Improving Adrenaline Autoinjector Adherence: a Psychologically-informed Training for Healthcare Professionals

Background: Clinicians draw on instructional approaches when training patients with anaphylaxis to use adrenaline auto-injectors, but patient use is poor. Psychological barriers to these behaviours exist but are not considered routinely when training patients to use auto-injectors. Health Psychology principles suggest exploring these factors with patients could improve their auto-injector use. Objective: To evaluate the impact of a 90 - minute workshop training clinicians in strategies and techniques for exploring and responding to psychological barriers to auto-injector use with patients. Attendees’ knowledge, confidence and likelihood of using the strategies were expected to improve. Methods: Impact was evaluated using a longitudinal mixed-method design. Twenty-nine clinicians (general and specialist nurses, general practitioners, pharmacists) supporting patients with anaphylaxis in UK hospitals and general practice attended. Self-rated knowledge, confidence and likelihood of using the strategies taught were evaluated online one week before, 1–3 and 6–8 weeks after the workshop. Clinicians were invited for telephone interview after attending to explore qualitatively the workshop impact. Results: Chi-square analyses were significant in most cases (p <.05), with sustained (6–8 weeks) improvements in knowledge, confidence and likelihood of using the strategies taught. Thematic analysis of interview data showed the workshop enhanced attendees’ knowledge of the care pathway, understanding of patient’s experience of anaphylaxis as psychological not purely physical, and altered their communication with this and other patient groups. However, interviewees perceived lack of time and organisational factors as barriers to using the strategies and techniques taught in clinical contexts. Conclusion: Training clinicians in psychologically- informed strategies produce sustained improvements in their confidence and knowledge around patient auto-injector education, and their likelihood of using strategies in clinical practice. Clinical Relevance: Exploring psychological barriers should be part of training patients with anaphylaxis in auto - injector use

‘I haven’t said goodbye to my kids’

People diagnosed with anaphylaxis in adulthood face unique, but largely ignored, psychological challenges. Psychology offers insights for understanding their needs, and the development of interventions to help this growing group live with severe allergies

Accelerated discharge of patients in the event of a major incident: observational study of a teaching hospital

BACKGROUND: Since October 2002 in the UK Primary Care Trusts (PCTs) have had statutory responsibility for having and maintaining a Major Incident plan and since 2005 they have been obliged to co-operate with other responders to an incident. We aimed to establish the number of beds in our Trust which could be freed up over set periods of time in the event of a major incident and the nature and quantity of support which might be required from PCTs in order to achieve this. METHODS: Repeated survey over 12 days in 3 months of hospital bed occupancy by type of condition and discharge capacity in an 855-bed UK tertiary teaching hospital also providing secondary care services. Outcome measures were bed spaces which could be generated, timescale over which this could happen and level and type of PCT support which would be required to achieve this. RESULTS: Mean beds available were 78 immediately, a further 69 in 1–4 hours and a further 155 in 4–12 hours, generating a total of 302 beds (36% of hospital capacity) within 12 hours of an incident. This would require support from a PCT of 150,000 population of 10 nursing care beds, 20 therapy-supported intermediate care beds, and 25 care packages in patients' own homes. CONCLUSION: In order to fulfill the requirements of the Civil Contingencies Act 2004, PCTs should plan to have surge capacity in the order of 30 residential placements and 25 community support packages per 150,000 population to support Acute Trusts in the event of a major incident

Leukotriene modifiers for asthma treatment

Leukotrienes (LTs), including cysteinyl LTs (CysLTs) and LTB 4 , are potent lipid mediators that have a role in the pathophysiology of asthma. At least two receptor subtypes for CysLTs, CysLT 1 and CysLT 2 , have been identified. The activation of the CysLT 1 receptor is responsible for most of the pathophysiological effects of CysLTs in asthma, including increased airway smooth muscle activity, microvascular permeability, and airway mucus secretion. LTB 4 might have a role in severe asthma, asthma exacerbations, and the development of airway hyperresponsiveness. CysLT 1 receptor antagonists can be given orally as monotherapy in patients with mild persistent asthma, but these drugs are generally less effective than inhaled glucocorticoids. Combination of CysLT 1 receptor antagonists and inhaled glucocorticoids in patients with more severe asthma may improve asthma control and enable the dose of inhaled glucocorticoids to be reduced while maintaining similar efficacy. The identification of subgroups of asthmatic patients who respond to CysLT 1 receptor antagonists is relevant for asthma management as the response to these drugs is variable. CysLT 1 receptor antagonists have a potential anti-remodelling effect that might be important for preventing or reversing airway structural changes in patients with asthma. This review discusses the role of LTs in asthma and the role of LT modifiers in asthma treatment.Cite this as: P. Montuschi and M. L. Peters-Golden, Clinical & Experimental Allergy , 2010 (40) 1732–1741.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79154/1/j.1365-2222.2010.03630.x.pd

Diagnostic Accuracy of a Convolutional Neural Network Assessment of Solitary Pulmonary Nodules Compared With PET With CT Imaging and Dynamic Contrast-Enhanced CT Imaging Using Unenhanced and Contrast-Enhanced CT Imaging

Background: Solitary pulmonary nodules (SPNs) measuring 8 to 30 mm in diameter require further workup to determine the likelihood of malignancy. Research Question: What is the diagnostic performance of a lung cancer prediction convolutional neural network (LCP-CNN) in SPNs using unenhanced and contrast-enhanced CT imaging compared with the current clinical workup? Study Design and Methods: This was a post hoc analysis of the Single Pulmonary Nodule Investigation: Accuracy and Cost-Effectiveness of Dynamic Contrast Enhanced Computed Tomography in the Characterisation of Solitary Pulmonary Nodules trial, a prospective multicenter study comparing the diagnostic accuracy of dynamic contrast-enhanced (DCE) CT imaging with PET imaging in SPNs. The LCP-CNN was designed and validated in an external cohort. LCP-CNN-generated risk scores were created from the noncontrast and contrast-enhanced CT scan images from the DCE CT imaging. The gold standard was histologic analysis or 2 years of follow-up. The area under the receiver operating characteristic curves (AUC) were calculated using LCP-CNN score, maximum standardized uptake value, and DCE CT scan maximum enhancement and were compared using the DeLong test. Results: Two hundred seventy participants (mean ± SD age, 68.3 ± 8.8 years; 49% women) underwent PET with CT scan imaging and DCE CT imaging with CT scan data available centrally for LCP-CNN analysis. The accuracy of the LCP-CNN on the noncontrast images (AUC, 0.83; 95% CI, 0.79-0.88) was superior to that of DCE CT imaging (AUC, 0.76; 95% CI, 0.69-0.82; P = .03) and equal to that of PET with CT scan imaging (AUC, 0.86; 95% CI, 0.81-0.90; P = .35). The presence of contrast resulted in a small reduction in diagnostic accuracy, with the AUC falling from 0.83 (95% CI, 0.79-0.88) on the noncontrast images to 0.80 to 0.83 after contrast (P < .05 for 240 s after contrast only). Interpretation: An LCP-CNN algorithm provides an AUC equivalent to PET with CT scan imaging in the diagnosis of solitary pulmonary nodules. Trial Registration: ClinicalTrials.gov Identifier; No.: NCT0201306

Sensitization of the histamine H1 receptor by increased ligand affinity.

Histamine regulates a variety of physiological processes including inflammation, gastric acid secretion, and neurotransmission. The cellular response to histamine is subject to dynamic control, and exaggerated histamine reactivity in response to cysteinyl leukotrienes and other stimuli is important in a variety of different pathological conditions. The molecular mechanisms controlling histamine responsiveness are still unresolved. In investigating histamine responses in embryonic stem (ES5) and F9 embryonic carcinoma cells, we encountered a novel mechanism controlling the cellular reaction to histamine. Unstimulated cells displayed neither