scholarly journals Precision medicine in bronchiectasis

Breathe ◽  
2021 ◽  
Vol 17 (4) ◽  
pp. 210119
Author(s):  
Thomas Pembridge ◽  
James D. Chalmers
Keyword(s):  
Mucociliary Clearance ◽  
Specific Treatment ◽  
Evidence Based ◽  
Airway Clearance ◽  
Infection Treatment ◽  
Improved Outcomes ◽  
Infection Susceptibility ◽  
Underlying Causes ◽  
Patients Experience ◽  
Intense Research

Bronchiectasis, due to its highly heterogenous nature, requires an individualised approach to therapy. Patients experience symptoms and exacerbations driven by a combination of impaired mucociliary clearance, airway inflammation and airway infection. Treatment of bronchiectasis aims to enhance airway clearance and to address the underlying causes of inflammation and infection susceptibility. Bronchiectasis has multiple causes and so the pathophysiology leading to individual symptoms and exacerbations are different between individuals. Standardised investigations are recommended by international guidelines to identify the underlying causes of bronchiectasis. The process of identifying the underlying biology within an individual is called “endotyping” and is an emerging concept across chronic diseases. Endotypes that have a specific treatment are referred to as “treatable traits” and a treatable traits approach to managing patients with bronchiectasis in a holistic and evidence-based manner is the key to improved outcomes. Bronchiectasis is an area of intense research. Endotyping allows identification of subsets of patients to allow medicines to be tested differently in the future where trials, rather than trying to achieve a “one size fits all” solution, can test efficacy in subsets of patients where the treatment is most likely to be efficacious.

scholarly journals Attitudes of psychiatrists to evidence-based guidelines

2002 ◽  
Vol 26 (11) ◽  
pp. 421-424 ◽  
Author(s):  
Harvey Rees ◽  
Attila Sipos ◽  
Matthew Spence ◽  
Glynn Harrison
Keyword(s):  
Response Rate ◽  
Postal Questionnaire ◽  
Clinical Implications ◽  
Evidence Based ◽  
Previous Survey ◽  
Health Partnership ◽  
Improved Outcomes ◽  
Actual Use ◽  
Evidence Based Guidelines ◽  
Improving Patient Care

Aims and MethodWe aimed to survey clinicians' attitudes on using evidence-based guidelines. A postal questionnaire based on a previous survey of general practitioners was sent to 105 psychiatrists working within Avon and Western Wiltshire Mental Health Partnership NHS Trust.ResultsThere was a 91% response rate. Respondents were generally in favour of clinical guidelines, with scores indicating a positive attitude to guidelines in 13 of the 18 statements. The majority felt that guidelines were effective in improving patient care, could be used flexibly to suit individual patients and did not impinge on their clinical judgement.Clinical ImplicationsPsychiatrists welcomed the increasing use of guidelines. Further research is needed to determine whether this will translate into actual use and improved outcomes for patients.

Superimposed Oscillations Enhance the Clearance of Mucus Simulant at Low Air Flows in a Rigid Tracheal Model

2002 ◽  
Author(s):  
Peter E. Krumpe ◽  
Cahit A. Evrensel ◽  
Amgad A. Hassan
Keyword(s):  
Pulmonary Disease ◽  
Mucociliary Clearance ◽  
Healthy People ◽  
Pulmonary Diseases ◽  
Flow Rates ◽  
Airway Clearance ◽  
Clearance Mechanism ◽  
Primary Means ◽  
Air Flows ◽  
Expiratory Flow Rates

Clearance of mucus by the beating action of cilia is the primary means of removing inhaled particulates and airway debris from airways in healthy people. However many pulmonary diseases are associated with impaired mucociliary clearance mechanisms. For these patients, cough is the default airway clearance mechanism. Unfortunately most pulmonary disease patients can only produce low expiratory flow rates and have difficulty coughing for this reason.

scholarly journals Enabling individualised health in learning healthcare systems

2019 ◽  
Vol 25 (4) ◽  
pp. 125-129
Author(s):  
Shannon Wongvibulsin ◽  
Scott L. Zeger
Keyword(s):  
Healthcare Systems ◽  
Data Driven ◽  
Successful Implementation ◽  
Learning Approach ◽  
Evidence Based ◽  
Continuous Learning ◽  
Improved Outcomes ◽  
Effective Delivery ◽  
Individualised Care ◽  
Based Medicine

The rising burden of healthcare costs suggests that the healthcare system could benefit from novel methods that allow for continuous learning to provide more data-driven, individualised care at lower costs and with improved outcomes. Here, we present our synergistic Learning approach for Prediction, Interpretation/Inference and Communication (Learning PIC) framework to address the challenges hindering the successful implementation of learning healthcare systems and to enable the effective delivery of evidence-based medicine.

scholarly journals 2208. Development and Evaluation of Predictive Models for Estimating Infection Susceptibility to Empiric Treatment Regimens Among Patients with Pneumonia in Intensive Care Units

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S753-S753
Author(s):  
Courtney M Dewart ◽  
Erinn Hade ◽  
Yuan Gao ◽  
Protiva Rahman ◽  
Mark Lustberg ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Predictive Models ◽  
Pathogenic Bacteria ◽  
Goodness Of Fit ◽  
Specific Treatment ◽  
Penalized Regression ◽  
Diagnostic Process ◽  
Antibiotic Prescribing ◽  
Treatment Regimens ◽  
Infection Susceptibility

Abstract Background Predictive models for empiric antibiotic prescribing often estimate the probability of infection with multidrug-resistant organisms. In this work, we developed models to predict coverage of specific treatment regimens to better target antibiotics to high- and low-risk patients. Methods We established a retrospective cohort of adults admitted to the ICU in a 1,300-bed teaching hospital from November 1, 2011 to June 30, 2016. We included patients with a diagnosis of pneumonia and positive respiratory culture collected during their ICU stay. We collected demographics, comorbidities, and medical history from the electronic health record. We evaluated three penalized regression methods for predicting infection susceptibility to 11 treatment regimens: least absolute selection and shrinkage operator (LASSO), minimax concave penalty (MCP), and smoothly clipped absolute deviation (SCAD). We developed models for susceptibility prediction at two stages of the diagnostic process: for all pathogenic bacteria and for infections with Gram-negative organisms only. We selected final models based on higher area under the receiver operating characteristic (AUROC), acceptable goodness of fit, lower variability of the AUROCs in the cross-validation run, and fewer predictors. Results Among 1,917 cases of pneumonia, 54 different pathogens were identified. The most frequently isolated organisms were: Pseudomonas aeruginosa (16.6%), methicillin-resistant Staphylococcus aureus (16.1%), and Staphylococcus aureus (13.5%). Frequently selected variables included age, Elixhauser score, tracheostomy status, recent antimicrobial use, and prior infection with a carbapenem-resistant organism. All final models used MCP or SCAD methods. Point estimates for the AUROCs in the training set ranged from 0.70 to 0.80, and estimates in the internal validation set ranged from 0.64 to 0.77. Conclusion MCP and SCAD outperformed LASSO. For some regimens, models predicted infection susceptibility with fair accuracy. These models have potential to help antibiotic stewardship efforts to better target appropriate antibiotic use. Disclosures All authors: No reported disclosures.

Current and Emerging Therapies for Ocular Rosacea

2013 ◽  
Vol 06 (02) ◽  
pp. 86
Author(s):  
Edward J Wladis ◽  
Alejandro P Adam ◽  
◽  
Keyword(s):  
Side Effects ◽  
Therapeutic Strategies ◽  
Treatment Modalities ◽  
Surgical Interventions ◽  
Oral Medications ◽  
Incurable Disease ◽  
Emerging Therapies ◽  
Improved Outcomes ◽  
Ocular Rosacea ◽  
Intense Research

Ocular rosacea is an incurable disease that affects millions of Americans annually. While multiple therapeutic strategies have been devised to address this disorder (including topical and oral medications, laser and light-based treatments, and surgical interventions), our current interventions are largely nonspecific and often ineffective. Nonetheless, ocular rosacea remains a source of intense research, and newer treatments offer tremendous promise for improved outcomes. In this review, we discuss the current and emerging treatment modalities for ocular rosacea and analyze novel basic science findings that will hopefully lead to highly targeted medications to treat this potentially blinding illness with greater specificity and fewer side effects.

scholarly journals Experiences of Physical Activity One Year after Bariatric Surgery

2014 ◽  
Vol 6 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Malin Wiklund ◽  
Monika Fagevik Olbers ◽  
Torsten Olbers ◽  
Carin Willén
Keyword(s):  
Physical Activity ◽  
Bariatric Surgery ◽  
Qualitative Content Analysis ◽  
Evidence Based ◽  
Structured Interviews ◽  
Weight Loss Outcome ◽  
Physically Active ◽  
One Year ◽  
Patients Experience ◽  
Global Health Problem

Background and purpose: Obesity is a major global health problem today and the only evidence-based method leading to a long-lasting weight reduction is bariatric surgery. Physical activity improves health, decreases the incidence of several diseases and may influence weight loss outcome after bariatric surgery. Knowledge regarding how patients experience physical activity after bariatric surgery could provide us with better tools to enhance physically active. Methods: The aim of the present study was to describe how patients experience physical activity one year after bariatric surgery. An inductive qualitative content analysis was used to analyse semi-structured interviews with twenty-four patients one year after bariatric surgery. Results: Results: The main findings emerged in four overarching themes: “Hindrances of physical activity”, “Physical activity with a less obese body implies achievement”, “Coming to an understanding of the benefits of physical activity” and “Need of support”. Conclusion: According to our findings patients experience both achievements and hinders with regard to physical activity one year after surgery. Patients had an increased understanding of the benefits of physical activities, but support appears necessary to obtain and maintain a suitable level.

Improved Outcomes Using a Systematic and Evidence-Based Approach to the Laparoscopic Roux-En-Y Gastric Bypass in a Single Academic Institution

2007 ◽  
Vol 73 (10) ◽  
pp. 955-958 ◽  
Author(s):  
Soo Hwa Han ◽  
Carlos Gracia ◽  
Amir Mehran ◽  
Nicole Basa ◽  
Joe Hines ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Average Length ◽  
Anastomotic Stricture ◽  
Preoperative Evaluation ◽  
Length Of Hospital Stay ◽  
Marginal Ulcer ◽  
Ulcer Bleeding ◽  
Evidence Based ◽  
Improved Outcomes

No standardized approach exists for laparoscopic Roux-en-Y gastric bypass (LRYGB). At a newly instituted bariatric surgery program, four experienced laparoscopic surgeons used the systematic and evidence-based approach consisting of multidisciplinary preoperative evaluation, screening, and education; standardized operative technique; inpatient clinical pathway; and close postoperative follow-up. The outcomes were subsequently analyzed to determine if this approach improved the morbidity and mortality. From January 2003 to June 2006, 835 consecutive LRYGBs were performed. The patient population was 85 per cent women with a mean body mass index (BMI) of 50.4 kg/m2 (range 33–96 kg/m2). The mean age was 44 (range 15–67). Sixty-two per cent of the patients had previous abdominal or pelvic operations. The conversion rate to open surgery was 0.2 per cent. The average length of hospital stay was 2.6 days (range 2–13 days). There were no anastomotic leaks or deaths. The 30-day readmission and re-operation rates were 3.2 per cent and 1.8 per cent, respectively. The incidence of anastomotic stricture, marginal ulcer, bleeding, pulmonary embolism, and internal hernia was 0.8 per cent, 3.5 per cent, 4.2 per cent, 0.1 per cent, and 0.4 per cent, respectively. A systematic and evidence-based approach to the LRYGB by experienced laparoscopic surgeons resulted in a lower incidence of complications when compared with the published results from other comparable institutions.

Abstract 52: An Evidence Based Animal Model Of Prolonged Ventricular Fibrillation Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Timothy J Mader
Keyword(s):  
Clinical Trials ◽  
Cardiac Arrest ◽  
Evidence Based ◽  
Chest Compressions ◽  
Time Intervals ◽  
Mean Values ◽  
Improved Outcomes ◽  
Response Interval ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: Promising basic science findings in cardiac resuscitation often do not translate into improved outcomes when studied in humans. One explanation is that the current animal models do not adequately reflect the out-of-hospital cardiac arrest (OHCA) clinical trial environment. The author sought to review the literature and devise a new model of prolonged VF with time intervals that more accurately simulate OHCA conditions. Methods: A systematic review of the literature (01/90 –12/06) was conducted using PUBMED and a comprehensive list of appropriate MESH headings. All OHCA human clinical trials were included. The most relevant studies underwent explicit and detailed review. Mean values with 95%CI were calculated for each specified interval. Suitable conditions and establishment of appropriate times were then devised. Results: Twenty-two papers with adequate detail for evaluation were examined, leading to the following recommendations: the duration of non-treatment (assuming no bystander CPR or first-responders) is 11” (3” for recognition and EMS activation, 7” response interval and 1” for paramedics to reach the patient); chest compressions are initiated immediately with passive oxygen insufflation; assuming they can be done simultaneously, IV access and intubation (ETI) are accomplished 4” after arrival; drugs are delivered by minute 16 - well into the metabolic phase; and 2” of CPR are needed to circulate the drugs for the first rescue shock (RS) at minute 18. Conclusions: This proposed evidence based experimental model of prolonged untreated VF cardiac arrest has conditions and time intervals that simulate those of human OHCA clinical trials.

scholarly journals What is a clinical review?

2003 ◽  
Vol 13 (2) ◽  
pp. 103-105 ◽  
Author(s):  
Norman Vetter
Keyword(s):  
Systematic Review ◽  
Foreign Language ◽  
Clinical Review ◽  
Systematic Reviews ◽  
Medical Literature ◽  
Specific Treatment ◽  
Relevant Information ◽  
Evidence Based ◽  
Hard Evidence ◽  
Meta Analyses

Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses, sometimes known as quantitative systematic reviews seek to answer a narrow clinical question, often about the specific treatment of a condition, using rigorous statistical analysis of pooled research studies. Updates review the medical literature almost as carefully as a systematic review but discuss the topic under question more broadly and make reasoned judgements where there is little hard evidence, based upon the expertise of the reviewer. It may not include evidence from foreign language journals or look for unpublished data on a topic, so will tend to be more applicable to the local situation than a systematic review, as it may take into account local shortages of equipment or personnel.

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