European Respiratory Society

AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews, version 2) and ROBIS are tools used to assess the methodological quality and the risk of bias in a systematic review (SR). We applied AMSTAR-2 and ROBIS to a sample of 200 published SRs. We investigated the overlap in their methodological constructs, responses by item, and overall, percentage agreement, direction of effect, and timing of assessments. AMSTAR-2 contains 16 items and ROBIS 24 items. Three items in AMSTAR-2 and nine in ROBIS did not overlap in construct. Of the 200 SRs, 73% were low or critically low quality using AMSTAR-2, and 81% had a high risk of bias using ROBIS. The median time to complete AMSTAR-2 and ROBIS was 51 and 64 minutes, respectively. When assessment times were calibrated to the number of items in each tool, each item took an average of 3.2 minutes per item for AMSTAR-2 compared to 2.7 minutes for ROBIS. Nine percent of SRs had opposing ratings (i.e., AMSTAR-2 was high quality while ROBIS was high risk). In both tools, three-quarters of items showed more than 70% agreement between raters after extensive training and piloting. AMSTAR-2 and ROBIS provide complementary rather than interchangeable assessments of systematic reviews. AMSTAR-2 may be preferable when efficiency is prioritized and methodological rigour is the focus, whereas ROBIS offers a deeper examination of potential biases and external validity. Given the widespread reliance on systematic reviews for policy and practice, selecting the appropriate appraisal tool remains crucial. Future research should explore strategies to integrate the strengths of both instruments while minimizing the burden on assessors.

People with COPD experience a severe symptom burden, yet palliative care integration remains limited in COPD treatment across Europe. The EU PAL-COPD project is a multidisciplinary, international initiative funded by Horizon Europe, running from 2024 to 2028. We will evaluate ICLEAR-EU, a non-pharmacological, team-based intervention targeting the palliative needs of people with advanced COPD. Here, we detail our project's aims, progress, and plans. ICLEAR-EU aims to facilitate collaboration between hospital respiratory teams, interdisciplinary palliative care teams, and primary care to promote shared decision-making, advance care planning, and prevent re-hospitalization after exacerbations. The intervention, originally developed and piloted in the UK, has been adapted and standardized for international use through extensive stakeholder input. ICLEAR-EU focuses on Identification, Communication, Levels of Escalation, Advance Care Planning, and ongoing Review of palliative care needs, starting when the patient is hospitalized due to a COPD exacerbation. EU PAL-COPD is the first large-scale international trial integrating palliative care into respiratory care for COPD. Using a stepped wedge cluster RCT, we will assess ICLEAR-EU’s effectiveness in approximately 1,200 people with advanced COPD across 18 hospitals in six European countries, applying cost-effectiveness analyses, mixed-methods subgroup analyses, and in-depth process and implementation evaluations. By addressing the complex palliative and end-of-life care needs of people with COPD, EU PAL-COPD aims to improve patient and family well-being while setting a new standard for coordinated care in respiratory and palliative services across Europe.

The Endobronchial Ultrasound (EBUS) technique is essential for diagnosis and staging of lung cancer and other thoracic diseases. The ERS launched a structured training programme, aiming to enhance clinicians' proficiency with EBUS. This programme includes comprehensive modules for theoretical and clinical knowledge and simulation training via hands-on practice and assessment. Long-term impact across Europe was evaluated via the feedback of a cohort of learners who completed the programme between 2017 and 2024. Complete data from 38 respondents consisted of institution, location, description of the EBUS equipment and impact of the training on practice and clinics. Responses were categorised to identify frequent challenges and needed improvements. Increased procedural confidence and diagnostic accuracy were reported across healthcare settings with successfully implemented EBUS programmes. Prevalent barriers for EBUS development included financial constraints and resources, administrative hurdles, and the need for broader and more specialised educational initiatives. Conversely, overall improvement is suggested to rely on implementation of enhanced training for general pulmonology and specialised EBUS; deployment of EBUS units; new online educational tools; improved financial backing; reliable resource allocation for equipment and facilities, development of standardised protocols and increased awareness. The ERS EBUS training programme shows a positive impact on the skills of healthcare professionals across Europe. Ongoing challenges highlight the need for continued evaluation, enhanced financial and educational support, and systematic integration efforts through collaborative networks and partnerships.

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The set up of new healthcare models by taking into account diagnosis and health education of the viral infection, aims to achieve the goals of the World Health Organization Global Health Sector Strategy on viral diseases for 2022-2030. In comparison to Europe, Poland is ranked among countries with an moderate prevalence of hepatitis B and C virus (HBV and HCV), also human immunodeficiency virus (HIV). An additional challenge is the changing epidemiological situation due to the impact of immigrants, resulting mainly from the war in Ukraine. The article presents current guidance for HCV and HIV diagnosis and presents the role of occupational health service (OHS) for primary and secondary prevention of the infectious diseases. It was considered to expand the scope of periodic examinations to include diagnosis of HBV, HCV and HIV infections among health care workers, who have not had it performed so far. In the case of abnormal level of alanine aminotransferase (ALT), aspartate aminotransferase (AST) or γ-glutamyl transpeptidase (GGT) found during routine pre-employment or periodic examinations for specific occupational exposures and it is considered crucial to implement further measures to exclude or confirm HBV or HCV infection, with indications for further management in primary care, and followed by subsequent periodic examinations. The need to pay attention to any symptoms that may indicate HBV, HCV and/or HIV infection, to perform additional diagnostic tests (e.g., point of care), and to determine the next steps in case of positive result was indicated. It emphasized the need to tailor the delivery of information to the patient, including taking care to ensure that immigrants' workers understand the next steps. It was recommended that the OHS conduct educational activities to raise health awareness of HIV, HCV, HBV infections, both through health policy programs as well as through broader activities in cooperation with the employer. Med Pr Work Health Saf. 2024;75(5):485-494.

Ten questions to assess to what degree a clinical practice guideline is likely to be trustworthy: 1) Do the authors have conflicts of interests? 2) Is the clinical question relevant? 3) Have relevant stakeholders been involved? 4) Have methods for study selection been described? 5) Is there a link between evidence and recommendations (transparent methods)? 6) Has the certainty of evidence been assessed? 7) Have the methods for reaching recommendations been described? 8) Are the recommendations unambiguous? 9) Are the recommendations relevant in your situation? 10) Is there an implementation strategy?

We evaluated whether the quantification of IgG to pneumococcal capsular polysaccharides is an accurate diagnostic test for pneumococcal infection in children with pneumonia in Nepal. Children with pneumococcal pneumonia did not have higher convalescent, or higher fold change, IgG to pneumococcal polysaccharides than children with other causes of pneumonia. Caution is needed in interpreting antibody responses in pneumococcal infections.

Major progress has been made in view of diagnosis and drug treatment of idiopathic pulmonary fibrosis (IPF) and other forms of progressive pulmonary fibrosis (PPF), yet interdisciplinary holistic care for these rare and irreversible diseases is still in its infancy. Patient advocacy groups and experts from across Europe emphasize that gaps in care remain and that patients have major unmet care needs. It remains unclear which patient-reported and clinical outcomes patients and professionals deem most relevant to consider within routine care. The COCOS-IPF project is funded by the EJP-RD programme and aims to develop a Core Outcome Set (COS) and corresponding measures for routine care in Europe. The consortium has co-design at its core and consists of social scientists, European Patient Advocacy Organizations and ILD experts. The project has three work packages (WPs): WP1: To identify the range of outcomes used in pulmonary fibrosis-related research, registries or clinical care based on literature reviews, surveys and stakeholder involvement. WP2: To determine the key outcomes to be used in routine care based on a multi-stakeholder Delphi study and consensus meeting. WP3: To determine the measures of the COS based on literature review, consensus meetings and patient input. <b>Conclusion:</b> The strengths of the project are its interdisciplinary and transnational collaboration, its collaboration with patients as research partners and its sound methodological underpinning. By paying attention to geographical, socio-economic, and healthcare system diversity within Europe, we will create a set of outcomes that patients value most within their care.

This article provides a brief overview of the Adult Cystic Fibrosis Conference (#ACFMilan2023) programme, which will be held on 1-2 December 2023, in Milan (Italy) and online. https://bit.ly/3sKpN6p.