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Extrapulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Patients with gastrointestinal symptoms who either respond to PPI therapy or exhibit pathological acid exposure on pH monitoring should be diagnosed with GERD. In contrast, patients with gastrointestinal symptoms who do not respond to PPI therapy nor exhibit pathological acid exposure on pH monitoring should be diagnosed with eosinophilic oesophagitis. The principle underlying this distinction is that GERD is the only disease that can cause oesophageal symptoms and eosinophilia and responds to PPI therapy. PPI treatment should last up to 8 weeks to thoroughly check whether it is effective or not.
Patient and public involvement: part 2
Published in Paul Bowie, Carl de Wet, Aneez Esmail, Philip Cachia, Safety and Improvement in Primary Care: The Essential Guide, 2020
PPI has always been and continues to be a key priority in the National Health Service. It potentially affects all aspects of healthcare from planning, design and development, through delivery and finally evaluation and improvement. However, the way in which PPI is translated and enacted in the day-to-day practice of healthcare professionals and the experiences of patients continues to evolve. While much is expected of PPI, and it is thought to confer many potential benefits, there is still a lack of rigorous evidence of its acceptability, feasibility and impact - that is, its overall utility as a method that can contribute to improving the patient experience, capturing learning and making healthcare safer and more efficient.
Upper GI Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Nicola C Tanner, Chris Collins
Histology confirms Barrett's oesophagus with intestinal metaplasia. How would you council and manage this patient?Findings should be discussed with the patient in an outpatient setting within 4–6 weeks, its implications (low but significant risk of cancer), lifestyle changes, indications for surveillance and the possible treatment options. There should be no age limit on offering surveillance due to the potential endoscopic therapies now available. A PPI should be initiated.In accordance with 2013 BSG guidelines on the management of Barrett's oesophagus7, the frequency of surveillance OGD depends on the length of the BO segment and the type of metaplasia. Patient with segments 3 cm or longer should receive surveillance OGD every 2–3 years. Patients with BO shorter than 3 cm with intestinal metaplasia, should receive endoscopic surveillance every 3–5 years. If a patient has a less than 3 cm segment with gastric metaplasia, repeat biopsies should be taken and if this confirms the absence of intestinal metaplasia then the patient can be considered for discharge as the risks of endoscopy probably outweigh the benefits.
Chronic cough: Investigations, management, current and future treatments
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
I. Satia, M. Wahab, E. Kum, H. Kim, P. Lin, A. Kaplan, P. Hernandez, J. Bourbeau, L. P. Boulet, S. K. Field
Lifestyle changes such as avoiding foods that exacerbate acidity, avoiding heavy meals before sleep and raising the head of the bed are important first steps to help control GERD. Guidelines also recommend elimination/reduction of caffeinated beverages (eg, coffee, tea, sodas), alcohol, chocolate, and citrus products.62 A trial of antacid medications (30 mins before meals) for 2 months (proton pump inhibitors [PPI] and H2 antagonists should only be undertaken in patients with objective evidence of reflux or at least symptoms of acid reflux.11 There are a few small randomized controlled trials of PPI in chronic cough and systematic reviews have not shown that PPI reduce coughs in the absence of symptomatic GERD.72,73 Only patients with symptoms of reflux or objective evidence of reflux on esophageal pH monitoring may have a modest benefit from PPI therapy. The duration of PPI trial has not been validated, however a minimum of 8 weeks is likely required to derive benefit.74
Cocaine Increases Sensorimotor Gating and is Related to Psychopathy
Published in Journal of Dual Diagnosis, 2021
Iván Echeverria, Ana Benito, Alejandro Fuertes-Saiz, María Luisa Graña, Isabel Aleixandre, Gonzalo Haro
Considering this above-mentioned literature, one of the research questions posed was whether PPI was related to the psychopathic traits shown by CD patients. Our primary hypothesis proposes that patients with CD and no comorbidities will have higher PPI than controls because they have shown greater restricted interest in drug-seeking behavior and consumption, specifically better at filtering non-drug-related stimuli (irrelevant and relevant). The secondary hypothesis proposes that CD patients will have an increase in psychopathic personality traits, which relate to PPI abnormalities, when compared to controls. A better understanding of PPI in this population could contribute to existing knowledge about the development of such behaviors and aid in the future development of new therapeutic strategies to curb these behaviors.
Incremental Validity of the Durand Adaptive Psychopathic Traits Questionnaire Above Self-Report Psychopathy Measures in Community Samples
Published in Journal of Personality Assessment, 2019
Although the PCL–R does not assess adaptive traits, two well-validated measures of psychopathic traits include an adaptive component in their definition of psychopathy. For instance, the Psychopathic Personality Inventory (PPI) divides eight psychopathic traits into two major factors, namely PPI–I (fearless dominance) and PPI–II (impulsive antisociality; Lilienfeld & Widows, 2005). Whereas PPI–II assesses negative personality traits, as enumerated previously, PPI–I focuses on adaptive characteristics, such as social charm, stress and anxiety immunity, and fearlessness. Although the relationship between PPI–I and the concept of psychopathy is highly debated (Berg et al., 2013; Blonigen, 2013; Lilienfeld et al., 2012; Lynam & Miller, 2012), a vast amount of research support the benefits of high PPI–I traits due to its relation with adaptive personality traits, such as superior attentional control (Baskin-Sommers, Zeier, & Newman, 2009); lower provoked violence (Camp, Skeem, Barchard, Lilienfeld, & Poythress, 2013); higher levels of self-esteem and stable happiness (Durand, 2016, 2018); stress, fear, and anxiety resilience (Dindo & Fowles, 2011; Durand & Plata, 2017); and emotional stability (Uzieblo, Verschuere, Van den Bussche, & Crombez, 2010). However, as noted previously, many experts have associated the construct of successful psychopathy with conscientiousness. Considering that fearless dominance is largely unrelated to conscientiousness, the factor might not be able to fully explain successful psychopathy (Lilienfeld et al., 2015).