Sophie Leconte

Validated methods of cough assessment : a systematic review of the literature

Background: Cough is a common symptom for which patients often seek medical advice and consume vast amounts of drugs. It is a real challenge for both the physician and the clinical researcher to evaluate a cough’s clinical importance and its precise response to treatment. Objectives: This systematic literature review has the following objectives: first, to make an inventory of the validated tools for assessing cough, and second, to investigate the extent to which the results of various assessment methods can be correlated. Methods: Two independent investigators searched the Medline, Embase, and Cochrane databases for validation studies on cough assessment tools. Results: Thirty-four studies were included. Several ambulatory cough monitors automatically identify cough and have been validated in a limited number of patients. Three cough-specific quality-of-life scales (Leicester Cough Questionnaire, Cough Quality of Life Questionnaire, and Burden of Cough Questionnaire) have been validated. No validation studies of descriptive scores or visual analogue scales were found. The correlations between quality-of-life scores and cough frequency were good. The correlations between descriptive scores or visual analogue scales and more objective methods, such as cough frequency monitoring or quality-of-life scores, were inconsistent. Conclusion: Cough-specific quality-of-life questionnaires can provide valid outcomes for research into cough. Although the current developments in cough monitoring devices are promising, further studies on a larger scale, under more realistic conditions, and for different patterns of cough are required before they can be recommended for widespread use.

Prolonged cough in children: a summary of the Belgian primary care clinical guideline

Prolonged cough is a frequent problem in the community. Several studies in the school setting have found that as many as 4.8% to 10.4% of children suffer from prolonged cough. There is no consensual definition of prolonged cough. In this guideline, we define prolonged cough as a daily cough lasting for more than three weeks. The literature review did not identify any quality study on the aetiology of prolonged cough in children in primary care. A diagnostic decision-tree based on the systematic literature review and expert opinion is proposed. Doctors should seek signs of any serious underlying condition. Chronic productive purulent cough should always be investigated. A careful evaluation of the impact of cough on the quality of life of the child is necessary. In absence of signs of specific underlying illness, coughing is generally a self-limiting condition. Symptomatic treatments have not yet been proven to be effective, and many of them may cause serious side effects. Their use should therefore be limited.

The objective assessment of cough frequency: accuracy of the LR102 device.

BackgroundThe measurement of cough frequency is problematic and most often based on subjective assessment. The aim of the study was to assess the accuracy of the automatic identification of cough episodes by LR102, a cough frequency meter based on electromyography and audio sensors.MethodsTen adult patients complaining of cough were recruited in primary care and hospital settings. Participants were asked to wear LR102 for 4 consecutive hours during which they were also filmed.ResultsMeasures of cough frequency by LR102 and manual counting were closely correlated (r = 0.87 for number of cough episodes per hour; r = 0.89 for number of single coughs per hour) but LR102 overestimated cough frequency. Bland-Altman plots indicate that differences between the two measurements were not influenced by cough frequency.ConclusionsLR102 offers a useful estimate of cough frequency in adults in their own environment, while significantly reducing the time required for analysis.

A novel assessment of an evidence-based practice course using an authentic assignment

Background: Evidence-based practice (EBP) is now a component of most medical curricula. Summative assessment instruments are often of debatable quality, do not cover the full spectrum of EBP or lack authenticity. Aim: To develop and evaluate the quality of an authentic assessment instrument for use in summative assessment of general practice trainees. Methods: An assignment was designed based on the ask, acquire, appraise and apply steps of EBP. Content validity was evaluated by external EBP experts. Concurrent validity was tested with the Fresno test. Inter-rater agreement and internal consistency were measured. Acceptability and feasibility were also assessed. Results: EBP experts agreed that the instrument had good content validity. Concurrent validity was good (disattenuated intraclass correlation coefficient 0.75). Inter-rater agreement varied from 0.70 to 0.83. Internal consistency was high (Cronbachs alpha 0.70–0.86). The procedure was feasible but only moderately acceptable to students. Conclusion: Our authentic assignment provided a valid, reliable and feasible procedure to assess our students. Acceptability was moderate, probably due to teething problems in instructions given and unfamiliarity with the format. Consequential validity data are lacking and would be of value. Our instrument could be an interesting alternative to other validated tests that may be less authentic.

Prolonged Cough in Pediatric Population First Line Care, Belgian Guidelines

Background: The clinical approach to a prolonged cough, i.e. a cough lasting more than three weeks, is challenging for general practitioners as well for primary care pediatricians. What the recommended clinical approach in primary care is, how cough duration or cough characteristics impact the diagnosis, and what the efficiency and safety of antibiotics or symptomatic treatments are remain in question for primary care physicians. Objective: The last Belgian guidelines were published in 2006 and needed to be reviewed. Those background questions were used to conduct our guideline updating procedure. Methods: We systematically performed a pyramidal literature search between the periods 2006-2014 in order to write evidence based guidelines. The data of the literature was summarized, discussed by the authors, experts and the Belgian primary care guidelines committee. Recommendations were formulated and scored following the GRADE classification. Results: The consultation history as well as the physical examination should be directed towards searching for warning signs (GRADE 1B) and towards the common etiologies depending on cough duration (GRADE 2C). If the cough lasts for more than eight weeks, chest radiography and spirometry should be considered (GRADE 2C). An antibiotic is recommended for a prolonged wet cough (over eight weeks) if prolonged bacterial bronchitis is suspected (GRADE 1B). In the absence of clinical signs of a specific etiology of a cough, no drug can be recommended (GRADE 1B). For all cases, it is initially suggested to avoid irritants (GRADE 1C) as well as to take into account the concerns of parents and inform them about the natural development of a cough. Conclusions: More research is needed to provide evidence on the clinical pathway on prolonged cough for primary care. Cough duration of more than eight weeks and prolonged wet cough are the most useful cough characteristics. Regarding a specific cough treatment, no medication has proved any effect greater than placebo. Attention to environmental triggers and patient-centered care remain the keystones of interventions

Young general practitioners' professional activities: a survey in the French-speaking part of Belgium.

Introduction: This study described the professional activities of graduates of the Advanced Master of General Practice of the Belgian French-speaking universities from 1999 to 2013 and identified factors influencing their situation. Methods: Between November 2014 and June 2015, all graduates were asked to complete a questionnaire concerning their professional activities. The first part of the analysis described the respondent’s socio-demographic and professional characteristics. The second part aimed at detecting possible factors influencing GPs’ professional situation. Results: The main results of the study showed that 78.5% of graduates still worked as GPs and 21.5% left and had another activity. The way graduates worked in General Practice was also highly diverse in terms of both working time and types of activities. Only a minority of them were exclusively performing General Practice (8.5%). 45.8% of GPs worked part-time, and were more commonly women and GPs in group practice. This survey confirmed feminisation of the profession and increasing work in associations. Among factors influencing retention in General Practice, preference for specialising in General Practice at time of graduation in medicine and duration of practice influence retention in practice. Conclusion: Our survey put the emphasis on the evolution of practice: job and vocational training planning should not be performed based only on previous generations. There is no one predefined way to practise; the blurred boundaries of General Practice activities do not allow for the drafting of a reference frame that could help workforce planning.

The online Cough Clinic

linezolid in treatment of complicated multidrug-resistant tuberculosis? Eur Respir J 2009; 34: 1492–1494. 10 Schecter GF, Scott C, True L, et al. Linezolid in the treatment of multidrug-resistant tuberculosis. Clin Infect Dis 2010; 50: 49–55. 11 Migliori GB, Richardson MD, Lange C. Of blind men and elephants: making sense of extensively drug-resistant tuberculosis. Am J Respir Crit Care Med 2008; 178: 1000–1001.To the Editors: The recent paper by Dettmar et al. 1 describes an important way in which patients with chronic cough (and their general practitioners) can obtain information online as to the probable diagnosis of their coughs and the preferred treatment. The only three possible diagnoses are reflux (gastro-oesophageal reflux (GOR)), asthma and rhinitis (post-nasal drip syndrome (PNDS)). We tested the questionnaire with histories of four patients. They had respectively post-viral, cigarette smoking, habit (Tourettes) and upper respiratory tract infection cough. Each was diagnosed as probable GOR. The paper raises a number of important questions. First, the paper lists 16 questions pointing to the probable diagnoses, which are identified for each question. However, the current online questionnaire (November 2009) adds a further five questions with no indication of the diagnoses they point to, surely essential information. Presumably this change in the questionnaire was made after the paper was submitted, but it means that the results described in the paper cannot be added to any results from the “new” online questionnaire. Secondly, how “specific” are the questions? For …