Computerized Clinical Decision Support To Prevent Medication Errors and Adverse Drug Events: Rapid Review.

Syrowatka A, Motala A, Lawson E, Shekelle P. 2024 Feb. In: Making Healthcare Safer IV: A Continuous Updating of Patient Safety Harms and Practices Agency for Healthcare Research and Quality (US); 2023 Jul–.2024 Feb

Excerpt

Objectives: To assess the evidence on the effects of computerized clinical decision support systems (CDSSs) on the prevention of medication errors and adverse drug events, related implementation outcomes such as rates of medication alert overrides, and unintended consequences of use. We also summarized the literature around the effective implementation of a CDSS.

Methods: We followed the rapid review processes of the Agency for Healthcare Research and Quality Evidence-based Practice Center Program. We queried PubMed and the Cochrane Library to locate relevant systematic reviews and primary studies published from 2015 to April 2023, supplemented by a targeted review of the grey literature. We narratively synthesized the evidence and assessed the overall strength of evidence for the outcomes of interest. The protocol for the review has been registered in PROSPERO (CRD42023449710).

Intranasal corticosteroids reduced acute rhinosinusitis in children with allergic rhinitis: A nested case–control study

Lin CL, Lee KH, Huang WT, Hsieh LC, Wang CM. J Microbiol Immunol Infect. 2024 Feb;57(1):175-183. doi: 10.1016/j.jmii.2023.11.005.

Abstract

Background

Children with allergic rhinitis (AR) have substantially more acute rhinosinusitis than children without AR. We evaluated whether intranasal corticosteroids (INCS), second-generation antihistamines (SGH), and/or intranasal antihistamines (INH) for AR affect acute rhinosinusitis in children with AR aged 2–18 years.

Methods

Flow chart of participant enrollment.

By using the National Health Research Institutes Database 2005 of Taiwan, a cohort of patients with AR aged 2–18 years treated with AR medications between 2002 and 2018 was made, within which a nested case–control study was performed. Risk settings for acute rhinosinusitis cases matched controls for age, sex, and comorbidities. Current users of INCS, INH, and/or SGH were compared with remote and recent users of any AR medications and current users of INCS with and without SGH were compared with current users of SGH.

Advancing Treatment in Atopic Dermatitis: A Comprehensive Review of Clinical Efficacy, Safety, and Comparative Insights Into Corticosteroids, Calcineurin Inhibitors, and Phosphodiesterase-4 Inhibitors as Topical Therapies

Hernandez T D, Aleman S J, Bao-Loc-Trung M, et al. Cureus 16(3): e55393. doi:10.7759/cureus.55393

Abstract

Atopic dermatitis (AD) is a pervasive and multifaceted dermatological disorder causing daily distress to afflicted individuals worldwide. This comprehensive review synthesizes the historical and contemporary advancements in therapeutic strategies, offering a critical analysis of their efficacy, safety profiles, and adaptability. The enduring role of topical corticosteroids in managing AD is examined, acknowledging their potent anti-inflammatory properties alongside their potential adverse side effects, particularly in extended usage. The article explores the utilization of topical calcineurin inhibitors like tacrolimus and pimecrolimus, highlighting their novel anti-inflammatory pathways while also scrutinizing concerns over potential malignancies that relegate them to second-line therapy.

Comparative studies of PDE4 inhibitors, calcineurin inhibitors, and topical
corticosteroids in the pharmacological management of atopic dermatitis

Revised clinical practice guidelines for diagnosing, classifying, and treating allergic bronchopulmonary aspergillosis/mycoses: a Delphi statement from the ISHAM-ABPA working group

Agarwal R, Singh Sehgal I, Muthu Vet al. Eur Respir J. 2024 Feb 29:2400061. doi: 10.1183/13993003.00061-2024.

Abstract

Background The ISHAM working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) nearly a decade ago. There is a need to update these recommendations due to advances in diagnostics and therapeutics.

Methods An international expert group was convened to develop guidelines for managing ABPA (caused by Aspergillus spp.) and allergic bronchopulmonary mycosis (ABPM, fungi other than Aspergillus spp.) in adults and children using a modified Delphi method (two online rounds and one in-person meeting). We defined consensus as ≥70% agreement or disagreement. The terms “recommend” and “suggest” are used when the consensus was ≥70% and <70%.

Revised International Society for Human and Animal Mycology (ISHAM)-ABPA
working group (AWG) consensus criteria for diagnosing allergic
bronchopulmonary mycosis (ABPM)

Results We recommend screening for A. fumigatus sensitization using fungus-specific IgE in all newly diagnosed adult asthmatics at tertiary care but only difficult-to-treat asthmatic children. We recommend diagnosing ABPA in those with predisposing conditions or compatible clinico-radiological presentation, with a mandatory demonstration of fungal sensitization and serum total IgE ≥500 IU·mL−1 and two of the following: fungal-specific IgG, peripheral blood eosinophilia, or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normal A. fumigatus-IgE. Additionally, diagnosing ABPM requires repeated growth of the causative fungus from sputum.
We do not routinely recommend treating asymptomatic ABPA patients. We recommend oral prednisolone or itraconazole monotherapy for treating acute ABPA (newly diagnosed or exacerbation), with prednisolone and itraconazole combination only for treating recurrent ABPA exacerbations. We have devised an objective multidimensional criterion to assess treatment response.

Conclusion We have framed consensus guidelines for diagnosing, classifying, and treating ABPA(M) for patient care and research.

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Maternal dietary indexes are not linked to early childhood wheezing or atopic eczema

Sivula E, Puharinen H, Hantunen S, Keski-Nisula L, Backman K.  Pediatr Allergy Immunol. 2024; 35:e14099. doi:10.1111/pai.14099

Abstract

Background

Several recent studies have investigated the association between maternal diet during pregnancy and wheezing or asthma in children. However, whether a specific dietary pattern during pregnancy protects children from wheezing or atopic diseases remains unclear. This study investigated the association between The Alternative Healthy Eating Index for Pregnancy (AHEI-P), the Dietary Inflammatory Index (DII), and the risk for wheezing and atopic eczema in children during the first year of life.

Methods

This study included 1330 mother–child pairs who attended the Kuopio Birth Cohort (KuBiCo) study and had dietary information during the last trimester and information on children's health in the first year of life.

House dust mite SCIT reduces asthma risk and significantly improves long-term rhinitis and asthma control—A RWE study

Jutel M, Klimek L, Richter H, Brüggenjürgen B, Vogelberg C.  Allergy. 2024; 00: 1-10. doi:10.1111/all.16052

Abstract

Background

The German Therapy Allergen Ordinance (TAO) triggered an ongoing upheaval in the market for house dust mite (HDM) allergen immunotherapy (AIT) products. Three HDM subcutaneous AIT (SCIT) products hold approval in Germany and therefore will be available after the scheduled completion of the TAO procedure in 2026. In general, data from clinical trials on the long-term effectiveness of HDM AIT are rare. We evaluated real-world data (RWD) in a retrospective, observational cohort study based on a longitudinal claims database including 60% of all German statutory healthcare prescriptions to show the long-term effectiveness of one of these products in daily life. Aim of this analysis was to provide a per product analysis on effectiveness of mite AIT as it is demanded by international guidelines on AIT.

Methods

Subjects between 5 and 70 years receiving their first (index) prescription of SCIT with a native HDM product (SCIT group) between 2009 and 2013 were included. The exactly 3:1 matched control group received prescriptions for only symptomatic AR medication (non-AIT group);

Attenuation of allergen-specific immunotherapy for atopic dermatitis by ectopic colonization of Brevundimonas vesicularis in the intestine.

Liu X, Xu B, Xu X, Wang Z, Luo Y, Gao Y, Ling S, Wang A, Zhou Y, Wang X, Leng SX, Li W, Yao X.  Cell Rep Med. 2023 Dec 19;4(12):101340. doi: 10.1016/j.xcrm.2023.101340.

Highlights

• The oral and gut microbiota are changed in patients with AD undergoing AIT

• B. vesicularis in the oral and gut microbiota is decreased following AIT

• Oral B. vesicularis may ectopically colonizes the gut of patients with AD

• B. vesicularis promotes Th17 polarization and attenuates the efficacy of AIT

Summary

Graphical abstract

Allergen-specific immunotherapy (AIT) has shown beneficial effects against atopic dermatitis (AD); however, the mechanisms and parameters underlying the efficacy of AIT remain unclear. Here, we report that the community structure and function of the oral and gut microbiota are changed in patients with AD undergoing AIT. Transplantation of fecal microbiota from patients who respond well to AIT improves AD-like dermatitis in mice. The abundance of Brevundimonas vesicularis in the gut of AD patients has been found to be positively correlated with disease severity and is decreased following AIT.

Short-Term Exposure to Fine Particulate Matter and Nitrogen Dioxide and Mortality in 4 Countries

Ma Y, Nobile F, Marb A, Dubrow R, Stafoggia M, Breitner S, Kinney PL, Chen K.  JAMA Netw Open. 2024 Mar 4;7(3):e2354607. doi: 10.1001/jamanetworkopen.2023.54607. PMID: 38427355.

Key Points

Question  What are the associations between short-term changes in fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) concentrations and changes in daily all-cause mortality rates?

Findings  This cross-sectional study of more than 8.9 million deaths found that a 10-μg/m³ increase in daily PM_2.5 concentrations was associated with increases in daily all-cause deaths per 100 000 people of 0.01 in Jiangsu, China, 0.03 in California, 0.10 in central-southern Italy, and 0.04 in Germany; corresponding increases in mortality rates for the same increase in NO₂ concentrations were 0.04, 0.03, 0.10, and 0.05, respectively.