Among the adults and children aged 5 yrs who attend PHC settings, 20-30% seeks to care for respiratory symptoms. Over 80-90% of the respiratory patients suffer from acute respiratory infections ...(ARI), followed by chronic obstructive pulmonary diseases (COPD), asthma, and less frequently with pneumonia and tuberculosis (TB). To improve the quality of care in patients who seek assistance for respiratory symptoms in PHC settings and the efficiency of respiratory service delivery within healthcare systems, WHO has designated several initiatives among which one is PAL (Practical Approach to Lung Health). PAL is an integrated and symptom-based approach focused on all priority respiratory illnesses encountered in PHC, including TB. Its patient-centred syndromic approach aims to improve the quality of diagnosis and treatment of respiratory illnesses in a PHC setting.
To evaluate the short-term impact of PAL approach in improving the management of patients with the most frequent respiratory diseases by the GPs from PHC settings in the Republic of Macedonia.
A total of 588 GPs were educated for the most frequent respiratory diseases during the PAL training from 2013-2016. To evaluate the efficiency of GPs education from PHC settings, GPs fill in a form out of 69 questions for the patients enrolled before (baseline survey) and after PAL training (impact survey), and the results of the two surveys were compared. This analysis aimed to assess if the theoretical and practical skills obtained during the PAL training have been used in the routine practice of the GPs who attended the training and to what degree.
Our results showed that in the impact study more patients with ARI (P < 0.000001) and more patients with COPD exacerbations were treated in the PHC settings (P < 0.000008). More patients suspected of asthma were referred to upper health level for diagnosis (P < 0.037). The comparison of the findings between the baseline and impact surveys suggest that training on PAL had an impact in decreasing drug prescription through a reduction in a prescription for antibiotics for ARI, COPD and asthma. Our study indicates that training on PAL is likely to increase the prescription of inhaled corticosteroids and tends to decrease the prescription of other formulation of these drugs (P < 0.0000001). The impact surveys showed that the patients with COPD and pneumonia in the PHC settings were better managed due to the more frequent use of CAT questionnaires and CURB test. And regarding TB cases, our study indicates that the GPs were more aware of this disease and were more willing to take part in the patient treatment follow-up (P < 0.000001).
The results from this study showed that implementation of PAL approach for GPs from the PHC setting in our country have positive results (effect) in the management of patients with respiratory symptoms: it is likely to reduce prescribing for antibiotics, to increase the use of inhalation medication which is highly recommended in the management of asthma and COPD, and to decrease the referral of patients with chronic diseases to the upper health level. However, more experience is needed for long-term influence on the effects over the cost-effectiveness of respiratory care services and on strengthening the health care system.
Povzetek Izhodisca: Etiolosko diagnosticiranje plevralnih izlivov je veckrat tezko in zahteva invazivne diagnosticne postopke. Odkrivanje oznacevalcev, ki omogocajo diferencialno diagnozo vsaj med ...malignimi in nemalignimi plevralnimi izlivi, je predmet vec raziskav. Metode: Dolocali smo raven adenozin deaminaze (ADA) in lizozima v plevralni tekocini in v serumu 84 bolnikov, od teh 52 s plevralnim izlivom s tuberkulozno in 32 z maligno etiologijo. Uporabljeni sta metoda Gusti/Galcanti in turbidimetrijska kineticna metoda. Rezultati: V skupini s tuberkuloznim plevralnim izlivom v primerjavi s skupino z malignim plevralnim izlivom so bile izmerjene znatno visje koncentracije ADA in lizozima v plevralni tekocini (ADAp; Lp) ter v serumu (ADAs; Ls). Mejne vrednosti razmerja ADAp/ADAs in Lp/Ls, ki naj bi bile pomembne v diferenciaciji diagnosticiranja med malignimi in tuberkuloznimi plevralnimi izlivi, so1,8 za ADA in 1,5 za lizozim. Razlika med dvema skupinama z dvema testoma je signifikantna (p < 0,001). V skupini s tuberkuloznim plevralnim izlivom ima 76,9% bolnikov vrednosti enake ali visje od 1,8 (= ali > 1,8) za razmerje ADAp/ADAs, medtem ko v skupini z malignim plevralnim izlivom to velja za 9,4% bolnikov. Kar se tice lizozima v skupini s tuberkuloznim plevralnim izlivom, ima 84,6% bolnikov razmerje Lp/Ls enako ali vecje od 1,5 (= ali > 1,5), v skupini z malignim plevralnim izlivom pa je samo 3,1%. Pri diagnosticiranju tuberkuloznega plevralnega izliva s testi ADAp/ADAs in Lp/Ls je obcutljivost 76,90% in 84,16%, specificnost pa 90,62% in 96,87%, napovedna vrednost za pozitivne izvide 93,02% in 97,77%, napovedna vrednost za negativne izvide 70,73% in 79,48%, diagnosticna zanesljivost pa 82,14% in 89,28%. Zakljucki: Testa ADAp/ADAs in Lp/Ls sta enostavni in hitri metodi, ki se lahko uporabita za presejanje v diferenciranju diagnoze malignih in tuberkuloznih plevralnih izlivov.
Background: The diagnosis of pleural effusions is sometimes difficult and needs invasive diagnostic procedures; the search for markers that will at least allow to obtain a differential diagnosis ...between malignant and benign effusions is the objective of many studies.Methods: The level of adenosine deaminase (ADA) and lysozyme in pleural fluid and serum was determined in 84 patients (52 with tuberculous pleural effusions – TB and 32 with malignant pleural effusions – CA), by Giusti/Galcanti and turbidimetric kinetic method.Results: In the group with TB there were significant higher serum and pleural fluid concentrations of ADA (ADAp; ADAs) and lysozyme (Lp; Ls) compared to CA. In the differential diagnosis between tuberculous and malignant pleural effusion ratios ADAp/ADAs = or > 1.8 and Lp/Ls = or > 1.5 were accepted as a cutoff level. We found significant differences between two groups in both tests (p < 0.001): in the group with TB 76.9% of patients had ADAp/ADAs ratio = or > 1.8 contrary to the group with CA where the percentage is only 9.4%. In the group with TB there were 84.6% of patients with Lp/Ls ratio = or > 1.5, contrary to the group with malignancy where the percentage is only 3.1%. ADAp/ADAs ratio of 1.8 and Lp/Ls ratio of 1.5 showed sensitivity of 76.92% and 84.65%, specificity of 80.70% and 87.71%, positive predictive value of 78.43% and 86.27%, negative predictive value of 78.83% and 86.20% and diagnostic accuracy of 78.83% and 86.23% in the diagnosis of tuberculous pleurisy, separately.Conclusions: These results suggest that the determination of the Lp/Ls and ADAp/ADAs ratios provides a simple and rapid method which can be used as a screening test in the differential diagnosis between tuberculous and malignant pleural effusions.
Introduction
There is growing evidence to support the use of co‐design in developing interventions across many disciplines. This scoping review aims to examine how co‐design methodology has been used ...in the development of cardiovascular disease (CVD) secondary prevention interventions within health and community settings.
Methods
We searched four academic databases for studies that used the co‐design approach to develop their intervention. Studies were included if consumers (adults with CVD) and key stakeholders (e.g. clinicians, service providers) were involved in the co‐design process. The review focused on methodology rather than traditional study outcomes; therefore, co‐design processes and activities were extracted and evaluated against a selected co‐design framework.
Results
Twenty‐two studies were included in this review. Studies were implemented across various settings with consumers and stakeholder groups most frequently consisting of patients and healthcare professionals, respectively. Most studies specifically stated that they used a ‘co‐design’ approach (n = 10); others used terms such as participatory action research (n = 3), user‐centred design (n = 3) and community‐based participatory research (n = 2). Although there was variability in terminology, co‐design processes, and participants, all studies adhered to the key principles of consumer engagement. Predominant co‐design activities included semistructured interviews, focus groups, co‐design/development workshops and advisory group meetings. Intervention effectiveness was assessed in eight studies showing mixed results.
Conclusions
This review provides an overview of how the co‐design approach has previously been used in the development of CVD secondary prevention interventions. These findings provide methodological considerations that can guide researchers and healthcare services when implementing co‐design to develop feasible and acceptable interventions that can improve outcomes for CVD populations.
Patient or Public Contribution
No patients, service users, caregivers, people with lived experience or members of the public were involved in this scoping review. This review article was written by academics who have undertaken a significant amount of co‐design work with consumers and stakeholders.
Deficits in health literacy are common in patients with coronary artery disease (CAD), and this is associated with increased morbidity and mortality. In this scoping review, we sought to identify ...health literacy interventions that aimed to improve outcomes in patients with CAD, using a contemporary conceptual model that captures multiple aspects of health literacy. We searched electronic databases for studies published since 2010. Eligible were studies of interventions supporting patients with CAD to find, understand and use health information via one of the following: building social support for health; empowering people with lower health literacy; improving interaction between patients and the health system; improving health literacy capacities of clinicians or facilitating access to health services. Studies were assessed for methodological quality, and findings were analysed through qualitative synthesis. In total, 21 studies were included. Of these, 10 studies aimed to build social support for health; 6 of these were effective, including those involving partners or peers. Five studies targeted interaction between patients and the health system; four of these reported improved outcomes, including through use of teach-back. One study addressed health literacy capacities of clinicians through communication training, and two facilitated access to health services via structured follow-up—all reporting positive outcomes. Health literacy is a prerequisite for CAD patients to self-manage their health. Through use of a conceptual framework to describe health literacy interventions, we identified mechanisms by which patients can be supported to improve health outcomes. Our findings warrant integration of these interventions into routine clinical practice.
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