Non-medical devices for chronic breathlessness: use, barriers and facilitators for patients, carers and clinicians - a scoping review.

BACKGROUND: Non-medical devices such as the handheld fan (fan), mobility aids (wheeled walkers with seats) and inspiratory muscle training (IMT) devices offer benefits for patient management of chronic breathlessness. We examined the published evidence regarding patient, carer and clinician use of the fan, mobility aids and IMT devices for chronic breathlessness management, and the potential barriers and facilitators to day-to-day use in a range of settings. METHODS: MEDLINE, Embase, Scopus, EBSCO and the Cochrane Database of Systematic Reviews were searched. Papers were imported into EndNote and Rayyan for review against a priori eligibility criteria. Outcome data relevant to use were extracted and categorised as potential barriers and facilitators, and a narrative synthesis exploring reasons for similarities and differences conducted. RESULTS: Seven studies met the inclusion criteria (n=5 fan, n=2 mobility aids and n=0 IMT devices). All of the studies presented patient use of non-medical devices only. Patients found the fan easy to use at home. Mobility aids were used mainly for outdoor activities. Outdoor use for both devices were associated with embarrassment. Key barriers included: appearance; credibility; self-stigma; technical specifications. Common facilitators were ease of use, clinical benefit and feeling safe with the device. CONCLUSION: The efforts of patients, carers and clinicians to adopt and use non-medical devices for the management of chronic breathlessness is impeded by lack of implementation research. Future research should improve knowledge of the barriers and facilitators to use. This would enhance understanding of how decision-making in patient-carer-clinician triads impacts on non-medical devices use for breathlessness management.

Ambulatory Pathway for the Management of Superficial Abscesses: Criteria for Safe Provision of Care.

Background Superficial abscesses are common surgical emergencies and unless complicated, are considered a low-priority emergency often leading to delayed primary treatment. Patients who are clinically stable benefit more from an ambulatory-care approach to their treatment. Aim of study This is a retrospective study to investigate the current practice of treatment of superficial abscesses at West Suffolk Hospital, United Kingdom, and evaluate the potential impact of implementing care via the ambulatory pathway to improve patients' experience, optimise the use of hospital resources and identify areas for service improvement. Patients and methods A total of 76 patients who required inpatient care for drainage of their superficial abscess under general anaesthesia over six months were a part of the study. Admission, procedure, and hospital stay characteristics were evaluated as well as our proposed superficial abscess ambulatory-care pathway (SAAP) criteria. Results The mean age was 39 ± 18 years. Perianal and pilonidal abscesses accounted for 53% of the procedures. Only 24% of the patients had a C-reactive protein (CRP) >100 at admission. The average waiting time before intervention was 19 hours (± 16.25) with patients spending two days on average in the hospital for a procedure that lasted an average of 31 minutes. Overall, 39.5% of the patients received drainage of their abscess on the same day of presentation to the hospital with only five discharges on the same day of admission. Of the total patients, 52.6% met our SAAP criteria for ambulatory care and could have avoided inpatient care and benefitted from same-day discharges. Conclusion Ambulatory care of a superficial abscess is a safe, feasible approach. We recommend establishing an ambulatory care pathway for the management of superficial abscess cases with our SAAP criteria serving as a useful objective guide for effective and safe triage of patients with reduced hospital stay and more efficient utilisation of resources.

Integrated miRNA/cytokine/chemokine profiling reveals severity-associated step changes and principal correlates of fatality in COVID-19.

Inflammatory cytokines and chemokines (CC) drive COVID-19 pathology. Yet, patients with similar circulating CC levels present with different disease severity. Here, we determined 171 microRNAomes from 58 hospitalized COVID-19 patients (Cohort 1) and levels of 25 cytokines and chemokines (CC) in the same samples. Combining microRNA (miRNA) and CC measurements allowed for discrimination of severe cases with greater accuracy than using miRNA or CC levels alone. Severity group-specific associations between miRNAs and COVID-19-associated CC (e.g., IL6, CCL20) or clinical hallmarks of COVID-19 (e.g., neutrophilia, hypoalbuminemia) separated patients with similar CC levels but different disease severity. Analysis of an independent cohort of 108 patients from a different center (Cohort 2) demonstrated feasibility of CC/miRNA profiling in leftover hospital blood samples with similar severe disease CC and miRNA profiles, and revealed CCL20, IL6, IL10, and miR-451a as key correlates of fatal COVID-19. These findings highlight that systemic miRNA/CC networks underpin severe COVID-19.