RATIONALE: Pulmonary Mycobacterium avium complex treatment guidelines rely largely on expert opinion. The extent to which nonexperts agree with recommendations of experts in this clinical area is unknown. OBJECTIVES: We sought to compare practices and perceptions of prognosis between experts and nonexperts. METHODS: We surveyed respirologists (Ontario, Canada, "nonexperts") and experts from nontuberculous mycobacterial disease centers of excellence (Canada and United States). MEASUREMENTS AND MAIN RESULTS: Forty-six Ontario respirologists (29% of 160) and 19 experts (73% of 26) participated. There was agreement between nonexperts and experts regarding disease duration before diagnosis (2 yr), likelihood of spontaneous remission (7-15%), typical duration of treatment (18 mo), first choice of therapy (guideline regimens), a subgroup of patients for whom less-intensive regimens are favored (10% after recurrence), likelihood of recurrence (30%), and median survival (10 yr in most patients). Noted differences were that nonexperts estimated fewer patients with a positive culture had disease (30% vs. 50%, P = 0.02), used intensive guidelines therapy less often in new cases (50% vs. 79%, P = 0.02), and perceived a slightly lower success rate with guidelines therapy (65% vs. 75%, P = 0.047). Response ranges were wider for nonexperts, significantly so for selection of intensive guidelines therapy in new (P = 0.01) and recurrent (P = 0.04) cases. CONCLUSION: Experts and nonexperts agreed on many issues. However, nonexperts perceived lower rates of disease among patients with isolates, tended to use less aggressive treatment approaches, and perceived lower success rates. Significant variability was observed in responses-often wider among nonexperts. Although these results are likely biased by referral, they may identify important areas for targeted education.
RATIONALE: Pulmonary Mycobacterium avium complex treatment guidelines rely largely on expert opinion. The extent to which nonexperts agree with recommendations of experts in this clinical area is unknown. OBJECTIVES: We sought to compare practices and perceptions of prognosis between experts and nonexperts. METHODS: We surveyed respirologists (Ontario, Canada, "nonexperts") and experts from nontuberculous mycobacterial disease centers of excellence (Canada and United States). MEASUREMENTS AND MAIN RESULTS: Forty-six Ontario respirologists (29% of 160) and 19 experts (73% of 26) participated. There was agreement between nonexperts and experts regarding disease duration before diagnosis (2 yr), likelihood of spontaneous remission (7-15%), typical duration of treatment (18 mo), first choice of therapy (guideline regimens), a subgroup of patients for whom less-intensive regimens are favored (10% after recurrence), likelihood of recurrence (30%), and median survival (10 yr in most patients). Noted differences were that nonexperts estimated fewer patients with a positive culture had disease (30% vs. 50%, P = 0.02), used intensive guidelines therapy less often in new cases (50% vs. 79%, P = 0.02), and perceived a slightly lower success rate with guidelines therapy (65% vs. 75%, P = 0.047). Response ranges were wider for nonexperts, significantly so for selection of intensive guidelines therapy in new (P = 0.01) and recurrent (P = 0.04) cases. CONCLUSION: Experts and nonexperts agreed on many issues. However, nonexperts perceived lower rates of disease among patients with isolates, tended to use less aggressive treatment approaches, and perceived lower success rates. Significant variability was observed in responses-often wider among nonexperts. Although these results are likely biased by referral, they may identify important areas for targeted education.
Authors: David E Griffith; Timothy Aksamit; Barbara A Brown-Elliott; Antonino Catanzaro; Charles Daley; Fred Gordin; Steven M Holland; Robert Horsburgh; Gwen Huitt; Michael F Iademarco; Michael Iseman; Kenneth Olivier; Stephen Ruoss; C Fordham von Reyn; Richard J Wallace; Kevin Winthrop Journal: Am J Respir Crit Care Med Date: 2007-02-15 Impact factor: 21.405
Authors: Jennifer Adjemian; Kenneth N Olivier; Amy E Seitz; Steven M Holland; D Rebecca Prevots Journal: Am J Respir Crit Care Med Date: 2012-02-03 Impact factor: 21.405
Authors: Richard D Kim; David E Greenberg; Mary E Ehrmantraut; Shireen V Guide; Li Ding; Yvonne Shea; Margaret R Brown; Milica Chernick; Wendy K Steagall; Connie G Glasgow; JingPing Lin; Clara Jolley; Lynn Sorbara; Mark Raffeld; Suvimol Hill; Nilo Avila; Vandana Sachdev; Lisa A Barnhart; Victoria L Anderson; Reginald Claypool; Dianne M Hilligoss; Mary Garofalo; Alan Fitzgerald; Sandra Anaya-O'Brien; Dirk Darnell; Rosamma DeCastro; Heather M Menning; Stacy M Ricklefs; Stephen F Porcella; Kenneth N Olivier; Joel Moss; Steven M Holland Journal: Am J Respir Crit Care Med Date: 2008-08-14 Impact factor: 21.405
Authors: Ethan E Bodle; Jennifer A Cunningham; Phyllis Della-Latta; Neil W Schluger; Lisa Saiman Journal: Emerg Infect Dis Date: 2008-03 Impact factor: 6.883