The Lung Association Saskatchewan

IntroductionRespiratory Health Professionals (RHPs) with specialty training in the management of asthma and COPD, often care for patients with advanced respiratory disease, who have less access to palliative care than patients with similar disease burden. The aims of this study were to: (i) explore the current and desired roles of RHPs in terms of palliative care and (ii) examine barriers to discussions with patients about palliative care.MethodsAn online survey addressing the aims of this study was developed and pilot tested. The survey was distributed nationally using the database of the Lung Association’s RESPTREC respiratory educator training program. Descriptive statistics were performed.ResultsA total of 123 completed surveys were returned, with respiratory therapists comprising the largest group of respondents. The majority indicated that end-of-life care was less than optimal for patients with advanced respiratory illnesses and agreed that palliative care should be a role of RHPs. Patient- and family-related barriers to having end-of-life discussions included: difficulty accepting prognosis, limitations and complications, and lack of capacity. For providers, the most important barriers were: lack of training, uncertainty about prognosis, and lack of time. The health care system barriers of concern were increasing demand for palliative care services and limited accessibility of palliative care for those with advanced respiratory diseases and difficulties in accurate prognostication for these conditions.DiscussionIncorporating a more defined role in palliative care was generally seen as a desirable evolution of the RHP role. A number of strategies to mitigate identified barriers to discussions with the patient are described. Better alignment of the services required with the needs of patients with advanced respiratory disease can be addressed in a number of ways.ConclusionsAs RHP roles continue to evolve, consideration should be given to the ways in which RHPs can contribute to improving the quality of care for patients with advanced respiratory disease. Building collaborations with RHPs, palliative care, and other existing health programs can ensure high quality of care. Creating and taking advantage of learning opportunities to build skills and comfort in using a palliative approach will benefit respiratory patients.

RATIONALE: Poor inhaler technique is a pervasive problem among patients with chronic respiratory conditions. It has been associated with inadequate drug delivery and poor respiratory outcomes.OBJECTIVES: This pilot study assessed the feasibility of having registered Pharmacy Technicians (PT) in community pharmacies assess and correct inhaler technique at inhaler refill pick-ups.METHODS: Assessment and correction of inhaler technique was conducted by PTs in three community pharmacies during a 30-day period. For each patient interaction, the following data was collected: estimated patient age and sex, type of issue detected (if any), perceived patient response, and length of interaction. Semi-structured interviews were conducted with the PTs and pharmacy managers at the end of the 30-day period to assess perceptions and feasibility of expanding the service.MEASUREMENTS AND MAIN RESULTS: Eighty-five percent (40/47) of patients that were offered the assessment accepted and demonstrated their inhaler technique; the median interaction time was 3 minutes. More than half of patients (52.5%) demonstrated at least one technical error, all of which the PTs were able to correct. Almost all patients (39/40) were perceived to be either satisfied or very satisfied with the assessment. Five primary themes emerged from the interviews, including: feasibility, patient benefit, potential to reduce pharmacist workload, professional development/job satisfaction, and barriers.CONCLUSIONS: PTs helped to identify inhaler misuse in community pharmacies, and this study identified barriers and potential solutions for expanding the service. Future studies should investigate the benefit of the PT expanded role on clinical outcomes in asthma and chronic obstructive pulmonary disease (COPD).

El problema principial, que se viene advirtiendo en nuestros Tribunales, cuando se pide la nulidad de matrimonio alegando la anomala de la esquizofrenia, es o se da en los casos en los que esta anomala se ha declarado con posterioridad a la celebracin del matrimonio. Se viene a conceder un tanto gratuitamente que esta anomala ya estaba latente y de algn modo antes de contraer y , por consiguiente, no pudo asumir aquello que posteriormente no podra cumplir. La causa de esta incapacidad, se viene a afirmar, ya estaba en el sujeto antes de las nupcias. Una sentencia de 5 de mayo de 1981 declaraba nulo el matrimonio por esquizofrenia de la esposa cuando los sntomas, esquizoides solamente, aparecieron once aos despus del matrimonio y solo ms tarde apareci la esquizofrenia.

Tuberculosis (TB) is a potentially fatal disease spread by an airborne pathogen infecting approximately one third of the globe. For decades, contact tracing (CT) has served a key role in the control of TB and many other notifiable communicable diseases. Unfortunately, CT is a labor-intensive and time-consuming process and is often conducted by a small and overworked nursing staff. To help improve the effectiveness of CT, we introduce a detailed, individual-based model of CT for the Canadian province of Saskatchewan. The model captures the detailed operation of TB CT, including loss to follow-up, and prophylactic and case treatment. This representation is used to assess the impact on active TB cases and TB infection prevalence of differential scoping, speed, prioritization of the CT process, and reduced loss to follow-up. Scenario results are broadly consistent with--but provide many additional insights beyond--our previously reported findings using an aggregate model. In the context of a stylized northern community, findings suggest that age- and ethnicity-prioritized schemes could improve CT effectiveness compared to unprioritized schemes by dramatically reducing TB infection and preventing on average roughly 11% (p < .0001) of active TB cases over a period of 20 years. Reducing loss to follow-up to 10% could yield 5.4% (p = .02) TB cases prevented on average with lower prevalence of TB infection, but improving the CT speed does not yield significant improvement in TB outcomes. Finally, although the work emphasized the value of social network analysis, we found that caution should be exercised in directly translating social network analysis-observed associations into prioritization recommendations.