Comparison of a New Multidose Powder Inhaler (Diskus©/Accuhaler©) and the Turbuhaler© Regarding Preference and Ease of Use

Many patients with asthma or chronic obstructive pulmonary disease (COPD) use their inhaler ineffectively. Several studies revealed that inhaler-specific design features contributed significantly to the failure rate, which clearly demonstrates the need for developing more “foolproof” inhalers. This study compared ease of use and patient preference of the Diskus®/Accuhaler® (DA) with the Turbuhaler® (TH). Fifty patients with asthma or COPD aged 15 years and older were included in a randomized, crossover comparison of DA with TH regarding patient preference and ease of use. All had to be naïve to DA and TH, but currently had to be using inhaled medication with another device. Inhalation technique was assessed using inhaler-specific checklists and patients had to state a preference for DA or TH regarding various aspects, as well as overall preference. With DA 46 patients (92%) made no errors regarding essential inhalation maneuvers, compared to 37 patients (74%) using TH (p = 0.023) This difference is exclusively caused by not loading the TH properly. When patients were asked which inhaler they would prefer, 17 wanted the DA, 25 the TH, and 8 did not state a preference. The difference was not significant. TH was favored over DA regarding factors related to size and the number of available dosages. The counting mechanism of the DA was preferred over the TH. It seems that patients have a clear, although not statistically significant, preference for TH, but with the DA fewer patients make crucial errors

The role of self-treatment guidelines in self-management education for adult asthmatics

Guidelines on asthma management have changed considerably in the last two decades. Patient education has gained in popularity and especially asthma self-management training is thought to be essential in the treatment of adult asthma. Since 1989 many researchers have added self-treatment guidelines to self-management programmes and several studies have found improvements in health outcomes, such as lung function, quality of life, use of health care facilities and asthma symptoms. However, because of the lack of proper control groups, it is not clear whether this has to be attributed to self-treatment guidelines or to, for example, more education or more medical attention. The only two studies that were placebo controlled did not show an effect of self-treatment. To assess the added benefit of self-treatment guidelines to a self-management programme, randomized ‘placebo’ controlled trials of sufficient size with sufficient follow-up time are necessary. The only difference between intervention and control groups should be guidelines for self-treatment

Sequence of radiotherapy and chemotherapy in breast cancer after breast-conserving surgery

Purpose The optimal sequence of radiotherapy and chemotherapy in breast-conserving therapy is unknown. Methods and Materials From 1983 through 2007, a total of 641 patients with 653 instances of breast-conserving therapy (BCT), received both chemotherapy and radiotherapy and are the basis of this analysis. Patients were divided into three groups. Groups A and B comprised patients treated before 2005, Group A radiotherapy first and Group B chemotherapy first. Group C consisted of patients treated from 2005 onward, when we had a fixed sequence of radiotherapy first, followed by chemotherapy. Results Local control did not show any differences among the three groups. For distant metastasis, no difference was shown between Groups A and B. Group C, when compared with Group A, showed, on univariate and multivariate analyses, a significantly better distant metastasis–free survival. The same was noted for disease-free survival. With respect to disease-specific survival, no differences were shown on multivariate analysis among the three groups. Conclusion Radiotherapy, as an integral part of the primary treatment of BCT, should be administered first, followed by adjuvant chemotherapy

Inhalation technique of 166 adult asthmatics prior to and following a self-management prograM

Self-management of asthma and self-treatment of exacerbations are considered important in the treatment of asthma. For successful self-treatment, medication has to be inhaled correctly, but the percentage of patients inhaling effectively varies widely. As part of a self-management program we checked and corrected inhalation technique. This paper addresses differences among inhalers in relation to patient characteristics and the effect of instruction, 1 year after enrollment. Maneuvers that are essential for adequate inhalation were identified. When errors in inhalation technique were observed, patients were instructed in the correct use of their devices. One year later, inhalation technique was checked again. Only patients who used the same inhaler throughout the entire study period were analyzed. Of the 245 adult asthmatic patients who were enrolled in the self-management program, 166 used the same inhaler throughout the study period. One hundred twenty patients (72%) performed all key items correctly at baseline and this increased to 80% after 1 year. At follow-up, older patients were less likely to demonstrate a perfect inhalation. Patients with a Diskhaler(r) made fewest errors. Adjustment for differences in patient characteristics did not significantly change the results. Because many patients with asthma use their inhaler ineffectively, there is a need to know which inhaler leads to fewest errors. Diskhaler was nominated by this study. When patients are not able to demonstrate adequate inhalation technique in a “tranquil” setting, it is doubtful that they can do so when they experience an exacerbation. Therefore, inhalation instruction should be considered an essential ingredient, not only of self-management programs, but also of asthma patient care in general

Patient satisfaction and amenorrhea rate after endometrial ablation by ThermaChoice III or NovaSure: a retrospective cohort study

Heavy menstrual bleeding poses an important health problem, which can be managed, besides other treatments, with endometrial ablation. Nowadays, the bipolar radio frequency device (NovaSure) is the most commonly used device for endometrial ablation, followed by the thermal balloon device (ThermaChoice III). Thus far, studies looking at treatment outcomes have mainly been done comparing NovaSure with the older ThermaChoice (I–II) devices. The aim of this study is to compare the effectiveness of the improved ThermaChoice III with NovaSure. Patients treated with ThermaChoice III at the Ziekenhuisgroep Twente hospital and NovaSure at the Medisch Spectrum Twente hospital were included in the study. The primary outcome measure was patient satisfaction after treatment, measured by the condition-specific menorrhagia multi-attribute scale (MMAS). The secondary outcome measure was effectiveness of the treatment, measured by the amenorrhea rate and the hysterectomy rate. Five hundred fourteen patients were included in this study; of these, 216 patients were treated with ThermaChoice III and 289 patients with NovaSure. The score on the condition-specific MMAS was high for both groups, without a significant difference between the groups (88.8 vs 86.5, p = 0.183). The amenorrhea rate was significantly higher in the NovaSure group (45 vs 27 %, p = 0.001). The hysterectomy rate was slightly higher in the ThermaChoice III group, without a significant difference between the groups (19 compared to 13 %, p = 0.066). Patient satisfaction is comparable in patients treated with ThermaChoice III or NovaSure. However, NovaSure endometrial ablation leads to a significantly higher amenorrhea rat

How do COPD patients distribute their daily activities?

Better insight in daily activity behaviour of COPD patients is needed as a first step to enable a tailoring of their treatment. The objective of this study was to measure the daily activity of COPD patients and to compare the daily activity distribution with asymptomatic controls, using triaxial accelerometry

Protective effect of a low single dose inhaled steroid against exercise induced bronchoconstriction

Objective Daily use of inhaled corticosteroids (ICS) reduces exercise induced bronchoconstriction (EIB) in asthmatic children. A high single dose of ICS also provided acute protection against EIB. Objective of this study is to investigate whether a low single dose of ICS offers protection against EIB in asthmatic children. Methods 31 Mild asthmatic children not currently treated with inhaled corticosteroids, 5–16 years, with EIB (fall in FEV0.5/1 ≥ 13%) were included in a prospective intervention study. They performed two ECT's within 2 weeks. Four hours before the second test children inhaled 200 μg beclomethasone-dipropionate (BDP) with a breath-actuated inhaler (BAI). Results The median fall in FEV0.5/1 after 200 μg BDP was significantly reduced from 30.9% at baseline to 16.0% (P < 0.001). Twenty children (64.5%) showed a good response to 200 μg BDP (≥50% decrease in fall of FEV0.5/1), while 8 children showed a moderate response (25–50%), and three children showed no response at all (< 25%). Conclusion A low single dose ICS offers acute protection against EIB in the majority of asthmatic children not currently treated with inhaled corticosteroid

Moving beyond a limited follow-up in cost-effectiveness analyses of behavioral interventions

Background Cost-effectiveness analyses of behavioral interventions typically use a dichotomous outcome criterion. However, achieving behavioral change is a complex process involving several steps towards a change in behavior. Delayed effects may occur after an intervention period ends, which can lead to underestimation of these interventions. To account for such delayed effects, intermediate outcomes of behavioral change may be used in cost-effectiveness analyses. The aim of this study is to model cognitive parameters of behavioral change into a cost-effectiveness model of a behavioral intervention. Methods The cost-effectiveness analysis (CEA) of an existing dataset from an RCT in which an high-intensity smoking cessation intervention was compared with a medium-intensity intervention, was re-analyzed by modeling the stages of change of the Transtheoretical Model of behavioral change. Probabilities were obtained from the dataset and literature and a sensitivity analysis was performed. Results In the original CEA over the first 12 months, the high-intensity intervention dominated in approximately 58% of the cases. After modeling the cognitive parameters to a future 2nd year of follow-up, this was the case in approximately 79%. Conclusion This study showed that modeling of future behavioral change in CEA of a behavioral intervention further strengthened the results of the standard CEA. Ultimately, modeling future behavioral change could have important consequences for health policy development in general and the adoption of behavioral interventions in particular