A qualitative study of GP, nurse and practice manager views on using targeted case-finding to identify patients with COPD in primary care

‘Finding the missing millions’ with chronic obstructive pulmonary disease became part of the Department of Health strategy for England in 2010. Targeted case-finding within primary care is one potential pro-active strategy, but currently little is known about the views of healthcare professionals on this approach. In this study, 36 healthcare professionals (12 GPs, 14 nurses, and 10 practice managers) from 34 UK practices participated in semi-structured telephone interviews about targeted case-finding. Interviews followed an interview guide, were audio-recorded, transcribed verbatim, coded and analysed using ‘Framework Approach’. Most of those interviewed practiced opportunistic case-finding. The main perceived barriers to wider case-finding programmes were the resource implications associated with running such programmes and identifying more chronic obstructive pulmonary disease patients. Financial incentives, support from specialist clinicians, and comprehensive guidance were viewed as facilitators. While targeted case-finding is conceptually accepted by primary care staff, scepticism surrounding (1) the value of identifying those with mild disease and (2) the availability of effective targeted case-finding methods, may lead some to favour an opportunistic approach. Key concerns were a lack of unequivocal evidence for the relative benefits vs. disadvantages of diagnosing patients earlier, and resource constraints in an already over-burdened system. Barriers to practical implementation of case-finding studies may be addressed with financial, human and educational resources, such as additional staff to undertake searches and perform spirometry tests, and practical and educational support from specialist teams

De verantwoordelijkheden van Nederland voor kinderen met een Nederlandse link in voormalige IS-strijdgebieden bezien vanuit het internationale kinderrechtenperspectief

Effective Protection of Fundamental Rights in a pluralist worl

Sourcing the ore from the Drierivier copper smelting site in central Namibia, using lead isotope fingerprinting

Copper smelting residues from C. AD 1650 found at the Drierivier site near Rehoboth in central Namibia have 207Pb/206Pb isotope ratios that match a particular deposit at Swartmodder, but are markedly different from other known occurrences in the Rehoboth–Windhoek areas. For this reason, precise lead isotope determination is not necessary to source the ore, and raw peak height ratios obtained by inductively coupled plasma mass spectrometry are sufficient. This characteristic signature is present in all samples of malachite ore, slag, and copper prills collected on the site. Significantly, it is absent from a sample of local native copper, as well as from seven copper beads found elsewhere in central Namibia. This not only identifies the probable source of malachite ore but also provides a powerful tool for provenancing copper artefacts made at the Drierivier site, distinguishing them from those made elsewhere in the Namibian highlands

De rechten van ongedocumenteerde kinderen in Curaçao: Een gezamenlijke verantwoordelijkheid

Effective Protection of Fundamental Rights in a pluralist worl

The Increased Burden of Morbidity Over the Life-Course Among Patients with COPD: A Register-Based Cohort Study in Sweden

Carolina Smith,1,2 Ayako Hiyoshi,1,3 Mikael Hasselgren,2,4 Hanna Sandelowsky,5– 7 Björn Ställberg,8 Scott Montgomery1,5,9 1Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 2Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden; 3Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; 4School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 5Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; 6Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden; 7Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden; 8Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden; 9Department of Epidemiology and Public Health, University College, London, UKCorrespondence: Carolina Smith, School of Medical Sciences, Faculty of Medicine and HealthÖrebro University, Örebro, 701 82, Sweden, Email [email protected]: Patients with a diagnosis of chronic obstructive pulmonary disease (COPD) often have other chronic disorders. This study aims to describe the life-course pattern of morbidity in patients with COPD.Patients and Methods: Among all residents aged 50– 90 years in Sweden in 1997, people with a hospital COPD diagnosis were identified using Swedish national registers (1997– 2018). Each patient with COPD was matched by sex, birthyear and county of residency with up to five COPD-free controls. Other chronic disease diagnoses were identified during 1987– 2018. Conditional logistic regression calculated risk of diseases diagnosed prior to first COPD diagnosis, producing odds ratios (OR) and 95% confidence intervals (95% CI). Cox regression estimated risk of diagnoses after first COPD diagnosis, producing hazard ratios (HR) and 95% CI.Results: Among 2,706,814 individuals, 225,159 (8.3%) had COPD. The nested case–control sample included 223,945 COPD-cases with 1,062,731 controls. Prior to first COPD diagnosis, future COPD patients had higher risks than controls for most examined conditions. Highest risks were seen for chronic heart failure (OR = 3.25, 3.20– 3.30), peripheral arterial disease (OR = 3.12, 3.06– 3.18) and lung cancer (OR = 12.73, 12.12– 13.37). Following the COPD diagnosis, individuals with COPD had higher risks of most conditions than individuals without COPD. Chronic heart failure (HR = 3.50, 3.46– 3.53), osteoporosis (HR = 3.35, 3.30– 3.42), depression (HR = 2.58, 2.53– 2.64) and lung cancer (HR = 6.04, 5.90– 6.18) predominated. The risk of vascular dementia was increased after COPD diagnosis (HR = 1.53, 1.48– 1.58) but not Alzheimer’s disease.Conclusion: Accumulation of chronic morbidity may precede COPD. Following the diagnosis, an increased burden of cardiovascular disease and cancer is to be expected, but subsequent depression, osteoporosis, and vascular dementia should also be noted. Management strategies for patients with COPD should consider the higher-than-average risk of multimorbidity.Keywords: COPD, multimorbidity, register-stud

Understanding the meaning of medications for patients: The medication experience

Objective: To understand and describe the meaning of medications for patients. Methods: A metasynthesis of three different, yet complementary qualitative research studies, was conducted by two researchers. The first study was a phenomenological study of patients’ medication experiences that used unstructured interviews. The second study was an ethnographic study of pharmaceutical care practice, which included participant observation, in-depth interviews and focus groups with patients of pharmaceutical care. The third was a phenomenological study of the chronic illness experience of medically uninsured individuals in the United States and included an explicit aim to understand the medication experience within that context. The two researchers who conducted these three qualitative studies that examined the medication experience performed the meta-synthesis. The process began with the researchers reviewing the themes of the medication experience for each study. The researchers then aggregated the themes to identify the overlapping and similar themes of the medication experience and which themes are sub-themes within another theme versus a unique theme of the medication experience. The researchers then used the analytic technique, “free imaginative variation” to determine the essential, structural themes of the medication experience. Results: The meaning of medications for patients was captured as four themes of the medication experience: a meaningful encounter; bodily effects; unremitting nature; and exerting control. The medication experience is an individual’s subjective experience of taking a medication in his daily life. It begins as an encounter with a medication. It is an encounter that is given meaning before it occurs. The experience may include positive or negative bodily effects. The unremitting nature of a chronic medication often causes an individual to question the need for the medication. Subsequently, the individual may exert control by altering the way he takes the medication and often in part because of the gained expertise with the medication in his own body. Conclusion: The medication experience is a practice concept that serves to understand patients’ experiences and to understand an individual patient’s medication experience and medication-taking behaviors in order to meet his or her medication-related needs