Background: This study explores the effectiveness and safety of microbiome-directed-antimicrobial-therapyversususual-antimicrobial-therapy in adult cystic fibrosis pulmonary exacerbations.Methods: A multi-centre two-arm parallel randomised control trial conducted across Europe/North-America enrolled 223 participants (January 2015 - August 2017). All participants were chronically colonised withPseudomonas aeruginosaand were randomised 1:1 into two study-arms. The “usual-therapy group” received 2-weeks of IV ceftazidime 3g thrice-daily (for allergies: aztreonam 2g thrice-daily) and tobramycin 5–10mg·kg⁻¹once-daily. The “microbiome-directed group” received the same usual-therapy plus an additional antibiotic with greatest presumed activity against the 2nd, 3rd and 4th most abundant genera present in the sputum microbiome, selected by a Consensus Expert Treatment Panel. The primary outcome was change in percentage of predicted FEV₁(ppFEV₁) at 14 days post initiation of antibiotics. Secondary outcomes examined ppFEV₁at 7 days, 28 days, and 3 months; time-to-next exacerbation; symptom burden at 7 days; Health Related Quality of Life (HRQoL) at 28 days; and number of exacerbations and IV antibiotic days at 12 months.Results: 149 participants had an eligible exacerbation (usual-therapy n=83, microbiome-directed therapy n=66). There was no difference between the groups for ppFEV₁at day 14 (−1.1%, 95%CI −3.9 to 1.7; p=0.46), or ppFEV₁measured at other time-points, or for time-to-next exacerbation (microbiome-directedversususual-therapy Hazard Ratio 0.91 [95%CI 0.60 to 1.38; p=0.66]). The microbiome-directed group trended to have more IV days (median 42versus28; p=0.08) and more subsequent exacerbations (median 3versus2; p=0.044) the following year. There were no appreciable differences in symptom burden; however, HRQoL sub-scores were consistently worse in the microbiome-directed group (−4.3 pointsversususual therapy (95%CI −8.3 to −0.3, p=0.033).Conclusion: The addition of a third antibiotic based on sputum microbiome sequencing analysis did not result in improved clinical outcomes.

Ultrasound education traditionally involves theoretical and practical training on patients or on simulators; however, difficulty accessing training equipment during the COVID-19 pandemic has highlighted the need for home-based training systems. Due to the prohibitive cost of ultrasound probes, few medical students have access to the equipment required for at home training. Our proof of concept study focused on the development and assessment of the technical feasibility and training performance of an at-home training solution to teach the basics of interpreting and generating ultrasound data. The training solution relies on monitor-based augmented reality for displaying virtual content and requires only a marker printed on paper and a computer with webcam. With input webcam video, we performed body pose estimation to track the student’s limbs and used surface tracking of printed fiducials to track the position of a simulated ultrasound probe. The novelty of our work is in its combination of printed markers with marker-free body pose tracking. In a small user study, four ultrasound lecturers evaluated the training quality with a questionnaire and indicated the potential of our system. The strength of our method is that it allows students to learn the manipulation of an ultrasound probe through the simulated probe combined with the tracking system and to learn how to read ultrasounds in B-mode and Doppler mode.

Background and Objective: With the increased adoption of digital health solutions, such as telehealth, there is a need to consider current practices and considerations towards digital health Literacy. The objective of this review is to explore what digital health literacy considerations have been detailed in cystic fibrosis telehealth papers. Methods: The found papers published from a recent systematic review exploring telehealth within cystic fibrosis care were taken and analysed. These papers were obtained from PubMed, Web of Science, and Scopus databases and included any paper written in English up to May 2021. Data pertaining to Health Literacy, Digital Literacy/Competency, Digital Health Literacy, Training, Readiness Assessments, and Sustained Use were extrapolated using Elicit AI Research Assistant 2024. Key Content and Findings: From the 26 papers, the data of interest was sparse and mostly unavailable for this review. This may be due to several reasons; however the implication of this mitigation is discussed with reference to the digital divide, health in-equalities, and safety. Conclusions: This review highlights that a structured approach to assess digital health literacy of care teams and people with cystic fibrosis is critical to the future success of safe telehealth use, and other digital health solutions.

Cystic Fibrosis (CF) is a chronic life-limiting condition that affects multiple organs within the body. Patients must adhere to strict medication regimens, physiotherapy, diet, and attend regular clinic appointments to manage their condition effectively. This necessary but burdensome requirement has prompted investigations into how different digital health technologies can enhance current care by providing the opportunity to virtually monitor patients. This review explores how virtual monitoring has been harnessed for assessment or performance of physiotherapy/exercise, diet/nutrition, symptom monitoring, medication adherence, and wellbeing/mental-health in people with CF. This review will also briefly discuss the potential future of CF virtual monitoring and some common barriers to its current adoption and implementation within CF. Due to the multifaceted nature of CF, it is anticipated that this review will be relevant to not only the CF community, but also those investigating and developing digital health solutions for the management of other chronic diseases.

Extract Reflecting broader societal trends, respiratory medicine is undergoing a profound transformation, driven by an exponential increase in the availability of digital health technologies [1, 2]. These innovations range from wearable biomarker sensors and digital “smart” inhalers to artificial intelligence (AI)-driven diagnostic algorithms and use of generative AI to support clinician–patient communication. Digital health technologies hold substantial promise for advancing personalised care and accelerating respiratory research; however, this rapid proliferation has created a paradoxical challenge. Shareable abstract Access to digital health tools is rapidly expanding, but adoption in respiratory care remains fragmented. The ERS CONNECT Repository provides a trusted, evidence-based resource to bridge innovation and practice and support meaningful implementation. https://bit.ly/3Pn2prp