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Canbolat O, Dogan Aktas AB, Sipal G, Nurdan K. Evaluation of the quality and content of YouTube videos as an educational resource in developing patients' inhaler use skills. J Asthma 2024:1-9. [PMID: 38359086 DOI: 10.1080/02770903.2024.2319846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND YouTube has educational videos on inhalers. However, their content and quality are not adequately known. OBJECTIVES This study investigated the quality and content of educational YouTube videos on inhalers. METHODS This descriptive study analyzed 178 YouTube videos on inhalers between May and July 2022. Two researchers independently evaluated the videos. The Global Quality Score (GQS), Journal of American Medical Association (JAMA) Benchmark Criteria, and Inhaler Application Checklist (IAC) were used to assess the quality and content of the videos. Spearman's correlation, Kruskal-Wallis, Mann-Whitney U, ANOVA, and Post hoc analysis Bonferroni test were used for data analysis. RESULTS The videos had a mean GQS score of 3.70 ± 1.24, and JAMA score of 2.22 ± 0.60. A negative correlation was between the quality score of the videos and views, likes, comments, duration, and likes/views (respectively; r = -0.237 p < 0.005, r = -0.217 p < 0.003, r = -0.220 p < 0.005, r = -0.147, p < 0.005). The videos narrated by nurses and doctors had significantly higher mean JAMA and GQS scores than others (p = 0.001). The videos missed some procedural steps [gargling (29.1%), adding no more than five ml of medication and device cleaning (41.9%), and exhaling through the nose (37.5%)]. Videos uploaded by individual missed significantly more procedural steps than professional organizations (p < 0.05). CONCLUSIONS YouTube videos about inhaler techniques have a moderate level of quality. Videos uploaded by doctors and nurses as content narrators were of higher quality. The videos missed some procedural steps. Individual video uploaders had higher missed procedural steps. Counseling should be provided to patients regarding the reliability of online information.
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Affiliation(s)
| | | | - Gulhayat Sipal
- Faculty of Medicine, Cebeci Research and Application Hospital, Ankara University, Ankara, Turkey
| | - Kokturk Nurdan
- Department of Pulmonary and Critical Care, Gazi University School of Medicine, Ankara, Turkey
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2
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Papi A, Faner R, Pavord I, Baraldi F, McDonald VM, Thomas M, Miravitlles M, Roche N, Agustí A. From treatable traits to GETomics in airway disease: moving towards clinical practice. Eur Respir Rev 2024; 33:230143. [PMID: 38232989 DOI: 10.1183/16000617.0143-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/24/2023] [Indexed: 01/19/2024] Open
Abstract
The treatable traits approach represents a strategy for patient management. It is based on the identification of characteristics susceptible to treatments or predictive of treatment response in each individual patient. With the objective of accelerating progress in research and clinical practice relating to such a treatable traits approach, the Portraits event was convened in Barcelona, Spain, in November 2022. Here, while reporting the key concepts that emerged from the discussions during the meeting, we review the current state of the art related to treatable traits and chronic respiratory diseases management, and we describe the possible actions that clinicians can take in clinical practice to implement the treatable traits framework. Furthermore, we explore the new concept of GETomics and the new models of research in the field of COPD.
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Affiliation(s)
- Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Rosa Faner
- University of Barcelona, Biomedicine Department, FCRB-IDIBAPS, Centro de Investigación Biomedica en Red M.P. (CIBER), Barcelona, Spain
| | - Ian Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Vanessa M McDonald
- School of Nursing and Midwifery, The University of Newcastle, NHMRC Centre of Excellence in Asthma Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Programme and Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Mike Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Marc Miravitlles
- Pneumology Department Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Nicholas Roche
- Respiratory Medicine Department, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, AP-HP and Université Paris Cité, Paris, France
| | - Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Barcelona, Spain
- Pulmonary Service, Respiratory Institute, Clinic Barcelona, Barcelona, Spain
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3
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Tian Z, Jiang Y, Zhang N, Zhang Z, Wang L. Analysis of the Current State of COPD Nursing Based on a Bibliometric Approach from the Web of Science. Int J Chron Obstruct Pulmon Dis 2024; 19:255-268. [PMID: 38283691 PMCID: PMC10813247 DOI: 10.2147/copd.s440715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024] Open
Abstract
Background and Aim COPD nursing plays a crucial role in alleviating disease symptoms, prolonging patient survival, and is therefore of paramount importance. However, authoritative research findings, research hotspots, and development trends in the field of COPD are still unclear. This study aimed to examine authoritative research findings, research hotspots, and trends in the field of COPD nursing. Descriptive statistics and bibliometric and visual analyses of the literature were conducted. Methods Bibliometric data were obtained from the Web of Science database. Citespace was used to explore publication trends, countries, institutions, journals, authors, keywords, and co-citation characteristics of the included literature in order to summarize the key research in the field of COPD nursing. Results In total, 693 articles on COPD nursing were published. 1998-2014 showed a rapid growth period in this research field, which stabilized in 2015-2022. The research content could mostly be summarized into five categories: acute exacerbation, quality of life, risk, evidence-based nursing, and pulmonary rehabilitation. The research hotspots in 1998-2014 included randomized controlled trials, education, elderly patients, nursing home residents, nursing homes, rehabilitation, and prevalence. Research in 2015-2022 focused on impact, palliative care, needs, and predictors. In recent years, research mainly concentrated on symptom management models, cost-effectiveness, and cumulative meta-analysis. Conclusion Bibliometric analysis of COPD nursing articles indicates that the focus of COPD nursing research is shifting from tertiary prevention to primary and secondary prevention. Helping patients achieve self-management of symptoms, reducing the financial burden of COPD on healthcare, and summarizing research evidence by meta-analyses will likely remain the focus of future research.
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Affiliation(s)
- Zheng Tian
- School of Nursing, Tianjin Medical University, Tianjin, 300070, People’s Republic of China
| | - Yachen Jiang
- School of Nursing, Tianjin Medical University, Tianjin, 300070, People’s Republic of China
| | - Nan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, 300070, People’s Republic of China
| | - Zhijun Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Lan Wang
- School of Nursing, Tianjin Medical University, Tianjin, 300070, People’s Republic of China
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4
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Basheti I, Salameh L, Mahboub B, Sakarneh MA, Saddik B, Al-Ani M, Al-Hajjaj M, Abu-Gharbieh E. A specialized training program on inhaler technique delivered by pharmacists to nurses: a study from the United Arab Emirates. Pharm Pract (Granada) 2022; 20:2726. [PMID: 36733507 PMCID: PMC9851819 DOI: 10.18549/pharmpract.2022.3.2726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/27/2022] [Indexed: 02/05/2023] Open
Abstract
Background Inhaled drug delivery has been hailed as a major advancement in respiratory therapeutics. However, a major limitation to use the inhaled medications effectively is the inability of patients and nurses to use and demonstrate the proper use of these devices correctly. Being the drug experts, pharmacists are in a pivotal position to delivered tailored education to their peers, the nurses. Aim This study aims to examine nurses' knowledge of asthma management, their ability to demonstrate proper inhaler technique, and the impact of a specialized workshop training program delivered by skilled pharmacists on improving their performance. Methods This is a pre- and post-cross-sectional study design in hospital setting where nurses were recruited from the respiratory and emergency departments within a healthcare facility in the United Arab Emirates (UAE). The nurses attended a training workshop prepared and delivered by skilled pharmacists on inhaler technique demonstration skills. Nurses' inhaler technique demonstration skills for Diskus, Turbuhaler, and pMDI were assessed at baseline, immediately after the workshop, and after four weeks. The nurses completed the demographic and Asthma Knowledge Questionnaire (AKQ). Results A random convenience sample of registered nurses (n=20) from the respiratory and emergency departments was recruited from a tertiary hospital in Sharjah, UAE, with a mean age of 35.25 (SD=6.96) years, of whom 90% were females. The mean number of years of experience was 12.00 years (SD=5.81). Inhaler technique assessment revealed low inhaler technique scores for all the three study inhalers at baseline (mean score for Diskus=3.85 (SD=2.87); Turbuhaler=3.70 (SD=3.20); pMDI=4.50 (SD=2.65)) Significant improvements in inhaler technique scores were noted after the workshop (Diskus=8.9 (SD=0.31); Turbuhaler=8.9 (SD=0.31); pMDI=8.0 (SD=0.00), P<0.001). A significant difference in AKQ scores was found before (mean=4.85 (SD=1.27)) and after (mean=7.50 (SD=0.95)) the workshop training session (P<0.001), and four weeks after the workshop training session (mean=7.55 (SD=0.76), P<0.001). Conclusion The UAE nurses' inhaler technique and AKQ scores were suboptimal at baseline. The specialized training program prepared and delivered by the skilled pharmacists improved nurses' inhaler technique demonstration skills and AKQ scores. Such improvements would reflect positively on patients' asthma management outcomes as nurses are the health care professionals who interact the most with the patients during hospitalization.
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Affiliation(s)
- Iman Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, P.O. Box 166, Amman 11931, Jordan.
| | - Laila Salameh
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, Rashid Hospital, Dubai Health Authority, Dubai 4545, United Arab Emirates.
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority, Dubai 4545, United Arab Emirates.
| | - Mohammad Abed Sakarneh
- Department of Special Education, Princess Rahama University College, Al-Balqa Applied University, Al Salt 19117, Jordan.
| | - Basema Saddik
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Mena Al-Ani
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates, UCL Great Ormond Street Institute of Child Health, Developmental Biology and Cancer Department, London WC1N 1EH, United Kingdom.
| | - Mohamed Al-Hajjaj
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, University Hospital Sharjah, Sharjah, Sharjah 72772, United Arab Emirates.
| | - Eman Abu-Gharbieh
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates.
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5
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Johnson BR, Franks AS, Bullock LN, Dennis DL, Heidel RE, Self TH. Pharmacist‐Led
Inhaler Training for Nurses on an Acute Care Pulmonary Unit. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Blake R. Johnson
- University of Tennessee Medical Center Knoxville Tennessee
- University of Georgia College of Pharmacy, Athens, Georgia (Dr. Johnson was a resident at UT Medical Center at the time of this study.)
| | - Andrea S. Franks
- University of Tennessee Medical Center Knoxville Tennessee
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
- University of Tennessee Graduate School of Medicine Knoxville Tennessee
| | - Laura N. Bullock
- University of Tennessee Medical Center Knoxville Tennessee
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
| | - Danielle L. Dennis
- University of Tennessee Medical Center Knoxville Tennessee
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
| | - R. Eric Heidel
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
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6
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Gonzalez E, Glick JA, Shan G, Talbot JN. Economic and workload impact of therapeutic interchange of inhaler medications and nebulizer solutions. Am J Health Syst Pharm 2021; 78:41-48. [PMID: 33103194 DOI: 10.1093/ajhp/zxaa343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To examine the financial impact of automatic formulary substitution of nebulization solutions for pressurized metered dose inhalers and dry powder inhalers and the effect of the automatic substitution initiative on respiratory care practitioner (RCP) workload at a community hospital. METHODS A retrospective observational study was conducted in a 326-bed nonacademic community hospital. Adult patients who received respiratory medications and had an inpatient stay, were admitted for observation, or had an emergency room visit from December 2016 through February 2017 (the control group) or from December 2017 through February 2018 (the study group) were included in the analysis. The primary outcomes were the cost of respiratory medications per hospital stay and the number of RCP visits per hospital stay. The secondary outcome was the cost of wasted doses per hospital stay. RESULTS A total of 3,766 patients were included in the study: 2,030 in the study group and 1,736 in the control group. The mean cost of respiratory medications per hospital stay was significantly lower in the study group vs the control group ($13.29 vs $36.48, P < 0.001). The mean number of RCP visits per hospital stay was also statistically lower in the study group vs the control group (11.6 vs 12.9, P = 0.04). The mean cost of wasted doses was significantly lower in study group vs the control group ($0.25 vs $22.91, P < 0.001). CONCLUSION Automatic formulary substitution of nebulization solutions for inhaler medications significantly decreased medication costs without increasing the average number of RCP visits per hospital stay.
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Affiliation(s)
- Elizabeth Gonzalez
- Roseman University of Health Sciences College of Pharmacy, Henderson, NV
| | - Jason Alan Glick
- Roseman University of Health Sciences College of Pharmacy, Henderson, NV
| | - Guogen Shan
- University of Nevada, Las Vegas, Las Vegas, NV
| | - Jeffery N Talbot
- College of Graduate Studies, Roseman University of Health Sciences College of Graduate Studies, Henderson, NV
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7
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Vaquero-Lozano P, Lassaletta-Goñi I, Giner-Donaire J, Gómez-Neira MDC, Serra-Batlles J, García-García R, Álvarez-Gutiérrez FJ, Blanco-Aparicio M, Díaz-Pérez D. [Asthma 2020 Nursing Consensus Document]. OPEN RESPIRATORY ARCHIVES 2021; 3:100079. [PMID: 37497358 PMCID: PMC10369614 DOI: 10.1016/j.opresp.2020.100079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023] Open
Abstract
Asthma is a chronic respiratory disease which presents with a risk of exacerbations. Good patient management and continuous monitoring are crucial for good disease control, and pharmacological and non-pharmacological interventions are essential for proper treatment. Nurses specialised in asthma can contribute to the correct management of asthmatic patients. They play a key role in diagnostic tests, administration of medication, and patient follow-up and education. This consensus arose from the need to address an aspect of asthma management that does not appear in the specific recommendations of current guidelines. This document highlights and updates the role of specialized nurses in the care and management of asthma patients, offering conclusions and practical recommendations with the aim of improving their contribution to the treatment of this disease. Proposed recommendations appear as the result of a nominal consensus which was developed during 2019, and validated at the beginning of 2020.
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Affiliation(s)
- Paz Vaquero-Lozano
- Servicio de Neumología, CEP Hermanos Sangro, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Jordi Giner-Donaire
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Joan Serra-Batlles
- Servicio de Neumología, Hospital Universitario de Vic, Barcelona, España
| | - Rocío García-García
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | - David Díaz-Pérez
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Sta. Cruz de Tenerife, España
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8
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Bidder TM. Effective management of adult patients with asthma. Nurs Stand 2020; 34:43-50. [PMID: 31468778 DOI: 10.7748/ns.2019.e11411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 11/09/2022]
Abstract
Asthma is a chronic respiratory condition that can affect people of all ages. Globally, asthma is one of the most common non-communicable diseases and is associated with significant personal, financial and societal costs. In some cases, asthma can be fatal, although many fatalities would have been preventable with appropriate management. People with asthma often underestimate the effects of their symptoms, and nurses should develop their knowledge and skills so that they can provide appropriate management advice. This article outlines the causes of asthma and its symptoms. It also explains the interventions used in the management of this condition, including medicines, patient education, appropriate lifestyle changes and referral to specialist services.
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Affiliation(s)
- Therese Marie Bidder
- Department of Specialist Allergy and Clinical Immunology, Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust, London, England
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9
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Karle E, Patel TP, Zweig J, Krvavac A. Understanding the Knowledge Gap and Assessing Comfort Level among Healthcare Professionals Who Provide Inhaler Education. COPD 2020; 17:197-204. [PMID: 32237908 DOI: 10.1080/15412555.2020.1746251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Inhaled medications play a pivotal role in the management of COPD and asthma. Provider knowledge and ability to teach various devices is paramount as poor inhaler technique directly correlates with worse disease control. The goal of our survey was to assess the knowledge and comfort level with various inhaled devices among providers involved in patient inhaler education. We constructed a 20-question survey consisting of a five-question Likert scale-based comfort assessment and a 15-question multiple-choice inhaler knowledge test that was distributed both internally and nationwide. Groups surveyed included internal medicine residents, family medicine residents, pulmonary fellows, respiratory therapists, nursing staff, and pharmacists. A total of 557 providers responded to the survey. The overall correct response rate among all respondents was only 47%. There was no significant difference between correct response rates among prescribers (internal medicine residents, family medicine residents, and pulmonary fellows) and non-prescribers (respiratory therapists, nursing staff, and pharmacists), 47% and 47%, respectively (p = 0.6919). However, respiratory therapists had the overall highest correct response rate of 85%. Over 72% of respondents indicated that they educate patients on inhaler technique as part of their clinical duties. Furthermore, the correct response rates for various inhaler devices varied with 55% among metered dose inhalers, 52% among dry powder inhalers, and 34% among soft-mist inhalers. Our study reveals that there is a continued need for education on the subject of inhaler devices among providers given their overall poor knowledge, particularly in an era of fast-changing inhaler devices. We continue without knowing what we teach.
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Affiliation(s)
- Ethan Karle
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Tarang P Patel
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Jason Zweig
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Armin Krvavac
- Division of Pulmonary, Critical Care, and Environmental Medicine, Department of Medicine, University of Missouri, Columbia, Missouri, USA
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10
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Ozoglu Aytac S, Kilic SP, Ovayolu N. Effect of inhaler drug education on fatigue, dyspnea severity, and respiratory function tests in patients with COPD. PATIENT EDUCATION AND COUNSELING 2020; 103:709-716. [PMID: 31733985 DOI: 10.1016/j.pec.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study was conducted to examine the effect of inhaler drug education on fatigue, dyspnea severity, and respiratory function tests in patients with chronic obstructive pulmonary disease (COPD). METHODS This randomized controlled study was conducted with a total of 85 patients treated at the chest diseases clinic and outpatient clinic of a state hospital. The data were collected using questionnaires, respiratory function tests, and the COPD and Asthma Fatigue Scale (CAFS) and Visual Analogue Scale (VAS-for dyspnea severity). RESULTS It was determined that after 4 weeks of inhaler drug education, the CAFS mean score decreased to 35.32 ± 14.36, the dyspnea severity mean score decreased to 4.76 ± 2.50, and the respiratory function tests mean scores increased to forced expiratory volume in 1 s (FEV1) = 58.83 ± 25.48, forced vital capacity (FVC) = 59.04 ± 19.19, and FEV1/FVC = 88.39 ± 21.59 in the intervention group (p < 0.05). No change was observed in the patients in the control group except for FEV1 and FVC mean scores (p > 0.05). CONCLUSION These results demonstrate that inhaler drug education can improve fatigue, dyspnea severity, and respiratory function tests of patients with COPD. PRACTICE IMPLICATIONS The training by nurses of every patient hospitalized in the clinic regarding inhaler drug therapy, and the regular checking of patients' way of using the inhaled drugs, will contribute to COPD management.
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Affiliation(s)
- Sema Ozoglu Aytac
- Gaziantep University, Şahinbey, Research and Application Hospital, Gaziantep, Turkey
| | - Serap Parlar Kilic
- İnonu University Faculty of Nursing, Department of Internal Medicine Nursing, Battalgazi/Malatya, 44000, Turkey.
| | - Nimet Ovayolu
- Gaziantep University Faculty of Health Sciences, Department of Internal Medicine Nursing, Gaziantep, Turkey
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11
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Ndukwe HC, Shaul D, Shin J, Pang CD, Swee CY, Hong BT, Dummer JF, Fitzgerald C, Wilby KJ, Marra CA. Assessment of inhaler technique among fourth-year pharmacy students: Implications for the use of entrustable professional activities. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:281-286. [PMID: 32273063 DOI: 10.1016/j.cptl.2019.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/27/2019] [Accepted: 12/04/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION It is unknown when and how often competency assessments should occur in pharmacy education. Using inhaler technique as an example competency, the study objectives were to measure the proportion of near-graduation students demonstrating correct technique approximately one year after initial training and to measure reliability between assessors. METHODS A sample of 45 near-graduation pharmacy students with prior education on correct inhaler technique participated in this direct observation study at the University of Otago. Five trained assessors simultaneously rated each participant's inhaler technique demonstration using a checklist. RESULTS Of 37 participants demonstrating a pressurized metered dose inhaler, 21.62% demonstrated correct technique. No participants among eight volunteers demonstrated proper use of a dry powder inhaler. On average, two steps were performed correctly for each inhaler type. Steps with the highest error rate were "hold the inhaler upright and shake well," "breath out gently, away from the inhaler," and "keep breathing in slowly and deeply". The intraclass correlation coefficient for any inhaler type was excellent (0.91), suggesting assessors had strong reliability. CONCLUSIONS Students did not retain ability to correctly demonstrate inhaler technique one year after initial instruction. This finding supports the notion that demonstrable tasks may need to be frequently assessed to ensure the task is mastered and becomes a routine part of a student's practice. It also suggests that assessment of milestones and/or entrustable professional activities may need to occur at different time points throughout a program, rather than allowing for "signing off" prematurely.
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Affiliation(s)
- Henry C Ndukwe
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand.
| | - Diana Shaul
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand.
| | - Juhyun Shin
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand.
| | - Chun Ding Pang
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand.
| | - Chia Yin Swee
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand
| | - Bee Teng Hong
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand.
| | - Jack F Dummer
- Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | | | - Kyle J Wilby
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand.
| | - Carlo A Marra
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand.
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12
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Al-Otaibi HM. Evaluation of health-care providers' knowledge in the science of aerosol drug delivery: Educational sessions are necessary. J Family Community Med 2020; 27:62-66. [PMID: 32030080 PMCID: PMC6984029 DOI: 10.4103/jfcm.jfcm_138_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND: Aerosolized drugs are widely used to treat and control a variety of pulmonary diseases. However, there is increasing evidence that patients are unable to use their drug delivery device correctly. The failure of aerosolized treatment is usually the result of poorly communicated instructions. The aim of this investigation was to evaluate the knowledge of health-care providers in the science of aerosol drug delivery (ADD) and assess the impact of further education on their knowledge. MATERIALS AND METHODS: One hundred and seventeen health-care providers attended a 4-hour educational course on ADD science. The course was conducted from June to August 2018 in Jeddah, Riyadh, and Dammam. Pre-course assessment done with a 12-item multiple-choice questionnaire. Post-course assessment was conducted after the end of course in which participants were asked to rate their knowledge of ADD on a scale of 1–10 (before and after the course). RESULTS: Sixty-six health-care providers (physicians, pharmacists, respiratory therapists, and health educators) completed the course. The participants' clinical experience, on average (±standard deviation), was 7.6 ± 7.3 years. Clinical experience favored physicians over other groups. The precourse score for all participants was 3.2 ± 1.9 out of 12 and the postcourse score was 6.97 ± 2.7. There was a significant statistical difference between pre- and postcourse assessment scores (P < 0.05). Differences between the four specialties were insignificant (P = 0.216), without a correlation between clinical experience and preassessment scores (P = 0.202). CONCLUSION: The present data indicate that health-care providers' knowledge of ADD is completely inadequate. There is an urgent need to introduce an ADD educational package in the curricula. An annual competency-based evaluation for health-care providers is critical as well.
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Affiliation(s)
- Hajed M Al-Otaibi
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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13
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Larson T. Economic impact and chronic obstructive pulmonary disease outcomes of a comprehensive inhaler to nebulization therapy protocol implementation in a large multi-state healthcare system. Curr Med Res Opin 2019; 35:1805-1817. [PMID: 31172836 DOI: 10.1080/03007995.2019.1628562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: There are currently 39 FDA-approved metered-dose (MDI) or dry-powder inhalers (DPI) on the US market. Most are high cost with significantly more drug in the device than needed for a typical average length of stay in acute care hospitals, which leads to significant waste. The objective was to assess the financial impact and chronic obstructive pulmonary disease (COPD) outcomes of a comprehensive inhaler to nebulization protocol implemented in a large multi-state US health system. Methods: The retrospective study evaluated respiratory drug costs at 28 hospitals in the health system after a phased implementation of the automatic inhaler to nebulization protocol. Purchasing data was collected for all respiratory medications impacted by the protocol for the twelve months preceding as well as the two subsequent twelve-month periods following implementation at each facility. COPD length of stay (LOS) and 30 day readmissions were also reviewed. An attempt was made to evaluate the impact on respiratory therapy (RT) department workload. Results: Compared to pre-implementation, system-wide drug expenditures declined $1,561,011 (38.5%) and $1,646,411 (40.6%) in post-implementation year 1 (PY1) and post-implementation year 2 (PY2), respectively. COPD LOS and 30 day readmissions were not adversely affected and remained relatively stable in comparative periods. Objective impact on RT productivity and labor statistics was not ascertained due to complicated variables and multiple service lines. Conclusions: In an era of increased drug costs incurred by hospitals, a comprehensive inhaler to nebulization protocol significantly decreased costs without incurring any negative observed trends in COPD LOS or readmissions.
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Affiliation(s)
- Trent Larson
- Banner Desert Medical Center, Banner Health , Mesa , AZ , USA
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Basak T, Demirtas A, Iyigun E. The effect of simulation based education on patient teaching skills of nursing students: A randomized controlled study. J Prof Nurs 2019; 35:417-424. [DOI: 10.1016/j.profnurs.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 11/29/2022]
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15
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Getch YQ, Neuharth-Pritchett S, Schilling EJ. Asthma and the Public School Teacher: A Two State Study. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2019; 32:109-116. [PMID: 32140279 PMCID: PMC7057052 DOI: 10.1089/ped.2019.1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
Background: Asthma is one of the most common chronic health problems experienced by school-age children. As a result, school professionals need to be well informed about this chronic illness so that they can adequately support the needs of students with asthma. Methods: This study examines data collected from a sample of teachers (n = 593) in 2 large southeastern states regarding their familiarity with asthma self-carry and self-administration laws and policies and training received related to general chronic health conditions including asthma. Results: Teachers, on average, reported little training received at either undergraduate or graduate levels. Although teachers noted knowledge about asthma, acquired through in-service training or to a lesser degree formal education, a high percentage of teachers reported receiving no asthma-related training through such approaches. Conclusions: Data in this study are consistent with data collected in a similar study in 2001 suggesting that while asthma prevalence has increased, education about the condition has not. Implications for school teachers, school administrators, school nurses, teacher educators, and asthma education personnel are provided.
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Affiliation(s)
- Yvette Q. Getch
- Department of Counseling and Instructional Sciences, University of South Alabama, Mobile, Alabama
| | | | - Ethan J. Schilling
- Department of Psychology, School Psychology Graduate Program, Western Carolina University, Cullowhee, North Carolina
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Barefield KL, DeBellis HF. A review of health‐related outcomes from community pharmacist interventions in patients with chronic obstructive pulmonary disease. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kimberly L. Barefield
- Department of Pharmacy Practice Philadelphia College of Osteopathic Medicine Suwanee Georgia
| | - Heather F. DeBellis
- Department of Pharmacy Practice South University School of Pharmacy Savannah Georgia
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Kerwin EM, Preece A, Brintziki D, Collison KA, Sharma R. ELLIPTA Dry Powder Versus Metered-Dose Inhalers in an Optimized Clinical Trial Setting. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1843-1849. [PMID: 30836228 DOI: 10.1016/j.jaip.2019.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reduced error rates have been demonstrated with the ELLIPTA inhaler versus other commonly used devices. OBJECTIVE This phase IV, randomized, crossover study evaluated correct use of ELLIPTA compared with 2 commonly prescribed metered-dose inhalers (MDIs) in adults with asthma and optimized inhaler technique. METHODS The study comprised 2 crossover substudies (ELLIPTA vs MDI-1 and ELLIPTA vs MDI-2). Inhaler use was assessed at the start of each period, following instruction from a health care professional, and after 28 days of use without instruction. Data for each inhaler were pooled within substudies, irrespective of treatment sequence; study objectives were addressed in each substudy. The primary end point, percentage of participants making 0 errors after 28 days of use, was analyzed separately for each substudy using a Mainland-Gart test for each ELLIPTA versus MDI comparison. RESULTS Correct use rates after 28 days were higher with ELLIPTA than with MDI-1 and MDI-2 (ELLIPTA vs MDI-1, 96% vs 84%; ELLIPTA vs MDI-2, 98% vs 91%). Among discordant cases, statistically significantly more participants correctly used ELLIPTA but made 1 or more overall error with MDIs than did those who correctly used the MDIs but made 1 or more overall error using ELLIPTA (87% vs 13% in both substudies; P < .001 and P = .007 for ELLIPTA vs MDI-1 and ELLIPTA vs MDI-2, respectively). More participants made multiple device errors with MDIs than with ELLIPTA. CONCLUSIONS Inhaler technique can be optimized in trial settings. In such settings, ELLIPTA is associated with higher rates of correct use and lower error rates than are MDIs.
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Affiliation(s)
- Edward M Kerwin
- Clinical Research Institute of Southern Oregon, Medford, Ore.
| | - Andrew Preece
- Respiratory Therapy Area Unit, GlaxoSmithKline plc., Stockley Park West, Uxbridge, Middlesex, United Kingdom
| | - Dimitra Brintziki
- Respiratory Clinical Statistics, GlaxoSmithKline plc., Stockley Park West, Uxbridge, Middlesex, United Kingdom
| | | | - Raj Sharma
- Respiratory Medical Franchise, GlaxoSmithKline plc., Brentford, Middlesex, United Kingdom
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Chee EJM, Prabhakaran L, Neo LP, Carpio GAC, Tan AJQ, Lee CCS, Liaw SY. Play and Learn with Patients-Designing and Evaluating a Serious Game to Enhance Nurses' Inhaler Teaching Techniques: A Randomized Controlled Trial. Games Health J 2019; 8:187-194. [PMID: 30649974 DOI: 10.1089/g4h.2018.0073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To describe the development and evaluation of a nurse-patient interactive serious game in improving nurses' self-efficacy and performances in teaching the correct inhaler technique. Materials and Methods: The technology, pedagogy, and content knowledge (TPACK) framework was applied to guide the development of the serious game. The learning effectiveness of the serious game was evaluated through a randomized controlled trial that involved 46 registered nurses. Participants in the experimental group were asked to teach the inhaler technique to a standardized patient using the serious game as a teaching tool, whereas participants in the control group were asked to provide their own usual teaching to a standardized patient without the serious game. The performances of both groups were assessed based on their feedback to a standardized patient who made several errors while demonstrating the inhaler technique. Self-efficacy levels of teaching the inhaler technique were examined before and after the intervention. Results: A significantly higher number of participants from the experimental group obtained perfect performance scores than those in the control group (65.21% vs. 21.74%, χ2 = 15.18, P < 0.01). The posttest self-efficacy mean scores for the experimental group improved significantly (P < 0.001) after the intervention, and significantly higher (P < 0.05) compared to the posttest mean scores of the control group. Conclusion: The study provided evidence on the effectiveness of a serious game in improving the self-efficacy and immediate postintervention performances of nurses teaching the inhaler technique. This game provides a practical and accessible learning tool to help nurses ensure effective patient education.
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Affiliation(s)
| | - Lathy Prabhakaran
- 1 Department of Nursing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lay Ping Neo
- 1 Department of Nursing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Guiller Augustin C Carpio
- 2 Centre for Learning Environment and Assessment Development, Singapore Institute of Technology, Singapore, Singapore
| | - Apphia Jia Qi Tan
- 3 Department of Nursing, National University Hospital, Singapore, Singapore
| | | | - Sok Ying Liaw
- 5 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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McCabe EM, McDonald C, Connolly C, Lipman TH. A Review of School Nurses' Self-Efficacy in Asthma Care. J Sch Nurs 2018; 35:15-26. [PMID: 30376756 DOI: 10.1177/1059840518808886] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Asthma is the most common pediatric chronic respiratory illness and has a significant influence on children's health, school attendance, and overall school success. Despite the effect of education and training, gaps remain in understanding school nurses' self-efficacy (SE) in asthma care. The purpose of this integrative literature review is to gain a greater understanding of school nurses' SE in asthma care. Themes and topics in the current school nursing literature regarding SE in asthma care include the value of continuing education, educational interventions, and the use of resources in clinical practice such as the asthma action plan. This review indicates the importance of developing a greater understanding of the unique features of school nursing, the necessary resources, and the external factors that influence practice. Further research to establish a framework to evaluate how a change in practice may support school nurses' SE and promote positive student health outcomes is needed.
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Affiliation(s)
- Ellen M McCabe
- 1 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Cynthia Connolly
- 1 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Terri H Lipman
- 1 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Scullion J. The Nurse Practitioners' Perspective on Inhaler Education in Asthma and Chronic Obstructive Pulmonary Disease. Can Respir J 2018; 2018:2525319. [PMID: 30154941 PMCID: PMC6098863 DOI: 10.1155/2018/2525319] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) can be debilitating conditions adversely affecting a person's quality of life. Effective treatments are available, but common errors in the use of inhalers compound the issue of disease control. The beliefs and concerns of a patient can also have an impact on treatment adherence, the consequences of which are diminished disease control and the occurrence of exacerbations. Once a treatment has been prescribed, it is often nurses who manage the patient long-term, and they may even be the main care provider. This puts nurses in a key position to monitor inhaler technique, communicate with the patient to improve adherence, and even suggest alternative treatments if the patient and therapy are incompatible. This review examines the central role that nurses play in disease management and emphasizes how effective inhaler education can make a difference to disease control. Good communication between the nurse and patient is vital if this is to be achieved. Recent updates to asthma and COPD guidelines are reviewed, and key resources available to help manage patients are highlighted. Finally, with regard to inhaler education, we reconsider the nursing keystones of "Know it," "Show it," "Teach it," and "Review it."
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Affiliation(s)
- Jane Scullion
- University Hospitals of Leicester NHS Trust, Leicester, UK
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A model to integrate patient preferences into delivery systems: the importance of end-user input into pulmonary delivery. Ther Deliv 2018; 7:591-3. [PMID: 27582231 DOI: 10.4155/tde-2016-0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Plaza V, Giner J, Rodrigo GJ, Dolovich MB, Sanchis J. Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:987-995. [PMID: 29355645 DOI: 10.1016/j.jaip.2017.12.032] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/15/2017] [Accepted: 12/30/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Inefficient inhaler technique (IT) compromises the optimal delivery of medication. However, the IT knowledge of health care professionals (HCPs) has received scant attention. OBJECTIVE The objective of this study was to perform a systematic review of published reports assessing the IT proficiency of HCPs in using pressurized metered dose (pMDI) and dry powder (DPI) inhalers. METHODS Studies published between 1975 and 2014 that directly assessed the IT skills of HCPs were selected according to predefined selection criteria. RESULTS Data were extracted from 55 studies involving 6,304 HCPs who performed 9,996 tests to demonstrate their IT proficiency. Overall, the IT was considered correct in 15.5% of cases (95% confidence interval [CI], 12-19.3), decreasing over time from 20.5% (95% CI, 14.9-26.8) from the early period (defined as 1975-1995) to 10.8% (95% CI, 7.3-14.8) during the late period (1996-2014). The most common errors in the use of pMDIs were as follows: not breathing out completely before inhalation (75%; 95% CI, 56-90), lack of coordination (64%; 95% CI, 29-92), and postinhalation breath-hold (63%; 95% CI, 52-72). The most common errors using DPI were deficient preparation (89%; 95% CI, 82-95), not breathing out completely before inhalation (79%; 95% CI, 68-87), and no breath-hold (76%; 95% CI, 67-84). CONCLUSIONS HCPs demonstrated inadequate knowledge of the proper use of inhalers. The poor understanding of the correct use of these devices may prevent these professionals from being able to adequately assess and teach proper inhalation techniques to their patients.
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Affiliation(s)
- Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Jordi Giner
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gustavo J Rodrigo
- Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Myrna B Dolovich
- Department of Medicine, Division of Respirology, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Joaquin Sanchis
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
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Post hospitalization management of patients with COPD. Nurs Manag (Harrow) 2017; 49:14-21. [PMID: 29287045 DOI: 10.1097/01.numa.0000527713.06404.d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eychenne N, Jaouadi A, Macquart de Terline D, Fratta A, Laribe-Caget S, Steichen O, Fernandez C, Antignac M. [Assessment of physicians' and nurses' knowledge and practices of aerosol therapy]. Rev Mal Respir 2016; 34:553-560. [PMID: 27863827 DOI: 10.1016/j.rmr.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Aerosol therapy is an efficient, but complex procedure. National and international practice guidelines are regularly updated. However, only a few studies have assessed the application of guidelines by users. The aim of this study is to assess the knowledge and practices of physicians and nurses regarding these guidelines. METHODS Two self-administered questionnaires were designed by a working team and presented to physicians and nurses of four university hospitals in Paris. A pharmacy resident collected and analyzed the data with the aid of an online survey website. RESULTS A total of 481 physicians and nurses completed the questionnaires (33 % of physicians and 67 % of nurses). Only 241/480 physicians and nurses (50 %) knew that several intravenous drugs cannot be nebulized. Ninety-four of 422 (22 %) of them always choose oxygen as the driving gas and 239/311 nurses (77 %) think that single use nebulizers can be re-used for the same patient. CONCLUSIONS This survey shows that many physicians and nurses lack knowledge and use inappropriate practices. Based on these results, a booklet has been designed by the working team. This booklet should help health professionals to harmonize practices across hospitals and to follow the guidelines correctly.
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Affiliation(s)
- N Eychenne
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - A Jaouadi
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - D Macquart de Terline
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - A Fratta
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Armand-Trousseau, 75012 Paris, France
| | - S Laribe-Caget
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Rothschild, 75012 Paris, France
| | - O Steichen
- Service de médecine interne, hôpitaux universitaires Est-Parisien, AP-HP, site Tenon, 75020 Paris, France; Faculté de médecine, UPMC, université Paris 6, Sorbonne universités, 75005 Paris, France
| | - C Fernandez
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Département de pharmacie clinique, faculté de pharmacie, université Paris Sud, 92290 Châtenay-Malabry, France
| | - M Antignac
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Empowering family physicians to impart proper inhaler teaching to patients with chronic obstructive pulmonary disease and asthma. Can Respir J 2016; 22:266-70. [PMID: 26436910 DOI: 10.1155/2015/731357] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) and asthma depend on inhalers for management, but critical errors committed during inhaler use can limit drug effectiveness. Outpatient education in inhaler technique remains inconsistent due to limited resources and inadequate provider knowledge. OBJECTIVE To determine whether a simple, two-session inhaler education program can improve physician attitudes toward inhaler teaching in primary care practice. METHODS An inhaler education program with small-group hands-on device training was instituted for family physicians (FP) in British Columbia and Alberta. Sessions were spaced one to three months apart. All critical errors were corrected in the first session. Questionnaires surveying current inhaler teaching practices and attitudes toward inhaler teaching were distributed to physicians before and after the program. RESULTS Forty-one (60%) of a total 68 participating FPs completed both before and after program questionnaires. Before the program, only 20 (49%) reported providing some form of inhaler teaching in their practices, and only four (10%) felt fully competent to teach patients inhaler technique. After the program, 40 (98%) rated their inhaler teaching as good to excellent. Thirty-four (83%) reported providing inhaler teaching in their practices, either by themselves or by an allied health care professional they had personally trained. All stated they could teach inhaler technique within 5 min. Observation of FPs during the second session by certified respiratory educators found that none made critical errors and all had excellent technique. CONCLUSION A physician inhaler education program can improve attitudes toward inhaler teaching and facilitate implementation in clinical practices.
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Optimising Inhaled Pharmacotherapy for Elderly Patients with Chronic Obstructive Pulmonary Disease: The Importance of Delivery Devices. Drugs Aging 2016; 33:461-73. [DOI: 10.1007/s40266-016-0377-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Han MK, Martinez CH, Au DH, Bourbeau J, Boyd CM, Branson R, Criner GJ, Kalhan R, Kallstrom TJ, King A, Krishnan JA, Lareau SC, Lee TA, Lindell K, Mannino DM, Martinez FJ, Meldrum C, Press VG, Thomashow B, Tycon L, Sullivan JL, Walsh J, Wilson KC, Wright J, Yawn B, Zueger PM, Bhatt SP, Dransfield MT. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. THE LANCET RESPIRATORY MEDICINE 2016; 4:473-526. [PMID: 27185520 DOI: 10.1016/s2213-2600(16)00094-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow. Although progress has been made in the the development of diagnostics, therapeutics, and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care. In this Commission, we summarise expert opinion from key stakeholders-patients, caregivers, and medical professionals, as well as representatives from health systems, insurance companies, and industry-to understand barriers to care delivery and propose potential solutions. Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location, and socioeconomic status. Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health-care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation. Although much attention has recently been focused on the reduction of hospital readmissions for COPD exacerbations, health systems in the USA struggle to meet these goals, and methods to reduce readmissions have not been proven. There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial. Financial incentives might be important in raising engagement of providers and health systems. Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available.
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Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, and VA Puget Sound Health Care System, US Department of Veteran Affairs, Seattle, WA, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Branson
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital & Health Sciences System, University of Illinois, Chicago, IL, USA
| | - Suzanne C Lareau
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | | | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Fernando J Martinez
- Department of Internal Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Catherine Meldrum
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - Valerie G Press
- Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Byron Thomashow
- Division of Pulmonary, Critical Care and Sleep Medicine, Columbia University Medical Center, New York, NY, USA
| | - Laura Tycon
- Palliative and Supportive Institute, Pittsburgh, PA, USA
| | | | | | - Kevin C Wilson
- Boston University School of Medicine, Boston, MA, USA; American Thoracic Society, New York, NY, USA
| | - Jean Wright
- Carolinas HealthCare System, Charlotte, NC, USA
| | - Barbara Yawn
- Family and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Patrick M Zueger
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
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Basheti IA, Hamadi SA, Reddel HK. Inter-professional education unveiling significant association between asthma knowledge and inhaler technique. Pharm Pract (Granada) 2016; 14:713. [PMID: 27011779 PMCID: PMC4800018 DOI: 10.18549/pharmpract.2016.01.713] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 03/04/2016] [Indexed: 12/02/2022] Open
Abstract
Objectives: To explore whether an association exists between health care professionals’ (HCPs) asthma knowledge and inhaler technique demonstration skills. Methods: HCPs’ asthma knowledge and inhaler technique demonstration skills were assessed at baseline at an inter-professional educational workshop focusing on asthma medication use. Asthma knowledge was assessed via a published questionnaire. Correct inhaler technique for the three inhalers, the Accuhaler, Turbuhaler and pressurized Metered Dose Inhaler (pMDI) was assessed using published checklists. Results: Two hundred HCPs agreed to participate: 10 specialists (medical doctors specialized in respiratory diseases) (5%), 46 general practitioners (23%), 79 pharmacists (39%), 15 pharmacists’ assistants (8%), 40 nurses (20%) and 10 respiratory therapists (5%). Backwards stepwise multiple regression conducted to determine predictors of HCPs’ inhaler technique, showed that out of many independent variables (asthma knowledge score, profession, age, gender, place of work, years in practice and previous personal use of the study inhaler/s), asthma knowledge score was the only variable showing significant association with inhaler technique (R2=0.162, p<0.001). Conclusion: This study revealed significant associations between asthma knowledge and inhaler technique scores for all HCPs. Providing inter-professional workshops for all HCPs involved integrating education on asthma knowledge and practice of inhaler technique skills are looked-for.
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Affiliation(s)
- Iman A Basheti
- Department of Clinical Pharmacy & Therapeutics, Faculty of Pharmacy, Applied Science University , Amman ( Jordan ).
| | - Salim A Hamadi
- Department of Pharmacology & Biomedical Sciences, Faculty of Pharmacy and Medical Sciences, Petra University . Amman ( Jordan ).
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney . Sydney, NSW ( Australia ).
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