Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis CHEST Guideline and Expert Panel Report

BACKGROUND: Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged METHODS: We used the CHEST expert cough panel\u27s protocol for systematic reviews and the American College of Chest Physicians (CHEST) methodologic guidelines and GRADE framework (the Grading of Recommendations Assessment, Development and Evaluation). Data from the systematic reviews in conjunction with patients\u27 values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus for the recommendations/suggestions made. RESULTS: Combining data from the systematic reviews, we found high-quality evidence in children aged 4 weeks\u27 duration) wet/productive cough that using appropriate antibiotics improves cough resolution, and further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be undertaken when specific cough pointers (eg, digital clubbing) are present. When the wet cough does not improve following 4 weeks of antibiotic treatment, there is moderate-quality evidence that further investigations should be considered to look for an underlying disease. New recommendations include the recognition of the clinical diagnostic entity of protracted bacterial bronchitis. CONCLUSIONS: Compared with the 2006 Cough Guidelines, there is now high-quality evidence for some, but not all, aspects of the management of chronic wet cough in specialist settings. However, further studies (particularly in primary health) are required

The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support

Background: Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. Methods: We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. Results: We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. Conclusions: The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed

EFSA CEF Panel (EFSA Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids), 2013. Scientific Opinion on Flavouring Group Evaluation 93, Revision 1 (FGE.93Rev1)

International audienc

Antiviral Combination Therapy with Interferon/Peginterferon Plus Ribavirin for Patients with Chronic Hepatitis C in Germany: A Health Technology Assessment Commissioned by the German Agency for Health Technology Assessment

Objective: The purpose of this health technology assessment (HTA), commissioned by the German Agency for HTA at the German Federal Ministry of Health and Social Security, was to systematically review the evidence on effectiveness and cost-effectiveness of antiviral treatment (AVT) for initial chronic hepatitis C (CHC) and to apply these data in the context of the German health care system. Methods: A systematic literature search was conducted to identify randomised controlled trials (RCTs), meta-analyses, and HTAs that evaluated initial AVT for CHC. A modified version of the German Hepatitis C Model (GEHMO) -- a decision-analytic Markov model -- was used to determine long-term morbidity, life expectancy, quality of life, costs and cost-effectiveness of different treatment strategies. Model parameters were derived from German databases, international RCTs, and a Cochrane Review. Results: Overall, 9 RCTs, 2 HTA reports, 1 Cochrane review, and 2 meta-analyses examining medical effectiveness of antiviral combination therapy, as well as 7 economic evaluations, met the inclusion criteria. These studies indicate that combination therapy with peginterferon plus ribavirin produced the highest sustained virological response rates (54-61%), followed by interferon plus ribavirin with 38-54%, and interferon monotherapy with 11-21%. Based on international cost-effectiveness studies, interferon plus ribavirin is cost-effective compared to interferon monotherapy. No published articles were available regarding cost-effectiveness of peginterferon plus ribavirin. In our decision analysis, these findings were confirmed and the discounted incremental cost-effectiveness ratio for peginterferon plus ribavirin was € 9,800 per quality-adjusted life-year gained compared to interferon monotherapy (as the next best non-dominated strategy). Sensitivity analyses showed robust results across a wide range of model parameters. Conclusions: This HTA suggests that initial combination therapy prolongs life, improves quality of life, and is cost-effective in patients with CHC. Combination of peginterferon and ribavirin is the most effective and efficient treatment strategy among the examined options

EFSA CEF Panel (EFSA Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids), 2014. Scientific Opinion on Flavouring Group Evaluation 74, Revision 3 (FGE.74Rev3): Consideration of Simple Aliphatic Sulphides and Thiols evaluated by the JECFA (53rd and 61st meeting) Structurally related to Aliphatic and Alicyclic Mono-, Di-, Tri-, and Polysulphides with or wi thout Additional Oxygenated Functional Groups from Chemical Group 20 evaluated by EFSA in FGE.08Rev5 (2012)

The Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids of the European Food Safety Authority was requested to consider evaluations of flavouring substances assessed since 2000 by the Joint FAO/WHO Expert Committee on Food Additives (the JECFA), and to decide whether further evaluation is necessary, as laid down in Commission Regulation (EC) No 1565/2000. The present consideration concerns a group of 19 simple aliphatic sulphides and thiols evaluated by the JECFA at the 53rd meeting in 1999 and the 61st meeting in 2003. The substances were evaluated through a stepwise approach that integrates information on structure-activity relationships, intake from current uses, toxicological threshold of concern, and available data on metabolism and toxicity. For nine substances [FL-no: 12.088, 12.179, 12.198, 12.212, 12.238, 12.239, 12.255, 12.257 and 12.291] considered in this FGE, the Panel concluded that they would pose “No safety concern at estimated levels of intake as flavouring substances” based on the MSDI approach. Besides the safety assessment of these flavouring substances, the specifications for the materials of commerce have also been considered for the substances evaluated through the Procedure and for all nine substances, the information is adequate. Thus, the Panel concluded that nine substances [FL-no: 12.088, 12.179, 12.198, 12.212, 12.238, 12.239, 12.255, 12.257 and 12.291] do not give rise to safety concern at their levels of dietary intake, estimated on the basis of the MSDI approach. For 10 candidate substances in FGE.74Rev3 [FL-no: 12.009, 12.013, 12.020, 12.023, 12.045, 12.074, 12.155, 12.169, 12.241 and 12.280] evaluated through the Procedure, the Panel concluded that additional toxicity data are required

Male gender is an important clinical risk factor for iron deficiency in healthy infants

Author's personal copy ; Acknowledgements to the children and families who were involved in this study, and to BH Pathology Clinic Dpt.Background & aims: To identify ID risk factors in infancy, and try to explore why ID is more prevalent in boys than in girls in the first year of life. Methods: A multiple logistic regression was performed on data of 201 infants, with ferritin<12 ng/ml as the dependent variable and months of breastfeeding, weight gain from birth to 9 months (WG), and gender as independent variables. To compare haematological parameters we used Manne-Whitney and t test. Results: From the 39 infants with IDA (19.4%), 24 (61.5%) were male and of the 162 infants without IDA, 50% were male (p ¼ 0.195). The median(minimum; maximum) ferritin concentrations in male infants at 9 months was of 9.8 ng/ml (0.5e67.0 ng/ml) and in females 14 ng/ml (0.5e74.5 ng/ml), p < 0.001. The average (±SD) WG was of 5863.3 g (±855.4 g) in male infants and 5556.9 g (±1054.3 g) in female infants (p = 0.027). A multiple logistic regression (OR; 95%CI) showed that male gender was the most important risk factor (OR: 3.3; 1.7e6.3; p < 0.001), followed by a higher weight increase (OR: 1.6; CI [1.1; 2.2]; p = 0.016) and longer breastfeeding time (OR: 1.1; CI [0.98; 1.2]; p = 0.099). Comparison of other haematological parameters at 9 months in relation to gender (males (M): 105; females (F): 96) showed significant differences in: mean ± SD, Mean Corpuscular Haemoglobin (M: 25.0 ± 2.1; F: 25.8 ± 2.4 pg, p = 0.001), Mean Corpuscular Volume (M: 73.4 ± 4.1; F: 75.3 ± 4.2 fl, 0.009), RDW (M: 14.6 ± 1.5; F: 14.1 ± 1.6%, p = 0.048), Plaquelets (M: 324.9 ± 77.9; F: 350.5 ± 81.4 x 10³/µl, p = 0.026). Conclusions: ID was significantly more frequent in male infants, independent of rapid growth or longer breastfeeding duration. The clinical risk profile for ID in infants includes male gender and not only rapid growth, and longer breastfeeding duration.This study received a scholarship from the Foment Commission for Investigation in Health Care, from the Health Ministry P.I. nº 87/07

Achievement of multiple therapeutic targets for cardiovascular disease prevention. Retrospective analysis of real practice in Italy

Background: Pharmacological therapy in patients at high cardiovascular (CV) risk should be tailored to achieve recommended therapeutic targets. Hypothesis: To evaluate individual global CV risk profile and to estimate the control rates of multiple therapeutic targets for in adult outpatients followed in real practice in Italy. Methods: Data extracted from a cross-sectional, national medical database of adult outpatients in real practice in Italy were analyzed for global CV risk assessment and rates of control of major CV risk factors, including hypertension, dyslipidemia, diabetes, and obesity. CV risk characterization was based on the European SCORE equation and the study population stratified into 3 groups: low risk ( 40 (males)/>50 (females) mg/dL (OR: 0.926, 95% CI: 0.895–0.958), triglycerides <160 mg/dL (OR: 0.925, 95% CI: 0.895–0.957), and BMI <25 kg/m2(OR: 0.888, 95% CI: 0.851–0.926), even after correction for diabetes, renal function, pharmacological therapy, and referring physicians (P < 0.001). Conclusions: Despite low prevalence and optimal medical therapy, individuals with high to very high SCORE risk did not achieve recommended therapeutic targets in a real-world practice