15,165 results
Search Results
2. Chronic pancreatitis for the clinician. Part 2: Treatment and follow-up. Interdisciplinary position paper of the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees
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Xavier Molero, Àngels Ginès, Lucas Ilzarbe, Teresa Serrano, Juli Busquets, Anna Casteràs, Carme Loras, Juan Ramón Ayuso, Gloria Fernàndez Esparrach, Mar Concepción, Esther Fort, Silvia Salord, Jorge J. Olsina, Miquel Masachs, Borobia Fg, Xavier Merino, Eva Cristina Vaquero, Joaquim Balsells, Jaume Boadas, Valentí Puig-Diví, and Míriam Cuatrecasas
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Abdominal pain ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Exocrine pancreatic insufficiency ,Interventional radiology ,General Medicine ,Evidence-based medicine ,medicine.disease ,Genetic mutations ,Therapeutic approach ,Diabetes mellitus ,Quality of life (healthcare) ,Health care ,medicine ,Pancreatitis ,Position paper ,Intensive care medicine ,business ,Chronic pancreatitis - Abstract
Chronic pancreatitis is associated with impaired quality of life, high incidence of comorbidities, serious complications and mortality. Healthcare costs are exorbitant. Some medical societies have developed guidelines for treatment based on scientific evidence, but the gathered level of evidence for any individual topic is usually low and, therefore, recommendations tend to be vague or weak. In the present position papers on chronic pancreatitis from the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees we aimed at providing defined position statements for the clinician based on updated review of published literature and on multidisciplinary expert agreement. The final goal is to propose the use of common terminology and rational diagnostic/therapeutic circuits based on current knowledge. To this end 51 sections related to chronic pancreatitis were reviewed by 21 specialists from 6 different fields to generate 88 statements altogether. Statements were designed to harmonize concepts or delineate recommendations. Part 2 of these paper series discuss topics on treatment and follow-up. The therapeutic approach should include assessment of etiological factors, clinical manifestations and complications. The complexity of these patients advocates for detailed evaluation in multidisciplinary committees where conservative, endoscopic, interventional radiology or surgical options are weighed. Specialized multidisciplinary units of Pancreatology should be constituted. Indications for surgery are refractory pain, local complications, and suspicion of malignancy. Enzyme replacement therapy is indicated if evidence of exocrine insufficiency or after pancreatic surgery. Response should be evaluated by nutritional parameters and assessment of symptoms. A follow-up program should be planned for every patient with chronic pancreatitis. © 2021 Elsevier España, S.L.U.
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- 2022
3. Management of Incidental Thyroid Nodules on Chest CT: Using Natural Language Processing to Assess White Paper Adherence and Track Patient Outcomes
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Benjamin Wildman-Tobriner, Steven Dondlinger, and Ryan G. Short
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Thyroid nodules ,Chest ct ,Thyroid ultrasound ,computer.software_genre ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,White paper ,Chart review ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Thyroid Nodule ,Natural Language Processing ,Retrospective Studies ,Incidental Findings ,business.industry ,Ultrasound ,Nodule (medicine) ,medicine.disease ,030220 oncology & carcinogenesis ,Artificial intelligence ,medicine.symptom ,Tomography, X-Ray Computed ,business ,computer ,Natural language processing - Abstract
Objective The purpose of this study was to develop a natural language processing (NLP) pipeline to identify incidental thyroid nodules (ITNs) meeting criteria for sonographic follow-up and to assess both adherence rates to white paper recommendations and downstream outcomes related to these incidental findings. Methods 21583 non-contrast chest CT reports from 2017 and 2018 were retrospectively evaluated to identify reports which included either an explicit recommendation for thyroid ultrasound, a description of a nodule ≥ 1.5 cm, or description of a nodule with suspicious features. Reports from 2018 were used to train an NLP algorithm called fastText for automated identification of such reports. Algorithm performance was then evaluated on the 2017 reports. Next, any patient from 2017 with a report meeting criteria for ultrasound follow-up was further evaluated with manual chart review to determine follow-up adherence rates and nodule-related outcomes. Results NLP identified reports with ITNs meeting criteria for sonographic follow-up with an accuracy of 96.5% (95% CI 96.2-96.7) and sensitivity of 92.1% (95% CI 89.8-94.3). In 10006 chest CTs from 2017, ITN follow-up ultrasound was indicated according to white paper criteria in 81 patients (0.8%), explicitly recommended in 46.9% (38/81) of patients, and obtained in less than half of patients in which it was appropriately recommended (17/35, 48.6%). Discussion NLP accurately identified chest CT reports meeting criteria for ITN ultrasound follow-up. Radiologist adherence to white paper guidelines and subsequent referrer adherence to radiologist recommendations showed room for improvement.
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- 2022
4. White paper on antimicrobial stewardship in solid organ transplant recipients
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Deborah Levine, Michael Spinner, Margaret R. Jorgenson, Jennifer Pisano, Dilek Ince, Helen S. Te, Sarah Kabbani, Miranda So, Stephanie M Pouch, Gopi Patel, Darshana Dadhania, Elizabeth C. Verna, Shahid Husain, Jonathan Hand, Linda Ohler, Graeme Forrest, Erika D. Lease, Lilian M. Abbo, Monica I. Ardura, Rachel Bartash, and Jeffrey D. Edelman
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Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Risk of infection ,MEDLINE ,Immunosuppression ,Organ Transplantation ,Tissue Donors ,Transplant Recipients ,United States ,Article ,Anti-Bacterial Agents ,Antimicrobial Stewardship ,White paper ,medicine ,Humans ,Immunology and Allergy ,Antimicrobial stewardship ,Pharmacology (medical) ,Stewardship ,Antibiotic prophylaxis ,Solid organ transplantation ,Intensive care medicine ,business - Abstract
Antimicrobial stewardship programs (ASPs) have made immense strides in optimizing antibiotic, antifungal, and antiviral use in clinical settings. However, although ASPs are required institutionally by regulatory agencies in the United States and Canada, they are not mandated for transplant centers or programs specifically. Despite the fact that solid organ transplant recipients in particular are at increased risk of infections from multidrug-resistant organisms, due to host and donor factors and immunosuppressive therapy, there currently are little rigorous data regarding stewardship practices in solid organ transplant populations, and thus, no transplant-specific requirements currently exist. Further complicating matters, transplant patients have a wide range of variability regarding their susceptibility to infection, as factors such as surgery of transplant, intensity of immunosuppression, and presence of drains or catheters in situ may modify the risk of infection. As such, it is not feasible to have a “one-size-fits-all” style of stewardship for this patient population. The objective of this white paper is to identify opportunities, risk factors, and ASP strategies that should be assessed with solid organ transplant recipients to optimize antimicrobial use, while producing an overall improvement in patient outcomes. We hope it may serve as a springboard for development of future guidance and identification of research opportunities.
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- 2022
5. The palliative clinical specialist radiation therapist: A CAMRT White Paper
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Nicole Harnett, Natalie Rozanec, and Carrie Lavergne
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medicine.medical_specialty ,Radiological and Ultrasound Technology ,Palliative Radiation Therapy ,business.industry ,Radiation Therapist ,media_common.quotation_subject ,medicine.medical_treatment ,food and beverages ,Cancer ,medicine.disease ,Radiation therapy ,White paper ,Health care ,medicine ,Radiology, Nuclear Medicine and imaging ,Quality (business) ,Incurable cancer ,Intensive care medicine ,business ,media_common - Abstract
Palliative radiation therapy (pRT) is an effective tool for people with incurable cancer, in the treatment of many cancer-related symptoms such as pain, bleeding and dyspnea. As utilization rates for palliative radiation therapy increase, the demands on the healthcare system continue to grow. Radiation Therapists with advanced knowledge, skills and judgements began demonstrating their ability to practice autonomously in 2004, with the development of the Clinical Specialist Radiation Therapist (CSRT) role. Since this time, CSRTs with a specific focus in pRT (pCSRT) have been increasing in both numbers as well as their positive effects on the cancer care system. Integrating a pCSRT into the existing pRT system has resulted in increased access to and quality of pRT being delivered to palliative cancer patients. The benefits of the addition of pCSRTs to the cancer care system include increasing system capacity and increasing quality of care. This white paper provides information related to the improvements that can be realized in a RT program related to the care and treatment of its palliative patients by adding a pCSRT to the interprofessional healthcare team and suggest it as one of many strategies that can be undertaken to make improvements to access and quality of care.
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- 2021
6. Diagnostic approach to neonatal and infantile cholestasis: A position paper by the SIGENP liver disease working group
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Maurizio Fuoti, Mara Cananzi, Giulia Paolella, Manila Candusso, Paola Francalanci, Lidia Monti, Emanuele Nicastro, Lorenzo D'Antiga, Carlo Dionisi Vici, Michele Pinon, Lorenza Matarazzo, Irene Degrassi, P. Gaio, Angelo Di Giorgio, Giusy Ranucci, Pier Luigi Calvo, Giuseppe Indolfi, Claudia Mandato, Fabio Mosca, Pietro Vajro, Maria Pia Bondioni, Maria Iascone, Maria Grazia Clemente, Federica Nuti, Marco Sciveres, Jean de Ville de Goyet, Claudia Della Corte, Marco Spada, Chiara Grimaldi, Federica Ferrari, Gabriella Nebbia, Giuseppe Maggiore, Fabio Fusaro, Daniele Serranti, Daniele Alberti, Fabiola Di Dato, Paola Roggero, Raffaele Iorio, and Giovanni Boroni
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Male ,medicine.medical_specialty ,Genetic liver disease ,Alagille syndrome ,Biliary atresia ,Diagnosis ,Inborn errors of metabolism ,Jaundice ,Monogenic liver disease ,Newborn ,Female ,Gastroenterology ,Humans ,Infant ,Infant, Newborn ,Cholestasis ,Evidence-Based Medicine ,Infant, Newborn, Diseases ,Practice Guidelines as Topic ,Diseases ,Disease ,Liver disease ,Epidemiology ,medicine ,Intensive care medicine ,Hepatology ,business.industry ,medicine.disease ,Etiology ,Position paper ,medicine.symptom ,business - Abstract
Neonatal and infantile cholestasis (NIC) can represent the onset of a surgically correctable disease and of a genetic or metabolic disorder worthy of medical treatment. Timely recognition of NIC and identification of the underlying etiology are paramount to improve outcomes. Upon invitation by the Italian National Institute of Health (ISS), an expert working grouped was formed to formulate evidence-based positions on current knowledge about the diagnosis of NIC. A systematic literature search was conducted to collect evidence about epidemiology, etiology, clinical aspects and accuracy of available diagnostic tests in NIC. Evidence was scored using the GRADE system. All recommendations were approved by a panel of experts upon agreement of at least 75% of the members. The final document was approved by all the panel components. This position document summarizes the collected statements and defines the best-evidence diagnostic approach to cholestasis in the first year of life.
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- 2022
7. Vaccination against COVID-19 for patients with primary immunodeficiency and hereditary angioedema: the position paper of the Russian Association of Allergology, Clinical Immunology, and the National Association of Experts in Primary Immunodeficiencies
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Elena A. Latysheva, Anna Shcherbina, Tatiana V. Latysheva, Musa R. Khaitov, Daria Fomina, Natalya I. Ilyina, Evgeniya V. Nazarova, Irina Kondratenko, and Irina A. Manto
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Pediatrics ,medicine.medical_specialty ,Angioedema ,business.industry ,Context (language use) ,General Medicine ,medicine.disease ,medicine.disease_cause ,Vaccination ,Hereditary angioedema ,Pandemic ,Primary immunodeficiency ,Medicine ,Position paper ,medicine.symptom ,business ,Coronavirus - Abstract
Since the end of 2019, the whole world has been seized by the COVID-19 pandemic caused by the SARS-CoV2 virus. To date, the infection has led to more than 4 million deaths worldwide, and to more than 140 thousand deaths in Russia. COVID-19 (abbreviation for COronaVIrus Disease 2019) is a potentially severe acute respiratory infection caused by the SARS-CoV-2 coronavirus (2019-nCoV). Vaccination against COVID-19 plays a key role in stopping the pandemic. According to existing experience in infections prevention, mass vaccination will reduce the virus’s expansion and the risk of vaccine-resistant strains’ development. In the context of the COVID-19 the question of the feasibility and safety of vaccination of patients with Primary Immunodeficiency and Hereditary Angioedema arises. The Russian Association of Allergists and Clinical Immunologists and the National Association of Experts in Primary Immunodeficiencies have developed and approved a position paper on vaccination of patients with Primary Immunodeficiency and Hereditary Angioedema against COVID-19. This position paper provides answers to key questions regarding the vaccination of patients with these diseases.
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- 2021
8. Recommendations for photoprotection of parenteral nutrition for premature infants: An ASPEN position paper
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Austin Michalski, Liliia Gutsul, Phil Ayers, Gordon S. Sacks, Daniel T. Robinson, Barbara Fleming, Beverly Holcombe, and Kathleen M. Gura
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Parenteral Nutrition ,medicine.medical_specialty ,Medicine (miscellaneous) ,Infant, Premature, Diseases ,Health outcomes ,Patient safety ,Enteral Nutrition ,medicine ,Humans ,Child ,Intensive care medicine ,Bronchopulmonary Dysplasia ,Nutrition and Dietetics ,business.industry ,Infant, Newborn ,Infant ,Retinopathy of prematurity ,medicine.disease ,United States ,Parenteral nutrition ,Bronchopulmonary dysplasia ,Photoprotection ,Necrotizing enterocolitis ,Position paper ,business ,Infant, Premature - Abstract
Although crucial in improving health outcomes in the preterm infants, parenteral nutrition (PN) is not without risk, especially if handled improperly. A growing body of evidence suggests that components of PN admixtures, including lipid injectable emulsions (ILEs), are susceptible to degradation, including oxidation when exposed to light (ie, photo-oxidation), resulting in the production of reactive oxygen species. Infants, especially those born preterm, are considered more susceptible to consequences of oxidative stress than children and adults. Oxidative stress is associated with bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and intestinal failure-associated liver disease. The American Society for Parenteral and Enteral Nutrition (ASPEN) assembled a working group to provide recommendations on clinical practice surrounding photoprotection of PN.This Position Paper reviews the scientific literature on the formation of quantifiable peroxides and other degradation products when PN admixtures and ILEs are exposed to light and reports adverse clinical outcomes in premature infants exposed to PN. Recommendations for photoprotection of PN admixtures and ILEs are provided, as well as the challenges in achieving complete photoprotection with the equipment, supplies, and materials currently available in the US. ASPEN and the authors understand that the full implementation of complete photoprotection may not currently be feasible given current product availability; recommendations provided in this paper serve to represent the goal to which to strive as well as to highlight the importance of product availability to achieve these practices. This paper has been approved by the ASPEN Board of Directors.
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- 2021
9. Pulling-Force Spinning Top for Serum Separation Combined with Paper-Based Microfluidic Devices in COVID-19 ELISA Diagnosis
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Ji Qi, Anyuan Sun, Dan Zhao, Haopeng Fang, Baolong Wang, Jianping Weng, Fanwu Gong, Bofeng Li, Huan Ma, Qiangsheng Li, Lianxin Liu, Jinglong Han, Bowei Li, Tengchuan Jin, Hua-xing Wei, Liu Liu, Hongliang He, Cuichen Ma, and Xucai Zheng
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COVID-19 diagnosis ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Microfluidics ,anti-RBD antibody ,Enzyme-Linked Immunosorbent Assay ,Bioengineering ,Antibodies, Viral ,Sensitivity and Specificity ,Article ,COVID-19 Testing ,Lab-On-A-Chip Devices ,serum separation ,medicine ,Humans ,Pull force ,microfluidic devices ,Instrumentation ,Spinning ,Fluid Flow and Transfer Processes ,medicine.diagnostic_test ,Human blood ,SARS-CoV-2 ,business.industry ,Process Chemistry and Technology ,COVID-19 ,Paper based ,Immunoassay ,business ,paper-based ELISA ,Biomedical engineering - Abstract
The spread of Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), resulting in a global pandemic with around four million deaths. Although there are a variety of nucleic acid-based tests for detecting SARS-CoV-2, these methods have a relatively high cost and require expensive supporting equipment. To overcome these limitations and improve the efficiency of SARS-CoV-2 diagnosis, we developed a microfluidic platform that collected serum by a pulling-force spinning top and paper-based microfluidic enzyme-linked immunosorbent assay (ELISA) for quantitative IgA/IgM/IgG measurements in an instrument-free way. We further validated the paper-based microfluidic ELISA analysis of SARS-CoV-2 receptor-binding domain (RBD)-specific IgA/IgM/IgG antibodies from human blood samples as a good measurement with higher sensitivity compared with traditional IgM/IgG detection (99.7% vs 95.6%) for early illness onset patients. In conclusion, we provide an alternative solution for the diagnosis of SARS-CoV-2 in a portable manner by this smart integration of pulling-force spinning top and paper-based microfluidic immunoassay.
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- 2021
10. Hypersensitivity reactions to chemotherapy: an EAACI Position Paper
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Patrizia Bonadonna, Emilio Alvarez-Cuesta, Adile Berna Dursun, Soledad Sanchez Sanchez, Mariana Castells, Josefina Cernadas, Mauro Pagani, Hamadi Sahar, Anca M. Chiriac, Ricardo Madrigal-Burgaleta, and Sevim Bavbek
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Drug ,medicine.medical_specialty ,Allergy ,media_common.quotation_subject ,medicine.medical_treatment ,Immunology ,Provocation test ,Drug allergy ,Antineoplastic Agents ,Disease ,Drug Hypersensitivity ,Neoplasms ,Humans ,Immunology and Allergy ,Medicine ,Intensive care medicine ,Anaphylaxis ,Skin Tests ,media_common ,Desensitization (medicine) ,business.industry ,medicine.disease ,Desensitization, Immunologic ,Position paper ,business - Abstract
Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions (HSRs), with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most reactions are caused by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. Despite their prevalence and relevance, the ideal pathways for diagnosis, treatment and prevention of these reactions are still unclear, and practice remains considerably heterogeneous with vast differences from center to center. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work-up in this field of drug hypersensitivity reactions. This position paper aims to provide consensus on the investigation of HSRs to chemotherapeutic drugs and give practical recommendations for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover risk factors, pathogenesis, symptoms, the role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section.
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- 2021
11. Peripheral blood RNA biomarkers for cardiovascular disease from bench to bedside: a position paper from the EU-CardioRNA COST action CA17129
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Stephanie Bezzina Wettinger, Maarten Vanhaverbeke, Costanza Emanueli, Johannes Grillari, Rosienne Farrugia, Monika Bartekova, Barbora Kalocayova, Soumaya Ben-Aicha, EU-CardioRNA Cost Action Ca, Markus Scholz, R. Attard, Yvan Devaux, Matthias Hackl, Fabio Martelli, David de Gonzalo-Calvo, Timo Brandenburger, and EU-CardioRNA COST Action (CA17129)
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Cardiovascular system -- Diseases ,Physiology ,business.industry ,RNA ,Genomics ,Disease ,Cardiovascular system -- Diseases -- Diagnosis ,Bioinformatics ,medicine.disease ,Transcriptome ,Physiology (medical) ,Heart failure ,Cardiovascular system -- Diseases -- Treatment ,Gene expression ,medicine ,Biomarker (medicine) ,Position paper ,Cardiology and Cardiovascular Medicine ,business - Abstract
Despite significant advances in the diagnosis and treatment of cardiovascular diseases, recent calls have emphasized the unmet need to improve precision-based approaches in cardiovascular disease. Although some studies provide preliminary evidence of the diagnostic and prognostic potential of circulating coding and non-coding RNAs, the complex RNA biology and lack of standardization have hampered the translation of these markers into clinical practice. In this position paper of the CardioRNA COST action CA17129, we provide recommendations to standardize the RNA development process in order to catalyse efforts to investigate novel RNAs for clinical use. We list the unmet clinical needs in cardiovascular disease, such as the identification of high-risk patients with ischaemic heart disease or heart failure who require more intensive therapies. The advantages and pitfalls of the different sample types, including RNAs from plasma, extracellular vesicles, and whole blood, are discussed in the sample matrix, together with their respective analytical methods. The effect of patient demographics and highly prevalent comorbidities, such as metabolic disorders, on the expression of the candidate RNA is presented and should be reported in biomarker studies. We discuss the statistical and regulatory aspects to translate a candidate RNA from a research use only assay to an in-vitro diagnostic test for clinical use. Optimal planning of this development track is required, with input from the researcher, statistician, industry, and regulatory partners., peer-reviewed
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- 2021
12. Vaccination of patients with allergic disease against novel coronavirus infection: position paper of the Russian Association of Allergology and Clinical Immunology
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O M Kurbacheva, N V Shartanova, Natalya I. Ilyina, Elena A. Latysheva, Musa R. Khaitov, Tatiana V. Latysheva, Evgeniya V. Nazarova, Natalia M. Nenasheva, and Elena S. Fedenko
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Pediatrics ,medicine.medical_specialty ,Allergy ,Clinical immunology ,business.industry ,General Medicine ,Disease ,medicine.disease_cause ,medicine.disease ,Virus ,Vaccination ,Pandemic ,Medicine ,Position paper ,business ,Coronavirus - Abstract
One of the key tasks of the previous year is to stop the spread of coronavirus disease (COVID-19), which became a pandemic that led to the deaths of more than 4 million people worldwide and more than 140 thousand deaths in Russia. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (2019-nCoV) virus of the coronavirus family. Vaccination plays a leading role in ending the pandemic. Currently, five vaccines against COVID-19 have been registered in Russia, namely, Sputnik V, Sputnik light, EpiVacCorona, EpiVacCorona-Н, and СoviVak. The short follow-up period and absence of randomized placebo-controlled trials of COVID-19 vaccines in certain patients with chronic diseases lead to several questions about the effectiveness/safety of vaccination in these patients. Given the wide spread of allergic diseases and the heterogeneity of patients with allergopathology, experts of the Russian Association of Allergology and Clinical Immunology have developed and approved a position paper on vaccination of patients with allergopathology.
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- 2021
13. Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand
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John Gornall, Laurence Ruane, Li Ping Chung, Anne E Holland, Helen K. Reddel, Philip G. Bardin, Sinthia Bosnic-Anticevich, Trudy Hopkins, Christopher Barton, Mark Hew, Vanessa M. McDonald, Peter G. Gibson, Lata Jayaram, John Blakey, John W. Upham, and John Harrington
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Adult ,Pulmonary and Respiratory Medicine ,Harm reduction ,medicine.medical_specialty ,Adolescent ,business.industry ,medicine.medical_treatment ,Administration, Oral ,medicine.disease ,Asthma ,Harm ,Adrenal Cortex Hormones ,Chronic Disease ,medicine ,Humans ,Position paper ,Smoking cessation ,Anti-Asthmatic Agents ,Stewardship ,Medical prescription ,Intensive care medicine ,business ,Adverse effect ,New Zealand - Abstract
Oral corticosteroids (OCS) are frequently used for asthma treatment. This medication is highly effective for both acute and chronic diseases, but evidence indicates that indiscriminate OCS use is common, posing a risk of serious side effects and irreversible harm. There is now an urgent need to introduce OCS stewardship approaches, akin to successful initiatives that optimized appropriate antibiotic usage. The aim of this TSANZ (Thoracic Society of Australia and New Zealand) position paper is to review current knowledge pertaining to OCS use in asthma and then delineate principles of OCS stewardship. Recent evidence indicates overuse and over-reliance on OCS for asthma and that doses >1000 mg prednisolone-equivalent cumulatively are likely to have serious side effects and adverse outcomes. Patient perspectives emphasize the detrimental impacts of OCS-related side effects such as weight gain, insomnia, mood disturbances and skin changes. Improvements in asthma control and prevention of exacerbations can be achieved by improved inhaler technique, adherence to therapy, asthma education, smoking cessation, multidisciplinary review, optimized medications and other strategies. Recently, add-on therapies including novel biological agents and macrolide antibiotics have demonstrated reductions in OCS requirements. Harm reduction may also be achieved through identification and mitigation of predictable adverse effects. OCS stewardship should entail greater awareness of appropriate indications for OCS prescription, risk–benefits of OCS medications, side effects, effective add-on therapies and multidisciplinary review. If implemented, OCS stewardship can ensure that clinicians and patients with asthma are aware that OCS should not be used lightly, while providing reassurance that asthma can be controlled in most people without frequent use of OCS.
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- 2021
14. International Continence Society white paper on ethical considerations in older adults with urinary incontinence
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Tiina Vaittinen, Nina Davis, Anne M. Suskind, William Gibson, Joan Ostaszkiewicz, Martha Spencer, Tamara Dickinson, Sakineh Hajebrahimi, and Adrian Wagg
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Geriatrics ,medicine.medical_specialty ,Health professionals ,business.industry ,Urology ,education ,Urinary incontinence ,medicine.disease ,Urinary Incontinence ,White paper ,Nursing ,medicine ,Humans ,Dementia ,Neurology (clinical) ,medicine.symptom ,business ,Ethical framework ,health care economics and organizations ,Aged - Abstract
Urinary incontinence is a common problem among older adults that is often complicated by many nuanced ethical considerations. Unfortunately, there is a lack of guidance for healthcare professionals on how to navigate such concerns. This International Continence Society white paper aims to provide healthcare professionals with an ethical framework to promote best care practices in the care of older adults with urinary incontinence.
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- 2021
15. Protocols for multi‐site trials using hyperpolarized 129 Xe MRI for imaging of ventilation, alveolar‐airspace size, and gas exchange: A position paper from the 129 Xe MRI clinical trials consortium
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Jonathan H. Rayment, Bastiaan Driehuys, Chase S. Hall, G. Wilson Miller, Zackary I. Cleveland, Sarah Svenningsen, Rachel L. Eddy, Jim M. Wild, John P. Mugler, Ho-Fung Chan, Peter Niedbalski, Mario Castro, Neil J. Stewart, Sean B. Fain, Giles E. Santyr, Brandon Zanette, Jason C. Woods, Guilhem Collier, Grace Parraga, Robert P. Thomen, Matthew M. Willmering, and Jaime F. Mata
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medicine.medical_specialty ,business.industry ,Image quality ,Multi site ,Clinical trial ,Lung structure ,Breathing ,Medicine ,Image acquisition ,Position paper ,Radiology, Nuclear Medicine and imaging ,Medical physics ,business ,Pulmonary disorders - Abstract
Hyperpolarized (HP) 129 Xe MRI uniquely images pulmonary ventilation, gas exchange, and terminal airway morphology rapidly and safely, providing novel information not possible using conventional imaging modalities or pulmonary function tests. As such, there is mounting interest in expanding the use of biomarkers derived from HP 129 Xe MRI as outcome measures in multi-site clinical trials across a range of pulmonary disorders. Until recently, HP 129 Xe MRI techniques have been developed largely independently at a limited number of academic centers, without harmonizing acquisition strategies. To promote uniformity and adoption of HP 129 Xe MRI more widely in translational research, multi-site trials, and ultimately clinical practice, this position paper from the 129 Xe MRI Clinical Trials Consortium (https://cpir.cchmc.org/XeMRICTC) recommends standard protocols to harmonize methods for image acquisition in HP 129 Xe MRI. Recommendations are described for the most common HP gas MRI techniques-calibration, ventilation, alveolar-airspace size, and gas exchange-across MRI scanner manufacturers most used for this application. Moreover, recommendations are described for 129 Xe dose volumes and breath-hold standardization to further foster consistency of imaging studies. The intention is that sites with HP 129 Xe MRI capabilities can readily implement these methods to obtain consistent high-quality images that provide regional insight into lung structure and function. While this document represents consensus at a snapshot in time, a roadmap for technical developments is provided that will further increase image quality and efficiency. These standardized dosing and imaging protocols will facilitate the wider adoption of HP 129 Xe MRI for multi-site pulmonary research.
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- 2021
16. ESC working group on cardiac cellular electrophysiology position paper: relevance, opportunities, and limitations of experimental models for cardiac electrophysiology research
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Dierk Thomas, Milan Stengl, Dobromir Dobrev, Matteo E. Mangoni, Jordi Heijman, Carol Ann Remme, Larissa Fabritz, Katja E. Odening, Godfrey L. Smith, Cristina E. Molina, Leonardo Sacconi, A.M. Gomez, Antonio Zaza, Frank R. Heinzel, Cardiologie, RS: Carim - H01 Clinical atrial fibrillation, RS: Carim - H04 Arrhythmogenesis and cardiogenetics, Cardiology, ACS - Heart failure & arrhythmias, APH - Methodology, University of Bern, Odening, K, Gomez, A, Dobrev, D, Fabritz, L, Heinzel, F, Mangoni, M, Molina, C, Sacconi, L, Smith, G, Stengl, M, Thomas, D, Zaza, A, Remme, C, and Heijman, J
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0301 basic medicine ,TORSADE-DE-POINTES ,Cardiac electrophysiology ,Medizin ,Cardiomyopathy ,Arrhythmias ,030204 cardiovascular system & hematology ,0302 clinical medicine ,BIO/09 - FISIOLOGIA ,Mechanisms ,Position paper ,Induced pluripotent stem cell ,LEFT-VENTRICULAR WALL ,SINOATRIAL NODE ,Atrial fibrillation ,Animal models ,3. Good health ,PRESERVED EJECTION FRACTION ,Ion channels ,cardiovascular system ,HEART-FAILURE ,Mechanism ,Ion channel ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,Experimental models ,PLURIPOTENT STEM-CELLS ,Arrhythmia ,Myocarditis ,Cellular electrophysiology ,LONG-QT SYNDROME ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Physiology (medical) ,SINUS NODE DYSFUNCTION ,medicine ,Animals ,Humans ,Animal model ,Experimental model ,business.industry ,TRANSGENIC RABBIT MODEL ,Cardiac arrhythmia ,Models, Theoretical ,medicine.disease ,Electrophysiological Phenomena ,030104 developmental biology ,Heart failure ,ATRIAL-FIBRILLATION ,business ,Neuroscience - Abstract
Cardiac arrhythmias are a major cause of death and disability. A large number of experimental cell and animal models have been developed to study arrhythmogenic diseases. These models have provided important insights into the underlying arrhythmia mechanisms and translational options for their therapeutic management. This position paper from the ESC Working Group on Cardiac Cellular Electrophysiology provides an overview of (i) currently available in vitro, ex vivo, and in vivo electrophysiological research methodologies, (ii) the most commonly used experimental (cellular and animal) models for cardiac arrhythmias including relevant species differences, (iii) the use of human cardiac tissue, induced pluripotent stem cell (hiPSC)-derived and in silico models to study cardiac arrhythmias, and (iv) the availability, relevance, limitations, and opportunities of these cellular and animal models to recapitulate specific acquired and inherited arrhythmogenic diseases, including atrial fibrillation, heart failure, cardiomyopathy, myocarditis, sinus node, and conduction disorders and channelopathies. By promoting a better understanding of these models and their limitations, this position paper aims to improve the quality of basic research in cardiac electrophysiology, with the ultimate goal to facilitate the clinical translation and application of basic electrophysiological research findings on arrhythmia mechanisms and therapies.
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- 2021
17. Management of oral leukoplakia: a position paper of the Society of Oral Medicine, Chinese Stomatological Association
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Xiaobo Luo, Hongxia Dan, Xin Zeng, Lu Jiang, Yu Zhou, Weiyi Pan, and Qianming Chen
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China ,medicine.medical_specialty ,Path diagram ,Oral Medicine ,MEDLINE ,Delphi method ,Cochrane Library ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Grading (education) ,business.industry ,030206 dentistry ,Oral leukoplakia ,Cell Transformation, Neoplastic ,030220 oncology & carcinogenesis ,Family medicine ,Position paper ,Surgery ,Leukoplakia, Oral ,Oral Surgery ,business ,Oral medicine - Abstract
Objective The objective of this study was to develop the first edition of a Chinese evidence-based position paper on the management of oral leukoplakia (OLK). Study Design The consultant group for drafting the position paper consisted of 31 oral medicine specialists and 2 evidence-based medicine specialists. English studies (searched in PubMed, EMBASE, and the Cochrane Library) and Chinese studies (searched in China National Knowledge Infrastructure and WanFang) published before January 2018 were used. The quality of the study was assessed using the Grading of Recommendations Assessment, Development, and Evaluation grid, and the strength of the recommendations was determined based on the results of 3 rounds of voting among the consultant group members using the Delphi method. Results Twenty-two evidence-based guidelines for clinical management and monitoring of OLK were established in this position paper. A clinical path diagram for oral health practitioners was constructed based on the recommendations. Conclusion Current evidence suggests that management and monitoring of patients with OLK should be performed by experienced clinicians to control the lesion and for early detection of malignant transformation. However, all recommendations are based on evidence of low or extremely low quality and may require further modification as new evidence is produced.
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- 2021
18. Examining guidelines and new evidence in oncology nutrition: a position paper on gaps and opportunities in multimodal approaches to improve patient care
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Carla M. Prado, Michael D. Bastasch, Shila M. Newman, Maureen Gardner, Chelsia Gillis, Anthony D. Sung, Martin Chasen, Suayib Yalcin, Abby C. Sauer, Suzanne Dixon, Refaat Hegazi, and Alessandro Laviano
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Nursing research ,Pain medicine ,Prehabilitation ,Disease ,medicine.disease ,Malnutrition ,Quality of life (healthcare) ,Multidisciplinary approach ,Internal medicine ,medicine ,Position paper ,business - Abstract
Malnutrition, muscle loss, and cachexia are prevalent in cancer and remain key challenges in oncology today. These conditions are frequently underrecognized and undertreated and have devastating consequences for patients. Early nutrition screening/assessment and intervention are associated with improved patient outcomes. As a multifaceted disease, cancer requires multimodal care that integrates supportive interventions, specifically nutrition and exercise, to improve nutrient intake, muscle mass, physical functioning, quality of life, and treatment outcomes. An integrated team of healthcare providers that incorporates societies’ recommendations into clinical practice can help achieve the best possible outcomes. A multidisciplinary panel of experts in oncology, nutrition, exercise, and medicine participated in a 2-day virtual roundtable in October 2020 to discuss gaps and opportunities in oncology nutrition, alone and in combination with exercise, relative to current evidence and international societies’ recommendations. The panel recommended five principles to optimize clinical oncology practice: (1) position oncology nutrition at the center of multidisciplinary care; (2) partner with colleagues and administrators to integrate a nutrition care process into the multidisciplinary cancer care approach; (3) screen all patients for malnutrition risk at diagnosis and regularly throughout treatment; (4) combine exercise and nutrition interventions before (e.g., prehabilitation), during, and after treatment as oncology standard of care to optimize nutrition status and muscle mass; and (5) incorporate a patient-centered approach into multidisciplinary care.
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- 2021
19. Simplifying assessment of dimensions of oral lesions using a syringe and ‘impression planimetry’ with printer paper
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P. Gole, S. Mahajan, Vidya Kharkar, Siddhi Chikhalkar, A. Kumar Bose, T. Vishwanath, and H. Balaji
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Observer Variation ,Paper ,business.industry ,Syringes ,Lichen Planus ,Reproducibility of Results ,Dentistry ,Dermatology ,Impression ,Clinical trial ,Pemphigoid, Bullous ,Humans ,Medicine ,Coloring Agents ,business ,Oral Ulcer ,Pemphigus ,Syringe - Abstract
Two novel methods of measuring the dimensions of oral lesions are described, which would be of help in deciding relative efficacies of different therapeutic agents when used in clinical trials after larger studies quantitatively assessed for inter/intraobserver variability.
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- 2021
20. Update on bone health: the International Menopause Society White Paper 2021
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Steven R. Goldstein and T. J. de Villiers
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Gerontology ,Population ageing ,business.industry ,Osteoporosis ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Bone health ,Menopause ,White paper ,Bone Density ,Intervention (counseling) ,Sarcopenia ,medicine ,Global health ,Humans ,business ,Aged - Abstract
Osteoporosis and associated fractures present a major challenge in improving global health outcomes. Key clinical aspects are the definition of osteoporosis and associated fractures, fracture risk prediction, stratification of risk of fracture, intervention thresholds and the most appropriate intervention based on integration of aforementioned. Correct understanding and application of these concepts are essential to stem the increasing tide of fragility fractures associated with an aging population. The role of muscle strength and function, sarcopenia, and the newly emerging concept of osteosarcopenia in maintaining bone health are discussed in detail.
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- 2021
21. Ventilatory support at home for children: A joint position paper from the Thoracic Society of Australia and New Zealand/Australasian Sleep Association
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Amanda Griffiths, Moya Vandeleur, Jacob Twiss, Jasneek Chawla, Andrew Tai, Andrew Wilson, Susan Wilson, Sadasivam Suresh, Karen A. Waters, Elizabeth A. Edwards, and Gillian M. Nixon
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Consensus ,business.industry ,Australia ,Expert consensus ,Home ventilation ,Family medicine ,Humans ,Medicine ,Position paper ,Sleep (system call) ,Child ,Sleep ,business ,Association (psychology) ,New Zealand - Abstract
The goal of this position paper on ventilatory support at home for children is to provide expert consensus from Australia and New Zealand on optimal care for children requiring ventilatory support at home, both non-invasive and invasive. It was compiled by members of the Thoracic Society of Australia and New Zealand (TSANZ) and the Australasian Sleep Association (ASA). This document provides recommendations to support the development of improved services for Australian and New Zealand children who require long-term ventilatory support. Issues relevant to providers of equipment and areas of research need are highlighted.
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- 2021
22. ANMCO POSITION PAPER: Role of intra-aortic balloon pump in patients with acute advanced heart failure and cardiogenic shock
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Roberta Rossini, Cesare Baldi, Massimo Imazio, Manlio Cipriani, Rossella Gilardi, Domenico Gabrielli, Nicola Gasparetto, Carlotta Sorini Dini, Fortunato Scotto di Uccio, Furio Colivicchi, Tullio Usmiani, Daniela Chiappetta, Alberto Somaschini, Marco Ferlini, Paolo Trambaiolo, Loris Roncon, Serafina Valente, Michele Massimo Gulizia, Simona Giubilato, Marco Marini, and Pasquale Caldarola
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medicine.medical_specialty ,business.industry ,Advanced heart failure ,Cardiogenic shock ,medicine.medical_treatment ,Articles ,Intra-Aortic Balloon Pumping ,medicine.disease ,Intra-aortic balloon pump ,Mechanical Circulatory Support (MCS) ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Position paper ,AcademicSubjects/MED00200 ,In patient ,Myocardial infarction ,Balloon pump ,Cardiology and Cardiovascular Medicine ,business - Abstract
The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.
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- 2021
23. ANMCO POSITION PAPER: Timing of coronary angiography in non-ST-segment elevation acute coronary syndromes
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Manlio Cipriani, Giuseppina Maura Francese, Furio Colivicchi, Vincenzo Amodeo, Stefano Urbinati, Andrea Di Lenarda, Pasquale Caldarola, Michele Massimo Gulizia, Nadia Aspromonte, Massimo Imazio, Loris Roncon, Giuseppe Di Pasquale, Stefano Domenicucci, Domenico Gabrielli, Gianni Casella, Adriano Murrone, Leonardo De Luca, Serafina Valente, and Fortunato Scotto di Uccio
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Coronary angiography ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Articles ,Guideline ,medicine.disease ,Revascularization ,Risk profile ,Scientific evidence ,Revascularization timing ,Medicine ,ST segment ,Position paper ,AcademicSubjects/MED00200 ,Non-ST-segment elevation acute coronary syndromes ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Risk stratification - Abstract
The European Society of Cardiology guidelines on non-ST-elevation acute coronary syndromes suggest different temporal strategies for the angiographic study depending on the risk profile. The scientific evidence underlying the guideline recommendations and the critical issues currently existing in Italy, that often do not allow either an extended strategy of revascularization within 24 h or the application of the principle of the same day transfer from a spoke to a hub centre, are analysed. The position paper focuses, in particular, on the subgroup of patients with a defined diagnosis of non-ST-elevation myocardial infarction by proposing a timing of coronary angiography/revascularization that takes into account the available scientific evidence and the organizational possibilities of a considerable part of national cardiology services.
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- 2021
24. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension
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Paul Muntner, Anastasios Kollias, Paul L. Padfield, Jonathan Mant, George S. Stergiou, Juan Eugenio Ochoa, Richard J McManus, Martino F Pengo, Thomas Mengden, James E. Sharman, Satoshi Hoshide, Geoff Head, G. Mancia, Stefano Omboni, A. de la Sierra, Cristina Giannattasio, Anastasia S. Mihailidou, William B. White, Agustin J. Ramirez, Kazuomi Kario, Paolo Palatini, Angeliki Ntineri, Michael A. Weber, Ji-Guang Wang, Kei Asayama, Eoin O'Brien, Rajiv Agarwal, Y. Imai, R. Asmar, José A. Octavio, Nicolas Postel-Vinay, Martin G. Myers, Grzegorz Bilo, Jirar Topouchian, Efstathios Manios, Camilla Torlasco, Andrew Shennan, Gianfranco Parati, Egle Silva, Paul K. Whelton, Y. Li, Philippe Gosse, Takayoshi Ohkubo, Dario Pellegrini, Teemu J. Niiranen, Michel Burnier, Parati, G, Stergiou, G, Bilo, G, Kollias, A, Pengo, M, Ochoa, J, Agarwal, R, Asayama, K, Asmar, R, Burnier, M, De La Sierra, A, Giannattasio, C, Gosse, P, Head, G, Hoshide, S, Imai, Y, Kario, K, Li, Y, Manios, E, Mant, J, Mcmanus, R, Mengden, T, Mihailidou, A, Muntner, P, Myers, M, Niiranen, T, Ntineri, A, O'Brien, E, Octavio, J, Ohkubo, T, Omboni, S, Padfield, P, Palatini, P, Pellegrini, D, Postel-Vinay, N, Ramirez, A, Sharman, J, Shennan, A, Silva, E, Topouchian, J, Torlasco, C, Wang, J, Weber, M, Whelton, P, White, W, and Mancia, G
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cardiovascular risk ,CHRONIC KIDNEY-DISEASE ,2019-20 coronavirus outbreak ,hypertension ,Coronavirus disease 2019 (COVID-19) ,blood pressure measurement ,Physiology ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,ORTHOSTATIC HYPOTENSION ,TARGET-ORGAN DAMAGE ,Blood Pressure ,MEDICAL INSTRUMENTATION/EUROPEAN SOCIETY ,cardiovascular disease ,SELF-MEASUREMENT ,Internal Medicine ,medicine ,Humans ,prevention and control ,Blood pressure monitoring ,Hypertension diagnosis ,Societies, Medical ,Science & Technology ,business.industry ,Blood Pressure Determination ,Blood Pressure Monitoring, Ambulatory ,medicine.disease ,WHITE-COAT HYPERTENSION ,home blood pressure monitoring ,PROGNOSTIC VALUE ,Blood pressure ,Peripheral Vascular Disease ,MEASURING DEVICES ,Hypertension ,Cardiovascular System & Cardiology ,Position paper ,Medical emergency ,FOLLOW-UP ,Cardiology and Cardiovascular Medicine ,business ,Life Sciences & Biomedicine ,OUTCOME-DRIVEN THRESHOLDS ,blood pressure monitorign, home, methodology - Abstract
The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH. ispartof: JOURNAL OF HYPERTENSION vol:39 issue:9 pages:1742-1767 ispartof: location:Netherlands status: published
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- 2021
25. Health Information Privacy, Protection, and Use in the Expanding Digital Health Ecosystem: A Position Paper of the American College of Physicians
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Dejaih Johnson, Lois Snyder Sulmasy, Professionalism Ethics, and Brooke Rockwern
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Digital Technology ,business.industry ,Internet privacy ,Privacy protection ,Privacy laws of the United States ,ComputingMilieux_LEGALASPECTSOFCOMPUTING ,General Medicine ,Digital health ,United States ,Health Records, Personal ,Privacy ,Health care ,Internal Medicine ,Electronic Health Records ,Humans ,Position paper ,Medicine ,Health information ,Privacy law ,business ,Computer Security ,Medical ethics - Abstract
Technologic advancements and the evolving digital health landscape have offered innovative solutions to several of our health care system's issues as well as increased the number of digital interactions and type of personal health information that is generated and collected, both within and outside of traditional health care. This American College of Physicians' position paper discusses the state of privacy legislation and regulations, highlights existing gaps in health information privacy protections, and outlines policy principles and recommendations for the development of health information privacy and security protections that are comprehensive, transparent, understandable, adaptable, and enforceable. The principles and recommendations aim to improve on the privacy framework in which physicians have practiced for decades and expand similar privacy guardrails to entities not currently governed by privacy laws and regulations. The expanded privacy framework should protect personal health information from unauthorized, discriminatory, deceptive, or harmful uses and align with the principles of medical ethics, respect individual rights, and support the culture of trust necessary to maintain and improve care delivery.
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- 2021
26. Alcohol-Related Liver Disease in the Covid-19 Era: Position Paper of the Italian Society on Alcohol (SIA)
- Author
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Pierluigi Allosio, Giovanni Addolorato, Fabio Caputo, Patrizia Balbinot, Davide Mioni, Doda Renzetti, Tiziana Fanucchi, Raffaella Rossin, Gianni Testino, Livia Maccio, Claudia Gandin, S. Arico, Michele Parisi, Maria Francesca Amendola, Aniello Baselice, Vincenzo Palmieri, Vito Campanile, Emanuele Scafato, Valentino Patussi, Mauro Bernardi, Giorgio Zoli, Cristina Meneguzzi, Teo Vignoli, Lisa Lungaro, Giovanni Greco, and Luigi C. Bottaro
- Subjects
medicine.medical_specialty ,Telemedicine ,Physiology ,medicine.medical_treatment ,Telehealth ,Alcohol use disorder ,Alcohol-related liver cirrhosis ,Alcohol-related liver disease ,ALD and SARS-CoV-2 ,Management of AUD ,SARS-CoV-2 infection ,Liver transplantation ,NO ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Internal medicine ,Pandemic ,medicine ,Humans ,Intensive care medicine ,Liver Diseases, Alcoholic ,Pandemics ,business.industry ,Gastroenterology ,COVID-19 ,Hepatology ,medicine.disease ,Alcoholism ,030220 oncology & carcinogenesis ,Communicable Disease Control ,Position paper ,Original Article ,030211 gastroenterology & hepatology ,business - Abstract
Background Coronavirus Disease 2019 (COVID-19), firstly reported in China last November 2019, became a global pandemic. It has been shown that periods of isolation may induce a spike in alcohol use disorder (AUD). In addition, alcohol-related liver disease (ALD) is the most common consequence of excessive alcohol consumption worldwide. Moreover, liver impairment has also been reported as a common manifestation of COVID-19. Aims The aim of our position paper was to consider some critical issues regarding the management of ALD in patients with AUD in the era of COVID-19. Methods A panel of experts of the Italian Society of Alcohology (SIA) met via “conference calls” during the lockdown period to draft the SIA’s criteria for the management of ALD in patients with COVID-19 as follows: (a) liver injury in patients with ALD and COVID-19 infection; (b) toxicity to the liver of the drugs currently tested to treat COVID-19 and the pharmacological interaction between medications used to treat AUD and to treat COVID-19; (c) reorganization of the management of compensated and decompensated ALD and liver transplantation in the COVID-19 era. Results and Conclusions The COVID-19 pandemic has rapidly carried us toward a new governance scenario of AUD and ALD which necessarily requires an in-depth review of the management of these diseases with a new safe approach (management of out-patients and in-patients following new rules of safety, telemedicine, telehealth, call meetings with clinicians, nurses, patients, and caregivers) without losing the therapeutic efficacy of multidisciplinary treatment.
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- 2021
27. Best‐practices for preventing skin injury beneath personal protective equipment during the COVID‐19 pandemic: A position paper from the National Pressure Injury Advisory Panel
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Barbara Delmore, Sharon Eve Sonenblum, Joyce Pittman, Nancy Munoz, Ann Marie Nie, Jill Cox, William V. Padula, Lee Ruotsi, Virginia Capasso, Joyce Black, David M. Brienza, Ann N. Tescher, Sarah Holden-Mount, and Janet Cuddigan
- Subjects
medicine.medical_specialty ,integumentary system ,030504 nursing ,Coronavirus disease 2019 (COVID-19) ,Discursive Paper ,Skin Injury ,business.industry ,Best practice ,General Medicine ,Discursive Papers ,03 medical and health sciences ,0302 clinical medicine ,Personal hygiene ,Health care ,Pandemic ,medicine ,Position paper ,030212 general & internal medicine ,0305 other medical science ,business ,Intensive care medicine ,Personal protective equipment ,General Nursing - Abstract
COVID‐19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID‐19 pandemic (April 2020), the U.S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear‐ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (1) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturizers; (2) Frequent PPE offloading to relieve pressure and shear applied to skin; (3) treat visible skin injuries immediately caused by PPE to minimize future infection; (4) non‐porous dressings may provide additional skin protection, but lack evidence; (5) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence‐based recommendations on prevention of device related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long‐term effects (e.g. scarring). These simple steps to minimize the risk of skin injury and reduce the risk of coronavirus infection from PPE can help.
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- 2021
28. Clinical Performance Monitoring in Undergraduate Dental Education - Paper-Based vs. Online Logbooks; Reporting by Students vs. Reporting by Instructors
- Author
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Fatin Abdulrahman Hasanain
- Subjects
03 medical and health sciences ,Medical education ,0302 clinical medicine ,business.industry ,education ,ComputingMilieux_COMPUTERSANDEDUCATION ,Clinical performance ,Medicine ,030212 general & internal medicine ,030206 dentistry ,Paper based ,Dental education ,business - Abstract
BACKGROUND Medical and dental education is highly dependent on the development of students’ clinical skills in addition to their theoretical knowledge. The use of logbooks to monitor the clinical procedures performed by students provides a great advantage in the educational process. Because of the pandemic, utilisation of digital logbooks may prove to be more advantageous. This study aims to investigate the effective use of online progress records and as to whether they actually decrease the chance of error compared to the traditional paper-based logbooks. METHODS In this quasi-experimental study, 139 student logbooks were studied to compare online and paper-based clinical procedures. Logbook monitoring of undergraduate dental students reported by the students themselves vs. instructors was compared. Students filled mandatory individual paper-based logbooks, reporting the number of clinical procedures performed in that year. Additionally, they filled online log- sheets, and updated them regularly. Instructors proofread and signed the paper-based students’ logbooks. Instructors also separately submitted individual online forms recording each student’s clinical procedure performed in clinical sessions. A total of 556 logbook records was collected. The mean number of procedures recorded by the students and instructors (online and paper-based) were statistically compared. RESULTS The mean number of procedures recorded in student-reported online logbooks were significantly lower than that in all other logbooks. Paper-based and online instructorreported logbook data was identical to that of student reported paper-based logbooks. CONCLUSIONS Within the scope of the study, it was concluded that online tools are an asset and may be used as a substitute for paper-based monitoring of clinical activity for instructors. However, students’ compliance updating and uploading online forms is a factor, which is a matter of concern. KEY WORDS Undergraduate Dental Logbooks, Clinical Progress Records, Monitoring Methods, Monitoring Tools, Undergraduate Dental Monitoring, Undergraduate Clinical Procedures Records
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- 2021
29. Paper towel test as independently self‐administered to quantify cough‐related urine loss: Compliance and comparisons with survey‐only data in SWAN
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Carrie A. Karvonen-Gutierrez, Siobán D. Harlow, Janis M. Miller, Kerry C Richards-McCullough, and Michelle M Hood
- Subjects
medicine.medical_specialty ,Epidemiologic study ,Urinary Incontinence, Stress ,Urology ,030232 urology & nephrology ,Urinary incontinence ,Urine ,Article ,Compliance (psychology) ,Mixed incontinence ,03 medical and health sciences ,0302 clinical medicine ,Group cohesiveness ,Surveys and Questionnaires ,Humans ,Medicine ,030219 obstetrics & reproductive medicine ,business.industry ,Test (assessment) ,Urinary Incontinence ,Cough ,Paper towel ,Physical therapy ,Women's Health ,Female ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Aims The epidemiologic Study of Women's Health Across the Nation (SWAN) includes urinary incontinence (UI) questionnaire items. We introduced an independently self-administered paper towel test (PTT-ISA; invention disclosure #2021-347) to objectively demonstrate UI. Aims were to determine: (1) PTT-ISA compliance and (2) relationship to questionnaire results. Methods 276 community women were invited to complete both SWAN questionnaire and PTT-ISA. For PTT-ISA, a woman holds a trifold brown paper towel against her perineum while coughing hard three times. She checks the towel for wetness and compares it with pictorial showing wetted area gradations (dry towel through >6 ml/saturated). She then selects the best photo match for her towel. A newly conceptualized variable constructed as PTT-ISA plus questionnaire results was formed. Results Of 276 women, noncompliance with PTT-ISA was 2.2% (6 women). Four others (1.5%) were missing questionnaires. For the remaining 266 women, conceptual cohesiveness between questionnaire-only and PTT-ISA + questionnaire was demonstrated in 165 (62.0%). Lack of cohesiveness occurred in 101 (38.9%), including 41 women who said "no" to the questionnaire item indicative of stress UI and had leakage on PTT-ISA; leakage degree varied across the full pictorial spectrum from drops to saturated. Conclusion PTT-ISA demonstrates high compliance, with rate comparable to survey compliance. It is a novel measure for objective sign of urine loss when independently self-administered by community women outside of a clinic environment. Further research comparing PTT-ISA with clinician-observed cough test is warranted. As independently self-administered, PTT-ISA is simple, noninvasive, inexpensive, and an acceptable test that adds value to otherwise survey-dependent research.
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- 2021
30. Disinfection of Ultrasound Transducers Using Non-Sterile Tissue Paper in Some Low-Cost Private Ultrasound Centres in Nigeria – Implications for Nosocomial Infection Management
- Author
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Obinna Everistus Abonyi, Kingsley Asogwa, Charles Ugwoke Eze, S.W.I. Onwuzu, and Anthony C. Ike
- Subjects
medicine.medical_specialty ,business.industry ,Ultrasound ,medicine ,Medical physics ,business ,Tissue paper - Abstract
Background/Aims: The incidence of disease outbreaks in clinical settings arising from ultrasound examinations is well documented, and is a source of worry. The ultrasound transducers and the coupling gel are potential sources of these infections since they come in direct contact with the patient’s skin. In this study, we examine the efficacy of the widespread practice of the use of plain non-sterile tissue paper in some low-cost private ultrasound centres in our locality as a method of disinfecting ultrasound transducers after each use. Its potential impact on nosocomial infection management in clinical practice is also examined. Methods: Swab samples from convex ultrasound transducers before and after transabdominal scanning of three consecutive patients were obtained from 10 different ultrasound centres in urban and rural areas of Enugu state. Ultrasound coupling gel samples were equally obtained, and all samples cultured for bacteria growth which was quantified in colony-forming units per ml (CFU/ml) and reported in 1000/ml. Paired sampled t-test was used to check for significance in a reduction in a bacterial load before and after the transducer was cleaned. Results: Nine different bacterial strains were isolated. Staphylococcus aureus and Klebsiella spp had the highest percentage of occurrence in all centres. Significant bacteria growth was recorded in the morning before the examination, and plain tissue paper significantly reduced the bacteria load in the ultrasound transducer. Conclusion: Even though disinfecting ultrasound transducers with non-sterile plain tissue paper alone is statistically effective and has the potential to minimize nosocomial infection, it is however not clinically effective and hence not advised.
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- 2022
31. Overview of virus and cancer relationships. Position paper
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O Fernández-Capetillo, D Gracia, Joaquín Arribas, M Martín Jiménez, Rafael Bañares, M B Barragán, J.M. Eiros Bouza, J Tovar, Emilio Bouza, Luis Paz-Ares, A Torné, E Valencia, L Alemany, P Muñoz, Esteban Palomo, E Felip, J Bautista Mollar, and Rogelio López-Vélez
- Subjects
Microbiology (medical) ,HPV ,Oncolytic virus ,viruses ,Review ,Cancer mortality ,Hepatitis C. HBV ,Virus ,Tumours ,EBV ,Neoplasms ,Tumor Virus ,Humans ,Medicine ,Papillomaviridae ,HHV-8 ,Tropism ,Cancer ,Pharmacology ,Vaccines ,business.industry ,Human Papillomavirus ,HIV ,virus diseases ,Oncogenes ,General Medicine ,Hepatitis B ,medicine.disease ,Virology ,Cancer-prevention ,Human T Lymphotropic Virus I ,Virus Diseases ,HTLV-1 ,Human Herpes Virus 8 ,HCV ,Etiology ,Position paper ,Oncogenic Viruses ,Cancer-economy ,business ,Epstein-Barr Virus ,Human Immunodeficiency Virus ,Biomedical sciences - Abstract
The role of certain viruses in the etiology of some tumors is today indisputable, but there is a lack, however, of annoverview of the relationship between viruses and cancer with amultidisciplinary approach. For this reason, the Health Sciences Foundation has convened a group of professionals from different areas of knowledge to discuss the relationship between viruses and cancer, and the present document is the result of these deliberations. Although viruses cause only 10-15% of cancers, advances in oncology research are largely due to the work done during the last century on tumor viruses. The clearest cancer-inducing viruses are: HPV, HBV, HCV, EBV and, depending on the geographical area, HHV-8, HTLV-1 and HIV. HPVs, for example, are considered to be the causative agents of cervical carcinomas and, more recently, of a proportion of other cancers. Among the Herpes viruses, the association with the development of neoplasms is well established for EBV and HHV-8. Viruses can also be therapeutic agents in certain neoplasms and, thus, some oncolytic viruses with selective tropism for tumor cells have been approved for clinical use in humans. It is estimated that the prophylaxis or treatment of viral infections could prevent at least 1.5 million cancer deaths per year.
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- 2021
32. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the Diagnosis and Management of Pediatric Acute Liver Failure
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Vania Kasper, Mercedes Martinez, Robert H. Squires, Samar H. Ibrahim, James E. Squires, Mohit Kehar, and Estella M. Alonso
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Liver failure ,MEDLINE ,Liver transplantation ,Hepatology ,Clinical decision support system ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Etiology ,Medicine ,Position paper ,business ,Intensive care medicine ,Pediatric gastroenterology - Abstract
Pediatric acute liver failure (PALF) is a rare, rapidly progressive clinical syndrome with significant morbidity and mortality. The phenotype of PALF manifests as abrupt onset liver dysfunction, which can be brought via disparate etiology. Management is reliant upon intensive clinical care and support, often provided by the collaborative efforts of hepatologists, critical care specialists, and liver transplant surgeons. The construction of an age-based diagnostic approach, the identification of a potential underlying cause, and the prompt implementation of appropriate therapy can be lifesaving; however, the dynamic and rapidly progressive nature of PALF also demands that diagnostic inquiries be paired with monitoring strategies for the recognition and treatment of common complications of PALF. Although liver transplantation can provide a potential life-saving therapeutic option, the ability to confidently determine the certainness that liver transplant is needed for an individual child has been hampered by a lack of adequately tested clinical decision support tools and accurate predictive models. Given the accelerated progress in understanding PALF, we will provide clinical guidance to pediatric gastroenterologists and other pediatric providers caring for children with PALF by presenting the most recent advances in diagnosis, management, pathophysiology, and associated outcomes.
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- 2021
33. How to Perform Intra-Operative Contrast-Enhanced Ultrasound of the Brain—A WFUMB Position Paper
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M. Yashar S. Kalani, Alberto Martegani, Emilio Quaia, Francesco DiMeco, Christoph F. Dietrich, Min S. Park, Luigi Solbiati, Kathryn N. Kearns, Francesco Prada, Antonio G. Gennari, Ignazio G. Vetrano, Giovanni Mauri, and Luca Maria Sconfienza
- Subjects
medicine.medical_specialty ,Brain tumors ,Central nervous system ,CEUS ,Contrast-enhanced ultrasound ,Intraoperative ultrasounds ,Neurosurgery ,Neurovascular diseases ,Brain Neoplasms ,Humans ,Intraoperative Period ,Ultrasonography ,Contrast Media ,Neurosurgical Procedures ,Intra operative ,Acoustics and Ultrasonics ,Biophysics ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Vascular supply ,Modality (human–computer interaction) ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Neurovascular bundle ,Position paper ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Intra-operative ultrasound has become a relevant imaging modality in neurosurgical procedures. While B-mode, with its intrinsic limitations, is still considered the primary ultrasound modality, intra-operative contrast-enhanced ultrasound (ioCEUS) has more recently emerged as a powerful tool in neurosurgery. Though still not used on a large scale, ioCEUS has proven its utility in defining tumor boundaries, identifying lesion vascular supply and mapping neurovascular architecture. Here we propose a step-by-step procedure for performing ioCEUS analysis of the brain, highlighting its neurosurgical applications. Moreover, we provide practical advice on the use of ultrasound contrast agents and review technical ultrasound parameters influencing ioCEUS imaging.
- Published
- 2021
34. ANMCO POSITION PAPER: Prognostic and therapeutic relevance of non-obstructive coronary atherosclerosis
- Author
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Francesco Orso, Serafina Valente, Adriano Murrone, Gabriele Grippo, Stefano Domenicucci, Stefania Angela Di Fusco, Giancarlo Casolo, Maurizio Giuseppe Abrignani, Marco Corda, Michele Massimo Gulizia, Giuseppe Di Tano, Domenico Gabrielli, Daniele Grosseto, Fortunato Scotto di Uccio, and Furio Colivicchi
- Subjects
medicine.medical_specialty ,Cardiovascular risk factors ,Coronary Artery Disease ,Disease ,Coronary angiogram ,Non-obstructive CAD ,Coronary Angiography ,Coronary artery disease ,Risk Factors ,medicine ,Humans ,Relevance (law) ,AcademicSubjects/MED00200 ,Intensive care medicine ,Coronary atherosclerosis ,business.industry ,Articles ,Atherosclerosis ,Prognosis ,medicine.disease ,Coronary arteries ,medicine.anatomical_structure ,Position paper ,Cardiology and Cardiovascular Medicine ,business - Abstract
Atherosclerosis often affects the coronary arterial tree. Frequently the disease does not translate in significant narrowing of the vessels, thus determining only a non-obstructive disease. This condition that is described as non-obstructive coronary artery disease (NobsCAD) should be distinguished from the absence of disease (i.e. smooth coronary arteries) as it carries a specific prognostic value. The detection and reporting of NobsCAD should prompt preventive measures that can be individualized upon the degree of the underlying burden of disease. The accompanying clinical condition, the other cardiovascular risk factors present, and the description of the severity and extent of NobsCAD should provide the framework for an individualized treatment that should also consider the best available scientific evidence and guidelines. The description of NobsCAD represents important information to be collected whenever a coronary angiogram (both invasive and non-invasive) is performed. Treating the patient according to the presence and extent of NobsCAD offers prognostic benefits well beyond those offered by considering only the traditional cardiovascular risk factors. In order to reach this goal, NobsCAD should not be confused with the absence of coronary atherosclerosis or even ignored when detected as if it was a trivial information to provide.
- Published
- 2021
35. ANMCO POSITION PAPER: The reorganization of cardiology in times of the SARS-CoV-2 pandemic
- Author
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Stefano Urbinati, Nadia Aspromonte, Vincenzo Amodeo, Luigi Tavazzi, Michele Massimo Gulizia, Massimo Imazio, Giuseppe Di Pasquale, Pasquale Caldarola, Manlio Cipriani, Loris Roncon, Domenico Gabrielli, Fortunato Scotto di Uccio, Stefano Domenicucci, Adriano Murrone, Giuseppina Maura Francese, Andrea Di Lenarda, Furio Colivicchi, and Serafina Valente
- Subjects
Telemedicine ,National Health Service ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Cardiology ,COVID-19 ,Articles ,Disease ,medicine.disease ,Phase (combat) ,Health care ,Pandemic ,medicine ,Position paper ,AcademicSubjects/MED00200 ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business ,Organization - Abstract
The COVID-19 pandemic represents an unprecedented event that has brought deep changes in hospital facilities with reshaping of the health system organization, revealing inadequacies of current hospital and local health systems. When the COVID-19 emergency will end, further evaluation of the national health system, new organization of acute wards, and a further evolution of the entire health system will be needed to improve care during the chronic phase of disease. Therefore, new standards for healthcare personnel, more efficient organization of hospital facilities for patients with acute illnesses, improvement of technological approaches, and better integration between hospital and territorial services should be pursued. With experience derived from the COVID-19 pandemic,new models, paradigms, interventional approaches, values and priorities should be suggested and implemented.
- Published
- 2021
36. Lab on a Paper‐Based Device for Coronavirus Biosensing
- Author
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Lucas F. de Lima, William R. de Araujo, Paulo de Tarso Garcia, and Ariana de Souza Moraes
- Subjects
business.industry ,Microfluidics ,medicine ,Nanotechnology ,Paper based ,medicine.disease_cause ,business ,Biosensor ,Coronavirus - Published
- 2021
37. Hypoglossal nerve stimulation for obstructive sleep apnea: updated position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery
- Author
-
Holger Woehrle, Joachim T. Maurer, Armin Steffen, Jan Löhler, Clemens Heiser, Eck Gunther, Simon-Dominik Herkenrath, Wolfgang Galetke, Boris A. Stuck, and Winfried Randerath
- Subjects
Hypoglossal Nerve ,medicine.medical_specialty ,medicine.medical_treatment ,Electric Stimulation Therapy ,Review Article ,Sleep medicine ,03 medical and health sciences ,DISE ,0302 clinical medicine ,Positive airway pressure ,Humans ,Medicine ,Neurostimulation ,030223 otorhinolaryngology ,Sleep Apnea, Obstructive ,Sleep endoscopy ,business.industry ,Endoscopy ,General Medicine ,Hypoglossal nerve stimulation ,medicine.disease ,Obstructive sleep apnea ,ddc ,030228 respiratory system ,Otorhinolaryngology ,Physical therapy ,Position paper ,Neurosurgery ,Sleep ,business ,CPAP failure ,Hypoglossal nerve - Abstract
Since the first statement of the German Society of Oto-Rhino-Laryngology, hypoglossal nerve stimulation (HNS) is meanwhile an established treatment option for obstructive sleep apnea (OSA). There are three HNS systems available in Germany which differ in their technical details of the underlying comparable basic principle. For the unilateral HNS with respiratory sensing, several comparative studies, high-volume register analysis and long-term reports exist. The continuous HNS without respiratory sensing does not require a sleep endoscopy for indication. For the bilateral continuous HNS as the single partially implantable device, a feasibility study exists. For indication, the assessment of positive airway pressure failure by sleep medicine is crucial, and the decision for HNS should be made in discussion of other treatment options for at least moderate OSA. The implantation center holds primarily responsibility among the interdisciplinary sleep team and is primary contact for the patient in problems. This depicts why structural processes are required to secure outcome quality and minimize the complications. The aftercare of HNS patients can be provided interdisciplinary and by different medical institutions, whereat, minimal reporting standards to document outcome and usage are recommended.
- Published
- 2021
38. Immunologically relevant aspects of the new COVID-19 vaccines—an ÖGAI (Austrian Society for Allergology and Immunology) and AeDA (German Society for Applied Allergology) position paper
- Author
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Hans F. Merk, Randolf Brehler, Wolfgang Wehrmann, Kathrin Eller, Ursula Wiedermann, Kaan Boztug, Wolfgang Pfützner, Winfried F. Pickl, Michael Bonelli, Karl-Christian Bergmann, Thomas Eiwegger, Natalija Novak, Birgit Pfaller, Thomas Fuchs, Norbert Mülleneisen, Johannes Ring, Elisabeth Förster-Waldl, Wolfram Hötzenecker, Lisa Göschl, Holger Wrede, Eva Untersmayr, Patrick M. Brunner, Ludger Klimek, Katharina Grabmeier-Pfistershammer, Galateja Jordakieva, Erika Jensen-Jarolim, Alexander R. Moschen, Wolfgang Schlenter, Walter Reinisch, and Uta Rabe
- Subjects
0301 basic medicine ,medicine.medical_specialty ,COVID-19 vaccination ,medicine.medical_treatment ,Population ,Immunomodulation ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,medicine ,Immunology and Allergy ,media_common.cataloged_instance ,ddc:610 ,030212 general & internal medicine ,Immune response ,European union ,Intensive care medicine ,education ,media_common ,education.field_of_study ,business.industry ,Immunosuppression ,Review article ,Vaccination ,030104 developmental biology ,Tolerability ,Position Article ,Position paper ,Vaccination effect ,business - Abstract
Allergo journal international 30(5), 155-168 (2021). doi:10.1007/s40629-021-00178-2, Published by Urban & Vogel, München
- Published
- 2021
39. Monitoring and Managing Lorlatinib Adverse Events in the Portuguese Clinical Setting: A Position Paper
- Author
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José Bravo Marques, Venceslau Hespanhol, Carlos Aguiar, Tiago Reis Marques, and Fernando Barata
- Subjects
Pharmacology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.drug_class ,MEDLINE ,Toxicology ,030226 pharmacology & pharmacy ,Lorlatinib ,Tyrosine-kinase inhibitor ,03 medical and health sciences ,0302 clinical medicine ,Magnetic resonance imaging of the brain ,ROS1 ,medicine ,Position paper ,Anaplastic lymphoma kinase ,Pharmacology (medical) ,030212 general & internal medicine ,Adverse effect ,Intensive care medicine ,business - Abstract
Rearrangements in the anaplastic lymphoma kinase (ALK) and proto-oncogene tyrosine-protein kinase ROS (ROS1) genes characterise two distinct molecular subsets of non-small cell lung cancer (NSCLC) tumours. Lorlatinib is a third-generation ALK/ROS1 tyrosine kinase inhibitor (TKI) shown to have systemic and intracranial activity in treatment-naive patients and in those who progressed on first- and second-generation TKIs. Despite being generally well tolerated, lorlatinib has a unique and challenging safety profile that includes hyperlipidaemia and central and peripheral nervous system adverse events (AEs). This article summarises a set of strategies designed to monitor and manage lorlatinib-related AEs that were agreed upon by a multidisciplinary panel of specialists in a meeting held in July 2020. Among the recommendations hereby described, special emphasis was placed on communication: prescribing physicians should inform patients and their families/caregivers about the likelihood and nature of lorlatinib AEs, encouraging them to report any symptoms, while at the same time reassuring them that most events are manageable and resolve spontaneously and have little to no interference with cancer treatment. Importantly, all patients should undergo a set of baseline assessments, including biochemical analysis, evaluation of cardiovascular risk, electrocardiogram (ECG), neurological evaluation and contrast-enhanced magnetic resonance imaging of the brain, which should be repeated regularly during lorlatinib treatment. Supportive medications to treat or relieve lorlatinib AEs were also discussed, as were the conditions requiring specialist consultations and/or adjustments in lorlatinib therapy. The overall goal of this article is to serve as a practical guide for oncologists to systematically and effectively approach lorlatinib AEs.
- Published
- 2021
40. International Liver Cancer Association (ILCA) White Paper on Biomarker Development for Hepatocellular Carcinoma
- Author
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Jorge A. Marrero, Morris Sherman, Yujin Hoshida, Ziding Feng, David J. Pinato, Young-Suk Lim, Amit G. Singal, Nabihah Tayob, Jean-Charles Nault, Valérie Paradis, Anna S. Lok, Sudhir Srivastava, Augusto Villanueva, Josep M. Llovet, and Jo Ann Rinaudo
- Subjects
Adult ,Male ,Oncology ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Cirrhosis ,medicine.disease_cause ,Risk Assessment ,Article ,White paper ,Predictive Value of Tests ,Internal medicine ,Biomarkers, Tumor ,medicine ,Overall survival ,Humans ,Progression-free survival ,Early Detection of Cancer ,Societies, Medical ,Retrospective Studies ,Hepatitis B virus ,Hepatology ,business.industry ,Liver Neoplasms ,Gastroenterology ,Middle Aged ,medicine.disease ,Research Design ,Case-Control Studies ,Hepatocellular carcinoma ,Biomarker (medicine) ,Female ,Neoplasm Grading ,Liver cancer ,business - Published
- 2021
41. Social Network Analysis of Male Dominance in the Paper Wasp Mischocyttarus mastigophorus (Hymenoptera: Vespidae)
- Author
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Rheanna Congdon, Katherine Fiocca, and Sean O'Donnell
- Subjects
Paper wasp ,Social network ,Vespidae ,business.industry ,Aggression ,Biology ,Affect (psychology) ,biology.organism_classification ,Eusociality ,Dominance (ethology) ,Animal ecology ,Insect Science ,medicine ,medicine.symptom ,business ,Ecology, Evolution, Behavior and Systematics ,Demography - Abstract
Social aggression is a pervasive feature of insect societies. In eusocial Hymenoptera, aggression among females can affect task performance and competition over direct reproduction (egg laying); in most species males participate in social interactions relatively rarely. Males of the independent-founding paper wasp Mischocyttarus mastigophorus are exceptional: they are aggressive toward female nestmates, leading us to explore the function of this unusual behavior. We applied social network analyses to data on M. mastigophorus social aggression to quantify sex differences in giving and receiving social aggression. The network analyses supported the pattern of biased male aggression toward female nestmates; females are relatively rarely aggressive to males. We then asked whether male aggression toward females was biased by females’ relative ovary development. Males were more aggressive toward females with better-developed ovaries, opposite to patterns of aggression among females. Because food brought to the colonies is often monopolized by dominant females, we suggest that males direct aggression toward socially dominant females with better-developed ovaries to obtain food. The implications of biased male aggression for female task performance and physiology are unknown.
- Published
- 2021
42. Health Care for Our Nation's Veterans: A Policy Paper From the American College of Physicians
- Author
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Ryan, Crowley, Omar, Atiq, David, Hilden, Thomas G, Cooney, and Michael, Tan
- Subjects
Mental Health Services ,Advisory Committees ,Population ,Holistic Health ,Modernization theory ,Health Services Accessibility ,Patient satisfaction ,Nursing ,Health care ,Internal Medicine ,Electronic Health Records ,Humans ,Medicine ,Health Workforce ,education ,Societies, Medical ,health care economics and organizations ,Patient Care Team ,education.field_of_study ,Primary Health Care ,Emergency management ,Delivery of Health Care, Integrated ,business.industry ,Health Policy ,Medical record ,General Medicine ,Telemedicine ,United States ,United States Department of Veterans Affairs ,Education, Medical, Graduate ,Veterans Health Services ,Position paper ,Private Sector ,Health Services Research ,business ,Administration (government) - Abstract
The Veterans Health Administration (VHA) is the United States' largest integrated health care delivery system, serving over 9 million enrollees at nearly 1300 health care facilities. In addition to providing health care to the nation's military veterans, the VHA has a research and development program, trains thousands of medical residents and other health care professionals, and conducts emergency preparedness and response activities. The VHA has been celebrated for delivering high-quality care to veterans, early adoption of electronic medical records, and high patient satisfaction. However, the system faces challenges, including implementation of an expanded community care program, modernization of its electronic medical records system, and providing care to a population with complex needs. The position paper offers policy recommendations on VHA funding, the community care program, medical and health care professions training, and research and development.
- Published
- 2021
43. Financial Profit in Medicine: A Position Paper From the American College of Physicians
- Author
-
Ryan, Crowley, Omar, Atiq, David, Hilden, and Michael, Tan
- Subjects
Finance ,Physician-Patient Relations ,Profit (accounting) ,Financial Management ,Financial stability ,business.industry ,General Medicine ,Organizational Policy ,United States ,Fiduciary ,Private equity ,Physicians ,Health care ,Internal Medicine ,Humans ,Position paper ,Medicine ,Economics, Hospital ,business ,Delivery of Health Care ,Health Facilities, Proprietary ,Societies, Medical ,health care economics and organizations ,Quality of Health Care - Abstract
The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States, helping to spur for-profit and private equity investment. Proponents say that this trend makes the health care system more efficient, encourages innovation, and provides financial stability to ensure access and improve care. Critics counter that such moves favor profit over care and erode the patient-physician relationship. American College of Physicians (ACP) underscores that physicians are permitted to earn a reasonable income as long as they are fulfilling their fiduciary responsibility to provide high-quality, appropriate care within the guardrails of medical professionalism and ethics. In this position paper, ACP considers the effect of mergers, integration, private equity investment, nonprofit hospital requirements, and conversions from nonprofit to for-profit status on patients, physicians, and the health care system.
- Published
- 2021
44. White Paper: Recognizing Child Trafficking as a Critical Emerging Health Threat
- Author
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Dawn Lee Garzon Maaks, Stacia M. Hays, Mikki Meadows-Oliver, and Jessica L. Peck
- Subjects
medicine.medical_specialty ,Adolescent ,Health Personnel ,media_common.quotation_subject ,education ,Vulnerability ,03 medical and health sciences ,0302 clinical medicine ,White paper ,Nursing ,030225 pediatrics ,Health care ,medicine ,Humans ,Family ,030212 general & internal medicine ,Child ,media_common ,Human rights ,business.industry ,Sex trafficking ,Public health ,Child Abuse, Sexual ,Health equity ,Human Trafficking ,Pediatrics, Perinatology and Child Health ,Public Health ,business ,Psychology ,Criminal justice - Abstract
Human trafficking is a pandemic human rights violation with an emerging paradigm shift that reframes an issue traditionally seen through a criminal justice lens to that of a public health crisis, particularly for children. Children and adolescents who are trafficked or are at risk for trafficking should receive evidence-based, trauma-informed, and culturally responsive care from trained health care providers (HCPs). The purpose of this article was to engage and equip pediatric HCPs to respond effectively to human trafficking in the clinical setting, improving health outcomes for affected and at-risk children. Pediatric HCPs are ideally positioned to intervene and advocate for children with health disparities and vulnerability to trafficking in a broad spectrum of care settings and to optimize equitable health outcomes.
- Published
- 2021
45. HRS White Paper on Clinical Utilization of Digital Health Technology
- Author
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Zachi I. Attia, Rod S. Passman, Elaine Wan, Lilas Dagher, Sana M. Al-Khatib, Nazem Akoum, Khaldoun G. Tarakji, Nassir F. Marrouche, Nicholas S. Peters, G. Stuart Mendenhall, Anthony Trela, David D. McManus, Eugene H. Chung, Hamid Ghanbari, Hirad Yarmohammadi, Mintu P. Turakhia, Rajeev Kumar Pathak, Samuel J. Asirvatham, David Schwartzman, and Emma Svennberg
- Subjects
business.industry ,Wearables ,Cardiovascular health ,Wearable computer ,medicine.disease ,Digital health ,law.invention ,Clinical Practice ,Heart Rhythm ,White paper ,Remote monitoring ,Randomized controlled trial ,law ,RC666-701 ,Medical technology ,General Earth and Planetary Sciences ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,Medical emergency ,R855-855.5 ,business ,Arrhythmia ,General Environmental Science - Abstract
This collaborative statement from the Digital Health Committee of the Heart Rhythm Society provides everyday clinical scenarios in which wearables may be utilized by patients for cardiovascular health and arrhythmia management. We describe herein the spectrum of wearables that are commercially available for patients, and their benefits, shortcomings and areas for technological improvement. Although wearables for rhythm diagnosis and management have not been examined in large randomized clinical trials, undoubtedly the usage of wearables has quickly escalated in clinical practice. This document is the first of a planned series in which we will update information on wearables as they are revised and released to consumers.
- Published
- 2022
46. Evidence based position paper on Physical and Rehabilitation Medicine practice for people with muscular dystrophies
- Author
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Milica Lazovic, Maria Gabriella Ceravolo, Kristian Borg, François Boyer, Mauro Zampolini, Carlotte Kiekens, and Dejan Nikolic
- Subjects
030506 rehabilitation ,medicine.medical_specialty ,Evidence-based practice ,viruses ,MEDLINE ,Delphi method ,Physical Therapy, Sports Therapy and Rehabilitation ,Muscular Dystrophies ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Humans ,Medicine ,media_common.cataloged_instance ,European union ,Muscular dystrophy ,media_common ,business.industry ,Rehabilitation ,virus diseases ,Physical and Rehabilitation Medicine ,medicine.disease ,humanities ,3. Good health ,Europe ,Systematic review ,Position paper ,0305 other medical science ,business ,030217 neurology & neurosurgery ,Progressive muscular weakness - Abstract
Introduction Muscular dystrophies present a group of inherited degenerative disorder that are characterized by progressive muscular weakness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. The aim of the paper is to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for people with muscular dystrophies. Evidence acquisition A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. Evidence synthesis The systematic literature review is reported together with thirty-three recommendations resulting from the Delphi procedure. Conclusions The role of the PRM physician is to assess the functional status of persons with muscular dystrophy and to plan, monitor and lead PRM program in an interdisciplinary setting within a multiprofessional team.
- Published
- 2021
47. Paper-based immunoassays for mobile healthcare: strategies, challenges, and future applications
- Author
-
Chao-Min Cheng, Yao-Hung Tsai, Ting Yang, and Ching-Fen Shen
- Subjects
Risk analysis (engineering) ,business.industry ,Medicine ,Paper based ,business - Published
- 2022
48. Preparation of Activated Bio-char from Corn Stalk for Color Treatment of Effluent from Packaging Paper Mill
- Author
-
Phan Huy Hoang, Nguyen Thi Thanh, and Nguyen Minh Dat
- Subjects
Environmental Engineering ,business.industry ,Ecological Modeling ,chemistry.chemical_element ,Paper mill ,Pulp and paper industry ,Pollution ,chemistry ,Wastewater ,Biochar ,medicine ,Environmental Chemistry ,Environmental science ,Sewage treatment ,business ,Carbon ,Pyrolysis ,Effluent ,Water Science and Technology ,Activated carbon ,medicine.drug - Abstract
In recent years, the paper industry is developing strongly and plays an important role in the industry of our country. Most of the factories have their own wastewater treatment systems. In general, wastewater in paper mill is very difficult to treat and to handle, especially color (Pt–Co) index. In this research, activated carbon with a high surface area and high adsorption capacity was prepared from corn stalks, an agricultural by-products. The suitable conditions of pyrolysis were investigated to prepare activated bio-char from corn stalk. Then, as-obtained carbon material was applied for color treatment of effluent from paper mill. The activated carbon showed high efficiency and capability in color removal of waste water, with the color reduction of 77%.
- Published
- 2021
49. Evidence-Based Blepharoplasty: An Analysis of Highly Cited Research Papers
- Author
-
Hong Kai Lim, Ankur Khajuria, Walton N Charles, Roselin C. Charles, and Mhafrin Basta
- Subjects
Blepharoplasty ,medicine.medical_specialty ,Evidence-based practice ,business.industry ,medicine.medical_treatment ,Clinical study design ,MEDLINE ,Specialty ,General Medicine ,Evidence-based medicine ,Ophthalmology ,Data extraction ,Family medicine ,medicine ,Humans ,Surgery ,Citation ,business - Abstract
Purpose The purpose of the study was to appraise the methodological quality of the highest impact blepharoplasty research and to describe prevalent research themes. Methods The 100 most highly cited research papers relevant to blepharoplasty were obtained from Web of Science, with no journal or date limitations applied. Data extraction included the study design, main research topic and specialty, outcome measures, and citation count. Each paper's level of evidence was independently evaluated by 2 authors according to the Oxford Centre for Evidence-Based Medicine system. Results Overall, the 100 most cited blepharoplasty research papers were cited by 4,194 papers. The mean number of citations for each paper was 73 (range: 42-239). Most of the papers presented level 4 (n = 51) or level 5 (n = 35) evidence, which is consistent with the predominance of case series (n = 47) and expert opinions (n = 18) amongst study designs. No papers achieved level 1 (highest) evidence. Six papers presented level 2 evidence and 8 papers presented level 3. Significant research foci included innovative surgical techniques (n = 65) and anatomical considerations (n = 10), with reconstructive and cosmetic implications. Senior authors were mainly affiliated with centers of plastic (n = 53) or ophthalmic/oculoplastic (n = 34) surgery. Only 3 papers used validated subjective or objective cosmetic outcome measures. Conclusions Despite a significant impact on current practice, the level of evidence of the highly cited blepharoplasty research was predominantly low. Robust research methodology, through well-designed studies and standardized outcome measures, is necessary to facilitate evidence synthesis and guide clinical practice.
- Published
- 2022
50. Editorial Comment: Selected Papers from the 9th International Congress of Arthroplasty Registries
- Author
-
Eric R, Bohm, Sarah, Kirby, Elly, Trepman, Brian R, Hallstrom, Ola, Rolfson, J Mark, Wilkinson, Adrian, Sayers, Søren, Overgaard, Stephen, Lyman, Patricia D, Franklin, Jennifer, Dunn, Geke, Denissen, Annette, W-Dahl, Lina Holm, Ingelsrud, and Ronald A, Navarro
- Subjects
medicine.medical_specialty ,Selected Papers from the 9th International Congress of Arthroplasty Registries Guest Editor: Ola Rolfson Md, Phd ,business.industry ,medicine.medical_treatment ,General Medicine ,Quality Improvement ,Arthroplasty ,Surveys and Questionnaires ,Family medicine ,International congress ,medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Patient Reported Outcome Measures ,Registries ,business - Abstract
BACKGROUND: Patient-reported outcome measures (PROMs) are validated questionnaires that are completed by patients. Arthroplasty registries vary in PROM collection and use. Current information about registry collection and use of PROMs is important to help improve methods of PROM data analysis, reporting, comparison, and use toward improving clinical practice. QUESTIONS/PURPOSES: To characterize PROM collection and use by registries, we asked: (1) What is the current practice of PROM collection by arthroplasty registries that are current or former members of the International Society of Arthroplasty Registries, and are there sufficient similarities in PROM collection between registries to enable useful international comparisons that could inform the improvement of arthroplasty care? (2) How do registries differ in PROM administration and demographic, clinical, and comorbidity index variables collected for case-mix adjustment in data analysis and reporting? (3) What quality assurance methods are used for PROMs, and how are PROM results reported and used by registries? (4) What recommendations to arthroplasty registries may improve PROM reporting and facilitate international comparisons? METHODS: An electronic survey was developed with questions about registry structure and collection, analysis, reporting, and use of PROM data and distributed to directors or senior administrators of 39 arthroplasty registries that were current or former members of the International Society of Arthroplasty Registries. In all, 64% (25 of 39) of registries responded and completed the survey. Missing responses from incomplete surveys were captured by contacting the registries, and up to three reminder emails were sent to nonresponding registries. Recommendations about PROM collection were drafted, revised, and approved by the International Society of Arthroplasty Registries PROMs Working Group members. RESULTS: Of the 25 registries that completed the survey, 15 collected generic PROMs, most frequently the EuroQol-5 Dimension survey; 16 collected joint-specific PROMs, most frequently the Knee Injury and Osteoarthritis Outcome Score and Hip Disability and Osteoarthritis Outcome Score; and 11 registries collected a satisfaction item. Most registries administered PROM questionnaires within 3 months before and 1 year after surgery. All 16 registries that collected PROM data collected patient age, sex or gender, BMI, indication for the primary arthroplasty, reason for revision arthroplasty, and a comorbidity index, most often the American Society of Anesthesiologists classification. All 16 registries performed regular auditing and reporting of data quality, and most registries reported PROM results to hospitals and linked PROM data to other data sets such as hospital, medication, billing, and emergency care databases. Recommendations for transparent reporting of PROMs were grouped into four categories: demographic and clinical, survey administration, data analysis, and results. CONCLUSION: Although registries differed in PROM collection and use, there were sufficient similarities that may enable useful data comparisons. The International Society of Arthroplasty Registries PROMs Working Group recommendations identify issues that may be important to most registries such as the need to make decisions about survey times and collection methods, as well as how to select generic and joint-specific surveys, handle missing data and attrition, report data, and ensure representativeness of the sample. CLINICAL RELEVANCE: By collecting PROMs, registries can provide patient-centered data to surgeons, hospitals, and national entities to improve arthroplasty care.
- Published
- 2021
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