Faculdade de Medicina da Universidade do PortoIntrodução à MedicinaIntrodução à Medicina

Home monitoring in respiratory chronic diseases: systematic

review

Turma 19

Orientador: Dr. João Fonseca

Summary:

Key-words; Abstract; Introduction; Querys; Participants and Methods; Expected Results; Task description; Acknowledgements; References.

KEY-WORDS

KEY-WORD: Home monitoring; Home Care Services; Chronic diseases; Asthma; COPD; Cystic Fibrosis;

ABSTRACT

Aim: Analyse the present situation of home monitoring in respiratory chronic diseases: Asthma, COPD and Cystic Fibrosis; methods: systematic review and meta analysis of randomized controlled studies published in the years 1996 to 2005 indexed at SCOPUS; results/discussion: If the chosen publications were similar, in other words, if the sample, the intervention and the conclusions were the same, it will be done, afterwards, a statistic analysis.

INTRODUCTION

Meta-analysis – definition: Statistic review, achieved by the analysis of a huge

number of articles, so that is possible to systematize the most credible information as possible;

it allows an easy analyse of the knowledge of different studies in the way that their information is systematized in one single article;

it is possible to obtain conclusion quickly that easily describe our reality in study

INTRODUCTION

Patients with respiratory chronic diseases may benefit from the regular assessment of their condition in their daily-lives. This monitorization between observations at medical facilities has the potential:

for detecting early negative events for providing a better insight to the variations of the disease to foster patients participation in their own care.

It is insufficiently known what are the methods, the diseases and the patients’s characteristics associated with better outcomes when using home monitoring.

INTRODUCTION

Home monitoring in respiratory chronic diseases– definition: Group of tests that measure the function of

airways; Used by many patients to monitoring their lung

function outside the hospital; Allows to anticipate when their breathing will

become worse and to take the appropriate cares.

Asthma

Definition: disease characterized by recurrent attacks of

breathlessness and wheezing, which vary in severity and frequency (WHO)

Why did we choose this chronic disease? It’s very frequent, mostly in childrens. Despite advances in the treatment of asthma the

mortality of this disease has increased significantly in the past several years.

Lack of live quality of those who have it.

COPD

Definition: chronic obstructive pulmonary disease state characterized by a reduction of the maximal airflow

with variable degrees of air sack enlargement and lung tissue destruction.

Emphysema and chronic bronchitis are the most common forms of COPD. (WHO)

Why did we choose this chronic disease? It’s very frequent; has a high level of mortality. Lack of live quality of those who have it

Cystic Fibrosis

Definition: hereditary disease in which the lungs,

liver and pancreas secrete large amounts of thick mucus. Cystic fibrosis, also called mucoviscidosis, cannot be

cured.(WHO)

Why did we choose this chronic disease? No cure is known, but health can be improved and life

extended considerably with attention to pulmonary complications.

Aims

Compare home monitoring with hospital monitoring, within asthma;

Compare the efficiency of different techniques within asthma (spirometry, telemonitoring, Global System for Mobile Comunication, SMS, Internet, FOT (forced oscillation technique)) and COPD (spirometry, pulse oximetry, Home automated telemanagement (HAT), ehealth);

In witch illness spirometry is more efficient;

Compare the efficiency of Global System for Mobile Communication, SMS, Internet in Asthma and COPD;

Which techniques show evidence to bring advantages of being used (economically, clinical).

QUERYS

- Home monitoring of respiratory chronic diseases AND Asthma OR COPD OR Cystic Fibrosis;

- Home Care Services AND Asthma OR COPD OR Cystic Fibrosis.

PARTICIPANTS AND METHODS

Systematic review and meta analysis of randomised controlled studies published in the years 1996 to 2005 indexed at SCOPUS, assessing the benefits of using home monitoring in patients with chronic respiratory diseases such as: Asthma, COPD and Cystic Fibrosis.

Inclusion Criteria:

Randomised controlled studies;

Those which describe and evaluate the health care of patients outside hospital, with Asthma, COPD and Cystic Fibrosis, using certain quality parameters.

Exclusion criteria:

Those publications that evaluate interventions in animals;

Those that are only concerned about: Therapy; Pharmacology intervention; Exclusively turned to education of patients and

professionals. No control groups

Begining

Bibliographic research(made by 2 groups, 3

people each)

Foud articlesN = 316

1st selection (reading of the

titles and abstracts)

Included articles

Exclusion Criteria:

· Animals

· Therapy

· Farmacology interventions

· Control groups

· Not randomized control groups

2nd Selection(reading of

complete article twice – 2 groups, 4 peolpe each)

Exclusion Criteria

Revision of the references

Quality avaliation

Data extraction

Group 1N = 87

Group 2N = 112

Group 3N = 71

Group 1N = 18

Group 2N = 26

Group 3N = 12

YES NO

Is it agreament between articles?

Excluded articlesN = X

Revision by a group of 3 people

NO

Included articlesN = X

Agreament

Arguing

YES

Is it enought for a meta analysis?

NO

Quality avaliation

Included articlesN = X

YES

FLOWCHART

RESULTS

Expected results: If the chosen publications were similar, in other words, if the sample, the intervention and the conclusions were the same, it will be done, afterwards, a statistic analysis, using software such as SPSS.

TASK DESCRIPTIONGANTT MAP

ID Nome da Tarefa Duração Início Conclusão Predecessoras

1 Distribuição dos temas 1 dia? 28-10-05 28-10-05

2 1ª FASE 17 dias 25-11-05 14-12-05

3 Planeamento do trabalho/ Distribuição de tarefas 1 dia 25-11-05 25-11-05

4 Elaboração do diagrama de Gantt 2 dias 25-11-05 27-11-05

5 Pesquisa bibliográfica no Scopus por 3 grupos de 2 pessoas 5 dias 28-11-05 02-12-05

6 Pré-selecção dos artigos por leitura de títulos e abstracts 4 dias 01-12-05 06-12-05

7 Fluxograma 0,67 dias 07-12-05 07-12-05 6

8 Introdução 6 dias 08-12-05 13-12-05

9 Definição dos objectivos 1 dia 08-12-05 08-12-05

10 Definição de métodos e limitações 2 dias 09-12-05 10-12-05

11 Escrever introdução 2 dias 12-12-05 13-12-05 10

12 Preparação da apresentação no Power Point 2 dias 13-12-05 14-12-05

13 1ª APRESENTAÇÃO 0,75 dias 16-12-05 16-12-05

14 2ª FASE 34 dias 05-02-06 14-03-06

15 Obtenção dos artigos completos pré-selecionados 1 dia 05-02-06 05-02-06

16 Leitura dos artigos por 2 grupos de 4 pessoas 6 dias 06-02-06 13-02-06 15

17 Confrontar opiniões (artigos incluidos, excluidos e duvidas) 1 dia 14-02-06 14-02-06

18 Se não houver concordância, leitura dos artigos todos por um grupo de 3 pessoas5 dias 15-02-06 19-02-06

19 Chegar a um consenso (artigos incluidos e excluidos) 1 dia 20-02-06 20-02-06 18

20 Elaboração de Tabelas com artigos excluidos e respectivos motivos de exclusão1 dia 23-02-06 23-02-06

21 Avaliação da qualidade dos artigos incluídos pelo RevMan 4.2 1 dia 26-02-06 26-02-06 20

22 Extracção dos dados dos artigos avaliados e incluidos 4 dias 27-02-06 02-03-06 21

23 Tabelas com os resultados 2 dias 04-03-06 06-03-06 22

24 Discussão dos resultados 5 dias 07-03-06 11-03-06 23

25 Preparação da apresentação no Power Point 2 dias 13-03-06 14-03-06 24

26 2ª APRESENTAÇÃO 0 dias 17-03-06 17-03-06

27 3ª FASE 15 dias 15-04-06 02-05-06

28 Análise estatística 9 dias 15-04-06 25-04-06

29 Produção do artigo (em inglês) 5 dias 23-04-06 27-04-06

30 produção do site (em inglês) 4 dias 28-04-06 02-05-06

31 Preparação da apresentação no Power Point 1 dia 02-05-06 02-05-06

32 3ª APRESENTAÇÃO 1 dia 05-05-06 05-05-06

Raquel Medeiros

Rosália Pena;Daniel Beirão;Rita Martins;Rita Cardona;Rita Ferreira;Rosa Barreira;Ricardo Fernandes;Ricardo Castro

Rosália Pena;Daniel Beirão;Rita Martins;Rita Cardona;Rita Ferreira;Rosa Barreira;Ricardo Fernandes;Ricardo Castro

Hugo Gaspar; Raquel Medeiros;Ricardo Ferreira

Rosália Pena;Daniel Beirão;Rita Martins;Rita Cardona;Rita Ferreira;Rosa Barreira;Ricardo Fernandes;Ricardo Castro;Hugo Gaspar; Raquel Medeiros;Ricardo Ferreira

Rosália Pena;Rita Martins

Ricardo Fernandes; Raquel Medeiros

Rita Cardona;Rosa Barreira;Ricardo Castro

Rita Cardona;Rosa Barreira;Ricardo Castro

Rosália Pena;Daniel Beirão;Rita Martins;Rita Cardona;Rita Ferreira, Rosa Barreira, Ricardo Fernandes, Ricardo Castro, Ricardo Ferreira; Raquel Medeiros;Hugo Gaspar

Raquel Medeiros;Rita Cardona;Ricardo Fernandes

17-03

Rosália Pena;Daniel Beirão

S T Q Q S S D S T Q Q S S D S T Q Q S S D S T Q Q S S D S T Q Q S13 Fev '06 20 Fev '06 27 Fev '06 06 Mar '06 13 Mar '06

Faced problems:

These are the problems we faced during the first stage of our work:

Lack of time; Great number of diseases that could be

studied; Great number of useless articles; Lack of techniques to compare

ACKNOWLEDGEMENTS

We would like to thank Dr. João Fonseca

REFERENCES

www.scopus.com WHO (world health organization) “Telematic system for monitoring of asthma

severity in patients' homes”; Finkelstein, J., Hripcsak, G., Cabrera, M. Correspondence address Department of Medical Informatics, Columbia University, New York, USA.