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Dyspnea primary health care

Daniel Doyle, Chaffee Tommarello, Mike Broce, Mary Emmett, Cecil Pollard
PURPOSE: To report on the implementation and clinical outcomes of a community-based pulmonary rehabilitation program in rural Appalachia. METHODS: Three rural health centers and a large referral hospital worked together to establish pulmonary rehabilitation services based on AACVPR guidelines. Each site hired at least 1 respiratory therapist. To measure clinical outcomes, a retrospective medical record study compared pre- and post-program values for the modified Medical Research Council dyspnea level, 6-minute walk test (6MWT), negative inspiratory force (NIF), respiratory disease knowledge, St George Respiratory Questionnaire (SGRQ), BODE index (body mass index, airflow obstruction, dyspnea and exercise capacity), and smoking status...
March 16, 2017: Journal of Cardiopulmonary Rehabilitation and Prevention
Glenmore Lasam, Roberto Ramirez
We report a case of a 48-year-old female who presented initially with an abrupt onset of left facial and hand numbness after her routine yoga with no associated syncope, palpitation, chest pain or dyspnea. She consulted her primary care physician and recommended hospital care for possible stroke. On the day of admission, she complained of left facial and hand hemiparesthesia. Cranial imaging and angiography were unremarkable but echocardiography and cardiac computed tomography revealed left atrial mass. She underwent resection of the left atrial mass with an incidental finding of patent foramen ovale intraoperatively...
February 2017: Cardiology Research
Yousuke T Horikawa, Tina Y Udaka, Janet K Crow, John I Takayama, Martin T Stein
Toshi, a 14-year-old Japanese boy, had uncontrolled asthma after relocating from Japan with his family 1 year ago. In Japan, he was diagnosed with moderate, persistent asthma, which was controlled with salmeterol and albuterol on an as needed basis. Since moving to the United States, Toshi complained of frequent dyspnea.Initially, he was seen by a Japanese physician who prescribed 200 mg of fluticasone 3 times a day and albuterol nebulization as needed. When Toshi came to the Pediatric Primary Care Clinic, he reported using his nebulizer up to 25 times daily...
February 2017: Journal of Developmental and Behavioral Pediatrics: JDBP
Andrés M Bur, Jason A Brant, Carolyn L Mulvey, Elizabeth A Nicolli, Robert M Brody, John P Fischer, Steven B Cannady, Jason G Newman
Importance: Unplanned hospital readmission is costly and in recent years has become a focus of health care legislation intended to reduce health care expenditures. Greater understanding of which perioperative complications are associated with hospital readmission after surgery for head and neck cancer is needed to reduce unplanned readmissions. Objective: To determine which clinical risk factors and complications are associated with 30-day unplanned readmission after surgery for malignant neoplasms of the head and neck...
December 1, 2016: JAMA Otolaryngology—Head & Neck Surgery
Ehud Chorin, Allison Padegimas, Ofer Havakuk, Edo Y Birati, Yacov Shacham, Anat Milman, Guy Topaz, Nir Flint, Gad Keren, Ori Rogowski
INTRODUCTION: Health care demand is increasing due to greater longevity of patients with chronic comorbidities. This increasing demand is occurring in a setting of resource scarcity. To address these changes, high-value care initiatives, such as telemedicine, are valuable resource-preservation strategies. This study introduces the Roth score as a telemedicine tool that uses patient counting times to accurately risk-stratify dyspnea severity in terms of hypoxia. HYPOTHESIS: The Roth score has correlation with dyspnea severity...
November 2016: Clinical Cardiology
Vicki Johnson-Warrington, Karen Rees, Colin Gelder, Mike D Morgan, Sally J Singh
INTRODUCTION: Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue. OBJECTIVE: To investigate if SPACE for COPD employed upon hospital discharge would reduce readmission rates at 3 months, compared with usual care...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Roberto Benzo, Kristin Vickers, Paul J Novotny, Sharon Tucker, Johanna Hoult, Pamela Neuenfeldt, John Connett, Kate Lorig, Charlene McEvoy
RATIONALE: Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. OBJECTIVES: To determine the effect of comprehensive health coaching on the rate of COPD readmissions. METHODS: A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care...
September 15, 2016: American Journal of Respiratory and Critical Care Medicine
Jin Ren, Bo Li, Dan Yu, Jing Liu, Zhongsen Ma
Haze weather is becoming one of the biggest problems in many big cities in China. It triggers both public anxiety and official concerns. Particulate matter (PM) plays the most important role in causing the adverse health effects. Chemical composition of PM2.5 includes primary particles and secondary particles. The toxicological mechanisms of PM2.5 to the human body include the oxidative stress, inflammation and carcinogenesis. Short or long-term exposure to PM (especially PM2.5) can cause a series of symptoms including respiratory symptoms such as cough, wheezing and dyspnea as well as other symptoms...
January 2016: Journal of Thoracic Disease
Yuko Okamoto, Sakiko Fukui, Kazuhiro Yoshiuchi, Takako Ishikawa
OBJECTIVE: Our goal was to investigate the association between actual place of death among Japanese home end-of-life care patients with advanced cancer and individual, illness, and environmental factors, including the presence or absence of symptoms. METHODS: Using structured interviews, we asked 44 nurses from 19 home-visit nursing agencies about changes in status of all 123 of their home end-of-life care patients with advanced cancer between April and September 2013...
May 2016: Journal of Palliative Medicine
David B Coultas, Bradford E Jackson, Rennie Russo, Jennifer Peoples, John Sloan, Karan P Singh, Jamile Ashmore, Steven N Blair, Minyong Uhm, Sejong Bae
RATIONALE: Physical inactivity is associated with poor outcomes among patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES: To determine effectiveness of a behavioral intervention intended to increase daily physical activity with the goal of improving health-related quality of life and functional performance. METHODS: We conducted a randomized trial among patients with COPD cared for in primary care and pulmonary clinics...
May 2016: Annals of the American Thoracic Society
Heidrun Lingner, Anika Großhennig, Kathrin Flunkert, Heike Buhr-Schinner, Rolf Heitmann, Ulrich Tönnesmann, Jochen van der Meyden, Konrad Schultz
BACKGROUND: Available data assessing the efficacy of pulmonary rehabilitation for patients with chronic sarcoidosis are scant; for Germany, there are none at all. OBJECTIVE: To gain information about the benefit of in-house pulmonary rehabilitation for patients with chronic sarcoidosis and for the health care system, we intend to collect data in a prospective multicenter "real-life" cohort trial. METHODS: ProKaSaRe (Prospektive Katamnesestudie Sarkoidose in der pneumologischen Rehabilitation) [Prospective Catamnesis Study of Sarcoidosis in Pulmonary Rehabilitation] will assess a multimodal 3-week inpatient pulmonary rehabilitation program for adult patients with chronic sarcoidosis over a 1-year follow-up time...
2015: JMIR Research Protocols
Hooman Sharifi, Mohammad Reza Masjedi, Habib Emami, Mostafa Ghanei, Alireza Eslaminejad, Golnar Radmand, Sonia Buist
BACKGROUND: Chronic obstructive pulmonary disease (COPD) was ranked the sixth-most common cause of death worldwide in 1990, but now it is the third-most common cause. The goal of the present study was to assess the prevalence and determine the causes and risk factors of COPD in Tehran. MATERIALS AND METHODS: This study followed a stratified cluster sampling strategy with proportional allocation within strata. The target population was all non-institutionalized inhabitants, aged 18 to 40 in one group and over 40 in another who resided in Tehran in 2013...
November 2015: Lung India: Official Organ of Indian Chest Society
Guy Brusselle, David Price, Kevin Gruffydd-Jones, Marc Miravitlles, Dorothy L Keininger, Rebecca Stewart, Michael Baldwin, Rupert C Jones
BACKGROUND: Real-world prescription pathways leading to triple therapy (TT) (inhaled corticosteroid [ICS] plus long-acting β2-agonist bronchodilator [LABA] plus long-acting muscarinic antagonist) differ from Global initiative for chronic Obstructive Lung Disease [GOLD] and National Institute for Health and Care Excellence treatment recommendations. This study sets out to identify COPD patients without asthma receiving TT, and determine the pathways taken from diagnosis to the first prescription of TT...
2015: International Journal of Chronic Obstructive Pulmonary Disease
Marilyn L Moy, Peter M Wayne, Daniel Litrownik, Douglas Beach, Elizabeth S Klings, Roger B Davis, Gloria Y Yeh
BACKGROUND: Persons with chronic obstructive pulmonary disease (COPD) have reduced exercise capacity and levels of physical activity. Supervised, facility-based pulmonary rehabilitation programs improve exercise capacity and reduce dyspnea, but novel long-term strategies are needed to maintain the benefits gained. Mind-body modalities such as Tai Chi which combine aerobic activity, coordination of breathing, and cognitive techniques that alleviate the physical inactivity, dyspnea, and anxiety and depression that are the hallmarks of COPD are promising strategies...
November 2015: Contemporary Clinical Trials
Cecilia López Ramírez, Carmen Calero Acuña, Cristina Represas Represas, Luz Aballe Santos, Ricard Casamor, Alberto Fernández-Villar, José Luis López-Campos
INTRODUCTION: Despite widespread recommendations to use standardized questionnaires and multidimensional indices for the assessment of patients with chronic obstructive pulmonary disease (COPD), few data are available on the application of these tools in clinical practice. This study evaluates the attitude of physicians participating in the On-Sint cohort toward the use of health status questionnaires and multidimensional indices, as well as toward the frequency of visits and spirometry in primary care and specialized care...
July 6, 2015: Clinical Respiratory Journal
Chun-Mei Xiao, Yong-Chang Zhuang
OBJECTIVES: To investigate the effectiveness of a 6-month Liuzijue qigong (LQG) program in promoting physical and psychosocial function in individuals with chronic obstructive pulmonary disease (COPD). DESIGN: Single-blind, randomized controlled trial. SETTING: Seven hospital respiratory care centers in Beijing. PARTICIPANTS: Individuals with COPD (N = 126; mean age 71.1 ± 2.7, range 65-85). METHODS: Participants were randomly assigned to one of two groups: LQG (n = 63) and control (n = 63)...
July 2015: Journal of the American Geriatrics Society
Abebaw Mengistu Yohannes, Patrick J Raue, Dora Kanellopoulos, Amanda McGovern, Jo Anne Sirey, Dimitris N Kiosses, Samprit Banerjee, Joanna K Seirup, Richard S Novitch, George S Alexopoulos
BACKGROUND: COPD is a major cause of all-cause mortality. We examined predictors of 1-year mortality in patients with severe COPD and major depression after inpatient treatment in a rehabilitation hospital. METHODS: We screened 898 consecutively admitted patients. Of these, 138 patients received the diagnoses of COPD according to American Thoracic Society Guidelines and major depression by Diagnostic and Statistical Manual of Mental Disorders, 4th edition and signed consent; 67 were randomized to a treatment adherence enhancement intervention and 71 to usual care...
February 2016: Chest
Maria Conceição de Castro Antonelli Monteiro de Queiroz, Maria Auxiliadora Carmo Moreira, Jose R Jardim, Maria Alves Barbosa, Ruth Minamisava, Heicilainy Del Carlos Gondim, Flávia Castro Velasco, Maria Vitoria Carmo Penhavel
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is often underdiagnosed, which might be attributable to a lack of knowledge about the disease among the general population. The objective of this study was to evaluate COPD-related knowledge among primary care users in an urban area in Brazil. METHODS: This study was carried out at primary care clinics (PCCs), including 12 general PCCs and 26 family health PCCs, in the city of Goiânia, Brazil. Between May 2013 and February 2014, we interviewed 674 PCC users, applying a questionnaire designed to assess COPD-related knowledge...
2015: International Journal of Chronic Obstructive Pulmonary Disease
Annemarie L Lee, Anne E Holland
Exercise intolerance, exertional dyspnea, reduced health-related quality of life, and acute exacerbations are features characteristic of chronic obstructive pulmonary disease (COPD). Patients with a primary diagnosis of COPD often report comorbidities and other secondary manifestations, which diversifies the clinical presentation. Pulmonary rehabilitation that includes whole body exercise training is a critical part of management, and core programs involve endurance and resistance training for the upper and lower limbs...
2014: International Journal of Chronic Obstructive Pulmonary Disease
Denis E O'Donnell, Kevin B Gebke
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and, although it is a preventable and treatable disease, it often remains undiagnosed in patients with mild disease. It is now evident that pathologic changes and physiologic impairment start early in disease progression, and even patients with mild airflow limitation have impairment in the form of exertional dyspnea, general fatigue, and exercise intolerance. Primary care physicians are optimally positioned to recognize these progressive activity restrictions in their patients, usually involving little more than a detailed patient history and a simple symptom questionnaire...
September 2014: Postgraduate Medicine
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