Search

Pseudoainhum is a term used to describe the presence of constricting bands of the extremities due to a variety of underlying causes. Progression of the lesions can cause irreversible damage and autoamputation of the affected digit. This report documents a rare association of pseudoainhum and psoriasis and emphasizes the importance of recognizing this condition. [ABSTRACT FROM AUTHOR]

Background: Accurate centre-level medication adherence measurement allows identification of highly performing CF centres, drives shared learning and informs quality improvement. Self-reported adherence is unreliable but data-logging nebulisers can capture objective data. However, adherence levels in current literature are limited by the use of agreed prescriptions and convenience sampling. In this single-centre retrospective study, we quantified the differences in centre-level adherence with different methods of calculating adherence (unadjusted vs normative adherence) and different data sampling frames (convenience sampling vs including difficult to obtain data)., Methods: Adherence data were objectively captured using I-neb® from 2013-2016 in Sheffield Adult CF Centre. Adults on non data-logging devices, on ivacaftor or with previous lung transplantation were excluded. Adherence was calculated based on agreed regimen ('unadjusted adherence') or minimum required regimen ('normative adherence'). I-nebs® not brought to clinic were downloaded during home visits. Adults not on any inhaled therapy but with chronic Pseudomonas aeruginosa infection were included by counting their adherence as "0"., Results: Of the 131 included adults, 126 provided I-neb® data. Calculating unadjusted adherence from I-nebs® brought to clinics resulted in the highest centre-level adherence (median 41.8% in 2013). Median adherence reduced after sequentially accounting for minimum required regimen (40.0% in 2013), I-nebs® not brought to clinics (32.9% in 2013) and adults not on any inhaled therapy (31.0% in 2013)., Conclusions: Different approaches of calculating adherence produced different adherence levels. Adherence levels based only on agreed regimen among adults who readily brought their nebulisers to clinics can over-estimate the effective adherence of CF centres., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2019. Published by Elsevier B.V.)

Rationale, Aims and Objective: Cross-country comparisons of cystic fibrosis (CF) outcomes can potentially identify variation in care but are dependent on data quality. An important assumption is that the UK annual review FEV 1 is only collected during periods of clinical stability. If this assumption does not hold, results of FEV 1 comparisons may be biased in favour of registries with encounter-based FEV 1 . We aimed to test the assumption that CF annual reviews in the UK are only performed during periods of clinical stability., Method: Prospective encounter-based data collected in Sheffield (n = 174) was used to establish whether annual review FEV 1 were always collected during periods of clinical stability and to determine the group-level discrepancy between annual review vs best FEV 1 . We then went on to quantify the group-level discrepancy between annual review and best annual FEV 1 readings within the UK registry (n = 2995) to determine if the differences observed in Sheffield also apply to the wider UK data., Results: Sheffield results showed a group-level discrepancy between best and annual review FEV 1 of -2.5% (95% CI -3.95% to -1.2%) for annual reviews performed during periods of clinical stability (n = 50). The group-level discrepancy is larger at -8.0% (95% CI -11.2% to -4.9%) among annual reviews performed during periods of clinical instability (n = 13). Therefore, the magnitude of this group-level discrepancy is a surrogate for the proportion of clinically stable annual reviews-smaller discrepancy indicates a higher proportion of clinically stable annual reviews and vice versa. The overall group-level discrepancy in the UK registry (-5.6%, 95% CI -5.9 to -5.4%) was similar to Sheffield (-6.1%, 95% CI -7.1 to -5.1%). Around 20% of the clinician reviewed, annual reviews in Sheffield were performed during periods of clinically instability., Conclusions: Annual review FEV 1 underestimates lung health of adults with CF in the UK and may bias cross-country comparisons., (© 2018 The Authors Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.)

Background: The Epidemiologic Study of Cystic Fibrosis using 1995-1996 and 2003-2005 data found that CF centres with lowest FEV 1 tended to use fewer intravenous antibiotics. We repeated the analyses using 2013-2014 UK CF registry data to determine if this was still the case., Methods: Analysing data for 2013 and 2014 separately, 28 adult CF centres were ranked according to median % age-adjusted FEV 1 . The top 7 centres were placed in the 'upper quarter' (best FEV 1 ), the bottom 7 centres in 'lower quarter' (lowest FEV 1 ), and the rest in 'middle half'. IV use was stratified according to %FEV 1 , then compared between the three groups., Results: Centres in the 'upper quarter' and 'middle half' used significantly more IV antibiotics compared to centres in the 'lower quarter' (van Elteren test P-value<0.001). Regression analyses showed that people with CF attending centres in the 'upper quarter' or 'middle half' are 30-50% more likely to receive at least one IV course per year compared to people attending centres in the 'lower quarter'., Conclusions: CF centres with lowest FEV 1 are still distinguished by lower use of intravenous antibiotics., (Copyright © 2017 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)