ORCID Profile
0000-0002-5460-0189
Current Organisations
Liverpool Hospital
,
Bond University
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Publisher: ASM Press
Date: 27-04-2017
Publisher: Elsevier BV
Date: 03-2020
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJOPEN-2018-027206
Abstract: There is a considerable implementation gap in managing early stage chronic kidney disease (CKD) in primary care despite the high prevalence and risk for increased morbidity and mortality associated with CKD. This systematic review aims to synthesise the evidence of efficacy of implementation interventions aimed at primary care practitioners (PCPs) to improve CKD identification and management. We further aim to describe the interventions’ behavioural change components. We will conduct a systematic review of studies from 2000 to October 2017 that evaluate implementation interventions targeting PCPs and which include at least one clinically meaningful CKD outcome. We will search several electronic data bases and conduct reference mining of related systematic reviews and publications. An interdisciplinary team will independently and in duplicate, screen publications, extract data and assess the risk of bias. Clinical outcomes will include all clinically meaningful medical management outcomes relevant to CKD management in primary care such as blood pressure, chronic heart disease and diabetes target achievements. Quantitative evidence synthesis will be performed, where possible. Planned subgroup analyses include by (1) study design, (2) length of follow-up, (3) type of intervention, (4) type of implementation strategy, (5) whether a behavioural or implementation theory was used to guide study, (6) baseline CKD severity, (7) patient minority status, (8) study location and (9) academic setting or not. Approval by research ethics board is not required since the review will only include published and publicly accessible data. Review findings will inform a future trial of an intervention to promote uptake of CKD diagnosis and treatment guidelines in our primary care setting and the development of complementary tools to support its successful adoption and implementation. We will publish our findings in a peer-reviewed journal and develop accessible summaries of the results. CRD42018102441.
Publisher: Wiley
Date: 06-02-2020
DOI: 10.1111/RESP.13774
Publisher: Public Library of Science (PLoS)
Date: 07-06-2021
DOI: 10.1371/JOURNAL.PONE.0252915
Abstract: Little is known about the treatment burden experienced by patients with obstructive sleep apnoea (OSA) who use continuous positive airway pressure (CPAP) therapy. 18 patients (33.3% males, mean age 59.7±11.8 years) with OSA who use CPAP therapy were interviewed. Patients treated with CPAP for OSA at a tertiary hospital outpatient clinic in Sydney, Australia, were invited to participate in an interview in person or via phone. Semi-structured interviews were used to explore the treatment burden associated with using CPAP. The interviews were recorded, transcribed, and analysed using NVivo 12 qualitative analysis software. Four categories of OSA-specific treatment burden were identified: healthcare tasks, consequences of healthcare tasks, exacerbating and alleviating factors of treatment burden. Participants reported a significant burden associated with using CPAP, independently of how frequently they used their device. Common sources of their treatment burden included attending healthcare appointments, the financial cost of treatment, lifestyle changes, treatment-related side effects and general discomfort. This study demonstrated that there is a significant treatment burden associated with the use of CPAP, and that treatment non-adherence is not the only consequence of treatment burden. Other consequences include relationship burden, stigma and financial burden. It is important for physicians to identify other negative impacts of treatment burden in order to optimise the patient experience.
Publisher: European Respiratory Society (ERS)
Date: 30-04-2016
Publisher: European Respiratory Society (ERS)
Date: 24-05-2018
DOI: 10.1183/13993003.00591-2018
Abstract: In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals. This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country via application for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 08-2015
Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJOPEN-2019-029105
Abstract: To pilot test the impact of the ICAN Discussion Aid on clinical encounters. A pre–post study involving 11 clinicians and 100 patients was conducted at two primary care clinics within a single health system in the Midwest. The study examined clinicians’ perceptions about ICAN feasibility, patients’ and clinicians’ perceptions about encounter success, videographic differences in encounter topics, and medication adherence 6 months after an ICAN encounter. 39/40 control encounters and 45/60 ICAN encounters yielded usable data. Clinicians reported ICAN use was feasible. In ICAN encounters, patients discussed diet, being active and taking medications more. Clinicians scored themselves poorer regarding visit success than their patients scored them this effect was more pronounced in ICAN encounters. ICAN did not improve 6-month medication adherence or lengthen visits. This pilot study suggests that using ICAN in primary care is feasible, efficient and capable of modifying conversations. With lessons learned in this pilot, we are conducting a randomised trial of ICAN versus usual care in erse clinical settings. NCT02390570 .
Publisher: MDPI AG
Date: 24-11-2021
DOI: 10.3390/DIAGNOSTICS11122179
Abstract: (1) Background: Computed tomography pulmonary angiography (CTPA) is the standard imaging test for the evaluation of acute pulmonary embolism (PE), but it is associated with patients' exposure to radiation. Studies have suggested that radiation exposure can be reduced without compromising PE detection by limiting the scan range (the
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.IJID.2016.11.006
Abstract: Around one third of the world's population may harbour latent tuberculosis infection (LTBI), an asymptomatic immunological state that confers a heightened risk of subsequently developing tuberculosis (TB). Effectively treating LTBI will be essential if the End TB Strategy is to be realized. This review evaluates the evidence in relation to the effectiveness of preventive antibiotic therapy to treat LTBI due to both drug-susceptible and drug-resistant bacteria. Current national and international preventive therapy guidelines are summarized, as well as ongoing randomized trials evaluating regimens to prevent drug-resistant TB. Populations that may benefit most from screening and treatment for LTBI include close contacts of patients with TB (particularly children under 5 years of age) and in iduals with substantial immunological impairment. The risks and benefits of treatment must be carefully balanced for each in idual. Electronic decision support tools offer one way in which clinicians can help patients to make informed decisions. Modelling studies indicate that the expanded use of preventive therapy will be essential to achieving substantial reductions in the global TB burden. However, the widespread scale-up of screening and treatment will require careful consideration of cost-effectiveness, while ensuring the drivers of ongoing disease transmission are also addressed.
Publisher: European Respiratory Society (ERS)
Date: 03-2020
Publisher: Public Library of Science (PLoS)
Date: 30-09-2013
Publisher: Elsevier BV
Date: 08-2021
Publisher: Cold Spring Harbor Laboratory
Date: 15-07-2020
DOI: 10.1101/2020.07.13.20153163
Abstract: Accurate seroprevalence estimates of SARS-CoV-2 in different populations could clarify the extent to which current testing strategies are identifying all active infection, and hence the true magnitude and spread of the infection. Our primary objective was to identify valid seroprevalence studies of SARS-CoV-2 infection and compare their estimates with the reported, and imputed, COVID-19 case rates within the same population at the same time point. We searched PubMed, Embase, the Cochrane COVID-19 trials, and Europe-PMC for published studies and pre-prints that reported anti-SARS-CoV-2 IgG, IgM and/or IgA antibodies for serosurveys of the general community from 1 Jan to 12 Aug 2020. Of the 2199 studies identified, 170 were assessed for full text and 17 studies representing 15 regions and 118,297 subjects were includable. The seroprevalence proportions in 8 studies ranged between 1%-10%, with 5 studies under 1%, and 4 over 10% - from the notably hard-hit regions of Gangelt, Germany Northwest Iran Buenos Aires, Argentina and Stockholm, Sweden. For seropositive cases who were not previously identified as COVID-19 cases, the majority had prior COVID-like symptoms. The estimated seroprevalences ranged from 0.56-717 times greater than the number of reported cumulative cases – half of the studies reported greater than 10 times more SARS-CoV-2 infections than the cumulative number of cases. The findings show SARS-CoV-2 seroprevalence is well below “herd immunity” in all countries studied. The estimated number of infections, however, were much greater than the number of reported cases and deaths in almost all locations. The majority of seropositive people reported prior COVID-like symptoms, suggesting that undertesting of symptomatic people may be causing a substantial under-ascertainment of SARS-CoV-2 infections. Systematic assessment of 17-country data show SARS-CoV-2 seroprevalence is mostly less than 10% - levels well below “herd immunity”. High symptom rates in seropositive cases suggest undertesting of symptomatic people and could explain gaps between seroprevalence rates and reported cases. The estimated number of infections for majority of the studies ranged from 2-717 times greater than the number of reported cases in that region and up to 13 times greater than the cases imputed from number of reported deaths.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.IJID.2017.03.004
Abstract: The importance of addressing the conditions that predispose in iduals and populations to develop tuberculosis is increasingly being recognized. Accurate quantification of the protective effect of preventive therapy and the provision of pragmatic guidance for clinical care and public health interventions is important. However, this approach must be nested within a socio-political context that addresses associated disadvantage and inequality.
Publisher: European Respiratory Society (ERS)
Date: 03-2019
DOI: 10.1183/20734735.0354-2018
Abstract: Challenges in the diagnostic process of chronic obstructive pulmonary disease (COPD) can result in diagnostic misclassifications, including overdiagnosis. The term “overdiagnosis” in general has been associated with variable definitions. In connection with efforts to reduce low-value care, “overdiagnosis” has been defined as a true positive diagnosis of a condition that is not associated with any harm in the diagnosed person. It is, however, unclear how the term “overdiagnosis” is used in the COPD literature. We conducted a rapid review of the literature to explore how the terms “overdiagnosis” and “misdiagnosis” are used in the context of COPD. Electronic searches of Medline were conducted from inception to October 2018, to identify primary studies that reported on over- and/or misdiagnosis of COPD using these terms. 28 articles were included in this review. Overdiagnosis and misdiagnosis in COPD were found to be used to describe five main concepts: 1) physician COPD diagnosis despite normal spirometry (14 studies) 2) discordant results for COPD diagnosis based on different spirometry-based definitions for airflow obstruction (10 studies) 3) COPD diagnosis based on pre-bronchodilator spirometry results (three studies) 4) comorbidities ( e.g. heart failure or asthma) that affect spirometry and have clinical features which overlap with COPD (two studies) and 5) normalisation of abnormal (post-bronchodilator) spirometry at follow-up (one study). The terms “overdiagnosis” and “misdiagnosis” were often used interchangeably and almost always referred to a false positive diagnosis. Performing (technically correct) spirometry with correct interpretation of the results could probably reduce misdiagnosis in a large proportion of the misdiagnosed cases of COPD. In addition, guidelines need to provide a more acceptable consensus spirometric definition of airflow obstruction. In the COPD literature, the terms “overdiagnosis” and “misdiagnosis” are often used interchangeably and almost always refer to a false positive diagnosis. Use of spirometry with correct interpretation of the results can avoid a substantial proportion of cases of misdiagnosis of COPD. To explore the use of the terms “overdiagnosis” and “misdiagnosis” in the COPD literature. To identify the main sources of overdiagnosis and misdiagnosis in COPD.
Publisher: BMJ
Date: 09-10-2018
DOI: 10.1136/BMJQS-2018-008022
Abstract: Clinicians’ satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes. We searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach. Twenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians’ satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid) only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors. Decision aids can improve clinicians’ satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians’ perspective on the decision making process or the likelihood of using a decision aid in the future.
Publisher: Public Library of Science (PLoS)
Date: 27-12-2011
Publisher: European Respiratory Society (ERS)
Date: 31-05-2013
Publisher: BMJ
Date: 28-12-2019
Publisher: AMPCo
Date: 02-2016
DOI: 10.5694/MJA15.00749
Publisher: European Respiratory Society (ERS)
Date: 08-2017
DOI: 10.1183/13993003.00157-2017
Abstract: There is uncertainty regarding whether patients with cancer should be screened for latent tuberculosis infection (LTBI). We performed a systematic review and meta-analysis to estimate the relative incidence of tuberculosis (TB) in cancer.We searched MEDLINE and Embase for studies published before December 21, 2016. We included studies that evaluated the incidence of TB in patients with solid cancers and haematological malignancies relative to a reference group (study control or general population). A pooled estimate of the incidence rate ratio (IRR) was obtained using standard meta-analysis methods.The search strategy identified 13 unique studies including 921 464 patients with cancer. The IRR of TB for adult patients with cancer was 2.61 (95% CI 2.12-3.22
Publisher: Agency for Healthcare Research and Quality (AHRQ)
Date: 14-10-2019
Publisher: Oxford University Press (OUP)
Date: 22-08-2017
DOI: 10.1093/CID/CIX516
Publisher: Elsevier BV
Date: 11-2017
Publisher: Informa UK Limited
Date: 06-2017
DOI: 10.2147/COPD.S130353
Publisher: Public Library of Science (PLoS)
Date: 22-01-2021
DOI: 10.1371/JOURNAL.PONE.0245492
Abstract: Patients’ burden from lung cancer treatment is not well researched, but this understanding can facilitate a patient-centred treatment approach. Current models of treatment burden suggest it is influenced by a patient’s perception of their disease and treatment and their capacity to do the work required to treat their disease. Sixteen patients and 1 carer who were undergoing or had completed conventional or stereotactic ablative radiotherapy, chemotherapy or immunotherapy for lung cancer in the last 6 months participated in a semi-structured interview. A treatment burden framework was used with three main themes: a) treatment work, b) consequences of treatment and c) psychosocial factors affecting treatment burden. The majority of patients did not feel unduly burdened by treatment tasks, despite having a large treatment-associated workload. Many saw treatment as a priority, causing them to restructure their life to accommodate for it. Patients wished that they would have been better informed about the lifestyle changes that they would have to make before treatment for lung cancer commenced and that the health service would provide services to assist them with this task. While there was a large burden associated with lung cancer treatment, patients felt motivated and equipped to manage the workload because the disease was considered severe and life-threatening, and the treatment was seen as beneficial. Before initiating treatment for lung cancer, patients should be informed about lifestyle changes they likely have to make and should be offered assistance.
Publisher: European Respiratory Society (ERS)
Date: 30-11-2018
Publisher: European Respiratory Society (ERS)
Date: 09-2020
Publisher: PeerJ
Date: 14-07-2017
DOI: 10.7717/PEERJ.3567
Abstract: The aim of our study was to identify barriers and enablers to implementation of the Xpert MTB/RIF test within Mongolia’s National Tuberculosis Program. Twenty-four semi-structured interviews were conducted between June and September 2015 with laboratory staff and tuberculosis physicians in Mongolia’s capital Ulaanbaatar and regional towns where Xpert MTB/RIF testing had been implemented. Interviews were recorded, transcribed, translated and analysed thematically using NVIVO qualitative analysis software. Eight laboratory staff (five from the National Tuberculosis Reference Laboratory in Ulaanbaatar and three from provincial laboratories) and sixteen tuberculosis physicians (five from the Mongolian National Center for Communicable Diseases in Ulaanbaatar, four from district tuberculosis clinics in Ulaanbaatar and seven from provincial tuberculosis clinics) were interviewed. Major barriers to Xpert MTB/RIF implementation identified were: lack of awareness of program guidelines inadequate staffing arrangements problems with cartridge supply management lack of local repair options for the Xpert machines lack of regular formal training paper based system delayed treatment initiation due to consensus meeting and poor s le quality. Enablers to Xpert MTB/RIF implementation included availability of guidelines in the local language provision of extra laboratory staff, shift working arrangements and additional modules capacity for troubleshooting internally access to experts opportunities for peer learning common understanding of diagnostic algorithms and decentralised testing. Our study identified a number of barriers and enablers to implementation of Xpert MTB/RIF in the Mongolian National Tuberculosis Program. Lessons learned from this study can help to facilitate implementation of Xpert MTB/RIF in other Mongolian locations as well as other low-and middle-income countries.
Publisher: The Sax Institute
Date: 2013
DOI: 10.1071/NB12099
Publisher: Cureus, Inc.
Date: 27-08-2017
DOI: 10.7759/CUREUS.1615
Publisher: Public Library of Science (PLoS)
Date: 22-10-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
DOI: 10.1097/CCM.0000000000003082
Abstract: To assess the effectiveness of noninvasive ventilation in patients with acute respiratory failure and do-not-intubate or comfort-measures-only orders. MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science from inception to January 1, 2017. Studies of all design types that enrolled patients in the ICU or hospital ward who received noninvasive ventilation and had preset do-not-intubate or comfort-measures-only orders. Data abstraction followed Meta-analysis of Observational Studies in Epidemiology guidelines. Data quality was assessed using a modified Newcastle-Ottawa Scale. Twenty-seven studies evaluating 2,020 patients with do-not-intubate orders and three studies evaluating 200 patients with comfort-measures-only orders were included. In patients with do-not-intubate orders, the pooled survival was 56% (95% CI, 49–64%) at hospital discharge and 32% (95% CI, 21–45%) at 1 year. Hospital survival was 68% for chronic obstructive pulmonary disease, 68% for pulmonary edema, 41% for pneumonia, and 37% for patients with malignancy. Survival was comparable for patients treated in a hospital ward versus an ICU. Quality of life of survivors was not reduced compared with baseline, although few studies evaluated this. No studies evaluated quality of dying in nonsurvivors. In patients with comfort-measures-only orders, a single study showed that noninvasive ventilation was associated with mild reductions in dyspnea and opioid requirements. A large proportion of patients with do-not-intubate orders who received noninvasive ventilation survived to hospital discharge and at 1 year, with limited data showing no decrease in quality of life in survivors. Provision of noninvasive ventilation in a well-equipped hospital ward may be a viable alternative to the ICU for selected patients. Crucial questions regarding quality of life in survivors, quality of death in nonsurvivors, and the impact of noninvasive ventilation in patients with comfort-measures-only orders remain largely unanswered.
Publisher: European Respiratory Society (ERS)
Date: 30-11-2018
Publisher: Public Library of Science (PLoS)
Date: 05-11-2012
Publisher: BMJ
Date: 12-10-2018
DOI: 10.1136/BMJ.K4065
Publisher: BMJ
Date: 26-02-2018
DOI: 10.1136/BMJEBM-2017-110852
Abstract: Surrogate endpoints are often used in clinical trials, as they allow for indirect measures of outcomes (eg, shorter trials with less participants). Improvements in surrogate endpoints (eg, reduction in low density lipoprotein cholesterol, normalisation of glycated haemoglobin) achieved with an intervention are, however, not always associated with improvements in patient-important outcomes. The common tendency in evidence-based medicine is to view results based on surrogate endpoints as less certain than results based on long term, final patient-important outcomes and rate them as ‘lower quality evidence’. However, careful appraisal of the validity of a surrogate endpoint as a measure of the final, patient-important outcome is more useful than an automatic judgement. In this guide, we use a contemporary and currently highly debated ex le of the surrogate endpoint ‘sustained viral response’ (ie, viral eradication considered to represent successful treatment) in patients treated for chronic hepatitis C virus. We demonstrate how the validity of a surrogate endpoint can be critically appraised to assess the quality of the evidence (ie, the certainty in estimates) and the implications for decision-making.
Publisher: Wiley
Date: 20-11-2019
DOI: 10.12788/JHM.3329
Abstract: High‐flow nasal cannula (HFNC) oxygen may provide tailored benefits in patients with preset treatment limitations. The objective of this study was to assess the effectiveness of HFNC oxygen in patients with do‐not‐intubate (DNI) and/or do‐not‐resuscitate (DNR) orders. We conducted a systematic review of interventional and observational studies. A search was performed using MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science, from inception to October 15, 2018. We included six studies evaluating 293 patients. All studies had a high risk of bias. The hospital mortality rates of patients with DNI and/or DNR orders receiving HFNC oxygen were variable and ranged from 40% to 87%. In two before and after studies, the initiation of HFNC oxygen was associated with improved oxygenation and reduced respiratory rates. One comparative study found no difference in dyspnea reduction or morphine doses between patients using HFNC oxygen versus conventional oxygen. No studies evaluated quality of life in survivors or quality of death in nonsurvivors. HFNC was generally well tolerated with few adverse events identified. While HFNC oxygen remains a viable treatment option for hospitalized patients who have acute respiratory failure and a DNI and/or DNR order, there is a paucity of high‐quality, comparative, effectiveness data to guide the usage of HFNC oxygen compared with other treatments, such as noninvasive ventilation, conventional oxygen, and palliative opioids.
Publisher: BMJ
Date: 20-04-2018
DOI: 10.1136/BMJEBM-2018-110893
Abstract: Several pharmacological and non-pharmacological therapies are used to treat stable bronchiectasis of non-cystic fibrosis (CF) aetiology. We conducted a systematic review and meta-analysis to assess the evidence of the effectiveness of pharmacological and non-pharmacological treatment options in patients with stable non-CF bronchiectasis with a focus on reducing exacerbations. Multiple databases were searched through September 2017. Outcomes included the number of patients with exacerbation events, mean number of exacerbations, hospitalisations, mortality, quality of life measures, and safety and adverse effects. Meta-analysis was conducted using the random effects model. 30 randomised controlled trials enrolled subjects with non-CF bronchiectasis using different interventions. Moderate-quality evidence supported the effect of long-term antibiotics (≥3 months) on lowering the number of patients experiencing exacerbation events (relative risk 0.77 (95% CI 0.68 to 0.89)), reducing number of exacerbations (incidence rate ratio 0.62 (95% CI 0.49 to 0.78)), improving forced expiratory volume (litre) in the first second (FEV 1 ) (weighted mean difference (WMD) 0.02 (95% CI 0.00 to 0.04)), decreasing sputum purulence scores (numerical scale of 1-8) (WMD −0.90 (95% CI −1.58 to −0.22)) and improving quality of life scores assessed by the St George’s Respiratory Questionnaire (WMD −6.07 (95% CI −10.7 to −1.43)). Bronchospasm increased with inhaled antibiotics while diarrhoea increased particularly with oral macrolide therapy. Moderate-quality evidence supports long-term antibiotic therapy for preventing exacerbations in stable non-CF bronchiectasis. However, data about the optimum agent, mode of therapy and length of treatment are limited. There is paucity of high-quality evidence to support the management of stable non-CF bronchiectasis including prevention of exacerbations.
Publisher: SAGE Publications
Date: 07-2021
DOI: 10.1177/23814683211058082
Abstract: Goals of care (GOC) conversations in the emergency department (ED) are often a brief discussion of code status rather than a patient-oriented dialogue. We aimed to develop a guide to facilitate conversations between ED clinicians and patients to elicit patient values and establish goals for end-of-life care, while maintaining ED efficiency. Paths of ED Care, a conversation guide, is the product of this work. A multidisciplinary/multispecialty group used recommended practices to adapt a GOC conversation guide for ED patients. ED clinicians used the guide and provided feedback on content, design, and usability. Patient-clinician interactions were recorded for discussion analysis, and both were surveyed to inform iterative refinement. A series of discussions with patient representatives, multidisciplinary clinicians, bioethicists, and health care designers yielded feedback. We used a process similar to the International Patient Decision Aid Standards and provide comparison to these. A conversation guide, eight pages with each page 6 by 6 inches in dimension, uses patient-oriented prompts and includes seven sections: 1) evaluation of patient/family understanding of disease, 2) explanation of possible trajectories, 3) introduction to different pathways of care, 4) explanation of pathways, 5) assessment of understanding and concerns, 6) code status, and 7) personalized summary. Recruitment of sufficient number of patients roviders to the project was the primary limitation. Methods are limited to qualitative analysis of guide creation and feasibility without quantitative analysis. Paths of ED Care is a guide to facilitate patient-centered shared decision making for ED patients, families, and clinicians regarding GOC. This may ensure care concordant with patients’ values and preferences. Use of the guide was well-received and facilitated meaningful conversations between patients and providers.
Publisher: Informa UK Limited
Date: 08-2022
DOI: 10.2147/COPD.S366412
Publisher: Ubiquity Press, Ltd.
Date: 09-08-2019
DOI: 10.5334/EGEMS.306
Abstract: Background: Stable angina patients have difficulty understanding the tradeoffs between treatment alternatives. In this analysis, we assessed treatment planning conversations for stable angina to determine whether inadequate health literacy acts as a barrier to communication that may partially explain this difficulty.Methods: We conducted a descriptive analysis of patient questionnaire data from the PCI Choice Trial. The main outcomes were the responses to the Decisional Conflict Scale and the proportion of correct responses to knowledge questions about stable angina. We also conducted a qualitative analysis on recordings of patient-clinician discussions about treatment planning. The recordings were coded with the OPTION12 instrument for shared decision-making. Two analysts independently assessed the number and types of patient questions and expressions of preferences.Results: Patient engagement did not differ by health literacy level and was generally low for all patients with respect to OPTION12 scores and the number of questions related to clinical aspects of treatment. Patients with inadequate health literacy had significantly higher decisional conflict. However, the proportion of knowledge questions answered correctly did not differ significantly by health literacy level.Conclusions: Patients with inadequate health literacy had greater decisional conflict but no difference in knowledge compared to patients with adequate health literacy. Inadequate health literacy may act as a barrier to communication, but gaps were found in patient engagement and knowledge for patients of all health literacy levels. The recorded patient-clinician encounters and the health literacy measure were valuable resources for conducting research on care delivery.
Publisher: BMJ
Date: 2012
Publisher: European Respiratory Society (ERS)
Date: 07-2018
Publisher: European Respiratory Society (ERS)
Date: 06-2020
Publisher: European Respiratory Society (ERS)
Date: 03-2019
DOI: 10.1183/20734735.0339-2018
Abstract: Overuse of computed tomography pulmonary angiography to diagnose pulmonary embolism in people who have only a low pre-test probability of pulmonary embolism has received significant attention in the past. The issue of overdiagnosis of pulmonary embolism, a potential consequence of overtesting, has been less explored. The term “overdiagnosis”, used in a narrow sense, describes a correct (true positive) diagnosis in a person but without any associated harm. The aim of this review is to summarise literature on the topic of overdiagnosis of pulmonary embolism and translate this epidemiological concept into the clinical practice of respiratory professionals. The review concludes that the location of pulmonary embolism at a subsegmental level, rather than whether a diagnosis was made incidentally or following an investigation for suspected pulmonary embolism, is the best predictor for situations in which anticoagulation may not be necessary. In the absence of strong evidence of the optimal management of subsegmental pulmonary embolism, treatment decisions should be made case by case, taking into account the patient's situation and preference. Since the introduction of computed tomography pulmonary angiography in 1998, there has been a steep increase in the diagnosis of pulmonary embolism (PE). An increased incidence of PE diagnoses, but an almost stable mortality from PE in the population, together with a decreased case fatality, point towards overdiagnosis (in the absence of more effective treatment). Whether PE is diagnosed as an incidental finding or following an investigation for suspected PE does not appear to influence the need for anticoagulation therapy. An isolated subsegmental PE may not require anticoagulation therapy, and treatment decisions should be made case by case, taking into account the patient's situation and preference. A suggested definition of overdiagnosis of PE: a diagnosis of PE that, if left untreated, would not lead to more harm than if it were treated with anticoagulation therapy, independent of symptoms. To understand the term “overdiagnosis” based on its narrow definition and be able to apply it to PE. To outline the diagnostic approach to PE. To summarise what is known about the treatment of incidentally detected PE. To summarise what is known about the treatment of subsegmental PE. To understand in which situations anticoagulation therapy for PE may not be beneficial.
Publisher: PeerJ
Date: 25-02-2016
DOI: 10.7717/PEERJ.1738
Abstract: Background. Healthcare workers have an increased risk of latent tuberculosis infection (LTBI), but previous studies suggested that they might be reluctant to accept preventive tuberculosis (TB) treatment. We aimed to examine doctors’ and nurses’ experience of TB screening and to explore their attitudes towards preventive TB treatment. Methods. We conducted a survey among randomly selected healthcare workers at a tertiary hospital in Sydney, Australia, using a paper-based questionnaire. Results. A total of 1,304 questionnaires were distributed and 311 (24%) responses were received. The majority of hospital staff supported preventive TB treatment in health care workers with evidence of latent TB infection (LTBI) in general (74%, 164/223) and for them personally (81%, 198/244) while 80 and 53 healthcare workers respectively had no opinion on the topic. Staff working in respiratory medicine were significantly less likely to support preventive TB treatment in health care workers in general or for them personally if they would have evidence of LTBI compared to other specialties ( p = 0.001). Only 13% (14/106) of respondents with evidence of LTBI indicated that they had been offered preventive TB treatment. Twenty-one percent (64/306) of respondents indicated that they did not know the difference between active and latent TB. Among staff who had undergone testing for LTBI, only 33% (75/230) felt adequately informed about the meaning of their test results. Discussion. Hospital staff in general had positive attitudes towards preventive TB treatment, but actual treatment rates were low and perceived knowledge about LTBI was insufficient among a significant proportion of staff. The gap between high support for preventive TB treatment among staff and low treatment rates needs to be addressed. Better education on the concept of LTBI and the meaning of screening test results is required.
Publisher: Informa UK Limited
Date: 06-2016
DOI: 10.2147/CEOR.S92244
Publisher: Elsevier BV
Date: 07-2017
Publisher: Elsevier BV
Date: 06-2020
Publisher: Wiley
Date: 12-2009
DOI: 10.1111/J.1445-5994.2008.01882.X
Abstract: The aim of this study was to determine the diagnostic yield of flexible bronchoscopy in endoscopically visible malignancies and to evaluate whether cytological examination, including bronchial washings and brushings, increase the diagnostic yield compared with bronchial biopsy alone. We reviewed a series of bronchoscopies over a period of 7.5 years in which an endoscopically visible tumour was identified and which had a definite cytological or histological diagnosis of pulmonary malignancy obtained by bronchoscopy or any other examination. The criteria were met by 174 bronchoscopies. In 155 bronchoscopies all specimens including bronchial washings, brushings and biopsies were obtained the overall diagnostic yield was 88%. This compared with a diagnostic yield of 77% for biopsies only (P < 0.001). The in idual diagnostic yields for biopsies, brushings and washings were 77, 50 and 38%, respectively. The overall diagnostic yield of cytology was 61%, providing a diagnosis in 95 patients. Of 11 repeat bronchoscopies after an initial non-diagnostic bronchoscopy, 9 were diagnostic. The tumour detection rate with flexible bronchoscopy in endoscopically visible lung malignancies is high. Cytology-based s ling techniques by means of bronchial washings and brushings significantly increase the overall diagnostic yield compared with forceps biopsy only. Repeat bronchoscopies after an initial non-diagnostic bronchoscopy have a relatively high diagnostic yield and should therefore be considered in all patients with endoscopically visible tumour.
Publisher: Oxford University Press (OUP)
Date: 04-10-2017
DOI: 10.1093/CID/CIX861
Abstract: Healthcare workers (HCWs) undergo occupational tuberculosis screening at regular intervals. However, the risk of contracting tuberculosis at the workplace in a setting with a low background tuberculosis incidence is unclear. We aimed to evaluate the risk of tuberculin skin test (TST) conversion and the risk of occupational tuberculosis infection among HCWs in such a setting. We conducted a retrospective cohort study of employees of a large tertiary medical center in the US Midwest who had undergone TST screening during the study period 1 January 1998 to 31 May 2014. Among 40142 HCWs who received a TST, only 123 converted over 16.4 years. Only 9 (7%) of the converters had a suspected tuberculosis exposure at the workplace and none developed active tuberculosis. The majority of TST converters (66%) had a negative QuantiFERON-TB test at the time of the conversion. In one of the largest cohorts of HCWs in a low-tuberculosis-incidence setting, we demonstrated an extremely low risk of occupational tuberculosis exposure among TST converters and no resulting active tuberculosis cases. In this setting, the approach of testing HCWs at baseline and after tuberculosis exposure, rather than at regular intervals, should be considered.
Publisher: American Society for Microbiology
Date: 23-12-2016
DOI: 10.1128/MICROBIOLSPEC.TNMI7-0026-2016
Abstract: Treatment with biologic agents, in particular tumor necrosis factor alpha (TNF-α) inhibitors, is associated with an increased risk of tuberculosis (TB), and screening and treatment for latent TB infection (LTBI) in patients undergoing such treatment is therefore indicated. The risk of TB associated with different biologics varies significantly, with the highest relative risks, 29.3 and 18.6, associated with adalimumab and infliximab, respectively. The risk of TB with newer TNF-α inhibitors and other biologics appears to be lower. Performance of LTBI screening tests is affected by immune-mediated inflammatory diseases and immunosuppressive therapy in patients due to commence TNF-α inhibitor treatment. Interferon gamma release assays (IGRAs) have a higher specificity than the tuberculin skin test (TST) in patients with Bacillus Calmette–Guérin (BCG) vaccination and have probably a better sensitivity than TST in immunosuppressed patients. LTBI screening programs prior to commencement of anti-TNF-α treatment significantly reduce the incidence of TB, but the optimal screening algorithm, in particular the question of whether a combination of IGRA and TST or a single test only should be used, is a matter of ongoing debate. Use of TST in combination with IGRA is justified to increase sensitivity. Repeat testing for LTBI should be limited to patients at increased risk of TB. If TB develops during anti-TNF-α treatment, it is more likely to be disseminated and extrapulmonary than are other TB cases. Discontinuation of anti-TNF-α treatment in patients diagnosed with TB is associated with an increased risk of immune reconstitution inflammatory syndrome, which is probably best managed by reintroduction of anti-TNF-α treatment.
Publisher: ACM
Date: 19-08-2007
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2022-064447
Abstract: The treatment workload associated with end-stage kidney disease (ESKD) is high. The treatment burdens experienced by patients with ESKD are not well understood. In this study, we aimed to elucidate the most important areas of treatment burden for discussion in a clinical encounter from the perspectives of patients with ESKD and nephrologists. We sought to explore possible solutions to these high priority treatment burden challenges. Nominal group technique (NGT) sessions. Three in-person NGT sessions were conducted with 19 patients with dialysis-dependent ESKD from one tertiary treatment centre (mean age 64 years range 47–82). All patients were either retired or on a disability pension 74% perceived moderate or severe treatment burden and 90% spent more than 11 hours on treatment-related activities per week (range 11–30). One online NGT session was conducted with six nephrologists from two Australian states. The primary outcome was a ranked list of treatment burden priorities. The secondary outcome was potential solutions to these treatment burden challenges. Every patient group ranked health system issues as the most important treatment burden priority. This encompassed lack of continuity and coordination of care, dissatisfaction with frequent healthcare encounters and challenges around healthcare access. Psychosocial burdens on patients and families were perceived to be the most important area of treatment burden by physicians, and were ranked the second highest priority by patients. Discussing treatment burden in a clinical encounter may lead to a better understanding of patients’ capacity to cope with their treatment workload. This could facilitate tailored care, improve health outcomes, treatment sustainability and patients’ overall quality of life.
Publisher: European Respiratory Society (ERS)
Date: 07-2018
DOI: 10.1183/23120541.00008-2018
Abstract: Following pre-migration screening for tuberculosis (TB), migrants who are deemed to be at a high risk of developing TB must attend post-entry follow-up in Australia. We aimed to evaluate the effectiveness of post-migration TB follow-up in the state of New South Wales to diagnose TB in these high-risk migrants. In this retrospective cohort study, we assessed the risk of TB in migrants who arrived in New South Wales between 2000 and 2015 and were referred for post-migration follow-up. Clinical notes were examined for a nested cohort to determine whether TB was diagnosed via the follow-up programme or via passive case finding. Of the 32 550 migrants referred for follow-up, 428 (1.3%) developed TB. The incidence of TB was 436 per 100 000 person-years (95% CI 384–491 per 100 000 person-years) in the first 2 years after arrival and 128 per 100 000 person-years (95% CI 116–140 per 100 000 person-years) over the mean study observation period of 10.3 years. An estimated 63% of cases were diagnosed via follow-up. TB notifications occurred 0.55 years earlier since time of arrival in Australia in migrants who attended follow-up than in those who did not. Post-migration follow-up detected 63% of TB cases in high-risk migrants and potentially prevented delay of TB diagnosis.
Publisher: European Respiratory Society (ERS)
Date: 12-2019
Publisher: Springer Science and Business Media LLC
Date: 12-07-2009
Publisher: European Respiratory Society (ERS)
Date: 12-2020
Publisher: European Respiratory Society (ERS)
Date: 06-2021
Publisher: European Respiratory Society (ERS)
Date: 04-2020
DOI: 10.1183/23120541.00301-2019
Abstract: Hospital readmissions within 30 days are used as an indicator of quality of hospital care. We aimed to evaluate the ability of the LACE (Length of stay, Acuity of admission, Comorbidities based on Charlson comorbidity score and number of Emergency visits in the last 6 months) index to predict the risk of 30-day readmissions in patients hospitalised for community-acquired pneumonia (CAP). In this retrospective cohort study a LACE index score was calculated for patients with a principal diagnosis of CAP admitted to a tertiary hospital in Sydney, Australia. The predictive ability of the LACE score for 30-day readmissions was assessed using receiver operator characteristic curves with C-statistic. Of 3996 patients admitted to hospital for CAP at least once, 8.0% (n=327) died in hospital and 14.6% (n=584) were readmitted within 30 days. 17.8% (113 of 636) of all 30-day readmissions were again due to CAP, followed by readmissions for chronic obstructive pulmonary disease, heart failure and chest pain. The LACE index had moderate discriminative ability to predict 30-day readmission (C-statistic=0.6395) but performed poorly for the prediction of 30-day readmissions due to CAP (C-statistic=0.5760). The ability of the LACE index to predict all-cause 30-day hospital readmissions is comparable to more complex pneumonia-specific indices with moderate discrimination. For the prediction of 30-day readmissions due to CAP, the performance of the LACE index and modified risk prediction models using readily available variables (sex, age, specific comorbidities, after-hours, weekend, winter or summer admission) is insufficient.
Publisher: Springer Science and Business Media LLC
Date: 08-05-2015
Publisher: European Respiratory Society (ERS)
Date: 2009
DOI: 10.1183/09031936.00104108
Abstract: Recurrence of active tuberculosis following treatment of an initial disease episode can occur due to endogenous re-activation or exogenous re-infection. Cases of recurrent tuberculosis in the Australian state of New South Wales between 1994 and 2006 were identified by data linkage analysis with confirmatory review of case notes. Patients with more than one culture-positive disease episode during that time period who had completed treatment for the initial disease episode were included. Genotyping of Mycobacterium tuberculosis was used to determine whether recurrence was likely to be due to re-activation or re-infection. There were 5,723 tuberculosis notifications between 1994 and 2006, 3,731 of which were culture-positive. Fifteen (0.4%) patients had recurrent culture-positive disease over a mean 5.7 yrs of follow-up (crude annual incidence 71 per 100,000 population). Recurrent tuberculosis was attributable to re-activation (indistinguishable strains) in 11 (73%) cases and to re-infection (different strains) in four (27%). In a low-incidence setting of tuberculosis, a control programme incorporating directly observed therapy for active disease resulted in a very low rate of recurrent tuberculosis over a long period of follow-up. Re-infection is less likely than re-activation, but still contributes significantly to the number of cases with recurrent disease.
Publisher: Elsevier BV
Date: 02-2017
Publisher: Hogrefe Publishing Group
Date: 10-2002
DOI: 10.1024/0369-8394.91.40.1664
Abstract: Das paroxysmale Fingerhämatom (Achenbach-Syndrom) ist ein wenig beschriebenes Krankheitsbild ungeklärter Ätiologie. Spontan oder nach geringen Traumata treten Hämatome an der Volarseite der Finger auf, welche von Schmerzen, Fingerschwellung und Parästhesien begleitet sind. Wir beschreiben eine Patientin mit diesem Krankheitsbild.
Publisher: Wiley
Date: 03-2015
Publisher: Informa UK Limited
Date: 2023
DOI: 10.2147/PPA.S385911
Publisher: American Medical Association (AMA)
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 28-10-2019
Publisher: Wiley
Date: 05-2009
DOI: 10.1111/J.1445-5994.2009.01882.X
Abstract: Aims: The aim of this study was to determine the diagnostic yield of flexible bronchoscopy in endoscopically visible malignancies and to evaluate whether cytological examination including bronchial washings and brushings increase the diagnostic yield compared with bronchial biopsy alone. Methods We reviewed a series of bronchoscopies over a period of 7.5 years in which an endoscopically visible tumour was identified and which had a definite cytological or histological diagnosis of pulmonary malignancy obtained by bronchoscopy or any other examination. Results The above criteria were met by 174 bronchoscopies. In 155 bronchoscopies all specimens including bronchial washings, brushings and biopsies were obtained, the overall diagnostic yield of which was 88%. This compared with a diagnostic yield of 77% for biopsies only (p<0.001). The in idual diagnostic yields for biopsies, brushings and washings were 77%, 50% and 38%, respectively. The overall diagnostic yield of cytology was 61%, providing a diagnosis in 95 patients. Of 11 repeat bronchoscopies after an initial non-diagnostic bronchoscopy, 9 were diagnostic. Conclusions The tumour detection rate with flexible bronchoscopy in endoscopically visible lung malignancies is high. Cytology-based s ling techniques by means of bronchial washings and brushings significantly increase the overall diagnostic yield compared to forceps biopsy only. Repeat bronchoscopies after an initial non-diagnostic bronchoscopy have a relatively high diagnostic yield, and should therefore be considered in all patients with endoscopically visible tumour.
Publisher: Springer Science and Business Media LLC
Date: 26-10-2020
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-027935
Abstract: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease, usually caused by tobacco smoking, but other important risk factors include exposures to combustion products of biomass fuels and environmental pollution. The introduction of several new (combination) inhaler therapies, increasing uncertainty about the role of inhaled corticosteroids and a rapid proliferation of the literature on management of stable COPD in general, call for novel ways of evidence synthesis in this area. A systematic review and evidence map can provide the basis for shared decision-making tools and help to establish a future research agenda. This systematic review will follow an umbrella systematic review design (also called overview of reviews). We plan to conduct a comprehensive literature search of Ovid MEDLINE (including epub ahead of print, in process and other non-indexed citations), Ovid Embase, Ovid Cochrane Database of Systematic Reviews and Scopus from database inception to the present. We will include systematic reviews that assessed the effectiveness of any pharmacological or non-pharmacological intervention on one or more patient-important outcomes and/or lung function in patients with stable COPD. For every intervention/outcome pair, one systematic review will be included. An a priori protocol will guide, which systematic reviews will be chosen, how their credibility will be evaluated, and how the quality of the body of evidence will be rated. Data will be synthesised into an evidence map that will present a matrix that depicts each available treatment for stable COPD with a quantitative estimate on symptoms/outcomes from the patient perspective, along with an indication of the size and certainty in the evidence. Approval by a research ethics committee is not required since the review will only include published data. The systematic review will be published in a peer-reviewed journal. CRD42018095079
Publisher: Springer Science and Business Media LLC
Date: 19-10-2020
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2021-053446
Abstract: Heart disease in chronic obstructive pulmonary disease (COPD) is a common but neglected comorbidity. Patients with COPD are frequently excluded from clinical trials of treatments aimed at reducing cardiac morbidity and mortality, which has led to undertreatment of cardiovascular disease in patients with COPD. A particular concern in COPD is the underuse of beta (β)-blockers. There is observational evidence that cardioselective β-blockers are safe and may even reduce mortality risk in COPD, although some evidence is conflicting. There is an urgent need to answer the research question: Are cardioselective β-blockers safe and of benefit in people with moderately severe COPD? The proposed study will investigate whether cardioselective β-blocker treatment in patients with COPD reduces mortality and cardiac and respiratory morbidity. This is a double-blind, randomised controlled trial to be conducted in approximately 26 sites in Australia, New Zealand, India, Sri Lanka and other countries as required. Participants with COPD will be randomised to either bisoprolol once daily (range 1.25–5 mg, dependent on tolerated dose) or matched placebo, in addition to receiving usual care for their COPD over the study duration of 24 months. The study will enrol 1164 participants with moderate to severe COPD, aged 40–85 years. Participants will be symptomatic from their COPD and have a postbronchodilator forced expiratory volume in 1 s (FEV 1 ) ≥30% and ≤70% predicted and a history of at least one exacerbation requiring systemic corticosteroids, antibiotics or both in the prior 24 months. The study protocol has been approved by the Sydney Local Health District Human Research Ethics Committee at The Concord Repatriation General Hospital. NCT03917914 CTRI/2020/08/027322.
Publisher: OMICS Publishing Group
Date: 2016
Publisher: European Respiratory Society (ERS)
Date: 09-2021
Publisher: MDPI AG
Date: 05-11-2021
DOI: 10.3390/ANTIBIOTICS10111355
Abstract: Tuberculosis (TB) does not respect borders, and migration confounds global TB control and elimination. Systematic screening of immigrants from TB high burden settings and—to a lesser degree TB infection (TBI)—is recommended in most countries with a low incidence of TB. The aim of the study was to evaluate the views of a erse group of international health professionals on TB management among migrants. Participants expressed their level of agreement using a six-point Likert scale with different statements in an online survey available in English, French, Mandarin, Spanish, Portuguese and Russian. The survey consisted of eight sections, covering TB and TBI screening and treatment in migrants. A total of 1055 respondents from 80 countries and territories participated between November 2019 and April 2020. The largest professional groups were pulmonologists (16.8%), other clinicians (30.4%), and nurses (11.8%). Participants generally supported infection control and TB surveillance established practices (administrative interventions, personal protection, etc.), while they disagreed on how to diagnose and manage both TB and TBI, particularly on which TBI regimens to use and when patients should be hospitalised. The results of this first knowledge, attitude and practice study on TB screening and treatment in migrants will inform public health policy and educational resources.
Publisher: Informa UK Limited
Date: 12-2018
DOI: 10.2147/CLEP.S149574
Publisher: Cureus, Inc.
Date: 12-07-2017
DOI: 10.7759/CUREUS.1461
Publisher: Elsevier BV
Date: 03-2020
Publisher: European Respiratory Society (ERS)
Date: 12-2020
DOI: 10.1183/20734735.0216-2020
Abstract: Extrapulmonary tuberculosis (EPT) can affect all organs. Its diagnosis is often challenging, especially when the lung is not involved. Some EPT locations, such as when the central nervous system is involved, are a medical emergency, and some have implications for treatment options and length. This review describes clinical features of EPT, diagnostic tests and treatment regimens.
Publisher: European Respiratory Society (ERS)
Date: 09-2020
Publisher: European Respiratory Society (ERS)
Date: 2018
DOI: 10.1183/23120541.00146-2017
Abstract: The aim of the study was to explore the views of tuberculosis (TB) physicians on treatment of latent TB infection (LTBI), focusing on decision making and communication in clinical practice. 20 Australian TB physicians participated in a semistructured interview in person or over the telephone. Interviews were recorded, transcribed and analysed thematically. The study identified challenges that physicians face when discussing treatment for LTBI with patients. These included difficulties explaining the concept of latency (in particular to patients from culturally and linguistically erse backgrounds) and providing guidance to patients while still framing treatment decisions as a choice. Tailored estimates of the risk of developing TB and the risk of developing an adverse effect from LTBI treatment were considered the most important information for decision making and discussion with patients. Physicians acknowledged that there is a significant amount of unwarranted treatment variation, which they attributed to the lack of evidence about the risk–benefit balance of LTBI treatment in certain scenarios and guidelines that refer to the need for case-by-case decision making in many instances. In order to successfully implement LTBI treatment at a clinical level, consideration should be given to research on how to best address communication challenges arising in clinical encounters.
Publisher: European Respiratory Society (ERS)
Date: 06-07-2020
Publisher: European Respiratory Society (ERS)
Date: 09-2019
Publisher: Public Library of Science (PLoS)
Date: 15-07-2015
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 06-2015
Abstract: Many countries restrict access to directly observed therapy (DOT) for tuberculosis (TB) to government health facilities. More innovative approaches are required to reduce non-adherence, improve patient outcomes and limit the risk of selecting drug-resistant strains. We performed a retrospective cohort study in sputum smear-positive patients treated with community-based DOT (home-based DOT or 'lunch' DOT, whereby DOT is provided with a free daily meal once sputum smear conversion has been documented), and conventional clinic-based DOT in Ulaanbaatar, the capital of Mongolia, in 2010-2011. We compared treatment success using community-based home DOT vs. conventional clinic DOT and describe treatment completion rates using lunch DOT. The overall treatment success among new sputum smear-positive TB patients was 85.1% (1505/1768). Patients receiving community DOT had higher cure rates (294/327, 89.9% vs. 1112/1441, 77.2% aOR 2.66, 95%CI 1.81-3.90) and higher treatment success (306/327, 93.6% vs. 1199/1441, 83.2% aOR 2.95, 95%CI 1.85-4.71, P < 0.001) than those treated with clinic DOT. Apart from one death, treatment completion was 100% among patients who received lunch DOT after sputum smear conversion. Community DOT improved treatment success in Ulaanbaatar, Mongolia. It should now be scaled up to be made available for more patients and in all regions of the country.
Publisher: Cold Spring Harbor Laboratory
Date: 23-09-2020
DOI: 10.1101/2020.09.20.20198184
Abstract: As the world struggles with the COVID-19 pandemic, health service demands have increased to a point where healthcare resources may prove inadequate to meet demand. Guidelines and tools on how to best allocate intensive care beds and ventilators developed during previous epidemics can assist clinicians and policy-makers to make consistent, objective and ethically sounds decisions about resource allocation when healthcare rationing is inevitable. This scoping review of 62 published guidelines, triage protocols, consensus statements and prognostic tools from crisis and non-crisis situations sought to identify a multiplicity of objective factors to inform healthcare rationing of critical care and ventilator care. It also took ethical considerations into account. Prognostic indicators and other decision tools presented here can be combined to create locally-relevant triage algorithms for clinical services and policy makers deciding about allocation of ICU beds and ventilators during a pandemic. Community awareness of the triage protocol is recommended to build trust and alleviate anxiety among the public. This review provides a unique resource and is intended as a discussion starter for clinical services and policy makers to consider formalising an objective triage consensus document that fits the local context. An evidence-based catalogue of objective variables from 62 published resources tested in crisis and non-crisis situations can help clinicians make locally relevant triage decisions on ICU and ventilator allocation in inevitable COVID-19 health rationing.
Publisher: European Respiratory Society (ERS)
Date: 06-2019
Publisher: AMPCo
Date: 02-2008
DOI: 10.5694/J.1326-5377.2008.TB01558.X
Abstract: To estimate the incidence of recurrence of culture-positive tuberculosis (TB) and the relative contributions of reinfection and reactivation (based on DNA fingerprinting). Retrospective analysis of all culture-positive TB notifications between 1994 and 2006 from Liverpool Chest Clinic in the south-west of Sydney. Patients with more than one notification of culture-positive TB during this period were identified. Genotyping of Mycobacterium tuberculosis was used to determine whether recurrence was due to reinfection or reactivation. Estimation of the incidence of recurrence of culture-positive TB (cases per 100 000 person-years of follow-up), and the proportions of reinfection and reactivation. Three cases of recurrent culture-positive disease were identified (incidence of recurrence: 57.7 per 100 000 person-years of follow-up). All three patients were treated with directly observed therapy. Two of these patients had evidence of reinfection with different strains both were natives of a country with a high incidence of TB and had returned to that country after the initial episode. The other patient had evidence of reactivation of the initial strain, indicating secondary failure of treatment. This patient had poor adherence to treatment. Our observations suggest there is a very low rate of reactivation of tuberculosis. The low incidence of recurrence due to reinfection reflects the low incidence of tuberculosis in Australia. When reinfection does occur, this probably has been sustained during residence in a country with a high incidence of tuberculosis.
Publisher: European Respiratory Society (ERS)
Date: 03-2021
Publisher: Wiley
Date: 17-06-2019
DOI: 10.1111/RESP.13623
Publisher: Wiley
Date: 25-07-2013
DOI: 10.1111/RESP.12132
Abstract: The term 'health care-associated pneumonia' (HCAP) was introduced by the American Thoracic Society and the Infectious Diseases Society of America in 2005 to describe a distinct entity of pneumonia that resembles hospital-acquired pneumonia rather than community-acquired pneumonia (CAP) in terms of occurrence of drug-resistant pathogens and mortality in patients that--while not hospitalized in the traditional sense--have been in recent contact with the health-care system. It was proposed that HCAP should be treated empirically with therapy for drug-resistant pathogens. Over the last few years, there has been increasing controversy over whether HCAP is a helpful definition, or leads to unnecessary and potentially problematic overtreatment. The term HCAP has been extensively criticized in Europe. While most studies have shown that HCAP is associated with more frequent drug-resistant pathogens and higher mortality than CAP, there is no clear evidence that this is due to inappropriate antibiotic therapy. Therapy consistent with HCAP treatment guidelines has also not been found to improve mortality. Based on current evidence, we suggest broad-spectrum antibiotic therapy to treat possible pathogens not usually covered in CAP be based on assessment of in idual risk factors rather than applying a HCAP classification system in the Asia-Pacific Region.
Publisher: European Respiratory Society (ERS)
Date: 03-2021
DOI: 10.1183/20734735.0003-2021
Abstract: The implementation of thickened fluids in patients with dysphagia is widely considered an effective strategy for safe and physiologically improved swallow. However, there is limited evidence to suggest that this intervention reduces the risk of dysphagia-related complications including aspiration pneumonia. In addition, there is growing evidence that this approach is associated with adverse clinical effects including dehydration, malnutrition and reduced health-related quality of life. This review summarises the rationale for thickened fluids, the evidence base (or lack thereof) underpinning their use, and current guideline recommendations. To review the evidence base for thickened fluids in the management of dysphagia. To examine the evidence that thickened fluids reduce aspiration pneumonia. To provide an overview of the advantages and disadvantages of thickened fluids in the management of dysphagia.
Publisher: The Sax Institute
Date: 2013
DOI: 10.1071/NB13012C
Publisher: Wiley
Date: 26-07-2020
DOI: 10.1111/RESP.13904
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 12-2016
Abstract: To investigate the epidemiology and the relative risk of tuberculosis (TB) in pregnant women in Mongolia, a high TB incidence setting with a low rate of human immunodeficiency virus co-infection, where active case finding for TB in pregnancy is implemented. We retrospectively collected data on pregnant women diagnosed with TB during 2013. Data were collected through doctors at central TB dispensaries who extracted the relevant information from patients' clinical records. The overall incidence of TB among pregnant women was 228 (95%CI 187276) per 100000 person-years, resulting in an incidence rate ratio of 1.31 (95%CI 1.081.59) in pregnant women compared to the general population. Twelve per cent of the pregnant women with TB chose to have an abortion. In this study, pregnant women had a 1.3-fold higher risk of developing TB than the general population. Based on a moderately increased risk of TB during pregnancy in our study and the potential for adverse health outcomes, TB screening among pregnant women can currently be justified, but the cost-effectiveness of this intervention remains unclear. Patients and doctors need to be educated about the safety of standard TB treatment in pregnancy to reduce the rate of abortions.
Publisher: American College of Physicians
Date: 25-02-2020
DOI: 10.7326/M19-3007
Publisher: Elsevier BV
Date: 12-2020
Publisher: American Medical Association (AMA)
Date: 04-02-2020
Publisher: European Respiratory Society (ERS)
Date: 31-08-2018
Publisher: European Respiratory Society (ERS)
Date: 24-09-2015
DOI: 10.1183/13993003.00577-2015
Abstract: We aimed to develop a decision aid that estimates whether treatment of latent tuberculosis infection (LTBI) is likely to have a net gain in quality-adjusted life-years for an in idual. A Markov model was developed which incorporated personalised estimates for risk of tuberculosis (TB) reactivation, TB death, quality-of-life impairments and treatment side-effects. The net effect of LTBI treatment was quantified in terms of quality-adjusted life-years gained or lost. Analyses were conducted for a representative set of hypothetical patients. LTBI treatment was estimated to be beneficial when the annual risk of TB reactivation exceeded 13/100 000 to 93/100 000 for females aged 10–75 years and 15/100 000 to 119/100 000 for males aged 10–75 years the numbers needed to treat to avoid one case of TB were 93, 77, 85 and 72, respectively, at these threshold levels. LTBI treatment was estimated to confer a positive net benefit across a broad range of patients with characteristics typically seen in a low incidence setting for TB. Use of the decision aid has the potential to facilitate and increase confidence with LTBI treatment decisions by providing clinicians and patients with personalised estimates of likely net benefit.
Publisher: European Respiratory Society (ERS)
Date: 03-2019
Publisher: BMJ
Date: 22-10-2017
DOI: 10.1136/EBMED-2017-110825
Abstract: Practitioners of evidence-based medicine commonly encounter diagnostic tests with continuous results and no gold standard. In contrast, the traditional critical appraisal teachings assume a binary test (2×2 table) with a gold standard. In this guide, we use the ex le of the tuberculin skin test to illustrate a simple approach facilitated by using stratum-specific likelihood ratios and odds of developing future patient-important events. This approach can aid practitioners in the interpretation and application of diagnostic tests to patient care.
Publisher: Wiley
Date: 07-09-2011
No related grants have been discovered for Claudia Dobler.