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160. Examination of COPD management in patients hospitalized with an acute exacerbation of COPD

Author

Wirth, Ingrid M., Penz, Erika D., and Marciniuk, Darcy D.

Abstract

AbstractBACKGROUNDOptimal chronic obstructive pulmonary disease (COPD) management includes both pharmacologic therapy and non-pharmacologic interventions including smoking cessation, vaccination, patient education/self-management and pulmonary rehabilitation. All of these elements should be optimized prior to hospital discharge in patients admitted for acute exacerbations of COPD (AECOPD).OBJECTIVES AND METHODS: We conducted a retrospective review of all patients admitted with an AECOPD in Saskatoon, Saskatchewan during 2016 to determine the proportion discharged on medical therapy consistent with the Global Initiative for Obstructive Lung Disease (GOLD) and Canadian Thoracic Society (CTS) guidelines, as well as the proportion who received appropriate non-pharmacologic interventions while in hospital — namely, nicotine replacement therapy (NRT), pneumococcal and influenza vaccination, COPD Nurse-Clinician and Respirologist involvement and pulmonary rehabilitation program (PRP) referral.RESULTSA total of 222 admissions were evaluated. Regarding non-pharmacologic management, 48% of smokers were prescribed NRT, while 3% and 24% of patients were vaccinated against pneumococcus and influenza, respectively, while in hospital. A total of 37% of patients were seen by a Respirologist and 66% were assessed by a COPD Nurse-Clinician, but only 8% were referred to PRP prior to discharge. In contrast, 86% of patients were discharged on guideline-adherent pharmacologic therapy. COPD Nurse-Clinician involvement, but not Respirologist involvement, was associated with guideline-adherent medical therapy on discharge.CONCLUSIONWhile most patients were discharged on appropriate pharmacologic therapy, the low rates of NRT prescription, pneumococcal and influenza vaccination, and PRP referral in these patients highlight meaningful opportunities for further optimizing care and warrant significant improvement. Given the documented benefits of these therapies in COPD, quality improvement initiatives should be undertaken to promote in-hospital COPD optimization.

Published
2022
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163. Establishing Pulmonary and Critical Care Medicine in China: 2016 Report on Implementation and Government Recognition

Author

Renli Qiao, Darcy Marciniuk, Nicki Augustyn, Mark J. Rosen, Huaping Dai, Rongchang Chen, Sinan Wu, Chen Wang, Darcy D. Marciniuk, Stephanie M. Levine, and Jack D. Buckley

Subjects
Pulmonary and Respiratory Medicine, Government, medicine.medical_specialty, Operationalization, business.industry, education, 05 social sciences, 050301 education, Critical Care and Intensive Care Medicine, Subspecialty, Online assessment, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Family medicine, medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, China, business, 0503 education, Fellowship training, Curriculum, Medical doctor
Abstract

This article provides an update on progress toward establishing pulmonary and critical care medicine (PCCM) fellowship training as one of the first four subspecialties to be recognized and supported by the Chinese government. Designed and implemented throughout 2013 and 2014 by a collaborative effort of the Chinese Thoracic Society (CTS) and the American College of Chest Physicians (CHEST), 12 leading Chinese hospitals enrolled a total of 64 fellows into standardized PCCM training programs with common curricula, educational activities, and assessment measures. Supplemental educational materials, online assessment tools, and institutional site visits designed to evaluate and provide feedback on the programs' progress are being provided by CHEST. As a result of this initial progress, the Chinese government, through the Chinese Medical Doctor's Association, endorsed the concept of subspecialty fellowship training in China, with PCCM as one of the four pilot subspecialties to be operationalized nationwide in 2016, followed by implementation across other subspecialties by 2020. This article also reflects on the achievements of the training sites and the challenges they face and outlines plans to enhance and expand PCCM training and practice in China.

Published
2016

164. Rural and remote care

Author

Donna Goodridge and Darcy D. Marciniuk

Subjects
Rural Population, Pulmonary and Respiratory Medicine, Respiratory Therapy, Telepharmacy, Telemedicine, Service delivery framework, Polysomnography, medicine.medical_treatment, media_common.quotation_subject, Respiratory Tract Diseases, Wearable computer, Telehealth, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Nursing, Pulmonary Medicine, medicine, Humans, Telemetry, Pulmonary rehabilitation, Quality (business), 030212 general & internal medicine, Referral and Consultation, Environmental planning, media_common, business.industry, Review Series, Pharmacy Service, Hospital, business, 030217 neurology & neurosurgery, Respiratory care
Abstract

The challenges of providing quality respiratory care to persons living in rural or remote communities can be daunting. These populations are often vulnerable in terms of both health status and access to care, highlighting the need for innovation in service delivery. The rapidly expanding options available using telehealthcare technologies have the capacity to allow patients in rural and remote communities to connect with providers at distant sites and to facilitate the provision of diagnostic, monitoring, and therapeutic services. Successful implementation of telehealthcare programs in rural and remote settings is, however, contingent upon accounting for key technical, organizational, social, and legal considerations at the individual, community, and system levels. This review article discusses five types of telehealthcare delivery that can facilitate respiratory care for residents of rural or remote communities: remote monitoring (including wearable and ambient systems; remote consultations (between providers and between patients and providers), remote pulmonary rehabilitation, telepharmacy, and remote sleep monitoring. Current and future challenges related to telehealthcare are discussed.

Published
2016

165. Fumonsin B(sub 1) production by Fusarium species other than F. moniliforme in section Liseola and by some related species

Author

Nelson, Paul E., Plattner, Ronald D., Shackelford, Darcy D., and Desjardins, Anne E.

Subjects
Fusarium -- Health aspects, Mycotoxins -- Research, Biological sciences
Abstract

All of the Fusarium species in section Liseola as well as four recently described species were tested for the ability to produce fumonisin B(sub 1). The results showed that some strains of the species F. proliferatum, F. nygamai, F. anthophilum, F. dlamini, F. napiforme were able to produce fumonisin. The latter three species have never been reported to produce fumonisin before. Of the fumonisin producers, F. proliferatum, F. napiforme andF. nygamai are of the most significance because of their association with food grains.

Published
1992

172. Effects of Clinical Pathways for COPD on Patient, Professional, and Systems Outcomes: A Systematic Review

Author

Christopher T, Plishka, Thomas, Rotter, Erika D, Penz, Mohammed R, Hansia, Shana-Kay A, Fraser, Darcy D, Marciniuk, and Fouche, Williams

Subjects
Pulmonary Disease, Chronic Obstructive, Patient Satisfaction, Health Personnel, Critical Pathways, Quality of Life, Humans, Delivery of Health Care
Abstract

COPD has a substantial burden seen in both patient quality of life and health-care costs. One method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs bring the best available evidence to a range of health-care professionals by adapting guidelines to a local context and detailing essential steps in care.A systematic review was conducted to address the following question: What are the effects of CPWs for COPD on patient-, professional-, and systems-level outcomes? The review used methods outlined by the Cochrane Collaboration. We included all studies that met our operational definition for CPWs and focused on COPD. All studies were evaluated for risk of bias, and all data regarding patient, professional, and systems outcomes were extracted.The search strategy identified 497 potentially relevant titles. Of these, 13 studies were included in the review. These studies reported a total of 398 outcomes, with sufficient data for meta-analysis of five outcomes: complications, length of stay, mortality, readmissions, and quality of life. Results showed statistically significant reductions in complications, readmissions, and length of stay but did not show changes in mortality or quality of life.This systematic review reveals evidence to suggest that CPWs for COPD have the potential to reduce complications, readmissions, and length of stay without negatively influencing mortality or quality of life. However, quality of evidence was generally low. The authors therefore acknowledge that results should be interpreted with caution and note the need for additional research in this area.

Published
2018

173. Effects of Prior Heavy Exercise in Heart Failure with Preserved Ejection Fraction on V̇O 2 Kinetics

Author

Dalisizwe M.K. Dewa, Calvin R. Wells, Stephen Pylypchuk, Janine Eckstein, Natasha G. Boyes, Mark J. Haykowsky, Darcy D. Marciniuk, Scotty J. Butcher, and Corey R. Tomczak

Subjects
0303 health sciences, medicine.medical_specialty, Chemistry, Kinetics, Biochemistry, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Genetics, Cardiology, medicine, Heart failure with preserved ejection fraction, Molecular Biology, 030217 neurology & neurosurgery, 030304 developmental biology, Biotechnology
Published
2018

174. Protocol for the Lactoferrin Infant Feeding Trial (LIFT) : A randomised trial of adding lactoferrin to the feeds of very-low birthweight babies prior to hospital discharge

Author

Martin, A., Ghadge, A., Manzoni, P., Lui, K., Brown, R., Tarnow-Mordi, W., Lu, K., Simes, J., Hague, W., Osborn, D., Deshpande, G., Kochar, A., Lewis, T., Watkins, A., Pritchard, M., Schofield, D., Mohamed, A. L., Soll, R., Darlow, B., Isaacs, D., Wilkinson, D., Wood, A., Mckenzie, A., Despande, G., Verry, H., Wright, I., Askie, L., Cruz, M., Berry, N., Mcguire, W., Broom, M., Osoborn, D., Reid, S., Sinn, J., Kwan, P., Tracy, M., Hua, C., Travadi, J., Black, R., Tobiansky, R., Darcy, D., Tai, S. N. H., Michalowski, J., Bhaskaracharya, A., Yeomans, E., Elsayed, K., Collins, C., Noble, E., Koorts, P., Lack, G., Mckeown, L., Liley, H., Nie, W., Morris, S., Cornthwaite, K., Goodchild, L., Austin, N., Graham, T., Patel, H., Sanchez, D., Mckinlay, C., Modi, N., Marschner, I., Stenson, B., and Espinoza, D.

Subjects
Male, Pediatrics, Enterocolitis, infant, lactoferrin, necrotizing, premature, sepsis, Clinical Protocols, Female, Hospital Mortality, Humans, Infant, Infant Mortality, Infant, Newborn, Intensive Care Units, Neonatal, Lactoferrin, Infant Food, Infant, Very Low Birth Weight, 0302 clinical medicine, Neonatal, Protocol, 030212 general & internal medicine, 2. Zero hunger, Enterocolitis, necrotizing, biology, Retinopathy of prematurity, General Medicine, 3. Good health, Intensive Care Units, Necrotizing enterocolitis, Gestation, medicine.symptom, medicine.medical_specialty, infant, premature, Breast milk, Sepsis, 03 medical and health sciences, 030225 pediatrics, medicine, business.industry, Very Low Birth Weight, Paediatrics, Newborn, medicine.disease, Infant mortality, biology.protein, business
Abstract

IntroductionVery-low birthweight (VLBW, Methods and analysisThis trial tests whether adding bovine lactoferrin (bLF) to feeds in VLBW infants improves (1) survival to hospital discharge free from brain injury, late-onset sepsis, NEC and treated retinopathy of prematurity (primary composite end point); (2) each component of the primary composite end point and (3) time to reach full enteral feeds, number of blood transfusions, chronic lung disease and length of hospital stay. It includes a cost-effectiveness analysis of bLF in improving survival free from major morbidity, and evaluates the effect of bLF on survival and developmental outcomes at 24 to 36 months corrected gestational age.This is a multicentre, two-arm, randomised trial comparing the treatment group receiving bLF added to breast milk or formula milk daily (up to 250 mg/kg/day bLF) versus the control group receiving no bLF supplementation. The intervention is administered until 34 completed weeks corrected gestation or for 2 weeks, whichever is longer, or until discharge home, if earlier. The target sample size of 1500 participants yields 85% power, at the two-sided 5% level significance, to detect a difference in proportions meeting the primary outcome assuming the true probability is 74% in controls and 80.5% in the bLF group.Ethics and disseminationThis protocol was approved by Northern Sydney Local Human Research Ethics Committee in January 2017 (Version 2.0, Reference 1003-118M) and other relevant ethics committees. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberACTRN12611000247976; Pre-results.

Published
2018

175. Canadian Thoracic Society Clinical Practice Guideline on pharmacotherapy in patients with COPD – 2019 update of evidence

Author

Bourbeau, Jean, primary, Bhutani, Mohit, additional, Hernandez, Paul, additional, Aaron, Shawn D., additional, Balter, Meyer, additional, Beauchesne, Marie-France, additional, D’Urzo, Anthony, additional, Goldstein, Roger, additional, Kaplan, Alan, additional, Maltais, François, additional, Sin, Don D., additional, and Marciniuk, Darcy D., additional

Published
2019
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176. The effects of marijuana smoking on lung function in older people

Author

Tan, Wan C., primary, Bourbeau, Jean, additional, Aaron, Shawn D., additional, Hogg, James C., additional, Maltais, François, additional, Hernandez, Paul, additional, Marciniuk, Darcy D., additional, Chapman, Kenneth R., additional, To, Teresa, additional, FitzGerald, J. Mark, additional, Walker, Brandie L., additional, Road, Jeremy, additional, Zheng, Liyun, additional, Zhou, Guohai, additional, Yau, Trevor, additional, Benedetti, Andrea, additional, O'Donnell, Denis, additional, and Sin, Don D., additional

Published
2019
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179. Peak Exercise and Post‐Exercise Recovery Oxygen Uptake and Muscle Oxygenation in Patients with Heart Failure and Preserved Ejection Fraction and Healthy Matched Adults

Author

Boyes, Natasha, primary, Eckstein, Janine, additional, Pylypchuk, Stephen, additional, Lahti, Dana, additional, Butcher, Scotty J, additional, Marciniuk, Darcy D, additional, Dewa, Dalisizwe M.K., additional, Wells, Calvin R, additional, Haykowsky, Mark J, additional, and Tomczak, Corey R, additional

Published
2019
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180. Effects of heavy-intensity priming exercise on pulmonary oxygen uptake kinetics and muscle oxygenation in heart failure with preserved ejection fraction

Author

Boyes, Natasha G., primary, Eckstein, Janine, additional, Pylypchuk, Stephen, additional, Marciniuk, Darcy D., additional, Butcher, Scotty J., additional, Lahti, Dana S., additional, Dewa, Dalisizwe M. K., additional, Haykowsky, Mark J., additional, Wells, Calvin R., additional, and Tomczak, Corey R., additional

Published
2019
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181. Profile of a national sample of Canadian children with participation and activity limitations

Author

Guangming Zhao, Donna C. Rennie, Donna Goodridge, Darcy D. Marciniuk, and Joshua Lawson

Subjects
Male, Parents, Canada, Mental Disorders, Sample (statistics), Pediatrics, Mental health, Disabled Children, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Environmental health, Surveys and Questionnaires, Pediatrics, Perinatology and Child Health, Activities of Daily Living, Humans, Female, 030212 general & internal medicine, Psychology, Child, Respiratory health
Abstract

Little is known about the nature of Canadian children with participation or activity limitations. Our objective was to profile a nationally representative sample of Canadian children with report of participation or activity limitation including identifying the major medical reasons attributed to these limitations and describe their sociodemographic and functional characteristics. We used data from the Canadian 2006 Participation and Activity Limitation Survey, a post-census Statistics Canada national survey of adults and children whose everyday activities were limited because of a condition or health problem. Data were collected by telephone interview of children’s (

Published
2017

182. Executive Summary

Author

Michael K. Stickland, Paul Hernandez, Donna Goodridge, Pat G. Camp, Jeremy Road, Mohit Bhutani, Meyer Balter, Marilyn G. Foreman, Nathaniel Marchetti, Stanley B. Fiel, Gerard J. Criner, Darcy D. Marciniuk, Daniel R. Ouellette, Joseph Ornelas, Gail Dechman, Nicola A. Hanania, Mark T. Dransfield, Belinda K. Ireland, Rebecca L. Diekemper, Kristen Curren, Bartolome R. Celli, Richard A. Mularski, and Jean Bourbeau

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, COPD, Exacerbation, business.industry, Evidence-based medicine, Guideline, Disease, Critical Care and Intensive Care Medicine, medicine.disease, respiratory tract diseases, Pulmonary function testing, Clinical trial, medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, business, Cause of death
Abstract

COPD is a common disease with substantial associated morbidity and mortality. Patients with COPD usually have a progression of airflow obstruction that is not fully reversible and can lead to a history of progressively worsening breathlessness, affecting daily activities and health-related quality of life.1-3 COPD is the fourth leading cause of death in Canada4 and the third leading cause of death in the United States where it claimed 133,965 lives in 2009.5 In 2011, 12.7 million US adults were estimated to have COPD.6 However, approximately 24 million US adults have evidence of impaired lung function, indicating an underdiagnosis of COPD.7 Although 4% of Canadians aged 35 to 79 years self-reported having been given a diagnosis of COPD, direct measurements of lung function from the Canadian Health Measures Survey indicate that 13% of Canadians have a lung function score indicative of COPD.4 COPD is also costly. In 2009, COPD caused 8 million office visits, 1.5 million ED visits, 715,000 hospitalizations, and 133,965 deaths in the United States.8 In 2010, US costs for COPD were projected to be approximately $49.9 billion, including $29.5 billion in direct health-care expenditures, $8.0 billion in indirect morbidity costs, and $12.4 billion in indirect mortality costs.9 Exacerbations account for most of the morbidity, mortality, and costs associated with COPD. The economic burden associated with moderate and severe exacerbations in Canada has been estimated to be in the range of $646 million to $736 million per annum.10 This value may be an underestimate given that the prevalence of moderate exacerbations is not well documented, COPD is underdiagnosed, and the rate of hospitalization due to COPD is increasing.11 Exacerbations are to COPD what myocardial infarctions are to coronary artery disease: They are acute, trajectory-changing, and often deadly manifestations of a chronic disease. Exacerbations cause frequent hospital admissions, relapses, and readmissions12; contribute to death during hospitalization or shortly thereafter12; reduce quality of life dramatically12,13; consume financial resources12,14; and hasten a progressive decline in pulmonary function, a cardinal feature of COPD. Hospitalization due to exacerbations accounts for > 50% of the cost of managing COPD in North America and Europe.15,16 COPD exacerbation has been defined as an event in the natural course of the disease characterized by a baseline change in the patient’s dyspnea, cough, and/or sputum that is beyond the normal day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD.17,18 Exacerbation in clinical trials has been defined for operational reasons on the basis of whether an increase in treatment beyond regular or urgent care is required in an ED or a hospital. Exacerbation treatment in clinical trials usually is defined by the use of antibiotics, systemic corticosteroids, or both.19 The severity of the exacerbation is then ranked or stratified according to the outcome: mild, when the clinical symptoms are present but no change in treatment or outcome is recorded; moderate, when the event results in a change in medication, such as the use of antibiotics and systemic corticosteroids; or severe, when the event leads to a hospitalization.1 Two-thirds of exacerbations are associated with respiratory tract infections or air pollution, but one-third present without an identifiable cause.17 Exacerbations remain poorly understood in terms of not only cause but also treatment and prevention. Although the management of an acute exacerbation has been the primary focus of clinical trials, the prevention of acute exacerbations has not been a major focus until recently. Most current COPD guidelines focus on the general diagnosis and evaluation of the patient with COPD, the management of stable disease, and the diagnosis and management of acute exacerbations.1,20 Although current COPD guidelines state that prevention of exacerbations is possible, little guidance is provided to the clinician regarding current available therapies for the prevention of COPD exacerbations.1,20 Moreover, new therapies have promise in preventing acute exacerbations of COPD (AECOPD) and would benefit from critical review of their efficacy in the exacerbation prevention management.21-23 The American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) jointly commissioned this evidence-based guideline on the prevention of COPD exacerbations to fill this important void in COPD management. The overall objective of this CHEST and CTS joint evidence-based guideline (AECOPD Guideline) was to create a practical, clinically useful document describing the current state of knowledge regarding the prevention of AECOPD according to major categories of prevention therapies. We accomplished this by using recognized document evaluation tools to assess and choose the most appropriate studies and evidence to extract meaningful data and to grade the level of evidence supporting the recommendations in a balanced and unbiased fashion. The AECOPD Guideline is unique not only for its topic but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature by clinical experts and researchers in the field of COPD would lead to a series of recommendations to assist clinicians in their management of the patient with COPD. This guideline is unique because a group of interdisciplinary clinicians who have special expertise in COPD clinical research and care led the development of the guideline process with the assistance of methodologists.

Published
2015

183. Prevention of Acute Exacerbations of COPD

Author

Pat G. Camp, Donna Goodridge, Nathaniel Marchetti, Joseph Ornelas, Jean Bourbeau, Richard A. Mularski, Stanley B. Fiel, Bartolome R. Celli, Kristen Curren, Paul Hernandez, Mark T. Dransfield, Belinda K. Ireland, Mohit Bhutani, Rebecca L. Diekemper, Gerard J. Criner, Meyer Balter, Darcy D Marciniuk, Marilyn G. Foreman, Jeremy Road, Daniel R. Ouellette, Michael K. Stickland, Nicola A. Hanania, and Gail Dechman

Subjects
Pulmonary and Respiratory Medicine, COPD, medicine.medical_specialty, education.field_of_study, Exacerbation, business.industry, Population, Evidence-based medicine, Guideline, Critical Care and Intensive Care Medicine, medicine.disease, respiratory tract diseases, law.invention, Quality of life (healthcare), Randomized controlled trial, law, medicine, Disease management (health), Cardiology and Cardiovascular Medicine, Intensive care medicine, education, business
Abstract

BACKGROUND:COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has accumulated about the prevention of acute exacerbations. METHODS:In recognition of the importance of preventing exacerbations in patients with COPD, the American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) joint evidence-based guideline (AECOPD Guideline) was developed to provide a practical, clinically useful document to describe the current state of knowledge regarding the prevention of acute exacerbations according to major categories of prevention therapies. Three key clinical questions developed using the PICO (population, intervention, comparator, and outcome) format addressed the prevention of acute exacerbations of COPD: nonpharmacologic therapies, inhaled therapies, and oral therapies. We used recognized document evaluation tools to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendations in each PICO question in a balanced and unbiased fashion. RESULTS:The AECOPD Guideline is unique not only for its topic, the prevention of acute exacerbations of COPD, but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature by clinical experts and researchers in the field of COPD would lead to a series of recommendations to assist clinicians in their management of the patient with COPD. CONCLUSIONS:This guideline is unique because it provides an up-to-date, rigorous, evidence-based analysis of current randomized controlled trial data regarding the prevention of COPD exacerbations.

Published
2015

184. Pulmonary Rehabilitation in Canada: A Report from the Canadian Thoracic Society COPD Clinical Assembly

Author

Michael K. Stickland, Paul Hernandez, Pat G. Camp, Mohit Bhutani, Darcy D. Marciniuk, Gail Dechman, Ashley Kirkham, Jean Bourbeau, Richard Debigaré, Donna Goodridge, and Jeremy Road

Subjects
Pulmonary and Respiratory Medicine, Canada, Respiratory Therapy, COPD, medicine.medical_specialty, RC705-779, business.industry, medicine.medical_treatment, Best practice, MEDLINE, Pulmonary disease, medicine.disease, Health Services Accessibility, Pulmonary Disease, Chronic Obstructive, Diseases of the respiratory system, Lung disease, Intervention (counseling), Humans, Medicine, Original Article, Pulmonary rehabilitation, business, Intensive care medicine
Abstract

BACKGROUND: Pulmonary rehabilitation (PR) is a recommended intervention in the management of individuals with chronic lung disease. It is important to study the characteristics and capacity of programs in Canada to confirm best practices and identify future areas of program improvement and research.OBJECTIVE: To identify all Canadian PR programs, regardless of setting, and to comprehensively describe all aspects of PR program delivery. The present article reports the results of the survey related to type of program, capacity and program characteristics.METHODS: All hospitals in Canada were contacted to identify PR programs. A representative from each program completed a 175-item online survey encompassing 16 domains, 10 of which are reported in the present article.RESULTS: A total of 155 facilities in Canada offered PR, of which 129 returned surveys (83% response rate). PR programs were located in all provinces, but none in the three territories. Most (60%) programs were located in hospital settings, 24% were in public health units and 8% in recreation centres. The national capacity of programs was estimated to be 10,280 patients per year, resulting in 0.4% of all Canadians with chronic obstructive pulmonary disease (COPD) and 0.8% of Canadians with moderate to severe COPD having access to PR. COPD, interstitial lung disease, and asthma were the most common diagnoses of patients. The majority of programs had at least four health care professionals involved; 9% had only one health care professional involved.CONCLUSION: The present comprehensive survey of PR in Canada reports an increase in the number of programs and the total number of patients enrolled since the previous survey in 2005. However, PR capacity has not kept pace with demand, with only 0.4% of Canadians with COPD having access.

Published
2015

185. Quantum-Dot Size and Thin-Film Dielectric Constant: Precision Measurement and Disparity with Simple Models

Author

Patrick O. Brown, Vladimir Bulovic, Moungi G. Bawendi, Daniel K. Harris, and Darcy D. W. Grinolds

Subjects
Materials science, business.industry, Scattering, Mechanical Engineering, Bioengineering, General Chemistry, Dielectric, Condensed Matter Physics, Capacitance, Condensed Matter::Soft Condensed Matter, Condensed Matter::Materials Science, chemistry.chemical_compound, Optics, chemistry, Quantum dot, Volume fraction, Optoelectronics, General Materials Science, Lead sulfide, Thin film, business, Constant (mathematics)
Abstract

We study the dielectric constant of lead sulfide quantum dot (QD) films as a function of the volume fraction of QDs by varying the QD size and keeping the ligand constant. We create a reliable QD sizing curve using small-angle X-ray scattering (SAXS), thin-film SAXS to extract a pair-distribution function for QD spacing, and a stacked-capacitor geometry to measure the capacitance of the thin film. Our data support a reduced dielectric constant in nanoparticles.

Published
2014

187. Intracerebral hemorrhage in ICU: is it worth treating?

Author

Sivakumar, S, Taccone, F, Desai, K, Lazaridis, C, Skarzynski, M, Sekhon, M, Henderson, W, Griesdale, D, Chapple, L, Deane, A, Williams, L, Strickland, R, Lange, K, Heyland, D, Chapman, M, Rowland, M, Garry, P, Westbrook, J, Corkill, R, Antoniades, C, Pattinson, K, Fatania, G, Strong, A, Myers, R, Jermaine, C, Robertson, C, Rusin, C, Hofmeijer, J, Sondag, L, Tjepkema Cloostermans, M, Beishuizen, A, Bosch, F, van Putten, M, Carteron, L, Patet, C, Solari, D, Oddo, M, Ali, M, Dias, C, Almeida, R, Vaz Ferreira, A, Silva, J, Monteiro, E, Cerejo, A, Rocha, A, Elsayed, A, Abougabal, A, Beshey, B, Alzahaby, K, Pozzebon, S, Ortiz, A, Cristallini, S, Lheureux, O, Brasseur, A, Vincent, J, Creteur, J, Hravnak, M, Yousef, K, Chang, Y, Crago, E, Friedlander, R, Abdelmonem, S, Tahon, S, Helmy, T, Meligy, H, Puig, F, Dunn Siegrist, I, Pugin, J, Gupta, S, Govil, D, Srinivasan, S, Patel, S, N, J, Gupta, A, Tomar, D, Shafi, M, Harne, R, Arora, D, Talwar, N, Mazumdar, S, Papakrivou, E, Makris, D, Manoulakas, E, Tsolaki, B, Karadodas, B, Zakynthinos, E, Garcia, I, Martin, A, Encinares, V, Ibañez, M, Montero, J, Labrador, G, Cangueiro, T, Poulose, V, Koh, J, Kam, J, Yeter, H, Kara, A, Aktepe, O, Topeli, A, Tsolakoglou, I, Intas, G, Stergiannis, P, Kolaros, A, Chalari, E, Athanasiadou, E, Martika, A, Fildisis, G, Faivre, V, Mengelle, C, Favier, B, Payen, D, Poppe, A, Winkler, M, Mudersbach, E, Schreiber, J, Wruck, M, Schwedhelm, E, Kluge, S, Zöllner, C, Tavladaki, T, Spanaki, A, Dimitriou, H, Kondili, E, Choulaki, C, Meleti, E, Kafetzopoulos, D, Georgopoulos, D, Briassoulis, G, la Torre, A, de la Torre Prados, M, Tsvetanova Spasova, T, Nuevo Ortega, P, Rueda Molina, C, Fernández Porcel, A, Camara Sola, E, Salido Díaz, L, García Alcántara, A, Meleti, D, Suberviola, B, Riera, J, Rellan, L, Sanchez, M, Robles, J, Lopez, E, Vicente, R, Miñambres, E, Santibañez, M, Le Guen, M, Moore, J, Mason, N, Windpassinger, M, Plattner, O, Mascha, E, Sessler, D, Research, O, Melia, U, Fontanet, J, 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Silva, J, Soares, M, Marqués, M, Moreno, A, Pizarraya, A, Smani, Y, Connell, M, Zhang, L, Parker, R, Banerjee, I, Clermont, G, Norberg, E, Oras, J, Cuisinier, A, Maufrais, C, Payen, J, Nottin, S, Walther, G, Arib, S, Bilotta, F, Badenes, R, Rubulotta, F, Mirek, S, Monfort, B, Stazi, E, Roig, A, Magnoni, S, Marando, M, Pifferi, S, Conte, V, Ortolano, F, Carbonara, M, Bertani, G, Scola, E, Cadioli, M, Triulzi, F, Colombo, A, Stocchetti, N, Rotzel, H, Lázaro, A, Prada, D, Guimillo, M, Piqueras, C, Guia, J, Simon, M, Arizmendi, A, Carratalá, A, El Maraghi, S, Yehia, A, Bakry, M, Shoman, A, Backes, F, Bianchin, M, Vieira, S, de Souza, A, Backes, A, Klein, C, Arunkumar, A, Lozano, A, Gallaher, C, Cattlin, S, Gordon, S, Picard, J, Fontana, V, Bond, O, Nobile, L, Mrozek, S, Delamarre, L, Capilla, F, Al Saati, T, Fourcade, O, Dominguez Berrot, A, Gonzalez Vaquero, M, Vallejo Pascual, M, Gupta, D, Ivory, B, Chopra, M, Mccarthy, J, Felderhof, C, Macneil, C, Maggiorini, M, Duska, F, Fumis, R, Junior, J, Amarante, G, Skorko, A, Sanders, S, Aron, J, Kroll, R, Redfearn, C, Krishnan, P, Khalil, J, Kongpolprom, N, Gulia, V, Lourenço, E, Duro, C, Baptista, G, Alves, A, Arminda, B, Rodrigues, M, Hayward, J, Baldwin, F, Gray, R, Katinakis, P, Stijf, M, Ten Kleij, M, Jansen Frederiks, M, Broek, R, de Bruijne, M, Spronk, P, Sinha, K, Luney, M, Palmer, K, Keating, L, Abu Habsa, M, Bahl, R, Baskaralingam, N, Ahmad, A, Kanapeckaite, L, Bhatti, P, Glace, S, Jeyabraba, S, Lewis, H, Kostopoulos, A, Raja, M, West, A, Ely, A, Turkoglu, L, Zolfaghari, P, Baptista, J, Marques, M, Martins, P, Pimentel, J, Su, Y, Villacres, S, Stone, M, Parsikia, A, Medar, S, O'Dea, K, Porter, J, Tirlapur, N, Jonathan, J, Singh, S, Takata, M, Mcwhirter, E, Lyon, R, Hariz, M, Azmi, E, Alkhan, J, Movsisyan, V, Petrikov, S, Marutyan, Z, Aliev, I, Evdokimov, A, Antonucci, E, Merz, T, Hartmann, C, Calzia, E, Radermacher, P, Nußbaum, B, Huber Lang, M, Gröger, M, Svoren Jabalera, E, Davenport, E, Humburg, P, Knight, J, Hinds, C, Jun, I, Kim, W, Besch, G, Perrotti, A, Puyraveau, M, Baltres, M, Samain, E, Chocron, S, Pili Floury, S, Plata Menchaca, E, Sabater Riera, J, Estruch, M, Boza, E, Toscana Fernández, J, Bruguera Pellicer, E, Ordoñez Llanos, J, Pérez Fernández, X, Cavaleiro, P, Tralhão, A, Arrigo, M, Lopes, J, Lebrun, M, Cholley, B, Perezvela, J, Marinmateos, H, Rivera, J, Llorente, M, De Marcos, B, Fernandez, F, Laborda, C, Zamora, D, Delgado, J, Imperiali, C, Dastis, M, Górka, J, Górka, K, Iwaniec, T, Frołow, M, Polok, K, Fronczek, J, Kózka, M, Musiał, J, Szczeklik, W, Sileli, M, Moursia, C, Maleoglou, H, Leleki, K, Uz, Z, Ince, Y, Papatella, R, Bulent, E, De Mol, B, Vicka, V, Gineityte, D, Ringaitiene, D, Norkiene, I, Sipylaite, J, Möller, C, Thomas Rueddel, D, Vlasakov, V, Rochwerg, B, Theurer, P, Al Sibai, J, Camblor, P, Fernandez, P, Gala, J, Guisasola, J, Tamura, T, Miyajima, I, Yamashita, K, Yokoyama, M, Dalampini, E, Nastou, M, Baddour, A, Ignatiadis, A, Asteri, T, Hathorn, K, Purtle, S, Viana, M, Tonietto, T, Gross, L, Costa, V, Tavares, A, Lisboa, B, Moraes, R, Viana, L, Azevedo, M, Ceniccola, G, Pequeno, R, Holanda, T, Mendonça, V, Araújo, W, Carvalho, L, Segaran, E, Vickers, L, Brinchmann, K, Wignall, I, De Brito Ashurst, I, Del Olmo, R, Vaquerizo, C, Carreño, R, Gálvez, V, Kaminsky, G, Nieto, B, Fuentes, M, De la Torre, M, Torres, E, Alonso, A, Velayos, C, Saldaña, T, Escribá, A, Grip, J, Kölegård, R, Sundblad, P, Rooyackers, O, Naser, B, Jaziri, F, Jazia, A, Barghouth, M, Hentati, O, Skouri, W, El Euch, M, Mahfoudhi, M, Turki, S, Abdelghni, K, Abdallah, B, Maha, B, Lorente, M, Włudarczyk, A, Hałek, A, Bargouth, M, Bennasr, M, Abdelghani, K, Abdallah, T, Geenen, I, Parienti, J, Shum, H, King, H, Yan, W, Londoño, J, Cardenas, C, Pedrosa, M, Gubianas, C, Bertolin, C, Batllori, N, Sirvent, J, Mukhopadhyay, A, Chan, H, Kowitlawakul, Y, Remani, D, Leong, C, Henry, C, Puthucheary, Z, Mendsaikhan, N, Begzjav, T, Lundeg, G, Dünser, M, Welsh, S, Guerra, E, Zerpa, M, Zechner, F, Berdaguer, F, Risso Vazquez, A, Masevicius, F, Greaney, D, Magee, A, Fitzpatrick, G, Lugo Cob, R, Tejeda Huezo, B, Cano Oviedo, A, Aydogan, M, Togal, T, Taha, A, Chai, H, Kam, C, Razali, S, Sivasamy, V, Kuan, L, Morales, M, Pires, T, and Azevedo, L

Subjects
intracerebral haemorrhage in intensive care
Published
2016

188. Can inhaled fluticasone alone or in combination with salmeterol reduce systemic inflammation in chronic obstructive pulmonary disease? – study protocol for a randomized controlled trial [NCT00120978]

Author

Ramesh Warren, Mainra Rajesh R, York Ernest, Wong Eric, FitzGerald Mark, Ford Gordon, Marciniuk Darcy D, Man SF Paul, Sin Don D, Melenka Lyle S, Wilde Eric, Cowie Robert L, Williams Dave, and Rousseau Roxanne

Subjects
Diseases of the respiratory system, RC705-779
Abstract

Abstract Background Systemic inflammation is associated with various complications in chronic obstructive pulmonary disease including weight loss, cachexia, osteoporosis, cancer and cardiovascular diseases. Inhaled corticosteroids attenuate airway inflammation, reduce exacerbations, and improve mortality in chronic obstructive pulmonary disease. Whether inhaled corticosteroids by themselves or in combination with a long-acting β2-adrenoceptor agonist repress systemic inflammation in chronic obstructive pulmonary disease is unknown. The Advair Biomarkers in COPD (ABC) study will determine whether the effects of inhaled corticosteroids alone or in combination with a long-acting β2-adrenoceptor agonist reduce systemic inflammation and improve health status in patients with chronic obstructive pulmonary disease. Methods/Design After a 4-week run-in phase during which patients with stable chronic obstructive pulmonary disease will receive inhaled fluticasone (500 micrograms twice daily), followed by a 4-week withdrawal phase during which all inhaled corticosteroids and long acting β2-adrenoceptor agonists will be discontinued, patients will be randomized to receive fluticasone (500 micrograms twice daily), fluticasone/salmeterol combination (500/50 micrograms twice daily), or placebo for four weeks. The study will recruit 250 patients across 11 centers in western Canada. Patients must be 40 years of age or older with at least 10 pack-year smoking history and have chronic obstructive pulmonary disease defined as forced expiratory volume in one second to vital capacity ratio of 0.70 or less and forced expiratory volume in one second that is 80% of predicted or less. Patients will be excluded if they have any known chronic systemic infections, inflammatory conditions, history of previous solid organ transplantation, myocardial infarction, or cerebrovascular accident within the past 3 months prior to study enrolment. The primary end-point is serum C-reactive protein level. Secondary end-points include circulating inflammatory cytokines such as interleukin-6 and interleukin-8 as well as health-related quality of life and lung function. Discussion If inhaled corticosteroids by themselves or in combination with a long-acting β2-adrenoceptor agonist could repress systemic inflammation, they might greatly improve clinical prognosis by reducing various complications in chronic obstructive pulmonary disease.

Published
2006
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189. Dead space loading and exercise limitation in patients with interstitial lung disease

Author

Marciniuk, Darcy D., Watts, Rodney E., and Gallagher, Charles G.

Subjects
Lung diseases, Interstitial -- Complications and side effects, Exercise tests, Health, Complications and side effects
Abstract

Study design: We tested the hypothesis that maximal exercise performance in subjects with interstitial lung disease (ILD) is limited by respiratory factors. Assuming this is so, ventilatory stimulation by added [...]

Published
1994

190. Global Initiative for Chronic Obstructive Lung Disease 2017 Classification and Lung Function Decline in Chronic Obstructive Pulmonary Disease

Author

Darcy D. Marciniuk, Guohai Zhou, Shawn D. Aaron, Paul Hernandez, François Maltais, Jean Bourbeau, Wan C. Tan, Don D. Sin, J. Mark FitzGerald, and Brandie L. Walker

Subjects
Pulmonary and Respiratory Medicine, Spirometry, Adult, Male, medicine.medical_specialty, Pathology, Internationality, MEDLINE, Pulmonary disease, Critical Care and Intensive Care Medicine, Severity of Illness Index, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Internal medicine, Forced Expiratory Volume, Severity of illness, medicine, Humans, 030212 general & internal medicine, Lung, Lung function, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Disease progression, Middle Aged, medicine.disease, Obstructive lung disease, 030228 respiratory system, Disease Progression, Female, business
Published
2017

191. Is psychological stress associated with smoking and physical activity levels in patients in the CanCOLD Study?

Author

Nicola J. Paine, Jean Bourbeau, Simon L. Bacon, Kim L. Lavoie, Wan C. Tan, Darcy D. Marciniuk, Brandie L. Walker, Pei Li, Shawn D. Aaron, Denis E. O'Donnell, Fancois Maltais, Kenneth R. Chapman, Mark FitzGerald, Don D. Sin, Paul Hernandez, Andrea Benedetti, and Laura Labonte

Subjects
business.industry, Physical activity, medicine, Psychological stress, In patient, medicine.disease_cause, business, Clinical psychology
Published
2017

192. Rapid root responses of seedlings exposed to a postdrought water pulse

Author

Nilsha Khurana, Jennifer L. Funk, Megan D. Blair, Marc V. Rosenfield, Monica A. Nguyen, Darcy D. Hardwick, Joanne S. Kim, and Julie E. Larson

Subjects
0106 biological sciences, Canopy, Mediterranean climate, Plant Science, 010603 evolutionary biology, 01 natural sciences, Plant Roots, Magnoliopsida, Species Specificity, Genetics, Ecosystem, Growth rate, Precipitation, Ecology, Evolution, Behavior and Systematics, biology, Coastal sage scrub, Water, 15. Life on land, biology.organism_classification, Agronomy, Seedling, Seedlings, Elongation, Introduced Species, 010606 plant biology & botany
Abstract

PREMISE OF THE STUDY Mediterranean-type climate ecosystems experience significant variability in precipitation within and across years and may be characterized by periods of extreme drought followed by a brief, high-intensity precipitation pulse. Rapid root growth could be a key factor in effective utilization of precipitation pulses, leading to higher rates of seedling establishment. Changes in root growth rate are rarely studied, however, and patterns in seedling root traits are not well explored. We investigated the influence of an extreme postdrought precipitation event on seedlings that occur in southern California coastal sage scrub. METHODS We measured root elongation rate, root tip appearance rate, new leaf appearance rate, and canopy growth rate on 18 mediterranean species from three growth forms. KEY RESULTS Root elongation rate responded more strongly to the precipitation pulse than did root tip appearance rate and either metric of aboveground growth. The majority of species exhibited a significant change in root growth rate within 1 week of the pulse. Responses varied in rapidity and magnitude across species, however, and were not generally predictable based on growth form. CONCLUSIONS While the majority of species exhibited shifts in belowground growth following the pulse, the direction and magnitude of these morphological responses were highly variable within growth form. Understanding the implications of these different response strategies for plant fitness is a crucial next step to forecasting community dynamics within ecosystems characterized by resource pulses.

Published
2017

193. Understanding multidimensional energy poverty in the Philippines

Author

Michael S. Leabres, Lana Rose A. Manaligod, Dwane Darcy D. Cayonte, and Celedonio B. Mendoza

Subjects
Poverty, 020209 energy, Incidence (epidemiology), Income poverty, Poverty measurement, 02 engineering and technology, 010501 environmental sciences, Management, Monitoring, Policy and Law, 01 natural sciences, Energy policy, General Energy, Low energy, Geography, 0202 electrical engineering, electronic engineering, information engineering, Composite index, Socioeconomics, Energy poverty, 0105 earth and related environmental sciences
Abstract

This paper attempted to calculate a composite index that would represent the magnitude of incidence and intensity of multidimensional household energy poverty (MEPI) in the Philippines using seven indicators of energy deprivation to analyse 17 regions and 81 provinces. Generally, the MEPI scores of regions from 2011 to 2016 revealed that the proportion of the multidimensional energy poor across all regions improved. Moreover, the study systematically put together a composite index that aims to capture the multidimensional aspects of household energy poverty. It consciously avoided a uni-dimensional stance in measuring energy poverty. Among the seven indicators, access to communication and education related appliances consistently had the highest incidence of deprivation among households across all regions at 90.4 percent. Conversely, a Filipino household is identified as multidimensional energy poor if it is deprived in at least the equivalent of 50 percent of the weighted seven indicators to be considered multidimensional poor. On the average, households in the Philippines are experiencing lower moderate energy poverty. Among the regions, Luzon (except MIMAROPA and Bicol) experienced low energy poverty levels. The energy-poorest regions are ARMM and Region IX (Zamboanga Peninsula). The statistical result suggests the association of MEPI and income poverty incidence points out a high correlation. In conclusion, an increase in poverty incidence would lead to a more multidimensionally deprived household. The correlation outcome validates that a significant relationship exists between MEPI and income poverty.

Published
2019

194. The effects of marijuana smoking on lung function in older people

Author

Wan C, Tan, Jean, Bourbeau, Shawn D, Aaron, James C, Hogg, François, Maltais, Paul, Hernandez, Darcy D, Marciniuk, Kenneth R, Chapman, Teresa, To, J Mark, FitzGerald, Brandie L, Walker, Jeremy, Road, Liyun, Zheng, Guohai, Zhou, Trevor, Yau, Andrea, Benedetti, Denis, O'Donnell, Don D, Sin, and Janet, Baran

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, Spirometry, Canada, medicine.medical_specialty, Vital capacity, Chronic bronchitis, Time Factors, Marijuana Smoking, Cohort Studies, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Lung function, Aged, 2. Zero hunger, COPD, biology, medicine.diagnostic_test, business.industry, Smoking, Age Factors, Middle Aged, biology.organism_classification, medicine.disease, 030228 respiratory system, Concomitant, Female, Cannabis, business, Cohort study
Abstract

BackgroundPrevious studies have associated marijuana exposure with increased respiratory symptoms and chronic bronchitis among long-term cannabis smokers. The long-term effects of smoked marijuana on lung function remain unclear.MethodsWe determined the association of marijuana smoking with the risk of spirometrically defined chronic obstructive pulmonary disease (COPD) (post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio 1in a subset of 1285 males and females, aged ≥40 years, who self-reported use (or non-use) of marijuana and tobacco cigarettes and performed spirometry before and after inhaled bronchodilator on multiple occasions. Analysis for the decline in FEV1was performed using random mixed effects regression models adjusted for age, sex and body mass index. Heavy tobacco smoking and marijunana smoking was defined as >20 pack-years and >20 joint-years, respectively.Results∼20% of participants had been or were current marijuana smokers with most having smoked tobacco cigarettes in addition (83%). Among heavy marijuana users, the risk of COPD was significantly increased (adjusted OR 2.45, 95% CI 1.55–3.88). Compared to never-smokers of marijuana and tobacco, heavy marijuana smokers and heavy tobacco smokers experienced a faster decline in FEV1by 29.5 mL·year−1(p=0.0007) and 21.1 mL·year−1(p−1(pInterpretationHeavy marijuana smoking increases the risk of COPD and accelerates FEV1decline in concomitant tobacco smokers beyond that observed with tobacco alone.

Published
2019

195. The Dominant Role of Exciton Quenching in PbS Quantum-Dot-Based Photovoltaic Devices

Author

Moungi G. Bawendi, Eric A. Dauler, Raoul E. Correa, and Darcy D. Wanger

Subjects
Luminescence, Photoluminescence, Materials science, Surface Properties, Exciton, Bioengineering, Trapping, Sulfides, law.invention, Condensed Matter::Materials Science, law, Quantum Dots, Solar cell, Nanotechnology, General Materials Science, Organic Chemicals, Condensed Matter::Quantum Gases, Photocurrent, Quenching (fluorescence), business.industry, Mechanical Engineering, General Chemistry, Condensed Matter::Mesoscopic Systems and Quantum Hall Effect, Condensed Matter Physics, Solid-state lighting, Lead, Semiconductors, Quantum dot, Optoelectronics, business
Abstract

We present a quantitative measurement of the number of trapped carriers combined with a measurement of exciton quenching to assess limiting mechanisms for current losses in PbS-quantum-dot-based photovoltaic devices. We use photocurrent intensity dependence and short-wave infrared transient photoluminescence and correlate these with device performance. We find that the effective density of trapped carriers ranges from 1 in 10 to 1 in 10,000 quantum dots, depending on ligand treatment, and that nonradiative exciton quenching, as opposed to recombination with trapped carriers, is likely the limiting mechanism in these devices.

Published
2013

197. Identification and definition of asthma–COPD overlap: The CanCOLD study.

Author

Barrecheguren, Miriam, Pinto, Lancelot, Mostafavi‐Pour‐Manshadi, Seyed‐Mohammad‐Yousof, Tan, Wan C., Li, Pei Z., Aaron, Shawn D., Benedetti, Andrea, Chapman, Kenneth R., Walker, Brandie, Fitzgerald, J. Mark, Hernandez, Paul, Maltais, François, Marciniuk, Darcy D., O'Donnell, Denis E., Sin, Don D., and Bourbeau, Jean

Subjects
DEFINITIONS, ATOPY, OBSTRUCTIVE lung diseases, QUALITY of life, SYMPTOMS
Abstract

Background and objective: Lack of consensus on diagnosis of ACO limits our understanding of the impact, management and outcomes of ACO. The present observational study aims to describe the prevalence, clinical characteristics and course of individuals with ACO based on various definitions used in clinical practice. Methods: We included individuals with COPD from the prospective, multisite CanCOLD study and defined subjects with ACO using seven definitions commonly used in the literature. Results: Data including questionnaires, lung function and CT scans were analysed from 522 individuals with COPD who were randomly recruited from the population. Among them, 264 fulfilled at least one of the seven definitions of ACO. Prevalence of ACO varied from 3.8% to 31%. Regardless of the definition, individuals with ACO had worse outcomes (lung function and higher percentage of fast decliners, symptoms and exacerbations, health‐related quality of life and comorbidities) than the remaining patients with COPD. Conversely, patients with non‐ACO had higher emphysema and bronchiolitis scores. The three definitions that included atopy and/or physician diagnosis of asthma identified subjects who differed significantly from patients with COPD. The two ACO definitions with post‐bronchodilator reversibility were concordant with COPD and were the least stable, with less than 50% of the patients from each group maintaining reversibility over visits. Conclusion: Atopy and physician‐diagnosed asthma are more distinguishing characteristics to identify ACO. This finding needs to be validated using measures of airway inflammation and other specific biomarkers. [ABSTRACT FROM AUTHOR]

Published
2020
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198. Hospital Library Development and the Impact of PSRMLS Services: Report of an Evaluation Project.

Author

California Univ., Los Angeles. Biomedical Library., Pacific Southwest Regional Medical Library Service, Los Angeles, CA., and Van Vuren, Darcy D.

Abstract

Since 1969, the Pacific Southwest Regional Medical Library Service (PSRMLS) has provided programs and services to promote the development of hospital libraries, both by encouraging the establishment of new libraries and by aiding existing libraries in improving services and resources. This document reports the results of an evaluation project designed to determine the development of hospital libraries in the Pacific Southwest Region over the past 15 years; measure the impact of PSRMLS; determine which hospitals in the region have organized libraries; and gather baseline data on hospital and other health sciences libraries for future comparison. Data gathered from a questionnaire were compared to the results of two previous surveys made in 1969 and 1971. Following an executive summary and introduction, the report is divided into six sections: (1) methodology of data collection and analysis; (2) hospital library development, including paired data comparison, composite data comparison, and existence of core services and resources; (3) the impact on the region of PSRMLS programs and services; (4) the identification of hospital libraries within the region; (5) the future use of baseline data; and (6) summaries of the study results. In addition to tables and charts presented in the text, appendixes contain detailed data breakdowns. (THC)

Published
1985

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