In most European countries, feedback is embedded in education, training and daily professional activities. It is a valuable tool for indicating whether things are going in the right direction or whether redirection is required. In the world of healthcare professionals, it is intended to provide doctors with information about their practice through the eyes of their peers. Feedback is a valuable tool for doctors to gather information, consolidate their awareness of strengths and areas to improve, and aims to support effective behaviour. Doctors of all levels may be approached by peers or juniors to give feedback, or they may ask others to give feedback on their own performance.

Clinical record keeping is an integral component in good professional practice and the delivery of quality healthcare. Regardless of the form of the records ( i.e. electronic or paper), good clinical record keeping should enable continuity of care and should enhance communication between different healthcare professionals. Consequently, clinical records should be updated, where appropriate, by all members of the multidisciplinary team that are involved in a patient’s care (physicians, surgeons, nurses, pharmacists, physiotherapists, occupational therapists, psychologists, chaplains, administrators or students). Should the need arise patients themselves should have access to their records to be able to see what has been done and what has been considered. Clinical records are also valuable documents to audit the quality of healthcare services offered and can also be used for investigating serious incidents, patient complaints and compensation cases. In this issue of Breathe we will present the importance of keeping good clinical records, ways of facilitating this and an overview of legal aspects linked with clinical record keeping. There is also a list of suggested reading from several countries that may prove useful [1–13].

BackgroundBlood culture is the standard diagnostic method for typhoid and paratyphoid (enteric) fever in surveillance studies and clinical trials, but sensitivity is widely acknowledged to be suboptimal. We conducted a systematic review and meta-analysis to examine sources of heterogeneity across studies and quantified the effect of blood volume.MethodsWe searched the literature to identify all studies that performed blood culture alongside bone marrow culture (a gold standard) to detect cases of enteric fever. We performed a meta-regression analysis to quantify the relationship between blood sample volume and diagnostic sensitivity. Furthermore, we evaluated the impact of patient age, antimicrobial use, and symptom duration on sensitivity.ResultsWe estimated blood culture diagnostic sensitivity was 0.59 (95% confidence interval [CI], 0.54–0.64) with significant between-study heterogeneity (I2, 76% [95% CI, 68%–82%]; P < .01). Sensitivity ranged from 0.51 (95% CI, 0.44–0.57) for a 2-mL blood specimen to 0.65 (95% CI, 0.58–0.70) for a 10-mL blood specimen, indicative of a relationship between specimen volume and sensitivity. Subgroup analysis showed significant heterogeneity by patient age and a weak trend towards higher sensitivity among more recent studies. Sensitivity was 34% lower (95% CI, 4%–54%) among patients with prior antimicrobial use and 31% lower after the first week of symptoms (95% CI, 19%–41%). There was no evidence of confounding by patient age, antimicrobial use, symptom duration, or study date on the relationship between specimen volume and sensitivity.ConclusionsThe relationship between the blood sample volume and culture sensitivity should be accounted for in incidence and next-generation diagnostic studies.

At a Glance CommentaryScientific knowledge on the subject: Increasing evidence supports the influence of early life factors on later lung function, which might prevent individuals from attaining maximum lung function and predispose them to increased risk of lung disease in later life.What this study adds to the field: This is the first systematic review and meta-analysis on the association of birth weight, weight at one year and weight gain in the first year of life with lung function measures of both restrictive and obstructive patterns in adulthood. We convincingly show a positive association between birth weight and restrictive impairment (low FVC), with findings consistent across studies. The meta-analysis for birth weight and airflow obstruction (low FEV1/FVC) might suggest a positive association but the evidence is much weaker. We identified gaps and limitations in the current evidence that should be addressed in future research.This article has an online data supplement, which is accessible from this issue's table of content online at www.atsjournals.org. 3 AbstractRationale: There is evidence suggesting that birth weight may influence lung function in adulthood, but it is unclear whether it might differentially affect restrictive (FVC) and obstructive (FEV1/FVC) patterns.Objectives: To summarize evidence available on the association of birth weight, weight at one year and weight gain in the first year of life with FVC and FEV1/FVC in adulthood. Methods:We performed a systematic review of the literature by searching MEDLINE, EMBASE and Web of Science through January 2015. Data were combined using inversevariance weighted meta-analysis with random effects models, and between-study heterogeneity evaluated. We conducted a priori subgroup or sensitivity analyses by age, country wealth, ethnicity, sex and smoking. Risk of bias was evaluated using the Newcastle-Ottawa Scale, and reporting bias using funnel plots. Measurements and Main Results:Eighteen articles were included in the review, and 13 in the meta-analyses. Most studies were from high-income countries, and all showed low risk of bias.We found strong evidence of association of birth weight with adult FVC, a 59.4mL higher FVC in adulthood per kg increase in birth weight (95%CI: 43.3 to 75.5), with no evidence of heterogeneity. Evidence of an association of birth weight with FEV1/FVC was weaker and showed some inconsistency across studies. Only one study investigated weight at one year, and another one weight gain in the first year. Conclusions:Our meta-analyses show strong and consistent evidence of an association of birth weight with adult FVC, a measure of restrictive impairment, with much weaker evidence for airflow obstruction.

Interactions between patients and medical practitioners can sometimes be challenging. We have all had consultations where the interaction was not optimal, either as medical practitioners or as a patient ourselves. Neither normally wishes to cause a difficult situation but common misunderstandings, by both groups, often result in such an occurrence. Communication and listening skills are essential for every consultation but in particular, for situations where the interaction may become difficult.

Typhoid and paratyphoid fever may follow a seasonal pattern, but this pattern is not well characterized. Moreover, the environmental drivers that influence seasonal dynamics are not fully understood, although increasing evidence suggests that rainfall and temperature may play an important role. We compiled a database of typhoid, paratyphoid, or enteric fever and their potential environmental drivers. We assessed the seasonal dynamics by region and latitude, quantifying the mean timing of peak prevalence and seasonal variability. Moreover, we investigated the potential drivers of the seasonal dynamics and compared the seasonal dynamics for typhoid and paratyphoid fever. We observed a distinct seasonal pattern for enteric and typhoid fever by latitude, with seasonal variability more pronounced further from the equator. We also found evidence of a positive association between preceding rainfall and enteric fever among settings 35°–11°N and a more consistent positive association between temperature and enteric fever incidence across most regions of the world. In conclusion, we identified varying seasonal dynamics for enteric or typhoid fever in association with environmental factors. The underlying mechanisms that drive the seasonality of enteric fever are likely dependent on the local context and should be taken into account in future control efforts.

We conducted a systematic literature review and meta-analysis and estimated the case fatality rate of enteric fever to be 2.49% (95% confidence interval, 1.65%–3.75%; n = 44), 2.5 times higher than what was assumed up until now.

We report an outbreak of coronavirus disease with 74 cases related to a nightclub in Germany in March 2020. Staff members were particularly affected (attack rate 56%) and likely caused sustained viral transmission after an event at the club. This outbreak illustrates the potential for superspreader events and corroborates current club closures.