ARIA 2016: care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for 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 for the management of rhinitis and asthma by a multi-disciplinary group and 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.European Innovation Partnership on Active and Healthy Ageing Reference Site MACVIA-France, EU Structural and Development Fund Languedoc-Roussillon, ARIA.info:eu-repo/semantics/publishedVersio

How to Deliver a Successful Learning Package for Family Medicine Trainees?

Like most learners, FM trainees are eager to learn to become competent professionals. It is the task of tutors and course organisers to guarantee the quality of learning. In order to be successful, learning programmes require a certain number of features. Family Medicine has been in the front line of innovation in designing learning and teaching programmes to fit the objectives and learning needs of trainees (1). Furthermore, it has published guidance and developed several courses to allow the development of teaching skills of tutors and teachers in family medicine (2,3). What Makes a Teaching Programme Successful? This text will review some of the characteristics of a teaching package that can include in-person learning, such as small group work modules combined with distance learning, mostly using problem based learning and integrating practical work in a real primary care setting. Learning objectives and content can be adapted to work with small groups, individual learning or one-to-one teaching in a residency programme. We will consider the six key features that make such a comprehensive programme effective. How to Deliver a Successful Learning Package for Family Medicine Trainees? (PDF Download Available). Available from: https://www.researchgate.net/publication/284726251_How_to_Deliver_a_Successful_Learning_Package_for_Family_Medicine_Trainees [accessed Jan 25 2018].info:eu-repo/semantics/publishedVersio

Routine primary care data: the new crystal ball?

[Excerpt] In their 2014 recommendation update, the Global Initiative for Asthma (GINA) called for a more risk-focused approach to management. If used appropriately primary care records capturing routine data can be used not only to characterize current asthma control and current/prior practice, but also to “predict future risk”. By considering aggregate patient data, it is possible to identify common characteristics associated with future events and to explore combinations of factors that, together, may have a stronger association with specific future risks, such as exacerbations, multiple exacerbations, hospitalisations. Used in this way, clinical records can point to opportunities to modify risk and to intervene to mitigate against future events. [...](undefined)info:eu-repo/semantics/publishedVersio

The relationship of H. pylori infection and gastric cancer

Introduction: The aim of this review is to assess whether there is a relationship between Helicobacter pylori infection and gastric cancer. Method: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the NHS Database of Abstracts of Reviews of Effectiveness; MEDLINE; EMBASE, Biological Abstracts and Science Citation Index-Expanded. We used the search terms Helicobacter pylori and (gastric or stomach) and (cancer$or neoplasm$) and (systematic review$or meta-anal$), and searched for articles in all languages and limited the search to humans. Evaluation of the Level of Evidence: We used the rating system of the American Family Physician journal: Level A (randomized controlled trial/meta-analysis); Level B (other evidence); and C (consensus/expert opinion). Results: H. pylori increases the odds ratio of gastric cancer in various studies. H. pylori is associated with the development of both types of gastric adenocarcinoma. On average only three per cent of those who carry H. pylori develop gastric carcinoma. The risk of gastric cancer is also increased if the individual has polymorphisms that result in the expression of higher than average levels of the cytokine IL-1β. There is no evidence that nutritional supplements prevent gastric cancer. Conclusions: Gastric cancer is preceded by a long latency period. Infection with H. pylori is a primary cause of the precancerous cascade from gastritis to dysplasia, and eradicating H. pylori by antibiotic therapy results in a modest retardation of the cancerous process. The research to date reviewed above suggests that the best strategy is twofold. Firstly, focus on high risk individuals with known risk factors of H. pylori exposure treat them for H. pylori and screen them endoscopically for the development of early gastric cancers which can be ideally resected endoscopically. Secondly, screen younger individuals (< 45 years) at risk for H. pylori who have not been exposed to H. pylori for as long and treat them.O objectivo da presente revisão é avaliar se existe uma relação entre a infecção por Helicobacter pylori e cancro gástrico. Pesquisámos o Cochrane Central Register of Controlled Trials, o Cochrane Database of Systematic Reviews e o NHS Database of Abstracts of Reviews of Effectiveness; MEDLINE; EMBASE; Silver- Platter, Biological Abstracts and Science Citation Index-Expanded. Usámos os termos de pesquisa Helicobacter pylori e (gastric or stomach) and (cancer$or neoplasm$) e (systematic review$or meta-anal$), e pesquisámos artigos de todas as línguas limitando a pesquisa a humanos. Avaliação do Nível de Evidência: usámos o sistema de classificação da revista American Family Physician: Nível A (ensaios clínicos aleatorizados/meta-análises). Nível B (outras fontes de evidência). Nível C (consensos/opinião de peritos). O H. Pylori aumenta a OR para cancro de estômago em vários estudos. O H. Pylori está associado ao desenvolvimento de ambos os tipos de adenocarcinoma gástrico. Em média, apenas três por cento dos portadores de H. Pylori desenvolvem carcinoma gástrico. O risco de cancro de estômago está igualmente aumentado se o indivíduo tem polimorfismos que resultam numa expressão maior do que os níveis médios da citocina IL-1β. Não existe evidência que os suplementos nutricionais previnam o cancro gástrico. O cancro gástrico é precedido por um longo período de latência. A infecção por H. pylori é uma causa primária da cascata pré-cancerosa da gastrite à displasia e a erradicação do H. pylori por terapêutica antibiótica resulta num atraso moderado do processo canceroso. A investigação apresentada revista até hoje sugere que a melhor estratégia é, primeiro, incidir nos indivíduos de alto risco com factores de risco conhecidos de exposição ao H. pylori e rastreá-los endoscopicamente para o desenvolvimento de cancros gástricos iniciais que podem ser ressecados endoscopicamente; seguidamente, rastrear indivíduos mais novos (< 45 anos) em risco para H. pylori que não foram expostos ao H. pylori por um período tão longo e tratá-los

Screening for helicobacter pylori

The aim of this review is to assess whether a screening programme for Helicobacter pylori will be both successful and cost-effective. Method: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the NHS Database of Abstracts of Reviews of Effectiveness; MEDLINE; EMBASE; SilverPlatter, Biological Abstracts and Science Citation Index-Expanded. We used the search terms Helicobacter pylori and (diagnos$or identif$ or find$) and (systematic review$ or meta-anal$), and searched for articles in all languages and limited the search to humans. Evaluation of the Level of Evidence: We used the rating system of the American Family Physician journal: Level A (randomized controlled trial/meta-analysis); Level B (other evidence); and C (consensus/expert opinion). Results: Serological tests: Antibody levels persist in serum for many years and do not permit us to distinguish between past and present infection or to identify treatment failures. Saliva and urine tests: A saliva test had sensitivity of 81% and specificity of 73%. A urine test had sensitivity of 86-89% and specificity of 69-91%. Breath urea tests: The tests have a high sensitivity and specificity but require expensive equipment. Stool tests: showed a high sensitivity and specificity. The European Helicobacter study group recommends either the breath urea or stool antibody tests in the initial diagnosis of H. pylori. Tests for specific gene sequences showed a high sensitivity and specificity. Endoscopy: is invasive, uncomfortable for patients, and expensive. The cost-effectiveness of tests for H. pylori: The better accuracy of the stool and breath tests, despite their greater cost, make them more cost-effective than the serology or near-patient tests. Conclusions: Tests with good sensitivity and specificity are available. The costs of non-invasive diagnostic tests acceptable to patients have been worked out, and the cost-effective dominance of stool and particularly urea breath tests over serological tests has been determined in a systematic review. What remains is to implement and test further the cost-effectiveness of national testing strategies

Faculty development for teachers of family medicine in Europe: Reflections on 16 years' experience with the international Bled course

Background: Instruction in principles and methods of medical education is a core component of the training of medical teachers. Curricula for new medical teachers have developed across Europe, but few European courses have had the success of the EURACT Bled course for teachers of family medicine. The course focuses on practical issues in medicine and the professional development of physicians. This article describes 16 years' experience with the Bled course for teachers in general practice/family medicine (GP/FM). Course structure: The course is centred on the preparation of a teaching module, exploring a specific theme in family medicine. The main teaching methods used are: keynote lectures, small group sessions, field work and preparation of a teaching module by the participants. Outcomes: This course has attracted 555 participants from 20 countries since 1992. The course and its outputs have been applied in undergraduate and postgraduate teaching, and in continuous professional development (CPD) in several countries. It is a respected forum for faculty development. The experience of the Bled course suggests that academic medicine may be better able to fulfil its responsibilities by paying attention to relevant topics and using appropriate methods in undergraduate and postgraduate medical curricula.info:eu-repo/semantics/publishedVersio

The IPCRG's teach the teacher programme: an educational initiative to promote improved management of difficult to manage asthma

The IPCRG is a network of organisations committed to improving primary care assessment and treatment of chronic respiratory disease. We developed an evidence-based resource, SIMPLES (Ryan D, et al. Prim Care Respir J 2013;22:365-73) to aid structured asthma review for difficult to manage asthma. An educational initiative was introduced to disseminate research findings from U-BIOPRED and promote improved primary care management. We aimed to support participants from seven European countries to design and plan local programmes of education:teaching clinical colleagues key messages about difficult to manage asthma, encouraging local adaptation of existing IPCRG resources. These took place in autumn 2015 involving over 230 health professionals - including early career and GPs with a special interest in asthma/COPD, specialist nurses and others. We proposed an evaluation framework(Guskey,T.Teachers&Teaching 2002;8:3, 381-391) which includes - i) participant reaction, ii) learning, iii) organisational changes, iv) use of new knowledge and v) impact on practice and service users. Programmes were well received by participants. There were many challenges encountered: in assessing local learning needs, setting up education programmes and supporting clinical practice change. The impact on participants' clinical practice and service users is more challenging to demonstrate and will require more time to evaluate. We reflect on the challenge of meaningful evaluation of practice change. These insights are important in thinking about the design, implementation and evaluation of clinical educational programmes globally.info:eu-repo/semantics/publishedVersio

Asthma incidence and accuracy of diagnosis in the Portuguese sentinel practice network

Aims: Asthma is frequently under-diagnosed with a wide variation in incidence rates. We aimed to assess how physicians in a Portuguese sentinel practice network perform using standardised diagnostic criteria. Method: Patients consulting one of the 43 network physicians with complaints suggestive of asthma were enrolled in the study over a four-year period. Symptom frequency and diagnoses of asthma were tabulated. Diagnostic accuracy was computed by dividing the rate of asthma diagnosis by the true rate using established diagnostic criteria. Results: Over four years, 43 physicians followed 32,103 patients (128,412 patient-years) and diagnosed asthma in 310. The diagnosis was,confirmed in 260 cases, giving a true incidence rate of 2.02/1000/year (95% confidence interval 1.8 to 2.2) and an accuracy of diagnosis of 84%. Conclusions: Asthma incidence approaches published rates if accepted criteria are used. Educational efforts to ensure more accurate diagnosis may improve outcomes for asthma patients.Funding for the Sentinel Practice Network is provided by the Portuguese Ministry of Healtinfo:eu-repo/semantics/publishedVersio

Study protocol : determinants of treatment success in chronic obstructive pulmonary disease

Study protocol - Determinants of Treatment Success in Chronic Obstructive Pulmonary DiseaseCOPD is a common, complex and heterogeneous disease. General objective is to identify factors which correction can be translated into improved health care for COPD patients. The study will take place in Guimarães hospital’s outpatient pulmonology care. COPD outpatients over 40 years of age, will be enrolled sequentially in order of appearance in the consultation during a one-year period. The most relevant demographic and clinical patients’ characteristics will be studied using appropriate tools, and will be transformed into variables, which will be used for descriptive and inferential analysis. The variables degree of severity, medication adherence, beliefs about the disease and about the inhaled medications, and the inhalation technique are intended to be related to each other, in order to understand the relative weight of each of these variables under study as factors of therapeutic success in COPD.info:eu-repo/semantics/publishedVersio