How Patient-Centred Are Inhaler Device Choices? A Survey of Canadian Prescribers.

Background: The choice of inhaler device type can play a crucial role in managing asthma and chronic obstructive pulmonary disease (COPD). With various devices available, differences in choice and application may lead to confusion for both prescribers and patients. Furthermore, improper use of a device may lead to suboptimal or inadequate treatment. Objectives: The primary objective was to identify factors that prescribers consider when selecting an inhaler device for a patient. The secondary objective was to evaluate the rankings of these factors, including identification of which factors had greater importance and frequency for prescribers' choice of inhaler device for patients. Methods: A 10-question online survey was developed and distributed in late 2021 to prescribers (physicians, nurse practitioners, and pharmacists) in western Canada in an outpatient setting. Prescribers were asked to use their own words to describe the factors they considered important and were then asked to rank the stated factors in order of importance for 2 scenarios: an 83-year-old woman with COPD and a 21-year-old man with asthma. The results were examined qualitatively and quantitatively. Recurring themes were identified, and each response was categorized on the basis of its corresponding theme. Results: In all, 82 respondents completed the survey (yielding a total of 164 responses across the 2 scenarios). Overall, prescriber experience (84/164, 51%), cost (84/164, 51%), patient ease of use (59/164, 36%), and other patient considerations (49/164, 30%) were the factors most frequently mentioned. The prescriber's experience was most often mentioned as a factor for scenario 1 (COPD), whereas cost was most often mentioned for scenario 2 (asthma). In both scenarios, prescriber experience was the highest-ranked factor. Conclusions: When determining the appropriate type of inhaler device, respondents frequently prioritized their own experience, as well as cost and ease of use. However, many respondents ranked prescriber experience higher than all other factors.

Contexte: Le choix du type d'inhalateur peut jouer un rôle crucial dans la gestion de l'asthme et de la maladie pulmonaire obstructive chronique (MPOC). Étant donné la diversité des dispositifs disponibles, les différences de choix et d'application peuvent prêter à confusion tant pour les prescripteurs que pour les patients. De plus, la mauvaise utilisation d'un appareil peut conduire à un traitement sous-optimal ou inadéquat. Objectifs: L'objectif principal consistait à identifier les facteurs pris en compte par les prescripteurs lors de la sélection de l'inhalateur pour un patient. L'objectif secondaire consistait à évaluer le classement de ces facteurs, notamment l'identification des facteurs les plus importants et des inhalateurs les plus fréquemment choisis par les prescripteurs. Méthodes: Un sondage en ligne de 10 questions a été préparé et distribué fin 2021 aux prescripteurs (médecins, infirmières praticiennes et pharmaciens) de l'ouest du Canada en milieu ambulatoire. Les prescripteurs devaient, dans leurs propres mots, décrire les facteurs qui leur semblaient importants avant de les classer par ordre d'importance dans le cadre de deux scénarios : une femme de 83 ans atteinte de MPOC et un homme de 21 ans avec de l'asthme. Les résultats ont fait l'objet d'un examen qualitatif et quantitatif. Des thèmes récurrents ont été identifiés et chaque réponse a été catégorisée en fonction du thème correspondant. Résultats: Au total, 82 répondants ont répondu au sondage (total de 164 réponses dans les 2 scénarios). Dans l'ensemble, l'expérience du prescripteur (84/164, 51 %), le coût (84/164, 51 %), la facilité d'utilisation pour le patient (59/164, 36 %) et d'autres considérations en rapport avec le patient (49/164, 30 %) étaient les facteurs déterminants les plus fréquemment mentionnés. Pour le scénario 1 (MPOC), l'expérience du prescripteur était le facteur le plus souvent mentionné, alors que le coût l'était pour le scénario 2 (asthme). Dans les deux scénarios, l'expérience du prescripteur était le facteur le plus important. Conclusions: Lors de la détermination du type d'inhalateur approprié, les répondants ont souvent donné la priorité à leur expérience personnelle, ainsi qu'au coût et à la facilité d'utilisation. Cependant, de nombreux répondants ont accordé une note plus élevée à l'expérience du prescripteur qu'à d'autres facteurs.

Autoantibody detection using indirect immunofluorescence on HEp-2 cells.

The detection of autoantibodies is an important element in the diagnosis and monitoring of disease progression in patients with autoimmune diseases. In laboratory diagnostic tests for connective tissue and autoimmune liver diseases, indirect immunofluorescence on HEp-2 cells plays a central role in a multistage diagnostic process. Despite the high quality of diagnostics, findings at different laboratories can differ considerably due to a lack of standardization, as well as subjective factors. The present paper formulates recommendations for the standardized processing and interpretation of the HEp-2 cell test for the detection of non-organ-specific (especially antinuclear) antibodies. It provides requirements regarding the diagnostic tests used, instructions for laboratory procedure and evaluation, and recommendations for interpretation. For an optimal laboratory diagnostic process, it is useful to have an informative, tentative clinical diagnosis and an experienced laboratory diagnostician. In addition, the following key elements are recommended: initial screening using indirect immunofluorescence on carefully chosen HEp-2 cells beginning with a serum dilution of 1:80 and evaluation under a microscope with powerful illumination; results from a titer of 1:160 upwards being considered positive; internal laboratory quality control; and standardized interpretation. The aim is to improve diagnostic tests and care of patients with autoimmune diseases as a central concern of the European Autoimmunity Standardization Initiative (EASI).

Standardization of autoimmune diagnostics in Germany: activities of the German group in the European Autoimmune Standardization Initiative.

The German Regional Group of EASI was established during the annual Meeting of the German Society of Immunology in Kiel in September 2005. Since this initial informative meeting, an active core group of about a dozen rheumatologists, immunologists, and laboratory specialists has been generating starter projects. In general, these projects do focus on clinically associated diagnostic questions, and do integrate a variety of specialists with profound knowledge in several related subjects. The aims of the German EASI group are to contribute to the definition of standards and to improve patient care. Therefore, the group is establishing guidelines for the diagnosis of autoimmune diseases, to standardize and improve their quality, combining the experience of clinical and laboratory specialists. The diagnostic activities focus currently on systemic lupus erythematosus (SLE) and on rheumatoid arthritis. These activities include laboratory investigations and diagnosis through clinical manifestations. Standardized diagnostics cannot be based solely on vague symptoms and positive laboratory tests. In laboratory diagnostics, standardization and implementation of objective methods for the detection of autoantibodies has been identified as a central challenge. Here, immune fluorescence techniques and the evaluation of RibP are used as first parameters that could improve SLE diagnostics. Furthermore, guidelines and proposals from scientific medical organizations, and in particular from other national EASI groups will be adapted to the German health system. A cornerstone of implementation is the identification and logistic preparation of existing serum banks, the definition of gaps that should be bridged, and, particularly, the definition and collection of adequate control groups. Through these measures, the German EASI group will provide a standardized diagnostic model of autoimmune disorders throughout Europe starting in the field of rheumatology. Diagnostics may become more rational, efficient, faster, and cost-efficient. Patients with autoimmune rheumatic disorders will profit from receiving an earlier and more accurate diagnosis, which again will allow earlier therapeutic intervention and lead to a better long-term clinical outcome.