224,240 results
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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. 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
7. 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
8. 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
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. The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper
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Ari Leppanemi, Belinda De Simone, Leonardo Pagani, Edoardo Picetti, Emmanouil Pikoulis, Fausto Catena, Salomone Di Saverio, Elie Chouillard, Gian Luca Baiocchi, A. B. Peitzmann, Federico Coccolini, Luca Ansaloni, Yoram Kluger, Gustavo Pereira Fraga, Walter L. Biffl, Massimo Sartelli, Massimo Valentino, Ernest E. Moore, Fikri M. Abu-Zidan, and Ciro Paolillo
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Infectious Disease Transmission, Patient-to-Professional ,Isolation (health care) ,Non operative management ,MEDLINE ,lcsh:Surgery ,030204 cardiovascular system & hematology ,Global Health ,Open surgery ,Perioperative Care ,03 medical and health sciences ,Postoperative care ,0302 clinical medicine ,COVID-19 Testing ,Personal protective equipment ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Pandemics ,Infection Control ,Pandemic ,business.industry ,SARS-CoV-2 ,Follow-up ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,COVID-19 ,Emergency department ,lcsh:RD1-811 ,lcsh:RC86-88.9 ,medicine.disease ,Trauma surgery ,Mass-casualty incident ,Surgical Procedures, Operative ,2019-nCoV ,Emergency Medicine ,Emergency surgery ,Laparoscopy ,Screening ,Position paper ,Surgery ,Medical emergency ,Emergencies ,business ,Research Article - Abstract
Background Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. Method A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. Results Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion. Conclusions The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.
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- 2021
24. Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee
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Hugues Chabriat, Geert Jan Biessels, Marco Duering, Joanna M. Wardlaw, Olivier Godefroy, Leonardo Pantoni, Ana Verdelho, Andreas Charidimou, Aleksandra M. Pavlović, and Repositório da Universidade de Lisboa
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medicine.medical_specialty ,Review ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,White paper ,Physical medicine and rehabilitation ,Medicine ,Dementia ,In patient ,cardiovascular diseases ,Cerebrovascular disease ,Cognitive impairment ,Stroke ,business.industry ,medicine.disease ,Small vessel disease ,3. Good health ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
© European Stroke Organisation 2021, Purpose: Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease. Methods: The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. Findings: Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options. Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.
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- 2021
25. European white paper
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Anna C.H. Willemsen, Chris Curtis, Taner Yılmaz, C. René Leemans, Jens Peter Klussmann, Lise Crevier-Buchman, Walmari Pilz, Nathalie Rommel, Leena-Maija Aaltonen, Giovanni Succo, Beatrice Manduchi, Kevin Hansen, Jean Paul Marie, Christoph Arens, Sefik Hosal, Denise MacCarthy, Markus Hess, Jesper Grau Eriksen, Christina Pflug, Annemie M. W. J. Schols, Kate Heathcote, Patrick Cras, Irene Wessel, Antonio Schindler, Laura W. J. Baijens, Wojciech Golusiński, Margaret Walshe, Reinie Cordier, Reza Nouraei, Pere Clavé, Roganie Govender, Renée Speyer, Julie Regan, Claire Parkes, LPP - Laboratoire de Phonétique et Phonologie - UMR 7018 (LPP), Université Sorbonne Nouvelle - Paris 3-Centre National de la Recherche Scientifique (CNRS), Clinicum, Korva-, nenä- ja kurkkutautien klinikka, HUS Head and Neck Center, KNO, RS: GROW - R2 - Basic and Translational Cancer Biology, MUMC+: MA Keel Neus Oorheelkunde (9), RS: MHeNs - R3 - Neuroscience, RS: NUTRIM - R3 - Respiratory & Age-related Health, Pulmonologie, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Otolaryngology / Head & Neck Surgery, and CCA - Cancer Treatment and quality of life
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medicine.medical_specialty ,MULTIDISCIPLINARY TEAM MANAGEMENT ,Aging ,MODULATED RADIATION-THERAPY ,ITEM RESPONSE THEORY ,Context (language use) ,FIBEROPTIC ENDOSCOPIC EVALUATION ,SKELETAL-MUSCLE MASS ,03 medical and health sciences ,0302 clinical medicine ,White paper ,TRANSORAL ROBOTIC SURGERY ,QUALITY-OF-LIFE ,Transoral robotic surgery ,medicine ,Humans ,3125 Otorhinolaryngology, ophthalmology ,[SHS.LANGUE]Humanities and Social Sciences/Linguistics ,030223 otorhinolaryngology ,Head and neck cancer ,Papillomaviridae ,business.industry ,General Medicine ,Evidence-based medicine ,Dysphagia ,A300 ,Swallowing ,medicine.disease ,3. Good health ,Deglutition ,Europe ,Systematic review ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Family medicine ,UPPER ESOPHAGEAL SPHINCTER ,SQUAMOUS-CELL CARCINOMA ,Human medicine ,medicine.symptom ,How I do it ,business ,LOCALLY ADVANCED HEAD ,Deglutition Disorders ,Oropharyngeal dysphagia - Abstract
Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
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- 2021
26. 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
27. 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
28. 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
29. 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
30. 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
31. 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
32. 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
33. 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
34. Imaging the adult with simple shunt lesions: position paper from the EACVI and the ESC WG on ACHD. Endorsed by AEPC (Association for European Paediatric and Congenital Cardiology)
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Katarina Hanseus, Jolien W. Roos-Hesselink, Luc Mertens, Victoria Parish, Sonya V. Babu-Narayan, Gilbert Habib, Thor Edvardsen, Michael A. Gatzoulis, Tarique Hussain, Annemien E. van den Bosch, Emanuela R. Valsangiacomo Buechel, Tal Geva, Alessandra Frigiola, Wei Li, Owen Miller, Giovanni Di Salvo, Beatrice Bonello, Helmut Baumgartner, Laura Dos Subira, Werner Budts, Nankai University (NKU), Department of Interventional Cardiology [Rotterdam, The Netherlands] (Erasmus MC), Erasmus University Medical Center [Rotterdam] (Erasmus MC)-Thorax Center [Rotterdam, The Netherlands], University of Texas Southwestern Medical Center [Dallas], Cardiothoracic Centre, Guy's and St Thomas' Hospital [London], Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Oslo University Hospital [Oslo], Aix Marseille Université (AMU), University Hospital Münster - Universitaetsklinikum Muenster [Germany] (UKM), Royal Brompton Hospital, University of Zurich, Budts, Werner, and Cardiology
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Heart Septal Defects, Ventricular ,shunt lesions ,Heart disease ,030204 cardiovascular system & hematology ,Multimodal Imaging ,Heart Septal Defects, Atrial ,Congenital ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,ACHD ,echocardiography ,030212 general & internal medicine ,Child ,Heart Defects ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,Persistent arterial duct ,imaging ,General Medicine ,GUCH ,Shunt (medical) ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,Radiology ,Cardiology and Cardiovascular Medicine ,Heart Defects, Congenital ,Adult ,medicine.medical_specialty ,Cardiology ,610 Medicine & health ,cardiac magnetic resonance ,2705 Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,adult congenital heart disease ,Medical imaging ,medicine ,Humans ,2741 Radiology, Nuclear Medicine and Imaging ,[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,Radiology, Nuclear Medicine and imaging ,Modalities ,Modality (human–computer interaction) ,computed tomography ,simple ,Atrial ,business.industry ,Heart Septal Defects ,Ventricular ,medicine.disease ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,10036 Medical Clinic ,Position paper ,business - Abstract
In 2018, the position paper ‘Imaging the adult with congenital heart disease: a multimodality imaging approach’ was published. The paper highlights, in the first part, the different imaging modalities applied in adult congenital heart disease patients. In the second part, these modalities are discussed more detailed for moderate to complex anatomical defects. Because of the length of the paper, simple lesions were not touched on. However, imaging modalities to use for simple shunt lesions are still poorly known. One is looking for structured recommendations on which they can rely when dealing with an (undiscovered) shunt lesion. This information is lacking for the initial diagnostic process, during repair and at follow-up. Therefore, this paper will focus on atrial septal defect, ventricular septal defect, and persistent arterial duct. Pre-, intra-, and post-procedural imaging techniques will be systematically discussed. This position paper will offer algorithms that might help at a glance. The document is prepared for general cardiologists, trainees, medical students, imagers/technicians to select the most appropriate imaging modality and to detect the requested information for each specific lesion. It might serve as reference to which researchers could refer when setting up a (imaging) study.
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- 2020
35. The Use of Fecal Calprotectin Testing in Paediatric Disorders: A Position Paper of the European Society for Paediatric Gastroenterology and Nutrition Gastroenterology Committee
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Paolo Lionetti, Ilse Broekaert, Carmen Ribes Koninckx, Alexandra Papadopoulou, Erasmo Miele, Nikhil Thapar, Frédéric Gottrand, Ester Donat, Rok Orel, Corina Pienar, Michela G. Schäppi, Michael Wilschanski, Kaija-Leena Kolho, Marc A. Benninga, Paediatric Gastroenterology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, Koninckx, Carmen Ribe, Donat, Ester, Benninga, Marc A, Broekaert, Ilse J, Gottrand, Frederic, Kolho, Kaija-Leena, Lionetti, Paolo, Miele, Erasmo, Orel, Rok, Papadopoulou, Alexandra, Pienar, Corina, Schäppi, Michela G, Wilschanski, Michael, Thapar, Nikhil, Children's Hospital, and HUS Children and Adolescents
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medicine.medical_specialty ,Constipation ,Gastrointestinal Diseases ,Inflammatory bowel disease ,Coeliac disease ,Infantile colic ,Helicobacter Infections ,Feces ,03 medical and health sciences ,0302 clinical medicine ,inflammatory bowel disease ,3123 Gynaecology and paediatrics ,030225 pediatrics ,Internal medicine ,Small intestinal bacterial overgrowth ,medicine ,Humans ,Child ,intestine ,ulcerative colitis ,Helicobacter pylori ,business.industry ,Infant, Newborn ,Gastroenterology ,Crohn disease ,medicine.disease ,Ulcerative colitis ,fecal calprotectin ,3. Good health ,inflammation ,3121 General medicine, internal medicine and other clinical medicine ,Pediatrics, Perinatology and Child Health ,Necrotizing enterocolitis ,030211 gastroenterology & hepatology ,Calprotectin ,medicine.symptom ,business ,Leukocyte L1 Antigen Complex ,position paper - Abstract
Objectives: The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. Methods: A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. Results: A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. Conclusions: Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schonlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.
- Published
- 2021
36. Recommendations for psoriatic arthritis management: A joint position paper of the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology
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Kai-Jieh Yeo, Tsen-Fang Tsai, Wen-Chan Tsai, Shang-Hung Lin, Woan-Ruoh Lee, Chih-Hung Lee, Yu-Huei Huang, Hsin-Hua Chen, Deng-Ho Yang, Chung-Tei Chou, Nan-Lin Wu, Chun-Hsiung Chen, Hsien-Tzung Liao, Jui-Cheng Tseng, Skin Immunology, Yi-Ju Chen, Rosaline Chung-Yee Hui, Hsien-Yi Chiu, Hung-An Chen, James Cheng-Chung Wei, Hwa Chang Liu, Ting-Shun Wang, Lin-Fen Hsieh, Po-Ju Lai, Tsu-Yi Hsieh, Ching-Chi Chi, Ying-Chou Chen, Ji-Chen Ho, and Chin-Hsiu Liu
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medicine.medical_specialty ,medicine.medical_treatment ,Taiwan ,Dactylitis ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Internal medicine ,Psoriasis ,Medicine ,lcsh:R5-920 ,Rehabilitation ,business.industry ,Incidence (epidemiology) ,Enthesitis ,General Medicine ,medicine.disease ,Rheumatology ,030220 oncology & carcinogenesis ,Immunology ,Position paper ,030211 gastroenterology & hepatology ,Rheumatologists ,medicine.symptom ,lcsh:Medicine (General) ,business ,Dermatologists - Abstract
In Taiwan, the incidence and prevalence of psoriatic arthritis (PsA) have risen significantly in recent years. Moreover, data from the Taiwan National Health Insurance Research Database (NHIRD) show that more than 85% of PsA patients are treated with just non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Taiwanese clinicians have also expressed concerns regarding uncertainties in the diagnosis of PsA and the delayed, interrupted, and/or tapered use of biologics, as well as differences in therapeutic preferences between and within dermatologists and rheumatologists. To address these issues, the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology jointly convened a committee of 28 clinicians from the fields of rheumatology, dermatology, orthopedics, and rehabilitation, to develop evidence-based consensus recommendations for the practical management of PsA in Taiwan. A total of six overarching principles and 13 recommendations were developed and approved, as well as a treatment algorithm with four separate tracks for axial PsA, peripheral PsA, enthesitis, and dactylitis. Psoriasis (PsO) management was not discussed here, as the Taiwanese Dermatological Association has recently published a comprehensive consensus statement on the management of PsO. Together, these recommendations provide an up-to-date, evidence-based framework for PsA care in Taiwan.
- Published
- 2021
37. Management of patients with chronic rhinosinusitis during the COVID‐19 pandemic—An EAACI position paper
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Jean Bousquet, Adam Chaker, Cezmi A. Akdis, Claus Bachert, Peter Valentin Tomazic, Marek Jutel, Sanna Toppila-Salmi, Valérie Hox, Wytske Fokkens, Carmen Rondon, Barbara Wollenberg, Banu Bozkurt, Jan Hagemann, Aspasia Karavelia, U Förster-Ruhrmann, Ralph Mösges, Cemal Cingi, Tilman Huppertz, Philippe Gevaert, Ioana Agache, Sven Becker, Ludger Klimek, HUS Inflammation Center, Department of Dermatology, Allergology and Venereology, University of Helsinki, and Helsinki University Hospital Area
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0301 basic medicine ,medicine.medical_specialty ,education ,Immunology ,MEDLINE ,Cochrane Library ,03 medical and health sciences ,Nasal Polyps ,0302 clinical medicine ,Adrenal Cortex Hormones ,Pandemic ,medicine ,Humans ,Immunology and Allergy ,biologics ,Nasal polyps ,Sinusitis ,Risk factor ,Intensive care medicine ,Rhinitis ,Biological Products ,SARS-CoV-2 ,business.industry ,chronic rhinosinusitis ,Standard treatment ,COVID-19 ,CRSwNP ,medicine.disease ,Dupilumab ,Asthma ,3. Good health ,030104 developmental biology ,030228 respiratory system ,3121 General medicine, internal medicine and other clinical medicine ,Chronic Disease ,Position paper ,business - Abstract
BackgroundChronic rhinosinusitis is regarded as a chronic airway disease. According to WHO recommendations, it may be a risk factor for COVID-19 patients. In most CRSwNP cases, the inflammatory changes affecting the nasal and paranasal mucous membranes are type-2 (T2) inflammation endotypes. MethodsThe current knowledge on COVID-19 and on treatment options for CRS was analyzed by a literature search in Medline, Pubmed, international guidelines, the Cochrane Library and the Internet. ResultsBased on international literature, on current recommendations by WHO and other international organizations as well as on previous experience, a panel of experts from EAACI and ARIA provided recommendations for the treatment of CRS during the COVID-19 pandemic. ConclusionIntranasal corticosteroids remain the standard treatment for CRS in patients with SARS-CoV-2 infection. Surgical treatments should be reduced to a minimum and surgery preserved for patients with local complications and for those with no other treatment options. Systemic corticosteroids should be avoided. Treatment with biologics can be continued with careful monitoring in noninfected patients and should be temporarily interrupted during the course of the COVID-19 infection.
- Published
- 2021
38. 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
39. Role of Dietary Factors, Food Habits, and Lifestyle in Childhood Obesity Development: A Position Paper From the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition
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Konstantinos Gerasimidis, Alexandre Lapillonne, Nicholas D. Embleton, Sissel J. Moltu, Barbara A. E. de Koning, Magnus Domellöf, Flavia Indrio, Elvira Verduci, Jutta Köglmeier, Jiri Bronsky, Lorenzo Norsa, and Pediatrics
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Pediatric Obesity ,MEDLINE ,Cochrane Library ,Childhood obesity ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,030225 pediatrics ,Environmental health ,Humans ,Medicine ,Child ,Life Style ,Snacking ,business.industry ,digestive, oral, and skin physiology ,Gastroenterology ,Feeding Behavior ,medicine.disease ,Obesity ,Diet ,Systematic review ,Pediatrics, Perinatology and Child Health ,Position paper ,Female ,030211 gastroenterology & hepatology ,Observational study ,business - Abstract
Childhood obesity has high societal and economic impact but current treatment approaches are sub-optimal. In the last decade, important studies have been conducted aiming to identify strategies to prevent obesity during critical periods of life. Updated recommendations for childhood obesity prevention are needed. We present data from systematic reviews and meta- analysis, randomised controlled trials (RCTs) and large observational studies, published from 2011 onwards that consider the possible role of the following factors in obesity development: breast-feeding; macronutrient composition and method of complementary feeding; parenting style; dietary patterns; sugar-sweetened beverage consumption; eating behaviour (eg, skipping breakfast, family dinners. etc); meal frequency and composition (fast foods, snacking), portion size; dietary modulators of gut microbiota (including pre-, pro-, and synbiotics); physical activity and sedentary behaviour. We used the Medline database and the Cochrane Library to search for relevant publications. Important research gaps were also identified. This position paper provides recommendations on dietary factors, food habits, and lifestyle to prevent childhood obesity development, based on the available literature and expert opinion. Clinical research and high-quality trials are urgently needed to resolve numerous areas of uncertainty.
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- 2021
40. Position papers and people with intellectual disabilities
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Adam Johnson and Kathy Boxall
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Position statement ,030506 rehabilitation ,business.industry ,05 social sciences ,Rehabilitation ,Public relations ,medicine.disease ,Life stage ,03 medical and health sciences ,Developmental Neuroscience ,Neurology ,Community living ,Intellectual disability ,medicine ,Position paper ,Position (finance) ,0501 psychology and cognitive sciences ,Neurology (clinical) ,Sociology ,0305 other medical science ,business ,050104 developmental & child psychology ,Service development - Abstract
This article discusses a scoping review of position papers aimed at enhancing the quality of life of people with intellectual disabilities. It describes the approach taken to conducting the scoping...
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- 2021
41. Biologicals in atopic disease in pregnancy: An EAACI position paper
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Adam Chaker, Zsolt Szépfalusi, Juan José Yepes-Nuñez, Onur Boyman, A. Vultaggio, Alexia Chatzipetrou, Oscar Palomares, Cezmi A. Akdis, Marek Jutel, Eva Untersmayr, Andrea Matucci, Mohammad Alsalamah, Alanna Marson, Sevim Bavbek, Paula Kauppi, Birgit Pfaller, Barbara Rogala, Antonios G.A. Kolios, Sarah Bendien, Susan Chan, Ioana Agache, Thomas Eiwegger, Carmen Li, Apostolos Bossios, George Du Toit, HUS Inflammation Center, Department of Dermatology, Allergology and Venereology, Helsinki University Hospital Area, University of Helsinki, University of Zurich, and Eiwegger, Thomas
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0301 basic medicine ,Allergy ,Omalizumab ,GUIDELINES ,Inflammatory bowel disease ,Biological Factors ,0302 clinical medicine ,10183 Swiss Institute of Allergy and Asthma Research ,Multicenter Studies as Topic ,Immunology and Allergy ,atopic dermatitis ,10177 Dermatology Clinic ,Atopic dermatitis ,CROHNS-DISEASE ,3. Good health ,biologicals ,2723 Immunology and Allergy ,Female ,Rituximab ,pregnancy ,medicine.drug ,medicine.medical_specialty ,1ST TRIMESTER ,Immunology ,610 Medicine & health ,OMALIZUMAB USE ,Dermatitis, Atopic ,03 medical and health sciences ,MANAGEMENT ,medicine ,Humans ,RITUXIMAB ,REGULATORY T-CELLS ,Intensive care medicine ,Asthma ,Biological Products ,2403 Immunology ,Pregnancy ,business.industry ,Infant, Newborn ,asthma ,medicine.disease ,body regions ,030104 developmental biology ,030228 respiratory system ,3121 General medicine, internal medicine and other clinical medicine ,10033 Clinic for Immunology ,MODIFYING ANTIRHEUMATIC DRUGS ,Position paper ,business ,INFLAMMATORY-BOWEL-DISEASE - Abstract
Biologicals have transformed the management of severe disease phenotypes in asthma, atopic dermatitis, and chronic spontaneous urticaria. As a result, the number of approved biologicals for the treatment of atopic diseases is continuously increasing. Although atopic diseases are among the most common diseases in the reproductive age, investigations, and information on half-life, pharmacokinetics defining the neonatal Fc receptors (FcRn) and most important safety of biologicals in pregnancy are lacking. Given the complex sequence of immunological events that regulate conception, fetal development, and the intrauterine and postnatal maturation of the immune system, this information is of utmost importance. We conducted a systematic review on biologicals in pregnancy for indications of atopic diseases. Evidence in this field is scare and mainly reserved to reports on the usage of omalizumab. This lack of evidence demands the establishment of a multidisciplinary approach for the management of pregnant women who receive biologicals and multicenter registries for long-term follow-up, drug trial designs suitable for women in the reproductive age, and better experimental models that represent the human situation. Due to the very long half-life of biologicals, pre-conception counseling, and health care provider education is crucial to offer the best care for mother and fetus. This position paper integrates available data on safety of biologicals during pregnancy in atopic diseases via a systematic review with a detailed review on immunological considerations how inhibition of different pathways may impact pregnancy.
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- 2021
42. ESUR/ESUI position paper: developing artificial intelligence for precision diagnosis of prostate cancer using magnetic resonance imaging
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Jochen Walz, Jonathan Richenberg, Tobias Penzkofer, Baris Turkbey, Jelle O. Barentsz, Anwar R. Padhani, Geert Villeirs, Vibeke Løgager, Masoom A. Haider, Valeria Panebianco, Olivier Rouvière, Georg Salomon, Ivo G. Schoots, Henkjan J. Huisman, and Radiology & Nuclear Medicine
- Subjects
Image-Guided Biopsy ,Male ,Artificial intelligence ,COMPUTER-AIDED DETECTION ,PREDICTION ,Disease ,artificial intelligence ,deep learning ,image-guided biopsy ,multiparametric magnetic resonance imaging ,prostate cancer ,Image-guided biopsy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Multiparametric magnetic resonance imaging ,Medicine and Health Sciences ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neuroradiology ,PI-RADS ,medicine.diagnostic_test ,business.industry ,Prostatic Neoplasms ,Interventional radiology ,Urogenital ,Deep learning ,General Medicine ,PERFORMANCE ,medicine.disease ,Magnetic Resonance Imaging ,Workflow ,Software deployment ,030220 oncology & carcinogenesis ,Urological cancers Radboud Institute for Health Sciences [Radboudumc 15] ,BIOPSY ,Position paper ,business ,600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit ,MRI - Abstract
Abstract Artificial intelligence developments are essential to the successful deployment of community-wide, MRI-driven prostate cancer diagnosis. AI systems should ensure that the main benefits of biopsy avoidance are delivered while maintaining consistent high specificities, at a range of disease prevalences. Since all current artificial intelligence / computer-aided detection systems for prostate cancer detection are experimental, multiple developmental efforts are still needed to bring the vision to fruition. Initial work needs to focus on developing systems as diagnostic supporting aids so their results can be integrated into the radiologists’ workflow including gland and target outlining tasks for fusion biopsies. Developing AI systems as clinical decision-making tools will require greater efforts. The latter encompass larger multicentric, multivendor datasets where the different needs of patients stratified by diagnostic settings, disease prevalence, patient preference, and clinical setting are considered. AI-based, robust, standard operating procedures will increase the confidence of patients and payers, thus enabling the wider adoption of the MRI-directed approach for prostate cancer diagnosis. Key Points • AI systems need to ensure that the benefits of biopsy avoidance are delivered with consistent high specificities, at a range of disease prevalence. • Initial work has focused on developing systems as diagnostic supporting aids for outlining tasks, so they can be integrated into the radiologists’ workflow to support MRI-directed biopsies. • Decision support tools require a larger body of work including multicentric, multivendor studies where the clinical needs, disease prevalence, patient preferences, and clinical setting are additionally defined.
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- 2021
43. 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.
- Published
- 2021
44. 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.
- Published
- 2022
45. PCR performance for the diagnosis of cutaneous leishmaniasis caused by Leishmania viannia complex using biopsy samples, compared with exudate samples from skin lesions on filter paper
- Author
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Max Carlos Ramírez-Soto, Mercedes Maritza Quispe-Flórez, Yahanda Gisela Apaza-Castillo, Rosa Luz Pacheco-Venero, and Elsa Gladys Aguilar-Ancori
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Exudate ,Pathology ,medicine.medical_specialty ,diagnosis ,Biopsy ,030231 tropical medicine ,Leishmaniasis, Cutaneous ,Diagnostic concordance ,Polymerase Chain Reaction ,Sensitivity and Specificity ,cutaneous leishmaniasis ,03 medical and health sciences ,0302 clinical medicine ,Leishmania viannia ,Cutaneous leishmaniasis ,Peru ,Skin Ulcer ,medicine ,Humans ,filter paper ,030212 general & internal medicine ,skin biopsy ,Skin ,Leishmania ,medicine.diagnostic_test ,Filter paper ,business.industry ,Public Health, Environmental and Occupational Health ,Exudates and Transudates ,General Medicine ,DNA, Protozoan ,medicine.disease ,Infectious Diseases ,Skin biopsy ,Parasitology ,medicine.symptom ,business ,Skin lesion ,purl.org/pe-repo/ocde/ford#3.03.06 [https] - Abstract
Background Cutaneous leishmaniasis (CL) is generally diagnosed by molecular methods, including PCR, using biopsy samples, skin scrapings and clinical exudates. In this study, we assessed the PCR performance for diagnosis of CL using skin of biopsy samples vs PCR of skin lesion exudate samples on filter paper and compared the diagnostic concordance of PCR using both sampling methods. Methods We assessed the PCR performance using 80 skin biopsy samples and 80 filter paper samples containing exudates from skin lesions obtained from 74 patients with clinical suspicion of CL in Cusco, Peru. Results : PCR using skin biopsy samples had superior diagnostic accuracy compared with filter paper PCR (62.5% [50/80] vs 38.7% [31/80], respectively; p˂0.005) and the diagnostic concordance between both sampling methods was ‘moderate’ (kappa coefficient=0.50, 95% CI 0.98 to 1.0). Conclusions PCR using biopsy samples remains the standard for diagnosis of CL.
- Published
- 2020
46. Unusual pneumoconiosis in two patients with heavy print toner, and paper dust exposure
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Henry D. Tazelaar, Adela Vrbenska, Kristopher W. Cummings, and Mrinal Sarwate
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medicine.medical_specialty ,Lung ,pneumoconiosis ,desquamative interstitial pneumonia ,business.industry ,Pneumoconiosis ,Public Health, Environmental and Occupational Health ,Case Report ,Desquamative interstitial pneumonia ,medicine.disease ,Asymptomatic ,Dermatology ,Lymphoid hyperplasia ,respiratory tract diseases ,paper dust ,medicine.anatomical_structure ,paper toner ,Lung disease ,Medicine ,giant cell interstitial pneumonia ,medicine.symptom ,business ,Photocopier toner ,Paper dust - Abstract
Workers in a print shop are exposed to photocopier toner dust and paper dust over a prolonged period of time. However, there are only rare case reports of toner and paper dust induced lung damage in humans. We reviewed our consultation files for a period of 30 years from 1987 to 2018 to look for cases with a diagnosis of giant cell interstitial pneumonia (GIP), printer toner exposure and paper dust exposure resulting in lung disease. There were two cases which met our inclusion criteria. Slides, clinical histories and imaging were reviewed. Both the patients had worked in print shops, and had no history of exposure to hard metals. Patient 1 presented with shortness of breath and cough over several months, while patient 2 was asymptomatic at presentation. Both the patients underwent surgical lung biopsies. Histopathologic examination from both the cases showed a spectrum of pathology, including features of GIP, desquamative interstitial pneumonia, chronic bronchiolitis with lymphoid hyperplasia, and particulate matter consistent with toner. Energy dispersive spectroscopy was performed on one case, and it revealed no cobalt or tungsten particles. The unusual combination of findings is very suggestive that toner particles with or without paper dust exposure were responsible for the pathologic changes in the lungs of these patients. This possibility should be explored further with additional patients who work in print shops where they are exposed to paper dust and paper toner and have signs or symptoms of diffuse lung disease.
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- 2020
47. Measuring physical activity with activity monitors in patients with heart failure: from literature to practice. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology
- Author
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Anna Wozniak, Ewa Piotrowicz, Andrew J.S. Coats, Ekaterini Lambrinou, Tiny Jaarsma, Barnabas Gellen, Leonie Klompstra, Martha Kyriakou, Maria Simonenko, Maurizio Volterrani, Massimo F Piepoli, Alain Cohen-Solal, Justien Cornelis, Klaus K. Witte, Emeline M. Van Craenenbroeck, David Niederseer, Francesco Orso, Elena Marques-Sule, Linköping University (LIU), Cyprus University of Technology, Limassol General Hospital, Nicosia General Hospital, Piacenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS San Raffaele Pisana), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Antwerp (UA), Belgian Health Care Knowledge Centre (KCE), Polyclinique de Poitiers - ELSAN (2PE), Universitat de València (UV), Universität Zürich [Zürich] = University of Zurich (UZH), University hospital of Zurich [Zurich], Azienda Ospedaliero-Universitaria Careggi [Firenze] (AOUC), National Institute of Cardiology [Warsaw, Poland] (NIC), Antwerp University Hospital [Edegem] (UZA), Ministry of Health of the Russian Federation (MHRF), University of Leeds, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust [Doncaster, UK] (DBTH), IRCCS Ospedale San Raffaele [Milan, Italy], University Medical Center [Utrecht], leboeuf, Christophe, University of Zurich, and Klompstra, Leonie
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medicine.medical_specialty ,Cardiology ,Physical activity ,610 Medicine & health ,Heart failure ,Fitness Trackers ,030204 cardiovascular system & hematology ,Medical and Health Sciences ,2705 Cardiology and Cardiovascular Medicine ,Exercise Capacity ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,medicine ,Humans ,Cardiac and Cardiovascular Systems ,In patient ,Exercise physiology ,Association (psychology) ,Set (psychology) ,Exercise ,Monitoring, Physiologic ,Heart Failure ,Kardiologi ,business.industry ,Activity monitor ,Motion sensor ,Accelerometer ,medicine.disease ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,10209 Clinic for Cardiology ,Position paper ,Position Paper ,Human medicine ,Clinical Medicine ,Cardiology and Cardiovascular Medicine ,Raw data ,business - Abstract
The aims of this paper were to provide an overview of available activity monitors used in research in patients with heart failure and to identify the key criteria in the selection of the most appropriate activity monitor for collecting, reporting, and analysing physical activity in heart failure research. This study was conducted in three parts. First, the literature was systematically reviewed to identify physical activity concepts and activity monitors used in heart failure research. Second, an additional scoping literature search for validation of these activity monitors was conducted. Third, the most appropriate criteria in the selection of activity monitors were identified. Nine activity monitors were evaluated in terms of size, weight, placement, costs, data storage, water resistance, outcomes and validation, and cut-off points for physical activity intensity levels were discussed. The choice of a monitor should depend on the research aims, study population and design regarding physical activity. If the aim is to motivate patients to be active or set goals, a less rigorously tested tool can be considered. On the other hand, if the aim is to measure physical activity and its changes over time or following treatment adjustment, it is important to choose a valid activity monitor with a storage and battery longevity of at least one week. The device should provide raw data and valid cut-off points should be chosen for analysing physical activity intensity levels. Other considerations in choosing an activity monitor should include data storage location and ownership and the upfront costs of the device. Funding Agencies|European Society of Cardiology Funding Source: Medline
- Published
- 2020
48. Long‐term follow‐up with filter paper samples in patients with propionic acidemia
- Author
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Begoña Merinero, Celia Pérez-Cerdá, Pedro Ruiz-Sala, Francisco Arrieta, Mercedes Martínez-Pardo, Sinziana Stanescu, Amaya Belanger-Quintana, and Borja M. Fernandez-Felix
- Subjects
Research Report ,follow‐up ,propionic acidemia ,medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Urinary system ,Metabolic acidosis ,Hyperammonemia ,Research Reports ,Urine ,medicine.disease ,Biochemistry, Genetics and Molecular Biology (miscellaneous) ,Gastroenterology ,Dried blood spot ,Internal medicine ,Metabolic control analysis ,Internal Medicine ,medicine ,Propionic acidemia ,business ,Prospective cohort study ,filter paper samples - Abstract
Background Propionic acidemia (PA) is an inherited disorder caused by deficiency of propionyl CoA carboxylase. Most patients with this disorder are diagnosed during the neonatal period because of severe metabolic acidosis and hyperammonemia. Patients are required to undergo blood and urine analysis at least 3 to 4 times per year, depending on age and metabolic control. Methods We designed a prospective study in which we investigated the results from blood and urinary samples collected monthly in filter paper from 10 PA patients followed in a single metabolic reference center from January 2015 to September 2017. The aim of this study was to evaluate the usefulness of filter paper samples in the follow‐up of the PA patients. Results During the follow‐up period, 163 dried blood spot (DBS) and 119 urine dried spot samples were analyzed and compared with 160 plasma and 103 liquid urine specimens; 64 specimens of plasma were analyzed for odd‐numbered long‐chain fatty acids (OLCFAs). A total of 40 metabolic crises, 18 of them with hyperammonemia were documented. We observed a strong correlation between the filter paper and the urine/plasma samples for the main PA parameters both in stable metabolic conditions as well as in acute decompensations. Also, there was a strong correlation between OLCFAs measured in plasma and quantification of odd number acylcarnitines in DBS. Conclusions We conclude that filter paper blood and urinary samples can be used for the follow‐up of the patients with PA, correctly reflecting their metabolic situation.
- Published
- 2020
49. 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
- Author
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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
- Subjects
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.
- Published
- 2021
50. Austere Resuscitative and Surgical Care in Support of Forward Military Operations—Joint Trauma System Position Paper
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Lance Stephens, Colin Frament, Stacy Shackelford, Maj D Marc Northern, Kyle N. Remick, Jay B Baker, D Aaron Baker, Jennifer M. Gurney, and Jason M Seery
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Military personnel ,Resuscitation ,business.industry ,Surgical care ,Public Health, Environmental and Occupational Health ,MEDLINE ,Position paper ,Medicine ,Joint trauma ,General Medicine ,Medical emergency ,business ,medicine.disease - Published
- 2021
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