Incorrect Technique Research Articles

Impact of Pharmacist-led Interventions on Medication Adherence and Inhalation Technique in Adult Patients with COPD and Asthma

Introduction: Inhalation technique and medication adherence are essential prerequisites for achieving optimal therapeutic effects in patients with chronic obstructive pulmonary disease (COPD) and asthma. Although there are various effective treatments for respiratory disorders, disease control in these patients is still sub-optimal because of incorrect inhalation techniques and poor medication adherence. Pharmacist-led interventions have demonstrated a positive impact on improving inhalation technique, better medication adherence, and thus subsequently improving the quality of life of patients. Methods: Search engines such as PubMed, Google Scholar, and Science Direct were used to identify the relevant information using keywords: Chronic Obstructive Pulmonary Disease, Asthma, Pharmaceutical care, Pharmacist Intervention, Medication Adherence and Inhalation Technique. The relevant articles that were published between 2005 to 2021 were included and reviewed for the Pharmacist-led interventions to improve medication adherence, inhalation technique, and quality of life of patients with COPD and asthma. Results: Of the 300 articles screened, a total of 14 articles met the inclusion criteria and were included for review. Pharmacist-led interventions help to improve the medication adherence, inhalation technique, and quality of life of patients with COPD and asthma. Similarly, the articles mentioned in this review found that the interventions provided by the pharmacist to COPD and asthma patients were cost-effective in terms of reducing hospitalization rates and severe exacerbation rates. Conclusion: Our review concluded that the pharmacists’ interventions have a significant improvement in medication adherence and inhalation techniques with the enhancement of therapeutic effects in adult patients with COPD and asthma.

Risk Factors for Lower Extremity Injuries in Hip-Hop Dancers

Background: Hip-hop dance is one of many types of dances that is very popular in the international community. Dance is a profession that combines art with sports so it is very vulnerable to injury. Lower extremity injuries in dancers can occur due to muscle weakness, extreme movements, or overuse. Objective: To determine the risk factors that can cause lower extremity injuries in hip-hop dancers. Method: The method used is a literature review with a compilation of journals related to risk factors of lower extremity injuries in hip-hop dancers taken in the form of PubMed page. Results: It's really common for dancers who report injuries to lose time for work because of the physical limitation due to the injury. Based on the journals reviewed, factors that often caused dancers to suffer injuries include overuse (35.2%), lack of or not warming up before dancing (37%) fatigue and muscle stiffness in the lower extremity (51.6%), joint hypermobility (43 %), and using incorrect dancing techniques (49.1%). Conclusion: Based on literature reviews and the discussion in the journals discussed, the results show that fatigue and muscle stiffness were the common factors that caused lower extremity injuries in hip-hop dancers. Keywords: Risk Factors, Lower Extremity Injury, Hip-Hop Dancer

Archery injuries: A literature review

BACKGROUND: Archery is one of the oldest human skills that survived to the present day. At first, it was used for hunting and war and later became a sport. The interest in archery has grown annually. Each type of sport has specific injuries. Information about archery-related injuries will allow us to develop preventive measures and help make this sport safer. The article will be useful for coaches, sports doctors, physiotherapists, and orthopedic surgeons.
 AIM: To present modern information about frequency, types of archery-related injuries, and preventive methods.
 MATERIALS AND METHODS: The publication search was performed in the PubMed/MEDLINE databases from 1978 to 2023 using combinations of OR, AND operators, and keywords: archery, archery injuries, rotator cuff injuries, arrow injuries, and overuse. Consequently, we extracted 49 foreign and domestic scientific sources.
 RESULTS: Archery injuries occur in 4.4 per 10,000 people involved in this sport. Acute injuries in archers are rare, mainly due to shooting errors and most often lead to soft tissue damage because of a fracture of a bow, arrow, or bowstring during a shot (83.3%) or as a result of touching the bowstring with a bow. Chronic injuries occur in 83.9% of archery athletes. The main risk factors for their occurrence include overuse, high repetitions during training, lack of strength of the athlete, and incorrect technique. Overuse (67.9%) is the most common cause of chronic tendon, ligament, and joint injuries. Injuries occurred in 30%–53% of cases in the shoulders (rotator cuff tear, scapular dyskinesia, and shoulder impingement syndrome), 12.8% in the elbow (medial and lateral epicondylitis and traumatic bursitis), 8.9%–19.9% in the spine and forearm (chronic tendovaginitis and tunnel syndromes).
 CONCLUSIONS: Proper training and safety measures help prevent acute injuries. Practicing archery techniques and strength training are the main measures of preventing muscle overuse and reducing the incidence of chronic injuries.

Systematic Review of Heel Puncture-Related Osteomyelitis of the Calcaneus in Newborn Infants.

Heel puncture (HP) in neonates can result in osteomyelitis if done non-aseptically or with incorrect technique. This study summarizes clinical experience with heel puncture-related osteomyelitis of the calcaneus (HP-CO) in newborns. We systematically reviewed studies that examined HP-CO in newborn patients using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search included the PubMed, Embase, and Cochrane Library databases until December 31, 2023. We used the National Institutes of Health (NIH) assessment scale to evaluate the quality of our analyzed studies. This study analyzed 15 neonatal calcaneal osteomyelitis (CO) cases due to HP conducted in six countries from 1976 to 2016. The average age of the cases was 8.87 ± 6.13days, with an average birth weight of 2367.27 ± 947.59g. The infants had undergone an average of 9.00 ± 8.90 HP, with 93.33% exhibiting swelling. Staphylococcus aureus was present in 80% of cases. Beta-lactam antibiotics were used, with satisfactory outcomes in 53.33% of cases. However, in seven cases, three patients had flatfoot due to calcaneal deformity, and other complications were observed in some patients after 7-8years. This study offers valuable insights into a rare condition, including its epidemiology, clinical and laboratory characteristics, and treatment options for infants with HP-CO. To prevent the risk of osteomyelitis in this vulnerable group of patients, increasing awareness and maintaining strict aseptic techniques is necessary. We recommend that infants presenting with tenderness, redness, purulent discharge, erythema, or fever and with a history of repeated HP and swollen ankles should be evaluated for suspicion of osteomyelitis. A graphical abstract is avilable for this article.

Reconstitution of oral antibiotic suspensions for paediatric use in households: a cross-sectional study among caregivers of 3–5-year-old children from a selected district, Sri Lanka

IntroductionReconstitution of oral pediatric antibiotic suspension by primary caregivers plays an essential role in determining the overall health outcome of the child. Incorrect reconstitution techniques could lead to underdosing, overdosing, or introduction of infection. Underdosing could lead to non-resolving infection and antimicrobial resistance.ObjectivesTo assess the practice and associated factors on reconstitution of oral pediatric antibiotic suspensions (OPAS) among primary caregivers of 3–5-year-old children in a selected district in Sri Lanka.MethodsA cross-sectional study was carried out among 835 primary caregivers selected using two-stage cluster sampling at field clinics to assess practices for the reconstitution of OPAS. A live demonstration of the reconstitution of the OPAS was assessed by a checklist. Associated factors with caregiver practices on reconstitution were assessed using Chi-square with the statistical significance level set at 0.05.ResultsA total of 820 respondents were recruited and completed the study (response rate = 98.2%). Overall, 56.0% displayed good performance in the demonstration of reconstitution of oral pediatric antibiotic suspension. Poorest performances were observed in shaking the bottle to loosen the powder (Correct: 53.7%), topping up the bottle with water up to the marked line (Correct: 58.0%), and filling the water below the marked line in the bottle (Correct: 59.0%). Caregivers in urban areas compared to rural and estate regions (45.6% vs. 22.7% and 26.5% respectively) and caregivers aged 35 years or above compared to less than 35 years age group (31.5% vs. 22.5%) performed the reconstitution of OPAS poorly. Parental factors, namely age, gender, level of education, and geographical region (urban/rural/estate) were significantly associated with the performance in reconstituting the oral paediatric antibiotic suspension (p = 0.002, p < 0.001, p < 0.001, and p < 0.001 respectively). Factors related to the child, specifically whether they attend preschool and whether they have an older sibling, were found to have a significant association with the correct execution of the reconstitution of OPAS (p = 0.017, and p = 0.030 respectively).Conclusions and recommendationsA significant number of primary caregivers displayed poor practice in key steps during the reconstitution of OPAS, which could have a negative impact on the health of the child. Targeted place-based behavioural change health programs with the use of infographic leaflets/ posters may correct the practices of caregivers.

IJCM_68A: Awareness and Practices towards Breast Self-Examination (BSE) for early detection of breast cancer among college-going students in Coastal Karnataka

Background: Breast cancer is one of the leading cancers among women especially in developing countries and is amenable to complete cure if detected early. BSE is one of the screening techniques for early detection of breast lumps and early detection of breast cancer. This study was done to study the awareness, attitudes, and practices towards BSE among the study participants. Methodology: This cross-sectional study was conducted on 656 female students in pre-university and non-health degree colleges of Mangalore, belonging to the Science and Commerce streams selected using cluster random sampling. Data collection was done using a semi-structured questionnaire and analysed using Statistical Package for Social Sciences (SPSS) version 25. Results were expressed using tables and figures. The chi-square test was used for comparison across the groups, and p-value &lt; 0.05 was considered statistically significant. Results: Among the 656 subjects,90%(n=570) belonged to age group of 18-20 years and 44.8%(n=287) were from science stream. Overall,41%(n=268) students were aware about the practice of BSE and a statistically significant association was seen with their stream. Also, 12%(n=78) performed BSE and out of them 69% (n=54) performed it at an ideal frequency. Among the students with a positive family history of breast cancer (4.5%), 92.3% felt the need for BSE education as compared to others. Conclusion: High number of young females (59.14%) did not have knowledge and those who performed BSE, followed incorrect techniques (94.7%). Most of them had a favourable attitude towards learning more about BSE.

Capillary effects and consolidation kinetics during selective laser melting of 316L powder

Selective laser melting (SLM) technology has the advantage of quickly producing complex-shaped parts. To achieve good mechanical properties, it's vital to minimize defects that can occur because of high residual porosity if incorrect processing techniques are used. One effective way to prevent defects is by using computer simulations of underlying processes before printing in the industry. This paper presents a reduced-order numerical model of SLM processing that accurately predicts material porosity by focusing on the key mechanisms that affect the melting and consolidation processes. The focus is on the formation of defects and the expected time that is required until the consolidation of a powder bed is completed. Then the elasticity of the SLM processed materials near defects is analyzed. The modeling results for powder consolidation are shown for comparison with experimental data on stainless steel 316L powder during SLM. This information can be further used for proper selection of SLM parameters such as the scanning speed and the power of the laser source.

Difficult-to-treat asthma: the most significant factors impeding control

Aim. The study of clinical and functional characteristics, features of pharmacotherapy and the level of adherence in severe and difficult-to-treat bronchial asthma in real clinical practice to optimize pathogenetic therapy measures.Materials and methods. 143 patients diagnosed with severe bronchial asthma were examined. Patients were divided into 2 groups: difficult-to-treat bronchial asthma and severe bronchial asthma. Examination methods included: anamnestic method, physical examination, filling out the ACQ-5 questionnaire, AST, the Morisky-Green questionnaire, instrumental (spirography with bronchodilator), laboratory methods.Results. Most of the studied patients were patients with difficultto-treat bronchial asthma (55%), while patients with severe bronchial asthma accounted for 45% of the total number of patients. We noted that patients of the 1st group were more often hospitalized due to an exacerbation of the disease. There were no significant differences in clinical and functional parameters and in the structure of comorbidity. All patients received the amount of basic therapy corresponding to stages 4 and 5 in accordance with GINA 2022. According to the results of the Morisky-Green questionnaire, lack of adherence was recorded in 79% of cases. Incorrect inhalation technique among patients of the 1st group was recorded in 32% of cases, while an uncontrolled course of concomitant pathology was detected in a third (33%) of cases. In group 2, 94% of patients had at least one marker of T2 inflammation.Conclusions. Among patients with difficult-to-treat asthma, truly severe bronchial asthma was confirmed in 45% of cases, bronchial asthma difficult-to-treat - in 55% of cases. Lack of adherence (79% of cases), uncontrolled course of comorbidity (33%), and incorrect inhalation technique (32% of cases) are the main factors hindering the achievement of control in the difficult-to-treat asthma group. For patients with difficult-to-treat asthma, it is necessary to take measures aimed primarily at improving adherence to treatment.

Asuhan Kebidanan Pada Bayi Baru Lahir dengan Perawatan Tali Pusat Di Klinik Pratama Medical Center Kota Batam

Newborns also called neonates are individuals who are growing and have just experienced birth trauma and must be able to make adjustments from intra uterine life to extra uterine life. A normal newborn is a baby born at 37-42 weeks gestation and weighs 2,500-4,000 grams. Care taken of newborns is care of hair, eyes, nose, mouth, ears and one of them is umbilical cord care. Umbilical cord care is needed to prevent the umbilical cord from becoming a breeding medium for pathogenic microorganisms: Incorrect care techniques can lead to tetanus neonatorum infection which can affect the length of cord detachment. This type of research is descriptive by applying a case study approach. The implementation of this study was carried out at the Pratama Medical Center Clinic on Mrs. W's baby by providing umbilical cord care to her baby.

Adverse events of anti-IL-5 drugs in patients with eosinophilic asthma: a meta-analysis of randomized controlled trials and real-world evidence-based assessments

BackgroundWe aimed to clarify comprehensively the safety profiles of anti-IL-5 drugs and pinpoint potential safety concerns that may arise in their post-marketing phase.MethodsTwo researchers conducted comprehensive searches of PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to September 2022. Additionally, we investigated the FDA AE Reporting System for post-marketing adverse event (AE) reports related to anti-IL-5 drugs. The outcomes fulfilled the proportional reporting rate criteria and the Bayesian confidence propagation neural network.ResultsWe included 24 published studies in our analysis. The anti-IL-5 treatment group showed an incidence of AEs comparable to the placebo group, and it exhibited a significantly lower frequency of serious AEs. Common AEs were asthma, nasopharyngitis, headache, upper respiratory tract infection (URTI), and bronchitis. The post-marketing data included 28,478 case reports associated with the suspect drugs and 75 suspect safety observations affecting 16 system organ classes. New suspect observations included incomplete therapeutic product effect, URTIs, and pulmonary mass in reports related to mepolizumab. Reports associated with mepolizumab and benralizumab also indicated issues with incorrect technique in device usage and product issues.ConclusionsIndividual anti-IL-5 drugs’ safety profiles largely matched their product inserts. We identified issues like improper device usage, product issue, and URTIs as potential concerns for mepolizumab and benralizumab. Additionally, all anti-IL-5 drugs showed signs of incomplete therapeutic effects.

Knowledge, Attitude and Practice and Associated Factors on Oxygen Therapy Among Nurses and Midwives in Y12 HMC-2022 Gc

Background: Oxygen is an essential medical therapy which saves a lot of lives. It is administered as a corrective treatment for conditions resulting in hypoxia (low level of oxygen in the blood). So, the nurse should have more skills and experience to performing this procedure in the aim to maintain the patient's life safe and avoid complications associated with incorrect oxygen administration technique. Objective: The study was conducted to assess the level of knowledge, attitude and practice towards oxygen therapy administration and associated factors among nurses and midwives at Yekatit 12 Hospital Medical college in 2022. Method: To achieve the research objectives a hospital based cross-sectional study was applied. The sample size drawn was 198. Pertinent data for the study were gathered through structured questionnaires. Descriptive and multiple logistic regression were used in the analysis of independent and outcome variables. Result: Data is collected from 211 participants and my response rate is (198)93.8%. Among 198 nurse and midwives 50.5% were males, 49.5% with the range of 30-39yrs and most of them (48.5%) have work experience of 6-9yrs.The mean score of knowledge, attitude and practice were 5.7(SD=1.608),4.01(SD=1.837) and 14.5(3.49) respectively. It is found that the level of knowledge was adequate in 117(59.1%) and poor 81 (40.9%) of participants. Practical skill is found to poor in 63.1% of participants and factors associated with this were absences of oxygen therapy guide line, not participating in any training about oxygen therapy and supply of oxygen delivery system with P-value of 0.01, 0.02 and 0.002 respectively. work experience also contributes for poor practice. Conclusion: There is a clear practical gap among nurses and midwives working in Y12HMC and this study also shows as there is poor attitude in almost have of the participants which high compared to another research. The possible associated factors for poor practice were identified as work experience less than 1yr and absence of training and oxygen guideline. So, to enhance safe use of oxygen therapy the referral hospital needs to push its effort for improving the practice and attitude of nurses and midwives towards oxygen therapy by facilitating trainings, increases the availability of guideline and supply of oxygen.

Critiquing lab technique videos prior to class: can it improve demonstrated technique?

During COVID-19 remote instruction, instructors were tasked with providing students with authentic laboratory experiences in an out-of-classroom environment. One solution developed for our introductory general chemistry laboratory involved students critiquing readily available technique videos to distinguish between correct and incorrect laboratory technique. After returning to in-person labs in Fall 2021, we incorporated this assessment into the pre-lab assignments in an effort to reduce the cognitive load of learning a new technique. Here we explore whether this critical-review exercise translates into improved technique as measured by precision and accuracy when using a 10 mL volumetric pipet. Additionally, we consider the impact of the pre-lab assignment given the involvement level of the TA, as some TAs are more willing to provide feedback on student technique during the lab period. We found that while students self-report the exercise as useful towards their learning, there are no significant changes in performance for most students. We did, however, find a reduction in the overall outliers and saw improvements when additional feedback (through a TA) was provided as well. These findings indicate that the exercise may be most useful for students who make large errors and who receive little individualized feedback.

Real-Time Feedback to Enhance the Teaching of Wire Tying.

Teaching the art of wire tying is difficult because the instructor is not able to gauge the effectiveness of the final product. The impact of an incorrect technique is usually not evident. Also, the instructor does not have a way to demonstrate the different levels of tension generated by different wire knotting techniques, nor their differing abilities to resist a load that a patient may apply. In this paper, a device is described that can provide real-time feedback on wire tension generated during knot tying, and how particular knots resist an applied distraction. This device has been used to deliver a live demonstration to reinforce lecture material, and in small group teaching exercises, where real-time feedback enhances skills and understanding. A stepwise training schedule for surgery residents structured as an entrustable professional activity is proposed.

Should a forgotten guidewire be removed after years? An undesirable complication of hemodialysis catheter wire left in the body

Today, one of the most common methods used in the emergency room or intensive care unit (ICU) in patients is the Seldinger technique to access the central venous system, shunting for hemodialysis, intra-aortic balloon pump, or arterial insertion. Accidental leaving of the guide wire is an uncommon but important complication that can occur as a result of an incorrect technique, and it is sometimes found accidentally or due to complications years after the procedure. The case is a 53-year-old patient who underwent aortic valve replacement with a mechanical valve and mitral valve repair with a ring 12 years ago and was treated with warfarin. Two years after the heart surgery, due to chronic renal failure, the patient underwent dialysis, and after the preparation of an arteriovenous fistula, he underwent stenting. After approximately ten years, the patient developed fever, chills, and shortness of breath. During the examination, endocarditis was diagnosed, and a part of the aortic valve was released. There was a severe paravalvular leak in the aortic valve, and an abscess was formed in the aorta root. We also noticed a forgotten guide wire in the superior vena cava, right atrium, inferior vena cava, and hepatic vein, and echogenic masses were located on the guidewire. The diagnosis was confirmed by echocardiography, chest x-ray, and phenocopy. After antibiotic therapy, the patients underwent heart surgery, aortic valve replacement, and aortic root repair, and the guidewire was removed (70 cm long). Unfortunately, despite all measures, the patient died a few days after the surgery. Due to complications, a forgotten guidewire should be removed immediately after diagnosis. The preferred intervention is the removal of the guidewire by endovascular interventions, but surgical treatment should also be considered in some cases.

Effectiveness of an educational intervention about inhalation technique in healthcare professionals in primary care: a cluster randomized trial.

Background: Incorrect inhalation technique (IT) is an important issue for chronic obstructive pulmonary disease (COPD) patients and healthcare professionals. Studies in which counseling is carried out with healthcare professionals beforehand so that they can properly educate their patients are required. The objective of the present trial is to assess the improvement in the performance of the IT in subjects with COPD and prescribed inhaled therapy after the implementation of an educational intervention conducted by their general practitioners. Methods: A cluster randomized clinical trial was conducted. A total of 286 COPD patients received scheduled inhalation therapy from 27 general practices in seven primary care centers. A teach-back educational intervention was implemented for both healthcare professionals and patients. The primary outcome of this study was the performance of the correct inhalation technique. It is considered a good technique if all steps in the inhalation data sheet are correctly performed. The secondary outcomes were assessed using forced spirometry, the basal dyspnea index, the Medical Research Council dyspnea scale, St George's Respiratory Questionnaire (SGRQ), and EuroQoL5D-5L for health-related quality of life. A one-year follow-up was conducted using an intention-to-treat analysis. Results: After the intervention, incorrect IT was observed in 92% of professionals and patients, with rates reaching 50% and 69.2%, respectively. The effectiveness in patients was significant, with a number needed to treat of 2.14 (95% CI 1.79-2.66). Factors related to correct IT in patients included the type of intervention, length of intervention (>25min), good pulmonary function, age (youngest <=65, oldest >83), and less limitation of activity due to dyspnea. There was no relation with the cluster. Conclusion: This study shows the effectiveness of direct inhaler technique training provided by a trained professional on an appropriate timescale (for example, a specific consultation for medication reviews), aiming to help subjects improve their performance using the teach-back method. This could be an encouraging intervention to improve medication adherence and health promotion in people with COPD. Clinical Trial Registration: clinicaltrials.gov, identifier ISRCTN93725230.

Personalized Intervention in Correcting Insulin Injection Errors and its Impact on A1C in the Study: A Cross-sectional Study

Background: Ever since the discovery of insulin, it has become an inevitable part of diabetes management in both type 1 and type 2 diabetes (T2D). Administering insulin subcutaneously following the correct insulin injection technique is often flawed in a considerable number of people with diabetes. Incorrect insulin techniques lead to poor glycemic control and invite serious adversities. Aims and Objectives: The study aims to evaluate impact of imparting educational intervention on reducing insulin injection errors and subsequent improvement in glycated hemoglobin in people with T2D. Materials and Methods: The study employed a survey-based cross-sectional design to evaluate the impact of the educational interventions on the injection techniques for the diabetes cohort. The data were collected from people with T2D visiting the outpatient department of four different comprehensive diabetes research centers in Kerala, India. All the statistical analysis was performed using R version 4.2.3. Results: Results showed a significant reduction in the HbA1c in people with type 2 diabetes. Conclusion: The cross-sectional study demonstrates that repeated educational interventions contribute to statistically significant improvement in HbA1c.

Accuracy of pharmacy student self-assessment of a single sterile compounding technique following didactic training

IntroductionThe primary objective was to determine pharmacy students' ability to self-assess sterile compounding technique in a single evaluation three semesters after training in the curriculum. MethodsSchool of pharmacy (SOP) students were trained and assessed on sterile compounding technique during their second year of school, with no additional formal assessments provided later in the curriculum. From 2016 to 2018, 262 students were asked to compound a simulated sterile product in their third year of pharmacy school and self-evaluate their technique, which was compared to an instructor evaluation with both people using the same rubric. ResultsTwo thresholds were used to define successful assessment: strict (ability to detect ideal technique) and lenient (ability to detect harmful technique). The average match rate was 70.2% and 87.6% in the strict and lenient analyses, respectively, with outcomes varying between categories. In the product preparation and inspecting product categories, students who disagreed with assessors tended to misidentify their incorrect technique as correct. ConclusionsPharmacy students who assessed themselves on sterile compounding technique three semesters after formal sterile compounding training were able to accurately self-assess in most cases, but when disagreeing with an assessor, commonly identified their incorrect technique as correct. Most students demonstrated the ability to self-assess sterile compounding technique and are prepared to assess their own sterile compounding in practice. SOPs could consider whether sterile compounding training coupled with self-assessment throughout the curriculum would be beneficial to further improve students' sterile compounding ability and accuracy of self-assessment.

Treatment of Iatrogenic Nerve Injury After Humeral Shaft Fracture Fixation: A Case Report

Background. Iatrogenic neuropathies of the radial nerve following intramedullary nailing of the humerus are observed in 2.9% of patients. In 30% of cases, iatrogenic nerve injury is associated with distal nail locking. Questions about the timing and volume of diagnostic measures to determine the nature of nerve damage, methods of conservative and surgical treatment, and their effectiveness remain relevant.&#x0D; Aim of the study to illustrate the causes, prevention methods, diagnosis, and treatment of iatrogenic radial nerve injuries in humeral shaft fractures through a clinical example.&#x0D; Case presentation. A 30-year-old female patient was admitted with a nonunion fracture of the left humerus and iatrogenic radial nerve injury three months after the fracture was fixed with a locking nail. A revision operation was performed: removal of the nail from the left humerus; re-fixation of the left humerus with a plate; revision, neurolysis, and plastic repair of the left radial nerve using autografts from the right sural nerve. Postoperative courses of medication therapy, physiotherapy, and therapeutic exercises were conducted. At 26 months after the surgery, complete range of motion and restoration of strength in active extension of the left wrist and three phalanges, abduction of the first finger, partial extension of the first finger, and restoration of sensitivity on the outer surface of the left forearm and the back of the hand were observed.&#x0D; Conclusion. Iatrogenic radial nerve injury primarily occurs as a result of incorrect technique when introducing locking screws during intramedullary nailing of humeral shaft fractures. Delayed examination and surgical treatment of patients with injured radial nerve lead to a lack of full functional recovery, potential muscle atrophy, and impairment of their motor function. Surgical treatment aimed at restoring the radial nerve at an early stage after injury, combined with a full range of postoperative rehabilitation for a year, is the only correct treatment approach.

A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension.

To achieve an excellent functional and cosmetic result, primary closure is preferred over leaving wounds to heal by secondary intention. However, traumatic wounds are often under excessive tension during wound closure and incorrect suture technique can compromise microcirculation, leading to skin necrosis and impaired wound healing. To describe an inexpensive and effective tension relief technique that helps the successful primary closure of a variety of equine wounds at high risk of dehiscence. Retrospective case series. All wounds that were managed with the Tension Tile System (TTS) at four Equine Hospitals between March 2017 and May 2021 were evaluated. The wounds were classified according to various criteria including anatomical location, time elapsed prior to surgery, depth of wound and post-surgical use of immobilisation. Outcome criteria were based on the success of primary intention healing. The duration of convalescence (weeks) after surgery was also recorded. During the study period, the TTS was used in 191/860 (22%) wounds repaired under general anaesthesia or standing sedation. Overall, primary intention healing (Group A) was achieved in 132 of 191 cases (69%, CI 62%-75%), with partial dehiscence (Group B) in a further 30/191 cases (16%, CI 11%-22%). Severe dehiscence (Group C) was recorded in 29/191 cases (15%, CI 11%-21%). The median convalescence time was 4 weeks (Range 3-15, interquartile range 4-6) in Group A. Retrospective nature of the study and subjective outcome assessment. The technique was applied to wounds under significant tension; however, this was based on a subjective assessment by the surgeons involved. The Tension Tile System is an economical and effective technique for challenging equine wounds under tension, in a variety of anatomical locations.

Characteristics of Inhaler Technique in COPD Patients in a Specialized Center in Armenia, Colombia: A Cross-Sectional Study.

The aim of this research was to evaluate the technique of using inhaled drugs in patients with a confirmed history of COPD and describe errors in inhaler technique. Descriptive cross-sectional study was conducted in patients with a history of COPD using inhalation therapy, attending pulmonology consultation between August 2020 and April 2021 in Armenia, Colombia. A non-probabilistic sample of 80 adult participants was calculated, and the inhalation technique was evaluated (depending on the device used) using a scale validated for Colombia. Descriptive analysis of the qualitative variables was performed using frequencies and percentages. The Chi-Square test and Fisher's exact test (in corresponding cases) were used to look for association relationships between categorical variables. A total of 80 participants were evaluated, of which 66.3% (n = 53) were male, and 32.5% were older than 80 years. Clinically, 30.0% (n = 24) were classified as Modified Medical Research Council Dyspnea Scale (mMRC) grade 3, and 51.2% (n = 41) had at least one exacerbation per year. The main comorbidity was hypertension (40.3%). Pressurized metered-dose inhalers with spacer were the most used device at 22.7% (n = 39). Incorrect technique (at least one error in the steps of the inhalation technique used) was found in 48.7%. The most frequent error among all the techniques was the failure to perform pre-inspiratory exhalation. No significant differences were observed between the development of the technique and the characteristics of the participants. Nearly half of the patients who use inhalation devices make errors in the technique. Patient education and training of healthcare personnel represent a fundamental pillar in mitigating the incorrect use of these devices.