ABSTRACT
While single-inhaler triple therapy (SITT) devices were not available when the Global Initiative for Chronic Obstructive Lung Disease strategy and National Institute for Health and Care Excellence guidelines were developed, two devices are now available in the UK. This paper offers practical, patient-focused advice to optimize placement of SITT in the management of COPD. A survey of UK health care professionals (HCPs) identified issues around, and attitudes toward, SITT, which informed a multidisciplinary expert panel's discussions. The survey confirmed the need to clarify the place of SITT in COPD management. The panel suggested three criteria, any one of which identifies a high-risk patient where escalation to triple therapy from monotherapy or double combination treatment is appropriate: 1) at least two exacerbations treated with oral corticosteroids, antibiotics, or both in the previous year; 2) at least one severe exacerbation that required hospital admission in the previous year; 3) one exacerbation a year on a repeated basis for 2 consecutive years. Appropriate non-pharmacological management is essential for all patients and should be considered before stepping up treatment. Regular review is essential. During each review, HCPs should consider stepping treatment up or down. If patients exacerbate despite adhering to triple therapy, an individualized approach should be considered if the inhaled corticosteroid (ICS) confers benefit or causes side effects. In this situation, the blood eosinophil count could aid decision making. ICSs should be continued when the history suggests that asthma overlaps with COPD. Training, counseling, and education should be individualized. HCPs should consider referral: 1) when there is limited response to treatment and persistent exacerbations; 2) where there is diagnostic uncertainty or suspected comorbidity; 3) whenever they feel "out of their depth." Overall, the panel concurred that when used correctly, SITT has the potential to improve adherence, symptom control, and quality of life, and reduce exacerbations. Studies using real-world evidence need to confirm these benefits.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Adrenergic beta-2 Receptor Agonists/administration & dosage , Bronchodilator Agents/administration & dosage , Lung/drug effects , Muscarinic Antagonists/administration & dosage , Nebulizers and Vaporizers , Primary Health Care , Pulmonary Disease, Chronic Obstructive/drug therapy , Administration, Inhalation , Clinical Decision-Making , Drug Combinations , Health Care Surveys , Humans , Lung/physiopathology , Patient Selection , Patient-Centered Care , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Recovery of Function , Treatment Outcome , United KingdomABSTRACT
The pattern of injuries caused when a helicopter crashed after an uncontrolled descent of approximately 15 m is described. Eleven patients were admitted to hospital for further treatment and observation, and 7 were treated in the Accident and Emergency Department. One-third of the victims sustained injuries to the dorsolumbar spine. Some conditions which could improve flight safety are discussed.
Subject(s)
Accidents, Aviation , Aircraft , Spinal Injuries/epidemiology , Craniocerebral Trauma/epidemiology , Humans , ScotlandABSTRACT
The pattern of injuries caused when a helicopter crashed after an uncontrolled descent of approximately 15 m is described. Eleven patients were admitted to hospital for further treatment and observation, and 7 were treated in the Accident and Emergency Departament. One-third of the victims sustained injuries to the dorsolumbar spine. Some conditions which could improve flight safety are discussed
Subject(s)
Accidents, Aviation , Wounds and Injuries , Health Effects of Disasters , Scotland , Man-Made DisastersABSTRACT
The British Orthopaedic Association assessment questionnaire for knee replacements was adapted to allow comparison of the severity of underlying polyarthritis with the benefits of geometric knee replacement in a retrospective study of 150 knees between six months and six years after operation. Total or partial relief of pain was achieved in 81 per cent of the operation, and changes in mobility occurred in fewer patients. Late sepsis remained a serious complication of nine per cent of the operations and one patient died from septicaemia. Late sepsis was associated with previous synovectomy or osteotomy. Retropatellar pain rarely interfered with the mobility of the patient. There was no association of operations that failed with a high erythrocyte sedimentation rate, a high platelet count, a low haemoglobin level or with a strongly positive rheumatoid factor but pain in the contralateral knee was associated with a diminished functional capacity.
Subject(s)
Arthritis, Rheumatoid/surgery , Knee Joint/surgery , Knee Prosthesis , Adult , Aged , Bacterial Infections/etiology , Female , Humans , Male , Middle Aged , Movement , Postoperative Complications , Reoperation , Retrospective StudiesSubject(s)
Toes/abnormalities , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Methods , Toes/surgerySubject(s)
Bone Diseases, Metabolic/diagnostic imaging , Etidronic Acid , Organotechnetium Compounds , Technetium , Adult , Aged , Bone and Bones/metabolism , Etidronic Acid/metabolism , Female , Fractures, Bone/diagnostic imaging , Humans , Kidney Diseases/diagnostic imaging , Male , Middle Aged , Radionuclide Imaging , Time FactorsABSTRACT
Vascular complications are rare in cases of simple anterior dislocation of the shoulder but the axillary artery and its branches may be damaged. Four cases of axillary artery injury, including 2 cases of complete transection of the artery, are presented. Full upper limb function may return if the vascular damage is recognized and prompt surgical treatment undertaken.
