Time To Start Comparing Apples With Apples

The study by Williams and colleagues advances the field by demonstrating that specific descriptors of breathlessness can be used to suggest a diagnosis of COPD. Prospective testing is necessary to examine whether fluency in this language can differentiate other common respiratory diseases. In a preliminary study of 142 patients presenting with a chief complaint of breathlessness, Harver and associates found that the descriptor “chest tightness or constriction” had a specificity of 95% and positive predictive value of 86% for the diagnosis of asthma. Two phrases “effort or work of breathing” and “can’t get a deep breath” had a sensitivity of 74% for the diagnosis of COPD.

health-care technologies

Based on this information, we encourage physicians and other health-care providers to ask patients about descriptors of dyspnea as part of the medical history. In the office setting, the nurse could take vital signs and then ask each patient to describe “what it feels like” when he/she has breathing discomfort. The nurse could write down (or enter into a computer) the key words along with the vital signs. The nurse could then give each patient a list of descriptors and ask him/her to select the “best two or three” that describe breathlessness. It is time for physicians to become fluent in the language of dyspnea! This will help us to better understand the experience of our patients, to diagnose the cause of breathlessness in a patient, and to and enhance our therapeutic efforts to provide relief.

She introduction of health-care technologies into medical practice is happening at a breathtaking pace. Some of these technologies are real advances and provide great benefits to patients, but many others offer only slight improvements despite substantially increasing health-care costs. Unfortunately, when faced with a decision to implement new technologies in their practices, many practitioners are often at a loss in determining the relative strengths and weaknesses of their options. When perusing the literature on reports about new technologies, it is frequently only case series or studies aimed at obtaining Food and Drug Administration approval that one can find, but no proper comparisons with conventional and established approaches.

Diabetes: Injectors insulin

INJECTING

Injectors

What is the ‘jet’ injector?

This is a needle-free injector, which works by penetrating the skin with insulin using very high pressure jets. It is not entirely painless and is fairly bulky. The recent model available in the UK (MHI-500) has been superceded by a new model, SQ-PEN.

Injectors insulin

Practical aspects of pens, needles, syringes and bottles

When I was discharged from hospital with newly-diagnosed diabetes I was given a pen device and a few disposable syringes and needles for my injections. How do I obtain more?

Pen devices, disposable insulin syringes and pen needles are available free on prescription. Your CP will supply you with a prescription for any make of insulin syringe and/or insulin pen needles that you choose, and they can then be obtained without charge from a chemist.

Alternatively you can buy them at your own cost directly from the chemist without a prescription, or you can send for them by post from suppliers such as Owen Mumford (Medical Shop).

What is the best way of disposing of insulin syringes and pen needles?

There is a device available called the BD Safe-Clip® which cuts the needle off the top of a syringe or insulin pen and retains it in the device. Once the needle is clipped off, put the used syringe or pen needle hub into a rigid sealable container (available on prescription as a Sharps bin) along with your lancets and follow your local council guidelines for safe disposal of medical waste. Some local authorities provide special containers and a collection service for people who are treated with insulin; however, there is no national policy.

The BD Safe-Clip is available free on prescription from your CP.

I have heard that pen needles and disposable syringes can be reused. How many times can they be reused and how can they be kept clean in between injections?

While pen needles and disposable syringes are designed to be used only once, some people do reuse them. However, reusing needles causes them to become blunt, and they can bend very easily. The tiny point on the end can also break off and remain embedded in the flesh. Needles have a fine coating of lubricant on them so they glide in and out of the skin, and reusing them removes this lubricant and may cause a more painful injection. So there are many reasons to use each needle once only.

If you decide to reuse them make sure the protective cover is placed over the needle.

There is a bewildering array of syringes and needles on the market. Which are the best types to use?

In the UK we use three sizes of syringe. They are used with U100 insulin, which is the standard strength of insulin in the UK and most countries, containing 100 units of insulin per 1 millilitre.

• The 0.5 mL syringe. This is marked with 50 single divisions for taking not more than 50 units of insulin in one injection.
• The 1 mL syringe, marked up to 100 units in 2 unit divisions for those taking more than 50 units of insulin in one injection.
• The 0.3 mL syringe, designed for children or those taking less than 30 units of insulin in one injection.

The most popular make is the BD syringe which comes complete with a fixed Micro-Fine+ 12.7 mm needle, but there are several other makes available.

All these syringes are marked with the word INSULIN on the side of the syringe and graduated in units of insulin. No other type should be used to inject insulin.