Institutional implementation of a clinical prediction tool into the decision-making process is feasible and significantly reduces the number of CTPA being performed, with substantial cost savings and patient benefits.

Worldwide, chronic obstructive pulmonary disease ranks among the most common chronic diseases and with the population ageing, its prevalence is predicted to increase. Established interventions that improve mortality include smoking cessation, and oxygen therapy in patients with significant hypoxaemia. Pharmacotherapy aims to alleviate symptoms, improve exercise tolerance and quality of life, and prevent and manage exacerbations. Although most medications are delivered via the inhaled route, adverse effects can manifest systemically. The likelihood of systemic adverse effects increases in the elderly and caution should be exercised in patients with comorbidities, such as cardiovascular disease. When indicated, combination therapies can offer superior efficacy over monotherapy. Assessment and education to ensure appropriate delivery device selection and use are integral to optimal care. J Pharm Pract Res 2009; 39: 302-6. INTRODUCTIONChronic obstructive pulmonary disease (COPD) is characterised by progressive airflow limitation with symptoms of cough, breathlessness and sputum production, and an estimated prevalence of 15% in those over 65 years of age. 1 If airflow limitation is fully or substantially reversible, that is forced expired volume in one second (FEV 1 ) response to bronchodilator of above 400 mL 2 , the older patient should be treated as for asthma. 2 COPD accounts for 20% of hospitalisations of older people in the US and by 2020 it is expected to rank as the third leading cause of death worldwide. 3,4 Available treatments can improve lung function, control symptoms, reduce severity and frequency of exacerbations, and increase exercise tolerance. 5 As older people are at an increased risk of adverse effects, careful consideration of treatments and modes of administration is paramount. RISK FACTORS AND PATHOPHYSIOLOGYAlthough cigarette smoking is the major risk factor for COPD, occupational exposure and environmental pollutants are also implicated.

Background: Multinodular goitre disease frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyroid. It also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid. This study evaluates all the factors that cause intra-operative blood loss and how it affects the Grave’s disease.Methods: This study was conducted in Raichur Institute of Medical Sciences Raichur on 200 patients with multinodular goitre disease, who underwent thyroidectomy during the period between November 2010 to July 2015.Results: The majority of patients were females which constitute about 76.3% with a median age of 33 years. The median period between the onset of the disease and operation was 15 months. Weight of thyroid in grams was 40. Post-operative hospital stay was 4 hours. Univariate analysis revealed that the strongest correlation of AIOBL was noted with the weight of thyroid (p <0.001). Additionally, AIOBL was correlated positively with the period between disease onset and surgery (p <0.001) and negatively with preoperative free T4 (p <0.01). Occurrences of postoperative complications, such as recurrent laryngeal nerve palsy or hypoparathyroidism, and postoperative hospital stay were not correlated with AIOBL.Conclusions: For multinodular goitre, for excessive bleeding during surgery, a large goiter presented as a predictive factor, and transfusion of blood should be considered in cases in which goitre weighs more than 200 g.

Background: Blood transfusion (BT) during or after delivery is a serious and sometimes a predictable event. This study helps to generate the information and knowledge regarding the various aspects of blood transfusions in obstetrics and its rational use and alternative strategies. Methods: This is retrospective study of 184 obstetric patients who had 288 blood transfusions during the month of March and April 2014 in the department of obstetrics in an urban tertiary care referral government teaching institute. Results: During this study period of 2 months from March to April 2014 there were 907 admissions in the labour room and 642 deliveries. Among these, 184 patients received blood transfusions. Numbers of blood transfused were 288. The main indication of blood transfusion was anaemia. Conclusions: As many as 56% of pregnant women are anaemic depending on the geographic and socio-economic group studies. Various strategies can be implemented to reduce the anaemia and decrease the number of blood transfusions so that patient will receive the maximum benefit with minimal risks.