Training of trainers on epinephrine autoinjector use

Hekimlerin çoğu adrenalin otoenjektörü nasıl kullanacağını bilmemektedir. Anafilaksi eğitimlerinin sadece teorik bilgi içermesi bunda rol oynayabilir. Bu çalışmada amacımız, adrenalin otoenjektör kullanımı ile ilgili pratik ve teorik eğitimi entegre ederek, hekimlerin doğru kullanımı üzerine etkisini belirlemektir. Çalışmaya dört ayrı üçüncü basamak hastanede allerji kliniklerinde çalışan hekimler hariç tutularak diğer pediatri asistan ve uzmanları dahil edilmiştir. Hekimlere öncelikle anafilaksi konusundaki mesleki deneyimlerinin ve bilgilerinin değerlendirildiği sekiz sorudan oluşan anket uygulanmıştır. Bundan sonra hekimlerin adrenalin otoenjektör kullanımları, otoenjektörle birebir aynı olan ancak ilaç içermeyen maketiyle puan verilerek değerlendirilmiştir (doğru uygulama beş puan). Doğru uygulamayı gösteremeyen her hekime maketle uygulama birebir eğitimle öğretilmiştir. Pratik değerlendirmenin ardından hekimlere anafilaksi konusunda teorik eğitim verilmiş ve bu eğitimin sonunda bir kez daha adrenalin otoenjektör pratik uygulaması gösterilmiştir. Altı ay sonra hekimlerin adrenalin otoenjektör kullanımları pratik uygulamayla tekrar değerlendirilmiştir. Çalışmaya katılan 196 hekiminin 151&#8217;i eğitim öncesi ve sonrası her iki uygulamaya da katılmıştır. Hekimlerin, eğitim sonrası adrenalin otoenjektörü doğru uygulama oranı eğitim öncesine göre % 23.3&#8217;ten % 74.2&#8217;ye, ortalama puanı ise 3.49±1.14&#8217;ten 4.66±0.65&#8217;e anlamlı oranda artmıştır (her biri için p<0.001). Hekimlerin eğitim sonrası ortalama adrenalin otoenjektör pratik uygulama süresi 28.07±6.22 saniyeden 19.62±5.01 saniyeye, uygulama öncesi prospektüs okuma ihtiyacı ise % 91.4&#8217;ten % 29.1&#8217;e düşmüştür (her biri için p<0.001). Adrenalin otoenjektör pratik uygulamalarında eğitim öncesine göre eğitim sonrasında yapılan hataların oranları anlamlı oranda azalırken, görülme sıklıklarında bir değişiklik saptanmamıştır (her biri için p<0.001). Bu çalışma, adrenalin otoenjektör konusunda entegre teorik ve pratik eğitimin, hekimlerin otoenjektörü doğru uygulama oranlarını artırdığını göstermiştir. Bu eğitime rağmen otoenjektör kullanımıyla ilgili devam eden hataların aynı basamaklarda yoğunlaşması, sorunun kısmen otoenjektör tasarımıyla da ilişkili olabileceğini desteklemektedir.The majority of physicians do not know how to use epinephrine autoinjectors. This displays that current education of physicians on anaphylaxis is inadequate for a thorough practice. We hypothesize that a theoretical lecture together with a practical session on epinephrine autoinjector use will improve its proper use by physicians. Residents, specialists and consultants from General Pediatrics excluding allergists and allergy fellows were included in this study. All physicians were given an eight item questionnaire followed by a practical session scoring and timing ability to use epinephrine autoinjector trainer. This ensued with one to one hands-on training on correct auto-injector use. Finally, a joint theoretic lecture on anaphylaxis including re-demonstration of epinephrine autoinjector use was given. All physicians were scored a second time on use of epinephrine autoinjector 6 months later. One hundred fifty one of 196 participants completed all steps of the study in four tertiary hospitals. Correct use of epinephrine autoinjector improved from 23.3% to 74.2%, mean score from 3.49±1.14 to 4.66±0.65, need for prospectus from 91.4% to 29.1% and mean time to administer autoinjector from 28.01±6.22s to 19.62±5.01s (p<0.001 for each). The rate of most common mistakes during autoinjector use decreased but the ranking did not change. An integrated theoretic and practical education increased correct of epinephrine autoinjector use by physicians. Ongoing mistakes despite this education may be related with its design

The pharmacists' ability to use pressurized metered-dose inhalers with a spacer device and factors affecting it

Objective: The aim of this study is to evaluate the pharmacists' ability to use pMDIs with a spacer device and the factors that affect this ability. Method: Face to face interviews were conducted with the pharmacists. A nine item questionnaire was completed and the checklist for how to use pMDIs with a spacer device was filled out. Results: A total of 307 pharmacists voluntarily participated in this study. Fifty-six (18.2%) of the pharmacists stated that they did not know how to use pMDIs with a spacer device. These pharmacists were excluded and remaining 251 pharmacists included in the study. Only 100 (39.8%) pharmacists demonstrated all of the inhaler spacer device usage steps correctly. The step in which pharmacists made the most mistakes was "take 5-6 deep and slow breaths, hold for 10 s and slow breaths." Those pharmacists who were more likely to correctly use pMDIs with a spacer device were younger (p = 0.023), had dispensed more asthma medications per day (p < 0.001), had dispensed more asthma medications per day for patients younger than six years of age (p = 0.016), and sold inhaler spacer devices at their pharmacy (p = 0.042). Conclusion: Approximately one third of the pharmacists in the current study were able to correctly demonstrate all of the steps for proper usage of pMDIs with a spacer device, which indicates that pharmacists should be included in the training program and be provided continuous training on the use of pMDIs with a spacer device

Effects of modifying visual inhaler spacer usage instructions on correct usage rate of untrained users

Background Pressurized metered-dose inhalers (pMDIs) used with spacers are considered the method of choice for delivery of inhaled drugs in preschool-age children. The aim of this study was to determine the effects of modifying the visual inhaler spacer usage guidelines on the correct usage rate. Methods The parents and caregivers of patients <6 years old who were prescribed inhalers with spacers for the first time were included in our study. The participants were randomly divided into a modified visual inhaler spacer usage guidelines group and an unmodified visual inhaler spacer usage guidelines group. All study participants underwent face-to-face interviews and completed questionnaires. Results A total of 510 participants with a median age of 31 (range, 20-46) years were included in this study. The modified visual guidelines group included 254 (49.6%) participants, and the unmodified visual guidelines group included 256 (50.4%) participants. One hundred sixty-five (65.2%) of the 254 participants in the modified visual guidelines group correctly demonstrated the inhaler spacer technique. In contrast, only 21 (8.2%) of the 256 participants in the unmodified visual guidelines group correctly demonstrated the inhaler spacer technique (p < 0.001). When comparing the inhaler spacer usage steps between the 2 groups, the modified visual guidelines group demonstrated the steps more correctly and more quickly (p < 0.001). Conclusion The current visual inhaler spacer usage guidelines are insufficient. We believe that improving the visual inhaler spacer usage guidelines, in particular, will increase the correct usage rate and decrease the number of usage errors

A novel gain-of-function mutation in STAT5Bis associated with treatment-resistant severe atopic dermatitis.

Additional information about study methods and findings are available in the following repository

Thanatechnology and the living dead: New concepts in digital transformation and human-computer interaction

In a digital society, shall we be the authors of our own experience, not only during our lifetime but also after we die? We ask this question because dying and bereavement have become even harder, and much less private, in the digital age. New big data-driven digital industries and technologies are on the rise, with promises of interactive 3D avatars and storage of digital memories of the deceased, so they can continue to exist online as the living dead in a digital afterlife. Famous rock and roll icons like Roy Orbison, Frank Zappa, Ronnie James Dio, and Amy Winehouse have famously been turned into holograms that can once again give live performances on the touring circuit, often pulling in large audiences. Death studies, dying, and grief have become virtual in the 21st century. We live in truly unprecedented times for human-computer interactions. Thanatology is the scientific study of death, dying, loss, and grief. In contrast to the biological study of biological aging (cellular senescence) and programmed cell death (apoptosis), thanatology employs multiple professional lenses, medical, psychological, physical, spiritual, ethical, descriptive, and normative. In 1997, Carla Sofka introduced the term thanatechnology as technological mechanisms such as interactive videodiscs and computer programs that are used to access information or aid in learning about thanatology topics. Onward to 2021, the advent of social media, the Internet of Things, and sensors that digitize and archive nearly every human movement and experience are taking thanatechnology, and by extension, digital transformation, to new heights. For example, what happens to digital remains of persons once they cease to exist physically? This article offers a critical study and snapshot of this nascent field, and the un-disciplinary sociotechnical issues digital thanatechnologies raise in relation to big data. We also discuss how best to critically govern this new frontier in systems science and the digital society. We suggest that new policy narratives such as (1) the right to nonparticipation in relation to information and communication technologies and (2) the planetary public goods deserve further attention to democratize thanatechnology and big data. To the extent that systems science often depends on data from online platforms, for example, in times of pandemics and ecological crises, critical thanatechnology studies, introduced in this article, is a timely and essential field of scholarship with broad importance for systems science and planetary health

Comparison of practical application steps of the previously used adrenaline auto injector in Turkey (EpiPen) and the currently available adrenaline auto injector (Penepin): a multi-center study

Aim: It has been shown by a great number of studies that the correct use of adrenaline auto injectors prescribed to patients with anaphylaxis is associated with the design of the auto injector, in addition to training. The aim of this study was to compare the skills of adults in using two different auto injectors prescribed to patients with anaphylaxis. Material and Methods: Parents of patients aged between 1 and 18 years who referred to allergy outpatients were included in the study. Results: A total of 630 volunteers from nine centers were included in the study. Four hundred fifty-seven (72.5%) of the participants were females and 235 (37.3%) were undergraduates. The rate of showing all the steps of auto injector trainers correctly e by the participants was found as (60.2%) (n=379) for EpiPen and 42.9% (n=270) for Penepin (p<0.001). The most frequent mistake with both auto injector trainers was the step of "place appropriate injection tip into outer thigh/press the trigger so it clicks." When the preferences of the volunteers were asked after training and application, 527 (83.7%) chose EpiPen, stating that it was easier and simpler to use. Conclusions: Our study showed that the correct usage rates of both adrenaline auto injectors were much lower than expected and there could be mistakes in the application of both. It could be appropriate to make improvements in the design of Penepin, which is still the only available adrenaline auto injector in Turkey, such that its application steps will be simpler and quicker

Anaphylaxis: Turkish National Guideline 2018

Anaphylaxis is an acute and potentially fatal systemic reaction that sould be recognized and managed by all helthcare professionals. This is the first national guideline of Turkish National Society of Allergy and Clinical Immunology on diagnosis and management of anaphylaxis. The guideline is prepared by Anaphylaxis Interest Group with the incorporation of 20 allergy/immunology specialists and the epidemiology, etiology, pathophysiology, symptoms and signs, diagnosis/differentials, and acute and long-term management of anaphylaxis are reviewed in detail

Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul

Aims: Type 2 diabetes mellitus (T2DM) is a risk factor for severe COVID-19. Our aim was to compare the clinical outcomes of patients with and without T2DM during the first hit of COVID-19 in Istanbul.& nbsp; Methods: A retrospective population-based study was conducted including all consecutive adult symptomatic COVID-19 cases. Patients were confirmed with rt-PCR; treated and monitored in accordance with standard protocols. The primary endpoints were hospitalization and 30-day mortality.& nbsp; Results: Of the 93,571 patients, 22.6% had T2DM, with older age and higher BMI. Propensity Score matched evaluation resulted in significantly higher rates of hospitalization (1.5-fold), 30-day mortality (1.6-fold), and pneumonia (1.4-fold). They revealed more severe laboratory deviations, comorbidities, and frequent drug usage than the Non-DM group. In T2DM age, pneumonia, hypertension, obesity, and insulin-based therapies were associated with an increased likelihood of hospitalization; whereas age, male gender, lymphopenia, obesity, and insulin treatment were considerably associated with higher odds of death.& nbsp; Conclusions: COVID-19 patients with T2DM had worse clinical outcomes with higher hospitalization and 30-day mortality rates than those without diabetes. Compared to most territories of the world, COVID-19 mortality was much lower in Istanbul, which may be associated with accessible healthcare provision and the younger structure of the population.& nbsp; (C)& nbsp;2021 Elsevier B.V. All rights reserved