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How to improve asthma patient outcomes using spaced education

Cover of "Living with Asthma"

Cover of Living with Asthma

There had been no plans to make this content public, but I thought I’d share it because of my interesting realisation that the Zemanta search tool may be  a reasonably valid way to winkle out papers relevant to a topic of interest. Out of habit it now I offer link to further content that on first appearances seems to  offer similar or contrasting views. Before I look at the selection that was offered to me, and the 7 from the 16 or so I was offered I am going to go through conventional route using the Open University Online Library and see what I may find that to any large extent differs.

I am not a physician or Medical Docotor, though I am asthmatic and have been in, on and off a variety of inhalers and sometimes oral steroids for some thirty years.

Preventer – Inhaled Steroid – two puffs twice a day. Used with a spacer to reduce chances of thrush.

Reliever – as needed, which is generally never, with rare need if I develop a chest infection, in which case I may end up on antibiotics anyway.

Oral Steroids – Very rarely, usually related to a chest infection. Once every five years?

Nebulizer – Never. Unlike my late father and one (or two) relations who take the view that they only need the preventer when they are wheezy … and end up hospitalised when they have an asthma attack and in the case of my father on steroids for so long that he became diabetic.

Preventative measures – know your triggers, avoid them, keep fit and attend an annual Asthma Clinic. I have to be cautious with house dust allergy and its partner in crime – damp. The odd list of triggers includes, at times, bleach, cumin seeds, one of the Lucozade sports drinks (odd that, coming from GSK who also produce asthma drugs). Possibly white flour. Yeast causes other problems too. We have a dog, but I’m not comfortable for long in a house with soft furnishings where there are cats. Get the bedroom windows open as often as possible. Use a specialist vacuum cleaner on the mattress, pillows and duvet. No carpets. No curtain. Leather sofa preferred.

Fig. 1. Twenty years ago I found myself producing, directing and writing a two information videos for a major pharmaceutical company – ‘Living with Asthma’ and ‘the Cost of Asthma’.

These had a shelf life of some ten to fifteen years, eventually to be replaced by DVD and online interactive equivalents. We did a combination of narrative drama reconstruction – a thread from a TV soap  in which a protagonist has an asthma attack, interviews with patients and experts (doctors and pharma) and narration with 3D animations and charts.

The purpose of this exercise is to:

  • Justify and explain the question for a piece of empirical research.
  • Offer FIVE pieces that  support then set you research on its way.
Though an academic exercise I’m going to treat this as something that could find funding, and that I could carry out.
What is the proposed research about? Asthma patient ignorance of best practice in relation to taking their prescribe drugs – why they are taking the drugs, how they work, when they should take them, how and how often …
What is it trying to find out or achieve? Improve patient care i.e. compliance (UK) – so taking their medicine correctly. This is important where the condition is chronic and the symptoms aren’t continuous. People tend to lapse taking the preventative drugs … it takes several days on onset of symptoms for these to kick in.
How will it go about doing that? A randomised controlled trial in which all asthmatics are invited to sign up to receive information over a period of x months, reminders about asthma and their drug taking regime.
What will we learn from it and why was it worth learning? That a significant percentage of asthmatics who have been prescribed an inhaled steroid (preventer medicine) to take twice daily are failing to do so, simply because they don’t see the need to do so unless they are feeling wheezy (a misconception, it should be taken regardless) or they allow their inhalers to run on empty for some time before being aware of this.That a significant percentage of asthmatics, probably largely the same group as above, misuse their reliever inhaler a) taking it too often b) not correctly inhaling so that drug ends up lining their mouth rather than entering their lungs.Taking the right dosage of inhaled steroid, as prescribed, in the correct manner, is likely to reduce need for the reliever inhaler to nil and will result in less long term damage being done to the lining of the lungs.It will improve patient outcomes, reduce the use of inhibitors and reduce hospital visits or overnights where a person has suffered an avoidable asthma attack.

 

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H809 Tutor Marked Assignment QQs on scope, sense cam and blogging

Blogging

The idea of looking behind blogging came from the reading … but did I reference it???

i.e that innovations never occur in isolation, there was always something else beforehand.

The mistake we all make is to assume that innovations land on a pristine landscape and we react with typically human surprise at this new marvel that will either revolutionise or destroy everything. I need to remember where I read that!

Something on innovations … eeek.

It does matter though, with blogs there is clearly a history of

a) keeping a diary

b) citizen journalism in the form of leaflets and ‘letters to the editor’

c) authors keeping a writer’s journal and

b) scientists and explorers keeping a formal ‘log’.

That and human nature to write stuff down – well, at least 1% of the population do, which gives the other 99% something to read.

Life Logging

Sense Cam came out of the efforts of Gordon Bell, now 81, and for the last 10 years head of research at Microsoft.

He got it into his head to digitise everything and then wear a gadget around his neck to capture even more. This seems moronic and his own writing isn’t academic, more a memoir, but others, Microsoft and University of Southampton, have pressed on. The Sense Cam is a fag-packet sized device you hang around your neck – a camera with a light and sound sensor, then triggers the taking of a picture as you go about your daily business (could be awkward). At the end of the day these pictures are downloaded and software filters the stuff.

Southampton (WebSciences) have examples of this.

You can now buy a SenseCam made by Microsoft and various Microsoft Research Labs are trying them out. The hope is that in time such a device will help support those with dementia or any kind of memory fade … the evidence from Southampton illustrate Ebbinghaus’s ‘Forgetting Curve’ – how we forget stuff pretty fast over days/weeks against use of various methods, including a Sense Cam. It does appear, naturally, that looking back regularly at a set of carefully selected pictures (I think there has be human intervention for obvious reasons) the patient/student subject is far better able to recall, retain, and therefore I presume to restore and ‘fix’ memories better.

I am starting to wonder if a person is indicating for Alzheimer’s or some such that they might use such a device ?

Or the Google Glass device to do the same thing. If I were a first year medical student doing my disection I’d like to use a sense cam to personalise a record of the activity, for example.

If I go down the blogging route ‘is blogging a valid activity for student assessment’ is far too broad while ‘Can blogging by students of journalism writing in English in Hong Kong be used as a formal part of assessment’ might be doable. Off the top of my head here, but let’s say there are 4 to 6 colleges where such a course is offered in Hong Kong …

So what about a geographically defined study?

China might be problematic due to restrictions on use of the Internet (and its vast size). Perhaps Poland!? Somewhere where the numbers aren’t huge. Then again, doesn’t it depend on the methods and tools you use? I am struck by this stuff they call ‘Big Data’ where a cohort of 10,000 on an Open Course (this at Stanford using Coursera) can reveal the nuances of ‘poor teaching’ – where in the past 1 or 2 students made the same mistake it goes unnoticed, but when 2000 students make the very same mistake then there’s clearly something wrong with the course.

To use Diana Laurillard’s apt phrase ‘it depends’. (don’t ask me where or when she said it, if you know, please tell me so that I can reference it correctly).

 

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