Activation for self-management in asthma or COPD patients referred to a pulmonologist
Noortje KoolenAlex J. van ‘t HulPhilip van der WeesRichard DekhuijzenGert P. WestertYvonne F. Heijdra
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Introduction: An understanding of the level of activation for self-management, defined as patients' knowledge, skills and self-efficacy regarding self-management is important. It gives clues how self-management may be improved in the individual patient. In this study, the level of activation for self-management was assessed in patients with asthma or COPD at the time of referral by their General Practitioner to a pulmonologist. Method: Between September 2014-December 2016, the integrated health status was determined in patients with asthma or COPD referred to a pulmonologist using a specifically developed diagnostic pathway. Part of this diagnostic pathway is to examine the level of activation for self-management using the 13-item Patient Activation Measurement (PAM-13). The PAM-13 measures patients' activation for self-management. Four different levels of activation can be distinguished, from very low (PAM-1) to high (PAM-4). Results: 112 valid PAMs were obtained in patients with asthma and 90 in patients with COPD. The distribution of PAM scores in asthma patients was: 35% of the PAM-1, 21% PAM-2, 38% PAM-3 and 5% PAM-4. In COPD patients the distribution was: 30% PAM-1, 28% PAM-2, 36% PAM-3 and 7% PAM-4. Conclusion: In 56% of the asthma patients and in 58% of the COPD patients there is little or no degree of activation for self-management (PAM-1 and PAM-2) at the time of referral from primary to secondary care.Keywords:
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Introduction: An understanding of the level of activation for self-management, defined as patients' knowledge, skills and self-efficacy regarding self-management is important. It gives clues how self-management may be improved in the individual patient. In this study, the level of activation for self-management was assessed in patients with asthma or COPD at the time of referral by their General Practitioner to a pulmonologist. Method: Between September 2014-December 2016, the integrated health status was determined in patients with asthma or COPD referred to a pulmonologist using a specifically developed diagnostic pathway. Part of this diagnostic pathway is to examine the level of activation for self-management using the 13-item Patient Activation Measurement (PAM-13). The PAM-13 measures patients' activation for self-management. Four different levels of activation can be distinguished, from very low (PAM-1) to high (PAM-4). Results: 112 valid PAMs were obtained in patients with asthma and 90 in patients with COPD. The distribution of PAM scores in asthma patients was: 35% of the PAM-1, 21% PAM-2, 38% PAM-3 and 5% PAM-4. In COPD patients the distribution was: 30% PAM-1, 28% PAM-2, 36% PAM-3 and 7% PAM-4. Conclusion: In 56% of the asthma patients and in 58% of the COPD patients there is little or no degree of activation for self-management (PAM-1 and PAM-2) at the time of referral from primary to secondary care.
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Show the possibilities of diagnosing non - tuberculous mycobacteriosis of the lungs (NTML) in the practice of the pulmonologist.A survey of 90 patients with a confirmed diagnosis of non - tuberculous mycobacteriosis of the lungs (NTML) was presented. The diagnosis of pulmonary mycobacteriosis was established in accordance with the criteria proposed in 2007 by the American Thoracic Society and the American Society of Infectious Diseases (ATS/IDRS). Among the patients, 55 (61.1%) women prevailed, the average age was 51.2±15.3 years. Patients were evaluated complaints, the presence of concomitant diseases of the lungs, was carried out computed tomography of the chest high - resolution (HRCT), a culture study of sputum, in the absence of sputum or a single determination of the NTM culture in it, a study was conducted on materials of bronchoalveolar washout (ALS/BAL), or lung biopsies. Statistical processing of the research results was performed using descriptive statistics using Microsoft® Excel for Windows xp® on a personal computer.As a result of the study, it was revealed that before the diagnosis of NTML was established, 66.7% of patients were long observed for chronic lung diseases (chronic obstructive pulmonary disease, chronic bronchitis), and in 55.6% of cases (50 people) were registered with a phthisiologist about pulmonary tuberculosis. According to the CT scan of OGK, dissemination was determined in 66.7% of cases, in 48.9% - bronchiectasis, single or multiple destruction cavities - 46.7% of cases. In 72.2% of cases, non - tuberculous mycobacteria (NTM) were found in sputum, in 33.3% - in ALS and in 22.2% of NTMs were found in the surgical material. In 14.4% of cases, only surgery allowed to establish the diagnosis of mycobacteriosis.Цель исследования. Показать возможности диагностики нетуберкулезных микобактериозов легких (НТМЛ) в практике пульмонолога. Материалы и методы. Представлены материалы обследования 90 пациентов с подтвержденным диагнозом НТМЛ. Диагноз микобактериоза легких установлен в соответствии с предложенными в 2007 г. критериями Американского торакального общества и Американского общества инфекционных болезней (ATS/IDRS). Среди пациентов преобладали женщины - 55 (61,1%) человек, средний возраст составил 51,2±15,3 года. У пациентов оценивали жалобы, наличие сопутствующих заболеваний легких, проводили компьютерную томографию высокого разрешения органов грудной клетки (КТ ОГК), культуральное исследование мокроты, в случае отсутствия мокроты или однократного определения в ней культуры нетуберкулезных микобактерий (НТМБ) проводилось исследование материалов бронхоальвеолярного смыва (БАС/БАЛ) или биоптатов легких. Статистическая обработка результатов исследования выполнена методом описательной статистики с использованием Microsoft® Excel для Windows хр® на персональном компьютере. Результаты и заключение. В результате проведенного исследования выявлено, что до установления диагноза НТМЛ 66,7% пациентов длительно наблюдались по поводу хронических заболеваний легких (хроническая обструктивная болезнь легких, хронический бронхит), а в 55,6% случаев (50 человек) находились на учете у врача - фтизиатра по поводу туберкулеза легких. По данным КТ ОГК в 66,7% случаев определялась диссеминация, в 48,9% - бронхоэктазии, в 46,7% - одиночные или множественные полости деструкции. В 72,2% случаев НТМБ были найдены в мокроте, в 33,3% - в БАС и в 22,2% обнаружены в операционном материале. В 14,4% случаев только оперативное вмешательство позволило установить диагноз микобактериоза.
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Objective: To determine whether the workers’ periodic chest x-ray screening techniques in accordance with the quality standards is the responsibility of physicians. Evaluation of differences of interpretations by physicians in different levels of education and the importance of standardization of interpretation.Methods: Previously taken chest radiographs of 400 workers who are working in a factory producing the glass run channels were evaluated according to technical and quality standards by three observers (pulmonologist, radiologist, pulmonologist assistant). There was a perfect concordance between radiologist and pulmonologist for the underpenetrated films. Whereas there was perfect concordance between pulmonologist and pulmonologist assistant for over penetrated films.Results: Pulmonologist (52%) has interpreted the dose of the films as regular more than other observers (radiologist; 44.3%, pulmonologist assistant; 30.4%). The frequency of interpretation of the films as taken in inspiratory phase by the pulmonologist (81.7%) was less than other observers (radiologist; 92.1%, pulmonologist assistant; 92.6%). The rate of the pulmonologist (53.5%) was higher than the other observers (radiologist; 44.6%, pulmonologist assistant; 41.8%) for the assessment of the positioning of the patients as symmetrical. Pulmonologist assistant (15.3%) was the one who most commonly reported the parenchymal findings (radiologist; 2.2%, pulmonologist; 12.9%).Conclusion: It is necessary to reorganize the technical standards and exposure procedures for improving the quality of the chest radiographs. The reappraisal of all interpreters and continuous training of technicians is required.doi: https://doi.org/10.12669/pjms.326.11267How to cite this:Binay S, Arbak P, Safak AA, Balbay EG, Bilgin C, Karatas N. Does periodic lung screening of films meets standards? Pak J Med Sci. 2016;32(6):1506-1511. doi: https://doi.org/10.12669/pjms.326.11267This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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