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Ana Cravo,1 Darush Attar,2 Daryl Freeman,3 Steve Holmes,4 Lindsay Ip,5 Sally J Singh6,7 1Medical Affairs, Boehringer Ingelheim Ltd, Bracknell, UK; 2North Central London Clinical Commissioning Group (CCG), London, UK; 3Norfolk Community Health & Care, Norwich, UK; 4The Park Medical Practice, Shepton Mallet, UK; 5King’s Health Partners and Ealing Community Partners, London, UK; 6Faculty of Health and Life Sciences, Coventry University, Coventry, UK; 7Department of Respiratory Sciences, University of Leicester, Leicester, UKCorrespondence: Steve HolmesThe Park Medical Practice, Cannard’s Grave Road, Shepton Mallet, Somerset, BA4 5RT, UKTel +44 1749 334383Email steve.holmes@btinternet.comAbstract: Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively under-utilized in clinical care compared with other chronic diseases. However, self-management interventions can play a valuable role in supporting people with COPD to respond to changing symptoms, and thereby make appropriate decisions regarding the management of their own chronic condition. In this review, we discuss the history and evolution of the concept of self-management, assess current multidisciplinary support programs and clinical interactions designed to optimize self-management, and reflect on how effective these are in terms of clinical and humanistic outcomes. We also evaluate the mechanisms for encouraging change from protocol-based care towards a more personalized care approach, and discuss the role of digital self-management interventions and the importance of addressing health inequalities in COPD treatment, which have been accelerated by the COVID-19 pandemic. Reflecting on the importance of self-management in the context of symptom monitoring and provision of educational support, including information from patient organizations and charities, we discuss the ideal components of a self-management plan for COPD and provide six key recommendations for its implementation: 1) better education for healthcare professionals on disease management and consultation skills; 2) new targets and priorities for patient-focused outcomes; 3) skills gap audits to identify barriers to self-management; 4) best practice sharing within primary care networks and ongoing professional development; 5) enhanced initial consultations to establish optimal self-management from the outset; and 6) negotiation and sharing of self-management plans at the point of diagnosis.Keywords: chronic obstructive pulmonary disease, COPD, self-management, personalized care

Evan M Pucillo,1 Nancy Christensen-Mayer,2 Shelly D Poole,2 Denise M Whitten,2 Danielle Freeman,3 Blake R Bohe,4 Brandon R Swensen,3 A Gordon Smith,1 Nicholas E Johnson1 1Department of Neurology, School of Medicine, 2Department of Physical Medicine & Rehabilitation, 3Outpatient Neurology, University of Utah Hospitals and Clinics, 4Business Support, University of Utah Information Technology, Salt Lake City, UT, USA Background: Team-based care has been shown to offer more comprehensive benefits to patients when compared to standard physician-based care alone in clinics for chronic conditions. However, apart from grant-funded multidisciplinary clinics, there are no reports on the usage of same-day physical therapy (PT) consults within a daily outpatient neuromuscular disease (NMD) physician clinic.Objective: To determine the impact of same-day PT consults at the University of Utah’s outpatient Clinical Neurosciences Center.Design: A qualitative assessment and survey of patient satisfaction.Methods: An eight question Health Insurance Portability and Accountability Act-compliant patient satisfaction survey using a 5-point Likert scale was administered. Demographic data and Press-Ganey Provider Satisfaction surveys were retrospectively collected from electronic medical records for patients receiving same-day PT encounters in the neuromuscular division over 1 year.Results: Mean (standard deviation) age was 54.22 (19.81) years for 134 patient encounters, median age was 60 years, with 76 male (57%) and 58 female (43%) patients. Mean Likert score for 61 self-reported patient satisfaction surveys for same-day PT consults was 4.87 (97.4%). Press-Ganey Provider Satisfaction scores improved from 89.9% (N=287) for the year prior to 90.8% (N=320) for the corresponding year (P=0.427). A total of 46 (75.4%) patients have either never before received PT care or never before received PT care for their NMD, 67.4% of whom were male.Conclusion: Same-day PT consults in an outpatient NMD physician clinic demonstrated excellent patient satisfaction and improved access to specialty care. This model could potentially be implemented in other academic medical centers to improve access to rehabilitation services for patients with NMD. Keywords: neuromuscular therapy, neuromuscular care, team-based health care, physical therapy consults, same-day physical therapy, physician clinics, patient satisfaction

Marjan Kerkhof,1 Daryl Freeman,2 Rupert Jones,3 Alison Chisholm,4 David B Price1,5 On behalf of the Respiratory Effectiveness Group 1Research in Real-Life, Cambridge, 2Mundesley Medical Centre, Norfolk, 3Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, 4Respiratory Effectiveness Group, Cambridge, 5Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK Purpose: Acute COPD exacerbations account for much of the rising disability and costs associated with COPD, but data on predictive risk factors are limited. The goal of the current study was to develop a robust, clinically based model to predict frequent exacerbation risk.Patients and methods: Patients identified from the Optimum Patient Care Research Database (OPCRD) with a diagnostic code for COPD and a forced expiratory volume in 1 second/forced vital capacity ratio

David Price,1,2 Alan Kaplan,3 Rupert Jones,4 Daryl Freeman,5 Anne Burden,2 Shuna Gould,2 Julie von Ziegenweidt,2 Muzammil Ali,2 Christine King,2 Mike Thomas6 1Academic Centre of Primary Care, University of Aberdeen, Aberdeen, 2Research in Real-Life, Cambridge, UK; 3Family Physician Airways Group of Canada, Richmond Hill, ON, Canada; 4Centre for Clinical Trials and Health Research, Plymouth University, Plymouth, 5Norfolk Community Health and Care NHS Trust, Norwich, 6Primary Care Research, University of Southhampton, Southhampton, UK Background: Randomized controlled trials indicate that addition of a long-acting muscarinic antagonist (LAMA) such as tiotropium may improve asthma control and reduce exacerbation risk in patients with poorly controlled asthma, but broader clinical studies are needed to investigate the effectiveness of LAMA in real-life asthma care. Methods: Medical records of adults with asthma (aged ≥18 years) prescribed tiotropium were obtained from the UK Optimum Patient Care Research Database for the period 2001–2013. Patients diagnosed with chronic obstructive pulmonary disease were excluded, but no other clinical exclusions were applied. Two primary outcomes were compared in the year before (baseline) and the year after (outcome) addition of tiotropium: exacerbations (asthma-related hospital emergency department attendance or inpatient admission, or acute oral corticosteroid course) and acute respiratory events (exacerbation or antibiotic prescription with lower respiratory consultation). Secondary outcomes included lung function test results and short-acting β2 agonist usage. The Wilcoxon signed-rank test was used for variables measured on the interval scale, the marginal homogeneity test for categorized variables, and the paired t-test for lung function indices. Results: Of the 2,042 study patients, 83% were prescribed an inhaled corticosteroid and 68% a long-acting ß2 agonist during the baseline year; 67% were prescribed both. Comparing baseline and outcome years, the percentage of patients having at least one exacerbation decreased from 37% to 27% (P

Claire Brockwell,1 Sundari Ampikaipakan,1,2 Darren W Sexton,1 David Price,3,4 Daryl Freeman,5 Mike Thomas,6 Muzammil Ali,4 Andrew M Wilson1,21Norwich Medical School, University of East Anglia, Norwich, UK; 2Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK; 3Academic Primary Care, University of Aberdeen, Aberdeen, UK; 4Research in Real Life, Cambridge, UK; 5Mundesley Medical Centre, Mundesley, Norwich, UK; 6Primary Care Research, Aldermoor Health Centre, University of Southampton, Southampton, UKPurpose: The objective of this pilot trial was to evaluate the safety and efficacy of AKL1, a patented botanical formulation containing extracts of Picrorhiza kurroa, Ginkgo biloba, and Zingiber officinale, as add-on therapy for patients with chronic obstructive pulmonary disease (COPD) and chronic cough.Patients and methods: This randomized, double-blind, placebo-controlled trial enrolled male and female patients >18 years old with COPD and Leicester Cough Questionnaire (LCQ) score of

Kerkhof M, Freeman D, Jones R, Chisholm A, Price DB. Int J Chron Obstruct Pulmon Dis. 2015;10:2439–2450.Page 2450, the formula shown in the Supplementary materials is incorrect. The correct formula is shown below. The formula: Risk of ≥2 COPD exacerbations within the next 12 months =1/{1 + exp[- (-0.7306 + 0.8840 × 1 previous exacerbation in last 12 months + 1.4786 × 2 previous exacerbations in last 12 months + 1.9857 × 3 previous exacerbations in last 12 months + 2.8811 × ≥4 previous exacerbations in last 12 months - 0.0093 × FEV1% predicted + 0.0360 × age - 0.0004 × age2 - 1.2194 × height (in meter) + 0.2518 × (blood eosinophil count ≥400/μL in a patient who is not currently smoking) + 0.2953 × any evidence of asthma × 0.3018 × history of non allergic rhinitis + 0.3298 × history of nasal polyps + 0.1164 × history of ischemic heart disease + 0.1071 × history of anxiety or depression + 0.1689 × history of GERD)]}. For the yes/no variables, a value of 1 should be used for “yes” and a value of 0 for “no.”Read the original article.

We present a general framework for constructing families of elliptic curves of prime order with prescribed embedding degree. We demonstrate this method by constructing curves with embedding degree k = 10, which solves an open problem posed by Boneh, Lynn, and Shacham [6]. We show that our framework incorporates existing constructions for k = 3, 4, 6, and 12, and we give evidence that the method is unlikely to produce infinite families of curves with embedding degree k > 12.