Audit strategies to reduce hospital admissions for acute asthma

An eightfold rise in hospital admissions for acute asthma from 1971-85 prompted two studies to audit the admissions policy at the Royal Alexandra Hospital. In the first study the on call senior house officer (SHO) was replaced by an experienced registrar and over a four month period 53 children out of 158 were sent home from the receiving room compared with six out of 39 seen by the SHOs. In the second study an SHO training programme was established together with a home treatment package. Over a 12 month period the on call SHOs assessed 687 children with acute asthma; 229 (43.5%) were deemed fit to be sent home. Only seven of these were readmitted within one week. Diary symptom score cards filled in by parents indicated that children sent home without admission fared no worsed at home than those admitted and then discharged for the two weeks after leaving hospital. The development of strategies to improve assessment and immediate management in the hospital receiving room can reduce hospital admissions for acute asthma, allowing more children to be safely managed in the community.</p

Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults.

Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and the leading cause of dysphagia and food impaction in children and young adults. This underlines the importance of optimizing diagnosys and treatment of the condition, especially after the increasing amount of knowledge on EoE recently published. Therefore, the UEG, EAACI ESPGHAN, and EUREOS deemed it necessary to update the current guidelines regarding conceptual and epidemiological aspects, diagnosis, and treatment of EoE. General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted up to August 2015 and periodically updated. The working group consisted of gastroenterologists, allergists, pediatricians, otolaryngologists, pathologists, and epidemiologists. Systematic evidence-based reviews were performed based upon relevant clinical questions with respect to patient-important outcomes. The guidelines include updated concept of EoE, evaluated information on disease epidemiology, risk factors, associated conditions, and natural history of EoE in children and adults. Diagnostic conditions and criteria, the yield of diagnostic and disease monitoring procedures, and evidence-based statements and recommendation on the utility of the several treatment options for patients EoE are provided. Recommendations on how to choose and implement treatment and long-term management are provided based on expert opinion and best clinical practice. Evidence-based recommendations for EoE diagnosis, treatment modalities, and patients' follow up are proposed in the guideline

Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults

Introduction: Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and the leading cause of dysphagia and food impaction in children and young adults. This underlines the importance of optimizing diagnosys and treatment of the condition, especially after the increasing amount of knowledge on EoE recently published. Therefore, the UEG, EAACI ESPGHAN, and EUREOS deemed it necessary to update the current guidelines regarding conceptual and epidemiological aspects, diagnosis, and treatment of EoE. Methods: General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted up to August 2015 and periodically updated. The working group consisted of gastroenterologists, allergists, pediatricians, otolaryngologists, pathologists, and epidemiologists. Systematic evidence-based reviews were performed based upon relevant clinical questions with respect to patient-important outcomes. Results: The guidelines include updated concept of EoE, evaluated information on disease epidemiology, risk factors, associated conditions, and natural history of EoE in children and adults. Diagnostic conditions and criteria, the yield of diagnostic and disease monitoring procedures, and evidence-based statements and recommendation on the utility of the several treatment options for patients EoE are provided. Recommendations on how to choose and implement treatment and long-term management are provided based on expert opinion and best clinical practice. Conclusion: Evidence-based recommendations for EoE diagnosis, treatment modalities, and patients’ follow up are proposed in the guideline. © 2017, © Author(s) 2017

Análise comparativa de fragmentos identificáveis de forrageiras, pela técnica micro-histológica Comparative analysis of identifiable fragments of forages, by the microhistological technique

Objetivou-se, com este trabalho, verificar, pela técnica micro-histológica, diferenças entre espécies forrageiras quanto ao percentual de fragmentos identificáveis, em função do processo digestivo e da época do ano. Lâminas foliares frescas recém-expandidas, correspondentes à última e à penúltima posição no perfilho, das espécies Melinis minutiflora Pal. de Beauv (capim-gordura), Hyparrhenia rufa (Nees) Stapf. (capim-jaraguá), Brachiaria decumbens Stapf. (capim-braquiária), Imperata brasiliensis Trin. (capim-sapé), de Medicago sativa L. (alfafa) e de Schinus terebenthifolius Raddi (aroeira), amostradas nos períodos chuvoso e seco, foram digeridas in vitro e preparadas de acordo com a técnica micro-histológica. Observou-se que as espécies apresentaram diferenças marcantes na porcentagem de fragmentos identificáveis e que a digestão alterou estas porcentagens em torno de 10 %; que o período de amos&shy;tragem não influenciou a porcentagem de fragmentos identificáveis para a maioria das espécies; que a presença de pigmentos e a adesão da epiderme às células dos tecidos internos da folha prejudicaram a identificação dos fragmentos; e que a digestão melhorou a visualização dos fragmentos dos capins sapé e jaraguá e da aroeira, mas prejudicou a do capim-braquiária e, principalmente, a da alfafa.<br>The objetive of this study was to verify differences among forages species in relation to the percentage of identifiable fragment as affected by the digestion process and season. Fresh last expanded leaf lamina samples of the species Melinis minutiflora Pal. de Beauv (Molassesgrass), Hyparrhenia rufa (Nees) Stapf. (Jaraguagrass), Brachiaria decumbens Stapf. (Signalgrass), Imperata brasilienses Trin. (Sapegrass), and foliar laminas of Medicago sativa L. (Alfalfa) and Schinus terebenthifolius Raddi (Aroeira), sampled in the rainy and dry seasons, were digested in vitro and prepared according to the microhistological technique. The digestion process caused change of 19 units in the percentage of identifiable fragments whose values varied among forage species. The season did not influence the percentage of identifiable fragments for most species; the presence of pigments and adherence of epidermis to internal tissues of the leaf hindered the identification of fragments. The digestion improved the identification of sapegrass fragments, jaraguagrass and Schinus terebenthifolius Raddi, but hindered identification of signalgrass fragments and mainly those of alfalfa