ABSTRACT
Objective: To assess the adherence of management of beta thalassaemia major patients at Lady Ridgeway Hospital to an established standard treatment protocol Method: A clinical audit was carried out in all six medical wards of Lady Ridgeway Hospital from 1st February 2008 to 31st March 2008 with retrospective data collected over the period 1st January 2005 to 31st December 2007. The study population comprised all beta thalassaemia major patients admitted to the wards during the study period. Patients who did not give consent and those having other transfusion dependant anaemias were excluded from the study. The study instrument used was a pretested structured data collection form. Data collection was done by referring the past medical records. Data on ‘compliance’ was based on recall by the parent. Data analysis was done on a Microsoft Excel worksheet. Results: During the study period data was collected from 61 patients. Age at time of diagnosis ranged from 2 months to 5 years. All patients had their diagnosis confirmed by haemoglobin electrophoresis, high performance liquid chromatography or both tests. Pre-transfusion haemoglobin levels ranged from 4.1 mg/dl to 11.2 mg/dl. Number of blood transfusions per year ranged from 4–18 per year. Almost 50% of the patients had serum ferritin levels above the potentially cardiotoxic level of 2500 µg/l. Conclusions: Compliance of the patients with the treatment protocol was unsatisfactory. A high proportion of patients had cardiotoxic levels of serum ferritin.
ABSTRACT
Objective To determine the use of inhaled corticosteroids in a cohort of children at Lady Ridgeway Hospital (LRH), Colombo. Method A cross-sectional descriptive study was carried out on all clinic and in-ward patients of ward 4 LRH receiving inhaled corticosteroids for more than 6 months. A pre-tested, structured interviewer administered questionnaire was used to collect data on the demography, type of drug and device, adherence and response to therapy. Results The study population comprised 185 children, 55% of whom were males and 35% in the 2-5 year age group. In 90% the inhaled steroid was beclomethasone. Metered dose inhaler was used by 64% and dry powder inhaler by 36% for steroid delivery. Ninety six percent of the study population used the correct inhaler device for their age group. The commonest indication for inhaled steroid was moderate persistent bronchial asthma. The technique was demonstrated at initiation to 99.5% of the users by the prescriber. Eighty four percent of the study population practised a ‘good’ technique. Nearly 80% of the patients adhered to the therapy daily and attended the clinic regularly. Around 15% needed hospitalisation. About 96% showed restricted lifestyles, mainly consumption of iced food. Inhaler technique of the patient had a significant effect on the clinical response to therapy (p<0.05). Conclusions Beclomethasone was the most commonly used inhaled corticosteroid in the study. Ninety six percent used the correct inhaler device for their age group. Inhaler technique had a significant effect on the clinical response. About 96% had restricted lifestyle despite optimal control.