Quest for certainty regarding early discharge in paediatric low-risk febrile neutropenia : a multicentre qualitative focus group discussion study involving patients, parents and healthcare professionals in the UK

OBJECTIVES: A systematic review of paediatric low-risk febrile neutropenia found that outpatient care is safe, with low rates of treatment failure. However, this review, and a subsequent meta-ethnography, suggested that early discharge of these patients may not be acceptable to key stakeholders. This study aimed to explore experiences and perceptions of patients, parents and healthcare professionals involved in paediatric febrile neutropenia care in the UK. SETTING: Three different centres within the UK, purposively selected from a national survey on the basis of differences in their service structure and febrile neutropenia management. PARTICIPANTS: Thirty-two participants were included in eight focus group discussions. PRIMARY OUTCOMES: Experiences and perceptions of paediatric febrile neutropenia care, including possible future reductions in therapy. RESULTS: Participants described a quest for certainty, in which they attempted to balance the uncertainty involved in understanding, expressing and negotiating risk with the illusion of certainty provided by strict protocols. Participants assessed risk using both formal and informal stratification tools, overlaid with emotional reactions to risk and experiences of risk within other situations. The benefits of certainty provided by protocols were counterbalanced by frustration at their strict constraints. The perceived benefits and harms of previous inpatient care informed participants' appraisals of future treatment strategies. CONCLUSIONS: This study highlighted the previously underestimated harms of admission for febrile neutropenia and the paternalistic nature of decision making, along with the frustrations and challenges for all parties involved in febrile neutropenia care. It demonstrates how the same statistics, generated by systematic reviews, can be used by key stakeholders to interpret risk differently, and how families in particular can view the harms of therapeutic options as different from the outcomes used within the literature. It justifies a reassessment of current treatment strategies for these children and further exploration of the potential to introduce shared decision making

Body Composition Assessment in Masters Level Swimmers

Body composition of collegiate swimmers has been extensively studied; however, there are limited reports of body composition among Masters swimmers. This study compared the accuracy of air displacement plethysmography (ADP) and bioelectrical impedance (BIA) to the gold standard method of underwater weighing (UWW) in Masters level swimmers. The relationship between percent body fat (%BF) and body mass index (BMI) was also assessed. Recruitment (n = 6 females, 11 males) occurred at two Masters swim clubs. Pearson correlation coefficients revealed no significant differences between ADP, BIA, and UWW (p \u3e 0.05). For both female and male Masters swimmers, the mean %BF was in the healthy range (30.4 ± 11.7% female, 21.3 ± 8.0% male); however, BMI was in the overweight range (27.0 ± 7.2 kg/m2 female, 26.4 ± 4.8 kg/m2 male). These findings suggest that while ADP, BIA, and UWW were comparable methods for assessing %BF in Masters swimmers, BMI did not adequately represent body composition and health risk for Masters swimmers

The Story of Josie: From Involvement to Influence

This is a personal account of the author’s journey through involvement with learning communities (LCs). She began college with little exposure to mentoring and research. Six years later, she graduated with a master’s degree, a trove of experience from LCs, and the confidence to take on a research role in her profession. The author’s personal roles in LCs over the years have taken many forms, but mainly relate to the mental health of college students. LCs have served as a vehicle for launching the author’s career by helping her gain valuable experience in peer mentoring, research projects, and student poster presentations as well as providing opportunities to network, engage in professional development, and hone leadership skills. Student involvement is valuable throughout the LC experience to foster growth and development of not only the student, but the LC as well. The author witnessed firsthand the benefits of a partnership between students and LC team, demonstrating how much LCs benefit from integrating student input

Nutrition Transition and Climate Risks in Nigeria: Moving Towards Food Systems Policy Coherence

Purpose of Review The purpose of this review is to describe the combined impacts of the nutrition transition and climate change in Nigeria and analyze the country’s national food-related policy options that could support human and planetary health outcomes

Relationship of Patient Self-Administered COPD Assessment Test to Physician Standard Assessment of Chronic Obstructive Pulmonary Disease in a Family Medicine Residency Training Program

Assessing the global impact of chronic obstructive pulmonary disease (COPD) on a patient’s life can be difficult to perform in the clinical setting due to time constraints and workflow challenges. The primary objective of this study was to compare disease impact ratings between patient selfadministered COPD Assessment Test (CAT) and physician standard office assessment. This prospective study was conducted at a family medicine residency clinic in northeast Tennessee. The study included two study groups: 1) adult patients seen at the clinic during the 3-month study period with an active diagnosis of COPD, and 2) their physicians. Physicians’ assessment of the impact of COPD on their patients’ daily lives was compared to patients’ self-administered CAT assessments. Physician assessment of COPD impact and patient ssessment of CAT categories significantly differed (χ2 =11.0, P=0.012). There was very poor agreement between patient and physician ratings (κ=0.003), with 42.9% of physician ratings underestimating the impact, 28.6% overestimating the impact, and 28.6% orrectly estimating the impact COPD had on their patients’ lives. These findings support the use of validated assessment tools to help providers understand the symptom burden for patients with COPD

Critical review of current clinical practice guidelines for antifungal therapy in paediatric haematology and oncology

PURPOSE: The incidence of invasive fungal disease (IFD) is rising, but its treatment in paediatric haematology and oncology patients is not yet standardised. This review aimed to critically appraise and analyse the clinical practice guidelines (CPGs) that are available for paediatric IFD. METHODS: Electronic searches of MEDLINE, MEDLINE in-Process & Other non-Indexed Citations, the Guidelines International Network (GIN), guideline.gov and Google were performed and combined fungal disease (Fung* OR antifung*OR Candida* OR Aspergill*) with prophylaxis or treatment (prophyl* OR therap* OR treatment). All guidelines were assessed using the AGREE II tool and recommendations relating to prophylaxis, empirical treatment and specific therapy were extracted. RESULTS: Nineteen guidelines met the inclusion criteria. The AGREE II scores for the rigour of development domain ranged from 11 to 92 % with a median of 53 % (interquartile range 32-69 %). Fluconazole was recommended as antifungal prophylaxis in all nine of the included guidelines which recommended a specific drug. Liposomal amphotericin B was recommended in all five guidelines giving empirical therapy recommendations. Specific therapy recommendations were given for oral or genital candidiasis, invasive candida infection, invasive aspergillosis and other mould infections. CONCLUSIONS: In many areas, recommendations were clear about appropriate practice but further clarity was required, particularly relating to the decision to discontinue empirical antifungal treatment, the relative benefits of empiric and pre-emptive strategies and risk stratification. Future CPGs could consider working to published guideline production methodologies and sharing summaries of evidence appraisal to reduce duplication of effort, improving the quality and efficiency of CPGs in this area

Assessment of Cardiovascular Risk in First-Semester College Students

Poster from the 2019 Food & Nutrition Conference & Expo. Poster Session: Wellness and Public Health

Using Evidence-Based Medicine to Support Clinical Decision-Making in RMS

The foundations of evidence-based practice are the triad of patient values and preferences, healthcare professional experience, and best available evidence, used together to inform clinical decision-making. Within the field of rhabdomyosarcoma, collaborative groups such as the European Paediatric Soft Tissue Sarcoma Group (EpSSG) have worked to develop evidence to support this process. We have explored many of the key research developments within this review, including patient and public involvement, decision-making research, research into areas other than drug development, core outcome sets, reporting and dissemination of research, evidence synthesis, guideline development and clinical decision rules, research of research methodologies, and supporting research in RMS

Does routine surveillance imaging after completing treatment for childhood solid tumours cause more harm than good? : A systematic review and meta-analysis protocol

BACKGROUND: This systemic review aims to synthesise the current literature surrounding off-therapy surveillance imaging in children and young people with extra-cranial solid tumours, with a view to establishing if routine imaging studies after treatment for childhood cancer increase overall survival, increase the psychological distress caused to patients and families, result in other harms to patients and are cost-effective strategies. Within this manuscript, we also describe how patient and public involvement has impacted upon the protocol. METHODS: The search will cover thirteen different databases, key conference proceedings and trial registers, as well as reference lists and forward citations of included papers. Prominent authors/clinicians in the field will be contacted. A full search strategy is provided. The study designs to be included in the review will be added in an iterative way (RCTs, quasi-randomised trials, prospective cohorts and retrospective cohorts). Qualitative studies will also be eligible for inclusion. We will include studies which examine a programme of surveillance imaging that aims to detect relapse in children or young people up to age 25 years who have completed treatment for a malignant extracranial solid tumour and have no evidence of active and ongoing disease at end of treatment. The primary outcome is overall survival, with secondary outcomes including psychological distress indicators, number of imaging tests performed, other harms of imaging and cost-effectiveness measures. Studies will be screened and data extracted by two researchers. Studies will be critically appraised using a stratified version of the ROBINS-I tool. Where appropriate, data will be synthesised using a random effects meta-analysis. A detailed analysis plan, including assessment of heterogeneity and publication bias, is provided. DISCUSSION: The aim of routine surveillance imaging is to detect recurrence of disease before clinical symptoms and signs develop. Some studies have suggested that most relapses of childhood cancer are detected due to clinical symptoms or signs, particularly in those with extra-cranial solid tumours, and when these relapses are detected by imaging, there is no increase in survival. This review aims to establish whether routine surveillance imaging is beneficial, as well as evaluating the potential negative impacts of surveillance programmes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018103764