Predictors of correct technique in patients using pressurized metered dose inhalers

Background: 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

A prospective audit of requests for CT Pulmonary Angiography (CTPA) in haemodynamically stable non-pregnant medical patients with suspected PE

Introduction: Pulmonary embolism (PE) is a common and occasionally fatal disease, therefore investigation must be targeted and accurate. Unnecessary investigation presents an increased risk of harm to the patient. On occasion, CT Pulmonary Angiography (CTPA) is not requested according to established guidelines. --- Aim: This study aimed to address the criteria by which CTPAs were being requested. Approval was obtained from data protection and ethics committees. Anonymous data was collected from hospital software and patients' case notes between Aug-Sept 2017. --- Methods: 106 patients were recruited. Hospital notes were examined for demographics, reason for presentation, documentation of pre-test probability (PTP) testing, arterial blood gases (ABGs), electrocardiogram (ECG), indication for CTPA, and any complications. Hospital software provided data on blood investigations including D-dimer, CXR, time of CTPA order, and department and grade of doctor ordering CTPA. --- Results: Dyspnoea, followed by a raised D-dimer, was the most common trigger for ordering CTPA (45.3%). A large majority (60.4%) of patients undergoing CTPA did not have ABGs taken. One fifth (21.7%) of CTPAs were positive. A PTP score was only documented in 10.4% of patients and was equally divided between Wells and Geneva scores. The Wells score was retrospectively calculated, with only 9.4% having a score >4 indicating likely PE. 1 patient had anaphylaxis to contrast and 5 developed contrast-induced nephropathy. --- Conclusions: A basis for requesting a CTPA needs to be established, utilising the well-validated Wells Score, and D-dimer where indicated. A suspicion of PE should trigger a request for an ABG. CTPA is not without morbidity, and therefore should only be requested according to evidence-base.peer-reviewe

Additional file 1: of Predictors of correct technique in patients using pressurized metered dose inhalers

Dataset. (XLSX 56 kb

Additional file 2: of Predictors of correct technique in patients using pressurized metered dose inhalers

Questionnaire. (PDF 157 kb

Membrane Bioreactor–Treated Domestic Wastewater for Sustainable Reuse in the Lake Victoria Region

Lake Victoria is a shared water resource between Kenya, Uganda, and Tanzania, which is the second largest freshwater lake in the world. It has long since suffered from the consequences of overexploitation of its resources, mainly fish stocks, and increasingly high pollution. The closure of 58% of the fish processing plants (FPPs) is attributed to the declining fish stocks due to overfishing and pollution in particular. The installation and operation of a pilot membrane bioreactor (MBR) in Kisumu, Kenya, adopts an integrated approach by providing an integral, sustainable, cost-effective, and robust solution for water sanitation, which also meets the demand for clean water in the fish processing industry, aquaculture, and irrigation. The innovative system comprises a pilot MBR coupled with a recirculation aquaculture system (RAS). The RAS is able to recirculate 90% to 95% of its water volume; only the water loss through evaporation and drum filter back flushing has to be replaced. To compensate for this water deficit, the MBR treats domestic wastewater for further reuse. Additionally, excess purified water is used for irrigating a variety of local vegetables and could also be used in FPPs. The pilot-scale MBR plant with around 6 m2 submerged commercial polyethersulfone (PES) membranes provides treated water in basic agreement with Food and Agriculture Organization (FAO) standards for irrigation and aquaculture, showing no adverse effects on tilapia fingerlings production. A novel membrane module with a low-fouling coating is operating stably but has not yet shown improved performance compared to the commercial one. Integr Environ Assess Manag 2020;16:942–954. © 2020 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC