scholarly journals General Practitioner Use of Generically Substitutable Inhaler Devices and the Impact of Training on Device Mastery and Maintenance of Correct Inhaler Technique

2020 ◽  
Vol 6 (2) ◽  
pp. 315-331
Author(s):  
Biljana Cvetkovski ◽  
Charlotte Hespe ◽  
Rachel Tan ◽  
Vicky Kritikos ◽  
Elizabeth Azzi ◽  
...  
Keyword(s):  
Generic Substitution ◽  
Instructional Video ◽  
Inhaler Technique ◽  
Dry Powder ◽  
Paired Data ◽  
Significant Difference ◽  
Level 3 ◽  
Level 1 ◽  
Level Of Training ◽  
Inhaler Devices

Abstract Introduction Generic substitution of inhaler devices is a relatively new phenomenon. The best patient outcomes associated with generic substitution occur when prescribers obtain consent from their patients to prescribe a generic inhaler and also teach their patient how to correctly use the new device. To date, no prospective observational study has assessed the level of training required for general practitioners (GPs) to demonstrate correct inhaler technique using two dry powder inhaler devices delivering fixed-dose combination budesonide/formoterol therapy. This study aims to (1) determine the level of training required for GPs to master and maintain correct IT when using two different dry powder inhalers that are able to be substituted in clinical practice and (2) determine the number and types of errors made by GPs on each device and inhaler device preference at each training visit. Method A randomized, parallel-group cross-over study design was used to compare the inhaler technique of participants with a Spiromax® placebo device and a Turbuhaler® placebo device. This study consisted of two visits with each participant over a period of 4 ± 1 weeks (visit 1 and visit 2). A total of six levels of assessment and five levels of training were implemented as required. Level 1, no instruction; level 2, following use of written instruction; level 3, following viewing of instructional video; level 4, expert tuition from the researcher; level 5/level 6, repeats of expert tuition from the researcher when required. Participants progressed through each level and stopped at the point at which they demonstrated device mastery. At each level, trained researchers assessed the inhaler technique of the participants. Participants were also surveyed about their previous inhaler use and training. Results In total, 228 GPs participated in this study by demonstrating their ability to use a Turbuhaler® and a Spiromax® device. There was no significant difference between the proportion of participants who demonstrated device mastery with the Turbuhaler® compared with the Spiromax® at level 1, (no instruction), (119/228 (52%) versus 131/228 (57%), respectively, n = 228, p = 0.323 (McNemar’s test of paired data). All but one participant had demonstrated correct inhaler technique for both devices by level 3(instructional video). There was a significant difference between the proportion of participants who demonstrated maintenance of device mastery with the Turbuhaler® compared with the Spiromax® at visit 2, level 1 (127/177 (72%) versus 151/177 (85%) respectively, p = 0.003; McNemar’s test of paired data). All but two participants achieved device mastery by level 3, visit 2. More participants reported previous training with the Turbuhaler® than with Spiromax®. Discussion This study demonstrates that GPs are able to equally demonstrate correct use of the Turbuhaler® and Spiromax® devices, even though most had not received training on a Spiromax® device prior to this study. The significance of being able to demonstrate correct technique on these two devices equally has ramifications on practice and supported generic substitution of inhaler devices at the point of prescribing, as the most impactful measure a GP can take to ensure effective use of inhaled medicine is the correct demonstration of inhaler technique.

scholarly journals Water poverty assessment based on the random forest algorithm: application to Gansu, Northwest China

Water Policy ◽  
2021 ◽  
Author(s):  
Xiang Gao ◽  
Ke Wang ◽  
Kevin Lo ◽  
Ruiyang Wen ◽  
Xingxing Huang ◽  
...  
Keyword(s):  
Random Forest ◽  
Northwest China ◽  
Random Forest Algorithm ◽  
Poverty Assessment ◽  
Significant Difference ◽  
Level 3 ◽  
Level 1 ◽  
Poverty Levels ◽  
High Dimensional Datasets

Abstract This study proposes a random forest algorithm to evaluate water poverty. It shows how the machine learning technique can be used to classify the degree of water poverty into five levels: very severe, severe, moderate, mild, and very mild. The strengths of the proposed random forest method include a high classification accuracy, good operational efficiency, and the ability to handle high-dimensional datasets. The success of the proposed method is empirically illustrated through a case study in Gansu, Northwest China. The analysis shows that from 2000 to 2017, the severity of water poverty in the study area declined. In 2000, most municipalities were classified as level 1 (very severe) or level 2 (severe). In 2017, level 1 water poverty disappeared, with most municipalities classified in as level 3 (moderate) and level 4 (mild). Spatially, there is a significant difference between the water poverty levels of the western, central, and eastern parts of Gansu, and the eastern part is affected by serious water poverty problems.

Isolation gowns as a potential work hazard

2020 ◽  
Vol 64 (6) ◽  
pp. 596-603
Author(s):  
Abigail Schirmer ◽  
Renard Sessions ◽  
Nikolaus Gravenstein ◽  
Kenneth Rand ◽  
Monika Oli ◽  
...  
Keyword(s):  
Skin Surface ◽  
Physical Structure ◽  
Patient Contact ◽  
Sterile Saline ◽  
Significant Difference ◽  
Microscope Imaging ◽  
Level 3 ◽  
Level 1 ◽  
Level 2 ◽  
Scanning Electron

Abstract Objectives Isolation gowns are used as a barrier to bacterial transmission from patient to provider and vice versa. If an isolation gown is ineffective, the patient and provider have a potential breach of safety and increased infection risk. This study compared the bacterial permeability of differently rated, commonly uses isolation gowns to assess their effectiveness in preventing simulated bacterial transmittance, and thus contamination, from patient to provider. Methods Serial dilutions of Staphylococcus epidermidis in sterile saline were applied to a simulated skin surface. Unrated and Levels 1 through 4 non-sterile isolation gowns contacted the solution, simulating patient contact. Both sides of the contaminated gowns were then cultured on blood agar by rolling a sterile swab across the gown and evenly inoculating the culture plate. Colony counts from inside and outside of the gowns were compared. Separately, S. epidermidis was placed on a sample of each gown and scanning electron microscopy was used to visualize the contaminated gowns’ physical structure. Results Mean bacterial transmittance from outside of the gown (i.e. patient contact side) to inside of the gowns (i.e. provider clothing or skin side) based on gown rating was as follows: unrated: 50.4% (SD 9.0%); Level 1: 39.7% (SD 11.2%); Level 2: 16.3% (SD 10.3%); Level 3: 0.3% (SD 0.8%); Level 4: 0.0% (SD 0.0%). Scanning electron microscope imaging of unrated, Level 1, and Level 2 gowns revealed gown pore sizes much larger than the bacteria. The Welch one-way analysis of variance statistic showed significant difference dependent on gown-level rating. Conclusions Unrated, Level 1, and Level 2 isolation gowns do not provide effective bacterial isolation barriers when bacteria like S. epidermidis make contact with one side of the gown material. Not studied, but implied, is that unrated and lower rated isolation gowns would be as or even more physically permeable to virus particles, which are much smaller than bacteria.

scholarly journals Mispronunciation and Substitution of Mid-high Front and Back Hausa Vowels by Yorùbá Native Speakers

2021 ◽  
Vol 3 (1) ◽  
pp. 1-16
Author(s):  
Sale Maikanti ◽  
Yap Ngee Thai ◽  
Jurgen Martin Burkhardt ◽  
Yong Mei Fung ◽  
Salina Binti Husain ◽  
...  
Keyword(s):  
Second Language ◽  
Language Learning ◽  
Second Language Learning ◽  
Native Speakers ◽  
Analysis Model ◽  
Speech Learning Model ◽  
Significant Difference ◽  
Level 3 ◽  
Level 1 ◽  
Speech Learning

The mid short vowels: /e/ and /o/ are among the vowels shared between Hausa and Yorùbá but differ in Hausa mid-high long, front and back vowels: /e:/ and /o:/. The phonemic differences in the two languages have caused learning difficulties among the Yorùbá native speakers to achieve their second language learning desire and competence. Yorùbá-Hausa learners mispronounce certain disyllabic Hausa words due to the substitution of vowels in the first and second syllables. Thus, both lexical and grammatical meanings of the Hausa words are affected. This study examined the production of the 12 Hausa vowels by level 1 and level 3 students who were learning Hausa as a second language to determine if there was a significant difference in how level 1 and level 3 students pronounced the short and long mid-high, front and back Hausa vowels. 88 Yorùbá native speakers were recruited using purposive sampling. Twenty-four different wordlists extracted from Bargery's (1934) Hausa-English dictionary and prepared in carrier phrases were audio-recorded. It was a mixed-method, and the results were discussed within the theoretical framework of Flege and Bohn's (2020) Revised Speech Learning Model and Corder's (1967) 'Error Analysis Model'. The results of the Mann-Whitney U test revealed that participants in level 1 generally performed lower than level 3 participants in the pronunciation of mid-Hausa vowels due to substitutions. Such errors have pedagogical implication in learning Hausa as a second language, and if not addressed accordingly, the standard of Hausa will continue to fall at an undesirable and alarming rate.

Anwendung des 10-Gruppenklassifikationssystems nach Robson für den Vergleich eines Perinatalzentrums Level 1 mit einem Level-3-Zentrum

2020 ◽  
Author(s):  
C Pulvermacher ◽  
P van de Vondel ◽  
L Gerzen ◽  
U Gembruch ◽  
W Merz
Keyword(s):  
Level 3 ◽  
Level 1

Alternativas farmacéuticas: ¿pueden ser intercambiables?

2020 ◽  
Vol 2 (2) ◽  
pp. 38-42
Author(s):  
Miriam del Carmen Carrasco-Portugal ◽  
Francisco Javier Flores-Murrieta
Keyword(s):  
Generic Substitution ◽  
In Vivo Studies ◽  
Regulatory Agencies ◽  
European Medicines Agency ◽  
Reference Formulation ◽  
Active Moiety ◽  
Significant Difference ◽  
Pharmaceutical Form ◽  
Extent Of Absorption

Pharmaceutical alternatives are products with the same active moiety, but different salt, ester or pharmaceutical form. Regulatory agencies have different criteria for this kind of drug. The European Medicines Agency (EMA) accepts the generic substitution using these alternatives, whereas the Food and Drug Administration (FDA) only authorizes generic substitution of pharmaceutical equivalents. The objective of this paper is to describe some relevant aspects that should be considered before deciding on making a generic substitution with pharmaceutical alternatives. It is important to note that a pharmaceutical alternative must show no significant difference in the rate and extent of absorption (bioequivalence) in a well-conducted in vivo study when compared with the reference formulation. Current Mexican regulations state that generic substitution is possible using pharmaceutical alternatives when bioequivalence is demonstrated in in vivo studies conducted under the NOM-177-SSA1-2013 criteria. In conclusion, generic substitution with pharmaceutical alternatives is possible if these products demonstrate in vivo bioequivalence when compared with the reference product.

EVALUASI PELATIHAN DI PT. PUPUK KUJANG CIKAMPEK

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Lania Muharsih ◽  
Ratih Saraswati
Keyword(s):  
Training Evaluation ◽  
Work Productivity ◽  
Learning Behavior ◽  
Level 3 ◽  
Level 1 ◽  
Four Levels ◽  
A Company ◽  
Level 2 ◽  
Evaluation Sheet ◽  
Assessment Factor

This study aims to determine the training evaluation at PT. Kujang Fertilizer. PT. Pupuk Kujang is a company engaged in the field of petrochemicals. Evaluation sheet of PT. Fertilizer Kujang is made based on Kirkpatrick's theory which consists of four levels of evaluation, namely reaction, learning, behavior, and results. At level 1, namely reaction, in the evaluation sheet is in accordance with the theory of Kirkpatrick, at level 2 that is learning should be held pretest and posttest but only made scale. At level 3, behavior, according to theory, but on assessment factor number 3, quantity and work productivity should not need to be included because they are included in level 4. At level 4, that is the result, here is still lacking to get a picture of the results of the training that has been carried out because only based on answers from superiors without evidence of any documents.   Keywords: Training Evaluation, Kirkpatrick Theory.    Penelitian ini bertujuan mengetahui evaluasi training di PT. Pupuk Kujang. PT. Pupuk Kujang merupakan perusahaan yang bergerak di bidang petrokimia. Lembar evaluasi PT. Pupuk Kujang dibuat berdasarkan teori Kirkpatrick yang terdiri dari empat level evaluasi, yaitu reaksi, learning, behavior, dan hasil. Pada level 1 yaitu reaksi, di lembar evaluasi tersebut sudah sesuai dengan teori dari Kirkpatrick, pada level 2 yaitu learning seharusnya diadakan pretest dan posttest namun hanya dibuatkan skala. Pada level 3 yaitu behavior, sudah sesuai teori namun pada faktor penilaian nomor 3 kuantitas dan produktivitas kerja semestinya tidak perlu dimasukkan karena sudah termasuk ke dalam level 4. Pada level 4 yaitu hasil, disini masih sangat kurang untuk mendapatkan gambaran hasil dari pelatihan yang sudah dilaksanakan karena hanya berdasarkan dari jawaban atasan tanpa bukti dokumen apapun.   Kata kunci: Evaluasi Pelatihan, Teori Kirkpatrick.

scholarly journals 905 How to prioritise patients and safely resume elective surgery during the Covid-19 pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Subbiah Ponniah ◽  
M Ahmed ◽  
T Edwards ◽  
J Cobb ◽  
E Dean ◽  
...  
Keyword(s):  
Patient Safety ◽  
High Risk ◽  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Paediatric Patients ◽  
Level 3 ◽  
Level 1 ◽  
Surgical Unit

Abstract Introduction There are now over 2.5 million NHS patients awaiting elective surgery, with the most in orthopaedics. We present an algorithm and results for safely and equitably restarting surgery at COVID-light sites. Method An MDT applied the COVID-19 Algorithm for Resuming Elective Surgery (CARES) on 1169 patients awaiting elective orthopaedic surgery. It assessed safety, procedural efficacy, and biopsychosocial factors, to prioritise patients. They were assigned to five categories and underwent surgery at one of three COVID-light sites (1. access to HDU/ITU/Paediatrics/specialist equipment, 2. an NHS elective surgical unit and 3. a private elective surgical unit). Results 21 ‘Urgent’ patients received expedited care; 118 were Level 1/2; 222 were Level 3; 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery. Conclusions We validated a widely generalisable model to facilitate resumption of elective surgery in COVID-light sites. It enabled surgery for patients in most suffering, undergoing the most efficacious procedures and/or at highest risk of deterioration, without compromising patient-safety.

scholarly journals An Atmospheric Visibility Grading Method Based on Ensemble Learning and Stochastic Weight Average

Atmosphere ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 869
Author(s):  
Xiuguo Zou ◽  
Jiahong Wu ◽  
Zhibin Cao ◽  
Yan Qian ◽  
Shixiu Zhang ◽  
...  
Keyword(s):  
Ensemble Learning ◽  
Traffic Accidents ◽  
Feature Sets ◽  
Atmospheric Visibility ◽  
Average Accuracy ◽  
Level 3 ◽  
Visual Characteristics ◽  
Level 1 ◽  
Grading Model ◽  
Level 2

In order to adequately characterize the visual characteristics of atmospheric visibility and overcome the disadvantages of the traditional atmospheric visibility measurement method with significant dependence on preset reference objects, high cost, and complicated steps, this paper proposed an ensemble learning method for atmospheric visibility grading based on deep neural network and stochastic weight averaging. An experiment was conducted using the scene of an expressway, and three visibility levels were set, i.e., Level 1, Level 2, and Level 3. Firstly, the EfficientNet was transferred to extract the abstract features of the images. Then, training and grading were performed on the feature sets through the SoftMax regression model. Subsequently, the feature sets were ensembled using the method of stochastic weight averaging to obtain the atmospheric visibility grading model. The obtained datasets were input into the grading model and tested. The grading model classified the results into three categories, with the grading accuracy being 95.00%, 89.45%, and 90.91%, respectively, and the average accuracy of 91.79%. The results obtained by the proposed method were compared with those obtained by the existing methods, and the proposed method showed better performance than those of other methods. This method can be used to classify the atmospheric visibility of traffic and reduce the incidence of traffic accidents caused by atmospheric visibility.

Artificial intelligence-guided image acquisition on patients with implanted electrophysiological devices: results from a pivotal prospective multi-center clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Surette ◽  
A Narang ◽  
R Bae ◽  
H Hong ◽  
Y Thomas ◽  
...  
Keyword(s):  
Qualitative Assessment ◽  
Funding Source ◽  
Software Performance ◽  
Private Company ◽  
Diagnostic Quality ◽  
Icd Leads ◽  
Significant Difference ◽  
Level 3 ◽  
And Function ◽  
The Impact

Abstract Background A novel, recently FDA-authorized software uses deep learning (DL) to provide prescriptive transthoracic echocardiography (TTE) guidance, allowing novices to acquire standard TTE views. The DL model was trained by >5,000,000 observations of the impact of probe motion on image orientation/quality. This study evaluated whether novice-acquired TTE images guided by this software were of diagnostic quality in patients with and without implanted electrophysiological (EP) devices, focusing on RV size and function, which were thought to be sensitive to EP devices. Some aspects of the study have previously been presented. Methods 240 patients (61±16 years old, 58% male, 33% BMI >30 kg/m2, 91% with cardiac pathology) were recruited. 8 nurses without echo experience each acquired 10 view TTEs in 30 patients guided by the software. 235 of the patients were also scanned by a trained sonographer without assistance from the software. 5 Level 3 echocardiographers independently assessed the diagnostic quality of the TTEs acquired by the nurses and sonographers to evaluate the effect of EP devices on DL software performance. Results Nurses using the AI-guided acquisition software acquired TTEs of sufficient quality to make qualitative assessments of right ventricular (RV) size and function in greater than 80% of cases for patients with and without implanted EP devices (Table). There was no significant difference between nurse- and sonographer-acquired scans. Conclusion These results indicate that new DL software can guide novices to obtain TTEs that enable qualitative assessment of RV size even in the presence of implanted EP devices. The results of the comparison to sonographer-acquired exams indicate the software performance is robust to presence of pacemaker/ICD leads visible in the images (Figure). Nurse-acquired TTE with visible ICD lead Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Caption Health, Inc.

Sign in / Sign up

Export Citation Format

Share Document