Food allergy management from the perspective of patients or caregivers, and allergists: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Research has shown that the long term management of food allergy is suboptimal. Our study aims to provide direction for improvement, by evaluating food allergy management from the perspective of, food allergic patients or their caregivers, and allergists in selected outpatient settings in Ontario.</p> <p>Methods</p> <p>This two-part study included an anonymous questionnaire completed by patients or their caregivers in allergy clinics, and a qualitative interview with allergists. In Part A, food allergic patients or their caregivers were surveyed about information they received on food allergy, their level of confidence with self-management, and their learning needs. In Part B, allergists were interviewed about teaching priorities and the challenges and strategies that currently exist in food allergy management. The questionnaire was developed and piloted at the Hamilton Health Sciences Corporation-McMaster University Medical Center Site. Using convenience sampling, participants were recruited from 6 allergy clinics in 5 Ontario cities. Patients of any age with food allergy who were evaluated by an allergist were considered for inclusion. Quantitative data was analyzed using descriptive statistics and frequency analysis. Audio recorded interviews with allergists were transcribed verbatim and analyzed using content analysis of grounded theory methodology.</p> <p>Results</p> <p>Ninety-two food allergic families in the care of 6 allergists in Toronto, Hamilton, London, Kitchener, and Kingston participated in the study. Key areas requiring improvement in food allergy management were identified: 33% of families were not shown how to use an epinephrine auto-injector with a trainer, only 57% were asked to demonstrate an auto-injector, despite being on average at their 5th visit, and only about 30% felt very confident about when and how to give an auto-injector. Fifty percent of families did not receive sufficient information on medical identification and 21% did not receive information about support groups. Interviews with allergists revealed limitations in time and nursing resources.</p> <p>Conclusions</p> <p>Our study highlights the educational gaps and overall experiences of food allergic families in Ontario, and the challenges faced by the allergists managing them.</p

Surgical Repair of a Giant Sinus of Valsalva Aneurysm with an Anomalous Left Circumflex Artery in a Patient with Bicuspid Aortic Valve

Congenital cardiac abnormalities are not always found in isolation. We describe a case of a giant right coronary sinus of Valsalva aneurysm with anomalous left circumflex artery in a 46-year-old male with bicuspid aortic valve and prior ventricular septal defect repair

A novel hybrid left renal vein transposition and endovascular stenting technique for the treatment of posterior nutcracker syndrome

Posterior nutcracker syndrome occurs when a retroaortic left renal vein becomes compressed between the abdominal aorta and the lumbar spine. Although open surgical approaches remain the treatment of choice, endovascular stenting has been used successfully. We describe a case of a 28-year-old man who presented with microscopic hematuria, left-sided flank pain, and testicular swelling. Computed tomography findings were consistent with posterior nutcracker syndrome. He underwent a novel hybrid operation that included left renal vein transposition followed by endovascular stenting. Repeated imaging at 3 and 12 months revealed a patent stent with complete resolution of symptoms