5 research outputs found
Community-acquired pneumonias in SARS-CoV-2 negative patients admitted at Mater Dei Hospital and their subsequent follow-up
Get PDFBACKGROUND: Community-acquired pneumonia refers to an acute infection of the lung parenchyma acquired within the community, and its management depends on the severity of symptoms and method of presentation. The aim of this audit is to evaluate community-acquired pneumonias in SARS-CoV-2 negative patients admitted at Mater Dei Hospital and their subsequent follow-up.METHODS: In this observational audit, demographic data was collected from 200 patients between June and September 2020. Follow-up of these patients was audited to assess whether local current practice is being adhered to as per British Thoracic Society recommendations.RESULTS: From our sample of 200 patients, 25.5% who were being treated for community-acquired pneumonia passed away during their admission. The age range of our patients varied from 18 to 99 years with the majority being over the age of 75. 31 out of 149 surviving patients (20.8%) had both imaging and medical outpatient follow-up booked, 18 patients (12.08%) had only a chest x-ray follow-up whilst 19 patients (12.75%) had medical outpatient follow-up only. In total 68 patients (45.63%) had imaging or medical outpatient follow-up, or both.CONCLUSION: Any patient admitted and treated for a community-acquired pneumonia should receive a follow-up appointment to assess for resolution of symptoms, and/or follow-up imaging to assess for resolution of changes. Non-resolution of these changes may necessitate discussion at a multi-disciplinary level to conclude how to further investigate such a patient.peer-reviewe
Predictors of correct technique in patients using pressurized metered dose inhalers
Get PDFBackground: Correct inhaler technique is recommended by guidelines for optimum asthma care. The objective of the study is to determine real life predictors of correct pressurized metered dose inhaler (pMDI) technique in Asthma and COPD patients. Methods: Two hundred eight adult patients aged 18+ from respiratory outpatients (69.2%) and the community on regular pMDI for a diagnosis of Asthma (78.9%) or COPD, were recruited. A questionnaire containing 31 possible predictors was administered and pMDI technique with or without spacer was observed by trained researchers on 12 point steps, of which 4 were considered critical. Results: 23.1% of patients had no errors in inhaler technique and 32.2% had no critical errors. Patients had a median of 10 correct steps (IQR9-11), and 3(IQR2-4) correct critical steps. Using binary logistic regression the predictors of 10 correct steps were, other healthcare professional (pharmacist, nurse, physiotherapist) explained OR 3.73(1.63–8.54, p = 0.001), male gender 2.70(1.35–5.39, p = 0.004), self-score 1–10 1.21(1.05–1.39, p = 0.007), spacer use 0.38(0.19–0.79, p = 0.007), inhaled steroid 3.71(1.34–10.25, p = 0.01), heart disease 0.31(0.13–0.77, p = 0.01), pneumococcal vaccine 2.48(1.0–6.15, p = 0.043), education level 1–4 1.44(1.00–2.06, p = 0.05) and respiratory physician explained 0–7 times, 1.11(0.99–1.26, p = 0.08). Using ordinal logistic regression, predictors for correct critical steps 0–4, were: technique self-score 1–10 1.2(1.05–1.42, p = 0.006), inhaled corticosteroid use 2.78(1.1–7.31, p = 0.03) and education level 1–4 1.41(1.02–1.95, p = 0.03 Times respiratory physician explained inhaler technique 0–7 1.1(0.98–1.24, p = 0.1), married status 1.55(0.85–2.82, p= 0.15), hypercholesterolaemia 0.52(0.25–1.01, p = 0.054) and male gender 1.76(0.97–3.18, p = 0.06). Conclusions: Known predictors of correct pMDI use, such as gender and education level were confirmed, while age and concomitant use of dry powder inhaler were not. Pneumococcal vaccination and awareness of steroid side effects were possible novel positive predictors, while the use of a spacer and co-morbidity with heart disease were found to be negative predictors. Patients’ self-assessment correlated well with actual performance. This information may be useful in defining approaches to optimize inhaler techniques which are so susceptible to human error.peer-reviewe
