News in brief: Algorithm allows asthma diagnosis without aerosol generating procedures; New Optimal Care Pathway for lung cancer; Physicians urged to avoid stigmatising language in medical records

Algorithm allows asthma diagnosis without aerosol generating procedures

With the need to avoid using aerosol generating procedures in the diagnosis of asthma during the pandemic, UK respiratory physicians have developed an accurate rule-in algorithm that avoids the need for spirometry.

Using data from wheeze on auscultation, blood eosinophilia and home peak flow variability, researchers from Manchester University found that in patients with a clinical suspicion of asthma their algorithm had a sensitivity of 55%, specificity of 100%, and negative predictive value 60%.

While the low sensitivity would still require two thirds of patients to have further investigations, the use of the algorithm could reduce pressure on respiratory physiology services by one-third and allow early treatment for many asthma patients, they said.

The results are published in Journal of Allergy and Clinical Immunology: In Practice.

New Optimal Care Pathway for lung cancer

An updated Optimal Care Pathway for people with lung cancer has been endorsed by Cancer Australia and the Cancer Council.

The second edition of the care pathways outline nationally agreed best practice for the best level of care in areas such as prevention and early detection, initial investigations and referral, as well as diagnosis, staging and treatment planning. They also cover care after initial treatment, prevention and management of recurrence and metastatic disease, and end-of-life care.

According to the developers, the pathways “describe the standard of care that should be available to all cancer patients treated in Australia. The pathways support patients and carers, health systems, health professionals and services, and encourage consistent optimal treatment and supportive care at each stage of a patient’s journey.”

Guidance is provided in relation to seven key principles of patient-centred care; safe and quality care; multidisciplinary care; supportive care; care coordination; communication; and research and clinical trials.

Professor Robert Thomas, Chair of the Project Steering Committee, says they should be read and understood by all those involved in cancer care including oncologists, radiologists, general practitioners and other doctors to allied health professionals, nurses and managers of cancer services.

“It’s important to note that the optimal care pathways are cancer pathways, not clinical practice guidelines. The decision about ‘what’ treatment is given is a professional responsibility and will usually be based on current evidence, clinical practice guidelines and the patients’ preferences,” he writes.

Physicians urged to avoid stigmatising language in medical records

When writing in a patient’s medical record, physicians should be conscious of the use of language that reinforces negative and stigmatising attitudes toward patients that may influence the decisions of other clinicians subsequently caring for that patient, according to the authors of a US study.

An analysis of 600 medical records written by 138 physicians at a major hospital identified five types of negative and judgmental language used to describe patient encounters that encompassed racial and class stereotyping, personal disapproval of their actions, questioning a patient’s credibility and portraying them as a difficult or non-compliant. The stigmatising attitudes found in medical notes also included the use of authoritative and paternalistic language by physicians in which they recorded themselves as ‘instructing’ patients, according to researchers from Johns Hopkins University.

In their article, published in JAMA Network Open, they offered six examples of how physicians could use positive and collaborative language in medical records including compliments, approval of positive behaviours and noting of humanising personal details, in addition to acknowledgement of the physician’s own negative attitude and explaining non-adherence in a non-judgmental way.

“Just as we have developed a greater understanding about microaggressions and micro-inequities, this study’s findings suggest that we must raise consciousness about how we write and read medical records,” they said.

“Language has a powerful role in influencing subsequent clinician attitudes and behaviour. Attention to this language could have a large influence on the promotion of respect and reduction of disparities for disadvantaged groups.”

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