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Purpose Obstructive sleep apnoea (OSA) is a common, significantly underdiagnosed sleep-related breathing disorder, characterised by upper airway collapse and resultant intermittent hypoxia. Oxygen plays an important role in collagen synthesis and as a result in wound healing. An association between OSA and wound healing has not been clearly delineated. A systematic review was performed to understand this association. Methods Randomised controlled trials, cohort, cross-sectional and case–control studies evaluating the relationship between OSA or OSA-related symptoms and wound healing in adult populations were searched in the systematic review using electronic databases PubMed, EMBASE and Ovid MEDLINE. Main results A total of 11 cohort studies and 1 case–control study with a total of 58,198,463 subjects were included. Most studies suggest that patients diagnosed with OSA or who are at high risk of having OSA are more likely to suffer from wound complications. Patients with OSA have been found to be at higher risk for post-operative wound infection and wound dehiscence. Contradictory results were obtained on time to heal, with one study concluding that individuals with OSA were more likely to heal earlier when compared to patients without OSA. Quality of evidence, however, was deemed very low due to high risk of bias. Conclusions This systematic review did identify an association between OSA and wound healing. However, due to the very low-quality evidence, further research is warranted to better characterise this association and investigate whether or not treating OSA can indeed affect wound healing.

Background: Correct inhaler technique is recommended by guidelines for optimum asthma care. The objective of the study is to determine real life predictors of correct pressurized metered dose inhaler (pMDI) technique in Asthma and COPD patients. Methods: Two hundred eight adult patients aged 18+ from respiratory outpatients (69.2%) and the community on regular pMDI for a diagnosis of Asthma (78.9%) or COPD, were recruited. A questionnaire containing 31 possible predictors was administered and pMDI technique with or without spacer was observed by trained researchers on 12 point steps, of which 4 were considered critical. Results: 23.1% of patients had no errors in inhaler technique and 32.2% had no critical errors. Patients had a median of 10 correct steps (IQR9-11), and 3(IQR2-4) correct critical steps. Using binary logistic regression the predictors of 10 correct steps were, other healthcare professional (pharmacist, nurse, physiotherapist) explained OR 3.73(1.63–8.54, p = 0.001), male gender 2.70(1.35–5.39, p = 0.004), self-score 1–10 1.21(1.05–1.39, p = 0.007), spacer use 0.38(0.19–0.79, p = 0.007), inhaled steroid 3.71(1.34–10.25, p = 0.01), heart disease 0.31(0.13–0.77, p = 0.01), pneumococcal vaccine 2.48(1.0–6.15, p = 0.043), education level 1–4 1.44(1.00–2.06, p = 0.05) and respiratory physician explained 0–7 times, 1.11(0.99–1.26, p = 0.08). Using ordinal logistic regression, predictors for correct critical steps 0–4, were: technique self-score 1–10 1.2(1.05–1.42, p = 0.006), inhaled corticosteroid use 2.78(1.1–7.31, p = 0.03) and education level 1–4 1.41(1.02–1.95, p = 0.03 Times respiratory physician explained inhaler technique 0–7 1.1(0.98–1.24, p = 0.1), married status 1.55(0.85–2.82, p= 0.15), hypercholesterolaemia 0.52(0.25–1.01, p = 0.054) and male gender 1.76(0.97–3.18, p = 0.06). Conclusions: Known predictors of correct pMDI use, such as gender and education level were confirmed, while age and concomitant use of dry powder inhaler were not. Pneumococcal vaccination and awareness of steroid side effects were possible novel positive predictors, while the use of a spacer and co-morbidity with heart disease were found to be negative predictors. Patients’ self-assessment correlated well with actual performance. This information may be useful in defining approaches to optimize inhaler techniques which are so susceptible to human error., peer-reviewed

Background Patients who suffer from rheumatoid arthritis have an increased risk of morbidity and mortality from cardiovascular disease. This is due to the high prevalence of traditional risk factors and the effect of systemic inflammation. Objectives The aim of the audit was to determine whether the cardiovascular risk assessment and management in rheumatoid arthritis patients at Mater Dei Hospital is in concordance with the recommendations by the European League Against Rheumatism (EULAR). Methods An audit was carried out retrospectively on 91 patients who suffer from rheumatoid arthritis by using the medical notes to collect data on demographics, co-morbidities, drug history and cardiovascular risk assessment and management over a two year period (August 2010 to July 2012). The results of the first audit were then disseminated through the rheumatology department and a form for cardiovascular risk assessment and management in rheumatoid arthritis patients was implemented. The audit was repeated on 107 patients and data was collected retrospectively over the two year period starting from January 2013 to December 2014. Results Documentation of cardiovascular risk factors over the two year period audited improved as follows from the first to the second audit: weight in 27.5% to 52.3%, height in 0% to 27.1%, BMI in 0% to 10.3%, smoking status in 72.5% to 93.5%, blood pressure in 72.5% to 92.5%, blood glucose in 72.5% to 97.1% and lipid profile in 54.9% to 96.3%. Documentation of smoking cessation advice improved from 15.8% to 41.1% and advice on other lifestyle changes improved from 14.3% to 18.7%. Moreover calculation of DAS28 over a one year period improved from 20.9% to 51.4%. In the first audit, 13.8% of patients who had complete data and in whom the ten year cardiovascular risk could be calculated (29 patients), would benefit from the use of a statin according to the guidelines (and were not currently receiving one). In the re-audit, this decreased to 8.6% of such patients (93 patients). In the second audit it was noted that the form that had been introduced for cardiovascular risk assessment was used in 15% (16 patients). The documentation of lifestyle advice was significantly higher ( p p p p p The prevalence of diagnosed hypertension in our cohort of rheumatoid arthritis patients was 49.0%; diabetes was 19.7%; hyperlipidaemia was 21.8%; and ischaemic heart disease was 8.8%. Conclusions Cardiovascular risk factors are highly prevalent in rheumatoid arthritis patients. This audit showed that cardiovascular risk assessment and management improved through raising awareness of its importance in the rheumatology department as well as the implementation of the cardiovascular risk assessment form. References Peters M JL, Symmons D PM, McCarey D, Dijkmans B AC, Nicola P, Kvien T K et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis, Feb 2010; 69: 325–33. Disclosure of Interest None declared