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The second European Rhinology Reserach Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held on 9-10th November 2017, combined with a specific symposium on air pollution and mobile Health technology (mHealth) with the GARD (Global Alliance against Chronic Respiratory Diseases) initiative of WHO (World Health Organization). Physicians from different specialities, researchers, as well as patients and industry representatives from more than 40 countries took part in the Forum. Relevant topics were debated with the aim of allowing the implementation of precision medicine (PM) in daily respiratory care. All debates started with positioning the current state of the art: identification of current gaps in practice, the current consensus and the need for implementation of novel approaches such as endotype-driven treatment, patient empowerment and eHealth tools. This report provides a summry of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2017, highlighting the research needs in PM, with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key drivers for improving current clinical practice.

Contains fulltext : 220931.pdf (Publisher’s version ) (Closed access) AIMS AND OBJECTIVES: To identify interventions to prevent and treat malnutrition in older adults, which can be integrated in nursing care, and to evaluate the effects of these interventions on outcomes related to malnutrition. BACKGROUND: Older adults are at great risk for malnutrition, which can lead to a number of serious health problems. Nurses have an essential role in nutritional care for older adults. Due to a lack of evidence for nursing interventions, adequate nursing nutritional care still lags behind. DESIGN: Systematic review. METHOD: We searched for and included randomised controlled trials on interventions, which can be integrated in nursing care for older adults, to prevent and treat malnutrition. We assessed the risk of bias with the Cochrane tool and evidence for outcomes with the GRADE. The PRISMA statement was followed for reporting. RESULTS: We included 21 studies of which 14 studies had a high risk of bias. Identified interventions were oral nutritional supplements, food/fluid fortification or enrichment, dietary counselling and educational interventions. In evaluating the effects of these interventions on 11 outcomes related to malnutrition, significant and nonsignificant effects were found. We graded the certainty of evidence as very low to moderate. CONCLUSION: Although slight effects were found in protein intake and body mass index, there is no convincing evidence about the effectiveness of the four identified interventions. There seems no harm in using these interventions, although it should be kept in mind that the evidence is sparse. Therefore, there is a need for high-quality research in building evidence for interventions in nursing nutritional care. RELEVANCE TO CLINICAL PRACTICE: Nurses can safely provide oral nutritional supplements and food/fluid fortification or enrichment, and give dietary counselling and education to older adults, as they are well placed to lead the essential processes of nutritional care to older adults.

International audience; The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.

To develop a benchmark measure of US physicians' level of knowledge and extent of use of pharmacogenomic testing, we conducted an anonymous, cross-sectional, fax-based, national survey. Of 397,832 physicians receiving the survey questionnaire, 10,303 (3%) completed and returned it; the respondents were representative of the overall US physician population. The factors associated with the decision to test were evaluated using χ(2) and multivariate logistic regression. Overall, 97.6% of responding physicians agreed that genetic variations may influence drug response, but only 10.3% felt adequately informed about pharmacogenomic testing. Only 12.9% of physicians had ordered a test in the previous 6 months, and 26.4% anticipated ordering a test in the next 6 months. Early and future adopters of testing were more likely to have received training in pharmacogenomics, but only 29.0% of physicians overall had received any education in the field. Our findings highlight the need for more effective physician education on the clinical value, availability, and interpretation of pharmacogenomic tests.

Objectives: This study was designed to determine whether genotype testing for patients initiating warfarin treatment will reduce the incidence of hospitalizations, including those due to bleeding o...

Study Objectives. To review the labels of United States Food and Drug Administration (FDA)-approved drugs to identify those that contain pharmacogenomic biomarker information, and to collect prevalence information on the use of those drugs for which pharmacogenomic information is included in the drug labeling. Design. Retrospective analysis. Data Sources. The Physicians' Desk Reference Web site, Drugs@FDA Web site, and manufacturers' Web sites were used to identify drug labels containing pharmacogenomic information, and the prescription claims database of a large pharmacy benefits manager (insuring > 55 million individuals in the United States) was used to obtain drug utilization data. Measurements and Main Results. Pharmacogenomic biomarkers were defined, FDA-approved drug labels containing this information were identified, and utilization of these drugs was determined. Of 1200 drug labels reviewed for the years 1945–2005, 121 drug labels contained pharmacogenomic information based on a key word search and follow-up screening. Of those, 69 labels referred to human genomic biomarkers, and 52 referred to microbial genomic biomarkers. Of the labels referring to human biomarkers, 43 (62%) pertained to polymorphisms in cytochrome P450 (CYP) enzyme metabolism, with CYP2D6 being most common. Of 36.1 million patients whose prescriptions were processed by a large pharmacy benefits manager in 2006, about 8.8 million (24.3%) received one or more drugs with human genomic biomarker information in the drug label. Conclusion. Nearly one fourth of all outpatients received one or more drugs that have pharmacogenomic information in the label for that drug. The incorporation and appropriate use of pharmacogenomic information in drug labels should be tested for its ability to improve drug use and safety in the United States.

Objective: This study examines demographic trends in the use of medications to treat ADHD in adult and pediatric populations. Method: Using pharmacy claims data for a large population of commercially insured Americans, the study measures ADHD treatment prevalence and drug use from 2000 to 2005. Results: In 2005, 4.4% of children (ages 0 to 19) and 0.8% of adults (ages 20 and older) used ADHD medications. Treatment rates were higher in boys (6.1%) than in girls (2.6%), but the rates for men and women were approximately equal (0.8%). During the period of the study, treatment prevalence increased rapidly (11.8% per year) for the population as a whole. Treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys. Conclusion: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use. ( J. of Att. Dis. 2007; 10(4) 335-342)

In day-to-day practice, asthma treatment and self-management often fall short of the objectives defined by clinical practice guidelines. The objective of this study was to determine whether a population-based asthma disease management program, using broad-based educational interventions, can have a favorable impact on physician and patient adherence to guidelines-based care. A longitudinal, before-and-after design was used to evaluate program impacts on pharmacotherapy and health status. Patients with asthma (n = 35 450) were enrolled in the program from September 2000 through to June 2001. Patients were identified for the study based on a 12-month retrospective analysis of pharmacy claims. Patients were members of prescription benefit plans managed by Medco Health and were aged 5 years and older. Patients in the intervention group received asthma education materials during the 12-month period following enrollment. The materials emphasized guidelines-based principles of asthma pharmacotherapy, self-management, trigger avoidance and patient-physician partnership. Physicians received guidelines-based flow sheets to facilitate therapy tracking, and pharmacotherapy review. Asthma drug utilization was measured during the 12-month period prior to enrollment and the 12-month period following enrollment. Utilization data on controller and reliever medications were derived from a pharmacy claims database. Drug utilization changes for the intervention group were compared with those for matched controls. A health survey was conducted on a random sample of program participants at enrollment and at 12-month follow-up. The health survey included questions on asthma-related quality of life (QOL), medical utilization, productivity, and self-management skills. The percentage of patients who started controller therapy during the study period was significantly higher for the intervention group than the control group (20.7% versus 18.1%, p < 0.001). The controller prescription fill rate increased significantly in the intervention group compared with controls (p < 0.0001); the increase was primarily driven by increased refill rates for patients already using controllers. Reliever prescription fill rates decreased for both the intervention group and controls. Program participants reported significant improvements in asthma-related QOL (p < 0.05) and self-management skills. Self-reported medical utilization decreased for office visits (p < 0.05) and emergency room visits (p < 0.01). A population-based asthma disease management program can improve controller prescribing rates (new therapy starts), controller adherence rates (refill persistency), and self-management skills. These changes in physician and patient behavior help close the gaps between guidelines and practice in asthma therapy.

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition with broad economic impacts. It presents a major opportunity for healthcare cost reduction and improved functional status. This study measures the gaps between current treatment practices and recently issued guidelines, and identifies the primary opportunities for COPD disease management. COPD patients (n = 1,036) were initially identified using pharmacy claims data on outpatient respiratory medication use. Through a health assessment survey, they confirmed their diagnosis and reported on their medical resource use, vaccinations, smoking, and health-related quality of life (QOL). Drug utilization was measured using a 12-month retrospective review of prescription claims. Patients were stratified by severity level based on QOL scores. A large subset of patients (25.7%) did not use inhaled bronchodilators, the preferred first-line therapy in COPD guidelines; instead, these patients used oral bronchodilators (8.1%) or no bronchodilat...

OBJECTIVE: To evaluate the impact of an asthma disease management program conducted by a pharmacy benefit management (PBM) organization. DESIGN: A prospective analysis of the outcomes of an education-based disease management program for a large population of asthma medication users, compared to the outcomes for a matched longitudinal control group. SETTING: Merck-Medco Managed Care, L.L.C., a national PBM that manages prescription benefits and provides mail-service and online pharmacy services. PATIENTS: The intervention group consisted of 19,289 patients with asthma, aged 6 and older, divided into high-risk, low-risk, and maintenance subgroups based on history of asthma medication use. The control group consisted of 19,253 asthma patients matched on age and gender. INTERVENTIONS: Patients in the intervention group received asthma education materials and had call-in access to pharmacists trained in optimal asthma care. Physicians were notified when their patients were enrolled, and they received asthma therapy guidelines if their patients’ medications or self-reported status indicated suboptimal therapy. MAIN OUTCOME MEASURES: Antiinflammatory controller medication (AICM) use and inhaled short-acting beta-agonist medication use. RESULTS: Intervention group patients showed larger increases in AICM use than control group patients (17.8% versus 13.6%, for high-risk patients, p

This study evaluates the differences between women and men in medication use, medication adherence, and prescribing alignment with clinical guidelines.We conducted an analysis of pharmacy and medical claims for 29.5 million adults with prescription benefits administered by a pharmacy benefits manager in the United States, age 18 and older, between January 1, 2010, and December 31, 2010. Prevalence and intensity of medication use were evaluated by sex, age group, and medication type (acute vs. chronic). Medication adherence was measured by the percentage of patients with a medication possession ratio (MPR) ≥80%. The percentage of patients receiving guideline-based treatment was measured for diabetes and select cardiovascular conditions.The study population comprised 16.0 million women and 13.5 million men with continuous pharmacy benefit eligibility. Women were significantly more likely than men to use one or more medications during the analysis period (68% vs. 59%, respectively, p0.001), and women used more unique medications, on average, than men (5.0 vs. 3.7 medications per year, respectively, p0.001). Differences in drug utilization were observed for all age groups and medication types. For all clinical metrics evaluated, women were less likely than men to be adherent in their use of chronic medications, and they were less likely to receive the medication treatment and monitoring recommended by clinical guidelines.There are significant disparities between women and men in their intensity of medication use, their adherence to medications, and their likelihood of receiving guideline-based drug therapy. These differences may indicate a need for more personalized drug selection and therapeutic management to improve clinical outcomes.

Introduction Assuming that STI patients visiting SHC have different risk profiles triggered STI surveillance by GP. The aim was to compare patient characteristics and to explore the contribution of the different health care settings to STI control. Methods STI surveillance exists since 2000 by voluntary participation of gynaecologists, dermatologists, medical centres for sex workers (SW), STI clinics, and aids reference centres (ARC), collecting socio-demographic, testing and behavioural data. They are defined as SHC. In order to compare STI patients consulting GP and SHC, the GP sentinel network was invited to participate STI surveillance in 2013. Chi2-test for proportions was used to test for significant differences. Results GP (N = 160) and SHC (N = 30) reported respectively 158 and 855 episodes. Patients did not differ in gender, age, education and STI diagnosis. GP patients consulted because of a STI plaints (GP: 67%; SHC: 42%), SHC performed more screening (GP: 17%, SHC: 36%). SHC patients mentioned more multi partnership (GP: 36%; SHC: 73%) and used more condoms (GP: 20%; SHC: 46%). The proportion of MSM, SW and drug users was higher in SHC (resp. GP: 39%, SHC: 66%; GP: 1%, SHC: 15%; GP: 0%, SHC: 3%). The proportion of MSM by STI, with exception of genital warts, was always higher in SHC and was strongest for syphilis (GP: 60%, SHC: 92%). Conclusion STI patients were analogue for age and gender in the 2 types of health care settings. GP screened less for STI and diagnosis was made in case of a particular plaint. High risk groups (MSM, SW and drug users) were more seen in SHC than in the GP network,. The probable lower risk profile of GP patients could be dedicated to lower STI knowledge and risk awareness, by as well GP and patient not belonging to a known risk group. GP training in STI consulting and opportunistic screening with risk factor awareness and strengthen condom use in general are recommended. Disclosure of interest statement Nothing to Declare.

Objective: The objective of this study was to evaluate the impact of medication adherence on healthcare utilization and cost for 4 chronic conditions that are major drivers of drug spending: diabetes, hypertension, hypercholesterolemia, and congestive heart failure. Research Design: The authors conducted a retrospective cohort observation of patients who were continuously enrolled in medical and prescription benefit plans from June 1997 through May 1999. Patients were identified for disease-specific analysis based on claims for outpatient, emergency room, or inpatient services during the first 12 months of the study. Using an integrated analysis of administrative claims data, medical and drug utilization were measured during the 12-month period after patient identification. Medication adherence was defined by days’ supply of maintenance medications for each condition. Patients: The study consisted of a population-based sample of 137,277 patients under age 65. Measures: Disease-related and all-cause medical costs, drug costs, and hospitalization risk were measured. Using regression analysis, these measures were modeled at varying levels of medication adherence. Results: For diabetes and hypercholesterolemia, a high level of medication adherence was associated with lower disease-related medical costs. For these conditions, higher medication costs were more than offset by medical cost reductions, producing a net reduction in overall healthcare costs. For diabetes, hypercholesterolemia, and hypertension, cost offsets were observed for all-cause medical costs at high levels of medication adherence. For all 4 conditions, hospitalization rates were significantly lower for patients with high medication adherence. Conclusions: For some chronic conditions, increased drug utilization can provide a net economic return when it is driven by improved adherence with guidelines-based therapy.

Background Sentinel STI surveillance with clinicians exists since 2000. STI within HIV patients triggered STI surveillance in ARC, specialised in care of HIV patients and patients at risk. No STI-HIV screening guidelines exist. STI is a driving force for HIV epidemics. Methods STI surveillance registers STI episodes, including questions on HIV serology, HIV testing and risk behaviour. HIV testing circumstances are analysed in both networks. Results In 2011, 744 STI patients were registered by the network of clinicians and 250 STI coinfected HIV patients by the ARC. HIV testing circumstances are known for 95% of the STI patients from the clinicians network. 51% was tested during STI consultation, 19% were never tested, being postponed, refused or not proposed. The remaining 30% was tested previously of whom 49% was HIV negative and not retested. Within the clinicians network, HIV serology was reported in 79% of the cases: 21% are HIV positive of whom 14% discovered their seropositivity at STI consultation. Within the ARC, 7% of the coinfected HIV patients discovered their HIV positivity simultaneously with the STI diagnosis. Among STI patients in the ARC with at first negative/unknown HIV status, 57% was tested for STI-HIV simultaneously: 15% were found HIV positive. 11% of the seronegative STI patients were not retested. For the other 32% of the STI patients, their HIV status remains unknown. Conclusions Surveillance of STI in both networks shows that HIV testing is not always performed during STI consultation, the HIV status may remain unknown and/or patients are not retested. Nevertheless, HIV positivity and STI are regularly found simultaneously. Knowing the HIV status of STI patients and screening HIV patients for STI is important for reducing HIV-STI transmission. National STI-HIV screening guidelines should be developed and implemented. Besides screening, condom use remains the most important preventive factor.

Background The observation of STI in HIV-patients has triggered a STI-Surveillance in AIDS Reference Centres (ARC). The aim of this surveillance is to identify STI emerging in HIV-patients, to analyse STI-trends in this group and to describe patient characteristics. Methods There are nine ARC in Belgium. The ARC are specialised in HIV-patient care, STI-consultation and treatment. Since April 2007, seven ARC participate in the surveillance. STI included are limited to Chlamydia, gonorrhoea , syphilis, Lymphogranuloma Venerum (LGV), hepatitis B (HBV) and hepatitis C (HCV) among men having sex with men (MSM). Results In 2008, 6962 HIV-patients (36.8% women; 63.2% men) were followed and 7454 patients (35.7% women; 63.9% men) in 2009. The HIV-population under follow-up increased by 7.1% (8.3% in men; 4.7% in women). In 2008 as well as in 2009, 279 STI were reported among the HIV-patients. It concerns 250 men and two women in 2008 and 251 men and two women in 2009; 242 were MSM in 2008 and 244 in 2009 (96%). The finding observed in 2009, with 5.3% HIV-infected men presenting an STI vs 5.7% in 2008 prevails a lower incidence of STI. This decrease is not statistically significant (χ 2 =0.76, a=0.38). In 2008 as well as in 2009, 13 patients were diagnosed with more than 1 STI (4.6% of the STI patients) The most frequent STI was syphilis, with 171 cases (61% of STI diagnosis) in 2008 and 160 cases (59%) in 2009, of whom one woman; respectively 94% and 95% of the men were MSM. Chlamydia has been found in 30 men and two women in 2008 and in 28 men and one woman in 2009. LGV was confirmed in 12 men in 2008 and in 15 in 2009. Gonorrhoea was found in 29 men in 2008 and 32 in 2009. HBV and HCV were respectively diagnosed in 2 and 14 men in 2008 and in 7 and 17 men in 2009. All men reported with Chlamydia, LGV, gonorrhoea, HBV and HCV were MSM. 64% (2008) and 75 % (2009) of the homosexual men with STI mentioned having multiple partners. Conclusions The surveillance in 2008 and 2009 confirms an STI-problem among HIV-infected MSM. These results highlight unsafe sex behaviour among MSM, also reflected by the high proportion of MSM reporting multiple partners. HIV-positive MSM are particularly vulnerable for syphilis. The incidence of LGV and HCV among HIV-positive men should be followed closely and an adaptation of the international screening policy for LGV and HCV is needed. Chlamydia patients belonging to high risk groups should be tested for the LGV variant.

Research in auditory perception has tended to emphasize the detection and processing of sound elements with quasi-stable spectral structure, such as tones, formants, and bursts of noise. In the spectral domain, these elements are distinguished by frequency peak or range, bandwidth, and amplitude. In the temporal domain, acoustic analysis has often focused on the durations of sound elements, the intervals and phase relations between them, and the influence of these on pitch and loudness perception, temporal acuity, masking, and localization. The auditory system has often been approached as an analyzer of essentially time-constant functions of frequency, amplitude, and duration, on the assumption that complex auditory percepts are compositions over sound elements having those properties, with certain temporal inter

The third formant transition is an important acoustic dimension in the identification of /r/ and /l/ by English listeners [Miyawaki et al. (in preparation)]. In this study, six listeners showed a consistent decrease in “r” responses following repeated presentation of /r/ stimuli and a complementary increase following /l/ stimuli. These shifts are similar to those found for perceptual boundaries between stops. Further tests suggest the shifts are not due to adaptation of context‐independent formant‐transition detectors: (1) repeated presentation of the isolated third formants from the original adapting stimuli produced no consistent boundary shifts; (2) when the listeners were asked to categorize the full series of isolated third formants, the nonspeech boundaries often differed from the speech boundaries; (3) the nonspeech boundaries were unstable, and no consistent shifts could be induced by either speech or nonspeech adapting stimuli. Adaptation effects may be restricted to adapting and test stimuli which are members of the same natural class of events.

In rapid speech, acoustic analysis reveals that steady state vowel targets characteristically are not reached. Lindblom and Studdert‐Kennedy [J. Acoust. Soc. Am. 42, 830–843 (1967)] found in an experiment with synthetic speech that listeners showed a shift in the boundary between medial vowels /e/ and /U/ with variations in the rate and direction of formant transitions. Apparently, perceivers compensate for simulated articulatory undershoot by perceptual overshoot. An experiment with natural speech demonstrated shifts in the acoustic criteria listeners employed in vowel recognition as a function of perceived rate of utterance. Nine American English vowels in /p‐p/ environment were produced by a panel of 15 talkers in a fixed sentence frame. The unstressed, rapidly articulated /p‐p/ syllables were excised from the tape recording and assembled into listening tests. In one condition, the /p‐p/ targets were prefaced by three slowly articulated syllables /hi, ha, hu/. In the other test condition, no precursors...