Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD). This review discusses the current understanding of the aetiology and pathogenesis of EPS, highlighting histological features which differentiate it from simple sclerosis of the peritoneal membrane which develops with time on PD. Diagnostic criteria are presented, including the role of imaging techniques. To date there are no randomised controlled trials to guide therapy; however, surgical techniques are an important treatment option. Collaborative research will be essential if this serious problem facing PD is to be solved.
in Asthma and All. RATIONALE: Previous quantitative studies suggest that food allergy (FA) management outcomes are suboptimal among low-income pediatric populations. However, no qualitative studies to date have attempted to comprehensively characterize barriers to optimal FA management within these communities. Therefore, this study aims to (a) identify barriers to providing proper FA management and acute care to Medicaid-insured FA children in Chicago and (b) understand the impact of these barriers on affected families. METHODS: We completed ten comprehensive semi-structured interviews with adult caregivers of Medicaid-insured food-allergic children in Chicago. The interview transcripts underwent a bifurcated qualitative analytic process that independently examined each objective and systematically identified relevant themes. RESULTS: Three themes were identified in the barriers analysis: (1) ''Limited caregiver knowledge'', which was indicated by participant assertions of faulty risk perception, uncertainty surrounding their child's specific allergens, and confusion about symptoms, treatment, and aftercare of a reaction. (2) ''Poor inter-caregiver management'', which was expressed via participant concerns regarding secondary caregivers' ability to properly manage their child's FA, understand the severity of a child's allergy, and effectively recognize/treat allergic reactions. Lastly, (3) ''Insecure access to safe food'' was articulated through caregivers' characterizations of allergen-free meals as expensive and time-consuming to prepare. The second analysis focusing on the impact of these barriers revealed psychosocial impacts on both caregiver and food allergic child, including mutual sentiments of restriction, social isolation, anxiety, and, ultimately, resilience. CONCLUSIONS: Numerous, substantial barriers to FA management exist within the Medicaid-insured population. These data will inform future studies/interventions to further understand how to mitigate these barriers.
Many food allergy action plans contain a controversial option to inject epinephrine for mild (''OptionA'') or no (''OptionB'') symptoms following allergen ingestion. There are no data on frequency/ criteria to select these options. METHODS: Surveys were administered in person/by email to a convenience sample of allergists and pediatricians. A chart review was conducted in a pediatric food allergy referral center to assess option use. RESULTS: Survey response rate was 35% (15 allergists, 43 pediatricians). All allergists and 74% pediatricians were familiar with OptionA; 93% and 72% for OptionB, respectively. Most allergists (80%) indicated that they used OptionA in 1-9% of plans, compared to 28% of pediatricians (p<.01). Most allergists (57%) used OptionB in 1-9% of plans, compared to 26% of pediatricians (p<.11). Cumulatively, 17% of allergists and 42% of pediatricians selected the options in over 9% of plans (p5.02). The top reasons to use the options for both allergists and pediatricians included past anaphylaxis, PICU admission, intubation, and cardiovascular collapse; the latter 3 were significantly more often identified by allergists (p <.05). Overall, 4.1% of chart review action plans indicated at least one option (OptionA-61%, OptionB-37%, both-2%), varying from 0% to 9% of plans among 9 allergists. Option selection was higher (p<.05) in patients with asthma, use of asthma treatments, prior anaphylaxis and prior epinephrine use, but not for atopic dermatitis and allergic rhinitis. CONCLUSIONS: Pediatricians endorsed use of epinephrine for mild/no symptoms more often than allergists. Severity of past reactions were drivers of selecting these options (more so for allergists than pediatricians). 738 The Food Allergy Management in Low Income Youth (FAMILY) Study: A family-centered approach to improving anaphylaxis knowledge and childhood food allergy management skills.
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