Recommendations from a Canadian Delphi consensus study on best practice for optimal referral and appropriate management of severe asthma.

BACKGROUND: In Canada, severe asthma affects an estimated 5-10% of people with asthma and is associated with frequent exacerbations, poor symptom control and significant morbidity from the disease itself, as well as the high dose inhaled, and systemic steroids used to treat it. Significant heterogeneity exists in service structure and patient access to severe asthma care, including access to biologic treatments. There appears to be over-reliance on short-acting beta agonists and frequent oral corticosteroid use, two indicators of uncontrolled asthma which can indicate undiagnosed or suboptimally treated severe asthma. The objective of this modified Delphi consensus project was to define standards of care for severe asthma in Canada, in areas where the evidence is lacking through patient and healthcare professional consensus, to complement forthcoming guidelines. METHODS: The steering group of asthma experts identified 43 statements formed from eight key themes. An online 4-point Likert scale questionnaire was sent to healthcare professionals working in asthma across Canada to assess agreement (consensus) with these statements. Consensus was defined as high if ≥ 75% and very high if ≥ 90% of respondents agreed with a statement. RESULTS: A total of 150 responses were received from HCPs including certified respiratory educators, respirologists, allergists, general practitioners/family physicians, nurses, pharmacists, and respiratory therapists. Consensus amongst respondents was very high in 37 (86%) statements, high in 4 (9%) statements and was not achieved in 2 (5%) statements. Based on the consensus scores, ten key recommendations were proposed. These focus on referrals from primary and secondary care, accessing specialist asthma services, homecare provision for severe asthma patients and outcome measures. CONCLUSIONS: Implementation of these recommendations across the severe asthma care pathway in Canada has the potential to improve outcomes for patients through earlier detection of undiagnosed severe asthma, reduction in time to severe asthma diagnosis, and initiation of advanced phenotype specific therapies.

Management of geriatric behavior problems.

Agitation has many causes, and we have no way of classifying it that dictates the choice of the right agents or methods of treatment. It is also difficult to judge the effectiveness of any method. Because agitation is an intermittent phenomenon one can seldom be certain if improvement or worsening is merely incidental to the form of treatment instituted. The complexity of behavior disturbances demands an approach that enlists the cooperation of all involved in the care of the patient, and the use of a broad range of remedies. With regard to prevention, we should help people anticipate infirmity and even dementia. If good health is not taken for granted, this encourages that the present be used more purposefully. More than ever before in history, it is important to plan for the last stages of life. A greater percentage of people can expect to live into the years of frailty than ever before. It may not seem like an attractive thing to do, but a periodic mental review of one's future may be prudent. The consequences of a lack of foresight are seen in too many elderly. A small dose of reality now can result in a better old age.

Visual word recognition in bilinguals: evidence from masked phonological priming.

Bilingual written language representation was investigated with the masked phonological priming paradigm. Pseudohomophonic and control primes of French target words were used to show that Dutch-French bilinguals exhibit the same pattern of phonological and orthographic priming as native French speakers, which suggests that the same processes underlie first-and second-language processing. It was also found that for bilinguals, but not monolinguals, it is possible to prime a target word of the second language with a homophonic stimulus (either word or nonword) of the first language. This interlingual phonological priming effect was of the same size as the intralingual priming effect. Implications for theories of bilingual written language representation and for the interpretation of the masked phonological priming paradigm are discussed.

The appearance of oestrone sulphate in the peripheral plasma of the pig early in pregnancy.

Detectable concentrations of oestrone sulphate were present in 50% of the plasma samples collected from pregnant animals by Day 17. No oestrone sulphate was detected in plasma from cyclic nonpregnant pigs.

Gait kinematics in below-knee child amputees: a force plate analysis.

A complete gait analysis was performed on six children with below-knee amputations to determine the kinematics and kinetics of amputee gait in children. A relatively new method of analysis--the inverse dynamic relationship--was used to determine the joint moments in the sagittal plane of the joints in the intact limb and the remaining portion of the amputated limb. The joint moments in the sagittal plane of the intact limb in the child amputee were found to be normal or below normal during level walking. From this study, it was concluded that providing a child amputee has a good prosthetic fit, there will be no increased forces across the joints of the intact or amputated limb and consequently no predisposition to premature degenerative arthritis.