Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema
Author(s) Altmann E.S.; Crossingham I.; Wilson S.; Davies H.R.
Source Cochrane Database of Systematic Reviews; Oct 2019; vol. 2019 (no. 10)
Background Pleural infection, including parapneumonic effusions and thoracic empyema, may complicate lower respiratory tract infections. Standard treatment of these collections in adults involves antibiotic therapy, effective drainage of infected fluid and surgical intervention if conservative management fails. Intrapleural fibrinolytic agents such as streptokinase and alteplase have been hypothesised to improve fluid drainage in complicated parapneumonic effusions and empyema and therefore improve treatment outcomes and prevent the need for thoracic surgical intervention. Intrapleural fibrinolytic agents have been used in combination with DNase, but this is beyond the scope of this review.
Training opportunities in thoracic ultrasound for respiratory trainees: Are current guidelines practical?
Author(s) Stanton A.E.; Evison M.; Roberts M.; Latham J.; Clive A.O. et al.
Source BMJ Open Respiratory Research; Sep 2019; vol. 6 (no. 1)
Introduction: Respiratory trainees in the UK face challenges in meeting current Royal College of Radiologists (RCR) Level 1 training requirements for thoracic ultrasound (TUS) competence, specified as attending 'at least one session per week over a period of no less than 3 months, with approximately five scans per session performed by the trainee (under supervision of an experienced practitioner)'. We aimed to clarify where TUS training opportunities currently exist for respiratory registrars.
Method(s): Data were collected (over a 4-week period) to clarify the number of scans (and therefore volume of training opportunities) within radiology departments and respiratory services in hospitals in the South West, North West deaneries and Oxford.
Result(s): 14 hospitals (including three tertiary pleural centres) provided data. Of 964 scans, 793 (82.3%) were conducted by respiratory teams who performed a mean of 17.7 scans per week, versus 3.1 TUS/week in radiology departments. There was no radiology session in any hospital with >=5 TUS performed, whereas 8/14 (86%) of respiratory departments conducted such sessions. Almost half (6/14) of radiology departments conducted no TUS scans in the period surveyed.
Conclusions The currently recommended exposure of regularly attending a list or session to undertake five TUS is not achievable in radiology departments. The greatest volume of training opportunities exists within respiratory departments in a variety of scheduled and unscheduled settings. Revision of the competency framework in TUS, and where this is delivered, is required.Copyright © 2019 Author(s) (or their employer(s)).
Author(s) Donovan T.; Crossingham I.; Bradley P.; Milan S.J.; Wang R.
Source Cochrane Database of Systematic Reviews; Sep 2019; vol. 2019 (no. 9)
Publication Date Sep 2019
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy and safety of monoclonal antibody therapies targeting IL-5 signalling (anti-IL-5 or anti-IL-5Ralpha) compared with placebo in the treatment of adults with COPD.Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Author(s): Chukkambotla S.
Source: Journal of the Intensive Care Society; May 2018; vol. 19 (no. 2); p. 26
Publication Date: May 2018
Publication Type(s): Conference Abstract
Abstract:Background: Patients with Interstitial Lung Disease presented with acute respiratory failure often referred to intensive care for ventilatory support. The study objective is to report the clinical outcomes of patients who have been admitted to intensive care unit with known or unknown Interstitial Lung Disease.
Author(s): Kelly C.; Relph N.; Spencer S.; Chalmers J.D.; Crossingham I.; Felix L.M.; Evans D.J.; Milan S.J.
Source: Cochrane Database of Systematic Reviews; Mar 2018; vol. 2018 (no. 3)
Publication Date: Mar 2018
Publication Type(s): Review
Abstract:Background: Bronchiectasis is a chronic respiratory disease characterised by abnormal and irreversible dilatation and distortion of the smaller airways. Bacterial colonisation of the damaged airways leads to chronic cough and sputum production, often with breathlessness and further structural damage to the airways. Long-term macrolide antibiotic therapy may suppress bacterial infection and reduce inflammation, leading to fewer exacerbations, fewer symptoms, improved lung function, and improved quality of life. Further evidence is required on the efficacy of macrolides in terms of specific bacterial eradication and the extent of antibiotic resistance.
Author(s): Kew K.M.; Carr R.; Crossingham I.
Source: Cochrane Database of Systematic Reviews; Apr 2017; vol. 2017 (no. 4)
Publication Date: Apr 2017
Publication Type(s): Review
Abstract:Background: Adolescents with asthma are at high risk of poor adherence with treatment. This may be compounded by activities that worsen asthma, in particular smoking. Additional support above and beyond routine care has the potential to encourage good self-management. We wanted to find out whether sessions led by their peers or by lay leaders help to reduce these risks and improve asthma outcomes among adolescents. Objectives: To assess the safety and efficacy of lay-led and peer support interventions for adolescents with asthma. Search methods: We identified trials from the Cochrane Airways Trials Register, which contains reports of randomised trials obtained from multiple electronic and handsearched sources, and we searched trial registries and reference lists of primary studies. We conducted the most recent searches on 25 November 2016. Selection criteria: Eligible studies randomised adolescents with asthma to an intervention led by lay people or peers or to a control. We included parallel randomised controlled trials with individual or cluster designs. We included studies reported as full text, those published as abstract only and unpublished data. Data collection and analysis: Two review authors screened the searches, extracted numerical data and study characteristics and assessed each included study for risk of bias. Primary outcomes were asthma-related quality of life and exacerbations requiring at least a course of oral steroids. We graded the analyses and presented evidence in a 'Summary of findings' table. We analysed dichotomous data as odds ratios, and continuous data as mean differences (MD) or standardised mean differences, all with a random-effects model. We assessed clinical, methodological and statistical heterogeneity when performing meta-analyses, and we described skewed data narratively. Main results: Five studies including a total of 1146 participants met the inclusion criteria for this review. As ever with systematic reviews of complex interventions, studies varied by design (cluster and individually randomised), duration (2.5 to 9 months), setting (school, day camp, primary care) and intervention content. Most risk of bias concerns were related to blinding and incomplete reporting, which limited the meta-analyses that could be performed. Studies generally controlled well for selection and attrition biases. All participants were between 11 and 17 years of age. Asthma diagnosis and severity varied, as did smoking prevalence. Three studies used the Triple A programme; one of these studies tested the addition of a smoke-free pledge; another delivered peer support group sessions and mp3 messaging to encourage adherence; and the third compared a peer-led asthma day camp with an equivalent camp led by healthcare practitioners. We had low confidence in all findings owing to risk of bias, inconsistency and imprecision. Results from an analysis of asthma-related quality of life based on the prespecified random-effects model were imprecise and showed no differences (MD 0.40, 95% confidence interval (CI) -0.02 to 0.81); a sensitivity analysis based on a fixed-effect model and a responder analysis suggested small benefit may be derived for this outcome. Most other results were summarised narratively and did not show an important benefit of the intervention; studies provided no analysable data on asthma exacerbations or unscheduled visits (data were skewed), and one study measuring adherence reported a drop in both groups. Effects on asthma control favoured the intervention but findings were not statistically significant. Results from two studies with high levels of baseline smoking showed some promise for self-efficacy to stop smoking, but overall nicotine dependence and smoking-related knowledge were not significantly better in the intervention group. Investigators did not report adverse events. Authors' conclusions: Although weak evidence suggests that lay-led and peer support interventions could lead to a small improvement in asthma-related quality of life for adolescents, benefits for asthma control, exacerbations and medication adherence remain unproven. Current evidence is insufficient to reveal whether routine use of lay-led or peer support programmes is beneficial for adolescents receiving asthma care. Ongoing and future research may help to identify target populations for lay-led and peer support interventions, along with attributes that constitute a successful programme.Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Author(s): Crossingham I.; Evans D.J.W.; Halcovitch N.R.; Marsden P.A.
Source: Cochrane Database of Systematic Reviews; Feb 2017; vol. 2017 (no. 2)
Publication Date: Feb 2017
Publication Type(s): Journal: Review
Abstract:Background: Asthma is a condition of the airways affecting more than 300 million adults and children worldwide. National and international guidelines recommend titrating up the dose of inhaled corticosteroids (ICS) to gain symptom control at the lowest possible dose because long-term use of higher doses of ICS carries a risk of systemic adverse events. For patients whose asthma symptoms are controlled on moderate or higher doses of ICS, it may be possible to reduce the dose of ICS without compromising symptom control.
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