The COPD assessment test (CAT) is a self-administered questionnaire that measures healthrelated quality of life. We aimed to systematically evaluate the literature for reliability, validity, responsiveness and minimum clinically important difference (MCID) of the CAT.Multiple databases were searched for studies analysing the psychometric properties of the CAT in adults with chronic obstructive pulmonary disease. Two reviewers independently screened, selected and extracted data, and assessed methodological quality of relevant studies using the COSMIN checklist.From 792 records identified, 36 studies were included. The number of participants ranged from 45 to 6469, mean age from 56 to 73 years, and mean forced expiratory volume in 1 s from 39% to 98% predicted. Internal consistency (reliability) was 0.85-0.98, and test-retest reliability was 0.80-0.96. Convergent and longitudinal validity using Pearson's correlation coefficient were: SGRQ-C 0.69-0.82 and 0.63, CCQ 0.68-0.78 and 0.60, and mMRC 0.29-0.61 and 0.20, respectively. Scores differed with GOLD stages, exacerbation and mMRC grades. Mean scores decreased with pulmonary rehabilitation (2.2-3 units) and increased at exacerbation onset (4.7 units). Only one study with adequate methodology reported an MCID of 2 units and 3.3-3.8 units using the anchor-based approach and distribution-based approach, respectively. Most studies had fair methodological quality.We conclude that the studies support the reliability and validity of the CAT and that the tool is responsive to interventions, although the MCID remains debatable. @ERSpublications Studies support the reliability, validity and responsiveness of the CAT as a HRQoL tool but its MCID remains unclear

SettingMumbai, India. A study conducted in Mumbai two decades ago revealed the extent of inappropriate tuberculosis (TB) management practices of private practitioners. Over the years, India's national TB programme has made significant progress in TB control. Efforts to engage private practitioners have also been made with several successful documented public-private mix initiatives in place.ObjectiveTo study prescribing practices of private practitioners in the treatment of tuberculosis, two decades after a similar study conducted in the same geographical area revealed dismal results.MethodsSurvey questionnaire administered to practicing general practitioners attending a continuing medical education programme.ResultsThe participating practitioners had never been approached or oriented by the local TB programme. Only 6 of the 106 respondents wrote a prescription with a correct drug regimen. 106 doctors prescribed 63 different drug regimens. There was tendency to over treat with more drugs for longer durations. Only 3 of the 106 respondents could write an appropriate prescription for treatment of multidrug-resistant TB.ConclusionsWith a vast majority of private practitioners unable to provide a correct prescription for treating TB and not approached by the national TB programme, little seems to have changed over the years. Strategies to control TB through public sector health services will have little impact if inappropriate management of TB patients in private clinics continues unabated. Large scale implementation of public-private mix approaches should be a top priority for the programme. Ignoring the private sector could worsen the epidemic of multidrug-resistant and extensively drug-resistant forms of TB.

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fIn an effort to update and clarify policies on tuberculosis drug susceptibility testing (DST), the World Health Organization (WHO) commissioned a systematic review evaluating WHO-endorsed diagnostic tests. We report the results of this systematic review and meta-analysis of the diagnostic accuracy and reproducibility of phenotypic DST for first-line and second-line antituberculosis drugs. This review provides support for recommended critical concentrations for isoniazid and rifampin in commercial broth-based systems. Further studies are needed to evaluate critical concentrations for ethambutol and streptomycin that accurately detect susceptibility to these drugs. Evidence is limited on the performance of DST for pyrazinamide and second-line drugs.T he global epidemic of drug-resistant tuberculosis (DR-TB), particularly multidrug-resistant TB (MDR-TB, defined as resistance to at least isoniazid and rifampin), is one of the most serious problems facing TB care and control efforts. In their most recent worldwide survey, the World Health Organization (WHO) documented the highest rates of MDR-TB ever reported (1). Effective management of drug-resistant TB relies on multiple components, including detection, treatment, prevention, surveillance, and continuous program evaluation (2). Expanding the capacity to diagnose cases of drug-resistant TB is a priority for global TB control, requiring clear policies on the use of diagnostic tests and strengthened laboratories in which testing can be safely and effectively carried out (3).Conventional phenotypic drug susceptibility testing (DST) using the proportion method (PM) on solid media has been well studied for isoniazid and rifampin, with a general consensus achieved regarding methodology, critical concentrations, and expected performance (4). However, the diagnostic accuracy and reproducibility of DST for other first-line and second-line drugs are inadequate (5). DST for second-line anti-TB drugs has not been standardized internationally, which is reflected in the wide variability of practices among supranational reference laboratories, underscoring the need for standardization of the methods and interpretive criteria for second-line DST (4, 6). Further complicating the lack of consensus is the increasing number of different DST methods that are available. In 2008, the WHO Stop TB Department published interim laboratory policy guidance for DST of second-line anti-TB drugs (4). Guideline recommendations for a specific DST method should ideally be based on the diagnostic test accuracy, reproducibility, ease of use, cost, and rapidity of result availability.In an attempt to address gaps in the evidence base, WHO initiated an update to the 2008 interim guidelines with an expanded scope to include DST for all first-line and second-line drugs. As part of the update, we conducted a systematic review to determine the diagnostic accuracy and reproducibility of WHO-endorsed phenotypic DST methods and commercial genotypic DST methods for first-line and second-line anti-TB drugs. Whi...