Comprehensive Care Management in Conjunction with Sputum Cytometry-Guided Pharmacotherapy in a Post-Discharge Clinic for Patients with COPD.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are amongst the most common reasons for hospital admission, and recurrent episodes occur frequently. Comprehensive care management (CCM) strategies have modest effect in preventing re-admissions. The objectives of this study were to examine the utility of optimizing anti-inflammatory therapy guided by sputum cytometry in the post-hospitalization setting, and to assess the feasibility and effectiveness of a clinic combining CCM and sputum-guided therapy. This is an observational study examining patients who received open-label CCM and sputum cytometry-guided pharmacotherapy in a COPD post-discharge clinic. Referral was based on high risk for readmission after hospitalization for AECOPD. The primary outcome was the change in COPD-related healthcare utilization before and after Visit 1, and this was analyzed with a mixed-effects negative binomial model controlling for age, number of follow-up clinic visits, pack years, current smoking and FEV1. Of 138 patients referred to the clinic, 73% attended at least one visit. Mean FEV1 was 42.8 (19.3) % predicted. Of the patients attending clinic, 42.6% produced an adequate sputum sample, and 32.7% had an abnormal sputum. By individual, infectious bronchitis was the most common (25.7%), followed by eosinophilic bronchitis (13.9%). Comparing the 6-months prior to and after the first clinic visit, there was a lower incidence rate ratio after visit 1 for COPD-related healthcare utilization (0.26 (95%CI 0.22,0.33; p < 0.001)). A COPD post-discharge clinic combining sputum-guided treatment and CCM was feasible and associated with a nearly 75% reduction in the incidence of COPD-related healthcare utilization.

Indigenous health research: a critical review of outputs over time.

OBJECTIVE: To determine the number and nature of publications on Indigenous health in Australia, Canada, New Zealand and the United States) in 1987-1988, 1997-1998 and 2001-2003. DATA SOURCES: MEDLINE and PsychLit databases were searched using the following terms: Aborigines or Aboriginal; Torres Strait Islander; Maori; American Indian; North American Indian, or Indian, North American; Alaska/an Native; Native Hawaiian; Native American; American Samoan; Eskimos or Inuit; Eskimos or Aleut; Metis; Indigenous. STUDY SELECTION: Publications were included if they were concerned with the health of Indigenous people of the relevant countries. 1763 Indigenous health publications were selected. DATA EXTRACTION: Publications were classified as either: original research; reviews; program descriptions; discussion papers or commentaries; or case reports. Research publications were further classified as either measurement, descriptive, or intervention. Intervention studies were then classified as either experimental or non-experimental. DATA SYNTHESIS: The total number of publications was highest in 1997-1998 for most countries. The most common type of publication across all time periods for all countries was research publications. In Australia only, the number of research publications was slightly higher in 2001-2003 compared with other time periods. For each country and at each time, research was predominantly descriptive (75%-92%), with very little measurement (0-11%) and intervention research (0-18%). Overall, of the 1131 research publications, 983 were descriptive, 72 measurement and 76 intervention research. CONCLUSIONS: The dominance of descriptive research in Indigenous health is not ideal, and our findings should be carefully considered by research organisations and researchers when developing research policies.

A community-based sports massage course for Aboriginal health workers.

OBJECTIVE: To pilot a community-based and owned sports massage course for Aboriginal health workers (AHWs). DESIGN: Descriptive, pilot educational intervention study. SETTING: Rural, Indigenous Australian community. SUBJECTS: AHWs working in a rural community. MAIN OUTCOME MEASURES: Cultural and logistical acceptability of the program to AHWs. RESULTS: The course was delivered within a culturally acceptable framework with applicability for the evaluation of sports massage skills and knowledge changes in a larger sample. CONCLUSION: The sports massage course demonstrated its applicability in this rural Aboriginal community and it has the potential to be adapted and adopted in other similar settings.

Identifying musculoskeletal conditions among rural indigenous peoples.

OBJECTIVE: To critically review the methodological properties of previous musculoskeletal studies among Indigenous populations. In particular, non-rheumatic, musculoskeletal conditions of mechanical origin are examined as these appear to be commonly related to syndromes of pain and disability. DESIGN: Systematic review. SETTING: Rural, Indigenous communities throughout the world. SUBJECTS: Indigenous peoples aged 16 and over living in rural communities. MAIN OUTCOME MEASURE: Minimum requirements for methodologically sound musculoskeletal health research according to previously published criteria. RESULTS: Due to methodological limitations in the 14 studies reviewed, only five methodologically acceptable studies were found. CONCLUSION: Given the paucity of methodologically sound musculoskeletal studies among Indigenous populations, the true prevalence of musculoskeletal conditions in these communities remains largely unknown.