scholarly journals Next-Generation Allergic Rhinitis Care in Singapore: 2019 ARIA Care Pathways

2020 ◽  
Vol 49 (11) ◽  
pp. 885-896
Author(s):  
Xuandao Liu ◽  
De Yun Wang ◽  
Tze Choong Charn ◽  
Leslie Timothy Koh ◽  
Neville WY Teo ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Care ◽  
Work Productivity ◽  
Suboptimal Control ◽  
Current Status ◽  
Local Context ◽  
Care Pathways ◽  
Important Health ◽  
Integrated Care Pathways ◽  
Important Health Issue

Allergic rhinitis (AR) is prevalent in Singapore, with a significant disease burden. Afflicting up to 13% of the population, AR impairs quality of life, leads to reduced work productivity and is an independent risk factor for asthma. In the last 2 decades, local studies have identified patient and physician behaviours leading to suboptimal control of the disease. Yet, there is an overall lack of attention to address this important health issue. Allergic Rhinitis and its Impact on Asthma (ARIA) is a European organisation aimed at implementing evidence-based management for AR worldwide. Recent focus in Europe has been directed towards empowering patients for self-management, exploring the complementary role of mobile health, and establishing healthcare system-based integrated care pathways. Consolidation of these ongoing efforts has led to the release of the 2019 ARIA care pathways. This review summarises the ARIA update with particular emphasis on the current status of adult AR in Singapore. In addition, we identify unmet needs and future opportunities for research and clinical care of AR in the local context. Keywords: Allergen immunotherapy, Allergic Rhinitis and its Impact on Asthma, clinical guideline

scholarly journals Home respiratory rehabilitation: a purposes literature review focusing on the clinical pathway management

2020 ◽  
Author(s):  
Civitillo Claudio ◽  
Romano Angelo ◽  
Di Lorenzo Luigi
Keyword(s):  
Clinical Pathways ◽  
Clinical Care ◽  
Care Program ◽  
Care Pathways ◽  
Critical Pathways ◽  
Management Plans ◽  
Integrated Care Pathways ◽  
Care Maps ◽  
Respiratory Rehabilitation

Clinical Care pathways, also known as critical pathways, integrated care pathways, case management plans, clinical care pathways or care maps, are used to systematically plan and follow up a patient focused care program. Clinical pathways are used all over the world and so for respiratory rehabilitation pathways (RR) and the importance of knowledge and learning Evidence Based Practice (EBP) is well known and mandatory. However, the EBP acquisitions of the home RR model and the knowledge of Clinical Care Pathways (PCA) are poorly defined.

Integrated care pathways in multiple sclerosis rehabilitation: completing the audit cycle

1998 ◽  
Vol 4 (2) ◽  
pp. 85-89 ◽  
Author(s):  
D A Rossiter ◽  
A Edmondson ◽  
R Al-Shahi ◽  
A J Thompson
Keyword(s):  
Multiple Sclerosis ◽  
Integrated Care ◽  
Clinical Care ◽  
Goal Achievement ◽  
Care Pathways ◽  
Rehabilitation Process ◽  
The Third ◽  
Fatigue Management ◽  
Age Variations ◽  
Integrated Care Pathways

The rehabilitation of progressive neurological disorders, such as Multiple Sclerosis (MS) requires comprehensive, expert management which is demanding of both time and resources. Mechanisms to monitor and audit both process and outcome are therefore essential. Integrated care pathways (ICPs) which detail the expected interventions during a given episode of clinical care, provide such a mechanism. In this study three cohorts of patients (totalling 125 episodes) with clinically definite progressive MS underwent a rehabilitation programme audited through ICPs. The cohorts were similar in relation to disability and age. Variations (departures from the expected pathway) were documented for both the rehabilitation process and goal achievement. Duration of stay reduced from 28 days for the first cohort to 18 days for the third and there was greater multidisciplinary input and carer involvement over time. Goal achievement increased from 79% for the first cohort to 87% for the third and there was an increased emphasis on cognitive function and fatigue management in relation to goals set. ICPs provide an excellent mechanism for closing the audit loop and have the potential to play an important role in improving service provision in MS.

Integrated Care Pathways for Black Persons With Traumatic Brain Injury: A Critical Transdisciplinary Scoping Review of the Clinical Care Journey

2021 ◽  
pp. 152483802110622
Author(s):  
Samira Omar ◽  
Stephanie Nixon ◽  
Angela Colantonio
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Integrated Care ◽  
Scoping Review ◽  
Black People ◽  
Clinical Care ◽  
Ethnic Disparities ◽  
The United States ◽  
Care Pathways ◽  
Integrated Care Pathways

Objectives: This novel critical transdisciplinary scoping review examined the literature on integrated care pathways that consider Black people living with traumatic brain injury (TBI). The objectives were to (a) summarize the extent, nature, and range of literature on care pathways that consider Black populations, (b) summarize how Blackness, race, and racism are conceptualized in the literature, (c) determine how Black people come to access care pathways, and (d) identify how care pathways in research consider the mechanism of injury and implications for human occupation. Methods: Six databases were searched systematically identifying 178 articles after removing duplicates. In total, 43 articles on integrated care within the context of Black persons with TBI were included. Narrative synthesis was conducted to analyze the data and was presented as descriptive statistics and as a narrative to tell a story. Findings: All studies were based in the United States where 81% reported racial and ethnic disparities across the care continuum primarily using race as a biological construct. Sex, gender, and race are used as demographic variables where statistical data were stratified in only 9% of studies. Black patients are primarily denied access to care, experience lower rates of protocol treatments, poor quality of care, and lack access to rehabilitation. Racial health disparities are disconnected from racism and are displayed as symptoms of a problem that remains unnamed. Conclusion: The findings illustrate how racism becomes institutionalized in research on TBI care pathways, demonstrating the need to incorporate the voices of Black people, transcend disciplinary boundaries, and adopt an anti-racist lens to research.

scholarly journals HealthPathways implementation in a New Zealand health region: a qualitative study using the Consolidated Framework for Implementation Research

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025094 ◽  
Author(s):  
Tim Stokes ◽  
Emma Tumilty ◽  
Fiona Doolan-Noble ◽  
Robin Gauld
Keyword(s):  
New Zealand ◽  
Implementation Research ◽  
Clinical Care ◽  
Referral System ◽  
Local Context ◽  
Successful Implementation ◽  
Care Pathways ◽  
Web Portal ◽  
Health Region ◽  
The Web

ObjectivesTo explore the process of implementation of an online health information web-based portal and referral system (HealthPathways) using implementation science theory: the Consolidated Framework for Implementation Research (CFIR).SettingSouthern Health Region of New Zealand (Otago and Southland).ParticipantsKey Informants (providers and planners of healthcare) (n=10) who were either involved in the process of implementing HealthPathways or who were intended end-users of HealthPathways.MethodsSemistructured interviews were undertaken. A deductive thematic analysis using CFIR was conducted using the framework method.ResultsCFIR postulates that for an intervention to be implemented successfully, account must be taken of the intervention’s core components and the adaptable periphery. The core component of HealthPathways—the web portal and referral system that contains a large number of localised clinical care pathways—had been addressed well by the product developers. Little attention had, however, been paid to addressing the adaptable periphery (adaptable elements, structures and systems related to HealthPathways and the organisation into which it was being implemented); it was seen as sufficient just to deliver the web portal and referral system and the set of clinical care pathways as developed to effect successful implementation. In terms of CFIR’s ‘inner setting’ corporate and professional cultures, the implementation climate and readiness for implementation were not properly addressed during implementation. There were also multiple failures of the implementation process (eg, lack of planning and engagement with clinicians). As a consequence, implementation of HealthPathways was highly problematic.ConclusionsThe use of CFIR has furthered our understanding of the factors needed for the successful implementation of a complex health intervention (HealthPathways) in the New Zealand health system. Those charged with implementing complex health interventions should always consider the local context within which they will be implemented and tailor their implementation strategy to address these.

scholarly journals ARIA 2016: Integrated care pathways for predictive medicine across the life cycle

2017 ◽  
Vol 14 (3) ◽  
pp. 46-54
Author(s):  
M R Khaitov ◽  
L S Namazova-Baranova ◽  
A G Chuchalin ◽  
N A Dayhes ◽  
N I Ilina ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Health Care Professionals ◽  
Social Inequalities ◽  
Symptom Control ◽  
Work Productivity ◽  
Clinical Decision ◽  
World Health ◽  
Predictive Medicine ◽  
Care Pathways ◽  
Sentinel Network

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization (WHO) workshop in 1999. The initial goals were to propose a new allergic rhinitis classification, to promote the concept of multi-morbidity in asthma and rhinitis and to develop guidelines with all stakeholders for global use in all countries and populations. ARIA - disseminated and implemented in over 70 countries globally - is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les MAladies Chroniques pour un Vieillissement Actif) - ARIA Sentinel NetworK] uses mobile technology to develop care pathways in order to enable the management of rhinitis and asthma by a multi-disciplinary group or by patients themselves. An App (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

scholarly journals Impact of active smoking on nasal functions in patients with allergic rhinitis

2019 ◽  
Vol 5 (3) ◽  
pp. 644
Author(s):  
Pratibha Chamarajanagara Bhaskara ◽  
Anita Ross ◽  
Neha Gupta
Keyword(s):  
Allergic Rhinitis ◽  
School Performance ◽  
Transit Time ◽  
Social Life ◽  
Mucociliary Clearance ◽  
Work Productivity ◽  
Olfactory Threshold ◽  
Threshold Test ◽  
Important Health ◽  
Nasal Mucociliary Clearance

<p class="abstract"><strong>Background:</strong> Allergic rhinitis is an important health problem in view of its prevalence and its impact on patients’ social life, school performance and work productivity. Smoking is known to affect the asthmatic airway inflammation. The additional effect of smoking in impairment of nasal functions in patients with allergic rhinitis is a subject of interest. The aim and objective of this study was to study the effect of active tobacco smoke on mucociliary clearance and olfactory thresholds in allergic rhinitis.</p><p class="abstract"><strong>Methods:</strong> A descriptive observational pilot study was carried out on 40 patients of allergic rhinitis. Nasal mucociliary clearance was measured by saccharine transit time and olfactory threshold test was measured by butanol threshold test score.  </p><p class="abstract"><strong>Results:</strong> The saccharine transit time was significantly prolonged in smokers as compared to nonsmokers. Amongst the subgroups of allergic rhinitis mucociliary clearance was found to be more prolonged with the severity of allergic rhinitis. Butanol threshold test scores were significantly lower in smokers when compared to non- smokers. Amongst the subgroups of allergic rhinitis olfactory threshold was found to be lower with the severity of allergic rhinitis.</p><p><strong>Conclusions:</strong> In the current study we found that nasal functions were significantly impaired in smokers with allergic rhinitis. This indicates that smoking leads to worsening of symptoms in allergic rhinitis.</p>

scholarly journals ARIA guideline 2019: treatment of allergic rhinitis in the German health system

2019 ◽  
Vol 28 (7) ◽  
pp. 255-276 ◽  
Author(s):  
Ludger Klimek ◽  
Claus Bachert ◽  
Oliver Pfaar ◽  
Sven Becker ◽  
Thomas Bieber ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Health System ◽  
Integrated Care ◽  
Respiratory Diseases ◽  
Social Systems ◽  
Real Life ◽  
Care Pathways ◽  
Chronic Respiratory Diseases ◽  
Number Of Patients ◽  
Integrated Care Pathways

Abstract Background The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results The present ICP (integrated care pathways) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.

scholarly journals ARIA 2019: Um Percurso Assistencial Integrado para a Rinite Alérgica em Portugal

2020 ◽  
Vol 33 (13) ◽  
Author(s):  
João Fonseca ◽  
Tiago Taveira-Gomes ◽  
Ana Margarida Pereira ◽  
Manuel Branco-Ferreira ◽  
Pedro Carreiro-Martins ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Integrated Care ◽  
Allergen Immunotherapy ◽  
Care Pathway ◽  
Response Monitoring ◽  
Care Pathways ◽  
The European Union ◽  
Levels Of Care ◽  
Integrated Care Pathways ◽  
Grade Methodology

The Allergic Rhinitis and Its Impact on Asthma (ARIA) initiative started more than 20 years ago and has developed and disseminated evidence-based guidelines and projects in the field of allergic rhinitis. This initiative is currently focused on providing patient-centred guidelines that contribute to an integrated care pathway between the various levels of care and take advantage of digital solutions, and the introduction of integrated care pathways in clinical practice has been recommended. In this article we describe the adaptation for Portugal of the ARIA Integrated Care Pathways document. After a brief review of the epidemiology and impact of allergic rhinitis in Portugal and the activities carried out in Portugal within the ARIA initiative, we describe the broad knowledge base used for the development of recommendations for the pharmacological treatment of allergic rhinitis, and these recommendations are based on the GRADE methodology, real world evidence acquired by mobile technology (mHealth) and resulting from allergenic exposure chamber studies. What follows is a summary of integrated care pathways for allergen immunotherapy produced in 2019. Allergen immunotherapy is considered an example of precision medicine where the use of mHealth technologies will improve stratification for patient selection and response monitoring. These recommendations were considered as best practices of integrated patient-centred care supported by digital systems from Directorate General for Health and Food Safety of the European Union (DG Santé) and represent the ARIA Phase4 Change Management strategy.

scholarly journals Medicinal Plants, Phytochemicals, and Herbs to Combat Viral Pathogens Including SARS-CoV-2

Molecules ◽  
2021 ◽  
Vol 26 (6) ◽  
pp. 1775
Author(s):  
Arumugam Vijaya Anand ◽  
Balasubramanian Balamuralikrishnan ◽  
Mohandass Kaviya ◽  
Kathirvel Bharathi ◽  
Aluru Parithathvi ◽  
...  
Keyword(s):  
Medicinal Plants ◽  
Severe Acute Respiratory Syndrome ◽  
Viral Entry ◽  
Antiviral Agents ◽  
Special Focus ◽  
Direct Inhibition ◽  
Viral Pathogens ◽  
Important Health ◽  
Antiviral Activities ◽  
Important Health Issue

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2), is the most important health issue, internationally. With no specific and effective antiviral therapy for COVID-19, new or repurposed antiviral are urgently needed. Phytochemicals pose a ray of hope for human health during this pandemic, and a great deal of research is concentrated on it. Phytochemicals have been used as antiviral agents against several viruses since they could inhibit several viruses via different mechanisms of direct inhibition either at the viral entry point or the replication stages and via immunomodulation potentials. Recent evidence also suggests that some plants and its components have shown promising antiviral properties against SARS-CoV-2. This review summarizes certain phytochemical agents along with their mode of actions and potential antiviral activities against important viral pathogens. A special focus has been given on medicinal plants and their extracts as well as herbs which have shown promising results to combat SARS-CoV-2 infection and can be useful in treating patients with COVID-19 as alternatives for treatment under phytotherapy approaches during this devastating pandemic situation.

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