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Biomedical subjects

M R Partridge

Publications and source records attributed to M R Partridge.

At least 37 records · Page 2Linked to original sources
PubMed2003

Development of the satisfaction with inhaled asthma treatment questionnaire.

For the management of a condition such as asthma, patients should feel confident with their medication, feel that the treatment is adequate in controlling symptoms and that side-effects of the treatment are minimal. As no comprehensive instrument to measure patient satisfaction with inhaled asthma medication existed, the Satisfaction with Asthma Treatment Questionnaire was developed. The procedures that were used are described, and the initial validation and reliability tests are reported. The study involved focus group meetings, development, testing and modification of a preliminary instrument, and testing of the revised instrument using different samples of patients with asthma. Factor analysis of the 26-item questionnaire identified four domains reflecting four aspects of satisfaction: effectiveness of treatment, ease of use, medication burden, and side-effects and worries. Cronbach's alpha showed evidence of internal consistency reliability. Test/retest reliability ranged from 0.66-0.74. Interscale correlations were moderate-to-high. Significant correlations were found between domain and overall scale scores and patients' overall level of satisfaction. The Satisfaction with Asthma Treatment Questionnaire is potentially a useful instrument for gaining insight into patient satisfaction with inhaled treatment for asthma.

Administration, Inhalation↗
PubMed2002

Living with a variable disease.

Asthma is a variable disease which, when not fully controlled, may leave the patient with a sense of bewilderment, fear, anger and a loss of many 'normal' activities of daily living. The reasons for these fears range from the concern of having an asthma attack to concerns about taking medications, perhaps especially steroids. Complex treatment regimens and a lack of understanding by the patient of their asthma may lead to denial and a reduction in adherence to medication resulting in poor treatment outcomes. Patients' lack of understanding may originate from poor communication between patient and physician. Improved communication and ensuring that all of the patient's questions are answered, as well as simpler treatment regimens may improve asthma control. Detailed, written personal asthma action plans should act as a foundation for building good relationships between doctor and patient and enhance adherence. Simplifying treatment regimens, such as having an inhaled corticosteroid and a long-acting, beta(2)-agonist in a single inhaler, used in conjunction with these personal asthma action plans, should provide a therapy that enables patients to be in control of their asthma without having to live in fear of their illness.

Administration, Inhalation↗
PubMed2000

The availability of smoking cessation advice from health professionals--a census from one East London District.

A survey of 382 hospital inpatients and a survey of 500 adults attending a GP open access chest X-ray service showed that 18% and 25% respectively were current smokers. Sixty per cent of the inpatient smokers and three quarters of the community smokers expressed a wish to stop smoking, and 44% of the inpatient smokers and 62% of the community smokers reported having received advice from their primary care physician to stop smoking. However, when the community smokers were asked about more specific advice they had received to help them stop smoking, only 13% had received advice regarding nicotine replacement therapies and under 5% had been given the telephone number of a smoking cessation support service (Smokers Quitline). Use of nicotine replacement therapies nearly doubles the success rate for smoking cessation, and it is essential for all health professionals to be able to give specific advice as to how smokers may be able to quit.

Adult↗
PubMed2000

Assessing the risk of hypoxia in flight: the need for more rational guidelines.

This study aimed to test the hypothesis that advice currently given by respiratory physicians to potentially hypoxic patients planning air travel varies and is not evidence-based. A prospective observational study was performed, surveying respiratory physicians in England and Wales. Sixty-two per cent responded. Nearly two-thirds worked in district general hospitals, a quarter in university hospitals, and the rest in tertiary referral (specialist) centres or a combination thereof. Most provide advice routinely; most of the remainder do on request or if concerned. Assessments comprise spirometry, blood gas level measurement, oximetry, predictive equations and hypoxic challenge tests. Twenty-five per cent of physicians measuring blood gas levels recommend in-flight oxygen when arterial oxygen tension (Pa,O2) <7.3 kPa, 50% when Pa,O2 is 7.3-8.0 kPa. Over two-thirds using spirometry recommend oxygen when the forced expiratory volume in one second <40% of the predicted value. Half recommend oxygen when arterial oxygen saturation (Sa,O2) <90%, 33% when Sa,O2 is 90-94%. Fewer than 10% of district hospital physicians (and none in other hospitals) use predictive equations. More than half of specialists but fewer than 10% of district hospital physicians perform hypoxic challenge tests. The risk of hypoxia at altitude is recognized by most respiratory physicians in England and Wales, but assessment methods and criteria for recommending oxygen vary widely. This suggests that most current advice is not evidence-based. Evidence-based guidelines are required.

Aircraft↗
PubMed2000

Enhancing care for people with asthma: the role of communication, education, training and self-management. 1998 World Asthma Meeting Education and Delivery of Care Working Group.

Reduction in the morbidity associated with asthma requires attention to several aspects of the behaviour of health professionals and patients, and to the interactions between these two groups. In this review, what has been learnt about health professional/patient communication and patient education (skills, settings and materials), lay and health professional liaison (including telephone helplines), patient education in low-income countries, the integration of patient education into clinical practice, health professional training and the implementation of guidelines, and the role of national asthma campaigns is drawn together. What changes in public policy would enhance asthma care, and whether the promotion of asthma self-management skills is cost effective are also considered. It is concluded that, although further research is necessary in many areas, well-educated health professionals who recognize the person with asthma as an individual, and who give advice about self-management, can significantly reduce the suffering and costs associated with asthma.

Asthma↗
PubMed1999

Clinical value and cost of a respiratory sleep-related breathing disorders screening service for snorers referred to a District General Hospital ENT department.

Sleep-related breathing disorders and snoring often co-exist in the community. We hypothesized that a significant proportion of patients referred from primary care to ENT surgeons for management of snoring might have significant sleep-related breathing disorders requiring medical management. The Respiratory Medicine Department at Whipps Cross Hospital, London, U.K. screened all such referrals using sleep questionnaires, overnight oximetry and diagnostic sleep studies where necessary as recommended by the Royal College of Physicians of London. Over 38 months, 115 patients were screened, of whom 43 (38%) had clinically significant sleep-disordered breathing. One-third were established on nasal continuous positive airway pressure ventilation and the remainder were mainly offered conservative treatment. The cost of the screening service is estimated at 14,000 Pounds for the initial year. The savings to the ENT service and the possible long-term benefits to the patients identified as having sleep-disordered breathing balance this. We conclude that screening all referred snorers for sleep-disordered breathing using a simple protocol identifies a significant number requiring medical management at a relatively low cost to the service provider.

Ambulatory Care↗
PubMed1999

The message from the World Asthma Meeting. The Working Groups of the World Asthma Meeting, held in Barcelona, Spain, December 9-13, 1998.

The 1998 World Asthma Meeting (WAM) has been the first multidisciplinary event aimed to consider asthma as a global public health problem in children and adults. The purpose of the meeting was to present state-of-the-art scientific information and to make recommendations on the research agenda for the coming years. Five Working Groups of invited experts were appointed to pin-point the established knowledge and the important questions in the areas of epidemiology, prevention, pathogenesis, management, and education. Their reports were discussed during the final plenary session, and are forming the current proceedings of the meeting. The message of the World Asthma Meeting provides a research agenda supported by the major international bodies involved in this disease. An integrated approach is considered to be essential in order to improve the prevention and care of asthma in all countries of the world.

Adult↗
PubMed1998

Chlorofluorocarbon-free inhalers: are we ready for the change?

Chlorofluorocarbons (CFCs) damage stratospheric ozone permitting enhanced levels of ultraviolet B radiation to reach the Earth's surface. As a result, production of CFCs is now banned under the Montreal Protocol with the exception of their temporary continued use in pressurized metered dose inhalers used to treat those with airway disorders. Replacement propellants have now been identified and shown to be safe and a major exercise is under way to reformulate the commonly used aerosolized medicines with the new propellants. The new products are now undergoing clinical trials and the first reformulated beta-agonist and corticosteroid inhalers have reached the marketplace. The majority of the current products will have been changed over to the new types over the next 3 yrs, and each country will adapt a transition strategy to oversee this process. The politicians, the environmentalists, the pharmaceutical industry and the regulatory authorities have fulfilled their part in this changeover, and respiratory interested health professionals now need to address what this means for them and their patients so that there may be a seamless transition for the millions of people who use inhaled medicines worldwide.

Chlorofluorocarbons↗
PubMed1997

Multiple tracheal strictures following mechanical ventilation.

Patients presenting with features of airway narrowing (cough, wheeze, exertional breathlessness and obstructive spirometry) may be suffering from either localized or generalized airway obstruction. Doctors sometimes overlook the possibility of localized obstruction (whether due to tumour, foreign body aspiration or stenosis), and patients may experience symptoms for a long time before the correct diagnosis is made.

Humans↗
PubMed1997

A national census of those attending UK accident and emergency departments with asthma. The UK National Asthma Task Force.

OBJECTIVE: To obtain a representative national picture of the type of people with asthma attending accident and emergency (A&E) departments in the UK, the reasons why they attend, and to determine the proportion admitted to hospital. DESIGN: A national census involving questionnaires. SETTING: 100 A&E departments throughout the UK. SUBJECTS: All those with asthma attending because of asthma during a one week period in September 1994. RESULTS: Details were obtained about 1292 attendances. About half of all attendances were by adults and half by children, and 87.8% were previously diagnosed asthmatics; 18.8% of adult attenders were unemployed. Perceived severity of asthma was the reason for attendance in 65.5%, but 11.5% reported non-availability, or perceived non-availability, of the general practitioner (GP) as the reason for attending. One fifth of adults had been kept awake by their asthma for over three nights before attendance. 425 of the 1292 attenders (32.9%) had been admitted to hospital in the previous 12 months and 316 (24.5%) had attended the A&E department in the previous three months. Only 24.6% of attenders had had contact with their general practitioner in the previous 24 h. 61.6% of under-5 attenders (n = 341) were admitted to hospital; the figures for those aged 5-15 and 15+ years and above were 265 (41.4%) and 665 (38.7%). CONCLUSIONS: Many people with asthma attend A&E departments without first having seen their GP. In many adult cases the asthma, while severe, is not acute, but a high proportion of both adults and children are admitted to hospital. Many of these attendances and admissions are repeat attendances. To enhance the quality of care provided to those with asthma may require easier access to primary care, enhanced patient education, or enhanced health professional education. Further study is needed of a variety of potential interventions.

Acute Disease↗
PubMed1997

The transition in practice: health professionals and patients.

The transition to CFC-free pressurised metered dose inhalers (pMDIs) raises issues for health professionals and patients. Health professionals need to be aware of any differences between old and reformulated products. The currently available reformulated salbutamol is equivalent to the old product so no dosage adjustment is implicated in the changeover. Available information on the new reformulated steroids suggests significantly smaller doses may be required for some reformulations as a result of improved drug deposition. This should not pose a problem if health professionals follow current asthma guidelines and titrate treatment against effect. Patients must be well prepared for transition, be aware of key facts about the new formulation and be aware of the reason their physician recommends change. The likelihood of a seamless transition to the new inhalers will be enhanced if health professionals coordinate the transition in a planned way in each district.

Chlorofluorocarbons↗