Personal Action Plans Research Articles

VISION TRAINING TO IMPROVE CLASSROOM ENDURANCE POST-TBI: A CASE STUDY WITH A 26-YEAR-OLD FEMALE

Background: Concussions, also referred to as a mild traumatic brain injury (mTBI), can present a multitude of symptoms due to the complex pathophysiology incurred by the brain. It is known that these mTBI-induced symptoms, when left unresolved, can lead to post-concussive syndrome (PCS). Commonly, these patients complain of vision-related dysfunctions. These dysfunctions interrupt patients’ everyday lives, including students when participating in the classroom due to the heavy visual involvement. Numerous vision therapies and management strategies have been successful for the treatment of mTBI-induced visual-related symptoms such as exotropia, suppression, and oculomotor dysfunction. Vision training has been found to be successful in improving oculomotor endurance, giving patients the ability to maintain focus for long periods of time and to mitigate against suppression. Background: Concussions, also referred to as a mild traumatic brain injury (mTBI), can present a multitude of symptoms due to the complex pathophysiology incurred by the brain. It is known that these mTBI-induced symptoms, when left unresolved, can lead to post-concussive syndrome (PCS). Commonly, these patients complain of vision-related dysfunctions. These dysfunctions interrupt patients’ everyday lives, including those of students, when participating in the classroom due to the heavy visual involvement. Numerous vision therapies and management strategies have been successful for the treatment of mTBI-induced visual-related symptoms such as exotropia, suppression, and oculomotor dysfunction. Vision training successfully improves oculomotor endurance, allowing patients to maintain focus for long periods andmitigate against suppression. Case Report: This report describes a 26-year-old female presenting with activity-induced sensory overload, specifically in the setting of her college classroom lectures. The patient described symptoms appearing as headache, fatigue, and blurred vision. Upon initial examination, she was determined to have a left eye exophoria with fatigue-induced left eye suppression and left eye lateral abduction deficiencies. A personalized action plan was designed to improve left-right oculomotor symmetry and endurance and mitigate against suppression through a weekly structured vision training program. In this 7-week program, individual and dual eye saccadic exercises improved, with both eye horizontal saccades improving from 26 characters read aloud per minute to 36 characters read out loud per minute. With these regular vision training sessions, the patient displayed improved oculomotor endurance, decreased suppression with prolonged activity, and better dual-eye coordination. After the post-vision training program, the patient could attend her college lectures without invoking symptoms.

Medication Adherence in Children with Asthma.

Asthma is the most common chronic disease in childhood. If untreated, asthma can lead to debilitating daily symptoms which affect quality of life, but more importantly can lead to fatal asthma attacks which unfortunately still occur globally. The most effective treatment strategy for controlling asthma is for the patient to follow a personalised asthma action plan (PAAP) which will invariably include regular use of an inhaled corticosteroid. To examine medication adherence in children with asthma, we collated recent evidence from systematic reviews in this area to address the following 5 key questions; What is adherence? Is there evidence that children are not adhering to preventer medication? Why is adherence poor and what are the barriers to adherence? Does good adherence improve outcomes in asthma? And lastly, how can treatment adherence be improved?

Impact of the implementation of a telemedicine program on patients diagnosed with asthma

BackgroundAsthma is one of the most common respiratory ailments worldwide. Despite broad understanding of the illness and of the available therapeutic options for it, patients with serious asthma suffer poor monitoring of their illness in 50% of cases.AimTo assess the impact of the implementation of a mobile application (ESTOI) to control asthma in patients diagnosed with the illness, their adherence to treatment, and their perceived quality of life.MethodologyRandomized clinical trial with 52 weeks’ follow-up of patients with asthma seen in a specialized hospital for their treatment in Spain. Some 108 included patients will be divided into two groups. The intervention group will undergo more exhaustive follow-up than normal, including access to the ESTOI application, which will have various categories of attention: control of symptoms, health recommendations, current treatment and personalized action plan, PEF record, nutritional plan, and chat access with a medical team. The asthma control questionnaire ACT is the main assessment variable. Other variables to be studied include an adherence test for the use of inhalers (TAI), the number of exacerbations, maximum exhalation flow, exhaled nitric oxide test, hospital anxiety and depression scale, asthma quality-of-life questionnaire, forced spirometry parameters (FVC, FEV1, and PBD), and analytic parameters (eosinophilia and IGE). The data will be collected during outpatient visits.Trial registrationThis trial has registered at ClinicalTrials.gov (Identifier: NCT06116292).

Climate change visualization awareness system

As the global community faces the escalating challenges posed by climate change, there is an increasing need for innovative tools that enhance public awareness and understanding of the complex and dynamic nature of environmental shifts. This paper introduces a Climate Change Visualization Awareness System (CCVAS), designed to bridge the gap between scientific data and public comprehension through immersive and accessible visualizations. Leveraging cutting-edge technologies, including augmented reality, interactive mapping, and data analytics, CCVAS provides users with real-time and historical insights into key climate indicators such as temperature variations, sea level rise, and extreme weather events. The CCVAS employs a user-centric approach, tailoring information to diverse audiences and promoting engagement through intuitive interfaces. Community engagement features facilitate collaborative efforts among users, enabling the sharing of experiences, knowledge, and initiatives aimed at addressing climate change challenges at the local and global levels. Users will be able to participate in discussions, organize events, and access community-driven resources within the CCVAS platform. Personalized user profiles enable individuals to customize their climate change experience within CCVAS, tailoring content and visualizations to their specific interests, expertise, and geographical locations. By providing personalized recommendations, alerts, and action plans based on user preferences and behavior, CCVAS will empower individuals to take meaningful steps towards climate resilience and sustainability in their daily lives. This paper outlines the architecture, functionality, and potential applications of the Climate Change Visualization Awareness System.

Asthma in Pregnancy: A Critical Review of Impact, Management, and Outcomes.

Asthma is a common chronic respiratory condition that can significantly impact the health of pregnant women and their developing fetuses. This comprehensive review provides insights into the prevalence of asthma in pregnant women, the physiological changes during pregnancy, and the multifaceted impact of asthma on maternal and fetal health. It emphasizes the importance of proper asthma diagnosis, medication management, and the development of personalized asthma action plans during pregnancy. Lifestyle modifications, trigger avoidance, and stress reduction are essential to effective management. Healthcare providers are pivotal in educating, monitoring, and individualized care to ensure optimal asthma control. The review underscores the critical significance of managing asthma during pregnancy, as it improves maternal and fetal outcomes and potentially influences long-term health for both mother and child. Future directions in this field involve ongoing research, personalized treatment, early intervention, and precision medicine to enhance the understanding and care of asthma during pregnancy.

A novel, multidomain, primary care nurse-led and mHealth-assisted intervention for dementia risk reduction in middle-aged adults (HAPPI MIND): study protocol for a cluster randomised controlled trial

IntroductionMiddle-aged multidomain risk reduction interventions targeting modifiable risk factors for dementia may delay or prevent a third of dementia cases in later life. We describe the protocol of a cluster...

A Digital Single-Session Intervention (Project Engage) to Address Fear of Negative Evaluation Among College Students: Pilot Randomized Controlled Trial.

Increasingly, college science courses are transitioning from a traditional lecture format to active learning because students learn more and fail less frequently when they engage in their learning through activities and discussions in class. Fear of negative evaluation (FNE), defined as a student's sense of dread associated with being unfavorably evaluated while participating in a social situation, discourages undergraduates from participating in small group discussions, whole class discussions, and conversing one-on-one with instructors. This study aims to evaluate the acceptability of a novel digital single-session intervention and to assess the feasibility of implementing it in a large enrollment college science course taught in an active learning way. To equip undergraduates with skills to cope with FNE and bolster their confidence, clinical psychologists and biology education researchers developed Project Engage, a digital, self-guided single-session intervention for college students. It teaches students strategies for coping with FNE to bolster their confidence. Project Engage provides biologically informed psychoeducation, uses interactive elements for engagement, and helps generate a personalized action plan. We conducted a 2-armed randomized controlled trial to evaluate the acceptability and the preliminary effectiveness of Project Engage compared with an active control condition that provides information on available resources on the college campus. In a study of 282 upper-level physiology students, participants randomized to complete Project Engage reported a greater increase in overall confidence in engaging in small group discussions (P=.01) and whole class discussions (P<.001), but not in one-on-one interactions with instructors (P=.05), from baseline to immediately after intervention outcomes, compared with participants in an active control condition. Project Engage received a good acceptability rating (1.22 on a scale of -2 to +2) and had a high completion rate (>97%). This study provides a foundation for a freely available, easily accessible intervention to bolster student confidence for contributing in class. OSF Registries osf.io/4ca68 http://osf.io/4ca68.

Feasibility and Usability of the Job Adjustment Mobile App for Pregnant Women: Longitudinal Observational Study.

Working pregnant women often need to adjust their physically demanding jobs for a healthy pregnancy. However, uncertainty about the extent of these adjustments can hinder their effectiveness. To address this, we developed the Job Adjustment mobile app, which allows users to input job and health details to generate a variety of personalized action plans. As this is the first version of the app, assessing its feasibility and usability is crucial. This study aims to verify the feasibility and usability of the Job Adjustment mobile app. A longitudinal observational study was conducted on pregnant Japanese women who were allowed to use the app anytime from 12 to 34 weeks of gestation; they received reminder emails every 2 weeks encouraging app use. A questionnaire was administered before app use and at 20 and 32 weeks of gestation. Feasibility was evaluated across 4 domains: implementation, demand, acceptability, and adverse events. Implementation was evaluated based on 3 parameters: dropout rate, initial reminder email receipt rate, and adherence rate (measured as pregnant women who used the app at intervals of 2.5 weeks or less). Demand was measured by intervals between use and intervals between log-in, and participants answered 15 questions to assess acceptability. Adverse events were assessed by analyzing the degree of anxiety related to work. Demographic data were analyzed to determine any statistically significant differences in intervals between uses. Usability was evaluated using the System Usability Scale. The analysis included 66 pregnant women, and 61% (n=40) of them were multipara. The dropout rate, adherence rate, and initial reminder email receipt rate were 18% (13/71), 44% (29/66), and 79% (52/66) respectively. The median intervals between use and intervals between log-in were 2.94 (IQR 2.00-5.13) weeks and 2.28 (IQR 1.81-4.00) weeks, respectively. Overall, 60% (35/58) to 90% (52/58) of the participants responded positively to all 15 questions assessing acceptability, and no anxiety regarding work was recorded. The mean System Usability Scale score was 66.1 points. Multipara women had significantly longer intervals between app use compared to primipara women (P=.01). The results demonstrated acceptable levels of feasibility and usability of the app. However, the low adherence rates, especially among multipara women, suggest the need for modifications to reduce the time burden of the app. Further research should explore more effective and acceptable intervals between use and timing, involving a larger sample and accounting for diverse characteristics of pregnant women. UMIN Clinical Trials Registry UMIN000042943; https://tinyurl.com/ydrchfas.

Factors Affecting Glaucoma Medication Adherence and Interventions to Improve Adherence: A Narrative Review.

Glaucoma is a leading cause of vision loss. First line therapy for primary open angle glaucoma (POAG) are topical ocular hypotensive drops. Patient adherence with topical therapy for glaucoma is a significant challenge with a reported adherence of 60%. The purpose of this review is to discuss factors associated with glaucoma adherence (including demographic factors, cost, patient education, health beliefs, treatment burden and regimen, and physical limitations) and to explore potential interventions to improve medication adherence. Articles included in this review were found by searching PubMed and Google Scholar using the key words "Glaucoma Treatment Adherence" and "Glaucoma Treatment Compliance." Data from this review demonstrates that higher medication cost, lower patient education/literacy levels, and being of African and Hispanic descent are associated with lower medication adherence rates. The data is inconclusive on whether medication regimen complexity lowers patient medication adherence rates. Interventions that have successfully improved medication adherence rates for minority patients have focused on building trust and addressing fears and false beliefs. For cost, explicit physician communication to patients regarding medication cost is important and can help the physician determine any patient concerns about cost. Outside the USA, adherence has been improved through adherence-contingent rebate systems and government subsidies. Most interventions that aim to increase adherence target patient education and literacy with the following interventions demonstrating efficacy: written instructions targeting glaucoma-specific health literacy, literacy level appropriate glaucoma education videos, and interactive and personalized educational programs. More clinic infrastructure and programs that utilize patient reminder tools and patient educators could help physicians and patients in support of these personalized action plans.

Regular (up to 10 puffs 4-hourly) inhaled salbutamol should be prescribed at discharge after an asthma attack: myth or maxim?

Over the past 20 years, the concept of asthma weaning plans on discharge after an attack has crept into common practice, although the precise origin of these plans is unclear. High use of short-acting β2-agonists (SABAs) may result in tolerance to their bronchodilator effects, thus diminishing their efficacy, particularly when they are most needed at the time of an acute attack. Furthermore, key warning signs of a deterioration in asthma control may be masked and the weaning plan may encourage the over-use and over-reliance on SABAs. Side-effects from over-use may also occur, including lactic acidosis, downregulation of the β2-adrenoreceptor, increased allergen response and pro-inflammatory effects. The need for asthma education at discharge, a personal asthma action plan and vigilance about prescribing and ensuring adherence to maintenance therapy are definitely important. However, the current authors conclude that the benefit of prescribing regular salbutamol (up to 10 puffs every 4 h) at discharge after an acute asthma attack is a myth, and a very dangerous one.

THE EFFECT OF A DIGITAL HEALTH INTERVENTION ON PEOPLE WITH DIAGNOSED AND UNDIAGNOSED HYPERTENSION: A RETROSPECTIVE COHORT ANALYSIS

Objective: This study aims to show that a digital health intervention can help people with diagnosed or undiagnosed hypertension reduce their blood pressure and control their disease. Design and method: This retrospective study was conducted in January 2023 on people who reported a diagnosis of hypertension (self-reported group) or who logged in a systolic blood pressure of &gt; = 140 mmHg or a diastolic blood pressure of &gt; = 90 mmHg (undiagnosed group) who were enrolled on CompleteHealth™ between January and June 2022. CompleteHealth™ is a digital platform that allows members to access both a coach-led multidisciplinary care team and a platform for monitoring and tracking their health. The care team (comprising nutritionists, behavioural wellness coaches, and a fitness coach) engages with the members through an omnichannel approach. It provides regular digital nudges on monitoring their blood pressure, health education, and nutritional advice. The members work with their health coaches to create personalised action plans to achieve their health goals, e.g increased exercise, weight loss, and better diets. Results: 1,203 people in both groups enrolled on CompleteHealth™ over the study period and entered a baseline and follow-up value for their blood pressure. 242 (20.12%) of these people self-reported a diagnosis of hypertension, while 961 (79.88%) presented with a baseline blood pressure of &gt;140/90 mmHg. In the self-reported group, 93 people (38.43%) had controlled blood pressure at baseline, which rose to 150 (61.98%) at the end of the study. The group saw their average blood pressure fall from 149/95 mmHg to 131/85 mmHg at the end of the study. The undiagnosed group saw the number of people with controlled blood pressure rise from 68 (7.08%) to 695 (72.32%), while the average blood pressure of the group fell from 140/94 mmHg to 129/82 mmHg at the end of the study. Conclusions: While there is a need for further awareness about hypertension, especially to encourage testing and diagnosis, we have been able to show that the combination of a digital health intervention and virtual health coaching can help people who have hypertension or elevated blood pressure control their blood pressure.

A brief online single session intervention increases undergraduate confidence speaking out in an active learning physiology course

Increasingly, college physiology courses are transitioning from traditional lecture to active learning because students learn more and fail less when they engage in their learning through activities and discussions in class. Fear of negative evaluation (FNE), defined as a student’s sense of dread associated with being unfavorably evaluated while participating in a social situation, discourages undergraduates from participating in small group discussions, whole class discussions, and conversing one-on-one with instructors. FNE disproportionately impacts women, persons excluded because of their ethnicity or race (PEERs), LGBTQ+ individuals, and those coming from low socioeconomic backgrounds. To equip undergraduates with skills to cope with fear of negative evaluation and bolster their confidence, clinical psychologists and biology education researchers developed Project Engage, a digital, self-guided single-session intervention for college students. It teaches students strategies for coping with and reducing fear of negative evaluation by providing biologically-informed psychoeducation, utilizing interactive elements for engagement, and generating a personalized action plan. In a study of 300 upper-level physiology students, participants randomized to complete Project Engage reported greater increases in overall confidence in engaging in small group discussions (p &lt; 0.01), whole class discussions (p &lt; 0.001) and one-on-one interactions with instructors (p&lt;0.05), from baseline to immediate post-intervention, compared to participants in an active control condition. This work provides a foundation for a freely-available, easily accessible intervention to bolster student confidence contributing in class, with the hope of creating more equitable active learning physiology courses. NSF grant #2141681 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Factors Influencing Use of Personalized Asthma Action Plans among Adult Patients Aged 18-65 in Nyamira County Kenya

Introduction: Globally the World Health Organization (WHO) estimates that up to 334 million people suffer from asthma. In Kenya it is estimated that about 10% of the Kenyan population, or 4 million people, have asthma.&#x0D; Aim: The objective of this study was to assess factors influencing the use of personalized asthma action plans among patients aged 18-65 in Nyamira County.&#x0D; Methodology: Cross-sectional study design was employed in this research. Participants were selected using systematic sampling. Significant differences in categorical variables were found using the Chi-square and Fisher's Exact Test. The threshold for statistical significance was set at p&lt;0.05.&#x0D; Results: The study sample size was 220 asthma patients. Findings showed that majority did not use PAAPs with a response of 168(76.4%) respondents while those who used were 52(23.6%). Knowledge on PAAPs was low at 160(72.7%) against, 60(27.3%) who were knowledgeable. There was poor attitude and practices on use of PAAPs. Statistically there were significant association between the various patients’ factors influencing use of asthma action plans among adult asthmatic patients with a p = 0. 021. Among the health care givers, on knowledge of PAAPs 3 had knowledge while 3 did not. Among those who had knowledge the practice on use was low in which majority indicated that they don’t discuss and prescribe PAAPs with a response of 5 while 1 do. Statistically there were significant association on the health care workers’ factors influencing use of PAAPs at p = 0.03. Lack of training was a key institutional factor hindering use in which 3 (60.0%) had received training in the last 6 months while 2(40.0%) had not received. Statistically there were significant association on the institutional factors influencing use of PAAPs at p = 0.004.&#x0D; Conclusion: From the respondent’s majority of the patients were found not to be using the personalized asthma action plan cards. Lack of knowledge was a leading factor among the patient’s respondents. There was also a poor attitude reported in the patients’ respondents in which majority felt that they were for very sick patients. Among the health care givers; only one out of the six had this template/card in their office. Although half of the health care givers had general knowledge but it was not demonstrated in the use of PAAPs hence showing a gap in some specific skills needed. More workload and lack of these templates in the clinics were the major institutional factors hindering use of these tools.

IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial

BackgroundAsthma is a common long-term condition and major public health problem. Supported self-management for asthma that includes a written personalised asthma action plan, supported by regular professional review, reduces unscheduled consultations and improves asthma outcomes and quality of life. However, despite unequivocal inter/national guideline recommendations, supported self-management is poorly implemented in practice. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMP2ART strategy increases the provision of asthma action plans and reduces unscheduled care in the context of routine UK primary care.MethodsIMP2ART is a parallel group, cluster randomised controlled hybrid II implementation trial. One hundred forty-four general practices will be randomly assigned to either the IMP2ART implementation strategy or control group. Following a facilitation workshop, implementation group practices will receive organisational resources to help them prioritise supported self-management (including audit and feedback; an IMP2ART asthma review template), training for professionals and resources to support patients to self-manage their asthma. The control group will continue with usual asthma care. The primary clinical outcome is the between-group difference in unscheduled care in the second year after randomisation (i.e. between 12 and 24 months post-randomisation) assessed from routine data. Additionally, a primary implementation outcome of asthma action plan ownership at 12 months will be assessed by questionnaire to a random sub-group of people with asthma. Secondary outcomes include the number of asthma reviews conducted, prescribing outcomes (reliever medication and oral steroids), asthma symptom control, patients’ confidence in self-management and professional support and resource use. A health economic analysis will assess cost-effectiveness, and a mixed methods process evaluation will explore implementation, fidelity and adaptation.DiscussionThe evidence for supported asthma self-management is overwhelming. This study will add to the literature regarding strategies that can effectively implement supported self-management in primary care to reduce unscheduled consultations and improve asthma outcomes and quality of life.Trial registrationISRCTN15448074. Registered on 2 December 2019.

Increased inhaled corticosteroids for treating acute asthma exacerbations

Increased inhaled corticosteroids for treating acute asthma exacerbations

Expert consensus on monitoring antimicrobial stewardship in French nursing homes using assessed reimbursement database indicators.

Monitoring the appropriateness of antibiotic prescriptions with indicators based on reimbursement data is required to guide antibiotic stewardship (AMS) interventions in nursing homes (NHs). Quantity metrics (QMs) monitor the volume of prescriptions while proxy indicators (PIs) reflect the appropriateness of antibiotic use. Our objectives were: (i) to provide a relevant consensual set of indicators to be used in French NHs; and (ii) to assess the feasibility of their implementation at the national and local scale. Nine French professional organizations implicated in AMS in NHs were asked to nominate at least one member to create a national expert panel of 20 physicians. Twenty-one recently published QMs and 11 PIs were assessed by the expert panel. Indicators were evaluated using a RAND-modified Delphi procedure comprising two online surveys and a videoconference meeting. Indicators were kept in the final list if >70% of stakeholders validated their relevance for estimating the volume (QMs) and appropriateness (PIs) of prescriptions. Of the 21 QM indicators submitted to the panel, 14 were selected, describing the consumption of antibiotics overall (n = 3), broad-spectrum (n = 6) and second-line antibiotics (n = 2). The three remaining QMs evaluated the route of administration (n = 1) and urine culture prescriptions (n = 2). Ten PIs (six modified, two rejected, one new) were selected to assess the appropriateness of prescriptions for urinary tract infections (n = 2), seasonal variations in prescriptions (n = 2), repeated prescriptions of fluoroquinolones (n = 1), cephalosporins' route of administration (n = 1), duration of treatment (n = 1), rate of second-line antibiotics (n = 1), co-prescriptions with non-steroidal anti-inflammatory drugs (n = 1), and flu vaccine coverage (n = 1). The panel was in favour of using these indicators for regional and facility level AMS programmes (91%), feedback to NH prescribers (82%), benchmarking by health authorities (55%) and public reporting at the facility level (9%). This consensual list of indicators, covering a wide range of frequent clinical situations, may be used as part of the French national AMS strategy for monitoring antibiotic prescriptions in NHs at the national and local levels. Regional AMS networks might manage this selected list to guide personalized action plans with concrete objectives of reducing the quantity and improving the quality of antibiotic prescriptions.

Knowledge, Attitude and Practices on the Use of Asthma Action Plans among Adult Asthmatic Patients Aged 18-65 in Nyamira, Kenya

Introduction: Globally the World Health Organization (WHO) estimates that up to 334 million people suffer from asthma. In Kenya it is estimated that about 10% of the Kenyan population, or 4 million people, have asthma.&#x0D; Aim: The objective of this study was to assess knowledge, attitude and practices of patients 18-65 on the use of personized asthma action plans in Nyamira County.&#x0D; Methodology: Cross-sectional study design was employed in this research. Participants were selected using systematic sampling. Significant differences in categorical variables were found using the Chi-square and Fisher's Exact Test. The threshold for statistical significance was set at p&lt;0.05.&#x0D; Results: The study sample size was 220 asthma patients. The majority of responders 72.7% were unaware of PAAPs. Concerning attitude, most of participants had a negative attitude about the use of PAAPs, believing that they should only be used by the extremely ill 63.6%. Poor practices were seen among the patients who had access to these tools, with 39.0% checking them at home and 61.0% never checking them at all. Statistically there were significant association between the various patients’ factors influencing use of asthma action plans among adult asthmatic patients with a p = 0. 021.&#x0D; Conclusion: The majority of the patients 76.4% who participated in this research did not use the personalized asthma action plan cards. Additionally, the majority of participants reported poor practices on PAAPs, low levels of awareness, and negative attitudes. To combat the low-level knowledge, negative attitude, and poor practices among asthma patients, the ministry of health should raise awareness about the use of PAAPs.

СУЧАСНІ ПІДХОДИ ЛІКУВАННЯ БРОНХІАЛЬНОЇ АСТМИ ЗГІДНО GINA 2023

In 1993 there was initiated the Global Initiative for Asthma Management and Prevention. Each year GINA is revised and each subsequent revision contains updated recommendations based on new data. It’s underlined in red throughout GINA 2023 the significance of ICScontaining therapy. The best treatment approach for adults and adolescents remains Track 1 with ICS/formoterol as needed. Track 2 now also includes an ICS/SABA combination as needed as an Anti-inflammatory Reliever (AIR), but Track 1 remains the “preferred” regimen. Although inhaled SABA are highly effective for rapid relief of asthma symptoms, patients whose asthma is treated with SABA alone (compared with ICS) have an increased risk of death and asthma-related emergency medical care needs. For safety reasons, GINA does not recommend SABA alone for the treatment of asthma in adults, adolescents, or children 6–11 years of age. Is it possible to treat asthma without SABA? In an asthma center in Argentina, since 2014, a treatment strategy with ICS-containing symptom relievers has been implemented: using only budesonide/formoterol in a single inhaler across all spectrums of asthma severity and completely excluding the use of SABA. As a result, the level of hospitalization decreased by 92%. The 2023 revision of GINA proposed new terminology for anti-asthma drugs: Maintenance therapy, controller drugs, reliever drugs, anti-inflammatory reliever, Maintenance and Reliever Therapy - MART. Clarifications have been made for the treatment of asthma exacerbations. Added details on drugs and doses of ICS/formoterol on demand and ICS/SABA as needed, MART regimen in individual asthma action plan, how and when to modify these drugs as the disease worsens. The inhaler prescription algorithm is written in more details, considering its impact on the environment. Conclusions: The GINA 2023 updates highlight the most significant role of ICS-containing therapy in achieving asthma control and preventing exacerbations. However, patient adherence to therapy remains quite low, so an approach that allows for the management of both symptoms and exacerbations simultaneously is simpler and remains the preferred way of asthma therapy. Global approaches to asthma management - limiting, where possible, the use of SABA and favoring delivery devices and treatment regimens with less environmental impact. Managing the patient according to his personal action plan and creating local protocols can limit the use of SABA, improve the patient’s asthma outcomes and environmental impact. Key words: asthma, GINA, inhalers, asthma control, exacerbation

Transition from pediatric to adult care in chronic respiratory diseases: The cystic fibrosis model

Increased life expectancy in cystic fibrosis has made transition from pediatric to adult cystic fibrosis centers a crucial step for patients, their families and caregivers. This transition must be gradual and carefully prepared. A formalized process, early discussion with patients and families about transition, patient's empowerment prior to transfer, and close links between pediatric and adult teams are key points to succeed. Therapeutic education, validated questionnaires, personalized action plans or connected tools can help. Transfer will take place at the appropriate time for each patient, ideally during a period of disease stability, in a progressive manner, with joint or alternating consultations between pediatric and adult cystic fibrosis center teams. Other chronic respiratory diseases with pediatric onset may benefit from similar transition processes.

Three Cooperative Extension initiatives funded to address Michigan's opioid crisis.

People living with opioid use disorder and those experiencing other types of substance misuse are part of a public health crisis in the United States. Rates of opioid misuse, overdose, and opioid-related deaths within different subpopulations show where prevention efforts must focus. Through concerted efforts, aligned with common goals, a statewide community-based educational organization (Michigan State University Extension) has demonstrated ability to acquire multi-year funding from varied sources of state and federal funds that has produced robust support for statewide projects and collaborations. Researchers, educators, public health program managers, and other practitioners can benefit from learning how three funded initiatives in one state resulted in improved awareness and access for individuals and healthcare organizations. By sharing our implementation of health educational programs and presentations, other states' can adopt these evidence-based strategies for similar outreach. Cooperative Extension in Michigan delivers program series and one-time education to the public on the self-management of chronic conditions and pain, mindfulness for stress reduction, anger management, and opioid misuse prevention, treatment, and recovery. These evidence- and research-based health programs implemented by Extension staff teach participants common aspects of prevention such as self-management care, communication skills, self-efficacy, and goal setting or personal health action plans. Education aims to reduce dependency on opioids, prevent opioid misuse and share non-pharmacological solutions to pain management for those living with chronic conditions or at risk for developing dependence. The funded initiatives targeted rural residents, older adults, health care providers, and people living with chronic pain who may have access to prescription opioids. In addition to direct education, projects supported local communities with the development of coalitions, including the training of community partners to become program facilitators thereby increasing community capacity for prevention programs, and through the creation of patient referrals from healthcare settings to community-based education. In rural areas, Cooperative Extension plays a crucial role in connecting community resources to address healthy aging, and chronic disease or chronic pain self-management education. Community partners engaged in public health education and promotion, and healthcare providers alike may not be aware that Cooperative Extension plays a vital role in providing community-based health education.