This position statement, updated from the 2015 guidelines for managing Australian and New Zealand children/adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis, resulted from systematic literature searches by a multi‐disciplinary team that included consumers. The main statements are: Diagnose CSLD and bronchiectasis early; this requires awareness of bronchiectasis symptoms and its co‐existence with other respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease). Confirm bronchiectasis with a chest computed‐tomography scan, using age‐appropriate protocols and criteria in children. Undertake a baseline panel of investigations. Assess baseline severity, and health impact, and develop individualized management plans that include a multi‐disciplinary approach and coordinated care between healthcare providers. Employ intensive treatment to improve symptom control, reduce exacerbation frequency, preserve lung function, optimize quality‐of‐life and enhance survival. In children, treatment also aims to optimize lung growth and, when possible, reverse bronchiectasis. Individualize airway clearance techniques (ACTs) taught by respiratory physiotherapists, encourage regular exercise, optimize nutrition, avoid air pollutants and administer vaccines following national schedules. Treat exacerbations with 14‐day antibiotic courses based upon lower airway culture results, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients with severe exacerbations and/or not responding to outpatient therapy are hospitalized for further treatments, including intravenous antibiotics and intensive ACTs. Eradicate Pseudomonas aeruginosa when newly detected in lower airway cultures. Individualize therapy for long‐term antibiotics, inhaled corticosteroids, bronchodilators and mucoactive agents. Ensure ongoing care with 6‐monthly monitoring for complications and co‐morbidities. Undertake optimal care of under‐served peoples, and despite its challenges, delivering best‐practice treatment remains the overriding aim.
Background The reported prevalence of cognitive impairment in patients with stable chronic obstructive pulmonary disease (COPD) ranges 36‐77%. Few studies report the prevalence of cognitive impairment in acutely unwell COPD patients. Aims To determine the prevalence and time course of cognitive impairment in patients with COPD during and after an admission to hospital with an exacerbation of the disease. Methods Patients admitted to hospital with an exacerbation of COPD between October 2013 and November 2014 were administered the Montreal Cognitive Assessment tool, COPD assessment test and modified Borg dyspnoea scale at three points in time: within 24 h of admission, between 48 and 72 h after admission and 6 weeks post discharge. Results Twenty‐five patients agreed to participate. Four withdrew from the study after the initial evaluation. The mean (range) COPD assessment test score 24 h after admission was 26 (18–37). Cognitive impairment was found in 19/25 (76%) patients at the initial evaluation, 16/21 (76%) patients at the second evaluation. Overall, 22/25 (88%) showed cognitive impairment within 72 h of an exacerbation of COPD. Fourteen out of 21 (66%) patients showed cognitive impairment at the final evaluation. The mean Montreal Cognitive Assessment scores improved from admission (22.6) to the second evaluation (23.3) to the final evaluation 3 (24.4), but this change was not statistically significant. Conclusion Cognitive impairment is highly prevalent during hospital admissions with an exacerbation of COPD. This impairment does improve with time, but only a minority recover within a normal range. This will affect patients’ abilities to understand and remember information given to them in hospital and adhere to medication regimens.
Background and purpose Nurse practitioners (NPs) in New Zealand have been able to prescribe medicines since 2001; however, little is known about their prescribing practice. This study describes the NPs who prescribe community‐dispensed medicines, the patients, and identifies the most frequently prescribed medications. Methods A retrospective search of the Ministry of Health pharmaceutical collection was completed from 2013 to 2015. NP registration number, patient age, gender, deprivation index, and the name and date of dispensed medication, including the New Zealand pharmaceutical schedule therapeutic group, were identified. Conclusions NPs prescribe a broad range of medications across all therapeutic groups with antibacterial and analgesics being the most commonly prescribed medicines. This is comparable to all prescribers in New Zealand and NPs in Australia. The majority of patients lived in the more deprived areas of New Zealand indicating that NPs are working in areas of greater health need. Implications for practice The majority of NPs registered in New Zealand prescribe medicines. Those in primary care prescribe the most medications. NPs prescribe a broad range of medicines across all drug therapeutic groups. The patients seen by NPs often live in the most deprived areas of New Zealand. Understanding prescribing patterns will help to inform curricular development and continuing education programs for NPs.
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