Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries. 2018 Lancet Infect Dis

OBJECTIVE. We sought to study the impact of emergency department (ED)-based intensive primary care linkage and initiation of asthma case management on long-term, patient-oriented outcomes for children with an asthma exacerbation.METHODS. Our study was a randomized, 3-arm, parallel-group, single-blind clinical trial. Children aged 2 through 17 years treated in a pediatric ED for acute asthma were randomly assigned to standard care (group 1), including patient education, a written care plan, and instructions to follow up with the primary care provider within 7 days, or 1 of 2 interventions. Group 2 received standard care plus assistance with scheduling follow-up, while group 3 received the above interventions, plus enrollment in a case management program.OUTCOMES. The primary outcome was the proportion of children having an ED visit for asthma within 6 months. Other outcomes included change in quality-of-life score and controller-medication use.RESULTS. Three hundred fifty-two children were enrolled; 78% completed followup, 69% were black, and 70% had persistent asthma. Of the children, 37.8% had a subsequent ED visit for asthma, with no difference among the treatment groups (group 1: 38.4%; group 2, 39.2%; group 3, 35.8%). Children in all groups had a substantial, but similar, increase in their quality-of-life score. Controller-medication use increased from 69.4% to 81.4%, with no difference among the groups.CONCLUSION. ED-based attempts to improve primary care linkage or initiate case management are no more effective than our standard ED care in improving subsequent asthma outcomes over a 6-month period. A STHMA, WHICH AFFECTS Ͼ6 million US children, is a chronic disease marked by acute exacerbations that account for much of the associated morbidity. 1-3 Much of the care of these acute flare-ups is provided in emergency departments (EDs), with Ͼ728 000 ED visits for childhood asthma in 2000. 1 Because the ED is a frequent source of care for patients with asthma, it may have a role in chronic disease management as well. 4 A 2002 publication by an expert panel outlined multiple policy recommendations to improve childhood asthma outcomes. 5 Three of these recommendations focused on improving access to and quality of asthma health care services, improving primary asthma care, and providing case management (CM) for high-risk asthmatic children.Linkage between the ED and the source of primary asthma care has been the subject of some investigation. In 1997, the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 2 6 emphasized the importance of ongoing preventive care and follow-up with a primary care provider (PCP) after acute care treatment in reducing asthma morbidity. However, although NAEPP guidelines recommend follow-up with a PCP within 3 to 5 days of an acute asthma exacerbation, numerous studies have demonstrated low rates of compliance with this recommendation. 7,8 A variety of strategies have been found to improve the rate of post-ED care follow-up, including scheduling of fo...

Cardiac output (CO) measurement has long been considered essential to the assessment and guidance of therapeutic decisions in critically ill patients and for patients undergoing certain high-risk surgeries. Despite controversies, complications and inherent errors in measurement, pulmonary artery catheter (PAC) continuous and intermittent bolus techniques of CO measurement continue to be the gold standard. Newer techniques provide less invasive alternatives; however, currently available monitors are unable to provide central circulation pressures or true mixed venous saturations. Esophageal Doppler and pulse contour monitors can predict fluid responsiveness and have been shown to decrease postoperative morbidity. Many minimally invasive techniques continue to suffer from decreased accuracy and reliability under periods of hemodynamic instability, and so few have reached the level of interchangeability with the PAC.

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T he purpose of this article is to describe the design and implementation of the Robert Wood Johnson Foundation's (RWJF) Allies Against Asthma crosssite evaluation. The Allies Against Asthma (Allies) program consists of seven coalition sites, each comprising various stakeholders such as local health care providers, schools and day care centers, community advocacy groups, businesses, local government organizations, managed care organizations, academic institutions, parent groups, and other community-based organizations, which aim to combat pediatric asthma. The evaluation approach for Allies was designed collaboratively by

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Objective. We examined the impact of a combination of home environmental interventions and nurse case management services on total settled dust loadings and on allergen concentrations in the homes of asthmatic children.Methods. Using a randomized longitudinal controlled trial study design, we randomly assigned homes of asthmatic children in Milwaukee to either a control (n564) or an intervention (n557) group. Control group homes received a visual assessment, education, bed/pillow dust mite encasings, and treatment of lead-based paint hazards. The intervention group received these same services plus nurse case management that included tailored, individual asthma action plans, provision of minor home repairs, home cleaning using special vacuuming and wet washing, and integrated pest management. Dust vacuum samples were collected from measured surface areas of floors in the TV room, kitchen, and child's bedroom at baseline and at three-, six-, and 12-month follow-up visits. Dust loading (mass per surface area) is a means of measuring total dust and the total amount of allergen present.Results. For the intervention group, geometric mean dust loadings declined significantly from baseline (39 milligrams per square foot [mg/ft 2 ]) to postintervention (11 mg/ft 2 ) (p,0.001). Baseline dust loading, treatment group, visit, and season were significant predictors of follow-up dust loadings. Mean post-intervention dust loadings were 72% higher in the control group. The total amount of allergen in settled house dust declined significantly following the intervention because total dust loading declined; the concentration of allergens in settled dust did not change significantly.Conclusion. The combination of nurse case management and home environmental interventions promotes collaboration between health and housing professionals and is effective in reducing exposures to allergens in settled dust.