9,375 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. Randomized Controlled Trial of Paper-Based at a Hospital versus Continual Electronic Patient-Reported Outcomes at Home for Metastatic Cancer Patients: Does Electronic Measurement at Home Detect Patients' Health Status in Greater Detail?
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Naruto Taira, Kojiro Shimozuma, Takashi Fukuda, Takuya Kawahara, Takeru Shiroiwa, Shinichi Noto, Yasuhiro Hagiwara, Tetsuya Iwamoto, and Keiko Konomura
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medicine.medical_specialty ,business.industry ,Health Policy ,Health Status ,Cancer ,Paper based ,medicine.disease ,Outcome (game theory) ,Eortc qlq c 30 ,Hospitals ,law.invention ,Randomized controlled trial ,Quality of life ,law ,Neoplasms ,Surveys and Questionnaires ,Physical therapy ,Quality of Life ,Medicine ,Humans ,Patient-reported outcome ,Patient Reported Outcome Measures ,Electronics ,business - Abstract
Purpose This study aimed to determine whether continual electronic patient-reported outcome (ePRO) measurements at home can capture the fluctuations in health-related quality of life (HRQOL) scores between visits. Methods We performed a randomized controlled trial to compare the scores obtained by standard practice (paper-based measurements in the hospital) to scores by continuous measurement of ePRO at home. Metastatic cancer patients were randomly assigned to either the paper-based ( n = 50) or the ePRO group ( n = 52). EQ-5D-5L and EORTC QLQ C-30 scores were obtained on 3 different chemotherapy days in the paper-based group. Meanwhile, scores were obtained on the chemotherapy day and on days 3, 7, 10, and 14 in the ePRO group during 2 cycles. The first hypothesis of our study was that both scores at the same time points would be equivalent despite different measurement frequency, place, or mode of measurement. The second hypothesis was that PRO score–adjusted time would be different between the groups. For equivalence, the endpoint was the mean EQ-5D-5L index value on the chemotherapy day before the outpatient treatment. Only if equivalence was shown, quality-adjusted life-days (QALDs) were considered using all the data. Results The adjusted mean difference in the EQ-5D-5L index was determined to be −0.013 (95% confidence interval [CI]: −0.049 to 0.022); the 95% CI did not exceed the equivalence margin. Similarly, the mean difference in global health status (2.28 [95% CI: −2.55 to 7.11]) also showed equivalence. However, the QALD by EQ-5D-5L was significantly lower in the ePRO group by 1.36 per 30 d (95% CI: −2.22 to −0.51; P = 0.0021). Conclusions Continual measurements of the HRQOL at home by ePRO may yield more detailed profiles of the HRQOL.
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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. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. Developing the subspecialty of cardio-nephrology: The time has come. A position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology
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Patricia de Sequera, Rafael Santamaria, Javier Díez, Alberto Ortiz, and Juan F. Navarro-González
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Nephrology ,medicine.medical_specialty ,Enfermedad cardiovascular ,030232 urology & nephrology ,Psychological intervention ,Specialty ,Disease ,030204 cardiovascular system & hematology ,Subspecialty ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Renal Insufficiency, Chronic ,Enfermedad renal crónica ,business.industry ,medicine.disease ,Diseases of the genitourinary system. Urology ,Cardio-nefrología ,Cardiovascular Diseases ,Family medicine ,Medicina cardiorenal ,Position paper ,Professional association ,RC870-923 ,business ,Kidney disease - Abstract
Patients with the dual burden of chronic kidney disease (CKD) and cardiovascular disease (CVD) experience unacceptably high rates of morbidity and mortality, which also entail unfavorable effects on healthcare systems. Currently, concerted efforts to identify, prevent and treat CVD in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this position paper endorse the need for a dedicated interdisciplinary team of subspecialists in cardio-nephrology that manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for training programs, guidelines and best clinical practice models, and research funding from nephrology, cardiology and other professional societies, to support the development of the subspecialty of cardio-nephrology. This position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology (S.E.N.) is intended to be the starting point to develop the subspecialty of cardio-nephrology within the S.E.N.. The implementation of the subspecialty in day-to-day nephrological practice will help to diagnose, treat, and prevent CVD in CKD patients in a precise, clinically effective, and health cost-favorable manner. Resumen: Los pacientes con enfermedad renal crónica (ERC) que presentan enfermedad cardiovascular (ECV) tienen índices de morbilidad y mortalidad inaceptablemente elevados, que impactan desfavorablemente sobre los sistemas de salud. En la actualidad, se requieren actuaciones multidisciplinares para identificar, prevenir y tratar la ECV en los pacientes con ERC, debiendo pues superarse la época de las actuaciones de las especialidades individuales. Los autores de este artículo respaldan la necesidad de un equipo interdisciplinar de subespecialistas en cardionefrología que gestione las intervenciones clínicas adecuadas en el entorno hospitalario y en el ambulatorio. Existe una gran necesidad de programas de formación, de guías y modelos de práctica clínica, y de fondos para la investigación en las sociedades de nefrología, cardiología y otras, para apoyar el desarrollo de la subespecialidad de cardio-nefrología. Este documento de opinión del comité coordinador del Grupo de Trabajo de Medicina Cardiorenal de la Sociedad Española de Nefrología (S.E.N.) pretende ser el inicio del desarrollo de la subespecialidad de Cardionefrología en el marco de la S.E.N. La implementación de la subespecialidad en la práctica nefrológica diaria contribuirá a diagnosticar, tratar y prevenir la ECV en los pacientes con ERC de una manera precisa, clínicamente efectiva y sanitariamente rentable.
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- 2021
16. 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
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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
17. 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
18. All around suboptimal health — a joint position paper of the Suboptimal Health Study Consortium and European Association for Predictive, Preventive and Personalised Medicine
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Olga Golubnitschaja, Bo Li, Zhaohua Zhong, Youxin Wang, Yulu Zheng, Yuxiang Yan, Xiuhua Guo, Enoch Odame Anto, Haifeng Hou, Zheng Guo, Timothy Kang, Monique Garcia, Gehendra Mahara, Xuerui Tan, and Wei Wang
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Behavioural patterns ,Medical ethics ,Sleep medicine ,Artificial intelligence (AI) ,Drug Discovery ,Health care ,Periodontal health ,Body mass index (BMI) ,Individualised patient profile ,Risk assessment ,Big data management ,Dietary habits ,Glycan ,Cardiovascular disease ,Health policy ,Adolescence ,Mood disorders ,Cancers ,medicine.medical_specialty ,Suboptimal health status (SHS) ,Stress overload ,Communicable ,Multi-parametric analysis ,Neurologic diseases ,Omics ,Risk management tools ,behavioral disciplines and activities ,medicine ,Predictive preventive personalised medicine (PPPM/3PM) ,Modifiable preventable risks ,Non-communicable diseases ,Intensive care medicine ,Epidemics ,Health economy ,Pandemics ,Liquid biopsy ,business.industry ,Research ,Biochemistry (medical) ,COVID-19 ,Traditional medicine ,medicine.disease ,Lifestyle ,Multi-level diagnostics ,Position paper ,Eye disorder ,Microbiome ,business ,Natural substances - Abstract
First two decades of the twenty-first century are characterised by epidemics of non-communicable diseases such as many hundreds of millions of patients diagnosed with cardiovascular diseases and the type 2 diabetes mellitus, breast, lung, liver and prostate malignancies, neurological, sleep, mood and eye disorders, amongst others. Consequent socio-economic burden is tremendous. Unprecedented decrease in age of maladaptive individuals has been reported. The absolute majority of expanding non-communicable disorders carry a chronic character, over a couple of years progressing from reversible suboptimal health conditions to irreversible severe pathologies and cascading collateral complications. The time-frame between onset of SHS and clinical manifestation of associated disorders is the operational area for an application of reliable risk assessment tools and predictive diagnostics followed by the cost-effective targeted prevention and treatments tailored to the person.This article demonstrates advanced strategies in bio/medical sciences and healthcare focused on suboptimal health conditions in the frame-work of Predictive, Preventive and Personalised Medicine (3PM/PPPM). Potential benefits in healthcare systems and for society at large include but are not restricted to an improved life-quality of major populations and socio-economical groups, advanced professionalism of healthcare-givers and sustainable healthcare economy. Amongst others, following medical areas are proposed to strongly benefit from PPPM strategies applied to the identification and treatment of suboptimal health conditions:Stress overload associated pathologiesMale and female healthPlanned pregnanciesPeriodontal healthEye disordersInflammatory disorders, wound healing and pain management with associated complicationsMetabolic disorders and suboptimal body weightCardiovascular pathologiesCancersStroke, particularly of unknown aetiology and in young individualsSleep medicineSports medicineImproved individual outcomes under pandemic conditions such as COVID-19.
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- 2021
19. 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
20. 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
21. 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
22. Alcohol-Related Liver Disease in the Covid-19 Era: Position Paper of the Italian Society on Alcohol (SIA)
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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
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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
23. White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults
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Margaret Walshe, Eric Verin, Reinie Cordier, Virginie Woisard, Weslania Viviane Nascimento, Daniele Farneti, Renée Speyer, Walmari Pilz, RS: MHeNs - R3 - Neuroscience, KNO, and MUMC+: MA Keel Neus Oorheelkunde (9)
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medicine.medical_specialty ,Future studies ,Psychometrics ,ORAL-HEALTH ASSESSMENT ,OF-LIFE QUESTIONNAIRE ,B100 ,ITEM RESPONSE THEORY ,Diagnostic accuracy ,FRAIL OLDER-PEOPLE ,Cerebral palsy ,Validity ,03 medical and health sciences ,Speech and Hearing ,0302 clinical medicine ,White paper ,PSYCHOMETRIC CHARACTERISTICS ,Swallowing ,otorhinolaryngologic diseases ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,ASPIRATION PNEUMONIA ,Aged ,ASSESSMENT-TOOL ,Aged, 80 and over ,business.industry ,Swallowing Disorders ,Gastroenterology ,Reproducibility of Results ,Responsiveness ,A300 ,OROPHARYNGEAL DYSPHAGIA ,NEUROLOGICAL DISORDERS ,medicine.disease ,Measures ,Reliability ,Dysphagia ,Deglutition ,Otorhinolaryngology ,Physical therapy ,RISK-FACTORS ,Original Article ,medicine.symptom ,Deglutition Disorders ,business ,030217 neurology & neurosurgery - Abstract
This White Paper by the European Society for Swallowing Disorders (ESSD) reports on the current state of screening and non-instrumental assessment for dysphagia in adults. An overview is provided on the measures that are available, and how to select screening tools and assessments. Emphasis is placed on different types of screening, patient-reported measures, assessment of anatomy and physiology of the swallowing act, and clinical swallowing evaluation. Many screening and non-instrumental assessments are available for evaluating dysphagia in adults; however, their use may not be warranted due to poor diagnostic performance or lacking robust psychometric properties. This white paper provides recommendations on how to select best evidence-based screening tools and non-instrumental assessments for use in clinical practice targeting different constructs, target populations and respondents, based on criteria for diagnostic performance, psychometric properties (reliability, validity, and responsiveness), and feasibility. In addition, gaps in research that need to be addressed in future studies are discussed. The following recommendations are made: (1) discontinue the use of non-validated dysphagia screening tools and assessments; (2) implement screening using tools that have optimal diagnostic performance in selected populations that are at risk of dysphagia, such as stroke patients, frail older persons, patients with progressive neurological diseases, persons with cerebral palsy, and patients with head and neck cancer; (3) implement measures that demonstrate robust psychometric properties; and (4) provide quality training in dysphagia screening and assessment to all clinicians involved in the care and management of persons with dysphagia.
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- 2022
24. 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
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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
25. ANMCO POSITION PAPER: Prognostic and therapeutic relevance of non-obstructive coronary atherosclerosis
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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
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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.
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- 2021
26. ANMCO POSITION PAPER: The reorganization of cardiology in times of the SARS-CoV-2 pandemic
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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
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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.
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- 2021
27. Multiple Sklerose Therapie Konsensus Gruppe (MSTKG): Positionspapier zur verlaufsmodifizierenden Therapie der Multiplen Sklerose 2021 (White Paper)
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Martin S. Weber, Stefan Bittner, Claudio Gobbi, Hayrettin Tumani, Renaud Du Pasquier, Fedor Heidenreich, Ralf A. Linker, Frank Weber, Michael Platten, Martin Stangel, Andrew T. Chan, Heinz Wiendl, Olaf Hoffmann, Thomas Berger, Christian Enzinger, die Multiple Sklerose Therapie Konsensus Gruppe, Elisabeth Fertl, Mathias Mäurer, Orhan Aktas, Uwe K. Zettl, Ralf Gold, Boris Kallmann, Christoph Kleinschnitz, Florian Deisenhammer, Fritz Leutmezer, Jan D. Lünemann, Volker Limmroth, Zoë R. Hunter, Klaus Gehring, Aiden Haghikia, Verena I. Leussink, Franziska Di Pauli, Martin Berghoff, Michael Guger, Luisa Klotz, Tobias Derfuss, Tjalf Ziemssen, Stephan Schmidt, Uta Meyding-Lamadé, Hans-Peter Hartung, Sven G. Meuth, Frauke Zipp, Karl Baum, Achim Gass, Peter Rieckmann, Adam Czaplinski, Norbert Goebels, and Andreas Lutterotti
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0301 basic medicine ,Central Nervous System ,medicine.medical_specialty ,Early therapeutic intervention ,Neurology ,Consensus ,Multiple Sclerosis ,Disease ,Guideline ,Behandlungsempfehlung ,03 medical and health sciences ,0302 clinical medicine ,Germany ,medicine ,Humans ,Intensive care medicine ,Leitlinie ,business.industry ,Multiple sclerosis ,Psychosomatic medicine ,General Medicine ,medicine.disease ,Autoimmune-mediated disease ,Immuntherapie ,Europe ,Psychiatry and Mental health ,030104 developmental biology ,Position paper ,Konsensuspapiere ,Neurology (clinical) ,Neurosurgery ,Psychopharmacology ,Immunotherapy ,business ,Treatment recommendation ,030217 neurology & neurosurgery ,Autoimmunerkrankung ,Frühe Therapieintervention - Abstract
Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, Switzerland).Die Multiple Sklerose ist eine komplexe, autoimmun vermittelte Erkrankung des zentralen Nervensystems, charakterisiert durch inflammatorische Demyelinisierung sowie axonalen/neuronalen Schaden. Die Zulassung verschiedener verlaufsmodifizierender Therapien und unser verbessertes Verständnis der Krankheitsmechanismen und -entwicklung in den letzten Jahren haben die Prognose und den Verlauf der Erkrankung deutlich verändert. Diese Aktualisierung der Behandlungsempfehlung der Multiple Sklerose Therapie Konsensus Gruppe konzentriert sich auf die wichtigsten Empfehlungen für verlaufsmodifizierende Therapien der Multiplen Sklerose im Jahr 2021. Unsere Empfehlungen basieren auf aktuellen wissenschaftlichen Erkenntnissen und gelten für diejenigen Medikamente, die in weiten Teilen Europas, insbesondere in den deutschsprachigen Ländern (Deutschland, Österreich, Schweiz), zugelassen sind.
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- 2021
28. Hypoglossal nerve stimulation for obstructive sleep apnea: updated position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery
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Holger Woehrle, Joachim T. Maurer, Armin Steffen, Jan Löhler, Clemens Heiser, Eck Gunther, Simon-Dominik Herkenrath, Wolfgang Galetke, Boris A. Stuck, and Winfried Randerath
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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.
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- 2021
29. International Liver Cancer Association (ILCA) White Paper on Biomarker Development for Hepatocellular Carcinoma
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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
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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
30. HFA of the ESC Position paper on the management of LVAD supported patients for the non LVAD specialist healthcare provider Part 1: Introduction and at the non-hospital settings in the community
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Miriam Abuhazira, Finn Gustafsson, Yaron D. Barac, Yoav Hammer, Marco Metra, Massimo F Piepoli, Stamatis Adamopoulos, Davor Miličić, Gerasimos Filippatos, Avishay Grupper, Ovidiu Chioncel, Israel Gotsman, Marisa G. Crespo-Leiro, Piotr Ponikowski, Andrew J.S. Coats, Arsen D. Ristić, Nicolaas de Jonge, Binyamin Ben Avraham, Aviv Shaul, Stefan D. Anker, Luciano Potena, Giuseppe M.C. Rosano, Righab Hamdan, Osnat Itzhaki Ben Zadok, Loreena Hill, Laurens F. Tops, Sanemn Nalbantgil, Johann Altenberger, Steven Tsui, Arjang Ruhparwar, Maria Frigeiro, Wilfried Mullens, Tiny Jaarsma, Stephan Winnik, Eva Goncalvesova, Tal Hasin, Jeremy Elliston, Frank Ruschitzka, Tuvia Ben Gal, Jacob Lavee, Petar M. Seferovic, Gustafsson, Finn/0000-0003-2144-341X, Ben Avraham, Binyamin, Crespo-Leiro, Marisa Generosa, Filippatos, Gerasimos, Gotsman, Israel, Seferovic, Petar, Hasin, Tal, Potena, Luciano, Milicic, Davor, Coats, Andrew J. S., Rosano, Giuseppe, Ruschitzka, Frank, Metra, Marco, Anker, Stefan, Altenberger, Johann, Adamopoulos, Stamatis, Barac, Yaron D., Chioncel, Ovidiu, De Jonge, Nicolaas, Elliston, Jeremy, Frigeiro, Maria, Goncalvesova, Eva, Grupper, Avishay, Hamdan, Righab, Hammer, Yoav, Hill, Loreena, Ben Zadok, Osnat Itzhaki, Abuhazira, Miriam, Lavee, Jacob, MULLENS, Wilfried, Nalbantgil, Sanemn, Piepoli, Massimo F., Ponikowski, Piotr, Ristic, Arsen, Ruhparwar, Arjang, Shaul, Aviv, Tops, Laurens F., Tsui, Steven, Winnik, Stephan, Jaarsma, Tiny, Gustafsson, Finn, and Ben Gal, Tuvia
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Shared Care ,LVAD ,medicine.medical_treatment ,Health Personnel ,Population ,Social and Clinical Pharmacy ,CPR ,Emergency medical systems ,General description ,Hospitals ,Humans ,Tissue Donors ,Heart Transplantation ,Heart-Assist Devices ,Heart-Assist Devices / adverse effects ,Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,ESC and HFA Paper ,Heart-Failure ,ESC and HFA Papers ,Ventricular Assist Devices ,Older population ,Tidal Carbon-Dioxide ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Cardiac-Output ,Cardiopulmonary resuscitation ,Tachyarrhythmias ,education ,education.field_of_study ,business.industry ,Samhällsfarmaci och klinisk farmaci ,Mechanical Circulatory Support ,Emergency department ,Controlled Trial ,medicine.disease ,equipment and supplies ,Implantation ,Ventricular assist device ,RC666-701 ,Cardiopulmonary-Resuscitation ,Position paper ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business ,Healthcare providers ,Destination therapy - Abstract
[Abstract] The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD-supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD-supported patients. The expected and non-expected device-related and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD-supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD-supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non-LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non-LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast-growing population of LVAD-supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD-supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD-supported patients.
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- 2022
31. Mobile Diary App Versus Paper-Based Diary Cards for Patients With Borderline Personality Disorder:Economic Evaluation
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Lars Holger Ehlers, Sabrina Storgaard Sørensen, Stig Helweg-Jørgensen, Sidsel Lund Laursen, Mia Beck Lichtenstein, Kim Mathiasen, Astrid Langergaard, and Jesper Søndergaard
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medicine.medical_specialty ,Health Economic Evaluation ,dialectical behavior therapy ,Borderline Personality Disorder/diagnosis ,Cost-Benefit Analysis ,medicine.medical_treatment ,Health Informatics ,Anxiety ,Suicidal Ideation ,law.invention ,Randomized controlled trial ,Borderline Personality Disorder ,law ,mobile app ,Health care ,medicine ,Humans ,Psychiatry ,mHealth ,Borderline personality disorder ,Depression (differential diagnoses) ,Original Paper ,mobile phone ,business.industry ,medicine.disease ,Mobile Applications ,Focus group ,Dialectical behavior therapy ,psychotherapy ,cost-consequence ,Economic evaluation ,business ,borderline personality disorder - Abstract
Background: The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patientswith borderline personality disorder is unknown.Objective: This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cardsin DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility.Methods: This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants wererecruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in amobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. Acost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years(QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability.All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industryrepresentatives to discuss the potential advantages and disadvantages of using a mobile diary app.Results: A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the papergroup dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an averageof 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants inthe paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, andsuicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054;SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costsranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector wassimilar across both time points and groups (difference: psychiatric hospitalization and 2.02; SE 3.19). Overall, the patients showed high acceptability and considered the app as being easy to use. Therapists worriedabout potential negative influences on the therapist-patient interaction from new work tasks accompanying the introduction ofthe new technology but pointed at innovation potential from digital database registrations.Conclusions: This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT comparedwith paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness. Background:The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patients with borderline personality disorder is unknown.Objective:This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cards in DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility.Methods:This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants were recruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in a mobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. A cost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years (QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability. All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industry representatives to discuss the potential advantages and disadvantages of using a mobile diary app.Results:A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the paper group dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, and suicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054; SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costs ranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector was similar across both time points and groups (difference: psychiatric hospitalization Conclusions:This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT compared with paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness.
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- 2021
32. HRS White Paper on Clinical Utilization of Digital Health Technology
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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
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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.
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- 2022
33. Evidence based position paper on Physical and Rehabilitation Medicine practice for people with muscular dystrophies
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Milica Lazovic, Maria Gabriella Ceravolo, Kristian Borg, François Boyer, Mauro Zampolini, Carlotte Kiekens, and Dejan Nikolic
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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.
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- 2021
34. Heart Failure Association of the European Society of Cardiology position paper on the management of left ventricular assist device-supported patients for the non-left ventricular assist device specialist healthcare provider
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Stamatis Adamopoulos, Wilfried Mullens, Avishai Grupper, Miriam Abuhazira, Davor Miličić, Lorrena Hill, Johann Altenberger, Marco Metra, Jacob Lavee, Petar M. Seferovic, Tiny Jaarsma, Laurens F. Tops, Frank Ruschitzka, Tal Hasin, Yoav Hammer, Marisa G. Crespo-Leiro, Gerasimos Filippatos, Jeremy Elliston, Osnat Itzhaki Ben Zadok, Eva Goncalvesova, Righab Hamdan, Andrew J.S. Coats, Massimo F Piepoli, Finn Gustafsson, Luciano Potena, Israel Gotsman, Tuvia Ben Gal, Binyamin Ben Avraham, Piotr Ponikowski, Aviv Shaul, Giuseppe M.C. Rosano, Stefan D. Anker, Steven Tsui, Yaron D. Barac, Arsen D. Ristić, Sanemn Nalbantgil, Arjang Ruhparwar, Maria Frigeiro, Ovidiu Chioncel, Nicolaas de Jonge, Stephan Winnik, Gustafsson, Finn/0000-0003-2144-341X, Milicic, Davor, Ben Avraham, Binyamin, Chioncel, Ovidiu, Barac, Yaron D., Goncalvesova, Eva, Grupper, Avishai, Altenberger, Johann, Frigeiro, Maria, Ristic, Arsen, De Jonge, Nicolaas, Tsui, Steven, Lavee, Jacob, Rosano, Giuseppe, Crespo-Leiro, Marisa Generosa, Coats, Andrew J. S., Seferovic, Petar, Ruschitzka, Frank, Metra, Marco, Anker, Stefan, Filippatos, Gerasimos, Adamopoulos, Stamatis, Abuhazira, Miriam, Elliston, Jeremy, Gotsman, Israel, Hamdan, Righab, Hammer, Yoav, Hasin, Tal, Hill, Lorrena, Ben Zadok, Osnat Itzhaki, MULLENS, Wilfried, Nalbantgil, Sanemn, Piepoli, Massimo Francesco, Ponikowski, Piotr, Potena, Luciano, Ruhparwar, Arjang, Shaul, Aviv, Tops, Laurens F., Winnik, Stephan, Jaarsma, Tiny, Gustafsson, Finn, and Ben Gal, Tuvia
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Death declaration ,LVAD ,medicine.medical_treatment ,Von-Willebrand-Factor ,Chest pain ,ESC and HFA Paper ,ESC and HFA Papers ,Long-Term Support ,Risk-Factors ,Cardiac and Cardiovascular Systems ,Ischemic-Stroke ,declaration ,education.field_of_study ,Emergency Service ,Kardiologi ,Bleeding ,Emergency department ,Neurological events ,Emergency Service, Hospital ,Health Personnel ,Humans ,Tissue Donors ,Cardiology ,Heart Failure ,Heart Transplantation ,Heart-Assist Devices ,Mechanical Circulatory Support ,Death ,Gender-Differences ,Blood-Pressure ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Gastrointestinal Hemorrhage ,medicine.medical_specialty ,Population ,Heart-Assist Devices / adverse effects ,Intracerebral Hemorrhage ,Hospital ,medicine ,Diseases of the circulatory (Cardiovascular) system ,education ,Intracranial Hemorrhage ,business.industry ,Heart Failure / epidemiology ,medicine.disease ,equipment and supplies ,RC666-701 ,Ventricular assist device ,Heart failure ,Emergency medicine ,Position paper ,business ,Healthcare providers ,Destination therapy - Abstract
[Abstract] The improvement in left ventricular assist device (LVAD) technology and scarcity of donor hearts have increased dramatically the population of the LVAD-supported patients and the probability of those patients to present to the emergency department with expected and non-expected device-related and patient-device interaction complications. The ageing of the LVAD-supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to suffer from other co-morbidities common in the older population. In this second part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, definitions and structured approach to the LVAD-supported patient presenting to the emergency department with bleeding, neurological event, pump thrombosis, chest pain, syncope, and other events are presented. The very challenging issue of declaring death in an LVAD-supported patient, as the circulation is artificially preserved by the device despite no other signs of life, is also discussed in detail.
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- 2021
35. Evidence-based position paper on Physical and Rehabilitation Medicine practice for people with amyotrophic lateral sclerosis
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Dejan Nikolic, Mauro Zampolini, Milica Lazovic, Carlotte Kiekens, Kristian Borg, François Boyer, and Maria Gabriella Ceravolo
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030506 rehabilitation ,medicine.medical_specialty ,Evidence-based practice ,viruses ,medicine.medical_treatment ,Delphi method ,Physical Therapy, Sports Therapy and Rehabilitation ,Article ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Medicine ,Humans ,Amyotrophic lateral sclerosis ,Physical Therapy Modalities ,Rehabilitation ,business.industry ,Amyotrophic Lateral Sclerosis ,virus diseases ,Professional Practice ,medicine.disease ,Physical and Rehabilitation Medicine ,humanities ,3. Good health ,Europe ,Systematic review ,Progressive motor neuron disease ,Position paper ,0305 other medical science ,business ,030217 neurology & neurosurgery ,Evidence synthesis - Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease that affects both upper and lower motor neurons and is fatal in its course. This evidence-based position paper represents the official position of the UEMS PRM Section. The aim of the paper is to define the role of the physical and rehabilitation medicine (PRM) physician and PRM professional practice for people with ALS. 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-two recommendations resulting from the Delphi procedure. CONCLUSIONS The responsibility of the PRM physician is functional assessment of persons with ALS and delivering the optimal and most effective PRM program of care. The rehabilitation program of patients with ALS should be delivered and monitored by the multiprofessional team, with the PRM physician as principal coordinator.
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- 2021
36. The Impact of Severe Acute Respiratory Syndrome Coronavirus Type 2 on Children With Liver Diseases: A Joint European Society for Pediatric Gastroenterology, Hepatology and Nutrition and Society of Pediatric Liver Transplantation Position Paper
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Steven J. Lobritto, Giuseppe Indolfi, Noelle H Ebel, Marian G. Michaels, Piotr Czubkowski, Mohit Kehar, Vicky L. Ng, Emanuele Nicastro, and Mercedes Martínez
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medicine.medical_specialty ,Pediatrics ,medicine.medical_treatment ,MIS-C ,Liver transplantation ,Chronic liver disease ,coronavirus disease 2019 ,Internal medicine ,medicine ,Humans ,severe acute respiratory syndrome coronavirus type 2 ,Child ,Pediatric gastroenterology ,multisystem inflammatory syndrome in children ,Acute liver injury ,immunosuppression ,Society Papers ,autoimmune hepatitis ,liver transplantation ,business.industry ,SARS-CoV-2 ,Liver Diseases ,autoimmune liver disease ,Gastroenterology ,COVID-19 ,Hepatology ,medicine.disease ,Systemic Inflammatory Response Syndrome ,Pediatrics, Perinatology and Child Health ,SARS-CoV2 ,Position paper ,RNA, Viral ,Severe acute respiratory syndrome coronavirus ,business ,PIMS-TS ,Hepatic decompensation - Abstract
Children are seldom affected by severe forms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2) infection; however, the impact of comorbidities in the clinical presentation and outcome of SARS-CoV2 in children is poorly characterized including that of chronic liver disease (CLD) and those taking immunosuppressive medications for autoimmune liver disease or following liver transplantation (LT). Although not the main target organ, a spectrum of liver involvement has been described in children infected with SARS-CoV2 and those presenting with Multisystem Inflammatory Syndrome in Children (MIS-C). The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the Society of Pediatric Liver Transplantation (SPLIT) present an evidence-based position paper on liver involvement in children with SARS-CoV2 infection and its impact on those with CLD as well as LT recipients. All children may exhibit acute liver injury from SARS-CoV2 infection, and those with CLD and may experience hepatic decompensation. Preventative and therapeutic measures are discussed.
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- 2021
37. 1038 A prospective study of filter paper card for the detection of human papilloma virus DNA in self-collected cervicovaginal samples
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J Dickson Calvin, Ajit Sebastian, Anitha Thomas, Abraham Peedicayil, R George Chandy, R Ck, D Susan Thomas, Pushpa Abraham, Rajesh Kannangai, and Vinotha Thomas
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Cervical cancer ,Human papilloma virus ,medicine.medical_specialty ,Filter paper ,business.industry ,Obstetrics ,Gold standard (test) ,medicine.disease ,Abnormal PAP Smear ,Specimen transport medium ,medicine ,business ,Prospective cohort study ,Kappa - Abstract
Introduction/Background* Many countries worldwide have recommended testing high-risk human papillomavirus (HPV) types for primary cervical cancer screening. New easy and patient-friendly screening methods for identifying high-risk HPV types are under evaluation and may facilitate the use of HPV testing in low-resource countries. Methodology Aim To compare the accuracy of detecting high-risk HPV DNA on dried cervicovaginal secretions on filter paper to the standard technique. Methods our study was a prospective diagnostic study where we recruited 40 patients with abnormal pap smear cytology. Three samples were collected from each patient, 1) self-collected cervicovaginal sample on filter paper, 2) cervical sample on filter paper collected by a physician, and 3) a cytobrush sample in specimen transport medium (STM) for analysis. Qualitative testing for high-risk HPV DNA was done using the hybrid capture technique. Sensitivity, specificity and NPV and PPV, and agreement of new method with the standard procedure were calculated. Result(s)* Of the 40 patients, 32.5% had low-grade lesions, and 67.5% had high-grade lesions on the pap smear. The overall prevalence of High-risk HPV in the sample was 67.5%. Detection of high-risk HPV DNA in the cervical sample collected on filter paper by the physician had a sensitivity of 77.8%, specificity 100%, positive predictive value 100%, and negative predictive value of 68.4%, taking STM as the gold standard. The patient‘s self-sampling of cervicovaginal secretions on filter paper also showed similar results, with sensitivity 66.7%, specificity 100%, PPV 100%, and NPV 59.1%. The agreement between the STM method and physician collected cervical sample on filter paper was substantial, kappa: 0.695(P= Conclusion* Our study showed that dried cervicovaginal samples collected by the patient on filter paper to detect High-Risk HPV could be done with acceptable accuracy and cost. It can be used as an alternative STM method for screening cervical cancer where a more uncomplicated, cost-effective technique may be better.
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- 2021
38. Cardiovascular disease and COVID-19:a consensus paper from the ESC Working Group on Coronary Pathophysiology & Microcirculation, ESC Working Group on Thrombosis and the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Heart Rhythm Association (EHRA)
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Maria Dorobantu, Dirk J. Duncker, Geneviève Derumeaux, Diana A. Gorog, Zorana Vasiljevic-Pokrajcic, Cor de Wit, Marija Vavlukis, Dimitris Tousoulis, Etto C. Eringa, Edina Cenko, Christian Hassager, Davor Miličić, Teresa Padró, Giuseppe De Luca, Gemma Vilahur, Marc J. Claeys, Lina Badimon, Danijela Trifunovic-Zamaklar, Raffaele Bugiardini, Frank R. Heinzel, Olivia Manfrini, Evangelos Oikonomou, Kurt Huber, RS: Carim - H08 Experimental atrial fibrillation, Fysiologie, Physiology, ACS - Diabetes & metabolism, Cenko E., Badimon L., Bugiardini R., Claeys M.J., De Luca G., de Wit C., Derumeaux G., Dorobantu M., Duncker D.J., Eringa E.C., Gorog D.A., Hassager C., Heinzel F.R., Huber K., Manfrini O., Milicic D., Oikonomou E., Padro T., Trifunovic-Zamaklar D., Vasiljevic-Pokrajcic Z., Vavlukis M., Vilahur G., and Tousoulis D.
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Physiology ,Disease ,Review ,CORONAVIRUS ,030204 cardiovascular system & hematology ,Bioinformatics ,endothelial dysfunction ,0302 clinical medicine ,cytokine ,Cardiometabolic Risk Factor ,thrombosi ,AcademicSubjects/MED00200 ,030212 general & internal medicine ,Endothelial dysfunction ,CARDIOLOGY ,Clinical Trials as Topic ,Sex Characteristics ,post-acute COVID-19 ,THROMBOEMBOLISM FOLLOWING HOSPITALIZATION ,Inflammation/complications ,Cardiovascular disease ,Thrombosis ,Pathophysiology ,3. Good health ,Cardiovascular Diseases ,Myocardial injury ,Cardiovascular Diseases/enzymology ,COVID-19/complications ,Angiotensin-Converting Enzyme 2 ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Infection ,Viral load ,POSITION PAPER ,Human ,ANGIOTENSIN-CONVERTING ENZYME ,EXPRESSION ,SEX-DIFFERENCES ,microcirculation ,Inflammation ,Angiotensin-Converting Enzyme 2/metabolism ,03 medical and health sciences ,Post-Acute COVID-19 Syndrome ,SDG 3 - Good Health and Well-being ,Physiology (medical) ,medicine ,Humans ,thrombosis ,business.industry ,SARS-CoV-2 ,INFLAMMATORY RESPONSE ,Cardiometabolic Risk Factors ,COVID-19 ,medicine.disease ,CARDIAC ARREST SYNDROME ,cytokines ,inflammation ,Cardiovascular Injury ,Myocardial fibrosis ,Human medicine ,business - Abstract
The cardiovascular system is significantly affected in coronavirus disease-19 (COVID-19). Microvascular injury, endothelial dysfunction, and thrombosis resulting from viral infection or indirectly related to the intense systemic inflammatory and immune responses are characteristic features of severe COVID-19. Pre-existing cardiovascular disease and viral load are linked to myocardial injury and worse outcomes. The vascular response to cytokine production and the interaction between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and angiotensin-converting enzyme 2 receptor may lead to a significant reduction in cardiac contractility and subsequent myocardial dysfunction. In addition, a considerable proportion of patients who have been infected with SARS-CoV-2 do not fully recover and continue to experience a large number of symptoms and post-acute complications in the absence of a detectable viral infection. This conditions often referred to as ‘post-acute COVID-19’ may have multiple causes. Viral reservoirs or lingering fragments of viral RNA or proteins contribute to the condition. Systemic inflammatory response to COVID-19 has the potential to increase myocardial fibrosis which in turn may impair cardiac remodelling. Here, we summarize the current knowledge of cardiovascular injury and post-acute sequelae of COVID-19. As the pandemic continues and new variants emerge, we can advance our knowledge of the underlying mechanisms only by integrating our understanding of the pathophysiology with the corresponding clinical findings. Identification of new biomarkers of cardiovascular complications, and development of effective treatments for COVID-19 infection are of crucial importance., Graphical Abstract Graphical Abstract
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- 2021
39. Current Indications of Secondary Enucleation in Retinoblastoma Management: A Position Paper on Behalf of the European Retinoblastoma Group (EURbG)
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Helen Jenkinson, Francis L. Munier, Philippe Maeder, Christina Stathopoulos, Livia Lumbroso-Le Rouic, François Doz, Maja Beck Popovic, Guillermo L. Chantada, Annette C. Moll, Manoj Parulekar, Ophthalmology, ACS - Diabetes & metabolism, APH - Health Behaviors & Chronic Diseases, APH - Quality of Care, CCA - Cancer Treatment and quality of life, CCA - Imaging and biomarkers, and Amsterdam Reproduction & Development (AR&D)
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Cancer Research ,medicine.medical_specialty ,Conservative management ,Enucleation ,Guidelines ,survival ,retinoblastoma ,intra-arterial chemotherapy ,External beam irradiation ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,metastasis ,Intensive care medicine ,RC254-282 ,Biologic marker ,intravenous chemotherapy ,business.industry ,Retinoblastoma ,Disease progression ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,eye diseases ,Oncology ,030220 oncology & carcinogenesis ,030221 ophthalmology & optometry ,Position paper ,secondary enucleation ,external beam irradiation ,business ,Disease persistence - Abstract
Simple Summary Although secondary enucleation (SE) is the treatment of choice for retinoblastoma eyes that did not respond favorably to conservative therapies, clear criteria for its indication are, however, currently missing. In this position paper on behalf of the European Retinoblastoma Group (EURbG), we discuss the available literature on SE, including its influence on metastases rate and survival, and propose guidelines to assist decision-making to interrupt eye-preserving therapies depending on the availabilities of advanced diagnostic and therapeutic modalities. Absolute indications to SE may be restricted to eyes with refractory tumor activity resisting all salvage treatments or eyes under apparent tumor control but no visual potential and irreducible complications. In contrast, eyes with an obscured optic nerve head and/or ocular complications amenable to specific surgical or medical management can be considered relative indications, provided that appropriate follow-up can be implemented and that parents are fully aware of a residual risk. Abstract Secondary enucleation (SE) puts an irreversible end to eye-preserving therapies, whenever their prolongation is expected to violate the presumed state of metastatic grace. At present, it must be acknowledged that clear criteria for SE are missing, leading to empiric and subjective indications commonly related to disease progression or relapse, disease persistence masking the optic nerve head or treatment-related complications obscuring the fundus view. This absence of evidence-based consensus regarding SE is explained by the continuously moving frontiers of the conservative management as a result of diagnostic and therapeutic advances, as well as by the lack of studies sufficiently powered to accurately stratify the risk of metastasis in conservatively treated patients. In this position paper of the European Retinoblastoma Group (EURbG), we give an overview of the progressive shift in the indications for SE over the past decades and propose guidelines to assist decision-making with respect to when SE becomes imperative or recommended, with corresponding absolute and relative SE indications. Further studies and validation of biologic markers correlated with the risk of metastasis are expected to set more precisely the frontiers of conservative management and thus consensual criteria for SE in the future.
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- 2021
40. Alcohol use disorder in the COVID‐19 era: Position paper of the Italian Society on Alcohol (SIA)
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S Arico, Lisa Lungaro, Tiziana Fanucchi, Raffaella Rossin, Cristina Meneguzzi, Gianni Testino, Teo Vignoli, Luigi C. Bottaro, Patrizia Balbinot, Emanuele Scafato, Doda Renzetti, Pierluigi Allosio, Vito Campanile, Valentino Patussi, Fabio Caputo, Giacomo Caio, Livia Maccio, Davide Mioni, Michele Parisi, Giorgio Zoli, Claudia Gandin, Maria Francesca Amendola, and Aniello Baselice
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Liver Cirrhosis ,Medicine (miscellaneous) ,Disease ,Alcohol use disorder ,Telehealth ,Liver Cirrhosis, Alcoholic ,Recurrence ,Ambulatory Care ,Drug Interactions ,infections ,Social isolation ,Societies, Medical ,Alcoholics Anonymous ,media_common ,Alcoholic ,Telemedicine ,Alcoholism ,Psychiatry and Mental health ,COVID‐19 infection ,Italy ,Original Article ,Disease Susceptibility ,medicine.symptom ,medicine.medical_specialty ,COVID-19 Vaccines ,media_common.quotation_subject ,alcohol use disorder ,NO ,Medical ,Intervention (counseling) ,mental disorders ,medicine ,Humans ,Psychiatry ,Immunosuppression Therapy ,Pharmacology ,SARS-CoV-2 ,business.industry ,Addiction ,COVID-19 ,Original Articles ,medicine.disease ,COVID-19 Drug Treatment ,COVID-19 infection ,Liver Transplantation ,Communicable Disease Control ,Position paper ,Societies ,business ,Delivery of Health Care - Abstract
Coronavirus disease 2019 (COVID‐19) first emerged in China in November 2019. Most governments have responded to the COVID‐19 pandemic by imposing a lockdown. Some evidence suggests that a period of isolation might have led to a spike in alcohol misuse, and in the case of patients with alcohol use disorder (AUD), social isolation can favour lapse and relapse. The aim of our position paper is to provide specialists in the alcohol addiction field, in psychopharmacology, gastroenterology and in internal medicine, with appropriate tools to better manage patients with AUD and COVID‐19,considering some important topics: (a) the susceptibility of AUD patients to infection; (b) the pharmacological interaction between medications used to treat AUD and to treat COVID‐19; (c) the reorganization of the Centre for Alcohol Addiction Treatment for the management of AUD patients in the COVID‐19 era (group activities, telemedicine, outpatients treatment, alcohol‐related liver disease and liver transplantation, collecting samples); (d) AUD and SARS‐CoV‐2 vaccination. Telemedicine/telehealth will undoubtedly be useful/practical tools even though it remains at an elementary level; the contribution of the family and of caregivers in the management of AUD patients will play a significant role; the multidisciplinary intervention involving experts in the treatment of AUD with specialists in the treatment of COVID‐19 disease will need implementation. Thus, the COVID‐19 pandemic is rapidly leading addiction specialists towards a new governance scenario of AUD, which necessarily needs an in‐depth reconsideration, focusing attention on a safe approach in combination with the efficacy of treatment., All health care systems need to be reorganized during and after the COVID‐19 pandemic, and also the CAATs in order to combine operator safety with patient safety and care. The multi‐disciplinary intervention involving experts in the treatment of AUD and ALD with specialists in the treatment of COVID‐19 disease will need implementation and the contribution of the family and of care‐givers in the management of AUD and ALD patients will play a significant role.
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- 2021
41. Paper-based ELISA diagnosis technology for human brucellosis based on a multiepitope fusion protein
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Han Li, Hai Jiang, Mingjun Sun, Qiongqiong Bai, Dehui Yin, Jingpeng Zhang, Xiling Wu, and Jihong Shao
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Bacterial Diseases ,Serum Proteins ,B Cells ,RC955-962 ,Disease ,Pathology and Laboratory Medicine ,Biochemistry ,Epitope ,Cell Fusion ,Epitopes ,White Blood Cells ,Medical Conditions ,Filter Paper ,Animal Cells ,Zoonoses ,Arctic medicine. Tropical medicine ,Medicine and Health Sciences ,Enzyme-Linked Immunoassays ,biology ,Bacterial Pathogens ,Laboratory Equipment ,medicine.anatomical_structure ,Infectious Diseases ,Medical Microbiology ,Engineering and Technology ,Pathogens ,Cellular Types ,Public aspects of medicine ,RA1-1270 ,Bacterial Outer Membrane Proteins ,Research Article ,Neglected Tropical Diseases ,China ,Cell Physiology ,Immune Cells ,Immunology ,Equipment ,Enzyme-Linked Immunosorbent Assay ,Brucella ,Research and Analysis Methods ,Sensitivity and Specificity ,Microbiology ,Brucellosis ,Antigen ,Diagnostic Medicine ,medicine ,Humans ,Immunoassays ,Antibody-Producing Cells ,Microbial Pathogens ,B cell ,Antigens, Bacterial ,Blood Cells ,Bacteria ,business.industry ,Public Health, Environmental and Occupational Health ,Organisms ,Biology and Life Sciences ,Proteins ,Cell Biology ,medicine.disease ,biology.organism_classification ,Tropical Diseases ,Fusion protein ,Virology ,Infectious disease (medical specialty) ,Immunologic Techniques ,business - Abstract
Background Brucellosis, as a serious zoonotic infectious disease, has been recognized as a re-emerging disease in the developing countries worldwide. In china, the incidence of brucellosis is increasing each year, seriously threatening the health of humans as well as animal populations. Despite a quite number of diagnostic methods currently being used for brucellosis, innovative technologies are still needed for its rapid and accurate diagnosis, especially in area where traditional diagnostic is unavailable. Methodology/Principal findings In this study, a total of 22 B cell linear epitopes were predicted from five Brucella outer membrane proteins (OMPs) using an immunoinformatic approach. These epitopes were then chemically synthesized, and with the method of indirect ELISA (iELISA), each of them displayed a certain degree of capability in identifying human brucellosis positive sera. Subsequently, a fusion protein consisting of the 22 predicted epitopes was prokaryotically expressed and used as diagnostic antigen in a newly established brucellosis testing method, nano-ZnO modified paper-based ELISA (nano-p-ELISA). According to the verifying test using a collection of sera collected from brucellosis and non-brucellosis patients, the sensitivity and specificity of multiepitope based nano-p-ELISA were 92.38% and 98.35% respectively. The positive predictive value was 98.26% and the negative predictive value was 91.67%. The multiepitope based fusion protein also displayed significantly higher specificity than Brucella lipopolysaccharide (LPS) antigen. Conclusions B cell epitopes are important candidates for serologically testing brucellosis. Multiepitope fusion protein based nano-p-ELISA displayed significantly sensitivity and specificity compared to Brucella LPS antigen. The strategy applied in this study will be helpful to develop rapid and accurate diagnostic method for brucellosis in human as well as animal populations., Author summary Brucellosis is one of the most important zoonosis in the world and has caused tremendous economic losses in agriculture and animal husbandry in many countries. Developing rapid, sensitive and specific diagnostic methods is very important for early detection and treatment of brucellosis patients. In this study, a novel diagnostic technique, nano-ZnO modified paper ELISA, was established. The antigen used in this technique was a fusion protein containing multiple B cell epitopes, which were predicted from Brucella major outer membrane proteins such as Bp26, Omp31, Omp16, Omp2b and Omp25. Comparing to traditional LPS antigen, this multiepitope based antigen displayed considerably higher sensitivity and higher specificity in laboratory. With the strategy described in this paper, more efficient epitopes and protein antigen can be identified in the future. Currently, LPS antigen is only prepared from live Brucella, while protein antigen can be produced in large quantities in prokaryotic expression system. In addition to nano-p-ELISA, this protein antigen can also be used for development other methods such as fluorescent polarization assay (FPA) and immunochromatographic assay (ICA) to meet the varied demand for brucellosis testing.
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- 2021
42. An ESPGHAN Position Paper on the Use of Breath Testing in Paediatric Gastroenterology
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Rut Ann Thomassen, Jernej Dolinsek, Carmen Ribes-Koninckx, Erasmo Miele, Christos Tzivinikos, Corina Pienar, Javier Martín-de-Carpi, Emmanuel Mas, Marc A. Benninga, Osvaldo Borrelli, Ilse Broekaert, Mike Thomson, University Hospital of Cologne [Cologne], Great Ormond Street Hospital for Children [London] (GOSH), University medical centre Maribor (UKC Maribor), Hospital Sant Joan de Déu [Barcelona], Institut de Recherche en Santé Digestive (IRSD ), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), 'Federico II' University of Naples Medical School, Victor Babeş University of Medicine and Pharmacy (UMFT), Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe, Oslo University Hospital [Oslo], Sheffield Children's NHS Foundation Trust, Al Jalila Children's Specialty Hospital, VU University Medical Center [Amsterdam], SEGUIN, Nathalie, Broekaert, Ilse Julia, Borrelli, Osvaldo, Dolinsek, Jernej, Martin-de-Carpi, Javier, Mas, Emmanuel, Miele, Erasmo, Pienar, Corina, Ribes-Koninckx, Carmen, Thomassen, Rut, Thomson, Mike, Tzivinikos, Christo, Benninga, Marc, and Hospital Universitari i Politècnic La Fe
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medicine.medical_specialty ,Malabsorption ,Consensus ,Carbohydrate malabsorption ,030309 nutrition & dietetics ,MEDLINE ,carbohydrate malabsorption ,small intestinal bacterial overgrowth ,Helicobacter pylori infection ,Helicobacter Infections ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics ,children ,Internal medicine ,Small intestinal bacterial overgrowth ,medicine ,breath testing ,Humans ,Intensive care medicine ,Exocrine pancreatic insufficiency ,Child ,Children ,0303 health sciences ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,business.industry ,Gastroenterology ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Hepatology ,medicine.disease ,[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,3. Good health ,Fat malabsorption ,Breath testing ,Systematic review ,Breath Tests ,Pediatrics, Perinatology and Child Health ,Position paper ,030211 gastroenterology & hepatology ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Systematic Reviews as Topic - Abstract
International audience; Objectives: Given a lack of a systematic approach to the use of breath testing in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimise its utility and safety. Methods: Nine clinical questions regarding methodology, interpretation, and specific indications of breath testing and treatment of carbohydrate malabsorption were addressed by members of the Gastroenterology Committee (GIC) of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). A systematic literature search was performed from 1983 to 2020 using PubMed, the MEDLINE and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes. During a consensus meeting, all recommendations were discussed and finalised. In the absence of evidence from randomised controlled trials, recommendations reflect the expert opinion of the authors. Results: A total of 22 recommendations were voted on using the nominal voting technique. At first, recommendations on prerequisites and preparation for as well as on interpretation of breath tests are given. Then, recommendations on the usefulness of H2-lactose breath testing, H2-fructose breath testing as well as of breath tests for other types of carbohydrate malabsorption are provided. Furthermore, breath testing is recommended to diagnose small intestinal bacterial overgrowth (SIBO), to control for success of Helicobacter pylori eradication therapy and to diagnose and monitor therapy of exocrine pancreatic insufficiency, but not to estimate oro-caecal transit time (OCTT) or to diagnose and follow-up on celiac disease. Conclusions: Breath tests are frequently used in paediatric gastroenterology mainly assessing carbohydrate malabsorption, but also in the diagnosis of small intestinal overgrowth, fat malabsorption, H. pylori infection as well as for measuring gastrointestinal transit times. Interpretation of the results can be challenging and in addition, pertinent symptoms should be considered to evaluate clinical tolerance.
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- 2021
43. Late phase of COVID‐19 pandemic in General Cardiology. A position paper of the ESC Council for Cardiology Practice
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Marc Ferrini, Alessandro Squizzato, Stefano Nistri, Giovanni Gaudio, Friedrich Koehler, Luigina Guasti, Francois Dievart, Dimitrios J. Richter, Ruxandra Christodorescu, and Riccardo Asteggiano
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medicine.medical_specialty ,‘Long COVID-19’ illness ,Myocarditis ,Cardiology ,Disease ,030204 cardiovascular system & hematology ,Chest pain ,ESC and HFA Paper ,ESC and HFA Papers ,SARS‐CoV‐2 ,03 medical and health sciences ,0302 clinical medicine ,Post-Acute COVID-19 Syndrome ,COVID‐19 ,Internal medicine ,Pandemic ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Outpatient clinic ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Pandemics ,Late phase ,business.industry ,Wearables ,SARS-CoV-2 ,General cardiology ,COVID-19 ,Pneumonia ,medicine.disease ,Telemedicine ,‘Long COVID‐19’ illness ,RC666-701 ,Post-COVID ,Heart failure ,Post‐COVID ,Myocardial injury ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Digital health - Abstract
Cardiovascular (CV) engagement in coronavirus disease 2019 (COVID‐19) is a huge determinant of prognosis during the acute phase of the disease. However, little is known about the potential chronic implications of the late phase of COVID‐19 and about the appropriate approach to these patients. Heart failure, type 1 and type 2 myocardial infarction, arrhythmias, myocarditis, pulmonary fibrosis, and thrombosis have been shown to be related to severe acute respiratory syndrome coronavirus 2 infection, and a ‘long COVID‐19’ illness has been recognized with fatigue, chest pain, and dyspnoea among the most frequent symptoms reported after discharge from hospital. This paper focuses on some open questions that cardiologists are going to face during the next months in a general cardiology outpatient clinic, in particular how to evaluate a ‘post‐COVID’ patient during follow‐up of CV complications of the acute phase and how to manage new CV symptoms that could be the consequence, at least in part, of heart/vessels and/or lung involvement of the previous virus infection. Present symptoms and signs, history of previous CV disease (both preceding COVID‐19 and occurring during viral infection), and specific laboratory and imaging measurements during the acute phase may be of interest in focusing on how to approach the clinical evaluation of a post‐COVID patient and how to integrate in our standard of care the new information on COVID‐19, possibly in a multidisciplinary view. Dealing with the increased COVID‐associated CV risk burden and becoming acquainted with potential new e‐cardiology approaches aimed at integrating the cardiology practice are relevant new challenges brought by severe acute respiratory syndrome coronavirus 2 infection and its sequelae.
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- 2021
44. Diagnostic comparison between cord blood and filter paper for the screening of congenital hypothyroidism
- Author
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Abeer Al-Sofyani, Saud F. Alshaikh, Meshari A. Turjoman, Eman Althobaiti, Anwar Borai, Seham Alameer, Feras Badriq, and Mohammed Mujalled
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Microbiology (medical) ,Male ,Pediatrics ,medicine.medical_specialty ,endocrine system ,Heel ,Time Factors ,endocrine system diseases ,Clinical Biochemistry ,Sensitivity and Specificity ,Neonatal Screening ,medicine ,Immunology and Allergy ,Humans ,filter paper ,Primary congenital hypothyroidism ,Diagnostic Errors ,Research Articles ,heel prick ,Alternative methods ,Blood Specimen Collection ,business.industry ,TSH ,Biochemistry (medical) ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,congenital hypothyroidism ,Hematology ,medicine.disease ,Fetal Blood ,Congenital hypothyroidism ,Medical Laboratory Technology ,medicine.anatomical_structure ,Cord blood ,cord blood ,Female ,Recall rate ,business ,hormones, hormone substitutes, and hormone antagonists ,Research Article - Abstract
Background Cord‐blood and heel‐prick TSH levels are essential in diagnosing and preventing the serious complications of congenital hypothyroidism, which mainly include intellectual disability. The study aimed to compare between cord‐blood and heel‐prick TSH sensitivity and specificity in detecting congenital hypothyroidism (CH) among newborn screened babies. Method The study included 21,012 newborn screened babies for congenital hypothyroidism starting from September 2013 until March 2019. Both cord‐blood and heel‐prick TSH were collected from each newborn. Heel prick and cord‐blood TSH cutoff values of >21 μU/ml and >30 mIU/L respectively were considered positive. Results Out of the total screened newborns, 12 were confirmed for having primary congenital hypothyroidism. Nine cases were positive for cord‐blood TSH (Sensitivity 75%, specificity 99.9%, and a recall rate of 0.004%), while 139 cases were positive for heel‐prick blood TSH (Sensitivity of 100%, specificity of 99.3%, and a recall rate of 0.60%). Conclusion For the screening of CH, heel prick is considered a superior method, but cord blood remains a practical option due to its cost‐effectiveness, immediate action, and lower recall rate. Therefore, whenever recall is difficult and/or early discharge is the practice, cord blood is an alternative method to heel prick but not with cases of prematurity., Cord blood and heel prick TSH levels are essential in diagnosing and preventing congenital hypothyroidism (CH). Out of the total screened newborn 12 were confirmed for having primary congenital hypothyroidism. 10 cases were positive for cord blood TSH (Sensitivity 75%, specificity 99.9%, and a recall rate of 0,004%) while 139 cases were positive for heel prick blood TSH (Sensitivity 100%, specificity 99.3%, and a recall rate of 0.60%). Cord blood is an alternative method to heel‐prick but not with cases of prematurity.
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- 2021
45. Apheresis medicine in the era of advanced telehealth technologies: An American Society for Apheresis position paper part II: Principles of apheresis medical practice in a 21st century electronic medical practice environment
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Walter J. Linz, Chester Andrzejewski, and Jan C. Hofmann
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business.industry ,Medical practice ,Hematology ,General Medicine ,Telehealth ,medicine.disease ,Telemedicine ,United States ,Apheresis (linguistics) ,Blood Component Removal ,Medicine ,Position paper ,Humans ,Medical emergency ,business ,Societies, Medical - Published
- 2021
46. Reply to: 'An EASL position paper for systemic treatment of hepatocellular carcinoma: Go forward courageously'
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Jordi Bruix, Lorenza Rimassa, Bruno Sangro, Stephen L. Chan, and Peter R. Galle
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Oncology ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Hepatology ,business.industry ,Liver Neoplasms ,MEDLINE ,medicine.disease ,Text mining ,Treatment Outcome ,Internal medicine ,Hepatocellular carcinoma ,medicine ,Position paper ,Humans ,business - Published
- 2021
47. How Collaborative Position Paper on the Management of Thrombocytopenia in Pregnancy
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Nolan Mcdonnell, Renee Eslick, Lisa Clarke, Jennifer Curnow, Claire McLintock, Briony Cutts, Sara Ng, Eileen Merriman, Antonia W. Shand, and Ian Kando
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medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,Obstetric medicine ,business.industry ,Infant, Newborn ,Parturition ,Obstetrics and Gynecology ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Thrombocytopenia ,Neonatal Thrombocytopenia ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Position paper ,Female ,business ,Intensive care medicine - Abstract
Thrombocytopenia in pregnancy is a common occurrence, affecting up to 10% of women by the time of birth. These recommendations aim to provide pragmatic guidance on the investigation, diagnosis and management of thrombocytopenia in pregnancy; including safety of neuraxial anaesthesia and precautions required for birth. Management of neonatal thrombocytopenia is also addressed. The authors are clinicians representing haematology, obstetric medicine, maternal-fetal medicine, and anaesthesia. Each author conducted a detailed literature review then worked collaboratively to produce a series of unanimous recommendations. The recommendation strength is limited by the lack of high-quality clinical trial data, and represents level C evidence.
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- 2022
48. An EASL position paper for systemic treatment of hepatocellular carcinoma: Go forward courageously
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Ming-Lung Yu, Ming-Lun Yeh, and Chia-Yen Dai
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Oncology ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Hepatology ,business.industry ,Liver Neoplasms ,medicine.disease ,Systemic therapy ,Hepatocellular carcinoma ,Internal medicine ,medicine ,Position paper ,Humans ,Chemoembolization, Therapeutic ,business ,Retrospective Studies - Published
- 2021
49. Diagnosis and Management of Heart Failure in Elderly Patients from Hospital Admission to Discharge: Position Paper
- Author
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Patrice Cacoub, Gilles Berrut, Olivier Hanon, Tahar Chouihed, Nicholas Lamblin, Nicholas Delarche, Emmanuel Andrès, Patrick Henry, Thibaud Damy, CHU Henri Mondor, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Centre hospitalier de Pau, Pôle hospitalo-universitaire de gérontologie clinique [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'Immunologie [CHU Pitié-Salpétrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Lille, CHU Strasbourg, AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Université de Paris (UP), Novartis provided financial support for logistic management but was not involved in the writing of the manuscript., CHU Henri Mondor [Créteil], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Université Paris Cité (UPCité), and Gestionnaire, HAL Sorbonne Université 5
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medicine.medical_specialty ,Hospital setting ,Management of heart failure ,Review ,030204 cardiovascular system & hematology ,elderly ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Multidisciplinary approach ,Community health care ,medicine ,Transitional care ,030212 general & internal medicine ,Intensive care medicine ,heart failure management ,business.industry ,General Medicine ,medicine.disease ,practical guidance ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,3. Good health ,Heart failure ,Hospital admission ,Medicine ,Position paper ,business - Abstract
International audience; Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly.
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- 2021
50. Re: Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: An ESPGHAN Position Paper
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Tjark Ebels, Frederik G. Dikkers, Ear, Nose and Throat, APH - Quality of Care, and Cardiovascular Centre (CVC)
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Button battery ,Electric Power Supplies ,business.industry ,Gastroenterology ,MEDLINE ,medicine.disease ,Foreign Bodies ,Eating ,Pediatrics, Perinatology and Child Health ,Diagnosis management ,Position paper ,Medicine ,Ingestion ,Humans ,Medical emergency ,business - Published
- 2021
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