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1.
BMJ Open Qual ; 13(1)2024 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-38191216

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the the most common disease-specific cause of adult emergency hospital admissions in Ireland. Preliminary groundwork indicated that treatment of acute exacerbations of COPD (AECOPD) in Ireland is not standardised between public hospitals. Applying Institute for Healthcare Improvement Breakthrough Series and Model for Improvement methodologies, Royal College of Physicians of Ireland designed and conducted a novel flexible and adaptive quality improvement (QI) collaborative which, using embedded evaluation, aimed to deliver QI teaching to enable teams to implement bespoke, locally applicable changes to improve and standardise acute COPD care at presentation, admission and discharge stages within their hospitals. METHODS: Eighteen teams from 19 hospitals across Ireland participated over 13 months. QI teaching was facilitated through inperson learning sessions, site visits, programme manager and coaching support. Teams submitted monthly anonymised patient data (n=10) for 22 measures of AECOPD care for ongoing QI evaluation. A mixed-methods survey was administered at the final learning session to retrospectively evaluate participants' experiences of QI learning and patient care changes. RESULTS: Participants reported that they learnt QI and improved patient care during the collaborative. Barriers included increased workload and lack of stakeholder buy-in. Statistically significant improvements (mean±SD) were seen for 'documented dyspnoea, eosinopenia, consolidation, acidaemia and atrial Fibrillation (DECAF) assessment' (7.3 (±14.4)% month(M)1 (n=15 sites); 49.6 (±37.7)% M13 (n=16 sites); p<0.001, 95% CI (14.3 to 66.7)), 'Documented diagnosis - spirometry' (42.5 (± 30.0)% M1 (n=16 sites); 69.1 (±29.9)% M13 (n=16 sites); p=0.0176, 95% CI 5.0 to 48.2) and 'inhaler technique review completed' (45.6 (± 34.1)% M1 (n=16 sites); 76.3 (±33.7)% M13 (n=16 sites); p=0.0131, 95% CI 10.0 to 65.0). 'First respiratory review' demonstrated improved standardisation. CONCLUSION: This flexible QI collaborative provided adaptive collaborative learning that facilitated participating teams to improve AECOPD patient care based on the unique context of their own hospitals. Findings indicate that involvement in the QI collaborative facilitated teams in achieving their improvements.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Melhoria de Qualidade , Adulto , Humanos , Estudos Retrospectivos , Aprendizagem , Doença Pulmonar Obstrutiva Crônica/terapia , Hospitais
2.
Nurs Open ; 7(2): 669-673, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32089866

RESUMO

Aim: This scoping review will gather existing evidence on specific interventions at presentation and discharge which aim to standardize care and/or reduce unnecessary admissions and/or readmissions to hospital for patients presenting with acute exacerbation of chronic obstructive pulmonary (airways) disease. Design: Scoping review of relevant literature from January 2000-March 2019. Methods: Database searches for primary evidence in peer-reviewed journals will be conducted electronically using Web of Science, EMBASE (Elsevier) and PUBMED. Eligibility criteria will include hospital-based interventions for presentations of acute exacerbation of chronic obstructive pulmonary disease with outcomes specific to standardizing care or reducing unnecessary admissions or readmissions. Abstract, full-text screening and data extraction will be completed independently by a panel of expert reviewers. Results: We aim to identify current interventions and improvement approaches in acute exacerbation of chronic obstructive pulmonary (airways) disease care that have an impact on admission and discharge processes or readmissions. Recommendations as a result of this review will aid the design and development of future improvement intervention.


Assuntos
Alta do Paciente , Doença Pulmonar Obstrutiva Crônica , Hospitalização , Hospitais , Humanos , Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Literatura de Revisão como Assunto
3.
BMJ Open Respir Res ; 7(1)2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33262103

RESUMO

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that may be punctuated by episodes of worsening symptoms, called exacerbations. Acute exacerbations of COPD (AECOPD) are detrimental to clinical outcomes, reduce patient quality of life and often result in hospitalisation and cost for the health system. Improved diagnosis and management of COPD may reduce the incidence of hospitalisation and death among this population. This scoping review aims to identify improvement interventions designed to standardise the hospital care of patients with AECOPD at presentation, admission and discharge, and/or aim to reduce unnecessary admissions/readmissions. METHODS: The review followed a published protocol based on methodology set out by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic database searches for peer-reviewed primary evidence were conducted in Web of Science, EMBASE (Elsevier) and PubMed. Abstract, full-text screening and data extraction were completed independently by a panel of expert reviewers. Data on type of intervention, implementation supports and clinical outcomes were extracted. Findings were grouped by theme and are presented descriptively. RESULTS: 21 articles met the inclusion criteria. Eight implemented a clinical intervention bundle at admission and/or discharge; six used a multidisciplinary care pathway; five used coordinated case management and two ran a health coaching intervention with patients. CONCLUSION: The findings indicate that when executed reliably, improvement initiatives are associated with positive outcomes, such as reduction in length of stay, readmissions or use of health resources. Most of the studies reported an improvement in staff compliance with the initiatives and in the patient's understanding of their disease. Implementation supports varied and included quality improvement methodology, multidisciplinary team engagement, staff education and development of written or in-person delivery of patient information. Consideration of the implementation strategy and methods of support will be necessary to enhance the likelihood of success in any future intervention.


Assuntos
Alta do Paciente , Doença Pulmonar Obstrutiva Crônica , Hospitalização , Hospitais , Humanos , Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida
4.
Eur J Med Chem ; 46(5): 1545-54, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21353729

RESUMO

In a continuation of our studies into indan and tetralin systems as novel modulators of allergic and inflammatory phenomena, we have extended our work to include dimers linked via C-C bonds. Of these compounds, 2-Benzyl-2-[2-phenyl-1-ethenyl]-1,2,3,4-tetrahydro-1-naphthalenol 12 exhibited most promising activity both in vitro and in vivo.


Assuntos
Antialérgicos/farmacologia , Mastócitos/efeitos dos fármacos , Naftóis/farmacologia , Animais , Antialérgicos/síntese química , Antialérgicos/química , Ácido Araquidônico , Contagem de Células , Sobrevivência Celular/efeitos dos fármacos , Otopatias/induzido quimicamente , Otopatias/tratamento farmacológico , Edema/induzido quimicamente , Edema/tratamento farmacológico , Hipersensibilidade/tratamento farmacológico , Masculino , Mastócitos/imunologia , Camundongos , Camundongos Endogâmicos , Estrutura Molecular , Naftóis/síntese química , Naftóis/química , Ratos , Estereoisomerismo
5.
Med Chem ; 7(3): 213-23, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21486212

RESUMO

In an investigation of 4-amino-3,4-dihydronaphthalen-1(2H)-ones as novel modulators of allergic and inflammatory phenomena, we have investigated a series of cyclic analogues. Tertiary amines of structural types 9, 10, 20 and 21 were synthesised and evaluated for mast cell stabilising activity. In vitro and in vivo studies showed that of these compounds, the cyclohexenylamino derivatives of tetralone and benzosuberone of series 20 and 21 exhibited interesting activity both in vitro and in vivo.


Assuntos
Aminas/farmacologia , Antialérgicos/farmacologia , Compostos Bicíclicos com Pontes/química , Mastócitos/efeitos dos fármacos , Naftalenos/química , Aminas/síntese química , Aminas/química , Animais , Antialérgicos/síntese química , Antialérgicos/química , Mastócitos/metabolismo , Estrutura Molecular , Ratos , Estereoisomerismo , Relação Estrutura-Atividade
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