Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD

Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD For this week’s discussion, you are asked to develop a Microsoft PowerPoint presentation (no more than 20 slides) following the guidelines provided below and base on the information from uploaded research proposal. Guidelines: Consider this a real-life simulation of a research presentation. However, you are only presenting the proposal, not the findings. Develop your slides to highlight key points and expand on this in the speaker notes. Do not simply copy/paste your paper but instead provide a condensed synthesis of the respective content. Include citations on the slide/speaker notes and references on the last slide(s). Use the following as your slide headings. Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD Significance Problem/Purpose Theoretical Framework Research Questions/Hypotheses Variables and Operational Definitions Sample/Setting Design Instruments Description of the Intervention Data Collection Procedures Data Analysis Plans Ethical Issues Limitations Implications ReferencesAssignment: The Use Of Pneumonia Vaccine For Prevention Of COPD Please use APA format. attachment_1 Research Project Proposal – The Use of Pneumonia Vaccine for Prevention of COPDQuynh DoanSouth University Online Table of Contents Chapter One: Introduction. 3 1.0 Background and Significance of the Problem.. 3 1.2 Problem Statement 4 1.3 Research Purpose. 5 1.4 Research Questions. 6 1.5 Objective of the Study. 7 1.6 Research Hypothesis. 7 1.7 Variables with Operational Definitions. 7 Chapter Two: Literature Review.. 8 2.0 Introduction. 8 2.1 Theoretical Framework. 11 2.1.1 Overview and Guiding Propositions. 11 2.1.2 Application of Theory. 12 Chapter Three: Methodology. 14 3.1 Sample/Setting. 14 3.2 Research Design. 14 3.3 Extraneous Variables. 15 3.4 Instruments. 15 3.5 Description of the Intervention. 15 3.6 Data Collection Procedures. 16 3.7 Data analysis plan. 16 3.8 Ethical Issues. 17 3.9 Limitations of Proposed Study. 17 References. 20 Chapter One: Introduction 1.0 Background and Significance of the Problem The analysis entails determining whether the current approaches to dealing with COPD exacerbations are sufficient or whether there is a need to take additional steps to solve this problem. COPD exacerbations have been on the rise and present enormous suffering among the people who contract the disease. Researchers have linked lung infections to Streptococcus Pneumoniae bacterium and re;garding the concern as a serious problem that should be resolved. Prior research has concentrated on the causes and ways to mitigate the problem, but few researchers have considered the applicability of pneumococcal vaccine. According to Schneeberg et al. (2014, p. 2), the author assert that “Vaccination is the primary means of prevention”.Most of these researchers agree that there is a need to solve the situation with urgency as it has proved to be very challenging, significantly burdening families, individuals, and communities who have been exposed to the illness. Solving this problem will be helpful for the entire health system as it relates to economic burden and quality of life. Indeed, the use of pneumonia vaccine will provide health practitioners with a new dimension through which to tackle the problem of COPD severity (Mackay & Hurst, 2012).Exacerbations of COPD have created an enormous socioeconomic burden among the populace. Current research has associated frequent exacerbations with an increase in health care costs as well as a declining state of health and wellness within society. Rodriguez-Roisin (2011), postulate that Tracheobronchial infections account for between 50-70% of exacerbations. Thus, one option for the health practitioners is to recommend the use of influenza and pneumococcal vaccines to prevent the disease and help foster a healthy population free of the disease. While other studies have centered around training patients on how they can manage acute cases of the disease, this study will aim to determine the patients’ knowledge concerning the use of influenza and pneumococcal vaccines to handle the condition. 1.2 Problem Statement Despite the aforesaid efforts by the researchers to facilitate effective management and self-care in pneumonia patients, gaps still exist concerning whether the patients are aware of the benefits of using Pneumonia vaccine to reduce COPD exacerbations. Verbrugge, Boer, and Georges (2013), states that vaccination is one of the methods that have been applied at the clinical level as a preventive measure for COPD exacerbations. However, while this method does not necessarily cure the illness when presented at the instance it is presented at the clinical level, its effectiveness as a preventive mechanism cannot be understated. Currently, there are two types of Pneumonia vaccines. These include the pneumococcal conjugate vaccine (PCV13) which is a vaccine meant for children and people aged beyond 65 years and the pneumococcal polysaccharide vaccine (PPSV23) which is meant for adults and helps prevents up to 23 strains of Streptococcus pneumonia bacteria (Rodriguez-Roisin, 2011). Despite the availability of these vaccines for children and adults which imply that they can be received at any age depending on the demographic and physical health of the patient, the use of the same has not been seen among the public. Therefore, it is probable that societal myths concerning the role of these vaccines or an existing knowledge gap have hindered patients from seeking this vaccine. On the other hand, the public healthcare sector has not taken aggressive measures or campaigns to inform and educate the public on the availability of these vaccines and their importance (Verbrugge, Boer & Georges, 2013). 1.3 Research Purpose The purpose of this research is to determine whether the use of pneumococcal vaccine can help reduce or prevent the cases of COPD exacerbations. There is no debate as to the clinical or applicable value of the use of the vaccine, as it has been used effectively and tested to be useful. However, its application as a public health measure to combat COPD exacerbations has not been studied. While we can hypothesize that the vaccine can play a key role in preventing COPD exacerbations, it is important to recognize that there could be other underlying factors that influence the prevalence of COPD exacerbations and not just the absence of a vaccine. For instance, at a societal level, vaccines tend to elicit debates as to their importance and role in managing an illness. On the other hand, some subgroups, either due to cultural or religious beliefs, tend to view vaccines as a forbidden method for managing health at an individual or public levels. In this regard, this study will weigh the pros and cons of this approach as well as the ethical implications of pneumonia vaccination as viewed at cultural, social and religious levels (Rodriguez-Roisin, 2011). Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD These will be weighed against the existing research evidence and empirical evidence to determine the existing differences. Once this is done, then it is possible to determine the areas and points where knowledge gaps exist and therefore work to fill those gaps.The study will also seek to determine the cultural perceptions as well as any particular societal myths associated with the use of vaccines and how they have impacted the use of the vaccine at the community level. This correlation will help determine whether the existing knowledge gap is a creation of the societal, cultural or religious beliefs or due to a complete absence of knowledge in regard to the applicability of pneumonia vaccine in prevention of COPD exacerbations.Subsequently, this research seeks to foster a better understanding of the elements that have been associated with the acceptance of pneumococcal vaccine within the elderly subgroup as well as the how such knowledge or evidence can be applied to develop tailored interventions with a view towards increasing coverage in this subgroup. While the CAT tool will help acquire data to indicate the effectiveness of the vaccine or lack of it, it is apparent that it will not be useful in collecting data in regard to the cultural or personal beliefs in regard to vaccines. This information will be important in determining the acceptability levels and the causes of the knowledge gap. In this regard, a set of five questions will be provided to the participants alongside the CAT to assess the ethical issues surrounding the use of vaccines. The correlations between the personal beliefs and the CAT scores could ultimately provide a chance to identify how these ethical issues influence the management and prevention of COPD exacerbations. 1.4 Research Questions On a scale of 0-10, how would you rate the impact of vaccines on any health issues or illness? On a scale of 0-10, how much do you think the pneumonia vaccine can significantly help eliminate a majority of the complications associated with COPD exacerbations? On a scale of 0-10, how likely are you to propose the use of the pneumonia vaccine to a friend or family member? On a scale of 0-10, how would you rate the possibility of side effects of vaccines either from your own experience or from what you have heard? On a scale of 0-10, how much do you think that the side effects experience or the experiences narrated to you have impacted on your future choice of vaccines as a preventive measure? 1.5 Objective of the Study To investigate whether the use of pneumococcal or influenza vaccine prevents or decrease COPD exacerbations. 1.6 Research Hypothesis Null Hypothesis H o : No evidence found on reduced COPD exacerbations cases for the patients receiving vaccine compare to those that did not receive pneumonia vaccination on the number of exacerbations. Alternative hypothesis H 1 : There is evidence that COPD patient receiving pneumonia vaccine will show to have decrease reoccurrence of exacerbations. 1.7 Variables with Operational Definitions Noteworthy the research will utilize two main types of quantitative variables the independent components as well as the dependent variable. The dependent variable in the research will be Decrease COPD exacerbation while the Independent variables will comprise of Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD COPD patients with vaccine and non-vaccines COPD patients. Chapter Two: Literature Review 2.0 Introduction According to Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2011 COPD guidelines, pneumococcal vaccines are recommended for all patients with COPD. The aim of my research proposal is to determine the impact of pneumonia vaccines and their overall value in respect to decreased exacerbation of COPD. Yasin and Tevfik (2012), assert that there is significant evidence across literature to indicate that the aspects of self- management and patients’ perceptions on the use of vaccines as well as their understandings of the disease process play a key role in the management and recovery process.However, it is important to note that self-care and self-management significantly depend on the knowledge available to the patient. William’s et.al (2014) sought to identify and explore the knowledge and understanding of the patients in relation to COPD illness process and its management. The research identified that patient who tended to have closer relations with their healthcare providers have a higher likelihood of developing effective self-management techniques and have a deeper understanding of the disease process. This study provides the basic idea as to the barriers and facilitators of utilization of health services such as vaccines. When patients have significant knowledge of the existing health services for their disease processes, they are likely to demand the same and eliminate any myths and perceptions that have previously held them back in utilizing the same. Therefore, this study supports the hypothetical position that the nurses and care provide have to take responsibility in teaching and educating patients and families on the importance of vaccines and this can only happen in an environment where communication and interaction with the patient population are significantly high. Moreover, the study recognized the benefits of such self-management strategies including early detections of the illness, which could help the patients to develop effective management mechanisms so that the illness does not progress to serious complications. While this research failed to adequately determine whether the use of pneumococcal vaccine was pivotal for the prevention of the COPD, it provided significant evidence that can be used to justify the importance of patient education and the increased communication between the healthcare provider and the patient.Correspondingly, a related study by Tsiligianni et.al (2015) sought to utilize the cases of four patients who at one time had an acute exacerbation of COPD. The study aimed to provide clear guidelines available and was utilized to prevent exacerbations among COPD patients. In the overall analysis of these cases, the researchers are of the opinion that while pharmacological management of COPD is necessary to prevent the progression to severity, it is also important to have preventive mechanisms, especially at the non-pharmacological level. Besides, the researchers insist on the importance of flu vaccines as well as the 23-valent pneumococcal vaccine which is regarded as part of the overall medical management of COPD. The researchers, however, insist that the benefits of the 23-valent pneumococcal vaccine may be geared towards the mid and long term as opposed to the short term. It was determined that the use of vaccines helps augment the pharmacological and self-care mechanisms adopted by the patient.From another perspective, Verbrugge, Boer and Georges (2013) in their study sought to analyze how Dutch nurses managed patients with COPD in a bid to improve self-care and self-management techniques. The authors note that the level of interaction between the patients and the nurses was at optimal levels and this was necessitated by the desire to develop tailored approaches towards the management of each patient. In cases where the experience and skill of nurses were low, there were increased mortalities and morbidities associated with COPD exacerbations. However, nurses with prior experience tended to emphasize on smoking cessation, appropriate dietary and nutrition management as well as light exercise and physical activity as measures of management. The use of vaccination was sought as a secondary measure that would augment the self-care and self-management techniques since even if the vaccination would have been implemented and patients lacked the knowledge and skill to initiate self-care activities, then there could be little impact on the frequency and consequences of exacerbations. Across the literature, there is an agreement across the various research entities and groups that the 23-valent pneumococcal vaccine can play a key role in the management of COPD and particularly to prevent the cases of progression of the illness to severity, (Verbrugge, Boer & Georges (2013). The application of the Behavior Change Theory to promote health promotion is defined by the World Health Organization’s (2015) as “the process of enabling people to increase control over their health and its determinants and thereby improve their health”. Hence, the pneumococcal vaccine can be the tool used to prevent future exacerbations in the absent of other tailored management strategies.Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD 2.1 Theoretical Framework 2.1.1 Overview and Guiding Propositions Health behavior change alludes to a substitution of replacement of health-compromising behaviors (e.g. physical exercise). Health behavioral change speculations are intended to look at an arrangement of mental builds that together go for disclosing what inspires individuals to change and how they take preventive action. Health action process approach (HAPA) is an open system of different motivational and voluntary models that are expected to clarify and foresee singular changes in health behavior practices. For example, stopping smoking or drinking, and enhancing physical movement levels, dental cleanliness, safety belt utilizes, bosom self-examination, dietary habits, and maintaining a strategic distance from drink driving. HAPA proposes that the selection, start, and support of wellbeing practices ought to be imagined as an organized procedure including an inspiration stage and a volition stage. The previous portrays the goal arrangement while the last alludes to arranging, and (activity, upkeep, recuperation). The model underscores the particular part of saw self-adequacy at various phases of wellbeing conduct change. HAPA is composed of an arrangement of two consistent self-administrative procedures, an objective setting stage (inspiration) and a good interest stage (volition). The first stage is characterized by being aware of risks, having results expectancy, and having self-efficacy, which leads to formulating an intention. Notably, in a case a person fails to believe in his or her capabilities to carry out an action, Schwarzer et.al (2003), assert that this can result in an individual failing to adopt, start, and maintain the action in question. Moreover, under this phase, a person must be driven by explicit objectives; thus, changing the habitual behavioral patterns. The second stage is subdivided into a pre-activity stage and an activity stage. In this way, one can superimpose these three (stages) on the continuum (middle person) display as a second layer, and view the phases as mediators.Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD This two-layer engineering permits to switch between the continuum display and the stage demonstrate, contingent upon the given research address. In utilizing this theory, the assumption is that the internal aspects of the patient do not have any influence on the behaviors and it is the environment that technically shapes behaviors. The theory is based on the perception that the environment can be modified so as to influence a change of behaviors in an individual as long as the factors being modified are regarded as having an influence on the individual’s behaviors (Braungart & Gramet, 2010). 2.1.2 Application of Theory The Behavior Change Theory can be applied to the concepts of this study. Health provider can recognize behaviors critical to health; evaluate the requirements of the person and counsels’ specific health behaviors. COPD can be managed or prevented effectively in cases where vaccination is regarded as one of the strategies. Knowledge of chronic condition is believed to increase behavior-specific self-efficacy. In this case, teaching patients about how pneumonia can be a serious complication for already damaged lungs and can be fatal if not treated, can help increase self-regulation. (Aliakbari, Parvin, Heidari & Haghani, 2015).In this research, the idea is to determine the value of vaccines in the management of COPD exacerbations and at the same time ensure that the general population appreciates the benefits of the vaccines. The idea is to increase education between the individual patient and the care provider whereby the care provider act as the entity that modifies the environment to enable conditioned response (Aliakbari, Parvin, Heidari & Haghani, 2015). The care provider or other community leaders will seek to educate the patient on the effectiveness, benefits and risks associated with vaccines and thereby impart a positive appreciation for vaccines in the patient. Gradually, as the contact between the patient and the care provider is enhanced, the patient is able to make choice to ingrate the vaccination methodology as one of the techniques to manage their condition (Braungart & Gramet, 2010). Chapter Three: Methodology 3.1 Sample/Setting The desired sample size is 34, using a sample greater than this one will have some financial implications on the researcher as it will costly and hence will not allow the researcher to work within the budget. We will collect data from patient chart number and primary care office. This research will include individuals 65 -80 years and older with over 3 years’ diagnosis of COPD. For an individual to get included, they must possess CAT score > than 10.The research will employ probability sampling: cluster sampling to get the data needed for the complete research. In this approach, the researcher will select samples from the whole group of people suffering from COPD and use the samples for further study.Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD The researcher will employ probability sampling and select units at random. A key reason for using this approach is that it will allow the researcher to make statistical inferences from the samples. 3.2 Research Design The researcher will engage the randomized, controlled trial describes the aim of showing whether there is any difference between individuals who have used the pneumonia vaccine and those who have not received the vaccine. The follow-up period of one year has been deemed appropriate since it offers a substantive time for the patients to learn, practice and embed the ideas in the management of their condition. A shorter period than that would not permit enough time to determine the effects of the vaccine as well as behavioral changes associated with the patient education goals of the project, (Creswell, 2013). 3.3 Extraneous Variables Health conditions of the individuals could also produce different results as the bodies of different people suffering from the condition could respond to the exposure to influenza and pneumococcal vaccines in a variety of ways. Another variable is age, which may make it difficult to determine how various age groups might respond to the treatment or exposure to influenza and pneumococcal vaccines, and hence might provide undesirable results. The control of the extraneous variable of age and health, the research would be to include only patients at the age of 65-80 years and have the qualification standard metabolic rate. Those that have other co-morbidity and over or under the age range will be excluded. 3.4 Instruments The researcher will also employ COPD Assessment Test [CAT] questionnaire for the study. The researcher will ensure reliability using Cronbach’s coefficient alpha to locate the consistency and frequently to evaluate correlation with the result of the assessment tool. The validity of the content of the CAT assessment tool is confirmed because the development of this instrument is created by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) a national expert that has accepted CAT assessment to be the “ gold standard”, (Sullivan, 2011). 3.5 Description of the Intervention Once the researcher gathers the data for the study and proves that indeed the use of the vaccine have a positive impact in reducing the incident occurring, the researcher will take a personal initiative to offer advice to the providers, health practitioners and parents on the benefits of providing patients with the vaccine. The intervention of targeting specific populations and engaging other influential leaders in promoting vaccination. As indicated by Jarrett, Wilson, O’Leary, Eckersberger, & Larson, 2015, the greatest invention for success in behavior change is knowledge, awareness or attitudes through education embedded into routine processes were found to be the most effective in changing the attitude toward behavior change and self- managements. 3.6 Data Collection Procedures Data for this study will come from observation of the conditions of the patients before and after being exposed to the vaccine and record their condition. At the end of the year, the researcher will have recorded the data at three-month intervals and will have The data collected via observation will be stored in an Excel spreadsheet. The patient medical record would be observed, but with only patient ID number listed. No other person will be able to identify the patients except for one researcher. At the conclusion of the study the information collected will be shared and burned for any electronic storage, after a retaining it for maybe 5years after publication. 3.7 Data Analysis Plan A dependent sample test will be conducted to examine if mean differences exist between patient receiving pneumonia vaccine and those that did not receive the vaccine. For instance, a question like; do you think that pneumonia vaccine can significantly help eliminate a majority of the complications associated with COPD exacerbations? Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD The most repeated response on the scale of 1-10 can give a general idea of what the patients perceive their COPD condition which then can be inferred the gap of knowledge related to the prevention of COPD exacerbation.The result obtained from the descriptive statistical analysis provides the basis for the inferential statistical tests. The inferential statistical tests will give the researcher judgment of the entire population represented by the sample used in the descriptive tests of the data analysis. The dependent samples test of correlated mean differences assumes a normal distribution or a curve that is bell-shaped and symmetrical. The assumption of normality will be examined, (Statistics Solutions, 2013). Analysis of the data will seek to provide a correlation between the use of pneumococcal vaccines and advance in the health of the patients. The analysis will also provide information regarding the variations of the pneumococcal vaccines and the differences in the response of various subgroups. 3.8 Ethical Issues The researcher will address this issue by doing everything possible to protect the information from accidental exposure, including password protecting the spreadsheet files and maintaining sole possession of all files (Grace, 2013). Another issue of concern is voluntary participation. For this research, participants will be completely informed concerning the study and must provide their written consent in order to participate. The risk of harm is another matter of concern for the study group patients. Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD. All possible risks will be explained beforehand, and the option to move out of the study at any time will be treated with the utmost respect, especially since the treatment may reveal unforeseen negative health issues (Speziale, Streubert, & Carpenter, 2011). 3.9 Limitations of Proposed Study Numerous barriers could arise during the study. One of the limitations could be cultural bias or selection bias. Selection bias might compel the researcher to collect data from a specified region and a particular group of people (Creswell, 2013). The data collected could be considered unreliable insofar as it will not provide an accurate picture of the entire population. Another limitation of this research is the lack of sufficient skills to gather the data. Very few researchers have performed a study on the subject and hence the researcher will lack abundant, reliable sources to use during the study. Limitations could also arise due to the confidence of the data. This move could make the data unreliable (Verbrugge, Boer & Georges, 2013). Implications of the limitations for practice The presence of the defects could have profound impacts on the practice. The limitations could have different levels of likelihood and magnitude. However, the limitation could influence the researcher to collect and analyze the data in a manner that could give a wrong impression of the data. This move could negatively affect the nursing practices as wrong data could result in the implementation of an approach that would not be helpful. The limitations also could lead to a rise in the mortality rates due to the implementation of a wrong approach. This method, therefore, calls for more research in this field to come up with more precise and reliable data for the nursing practices. Conclusion In brief, COPD is a chronic illness that can be managed. There is no single strategy or at least one that is known to researchers that can accurately be regarded the only suitable method for management of COPD. However, at the primary level of prevention, the use of PCV13 in children or the PPSV23 in adults has been associated with positive benefits especially due to the ability to minimize exacerbations and therefore eliminate the burden of costs in self-care and self-management. Healthcare providers, therefore, have a role to inform the patients about the usefulness of efficacy of pneumonia vaccines so as to enable them to make informed choices in the management of the condition. However, there are significant barriers associated with the use of vaccines and these could be due to cultural or religious beliefs. The nurse or the healthcare provider employ demonstrate excellent negotiation skills as they inform and educate these groups about the truths and myths associated with vaccines. Assignment: The Use Of Pneumonia Vaccine For Prevention Of COPD References Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (2015). Learning theories application in nursing education. Journal of education and health promotion , 4 .Braungart, R. G., & Gramet, P. R. (2010). Applying Learning Theories to. Health professional as an educator: Principles of teaching and learning , 55.Burge, S., &Wedzicha, J. A. (2013). COPD exacerbations: definitions and classifications. European Respiratory Journal, 21 (41 suppl), 46s-53s.Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approach . Sage publications.Jarrett, C., Wilson, R., O’Leary, M., Eckersberger, E., & Larson, H. J. (2015). Strategies for addressing vaccine hesitancy – A systematic review. Vaccine,33 (34), 4180-4190.doi:http://dx.doi.org.southuniversity.libproxy.edmc.edu/10.1016/j.vaccine.2015.04.040Evensen, A. E. (2010). Management of COPD exacerbations . American family physician, 81 (5), 607-613.In Chronic Obstructive Pulmonary Disease. PloS one , 11 (6), e0158727.Fromer, L. (2011). Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes. Int J Chron Obstruct Pulmon Dis , 6 , 605-614.Grace, P. J. (2013). Nursing ethics and professional responsibility in advanced practice . Jones & Bartlett Publishers.Mackay, A. J., & Hurst, J. R. (2012). COPD exacerbations: causes, prevention, and treatment. Medical Clinics of North America , 96 (4), 789-809.Rodriguez-Roisin, R. (2011). Toward a consensus definition for COPD exacerbations. CHEST Journal, 117 (5_suppl_2), 398S-401S. Santibáñez, M., Garrastazu, R., Ruiz-Nuñez, M., Helguera, J. M., Arenal, S., Bonnardeux, C., … & García-Rivero, J. L. (2016). Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease. PloS one , 11 (6), e0158727.Speziale, H. S., Streubert, H. J., & Carpenter, D. R. (2011). Qualitative research in nursing: Advancing the humanistic imperative . Lippincott Williams & Wilkins. Stimulate self?management in patients with COPD. Journal of clinical nursing , 22 (19-20), 2787-2799.Sullivan, G. M. (2011). A Primer on the Validity of Assessment Instruments. Journal of Graduate Medical Education , 3 (2), 119–120. http://doi.org/10.4300/JGME-D-11-00075.1Tsiligianni, I., Goodridge, D., Marciniuk, D., Hull, S., & Bourbeau, J. (2015). Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations. NPJ primary care respiratory medicine , 25 , 15023. doi:10.1038/npjpcrm.2015.23Verbrugge, R., Boer, F., & Georges, J. J. (2013). Strategies used by respiratory nurses to stimulate self?management in patients with COPD. Journal of clinical nursing , 22 (19-20), 2787-2799.Williams, V., Hardinge, M., Ryan, S., & Farmer, A. (2014). Patients’ experience of identifying and managing exacerbations in COPD: a qualitative study. NPJ primary care respiratory medicine , 24 , 14062.Yasin, A. B. U. L., & Tevfik, Ö. Z. L. Ü. (2012). Global Initiative for Chronic Obstr

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