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[Objectives] Chronic diseases are the leading cause of disability globally. Most chronic disease management occurs in primary care with outcomes varying across primary care providers. Computerised clinical decision support systems (CDSS) have been shown to positively affect clinician behaviour by improving adherence to clinical guidelines. This study provides a summary of the available evidence on the effect of CDSS embedded in electronic health records on patient-reported and clinical outcomes of adult patients with chronic disease managed in primary care., [Design and eligibility criteria] Systematic review, including randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, interrupted time series and controlled before-and-after studies, assessing the effect of CDSS (vs usual care) on patient-reported or clinical outcomes of adult patients with selected common chronic diseases (asthma, chronic obstructive pulmonary disease, heart failure, myocardial ischaemia, hypertension, diabetes mellitus, hyperlipidaemia, arthritis and osteoporosis) managed in primary care., [Data sources] Medline, Embase, CENTRAL, Scopus, Health Management Information Consortium and trial register clinicaltrials.gov were searched from inception to 24 June 2020., [Data extraction and synthesis] Screening, data extraction and quality assessment were performed by two reviewers independently. The Cochrane risk of bias tool was used for quality appraisal., [Results] From 5430 articles, 8 studies met the inclusion criteria. Studies were heterogeneous in population characteristics, intervention components and outcome measurements and focused on diabetes, asthma, hyperlipidaemia and hypertension. Most outcomes were clinical with one study reporting on patient-reported outcomes. Quality of the evidence was impacted by methodological biases of studies., [Conclusions] There is inconclusive evidence in support of CDSS. A firm inference on the intervention effect was not possible due to methodological biases and study heterogeneity. Further research is needed to provide evidence on the intervention effect and the interplay between healthcare setting features, CDSS characteristics and implementation processes., [PROSPERO registration number] CRD42020218184.

Journal Article; Research Support, Non-U.S. Gov't; OBJECTIVE We aimed to analyze health-related quality of life (HRQOL) in adults with newly diagnosed respiratory allergy according to the sensitization profile for relevant aeroallergens in their usual area of residence. METHODS We performed a cross-sectional, epidemiological, observational, descriptive, multicenter study in allergy clinics in Spain. The sample comprised adults diagnosed with rhinitis, asthma, or both caused by significant allergens in their residential area (olive and/or grass pollen or house dust mite). Allergic rhinitis was classified according to the Allergic Rhinitis and its Impact on Asthma guidelines; asthma was classified according to the Guía Españiola para el Manejo del Asma (Spanish Guideline on the Management of Asthma). HRQOL was studied according to the ESPRINT-15 questionnaire and Mini Asthma Quality of Life Questionnaire. Control of asthma was measured using the Asthma Control Questionnaire 5. RESULTS We studied 1437 patients. Rhinitis was the most common respiratory disease. The HRQOL of rhinitis patients was lower in those sensitized to olive pollen only and in those with combined sensitization to olive and grass pollens. HRQOL associated with rhinitis was worse in patients diagnosed with both rhinitis and asthma than in patients diagnosed with rhinitis only. Asthma patients sensitized to olive pollen or olive and grass pollens had worse HRQOL. CONCLUSIONS In our study population, the HRQOL of patients with respiratory allergies varied with the allergen responsible for symptoms. In patients with rhinitis, the presence of asthma significantly worsened rhinitis-associated HRQOL. Yes Objetivo: Valorar si la afectación en la calidad de vida relacionada con la salud (CVRS) de los pacientes adultos diagnosticados por primera vez de enfermedad respiratoria alérgica se ve influida por el alérgeno causante. Método: Se realizó un estudio epidemiológico, multicéntrico, transversal, observacional y descriptivo en consultas de Alergología de España.Se incluyeron pacientes adultos diagnosticados de rinitis y/o asma alérgica causados por los alérgenos signifi cativos de su lugar de residencia (polen de olivo y/o gramíneas o ácaros del polvo doméstico). La rinitis alérgica se clasificó según los criterios de la guía ARIA y el asma según la guía GEMA. La CVRS se estudió según los cuestionarios ESPRINT-15 y miniAQLQ. El control del asma se midió utilizando el cuestionario ACQ5. Resultados: Se evaluaron un total de 1.437 pacientes. La rinitis fue la enfermedad respiratoria alérgica más común. La CVRS fue menor en pacientes monosensibilizados al polen de olivo y en los que presentaban polisensibilización a polen de olivo y gramíneas. La CVRS asociada a la rinitis fue menor en pacientes con diagnóstico de rinitis y asma, comparados con los pacientes diagnosticados solo de rinitis. Conclusiones: Los pacientes asmáticos sensibilizados al polen de olivo o a polen de gramíneas y olivo presentaban peor calidad de vida. Los pacientes alérgicos a los pólenes presentan peor calidad de vida que los pacientes alérgicos a los ácaros. La presencia de asma en pacientes con rinitis empeora la CVRS asociada a la rinitis.

Journal Article; Research Support, Non-U.S. Gov't; BACKGROUND Neutrophil defensins, originally identified as broad-spectrum antimicrobial peptides, have been implicated in the regulation of inflammatory and immunological processes. OBJECTIVES To investigate whether the in vitro challenge of neutrophils from patients with bronchial asthma with allergens stimulated the release of alpha-defensins and whether levels released were dependent on lung infections. METHOD The neutrophils were cultivated with different agonists and the concentration of alpha-defensin in cell-free supernatant was measured with enzyme-linked immunosorbent assay (ELISA). RESULTS Neutrophils from allergic patients released alpha-defensins via an allergen-dependent mechanism. Our results indicate that the in vitro activation of neutrophils is highly allergen-specific. In this context, allergens other than those which produced clinical symptoms did not elicit alpha-defensin release, and allergens had no effect on neutrophils from healthy donors. However, neutrophils from both allergic patients and healthy controls were able to release alpha-defensins upon treatment with PMA. In the allergen-stimulated neutrophils, cells from asthmatic patients stimulated with a sensitizing allergen showed a significantly higher production of alpha-defensin under respiratory tract infection than cells from the same patients without such an infection. CONCLUSION Neutrophils from allergic patients release alpha-defensins via an allergen-dependent mechanism. Yes