Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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European journal of pediatrics
Health-related quality of life and associated factors in children with bronchiectasis: A systematic review
UNLABELLED: This systematic review aimed to summarize the current evidence on health-related quality of life (HRQoL) and its associated factors in children with bronchiectasis. Following the PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, ScienceDirect, CINAHL, CENTRAL, CNKI, WanFang, VIP, and CBM published from inception to October 2025. Two reviewers independently screened studies, extracted data, and assessed quality using standardized tools. Descriptive synthesis was performed. Nine studies were included, with overall moderate to high quality. HRQoL scores in children with bronchiectasis were significantly lower than those in healthy controls across most scales, though findings varied across physical and psychosocial domains. Parent-proxy scores were generally lower than child self-reports. Lower HRQoL was associated with impaired lung function, frequent exacerbations, higher symptom burden, and anxiety/depression. CONCLUSION: HRQoL is substantially impaired in children with bronchiectasis. Routine assessment of HRQoL and integrated interventions addressing both physical and psychosocial aspects are warranted in clinical practice. WHAT IS KNOWN: • Bronchiectasis is a chronic respiratory disease that causes coughing and breathing difficulties in children. • Previous studies have reported inconsistent findings on quality of life in children with bronchiectasis. WHAT IS NEW: • This systematic review consolidates evidence from nine studies, confirming that children with bronchiectasis have significantly lower quality of life than healthy children. • Poor lung function, frequent exacerbations, and anxiety/depression are key determinants; parents tend to rate their child's quality of life lower than the children themselves, underscoring the need for integrated care including psychological support.
31 July 2026
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Multifaceted Strategies for Hypertension Control in Low-Income Patients
BACKGROUND: Uncontrolled hypertension disproportionately affects populations that have substantial health disparities. Data regarding the effectiveness and implementation of multifaceted, team-based strategies for hypertension control among low-income patients are lacking. METHODS: We randomly assigned federally qualified health center clinics in Louisiana and Mississippi to use either a multifaceted implementation strategy (intervention group) or enhanced usual care (control group) for hypertension control. The intervention included team-based care, protocol-based intensive blood-pressure management, blood-pressure audit and feedback, health coaching on lifestyle changes and medication adherence, and home blood-pressure monitoring. Enhanced usual care involved educating physicians about clinical guidelines for hypertension. The primary effectiveness outcome was the mean change in systolic blood pressure from baseline to 18 months. The primary implementation outcome was the adherence summary score (on a scale of 0 to 4, with higher scores indicating better adherence to blood-pressure management). RESULTS: A total of 36 clinics underwent randomization. Among these clinics, we enrolled 1272 patients with uncontrolled hypertension who were 40 years of age or older; 642 were in the intervention group and 630 were in the control group. The mean age of the patients was 58.8 years, 56.7% were women, 63.4% were Black, 75.9% were unemployed, and 73.4% had a family income of less than $25,000 per year. At 18 months, the mean change from baseline in the systolic blood pressure was -15.5 mm Hg (95% confidence interval [CI], -17.4 to -13.6) in the intervention group and -9.1 mm Hg (95% CI, -11.0 to -7.2) in the control group (between-group difference, -6.4 mm Hg; 95% CI, -9.0 to -3.8; P<0.001). The mean adherence summary score over the 18-month follow-up period was 2.8 (95% CI, 2.7 to 2.9) in the intervention group and 2.1 (95% CI, 2.0 to 2.2) in the control group (between-group difference, 0.7 points; 95% CI, 0.6 to 0.8; P<0.001). Serious adverse events occurred in 20.9% of the patients in the intervention group and in 21.7% of those in the control group. CONCLUSIONS: Among low-income patients with hypertension, a multifaceted, team-based implementation strategy resulted in a significantly greater reduction in systolic blood pressure than enhanced usual care. (Funded by the National Heart, Lung, and Blood Institute and others; IMPACTS-BP ClinicalTrials.gov number, NCT03483662.).
9 Apr 2026
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