BACKGROUND:The assessment of the severity of chronic obstructive pulmonary disease (COPD) should involve a multidimensional approach that is now clearly shown to be better than using spirometric impairment alone. The aim of this study is to validate and compare novel tools without an exercise test and to extend prognostic value to patients with less severe impairment of Forced expiratory volume 1 s.METHODS:A prospective, observational, primary care cohort study identified 458 eligible patients recruited from the primary care clinics in the northeast of England in 1999–2002. A new prognostic indicator – body mass index, airflow obstruction and dyspnea (BOD) together with the conventional prognostic indices age, dyspnea and airflow obstruction (ADO), global initiative for chronic obstructive lung disease (GOLD) and new GOLD matrix were studied. We also sought to improve prognostication of BOD by adding age (A) and smoking history as pack years (S) to validate BODS (BOD with smoking history) and BODAS (BOD with smoking history and age) as prognostic tools and the predictive power of each was analyzed.RESULTS:The survival of the 458 patients was assessed after a median of 10 years when the mortality was found to be 33.6%. The novel indices BOD, BODS, and BODAS were significantly predictive for all-cause mortality in our cohort. Furthermore with ROC analysis the C statistics for BOD, BODS, and BODAS were 0.62, 0.66, and 0.72, respectively (P < 0.001 for each), whereas ADO and GOLD stages had a C statistic of 0.70 (P < 0.001) and 0.56 (P < 0.02), respectively. GOLD Matrix was not significant in this cohort.CONCLUSION:BOD, BODS, and BODAS scores are validated predictors of all-cause mortality in a primary care cohort with COPD.
Background Life expectancy is 10-20 years lower among people with a severe mental health disorder. Most of these early deaths are due to chronic conditions, including cardiovascular and respiratory diseases. Smoking is a major risk factor for these conditions and introducing nicotine management policies has been recommended to mental health service providers. This paper reports an evaluation of introducing these policy recommendations. Aim To reflect on the process and effectiveness outcomes when introducing nicotine management policies, including smokefree sites, in National Health Service (NHS) Trusts providing mental health services in an English region. Method Process data were collected through semi-structured interviews with staff (n=51), members of partnering organisations (n=5), service users (n=7) and carers (n=2) between November 2016–April 2017. Normalization Process Theory (NPT) was used to design the data collection tools and analyse the data. A framework approach was taken with the analysis using the four concepts of NPT: coherence, cognitive participation, collective action and reflexive monitoring. Aggregate routine quantitative data indicating the smoking status of service users were collected by querying patient administration systems every other quarter between 2013 and 2017. The data were analysed to investigate quality and completeness and to monitor smoking prevalence among service users over time. Results The policy made sense to some staff (coherence) who ‘bought-into’ the idea (cognitive participation) but other staff disagreed. Although nicotine management interventions were operationalised (collective action), sometimes they were opposed. Progress was made, especially in some units, but continued to be resisted in others. Informal appraisal of progress (reflexive monitoring) presented a varied picture. Routinely collected numerical data were of limited quality due to the high proportion of missing values; although there was some evidence of reducing smoking prevalence in both Trusts. Conclusion Some progress has been made in terms of changing entrenched, smoking cultures into one that is smokefree on Trust sites across the region. Systems for accurate, routine data capture of continued smoking and stop smoking journeys need to be established. Perseverance and resourcing over the long-term is required to establish routine data capture and a non-smoking culture in on-site provision of mental health services.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.