Questionnaires and pocket spirometers provide an alternative approach for COPD screening in the general population.

BACKGROUND: In response to the Agency for Healthcare Research and Quality statement questioning the usefulness of "screening spirometry," the National Heart, Lung, and Blood Institute and the COPD Foundation held a consensus conference in June 2008 to establish a procedure to detect cases of COPD in the general population. Conference participants developed a three-stage approach, using a brief questionnaire, peak flow measurement with a pocket spirometer, and diagnostic quality spirometry. The overall objective of this study was to examine the usefulness of a simple questionnaire and peak flow measurement in screening for COPD in a self-selected population. We hypothesized that this combination would efficiently screen for clinically relevant COPD. METHODS: We queried individuals attending public events regarding the presence of wheeze and/or asthma, mucus production, dyspnea, exposure to irritants, and tobacco use. Peak expiratory flow (PEF) was then measured with a pocket spirometer. If PEF was < 70% predicted, spirometry was performed. In order to estimate the false-negative rate, a random sample of every 10th participant was also selected for spirometry. RESULTS: Between June 2008 and December 2009, 5,761 adults completed the risk assessment questionnaire. The mean age of the respondents was 54 years, 58% were women, and 88% were white. Of these, 5,638 participants completed pocket spirometry, and 315 (5.6%) had PEF < 70% predicted. Of 5,323 with normal PEF, 651 underwent spirometry. The performance of PEF was assessed via positive and negative predictive values relative to a diagnosis of clinically significant airflow obstruction, defined as FEV(1)/FEV(6) < the lower limit of normal and FEV(1) < 60% predicted. Of 4,238 subjects with at least two risk factors, 267 (6.3%) had PEF < 70%, compared with 48 of the 1,400 subjects (3.4%) with fewer than two risk factors (P < .001). Based on 729 participants with acceptable spirometry, 63.1% (113 of 179) of those with abnormal PEF tested positive for clinically significant airflow obstruction, compared with 5.5% (30 of 550) with normal PEF (P < .001). The estimated prevalence of significant COPD among the 5,638 screened was 8.7%, and sensitivity and specificity were 40.7% and 97.7%, respectively. CONCLUSIONS: A staged approach to COPD screening in adults is useful for detecting clinically significant airflow obstruction in our study population.

Information management during mass casualty events.

Preparing for a mass casualty event starts long before the event. Being able to provide care during an event requires collecting information about processes, equipment, supplies, and personnel to anticipate different situations. Planning should include an impact analysis to identify and prioritize critical services that need to be maintained. Impact analysis is carried out in concert with the entire health care delivery organization, not by individual departments. Planning may include addressing inadequate staffing, disrupted supply chains, and loss of information systems. Care may need to be provided in alternate locations, without access to the usual information resources. Mass casualty events also depend on the availability of communications to inform others on the emergency response teams, as well as to inform patients and the public.

Privacy and medical information on the Internet.

Health-care consumers are beginning to realize the presence and value of health-care information available on the Internet, but they need to be aware of risks that may be involved. In addition to delivering information, some Web sites collect information. Though not all of the information might be classified as protected health information, consumers need to realize what is collected and how it might be used. Consumers should know a Web site\'s privacy policy before divulging any personal information. Health-care providers have a responsibility to know what information they are collecting and why. Web servers may collect large amounts of visitor information by default, and they should be modified to limit data collection to only what is necessary. Providers need to be cognizant of the many regulations concerning collection and disclosure of information obtained from consumers. Providers should also provide an easily understood privacy policy for users.

Not so fast! The dark side of computers in health care.

There are now computers in numerous health care devices, from thermometers to ventilators, and there are pitfalls to avoid in our increasing dependence on computers. To be useful, information must be delivered in the right context. Computer systems must be protected from worms, viruses, and other harmful code, and they must prevent unauthorized access to data. The source of all underlying decision algorithms must be known and appropriate for the population being served. And there must be contingency plans to mitigate losses caused by system unavailability.

Conference summary: computers in respiratory care.

Computers and data management in respiratory care reflect the larger practices of hospital information systems: the diversity of conference topics provides evidence. Respiratory care computing has shown a steady, slow progression from writing programs that calculate shunt equations to departmental management systems. Wider acceptance and utilization have been stifled by costs, both initial and on-going. Several authors pointed out the savings that were realized from information systems exceeded the costs of implementation and maintenance. The most significant finding from one of the presentations was that no other structure or skilled personnel could provide respiratory care more efficiently or cost-effectively than respiratory therapists. Online information resources have increased, in forms ranging from peer-reviewed journals to corporate-sponsored advertising posing as authoritative treatment regimens. Practitioners and patients need to know how to use these resources as well as how to judge the value of information they present. Departments are using computers for training on a schedule that is more convenient for the staff, providing information in a timely manner and potentially in more useful formats. Portable devices, such as personal digital assistants (PDAs) have improved the ability not only to share data to dispersed locations, but also to collect data at the point of care, thus greatly improving data capture. Ventilators are changing from simple automated bellows to complex systems collecting numerous respiratory parameters and offering feedback to improve ventilation. Clinical databases routinely collect information from a wide variety of resources and can be used for analysis to improve patient outcomes. What could possibly go wrong?