A Written Action Plan for Early Treatment of COPD Exacerbations: An Important Component to the Reduction of Hospitalizations
Bibliographic record
Abstract
Background: This study explored the role of a written action plan in reducing hospitalizations as a component of a COPD self-management program in a recent multi-centre RCT. Methods: Patients were randomly allocated into 2 groups: intervention or usual care. The intervention group had access to a self-management education program Living Well with COPD, the support of a case manager, and a written action plan with a self-administered prescription of antibiotics and prednisone. Patients were instructed to start both antibiotics and prednisone in case of exacerbation with a change in 2 or more symptoms (increased dyspnea, increased sputum volume and/or purulent sputum) for at least 24 hr. Results: One hundred and sixty six patients with COPD presented with one exacerbation or more in the 12-month study period. Exacerbations (608) were confirmed by a change in at least one symptom; 429 (70.6%) by a change in 2 or more. Antibiotics were used in 61.3% of the exacerbations and prednisone in 47.7%. The combination of antibiotics and prednisone was used more often by the intervention group in exacerbations presenting changes in 2 or more symptoms (52.97% vs. 34.8%, P < 0.001). This difference was driven by a higher use of prednisone in the intervention group (55.7% vs. 44.3%, P < 0.001) consistent with dyspnea deterioration. In the intervention group, exacerbations treated with antibiotics and prednisone had less risk of requiring an hospitalization than those occurring in the control group (16.5% vs. 35.1%, P < 0.001). Conclusions: Improved access to treat exacerbations provided by the written action plan plays an important role in reducing hospitalization risk.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".