Is impulse oscillometry (IOS) better than spirometry for monitoring treatment outcomes in adult cystic fibrosis (CF) pulmonary exacerbations? A pilot study

BackgroundDespite advances in cystic fibrosis (CF) management and survival, the optimal treatment of pulmonary exacerbations remains unclear. Understanding the variability in treatment approaches among physicians might help prioritise clinical uncertainties to address through clinical trials.MethodsPhysicians from Australia and New Zealand who care for people with CF were invited to participate in a web survey of treatment preferences for CF pulmonary exacerbations. Six typical clinical scenarios were presented; three to paediatric and another three to adult physicians. For each scenario, physicians were asked to choose treatment options and provide reasons for their choices.ResultsForty-nine CF physicians (31 paediatric and 18 adult medicine) participated; more than half reported 10+ years of experience. There was considerable variation in primary antibiotic selection; none was preferred by more than half of respondents in any scenario. For secondary antibiotic therapy, respondents consistently preferred intravenous tobramycin and a third antibiotic was rarely prescribed, except in one scenario describing an adult patient. Hypertonic saline nebulisation and twice daily chest physiotherapy was preferred in most scenarios while dornase alfa use was more variable. Most CF physicians (>80%) preferred to change therapy if there was no early response. Professional opinion was the most common reason for antibiotic choice.ConclusionsVariation exists among CF physicians in their preferred choice of primary antibiotic and use of dornase alfa. These preferences are driven by professional opinion, possibly reflecting a lack of evidence to base policy recommendations. Evidence from high-quality clinical trials is needed to inform physician decision making.

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Post audio-visual biofeedback training visual functions and quality of life in paediatric idiopathic infantile nystagmus: A pilot study

European Journal of Ophthalmology ◽

10.1177/1120672121991048 ◽

2021 ◽

pp. 112067212199104

Author(s):

Monica Daibert-Nido ◽

Yulia Pyatova ◽

Michelle Markowitz ◽

Maryam Taheri-Shirazi ◽

Samuel N Markowitz

Keyword(s):

Quality Of Life ◽

Pilot Study ◽

Contrast Sensitivity ◽

Reading Speed ◽

Biofeedback Training ◽

Visual Functions ◽

Infantile Nystagmus ◽

Fixation Stability ◽

Better Than

Purpose: Biofeedback training (BT) was adapted to idiopathic infantile nystagmus syndrome (IINS) cases to enhance visual functions and quality of life (QoL). Methods: 10 patients (age 9 ± 3.2 years) treated with the audio-visual BT module of the MAIA microperimeter (Centervue, Padova, Italy) were assessed in two baseline visits and 1week post-BT (BT 80 min in total). The outcomes were distance and near binocular best corrected visual acuity (BBCVA), fixation stability, reading speed, contrast sensitivity, stereopsis and Children’s Visual Function Questionnaire. One-way repeated measured ANOVA and paired t-tests were used. Results: Distance BBCVA improved from 0.46 ± 0.21 and 0.43 ± 0.18 pre-BT to 0.33 ± 0.2 logMAR post-BT ( F (2,27) = 13.75, p = 0.0002). Post-BT was better than baseline ( p = 0.0001) and pre-BT ( p = 0.001). Near BBCVA improved from 0.23 ± 0.09 and 0.21 ± 0.14 pre-BT to 0.04 ± 0.08 post-BT (F (2,27) = 22.12, p = 0.000014), post-BT was better than baseline ( p = 0.0001) and pre-BT ( p = 0.0006). Stereopsis improved from 283 ± 338″ to 39 ± 32.2″ ( p = 0.04), contrast sensitivity from 0.26 ± 0.17 to 0.08 ± 0.12 log units ( p = 0.01), and reading speed improved from 74.7 ± 51.2 wpm to 104.7 ± 53.6 wpm ( p = 0.0006). Fixation stability improved from 33.6 ± 28.1 to 14.3 ± 10.1 sq. QoL increased from 23.8 ± 2.2 to 26.3 ± 2.3 units ( p = 0.001). Conclusion: BT benefited all visual functions and QoL in this pilot study, heralding a new possibility for Low Vision Rehabilitation in IINS.

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