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J Asthma ; 46(3): 212-6, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19373625


Correct use of inhalation devices is one essential component of optimal management of asthma. Several longstanding controversies regarding specific steps to correct use of metered dose inhalers (MDI) include the lung volume when the MDI should be actuated. As a primary objective, literature was reviewed examining this one step in MDI use. Results from six of nine investigations support the need to gently exhale either to functional residual capacity (FRC) or residual volume (RV) before MDI actuation. Literature is also summarized regarding the need to exhale to FRC or RV before inhaling from MDI plus valved holding chambers or other extension devices and from dry powder inhalers. Numerous studies indicate that many patients as well as health care professionals either do not know or forget to exhale to RV or FRC before inhaling asthma medications. Both patients and health care professionals need education to help ensure correct use of MDI and other asthma inhalation devices, including instruction to first exhale gently to RV or FRC before inhaling the medication.

Asma/tratamiento farmacológico , Espiración , Nebulizadores y Vaporizadores/estadística & datos numéricos , Asma/fisiopatología , Ensayos Clínicos como Asunto , Humanos , Mediciones del Volumen Pulmonar
Curr Opin Clin Nutr Metab Care ; 8(2): 177-81, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15716797


PURPOSE OF REVIEW: The number of published clinical trials has increased exponentially over the past few decades. The majority of clinical research questions has been addressed by several small or moderately sized trials. Statisticians have developed guidelines for meta-analyses, which provide objective quantitative reviews to lighten the burden of clinicians who seek to keep themselves current in one or more areas of clinical investigation. The purpose of this review is to illustrate how to read critically a meta-analysis of nutrition support in critically ill patients. RECENT FINDINGS: Summary evidence based on a meta-analysis is observational, even though the individual elements of the meta-analysis are clinical trials. The level of evidence from a meta-analysis is thus similar to that derived from a case series or a cohort, with the stipulation that the 'subjects' are clinical trials instead of individuals. The effects of the combination of parenteral and enteral nutrition on mortality and infection rates in critically ill patients have been compared with enteral nutrition alone. Meta-analysis results show non-significant reductions in mortality and infectious complications favoring enteral nutrition. In patients with acute pancreatitis, the summary effects of parenteral versus enteral nutrition on the infection rate indicate a significant reduction in risk favoring enteral nutrition. SUMMARY: An interpretation of meta-analysis summary results is put in perspective with underlying medical assumptions. This critical review indicates what issues a meta-analysis can and cannot address.

Interpretación Estadística de Datos , Metaanálisis como Asunto , Medicina Basada en la Evidencia , Humanos , Investigación