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

Structuring effect of tools conceptualized through initial goal fixedness for work activity

Analysis of work activities in nuclear industry has highlighted a new psycho-cognitive phenomenon: the structuring effect of tools (SET) sometimes leading to unexpected operating deviations; the subject is unable to perform a task concerning object A using or adapting a tool designed and presented to perform the same task concerning object B when object A is expected by the subject. Conditions to isolate and identify the SET were determined and reproduced in experiments for further analysis. Students and seven professional categories of adults (N = 77) were involved in three experimental conditions (control group, group with prior warning, group with final control) while individually performing a task with similar characteristics compared to real operating conditions and under moderate time-pressure. The results were: (1) highest performance with prior warning and (2) demonstration that academic and professional training favor the SET. After discussing different cognitive processes potentially related to the SET, we described (3) the psycho-cognitive process underlying the SET: Initial Goal Fixedness (IGF), a combination of the anchoring of the initial goal of the activity with a focus on the features of the initial goal favored by an Einstellung effect. This suggested coping with the negative effect of the SET by impeding the IGF rather than trying to increase the subjects’ awareness at the expense of their health. Extensions to other high-risk industries were discussed

Updated Guidance Regarding The Risk ofAllergic Reactions to COVID-19 Vaccines and Recommended Evaluation and Management: A GRADE Assessment, and International Consensus Approach

This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against \u3e 15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history

Intérêt et propriétés du Sexual Activity Questionnaire (SAQ) pour la mesure de la fonction sexuelle dans la prise en charge thérapeutique des patientes souffrant d'endométriose

Endometriosis is a benign chronic pathology affecting 5 to 10% of women during their genital period. It is responsible of painful symptoms and impaired quality of sexual life. The evaluation of the sexual function of these women is a key element of the management. It requires the use of Patient Reported Outcome (PRO), such as questionnaires. Sexual function questionnaires usually used are heterogeneous and have not been validated in this specific population. This thesis focused on the Sexual Activity Questionnaire (SAQ), a questionnaire originally developed to assess the effect of antihormonal treatment in patients at risk of developing breast cancer. The SAQ had subsequently been used to evaluate the efficacy of endometriosis surgery but had not been validated in this specific population.We assessed the psychometric properties of the SAQ according to COSMIN criteria such as construct validity, internal consistency, and responsiveness. The psychometric validity of the SAQ was confirmed in an observational cohort of patients with endometriosis managed by medical and/or surgical treatment. The unidimensional nature of the SAQ in this population made it possible to calculate an SAQ score by summing the 10 items (score from 0 to 30, 30 being the best sexual function). The responsiveness of the SAQ was good in the context of surgical treatments. Finally, we determined a minimal clinical important difference (MCID) for the SAQ score of 2.2.We then used the SAQ in a study evaluating the influence of high dose progestins treatments on sexual function in women with endometriosis. The SAQ score was significantly lower after treatment in the group of patients receiving high dose progestins, indicating an impairment of sexual function in thesepatients before adjustment (mean: 15.5±6.3 versus 18.3±6.2; p=0.03) and after adjustment (adjusted effect size -0.44 (95% confidence interval -0.86, -0.02), p=0.04) despite an improvement of dyspareunia after treatment (mean: 45±29 versus 28±29, P<0.001).High dose progestins treatments were associated with lower sub-scores for 2 items: pleasure (1.8±0.8 vs 2.2±0.9, p=0.02) and satisfaction with frequency of intercourse (1.2±1.2 vs 1.8±1.1, p=0.02).Finally, we performed a systematic review over 20 years to assess a detailed description, using COSMIN criteria, of the psychometric properties of all sexual questionnaires used in the field of endometriosis. This rigorous evaluation of the qualities and shortcomings of the different PROs available will allow for a better choice of tools for measuring sexual function in future research in this field. The results show that the SAQ is a great tool for the evaluation of surgical treatment, one of the major axes of endometriosis management. The FSFI is multidimensional and allows to study more precisely some sub-areas such as desire, arousal, lubrication, orgasm and satisfaction.In conclusion, the SAQ is now validated for the evaluation of sexual function in patients with endometriosis. The determination of a MCID makes it very useful for clinical practice and for research. Its use has made it possible to show alteration of sexual function associated to the use of high dose progestins. Among different questionnaires available, the SAQ stands out with high quality measurement properties that make it a potential candidate to be integrated in a core outcomes measures recommended for care and research.L’endométriose est une pathologie chronique bénigne touchant de 5 à 10% des femmes en période d’activité génitale. Elle est responsable de symptômes douloureux et d’une altération de la qualité de vie sexuelle. L’évaluation de la fonction sexuelle de ces femmes est un élément essentiel de la prise en charge. Elle passe par l’utilisation de critères de jugement rapportés par les patients ou Patient Reported Outcome (PRO), tels que des questionnaires. Les questionnaires d’évaluation de la fonction sexuelle habituellement utilisés sont hétérogènes et n’ont pas été validés dans cette population. Ce travail de thèse s’est intéressé au Sexual Activity Questionnaire (SAQ), un questionnaire développé initialement pour évaluer l’effet d’un traitement antihormonal chez les patientes à risque de développer un cancer du sein. Le SAQ avait ensuite été utilisé pour évaluer l’efficacité de la chirurgie de l’endométriose mais n’avait pas été validé dans cette population spécifique.Nous avons évalué les propriétés psychométriques du SAQ selon les critères COSMIN tels que la validité de construit, la consistance interne et la sensibilité au changement. La validité psychométrique du SAQ a été confirmée dans une cohorte observationnelle de patientes souffrant d’endométriose et prises en charge par traitement médical et/ou chirurgical. Le caractère unidimensionnel du SAQ dans cette population a permis de calculer un score SAQ par sommation des 10 items (score de 0 à 30, 30 étant la meilleure fonction sexuelle). Le SAQ présentait une bonne sensibilité au changement en cas de traitements chirurgicaux. Enfin, nous avons déterminé une «différence cliniquement importante» (Minimal Clinical Important Difference (MCID)) pour le score SAQ de 2,2. Nous avons ensuite utilisé le SAQ dans une étude évaluant l’influence des traitements par macroprogestatifs sur la fonction sexuelle des femmes atteintes d’endométriose. Le score SAQ était significativement inférieur après traitement dans le groupe de patientes recevant un macroprogestatif témoignant d’une altération de la fonction sexuelle chez ces patientes avant ajustement (Moyenne : 15,5±6,3 versus 18,3±6,2 ; p=0,03) et après ajustement (taille d’effet ajusté -0,44 (intervalle de confiance à 95% -0,86, -0,02), p=0,04) malgré une amélioration de la dyspareunie après traitement (EVA : 45±29 vs 28±29, P<0,001). Les traitements par macroprogestatifs étaient associés à des valeurs plus basses pour 2 items du SAQ : plaisir (1,8±0,8 vs 2,2±0,9, p=0,02) et satisfaction avec la fréquence des rapports (1,2±1,2 vs 1,8±1,1, p=0,02). Nous avons enfin, réalisé une revue systématique sur 20 ans produisant une description précise, grâce aux critères COSMIN, des propriétés psychométriques de tous les questionnaires sexuels utilisés dans le domaine de l’endométriose. Cette évaluation rigoureuse des qualités et les défauts des différents PRO disponibles permettra de mieux choisir les outils de mesure de la fonction sexuelle dans les futurs travaux de recherche dans ce domaine. Il en ressort que le SAQ est un outil de choix pour l’évaluation du traitement chirurgical, un des axes majeurs de la prise en charge de l’endométriose. Le FSFI présente un caractère multidimensionnel et permet d’étudier plus précisément certains sous-domaines de la fonction sexuelle tels que le désir, l’excitation, la lubrification, l’orgasme, la satisfaction. En conclusion, le SAQ est maintenant validé pour l’évaluation de la fonction sexuelle des patientes souffrant d’endométriose. La détermination d’une MCID fait de lui un outil particulièrement utile en pratique clinique et en recherche. Son utilisation a permis de montrer l’altération de la fonction sexuelle liée à la prise de macroprogestatifs. Parmi les différents questionnaires disponibles le SAQ se démarque avec des propriétés de mesures de grande qualité qui font de lui un candidat potentiel pouvant être intégré dans un ensemble d’outils de mesure recommandés pour le soin et la recherche