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Background: Currently, most primary healthcare providers manage chronic obstructive pulmonary disease (COPD) through pharmacological treatments, often lacking assessment of the patient’s social support. A lack of social support negatively impacts the quality of life (QOL) of individuals with COPD resulting in increased morbidity, hospital readmissions and excessive costs (Metting, van der Molen, & Kocks, 2016). A comprehensive approach extends beyond pharmacological management to include ways that improve patients’ disease knowledge and self-efficacy, resulting in better disease management and improved QOL. Aim: The purpose of this quality improvement (QI) project is to increase healthcare providers’ understanding of the importance of adding a social support referral as part of a comprehensive treatment for patients with COPD. Methods: The QI project was conducted at Banner Desert Medical Center in Mesa, Arizona. The targeted participants were registered nurses, case managers, social workers, and any other care providers in telemetry units, where most COPD patients are treated. The project included a pre- and post-test survey questionnaire and a brief PowerPoint educational presentation. The presentation showed the positive role of social support groups for COPD patients based on multiple evidence-based studies and introduced several options of social support groups to the participants. Results: Total number of participants who completed the project were 42 (n=42), and included registered nurses, one case manager, and one social worker. Most of the participants were not aware of the existence of any social support group before the educational presentation. After the presentation, the collected data demonstrated increased participants’ knowledge and attitudes about the social support groups and the participants’ willingness to utilize the social support referral as part of a comprehensive education and treatment for COPD patients. Conclusion: The referral of social s

Chronic Obstructive Pulmonary Disease (COPD) exacerbations and hospitalizations are increasing. COPD readmissions are also becoming a burden to the healthcare system. Pulmonary rehabilitation (PR) is a treatment modality that has shown to reduce hospital readmissions by as much as 24% and increases the patient’s quality of life. Research has shown that only 9-16% of COPD patients discharged from the hospital after a COPD exacerbation were ever referred to a PR program. This study was designed to investigate the COPD hospital admission/readmission prevalence in a rural Arizona community. This study also investigated provider barriers to PR referrals, via a provider survey, and then made recommendations to systems and process to address these barriers to increase the number of provider PR referrals in a rural community in Arizona. It was found that the COPD hospital admission/readmission rates were significantly lower than the national average with 20.5-22.6% readmissions nationally with while readmission rates were at 4.2%. The provider survey results indicated several categories that affected the number of provider referrals to a PR program. These include lack of education for providers and patients; lack of provider time to initiate PR referrals; patient health status, home support and home responsibilities; and lack of patient progress and follow up data reporting. Recommendations to the study institution were designed to address these barriers.

Cigarette smoke contributes to many diseases. The actions of second and third hand smoke, which have implications for non-smokers and the very young, are just beginning to be appreciated. The overarching hypothesis of this project is that cigarette smoke has different injurious actions on alveolar cells based on chronological age. The purpose here was to learn more about the susceptibility of alveolar cells to cigarette smoke extract (CSE)- induced injury by performing studies on pulmonary alveolar and endothelial cells derived from neonatal, young, and old rats. The aims involved: 1. Developing cell culture models to study age-related effects of cigarette smoke on alveolar type I cells and microvascular endothelial cells from the lung, and 2. Using these models to examine the effects of CSE on markers of oxidative stress, inflammation and aging in alveolar cells harvested from neonatal, young and old rats. Descriptive and experimental studies involved using a variety of cell culture, biochemical and molecular techniques, including gene expression arrays. The most significant findings were that: 1. primary proliferating alveolar type I cells were used to develop novel cell culture model systems, including single culture, co-culture and three-dimensional cultures that were used to study the effects of CSE; 2. Hydrogen peroxide production by endothelial cells was markedly reduced by co-culturing with AT I cells; 3. Gene expression profiling of oxidative stress-specific pathways suggest that genes responsible for both stopping production of H2O2 or mopping-up H2O2 are involved; and 4. Cigarette smoke shortens telomeres of cells from neonates, but unexpectedly preserves telomere length of cells from young and old rats. Data from telomeric pathway-specific gene expression arrays suggest that there are age-related differences in response to gene expression to CSE. The significant conclusions are: 1. Contrary to prior observations, alveolar type I cells demonstrate prolong