scholarly journals The impact of inappropriate use of short acting beta agonists in asthma

2017 ◽  
Vol 131 ◽  
pp. 135-140 ◽  
Author(s):  
J. Mark FitzGerald ◽  
Hamid Tavakoli ◽  
Larry D. Lynd ◽  
Khalid Al Efraij ◽  
Mohsen Sadatsafavi
2021 ◽  
pp. 026988112199688
Author(s):  
Eduardo R Butelman ◽  
Caroline Baynard ◽  
Bryan D McElroy ◽  
Thomas E Prisinzano ◽  
Mary Jeanne Kreek

Background: Novel short-acting κ(kappa)-opioid receptor selective antagonists are translational tools to examine the impact of the κ-receptor/dynorphin system in assays related to central nervous system dysfunction (e.g., substance use disorders, anhedonia and depression). The effects of such compounds have been compared in males and females under very limited conditions. Aims: The goal of this study was to examine potential sex differences in the effects of a κ-agonist and a short-acting κ-antagonist in an ethologically relevant test of anhedonia, the “splash test” of self-grooming, and also in the forced swim test and in locomotor activity. Methods: We examined the dose-dependence of grooming deficits caused by the κ-agonist U50,488 (0.1–3.2 mg/kg intraperitoneal (i.p.)) in gonadally intact adult male and female C57BL/6J mice. We then compared the effects of the short-acting κ-antagonist LY2795050 ((3-chloro-4-(4-(((2S)-2-pyridin-3-ylpyrrolidin-1-yl)methyl) phenoxy)benzamide)); 0.032–0.1 mg/kg i.p.) in blocking grooming deficits caused by U50,488 (3.2 mg/kg). The effects of LY2795050 were also studied in the forced swim test (FST). The effects of LY2795050 in blocking the locomotor depressant effects of U50,488 (10 mg/kg) were also studied. Results: U50,488 produced dose-dependent grooming deficits in male and female mice, and LY2795050 prevented these effects. In contrast, LY2795050 decreased immobility in the FST in males at a dose of 0.1 mg/kg, but not in females, up to a dose of 0.32 mg/kg. Also, LY2795050 (0.32 mg/kg) prevented and also reversed the locomotor-depressant effects of U50,488 (10 mg/kg), in males and females. Conclusions: This study further implicates the κ-receptor system in ethologically relevant aspects of anhedonia, and confirms sexual dimorphism in some behavioral effects of novel κ-antagonists.


Author(s):  
Heinz Grossekettler

AbstractThis paper considers the impact over time of the German “Economic Growth and Stability Law”, which had its 40th anniversary on the 6th June, 2007. After looking at the history and development of the law and the associated expectations, the intended functions are analysed critically. Inappropriate use of the law is analysed from the perspective of public choice, as well as the insufficient consideration of reaction delays and, above all, the underestimation of the role of expectations. Furthermore, attention is paid to the fact that planning and coordination problems have not been satisfactorily resolved. A comparison with a control group from major European countries is then used to determine whether one can talk meaningfully in the German context of particular success stories in countering fluctuations in business cycles, the development of governmental debt and of legal objectives with respect to “price level stability”, “high levels of employment”, “current account equilibrium” and “satisfactory economic growth”. It becomes evident that government debt and unemployment have risen more in Germany and that growth rates have declined more sharply than in the countries on which the comparison is based. After discussing the hypotheses for explaining the weak German growth, growth accounting demonstrates that changes in the demographic structure, the substantial shortening of working hours and early retirement, blunders in the reunification process and an aggressive wage policy on the part of trade unions, particularly in the seventies, are the main reasons for low growth. This wage policy was triggered by the expectation of the trade unions that, with the aid of the Stability and Growth Law, the state would ensure full employment. In reality, however, the wage policy led to a reduced rate of investment and growth. This process could only be terminated by the restrained wage policy of the past few years.


2018 ◽  
Vol 7 (3) ◽  
pp. 214-227
Author(s):  
Andrew Kirk ◽  
Kevin Armstrong ◽  
Niina Nurkka ◽  
Annette Jinks

Purpose The purpose of this paper is to explore English and Finnish paramedic perceptions of the healthcare blame culture, its relationship to complaints, the use of defensive practice and if this impacts on paramedic practice and clinical care. Design/methodology/approach Participants were recruited from English and Finnish ambulance services that have similar organisational and professional scopes of practice. The aim was to gain insight into the similarities and differences between the countries regarding the existence of a blame culture in paramedic practice. Semi-structured focus groups and interviews involving 20 English and Finnish paramedics were undertaken. Qualitative perceptions concerning the reality of a blame culture in paramedic practice and its impact on professional roles were sought. Findings Three major themes that were identified in the thematic analysis included: blame culture and its influences; the impact of complaints against paramedics; and the use of defensive practice within their roles. These data themes were similar for both groups of participants. The majority of participants thought the healthcare blame culture to be widespread and believed that this was likely to directly influence paramedics’ working practices. Originality/value Whilst the impact of blame culture and complaints on the medical profession has previously been examined, this study makes an important contribution by exploring the factors that impact on paramedics’ lives and their practice, within two European countries. The inappropriate use of social media by some members of the public in both countries was a disturbing issue for many participants and was identified as an area for further research.


BMJ Leader ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 92-98 ◽  
Author(s):  
Anurag Saxena ◽  
Diane Meschino ◽  
Lara Hazelton ◽  
Ming-Ka Chan ◽  
David A Benrimoh ◽  
...  

Power and leadership are intimately related. While physician leadership is widely discussed in healthcare, power has received less attention. Formal organisational leadership by physicians is increasingly common even though the evidence for the effectiveness of physician leadership is still evolving. There is an expectation of leadership by all physicians for resource stewardship. The impact of power on interprofessional education and practice needs further study. Power also shapes the profession’s attempts to address physician and learner well-being with its implications for patient care. Unfortunately, the profession is not exempt from inappropriate use of power. These observations led the authors to explore the concept and impact of power in physician leadership. Drawing from a range of conceptualisations including structuralist (French and Raven), feminist (Allen) and poststructuralist (Foucault) conceptualisations of power, we explore how power is acquired and exercised in healthcare systems and enacted in leadership praxis by individual physician leaders (PL). Judicious use of power will benefit from consideration and application of a range of concepts including liminality, power mediation, power distance, inter-related use of power bases, intergroup and shared leadership, inclusive leadership, empowerment, transformational leadership and discourse for meaning-making. Avoiding abuse of power requires moral courage, and those who seek to become accountable leaders may benefit from adaptive reflection. Reframing ‘followers’ as ‘constituents or citizens’ is one way to interrupt discourses and narratives that reinforce traditional power imbalances. Applying these concepts can enhance creativity, cocreation and citizenship-strengthening commitment to improved healthcare. PLs can contribute greatly in this regard to further transform healthcare.


Author(s):  
Kevin Walker ◽  
Sara Shearkhani ◽  
Yu Qing Bai ◽  
Katherine S McGilton ◽  
Whitney B Berta ◽  
...  

Abstract Background We report on the impact of two system-level policy interventions (the Long-Term Care Homes Act [LTCHA] and Public Reporting) on publicly reported physical restraint use and non-publicly reported potentially inappropriate use of antipsychotics in Ontario, Canada. Methods We used interrupted time series analysis to model changes in the risk-adjusted use of restraints and antipsychotics before and after implementation of the interventions. Separate analyses were completed for early ([a] volunteered 2010/2011) and late ([b] volunteered March 2012; [c] mandated September 2012) adopting groups of Public Reporting. Outcomes were measured using Resident Assessment Instrument Minimum Data Set (RAI-MDS) data from January 1, 2008 to December 31, 2014. Results For early adopters, enactment of the LTCHA in 2010 was not associated with changes in physical restraint use, while Public Reporting was associated with an increase in the rate (slope) of decline in physical restraint use. By contrast, for the late-adopters of Public Reporting, the LTCHA was associated with significant decreases in physical restraint use over time, but there was no significant increase in the rate of decline associated with Public Reporting. As the LTCHA was enacted, potentially inappropriate use of antipsychotics underwent a rapid short-term increase in the early volunteer group, but, over the longer term, their use decreased for all three groups of homes. Conclusions Public Reporting had the largest impact on voluntary early adopters while legislation and regulations had a more substantive positive effect upon homes that delayed public reporting.


2001 ◽  
Vol 8 (4) ◽  
pp. 261-265 ◽  
Author(s):  
Shelley Anne Diamond ◽  
Kenneth Ross Chapman

OBJECTIVE: To assess the impact of a nationally coordinated pharmacy-based educational intervention on self-management behaviour and markers of asthma control in self-referred patients with asthma.DESIGN: An asthma clinic day was set up by a national chain of community pharmacies whereby pharmacists used a structured questionnaire to assess asthma control and self-care among self-referred patients with doctor-diagnosed asthma. In a one-on-one counselling session, each patient's educational needs were identified and the appropriate education offered. A telephone follow-up 30 days later assessed the impact of teaching.SETTING: Community pharmacies across Canada.OUTCOME MEASURES: The follow-up questionnaire quantified the number of wheezing episodes or other symptoms per week, the number of night-time awakenings per week, and the frequency of use of reliever and preventive medications.RESULTS: Of 4080 patients assessed, 22.2% used an inadequate inhaler technique, 16.4% used a short acting beta2-agonist excessively and 21.0% were not using an inhaled corticosteroid daily despite a frequency of symptoms that would suggest that it was needed. Common educational interventions included a review of inhaler technique (41.9%), a recommendation for regular inhaled corticosteroids (31.5%) and a referral to the primary care physician (21.0%). Thirty days after the educational intervention, patients reported significant decreases in the frequency of daytime asthma symptoms, the frequency of nocturnal symptoms and the frequency with which short acting beta2-agonists were used, while reporting significant increases in their use of preventive medication.CONCLUSIONS: A brief assessment and an educational intervention in the community pharmacy can produce significant short term improvements in patient-reported symptom control and appropriate self-management behaviour.


Author(s):  
HIDAYAH KARUNIAWATI ◽  
TRI YULIANTI ◽  
DEWI KUROTA AINI ◽  
FINISHIA ISNA NURWIENDA

Objective: Antibiotic resistance is a serious problem worldwide. One cause of antibacterial resistance is the inappropriate use of antibiotics. Thestudy of antibiotic use in hospitals found that 30–80% were not based on indications. Antimicrobial Stewardship Programs (ASP) was developed tocontrol antimicrobial resistance. This study aims to evaluate the impact of ASP in pneumonia patients qualitatively and quantitatively pre-post ASPapplied.Methods: This research is a non-experimental study. Data were taken from the medical records of pneumonia patients and analyzed qualitativelyusing the Gyssens method and quantitatively using the Defined Daily Dose (DDD) method. Sampling was conducted through purposive sampling andresults were described descriptively.Results: During the study period, 96 samples were obtained with 48 data pre-ASP and 48 data post-ASP. The results of the qualitative analysis usingthe Gyssens method show an increase in the prudent use of antibiotics from 31.25% to 62.5% pre-post ASP, respectively. Quantitative evaluationshows a decrease of antibiotic use pre-post ASP from 90.84 DDD/100 patients-days to 61.42 DDD/100 patients-days.Conclusion: The ASP can improve the quality of antibiotic use in pneumonia patients quantitatively and qualitatively.


2020 ◽  
Vol 2 (2) ◽  
pp. 16-19
Author(s):  
Nuranita Naningsi

This study aims to determine the effect of using green Local Microorganisms for cocoa plants ((Theobroma cacao L) Cocoa is a plant that has many benefits. Production of cocoa beans often decreases. One of the contributing factors is due to white bug infestation (Planococcus minor). These insects suck the small fruit so the fruit will dry up and fruit growth is inhibited. Inappropriate use of synthetic insecticides will have a bad impact. Local Microorganisms is fermented solution made from the materials around us. The aim of this study giving farmers an understanding of the purpose, benefits and mechanism for using green Local Microorganisms to reduce the impact of using chemical pesticides. Green Local Microorganisms is very effective in killing white lice on cocoa plants.


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