Notes

Relationship developing along with see memory space: Measures might 'speak' more louder compared to words and phrases.
The additive at the proposed application rate of 1 × 109 CFU/kg fresh material has the potential to improve the fermentation of the silages from easy to moderately difficult to ensile forages.Following a request from the European Commission, the Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) was asked to deliver a scientific opinion on the assessment of the application for renewal of authorisation of Pediococcus acidilactici DSM 16243 as a technological additive for all animal species. The applicant has provided evidence that the additive currently on the market complies with the existing conditions of authorisation. There is no evidence that would lead the FEEDAP Panel to reconsider its previous conclusions. Thus, the Panel concludes that the additive remains safe for all animal species, consumer and the environment under the authorised conditions of use. Regarding user safety Pediococcus acidilactici DSM 16243 is not irritant to skin and eyes but is considered a skin and respiratory sensitiser. There is no need for assessing the efficacy of the additive in the context of the renewal of the authorisation.The latest issue of Breathe focuses on adherence to treatment read the introductory editorial by Chief Editor @ClaudiaCDobler https//bit.ly/3vVRjKU.This article provides a brief description of the Early Career Member session and guidance on how to get the most out of the European Respiratory Society (ERS) International Congress 2021, to help attendees plan their Congress in advance. https//bit.ly/3dBNrYC.Current guidance states that advanced therapies should only be used when adherence to maintenance therapy (inhaled corticosteroid/long-acting β-agonist) has been proven. This is based on the costs of advanced therapies, the fact that they were generally trialled as add-ons to maintenance therapy, and the assumed efficacy of maintenance therapy in the majority of adherent patients. In this pro/con debate, we argue that such a rigid view of access downplays the complex and multifactorial nature of poor adherence. Not only does the evidence indicate a role for psychosocial factors in both poor adherence and poor asthma outcomes, failure of maintenance therapy itself may be a driver of poor adherence behaviours. Some individuals at high risk of poor asthma outcomes will therefore also have poor adherence that is not rapidly amenable to intervention. Rather than punishing them for factors outside of their control, they should be allowed access to advanced therapies in order to reduce their adverse risk resulting from uncontrolled asthma.Oral corticosteroid side-effects in severe asthma affect a person's image and sense of self. Patients balance a web of risks and benefits around treatment adherence. Biological therapies may offer targeted treatment with a lower side-effect burden. https//bit.ly/3cHmcuk.For a physician, the final step of a consultation consists of developing a treatment plan and prescription. For the patient, this is the start of a process. First, their role in the treatment plan must be clarified, then they may have to obtain an alternative prescription from their general practitioner. Next, they must have the prescription filled and dispensed from the pharmacy and, finally, they must take the treatment on time and for the required duration. For people with chronic conditions, this requires repeatedly returning to the pharmacy for the prescription to be renewed and dispensed. Given that many patients are on multiple treatment regimens and may have poor health literacy, this becomes a complex process and it is not surprising that this can, and frequently does, go wrong. Research shows that when a patient does not adhere to standard asthma or COPD treatment, they report poor control and overuse of rescue β-agonists, experience frequent exacerbations and are often prescribed add-on treatments or adherence to standard treatments for airways diseases.To describe how poor treatment adherence manifests as complications of the condition.To highlight that when a patient does not benefit as might be expected from a treatment, poor adherence should be considered and evaluated for, before more treatment is added.
To highlight the clinical consequences of poor adherence to standard treatments for airways diseases.To describe how poor treatment adherence manifests as complications of the condition.To highlight that when a patient does not benefit as might be expected from a treatment, poor adherence should be considered and evaluated for, before more treatment is added.Non-adherence to medication is one of the most significant issues in all airways disease and can have a major impact on disease control as well as on unscheduled healthcare utilisation. It is vital that clinicians can accurately determine a patient's level of adherence in order to ensure they are gaining the maximal benefit from their therapy and also to avoid any potential for unnecessary increases in therapy. It is essential that measurements of adherence are interpreted alongside biomarkers of mechanistic pathways to identify if improvements in medication adherence can influence disease control. In this review, the most common methods of measuring adherence are discussed. These include patient self-report, prescription record checks, canister weighing, dose counting, monitoring drug levels and electronic monitoring. We describe the uses and benefits of each method as well as potential shortcomings. The practical use of adherence measures with measurable markers of disease control is also discussed.
To understand the various methods available to measure adherence in airways disease.To learn how to apply these adherence measures in conjunction with clinical biomarkers in routine clinical care.
To understand the various methods available to measure adherence in airways disease.To learn how to apply these adherence measures in conjunction with clinical biomarkers in routine clinical care.What is the diagnosis of this woman with multiple respiratory infections in the previous year and a recent onset of progressive dyspnoea and wheezing? https//bit.ly/3bLgw2A.Heightened capsaicin cough sensitivity is independently associated with poor asthma control in moderate-to-severe asthma patients https//bit.ly/3mkbLkI.Most bronchogenic cysts are found incidentally and clinicians should be aware of an atypical case presentation. Total surgical resection is the treatment of choice of a bronchogenic cyst, especially in symptomatic patients. https//bit.ly/3uQrFXo.In children with persistent chylothoraces of unknown origin, intranodal lymphangiography can be used to help identify the source of a leak. This may enable embolisation with glue and coils to enable resolution of the chylothoraces. https//bit.ly/3gskhgJ.Inflammatory myofibroblastic tumour (IMT) is a rare neoplasm, most commonly described in children and young adults. We present a case of IMT in an elderly man. https//bit.ly/355wf8X.Inhaled corticosteroids (ICS) are the core component of asthma treatment and the only maintenance therapy known to prevent asthma death. There is currently no evidence that biologics prevent asthma death in people with asthma, and as such, biologics cannot be recommended as an alternative to ICS therapy. Taking the time to assess adherence and provide interventions and education to support patients in asthma self-management has been shown to improve patient outcomes. It is therefore our responsibility as healthcare professionals to ensure that patients are supported, educated and motivated to adhere to ICS therapy before progressing to biologic therapies.Non-adherence to medicines is a significant clinical and financial burden, but successful strategies to improve it, and thus bring about significant improvements in clinical outcome, remain elusive. Many barriers exist, including a lack of awareness amongst some healthcare professionals as to the extent and impact of non-adherence and a dearth of skills to address it successfully. AMD3100 Patients may not appreciate that they are non-adherent, feel they cannot disclose it or underestimate its impact on their health in the short and longer term. In describing the evidence-based frameworks that identify the causal factors behind medicines taking (or not taking) behaviours, we can start to personalise interventions to enable individuals to make informed decisions about their treatments and thus overcome real and perceived barriers to adherence.
To understand the underlying principles of why a patient may or may not take medicines as agreed.To choose targeted interventions to support better adherence.
To understand the underlying principles of why a patient may or may not take medicines as agreed.To choose targeted interventions to support better adherence.What is the diagnosis of this man with a chronic dry cough and left hilar prominence on chest radiography? https//bit.ly/3fL7QMx.Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing lung disease with an estimated median survival of 2-5 years and a significant impact on quality of life (QoL). Current approved medications, pirfenidone and nintedanib, have shown a reduction in annual decline of forced vital capacity but no impact on QoL. The minimal clinically important difference (MCID) is a threshold value for a change in a parameter that is considered meaningful by the patient rather than solely relying on statistically significant change in the parameter. This review provides a brief overview of the MCID methodology along with detailed discussion of reported MCID values for commonly used physiological measures and patient-reported outcome measures in IPF. While there is no gold standard methodology for determining MCID, there are certain limitations in the MCID literature in IPF, mainly the choice of death, hospitalisation and pulmonary function tests as sole anchors, and pervasive use of distribution-based methods which do not take into account the patient's input. There is a critical need to identify accurate thresholds of outcome measures that reflect patient's QoL over time in order to more precisely design and evaluate future clinical trials and to develop algorithms for patient-oriented management of IPF in outpatient clinics.
To understand the concept of MCID and the methods used to determine these values.To understand the indications and limitations of MCID values in IPF.
To understand the concept of MCID and the methods used to determine these values.To understand the indications and limitations of MCID values in IPF.Ambulatory pneumothorax management in primary spontaneous pneumothorax is safe and feasible https//bit.ly/39w3EfD.Given the poor survival of lung cancer patients and the promising observations herein, future studies (RCTs) should further investigate both time- and dose-dependent effects of combination therapies across all categories of prevention of lung cancer. https//bit.ly/3hlYTtY.Pulmonary lymphoproliferative diseases are often associated with collagen diseases. In addition to treatment of the primary disease, additional treatments may be considered depending on the pathology presented in the case. https//bit.ly/3vKqsls.Simulation-based medical education is recognised as a highly effective training tool. Novel technologies such as breathing simulators have the potential to revolutionise how we train healthcare professionals to manage patients requiring NIV. https//bit.ly/3f4Hnt1.
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