[Executive Summary of ARIA 2019: Integrated care pathways for allergic rhinitis in Argentina, Spain and Mexico]. / Resumen ejecutivo de ARIA 2019: Vías integradas de atención para la rinitis alérgica en Argentina, España y México.

The health and economic impact of allergic diseases are increasing rapidly, and changes in management strategies are required. Its influence reduces the capacity of work and school performance by at least a third. The ICPs of the airways (integrated care pathways for respiratory diseases) are structured multidisciplinary healthcare plans, promoting the recommendations of the guidelines in local protocols and their application to clinical practice. This document presents an executive summary for Argentina, Mexico, and Spain. Next-generation ARIA guidelines are being developed for the pharmacological treatment of allergic rhinitis (AR), using the GRADE-based guidelines for AR, tested with real-life evidence provided by mobile technology with visual analogue scales. It is concluded that in the AR treatment, H1-antihistamines are less effective than intranasal corticosteroids (INCS), in severe AR the INCS represent the first line of treatment, and intranasal combination INCS + anti-H1 is more effective than monotherapy. However, according to the MASK real-life observational study, patients have poor adherence to treatment and often self-medicate, according to their needs.

El impacto sanitario y económico de las enfermedades alérgicas está aumentando rápidamente y se necesitan cambios en las estrategias para su manejo. Su influencia reduce al menos en un tercio la capacidad de desempeño laboral y escolar. Los ICP (Vías Integradas de Atención) de las enfermedades de las vías respiratorias son planes de atención estructurados y multidisciplinarios, que promueven las recomendaciones de las guías en protocolos locales y su aplicación a la práctica clínica. En este documento se presenta un resumen ejecutivo para Argentina, México y España. Se desarrollan las guías ARIA de próxima generación para el tratamiento farmacológico de la rinitis alérgica (RA) utilizando las pautas basadas en GRADE para RA, probadas con evidencia de la vida real proporcionada por tecnología móvil basada en escalas visuales analógicas. Se concluye que en el tratamiento de la RA, los antihistamínicos anti-H1 son menos efectivos que los corticoides intranasales (CINS), que en la rinitis gravelos CINS representan la primera línea de tratamiento, y que la combinación intranasal de CINS + anti-H1 es más eficaz que la monoterapia. Sin embargo, según el estudio MASK observacional en vida real, los pacientes tienen pobre adherencia al tratamiento y frecuentemente se automedican de acuerdo con sus necesidades.

[ARIA 2016 executive summary: Integrated care pathways for predictive medicine throughout the life cycle in Argentina]. / Resumen ejecutivo de ARIA 2016: vías integradas de atención para la medicina predictiva a lo largo del ciclo de vida en Argentina.

The ARIA initiative was started during a World Health Organization workshop in 1999. The initial goals were to propose a new classification for allergic rhinitis, to promote the concept of multi-morbidity in asthma and rhinitis and to develop guidelines with stakeholders for world-wide use. ARIA is now focused on the implementation of emerging technologies for individualized and predictive medicine. MASK: MACVIA-Aria Sentinel Network uses mobile technology to develop care pathways that enable management by a multidisciplinary group or by patients themselves. An App for iOS and Android uses a visual analogue scale to assess symptom control and work productivity, as well as a clinical decision support system; it is associated with an interoperable tablet for health professionals. The escalation strategy uses recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of ARIA's new approach is to provide an active and healthy life to people affected by rhinitis, regardless of age, gender or socioeconomic status, in order to reduce social and health inequalities caused by the disease.

La iniciativa ARIA (Rinitis Alérgica y su Impacto en el Asma) se inició durante un taller de la Organización Mundial de la Salud en 1999. Los objetivos iniciales fueron proponer una nueva clasificación de rinitis alérgica, promover el concepto de multimorbilidad en asma y rinitis y desarrollar guías con todas las partes interesadas para su en todos los países y poblaciones. ARIA, difundida e implementada en más de 70 naciones, ahora se centra en la implementación de tecnologías emergentes para la medicina individualizada y predictiva. MASK (MACVIA [Contre les Maladies Chroniques pour un Vieillissement Actif] Aria Sentinel Network) utiliza la tecnología móvil para desarrollar vías de atención que permitan el manejo de la rinitis y del asma por un grupo multidisciplinario o por los propios pacientes. Una aplicación (app) para iOS y Android está disponible en 20 países y 15 idiomas; utiliza una escala analógica visual para evaluar el control de los síntomas y la productividad del trabajo, así como un sistema de apoyo para las decisiones clínicas. Se asocia con una tabla interoperable (que permite intercambiar información) para médicos y otros profesionales de la salud. La estrategia de escalamiento utiliza las recomendaciones de la Asociación Europea de Innovación para el Envejecimiento Activo y Saludable. El objetivo del nuevo enfoque ARIA es proporcionar una vida activa y saludable a las personas afectadas por la rinitis, cualquiera que sea su edad, sexo o condición socioeconómica, con el fin de reducir las desigualdades sociales y de salud causadas por la enfermedad.

Towards a Unified Testing Framework for Single-Sided Deafness Studies: A Consensus Paper.

BACKGROUND: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL. METHODS: This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada. RESULTS: A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable. CONCLUSION: A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.