No abstract

The British Thoracic Society guideline for respiratory management of children with neuromuscular weakness summarises the available evidence in this field and provides recommendations that will aid healthcare professionals in delivering good quality patient care.Neuromuscular diseases as a group are relatively common with a prevalence of about 1 in 3000. Neuromuscular weakness (NMW) can directly reduce respiratory muscle strength and compromise upper airway muscle tone, airway protection and spinal support. The respiratory consequences are hypoventilation, upper airway obstruction, aspiration lung disease, secretion retention and lower airway infection, and the mechanical effects of progressive scoliosis. Acute respiratory failure associated with respiratory infection is the most frequent reason for unplanned hospital admission, and chronic respiratory failure is a frequent cause of death. With appropriate intervention, the incidence of unplanned hospital admission can be reduced and life expectancy can be improved.This British Thoracic Society guideline 1 attempts to summarise the available evidence in this field and provides recommendations that will aid healthcare professionals in delivering good quality patient care. Many of the principles of respiratory management are not disease specific and the objective of this guideline is to provide recommendations that can be applied to all children with NMW. The evidence for much of current practice is weak and is based largely on observational studies. The Guideline Committee attempted to identify and summarise the existing evidence, and when that is lacking, provide expert consensus opinion. The guideline starts with a background overview of respiratory problems in children with NMW. A brief summary of the conditions covered by the guideline is provided in an appendix. The respiratory management of children with NMW is then covered in eight sections: < Identifying children at risk of respiratory complications < Airway clearance and respiratory muscle training < Assisted ventilation < Planning for surgical procedures < Scoliosis < Other interventions that impact on respiratory health < Transition to adult care < Quality of life and palliative care A summary of the recommendations and good practice points for each of these sections is provided at the beginning of the guideline. In this commentary, I am going to focus on two aspects of the respiratory care of children with NMW which cause particular anxiety for clinical teams, carers and families: the management of acute respiratory failure and the identification and management of chronic hypoventilation.

No abstract

Purpose Active pain self-management (PSM) for patients with chronic pain is assumed to require multidisciplinary care, leaving prescribing analgesics the most accessible option for general practitioners (GPs). We sought to upskill GPs in multimodalPSM with a harm minimisation approach for any opioid prescribing. Design and Methodology Having developed an educational training resource, a multidisciplinary team delivered the program to attendees at a GP conference in 2017. The educational package comprised pre-readings, a 6-hour interactive, skills-based workshop, and post-workshop resources. The single-group intervention was evaluated with an original and unvalidated pre/post-test (three months) survey of four domains: knowledge; attitudes; utilisation of strategies involving PSM and opioid harm minimization. Paired t-tests were conducted on each domain score and overall, with effect sizes assessed with Cohen’s d. A sensitivity analysis was performed on the data lacking a post-test survey response. Post-survey scores were imputed via chained regression equations, then paired t-tests analyses were conducted on imputed datasets using Rubin's method to pool estimates. FindingsOf 99 participants, 33 returned both surveys for primary analysis. These were combined in the sensitivity analysis with 60 unpaired surveys. Internal consistency was modest (Cronbach’s alpha 0.736). Primary analysis demonstrated significant self-reported improvements in each educational domain with overall score increasing 10.54 points out of 130 (p<0.001 Cohen’s d 1.11). Improvements were similar in a sensitivity analysis. Discussion, Limitations and Conclusions This study found that a brief GP educational package may be a viable intervention for facilitating PSM and promoting safer prescribing strategies. Outcomes at three months, from this unvalidated survey instrument, suggest improvements in knowledge, attitudes and self-reported facilitation of PSM and opioid prescribing. As this study did not measure clinician behaviour or patient outcomes objectively, further educational research is indicated to confirm these findings and identify how best to deliver chronic pain management training.

No abstract