Biomedical subjects

A H Kerkhoff

Publications and source records attributed to A H Kerkhoff.

11 recordsLinked to original sources

PubMed1999

Inhalation technique of 166 adult asthmatics prior to and following a self-management program.

Self-management of asthma and self-treatment of exacerbations are considered important in the treatment of asthma. For successful self-treatment, medication has to be inhaled correctly, but the percentage of patients inhaling effectively varies widely. As part of a self-management program we checked and corrected inhalation technique. This paper addresses differences among inhalers in relation to patient characteristics and the effect of instruction, 1 year after enrollment. Maneuvers that are essential for adequate inhalation were identified. When errors in inhalation technique were observed, patients were instructed in the correct use of their devices. One year later, inhalation technique was checked again. Only patients who used the same inhaler throughout the entire study period were analyzed. Of the 245 adult asthmatic patients who were enrolled in the self-management program, 166 used the same inhaler throughout the study period. One hundred twenty patients (72%) performed all key items correctly at baseline and this increased to 80% after 1 year. At follow-up, older patients were less likely to demonstrate a perfect inhalation. Patients with a Diskhaler made fewest errors. Adjustment for differences in patient characteristics did not significantly change the results. Because many patients with asthma use their inhaler ineffectively, there is a need to know which inhaler leads to fewest errors. Diskhaler was nominated by this study. When patients are not able to demonstrate adequate inhalation technique in a "tranquil" setting, it is doubtful that they can do so when they experience an exacerbation. Therefore, inhalation instruction should be considered an essential ingredient, not only of self-management programs, but also of asthma patient care in general.

Administration, Inhalation↗

PubMed1998

[Knowledge about drugs used by adult patients with asthma for self-treatment].

OBJECTIVE: To assess the knowledge of adult asthmatics about medication for self-treatment. DESIGN: Descriptive. SETTING: Department of Pulmonary Diseases, Medisch Spectrum Twente, Enschede, the Netherlands. METHODS: As a part of a larger project aimed at improvement of self-management and self-treatment, all adults aged 18-65 years in Enschede (population 146,000) reported by the city pharmacists as using medication for asthma or chronic obstructive pulmonary disease, in 1994 were sent a questionnaire including 7 items pertaining to knowledge about lung medication. From among those who failed to respond after a written reminder and an appeal in local papers, a random group of 9% were interviewed by telephone. Of the responders who reported that according to their GPs they had asthma and who had answered the questions on medication, the number of questions answered correctly was counted; in addition, the question was investigated whether their level of knowledge was related to sex, education, use of (inhalation) corticosteroids and the form of explanation received. RESULTS: A total of 4563 questionnaires were sent out: 2259 (50%) usable forms were returned. The responders were better educated than the 192 non-responders interviewed, but did not differ as to age or sex. Of the responders, 1262 (56%) reported that their GPs had told them they had asthma. On average they had answered 2.4 (range: 0-7) out of 7 questions correctly. Previous instruction, number of sources of information, duration of taking medication, use of inhaled steroids, female sex and better education were all positively related with a higher knowledge score in this group. CONCLUSION: Adult asthmatics did not have sufficient knowledge about their medication. Improving such knowledge should therefore be an important element in the development of a self-management programme.

Adult↗

PubMed1997

Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines.

Inhaled medication is important in the treatment of chronic obstructive pulmonary disease (COPD). In this paper a comparison of the long-term efficacy of three instruction-models is presented. A total of 152 COPD-patients were randomized into one of four groups: Personal-, video-, group-instruction and a control group. Inhalation technique was assessed by means of checklists, on which essential inhalation manoeuvres were identified. Up to 9 months later, 148 patients returned for follow-up assessment. Prior to instruction 61% of patients in the control group had a perfect score on essential actions, compared to 62, 65 and 53% for those receiving group-, personal- and video-instruction respectively. At follow-up these percentages were 49, 97, 75 and 76%. For group-(35%) and video-instruction (24%) the increase from baseline was significant. Examining the different inhalers under investigation, it is striking, that only 24% of all patients with a Metered Dose Inhaler (MDI) performed all essential checklist items correctly, versus 96% for those using a Diskhaler. The fact that for the MDI this percentage improved to 90% post-instruction, shows that time spent on instruction, is time well spent. We conclude that group instruction seems superior to personal counselling, and equally effective or even better than video instruction. Personal instruction should not be dismissed and a combination with video instruction might prove to be effective as well.

Administration, Inhalation↗

PubMed1995

Evaluation of the effectiveness of four different inhalers in patients with chronic obstructive pulmonary disease.

BACKGROUND: The percentage of patients inhaling their medication effectively varies widely, according to methods of assessment and inhalers used. This study was carried out to assess differences among four types of inhalers using inhaler-specific checklists. METHODS: Inhalation technique was evaluated in adult patients with chronic obstructive pulmonary disease (COPD). Inhalers investigated were either metered dose inhalers (MDIs) or the dry powder inhalers Turbohaler (Turbuhaler), Diskhaler, and Rotahaler. Errors were recorded against inhaler-specific checklists. From these, scores were derived by dividing the number of items correctly completed by the total number of items on the checklist and the result was expressed as a percentage. For every inhaler "essential actions" were identified and scores on these key manoeuvres were calculated. The percentage of patients performing all these essential actions correctly was also calculated. Scores were also compared with adjustment for differences in relevant patient characteristics. RESULTS: Important differences among inhalers were found. Of 152 patients with COPD (mean (SD) age 55.1 (8.7) years), those with MDIs performed worst, especially when only essential items were considered. Patients with a Diskhaler did best, although after correction for patient characteristics the differences tended to diminish. Only 60% of patients were able to perform all essential inhaler actions satisfactorily. Of those using the Diskhaler, 96% did so correctly, while the corresponding figure for those using the MDI was only 24%. CONCLUSIONS: Many patients with COPD use their inhaler ineffectively. After adjusting for patient characteristics, differences among inhalers, although less pronounced, persist. Patients using a Diskhaler made fewest errors, while most patients using MDIs made crucial mistakes.

Adult↗

PubMed1994

[Poor technique in the use of inhalation drugs by patients with chronic bronchitis/pulmonary emphysema].

OBJECTIVE: To describe errors in inhaler technique of patients with chronic obstructive pulmonary disease (COPD). SETTING: Outpatient clinic, Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands. DESIGN: Descriptive. METHOD: Adult COPD patients who already used an inhaler were asked to demonstrate their inhaler technique. Using a inhaler-specific checklist errors were registered. A division was made into good, adequate and inadequate technique. For each inhaler a selection of critical actions with regard to effective inhaler technique was made. RESULTS: Inhaler technique was assessed in 123 COPD patients. Over one-third of all patients had a very poor inhaler technique, which probably resulted in little or even no drug deposition at all. 42% of the patients performed all essential inhaler actions correctly. For patients with a Diskhaler this was 86%, significantly higher than for the other inhalers, Rotahaler and Turbuhaler, which did not differ much (35% and 46%). Poor inhalation technique leads to insufficient bronchodilating or prophylactic effect, to the prescription of more or additional medication with a higher probability of side effects, and to increased costs. CONCLUSION: The inhalation technique can be improved substantially with a good instruction protocol.

Administration, Inhalation↗

PubMed1992

[Estimation of the potential number of donor organs in 1988 and 1989 in 13 hospitals with a major neurosurgical department].

In the Netherlands the supply of donor organs for transplantation still fails to meet demand. This study deals with the total number of donors and donor organs available in the 13 Dutch hospitals with a large neurosurgical department. The number of kidneys that could have been donated was twice as large, hearts and livers five times as large, and pancreas 35 times as large as the numbers actually donated (in absolute numbers for 1988 and 1989 respectively 631 and 642 (kidneys), 173 and 204 (livers), 154 and 178 (hearts) and 239 and 285 (pancreata). Refusal by the potential donor's family was the main reason for not donating organs.

Family↗

PubMed1990