Conectar
Approximately 6%–10% of adults carry food allergy labels. Many such labels are unverified and may be incorrect, contributing to delays in appropriate care, significant dietary restriction, anxiety and unnecessary use of emergency medications. Oral food challenges (OFCs) are the gold standard for confirming or excluding food allergy, but the current model of clinic-based challenges often has long wait times and logistical barriers. This study aims to investigate the feasibility and safety of home-based OFCs compared with standard in-clinic challenges in adults with negative skin-prick testing.
Food Challenge at HOme or in Medical Practice is a pilot multicentre randomised controlled trial enrolling 120 adults with reported food allergy labels and negative skin prick testing to the implicated food. Participants will be randomised 1:1 to undergo an OFC either at home or in-clinic. The study is designed to generate feasibility and preliminary safety data for home-based OFC, measured by the proportion of participants experiencing immune-mediated adverse events (AEs), compared with clinic-based OFC. Feasibility metrics (screening to recruitment ratio, protocol completion), non-immune AEs, protocol adherence and quality of life assessed using the Food Allergy Quality of Life Questionnaire-12 at baseline prior to OFC and 6 months post OFC will also be collected. Statistical analysis will include descriptive statistics, with comparisons between arms using risk differences and relative risks with 95% CIs.
The trial has received ethics approval from the Austin Health Human Research Ethics Committee (HREC/111750/Austin-2024). Findings will be disseminated through peer-reviewed publications and scientific meetings. Data will be presented in aggregated, de-identified form.
Continuous pulse oximetry monitoring has been used in patient deterioration recognition systems for decades. For patients on supplemental O2, questions related to the effectiveness of this approach have been raised due to elevation of SpO2 from O2 therapy. We examine this issue in the context of a stable inpatient continuous pulse oximetry-based rescue system with the aim of ascertaining if patients receiving supplemental oxygen are at risk of experiencing clinically meaningful delays in deterioration recognition as compared to patients on room air.
Retrospective observational analysis.
Clinical markers of deterioration recognition timeliness and impact were compared for patients receiving various levels of supplemental oxygen and those on room air over 6 years. Chart review was conducted to assess cause and likelihood of preventability and improvement in detection with other monitoring modalities for emergent cases.
Analysis adjusted for patient characteristics, and population level supplemental oxygen use showed no difference between patients on supplemental oxygen vs. room air for transfer rate, emergent transfer rate, or death after rescue or transfer. Analysis excluding population supplemental oxygen modeling showed limited increases in event likelihood, but not for emergent transfers. Chart review of emergent transfers revealed no pattern of delay in recognition of deterioration for patients on supplemental oxygen.
This study found no evidence that pulse oximetry-based continuous monitoring significantly degrades or delays detection of severe deterioration episodes for patients receiving supplemental oxygen. These findings challenge arguments suggesting pulse oximetry is not an appropriate continuous monitoring modality for general care patients receiving oxygen.
This study provides clinical nurses with information about using continuous monitoring when caring for patients who are receiving supplemental oxygen in the general care setting. The study also assesses patient safety of the practice of using pulse oximetry for monitoring in this patient population.
This study addresses concerns related to using continuous pulse oximetry monitoring for deterioration detection when patients are receiving supplemental oxygen. This study found no evidence that pulse oximetry-based continuous monitoring significantly degrades or delays detection of severe deterioration episodes for patients receiving supplemental oxygen. The results can be used by the inpatient nursing community to ensure safe practices are in place for patient care.
This study adheres to the STROBE reporting method.
Patient and/or public contribution was not deemed applicable for the rigorous design and execution of this study.
One of the challenges in managing patients with hantavirus infection is accurately identifying individuals who are at risk of developing severe disease. Prompt identification of these patients can facilitate critical decisions, such as early referral to an intensive care unit. The identified prognostic factors could be of utility in guiding medical care to enhance the management of hantavirus infection.
To identify and evaluate prognostic factors associated with mortality in hantavirus infection.
We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-reported systematic review following Cochrane guidance adapted for prognosis. We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Biblioteca Virtual de Saúde or Lilac and EMBASE, from 1 January 1993 to 2 October 2025. We included studies evaluating individual prognostic factors or risk assessment models of New World hantavirus infections, with no restrictions on study design, publication status or language. When feasible, we conducted meta-analyses for prognostic factors using the inverse variance-based method with random effect model. We assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.
We included 25 studies with a total of 7284 participants. We identified the following prognostic factors for which we found moderate to high certainty that are associated with increased mortality: age over 18 years, female sex, rural residence, elevated creatinine levels, increased haematocrit, signs of bleeding and the presence of infiltrates on chest radiographs.
Our systematic review identified prognostic factors for mortality in patients with New World hantavirus infection. These factors can inform clinicians in making more informed management decisions. Furthermore, our findings lay the groundwork for the future development of a clinical prognostic model, potentially enhancing patient care and outcomes.
CRD42021225823.
The predisposition to food allergy development and the induction of allergen-specific immune responses appears to be initiated early in infancy. Early exposure to food allergens, such as peanut and cashew nut, via human milk is likely important in initiating oral tolerance and reducing risk of food allergy development. This trial aims to determine if the risk of developing peanut and cashew nut allergy during infancy can be reduced by a high peanut and cashew nut maternal diet during lactation.
This is a multisite, parallel, two-arm (1:1 allocation), single-blinded (outcome assessors, statistical analyst and investigators), randomised controlled trial. Target sample size is 4412 participants (2206 per group). Women (aged 18–50 years) with a singleton pregnancy, who are planning to breastfeed and do not have peanut and/or cashew nut allergies are eligible to participate. After obtaining written informed consent, participants are randomised to either a high peanut and cashew nut diet (at least 60 peanuts and 40 cashew nuts per week) or a low peanut and cashew nut diet (no more than 20 peanuts and 12 cashew nuts per week). Participants are asked to follow their allocated diet from birth to 6 months postnatal. Individual lactation consultant advice and support is provided as required. The study’s primary outcome is food challenge proven IgE-mediated peanut and/or cashew nut allergy during infancy (0–18 months). Key secondary outcomes include infant sensitisation to peanut and/or cashew nut. Analyses will be performed on an intention-to-treat basis according to a prespecified statistical analysis plan.
Ethical approval has been granted from the Western Australian Child and Adolescent Health Service Human Research Ethics Committee (approval number RGS0000006685). Trial results will be presented at scientific conferences and published in peer-reviewed journals.
Australian New Zealand Clinical Trials Registry (ACTRN ACTRN12624000134527)
To determine how high performing is defined in relation to a health system and chart the literature on the definitions and key concepts of high-performing healthcare systems.
Scoping review.
MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were searched from inception to July 2024. The grey literature was also searched.
Included studies reported on health systems and high performance to identify explicit definitions, research outcomes and knowledge gaps.
Two reviewers independently screened 5721 citations and 507 full-text articles, resulting in the inclusion of 35 primary articles and 47 companion documents in the review. Three independent definitions for a high-performance health system were identified. 24 research studies reported outcomes on the elements of a high-performing health system (58%), system evaluation (32%) and tool development or validation (10%). Knowledge gaps identified were the lack of a common definition, a lack of common indicators, strategies for moving evidence into policy and practice, and difficulties with comparisons across health systems.
We found limited definitions and a lack of empirical evidence on our topic. There is an opportunity for primary research in the area of health systems and high performance.
FreshRSS 