Primary care management of chronic obstructive pulmonary disease: An integrated goal-directed approach
ABSTRACT This review discusses the role of the primary care physician in the care of the patient with chronic obstructive pulmonary disease and considers how an integrated chronic care model can be applied.
Evidence suggests that a multidisciplinary approach can be successfully applied to a chronic obstructive pulmonary disease patient. These interventions can lead to improvement in quality of life and reduced healthcare utilization.
An integrated care program for chronic obstructive pulmonary disease to assist the primary care provider should include the elements of the chronic care model. The support of a community-based outreach nurse, allied health staff, rehabilitation services and a case manager can assure best practices and identify gaps in quality care.
Conference Paper: Examples of extreme cases in l1 and H∞ optimization[Show abstract] [Hide abstract]
ABSTRACT: Advances in the theory of robust control have brought forth two methodologies for controller design: l<sub>1</sub> and H<sub>∞ </sub>. In this paper the authors take the approach of using examples to illustrate some tradeoffs while designing controllers using either of the two methodologies. Further, for the sake of simplicity the authors consider the case of minimization of the sensitivity transfer function in all the examples. First, the authors discuss the frequency domain properties of l<sub>1</sub> optimal solutions and compare them with H <sub>∞</sub> optimal solutions. Next the authors contrast l<sub>1 </sub> and H<sub>∞</sub> optimal solutions and explore their extreme behavior. Finally with the help of an example the authors illustrate some interesting properties of mixed minimizationDecision and Control, 1993., Proceedings of the 32nd IEEE Conference on; 01/1994
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ABSTRACT: During the last decades progress has been made in the treatment of Chronic Obstructive Pulmonary Disease (COPD). We compared a random sample of patients admitted for an exacerbation in the period 2001-2005 (n = 101), with a random sample of patients hospitalized for the same reason in the period 1980-1984 (n = 51). Patients of the 2001-2005 cohort had a lower FEV1 (48 ± 3 vs. 41 ± 2% predicted, p = 0.01) for similar mean age, gender and body- mass index when compared to the historical sample. Co-morbidities, according to the Charlson's index, were more prevalent in the 2001-2005 cohort compared to the 1980-1984 cohort, with a reduction of hemoglobin (13.9 ± 0.2 gr/dl vs. 14.9 ± 0.2, p < 0.01) and higher prevalence of anemia in the most recent cohort. We found an increase in the use of cardiovascular drugs and respiratory medications over time with exception for the long-term use of oxygen. Despite lower FEV1 and more prevalent co-morbidities, no difference in length of hospitalization (13.6 ± 1.4 days vs. 12.7 ± 0.7 days, p = 0.52) and 30 months survival post-exacerbation was noted (66.6% vs. 69.3%, p = 0.85). Over the course of 20 years, the presentation of COPD patients admitted for an exacerbation seems to be changed towards a more severe phenotype with lower FEV1 and more co-morbidities. As the length of hospitalization and the overall survival were not different between the two samples, a currently improved management of COPD can be hypothesized.COPD Journal of Chronic Obstructive Pulmonary Disease 10/2010; 7(5):345-51. DOI:10.3109/15412555.2010.510546 · 2.62 Impact Factor
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ABSTRACT: To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD). A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records. No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009). The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.Primary care respiratory journal: journal of the General Practice Airways Group 06/2011; 20(4):427-33. DOI:10.4104/pcrj.2011.00060