Development
of a novel research proposal15 pages, specific to your role specialization. The
project must include an intervention appropriate to nursing practice and
consistent with your MSN role option.
The
research question being investigated is “Does pneumococcal/ influenza vaccine/
or smoking cessation counseling prevent or decrease COPD exacerbations?” This could be change if the writer feels that
the research question is not answerable, or feasible. The population for this study will be any patients
with COPD over the age of 18 and based on the COPD Assessment Test (CAT).
1
Craft
the problem statement and research purpose.
2
Design
your research question aimed at solving (a part of) the problem and include the
following components which will focus the literature review.
PICOT
Question:
Patient, Population or Problem
1 What are the characteristics of the
patient or population?
2 What is the condition or disease you
are interested in?
Intervention or exposure
3 What do you want to do with this
patient (e.g. treat, diagnose, observe)?
Comparison
4 What is the alternative to the
intervention (e.g. placebo, different drug, surgery)?
Outcome
5 What are the relevant outcomes (e.g.
morbidity, death, complications)?
3.
Ensure that the research question is answerable, feasible and clinically
relevant
PLEASE FOLLOW THE RUBRIC PROVIDED AND YOU MAY MAKE CORRECTIONS AS NEEDED FOR THE LITERATURE REVIEW ( PROVIDED) SECTION. THE POPULATION OF THE SELECTED IS BASED ON
any patients with COPD over the age of
18 and based on the COPD Assessment Test (CAT). The CAT is a patient-completed
instrument that complements existing approaches to assessing COPD, such as FEV1
measurement. It has been designed to provide a straightforward and reliable
measure of health status in COPD and assists patients and their physicians in
quantifying the impact of COPD on the patient’s health. The CAT is a validated,
short (8-item) and single patient completed questionnaire, with good
discriminant properties, developed for use in routine clinical practice to
measure the health status of patients with COPD1. Despite the small number of
component items, it covers a broad range of effects of COPD on patients’
health. Using this assessment scale, the patient that the intervention of
non-pharmacologic treatment could benefit would be patients with a score of 10
and greater no matter age, (American Thoracic Society, 2011).
Based
on the CAT, patient with < 10 scores then most days are good, but COPD
causes a few problems and stops people doing one or two things that they would
like to do. They usually cough several days a week and get breathless when
playing sports and games and when carrying heavy loads. They have to slow down
or stop when walking up hills or if they hurry when walking on level ground.
They get exhausted quickly, (GOLDCOPD, 2011). This is my thought process, could be change to fit better with research
question if needed.I also included some articles to be used as references. I uploaded the template and the detailed rubric.
rc_journal___mobile.pdf
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Should Patients With COPD Be Vaccinated?
Abstract
BACKGROUND: Exacerbations of COPD are a major component of the socioeconomic burden
related to COPD, and frequent exacerbations are associated with greater decline in health
status. Tracheobronchial infections are involved in 50–70% of exacerbations, so influenza and
pneumococcal vaccines are recommended for prevention. The aim of this study was to
determine the level of knowledge among COPD patients about the vaccines, find the rate of
patients inoculated with both influenza and pneumococcal vaccines, and assess the
effectiveness of vaccination status.
METHODS: Patients with COPD were recruited from the out-patient clinic of our hospital
between September and October 2012. Subject demographic data such as age, gender, level of
education, and smoking status were recorded. Vaccination status, number of subjects who were
informed by a health-care professional about immunization, and COPD-related emergency or
hospital admissions triggered by tracheobronchial infections over 1 y after administration of both
influenza and pneumococcal vaccines were noted.
RESULTS: Eighty-eight subjects were enrolled during the study period. Eighty-two subjects were
male (93.2%), 6 subjects were female (6.8%), and the median age was 61.5 y. According to
Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006 classification, 5 subjects
were in stage 1 (5.7%), 22 subjects were in stage 2 (25%), 34 subjects were in stage 3 (38.6%),
and 27 subjects were in stage 4 (30.7%). Sixty-two subjects had graduated from primary school
(70.5%), 21 subjects had graduated from high school (23.9%), one subject had graduated from
university (1.1%), and 4 subjects had no education (4.5%). Forty-five subjects (51%) were
vaccinated. There was no significant correlation between level of education and vaccination
status (P = .37). Both COPD-related emergency department and hospital visits were significantly
decreased in vaccinated patients with COPD (P < .001 and P = .02, respectively). Of all the
subjects, 39.7% (35 of 88 subjects) mentioned that no health-care professional recommended
vaccination.
CONCLUSIONS: Physicians should be more aware of vaccination and recommend both
influenza and pneumococcal vaccines to all patients with COPD to reduce exacerbations.
chronic obstructive pulmonary disease COPD influenza vaccination pneumococcal
vaccination immunization
Introduction
COPD is a leading cause of morbidity and mortality worldwide and results in an economic and
social burden that is both substantial and increasing. 1 A COPD exacerbation is described as “an
acute event characterized by a worsening of the patient's respiratory symptoms that is beyond
normal day to day variations and leads to a change in medication” by different sources. 2 – 4
Hospitalization for exacerbation represents a major component of the socioeconomic burden
related to COPD. 5 Frequent exacerbations of > 2/y have been associated with greater decline in
health status. 6 , 7 There are many reasons for COPD exacerbation, but the most common
seems to be viral and bacterial respiratory tract infections. Thus, prevention of exacerbations
plays an important role in COPD management. Vaccination is accepted as an effective and
simple method for this goal. The most common vaccines given to patients with COPD are for the
prevention of pneumococcal and influenza infections, which have high exacerbation rates.
According to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 COPD
guidelines, both influenza and pneumococcal vaccines are suggested for all patients with
COPD. 1
The aim of this study was to determine the level of knowledge among COPD patients regarding
these vaccines, find the rate of patients who were inoculated with both influenza and
pneumococcal vaccines following the GOLD guidelines, and assess the effectiveness of
vaccination status.
QUICK LOOK
Current knowledge
Exacerbations of COPD contribute significantly to the socioeconomic burden related to
COPD, and frequent exacerbations are associated with declines in health status. Infections
are involved in 50–70% of exacerbations; influenza and pneumococcal vaccines are
recommended as a preventive strategy.
What this paper contributes to our knowledge
In a small population of subjects with COPD, vaccination status was not associated with level
of education, but was associated with a decrease in emergency department and hospital
visits. Doctors recommended vaccinations only to 60% of subjects. Caregivers should
recommend administration of both influenza and pneumococcal vaccines to patients with
COPD to reduce exacerbations and the socioeconomic burden related to COPD.
Methods
In this prospective cohort study, patients with COPD from mild to very severe were recruited from
the out-patient clinic of our hospital. Subjects were excluded from the study if they were
immunosuppressed or had known neoplasia, renal insufficiency with the need for dialysis, and
uncontrolled heart failure. Subject demographic data such as age, gender, level of education,
and smoking status were recorded. All subjects were compliant with their medication. The
number of unvaccinated subjects and the number of subjects who were inoculated with both
influenza and 23-valent pneumococcal capsular polysaccharide vaccines between September
and October 2011 (beginning of the 2011–2012 flu season) were noted. All subjects were asked
if they had fever, purulent sputum, dyspnea, cough, and other symptoms that might suggest a
tracheobronchial infection up to the beginning of the new flu season (September to October
2012), and COPD-related emergency or hospital admissions due to tracheobronchial infections
during this 1-y follow-up were recorded. In addition, the number of subjects informed by a health-
care professional about immunization was recorded. All analyses were conducted using SPSS
Statistics 17.0 (IBM, Armonk, New York). Continuous variables were expressed as medians (25th
to 75th percentile) and categoric variables as numbers (%). Intercorrelations of continuous
variables were analyzed using the Pearson product moment correlation test, and P < .05 was
considered to be statistically significant. Categoric variables were compared by the Fisher exact
test. The protocol was approved by the local ethics committee, and all participating subjects
signed informed consent forms.
Results
A total of 114 subjects signed an informed consent form, but 26 subjects were excluded from the
study according to the exclusion criteria. Eighty-eight subjects were enrolled during the study
period. Eighty-two subjects were male (93.2%), 6 subjects were female (6.8%), and the median
age was 61.5 y. According to GOLD 2006 classification, 5 subjects were in stage 1 (5.7%), 22
subjects were in stage 2 (25%), 34 subjects were in stage 3 (38.6%), and 27 subjects were in
stage 4 (30.7%). Sixty-two subjects had graduated from primary school (70.5%), 21 subjects had
graduated from high school (23.9%), one subject had graduated from university (1.1%), and 4
subjects had no education (4.5%). Four of 5 subjects in stage 1 (80%), 15 of 22 subjects in stage
2 (68.1%), 18 of 34 subjects in stage 3 (52.9%), and 8 of 27 subjects in stage 4 (29.6%) were
vaccinated. Forty-five subjects (51.1%) were vaccinated with both influenza and pneumococcal
vaccines, and 43 subjects (48.9%) had no history of vaccination (Table 1). Seven of the
vaccinated subjects had no history of smoking, 35 subjects were ex-smokers, and 3 subjects
were active smokers. Fourteen of the unvaccinated subjects had no history of smoking, 28
subjects were ex-smokers, and one subject was an active smoker.
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Table 1.
Subject Characteristics
There was no significant correlation between level of education and vaccination status (P = .37).
A total of 52 subjects (59.1%) were informed by doctors regarding vaccination, and 44 of these
subjects were vaccinated (84.6% of the informed subjects).
Both COPD-related emergency department and hospital visits were significantly decreased in
vaccinated patients with COPD (P < .001 and P = .02, respectively) (Figs. 1 and 2).
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Fig. 1.
Relationship between vaccination status and COPD-related emergency department
visits. P < .001.
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Fig. 2.
Relationship between vaccination status and COPD-related hospitalizations. P = .02.
Discussion
This study showed that additive inoculation of influenza and pneumococcal vaccines may
decrease both COPD-related emergency department and hospital admission rates triggered by
tracheobronchial infections. However, subjects did not have sufficient knowledge regarding the
importance of immunization, and half of subjects with COPD remain unvaccinated. Another
finding is that getting vaccinated is not related to level of education, but the advice of a healthcare professional (particularly a doctor) leads to high vaccination compliance. In this study,
39.7% of all subjects (35 of 88 subjects) said that they did not receive any information about
vaccination from health-care professionals. In contrast, 84.6% of those subjects (44 of 52
subjects) who were informed by doctors (pulmonologists and family doctors) took this advice into
consideration and were more compliant with vaccination.
Tracheobronchial infections are involved in 50–70% of COPD exacerbations. 8 Studies show that
8–35% of these exacerbations are due to influenza virus 9 – 12 and 8–25% are due to
pneumococcal infection. 13 The mortality rate of COPD exacerbation after hospitalization is 8%,
and patients with frequent exacerbations have a mortality rate of 23%/y. 8 Both influenza and
pneumococcal vaccination of patients with COPD seems to be an effective way to prevent some
of the bad outcomes of COPD.
Despite the fact that GOLD guidelines recommend administration of both influenza and
pneumococcal vaccines for all patients with COPD, the majority of previous studies aimed to
determine the effectiveness of these vaccines separately. These studies demonstrated different
results for reduction in COPD-related hospital admissions, hospitalizations, emergency
department visits, and mortality.
Nichol et al 14 , 15 reported that influenza vaccination reduced mortality and hospitalization rates
due to COPD exacerbations. As a result of a review including 2,469 subjects, Poole et al 16
demonstrated that influenza vaccination reduced COPD exacerbations effectively by 60%, but
they also mentioned that vaccination had no effect on mortality or hospitalization rates.
Results of studies that aimed to demonstrate the effectiveness of pneumococcal vaccine in
COPD have conflicting results as well. In a retrospective cohort control study of elderly subjects
with COPD, Nichol et al 15 demonstrated that pneumococcal vaccination reduced hospitalization
(43%) and mortality (29%), whereas Leech et al 17 failed to demonstrate reduction of these
parameters in subjects with COPD who were vaccinated with the 14-valent pneumococcal
vaccine. Alfageme et al 18 had the same results showing no mortality benefit with the 23-valent
pneumococcal capsular polysaccharide vaccine.
Despite these different results from separate administration of influenza and pneumococcal
vaccines in subjects with COPD, there is some evidence that influenza and pneumococcal
vaccines have an additive role in preventing exacerbations of the disease, as this study revealed.
Consistent with our data, Furumoto et al 13 demonstrated fewer exacerbations in subjects with
COPD who were vaccinated with both vaccines instead of only the influenza vaccine. Sumitani et
al 19 assessed respiratory infection and hospitalization reduction in subjects with chronic
respiratory disease who received both vaccines compared with those subjects who received only
the influenza vaccine. The Centers for Disease Control and Prevention recommends
administration of both influenza and pneumococcal vaccines at the same time if possible and
vaccination of patients whose history of pneumococcal vaccination is unclear. 20
Although both influenza and pneumococcal vaccines are suggested for all patients with COPD,
this advice seems not to be taken into consideration by physicians and patients. The vaccination
rates for patients with COPD are not high enough. Similar to the results of this study, < 50% of
subjects were previously found to be vaccinated (33% and 34%, respectively). 21 , 22 The
Centers for Disease Control and Prevention announced that the influenza immunization rate was
below 70% and less than that for some subgroups, although the targeted rate was 90% in
2006. 23 In a previous study of subjects with COPD, 44% of subjects had no knowledge
regarding the importance of vaccination. 24 Zimmerman et al 25 reported that more than one
third of unvaccinated subjects stated that their physician did not recommend vaccination. Some
studies discussed the subjects themselves as a reason for low vaccination rates. Fear of adverse
effects of vaccination 26 and doubting the effectiveness of vaccinations were found to be the
main reasons for remaining unvaccinated. 27
There are some limitations of this study. The majority of subjects were male, so the results for
male and female subjects could not be compared. Moreover, the sample size was small due to
the limited period of the study. Finally, these data reflect the attitudes and outcomes of subjects
from a single center, which limits the generalizability of the results.
In conclusion, health-care professionals, particularly doctors, should be more aware of
vaccination and recommend administration of both influenza and pneumococcal vaccines to
patients with COPD to reduce exacerbations and the socioeconomic burden related to COPD.
Footnotes
Correspondence: Mehmet Unlu MD, Izmir Dr Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim
ve Araştırma Hastanesi, 1, Göğüs Hastalıkları Servisi, Gaziler Caddesi 35210 Yenişehir, Izmir,
Turkey. E-mail: lidokain21@hotmail.com.
The authors have disclosed no conflicts of interest.
Copyright © 2015 by Daedalus Enterprises
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