Background Pulmonary rehabilitation (PR) is formally indicated to all COPD patients in groups B and E. It positively impacts dyspnoea, health-related quality of life and exercise tolerance, reducing admissions among people with chronic obstructive pulmonary disease (COPD) who have had a recent exacerbation and symptoms of anxiety and depression. There is limited access to PR programmes in Portugal, partially due to insufficient resources or referrals. This study aims to characterise COPD patients and assess whether they have criteria for PR programmes. Data from this study may provide strategic information for healthcare organisations to differentiate and innovate their response to COPD patients. Methodology A cross-sectional study was conducted in an urban municipality in the northern region of Portugal. The sample was randomly extracted from the national primary electronic health records. The sample size (n = 339) was determined considering the population of COPD patients in this region (N = 2818), a 95% confidence level and a margin of error of 5%. Results In this population, the prevalence of COPD is 1.8%. Furthermore, in this sample, 40% (n = 136) of people diagnosed with COPD have a formal indication to participate in PR programmes, although only 14.2% (n = 48) of these patients had access to PR. Conclusion COPD is probably underdiagnosed in this Portuguese region. Most COPD patients have eligibility criteria to be offered PR programmes, although most of them do not benefit from this vital treatment. Investing in community and home-based programmes may increase PR access, reducing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admissions.

BACKGROUND: Calciphylaxis is an ischemic vasculopathy with high morbidity and mortality. Early and accurate diagnosis is critical to management of calciphylaxis. Clinical mimickers may contribute to delayed or misdiagnosis.
OBJECTIVE: To assess the rate and risk factors for misdiagnosis and to identify clinical mimickers of calciphylaxis.
METHODS: A retrospective medical record review was conducted of patients with calciphylaxis at a large urban tertiary care hospital between 2006 and 2018.
RESULTS: Of 119 patients diagnosed with calciphylaxis, 73.1% were initially misdiagnosed. Of patients not initially misdiagnosed, median time to diagnosis from initial presentation was 4.5 days (interquartile range, 1.0-23.3), compared to 33 days (interquartile range, 13.0-68.8) in patients who were initially misdiagnosed (P = .0002). The most common misdiagnoses were cellulitis (31.0%), unspecified skin infection (8.0%), and peripheral vascular disease (6.9%). Patients who were misdiagnosed frequently received at least 1 course of antibiotics. Patients with end-stage renal disease were less likely to be misdiagnosed than those without this disease (P = .001).
CONCLUSIONS: Single-center, retrospective study.
CONCLUSIONS: Understanding the risk factors for misdiagnosis of calciphylaxis is an opportunity for further education concerning this rare disease.

OBJECTIVE: The aim was to explore patient experiences and views of their symptoms, delays in diagnosis, misdiagnoses and medical support, to identify common experiences, preferences and unmet needs.
METHODS: Following a review of LUPUS UK\'s online forum, a questionnaire was posted online during December 2018. This was an exploratory mixed methods study, with qualitative data analysed thematically and combined with descriptive and statistically analysed quantitative data.
RESULTS: There were 233 eligible respondents. The mean time to diagnosis from first experiencing symptoms was 6 years 11 months. Seventy-six per cent reported at least one misdiagnosis for symptoms subsequently attributed to their systemic autoimmune rheumatic disease. Mental health/non-organic misdiagnoses constituted 47% of reported misdiagnoses and were indicated to have reduced trust in physicians and to have changed future health-care-seeking behaviour. Perceptions of physician knowledge and listening skills were highly correlated with patient ratings of trust. The symptom burden was high. Fatigue had the greatest impact on activities of daily living, yet the majority reported receiving no support or poor support in managing it. Assessing and treating patients holistically and with empathy was strongly felt to increase diagnostic accuracy and improve medical relationships.
CONCLUSIONS: Patient responses indicated that timely diagnosis could be facilitated if physicians had greater knowledge of lupus/related systemic autoimmune diseases and were more amenable to listening to and believing patient reports of their symptoms. Patient priorities included physicians viewing them holistically, with more emotional support and assistance in improving quality of life, especially in relation to fatigue.