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Academic Year 2010/2011 Advisers: Dr. João Fonseca Dr. Luís Silva Daniela Linhares Regent: Prof. Dr. Altamiro Pereira Introdução à Medicina II.

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Presentation on theme: "Academic Year 2010/2011 Advisers: Dr. João Fonseca Dr. Luís Silva Daniela Linhares Regent: Prof. Dr. Altamiro Pereira Introdução à Medicina II."— Presentation transcript:

1 Academic Year 2010/2011 Advisers: Dr. João Fonseca Dr. Luís Silva Daniela Linhares Regent: Prof. Dr. Altamiro Pereira Introdução à Medicina II

2 Table of contents o Introduction: Background and justification o Aim and Research Question o Participants and Methods o Flowchart o Results o Discussion and Conclusion o References

3 Disease Asthma Asthma is a serious health problem throughout the world It has a big impact on adults but more severely in children compromise the person’s development and also the life itself Introduction: Background and justification IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences common chronic inflammatory airway disorder that it is currently considered undertreated Definition [1] Lim, KG, Mottram C.The Use of Fraction of Exhaled Nitric in Pulmunary Practice 2008 American College of Chest Physicians [2] Kostikas K, Papaioannou A, Tanou K, Koutsokera A, Papala M, Gourgoulianis K. Portable Exhaled Nitric Oxide as a Screening Tool fo Asthma in Young Adults During Pollen Season. 2008 American College of Chest Physicians

4 Introduction: Background and justification IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Self- management avoidance of triggers; patient adherence to controller medication; patient’s ability to recognize asthma symptoms and respond appropriately. Achieved by routine feature in the management of this disease reduce the impact of asthma on related morbidity, functional ability and mostly on quality of life Ultimate goal Liberati A, et al: The PRISMA statement for reporting systematic review sand meta-analyses of studies that evaluate health care interventions explanation and elaboration. PLoS Med 2009, 6(7):e1000100, Epub 2009 Jul

5 Introduction: Background and justification IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences o A lack of systematic reviews about the topic; o New approaches on asthma's treatment to improve quality of life weren’t known; o There is a need to keep information update

6 assess the impact of self-management in asthma’s control by comparing the quality of life, using numbers of hospitalizations during the treatment. Aim IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences

7 Research Question IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences

8 Question: Is self-management a better solution for asthmatic children than standard procedures in order to decrease the number of hospitalizations and increase quality of life? Population: Children Intervention: Self-management Comparison: With standard procedures Outcome: Quality of life Decreasing of the number of hospitalizations Methods: Explanation Ages 6 to 12 IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences

9 o Type of study; o Study Participants; o Data collection methods; o Study design; o Variable description and expected outcome. Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences

10 Methods: Explanation Systematic Review Definition: type of synthesis study in which we use a methodological and explicit way to expose high leveled evidence regarding certain clinical question Steps: o Formulation of the question (population; intervention; comparison; outcome) o Define the selection criteria (inclusion and exclusion) o Define the search strategies IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Type of study

11 Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Each group was given a determined number of articles to evaluate Group 1 Group 2Group 3Group 4Group 5 1 - 3738 - 7475 - 114115 - 154155 - 189 We randomly split the class in 5 groups using a service from a website Diogo GalvãoJoana AlmeidaFernando MendonçaRui FreitasDaniel Teles Filipa SousaCarolina SimasRaquel AraújoInês MoreiraCatarina Ferreira Pedro Pinto

12 Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences First form –Title and Abstract selection

13 Flowchart – Study Design IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences First phase – Title and Abstract selection The articles obtained were subjected to a process of critical appraising according to its quality.

14 Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Second form –Full-text selection

15 Inclusion criteria Articles regarding self-management in asthma Articles about children, ages 6 to 12, with asthma Articles concerning quality of life and amount of times these children are admitted to hospital Exclusion criteria Articles about efficacy of educational school programs in the treatment of asthma and its costs Articles older than 15 years Articles not written in English, Portuguese, Spanish and French Articles Containing secondary information Abstracts without study details Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences

16 Flowchart – Study Design IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences First phase – Title and Abstract selection Second phase – Full- text selection

17 Flowchart – Study Design IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Third phase – Data Extraction First phase – Title and Abstract selection Second phase – Full- text selection

18 How to extract data? Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences o List of characteristics and measures to extract (variables); o Specific formulary for the extraction of data; o Trial Study to evaluate methods and formulary; o Extraction by two revisionists; o Definition of ways to work out divergences and evaluate the reproducibility of the process.

19 Methods: Explanation Variable Description IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Type of study Quality of life – measured in PA-QOL and PC-QOL questionnaires Sample size Type of comparison – Control vs Education or 2 different types of education Sessions – frequency, duration and number Type of education – topics addressed in intervention Severity of asthma Social economical status Age group Urgent physician visits for asthma prior and after education Emergency room visits prior and after education Number of hospitalizations prior and after education FEV 1 - Lung function reported as changes in absolute forced expiratory volume in one second Other comparison

20 Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Quality of life – measured in PA-QOL and PC-QOL questionnaires

21 Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Third form –Data Extraction

22 Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Third form –Data Extraction

23 Methods: Explanation IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences Search result 264 Included 58 Excluded 206 1st Phase Title and abstract selection Excluded 45 2nd Phase Full-text selection Included 13

24 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences a - Articles not regarding asthma b-Education programs that aren´t about children, ages 6 to 12 c -Articles about efficacy of educational school programs in the treatment of asthma and its costs d- Articles containing secondary information (systematic reviews, meta-analisys ) e- Articles not concerning quality of life and amount of times children are admitted to hospital f – Other exclusion criteria (Abstracts without study details, Any intervention except self-management) *Final count for articles with free full-text 18777 76 Pubmed ISI Web of knowledge

25 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences

26 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences

27 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences Variable extraction

28 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences

29 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences Effect of educational programmes in self management of asthma on number of visits to an emergency department. Visits refers to hospital emergency departments, reported as mean number of visits for a year

30 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences Effect of educational programmes in self management of asthma on lung function. Lung function was reported as changes in absolute forced expiratory volume in one second or peak expiratory flow rate

31 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences Effect of educational programmes in self management of asthma on number of hospitalizations, reported as mean number of hospitalizations for a year.

32 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences PA-QOLQ Effect of educational programmes in self management of asthma on quality of life measures. Quality of life was reported on a Paediatric Asthma Quality of Life Questionnaire

33 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences PC-QOLQ Effect of educational programmes in self management of asthma on quality of life measures. Quality of life was reported on a Paediatric Asthma Caregiver’s Quality of Life Questionnaire

34 Results IntroductionKeywordsAim/RQMethods Disc&ConclResults FlowchartReferences Physician visits Effect of educational programmes in self management of asthma on number of visits to a physician, reported as mean number of urgent visits for a year.

35 Discussion IntroductionKeywordsAim/RQMethods Disc&Concl Results FlowchartReferences Association with modest to moderate improvement in many outcome measures: o lung function o self efficacy o absenteeism from school o number of days of restricted activity o number of visits to an emergency department o possibly nights disturbed by asthma  Few children participate on educational programmes, because programmes take to much time and their costs are not supported by the government. Noreen Clark, CR Houle, MR Partridge. Educational Interventions to Improve Asthma Outcomes in Children. JCOM October 2007,Vol. 14, No. 10

36 Discussion IntroductionKeywordsAim/RQMethods Disc&Concl Results FlowchartReferences The query may not have covered all studies Our study has several limitations There were insufficient studies and a lack of direct comparisons to reliably estimate group variables.

37 Discussion IntroductionKeywordsAim/RQMethods Disc&Concl Results FlowchartReferences improve outcomes Future studies should include more opportunities for interaction between educators and children, studies should be conducted over higher periods, and increase the number of sessions. Our study has important implications for practice and research

38 Conclusion IntroductionKeywordsAim/RQMethods Disc&Concl Results FlowchartReferences The intervention: o reduces the mean number of hospitalizations, emergency departments visits for asthma and increases quality of life. o education can reduce the morbidity and the cost of the disease and improve the quality of life asthmatic children and their parents. Educational programmes should be considered a part of the routine care of young people with asthma.

39 (1) Lim, KG, Mottram C.The Use of Fraction of Exhaled Nitric in Pulmunary Practice 2008 American College of Chest Physicians (2) Kostikas K, Papaioannou A, Tanou K, Koutsokera A, Papala M, Gourgoulianis K. Portable Exhaled Nitric Oxide as a Screening Tool fo Asthma in Young Adults During Pollen Season. 2008 American College of Chest Physicians (3)Pai M, McCullock M, Gorman JD, Pai N, Enanoria W, Kennedy G, Tharyan P, Colford JM Jr. Systematic reviews and meta-analyses: Na illustrated, step-by-step guide. The National Medical Journal of India 2004; 17(2): 86-95 (4) Liberati A, et al: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions explanation and elaboration. PLoS Med 2009, 6(7):e1000100, Epub 2009 Jul (5) Egger M, Smith GD, Phillips AN. Meta-analysis: principles and procedures. BMJ. 1997;315:1533-1537. (6) Indinnimeo L, et all. Clinical effects of a Long-term Educational Program for children with asthma - Aironet. A 1-yr randomized controlled trial.2009 Nov;20(7):654-9. Epub 2009 Jun 12. References IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences

40 Guevara JP, Wolf FM, Grum CM, Clark NM. Effects of educational interventions for self management of asthma in children and adolescents: systematic review and metaanalysis. BMJ 2003; 326: 1308–1309. E.D. Bateman, etal. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008; 31: 143–178 Noreen Clark, CR Houle, MR Partridge. Educational Interventions to Improve Asthma Outcomes in Children. JCOM October 2007,Vol. 14, No. 10 Noreen M. Clark, Herman E. Mitchell and Cynthia S. Rand. Effectiveness of Educational and Behavioral Asthma Interventions. Pediatrics 2009;123;S185-S192 References IntroductionKeywordsAim/RQMethods Disc&Concl ResultsFlowchartReferences

41 Class 3 Carolina Simas Catarina Ferreira Daniel Teles Diogo Galvão Fernando Mendonça Filipa Sousa Inês Moreira Joana Almeida Pedro Pinto Raquel Araújo Rui Freitas


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