Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. The aim of this journal is to provide an eviden...ce-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children.
For that, the South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ.
The final conclusions are that it is important to ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.
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Secondhand smoke can infiltrate into other units through hallways and stairwells. Don’t be shy when it comes to your health. Talk to your building manager about making your apartment smokefree.
Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children. A task force supported by the European Respiratory Society has developed these evidence...-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
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The South African (SA) guidelines for cardiac patients for non-cardiac surgery were developed to address the need for cardiac risk assessment and risk stratification for elective non-cardiac surgical patients in SA, and more broadly in Africa.
The guidelines were developed by updating the Canadian ...Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment
and Management for Patients Who Undergo Non-cardiac Surgery, with a search of literature from African countries and recent publications. The updated proposed guidelines were then evaluated in a Delphi consensus process by SA anaesthesia and vascular surgical experts.
The recommendations in these guidelines are:
1. We suggest that elective non-cardiac surgical patients who are 45 years and older with either a history of coronary artery disease, congestive cardiac failure, stroke or transient ischaemic attack, or vascular surgical patients 18 years or older with peripheral vascular disease require further preoperative risk stratification as their predicted 30-day major adverse cardiac event (MACE) risk exceeds 5%
(conditional recommendation: moderate-quality evidence).
2. We do not recommend routine non-invasive testing for cardiovascular risk stratification prior to elective non-cardiac surgery in adults (strong recommendation: low-to-moderate-quality evidence).
3. We recommend that elective non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease should have preoperative natriuretic peptide (NP) screening (strong recommendation: high-quality evidence).
4. We recommend daily postoperative troponin measurements for 48 - 72 hours for non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease, i.e. (i) a baseline risk >5% for MACE 30 days after elective surgery (if no preoperative NP screening), or (ii) an elevated B-type natriuretic peptide (BNP)/N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) measurement before elective surgery (defined as BNP >99 pg/mL or a NT-proBNP >300 pg/mL) (conditional recommendation: moderate-quality evidence).
Additional recommendations are given for the management of myocardial injury after non-cardiac surgery (MINS) and medications for comorbidities.
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A worldwide increase in the prevalence of asthma has been reported in recent years. With an increase in prevalence comes an increased burden of disease in terms of morbidity, mortality and compromised quality of life. The economic burden in terms of utilisation of healthcare resources and limitation... of the earning capacity of the individuals and families is an added problem. Various indicators such as disability-adjusted life years and healthy life years have been used to define the economic burden. The data from Asian countries regarding these parameters is scarce, underlining the need for systematic studies in these countries, especially those that are resource poor. The purpose of this review is to highlight the varying prevalence of asthma in Asia and to assess the likely economic burden for the future.
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The document is a visual guide created by the IPCRG for managing COPD, focusing on self-management, treatment options (such as inhaler use, pulmonary rehabilitation, and medications), and addressing comorbidities. It highlights the importance of personalized care plans, patient education, risk reduc...tion, vaccinations, and the correct use of therapies to improve quality of life and manage COPD effectively.
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The INEE Minimum Standards Handbook is the only global tool that articulates the minimum level of educational quality and access in emergencies through to recovery. The Minimum Standards express a commitment that all individuals—children, youth and adults—have a right to education. The aim of th...e Handbook is 1) to enhance the quality of educational preparedness, response and recovery; 2) to increase access to safe and relevant learning opportunities for all learners, regardless of their age, gender or abilities; and 3) to ensure accountability and strong coordination in the provision of education in emergencies through to recovery.
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PEN-Plus is an integrated care delivery strategy focused on alleviating the noncommunicable disease (NCD) burden among the poorest children and young adults by increasing the accessibility and quality of chronic care services for severe NCDs—such as type 1 diabetes, rheumatic heart disease, and si...ckle cell disease—in the rural areas of low- and lower-middle-income countries, where more than 90 percent of the world’s poorest people live.
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Le Sénégal a réalisé des Enquêtes Démographiques et de Santé (EDS) en 1986, 1992, 1997, 2005, et 2010-2011. Au sortir de l’édition de 2010-2011, le pays s’est engagé dans la mise en œuvre d’un programme d’enquêtes dont la périodicité de collecte de données est ramenée à un an... (EDScontinue). C’est ainsi que la première phase a été réalisée en 2012-2013 et celle de 2017 est la cinquième. L’EDS- Continue comporte un volet traitant de la production d’indicateurs sociodémographiques et sanitaires (volet ménages) et un autre qui apprécie la disponibilité des ressources matérielles et humaines ainsi que la qualité des soins offerts par les services de santé aux populations (volet établissements de santé).
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Les périodes périnatale et néonatale constituent des moments critiques dans la vie des mères et des nouveau-nés. En effet, pendant ces périodes, des complications obstétricales, foetales et néonatales surviennent entrainant des mort-nés, des décès néonatals et des possibilités d’incap...acités si l’enfant survit. Les présentes directives nationales de santé des nouveau-nés, définies comme des lignes de conduite données par l’Autorité, en l’occurrence le Ministre de la Santé, visent à prévenir, dépister et prendre en charge ces complications en vue de d’améliorer la qualité des soins et de réduire la morbidité et la mortalité foetales et néonatales, ainsi que les handicaps à moyen ou long terme chez l’enfant. Les directives se focalisent principalement sur la période autour de l’accouchement, les premières heures et les sept (7) premiers jours de vie de l’enfant.
Pour les rendre opérationnelles, il faudrait
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Research globally has shown that metered dose inhaler (MDI) technique is poor,
with patient education and regular demonstration critical in maintaining correct use of
inhalers. Patient information containing pictorial aids improves understanding of medicine
usage; however, manufacturer leaflets i...llustrating MDI use may not be easily understood by
low-literacy asthma patients.
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We have created a special Toolbox on Tuberculosis (TB), please click here to see all guidelines, manuals, reports & studies
You can find manuals, guidelines and information in our Section Radiological & Nuclear Hazards in the SPECIFIC HAZARDS TOOLBOX
Drug Distribution and Control: Preparation and Handling
This Technical Assistance Bulletin is intended to assist pharmacists in the extemporaneous compounding of non-sterile drug products for individual patients. Included in this document is information on facilities and equipment, ingredient... selection, training, documentation and record keeping, stability and beyond-use dating, packaging and labeling, and limited batch compounding. This document is not intended for manufacturers or licensed repackagers.
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Integrated Management of pregnancy and childbirth