Less than half of the sample performed the inhalation technique correctly. Incorrect inhalation technique was related to lower number of evaluations of the use of the inhalation device and uncontrolled asthma.

Objective: To demonstrate the most frequent errors in inhalation technique in patients with asthma undergoing treatment at a tertiary care hospital. Methods: A cross-sectional study with a convenience sample of asthma patients aged 18 years or over, treated at a pulmonology outpatient clinic of a tertiary care hospital. The assessment of inhalation technique of users of the dry powder inhalers Aerolizer ® , Aerocaps and Diskus ® , or metered-dose inhalers was based on the manufacturer's instructions for use of each inhaler device. Patients demonstrated the inhalation technique with empty inhaler devices, and it was considered correct when all stages were performed properly, or when errors probably did not interfere with the treatment outcome. Results: Among 71 participants, 43 (60.5%) performed inhalation technique incorrectly. Among metered-dose inhalers and dry powder inhalers users, inhalation technique errors were found in 84.2% and 51.9%, respectively (p=0.013). Errors were more frequent at the exhalation stage (67.4%), followed by breathing in (58.1%) and apnea (51.2%). In the group using dry powder inhalers, the most common errors occurred during exhalation and, for those using metered-dose inhalers, the most compromised stage was aspiration. Conclusion: Errors were more frequent among those using metered-dose inhalers compared with dry powder inhalers. Misconceptions are more common at the expiration stage among users of dry powder inhalers and in aspiration among those on metered-dose inhalers.

Background To describe the effect of the COVID-19 pandemic on emergency general surgery operative volumes during governmental shutdowns secondary to the pandemic and characterize differences in disease severity, morbidity, and mortality during this time compared to previous years. Methods This retrospective cohort study compares patients who underwent emergency general surgery operations at a tertiary hospital from March 1st to May 31st of 2020 to 2019. Average emergent cases per day were analyzed, comparing identical date ranges between 2020 (pandemic group) and 2019 (control group). Secondary analysis was performed analyzing disease severity, morbidity, and mortality. Results From March 1st to May 31st, 2020, 2.5 emergency general surgery operations were performed on average daily compared to 3.0 operations on average daily in 2019, a significant decrease ( P = .03). No significant difference was found in presenting disease severity, morbidity, or mortality between the pandemic and control groups. Discussion This study demonstrates a decrease of 65% in emergency general surgery operations during governmental restrictions secondary to the COVID-19 pandemic. This decrease in operations was not associated with worse disease severity, morbidity, or mortality.

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the growth of knowledge was significantly higher in the group that assiduously participated in the League, which reinforces its importance in complementing the traditional content of medical courses.

Background: The use of cold whole blood (WB) is rapidly resurging as one of the treatment modalities of choice for the initial resuscitation of civilian trauma patients across the United States. The purpose of our study was to evaluate the effectiveness and safety of cold whole blood (WB) as compared to blood component therapy (BCT) in resuscitation of civilian trauma patients. Methods: This was a retrospective cohort study of trauma patients who received at least one unit of WB transfusion during emergent resuscitation between November 2015 and October 2019 at a level I trauma center. Primary outcome was mortality up to 30 days after trauma. Secondary outcomes included overall blood product utilization and incidence of transfusion reactions. Outcomes were compared between patients who received WB and a cohort receiving BCT who did not receive WB matched for age, sex, mechanism of injury, heart rate, systolic blood pressure, Glasgow Coma Scale, injury severity score, and FAST results. Results: We included 78 patients who received WB transfusion and 78 matched controls. Within 30 days of injury, there were 19 deaths (24.4%) in the WB cohort and 28 (35.9%) deaths in controls (hazard ratio 0.62, 95% CI 0.33 to 1.15, p = 0.086). Patients in the WB cohort received as many units of blood products as controls (median number of units was 10 (IQR 6, 20) vs. 12 (IQR 6, 23), p = 0.43). The incidence of any transfusion reactions was similar between groups (7.7% in WB vs 9.0% in controls, p = 0.78). Life-threatening reactions did not occur in any of the groups. Conclusions: There was no mortality difference between patients receiving cold WB and BCT. Cold WB was safe in this cohort with no life-threatening transfusion reactions.

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