English tweets on allergy: Content analysis and association with surveillance data.

BACKGROUND: Analysis of X (formerly Twitter) posts can inform on the interest/perceptions that social media users have on health subjects. In this study, we aimed to analyse tweets on allergic conditions, comparing them with surveillance data. METHODS: We retrieved tweets from England on "allergy," "asthma," and "allergic rhinitis," published between 2016 and 2021. We estimated the correlation between the frequency of tweets on "asthma" and "allergic rhinitis" and English surveillance data on the incidence of asthma and allergic rhinitis medical visits. We performed sentiment analysis, computing a score informing on the emotional tone of assessed tweets. We applied a topic modelling approach to identify topics (clusters of words frequently occurring together) for tweets on each assessed condition. RESULTS: We analysed a total of 13,605 tweets on "allergy," 7767 tweets on "asthma," and 11,974 tweets on "allergic rhinitis." Food-related words were preponderant on tweets on "allergy," while "eyes" was the most frequent meaningful word on "allergy rhinitis" tweets. We observed seasonal patterns for tweets on "allergic rhinitis," both in their frequency and sentiment - the incidence of allergic rhinitis medical visits was moderately to strongly correlated with the frequency (ρ = 0.866) and sentiment (ρ = -0.474) of tweets on "allergic rhinitis." For tweets on "asthma," no such patterns/correlations were observed. The average sentiment score was negative for all assessed conditions, ranging from -0.004 ("asthma") to -0.083 ("allergic rhinitis"). CONCLUSIONS: Tweets on "allergic rhinitis" displayed a seasonal pattern regarding their frequency and sentiment, which correlated with surveillance data. No such patterns were observed for "asthma."

Cross-cultural validation of the Portuguese version of the Dialysis Symptom Index for haemodialysis patients.

Background: Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) are associated with low quality of life (QoL) and high disease-related symptoms. The patient self-report instruments can assess the burden of physical and psychological symptoms. The Dialysis Symptom Index (DSI) is a specific instrument to evaluate the multidimensional reported symptoms by patients undergoing HD. Aims: To translate, validate and assess the psychometric properties of the Portuguese version of the DSI. Methods: A cross-cultural adaptation process from English to Portuguese and a validation study (n = 156) were conducted. Reliability, validity and responsiveness were assessed. Results: The patients' most reported symptoms were, nausea (n = 86, 55%), muscle cramps (n = 92, 59%), feeling tired or lack of energy (n = 92, 59%), bone or joint pain (n = 88, 56%) and trouble staying asleep (n = 95, 60%). Cronbach's alpha of the DSI was 0.87, and intraclass correlation coefficient was 0.868 (95%CI 0.836-0.896). The smallest detectable change was 28.32. Conclusion: The Portuguese DSI demonstrates excellent psychometric properties for assessing HD patients' reported symptoms. It highlights symptom severity and impact, providing valuable insights for healthcare practitioners. Nurses can use the DSI to tailor interventions and enhance patient-centred care.

The impact of patient and public involvement in chronic respiratory disease research: the ConectAR experience.

ConectAR has demonstrated the feasibility and value of involving patients with chronic respiratory diseases and caregivers as co-researchers, actively considering their perspectives from project inception to implementation and dissemination https://bit.ly/3Oq13se.

Content validity of a patient-reported experience measure (CQRA-PREM) for patients with rheumatoid arthritis in Portugal.

TBackground: The evaluation of perceptions of patients with rheumatoid arthritis (RA) has a positive influence in their health outcomes and overall experience of care. The Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) was developed to provide the perceptions and the feedback of the patients with RA to the health professionals team. This PREM is already validated and in use in the United Kingdom (UK) and Netherlands. In Portugal, there is no validated PREM to evaluate the experience of patients with RA. OBJECTIVE: To translate, cultural adapt and validate the content of the CQRA-PREM for the Portuguese population. METHODS: A qualitative study using focus groups was conducted to evaluate CQRA-PREM content validity. The CQRA-PREM was first translated and cultural adapted to Portuguese by two researchers, and after back translation, a panel of experts agreed on the preliminary Portuguese version of CQRA-PREM. Patients with RA were recruited from a rheumatology center at a tertiary university hospital center to participate in focus group meetings. Before the focus group they filled in the preliminary version of CQRA-PREM, with its 7 domains and 24 items (Likert scale 1-5). RESULTS: Twelve participants (median 54 (45-58) years old; 92% female) were included in two focus groups. All domains of the questionnaire had medians of 3 or above. Seven major themes and six subthemes emerged. Participants considered the questionnaire as very clear and simple and with adequate questions. Patients pointed as extremely important being treated with dignity and respect and considered the awareness of the multidisciplinary team and the presentation of support programs and organizations as areas for improvement. CONCLUSION: The Portuguese version of the CQRA-PREM is acceptable and its content is valid in the perspective of patients with RA to assess the quality of care provided by the healthcare services.

Patients' Satisfaction with Remote Asthma Medical Follow-Up Before and During the COVID-19 Pandemic.

Background: The COVID-19 pandemic forced the change of health care services, favoring the use of remote consultations. Objective: To assess the differences in asthma medical follow-up before and during the COVID-19 pandemic and to evaluate patients' satisfaction regarding remote consultations. Methods: A cross-sectional, observational, web-based study, including 335 Portuguese patients with self-reported physician-diagnosed asthma, was conducted. The survey was available between February and May 2021 and included questions about patients' sociodemographic and clinical characteristics and follow-up (consultations' type and satisfaction in 2019 and 2020). Satisfaction was assessed using 10 statements on different aspects of patient experience (Likert scale 1-5), with a total score between 10 and 50. Results: The 335 patients included had a median [P25-P75] age of 27 [21-43] years and 75% had uncontrolled asthma. Overall, fewer participants had consultations during the pandemic compared to 2019 (161 vs. 185; p < 0.001). Most patients had ≥1 face-to-face consultation both in 2020 and 2019 (131 vs. 184; p < 0.001). In 2020, there was an increase in the proportion of participants reporting ≥1 remote (telephonic plus video) consultation (40% vs. 3%; p < 0.001). This increase was mainly attributed to the use of telephonic consultation (38% vs. video 3%, p < 0.001). Patients' satisfaction was similar in 2020 and 2019 for face-to-face consultations (44 [38-47] and 44 [39-48], p = 0.136). In 2020, satisfaction with remote consultations was slightly lower than with face-to-face (43 [37-46] vs. 44 [38-47], p < 0.001). Conclusions: Even though patients were slightly more satisfied with face-to-face consultations, remote consultations can be an alternative in follow-up services for patients with asthma in the near future.

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment.

BACKGROUND: Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. METHODS: This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). RESULTS: A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). CONCLUSIONS: Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.

Impact of multimorbidity patterns in hospital admissions: the case study of asthma.

Background: Most previous studies assessing multimorbidity in asthma assessed the frequency of individual comorbid diseases. Objective: We aimed to assess the frequency and clinical and economic impact of co-occurring groups of comorbidities (comorbidity patterns using the Charlson Comorbidity Index) on asthma hospitalizations. Methods: We assessed the dataset containing a registration of all Portuguese hospitalizations between 2011-2015. We applied three different approaches (regression models, association rule mining, and decision trees) to assess both the frequency and impact of comorbidities patterns in the length-of-stay, in-hospital mortality and hospital charges. For each approach, separate analyses were performed for episodes with asthma as main and as secondary diagnosis. Separate analyses were performed by participants' age group. Results: We assessed 198340 hospitalizations in patients >18 years old. Both in hospitalizations with asthma as main or secondary diagnosis, combinations of diseases involving cancer, metastasis, cerebrovascular disease, hemiplegia/paraplegia, and liver disease displayed a relevant clinical and economic burden. In hospitalizations having asthma as a secondary diagnosis, we identified several comorbidity patterns involving asthma and associated with increased length-of-stay (average impact of 1.3 [95%CI=0.6-2.0]-3.2 [95%CI=1.8-4.6] additional days), in-hospital mortality (OR range=1.4 [95%CI=1.0-2.0]-7.9 [95%CI=2.6-23.5]) and hospital charges (average additional charges of 351.0 [95%CI=219.1-482.8] to 1470.8 [95%CI=1004.6-1937.0]) Euro compared with hospitalizations without any registered Charlson comorbidity). Consistent results were observed with association rules mining and decision tree approaches. Conclusions: Our findings highlight the importance not only of a complete assessment of patients with asthma, but also of considering the presence of asthma in patients admitted by other diseases, as it may have a relevant impact on clinical and health services outcomes.

Prevalence and Characterisation of Patients with Asthma According to Disease Severity in Portugal: Findings from the EPI-ASTHMA Pilot Study.

Objective: To assess the feasibility of the procedures of EPI-ASTHMA. EPI-ASTHMA is a population-based multicentre stepwise study about the prevalence and characterisation of patients with asthma based on disease severity in Portugal. Methods: A pilot study of EPI-ASTHMA was conducted with adults from three primary care centres. We followed a stepwise approach comprising 4 stages: stage 0-invitation phone call (n ~1316); stage 1-telephone interview (n ~658); stage 2-clinical assessment with physical examination, diagnostic tests, and patient-reported outcome measures, to confirm the diagnosis of those with possible asthma at stage 1 (n ~160); stage 3-characterization of a subgroup of asthma patients by collecting data through a telephone interview, patient file review and CARATm app (n ~40), after 3-months. The frequency of asthma was calculated in relation to the entire study population (stage 1) and the frequency of difficult-to-treat/severe asthma in relation to the number of asthma patients (stage 3). Results: From 1305 adults invited, 892 (68%) accepted to participate (stage 0) and 574 (64%; 53[42-67] y; 43% male) were interviewed (stage 1). From those, 148 (26%; 60[46-68] y; 43% male) were assessed at stage 2, and 46 (31%; 51[39-67] y; 44% male) were diagnosed with asthma. Half of these patients (n = 23) accepted to install the app. Stage 3 was completed by 41 (93%) patients, of whom 31 (83%) had asthma confirmed by their file review. A total of 8% of participants had asthma, of those 17% had difficult-to-treat and 5% severe asthma. Conclusion: Attained recruitment rates and the quality of the results confirmed the feasibility of the EPI-ASTHMA stepwise approach. This pilot study provided insight into the improvement of the procedures to be generalized across the country.

Portuguese adaptation and validation of a patient-reported experience measure for patients with rheumatoid arthritis: A protocol study.

Background: There is a growing attention to patient-reported experience measures in assessing the quality of care in patient-centered care models. A specific patient-reported experience measure for patients with rheumatoid arthritis (RA) has been developed in the United Kingdom-Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure. This patient-reported experience measure might be feasible to be used in Portugal, yet an adaptation and validation process is needed. Therefore, the aims of this study will be to translate and cross-culturally adapt the Portuguese version of the Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure, evaluate its content and face validity through a qualitative approach, and evaluate its psychometric properties through a clinical field testing. Methods: This study is based on a multimethod approach combining qualitative and quantitative approaches. This study will include patients with RA from a single rheumatology center. Three sequential phases are planned: Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure translation and cultural adaptation, Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure content and face validity assessed through 2 focus groups with at least 10 patients, and the Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure field testing through a cross-sectional study with 50 patients. Conclusions: By involving patients with RA in the validation and implementation of the Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure, we expect to demonstrate the usefulness of this specific patient-reported experience measure to improve health care provided to patients with RA.

Control of Allergic Rhinitis and Asthma Test: A systematic review of measurement properties and COSMIN analysis.

The Control of Allergic Rhinitis and Asthma Test (CARAT) is a patient-reported outcome measurement (PROM) assessing the control of asthma and allergic rhinitis (AR) at a 4 week interval. This systematic review aimed to evaluate the measurement properties of CARAT. Following PRISMA and COSMIN guidelines, we searched five bibliographic databases and retrieved studies concerning the development, assessment of properties, validation, and/or cultural adaption of CARAT. The studies' methodological quality, the quality of measurement properties, and the overall quality of evidence were assessed. We performed meta-analysis of CARAT measurement properties. We included 16 studies. Control of Allergic Rhinitis and Asthma Test displayed sufficient content validity and very good consistency (meta-analytical Cronbach alpha = 0.83; 95% CI = 0.80-0.86;I2  = 62.6%). Control of allergic rhinitis and Asthma Test meta-analytical intraclass correlation coefficient was 0.91 (95% CI = 0.64-0.98;I2  = 93.7%). It presented good construct validity, especially for correlations with Patient-reported outcome measures assessing asthma (absolute Spearman correlation coefficients range = 0.67-0.73; moderate quality of evidence), and good responsiveness. Its minimal important difference is 3.5. Overall, CARAT has good internal consistency, reliability, construct validity and responsiveness, despite the heterogeneous quality of evidence. Control of Allergic Rhinitis and Asthma Test can be used to assess the control of asthma and AR. As first of its kind, this meta-analysis of CARAT measurement properties sets a stronger level of evidence for asthma and/or AR control questionnaires.

Usage patterns of oral H1-antihistamines in 10 European countries: A study using MASK-air® and Google Trends real-world data.

Real-world data represent an increasingly important source of knowledge in health care. However, assessing their representativeness can be challenging. We compared (i) real-world data from a mobile app for allergic rhinitis (MASK-air®) on the usage of oral H1-antihistamines from 2016 to 2020 in 10 European countries with (ii) Google Trends data on the relative volume of searches for such antihistamines. For each country, we sorted 5 different oral H1-antihistamines by their frequency of use and volume of searches. We found perfect agreement on the order of antihistamine use in MASK-air® and in Google Trends searches in 4 countries (France, Germany, Sweden, and the United Kingdom). Different levels of agreement were observed in the remaining countries (kappa coefficient from -0.50 to 0.75). Oral H1-antihistamine data from Google Trends and MASK-air® were consistent with nationwide medication sales data from France, Germany, and the United Kingdom. These results suggest that MASK-air® data may be consistent with other sources of real-world data, although assessing the representativeness of their users may require further studies.

Development and Validation of a Digital Image Processing-Based Pill Detection Tool for an Oral Medication Self-Monitoring System.

Long-term adherence to medication is of critical importance for the successful management of chronic diseases. Objective tools to track oral medication adherence are either lacking, expensive, difficult to access, or require additional equipment. To improve medication adherence, cheap and easily accessible objective tools able to track compliance levels are necessary. A tool to monitor pill intake that can be implemented in mobile health solutions without the need for additional devices was developed. We propose a pill intake detection tool that uses digital image processing to analyze images of a blister to detect the presence of pills. The tool uses the Circular Hough Transform as a feature extraction technique and is therefore primarily useful for the detection of pills with a round shape. This pill detection tool is composed of two steps. First, the registration of a full blister and storing of reference values in a local database. Second, the detection and classification of taken and remaining pills in similar blisters, to determine the actual number of untaken pills. In the registration of round pills in full blisters, 100% of pills in gray blisters or blisters with a transparent cover were successfully detected. In the counting of untaken pills in partially opened blisters, 95.2% of remaining and 95.1% of taken pills were detected in gray blisters, while 88.2% of remaining and 80.8% of taken pills were detected in blisters with a transparent cover. The proposed tool provides promising results for the detection of round pills. However, the classification of taken and remaining pills needs to be further improved, in particular for the detection of pills with non-oval shapes.

Seroprevalence of SARS-CoV-2 and assessment of epidemiologic determinants in Portuguese municipal workers.

OBJECTIVES: To assess the seroprevalence of SARS-CoV-2 antibodies in municipal employees of Northern Portugal during the first pandemic wave (May-June 2020) and its association with potentially related risk factors for infection. MATERIAL AND METHODS: The authors assessed municipal employees of 2 cities in Northern Portugal, in whom serological tests to SARS-CoV-2 and an epidemiological survey were applied. The authors assessed the proportion of individuals presenting IgM and/or IgG antibodies to SARS-CoV-2, and evaluated the association between having positive serological test results, epidemiologic variables and clinical presentations. Reported symptoms were evaluated on their sensitivity, specificity, and predictive values. RESULTS: The authors assessed 1696 employees, of whom 22.0% were firefighters, 10.4% were police officers, 10.3% were maintenance workers, and 8.1% were administrative assistants. The seroprevalence of SARS-CoV-2 infection was 2.9% (95% CI: 2.1-3.7%). Administrative assistants comprised the professional group with highest seroprevalence of SARS-CoV-2 (OR = 1.9 in the comparison with other occupational groups, 95% CI: 0.8-4.3, p = 0.126). The seroprevalence of SARS-CoV-2 infection among those who were in direct contact with COVID-19 patients in their professional activity was 3.9%, compared to 2.7% among those who were not in direct contact with such patients (OR = 1.5, 95% CI: 0.8-2.8, p = 0.222). The highest risk of infection was associated with the presence of a confirmed SARS-CoV-2 infection in the household (OR = 17.4, 95% CI: 8.3-36.8, p < 0.001). Living with a healthcare professional was not associated with a higher risk of infection (OR = 1.0, 95% CI: 0.4-2.5, p = 0.934). Anosmia/ dysgeusia was the symptom with the highest positive predictive value (52.2%, 95% CI: 31.8-72.6, p < 0.001) and specificity (99.3%, 95% CI: 98.9-99.7, p < 0.001), while cough was the most prevalent symptom among SARS-CoV-2 seropositive participants (36%). CONCLUSIONS: The authors observed a SARS-CoV-2 seroprevalence of 2.9% among assessed municipal employees. Anosmia/dysgeusia was the COVID-19 symptom which displayed the highest positive predictive value and specificity. Int J Occup Med Environ Health. 2022;35(3):297-307.

What Do Physicians Think About the Use of Telemedicine to Recruit and Assess Participants in mHealth-Related Clinical Studies as a Consequence of the COVID-19 Pandemic?

Objectives: To evaluate physician's opinion and availability to participate in mHealth-related clinical studies with patient recruitment and assessment via telemedicine and to identify characteristics associated with the willingness to participate. Methods: Cross-sectional, observational study, based on an anonymous web survey conducted in May-Jun of 2020 to 237 physicians, from Portugal and Spain that collaborated with an asthma mHealth project (INSPIRERS). Results: Response rate was 51% (n = 120). Most (74%, n = 89) physicians were available to participate in such studies, but 62% anticipated lower recruiting capacity and 40% increased difficulty in obtaining quality data. Physicians aged ≤40 years, from secondary care (vs. general practitioners) and that used apps in personal life or clinical practice were more likely to be available. Conclusions: Three-quarters of the physicians were available to participate in mHealth-related clinical studies with patient recruitment and assessment through telemedicine. Age group, medical specialty, and app use were associated with the willingness to participate.

A qualitative study of patient and carer experiences with home respiratory therapies: Long-term oxygen therapy and home mechanical ventilation.

Studies exploring the experience of patients receiving home respiratory therapies (HRT), such as long-term oxygen therapy (LTOT) and home mechanical ventilation (HMV), are still limited. This study focused on patients' and carers' experience with LTOT and HMV. An exploratory, cross-sectional qualitative study, using semi-structured focus groups, was carried out with 18 patients receiving HRT (median 71y, 78% male, 56% on both LTOT and HMV) and 6 carers (median age 67y, 67% female). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. Patients' and carers' experience was reflected in seven major topics, linked to specific time points and settings of the treatment: Initial symptoms/circumstances (n = 41), Prescription (n = 232), Implementation (n = 184), Carer involvement (n = 34), Quality of life impact (n = 301), Health care support/navigability (n = 173) and Suggestions (n = 14). Our findings demonstrate a general good perception of the HRT by patients and carers recognizing a significative quality of life impact improvement, while identifying specific points where improvements in healthcare are needed, particularly about navigability issues, articulation between the hospital, primary care and homecare teams, especially regardingprescriptionrenewal. This knowledge is crucial to promote a long-term HRT adherence and to optimize HRT delivery in line with patients' experience, needs, and values. Moreover, these key points can inform the development of a specific patient-reported experience measure (PREM) for patients on HRT, which is not currently available, and foster a more integrated respiratory care model.

Prediction of Asthma Hospitalizations for the Common Cold Using Google Trends: Infodemiology Study.

BACKGROUND: In contrast to air pollution and pollen exposure, data on the occurrence of the common cold are difficult to incorporate in models predicting asthma hospitalizations. OBJECTIVE: This study aims to assess whether web-based searches on common cold would correlate with and help to predict asthma hospitalizations. METHODS: We analyzed all hospitalizations with a main diagnosis of asthma occurring in 5 different countries (Portugal, Spain, Finland, Norway, and Brazil) for a period of approximately 5 years (January 1, 2012-December 17, 2016). Data on web-based searches on common cold were retrieved from Google Trends (GT) using the pseudo-influenza syndrome topic and local language search terms for common cold for the same countries and periods. We applied time series analysis methods to estimate the correlation between GT and hospitalization data. In addition, we built autoregressive models to forecast the weekly number of asthma hospitalizations for a period of 1 year (June 2015-June 2016) based on admissions and GT data from the 3 previous years. RESULTS: In time series analyses, GT data on common cold displayed strong correlations with asthma hospitalizations occurring in Portugal (correlation coefficients ranging from 0.63 to 0.73), Spain (ρ=0.82-0.84), and Brazil (ρ=0.77-0.83) and moderate correlations with those occurring in Norway (ρ=0.32-0.35) and Finland (ρ=0.44-0.47). Similar patterns were observed in the correlation between forecasted and observed asthma hospitalizations from June 2015 to June 2016, with the number of forecasted hospitalizations differing on average between 12% (Spain) and 33% (Norway) from observed hospitalizations. CONCLUSIONS: Common cold-related web-based searches display moderate-to-strong correlations with asthma hospitalizations and may be useful in forecasting them.

Lung Auscultation Using the Smartphone-Feasibility Study in Real-World Clinical Practice.

Conventional lung auscultation is essential in the management of respiratory diseases. However, detecting adventitious sounds outside medical facilities remains challenging. We assessed the feasibility of lung auscultation using the smartphone built-in microphone in real-world clinical practice. We recruited 134 patients (median[interquartile range] 16[11-22.25]y; 54% male; 31% cystic fibrosis, 29% other respiratory diseases, 28% asthma; 12% no respiratory diseases) at the Pediatrics and Pulmonology departments of a tertiary hospital. First, clinicians performed conventional auscultation with analog stethoscopes at 4 locations (trachea, right anterior chest, right and left lung bases), and documented any adventitious sounds. Then, smartphone auscultation was recorded twice in the same four locations. The recordings (n = 1060) were classified by two annotators. Seventy-three percent of recordings had quality (obtained in 92% of the participants), with the quality proportion being higher at the trachea (82%) and in the children's group (75%). Adventitious sounds were present in only 35% of the participants and 14% of the recordings, which may have contributed to the fair agreement between conventional and smartphone auscultation (85%; k = 0.35(95% CI 0.26-0.44)). Our results show that smartphone auscultation was feasible, but further investigation is required to improve its agreement with conventional auscultation.

Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta-analysis.

BACKGROUND: Patients with a penicillin allergy label tend to have worse clinical outcomes and increased healthcare use. Drug provocation tests (DPT) are the gold-standard in the diagnostic workup of penicillin allergy, but safety concerns may hinder their performance. We aimed to assess the frequency of severe reactions following a DPT in patients with reported allergy to penicillins or other ß-lactams. METHODS: We performed a systematic review, searching MEDLINE, Scopus, and Web of Science. We included primary studies assessing participants with a penicillin allergy label who underwent a DPT. We performed a Bayesian meta-analysis to estimate the pooled frequency of severe reactions to penicillin DPTs. Sources of heterogeneity were explored by subgroup and metaregression analyses. RESULTS: We included 112 primary studies which included a total of 26,595 participants. The pooled frequency of severe reactions was estimated at 0.06% (95% credible interval [95% CrI] = 0.01%-0.13%; I2  = 57.9%). Most severe reactions (80/93; 86.0%) consisted of anaphylaxis. Compared to studies where the index reaction was immediate, we observed a lower frequency of severe reactions for studies assessing non-immediate index reactions (OR = 0.05; 95% CrI = 0-0.31). Patients reporting anaphylaxis as their index reaction were found to be at increased risk of developing severe reactions (OR = 13.5; 95% CrI = 7.7-21.5; I2  = 0.3%). Performance of direct DPTs in low-risk patients or testing with the suspected culprit drug were not associated with clinically relevant increased risk of severe reactions. CONCLUSIONS: In patients with a penicillin allergy label, severe reactions resulting from DPTs are rare. Therefore, except for patients with potentially life-threatening index reactions or patients with positive skin tests-who were mostly not assessed in this analysis -, the safety of DPTs supports their performance in the diagnostic assessment of penicillin allergy.