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The quality of asthma care may be affected if asthma management is overlooked, thus needing frequent clinical audits to identify areas for improvement. The purpose of this paper is to evaluate the quality of the process (e.g. documentation of asthma-specific information), the structure (e.g. availability of resources) and the outcome (e.g. proportion of patients prescribed with asthma medications) at a university-based primary care clinic. The associated clinical factors for non-documentation of asthma control at the last visit were also examined.

This retrospective study involved auditing medical records and the pharmacy data system of 433 adult patients with asthma to evaluate 18 quality indicators. The standard target for the indicators of process and structure was 80 percent and the standard target for the indicators of outcome was 100 percent.

All the indicators failed to reach the standard targets. Documentation of asthma-specific information and availability of resources were deficient. The non-documentation of asthma control was significantly associated with presence of acute complaint(s) unrelated to asthma, presence of other issues and number of the documented parameters for asthma control. Although the prescription rates of inhaled reliever and preventer were substandard, they were reasonably high compared to the targets.

In this study, evaluation of the quality of care was limited by absence of asthma register, use of paper-based medical records and restricted practice capacity. Besides, the asthma-specific assessments and management were only audited at one particular time. Furthermore, the findings of this study could not be generalised to other settings that used other methods of record keeping such as patient-held cards and electronic medical records. Future studies should sample asthma patients from a register, evaluate more reliable quality indicators (e.g. over-prescription of short-acting β-2 agonist and underuse of inhaled corticosteroid) and assess asthma management over a duration of time.

This study provides quality information on all aspects of asthma care (process, structure and outcome) which can be a basis for clinical improvement. It is hoped that the study could assist the stakeholders to plan strategies for improvement of the asthma care. A more strategic and reliable system of documentation is needed, such as the use of a simple template or structured form, which should not jeopardise the provision of personalised and comprehensive care. With complete documentation, thorough investigational audits can be continuously performed to determine the quality of asthma care.

This study could provide useful findings to guide healthcare providers in developing a more strategic model of asthma care that can ensure asthma patients to receive a personalised, comprehensive, holistic and continuous care. Through this approach, their physical and psychosocial well-being can be optimised.

Even though our healthcare has advanced, the quality of asthma care is still suboptimal which requires further improvement. However, it could be considered assuring due to high outcome levels of asthma care despite having limited resources and practice capacity.

The purpose of this paper is to investigate children's vulnerability to asthma and its relationship with marginalized locations. More specifically, the effects of zip code level social predictors on children's asthma and their conditionality on location in the Texas‐Mexico border region are explored. The border region is perhaps the most marginalized in the USA.

Data for analysis comes from the State of Texas and the US Bureau of the Census. Negative binomial regression models are used to predict asthma hospitalizations using a set of social predictors. Then, interaction effects are used to test if social predictors are conditional on border location.

Within the state of Texas, location in a metropolitan area, location along the US‐Mexico border, percent Hispanic, percent African American and percent Native American are positive and significant predictors of asthma hospitalizations; social class is negative and significant. The effects of proportion of Hispanics who were foreign born, median year of home construction, and percent of homes with inadequate heating are conditional on a zip code's location relative to the US‐Mexico border, with the slopes being steeper in border locations. Findings in general suggest that locational and social factors intersect in marginalized places (i.e. border regions of Texas) to create vulnerability to asthma hospitalizations.

This study is conducted solely in the USA.

As sociologists continue to consider space as a factor in health inequalities, this paper demonstrates the utility of considering space as operating at more than one scale.

Asthma is a chronic inflammatory airways disease characterized by acute exacerbations interspaced by symptom‐free periods. Its management imposes a substantial burden on healthcare services, as well as personal suffering and significant financial tolls. The aim of this paper is to demonstrate links between routinely used computerized databases and to establish an automatic mechanism for monitoring asthma patients.

The study population was all adult subscribers to a major health maintenance organization (HMO) in Southern Israel (230,000 adults, age 20‐65 years). Relevant data for this retrospective analysis (2000 to 2004) were extracted from several computerized databases routinely used in the service: pharmacy; administrative; and each person's personal computerized medical file in the primary care clinic.

Based on data from 72 regional primary care clinics, during the study period, 11,054 adults were treated simultaneously by β₂ agonists and steroids – assumed to be asthmatics. In contrast, asthma diagnosis was recorded in only 4,061 personal files. The intersection between two databases yielded 2,569 persons recorded in both. These findings attest to the feasibility of developing computerized automatic surveillance systems for monitoring asthma patients with certain algorithms to assure service quality.

Data extracted from the various databases were unequal quality, a factor that imposed data management difficulties.

Similar surveillance systems can be developed relatively easily by using comparable algorithms for monitoring different chronic diseases or introducing management indices to secure quality of services.

The paper focuses on developing an automatic asthma monitoring model, using information from routinely used computerized HMO DBs.

Patients with severe asthma were choosing not to use the emergency department (ED) in extremis and were self-medicating when experiencing severe asthma, putting their lives at risk. This local issue reflected a nationwide situation. The purpose of this paper is to better understand the reasons behind patients’ reluctance to attend ED and to consider practical solutions in a structured way.

Systems thinking (soft systems methodology) was used to examine the issues resulting in this reluctance to attend the ED. Once this tame (well-defined) problem was revealed, a potential solution was developed in co-production with patients.

Patients feared attending the ED and felt vulnerable while in the ED for several reasons. This appeared to be a well-defined and solvable problem. The solution proposed was an asthma patient passport (APP), which increased patient’s confidence in their ability to communicate their needs while in severe distress. The APP decreases (from 12 to 5 steps) the work patients had to do to achieve care. The APP project is currently being evaluated.

The APP should be offered to all people with severe asthma.

By revisiting systems thinking and identifying problems, a solution was identified. Although methods such as soft systems methodology have limitations when used in wicked (difficult or impossible to resolve) problems, such methods still have merit in tame problems and were applicable in this case to fully understand the issues, and to design practical solutions.

This study explored self-management in the context of asthma experiences of school-age children and the factors that facilitate asthma self-management.

This is qualitative research used in-depth interviews. Purposive sampling was employed to select 15 school-age children with asthma attending the outpatient pulmonary department at university hospital in Thailand. Semistructured in-depth individual interviews were conducted. which were audiotaped and transcribed verbatim. Content analysis was used to analyze the data.

Two major themes emerged from this study: (1) perspectives on managing asthma and (2) facilitators in asthma self-management. Four subthemes emerged from the first major theme related to views on managing asthma: (1) emphasizing use of an inhaler for asthma, (2) self-monitoring for symptom, (3) difficulties with the daily regimens and (4) family support on asthma self-management. Two subthemes emerged from the second major theme related to facilitators in asthma self-management: (1) confidence in performing asthma care behaviors and (2) asthma communication.

This study described strategies that support asthma management of children in Thailand and provided insight into factors that influence asthma self-management. Findings will inform the development of future self-management interventions for school-age children with asthma.

Fear is seldom reported in the research literature on barriers to accessing general practitioner (GP) care. One reason may be that some patients are unwilling to admit to fear of this care. This is especially so for patients who, for social, cultural and historical reasons, have a poor sense of self, or do not wish to challenge professionals, or both. In New Zealand, the Maori and Pacific peoples are disproportionately characteristic of these patients and have poor access to GP care, including asthma in children. This paper contributes to the literature on using key informants to interpret another group’s needs, and integrates and adds to known patient attitudes that can hinder access to GP services.

Examines the relationships between different aspects involved in asthma treatment. Analyses each aspect's impact on overall patient satisfaction with asthma treatment. Also studies how outcome variables such as compliance with physician's recommendations, health‐related quality of life and resource use are affected by the degree of patient satisfaction. The results refer to asthma patients as a group but not necessarily to each patient as an individual. The statistical technique applied for this analysis is partial least squares. Tests the suggested generic model on 599 respondents from a questionnaire survey. The structure of the suggested model is well supported by the data.

There is considerable heterogeneity between primary care systems that have evolved in individual national cultural environments. Models of Child Health Appraised (MOCHA) studied how the transfer of models or their individual components can be achieved across nations, using examples of combinations of settings, functions, target groups and tracer conditions. There are many factors that determine the feasibility of successful transfer of these from one setting to another, which must be recognised and taken into account. These include the environment of the care system, national policy-making and contextual means of directing population behaviour – in the form of penalties and incentives, which cannot be assessed or expected to work by means of rational actions alone. MOCHA developed a list of criteria to assess transferability, summarised in a population characteristics, intervention content, environment and transfer (PIET-T) process. To explore the process and means of transferability, we obtained consensus statements from the researchers on optimum model scenarios and conducted a survey of stakeholders, professionals and users of children’s primary care services that involved three specific health topics: vaccination coverage in infants, monitoring of a chronic or complex condition and early recognition of mental health problems. The results give insight into features of transferability – such as the availability and the use of guidelines and formal procedures; the barriers and facilitators of implementation and similarities and differences between model practices and the existing model of child primary care in the country. We found that successful transfer of an optimal model is impossible without tailoring the model to a specific country setting. It is vital to be aware of the sensitivity of the population and environmental characteristics of a country before starting to change the system of primary care.

The purpose of this paper is to investigate physicians' attitudes toward smart fabric medical innovation and more specifically to examine how perceived ease of use and perceived usefulness affect physicians' attitudes and intention to use smart fabric technology.

Data for this study were collected using a web‐based survey instrument delivered via email to a randomly selected group of physicians (n=207) responses with no missing data). Physicians were chosen because physicians' acceptance is key to social acceptance of smart medical innovations, whether as an instrument to further their efforts to monitor patients through telemedicine or to expand their diagnostic capabilities.

Significant effects were found for the direct relationships between attitude and intention to use and between perceived ease of use and perceived usefulness. However, the relationships between attitude on intention to use, perceived usefulness on intention to use and perceived ease of use on perceived usefulness were not statistically significant.

Smart fabric technology is a recent development that has received widespread attention in textile industry publications as well as consumer market publications, but relatively little in medical journals. Even though many of the applications are still limited to military situations, the diffusion of these “smart” innovations into mainstream markets has the potential to significantly impact numerous lives. This is especially true for smart fabrics that have been developed for medical markets because these innovations have the potential to save lives, alter the way physicians practice and impact significantly the quality of care provided to patients.

The purpose of this paper is to develop an automatic control system for mechanical ventilation therapy based on the open lung concept (OLC) using artificial intelligence. In addition, mean arterial blood pressure (MAP) is stabilized by means of a decoupling controller with automated noradrenaline (NA) dosage to ensure adequate systemic perfusion during ventilation therapy for patients with acute respiratory distress syndrome (ARDS).

The aim is to develop an automatic control system for mechanical ventilation therapy based on the OLC using artificial intelligence. In addition, MAP is stabilized by means of a decoupling controller with automated NA dosage to ensure adequate systemic perfusion during ventilation therapy for patients with ARDS.

This innovative closed-loop mechanical ventilation system leads to a significant improvement in oxygenation, regulates end-tidal carbon dioxide for appropriate gas exchange and stabilizes MAP to guarantee proper systemic perfusion during the ventilation therapy.

Currently, this automatic ventilation system based on the OLC can only be applied in animal trials; for clinical use, such a system generally requires a mechanical ventilator and sensors with medical approval for humans.

For implementation of a closed-loop ventilation system, reliable signals from the sensors are a prerequisite for successful application.

The experiment with porcine dynamics demonstrates the feasibility and usefulness of this automatic closed-loop ventilation therapy, with hemodynamic control for severe ARDS. Moreover, this pilot study validated a new algorithm for implementation of the OLC, whereby all control objectives are fulfilled during the ventilation therapy with adequate hemodynamic control of patients with ARDS.