scholarly journals P075: Emergency physicians’ self-reported management of benign headache in Alberta emergency departments

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S90
Author(s):  
L. Krebs ◽  
C. Villa-Roel ◽  
S. Couperthwaite ◽  
M. Ospina ◽  
B. Holroyd ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Online Survey ◽  
Management Practices ◽  
Treatment Preferences ◽  
Emergency Physicians ◽  
Severe Condition ◽  
Convenience Sample ◽  
Patient Expectation ◽  
Traditional Therapy ◽  
Clinical Scenarios

Introduction: Benign headache (BHA) management varies across emergency departments (EDs). This study documented current BHA management by Alberta emergency physicians (EP) in order to develop a provincial intervention to improve standardized practice. Methods: A convenience sample of Alberta EPs completed an online survey exploring their ED BHA management practices. Results are expressed as proportions. Results: A total of 73 EPs (73/192; 38%) who were mostly male (63%) and practiced emergency medicine for at least 15 years (51%) responded. EPs reported routine ED orders for metoclopramide (97%), ketorolac (90%) and IV fluids (85%) for patients with BHA showing no signs of pathological headache. For moderate-severe BHA's that did not improve with routine treatment, preferences were: IV narcotic (58%), IV dexamethasone (44%), and IV/IM dihydroergotamine (27%). Typically, EPs reported not ordering investigations for moderate-severe BHA presentations (88%); however, for those not improving the most common investigation was computed tomography (CT; 47%). CT ordering was associated with the following clinical scenarios: 1) not responding to traditional therapy and consulted to specialist (64%); 2) not responding to traditional therapy and being admitted (64%); 3) first presentation and afebrile (19%); 4) severe pain (11%); and 5) responding to traditional therapy and febrile (11%). One-quarter of EPs (27%) believed their patients usually or frequently expected a CT. Most EPs (60%) reported being completely or mostly comfortable discussing CT risks. Only 44% reported always or usually discussing risks prior to ordering. EPs reported that they were most frequently prevented from discussing risks because the patient was critically ill (42%) or because they believed explaining risks would not alter patient expectations (21%). These concerns were mirrored in the barriers EPs anticipated to limiting imaging, specifically the fear of missing a severe condition (62%), and patient expectation/request for imaging (48%). Conclusion: Self-reported treatment preferences for uncomplicated BHAs appear to be relatively consistent. Chart reviews could help assessing the reliability of self-reported BHA management practices. Perceived patient expectation appears to be an important influence on EP imaging ordering. Studies examining the communication between EPs and their patients are needed to explore how these expectations and perceived expectations are negotiated in the ED.

scholarly journals Perceptions of Responsible Cat Ownership Behaviors among a Convenience Sample of Australians

Animals ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. 703 ◽  
Author(s):  
Elliott ◽  
Howell ◽  
McLeod ◽  
Bennett
Keyword(s):  
Social Media ◽  
Interest Groups ◽  
Online Survey ◽  
Management Practices ◽  
Management Practice ◽  
Companion Animal ◽  
Frequency Data ◽  
Convenience Sample

Responsible cat ownership is important for keeping pet cats and wildlife safe. Much research investigating levels of compliance with and attitudes towards responsible cat ownership practices has focused on cat owners. Non-owner attitudes are relevant because their opinions may encourage cat-owning friends and family to engage (or not) in a cat management practice. The aim of this study was to determine levels of compliance with responsible cat ownership practices among cat owners, as well as attitudes towards those behaviors by owners and non-owners alike. An online survey was completed by 6808 people living in Australia who were recruited via companion animal or wildlife interest groups on social media. Frequency data were used to measure owner compliance with responsible cat ownership behaviors and t-tests were used to determine whether owners and non-owners differed in their attitudes towards these behaviors. Owner compliance with responsible practices ranged from 46.5% (complete cat containment all day and night) to 76.9% (cat is de-sexed). Owner attitudes towards these practices were generally more positive than the reported levels of management practices implemented for their own cat. For example, 47.3% of owners agreed or strongly agreed that cats should always be contained and 88.6% agreed that cats should be contained at night. Non-owners were more likely than owners to agree that cats should be contained during the day, but there was no difference for containment at night. Owners were more likely to report that cats should be de-sexed. These results can be used to inform campaigns aimed at increasing compliance with responsible cat ownership behaviors.

scholarly journals A protocol for a discrete choice experiment: understanding patient medicine preferences for managing chronic non-cancer pain

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027153 ◽  
Author(s):  
Marian Shanahan ◽  
Briony Larance ◽  
Suzanne Nielsen ◽  
Milton Cohen ◽  
Maria Schaffer ◽  
...  
Keyword(s):  
Focus Group ◽  
Cancer Pain ◽  
Discrete Choice ◽  
Online Survey ◽  
Latent Class ◽  
Management Strategies ◽  
Discrete Choice Experiments ◽  
Research Centre ◽  
Treatment Preferences ◽  
Convenience Sample

IntroductionHigh rates of chronic non-cancer pain (CNCP), concerns about adverse effects including dependence among those prescribed potent pain medicines, the recent evidence supporting active rather than passive management strategies and a lack of funding for holistic programme have resulted in challenges around decision making for treatment among clinicians and their patients. Discrete choice experiments (DCEs) are one way of assessing and valuing treatment preferences. Here, we outline a protocol for a study that assesses patient preferences for CNCP treatment.Methods and analysisA final list of attributes (and their levels) for the DCE was generated using a detailed iterative process. This included a literature review, a focus group and individual interviews with those with CNCP and clinicians who treat people with CNCP. From this process a list of attributes was obtained. Following a review by study investigators including pain and addiction specialists, pharmacists and epidemiologists, the final list of attributes was selected (number of medications, risk of addiction, side effects, pain interference, activity goals, source of information on pain, provider of pain care and out-of-pocket costs). Specialised software was used to construct an experimental design for the survey. The survey will be administered to two groups of participants, those from a longitudinal cohort of patients receiving opioids for CNCP and a convenience sample of patients recruited through Australia’s leading pain advocacy body (Painaustralia) and their social media and website. The data from the two participant groups will be initially analysed separately, as their demographic and clinical characteristics may differ substantially (in terms of age, duration of pain and current treatment modality). Mixed logit and latent class analysis will be used to explore heterogeneity of responses.Ethics and disseminationEthics approval was obtained from the University of New South Wales Sydney Human Ethics committee HC16511 (for the focus group discussions, the one-on-one interviews and online survey) and HC16916 (for the cohort). A lay summary will be made available on the National Drug and Alcohol Research Centre website and Painaustralia’s website. Peer review papers will be submitted, and it is expected the results will be presented at relevant pain management conferences nationally and internationally. These results will also be used to improve understanding of treatment goals between clinicians and those with CNCP.

scholarly journals Shift Work Disorder - Prevalence & Burden of Illness in Healthcare Providers of India

2019 ◽  
Vol 4 (6) ◽  
Keyword(s):  
Job Satisfaction ◽  
Emergency Medicine ◽  
Random Sample ◽  
Shift Work ◽  
Emergency Departments ◽  
Burden Of Illness ◽  
Sleep Hygiene ◽  
Emergency Physicians ◽  
Convenience Sample ◽  
Shift Work Disorder

Background: The proportion of shift workers in the society has taken a big leap in the last 2 decades or so. Thus, the epidemiological significance of shift work disorder (SWD) can no longer be ignored. Emergency Physicians & nurses almost always work in shifts and are an important subset of the population whose health and wellbeing directly and indirectly impacts the morbidity and mortality of the rest of the population. It is thus important to understand the magnitude of the problem in this population. Several studies describe a high incidence of SWD and psychosomatic complaints in EP. The main objective of this study is to examine the prevalence of symptoms of SWD; contribution of demographics, working hours, shift work, morningness/eveningness & sleep hygiene practices to occurrence of SWD, related health & occupational hazards and job satisfaction in a random sample of Emergency Physicians & nurses of India. Methods: A cross sectional survey of nurses and doctors working in emergency departments of at least 12 major urban hospitals across India was conducted during October 2016 – March 2017. Peer validated questionnaire with standard scales, descriptive & objective questions was emailed only to individuals who were known to be working in Emergency departments as nurses and doctors. This convenience-sample of email addresses was obtained through personal and professional contacts of the researcher. Those who volunteered responses were included in the study. No identifying information was collected. Those who reported diagnosed sleeping disorders were excluded from the analysis. For analysis, responses were divided into 2 groups – those who reported symptoms of SWD and those who did not. With aid of a professional biostatistician, these 2 groups were then compared for unique characteristics and statistically significant variables using t test, chi square test, odds ratio and logistic regression Results: Prevalence of symptoms indicative of SWD in a random sample of emergency medicine physicians and nurses in India ranges from 13-27% and was significantly (p=0.048) higher in those who did shift work and night shift work depending on the method of assessment. Women have 3 times higher risk than men. More than half (51%) the number of Emergency medicine physicians and nurses in the study suffer sleep disturbances due to work timings. This group may develop SWD in the future, pending due intervention. SWD is strongly (p<0.02) associated with bad sleep hygiene and excessive daytime sleepiness. The presence of symptoms of SWD also leads to poor job satisfaction. (p<0.05). Majority (60%) report preference for shifts that start later in the day

scholarly journals P071: Choosing Wisely in the emergency department: exploring the reach, support and potential for the Choosing Wisely Canada® campaign among emergency physicians

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S102
Author(s):  
L. Krebs ◽  
L.B. Chartier ◽  
B.R. Holroyd ◽  
S. Dowling ◽  
A.H. Cheng ◽  
...  
Keyword(s):  
Online Survey ◽  
Response Rate ◽  
Tertiary Care ◽  
Legal Protection ◽  
Barriers And Facilitators ◽  
Choosing Wisely ◽  
Emergency Physicians ◽  
High Quality ◽  
Severe Condition ◽  
Canadian Association

Introduction: Choosing Wisely Canada® (CWC) launched in April 2012. Since then, the Emergency Medicine (EM) top-10 list of tests, treatments and procedures to avoid has been released and initiatives are on-going. This study explored CWC awareness and support among emergency physicians. Methods: A 60-question online survey was distributed to Canadian Association of Emergency Physicians (CAEP) members with valid e-mails. The survey collected information on demographics, awareness/support for CWC as well as physicians’ perceived barriers and facilitators to implementation. Descriptive statistics were performed in SPSS (Version 24). Results: Overall, 324 surveys were completed (response rate: 18%). Respondents were more often male (64%) and practiced at academic/tertiary care hospitals (56%) with mixed patient populations (74%) with annual ED volumes of &gt;50,000 (70%). Respondents were familiar with campaigns to improve care (90%). Among these respondents, 98% were specifically familiar with CWC and 73% felt these campaigns assisted them in providing high-quality care. Respondents felt that the top-5 EM recommendations were supported by high quality evidence, specifically the first 4 recommendations (&gt;90% each). The most frequently reported barriers to implementation were: patients’ expectations/requests (33%), the possibility of missing severe condition(s) (20%), and requirements of ED consultations (12%). Potential facilitators were identified as: strong evidence-base for recommendations (37%), medico-legal protection for clinicians who adhere to guidelines (13%), and support from institutional leadership (11%). Conclusion: CWC is well-known and supported by emergency physicians. Despite the low response rate, exploring the barriers and facilitators identified here could enhance CWC’s uptake in Canadian emergency departments.

scholarly journals Current management of children with acute otitis media: a feasibility survey for a pragmatic study

2019 ◽  
Vol 59 (6) ◽  
pp. 303-17
Author(s):  
Respati Wulansari Ranakusuma ◽  
Amanda R. McCullough ◽  
Elaine M. Beller ◽  
Christopher B. Del Mar ◽  
Eka Dian Safitri ◽  
...  
Keyword(s):  
Otitis Media ◽  
Management Practices ◽  
Acute Otitis Media ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Willingness To Participate ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Primary Care Hospital ◽  
Clinical Scenarios

Background Acute otitis media (AOM) is a common self-limiting infection where antibiotics confer limited benefit. Other treatments, such as anti-inflammatory agents have been proposed as an alternative to antibiotics, but no high-quality clinical trials have tested this. Objective To identify current AOM management practices among Indonesian clinicians. We also required this information for our proposed corticosteroids clinical trial for AOM. Methods This cross-sectional study surveyed a convenience sample of general practitioners (GPs), pediatricians, and Ear-Nose-Throat (ENT) specialists in Jakarta, Depok, and Bekasi. We addressed their current AOM management practices and willingness to participate in a future trial on corticosteroids. Results We distributed 2,694 questionnaires through conferences, primary care/hospital visits, and by mail-list group. Of 492 questionnaires received (response rate 18%), 352 were from eligible clinicians. Most clinicians diagnosed AOM by using an otoscope (64-91%). Tympanometry was used by a quarter of ENT specialists. Amoxicillin-clavulanate was the most common antibiotic for AOM, prescribed by pediatricians and ENT specialists, whilst most GPs prescribed amoxicillin. Clinical scenarios indicated most ENT specialists (88%) would prescribe antibiotics and most pediatricians (54%) would choose expectant observation by withholding antibiotics for mild AOM. Almost half of clinicians would consider using corticosteroids in a trial. Conclusion Most clinicians would prescribe antibiotics for mild AOM. However, slightly over half of pediatricians would solely choose expectant observation. Adequate numbers of potential participating clinicians, who would consider using corticosteroids, make our proposed corticosteroids trial for AOM feasible. We found gaps between clinical practice and evidence requiring further investigation to improve AOM management in Indonesia.

scholarly journals Concussion Knowledge and Clinical Experience Among Athletic Trainers: Implications for Concussion Health Care Practices

2020 ◽  
Vol 55 (7) ◽  
pp. 666-672
Author(s):  
Landon B. Lempke ◽  
Julianne D. Schmidt ◽  
Robert C. Lynall
Keyword(s):  
Clinical Experience ◽  
Online Survey ◽  
Management Practices ◽  
Athletic Trainers ◽  
Signs And Symptoms ◽  
Assessment Tools ◽  
Return To Play ◽  
Management Tools ◽  
Convenience Sample ◽  
Concussion Knowledge

Context Athletic trainers (ATs) are heavily involved in concussion assessment and return-to-play (RTP) decision making. Despite ATs' crucial role, few researchers have directly examined ATs' knowledge of concussions or whether concussion knowledge or clinical experience affects clinical concussion-management practices. Objective To determine the overall concussion knowledge of ATs and whether concussion knowledge and clinical experience affect concussion-assessment and -management practices. Design Cross-sectional study. Setting Online survey. Patients or Other Participants Random convenience sample of 8725 (15.0% response rate [1307/8725]; certified, 14.8 ± 10.6 years) ATs surveyed from the National Athletic Trainers' Association membership. Main Outcome Measure(s) The survey collected demographics, concussion-assessment and -management tools used, and concussion knowledge (patient-clinician scenarios, signs and symptoms recognition). We used multiple logistic regression models to determine the odds ratios (ORs) for using assessment and management tools based on signs and symptoms recognition and years of clinical experience. Results The ATs correctly identified 78.0% ± 15.1% of concussion signs and symptoms. Approximately 46% (357/770) of ATs indicated an athlete could RTP if the athlete stated he or she had a “bell rung.” Every additional year of clinical experience decreased the odds of using standardized sideline-assessment tools by 3% (OR = 0.97, 95% Confidence Interval [CI] = 0.95, 0.99). The odds of using standardized sideline tools (OR = 0.98, 95% CI = 0.96, 0.99) and symptom checklists (OR = 0.98, 95% CI = 0.97, 0.99) for RTP assessment were significantly decreased for each additional year of clinical experience. No other tools used for RTP assessment were influenced by signs and symptoms recognition (P ≥ .136) or clinical experience (P ≥ .158). Conclusions The ATs with greater clinical experience had lower odds of using concussion-assessment and -management tools. Athletic trainers should frequently review and implement current consensus guidelines into clinical practice to improve concussion recognition and prevent improper management.

Understanding current practice of opioid use disorder management in emergency departments across Canada: A cross-sectional study

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 494-498
Author(s):  
Patricia Hoyeck ◽  
David Wiercigroch ◽  
Cara Clarke ◽  
Rahim Moineddin ◽  
Hasan Sheikh ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Management Practices ◽  
Cross Sectional Study ◽  
Opioid Use Disorder ◽  
Emergency Physicians ◽  
Sectional Study ◽  
Opioid Use ◽  
Current Management ◽  
Cross Sectional ◽  
Canadian Association

ABSTRACTObjectiveOpioid-related deaths are increasing at alarming rates in Canada, with a 34% increase from 2016 to 2017. Patients with opioid use disorder often visit emergency departments (ED), presenting an opportunity to engage patients in treatment. Buprenorphine-naloxone is first-line treatment for opioid use disorder, but current management in the ED is unknown. This study aimed to characterize opioid use disorder management in the ED.MethodsWe conducted a cross-sectional study of emergency physicians across Canada. A survey was circulated electronically to the Canadian Association of Emergency Physicians members. Participants were asked about their current management practices, satisfaction, and helpfulness of resources. SAS (version 9.4) was used for statistical analysis. We dichotomized Likert-scale responses to approximate relative risk ratios via a log binomial analysis.ResultsThe survey was completed by 179 participants for a response rate of 11.1%; 143 (79.9%) physicians treated patients with opioid use disorder more than once a week. Only 7% (n = 13) of respondents always/often gave buprenorphine in the ED. Referral to an addiction clinic where patients were seen quickly was deemed the most helpful (90.5%, n = 162). Physicians who reported satisfaction with opioid use disorder management were four times more likely to prescribe buprenorphine in the ED or as an outpatient script (RR = 4.41, CI = 2.33–8.33, p < 0.01; RR = 4.51, CI = 2.21–9.22, p < 0.01).ConclusionThis study found that buprenorphine is not frequently prescribed in the ED setting, which is incongruent with the 2018 guidelines. Care coordination and on-site support were helpful to ED physicians. Hospitals should use knowledge translation strategies to improve the care of patients with an opioid use disorder.

scholarly journals Beyond the high: Mapping patterns of use and motives for use of cannabis as medicine

2021 ◽  
pp. 145507252098596
Author(s):  
Sinikka L. Kvamme ◽  
Michael M. Pedersen ◽  
Sagi Alagem-Iversen ◽  
Birgitte Thylstrup
Keyword(s):  
Mental Health ◽  
Side Effects ◽  
Sleep Disturbances ◽  
Online Survey ◽  
Cannabis Use ◽  
Health Conditions ◽  
Convenience Sample ◽  
Mental Health Conditions ◽  
Patient Organisations ◽  
Patterns Of Use

Background: In Denmark the boundaries between cannabis as an illicit drug and licit medicine have shifted rapidly in recent years, affecting also policy. However, the vast majority of Danes, who use cannabis as medicine (CaM) continue to rely on the unregulated market for supply. This study explores patterns of use and motives for use of CaM in Denmark. Methods: An anonymous online survey was made available to a convenience sample of users of CaM from July 14, 2018 to November 1, 2018. Participants were recruited through patient organisations, social and public media, and the illegal open cannabis market. Results: Of the final sample ( n = 3,021), a majority were women (62.6%) and the mean age was 49 years. Most had no prescription for CaM (90.9%), a majority had no or limited previous experience with recreational cannabis use (63.9%), and had used CaM for two years or less (65.0%). The most common form of intake was oil (56.8%) followed by smoke (24.0%). CBD oil (65.0%) was used more than hash, pot or skunk (36.2%). Most frequent conditions treated were chronic pain (32.0%), sleep disturbances (27.5%), stress (23.7%), osteoarthritis (22.7%), anxiety (19.6%), and depression (19.6%). Overall, users experienced CaM to be effective in managing somatic and mental health conditions and reported relatively few side-effects. CBD oil only users were more likely to be women, older, have limited recreational experience and have initiated use recently. Conclusions: A new user group has emerged in Denmark that, for the most part, use illegally sourced CaM to treat a broad range of somatic and mental health conditions, often with experienced effect and relatively low level of side-effects. The prevalent use of low-potency CBD oil indicates an interest in effects beyond the high normally associated with cannabis use. More clinical research into the effects and side-effects of CaM is needed to draw the boundaries of the medical utility of cannabis.

scholarly journals Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sinikka L. Kvamme ◽  
Michael M. Pedersen ◽  
Kristine Rømer Thomsen ◽  
Birgitte Thylstrup
Keyword(s):  
Side Effects ◽  
Drug Use ◽  
Prescription Drug ◽  
Prescription Drugs ◽  
Online Survey ◽  
Convenience Sample ◽  
Patient Organizations ◽  
Public Media ◽  
Prescription Drug Use ◽  
The Impact

Abstract Background The use of cannabis as medicine (CaM) both prescribed and non-prescribed has increased markedly in the last decade, mirrored in a global shift in cannabis policy towards a more permissive stance. There is some evidence that cannabis functions as a substitute for prescription drugs, particularly opioids; however, more knowledge is needed on the motives of substitution users, their patterns of use, and perceived effects of substitution use. Aims To explore who substitutes prescription drugs with cannabis, the type of prescription drugs substituted and the type of cannabis used, and the impact that substitution with cannabis has on prescription drug use as well as the motives for substitution in terms of experienced effects and side effects. Methods A self-selected convenience sample was recruited through social media, public media, and patient organizations to take part in an anonymous online survey. Inclusion criteria were 18 years or older and use of cannabis (prescribed or non-prescribed) with a medical purpose. Results The final sample included 2.841 respondents of which the majority (91%) used non-prescribed cannabis, and more than half (54.6%) had used CaM with the purpose of replacing a prescribed drug. Compared to non-substitution users, substitution users were more likely to be women and to use CaM in the treatment of chronic pain and other somatic conditions. Pain medication (67.2%), antidepressants (24.5%), and arthritis medication (20.7%) were the most common types of drugs replaced with CaM. Among substitution users, 38.1% reported termination of prescription drug use, and 45.9% a substantial decrease in prescription drug use. The most frequent type of cannabis used as a substitute was CBD-oil (65.2%), followed by ‘hash, pot or skunk’ (36.6%). More than half (65.8%) found CaM much more effective compared to prescription drugs, and 85.5% that the side effects associated with prescription drug use were much worse compared to use of CaM. Conclusion CaM is frequently used as a substitute for prescription drugs, particularly opioids. More research is needed on the long-term consequences of use of CaM, including the impact from low and high THC cannabis products on specific somatic and mental health conditions.

scholarly journals Variation in treatment preferences of pulmonary exacerbations among Australian and New Zealand cystic fibrosis physicians

2021 ◽  
Vol 8 (1) ◽  
pp. e000956
Author(s):  
Grace Currie ◽  
Anna Tai ◽  
Tom Snelling ◽  
André Schultz
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Trials ◽  
New Zealand ◽  
Treatment Options ◽  
Early Response ◽  
Treatment Preferences ◽  
Dornase Alfa ◽  
Clinical Scenarios ◽  
Professional Opinion ◽  
Pulmonary Exacerbations

BackgroundDespite advances in cystic fibrosis (CF) management and survival, the optimal treatment of pulmonary exacerbations remains unclear. Understanding the variability in treatment approaches among physicians might help prioritise clinical uncertainties to address through clinical trials.MethodsPhysicians from Australia and New Zealand who care for people with CF were invited to participate in a web survey of treatment preferences for CF pulmonary exacerbations. Six typical clinical scenarios were presented; three to paediatric and another three to adult physicians. For each scenario, physicians were asked to choose treatment options and provide reasons for their choices.ResultsForty-nine CF physicians (31 paediatric and 18 adult medicine) participated; more than half reported 10+ years of experience. There was considerable variation in primary antibiotic selection; none was preferred by more than half of respondents in any scenario. For secondary antibiotic therapy, respondents consistently preferred intravenous tobramycin and a third antibiotic was rarely prescribed, except in one scenario describing an adult patient. Hypertonic saline nebulisation and twice daily chest physiotherapy was preferred in most scenarios while dornase alfa use was more variable. Most CF physicians (>80%) preferred to change therapy if there was no early response. Professional opinion was the most common reason for antibiotic choice.ConclusionsVariation exists among CF physicians in their preferred choice of primary antibiotic and use of dornase alfa. These preferences are driven by professional opinion, possibly reflecting a lack of evidence to base policy recommendations. Evidence from high-quality clinical trials is needed to inform physician decision making.

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