UK, home-based patients with COPD receive specialist care from respiratory physicians, nurses, and general practitioners (GPs), but increasing complexity of therapeutic options and a GP/Nurse workforce crisis suggests merit in testing the role of home visits by a clinical pharmacist. We conducted a non-randomised intervention study with a contemporaneous comparator group, in Glasgow (Scotland). A clinical pharmacist (working closely with a consultant respiratory physician) visited patients with COPD living at home, assessing respiratory and other co-morbid conditions, and medicines then, with patient approval, agreed treatment modifications with a consultant physician. Comparator group-patients were drawn from another hospital out-patient clinic. Main outcomes were exacerbations during 4-months of follow-up and respiratory hospitalisations (number and duration) after 1 year. In the intervention group, 86 patients received a median of three home visits; 87 received usual care (UC). At baseline, patients in the intervention group were similar to those in UC in terms of respiratory hospitalisations although slightly younger, more likely to receive specific maintenance antibiotics/Prednisolone and to have had exacerbations. Sixty-two (72.1%) of the intervention group received dose changes; 45 (52.3%) had medicines stopped/started and 21 (24.4%) received an expedited review at the specialist respiratory consultant clinic; 46 (53.5%) were referred to other healthcare services. Over one-third were referred for bone scans and 11% received additional investigations. At follow-up, 54 (63.5%) of intervention group participants had an exacerbation compared with 75 (86.2%) in the UC group (p = 0.001); fewer had respiratory hospitalisations (39 (45.3%) vs. 66 (76.7%); p < 0.001). Hospitalisations were shorter in the intervention group. Pharmacist-consultant care for community dwelling patients with COPD, changed clinical management and improved outcomes. A randomised controlled trial would establish causality.
Background/Aims: Intrauterine growth restriction is an indication for growth hormone treatment. Birth length (BL) is needed to evaluate the influence of birth size on childhood short stature. However, BL is commonly measured only approximately, if at all. A single-centre study was undertaken to determine the value of measuring accurate and targeted BL and parental height (PH) for neonates with a birth weight (BW) ≤9th centile, identifying short [BL ≤-2 standard deviation scores (SDS)] and light newborns (BW ≤-2 SDS), and remeasuring short neonates at 2 years in order to detect those not showing catch-up growth. Methods: Information was collected on all live births (n = 3,798) in a single maternity unit during a 1-year period. Results: BW was ≤9th centile in 481 neonates (12.7%) of whom 47 were light but not short, 46 were short, and 60 were both light and short. Of 107 eligible infants, 57 (53%) attended the 2-year follow-up; failure of catch-up growth was identified in 6 infants (11%) of whom only 1 was already known to medical services. PH was measured in both parents of 52/153 (34%) light and/or short infants. Conclusion: Targeted and accurate BL measurement in newborns with a BW ≤9th centile is a promising alternative to the current practices. The feasibility of PH measurement after birth still requires further evaluation.
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