Surfactant therapies for pediatric and neonatal ARDS: ESPNIC expert consensus opinion for future research steps

Abstract Pediatric (PARDS) and neonatal (NARDS) acute respiratory distress syndrome have different age-specific characteristics and definitions. Trials on surfactant for ARDS in children and neonates have been performed well before the PARDS and NARDS definitions and yielded conflicting results. This is mainly due to heterogeneity in study design reflecting historic lack of pathobiology knowledge. We reviewed the available clinical and preclinical data to create an expert consensus aiming to inform future research steps and advance the knowledge in this area. Eight trials investigated the use of surfactant for ARDS in children and ten in neonates, respectively. There were improvements in oxygenation (7/8 trials in children, 7/10 in neonates) and mortality (3/8 trials in children, 1/10 in neonates) improved. Trials were heterogeneous for patients’ characteristics, surfactant type and administration strategy. Key pathobiological concepts were missed in study design. Consensus with strong agreement was reached on four statements: There are sufficient preclinical and clinical data to support targeted research on surfactant therapies for PARDS and NARDS. Studies should be performed according to the currently available definitions and considering recent pathobiology knowledge. PARDS and NARDS should be considered as syndromes and should be pre-clinically studied according to key characteristics, such as direct or indirect (primary or secondary) nature, clinical severity, infectious or non-infectious origin or patients’ age. Explanatory should be preferred over pragmatic design for future trials on PARDS and NARDS. Different clinical outcomes need to be chosen for PARDS and NARDS, according to the trial phase and design, trigger type, severity class and/or surfactant treatment policy. We advocate for further well-designed preclinical and clinical studies to investigate the use of surfactant for PARDS and NARDS following these principles.

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The implementation of remote home monitoring models during the COVID-19 pandemic in England

10.1101/2020.11.12.20230318 ◽

2020 ◽

Author(s):

Cecilia Vindrola-Padros ◽

Manbinder S Sidhu ◽

Theo Georghiou ◽

Chris Sherlaw-Johnson ◽

Kelly Elizabeth Singh ◽

...

Keyword(s):

Resource Allocation ◽

Home Monitoring ◽

Future Research ◽

List Type ◽

Convenience Sample ◽

Good Communication ◽

Healthcare Settings ◽

Use Of Data ◽

Key Characteristics ◽

Mean Cost

ABSTRACTObjectiveThere is a paucity of evidence for the implementation of remote home monitoring for COVID-19 infection. The aims of this study were to: identify the key characteristics of remote home monitoring models for COVID-19 infection, explore the experiences of staff implementing these models, understand the use of data for monitoring progress against outcomes, and document variability in staffing and resource allocation.MethodsThis was a multi-site mixed methods study that combined qualitative and quantitative approaches to analyse the implementation and impact of remote home monitoring models during the first wave of the COVID-19 pandemic (March to August 2020). The study combined interviews (n=22) with staff delivering these models across eight sites in England with the collection and analysis of data on staffing models and resource allocation.ResultsThe models varied in relation to the healthcare settings and mechanisms used for patient triage, monitoring and escalation. Implementation was embedded in existing staff workloads and budgets. Good communication within clinical teams, culturally-appropriate information for patients/carers and the combination of multiple approaches for patient monitoring (app and paper-based) were considered facilitators in implementation. The mean cost per monitored patient varied from £400 to £553, depending on the model.ConclusionsIt is necessary to provide the means for evaluating the effectiveness of these models, for example, by establishing comparator data. Future research should also focus on the sustainability of the models and patient experience (considering the extent to which some of the models exacerbate existing inequalities in access to care).STRENGTHS AND LIMITATIONS OF THE STUDYThe study makes a contribution to existing evidence on remote home monitoring models by exploring the design and implementation of these models for confirmed or suspected COVID-19 cases.The study was carried out across eight remote home monitoring models implemented in England, capturing variability in the mechanisms used for triage, monitoring and escalation.Limited evidence was available to assess the effectiveness of the remote home monitoring models.No comparator data were available for the absence of remote home monitoring.The study was designed as a rapid evaluation and only captured experiences and processes of implementation in a convenience sample of eight models implemented during the first wave of the pandemic in England.

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AB0862 CONSENSUS STATEMENT ON INTRA-ARTICULAR INJECTIONS OF PLATELET-RICH PLASMA FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.618 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1738.3-1738

Author(s):

F. Eymard ◽

P. Ornetti ◽

J. Maillet ◽

E. Noel ◽

P. Adam ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Task Force ◽

Platelet Rich Plasma ◽

Symptomatic Treatment ◽

Future Research ◽

List Type ◽

Clinical Practices ◽

Efficient Treatment ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee

Background:There has been much debate regarding the use of intra-articular injections of platelet-rich plasma (PRP) as symptomatic treatment for knee osteoarthritis. The heterogeneity of the preparation and injection protocols limits the extrapolation of data from randomized controlled trials and meta-analyses.Objectives:The objective of this expert consensus was to develop the first clinical practice recommendations for PRP injections in knee osteoarthritis.Methods:Fifteen physicians (10 rheumatologists, 4 specialists in rehabilitation and sport medicine and 1 interventional radiologist) from different countries were selected given to their expertise in the fields of PRP and osteoarthritis. Twenty-five recommendations were finally retained after several meetings using the modified Delphi method to establish clinical consensus. All experts voted their agreement or not for each recommendation using a score between 1 (totally inappropriate) and 9 (totally appropriate). Depending on the median value and extreme scores, recommendations were judged as appropriated or unappropriated with a strong or relative agreement but could also be judged as uncertain due to indecision or absence of consensus.Results:The main recommendations are listed below:- Intra-articular injections of PRP constitute an efficient treatment of early or moderate symptomatic knee osteoarthritis. Median = 8 [6-9] – Appropriate. Relative agreement.- Intra-articular injections of PRP may be useful in severe knee osteoarthritis (Kellgren-Lawrence grade IV). Median = 7 [6-7] – Appropriate. Relative agreement.- Intra-articular injections of PRP in knee osteoarthritis should be proposed as second-line therapy, after failure of non-pharmacological and pharmacological (oral and topic) symptomatic treatment. Median = 9 [5-9] – Appropriate. Relative agreement.- Intra-articular injections of PRP should not be performed in osteoarthritis flare-up with significant effusion. Median = 7 [5-9] – Appropriate. Relative agreement.- Intra-articular PRP treatment may include 1 to 3 consecutive injections. Median = 9 [7-9] – Appropriate. Strong agreement.- Leukocyte-poor PRP should be preferred for knee OA treatment. Median = 8 [5-9] – Appropriate. Relative agreement.- PRP injections should be performed under ultrasound or fluoroscopic guidance. Median = 8 [3-9] – Uncertain. No consensus.- PRP should not be mixed with injectable anesthetic or corticosteroid. Median = 9 [6-9] – Appropriate. Relative agreement.Conclusion:Twenty-five recommendations were discussed by an international multidisciplinary task force group in order to provide a basis for standardization of clinical practices and future research protocols.Disclosure of Interests:Florent Eymard Consultant of: Regenlab, Paul Ornetti: None declared, Jérémy Maillet Consultant of: Regenlab, Eric Noel Consultant of: Regenlab, Philippe Adam Consultant of: Regenlab, Virginie Legré Boyer Consultant of: Regenlab, Thierry Boyer Consultant of: Regenlab, Fadoua Allali: None declared, Vincent Grémeaux Bader: None declared, Jean-François Kaux: None declared, Karine Louati: None declared, Martin Lamontagne Consultant of: Pendopharm, Fabrice Michel: None declared, Pascal Richette: None declared, Hervé Bard Consultant of: Regenlab

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Feedback for Learning in Pharmacy Education: A Scoping Review

Pharmacy ◽

10.3390/pharmacy9020091 ◽

2021 ◽

Vol 9 (2) ◽

pp. 91

Author(s):

Nicholas R. Nelson ◽

Rebecca B. Carlson ◽

Amanda H. Corbett ◽

Dennis M. Williams ◽

Denise H. Rhoney

Keyword(s):

Student Perceptions ◽

Study Design ◽

Scoping Review ◽

Clinical Training ◽

Pharmacy Education ◽

Future Research ◽

Development Programs ◽

Quality Feedback ◽

English Articles ◽

Work Up

Feedback is an effective pedagogy aimed to create cognitive dissonance and reinforce learning as a key component of clinical training programs. Pharmacy learners receive constant feedback. However, there is limited understanding of how feedback is utilized in pharmacy education. This scoping review sought to summarize the breadth and depth of the use of feedback within pharmacy education and identify areas for future research. PubMed, Embase, Scopus, and Web of Science were searched for English articles since January 2000 to identify studies related to feedback in pharmacy education. Sixty-four articles were included for analysis, stratified by moderate and major theory talk, where moderate theory talk explicitly included feedback into study design and major theory talk included feedback into both study design and analysis. Feedback was provided in Bachelor (14%), Master (15.6%), Doctor of Pharmacy (67.2%) and post-graduate programs (4.7%) on a variety of curricular objectives including communication and patient work up in didactic, objective structured clinical examination (OSCE), and experiential settings, and career/interview preparation in the co-curriculum. Feedback comments were mostly written in didactic courses, and both written and verbal in OSCE, experiential, and co-curricular settings. The pharmacy education feedback literature lacks depth beyond student perceptions, especially with respect to assessing the effectiveness and quality of feedback for learning. While feedback has been utilized throughout pharmacy education across myriad outcomes, several areas for inquiry exist which can inform the design of faculty and preceptor development programs, ensuring provision of effective, quality feedback to pharmacy learners.

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Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Critical Care ◽

10.1186/s13054-020-03369-5 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Arif Hussain ◽

Gabriele Via ◽

Lawrence Melniker ◽

Alberto Goffi ◽

Guido Tavazzi ◽

...

Keyword(s):

Lung Ultrasound ◽

Expert Panel ◽

Point Of Care ◽

Expert Consensus ◽

Future Research ◽

Point Of Care Ultrasound ◽

The Past ◽

Modified Delphi ◽

Grade Methodology

AbstractCOVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

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The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-020-00866-8 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Giorgia Gon ◽

Abdunoor M. Kabanywanyi ◽

Petri Blinkhoff ◽

Simon Cousens ◽

Stephanie J. Dancer ◽

...

Keyword(s):

Pilot Study ◽

Study Design ◽

Low Income ◽

High Volume ◽

Surface Cleaning ◽

Low Income Countries ◽

Training Period ◽

Future Research ◽

Environmental Hygiene ◽

The Impact

Abstract Background Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. Methods This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. Results Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11–1.60), and by 1.08 (CI = 1.03–1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. Conclusions The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design.

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Stress and burnout in Improving Access to Psychological Therapies (IAPT) trainees: a systematic review

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x21000179 ◽

2021 ◽

Vol 14 ◽

Author(s):

Joel Owen ◽

Louise Crouch-Read ◽

Matthew Smith ◽

Paul Fisher

Keyword(s):

Mental Health ◽

Systematic Review ◽

Mental Health Professionals ◽

Health Professionals ◽

Future Research ◽

List Type ◽

Dual Roles ◽

Eligibility Criteria ◽

Psychological Therapies ◽

Current State

Abstract For more than a decade, Improving Access to Psychological Therapies (IAPT) has been training a new workforce of psychological therapists. Despite evidence of stress and burnout both in trainee mental health professionals, and qualified IAPT clinicians, little is known about these topics in IAPT trainees. Consequently, this systematic review sought to establish the current state of the literature regarding stress and burnout in IAPT trainees. Electronic databases were searched to identify all published and available unpublished work relating to the topic. On the basis of pre-established eligibility criteria, eight studies (including six unpublished doctoral theses) were identified and assessed for quality. This review identifies that research into the experience of IAPT trainees is under-developed. Existing evidence tentatively suggests that IAPT trainees may experience levels of stress and burnout that are higher than their qualified peers and among the higher end of healthcare professionals more generally. The experience of fulfilling dual roles as mental health professionals and university students concurrently appears to be a significant source of stress for IAPT trainees. More research regarding the levels and sources of stress and burnout in IAPT trainees is urgently needed to confirm and extend these findings. Recommendations for future research in the area are given. Key learning aims (1) To establish the current state of the literature regarding stress and burnout in IAPT trainees. (2) To raise practitioner, service and education-provider awareness regarding the levels and perceived sources of stress and burnout in IAPT trainees. (3) To make recommendations regarding future research on the topic.

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The Infinity Formulation: how transdiagnostic behaviours and endeavours for behavioural change serve to maintain co-morbid mental health presentations

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x21000118 ◽

2021 ◽

Vol 14 ◽

Author(s):

Alison Bennetts

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Cognitive Biases ◽

Behavioural Change ◽

Psychological Theory ◽

Primary Treatment ◽

Future Research ◽

List Type ◽

Cognitive Behavioural ◽

Co Morbidity

Abstract Treatment recommendations for mental health are often founded on diagnosis-specific models; however, there are high rates of co-morbidity of mental health presentations and growing recognition of the presence of ‘transdiagnostic processes’ (cognitive, emotional or behavioural features) seen across a range of mental health presentations. This model proposes a novel conceptualisation of how transdiagnostic behaviours may maintain co-morbid mental health presentations by acting as a trigger event for the cognitive biases specific to each presentation. Drawing on existing evidence, psychological theory and the author’s clinical experience, the model organises complex presentations in a theory-driven yet accessible manner for use in clinical practice. The model offers both theoretical and clinical implications for the treatment of mental health presentations using cognitive behavioural approaches, positing that transdiagnostic behaviours be the primary treatment target in co-morbid presentations. Key learning aims (1) To understand the strengths and limitations of existing transdiagnostic CBT formulation models. (2) To learn about a novel, transdiagnostic and behaviourally focused formulation for use in clinical practice. (3) To understand how to use the tool in clinical practice and future research.

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Working with Industrial Cobots: The Influence of Reliability and Transparency on Perception and Trust

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181321651110 ◽

2021 ◽

Vol 65 (1) ◽

pp. 77-81

Author(s):

Lina Kluy ◽

Eileen Roesler

Keyword(s):

Study Design ◽

Real Life ◽

Error Rates ◽

Future Research ◽

Negative Effects ◽

Perceived Safety ◽

Fine Grained ◽

Online Study ◽

Human Robot Collaboration ◽

Positive Effect

Industrial human-robot collaboration (HRC) is not yet widely spread but on the rise. This development raises the question about properties collaborative robots (cobots) need, to enable a pleasant and smooth interaction. Therefore, this study investigated the influence of transparency and reliability on perception of and trust towards cobots. A video-enhanced online study with 124 participants was conducted. Transparency was provided through the presentation of differing information, and reliability was manipulated through differing error rates. The results showed a positive effect of transparency on perceived safety and intelligence. Reliability had a positive effect on perceived intelligence, likeability and trust. The effect of reliability on trust was more pronounced for low transparent robots. The results indicate the relevance of carefully selected information to counteract negative effects of failures. Future research should transfer the study design into a real-life experiment with more fine-grained levels of transparency and reliability.

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Experimental Study on Critical Shear Stress of Cohesive Soils and Soil Mixtures

Transactions of the ASABE ◽

10.13031/trans.14065 ◽

2021 ◽

Vol 64 (2) ◽

pp. 587-600

Author(s):

Xiaojing Gao ◽

Qiusheng Wang ◽

Chongbang Xu ◽

Ruilin Su

Keyword(s):

Experimental Data ◽

Shear Stress ◽

Critical Shear Stress ◽

Cohesive Soil ◽

Future Research ◽

Cohesive Soils ◽

List Type ◽

Soil Mixture ◽

Linear Relationships ◽

Soil Mixtures

HighlightsErosion tests were performed to study the critical shear stress of cohesive soils and soil mixtures.Linear relationships were observed between critical shear stress and cohesion of cohesive soils.Mixture critical shear stress relates to noncohesive particle size and cohesive soil erodibility.A formula for calculating the critical shear stress of soil mixtures is proposed and verified.Abstract. The incipient motion of soil is an important engineering property that impacts reservoir sedimentation, stable channel design, river bed degradation, and dam breach. Due to numerous factors influencing the erodibility parameters, the study of critical shear stress (tc) of cohesive soils and soil mixtures is still far from mature. In this study, erosion experiments were conducted to investigate the influence of soil properties on the tc of remolded cohesive soils and cohesive and noncohesive soil mixtures with mud contents varying from 0% to 100% using an erosion function apparatus (EFA). For cohesive soils, direct linear relationships were observed between tc and cohesion (c). The critical shear stress for soil mixture (tcm) erosion increased monotonically with an increase in mud content (pm). The median diameter of noncohesive soil (Ds), the void ratio (e), and the organic content of cohesive soil also influenced tcm. A formula for calculating tcm considering the effect of pm and the tc of noncohesive soil and pure mud was developed. The proposed formula was validated using experimental data from the present and previous research, and it can reproduce the variation of tcm for reconstituted soil mixtures. To use the proposed formula to predict the tcm for artificial engineering problems, experimental erosion tests should be performed. Future research should further test the proposed formula based on additional experimental data. Keywords: Cohesive and noncohesive soil mixture, Critical shear stress, Erodibility, Mud content, Soil property.

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Multiple breath washout: measuring early manifestations of lung pathology

Breathe ◽

10.1183/20734735.0016-2021 ◽

2021 ◽

Vol 17 (3) ◽

pp. 210016

Author(s):

Sanja Stanojevic ◽

Cole Bowerman ◽

Paul Robinson

Keyword(s):

Early Intervention ◽

Lung Function ◽

Respiratory Disease ◽

Future Research ◽

Testing Time ◽

List Type ◽

Lung Pathology ◽

Lung Function Decline ◽

Airway Pathology ◽

Multiple Breath Washout

The multiple breath washout (MBW) test measures the efficiency of gas mixing in the lungs and has gained significant interest over the past 20 years. MBW outcomes detect early lung function impairment and peripheral airway pathology, through its main outcome measure lung clearance index (LCI). LCI measures the number of lung turnovers required to washout an inert tracer gas. MBW is performed during normal (tidal) breathing, making it particularly suitable for young children or those who have trouble performing forced manoeuvres. Additionally, research in chronic respiratory disease populations has shown that MBW can detect acute clinically relevant changes before conventional lung function tests, such as spirometry, thus enabling early intervention. The development of technical standards for MBW and commercial devices have allowed MBW to be implemented in clinical research and potentially routine clinical practice. Although studies have summarised clinimetric properties of MBW indices, additional research is required to establish the clinical utility of MBW and, if possible, shorten testing time. Sensitive, feasible measures of early lung function decline will play an important role in early intervention for people living with respiratory diseases.Educational aimTo describe the multiple breath washout test, its applications to lung pathology and respiratory disease, as well as directions for future research.

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