Surveys and Questionnaires

Introduction: To reduce air pollution exposure, the U.S. asthma guidelines recommend that children check the Air Quality Index before outdoor activity. Whether adding the Air Quality Index and recommendations to asthma action plans reduces exacerbations and improves control and quality of life in children with asthma is unknown.

Methods: A pilot, unblinded, randomized clinical trial of 40 children with persistent asthma, stratified by age and randomized 1:1, recruited from the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh (Pittsburgh, PA) was conducted. All participants received asthma action plans and Air Quality Index education. The intervention group received printed Air Quality Index information and showed the ability to use AirNow. Asthma exacerbations were assessed through a questionnaire, asthma control was assessed with the Asthma Control Test and Childhood Asthma Control Test, and quality of life was assessed with the Pediatric Asthma Quality of Life Questionnaire. After randomization (July-October 2020), participants were followed monthly for 6 months (exit January-March 2021). Outcome differences between groups were evaluated at the exit visit and over time (analysis was in 2021).

Results: At randomization, there were no significant differences in age, sex, race, or asthma severity. At exit, more intervention participants checked the Air Quality Index (63% vs 15%) with no differences in the proportion of asthma exacerbations or mean Childhood Asthma Control Test or Pediatric Asthma Quality of Life Questionnaire scores. The mean change in Asthma Control Test score was higher in the intervention group (change in Asthma Control Test=2.00 vs 0.15 for the control), which was modified by time (β=1.85, CI=0.09, 3.61). Physical activity was decreased overall and showed modification by treatment and time.

Conclusions: Addition of the Air Quality Index to asthma action plans led to improved asthma control by Asthma Control Test scores but may decrease outdoor activity.

Author/s:

Rosser, F. J., Rothenberger, S. D., Han, Y., Forno, E., Celedón, J. C.

Prevalence of Allergic Reactions After Pfizer-BioNTech COVID-19 Vaccination Among Adults With High Allergy Risk

Bethie Seay — Fri, 03 Sep 2021 05:00:00 +0000

Date Added:

September 3, 2021

Type:

Clinical Research Results

DOI (1):

10.1001/jamanetworkopen.2021.22255

MeSH

referral and consultation

Surveys and Questionnaires

Algorithms

SARS-CoV-2

Highly allergic individuals can safely receive the COVID vaccine if certain precautions are taken. Anaphylaxis is very unlikely (0.7%).

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Importance
Allergic reactions among some individuals who received the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine discourage patients with allergic conditions from receiving this vaccine and physicians from recommending the vaccine.

Objective
To describe the assessment and immunization of highly allergic individuals with the BNT162b2 vaccine.

Design, Setting, and Participants
In a prospective cohort study from December 27, 2020, to February 22, 2021, 8102 patients with allergies who applied to the COVID 19 vaccine referral center at the Sheba Medical Center underwent risk assessment using an algorithm that included a detailed questionnaire. High-risk patients (n = 429) were considered “highly allergic” and were immunized under medical supervision.

Exposures
Pfizer-BioNTech (BNT162b2) COVID-19 vaccine.

Main Outcomes and Measures
Allergic and anaphylactic reactions after the first and second doses of BNT162b2 vaccine among highly allergic patients.

Results
Of the 429 individuals who applied to the COVID-19 referral center and were defined as highly allergic, 304 (70.9%) were women and the mean (SD) age was 52 (16) years. This highly allergic group was referred to receive immunization under medical supervision. After the first dose of the BNT162b2 vaccine, 420 patients (97.9%) had no immediate allergic event, 6 (1.4%) developed minor allergic responses, and 3 (0.7%) had anaphylactic reactions. During the study period, 218 highly allergic patients (50.8%) received the second BNT162b2 vaccine dose, of which 214 (98.2%) had no allergic reactions and 4 patients (1.8%) had minor allergic reactions. Other immediate and late reactions were comparable with those seen in the general population, except for delayed itch and skin eruption, which were more common among allergic patients.

Conclusions and Relevance
The rate of allergic reactions to BNT162b2 vaccine, is higher among patients with allergies, particularly among a subgroup with a history of high-risk allergies. This study suggests that most patients with a history of allergic diseases and, particularly, highly allergic patients can be safely immunized by using an algorithm that can be implemented in different medical facilities and includes a referral center, a risk assessment questionnaire, and a setting for immunization under medical supervision of highly allergic patients. Further studies are required to define more specific risk factors for allergic reactions to the BNT162b2 vaccine.

Author/s:

Shavit, R., Maoz-Segal, R., Iancovici-Kidon, M.

Triple vs Dual Inhaler Therapy and Asthma Outcomes in Moderate to Severe Asthma: A Systematic Review and Meta-analysis

Devin Evans — Fri, 21 May 2021 05:00:00 +0000

Date Added:

May 21, 2021

Journal/Publication:

Journal of the American Medical Association

Publication Date:

May 19, 2021

URL:

Triple vs Dual Inhaler Therapy and Asthma Outcomes in Moderate to Severe Asthma: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2021.7872

Keywords

asthma

inhalers

Inhaler Therapy

PMID (1):

34009257

MeSH

Surveys and Questionnaires

An RCT comparing dual vs. triple medication inhaler therapy for chronic treatment of people with moderate to severe asthma. (a 5% reduction in severe exacerbations but no improvement in QOL) James W. Mold, MD. MPH

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Importance: The benefits and harms of adding long-acting muscarinic antagonists (LAMAs) to inhaled corticosteroids (ICS) and long-acting β2-agonists (LABAs) for moderate to severe asthma remain unclear.

Objective: To systematically synthesize the outcomes and adverse events associated with triple therapy (ICS, LABA, and LAMA) vs dual therapy (ICS plus LABA) in children and adults with persistent uncontrolled asthma.

Data sources: MEDLINE, Embase, CENTRAL, ICTRP, FDA, and EMA databases from November 2017, to December 8, 2020, without language restriction.

Study selection: Two investigators independently selected randomized clinical trials (RCTs) comparing triple vs dual therapy in patients with moderate to severe asthma.

Data extraction and synthesis: Two reviewers independently extracted data and assessed risk of bias. Random-effects meta-analyses, including individual patient-level exacerbation data, were used. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess certainty (quality) of the evidence.

Main outcomes and measures: Severe exacerbations, asthma control (measured using the Asthma Control Questionnaire [ACQ-7], a 7-item list with each item ranging from 0 [totally controlled] to 6 [severely uncontrolled]; minimal important difference, 0.5), quality of life (measured using the Asthma-related Quality of Life [AQLQ] tool; score range, 1 [severely impaired] to 7 [no impairment]; minimal important difference, 0.5), mortality, and adverse events.

Results: Twenty RCTs using 3 LAMA types that enrolled 11 894 children and adults (mean age, 52 years [range, 9-71 years]; 57.7% female) were included. High-certainty evidence showed that triple therapy vs dual therapy was significantly associated with a reduction in severe exacerbation risk (9 trials [9932 patients]; 22.7% vs 27.4%; risk ratio, 0.83 [95% CI, 0.77 to 0.90]) and an improvement in asthma control (14 trials [11 230 patients]; standardized mean difference [SMD], -0.06 [95% CI, -0.10 to -0.02]; mean difference in ACQ-7 scale, -0.04 [95% CI, -0.07 to -0.01]). There were no significant differences in asthma-related quality of life (7 trials [5247 patients]; SMD, 0.05 [95% CI, -0.03 to 0.13]; mean difference in AQLQ score, 0.05 [95% CI, -0.03 to 0.13]; moderate-certainty evidence) or mortality (17 trials [11 595 patients]; 0.12% vs 0.12%; risk ratio, 0.96 [95% CI, 0.33 to 2.75]; high-certainty evidence) between dual and triple therapy. Triple therapy was significantly associated with increased dry mouth and dysphonia (10 trials [7395 patients]; 3.0% vs 1.8%; risk ratio, 1.65 [95% CI, 1.14 to 2.38]; high-certainty evidence), but treatment-related and serious adverse events were not significantly different between groups (moderate-certainty evidence).

Conclusions and relevance: Among children (aged 6 to 18 years) and adults with moderate to severe asthma, triple therapy, compared with dual therapy, was significantly associated with fewer severe asthma exacerbations and modest improvements in asthma control without significant differences in quality of life or mortality.

Author/s:

Kim, L.H.Y., Saleh, C., Whalen-Browne, A., O'Byrne, P.M., Chu, D.K.

Human Papillomavirus Immunization in Rural Primary Care

Brian Desmarais — Thu, 20 Aug 2020 14:11:00 +0000

Date Added:

August 20, 2020

Journal/Publication:

American Journal of Preventive Medicine

Publication Date:

June 27, 2020

Issue:

Volume:

Pages:

377-385

URL:

Human Papillomavirus Immunization in Rural Primary Care

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amepre.2020.03.018

MeSH

Papillomavirus Vaccines

Papillomaviridae

Papillomavirus Infections

Immunization Programs

Parents

vaccination

Surveys and Questionnaires

primary health care

An OKPRN-like study of high performing practices on HPV immunization. James W. Mold, MD, MPH

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Abstract

Introduction: Despite the safety and efficacy of the human papillomavirus vaccine, thousands are impacted by human papillomavirus and its related cancers. Rural regions have disproportionately low rates of human papillomavirus vaccination. Primary care clinics play an important role in delivering the human papillomavirus vaccine. A positive deviance approach is used to identify workflows, organizational factors, and communication strategies in rural clinics with higher human papillomavirus vaccine up-to-date rates. Positive deviance is a process by which exceptional behaviors and strategies are identified to understand factors that enable success.

Methods: Rural primary care clinics were rank ordered by human papillomavirus vaccine up-to-date rates using 2018 Oregon Immunization Program data, then recruited via purposive sampling of clinics in the top and bottom quartiles. Two study team members conducted previsit interviews, intake surveys, and 2-day observation visits with 12 clinics and prepared detailed field notes. Data were collected October-December 2018 and analyzed using a thematic approach January-April 2019.

Results: Four themes distinguished rural clinics with higher human papillomavirus vaccine up-to-date rates from those with lower rates. First, they implemented standardized workflows to identify patients due for the vaccine and had vaccine administration protocols. Second, they designated and supported a vaccine champion. Third, clinical staff in higher performing sites were comfortable providing immunizations regardless of visit type. Finally, they used clear, persuasive language to recommend or educate parents and patients about the vaccine's importance.

Conclusions: Positive deviance identified characteristics associated with higher human papillomavirus vaccine up-to-date rates in rural primary care clinics. These findings provide guidance for rural clinics to inform human papillomavirus vaccination quality improvement interventions.

Author/s:

Ferrara, Laura, K., Gunn, Rose, Dickinson, Caitlin, Stock, Isabel, Griffith-Weprin, Jennifer, Wiser, Amy, Hatch, Brigit, Fagnan, L.J., Carney, P.A., Davis, M.M.

Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020

Brian Desmarais — Wed, 29 Jul 2020 15:21:15 +0000

Date Added:

July 29, 2020

Publisher:

Centers for Disease Control and Prevention

Publication Date:

July 24, 2020

URL:

Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020

Type:

Clinical Research Results

Format:

Article

DOI (1):

http://dx.doi.org/10.15585/mmwr.mm6930e1

MeSH

COVID-19

public health

outpatients

severe acute respiratory syndrome coronavirus 2

Severe Acute Respiratory Syndrome

Public Health Practice

Telephone

Surveys and Questionnaires

Young Adult

Adults

It often takes a long time to recover from COVID-19. James W. Mold, MD, MPH

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Summary

What is already known about this topic?

Relatively little is known about the clinical course of COVID-19 and return to baseline health for persons with milder, outpatient illness.

What is added by this report?

In a multistate telephone survey of symptomatic adults who had a positive outpatient test result for SARS-CoV-2 infection, 35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health.

What are the implications for public health practice?

COVID-19 can result in prolonged illness, even among young adults without underlying chronic medical conditions. Effective public health messaging targeting these groups is warranted.

Author/s:

Tenforde, M.W., Kim, S.S., Lindsell, C.J., Rose, E.B.

Pets Are Associated with Fewer Peer Problems and Emotional Symptoms, and Better Prosocial Behavior: Findings from the Longitudinal Study of Australian Children

Brian Desmarais — Wed, 22 Apr 2020 23:44:31 +0000

Date Added:

April 22, 2020

Journal/Publication:

Journal of Pediatrics

Publication Date:

February 21, 2020

URL:

Pets Are Associated with Fewer Peer Problems and Emotional Symptoms, and Better Prosocial Behavior: Findings from the Longitudinal Study of Australian Children

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jpeds.2020.01.012.

Keywords

MeSH

Family Characteristics

social change

Surveys and Questionnaires

This study supports pet ownership to support healthy childhood development. James W. Mold, MD, MPH

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Abstract

OBJECTIVE:

To investigate the longitudinal association between pet ownership and children's social-emotionaldevelopment.

STUDY DESIGN:

Two time-points of data from the Longitudinal Study of Australian Children were analyzed for children at ages 5 (n = 4242) and 7 (n = 4431) years. The Strengths and Difficulties Questionnaire (SDQ) measured children's social-emotional development. Pet ownership status and type (dog, cat, other) as well as sociodemographic and other potential confounders were collected. Longitudinal panel regression models were used.

RESULTS:

Overall, 27% of children had abnormal scores on 1 or more SDQ scales. By age 7, 75% of children had pets with ownership highest in single-child households. Owning any type of pet was associated with decreased odds of abnormal scores for emotional symptoms (OR, 0.81; 95% CI, 0.67-0.99), peer problems (OR, 0.71; 95% CI, 0.60-0.84), and prosocial behavior (OR, 0.70; 95% CI, 0.38-0.70), compared with non-pet owners. Dog ownership was associated with decreased odds of abnormal scores on any of the SDQ scales (OR, 0.81; 95% CI, 0.71-0.93). For children without any siblings, only the prosocial behavior scale was significantly associated with pet ownership (OR, 0.21; 95% CI, 0.07-0.66). In longitudinal models, cat-only and dog-only groups were associated with feweremotional symptoms and peer problems compared with non-pet owners.

CONCLUSIONS:

Early school age is an important period for family pet acquisition. Pets may protect children from developing social-emotional problems and should be taken into account when assessing child development and school readiness. Children without siblings may benefit most in terms of their prosocial behavior.

Author/s:

Christian, H., Mitrou, F., Cunneen, R., Zubrick, S.R.

5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study

John Bayhi — Fri, 21 Feb 2020 19:36:07 +0000

Date Added:

February 21, 2020

Journal/Publication:

The Lancet Child and Adolescent Health

Publisher:

Elsevier Ltd.

Publication Date:

January 21, 2020

Issue:

Volume:

Pages:

P210-219

URL:

5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/S2352-4642(20)30024-9

Keywords

PMID (1):

31978372

Bariatric surgery in adolescents can improve BMI but not mental health, at least not in Sweden. James W. Mold, MD, MPH

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BACKGROUND:

Mental health problems are prevalent among adolescents with severe obesity, but long-term mental health outcomes after adolescent bariatric surgery are not well known. We aimed to assess mental health outcomes over 5 years of follow-up after Roux-en-Y gastric bypass surgery in adolescents who participated in the Adolescent Morbid Obesity Surgery (AMOS) study.

METHODS:

This was a non-randomised matched-control study in adolescents aged 13-18 years who had a BMI of 40 kg/m2 or higher, or 35 kg/m2 or higher in addition to obesity-related comorbidity; who had previously undergone failed comprehensive conservative treatment; and were of pubertal Tanner stage III or higher, with height growth velocity beyond peak. A contemporary control group, matched for BMI, age, and sex, who underwent conventional obesity treatment, was obtained from the Swedish Childhood Obesity Treatment Register. Data on dispensed psychiatric drugs and specialist treatment for mental disorders were retrieved from national registers with complete coverage. In the surgical group only, questionnaires were used to assess self-esteem (Rosenberg Self-Esteem [RSE] score), mood (Mood Adjective Checklist [MACL]), and eating patterns (Binge Eating Scale [BES] and Three-Factor Eating Questionnaire-R21 [TFEQ]). This study is registered with ClinicalTrials.gov (NCT00289705).

FINDINGS:

Between April 10, 2006, and May 20, 2009, 81 adolescents (53 [65%] female) underwent Roux-en-Y gastric bypass surgery, and 80 control participants received conventional treatment. The proportion of participants prescribed psychiatric drugs did not differ between groups in the years before study inclusion (pre-baseline; absolute risk difference 5% [95% CI -7 to 16], p=0·4263) or after intervention (10% [-6 to 24], p=0·2175). Treatment for mental and behavioural disorders did not differ between groups before baseline (2% [-10 to 14], p=0·7135); however, adolescents in the surgical group had more specialised psychiatric treatment in the 5 years after obesity treatment than did the control group (15% [1 to 28], p=0·0410). There were few patients who discontinued psychiatric treatment post-surgery (three [4%] receiving psychiatric drug treatment and six [7%] receiving specialised care for a mental disorder before surgery). In the surgical group, self-esteem (RSE score) was improved after 5 years (mixed model mean 21·6 [95% CI 19·9 to 23·4]) relative to baseline (18·9 [17·4 to 20·4], p=0·0059), but overall mood (MACL score) was not (2·8 [2·7 to 2·9] at 5 years vs 2·7 [2·6 to 2·8] at baseline, p=0·0737). Binge eating was improved at 5 years (9·3 [7·4 to 11·2]) relative to baseline (15·0 [13·5 to 16·5], p<0·0001). Relative changes in BMI were not associated with the presence or absence of binge eating at baseline.

INTERPRETATION:

Mental health problems persist in adolescents 5 years after bariatric surgery despite substantial weight loss. Although bariatric surgery can improve many aspects of health, alleviation of mental health problems should not be expected, and a multidisciplinary bariatric team should offer long-term mental health support after surgery.

FUNDING:

Swedish Research Council, VINNOVA, Västra Götalandsregionen, ALF VG-region, Region Stockholm, Swedish Child Diabetes Foundation, Swedish Heart and Lung Foundation, Tore Nilsson's Foundation, SUS Foundations and Donations, Capio Research Foundation, and Mary von Sydow's Foundation.

Author/s:

Järvholm, K, Bruze, G, Peltonen, M, Marcus, C, Flodmark, CE, Henfridsson, P, Beamish, AJ, Gronowitz, E, Dahlgren, J, Karlsson, J, Olbers, T

Twenty-Four-Hour Movement Guidelines and Body Weight in Youth

John Bayhi — Thu, 20 Feb 2020 18:44:17 +0000

Date Added:

February 20, 2020

Journal/Publication:

The Journal of Pediatrics

Publisher:

Elsevier, Inc.

Publication Date:

January 17, 2020

Issue:

March 2020

Volume:

218

Pages:

204-209

URL:

Twenty-Four-Hour Movement Guidelines and Body Weight in Youth

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jpeds.2019.11.031

Keywords

24-hour healthy movement

PMID (1):

31959469

MeSH

Cross-Sectional Studies

Surveys and Questionnaires

I thought some of you might be interested in seeing or re-reviewing the three 24-hour movement guidelines for children (potentially useful for providing parents with specific/official guidance). James W. Mold, MD, MPH

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Objective

To examine the prevalence of youth meeting the 24-hour healthy movement guidelines (ie, ≥60 minutes of moderate-to-vigorous physical activity, ≤2 hours of screen time, age-appropriate sleep duration), and which combination of meeting these guidelines was most associated with bodyweight status, in a nationally representative US sample.

Study design

Cross-sectional data from the 2016-2017 National Survey of Children's Health were used. A multinomial regression model of body weight status was generated (underweight, overweight, obese vs healthy weight) and then stratified by sex. Analyses were adjusted for potential confounders.

Results

The sample (n = 30 478) was 50.4% female, 52.4% white, and the mean age was 13.85 ± 2.28 years; 15% percent were obese and 15.2% were overweight. Overall, 9.4% met all 3 of the 24-hour healthy movement guidelines, 43.6% met 2, 37.9% met 1, and 9.1% met none. Meeting zero guidelines (vs 3) was associated with the greatest likelihood of overweight (aOR, 1.85; 95% CI, 1.31-2.61), and obesity (aOR, 4.25; 95% CI, 2.87-6.31). Females (aOR, 4.97; 95% CI, 2.59-9.53) had higher odds of obesity than males (aOR, 3.99; 95% CI, 2.49-6.40) when zero (vs 3) guidelines were met. Meeting the moderate-to-vigorous physical activity guideline, either alone or in combination with screen time or sleep duration (vs all 3), was associated with the lowest odds for overweight and obesity in the full sample.

Conclusion

Meeting all movement guidelines was associated with the lowest risk for obesity, particularly in females. Meeting the moderate-to-vigorous physical activity guideline may be a priority to prevent overweight and obesity in youth.

Author/s:

Zhu, X, Healy, S, Haegele, JA, Patterson, F

Association of household secondhand smoke exposure and mortality risk in patients with heart failure

John Bayhi — Fri, 03 Jan 2020 17:30:23 +0000

Date Added:

January 3, 2020

Journal/Publication:

BMC Cardiovascular Disorders

Publisher:

BioMed Central Ltd

Publication Date:

December 2, 2019

Issue:

Volume:

URL:

Association of household secondhand smoke exposure and mortality risk in patients with heart failure

Type:

Clinical Research Results

DOI (1):

10.1186/s12872-019-1269-y

Keywords

heart failure

mortality

secondhand smoke

PMID (1):

31791236

MeSH

Adult

Humans

self report

Proportional Hazards Models

risk factors

Tobacco Smoke Pollution

Nutrition Surveys

cardiovascular diseases

follow-up studies

Odds Ratio

health status

Surveys and Questionnaires

Prognosis

heart failure

Socioeconomic Factors

Second-hand smoke exposure appears to hasten death in patients with CHF. James W. Mold, MD, MPH

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BACKGROUND:

Secondhand smoke (SHS) exposure is a well-established cardiovascular risk factor, yet association between SHS and prognosis of heart failure remains uncertain.

METHOD:

Data were obtained from the US National Health and Nutrition Examination Surveys III from 1988 to 1994. Currently nonsmoking adults with a self-reported history of heart failure were included. Household SHS exposure was assessed by questionnaire. Participants were followed up through December 31, 2011. Cox proportional-hazards models were used to assess the association of household SHS exposure and mortality risk. Potential confounding factors were adjusted.

RESULTS:

Of 572 currently nonsmoking patients with heart failure, 88 were exposed to household SHS while 484 were not. There were totally 475 deaths during follow-up. In univariate analysis, household SHS was not associated with mortality risk (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.76-1.26, p = 0.864). However, after adjustment for demographic variables, socioeconomic variables and medication, heart failure patients in exposed group had a 43% increase of mortality risk compared with those in unexposed group (HR: 1.43, 95% CI: 1.10-1.86, p = 0.007). Analysis with further adjustment for general health status and comorbidities yielded similar result (HR: 1.47, 95% CI: 1.13-1.92, p = 0.005).

CONCLUSION:

Household SHS exposure was associated with increased mortality risk in heart failure patients.

Author/s:

He, X, Zhao, J, He, J, Dong, Y, Liu, C

Testing of a Tool for Prostate Cancer Screening Discussions in Primary Care

John Bayhi — Thu, 26 Sep 2019 13:53:04 +0000

Date Added:

September 30, 2019

Journal/Publication:

Frontiers in Oncology

Publisher:

Frontiers Media S.A.

Publication Date:

June 28, 2018

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.3389/fonc.2018.00238

Keywords

cancer screening

clinical decision-making

prostate cancer

prostate-specific antigen

shared decision-making

PMID (1):

30003062

MeSH

early detection of cancer

Surveys and Questionnaires

This tool was developed and tested in primary care settings as a way to facilitate discussions about prostate cancer screening. Both clinicians and patients seemed to like it. James W. Mold, MD, MPH

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BACKGROUND:

As prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed.

METHODS:

A previously created 9-item tool to aid PCa screening discussions was tested in five diverse primary care clinics. Fifteen providers were recruited to use the tool for 4 weeks, and the tool was revised based upon feedback. The providers then used the tool with a convenience sample of patients during routine clinic visits. Pre- and post-visit surveys were administered to assess patients' knowledge of the option to be screened for PCa and of specific factors to consider in the decision. McNemar's and Stuart-Maxwell tests were used to compare pre-and post-survey responses.

RESULTS:

14 of 15 providers completed feedback surveys and had positive responses to the tool. All 15 providers then tested the tool on 95 men aged 40-69 at the five clinics with 2-10 patients each. The proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% (p = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect PCa risk from 34 to 47% (p = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% (p = 0.009).

CONCLUSION:

A brief conversation tool for the PCa screening discussion was well received in busy primary-care settings and improved patients' knowledge about the screening decision.

Author/s:

Misra-Hebert, AD, Hom, G, Klein, EA, Bauman, JA, Gupta, N, Ji, X, Stephenson, AJ, Jones, JS, Kattan, Kattan, MW

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

John Bayhi — Thu, 11 Jul 2019 19:47:05 +0000

Date Added:

July 11, 2019

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

July 11, 2019

Issue:

Volume:

381

Pages:

111-120

URL:

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1803185

Keywords

C-reactive protein

primary care

chronic obstructive pulmonary disease

copd

CRP

randomized control trial

antibiotics

PMID (1):

31291514

MeSH

Point-Of-Care Testing

anti-bacterial agents

technology assessment, biomedical

Wales

follow-up studies

random allocation

pulmonary disease, chronic obstructive

health status

Surveys and Questionnaires

primary health care

referral and consultation

England

In adults with acute COPD exacerbations, serum CRP-based decision-making led to fewer antibiotic prescriptions with no adverse consequences. Physicians and patients in the intervention group were advised to consider all clinically relevant information. However, they were advised to consider that CRP levels < 4omg/L indicated that antibiotics were probably not needed, levels between 20 and 40 mg/L were indeterminant, and levels above 40 mg/L suggested that antibiotics were probably necessary. Note: In this study, physicians were able to obtain CRP levels at the point of care. James W. Mold, MD, MPH

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BACKGROUND

Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).

METHODS

We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority).

RESULTS

A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was −0.19 points (two-sided 90% CI, −0.33 to −0.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation.

CONCLUSIONS

CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm. (Funded by the National Institute for Health Research Health Technology Assessment Program; PACE Current Controlled Trials number, ISRCTN24346473.)

Author/s:

Butler, Christopher C., Gillespie, David, White, Patrick, Bates, Janine, Lowe, Rachel, Thomas-Jones, Emma, Wootton, Mandy, Hood, Kerenza, Phillips, Rhiannon, Melbye, M., Llor, Carl, Cals, Jochen W.L.

Spending at least 120 minutes a week in nature is associated with good health and wellbeing

Brian Desmarais — Wed, 19 Jun 2019 01:06:53 +0000

Date Added:

June 18, 2019

Journal/Publication:

Scientific Reports

Publication Date:

June 13, 2019

URL:

Spending at least 120 minutes a week in nature is associated with good health and wellbeing

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1038/s41598-019-44097-3

Keywords

Recreation

Psychology and behaviour

Epidemiology

exercise

MeSH

Recreation

Residence Characteristics

Surveys and Questionnaires

exercise

Spending at least two hours per week outdoors appears to improve perceived health and well-being. James W. Mold, MD, MPH

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Spending time in natural environments can benefit health and well-being, but exposure-response relationships are under-researched. We examined associations between recreational nature contact in the last seven days and self-reported health and well-being. Participants (n = 19,806) were drawn from the Monitor of Engagement with the Natural Environment Survey (2014/15-2015/16); weighted to be nationally representative. Weekly contact was categorised using 60 min blocks. Analyses controlled for residential greenspace and other neighbourhood and individual factors. Compared to no nature contact last week, the likelihood of reporting good health or high well-being became significantly greater with contact ≥120 mins (e.g. 120-179 mins: ORs [95%CIs]: Health = 1.59 [1.31-1.92]; Well-being = 1.23 [1.08-1.40]). Positive associations peaked between 200-300 mins per week with no further gain. The pattern was consistent across key groups including older adults and those with long-term health issues. It did not matter how 120 mins of contact a week was achieved (e.g. one long vs. several shorter visits/week). Prospective longitudinal and intervention studies are a critical next step in developing possible weekly natureexposure guidelines comparable to those for physical activity.

Author/s:

White, M.P., Alcock, I., Grellier, J, Wheeler, B.W., Hartig, T., Warber, S.L., Bone, A., Depledge, M.H., Fleming, L.E.