scholarly journals Evaluating the technique of using MDI and DPI in patients with respiratory disease

2021 ◽  
Vol 6 (4) ◽  
pp. 212-216
Author(s):  
Rayas Rucha V ◽  
Jagtap Tanmay P ◽  
Shyam Ashok K ◽  
Sancheti Parag K
Keyword(s):  
Respiratory Disease ◽  
Tertiary Care ◽  
Dry Powder Inhaler ◽  
Inhalation Therapy ◽  
Dose Inhaler ◽  
Inhalation Technique ◽  
Breath Hold ◽  
Care Hospital ◽  
The Difference ◽  
Device Use

Inhalation therapy plays a major role in treatment of respiratory diseases. Correct inhalation technique is crucial for effective clinical outcomes. The aim of this study was to evaluate and analyse technique of use of Metered Dose Inhaler (MDI) and Dry Powder Inhaler (DPI) in patients with respiratory disease. This observational study was conducted at pulmonary outpatient department of a tertiary care hospital. 30 patients were enrolled using convenience sampling. Participants’ demographic and disease specific data was recorded. Participants were asked to use their inhaler just as they would at home. The technique of device use was observed and recorded using inhaler specific checklists. Data collected was analyzed using descriptive statistics. Out of 30 patients 26 were using MDI, 23 of which (92%) performed at least 1 error. Among 4 patients using DPI, 3 (75%) performed at least 1 error. Patients using MDI for more than 1 year performed less errors compared to those who had been using MDI for less than 1 year, however the difference observed was not significant (n=26, p= 0.304). 29 patients (96%) received education about inhaler device use. The most common incorrectly performed steps were “complete exhalation” and “breath hold.” 92% of MDI and 75% of DPI users made at least one error during the inhalation maneuver despite majority being educated about inhaler technique. The most frequently performed incorrect steps for MDI and DPI were “Complete exhalation” and “Breath hold”.

scholarly journals STUDY OF EFFICACY OF METERED DOSE INHALER (MDI) AND DRY POWDER INHALER (DPI) FOR DELIVERY OF SALBUTAMOL IN TREATMENT OF ACUTE EXACERBATION OF ASTHMA IN PATIENTS, ATTENDING IN TERTIARY CARE HOSPITAL AT, PATNA

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Ajit Kumar ◽  
Raj Narayan Seth
Keyword(s):  
Acute Exacerbation ◽  
Bronchial Asthma ◽  
Tertiary Care ◽  
Dry Powder Inhaler ◽  
Dose Inhaler ◽  
Care Hospital ◽  
Metered Dose Inhaler ◽  
Dry Powder ◽  
Accessory Muscle ◽  
Metered Dose

Objective: Present study was undertaken to compare the efficacy of Metered dose inhaler (MDI) with spacer and with Dry powder inhaler (DPI) for delivery of salbutamol in acute exacerbation of bronchial asthma. It is a randomized controlled trial study. Material and Methods: A total of 78 children in the age group of 6-14 years who presented with a mild or moderate acute exacerbation of asthma were included in the study. Salbutamol dose of 400µg were given to all the children’s by either a MDI with spacer or a DPI in randomized pattern. All the changes in the wheezing and accessory muscle scores, Sa02, and PEFR were noted. Results: Out of 78 children, 42 were assigned to the MDI spacer group and 36 to rotahaler (DPI) group. After receiving treatment, the PEFR improved by about 14% in both the groups. The oxygen saturation increased by 2.1% in both the groups. Within each group, the improvement in PEFR, Sa02, wheeze and accessory muscle score after the treatment was statistically significant. Conclusion: Metered dose inhaler with spacer and Dry powder inhaler are equally effective in delivering salbutamol in therapy of mild to moderate acute exacerbations of bronchial asthma in children between 6-14 years of age Keyword: DPI, Salbutamol, Treatment, Asthma, Children, MDI, PEFR

Assessment of Patient Acceptance and Inhalation Technique of a Pressurized Aerosol Inhaler and Two Breath-Actuated Devices

1993 ◽  
Vol 27 (7-8) ◽  
pp. 922-927 ◽  
Author(s):  
Cindy J. Reesor Nimmo ◽  
Daniel N.M. Chen ◽  
Shelagh M. Martinusen ◽  
Tina L. Ustad ◽  
David N. Ostrow
Keyword(s):  
Tertiary Care ◽  
The Other ◽  
Dose Inhaler ◽  
Patient Acceptance ◽  
Inhalation Technique ◽  
Care Hospital ◽  
Clinical Use ◽  
Verbal Instruction ◽  
Inhalation Devices ◽  
Correct Technique

OBJECTIVE: To assess inhalation technique in patients after written instruction alone, written and verbal instruction, and clinical use of two new inhalation devices. DESIGN: Randomized, crossover evaluation of the albuterol Diskhaler and the terbutaline Turbuhaler. SETTING: Canadian tertiary-care hospital. PATIENTS: Twenty hospitalized adults with asthma or chronic obstructive pulmonary disease currently using an albuterol metered-dose inhaler (MDI). Nineteen patients received Diskhaler, 16 received Turbuhaler, 15 received both inhalers, and 10 patients used both inhalers for three days each. INTERVENTIONS: Patients were randomized to receive either Diskhaler or Turbuhaler for three days. Inhaler technique was assessed after written instruction, written plus verbal instruction, at the first scheduled dose after instruction, and after three days of clinical use. Patients remaining in the hospital after three days crossed over to the other study inhaler and the same protocol was followed. MAIN OUTCOME MEASURES: Patient inhalation technique was assessed and compared for the MDI, Diskhaler, and Turbuhaler. RESULTS: Assessment of MDI technique revealed that 35 percent of patients used their MDI correctly on the first puff, and 42 percent used it correctly on the second puff. Following written instruction alone, correct technique was demonstrated by 32 percent of patients with Diskhaler and 6 percent with Turbuhaler. Technique significantly improved following verbal instruction, although 40 percent of the patients required up to three attempts to demonstrate correct technique on at least one of the study inhalers. After three days of clinical use, correct technique was demonstrated in only 54 percent of the Diskhaler and 64 percent of the Turbuhaler assessments. Performance at this assessment was, however, significantly better on the Turbuhaler than on the MDI (p=0.01). Performance on the Diskhaler was not significantly different from the performance on the other inhalers. CONCLUSIONS: Written instruction alone is inadequate in teaching correct inhalation technique. Verbal instruction and technique assessment are essential for patients to achieve proper technique. Patients may perform better on the Turbuhaler than on other inhalation devices.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals Most frequent errors in inhalation technique of patients with asthma treated at a tertiary care hospital

2019 ◽  
Vol 17 (2) ◽  
Author(s):  
Carlos Leonardo Carvalho Pessôa ◽  
Maria Julia da Silva Mattos ◽  
Artur Renato Moura Alho ◽  
Marianna Martini Fischmann ◽  
Bruno Mendes Haerdy ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Inhalation Technique ◽  
Care Hospital

A COMPARATIVE STUDY OF INTRALESIONAL TRIAMCINOLONE ACETONIDE ALONE VERSUS COMBINATION OF 5-FLUOROURACIL AND TRIAMCINOLONE ACETONIDE IN THE TREATMENT OF KELOID

2021 ◽  
pp. 71-74
Author(s):  
Neha Gupta ◽  
Vijay Paliwal ◽  
Kanchan Kumawat ◽  
Narendra Kumar ◽  
Imran Khan ◽  
...  
Keyword(s):  
Triamcinolone Acetonide ◽  
Tertiary Care ◽  
Inhibitory Effect ◽  
Combination Group ◽  
Intralesional Injection ◽  
Care Hospital ◽  
Intralesional Corticosteroid ◽  
Pyrimidine Analogue ◽  
The Difference ◽  
Group B

Background: Keloids are benign proliferative condition of dermal broblast. Intralesional corticosteroid improves keloid but associated with signicant adverse effects like dyspigmentation, tissue atrophy and telengectasia and contraindicated in certain conditions like hypertension and diabetes. 5-Fluorouracil (5-FU), a pyrimidine analogue with an inhibitory effect on TGF-β induced broblast proliferation is useful in treatment of keloids but is associated with ulceration and pain. A low dose of Triamcinolone if added to 5-FU injection overcomes these issues. Approach: This study was conducted in a tertiary care hospital. Sixty patients; thirty in each group were included. In group A, once weekly intralesional Triamcinolone and in group B, intralesional injection of Triamcinolone mixed with 5-Flurouracil in 1: 9 dilution were injected for 8 sessions. Parameters of Vancouver scale were noted at the baseline and at the end of treatment. Results: Out of 60 patients enrolled in this study. The combination group was better in improving height (62.11% vs 78%), pliability (44.14% vs 8.81%), and vascularity (55.78% vs 61.30%) and results were statistically signicant (P valve <0.05) however it was not better in improving pigmentation (43.47% vs 20%) and volume (69.79% vs 80.76%) (P valve > 0.05). Pain and pruritus improved completely (100%) in both the groups at the end of the treatment. Excellent improvement in patient and observer assessment score was seen in 96.67% vs 3.33% in combination group and TAC group respectively. The difference was statistically signicant (P valve<0.05). Combination was better irrespective of age of the patient, duration, site, and origin of keloid. All patients treated with 5 FU develop ulceration and pain. Conclusion: Both the therapies are effective but combination is superior to TAC alone. We advocate that 5-FU should be used alone, addition of TCA does not have any added advantage in therapeutic outcome rather it increases the cost of treatment.

Development of a Modified Surveillance Definition of Central Line–Associated Bloodstream Infections for Patients with Hematologic Malignancies

2012 ◽  
Vol 33 (9) ◽  
pp. 865-868 ◽  
Author(s):  
Megan J. DiGiorgio ◽  
Cynthia Fatica ◽  
Mary Oden ◽  
Brian Bolwell ◽  
Mikkael Sekeres ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
Central Line ◽  
Marrow Transplant ◽  
Care Hospital ◽  
The Difference ◽  
Definition Of ◽  
Clabsi Rate

Objective.To develop a modified surveillance definition of central line-associated bloodstream infection (mCLABSI) specific for our population of patients with hematologic malignancies to better support ongoing improvement efforts at our hospital.Design.Retrospective cohort study.Patients.Hematologic malignancies population in a 1,200-bed tertiary care hospital on a 22-bed bone marrow transplant (BMT) unit and a 22-bed leukemia unit.Methods.An mCLABSI definition was developed, and pathogens and rates were compared against those determined using the National Healthcare Safety Network (NHSN) definition.Results.By the NHSN definition the CLABSI rate on the BMT unit was 6.0 per 1,000 central line-days, and by the mCLABSI definition the rate was 2.0 per 1,000 line-days (P < .001). On the leukemia unit, the NHSN CLABSI rate was 14.4 per 1,000 line-days, and the mCLABSI rate was 8.2 per 1,000 line-days (P = .009). The top 3 CLABSI pathogens by the NHSN definition were Enterococcus species, Klebsiella species, and Escherichia coli. The top 3 CLABSI pathogens by the mCLABSI definition were coagulase-negative Staphylococcus (CONS), Pseudomonas aeruginosa, and Staphylococcus aureus. The difference in the incidence of CONS as a cause of CLABSI under the 2 definitions was statistically significant (P < .001).Conclusions.A modified surveillance definition of CLABSI was associated with an increase in the identification of staphylococci as the cause of CLABSIs, as opposed to enteric pathogens, and a decrease in CLABSI rates.

scholarly journals Impact of Fluoroquinolone Exposure Prior to Tuberculosis Diagnosis on Clinical Outcomes in Immunocompromised Patients

2016 ◽  
Vol 60 (7) ◽  
pp. 4005-4012 ◽  
Author(s):  
Ju Young Lee ◽  
Hyun Jung Lee ◽  
Yong Kyun Kim ◽  
Shinae Yu ◽  
Jiwon Jung ◽  
...  
Keyword(s):  
Median Time ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Care Hospital ◽  
Immunocompromised Patients ◽  
Tb Treatment ◽  
Significant Difference ◽  
Tuberculosis Diagnosis ◽  
The Difference

ABSTRACTThere have been concerns about an association of fluoroquinolone (FQ) use prior to tuberculosis (TB) diagnosis with adverse outcomes. However, FQ use might prevent clinical deterioration in missed TB patients, especially in those who are immunocompromised, until they receive definitive anti-TB treatment. All adult immunocompromised patients with smear-negative and culture-positive TB at a tertiary care hospital in Korea over a 2-year period were included in this study. Long-term FQ (≥7 days) use was defined as exposure to FQ for at least 7 days prior to TB diagnosis. A total of 194 patients were identified: 33 (17%) in the long-term FQ group and 161 (83%) in the comparator, including a short-term FQ group (n= 23), non-FQ group (n= 78), and a group receiving no antibiotics (n= 60). Patients in the long-term FQ group presented with atypical chest radiologic pattern more frequently than those in the comparator (77% [24/31] versus 46% [63/138];P= 0.001). The median time from mycobacterial test to positive mycobacterial culture appeared to be longer in the long-term FQ group (8.1 weeks versus 7.7 weeks;P= 0.09), although the difference was not statistically significant. Patients in the long-term FQ group were less likely to receive empirical anti-TB treatment (55% versus 74%;P= 0.03). The median time from mycobacterial test to anti-TB therapy was longer in the long-term FQ group (4.6 weeks versus 2.2 weeks;P< 0.001), but there was no significant difference in FQ resistance (0% versus 3%;P> 0.99) or in the 30-day (6% versus 6%;P> 0.99) or 90-day (12% versus 12%;P> 0.99) mortality rate between the two groups. FQ exposure (≥7 days) prior to TB diagnosis in immunocompromised patients appears not to be associated with adverse outcomes.

scholarly journals A comparative study of tapentadol versus tramadol in the treatment of low back pain

2020 ◽  
Vol 9 (7) ◽  
pp. 1064
Author(s):  
Laxman Verma ◽  
Pankaj Kumar Chaudhary ◽  
Chandresh Gupta ◽  
Umesh Saroj
Keyword(s):  
Pain Intensity ◽  
Tertiary Care ◽  
Care Hospital ◽  
Medical Assessment ◽  
Group I ◽  
Parallel Group ◽  
Reduction Of Pain ◽  
The Mean ◽  
Group Ii ◽  
The Difference

Background: Nontraumatic musculoskeletal disorders are the main reason for presentation to the emergency department with Rachialgia being the most common reason to request medical assessment among them. Methods: This was a prospective, randomized, parallel group open labelled study conducted in a district level tertiary care hospital attached to a medical teaching institute. Patients were randomized into two groups. Group I (63 patients) received tablet tramadol 50 mg twice daily orally and group II (63 patients) received tablet tapentadol 50 mg twice daily orally.Results: The mean age of the patients of group I was 40.6±9.6 years and in the group II was 42.7±10.6 years. A total of 61 males participated in the study of which 31 males were enrolled in group I and 30 in group II while 65 females participated in the study of which 32 females were enrolled in group I and 33 in group II. The mean reduction of pain intensity VAS score at the end of 4 weeks from baseline in group I and group II were 34.57 and 37.55 respectively. The difference in the mean reduction of pain intensity VAS between the two groups was not statistically significant.Conclusions: We conclude that both the drugs show significant reduction in the pain intensity in moderate to severe CLBP patients. Tapentadol is as efficacious as tramadol in moderate to severe CLBP. However, tapentadol is better tolerated than tramadol.

scholarly journals Tamsulosin versus tadalafil as medical expulsive therapy of distal ureteric stones: a comparative study

2019 ◽  
Vol 6 (3) ◽  
pp. 982
Author(s):  
Chirag Parikh ◽  
Vipul Gurjar ◽  
Sneh Shah
Keyword(s):  
Comparative Study ◽  
Tertiary Care ◽  
Care Hospital ◽  
Analgesic Requirement ◽  
Medical Expulsive Therapy ◽  
Significance Levels ◽  
Colicky Pain ◽  
The Difference ◽  
Primary Focus ◽  
Distal Ureteric Stones

Background: The management of patients with ureteral calculi has changed dramatically in the current era, with the conservative approach being the primary focus, its main benefit being minimum patient morbidity. The use of the expectant approach for distal ureteric stones can be extended with the use of adjuvant medical expulsive therapy (MET), which is able to reduce symptoms and facilitate stone expulsion. The present study was thus conducted to determine single best monotherapy for medical expulsive therapy of distal ureteric stones by comparing Tadalafil and Tamsulosin.Methods: A hospital based comparative study was conducted at Department of Surgery of a tertiary care hospital. A total of 60 eligible cases of lower uretric calculus were included in the study. These 60 patients were then divided into 2 groups of 30 each to receive one of the two medical therapy i.e. Tadalafil and Tamsulosin.Results: Mean expulsion of calculi was significantly earlier in patients managed by tadalafil as compared to tamsulosin (13.1 vs 16.92 days; p<0.05). Complete expulsion was seen in 86.7% cases on tadalafil as compared to only 63.3% cases on tamsulosin (p<0.05). Mean analgesic use (2.69 vs 1.81; p<0.05) and episodes of colicy pain (1.41 vs 0.43; p<0.05) were significantly higher in patients managed by tamsulosin. The number of hospital visits required during treatment was also more with tamsulosin, but the difference did not reach significance levels (2.56 vs 2.02 days; p=0.06). No difference was seen in the adverse effect profile of both drugs.Conclusions: Tadalafil also provides early stone expulsion, a greater decrease in colicky pain episodes, and a greater decrease in analgesic requirement. Both drugs are safe, effective, and well tolerated with minor side effects. Thus tadalafil is safe, efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones.

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