ABSTRACT
Background: In this study, we compare management of patients with high-risk chronic obstructive pulmonary disease (COPD) in the United States to national and international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). Methods: Patients were identified from the DARTNet Practice Performance Registry and categorized into three high-risk cohorts in each year from 2011 to 2019: newly diagnosed (≤12 months after diagnosis), already diagnosed, and patients with potential undiagnosed COPD. Patients were considered high-risk if they had a history of exacerbations or likely exacerbations (respiratory consult with prescribed medication). Descriptive statistics for 2019 are reported, along with annual trends. Findings: In 2019, 10% (n = 16,610/167,197) of patients met high-risk criteria. Evidence of spirometry for diagnosis was low; in 2019, 81% (n = 1228/1523) of patients newly diagnosed at high-risk had no record of spirometry/peak expiratory flow in the 12 months pre- or post-diagnosis and 43% (n = 651/1523) had no record of COPD symptom review. Among those newly and already diagnosed at high-risk, 52% (n = 4830/9350) had no evidence of COPD medication. Interpretation: Findings suggest inconsistent adherence to evidence-based guidelines, and opportunities to improve identification, documentation of services, assessment, therapeutic intervention, and follow-up of patients with COPD. Funding: This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.
ABSTRACT
This study examined survey data and neural reactivity associated with voluntarily engaging in high arousal negative experiences (VANE). Here we suggest how otherwise negative stimuli might be experienced as positive in the context of voluntary engagement. Participants were recruited from customers who had already purchased tickets to attend an "extreme" haunted attraction. Survey data measuring self-report affect, expectations, and experience was collected from 262 adults (139 women and 123 men; age M = 27.5 years, SD = 9.3 years) before and after their experience. Changes in electroencephalographic (EEG) indices of reactivity to cognitive and emotional tasks were further assessed from a subsample of 100 participants. Results suggested that participants' reported affect improved, particularly for those that reported feeling tired, bored, or stressed prior to the experience. Among those whose moods improved, neural reactivity decreased in response to multiple tasks. Together, these data suggest that VANE reduces neural reactivity following stress. This result could explain post-VANE euphoria and may be adaptive in that it could help individuals to cope with subsequent stressors. To the extent that this phenomenon replicates in clinical situations, it could inform clinical interventions by using VANE principles to reduce neural reactivity to subsequent stressors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
