ABSTRACT
This article describes health and social care professionals' perceptions of palliative care and facilitators and barriers to the delivery of such care for patients with advanced chronic obstructive pulmonary disease. Health professionals participated in semi structured interviews and focus groups which were analysed using content analysis. According to participants, care of patients with chronic obstructive pulmonary disease is focused upon the management of symptoms, with emphasis focused predominately on an acute model of care. Key barriers towards the delivery of palliative care included the reluctance to negotiatie end-of-life decisions and a perceived lack of understanding among patients and carers regarding the illness trajectory. Consequently the delivery of palliative care was viewed as a specialist role rather than an integral component of care. There is a need for education and training for health and social care professions to plan and provide high quality end-of-life care.
Subject(s)
Attitude of Health Personnel , Caregivers , Health Services Needs and Demand/standards , Palliative Care/standards , Pulmonary Disease, Chronic Obstructive/therapy , Quality of Life , Adult , Aged , Female , Focus Groups , Health Services Needs and Demand/organization & administration , Humans , Male , Middle Aged , Needs Assessment/organization & administration , Needs Assessment/standards , Palliative Care/organization & administration , Qualitative ResearchABSTRACT
Latent viral infection has been implicated in the pathophysiology of chronic obstructive pulmonary disease (COPD). Epstein-Barr virus (EBV) is known to be important in pulmonary fibrosis. The current authors hypothesised that EBV is associated with the pathogenesis of COPD. Sputum samples were collected from patients both during exacerbations of COPD and when stable. A control group of smokers who did not have airways obstruction also had their sputum examined. The presence of EBV DNA was established and quantified using a real-time nucleic acid amplification assay. A total of 136 patients with COPD were recruited during an acute exacerbation and a total of 68 when stable. EBV was detected in 65 (48%) exacerbation cases and 31 (46%) stable patients. In the comparison group of 16 nonobstructed smokers, EBV was demonstrated in only one (6%) case. Risk of COPD in patients with EBV and who are smokers confers an odds ratio of 12.6. Epstein-Barr virus DNA is more frequently identified in the respiratory tract of chronic obstructive pulmonary disease patients in comparison with unaffected smokers. It is present both during exacerbation and when stable, suggesting that infection is persistent. Smokers who do not develop chronic obstructive pulmonary disease rarely have Epstein-Barr virus in their sputum. This finding may be of importance in the pathogenesis of chronic obstructive pulmonary disease.
Subject(s)
Epstein-Barr Virus Infections/diagnosis , Herpesvirus 4, Human/isolation & purification , Pulmonary Disease, Chronic Obstructive/virology , Sputum/virology , Aged , Case-Control Studies , Female , Humans , Male , Middle Aged , Odds Ratio , Polymerase Chain Reaction , Risk , SmokingABSTRACT
Nurses can have a major impact on the management of patients with COPD. A carefully planned care pathway can improve patient and staff satisfaction. The BTS COPD guidelines provided the impetus for improving levels of care.
Subject(s)
Critical Pathways , Nurse Clinicians , Nurse's Role , Pulmonary Disease, Chronic Obstructive/nursing , Humans , Interprofessional Relations , Nursing Audit , Patient Satisfaction , Quality of Health CareABSTRACT
Sodium restriction and fish oil supplementation are effective dietary measures for preventing or treating mild hypertension. However, their usefulness as an adjunct to drug treatment of hypertension requires further evaluation. In the present study, we examined the influence of dietary sodium and fish oil on the antihypertensive effect of the angiotensin converting enzyme (ACE) inhibitor enalapril in stroke-prone spontaneously hypertensive rats (SHRSP). Rats were fed experimental diets containing fish oil or olive oil (5% w/w) and low (0.04% w/w) or normal (0.23% w/w) sodium from 1 to 4 months of age. Tail-cuff blood pressure (BP) rose by 8.4 and 4.3 mm Hg/week, respectively, in untreated and enalapril-treated (2.5 mg/kg/day, orally) rats fed the olive oil/normal sodium diet. Feeding fish oil further reduced the rise in enalapril-treated rats to 2.8 mm Hg/week. When sodium intake was also restricted, the BP rise was almost prevented (1.1 mm Hg/week). In older rats with established hypertension, the low sodium/fish oil diet also potentiated the blood pressure reduction by enalapril (tail-cuff BP fell by 61 mm Hg compared to 25 mm Hg with enalapril alone). These observations were confirmed by direct BP recording in conscious rats following the implantation of aortic catheters. Factorial analysis revealed a highly significant antihypertensive effect of fish oil in both young and adult SHRSP receiving enalapril, and a further interactive effect of dietary sodium restriction with fish oil feeding in young rats. The antihypertensive effects of the dietary interventions were associated with further reductions of cardiac hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)
