The devastating 2011 earthquake in Christchurch destroyed or badly damaged healthcare infrastructure, including Christchurch Hospital. This forced change in management of exacerbations of chronic obstructive pulmonary disease (COPD), which until that point had frequently led to admission to hospital and focused attention on providing safe community options for care. This paper describes the process of understanding factors contributing to high admission frequency with exacerbations of COPD and also describes a process of change, predominantly to healthcare delivery systems and philosophies, and the subsequent outcomes. What became clear in understanding admissions with COPD to Christchurch Hospital was that the behaviour of the patient, in the context of exacerbations, and the subsequent response of the system to the patient, led to admission being the default option, in spite of low severity of the exacerbation itself. By altering systems' responses to exacerbations, with a linked care process between ambulances, community care and hospitals, we were able to safely reduce admissions for COPD, with a sustained overall reduction in bed-day occupancy for COPD of ~48%. We would encourage these discussions and changes to occur without the stimulus of an earthquake in your healthcare environment!
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http://dx.doi.org/10.1136/bmjresp-2018-000286 | DOI Listing |
Ann Vasc Surg
January 2025
Vascular and Endovascular Surgery Department, São Paulo University Medical School, São Paulo, Brazil, Avenida Dr Enéas de Carvalho Aguiar, 155, 6º andar, bloco B. Secretaria da Cirurgia Vascular. Cerqueira Cesar, São Paulo, SP, Brazil, 05403-000.
Introduction: This study compared outcomes of patients with acute limb ischemia (ALI) before, during, and after the COVID-19 pandemic, hypothesizing that poor outcomes observed during the pandemic have not yet been resolved.
Methods: This retrospective, observational, single-center study analyzed ALI patients from 2019 to 2023.
Results: Over five years, 298 patients underwent surgery for ALI at our hospital: 35 had COVID-19 (COVID Group), 132 tested negative (Non-COVID Group), 71 were treated before the pandemic (Pre-COVID Group), and 60 after (Post-COVID Group).
Medicina (Kaunas)
January 2025
Respiratory Medicine Unit, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy.
COPD is one of the leading causes of death worldwide, so it represents a significant public health challenge. Over the years, new effective therapies have been proposed. However, the burden of COPD is still conditioned by frequent acute events defined as exacerbations (exacerbation of COPD-ECOPD), which have a significant impact not only on the patient's quality of life but also on the progression of the disease, morbidity, and mortality.
View Article and Find Full Text PDFDiseases
January 2025
Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain.
Background: Respiratory syncytial virus (RSV) infection is a common cause of hospital admission. The association between chronic obstructive pulmonary disease (COPD) exacerbation and RSV infection is not well studied.
Objective: To analyze the hospitalizations of patients with COPD and RSV infection in Spain between 2018 and 2022.
Respir Res
January 2025
Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Background: Severe and critical COVID-19 is characterized by pulmonary viral infection with SARS-CoV-2 resulting in local and systemic inflammation. Dexamethasone (DEX) has been shown to improve outcomes in critically ill patients; however, its effect on tissue remodeling, particularly collagen turnover, remains unclear. This study investigated the association between circulating extracellular matrix (ECM) remodeling neo-epitopes and COVID-19 severity, their relationship with mortality, and the effect of DEX on these markers.
View Article and Find Full Text PDFBMJ Open Respir Res
January 2025
Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain.
Introduction: Reducing unplanned hospital admissions in chronic patients at risk is a key area for action due to the high healthcare and societal burden of the phenomenon. The inconclusive results of preventive strategies in patients with chronic obstructive respiratory disorders and comorbidities are explainable by multifactorial but actionable factors.The current protocol (January 2024-December 2025) relies on the hypothesis that intertwined actions in four dimensions: (1) management change, (2) personalisation of the interventions based on early detection/treatment of acute episodes and enhanced management of comorbidities, (3) mature digital support and (4) comprehensive assessment, can effectively overcome most of the limitations shown by previous preventive strategies.
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