Anne Dichmann Sorknæs

Nurse tele-consultations with discharged COPD patients reduce early readmissions--an interventional study.

Introduction:  Exacerbations of chronic obstructive pulmonary disease (ECOPD) are the most common cause for admissions and readmissions to medical wards worldwide.

Effect of diagnosis of “smoker's lung”

Vol 349 • January 25, 1997 253 contracted; electromyography (EMG) revealed a marked increase in interference pattern. With use of EMG, and after obtaining informed consent, we injected 10 units of botulinum toxin (BOTOX, Allergan) into two sites of the anterior vaginal wall muscles. Spasms improved within 24 h, and resolved within 60 h; the benefit persisted for 5 weeks. 7 weeks after her initial injection, 40 units of botulinum toxin were injected under EMG guidance. By 8 days, bladder, urethral, and vaginal symptoms resolved. 2 weeks later, she had intercourse for the first time in 8 years. The benefit has persisted for over 24 months; she is now engaged to be married. Botulinum toxin blocks release of acetylcholine, preventing neuromuscular transmission and leading to muscle weakness. Local botulinum toxin injections have been shown to be safe and effective in relieving the muscle spasms associated with dystonia, spasticity and other sphincters including the larynx, urinary sphincter, cricopharyngeal muscle, oesophageal sphincters in achalasia, rectal sphincters associated with intractable constipation, and anal fissures. Unlike dystonia, most patients with vaginismus are effectively treated with behavioural therapy or progressive dilator therapy. Other similar urological conditions include interstitial cystitis, and urethral syndrome, voiding dysfunction, and pelvic pain, often presenting with urgency, frequent urination, and pain associated with inappropriate contraction of the pelvic floor musculature and/or urethral sphincter. Botulinum toxin therapy acutely relieved the inappropriate spasms, allowing resumption of intercourse.

The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation

Summary We investigated the effect of daily real-time teleconsultations for one week between hospital-based nurses specialised in respiratory diseases and patients with severe COPD discharged after acute exacerbation. Patients admitted with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) at two hospitals were recruited at hospital discharge. They were randomly assigned to intervention or control. The telemedicine equipment consisted of a briefcase with built-in computer including a web camera, microphone and measurement equipment. The primary outcome was the mean number of total hospital readmissions within 26 weeks of discharge. A total of 266 patients (mean age 72 years) were allocated to either intervention (n = 132) or control (n = 134). There was no significant difference in the unconditional total mean number of hospital readmissions after 26 weeks: mean 1.4 (SD 2.1) in the intervention group and 1.6 (SD 2.4) in the control group. In a secondary analysis, there was no significant difference between the two groups in mortality, time to readmission, mean number of total hospital readmissions, mean number of readmissions with AECOPD, mean number of total hospital readmission days or mean number of readmission days with AECOPD calculated at 4, 8, 12 and 26 weeks. Thus the addition of one week of teleconsultations between hospital-based nurses and patients with severe COPD discharged after hospitalisation did not significantly reduce readmissions or affect mortality.

Danish Register of chronic obstructive pulmonary disease.

Aim of database The Danish Register of Chronic Obstructive Pulmonary Disease (DrCOPD) is a nationwide database aiming to describe the quality of treatment of all patients with chronic obstructive pulmonary disease (COPD) in Denmark. Study population DrCOPD comprises data on all patients with a diagnosis of COPD. In the hospital setting, both in- and outpatients are included. In the setting of the general practice (GP), DrCOPD aims to include all patients with a COPD diagnosis who attend an annual control visit for COPD. Main variables DrCOPD includes information on forced expiratory volume in 1 second, smoking status, body mass index, dyspnea, treatment modalities such as rehabilitation, smoking cessation, medical treatment, and the use of noninvasive ventilation during hospitalization due to exacerbations. The outcome variables include frequency of readmission and death 30 days after discharge from hospital. Descriptive data Since 2008, the registration in the Danish hospitals has gradually become more comprehensive. In 2014, ~90% of 16,106 eligible patients had complete data sets that showed an improvement in the processes describing quality of care, including increased offering of smoking cessation, rehabilitation, and correct treatment with inhaled medication. Data from GPs have been included since 2011, but are still incomplete and comprise only ~20% of all COPD patients seen. The collection of data from GP settings has recently been hampered due to legislative controversies. Conclusion In relatively few years, DrCOPD has become increasingly comprehensive and has documented an improvement in the management of COPD in Danish hospitals.

Validity and reliability of the Danish version of the Ice Expressive Family Functioning and Ice Family Perceived Support questionnaires

AIM International research has only rarely examined the functioning of families experiencing chronic illness and the perception of nurses towards involving families in patient care. This has also been the case in Denmark. To undertake this kind of research, carefully translated questionnaires are needed. The purpose of this study was therefore to translate the Ice Expressive Family Functioning (ICE-EFFQ) and the Ice Family Perceived Support (ICE-FPSQ) into Danish, and to test the validity and reliability of the Danish versions. METHODS The study had a cross-sectional design. The questionnaires were translated into Danish using forward-backward translation. Then, they were tested empirically among adult patients with chronic diseases and their family members in three different settings. A total of 81 patients were included in the testing of ICE-EFFQ and 70 patients were included in the testing of ICE-FPSQ. Internal consistency reliability was assessed followed by confirmatory factor analysis. RESULTS Both questionnaires showed acceptable construct validity, reliability (Cronbachs alpha 0.93 and 0.94), internal consistency were confirmed, and there was good reproducibility (Cronbachs alpha 0.76 and 0.77). Furthermore, confirmatory factor analysis showed acceptable to good fit for both questionnaires. CONCLUSIONS The ICE-EFFQ and the ICE-FPSQ were both found to be valid and reliable instruments to measure family functioning and perceived support among families experiencing chronic illness in a Danish context.

The Effect of Tele-Consultation Between a Hospital-Based Nurse and a COPD Patient.

Patients admitted with exacerbation COPD (AECOPD) were at hospital discharge randomly assigned (1:1) to either daily teleconsultation for one week between hospital-based telenurses and patients with severe COPD or conventional treatment. Addition of one week of teleconsultations was as safe and effective as conventional treatment, but it did not significantly reduce readmissions or affect mortality