Incorrect Technique Research Articles

A study to assess the effectiveness of a structured teaching programme on knowledge and practice of safe insulin administration among nurses in a tertiary care hospital: A pre-post design

Background and objective: Diabetes Mellitus (DM) is not only a health issue but also an economic issue in India. Incorrect insulin injection techniques can lead to side effects such as pain, lipohypertrophy, and poor glycemic control. We designed the present study to assess nurses’ knowledge about safe insulin administration and evaluate the role of a planned teaching programme on knowledge and practices of safe insulin injection techniques in a group of nurses in tertiary care hospital.Methods: This is a pre-post design to study the effectiveness of the structured training programme - one hour of didactic lecture followed by demonstration of safe injection practices. Demographic data and knowledge about safe insulin practices were collected at baseline. We conducted two post training assessments–day one and three months after training. The injection practices were assessed using a check-list. We used the random effects linear regression model to identify factors associated with change in scores over these three observations.Results: The mean (SD) scores for insulin knowledge at baseline was 6.81 (2.28). It significantly increased to 16.85 (1.84) immediately after training (p < .001). These scores reduced significantly after three months compared with post-training scores (14.18 [2.14]; p < .001). A significantly higher proportion of nurses had used re-suspension technique for insulin injection after three months (76.3% vs 52.5%, p = .003) and cleaned the injection site with alcohol swab before injection (93.8% vs. 75.0%, p = .001). On an average, knowledge scores changed by -0.15 (95% CI: -0.29, -0.02; p = .03) with each unit increase in age (years). The average score in nurses with a degree was significantly higher compared with those who had a diploma (1.02, 95% CI: 0.28, 1.76; p = .007).Conclusions: The study demonstrated that insulin injection practices improve with adequate guidance and information. However, there is a need to have a regular training programme to sustain the practices. Certain practices such as site rotation and assessing lipo-hypertrophy, and the relation between these two should be emphasized in these sessions.

Estimation of direct cost related to asthma among school-age children with asthma

Abstract Background Childhood asthma still imposes a substantial burden on the health care system and community. Its management requires a significant direct cost. Several factors can influence the cost of asthma management, particularly severe asthma. There is scant information about the predictors of asthma-related cost. Thus, the purpose of this study was to estimate direct asthma-related cost among children with chronic asthma and to identify factors that have the greatest contribution to change it. Methods This cross-sectional study was carried out in Farhat Hached University Hospital in Sousse (Tunisia, Africa) over a period of three months (April-June 2018) among children with asthma aged 7-17 years. The direct cost was defined as the costs of health resources utilization and medication related to asthma in the past 12 months. Purchasing power parity technique was used to convert TND to USD. Multiple linear regression was performed to examine the association between dependent and independent variables. Results A total of 90 subjects participated in the study. The mean age was 9.81±2.56 and 55.6% were male. The annual mean of the total direct cost was USD 616.71±454. Multivariate analysis showed that the severity of asthma, inhalation technique and emotional domain of QOL predict asthma cost and that the latter was the best predictor (p = 0.005, p = 0.03, p = 0.004, respectively). This data indicates that for one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months. Conclusions This study showed that higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma. These results are useful for health care providers and community since they provide information about the impact of modifiable risk factors on direct asthma cost. Key messages For one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months. Higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma.

The Experience of ACL Reconstruction with Synthetics Ligament: Where are we now?

The dispute on artificial ligaments used for anterior cruciate ligament (ACL) reconstruction has been a long time issue. Admittedly, due to designing defects, materials deficient without creeping, viscoelasticity and biocompatibility, and incorrect surgical technique, early application of synthetic ligament in ACL reconstruction did not yield good outcomes. For a long time, a poor outcome occupied our consensus. Whilst the poignant lessons didn’t drive people to thoroughly figure out underlying reasons but amplified the fear of synthetics ligament in the ACL reconstruction. Recent 15 years, a new generation synthetic ligament, Ligament Advanced Reinforcement System (LARS) developed for ACL/PCL reconstruction has been widely used in China. There are at least 147 papers on LARS published in Chinese and over 47 SCI papers published in English. Consistently, a positive outcome has been concluded in most reports with an early return to sports and lower complication or failure rate. Cumulative failure rate from short- and mid-term follow-ups was only 2.6% according to Batty et al., which has been commended as “surprisingly impressive” by James H. Lubowitz of journal Arthroscopy. In China, LARS ligaments have been approved by CFDA since 2004 and been used for ACL reconstruction over 30,000 cases. Recently a national multi-centers clinical investigation has been done in long-term failure analysis of the ACLR with LARS, which has involved 20 Chinese clinical centers and 1146 cases with mean follow-up time of 87 months（7 years）, organized by the Chinese Artificial Ligament Study Group (CALSG), with an acceptable outcome in failure rate of 4.5% and complication rate of 4.1%. The following factors were concluded as main failure reasons, 1）incorrect surgical technique in a non-isometric ACL reconstruction, 2）lack of the graft biocompatibility and rigid screw interface fixation, 3) non-suitable indicated patients’ selection and rehabilitation program. Compared with reported long-term failure rate in auto（10%）or in allografts（24%）, the outcome of Synthetic ligament was more superior and acceptable results. Moreover, the functional evaluation and return to sports of the patients were also high satisfying, despite some complication, such as screw loose, remnant stimulation but very rear synovitis. Non-isometric tunnel position was the main failure reason which caused by surgeons tech. An ISOMETRIC surgical technique should be stressed especially in ACL reconstruction using synthetic, focused on surgeon education, instead of simply blaming the artificial graft. Based on the systemic review and our study, a modification of synthetic graft has been developed successfully in experiment, graft fixation, synthetics materials modified with Polyethylene Terephthalate (PET) which has facilitated the biocompatibility. Our clinical investigation has also focused on a near-isometric ACL reconstruction, which would decrease the graft tunnel motion and facilitate artificial graft successful. Non-isometric input will predispose the grafts easy failure because of over tension on the graft while joint moving. Carefully selected patients, proper surgical technique, and standard rehabilitation program will ensure artificial ligament successfully. We will keep devoting to innovate artificial ligaments, including tissue engineering, bio-mimics design, advanced fixation, hybrid graft designing and more precise Isometric surgical technique. Never forgetting our beginning mind, the artificial ligaments will open a new epoch in the future of ACL reconstruction.

Inhalation therapy in children: new opportunities

Inhalation therapy is widely used for treatment of acute respiratory infections and asthma in children, and provides more rapid drug delivery in the airways. Treatment success in children with respiratory diseases is defined not only by an adequate choice of the drug and the dosage regimen, but also by inhalation drug delivery system. The choice of drug delivery device in children depends on the child's age and ability to carry out instructions related to the inhalation technique. Incorrect inhalation technique is associated with inappropriate distribution of the drug in the respiratory tract and an unreasonable increase in the volume of therapy, risk of adverse effects, and the total cost of the treatment. Currently, a great number of various drug delivery systems are commercially available, such as a pressurised metered dose inhaler (MDI), a MDI with spacer and facemask, a dry powder inhaler, and a nebulizer. The most optimal inhalation drug delivery device for children is a nebulizer. In this article, the authors discussed benefits and limitations of various drug delivery systems and modern nebulizers used for treatment of the upper and the lower airways including DuoBaby nebulizer 2-in-1 with a nasal aspirator.

Characteristics and factors of concussion events for tacklers in collegiate rugby union.

The purpose of this study was to determine the factors related to the occurrence of concussion in rugby tacklers. Match video records showing tackles leading to concussion were used to identify injury-inciting events. Additionally, noninjury tackles by concussed tacklers (prior to concussion) and position-matched tacklers from the same matches were used as a control cohort. All tackles were coded according to the tackling characteristics. The odds ratio (OR) was reported by logistic regression. The results demonstrated that a side step of the ball-carrier reduced the risk of concussion for tacklers (OR=0.13 [95% CI, 0.03-0.58]; P=.008). Conversely, the tackler's head/neck contacting the ball-carrier (OR=18.62 [95% CI, 4.59-75.49]; P<.001) and not remaining bound to the ball-carrier since making initial contact (OR=4.38 [95% CI, 1.69-11.34]; P=.002) were identified as risk factors for the concussion of tacklers. These results suggest that avoidance movements of the ball-carrier prior to tackling reduced the risk of concussion and that incorrect tackling techniques contributed to an increased occurrence of concussion. Furthermore, the probability of concussion for tacklers increased when their head was in front or to one side of the ball-carrier, and the direction of the tackle also affected the risk of concussion, especially from the side. Therefore, it is important to emphasize the tackler's head position in conjunction with the direction of tackle.

A Comparison of the Hamstring to Quadriceps Activation Ratio in the Toe-in or Neutral Toe Position After Triple Jump Spikes in Female Volleyball Players

Background: Performing exercises or playing sports with an incorrect technique can cause musculoskeletal injuries. Objectives: The present study was conducted to compare the hamstring to quadriceps activation ratio when landing in a two-way spike in female volleyball players. Methods: In this cross-sectional study, 15 elite female volleyball players performed triple jump spikes (TJS) with their toe in and in a neutral ankle position. Electromyography (EMG) was used to measure the muscle activity of the biceps femoris, semitendinosus, vastus medialis and vastus lateralis in two phases before and after the initial contact. Data were analyzed using the Wilcoxon test at the significance level of P < 0.05. Results: The ratio of biceps femoris activity to vastus medialis (P = 0.04) and vastus lateralis (P = 0.04) activities in TJS with a toe-in ankle decreased significantly in the feed-back phase and the ratio of semitendinosus activity to vastus lateralis activity also decreased significantly in the feed-forward phase of TJS with a natural ankle angle (P = 0.02). Conclusions: A lower muscle activity ratio for biceps femoris to vastus lateralis and medialis in the toe-in position may lower hamstring muscle support from the anterior cruciate ligament (ACL) after landing, which might increase the risk of ACL injury when landing.

Prevalence and impact of risk factors for poor asthma outcomes in a large, specialist-managed patient cohort: a real-life study.

BackgroundRisk factors for poor asthma outcomes may have considerable influence on the control level and medical care of asthmatic patients. Our objective was to conduct a study that provides data on the level of symptom control and the frequency of specific risk factors for poor asthma outcomes on a large patient cohort.MethodsA cross-sectional, non-interventional real-life study was conducted among asthmatic patients treated by respiratory specialists in Hungary. Asthma control and risk factor assessment were done according to Global Initiative for Asthma guideline (Box 2–2). In the data analysis, phase descriptive statistics, graphical outputs, and Fisher’s exact tests were used.ResultsOf 12743 patients enrolled by 187 specialists, asthma was well controlled in 36.0%, partially controlled in 29.29%, and uncontrolled in 34.71% of the cases. The most common comorbidities were rhinitis/sinusitis (66.84%), cardiovascular diseases (43.81%), and gastroesophageal reflux disease (20.11%). The following risk factors had the strongest relationship with uncontrolled disease: incorrect inhaler technique causing side effects (odds ratio, OR 4.86, 3.51–6.8), previous severe exacerbation (OR 4.79, 4.02–5.72), high short-acting beta agonist (SABA) use (OR 4.46, 4.03–4.93), incorrect inhaler technique associated with an exacerbation (OR 3.91, 3.06–5.03), and persistently low forced expiratory volume in 1 s (FEV1, OR 3.14, 2.8–3.52). The most frequent risk factors were smoking (OR 1.47, 1.36–1.59) and obesity (OR 1.34, 1.24–1.45). Furthermore, high loss of control was associated with an initial low FEV1 (OR 2.21, 2.01–2.44), frequent oral corticosteroid (OCS) use (OR 1.83, 1.64–2.05), poor adherence to treatment (OR 2.51, 2.21–2.86), and allergen exposure (OR 1.63, 1.47–1.81).ConclusionsThis study indicated that the presence of risk factors for poor asthma outcomes listed by the Global Initiative for Asthma document significantly influenced actual control level in a real-world large patient cohort, with high SABA use, previous severe exacerbation, incorrect inhaler technique, persistently low FEV1, and poor adherence to treatment having the highest impact.

Impact of Advanced Patient Counseling Using a Training Device and Smartphone Application on Asthma Control.

Pressurized metered-dose inhalers (pMDIs) are among the most commonly used aerosol delivery devices. Poor lung deposition from a pMDI is often a result of incorrect inhalation technique. The aim of this study was to compare the impact of combining a newly released training device with a smartphone application (advanced counseling) in asthma control to the impact of traditional verbal training. A total of 371 subjects with asthma were divided into 2 groups: advanced counseling (n = 187) and verbal counseling (n = 184). Both groups had 3 visits, each meeting being a month apart. At each visit, lung function (ie, FEV1, ratio of FEV1 to forced vital capacity [FEV1/FVC], and peak expiratory flow) were measured, an asthma control test was given, and subjects were trained in the correct inhalation technique. Inhalation flow through the pMDI was also recorded at each visit because the correct pMDI technique requires an inspiratory flow of < 60 L/min. In the advanced counseling group, lung function significantly improved after both the first and the second visit (P < .001), whereas in the verbal group, lung function improved significantly only after the second visit (P < .001). Although the inspiratory flow through the pMDI improved significantly in both groups, it was closest to the target range in the advanced counseling group. In addition, more subjects in the advanced counseling group had monthly increases of ≥ 3 points in their asthma control test scores compared to the verbal counseling group. The use of a training device with a smartphone application in conjunction with traditional verbal counseling in pMDI technique resulted in significant improvements in asthma control compared to traditional verbal counseling in pMDI technique alone.

Design and Development of a Novel Oral Care Simulator for the Training of Nurses.

A Novel Oral Care Simulator was designed and developed to measure and visualise the facial and lingual forces exerted on teeth by the action of tooth brushing, considering the irregular geometry and structural composition of human dentition and the emulation of the realistic biomechanical deflection of the teeth. FEA simulations were carried out on a central incisor under facial loading and an appropriate force sensing mechanism was designed. An anatomically accurate mandibular jaw and 16 teeth were 3D printed, on which 16 force sensing structures were embedded. The signals from the sensors were amplified using a multichannel signal amplifier built using instrumentation amplifiers which were then visualised through a GUI. The developed simulator is capable of indicating the magnitude of a force upto 15 N exerted on to the facial and lingual surfaces of teeth at a frequency of 60Hz and above and it is capable of alerting the user if the force exceeds a pre-specified threshold. The designed force sensing mechanism considers the irregular geometry and structural composition of human dentition in measuring the facial and lingual forces. It provides a reliable feedback by indicating the force and emulating the realistic biomechanical deflection of teeth. Nurses who care for the disabled, elderly and sick have explicitly stated the requirement for a simulator to train themselves on brushing the teeth of their subjects as their incorrect technique can cause longterm dental damage, for which a device has not been developed to date.

Inadequate Inhaler Technique, an Everlasting Problem Associated with Poor Disease Control—A Cross-Sectional Study

Introduction: Dry powder inhalers (DPI) have been in use in the treatment of chronic respiratory diseases for decades. DPIs require proper inhaler technique to ensure appropriate dose delivery to the lungs which in turn provides disease control and hence reduces the economic burden due to frequent acute attacks and hospital visits. Inadequate inhaler technique remains an everlasting problem among patients with chronic respiratory disease. Hence the aim is to assess the inhaler technique in patients using DPI and to determine the factors associated with inhaler technique. Material and methods: A cross-sectional study was conducted and 385 patients with asthma or chronic obstructive pulmonary disease (COPD) were recruited. Patient-related and disease-related factors were noted. Severity of the disease were assessed using asthma control test/COPD assessment test questionnaire and spirometer. The investigator assessed the inhaler technique of the patient against standard checklist. Results: Nearly 46.2% of the patients performed incorrect inhaler technique. Multivariate analysis showed factors like young age [Odd’s ratio (OR) 4.13, CI 1.31–17.8], well controlled disease (OR 2, CI 1.1–3.65), and the patients who learnt the technique from a medical personnel (OR 3.67, CI 1.46–9.24) had better inhaler technique. Conclusion: This study shows that the proper use of inhaler is still an unattained goal and significance of correct use has to be reiterated.

User and system pitfalls in liver imaging with LI-RADS.

The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver imaging, created specifically for patients at risk for hepatocellular carcinoma. Over the past years, LI-RADS has been progressively implemented into clinical practice, but pitfalls remain related to user error and inherent limitations of the system. User pitfalls include the inappropriate application of LI-RADS to a low-risk patient population, incorrect measurement techniques, inaccurate assumptions about LI-RADS requirements, and improper usage of LI-RADS terminology and categories. System pitfalls include areas of discordance with the Organ Procurement and Transplantation Network (OPTN) as well as pitfalls related to rare ancillary features. This article reviews common user pitfalls in applying LI-RADS v2018 and how to avoid preventable errors and also highlights deficiencies of the current version of LI-RADS and how it might be improved in the future. Level of Evidence:3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2019;50:1673-1686.

Inhaler Technique in Low-Income, Inner-City Adults with Uncontrolled Asthma

Poor inhaler technique has been shown to be associated with less asthma control and increased health care utilization. Little is known about the impact of inhaler technique on the most vulnerable patients. This study examined inhaler technique in low-income, inner-city adults with uncontrolled asthma. Inhaler technique data and other patient characteristics were evaluated in adults drawn from 2 studies conducted at the University of Pennsylvania. Subjects were from low-income Philadelphia neighborhoods and had uncontrolled asthma. Baseline characteristics were collected. Inhaler technique was rated by research coordinators who were trained with written materials. In 584 adults, 56% of metered dose inhaler users and 64% of dry powder inhaler users had adequate visually assessed inhaler technique. Inhaler technique did not vary by reading comprehension or numeracy levels. In this group of patients with uncontrolled asthma, visually assessed inhaler technique was adequate in more than one-half. Although incorrect inhaler technique is generally common and must be routinely addressed, this study suggests that other factors that lead to poor control must be identified.

A study on effectiveness and progress outcomes of educational inhaler technique intervention in asthma and COPD patients

Aim: A study on effectiveness and success factors of educational inhaler technique intervention in asthma and COPD.&#x0D; Objectives: To identify the percentage of common errors done by people who use inhalers. To identify the risk factors associated with asthma and COPD.&#x0D; Method: Data was collected from the subject’s face to face interview in a community setup and the lung capacities were measured using spirometer and peak flow meter; the values were noted and the subjects were asked to demonstrate their inhaler technique using placebo inhalers; numbers of correct and incorrect steps were noted. After a period of one month; the subjects were taken to follow up and measured the lung capacities and checked the inhaler steps; number of correct and incorrect steps were noted.&#x0D; Results: A total of 572 samples were collected and 500 were followed up, in which 300 had Asthma and 200 had COPD. Out of which 189 were female and 311 were male. Low education level was the single most important factor leading to incorrect technique. Formal training resulted in a statistically significant increase in the percentage of correct techniques for all the devices. For pMDI (54.01% vs. 91.03%, *p=0.005 before &amp; after training respectively). For pMDI+Spacer (52.75% vs. 94.85%, *p=0.007 before &amp; after training respectively). For Accuhaler (54.07% vs. 91.27%, *p=0.017 before &amp; after training respectively). For Rotahaler (63.94 vs. 98.64%. *p=0.029 before &amp; after training respectively). For Nebuliser (56.97% vs. 91.88%, *p=0.001 before &amp; after training respectively.&#x0D; Conclusion: Proper education to patients on correct usage may not only improve control of the symptoms of the disease but might also allow dose reduction in long term. The number of subjects doing correct steps gradually increased after the pharmacist led intervention. Thus, proper counselling for the inhaler use in patients must be encouraged as it is directly linked to the quality of life of patient.&#x0D; Keywords: Asthma and COPD control inhaler devices, inhaler technique, pharmacist intervention, inhaler education.

Soft Tissue Sarcoma - a Current Review of the Diagnostic and Treatment Strategies.

Soft tissue sarcomas are a heterogeneous group of neoplasias that due to their often clinically silent appearance often remain undetected or experience delayed treatment. Especially soft tissue swelling is often misinterpreted by patients and doctors and trivialized or verified with an incorrect biopsy technique. The hereby evoked complications for the patients are serious and may be reduced by simply following the available guidelines. The treatment of soft tissue sarcomas requires a close interdisciplinary coordination between specialists in tumor orthopedics, oncology, radiology, pathology and radiotherapy. On the basis of a selective literature review, the following article points out the current evidence on the treatment and illustrates a treatment algorithm.

What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape.

Inhaled therapies are the cornerstone of treatment in asthma and chronic obstructive pulmonary disease, and there are a multitude of devices available. There is, however, a distinct lack of evidence-based guidance for healthcare providers on how to choose an appropriate inhaler. This review aims to summarise recent updates on topics related to inhaler choice, and to offer practical considerations for healthcare providers regarding currently marketed devices. The importance of choosing the right inhaler for the right patient is discussed, and the relative merits of dry powder inhalers, pressurised metered dose inhalers, breath-actuated pressurised metered dose inhalers, spacers and soft mist inhalers are considered. Compiling the latest studies in the devices therapy area, this review focuses on the most common types of handling errors, as well as the comparative rates of incorrect inhalation technique between devices. The impact of device-specific handling errors on inhaler performance is also discussed, and the characteristics that can impair optimal drug delivery, such as inhalation flow rate, inhalation volume and particle size, are compared between devices. The impact of patient perceptions, behaviours and problems with inhalation technique is analysed, and the need for appropriate patient education is also highlighted. The continued development of technology in inhaler design and the need to standardise study assessment, endpoints and patient populations are identified as future research needs.The reviews of this paper are available via the supplemental material section.

Inhaler Technique and Adherence to Inhaled Medications among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Vietnam.

Sub-optimal chronic obstructive pulmonary disease (COPD) management has been found largely due to patients’ medication non-adherence and incorrect inhaler technique. This study aimed to examine inhaler use technique and medication adherence among Vietnamese COPD patients as well as potential associated factors. A cross-sectional study involving 70 COPD exacerbators was conducted. Inhaler technique and adherence were evaluated by the 10-item and 12-item Test of Adherence to Inhaler (TAI). Data on the history of COPD, home prescription of inhalers and duration of hospitalization were also collected. Generalized linear regression models were used to determine the associated factors with inhaler use and medication adherence. The results showed that the proportion of patients with good inhaler technique was 22.7% for metered-dose inhalers (MDI), 30.4% for dry powder inhalers (DPI) and 31.8% for soft-mist inhalers (SMI). Full exhalation was the most common mistake. The rates of non-compliance patterns were: “ignorant” (77.1%), “sporadic” (58.6%), and “deliberate” (55.7%). Worse dyspnea, greater health condition impairment, and an increased frequency of exacerbations and hospitalizations were found to be associated negatively with correct inhaler use and treatment adherence. Instructions to COPD patients about using inhalers should focus on correct inhaler technique and adherence even when feeling healthy.

Preference of diagnostic tools, medications, and devices for asthma management: A survey of doctors in Algeria.

Aim:This study aimed to evaluate the doctors' perspectives in using tools for diagnosis, prescribing medications, and devices for the treatment of asthma in Algeria.Methods:Data were collected from randomly selected physicians, pediatricians, allergists, and pulmonologists through a questionnaire-based survey in 12 cities and 60 rural locations across Algeria.Results:Of the 213 doctors who responded to the survey, >90% doctors attended an average of 20 asthma patients daily. Peak flow meter was used by 69% doctors for diagnosis and by 93% for monitoring of asthma. Spirometer was used by 76% doctors for diagnosis of asthma. Budesonide (86%), fluticasone (46%), and beclomethasone (40%) were the most prescribed inhaled corticosteroid (ICS) by doctors. Formoterol/budesonide was the most preferred ICS/long-acting β2-agonist (LABA) (72%), followed by salmeterol/fluticasone (57%) for asthma treatment. Salbutamol was preferred by 93% doctors as reliever medication. ICS was the preferred controller in mild asthma (76%), and ICS/LABA combination in moderate (74%) and severe asthma (80%). Most doctors (94%) preferred pressurized metered-dose inhalers (pMDIs) with (46%) or without spacer (48%) for their asthma patients. About 83% doctors believed that pMDI with spacer would show a better outcome in asthma, over pMDI alone. Continuous exposure to allergens/smoking (73%) and incorrect inhaler technique (66%) were the most common reasons for uncontrolled asthma.Conclusion:The use of diagnostic tools in asthma was found to be adequate among the doctors in Algeria. Most of the doctors managed asthma in accordance with the global initiative for asthma guidelines. Spacers were found to be less prescribed in regular treatment, despite having good awareness about its better outcomes.

Use and inhalation technique of inhaled medication in patients with asthma and COPD: data from a randomized controlled trial

BackgroundThe burden of asthma and COPD among patients is high and people affected are frequently hospitalized due to exacerbations. There are numerous reasons for the lack of disease control in asthma and COPD patients. It is associated with non-adherence to guidelines on the part of the health care provider and with poor inhalation technique and/or non-adherence to the prescribed treatment plan by the patient. This study aims to present data on inhaler technique and its impact on quality of life (QoL) and symptom control in a typical population of patients with chronic lung disease from a randomized controlled trial on medication adherence.MethodsFor this cross-sectional analysis, 165 asthma and COPD patients were analyzed. Correct application of inhaler devices was tested using pre-defined checklists for each inhaler type. QoL and symptom control were investigated using COPD Assessment Test (CAT) and Asthma Control Test (ACT). Spirometry was used to measure forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).ResultsOverall, incorrect inhalation technique ranged from 0 to 53% depending on the type of inhaler. COPD patients with incorrect device application had a higher CAT sum score compared to those with a correct device application (P = .02). Moreover, COPD patients with incorrect device application were more likely to suffer from cough (P = .03) and were more breathless while walking uphill or a flight of stairs (P = .02). While there was no significance found in asthma patients, COPD patients who used their devices correctly had a significantly better mean FEV1% predicted at baseline compared to those who applied their devices incorrectly (P = .04).ConclusionsCorrect inhalation of prescribed medication is associated with improved health status and lung function. These findings should encourage health professionals to provide instructions on correct inhalation technique and to regularly re-evaluate the patients’ inhalation technique.Trial registrationClinicalTrials.gov: NCT0238672, Registered 14 February 2014.

Knowledge of Dental Students in Relation to Local Anesthetics and Associated Complications

Local anesthesia is the most frequently performed procedure for all dentists and, despite their possible complications, often aspects such as dosage, contraindications and systemic effects are neglected. The objectives of this study are to evaluate prospectively the knowledge of undergraduate students for the technical, dosage and indication of local anesthetics in daily dental practice, in addition to clinical observation of possible complications from anesthesia. Questionnaires were distributed to students asking about the procedure undertaken, anesthetic volume used, because of the choice of the anesthetic, anesthetic dosage calculation, habit of relating the patient's weight dosage with the dosage being applied, habit of observing the reflux in cartridge in the anesthetic infiltration act and adverse effects on patients, type of anesthetic technique performed and expected time to onset of action of the drug. At the end of this study, we intend to be a greater awareness of students (undergraduates) about the systemic effects of local anesthetics in patients, and possibly decrease the expenses of the institution with excessive use of anesthetic cartridges arising from incorrect anesthetic technique. The vast majority of undergraduate students have no knowledge about the type of anesthesia to be used, the amount to be administered and the anesthetic action time. The awareness of students about the dosage of anesthetics and their systemic problems, reduces waste and the cost of the institution by the indiscriminate use of anesthetics, therebycontributing to improve the clinical management of students at graduation.

Confronting the Challenge of COPD: What Is New in the Approaches to Diagnosis, Treatment, and Patient Outcomes

As seen in this CME online activity (available at http://courses.elseviercme.com/730), COPD is the third leading cause of death in the United States among people 65 years of age and older and the fourth leading cause of death among people 45 to 65 years of age. A recent survey reported that about 12 to 15 million people in the United States have physician-diagnosed COPD. However, COPD is significantly underdiagnosed, and data suggest as many as 12 million people in the United States have undiagnosed COPD. In addition to being underdiagnosed, COPD is significantly undertreated, with numerous literature sources indicating that patients with COPD are not receiving guideline concordant pharmacotherapy. Consistent with these sources, an analysis of claims data for > 50,000 patients with COPD indicated a high degree of undertreatment in these patients. For patients using an inhaler, adherence to inhaler medications and correct inhaler device technique are crucial to successful COPD management. However, the literature indicates > 50%of patients with COPD demonstrate poor medication adherence and rates of incorrect inhalation technique range from 35%to 85%. Studies have shown that regular training by a physician improved inhaler techniques among patients with COPD. Further, studies have shown that repeated instruction on inhalation techniques improved both adherence and quality of life outcomes. This CME-certified webcast provides insights into new approaches to identifying patients with undiagnosed COPD, the importance of early initiation of pharmacologic treatment in a guideline-congruent manner, and the importance of repeated patient training in correct inhaler techniques to improve adherence and patient outcomes. Additionally, the online program is part of a larger learning platform (available at https://copd.elsevierresource.com/) that provides free access to the latest clinical information related to the diagnosis and management of COPD. The COPD Learning Center is a freely accessible platform that aims to increase clinical knowledge by providing CME activities, research articles, and resources for health-care providers who treat patients with COPD.