Guidance to 2018 good practice : ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma

AimsMobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.MethodsMASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.StakeholdersInclude patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors.ResultsMASK is deployed in 23 countries and 17 languages. 26,000 users have registered.EU grants (2018)MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).Lessons learnt(i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.Peer reviewe

Adherence to treatment in allergic rhinitis using mobile technology. The MASK Study

Background: Mobile technology may help to better understand the adherence to treatment. MASK-rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient-centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries. Objectives: To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App. Methods: An observational cross-sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach. Results: A total of 12143 users were registered. A total of 6949 users reported at least one VAS data recording. Among them, 1887 users reported >= 7 VAS data. About 1195 subjects were included in the analysis of adherence. One hundred and thirty-six (11.28%) users were adherent (MPR >= 70% and PDC = 70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non-adherent to medications (MPR Conclusion and clinical relevance: Adherence to treatment is low. The relative efficacy of continuous vs on-demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication-taking behaviour in a real-world setting.Peer reviewe

Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018) : Change management in allergic rhinitis and asthma multimorbidity using mobile technology

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.Peer reviewe

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air (R) App

Background In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently. Methods All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated. Results A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures. Conclusions VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.Peer reviewe

Controversies in the Use of MIGS

Abstract Minimally invasive glaucoma surgery (MIGS) has fulfilled an unmet need in the management of glaucoma. This chapter highlights some controversial issues regarding the use of MIGS in clinical practice, including (1) whether there is sufficient evidence to advocate combining MIGS with cataract surgery over cataract surgery alone, (2) the merits and drawbacks of different approaches to trabecular bypass and canal-based MIGS procedures, (3) the effect of MIGS on endothelial cell loss, (4) suprachoroidal MIGS devices and whether there is still a role for these procedures, and (5) a comparison between subconjunctival MIGS and trabeculectomy. Several questions are still left unanswered and hopefully, further research and more clinical experience with these new technologies will help improve surgical outcomes for patients

Next-generation ARIA care pathways for rhinitis and asthma : a model for multimorbid chronic diseases

Background In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. Main body As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Sante as a Good Practice in the field of digitally-enabled, integrated, person-centred care. Conclusion In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.Peer reviewe

Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018): Change management in allergic rhinitis and asthma multimorbidity using mobile technology

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional

Pachymétrie cornéenne centrale et épaisseur de la couche des fibres optiques chez les sujets normotones et hypertones

National audienceTo evaluate the retinal nerve fiber layer thickness and the central corneal thickness in ocular hypertensive patients and healthy subjects. We prospectively included 55 ocular hypertensive patients (126 eyes) and 63 healthy subjects (110 eyes). In each individual we measured standard automatic perimetry, frequency doubling technique visual field, and central corneal thickness with an ultrasonic pachymeter and optical coherence tomography (OCT). Retinal nerve fiber layer thickness was evaluated with GDx-VCC and OCT. Central corneal thickness was significantly thicker in ocular hypertensive patients (p<0.009 and p<0.033 respectively). We found a significant correlation between ultrasonic pachymeter and OCT central corneal thickness in both groups (p<0.0001). Retinal nerve fiber layer thickness was not statistically different between healthy and ocular hypertensive subjects, but was significantly thinner in ocular hypertensive patients with thin central corneal thickness only with GDx-VCC. In the control group, no statistically significant linear correlation was noted between central corneal thickness and retinal nerve fiber layer thickness. In the ocular hypertensive group, we found a linear correlation between ultrasonic pachymeter and OCT central corneal thickness and the average retinal nerve fiber layer thickness with the GDx-VCC. Retinal nerve fiber layer thickness was globally similar in both healthy and ocular hypertensive subjects. Although some statistically significant differences in the retinal nerve fiber layer thickness were observed between these two groups, they were not clinically relevant.Introduction : Le but de cette étude était d’évaluer la pachymétrie cornéenne centrale et l’épaisseur de la couche des fibres optiques chez des patients normotones et hypertones. Patients et méthodes : Cent vingt-six yeux de 63 patients normotones et 110 yeux de 55 patients avec une hypertonie intraoculaire ont été inclus dans cette étude prospective comparative. Tous les patients ont eu un examen ophtalmologique complet, une périmétrie automatisée standard, une périmétrie par technologie en doublement de fréquence, une mesure par ultrasons et en tomographie à cohérence optique (OCT) de l’épaisseur cornéenne centrale et une mesure de l’épaisseur des fibres en polarimétrie laser (GDx-VCC) et en OCT. Tous les patients hypertones inclus avaient une périmétrie automatisée standard et une périmétrie par technologie en doublement de fréquence normale. Résultats : La pachymétrie ultrasonique et par OCT était statistiquement plus élevée chez les patients hypertones (p<0,009 et p<0,033 respectivement). Une corrélation a été retrouvée entre les pachymétries ultrasonique et par OCT dans les deux groupes (p<0,0001). Aucune différence statistiquement significative en terme d’épaisseur moyenne des fibres en GDx-VCC et en OCT n’était constatée entre les deux groupes (p=0,09 et p=0,56, respectivement). L’épaisseur moyenne des fibres en GDx-VCC était statistiquement plus faible chez les patients hypertones avec une cornée amincie. Dans le groupe des patients normotones, il n’existait pas de corrélation entre la pachymétrie par OCT ou ultrasonique et l’épaisseur des fibres en GDx-VCC et en OCT. Dans le groupe des patients hypertones, une corrélation marginale entre la pachymétrie ultrasonique et par OCT et l’épaisseur moyenne des fibres en GDx-VCC a été retrouvée. Discussion : Les patients hypertones avec une périmétrie par technologie en doublement de fréquence normale ne diffèrent pas des sujets normotones en terme d’épaisseur de la couche des fibres optiques. Conclusion : Cette étude a montré quelques différences statistiquement significatives au niveau de l’épaisseur des fibres optiques entre des patients normotones et des patients hypertones. Néanmoins, ces différences ne sont pas cliniquement signifiantes dans la population sélectionnée

Genetic variation of the cholesterol 24-hydroxylase (CYP46) gene in patients with agre-related macular degeneration or primary open-angle glaucoma

International audienc

Chirurgie rétino-vitréenne en ambulatoire : une expérience enrichissante, mais coûteuse…

National audienc