Canadian Journal of Respiratory, Critical Care, and Sleep Medicine最新文献

{"title":"Air Quality Health Index in primary care: A feasibility study","authors":"Ross E. G. Upshur, A. Abelsohn, A. D’Urzo, B. O’Neill, Farhan M. Asrar, S. B. Hashemi, Sheena Melwani, B. Aliarzadeh","doi":"10.1080/24745332.2022.2043204","DOIUrl":"https://doi.org/10.1080/24745332.2022.2043204","url":null,"abstract":"Abstract Rationale: Exposure to poor air quality is associated with increased morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD), asthma and heart failure. A number of countries, including Canada, report utilization of the Air Quality Health Index (AQHI) and associated health messages tailored to different AQHI categories for the public and at-risk populations to reduce exposure, adjust physical activity and optimize clinical management. Studies indicate AQHI advisories may not adequately reach or inform at-risk populations. Objectives: The objectives of this study were to design a text alert system and evaluate the feasibility of delivering AQHI forecast alerts to participants when AQHI readings exceeded low health risk. Secondary and tertiary objectives were to determine the frequency and accuracy of the alerts. Methods: Feasibility was assessed by the following steps: recruiting older adults with asthma, COPD and heart failure from primary care practices; developing software for extracting AQHI data from the Health Canada database; registering patients on the automatic dispatch messages system; and automatically sending AQHI forecast alerts of moderate health risk or above to participants’ cell-phones the preceding night. Results: We successfully queried the Environment Canada database, detected AQHI alerts and delivered them to participants. Forecast alerts of moderate health risk were higher in summer and winter 2018-2019 in the study areas. The accuracy of AQHI forecast alerts for North Toronto versus Downtown Toronto were 81.7% (75.9 − 86.6%) and 80.7% (74.8 − 85.7%), respectively. Conclusions: Delivering AQHI alerts through text messages to patients in the primary care setting was feasible. Colder seasons should not be underestimated for moderate risk AQHI conditions.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"28 1","pages":"248 - 255"},"PeriodicalIF":0.8,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76586647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 mRNA vaccine-induced lung injury: A case report","authors":"Pauline Luczynski, K. Aboulhosn","doi":"10.1080/24745332.2022.2048979","DOIUrl":"https://doi.org/10.1080/24745332.2022.2048979","url":null,"abstract":"Abstract Vaccination is the most effective method for preventing severe COVID-19 illness. With billions of people having received the COVID-19 mRNA vaccine, rare adverse events are now surfacing. We report a case of acute lung injury with concurrent inflammatory pneumonitis, pneumothorax and pulmonary emboli following mixed COVID-19 mRNA vaccination. The patient was admitted to hospital for hypoxemic respiratory failure and gradually improved clinically and radiographically after treatment with steroids. As our population is vaccinated against COVID-19, including boosters, mixed vaccination will undoubtably become more common. It will therefore be important to recognize that lung injury may be a rare but serious adverse reaction to the COVID-19 mRNA vaccine, with mixed mRNA vaccination being a possible added risk factor.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"26 1","pages":"216 - 220"},"PeriodicalIF":0.8,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86422849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of airway inflammation and disease burden in moderate to severe asthmatic smokers","authors":"C. Lemière, A. Forget, L. Blais","doi":"10.1080/24745332.2022.2043206","DOIUrl":"https://doi.org/10.1080/24745332.2022.2043206","url":null,"abstract":"Abstract BACKGROUND: Conflicting results have been found among studies assessing the effect of smoking on airway inflammation among asthmatic subjects. OBJECTIVE: We sought to compare the inflammatory and clinical characteristics of active smokers and nonsmokers with uncontrolled moderate-to-severe asthma. Methods: We conducted a cross-sectional study comparing active-smoker and nonsmoker subjects with uncontrolled moderate-to-severe asthma. Sociodemographic and clinical data were collected. FeNO levels and spirometry were measured. We obtained sputum and blood cell counts and measured the cotinine level. The clinical data were linked to 3 Québec administrative databases. RESULTS: A total of 40 active smokers and 39 nonsmokers were included. Uncontrolled asthmatic smokers and nonsmokers had the same clinical characteristics. Although, blood eosinophil counts were similar between groups, the number of subjects with a high sputum eosinophil count (> 10%) was higher in nonsmokers. Asthmatic smokers had lower levels of FeNO than nonsmoker asthmatics. The nonsmoker group showed a higher number of total asthma exacerbations (1.9 ± 0.7) than the smoker group (1.0 ± 1.2) (p < 0.01) in the year preceding their assessment. The annual costs related to asthma care tended to be higher in uncontrolled asthmatic nonsmokers (352.05 ± 813.45CAD) than in smokers (263.38 ± 684.00CAD), whereas the annual cost for health care of all causes tended to be lower in nonsmokers (1617.57 ± 1736.53 CAD) than in smokers (2575.07 ± 3453.30 CAD). INTERPRETATION: The clinical characteristics of uncontrolled moderate-to-severe active asthmatic smokers and nonsmokers were similar. Although the FeNO levels were profoundly affected by smoking, the impact of smoking on airway eosinophilic inflammation appeared marginal. CLINICAL TRIAL REGISTRATION: NCT02833727","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"57 5 1","pages":"256 - 264"},"PeriodicalIF":0.8,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80818341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indwelling tunneled pleural catheters in patients with hepatic hydrothorax: A single-center analysis for outcomes and complications","authors":"Fatmah F. Alhabeeb, K. Carle-Talbot, N. Rakocevic, Tinghua Zhang, Michael A. Mitchell, K. Amjadi, Chanel Kwok","doi":"10.1080/24745332.2022.2125459","DOIUrl":"https://doi.org/10.1080/24745332.2022.2125459","url":null,"abstract":"Abstract Rationale Patients with refractory hepatic hydrothorax (HH) are challenging to manage due to associated risks involved with repeated procedures required for drainage of the effusion. There is paucity of data describing the role of indwelling pleural catheters (IPC) in HH. We describe our experience with IPCs for management of refractory HH in collaboration with our homecare nursing services. Objective We are describing our Canadian experience using IPCs for HH, focusing on outcomes, safety, and complications to improve the management of this condition. Methods This is a retrospective study of a prospectively maintained database of all patients with HH who underwent IPC insertion between May 2006 and February 2019 at our tertiary center. Patients’ characteristics, procedural variables, outcomes and estimated survival analysis post IPC insertion were analyzed. Measurements and main results A total of 40 patients underwent 43 IPC insertions. Seven catheters (17.5%) resulted in pleural infection, without any associated deaths. Mean pleural fluid protein level was lower among patients who developed pleural infection compared to those who did not (11.5 g/L vs 16 g/L; p = 0.0015). Median survival was 12.7 months (95% CI, 6.4-43.4). Twenty-one catheters were removed within 149 days (+/- 50.2). Twelve patients died with the IPC in-situ within 69.5 days (+/- 48.7). Conclusion In refractory HH, IPCs can be safely used. Associated complications can be mitigated with frequent clinical monitoring and intermittent drainage of the effusion by dedicated homecare nursing services. Further studies establishing the role for prophylactic antibiotics in high-risk population may be of value.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"27 1","pages":"4 - 9"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79664876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilation and perfusion abnormalities following recovery from noncritical COVID-19","authors":"Carmen Venegas, C. Marriott, T. Ho, K. Son, R. Jamil, Meher Jamal, M. Kjarsgaard, Chynna Huang, K. Radford, M. Dolovich, C. Farrow, T. Farncombe, Matthew Lubanovic, E. Haider, P. Nair, M. Mukherjee, S. Svenningsen","doi":"10.1080/24745332.2022.2054047","DOIUrl":"https://doi.org/10.1080/24745332.2022.2054047","url":null,"abstract":"Abstract RATIONALE: Dyspnea and respiratory impairment are sequelae of COVID-19. OBJECTIVES The objectives of this study were to observe the prevalence and clinical relevance of ventilation (V) and perfusion (Q) impairment, evaluated by ventilation/perfusion-single-photon emission computed tomography-computed tomography (VQ-SPECT-CT), in individuals with no history of lung disease 4-weeks after recovery from noncritical COVID-19. METHODS We enrolled 25 COVID-19 patients’ post-recovery and 11 control subjects. All participants underwent VQ-SPECT-CT using 99mTc-Technegas for V and 99mTc-macroaggregated albumin for Q, spirometry, six-minute-walk-test, blood draw and completed the modified Medical Research Council (mMRC) dyspnea-scale and St. Georges Respiratory Questionnaire (SGRQ). VQ-SPECT-CT was reviewed to report lung function and structure abnormalities and ventilation-heterogeneity was quantified to evaluate associations with symptoms, exercise-capacity and inflammatory markers. MEASUREMENTS AND MAIN RESULTS: Of 25 post-COVID-19 participants, 9 were hospitalized and 16 home-isolated during acute-infection. A total of 88% of hospitalized and 44% of home-isolated participants were reported to have V defects (matched VQ defects: 63% and 44%; mismatched V defects: 38% and 13%), compared to 30% of never-COVID-19 controls (matched VQ defects: 30%, mismatched V defects: 10%) (P = 0.02 and P = 0.68, respectively). Ventilation-heterogeneity was greater in hospitalized (P = 0.003), but not home-isolated participants, compared to the never-COVID-19 controls. Post-COVID-19 ventilation-heterogeneity correlated with the dyspnea-scale (r = 0.45, P = 0.03), SGRQ-score (r = 0.41, P = 0.04), 6MWD (r=-0.49, P = 0.02), SpO2 (P = -0.55, P = 0.005), CT parenchymal opacities (r = 0.42, P = 0.04) and neutrophil percent (r = 0.45, P = 0.04), but not pro-inflammatory cytokines, C-reactive protein or D-dimer. CONCLUSIONS This small functional lung imaging study revealed ventilation impairment in individuals with no history of lung disease recovering from noncritical COVID-19 that was associated with parenchymal opacities, respiratory symptoms and exercise-capacity.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"22 1","pages":"304 - 313"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81013879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural history of COVID-19 recovery: Changes in physiologic, radiologic and patient-reported outcomes 12 months after symptom onset","authors":"A. Wong, Aditi S. Shah, C. Hague, J. Johnston, C. Ryerson, C. Carlsten","doi":"10.1080/24745332.2022.2087124","DOIUrl":"https://doi.org/10.1080/24745332.2022.2087124","url":null,"abstract":"Abstract RATIONALE: The long-term trajectory of people recovering from COVID-19 and the cause of persistent symptoms remains poorly understood. OBJECTIVE: We sought to determine how pulmonary function tests (PFTs), patient-reported outcome measures (PROMs) and radiologic features change over 12 months in people hospitalized with COVID-19. METHODS: A prospective, consecutive cohort of patients hospitalized with PCR-confirmed SARS-CoV-2 were recruited. Longitudinal clinical data, PROMs, PFTs and computed tomography (CT) chests were collected at 3, 6 and/or 12 months after symptom onset. Repeated analysis of variance (ANOVA) and Friedman tests were used to compare changes in outcomes over time. MEASUREMENT AND MAIN RESULTS: Eighty-one patients were enrolled with 70 completing the 12-month visit. At 3 months, the mean diffusing capacity of the lung for carbon monoxide was reduced at 76 ± 16%-predicted and improved to 80 ± 16%-predicted at 6 months (p < 0.001). The median values for dyspnea, cough, sleep and quality of life (QoL) were abnormal at 3 months, with QoL being the only PROM that significantly improved at 6 months. There was no further statistically significant change in PFT parameters or PROMs between 6 and 12 months. The percentages of lung affected by ground glass and reticulation at 3 months were 11.3% (IQR 5.6–19.6) and 4.4% (IQR 1.6–7.9), respectively. These improved at 12 months with ground glass being 0% (IQR 0-3.3) and reticulation 1.7% (IQR 0–3.3). CONCLUSIONS: PFTs improve between 3 and 6 months, with no change over the subsequent 6 months in patients hospitalized with COVID-19. Despite improved and nearly normal physiologic and radiologic results in most patients, 60% report abnormal PROMs at 12 months.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"52 1","pages":"270 - 274"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80211692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Canadian Respiratory Research Network (CRRN): Past, present and future","authors":"A. Gershon, K. Vandemheen, S. Aaron","doi":"10.1080/24745332.2022.2038723","DOIUrl":"https://doi.org/10.1080/24745332.2022.2038723","url":null,"abstract":"There was fantastic respiratory disease research going on in Canada before 2013, but it was happening in localized silos, with minimal communication or collaboration between different academic centers, and even less between different disciplines. Enter the Canadian Institutes of Health Research (CIHR) and the Canadian Lung Association, who announced in 2013 a new funding initiative to support an Emerging Network in respiratory research. Spurred on by this opportunity, the Canadian respiratory research community set out to develop a plan to attract partners and generate funding for a cohesive respiratory research network in Canada. The new network, led by Dr. Shawn Aaron, and co-led by Dr. James Martin, was named The Canadian Respiratory Research Network (CRRN), and was ultimately funded by CIHR, The Canadian Lung Association, The BC Lung Association, and by industry partners GlaxoSmithKline, BoehringerIngelheim, AstraZeneca and Novartis. The CRRN’s goal—even back then—was to improve patient care and outcomes for patients with chronic respiratory disease. The network has been a great success. It has achieved its goal through the creation of an enduring national network of investigators and research platforms that enable innovative, collaborative respiratory health research that has influenced both clinical and policy decision making. Furthermore, the CRRN has provided high quality training and career development to new generations of respiratory disease investigators. While its main focus has been asthma1,2 and COPD,3,4 the two most important chronic airway diseases in Canada, the CRRN has also advanced our understanding of COVID-19, alpha-1 antitrypsin deficiency5 and bronchopulmonary dysplasia.6 In the early days of the CRRN, there were 11 research platforms designed to study and facilitate Canadian research in airway disease. These platforms ran the gamut from laboratory sciences, such as physiology, airway imaging, biomarkers, pollution exposure and basic sciences to applied clinical science platforms in health economics, health services research, pharmaco-epidemiology, population health, environmental health and the Canadian Cohort of Obstructive Lung Disease (CanCOLD) cohort. Later, platforms for behavioral science and knowledge translation were added. In more recent years, patient engagement and equity, diversity and inclusion initiatives were started that crossed all platforms. From the beginning, the CRRN has had a focus on training the next generation of Canadian respiratory researchers, spearheaded by a Training Committee chaired by Dr. Andrew Halayko. The Emerging Research Leaders Initiative supported the careers of many young new investigators as they began independent research careers. The CRRN fellowship program enabled many trainees to pursue post-doctoral training in Canadian research labs, and its studentship program permitted PhD students to be financially supported to pursue respiratory disease research. The CRRN, however, does","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"25 1","pages":"214 - 215"},"PeriodicalIF":0.8,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84169570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Driving consequences of sleepiness in Canadians with obstructive sleep apnea: A population survey","authors":"M. Povitz, N. Bansback, M. Fenton, F. Almeida, D. Ratycz, N. Huynh, N. Ayas, J. Chiu, S. Pendharkar","doi":"10.1080/24745332.2022.2043205","DOIUrl":"https://doi.org/10.1080/24745332.2022.2043205","url":null,"abstract":"Abstract INTRODUCTION Untreated OSA has been associated with an increased risk of motor vehicle crashes. Previous studies are now 2 decades old and may have been impacted by bias; thus, modern, anonymous estimates are needed. MATERIALS AND METHODS We conducted an anonymous survey, which asked about experiences with OSA, including the impact of OSA on driving. Logistic regression models were used to assess the association between the risk of falling asleep while driving and crashes/near miss and potential predictors, including OSA severity, age, sex, hours driven per week, current treatment and work schedule. RESULTS Six hundred complete responses were received. Ninety percent of respondents drove regularly with 72% driving between 1 and 20 hours a week. Twenty-eight percent of respondents reported having fallen asleep while driving and 5% had experienced a crash or near miss related to sleepiness within the previous 5 years. After adjusting for OSA severity, age, sex and hours driven per week, falling asleep while driving was associated with severe OSA (OR 1.76 [95% CI 1.05, 3.01]) and higher age (in years) (OR 0.98 [95% CI 0.97, 1.00]). Use of continuous positive airway pressure (CPAP) and higher age were associated with reduced crash or near miss in the multivariable analysis (OR 0.27 [95% CI 0.08, 0.89]; OR 0.96 [95% CI 0.92,1.00]), and shift work was associated with increased risk (OR 3.26 [95% CI 1.08, 10.11]). CONCLUSIONS Falling asleep or crashing while driving remains common among individuals with OSA. This supports continued efforts to identify and treat affected individuals. RÉSUMÉ INTRODUCTION: L’apnée obstructive du sommeil (AOS) non traitée a été associée à un risque accru d’accidents de la route. Les études antérieures datent maintenant de deux décennies et peuvent avoir été influencées par des biais; par conséquent, des estimations modernes et anonymes sont nécessaires. MATÉRIELS ET MÉTHODES: Nous avons mené une enquête anonyme, qui posait des questions sur les expériences avec l’AOS y compris ses répercussions sur la conduite. Des modèles de régression logistique ont été utilisés pour évaluer l’association entre le risque de s’endormir en conduisant et les accidents/quasi-accidents de même que les prédicteurs potentiels, y compris la gravité de l’AOS, l’âge, le sexe, le nombre d’heures de conduite par semaine, le traitement actuel et l’horaire de travail. RÉSULTATS: Six cents réponses complètes ont été reçues. Quatre-vingt-dix pour cent des répondants conduisaient régulièrement et 72 % conduisaient entre 1 et 20 heures par semaine. Vingt-huit pour cent des répondants ont déclaré s’être endormis en conduisant et 5 % avaient eu un accident ou un quasi-incident lié à la somnolence au cours des cinq années précédentes. Après ajustement en fonction de la gravité de l’AOS, de l’âge, du sexe et du nombre d’heures de conduite par semaine, l’endormissement pendant la conduite était associé à une AOS sévère (RC 1,76 [IC à 95 % 1,05, 3,01]) ","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"214 1 1","pages":"298 - 303"},"PeriodicalIF":0.8,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74588763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chapter 3: Diagnosis of tuberculosis disease and drug-resistant tuberculosis","authors":"M. Behr, S. Lapierre, D. Kunimoto, Robyn S. Lee, R. Long, I. Sekirov, H. Soualhine, C. Turenne","doi":"10.1080/24745332.2022.2035638","DOIUrl":"https://doi.org/10.1080/24745332.2022.2035638","url":null,"abstract":"adepartment of Medicine, McGill university, Montréal, Québec, Canada; bdepartment of Microbiology, infectious disease and immunology, faculty of Medicine, université de Montréal, Montréal, Québec, Canada; cdepartment of Medicine, faculty of Medicine & dentistry, university of alberta, edmonton, alberta, Canada; ddalla lana school of public Health, university of toronto, toronto, ontario, Canada; edepartment of pathology & laboratory Medicine, faculty of Medicine, university of British Columbia, Vancouver, British Columbia, Canada; fnational reference Centre for Mycobacteriology, national Microbiology laboratory, public Health agency of Canada, Winnipeg, Manitoba, Canada; gdepartment of Medical Microbiology and infectious diseases, Max rady College of Medicine, university of Manitoba, Winnipeg, Manitoba, Canada","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"17 1","pages":"33 - 48"},"PeriodicalIF":0.8,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87179361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appendix B: De-isolation review and recommendations","authors":"R. Cooper","doi":"10.1080/24745332.2022.2046926","DOIUrl":"https://doi.org/10.1080/24745332.2022.2046926","url":null,"abstract":"• The preponderance of data suggests that appropriate treatment rapidly renders people with tuberculosis (TB) non-infectious, perhaps within a few days of treatment initiation, even for initially smear-positive cases. • These studies also suggest that sputum smear and culture status are less predictive of infectiousness once patients are established on effective therapy. • Nevertheless, there remains some uncertainty as to when, precisely, people with TB on treatment are rendered completely non-infectious. • The insistence on smear conversion before lifting airborne precautions may unnecessarily prolong isolation and cause patient harm with little public health benefit. • For people with TB that are medically well enough, ambulatory treatment and home isolation is to be preferred over prolonged hospital isolation. This will attenuate some but not all harms of prolonged isolation.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"26 1","pages":"248 - 255"},"PeriodicalIF":0.8,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84994785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}