventilation in Adults with Acute Respiratory Distress: A Primer for the Clinician

Noninvasive ventilation (NIV) has become an integral part of critical care management. Despite > 2 decades of experience, it is relatively underused, with general utilization reported as a little over 10% in a recent international survey. Lack of training, knowledge, equipment, and experience with NIV may account for its slow adoption. Patient selection, staff training and experience, and prompt recognition of ineffective NIV are important components to successful application of NIV. Noninvasive ventilation does have a learning curve that may be steep for some institutions but must be mastered if the procedure is to become a successful institutional component of care. Patients with acute respiratory failure due to chronic obstructive pulmonary disease or congestive heart failure are ideal candidates for NIV, and optimal efficacy in associated conditions is often linked to these 2 conditions. Technical issues and written guidelines are addressed, including details of an adequate trial of therapy as well as criteria for intubation. Attention to these elements should increase the success rate of NIV, which in turn should increase its general use.

Gripe A (H1N1). Experiencia de Estados Unidos

Pneumonia and seasonal influenza have major repercussions on mortality, morbidity and costs worldwide. At the end of March 2009, an outbreak of influenza A (H1N1) was reported in Mexico that rapidly spread throughout the world, including the United States, reaching pandemic proportions. The activity of influenza A (H1N1) has reached levels higher than those reported in previous years, mainly affecting the pediatric population aged less than 18 years old. In addition, a group of comorbid conditions were more frequently associated in patients with severe influenza A (H1N1), including chronic pulmonary disease, immunosuppression, heart disease, obesity and pregnancy. The current pandemic has had a substantial impact on public health in the United States and in many other countries worldwide. Therefore, the present review aims to examine the North American experience of the influenza A (H1N1) epidemic, focussing chronologically on the epidemiology of the virus, high risk groups, diagnosis, vaccination and management.