Capstone Project Topic Selection and Approval.

Posted: November 10th, 2022

Capstone Project Topic Selection and Approval.

 

Change Topic:PICOT question
In patients with COPD exacerbations requiring hospitalization (P), can implementation of a GOLD guidelines criteria care bundle (I) when compared to no care bundle (C) reduce exacerbation requiring hospitalization (O) within the first 60 days after discharge?
Criteria Article 1 Article 2 Article 3 Article 4
Author, Journal
(Peer-Reviewed)
Augustin, I. M., Spruit, M. A., Houben-Wilke, S., Franssen, F. M., Vanfleteren, L. E., Gaffron, S., …&Wouters, E. F.
PloS one Adam I. Biener, Sandra L. Decker, &Frederick Rohde

JAMA. 2019;322(7) Criner G & Jean B.Capstone Project Topic Selection and Approval.

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Chest, 147(4) Franssen F, Peter A, Bar N, Birke J, Lurato S, Majer D, Spruit M, Claus V, Wouters E & Bernd S.
Article Title and
Year Published
The respiratory physiome: clustering based on a comprehensive lung function assessment in patients with COPD
(2018) Prevalence and Treatment of Chronic Obstructive Pulmonary Disease (COPD) in the United States
(2019) Prevention of Acute Exacerbations of COPD. Chest
(2015) Personalized medicine for patients with COPD: where are we?
(2019)
Research Questions (Qualitative)/
Hypothesis (Quantitative),
and Purposes/Aim of Study
Can pathophysiological clusters in COPD based on an integrated set of standard lung function attributes clusters predict patient-related outcomes and differ in clinical characteristics?

To identify pathophysiological clusters in COPD based on an integrated set of standard lung function attributes and to investigate whether these clusters can predict patient-related outcomes and differ in clinical characteristics. What is the prevalence of COPD in the US?

To investigate the population of adults with COPD

To recognize the impacts ofCOPD. What is the prevention of acute exacerbations of COPD?

Addressing the nonpharmacological therapies, inhaled therapies, and oral therapies

To provide an up-to-date, rigorous, evidence-based analysis of current randomized controlled trial data regarding the prevention of COPD exacerbations. What is the current status of and unmet needs regarding personalized medicine for patients with COPD?Capstone Project Topic Selection and Approval.

Provides a descriptionof the current status andunmet needs regarding personalized medicine for patients with COPD.

To proposes a
systems medicine approach, integrating genetic, environmental, (micro)biological, and clinical factors in experimental and computational models in order to decipher the multilevel
complexity of COPD
Design (Type of Quantitative, or
Type of Qualitative)
Chance study: cross-sectional, Observational, prospective, single-center quantitative study Systematic review
Randomized controlled trial
SGRQSt. George’s Respiratory Questionnaire Randomized controlled trial Longitudinal prospective cohort study
Setting/Sample
Patients with clinically stable COPDreferred by a chest physician for a comprehensive pulmonary rehabilitation program at CIRO
518 participants Patients with COPD None All COPD patients
Methods: Intervention/
Instruments
Integrated assessment including clinical characteristics, dyspnea score, exercise performance, mood and health status, and lung function measurements

Self-organizing maps were used to generate lung function based clusters. Document evaluation tools
systematic review and critical evaluation of the published literature Systematic review
critical evaluation Interventional therapies
Statistical models

Analysis
Viscovery Profiler 7.1 by Viscovery Software GmbH was used for all statistical analyses

Ordered presentation through self-organizing maps Graphical analysis Up-to-date, rigorous, evidence-based analysis of current randomized controlled trial data regarding the prevention of COPD exacerbations. Non-parametric regression technique,
Key Findings
All clusters show differences in dyspnea score, proportion of men/women, age, number of exacerbations and hospitalizations, proportion of patients using long-term oxygen and number of comorbidities. Prevalence of COPD has declined.
The prevalence is higher among adults with lower income, public insurance and smoking history

Drug expenditure and ED visits have increased among adults with COPD. AECOPD Guideline is unique in Preventing Acute Exacerbations of COPD Patients’ needs are currently based on a more personalized approach.Capstone Project Topic Selection and Approval.

Recommendations
Follow-up studies will also be needed to validate our identified clusters in other cohorts as well as transition of clusters over time

The current findings need to be corroborated in different COPD samples. The use of AECOPD Guideline in Preventing Acute Exacerbations of COPD in the clinical setting A multidisciplinary systems medicine approach may reveal the multilevel
complexity of COPD and fill current gaps in optimization
of treatment for individuals at risk and those with established airflow limitation.
Explanation of How the Article Supports EBP/Capstone Project
Provides evidence-based information essential in prevention, prevalence and management of COPD Provides evidence-based information essential in prevention, prevalence and management of COPD Provides evidence-based information essential in prevention, prevalence and management of COPD Provides evidence-based information essential in prevention, prevalence and management of COPD
Criteria Article 5 Article 6 Article 7 Article 8
Author, Journal
(Peer-Reviewed),
Patel A, Patel A, Signh S, Singh S & Imran K. Singh D, Agusti A, Anzueto A, Barnes P, Bourbeau J, Celli B, Criner G et al. Zha, Z., Leng, R., Xu, W. et al.
BMC Pulm Med, 19(102) 2019 Global Initiative for Chronic Obstructive Lung Disease, Inc.
Article Title and
Year Published
Global Initiative for Chronic Obstructive Lung Disease: The Changes Made
(2019) Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019
(2019) Prevalence and risk factors of chronic obstructive pulmonary disease in Anhui Province, China: a population-based survey
(2019) Global strategy for the diagnosis, management, and prevention of COPD: global initiative for chronic obstructive lung disease (GOLD)
Research Questions (Qualitative)/Capstone Project Topic Selection and Approval.
Hypothesis (Quantitative),
and Purposes/
aim of Study
What ae the changes made by the Global Initiative for Chronic Obstructive Lung Disease?

The research summarizes the current state of theChronic Obstructive Lung Disease.

To create awareness on the burden of COPD

What is the global strategy for the diagnosis, management, and prevention of Chronic Obstructive Lung Disease?

To explain the evidence and rationale for the GOLD 2019 pharmacological treatment recommendations.

To distinguish between initial and follow-up pharmacological management for COPD. What is the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) in Anhui?

The study provides the first estimate of the prevalence and risk factors of COPD in Anhui

To fill this knowledge gap and provide the first estimation of the prevalence and risk factors of spirometry-defined COPD in Anhui.
What is the Global strategy for the diagnosis, management, and prevention of COPD?Capstone Project Topic Selection and Approval.

To raise awareness of chronic obstructive pulmonary disease (COPD)

To developevidence-based strategy documents
To improve prevention and treatment of this lung disease.
Design (Type of
Quantitative, or
Type of
Qualitative)
Randomized controlled trials

Non- randomized trials: Observation studies
Randomized controlled trials Cross-sectional study Longitudinal clinical study
Setting/Sample
None None Anhui Province:
3000 participants aged 40 years or older None
Methods:
Intervention/
Instruments
Pharmacological treatment algorithms Population-based survey
complex, multistage, and probability sampling method
Interviews
Questionnaires
Survey Statistical models
Analysis
Meta-analysis Meta-analysis Multivariable logistic regression was used to investigate potential risk factors for COPD

Statistical significance of difference was assessed by the χ2 test

All statistical analyses conducted in 2018 were performed using Stata version 14.2 Meta-analysis
Key Findings
COPD is often comorbid with other disorders
Precision medicineintegrates all relevant clinical, genetic and biological information in order to optimize the therapeutic benefit COPD is prevalent in Anhui and the prevalence is highest in north region. COPD is often comorbid with other disorders.Capstone Project Topic Selection and Approval.
Recommendations
COPD treatment should be kept simple in the light of unbearable polypharmacy that patients are exposed to. There is a need for a different system to guide COPD pharmacological management during follow-up. Strategies aiming at prevention, early detection and treatment of COPD are urgently needed to reduce COPD-related burden. Identification and reduction of exposure to risks in the clinical setting
Explanation of
How the Article Supports EBP/
Capstone
Provides evidence-based information essential in prevention, prevalence and management of COPD Provides evidence-based information essential in prevention, prevalence and management of COPD Provides evidence-based information essential in prevention, prevalence and management of COPD Provides evidence-based information essential in prevention, prevalence and management of COPD

 

Capstone Project Topic Selection and Approval

Topic: Use of GOLD guidelines for patients with Chronic obstructive pulmonary disease (COPD) in an acute care setting to reduce the readmission rate.Capstone Project Topic Selection and Approval.

Introduction

COPD is a chronic lung disease that is typified by difficult breathing, repetitive respiratory symptoms, as well as airflow limitations due to the abnormalities of the airway/alveolar (Zha et al., 2019). A COPD exacerbation is marked by symptom escalation and significantly contributes to the worsening of lung function, reduced quality of life, need for hospitalization or urgent care, and increased the cost of care (Augustin et al., 2018). COPD affects about 24 million individuals and is among the leading causes of mortality and morbidity within America (Biener et al., 2019). Biener et al (2019) explain that COPD is not only the third leading cause of deaths within the USA but also causes about 800,000 hospitalizations every year in America. Statistics show that 1 in 4 patients admitted for COPD is readmitted within 30 days post-discharge. Healthcare costs allied to COPD total to about $32–40 billion annually (Biener et al., 2019). Therefore, there is a need to research more on the interventions and strategies that can reduce the rate of patients with acute exacerbations in COPD and the readmission rates for this population. Global Initiatives for Chronic Obstructive Lung Disease (GOLD) guidelines have been demonstrated to improve outcomes of COPD patients and prevent acute exacerbations.Capstone Project Topic Selection and Approval.

PICOT

In patients with COPD exacerbations requiring hospitalization (P), can implementation of a GOLD guidelines criteria care bundle (I) when compared to no care bundle (C) reduce exacerbation requiring hospitalization (O) within the first 60 days after discharge?

 

Setting

This proposed capstone project will be implemented in the acute care setting where the readmission rate of COPD patients will be examined to examine if the implementation of GOLD guidelines during care of COPD patients reduces the risk of future exacerbations and thus the readmission rate.

Significance of the Problem

Even though COPD is preventable and treatable, it is the third leading cause of death globally. The GOLD guidelines present the “best practices” for assessment, diagnosis, and treatment of COPD. The majority of patients hospitalized with acute exacerbations in COPD do not receive the required treatment and the appropriate follow-up treatment after discharge (Criner & Jean, 2015). This significantly contributes to the readmission of acute exacerbations within 30 days post-discharge. The use of the Gold guidelines can significantly reduce the high costs and reimbursement penalties associated with rehospitalizations of patients with acute exacerbation of COPD. Nonetheless, the GOLD guidelines are underutilized during the care of patients with COPD. Utilization of GOLD guidelines results in better patient outcomes by reducing the acute exacerbations for patients with COPD, which worsens the flow of air and increases mortality (Franssen et al., 2019). The use of the GOLD guidelines also reduces hyperinflation for patients with COPD and also improves their ability to exercise (Patel et al., 2019). Therefore, appropriate utilization of the GOLD guidelines can be effective in reducing the readmission rate for patients with acute exacerbations in COPD. Capstone Project Topic Selection and Approval.

 

 

Global Obstructive Lung Disease (GOLD) Guidelines

For the assessment and diagnosis of COPD, the GOLD guidelines recommend that COPD should be considered for patients with chronic cough/sputum, dyspnea, history of exposure to risk factors of COPD, and a history of persistent lower respiratory infections. Spirometry is needed to confirm a COPD diagnosis and COPD assessment should aim to establish the level of airflow limitation, how the disease impacts the health status of the patient, and the risk for future acute exacerbations (Patel et al., 2019). The ABCD assessment tool is used to grade the severity of airflow limitation.

For the prevention and maintenance treatment, smoking cessation is prioritized. Pharmacological treatment can lessen symptoms, reduce the severity and frequency of exacerbations, and generally improve exercise tolerance and health status (Singh et al., 2019). The pharmacological therapy should be personalized and directed by the symptom severity, risk of future exacerbations, side effects, availability of medications and costs, comorbidities, response to treatment, and the ability of the patient to utilize various medication delivery devices. The GOLD guidelines also recommend that regular assessment of the inhaler technique (Singh et al., 2019).Capstone Project Topic Selection and Approval. Influenza and pneumococcal vaccinations lower the rate of lower tract infections while pulmonary rehabilitation significantly improves symptoms and the quality of life. For patients having serious resting chronic hypoxemia, long-term oxygen therapy has been shown to improve the survival rate. Long term non-invasive ventilation is suggested for patients having severe chronic hypercapnia and a history of respiratory failure. Medications for COPD include bronchodilators, inhaled corticosteroids, and Anti-cholinergic meter dosed inhaler (Singh et al., 2019).Capstone Project Topic Selection and Approval.