Medicine and Health Sciences Commons^™

Hospital Readmissions For Childhood Asthma: The Role Of Individual And Neighborhood Factors., Sze Yan Liu, Deborah Pearlman

Sze Yan Liu

Objectives

This study used a Cox proportional hazards model to determine whether neighborhood characteristics are associated with risk of readmission for childhood asthma independently of individual characteristics.

Methods

Rhode Island Hospital Discharge Data from 2001 to 2005 were used to identify children younger than 19 years of age at the time of the index (i.e., first) asthma admission, defined as a primary diagnosis of asthma or a primary diagnosis of respiratory illness with a secondary or tertiary diagnosis of asthma (n=2,919). Hazard ratios of repeat hospitalizations for childhood asthma from 2001 to 2005 were estimated, controlling for individual- …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Terry Frederick

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Jacob Bidwell, MD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics. Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics. Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Aurora Family Medicine Residents

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics. Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics. Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Lisa Sullivan Vedder, MD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Deborah Simpson, PhD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Don’T Leave Without Them: Dispensing Asthma Medications To Pediatric Patients Upon Discharge Is Associated With Decreased Hospital Readmissions, Kelly J. Hiteshew, Thaddeus T. Franz, Kristen Lamberjack, Aleda M.H. Chen

Kelly J. Wright, R.Ph., Pharm.D.

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During …

Asthma Knowledge, Control, And Administration Techniques In Hispanic Caregivers Of Pediatrics, Kelly J. Wright, Joshua Arnold, Rachel Culp, Kyle Hultz, Benjamin Robertson, Jon Wilkie, Amy Wuobio

Kelly J. Wright, R.Ph., Pharm.D.

Objectives: The objectives of this study were to (1) describe asthma knowledge, control, and administration techniques in Hispanic caregivers of pediatric asthma patients in primary care clinics and (2) determine the association between asthma knowledge and control. Methods: A pilot, cross-sectional study was conducted by administering a survey to Spanish-speaking primary caregivers of children under 12 years old with a current diagnosis of asthma. The survey contained: demographic questions (8 items), a modified version of the Asthma Control Test (ACT, 5 self-assessment items, 5-point, Likert-type scale), knowledge (21 items, correct/incorrect response), and inhaler use (1 item, rank ordering steps for …

Treatment Of Asthma Exacerbations With The Human-Powered Nebuliser: A Randomised Parallel-Group Clinical Trial, M Therese Lysaught, Christopher J. Hallberg, Rene Antonio Najarro, Fausto Cea Gill, Clara Villatoro, Ana Celia Diaz De Uriarte, Lars E. Olson

M. Therese Lysaught

Aims: The aim of this study was to compare a low-cost, human-powered nebuliser compressor with an electric nebuliser compressor for the treatment of mild to moderate asthma exacerbations in adults and children. Methods: This was a non-blinded, parallel-group, equivalence study, with 110 subjects between 6 and 65 years of age, conducted in the emergency department of a district hospital in Ilopango, El Salvador. Participants were assigned by random allocation to receive a 2.5-mg dose of salbutamol from the experimental human-powered nebuliser or the electric nebuliser control. All assigned participants completed treatment and were included in analysis. The study was not …

Question: What Is The Difference Between Volmax® And Proventil Repetabs®?, Jeffery A. Goad, Robert Andonian, Chris Chang, Greg Thompson

Jeff Goad

Answer: There are noticeable differences between Volmax and Proventil Repetabs, two of the available oral forms of administering albuterol to patients suffering from asthma. These differences are discussed below.

Asthma In Focus, Shaunta' M. Ray, Sarah Nisly

Sarah A. Nisly

Book review of Asthma in Focus, by Anna Murphy.

Asthma And Adaptive Functioning Among Homeless Kindergarten-Aged Children In Emergency Housing, J. J. Cutuli, Janette E. Herbers, Theresa L. Lafavor, Sandra M. Ahumada, Ann S. Masten, Charles N. Oberg

J. J. Cutuli

Background. Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters. Methods. Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning. Results. Asthma diagnosis was reported for 21% of 4‑to‑6‑year‑ old children, about twice the national and state prevalences. Children with asthma used more health care services …

Asthma Knowledge, Adherence, And Administration Techniques In Hispanic Caregivers Of Pediatrics, Joshua Arnold, Rachel Culp, Kyle Hultz, Benjamin Robertson, Jon Wilkie, Amy Wuobio, Marty L. Eng, Kelly J. Hiteshew

Kelly J. Wright, R.Ph., Pharm.D.

7.5% of Hispanics in the United States suffer from asthma-related diseases, and Latino children are not as likely to use preventative asthma medications as compared with Caucasians. Educational interventions may reduce the number of visits to emergency-care. The reasons for non-adherence are currently unknown, and discovering these reasons will help to address the problem.

Don’T Leave Without Them: Dispensing Asthma Medications To Pediatric Patients Upon Discharge Is Associated With Decreased Hospital Readmissions, Kelly J. Hiteshew, Thaddeus T. Franz, Kristen Lamberjack, Aleda M.H. Chen

Kelly J. Wright, R.Ph., Pharm.D.

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During …

Perceptions And Practices Of Adults With Asthma: A Social Cognitive Analysis, Kelly L. Andrews, Sandra C. Jones, Judy Mullan

Judy Mullan

This article describes a qualitative study that investigated the experiences, attitudes, and opinions of adults with asthma regarding self-managing their disease. Focus groups were conducted with 22 adults living in metropolitan and regional New South Wales, Australia. Key findings were that the perceived stigma of asthma, the need for social support, and the need for "asthma-friendly general practitioners" concerned participants more than formal self-management procedures such as written Asthma Action Plans and medication regimes. Social cognitive theory was used to explain the fluid relationship between persons with asthma, their environment, and their behavior in relation to self-management strategies and in …

Perceptions And Practices Of Adults With Asthma: A Social Cognitive Analysis, Kelly L. Andrews, Sandra C. Jones, Judy Mullan

Sandra Jones

This article describes a qualitative study that investigated the experiences, attitudes, and opinions of adults with asthma regarding self-managing their disease. Focus groups were conducted with 22 adults living in metropolitan and regional New South Wales, Australia. Key findings were that the perceived stigma of asthma, the need for social support, and the need for "asthma-friendly general practitioners" concerned participants more than formal self-management procedures such as written Asthma Action Plans and medication regimes. Social cognitive theory was used to explain the fluid relationship between persons with asthma, their environment, and their behavior in relation to self-management strategies and in …

Asthma In Pregnancy: Pathophysiology, Diagnosis And Management., Abbey Hardy-Fairbanks, Emily Baker

Abbey J Hardy-Fairbanks

Asthma is a common, potentially serious, even life-threatening, chronic medical condition seen amongst nearly all groups of patients, regardless of ethnicity and socioeconomic circumstances. This article addresses the group of pregnant women with symptomatic asthma as well as those whose asthma is asymptomatic as a result of good control. The incidence, the pathophysiologic changes of pregnancy, and the interplay between these changes and asthma are reviewed in this article. The classification of these patients and appropriate management strategies are discussed.

Pharmacist-Led Interventions For Adults With Asthma Or Copd, Cristin Ryan, Amanda Mccullough, Stuart Elborn, Carmel Hughes

Amanda McCullough

Background Chronic lung diseases such as asthma and chronic obstructive pulmonary disease (COPD) are major causes of morbidity, mortality and cost to healthcare service providers globally (WHO 2010). As a result of continued exposure to risk factors, the prevalence of these conditions is expected to increase worldwide. There are approximately 300 million asthma suffers globally, with the prevalence projected to increase by 50% every decade (GINA 2012). COPD is presently the fourth leading cause of chronic morbidity and mortality in the US, and is projected to be the third leading cause of death by 2020 (Mannino 2006).

Relationship Between Respiratory Load Perception And Perception Of Nonrespiratory Sensory Modalities In Subjects With Life-Threatening Asthma, Kathleen Davenport, Chien Huang, Matthew Davenport, Paul Davenport

Matthew P Davenport

Subjects with life-threatening asthma (LTA) have reported decreased sensitivity to inspiratory resistive (R) loads. It is unknown if decreased sensitivity is specific for inspiratory R loads, other types of respiratory loads, or a general deficit affecting sensory modalities. This study hypothesized that impairment is specific to respiratory stimuli. This study tested perceptual sensitivity of LTA, asthmatic (A), and nonasthmatic (NA) subjects to 4 sensory modalities: respiratory, somatosensory, auditory, visual. Perceptual sensitivity was measured with magnitude estimation (ME): respiratory loads ME, determined using inspiratory R and pressure threshold (PT) loads; somatosensory ME, determined using weight ranges of 2–20 kg; auditory ME, …

Asthma And Depression: A Pragmatic Review Of The Literature And Recommendations For Future Research, Melissa Opolski, Ian Wilson

Ian G Wilson

Background: Although the association between asthma and psychosocial factors has long been recognised, it is only in the last decade that the impact of coexisting asthma and depression has become the focus of considerable research interest. However, the findings so far have been confusing and often contradictory. This paper sets out a methodical review and appraisal of the literature to date, including suggestions for future research. Method: PubMed and PsycINFO databases were used to search for English-language articles relating to asthma and depression research. The resulting articles were then reviewed and summarised, creating a report that was used to develop …

Antenatal Risk Factors, Cytokines And The Development Of Atopic Disease In Early Childhood, Esther Chung, Rachel Miller, Michael Wilson, Stephen Mcgeady, Jennifer Culhane

Esther K. Chung

Atopic diseases are complex entities influenced by an array of risk factors including genetic predisposition, environmental allergens, antenatal exposures, infections and psychosocial factors. One proposed mechanism by which these risk factors contribute to the development of atopic disease is through alterations in the production of T helper type 1 (Th1) and type 2 (Th2) cytokines. The objectives of this review are to discuss antenatal exposures that are associated with pediatric atopic diseases, to discuss the influence of the intrauterine environment on neonatal immune responses, to provide an overview of the Th1 and Th2 pathways and how they relate to atopic …

Serum 25-Hydroxyvitamin D Levels Do Not Correlate With Asthma Severity In A Case-Controlled Study Of Children And Adolescents, Jennifer Menon, Louise Maranda, Benjamin U. Nwosu

Benjamin U. Nwosu

Background: There is no consensus on the association between vitamin D and asthma.

Objective: To determine the relationship between 25-hydroxyvitamin D [25(OH)D] levels and asthma symptom severity in children and adolescents.

Methods: A retrospective, case-control study of 263 subjects of ages 2–19 years with asthma who were compared to 284 non-asthmatic controls of similar ages. Subjects were excluded if they had diseases of calcium or vitamin D metabolism or were receiving calcium or vitamin D supplementation. Serum 25(OH)D was measured in all subjects. Asthma symptom severity, usually stratified into 6 steps, was stratified into five steps [1–5] based on the …

The Associations Between Victimization, Feeling Unsafe, And Asthma Episodes Among Us High-School Students, Monica Swahn, Robert Bossarte

Monica H. Swahn

We examined the associations between victimization, missed school because of feeling unsafe, and asthma episodes among US high-school students using the 2003 Youth Risk Behavior Survey. Cross-sectional analyses on adolescents with asthma (n=1943) showed that any victimization and missed school because of feeling unsafe significantly increased the odds of having an asthma episode in the past year (adjusted odds ratio [OR]=1.45; 95% confidence interval [CI] = 1.07, 1.95 and adjusted OR = 2.93; 95% CI = 1.90, 4.53, respectively). Victimization and feeling unsafe are important but poorly understood risk factors for asthma.

The Associations Between Area Of Residence, Sexual Violence Victimization, And Asthma Episodes Among Us Adult Women In 14 States And Territories, 2005-2007, Robert Bossarte, Monica Swahn, Ekta Choudhary

Monica H. Swahn

Gaps in understanding of how area-based differences in exposure to violence are associated with asthma prevalence may limit the development of effective prevention programs and the identification of risk for asthma episodes. The current investigation examines the associations between sexual violence victimization and asthma episodes among US adult women across three different metropolitan settings. The association between sexual assault victimizations and asthma attacks in the past year was examined using data from the 2005, 2006, and 2007 Behavioral Risk Factor Surveillance System surveys. Cross-sectional analyses were based on adult women with current asthma (n = 4,099). Multivariate logistic regression models …

A Patient-Centered Telephone Intervention Using The Asthma Action Plan, Jaysri Dasar Raju, Naaz Aziz, Ambica Soni, Jeffrey D. Tiemstra Md, Memoona Hasnain

Jeffrey Tiemstra

Service-Learning At A Camp For Children With Asthma As Part Of An Advanced Pharmacy Practice Experience, Jennifer L. Kirwin, Jenny A. Van Amburgh, Kristyn M. Napoli

Jennifer L. Kirwin

Objectives. To describe a service-learning opportunity within an advanced pharmacy practice experience and report satisfaction survey results from 2001 through present. Design. Pharmacy students volunteered to attend asthma camp during an ambulatory care rotation. Students administered and monitored medications and coordinated educational activities for campers. Students set goals for the week and completed reflective journals about the experience. A survey was administered 1 week and 6 months after the experience to assess satisfaction, changes in attitudes toward children with chronic asthma, and empathy towards patients.Assessment. Most students accomplished their goals and were satisfied with the experience. Approximately 40% of students …

Service-Learning At A Camp For Children With Asthma As Part Of An Advanced Pharmacy Practice Experience, Jennifer Kirwin, Jenny Van Amburgh, Kristyn Napoli

Jenny A. Van Amburgh

Objectives. To describe a service-learning opportunity within an advanced pharmacy practice experience and report satisfaction survey results from 2001 through present. Design. Pharmacy students volunteered to attend asthma camp during an ambulatory care rotation. Students administered and monitored medications and coordinated educational activities for campers. Students set goals for the week and completed reflective journals about the experience. A survey was administered 1 week and 6 months after the experience to assess satisfaction, changes in attitudes toward children with chronic asthma, and empathy towards patients.Assessment. Most students accomplished their goals and were satisfied with the experience. Approximately 40% of students …

Challenging The Views Of Self Management For Asthma, Kelly L. Andrews, Sandra C. Jones, Melinda Williams, Judy Mullan

Judy Mullan

• Individual nature of asthma and the asthmatic are not well understood or prioritised as a starting point to improve the uptake of self management strategies • Fuller understanding of 4 P’s from a consumer perspective required • Preliminary audience segmentation herein provide a sound platform for future investigations • Consumer focused evaluations are necessary to understand the present barriers and future facilitators of health behaviour change.

Challenging The Views Of Self Management For Asthma, Kelly L. Andrews, Sandra C. Jones, Melinda Williams, Judy Mullan

Sandra Jones

• Individual nature of asthma and the asthmatic are not well understood or prioritised as a starting point to improve the uptake of self management strategies • Fuller understanding of 4 P’s from a consumer perspective required • Preliminary audience segmentation herein provide a sound platform for future investigations • Consumer focused evaluations are necessary to understand the present barriers and future facilitators of health behaviour change.

Exposure To Indoor Biomass Fuel Pollutants And Asthma Prevalence In Southeastern Kentucky: Results From The Burden Of Lung Disease (Bold) Study, Anna C. Barry, David M. Mannino, Claudia Hopenhayn, Heather Bush

David M. Mannino

BACKGROUND:

Asthma is a chronic inflammatory respiratory disease, characterized by episodic and reversible airflow obstruction and airway hyperresponsiveness and is influenced by both genetic and environmental factors.

METHODS:

The Burden of Obstructive Lung Disease (BOLD) survey was used to determine the prevalence of self-reported asthma in a target population of 325,000 adults aged > or =40 in Southeastern Kentucky. Postbronchodilator spirometry was used to classify subjects based on lung function. Risk factors for asthma in this population, in particular indoor usage of biomass fuels, were evaluated.

RESULTS:

The overall study population was comprised of 508 individuals, with 15.5% reporting current asthma …