scholarly journals The Global Usability Score Short-Form for the simplified assessment of dry powder inhalers (DPIs) usability

2020 ◽  
Vol 15 ◽  
Author(s):  
Massimiliano Povero ◽  
Paola Turco ◽  
Luca Bonadiman ◽  
Roberto W. Dal Negro
Keyword(s):  
Clinical Practice ◽  
Short Form ◽  
Objective Assessment ◽  
Indirect Comparison ◽  
Real Life ◽  
Dry Powder Inhaler ◽  
High Specificity ◽  
Lasso Regression ◽  
Dry Powder ◽  
Specificity And Sensitivity

Background: The choice of the Dry Powder Inhaler (DPI) to prescribe is a critical issue. The estimation of DPIs usability depends on the objective assessment of several indices related to both subjective and objective determinants. The Global Usability Score (GUS) Questionnaire is a comprehensive tool usable for checking, comparing, and ranking inhalers’ usability objectively in real life, but it takes some time to fill.Aim: The aim of this study was to favour the quicker check of DPIs usability in clinical practice by means of a simplified short-form GUS (S-GUS) Questionnaire, while maintaining the high specificity and sensitivity of the original, extended version of the Questionnaire (O-GUS questionnaire).Methods: The usability of the six most prescribed DPIs was assessed in 222 patients with persistent airway obstruction and needing long-term inhalation treatments. LASSO regression and multicollinearity test were used to select the subset of questions of the O-GUS questionnaire, with the highest information power. Each item was then scored using the corresponding coefficient in the linear regression (normalized at 50 as the O-GUS score). Agreement between the original and the short-form questionnaire was evaluated using the Cohen’s kappa statistic (κ). The overall S-GUS values obtained for each DPI were then compared to those from the O-GUS, in the same patients, using a Bayesian indirect comparison (IC) model.Results: After the statistical selection of the items mostly contributing to the overall score, the novel S-GUS questionnaire consists of twelve items only. Nine items are related to patients’ opinion before DPIs handling, and three to the nurse’s assessment after DPIs practicality. O-GUS and S-GUS score were strongly correlated (R2=0.9843, p<0.0001) and the usability score calculated for each DPI by means of the O- and of S- GUS overlapped almost completely (κ=84.5%, 95% CI 81.3% to 89.2%). Furthermore, S-GUS was much faster to complete than O-GUS (mean time 6.1 vs 23.4 minutes, p<0.001). Estimates of S-GUS, obtained from the IC model, allowed to propose a simple classification of usability: “good” by GUS values >25; “pretty good” by values ≤25≥15, and “insufficient” by values <15.Conclusions: The S-GUS proves as much specific and suitable as the extended O-GUS questionnaire in measuring DPIs usability, while maintaining the same high sensitivity. As the time required for its use is quite shorter, S-GUS is also particularly suitable and helpful in current clinical practice.

scholarly journals A Bayesian Framework to Assess the Usability of Dry Powder Inhalers in a Cohort of Asthma Adolescents in Italy

Children ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 28
Author(s):  
Roberto Walter Dal Negro ◽  
Massimiliano Povero
Keyword(s):  
Short Form ◽  
Indirect Comparison ◽  
Real Life ◽  
Pairwise Comparisons ◽  
Dry Powder Inhalers ◽  
Current Clinical Practice ◽  
Dry Powder ◽  
Asthma Patients ◽  
Time Required ◽  
Short Time

The useability of DPIs (dry powder inhalers) depends on several factors that are influenced by the patients’ subjectivity and objectivity. The short-form global usability score (S-GUS), a specific tool for the quick ranking and comparison in real life of an inhaler’s usability, was used to investigate six of the most prescribed DPIs (Breezhaler, Diskus, Ellipta, Nexthaler, Spiromax, and Turbohaler) in consecutive asthma patients aged <18 years. A Bayesian indirect comparison (IC) was carried out to merge all pairwise comparisons between the six DPIs. Thirty-three subjects participated: eighteen tested Breezhaler, Spiromax, Nexthaler, and Ellipta simultaneously, while fifteen tested Breezhaler, Spiromax, Diskus, and Turbohaler. The estimates of the S-GUS, by the IC model, allowed us to rank the DPIs by their degree of usability: Ellipta, Diskus, and Spiromax were classified as “good to pretty good” (S-GUS > 15), while Spiromax, Turbohaler, and Breezhaler were classified as “insufficient” (S-GUS < 15). The multidomain assessment is recommended in asthma adolescents in order to approximate the effective usability of different DPIs as best as possible. The S-GUS proves particularly suitable in current clinical practice because of the short time required for its use in adolescents.

scholarly journals REVIEW ON DRY POWDER INHALERS: CURRENT ADVANCES AND LIMITATIONS

2021 ◽  
pp. 63-67
Author(s):  
A. V. Badarinath ◽  
S A Sreenivas ◽  
M. Suresh Babu
Keyword(s):  
Clinical Practice ◽  
Focal Point ◽  
Dry Powder Inhaler ◽  
Dry Powder Inhalers ◽  
Clinical Use ◽  
Expected Loss ◽  
Dry Powder ◽  
Everyday Clinical Practice ◽  
Innovative Work

Inhalers are the focal point of quickened innovative work as a result of the possibility to deliver greatest medication to the site of pathology in the lungs. Among the accessible conveyance choices, the dry powder inhaler (DPI) is the favoured gadget for the treatment of an undeniably different scope of ailments. Advancement of DPI frameworks that focus on the conveyance of fine medication particles to the more profound aviation routes in the lungs utilizing a mix of improved medication definitions and upgraded conveyance gadget advances implies that every one of these variables adds to in general execution of the vaporized framework. There are enormous scopes of gadgets for clinical use, anyway no individual gadget shows prevalent clinical viability. A significant worry that is pertinent in everyday clinical practice is the between and intra-understanding fluctuation of the medication measurements conveyed to the profound lungs from the inward breath gadgets, where the degree of changeability relies upon the medication definition, the gadget plan, and patient's breath profile. This fluctuation may result in under-dosing of medication to the patient and expected loss of pharmacological viability. This article audits ongoing advances in container based DPI innovation and the presentation of the 'dispensable' DPI gadget.

scholarly journals Patients' usability of seven most used dry-powder inhalers in COPD

2019 ◽  
Vol 14 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Paola Turco ◽  
Massimiliano Povero
Keyword(s):  
Indirect Comparison ◽  
Real Life ◽  
Small Sample ◽  
Dry Powder Inhalers ◽  
Dry Powder ◽  
Inhalation Devices ◽  
Therapeutic Outcomes ◽  
Copd Patients ◽  
Specialist Centre ◽  
Ranking Order

Introduction: Inhalation devices affect both the effectiveness and the therapeutic outcomes in persistent airway obstruction, and the effects are largely independent of the drug(s) assumed. Usability is a complex and comprehensive indicator of inhalation devices’ performance. The Global Usability Score (GUS) Questionnaire is an investigational tool designed to assess objectively the patients’-related and unrelated domains of devices’ usability. Methods: The GUS questionnaire was administered to all consecutive COPD patients referring for three months to the Lung Unit of CEMS Specialist Centre (Verona, Italy). The usability of seven Dry Powder Inhalers (DPIs) indicated as appropriate in COPD was tested and compared: Breezhaler, Diskus, Ellipta, Genuair, Nexthaler, Spiromax, and Turbohaler. Patients were divided in two groups, checked separately, according to their DPIs previous experience. A Bayesian Indirect Comparison (IC) model was built to assess “global usability” ranking. Results: A total of 103 patients were investigated: 74 patients already instructed in DPI use and 29 naive to DPIs. IC analysis proved Ellipta as the device characterized by the highest usability, while Breezhaler the device with the lowest usability in both groups of COPD patients (both with probability > 90%). Moreover, Turbohaler ranked second according to the Bayesian pooling, followed by Diskus, Spiromax, Nexthaler, and Genuair in patients already instructed in DPI use, while the ranking order was not as much well defined in naïve patients, likely due to their too small sample. Conclusions: Usability is a multifaceted indicator that contributes to assess the factual DPIs’ convenience in real life. DPIs are characterized by different levels of real-life usability, which can be checked, compared and ranked by means of the GUS score.

Patient Handling of a Dry-Powder Inhaler in Clinical Practice

CHEST Journal ◽  
2001 ◽  
Vol 120 (5) ◽  
pp. 1480-1484 ◽  
Author(s):  
Stanley Epstein ◽  
Ari Maidenberg ◽  
David Hallett ◽  
Kay Khan ◽  
Kenneth R. Chapman
Keyword(s):  
Clinical Practice ◽  
Dry Powder Inhaler ◽  
Dry Powder ◽  
Patient Handling

Density of nerve fibres in eutopic endometrium in women with endometriosis

Open Medicine ◽  
2013 ◽  
Vol 8 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Ruta Liutkeviciene ◽  
Zana Bumbuliene ◽  
Jolita Zakareviciene
Keyword(s):  
Clinical Practice ◽  
Minimally Invasive ◽  
High Specificity ◽  
Nerve Fibers ◽  
Endometrial Biopsy ◽  
Nerve Fibres ◽  
Exclusion Criteria ◽  
Eutopic Endometrium ◽  
Specificity And Sensitivity ◽  
Wide Range

AbstractEndometriosis is the disease which usually takes a wide range of time to be diagnosed. Recently, the investigators found that endometriosis could be diagnosed using the density of nerve fibers in eutopic endometrium after taking endometrium bioptate. The aim of the article is to summarize the existing literature on density of nerve fibers in eutopic endometrium in women with and without endometriosis. In this review were involved only those studies which used the same exclusion criteria and the same technology to detect nerve fibers in eutopic endometrium. Our review confirmed the position of all studies’ results that detection of specific nerve fibers within eutopic endometrium using minimally invasive endometrial biopsy technique could be widely used in clinical practice to diagnose endometriosis with high specificity and sensitivity.

scholarly journals Need of education for dry powder inhaler storage and retention – a patient-reported survey

2016 ◽  
Vol 11 ◽  
Author(s):  
Birger Norderud Lærum ◽  
Gunilla Telg ◽  
Georgios Stratelis
Keyword(s):  
Real Life ◽  
Dry Powder Inhaler ◽  
Patient Characteristics ◽  
Storage Conditions ◽  
Dry Powder ◽  
Expiry Date ◽  
Patient Reported ◽  
Asthma Patients ◽  
On Line ◽  
Inhaler Devices

Background: Dry powder inhalers (DPIs) are the most commonly used devices in asthma treatment in the Nordic countries. As new DPIs become available, patients are likely to be exposed to more than one type of device, with variable optimal handling. The aim was to examine real life storage and retention of multidose DPIs in patients with asthma. Methods: This patient-reported survey on real life storage and retention of DPIs included asthma patients using multidose DPIs. Basic patient characteristics, information on inhaler use and storage, check of expiry date, and concurrent inhaler use was examined using an on line questionnaire. Results: A total of 738 patients were included with a median age of 41 years, out of which 83 % were women. Sixty-three per cent reported storage conditions pre-defined as risk locations for their maintenance inhaler and 38 % of the responding patients had more than one maintenance inhaler in use at the same time. Two thirds of the study population checked inhaler expiry date less than monthly or not at all. Use after expiry date was frequently reported. Two thirds of the patients had not received information on DPI storage, either from their doctor and/or nurse or at the pharmacy. Conclusions: This patient reported survey indicates that two thirds of the patients store their inhaler devices in suboptimal conditions, and only a minority had received instruction regarding inhaler handling. Non awareness of inhalers’ expiry dates and use of more than one maintenance inhaler simultaneously was common. As inhaler mishandling may impact device functionality, improved communication and patient education is needed.

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