Search

Summary: Currently, there is no guideline to support the use of immunoglobulin replacement therapy (IgRT) in primary and secondary immunodeficiency disorders in UK. The UK Primary Immunodeficiency Network (UK-PIN) and the British Society of Immunology (BSI) joined forces to address this need. Given the paucity of evidence, a modified Delphi approach was used covering statements for the initiation, monitoring, discontinuation of IgRT as well as home therapy programme. A group of six consultant immunologists and three nurse specialists created the statements, reviewed responses and feedback and agreed on final recommendations. This guideline includes 22 statements for initiation, 22 statements for monitoring, 11 statement for home therapy, and 19 statements for discontinuation of IgRT. Further areas of research are proposed to improve future delivery of care. [ABSTRACT FROM AUTHOR]

Ten percent of the general population believe themselves to be allergic to beta-lactams, many erroneously. Alternative, broader-spectrum antibiotics are associated with increased drug costs and colonization with resistant organisms. A point prevalence study of hospital inpatients determined the local reported rate of penicillin allergy, the nature of allergy described, evidence of antimicrobial resistance and antimicrobial regimens used as a result. Of the 583 patients assessed, the overall rate of penicillin allergy was 13.7% [95% confidence interval (CI) 11-17%]. Rash was the most commonly reported reaction (27.5%, 95% CI 18-39%). Details of the nature of the penicillin allergy were poorly recorded on drug charts. Significantly higher rates of meticillin-resistant Staphylococcus aureus were seen in the allergic cohort (P=0.0065) compared with those without a label of penicillin allergy; this was also seen for vancomycin-resistant enterococci, but this did not reach significance. This study demonstrates an increase in detection of resistant organisms in penicillin-allergic patients which may result from use of broader-spectrum antibiotics in this group. [ABSTRACT FROM AUTHOR]

Summary: Common variable immunodeficiency (CVID) represents a heterogeneous group of rare disorders. There is considerable morbidity and mortality as a result of non‐infectious complications, and this presents clinicians with management challenges. Clinical guidelines to support the management of CVID are urgently required. The UK Primary Immunodeficiency Network and the British Society for Immunology funded a joint project to address this. A modified Delphi Survey was conducted for the assessment, diagnosis and treatment of the non‐infectious blood, respiratory, gut and liver complications of CVID. A steering group of 10 consultant immunologists and one nurse specialist developed and reviewed the survey statements and agreed the final recommendations. In total, 22 recommendations and three areas for research were developed. [ABSTRACT FROM AUTHOR]

C1 inhibitor deficiency is a rare disorder manifesting with recurrent attacks of disabling and potentially life-threatening angioedema. Here we present an updated 2014 United Kingdom consensus document for the management of C1 inhibitor-deficient patients, representing a joint venture between the United Kingdom Primary Immunodeficiency Network and Hereditary Angioedema UK. To develop the consensus, we assembled a multi-disciplinary steering group of clinicians, nurses and a patient representative. This steering group first met in 2012, developing a total of 48 recommendations across 11 themes. The statements were distributed to relevant clinicians and a representative group of patients to be scored for agreement on a Likert scale. All 48 statements achieved a high degree of consensus, indicating strong alignment of opinion. The recommendations have evolved significantly since the 2005 document, with particularly notable developments including an improved evidence base to guide dosing and indications for acute treatment, greater emphasis on home therapy for acute attacks and a strong focus on service organization. [ABSTRACT FROM AUTHOR]

Results from a 16-question survey about self-administration of hereditary angioedema (HAE) therapy, administered in Europe, Canada and the USA, were used to guide discussion at an international HAE expert meeting. The aim was to capture information about current practice in self-administered HAE therapy in these countries, including self-administration training, the key benefits of switching to self-administration, the barriers to self-administration and trends in self-administration. Overall, switching to self-administration therapy is looked upon favourably from both patient and clinician perspectives by virtue of the potential improvement in quality of life arising from optimisation of therapy and early intervention. The recent changes to product licences allowing self-administration provide additional options for the management of HAE. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10-session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty-five professionals, representing 15 professions, attended at least some sessions, although attendance was variable. Data were collected between September 2006 and December 2007. The programme was evaluated using a mixed methods approach. Participants reported high levels of satisfaction for all topics and all aspects of the presentations: they were most satisfied with the opportunity to interact with other professionals and least satisfied with the videoconference technology. Professionals' confidence ( n = 49) with mental health interventions, issues and populations was measured pre- and post-programme. There was a significant increase in confidence for seven of the eight mental health interventions and four of the six mental health issues that had been taught in the programme. Participants reported developing a more reflective mental health practice, becoming more aware of mental health issues, integrating new knowledge and skills into their work and they expressed a desire for further mental health training. They noted that interprofessional referrals, inter-agency linkages and collaborations had increased. Conditions that appeared to underpin the programme's success included: scheduling the programme over an extended time period, a positive relationship between the facilitator and participants, experiential learning format and community co-ordinators as liaisons. Participants' dissatisfaction with the videoconference technology was mitigated by the strong connection between the facilitator and participants. One challenge was designing a curriculum that met the needs of professionals with varied expertise and work demands. The programme seemed to benefit most of those professionals who had a mental health background. This programme has the potential to be of use in rural communities where professionals often do not have access to professional development in mental health. [ABSTRACT FROM AUTHOR]

The benefits of interprofessional care in providing mental health services have been recognized, particularly in rural communities where health services are limited. In addition, there is a need for more continuing professional education in mental health intervention in rural areas. Although interprofessional collaboration and continuing education have both been proposed to address the paucity of mental health services available in rural areas, there have been no programs developed in which the two components have been combined. This paper describes the development, implementation, and evaluation of an interprofessional continuing education program specifically designed to enhance rural mental health capacity. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Qualitative exploration of the experience of family practice residents in using semistructured case-based reflection exercises as a learning medium.DESIGN: Qualitative study using in-depth interviews.SETTING: Memorial University's Family Medicine Residency Program in St John's, Newfoundland.PARTICIPANTS: Graduates of the residency program who had taken part in a pilot project that involved completion of case-based reflection exercises as a medium for enhancing learning.METHOD: In-depth interviews were conducted with graduates who had used the reflection exercises during their postgraduate training. All participants were in active practice. All of the audiotaped interviews were transcribed verbatim. Thematic analysis continued until saturation was reached.MAIN FINDINGS: Eight interviews were conducted that included 5 women and 3 men. Three themes emerged from the data analysis: effect on the learning process, effect on the patient-doctor relationship, and effect on the learner.CONCLUSION: The experience of using the reflection exercises appeared to affect how family practice residents learned. Three major themes emerged: the reflection exercises as a continuing education process offered participants a strategy for future learning in practice; the exercises offered a different perspective on the patient-doctor interaction that had doctors looking for cues to deeper meaning; and the exercises engaged the learners in a reflective process that revealed qualities about themselves that gave them personal insight. These reflective strategies have relevance for all physicians in their attempts to incorporate new knowledge and understanding into their practices. Similar dimensions are articulated in the educational literature, and this study supports the usefulness of case-based reflection as a catalyst in the education of family physicians. [ABSTRACT FROM AUTHOR]

Abstract Background Currently in the United Kingdom (UK), there is a mismatch between limited financial resources and the large proportion of patients with suspected allergies actually being referred to specialist allergy clinics. To better understand the case mix of patients being referred, we audited referrals to a regional allergy service over an 8 year period. The main source of data was consultant letters to General Practitioners (GP) summarising the diagnosis of patients, archived from January 2002 to September 2009. Letters were reviewed, extracting the clinic date, doctor seen, gender, date of birth, postcode, GP, and diagnoses. Diagnoses were classified into seven groups and illustrative cases for each group noted. Findings Data from 2,028 new referrals with suspected allergy were analysed. The largest group of patients (43%) were diagnosed with a type I hypersensitivity. The other diagnostic groups were chronic idiopathic (spontaneous) urticaria (35%), suspected type I hypersensitivity but no allergen identified (8%), idiopathic (spontaneous) angioedema (8%), physical urticaria (2.5%), non-allergic symptoms (1.6%), type IV hypersensitivity (0.8%) and ACE inhibitor sensitivity (0.5%). Two thirds of patients seen were female with a higher percentage of female patients in the non type-I hypersensitivity group (71%) than the type 1 hypersensitivity (66%) (χ2 = 5.1, 1df, p = 0.024). The type 1 hypersensitivity patients were younger than other patients (38 Vs 46 years, t = -10.8, p < 0.001) Conclusions This study highlights the complexity of specialist allergy practice and the large proportion of patients referred with non-type I hypersensitivities, chronic idiopathic (spontaneous) urticaria being by far the largest group. Such information is critical to inform commissioning decisions, define referral pathways and in primary care education.

Abstract Hereditary angioedema (C1 inhibitor deficiency, HAE) is associated with intermittent swellings which are disabling and may be fatal. Effective treatments are available and these are most useful when given early in the course of the swelling. The requirement to attend a medical facility for parenteral treatment results in delays. Home therapy offers the possibility of earlier treatment and better symptom control, enabling patients to live more healthy, productive lives. This paper examines the evidence for patient-controlled home treatment of acute attacks ('self or assisted administration') and suggests a framework for patients and physicians interested in participating in home or self-administration programmes. It represents the opinion of the authors who have a wide range of expert experience in the management of HAE.