Association between allergen component sensitisation and clinical allergic disease in children

Background: Allergen component sensitisation testing is becoming increasingly important in the diagnosis of peanut allergy. The aim of the present study was to evaluate the relationship between sensitisation and symptoms of allergic disease in children by testing a large panel of inhalants, food allergens, and allergen components. Methods: For 287 children visiting our laboratory for allergy testing, symptoms of allergic disease were recorded by standardised validated questionnaires. Specific IgE to 11 whole allergens was assessed by ImmunoCAP, and to 112 allergen components by ISAC ImmunoCAP assay. We used latent class analysis (LCA) to distinguish clinical phenotypes. Results: Inhalant and food allergen sensitisation was common, irrespective of the children's allergic symptom type. Less than 10% of the variance in symptom scores was explained by variations in the number of allergens (components) that the child was sensitised to. In LCA, 135 children (50.2%) had mild allergy, with few symptoms and sensitisation to no or few allergens, 74 children (27.5%) had more symptoms and sensitisation to inhalant allergens (respiratory allergy) and 60 children (22.3%) showed polysensitisation to a median of six allergens and had more severe symptoms of different organ systems. Adding allergen component test results to LCA failed to result in identifiable classes of allergic disease in children. Conclusions: In this group of children with allergic symptoms, referred for allergy testing by their physician, broad screening for allergen component sensitisation did not contribute to distinguishing phenotypes of allergic disease. (C) 2022 Codon Publications. Published by Codon Publications

Design of the ZWOT-CASE study : An observational study on the effectiveness of an integrated programme for cardiovascular risk management compared to usual care in general practice

Background: Cardiovascular diseases (CVD) contribute considerably to mortality and morbidity. Prevention of CVD by lifestyle change and medication is important and needs full attention. In the Netherlands an integrated programme for cardiovascular risk management (CVRM), based on the Chronic Care Model (CCM), has been introduced in primary care in many regions in recent years, but its effects are unknown. In the ZWOT-CASE study we will assess the effect of integrated care for CVRM in the region of Zwolle on two major cardiovascular risk factors: systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-cholesterol) in patients with or at high risk of CVD. Methods: This study is a pragmatic observational study comparing integrated care for CVRM with usual care among patients aged 40-80 years with CVD (n = 370) or with a high CVD risk (n = 370) within 26 general practices. After 1 yr follow-up, primary outcomes (SBP and LDL-cholesterol level) are measured. Secondary outcomes include lifestyle habits (smoking, dietary habits, alcohol use, physical activity), risk factor awareness, 10-year risk of cardiovascular morbidity or mortality, health care consumption, patient satisfaction and quality of life. Conclusion: The ZWOT-CASE study will provide insight in the effects of integrated care for CVRM in general practice in patients with CVD or at high CVD risk. Trial registration: The ZWOlle Transmural Integrated Care for CArdiovaScular Risk Management Study; ClinicalTrials.gov; Identifier: NCT03428061; date of registration: 09-02-2018; This study has been retrospectively registered

Design of the ZWOT-CASE study:an observational study on the effectiveness of an integrated programme for cardiovascular risk management compared to usual care in general practice

Background: Cardiovascular diseases (CVD) contribute considerably to mortality and morbidity. Prevention of CVD by lifestyle change and medication is important and needs full attention. In the Netherlands an integrated programme for cardiovascular risk management (CVRM), based on the Chronic Care Model (CCM), has been introduced in primary care in many regions in recent years, but its effects are unknown. In the ZWOT-CASE study we will assess the effect of integrated care for CVRM in the region of Zwolle on two major cardiovascular risk factors: systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-cholesterol) in patients with or at high risk of CVD. Methods: This study is a pragmatic observational study comparing integrated care for CVRM with usual care among patients aged 40-80 years with CVD (n = 370) or with a high CVD risk (n = 370) within 26 general practices. After 1 yr follow-up, primary outcomes (SBP and LDL-cholesterol level) are measured. Secondary outcomes include lifestyle habits (smoking, dietary habits, alcohol use, physical activity), risk factor awareness, 10-year risk of cardiovascular morbidity or mortality, health care consumption, patient satisfaction and quality of life. Conclusion: The ZWOT-CASE study will provide insight in the effects of integrated care for CVRM in general practice in patients with CVD or at high CVD risk. Trial registration: The ZWOlle Transmural Integrated Care for CArdiovaScular Risk Management Study; ClinicalTrials.gov; Identifier: NCT03428061; date of registration: 09-02-2018; This study has been retrospectively registered

Integrated cardiovascular risk management programme versus usual care in patients at high cardiovascular risk:an observational study in general practice

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Despite the impact of CVDs, risk factors are often insufficiently controlled in patients at high risk. Recently, integrated multidisciplinary cardiovascular risk management (CVRM) programmes have been introduced in primary care. AIM: To investigate the effects of a CVRM programme on systolic blood pressure (SBP) and low-density lipoprotein (LDL)-cholesterol. DESIGN & SETTING: A prospective observational study was undertaken in patients at high cardiovascular (CV) risk who were aged 40–80 years. Integrated CVRM care was compared with usual care in general practice in the Netherlands. METHOD: Intervention and usual care patients were matched at baseline on age, sex, and presence of CVD. During 1 year of follow-up, patients received integrated or usual CVRM care in general practice. Primary outcomes were SBP and LDL-cholesterol. Secondary outcomes included calculated 10-year CV risk, body mass index (BMI), lifestyle (smoking, physical activity, and dietary habits), medication use, patient satisfaction, healthcare consumption, morbidity, comorbidity, and mortality. Mixed-model analyses were used to assess the outcomes. RESULTS: Totals of 372 and 317 patients were included in the intervention and usual care group, respectively. Mean age at baseline was 65.1 years and 66.2 years, respectively, and 42% were female in both groups. After 1 year, no differences were observed in: SBP (137.2 mmHg versus 139.0 mmHg in the intervention and usual care group, respectively); LDL-cholesterol (2.6 mmol/l in both groups); or in any of the secondary outcomes. CONCLUSION: Integrated CVRM care in general practice did not lead to a lower SBP or LDL-cholesterol in patients at high CV risk. Further research is needed to improve CVRM

Optimising drug prescribing and dispensing in subjects at risk for drug errors due to renal impairment:improving drug safety in primary healthcare by low eGFR alerts

<p>Objectives: To assess the risk of medication errors in subjects with renal impairment (defined as an estimated glomerular filtration rate (eGFR)</p><p>Design: Clinical survey.</p><p>Setting: The city of Zwolle, The Netherlands, in a primary care setting including 22 community pharmacists and 65 general practitioners.</p><p>Participants: All adults who underwent ambulatory creatine measurements which triggered an eGFR</p><p>Primary and secondary outcome measures: The total number of ambulatory subjects with an eGFR</p><p>Results: Creatine measurements were performed in 25 929 adults. An eGFR = 5 drugs) was present. In 15% (n=211) of these subjects, a medication error was detected. The proportion of errors increased with age. Pharmacists recommended 342 medication adjustments, mainly concerning diuretics (22%) and antibiotics (21%). The physicians' acceptance rate was 66%. Of all the medication errors, 88% were regarded as potential ADEs, with most classified as significant or serious. At follow-up, the ADE risk (n=40) appeared highest when the proposed medication adjustments were not implemented (38% vs 6%).</p><p>Conclusions: The introduction of automatic eGFR-alerts identified a considerable number of subjects who are at risk for ADEs due to renal impairment in an ambulatory setting. The nationwide implementation of this simple protocol could identify many potential ADEs, thereby substantially reducing iatrogenic complications in subjects with impaired renal function.</p>