Objective and background: The role of COPD self‐management plans in improving health outcomes remains unclear. The objective of this study was to assess whether self‐management plans administered in ...primary care have beneficial effects on quality of life, self‐care behaviour and health outcomes in the long term for patients with COPD.
Material, patients and methods: The study was a prospective, unblinded, randomized controlled trial of usual care vs. usual care plus structured education on the use of a written self‐management plan and patient‐initiated short courses of antibiotics and oral corticosteroids. The study was conducted in general practice, in Christchurch, New Zealand. Participants were 159 patients with COPD randomized by general practice site into control or intervention groups. The primary outcome measure was change in St. George’s Respiratory Questionnaire. Secondary variables were frequency of hospital and primary‐care attendance, frequency of use of courses of antibiotics and oral corticosteroids over 12 months, and change in Hospital Anxiety and Depression Scale. Self‐management knowledge was assessed using a structured interview, the COPD Self‐Management Interview.
Results: Self‐management plans and structured education were associated with higher levels of self‐management knowledge at 12 months, but had no effect on change in St. George’s Respiratory Questionnaire, health utilization, mental health or self‐reported outcomes of patients with COPD managed in general practice.
Conclusions: Self‐management knowledge was higher in the intervention group but there was no difference in quality of life or health outcomes due to self‐management plans.
Asthma and allergy are highly prevalent in industrialised countries. Longitudinal and cross-sectional studies have identified a number of potential risk factors for these conditions, including ...genetic and environmental factors, with significant gene-environment relationships. Birth cohort studies have been proposed as an important tool to explore these risk factors, particularly exposures in early life that are associated with later disease or protection from disease. This paper describes the establishment of a birth cohort in New Zealand.
A birth cohort was established in 1996 in Christchurch and Wellington and infants recruited between 1997-2001. Expectant mothers were recruited by midwives. Children and mothers have undergone assessment by serial questionnaires, environmental assessment including mould and allergen exposure, skin-prick testing, and at age six years are undergoing full assessment for the presence of asthma, atopy and allergic disease, including genetic assessment.
A total of 1105 children have been recruited, and the retention rate at fifteen months was 91.4%. 15.2% of the children at recruitment have been identified as Maori. A positive family history of asthma, eczema or hay fever has been reported in 84% of children. All children have now been assessed at fifteen months and 685 children from the cohort have reached age six years and have completed the six year assessment.
The cohort is fully assembled, and assessment of children is well advanced, with good retention rates. The study is well placed to address many current hypotheses about the risk factors for allergic disease and asthma.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The Internet is a relatively recent endeavor that has continued without conclusion for a considerable length of time, growing in importance to individuals, organizations, and governments everywhere ...until we finally settled on the term Internet of Things (IoT) to describe its ubiquitous application of multiple technologies across all spheres of human endeavor. In addition, the variety of IoT applications and use cases expands annually. There will be a need for this trend to grow substantially in order to satisfy the enormous amount of demand. Whether or not an IoT application is successful, simple to deploy, and user-friendly depends on a number of things. Based on research on the causes of success and failure in the implementation of IoT, it has become clear that most studies focus on either success factors alone or failure factors alone; this paper aims to bridge that gap by discussing the factors that contribute to the Internet of Things' success and the factors that lead to its failure, both of which aid in the technology's growth and dissemination and provide guidance to experts in the field.
Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis and legal regulation. This document compiled by the ...Critical Care Society of Southern Africa outlines the core standards for determination of death in the hospital context. It aligns with the latest evidence-based research and international guidelines and is applicable to the South African context and legal system. The aim is to provide clear medical standards for healthcare providers to follow in the determination of death, thereby promoting safe practices and high-quality care through the use of uniform standards. Adherence to such guidelines will provide assurance to medical staff, patients, their families and the South African public that the determination of death is always undertaken with diligence, integrity, respect and compassion, and is in accordance with accepted medical standards and latest scientific evidence. The consensus guidelines were compiled using the AGREE II checklist with an 18-member expert panel participating in a three-round modified Delphi process. Checklists and advice sheets were created to assist with application of these guidelines in the clinical environment (https://criticalcare.org.za/resource/death-determination-checklists/). Key points • Brain death and circulatory death are the accepted terms for defining death in the hospital context. • Death determination is a clinical diagnosis which can be made with complete certainty provided that all preconditions are met. • The determination of death in children is held to the same standard as in adults but cannot be diagnosed in children <36 weeks' corrected gestation. • Brain-death testing while on extra-corporeal membrane oxygenation is outlined. • Recommendations are given on handling family requests for accommodation and on consideration of the potential for organ donation. • The use of a checklist combined with a rigorous testing process, comprehensive documentation and adequate counselling of the family are core tenets of death determination. This is a standard of practice to which all clinicians should adhere in end-of-life care.
The purpose of beach management practices has widened in recent years, although there is still no complementary or bottom-up research that determines the preferences and demands of beach users. ...Therefore, this study seeks to evaluate the service quality perceptions of international tourists' intentions to revisit beach routes. The study uses a cross-sectional questionnaire survey to collect data from 185 respondents who are international tourists. Specifically, this paper aims to assess service quality perceptions of international tourists based on a survey conducted in Langkawi Island in Malaysia. The study employs PLS-SEM to analyse the data collected on service quality perceptions and the revisit intentions of tourists to beach routes. The study shows that three factors namely assurance, responsiveness and tangible have influences on the service quality perceptions of international tourists. The findings are fundamental for service providers to gain better insights into the perceptions of service quality of international tourists.
Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis and legal regulation. This document compiled by the ...Critical Care Society of Southern Africa outlines the core standards for determination of death in the hospital context. It aligns with the latest evidence-based research and international guidelines and is applicable to the South African context and legal system. The aim is to provide clear medical standards for healthcare providers to follow in the determination of death, thereby promoting safe practices and high-quality care through the use of uniform standards. Adherence to such guidelines will provide assurance to medical staff, patients, their families and the South African public that the determination of death is always undertaken with diligence, integrity, respect and compassion, and is in accordance with accepted medical standards and latest scientific evidence. The consensus guidelines were compiled using the AGREE II checklist with an 18-member expert panel participating in a three-round modified Delphi process. Checklists and advice sheets were created to assist with application of these guidelines in the clinical environment (https://criticalcare.org.za/resource/death-determination-checklists/). Key points • Brain death and circulatory death are the accepted terms for defining death in the hospital context. • Death determination is a clinical diagnosis which can be made with complete certainty provided that all preconditions are met. • The determination of death in children is held to the same standard as in adults but cannot be diagnosed in children <36 weeks’ corrected gestation. • Brain-death testing while on extra-corporeal membrane oxygenation is outlined. • Recommendations are given on handling family requests for accommodation and on consideration of the potential for organ donation. • The use of a checklist combined with a rigorous testing process, comprehensive documentation and adequate counselling of the family are core tenets of death determination. This is a standard of practice to which all clinicians should adhere in end-of-life care.
This paper examines how family businesses manage risks when transferring wealth across generations to ensure sustainability. It develops a thorough framework focusing on maintaining family legacies ...and business continuity. Key challenges identified include managing control, balancing interests, planning succession, preparing future leaders, and maintaining respect for leadership. The study uses a quantitative method to show that managing risks related to the owner's death is crucial. The findings suggest that managing inheritance risks and achieving successful transitions are vital for the sustainability of family businesses. Inheritance Risk Management (IRM) also helps mediate the impact of legacy risk management on sustainability. The paper recommends creating guidelines, launching awareness campaigns, offering specialized courses, and promoting family governance to improve business performance and social responsibility. Additionally, this research contributes to family business studies by enhancing understanding of inheritance risks and setting the stage for ongoing research and best practices development. These strategies aim to equip family businesses to meet current needs and future challenges effectively.
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