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H Worth

Publications and source records attributed to H Worth.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Evaluation of a structured education programme for patients with COPD under outpatient conditions-- a pilot study].

In contrast to other chronic diseases, such as bronchial asthma, the role of patient education in the management of COPD still remains unclear. Therefore, we evaluated the efficacy of a structured education programme for COPD-patients under outpatient conditions in a prospective pilot study including 21 patients with mild to moderate COPD over a period of two years. The main teaching items of the programme are: self-control of the disease with regular peak flow measurements, the observation of typical symptoms and the patients diary, effects and side effects of the medication, correct inhalation technique and the patients' ability to change the medication with respect to the actual degree of airflow limitation. The frequency of episodes of dyspnoea per day was significantly reduced after the first year. Before the training course the patients had an average of 1.6 +/- 0.5 episodes of dyspnoea per day, after the first year 1.0 +/- 0.5 (p < 0.05). With respect to the year before the intervention, the total number of the exacerbations did not change significantly in the two years after the participation in the programme, but the number of self-managed exacerbations increased. Further effects were an improvement of the knowledge of the patients about the effects and side effects of the medication: before the education the number of correct answers in a multiple choice test was 9.1%, one year later 68.7% (p < 0.01) and after the second year 70.5% (p < 0.01). The self-control of the disease could be improved by regular observation of symptoms, peak flow measurements and patients' diary. The number of hospital days due to the diagnosis COPD decreased from 10.1 +/- 0.5 days per patient and year to 2.1 +/- 0.2 days (p < 0.01) in the first year after the education and remained constant with 2.4 +/- 0.6 days (p < 0.01) even in the second year after the course. The efficacy of the education programme is still evident two years after the training. In comparison to the results one year after the programme we found a loss of efficacy in some aspects, particularly in the self-control of the disease. In conclusion, structured education programmes under outpatient conditions could improve the self management abilities in patients with mild to moderate COPD. Randomized controlled trials with a larger sample size are needed to confirm the results of this pilot study.

Aged↗
PubMed2002

[In-patient asthma education and self-management training in clinical practice--a national survey in Germany].

BACKGROUND: According to international guidelines patient education is a key component of modern asthma-management. Especially in rehabilitation, patient training is considered essential for long-term treatment success. Based on growing empirical evidence for clinical efficacy of asthma self-management training, standardized education programs as well as guidelines and recommendations for quality management in health care practice have been developed. AIM: Due to the lack of evidence [empirical data] on compliance to these recommendations we conducted a nation-wide survey including in-patient pneumological clinics in Germany. METHODS: Exploiting address registers of national asthma organizations (i. e. Deutsche Atemwegsliga) we identified 75 clinics that offer education programs on a regular basis, 65 of which participated in this study (drop-out-rate: 12 %). These institutions were asked to complete a questionnaire in order to assess various aspects of their education practice. RESULTS: Although 91 % of clinics reported to adhere to guidelines and recommendations for patient education, merely 50 % supplied standardized and evaluated education and self-management training programs. A rather small proportion (19 %) was found to fully adhere to protocol (maximum treatment integrity, no mixing of different education schemes). Furthermore, substantial variance between clinics was observed in actual performance of asthma education, the major indicators being: indication criteria and eligibility of patients; education contents; group size, duration and frequency of sessions; extent and intensity; didactical methods; number and qualification of trainers; measures of quality management, and settings. Accordingly, a consistent standard of patient education in rehabilitation practice has not yet been achieved. CONCLUSION: While substantial advances in the proposition of patient education and self-management trainings in in-patient health care remain unquestioned, there are some deficits in actually performing such programs in clinical practice. Results also show that another question needs to be addressed: qualifying trainers. Less than half of trainers participating in this study reported to have absolved a train-the-trainer-course.

Asthma↗
PubMed2001

Men sex workers and other men who have sex with men: how do their HIV risks compare in New Zealand?

Sex workers have their perspective on HIV transmission, claiming that in general they are more similar than different from other people in HIV status and the practice of safe sex. Such an assertion of similarity goes against public and professional opinion that prostitution is a major vector in the spread of AIDS. Taking the sex workers' similarity claim seriously, this paper considers the conditions under which it would be valid. We focus on those factors that make a population more or less vulnerable to HIV and how they affect its spread into the sex work population. Data from New Zealand comparing men sex workers and other men who have sex with men is used to evaluate these ideas. Data partially support the hypothesis in that these two groups of men are similar with regard to their HIV status. We do find the sex workers to be different, however, in their being less likely to engage in safe sex practices. We provide an explanation for why this has not lead to their having a higher rate of seropositivity.

Adult↗
PubMed2001

[Evaluation of a structured education program for adult outpatient asthmatics].

BACKGROUND AND METHODS: The efficacy of a structured education programme (AFAS) unter outpatient conditions was evaluated in a pilot study including 25 mild to severely ill adult asthmatics (age 41 +/- 2 yrs.) over a period of two and a half years. The main teaching items of the programme are: self-control of the disease with regular peak flow measurements, monitoring of symptoms with a patient diary, effects and side effects of the treatment, correct inhalation technique of asthma medication and the ability of self-management with regard to the actual degree of airflow limitation by the patients. RESULTS: After AFAS the knowledge of the patients regarding the disease as well as the medication increased significantly. There was an improvement of drug therapy: before AFAS only 52% of the patients used inhaled steroids on a regular basis with regard to 96% one and two years after participation of AFAS (p < 0.01). The self-control of the disease was improved: before AFAS no patient measured peak flow during acute dyspnoea, compared with 88% (p < 0.001) and 75% (p < 0.001) one and two years after AFAS, respectively. The number of severe asthma-attacks decreased significantly from 10.7 +/- 2.5 per patient and year before education to 1.3 +/- 0.2 (p < 0.001) after the first year and to 2.0 +/- 0.3 (p < 0.05) after the second year. The total number of hospital days due to asthma decreased from 219 days in the year before the participation in AFAS to zero (p < 0.001) in the first year after the education and to 17 days (p < 0.001) after the second year. CONCLUSIONS: The efficacy of patient education with AFAS is still evident two years after the course, but a reduction of self-control of the disease was observed during the follow-up period. In conclusion, structured education programmes for adult asthmatics can be effective even under outpatient conditions.

Adolescent↗
PubMed2001

Comparison of hydrofluoroalkane-beclomethasone dipropionate Autohaler with budesonide Turbuhaler in asthma control.

BACKGROUND: Hydrofluoroalkane-beclomethasone dipropionate Autohaler (HFA-BDP AH) is a breath-actuated chlorofluorocarbon (CFC)-free metered dose inhaler in which BDP is in a solution of HFA propellant. Budesonide Turbuhaler (BUD TH) is a breath-dependent dry powder inhaler. OBJECTIVES: To test the hypothesis that half the daily dose of HFA-BDP AH would provide an equivalent control of asthma symptoms to the BUD TH. METHODS: This was an 8-week open study in patients with symptomatic moderate-to-severe asthma, previously on BUD 500-1,000 microg x day(-1), or an equivalent. After 5-14 days' run-in, patients were randomized to HFA-BDP AH 800 microg x day(-1) or BUD TH 1,600 microg x day(-1). The intent-to-treat population consisted of 111 patients on HFA-BDP AH and 98 patients on BUD TH. RESULTS: Mean change from baseline in PEF in the morning (AM PEF) at week 8 was 23.95 liters x min(-1) for HFA-BDP AH and 24.46 liters x min(-1) for BUD TH. A two-sided equivalence test using the 0.51 liter x min(-1) difference gave 95% confidence intervals within a defined equivalence interval of (-infinity, 25 liters x min(-1)) indicating that the mean change in AM PEF was equivalent for the two groups. There were no significant differences in the mean change from baseline in FEV1 or beta-agonist use. Patients using HFA-BDP AH had a significantly greater mean change from baseline in the percentage of days free from shortness of breath (p = 0.05), chest tightness (p = 0.02) and nights without sleep disturbance (p = 0.04) at week 3, and wheeze (p = 0.01), shortness of breath (p = 0.02), chest tightness (p < 0.01) and daily asthma symptoms (p = 0.03) at week 8. The incidence, type and severity of adverse events were similar in each group. At week 8, the mean change from baseline in corrected urine cortisol/creatinine ratio in a subgroup of patients was -0.36 for HFA-BDP and -4.88 for BUD TH (p < 0.01). CONCLUSIONS: HFA-BDP 800 microg x day(-1) provided control of moderate-to-severe asthma with efficacy and safety at least similar to BUD TH 1,600 microg x day(-1).

Administration, Inhalation↗