An analysis of maximising health in admission assessment and diagnosis of patients with copd

A strategy of empowering patients through a nutrition intervention is well suited to China. The link between food and health is embedded in traditional Chinese culture, where food choices are seen as healing or disruptive to health. Unfortunately doctors do not have the time or knowledge needed to address nutrition questions and there is a dearth of dieticians.

No part of this publication may be reproduced, stored in a retrievalsystem, or transmitted, in any form or by any means, without the prior permission in writingof Clinical Publishing or Atlas Medical Publishing Ltd.

Although every effort has been made to ensure that all owners of copyright material havebeen acknowledged in this publication, we would be glad to acknowledge in subsequentreprints or editions any omissions brought to our attention.

A catalogue record for this book is available from the British Library. ISBN 13 1 71 2ISBN e-book 1 8The publisher makes no representation, express or implied, that the dosages in this book arecorrect.

Readers must therefore always check the product information and clinical procedureswith the most up-to-date published product information and data sheets provided by themanufacturers and the most recent codes of conduct and safety regulations.

The authors andthe publisher do not accept any liability for any errors in the text or for the misuse ormisapplication of material in this work. The latest GOLD guidelines also provide a clas-sification of the severity of the exacerbations of COPD based on clinical parameters to drive the necessity and the type of antibiotic therapy [1].

The term sustained implies a change from baseline lasting 48 h or more. In addition, COPD exacerbations are defined as either puru-lent or non-purulent on the assumption that this is helpful in predicting the need for anti-biotic therapy [2].

Again, in a strict analogy to the latest GOLD guidelines, the CTS update also provides a classification of the severity of purulent exacerbations of COPD, recognising both simple and complicated purulent COPD exacerbations, based on the presence of clin-ical risk factors that either increase the likelihood of treatment failure or are more likely to be associated with more virulent or resistant bacterial pathogens [2].

Although both the GOLD and CTS definitions and classifications of the severity of COPD exacerbations may provide a useful practical tool for clinical studies, they have not been for-mally validated in clinical trials and are rather cumbersome and difficult to use in clinical practice.

Other definitions derived from the literature are also used and are discussed below. Acute Exacerbations in COPDThere are currently no known biomarkers equivalent to the troponin test for myocardial infarction or D-dimer test in pulmonary embolism included in the definition of COPD exacerbation [3].

A standardised definition of an exacerbation of COPD remains an unmet need in respira-tory medicine. Indeed, the absence of a standardised definition of COPD exacerbation makes it very difficult to compare the results of the different studies on the pharmacological treat-ment and prevention of COPD exacerbations.

It may be difficult to distinguish a COPD exacerbation from other diseases presenting with similar clinical features during the first documented episode.

This is very important because, for example, a severe asthmatic exacerbation in an old asthmatic patient who smokes may be confused with an exacerbation of COPD if the presence of asthma is unknown to the phys-ician in charge of the patient [5]. Bronchiectasis is also often confused in general practice with COPD [6, 7].

Furthermore, patients with a definite COPD diagnosis may also have comorbidities that need to be considered in the differential diagnosis when looking for other possible causes of an acute deterioration of respiratory symptoms outside of a true COPD exacerbation. The most common of these alternative diagnoses are acute heart failure [8], pneumonia [9], pulmo-nary thromboembolism [], cardiac arrhythmia mainly atrial fibrillation [14], pneu-mothorax [15, 16] and lung cancer, amongst others.

It is worth noticing that COPD patients have an increased risk of developing lung cancer compared with age-matched smokers with normal lung function and similar smoking history [17].

These clinical conditions, even when co-existing e. The measurement of the serum level of brain natriuretic peptide BNP, or its precursor aminoterminus [NT]-proBNP and troponins may be useful in the differential diagnosis of the cause cardiogenic vs.

Interestingly, the presence of COPD does not affect the diagnostic performance of clinical probability estimate CPED-dimer testing, spiral computed tomographic angiography SCTAor pulmonary angiography in the diagnosis of pulmonary thromboembolism in these patients [23].• Caveats of HF-related code as principal diagnosis.

Field () Patients admitted to SA and NT hospitals only. Design: or linked chronic obstructive pulmonary disease with HF in this population. Social determinants and the health of Indigenous Australians. Med J Aust. , (10): The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline.

Sep 10,  · An information and research blog for health professionals, compiled by Coffs Harbour Health Campus & Port Macquarie Base Hospital Library staff. A to Z of Departments.

Details Last Updated: Tuesday, 11 September To run two hospitals takes a lot of different departments - clinical and non-clinical - as well as over 3, staff members.

Our aims through Connected Health Cities are to: patients who have been admitted with a seizure to their outpatient appointments maximising patient outcomes for a targeted population suffering from multiple morbidities including COPD, heart failure, and dementia.

European Primary Care Cardiovascular Society (EPCCS) consensus guidance on stroke prevention in atrial fibrillation (SPAF) in primary care is associated with more severe strokes and is therefore a major health risk to modify in patients and an important disease target for health systems.

The practicalities of screening, diagnosis.