Osmond MH, Gazarian M, Henry RL, Clifford TJ, Tetzlaff  J, the PERC Spacer Study Group. Canada 

Acad Emerg Med 2007; Aug 15 epub ahead of print

Inglese

Background Metered-dose inhalers and spacers (MDI+S) are at least as effective as nebulizers for treating children with mild to moderate asthma exacerbations. Despite advantages in terms of efficacy, side effects, and ease of use, MDI+S are not used in many North American pediatric emergency departments (PEDs). Objectives To survey emergency physicians, emergency nurses, and respirologists in Canadian pediatric teaching hospitals regarding their practices, beliefs, and barriers to change with respect to bronchodilator delivery. Methods This was a cross-sectional, mailed survey of all emergency physicians, all respirologists, and a random sample of emergency nurses at ten Canadian PEDs. Results A total of 291 of 349 health care professionals (83%) responded. Twenty-one percent of emergency physicians use MDI+S in the PED (largely concentrated at two "user sites"). A majority at nonuser sites, and virtually all professionals at user sites, responded that MDI+S are at least as effective as nebulizers, switching to MDI+S is justified by existing research, patient outcomes would be equal or better, and they have the required knowledge and skills to use MDI+S in the emergency department. The largest perceived barriers to MDI+S implementation include concerns regarding safety and costs, related to feasibility of providing and sterilizing spacers, and parental expectations for nebulizers. Other barriers included staff beliefs regarding the effectiveness of MDI+S, changes in nursing workload, and lack of a physician champion for change. Conclusions MDI+S are infrequently used to treat patients with acute asthma in Canadian PEDs, despite the fact that most emergency staff believe they are effective. Important barriers to using MDI+S have been identified in this study and should be used to guide future implementation strategies.

PMID: 17699806 [PubMed - as supplied by publisher]

Osservazionale

Inglese

STUDY OBJECTIVE: We explore perceptions surrounding use of portable inhalers and holding chambers (spacers) for delivery of beta-agonist respiratory medications to children in the emergency department (ED) and factors influencing practice change. METHODS: This was a qualitative study guided by principles of grounded theory. Data were collected through focus groups and individual interviews at 2 sites in eastern Canada: Hospital A, where inhalers and holding chambers are used routinely; and Hospital B, where prevailing practice is the use of nebulization. Participant encounters were transcribed verbatim and analyzed for emerging themes. RESULTS: At Hospital A, 6 physicians and 7 nurses participated in separate focus groups. Four interviews were conducted with physician, nurse, respiratory therapy, and pharmacy leaders. At Hospital B, 4 physicians and 3 nurses participated in focus groups, and 6 leaders were interviewed. Perceptions negatively influencing the adoption of inhalers and holding chambers included increased workload, increased equipment costs, myths about the superiority of nebulization, and interprofessional conflict. Health professionals reported that their most prominent concern about administering medications with inhalers and holding chambers was the time demand. Nurses especially seemed to think this way, tipping the balance in favor of nebulization despite knowledge of evidence to the contrary and affecting physician decisionmaking as well. Professional territorialism appeared to hinder efforts to ameliorate workload issues through the use of respiratory therapists in the ED. CONCLUSION: Findings from this study could be used to inform a change program to close the gap between evidence and practice with respect to use of inhalers and holding chambers in the ED.

17559971 [PubMed - as supplied by publisher]

Osservazionale

3

Si tratta di un questionario proposto a medici ed infermieri durante un focus group, in 2 sedi ospedaliere del Canada. (1 escusivamente pediatrica) per verificare quali fossero i principali problemi nel sostituire i nebulizzatori con i distanziatori per somministrare i broncodilatatori nell'asma acuto. I risultati: la maggior parte delle infermiere pensa di perdere troppo tempo a controllare che il paziente esegua la tecnica dello spray con il distanziatore e che vi sia anche un eccesso di spesa.

Titolo del documento

Comparison of efficiency and preference of metal and plastic spacers in preschool children.

Autori e Nazionalità

Amirav I, Tiosano T, Chamny S, Chirurg S, Oren S, Grossman Z, Kahan E, Newhouse MT, Mansour Y. Israele 

Fonte bibliografica

Annals Allergy Asthma Immunol 2004;93:249-252

Lingua

Inglese

Abstract

BACKGROUND: The metal NebuChamber valved holding chamber (VHC) has gained wide acceptance among children with asthma. Due to its nonelectrostatic properties and larger volume, the 250-mL, metal NebuChamber delivers a greater mass of aerosol to a filter at the mouth compared with the commonly used 150-mL polypropylene AeroChamber VHC. Such in vitro results have been used to suggest that this may provide increased efficacy with the NebuChamber. No comparative efficacy data exist for preschool children with asthma. OBJECTIVE: To compare efficiency and preference of metal and plastic spacers in preschool children. METHODS: Children with mild-to-moderate persistent asthma received 200 microg of budesonide twice daily by NebuChamber or AeroChamber, both with the mask provided in a randomized, 2-month, crossover trial. Symptom diary cards, beta-agonist use, and preference by children and parents were compared. RESULTS: Thirty children (mean +/- SD age, 4.3 +/- 0.3 years) completed the study. There was no difference between the AeroChamber and NebuChamber in clinical efficacy outcomes. There was no difference between the AeroChamber and NebuChamber in parents' view of ease of use, design, acceptability by the children, and overall satisfaction. CONCLUSIONS: Despite a greater total dose delivered to the mouth, the NebuChamber appears no more effective than the AeroChamber and it is not preferred by patients or parents. More parents chose to continue to use the NebuChamber after the study.

PMID

15478384 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

Nonostante con la Nebuchamber di metallo la dose di budesonide che arrivi alla bocca è maggiore di quella che si ottiene  con l'Aerochamber non c'è differenza di efficacia fra i due distanziatori. Il secondo è quello preferito dai bambini e dai loro genitori

Titolo del documento

Child and parent satisfaction with the use of spacer devices in acute asthma

Autori e Nazionalità

Cotterell EM, Gazarian M, Henry RL, O'Meara MW, Wales SR. Australia

Fonte bibliografica

J Paediatr Child Health 2002,38:604-607.

Lingua

Inglese

Abstract

OBJECTIVE: To evaluate child and parent satisfaction with the use of spacers in acute asthma. METHODS: All parents of children presenting to the emergency department of Sydney Children's Hospital over a 3-month period with mild to moderately severe acute asthma who were treated with bronchodilators by spacer device were asked to complete an anonymous questionnaire. Children aged 8 years and older completed a separate questionnaire independently. RESULTS: One hundred and eleven of 158 parents (70%) responded. The majority (84%) found it 'easy' or 'very easy' to use the spacer and 85% reported that they intended to use the spacer at home. Of those parents who had previously used a nebulizer (n = 73), 84% said that the spacer was easier to use, 77% said that the spacer was better tolerated by their child and 84% said that overall they preferred the spacer. Seventeen of 31 children aged 8-14 years treated with a spacer (55%) responded to the satisfaction survey. All respondents found it 'easy' or 'OK' to use the spacer and the majority (82%) 'liked it' or thought 'it was OK'. The majority of children (82%) said that they preferred using spacers because it was quicker (29%) or easier to use (53%). CONCLUSION: The use of spacer devices in mild to moderately severe acute asthma is highly acceptable for children and parents; the majority prefer this mode of drug delivery to nebulization.

PMID

12410876 [PubMed - indexed for MEDLINE]

Tipo di studio

Inchiesta tramite questionario

Livello di evidenza

3

Commento

i bambini preferiscono lo spray con il distanziatore al nebulizzatore per somministrare i broncodilatatori nell'attacco acuto d'asma

Titolo del documento

Parent satisfaction with services in an emergency department located at a paediatric teaching hospital

Autori e Nazionalità

Brown K, Sheehan E, Sawyeer M, Raftos J, Smith V. Australia

Fonte bibliografica

J Paediatr Child Health 1995;311(5):435-39.

Lingua

Inglese

Abstract

OBJECTIVE: To evaluate parents' satisfaction with the services provided in an emergency department located at a paediatric hospital. METHODOLOGY: A descriptive study in which the parents of children with non-life-threatening illnesses attending an emergency department completed a questionnaire describing their satisfaction with services in the department. RESULTS: The majority of parents were satisfied with the services provided. However, less satisfied parents reported having to wait significantly longer before receiving medical attention than satisfied parents. Consistent with this finding, 77% of less satisfied parents reported that staff did not attend to their children's needs quickly enough and 62% felt that there were insufficient staff available to provide help. Twenty-nine per cent of the less satisfied parents reported that they did not know what was required for the ongoing care of their children after their discharge from the emergency department. CONCLUSIONS: In order to address the concerns of less satisfied parents, emergency departments need to give careful attention to the maintenance of reasonable waiting times, the provision of adequate staffing, and the quality of staff-parent communication. Addressing these issues may improve the ongoing care of children after their discharge from emergency departments.

PMID

8554865 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Uno studio che esamina il gradimento dei genitori che si sono recati al Pronto Soccorso con il proprio figlio