A stakeholder-informed approach to the identification of criteria for the prioritization of zoonoses in Canada

Background

Zoonotic diseases account for over 60% of all communicable diseases causing illness in humans and 75% of recently emerging infectious diseases. As limited resources are available for the control and prevention of zoonotic diseases, it is necessary to prioritize diseases in order to direct resources into those with the greatest needs. The selection of criteria for prioritization has traditionally been on the basis of expert opinion; however, details of the methods used to identify criteria from expert opinion often are not published and a full range of criteria may not be captured by expert opinion.

Methodology/Principal Findings

This study used six focus groups to identify criteria for the prioritization of zoonotic diseases in Canada. Focus groups included people from the public, animal health professionals and human health professionals. A total of 59 criteria were identified for prioritizing zoonotic diseases. Human-related criteria accounted for the highest proportion of criteria identified (55%), followed by animal-related criteria (26%) then pathogen/disease-related criteria (19%).Similarities and differences were observed in the identification and scoring of criteria for disease prioritization between groups; the public groups were strongly influenced by the individual-level of disease burden, the responsibility of the scientific community in disease prioritization and the experiences of recent events while the professional groups were influenced by the societal- and population-level of disease burden and political and public pressure.

Conclusions/Significance

This was the first study to describe a mixed semi-quantitative and qualitative approach to deriving criteria for disease prioritization. This was also the first study to involve the opinion of the general public regarding disease prioritization. The number of criteria identified highlights the difficulty in prioritizing zoonotic diseases. The method presented in this paper has formulated a comprehensive list of criteria that can be used to inform future disease prioritization studies.     

Expert opinion on laparoscopic surgery for colorectal cancer parallels evidence from a cumulative meta-analysis of randomized controlled trials

Background

This study sought to synthesize survival outcomes from trials of laparoscopic and open colorectal cancer surgery, and to determine whether expert acceptance of this technology in the literature has parallel cumulative survival evidence.

Study Design

A systematic review of randomized trials was conducted. The primary outcome was survival, and meta-analysis of time-to-event data was conducted. Expert opinion in the literature (published reviews, guidelines, and textbook chapters) on the acceptability of laparoscopic colorectal cancer was graded using a 7-point scale. Pooled survival data were correlated in time with accumulating expert opinion scores.

Results

A total of 5,800 citations were screened. Of these, 39 publications pertaining to 23 individual trials were retained. As well, 414 reviews were included (28 guidelines, 30 textbook chapters, 20 systematic reviews, 336 narrative reviews). In total, 5,782 patients were randomized to laparoscopic (n = 3,031) and open (n = 2,751) colorectal surgery. Survival data were presented in 16 publications. Laparoscopic surgery was not inferior to open surgery in terms of overall survival (HR = 0.94, 95% CI 0.80, 1.09). Expert opinion in the literature pertaining to the oncologic acceptability of laparoscopic surgery for colon cancer correlated most closely with the publication of large RCTs in 2002–2004. Although increasingly accepted since 2006, laparoscopic surgery for rectal cancer remained controversial.

Conclusions

Laparoscopic surgery for colon cancer is non-inferior to open surgery in terms of overall survival, and has been so since 2004. The majority expert opinion in the literature has considered these two techniques to be equivalent since 2002–2004. Laparoscopic surgery for rectal cancer has been increasingly accepted since 2006, but remains controversial. Knowledge translation efforts in this field appear to have paralleled the accumulation of clinical trial evidence.     

Elicitation of Expert Prior Opinion: Application to the MYPAN Trial in Childhood Polyarteritis Nodosa

Objectives

Definitive sample sizes for clinical trials in rare diseases are usually infeasible. Bayesian methodology can be used to maximise what is learnt from clinical trials in these circumstances. We elicited expert prior opinion for a future Bayesian randomised controlled trial for a rare inflammatory paediatric disease, polyarteritis nodosa (MYPAN, Mycophenolate mofetil for polyarteritis nodosa).

Methods

A Bayesian prior elicitation meeting was convened. Opinion was sought on the probability that a patient in the MYPAN trial treated with cyclophosphamide would achieve disease remission within 6-months, and on the relative efficacies of mycophenolate mofetil and cyclophosphamide. Expert opinion was combined with previously unseen data from a recently completed randomised controlled trial in ANCA associated vasculitis.

Results

A pan-European group of fifteen experts participated in the elicitation meeting. Consensus expert prior opinion was that the most likely rates of disease remission within 6 months on cyclophosphamide or mycophenolate mofetil were 74% and 71%, respectively. This prior opinion will now be taken forward and will be modified to formulate a Bayesian posterior opinion once the MYPAN trial data from 40 patients randomised 1:1 to either CYC or MMF become available.

Conclusions

We suggest that the methodological template we propose could be applied to trial design for other rare diseases.     

ETB receptor polymorphism is associated with airway obstruction

Background

Cardiopulmonary exercise testing (CPET) has become an important modality for the evaluation and management of patients with a diverse array of medical problems. However, interpreting these tests is often difficult and time consuming, requiring significant expertise.

Methods

We created a computer software program (XINT) that assists in CPET interpretation. The program uses an integrative approach as recommended in the Official Statement of the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) on Cardiopulmonary Exercise Testing. In this paper we discuss the principles behind the software. We also provide the detailed logic in an accompanying file (Additional File 1). The actual program and the open source code are also available free over the Internet at http://www.xint.org. For convenience, the required download files can also be accessed from this article.

Results

To test the clinical usefulness of XINT, we present the computer generated interpretations of the case studies discussed in the ATS/ACCP document in another accompanying file (Additional File 2). We believe the interpretations are consistent with the document's criteria and the interpretations given by the expert panel.

Conclusion

Computers have become an integral part of modern life. Peer-reviewed scientific journals are now able to present not just medical concepts and experimental studies, but actual functioning medical interpretive software. This has enormous potential to improve medical diagnoses and patient care. We believe XINT is such a program that will give clinically useful interpretations when used by the medical community at large.     

Customized scoring and weighting approaches for quantifying and aggregating results in social life cycle impact assessment

Purpose

In social life cycle assessment (SLCA), to measure the social performance, it is necessary to consider the subcategory indicators related to each stakeholder dimension, such as workers, local community, society, consumers and value chain participants. Current methods in SLCA scientific literature consider a standard arbitrary linear score set to translate qualitative performances into a quantitative assessment for all subcategory indicators, i.e., it translate a A, B, C, D scoring into a 4, 3, 2, 1 ordinal scale. This assumption does not cover the complexity of the subcategory indicators in the social life cycle assessment phase. The aim of this paper is to set out a customized scoring and weighting approach for impact assessment in SLCA beyond the assumption of arbitrary linearity and equal weighting.

Methods

This method overcomes the linearity assumption and develops specific value functions for each subcategory indicator and an approach to establish the weighting factors between the indicators for each social dimension (workers, local community, and society). The value function and weighting factors are based on the considered opinions of SLCA experts in Québec.

Results and discussion

The results show that value functions with different shapes used to score the performance of the product within each subcategory indicator influence SLCA results and have the potential to reverse the conclusions. The customized score is more realistic than the linear score because it can better capture the complexity of the subcategory indicators based on SLCA expert judgment.

Conclusions

Our approach addresses a methodological weakness of the impact assessment phase of SLCA through a more representative performance of the potential social impacts based on the judgment of the SLCA expert rather than a simplified assumption of linearity and equal weighting among indicators. This approach may be applied to all types of product systems.

Recommendations

The value functions and weighting factors cannot be generalized for all cases and the proposed approach must be adapted for each study. We stopped at the aggregation of the subcategory indicators based on expert judgment at the stakeholder level. If a complete aggregation in a single score is required, we recommend developing a framework that accounts for the value judgment of the decision-maker rather than the SLCA expert.

     

Diabetes screening intervals based on risk stratification

Background

Guidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed screening intervals typically based on expert opinion. This study aims to demonstrate that HbA1c screening intervals may differ substantially when considering individual risk for diabetes.

Methods

This was a multi-institutional retrospective open cohort study. Data were collected between April 1999 to March 2014 from one urban and one rural cohort in Japan. After categorization by age, we stratified individuals based on cardiovascular disease risk (Framingham 10-year cardiovascular risk score) and body mass index (BMI). We adapted a signal-to-noise method for distinguishing true HbA1c change from measurement error by constructing a linear random effect model to calculate signal and noise of HbA1c. Screening interval for HbA1c was defined as informative when the signal-to-noise ratio exceeded 1.

Results

Among 96,456 healthy adults, 46,284 (48.0%) were male; age (range) and mean HbA1c (SD) were 48 (30–74) years old and 5.4 (0.4)%, respectively. As risk increased among those 30–44 years old, HbA1c screening intervals for detecting Type 2 DM consistently decreased: from 10.5 (BMI <18.5) to 2.4 (BMI?>?30) years, and from 8.0 (Framingham Risk Score <10%) to 2.0 (Framingham Risk Score ≥20%) years. This trend was consistent in other age and risk groups as well; among obese 30–44 year olds, we found substantially shorter intervals compared to other groups.

Conclusion

HbA1c screening intervals for identification of DM vary substantially by risk factors. Risk stratification should be applied when deciding an optimal HbA1c screening interval in the general population to minimize overdiagnosis and overtreatment.

     

Exercise-based cardiac rehabilitation in patients with coronary heart disease: a practice guideline

Background

To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) the CR guideline from the Dutch Royal Society for Physiotherapists (KNGF) has been updated. This guideline can be considered an addition to the 2011 Dutch Multidisciplinary CR guideline, as it includes several novel topics.

Methods

A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based interventions during all CR phases in patients with CHD. Evidence was graded (1–4) according the Dutch evidence-based guideline development (EBRO) criteria. In case of insufficient scientific evidence, recommendations were based on expert opinion. This guideline comprised a structured approach including assessment, treatment and evaluation.

Results

Recommendations for exercise-based CR were formulated covering the following topics: preoperative physiotherapy, mobilisation during the clinical phase, aerobic exercise, strength training, and relaxation therapy during the outpatient rehabilitation phase, and adoption and monitoring of a physically active lifestyle after outpatient rehabilitation.

Conclusions

There is strong evidence for the effectiveness of exercise-based CR during all phases of CR. The implementation of this guideline in clinical practice needs further evaluation as well as the maintenance of an active lifestyle after supervised rehabilitation.     

Integrating expert knowledge and ecological niche models to estimate Mexican primates’ distribution

Ecological niche modeling is used to estimate species distributions based on occurrence records and environmental variables, but it seldom includes explicit biotic or historical factors that are important in determining the distribution of species. Expert knowledge can provide additional valuable information regarding ecological or historical attributes of species, but the influence of integrating this information in the modeling process has been poorly explored. Here, we integrated expert knowledge in different stages of the niche modeling process to improve the representation of the actual geographic distributions of Mexican primates (Ateles geoffroyi, Alouatta pigra, and A. palliata mexicana). We designed an elicitation process to acquire information from experts and such information was integrated by an iterative process that consisted of reviews of input data by experts, production of ecological niche models (ENMs), and evaluation of model outputs to provide feedback. We built ENMs using the maximum entropy algorithm along with a dataset of occurrence records gathered from a public source and records provided by the experts. Models without expert knowledge were also built for comparison, and both models, with and without expert knowledge, were evaluated using four validation metrics that provide a measure of accuracy for presence-absence predictions (specificity, sensitivity, kappa, true skill statistic). Integrating expert knowledge to build ENMs produced better results for potential distributions than models without expert knowledge, but a much greater improvement in the transition from potential to realized geographic distributions by reducing overprediction, resulting in better representations of the actual geographic distributions of species. Furthermore, with the combination of niche models and expert knowledge we were able to identify an area of sympatry between A. palliata mexicana and A. pigra. We argue that the inclusion of expert knowledge at different stages in the construction of niche models in an explicit and systematic fashion is a recommended practice as it produces overall positive results for representing realized species distributions.     

A nationwide telepathology consultation and quality control program in China: implementation and result analysis

Background

Telepathology may play an important role in pathology consultation and quality control for cancer diagnosis in China, as the country has the largest population of cancer patients worldwide. In 2011, the Pathology Quality Control Center of China and Ministry of Health developed and implemented a nationwide telepathology consultation and quality control program for cancer diagnosis in China. We here report the results of the two-year implementation and experiences.

Methods

the program built an Internet based telepathology platform to connect participating hospitals and expert consultants. The hardware and software used for the platform were validated in previous validation studies in China. The program had three regional centers consisting of Peking Union Medical College, Huasi Medical College of Sichuan and 2nd affiliated hospital of Zhejiang University. It also had 20 provincial consultation centers based in the provincial referral hospitals. 80 provincial or national pathologists served as expert consultants for the program, providing telepathology consultation for cancer diagnosis for more than 60 participating hospitals.

Results

from 2011 to July 2013, 16,247 pathology cases were submitted to the platform for consultation. Among them, 84% were due to diagnostic difficulty and 16% were due to request by patients. The preliminary diagnosis provided by submitting pathologists were in agreement with expert opinion in 59.8% of cases but was in disagreement with expert opinion in 24.2% of cases. 16.0% of cases were not provided with preliminary diagnosis. The distribution of pathology cases by system or organ were: digestive system, 17.3%; gynecologic system, 16.7%; head and neck, 15.7%; bone and soft tissue, 10.4%; lung and mediastinum, 8.6%; breast, 7.6%; urinary system, 7.5%; hematopathology, 6.4%; skin, 5.2%; neuropathology, 2.5% and cytopathology, 1.3%. Expert consultants also provided assessment of quality of slide preparation and staining, online lectures and guidance for pathology quality control.

Conclusion

our results of two years' implementation indicated that telepathology could solve the problem of uneven distribution of pathology resources and provide a solution for countrywide pathology quality control in China. Telepathology could play an important role in improving pathology diagnosis in China.

     

Declining <Emphasis Type="Italic">Google Trends</Emphasis> of public interest in biodiversity: semantics,statistics or traceability of changing priorities?

The paper examines a series of critiques and alternative propositions regarding the assumption of declining public interest in biodiversity related issues uncovered by Google Trends of query volumes since 2004. GTs are compared to actual results of public opinion polls among European Union nationals during the period 2004–2016. Critiques are re-examined at both the statistic and cultural-linguistic level. Results tend to support the initial statement of declining GT for biodiversity. The need for a new communication discourse regarding biodiversity issues is repeated if public opinion is to be engaged in conservation issues.     

Politics or metaphysics? On attributing psychological properties to animals

Following recent arguments that there is no logical problem with attributing mental or agential states to animals, I address the epistemological problem of how to go about making accurate attributions. I suggest that there is a two-part general method for determining whether a psychological property can be accurately attributed to a member of another species: folk expert opinion and functionality. This method is based on well-known assessments used to attribute mental states to humans who are unable to self-ascribe due to an early stage of development or impairment, and can be used to describe social and emotional development as well as personality. I describe how instruments such as the Child Behavior Checklist, which relies on intersubjective expert opinion, could be modified to assess other species subjects. The measures are validated via the accuracy of the predictions that are derived, which is an example of the functionality of attribution. I respond to theoretical criticisms against use of this method, and argue that if the method counts as good science for infant cognition research, then it should count as good science for animal cognition research as well. Correspondingly, if the method doesn’t count as good science for animal cognition research, then we must be very skeptical of its use with nonverbal humans.

Review of LCA datasets in three emerging economies: a summary of learnings

Purpose

In response to a need for interoperable LCA databases of adequate quality, a review of 40 datasets from emerging economies has been conducted with UNEP support by independent LCA experts, with the purpose to encourage improvements, either prior to publication or as part of a continuous improvement cycle. We discuss the lessons learned during this reviewing process.

Methods

The review effort had to be delivered in a set and limited timeline of 9 months and covered 20 datasets from Malaysia, ten from Brazil, and ten from Thailand. The developed review process consisted in, among others, (i) developing a set of review criteria for this specific effort, (ii) pairing a local sector reviewer with an international LCA expert to enhance capacity development, (iii) establishing a legal relationship via a non-disclosure agreement (NDA) between the data provider and the data reviewers, and (iv) providing a review report for each dataset that assesses the presence and magnitude of gaps or deficiencies relative to the criteria, as well as their implications for qualifying usage.

Results and discussion

The reviews provided solid recommendations for improvement to the majority of the datasets submitted by the three countries. This review exercise has been conducted in the given timeframe for the majority of the datasets. Many challenges have been faced along the way; among them agreeing on an NDA, the need for sufficient information, and the question of the confidentiality of the data. The developed set of criteria for this exercise have not been presented or discussed outside of the narrow review exercise and therefore can be seen as a starting point for further debates and improvements that should involve the broad LCA community.

Conclusions

This hands-on exercise provided some valuable insights into the road towards global consensus and guidance on data review. Beyond this time-constrained effort, a broader discussion and consensus at international level on the review of datasets and a continuous effort in reviewing datasets is desirable. Four key aspects were identified as necessary to consider: review criteria, review process, reviewers’ selection criteria, and development of a legal basis which protects the confidentiality of the data, as well as the position of the reviewers. This last aspect is sensitive as, in LCA datasets reviews, companies and/or countries might disclose some information with high stakes regarding competition and trade.

     

Likely health outcomes for untreated acute febrile illness in the tropics in decision and economic models; a Delphi survey

Background

Modelling is widely used to inform decisions about management of malaria and acute febrile illnesses. Most models depend on estimates of the probability that untreated patients with malaria or bacterial illnesses will progress to severe disease or death. However, data on these key parameters are lacking and assumptions are frequently made based on expert opinion. Widely diverse opinions can lead to conflicting outcomes in models they inform.

Methods and Findings

A Delphi survey was conducted with malaria experts aiming to reach consensus on key parameters for public health and economic models, relating to the outcome of untreated febrile illnesses. Survey questions were stratified by malaria transmission intensity, patient age, and HIV prevalence. The impact of the variability in opinion on decision models is illustrated with a model previously used to assess the cost-effectiveness of malaria rapid diagnostic tests. Some consensus was reached around the probability that patients from higher transmission settings with untreated malaria would progress to severe disease (median 3%, inter-quartile range (IQR) 1–5%), and the probability that a non-malaria illness required antibiotics in areas of low HIV prevalence (median 20%). Children living in low transmission areas were considered to be at higher risk of progressing to severe malaria (median 30%, IQR 10–58%) than those from higher transmission areas (median 13%, IQR 7–30%). Estimates of the probability of dying from severe malaria were high in all settings (medians 60–73%). However, opinions varied widely for most parameters, and did not converge on resurveying.

Conclusions

This study highlights the uncertainty around potential consequences of untreated malaria and bacterial illnesses. The lack of consensus on most parameters, the wide range of estimates, and the impact of variability in estimates on model outputs, demonstrate the importance of sensitivity analysis for decision models employing expert opinion. Results of such models should be interpreted cautiously. The diversity of expert opinion should be recognised when policy options are debated.     

Expert-based versus habitat-suitability models to develop resistance surfaces in landscape genetics

Landscape genetics aims to investigate functional connectivity among wild populations by evaluating the impact of landscape features on gene flow. Genetic distances among populations or individuals are generally better explained by least-cost path (LCP) distances derived from resistance surfaces than by simple Euclidean distances. Resistance surfaces reflect the cost for an organism to move through particular landscape elements. However, determining the effects of landscape types on movements is challenging. Because of a general lack of empirical data on movements, resistance surfaces mostly rely on expert knowledge. Habitat-suitability models potentially provide a more objective method to estimate resistance surfaces than expert opinions, but they have rarely been applied in landscape genetics so far. We compared LCP distances based on expert knowledge with LCP distances derived from habitat-suitability models to evaluate their performance in landscape genetics. We related all LCP distances to genetic distances in linear mixed effect models on an empirical data set of wolves (Canis lupus) from Italy. All LCP distances showed highly significant (P ≤ 0.0001) standardized β coefficients and R ² values, but LCPs from habitat-suitability models generally showed higher values than those resulting from expert knowledge. Moreover, all LCP distances better explained genetic distances than Euclidean distances, irrespective of the approaches used. Considering our results, we encourage researchers in landscape genetics to use resistance surfaces based on habitat suitability which performed better than expert-based LCPs in explaining patterns of gene flow and functional connectivity.     

What causes more LCA research—subjective values,objective problems,or scientific traditions?

Purpose

This paper aims to verify whether life cycle assessment (LCA) research can be mainly treated as a kind of pro-environmental behavior due to public environment concerns, or academic and research activities based on scientific traditions.

Methods

This paper uses the international comparisons method for modeling and SPSS 16.0 for data processing. The data in this study were obtained from the Human Development Report by the United Nations Development Programme and the Web of Science by the Institute for Scientific Information.

Results and discussion

Our empirical study shows that the two main factors influencing the outputs per capita of the research articles in LCA in a particular country are the value of Environmental Performance Index, which represents the overall environmental quality, as well as the outputs per capita of the research articles in environmental science and technology. The results of statistical analysis show two J-type curves: with the change of the independent variables, the dependent variable changes in the same direction, but at a rate that is first slow, then fast.

Conclusions

LCA research results from scientific traditions and can only develop based on fundamental research in environmental science and technology. Further, LCA research is a pro-environmental behavior due to actual and objective effects rather than subjective motives as more research on LCA can accompany, even in some degree may lead to better overall environmental qualities. However, although environmental concerns are likely to affect the number of LCA studies as an implicit variable, this has not been empirically confirmed in our optimization model.

     

Can pre-collected register data be used to identify dairy herds with good cattle welfare?

Background

Pre-recorded register data from dairy herds are available in almost all Nordic countries. These databases can be used for research purposes, and one of the research areas is animal welfare. The aim of this study was to investigate if pre-recorded register data could be used to identify herds with good welfare, and to investigate if a combination of register data sets could be used to be able to more correctly distinguish between herds with good welfare and herds with welfare deficiencies.

Methods

As a first step, nine animal-based measurements on calves, young stock and cows in 55 randomly selected herds were performed on-farm as the basis for a classification of welfare at the herd level. The definition for being a case herd with “good welfare” was no score lying among the 10% worst in any of the nine welfare measurements. Twenty-eight of the 55 herds were cases according to this definition. As a second step, 65 potential welfare indicators, based on register data in a national dairy database, were identified by expert opinion. In the final step, the extent to which the suggested welfare indicators predicted farms’ as having good welfare according to the stated definition was assessed. Moreover, the effect of combining in sequence a previously developed model that identified herds with poor welfare with the present model identifying herds with good welfare was investigated.

Results

The final set of welfare indicators used to identify herds with good animal welfare included two fertility measures, cow mortality, stillbirth rate, mastitis incidence and incidence of feed-related diseases (including gastrointestinal disturbances but excluding paralyses and cramps). This set had a test sensitivity of correctly classifying herds with no score lying among the 10% worst of the nine welfare measurements of 96 %. However, the specificity of the test was only 56% indicating difficulties for the test to correctly classifying herds with one or more scores lying among the 10% worst. Combining the previously developed model with the present model, improved the welfare classification.

Conclusions

This study shows that pre-collected register data may be used to give approval to dairy farms with “good welfare” and that combining different sets of register data can improve the classification of herd welfare.

     

Obstetricians’ Opinions of the Optimal Caesarean Rate: A Global Survey

Background

The debate surrounding the optimal caesarean rate has been ongoing for several decades, with the WHO recommending an “acceptable” rate of 5–15% since 1997, despite a weak evidence base. Global expert opinion from obstetric care providers on the optimal caesarean rate has not been documented. The objective of this study was to examine providers’ opinions of the optimal caesarean rate worldwide, among all deliveries and within specific sub-groups of deliveries.

Methods

A global online survey of medical doctors who had performed at least one caesarean in the last five years was conducted between August 2013 and January 2014. Respondents were asked to report their opinion of the optimal caesarean rate—defined as the caesarean rate that would minimise poor maternal and perinatal outcomes—at the population level and within specific sub-groups of deliveries (including women with demographic and clinical risk factors for caesareans). Median reported optimal rates and corresponding inter-quartile ranges (IQRs) were calculated for the sample, and stratified according to national caesarean rate, institutional caesarean rate, facility level, and respondent characteristics.

Results

Responses were collected from 1,057 medical doctors from 96 countries. The median reported optimal caesarean rate was 20% (IQR: 15–30%) for all deliveries. Providers in private for-profit facilities and in facilities with high institutional rates reported optimal rates of 30% or above, while those in Europe, in public facilities and in facilities with low institutional rates reported rates of 15% or less. Reported optimal rates were lowest among low-risk deliveries and highest for Absolute Maternal Indications (AMIs), with wide IQRs observed for most categories other than AMIs.

Conclusions

Three-quarters of respondents reported an optimal caesarean rate above the WHO 15% upper threshold. There was substantial variation in responses, highlighting a lack of consensus around which women are in need of a caesarean among obstetric care providers worldwide.     

The perception of Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS) among Italian general practitioners

Background

Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS) is a common disorder in the general population but often underestimated and underdiagnosed.

Methods

This questionnaire-based study evaluated the overall level of knowledge about OSAHS among Italian General Practitioners (GPs), who are frequently involved in the management of this complex disease. This represents an interesting aspect, because GPs intercept many of the patients with OSAHS, in which C-PAP could be potentially indicated. Randomly-selected GPs were provided with questionnaires, which were then returned anonymously.

Results

80 questionnaires have been validated; the participants in the sample examined were represented by 43 females and 37 males; the average age of participants was 51 years. The general knowledge on OSAHS is overall satisfactory among GPs; it is recognized by most of the GPs interviewed as pathology in constant increase, and associated with predisposing factors such as obesity. High blood pressure is perceived as an independent cardiovascular risk factor in patients with OSAHS, in line with the majority of international studies. The C-PAP has been identified as the care gold standard in patients with OSAHS, despite the lack of patient compliance in relation to this procedure, while polysomnography was found to be the main instrumental procedure used in the diagnostic workup of OSAS. The pulmonologist and a multidisciplinary team have been identified as the specialist figures of reference to which to direct the patient through the diagnostic workup. Respiratory therapists and nurses represent the role of educator in the proper management of the C-PAP in the opinion of 62% of respondents, while only 34% think that this role should be played by the GPs and/or other specialists.

Conclusions

In conclusion, this survey about the perception of OSAHS among GPs in Italy highlighted a satisfactory overall knowledge of OSAHS and only few weak points.