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Lopez-Rippe J, Schwartz ES, Davis JC, Dennis RA, Francavilla ML, Jalloul M, Kaplan SL. Imaging Stewardship: Triage for Neuroradiology MR During Limited-Resource Hours. J Am Coll Radiol 2024; 21:70-80. [PMID: 37863151 DOI: 10.1016/j.jacr.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES To decrease call burden on pediatric neuroradiologists, we developed guidelines for appropriate use of MR overnight. These guidelines were implemented using triage by in-house generalist pediatric radiologists. Process measures and balancing measures were assessed during implementation. METHODS For this improvement project, interdepartmental consensus guidelines were developed using exploratory mixed-methods design. Implementation of triage used plan-do-study-act cycles. Process measures included reduction in the number of telephone calls, frequency of calls, triage decisions, and number and type of examinations ordered. Balancing measures included burden of time and effort to the generalist radiologists. Differences in examination orders between implementation intervals was assessed using Kruskal-Wallis, with significance at P < .05. RESULTS Consensus defined MR requests as "do," "defer," or "divert" (to CT). Guidelines decreased neuroradiologist calls 74% while adding minimal burden to the generalist radiologists. Most nights had zero or one triage request and the most common triage decision was "do," and the most common examination was routine brain MR. Number of MR ordered and completed overnight did not significantly change with triage. DISCUSSION Multidisciplinary consensus for use of pediatric neurological MR during limited resource hours overnight is an example of imaging stewardship that decreased the burden of calls and burnout for neuroradiologists while maintaining a comparable level of service to the ordering clinicians.
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Affiliation(s)
- Julian Lopez-Rippe
- Research Scholar, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Erin S Schwartz
- Division Chief Neuroradiology and Associate Chair for Diversity, Equity, and Inclusion, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Christopher Davis
- Section Director for Emergency Radiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Assistant Professor of Clinical Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca A Dennis
- Director of Fellowship, Residency and Observership Program, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Assistant Professor of Clinical Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael L Francavilla
- Associate Professor and Chief Medical Information Officer for Radiology, Department of Radiology, University of South Alabama, Mobile, Alabama
| | - Mohammad Jalloul
- Research Scholar, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Summer L Kaplan
- Associate Chair for Quality and Medical Director of Point-of-Care Ultrasound, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Assistant Professor of Clinical Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Grover S, Lichter KE, Likhacheva A, Jang JW, Ning MS, Robin TP, Small W, Kudchadker RJ, Swamidas J, Chopra S, Rai B, Sharma SD, Sharma DN, Kuppusamy T, Yang R, Berger D, Mendez LC, Glaser S, Erickson DL, Chino J, Mourtada F, Abdel-Wahab M, Jhingran A, Simonds H, Mahantshetty U. The American Brachytherapy Society and Indian Brachytherapy Society consensus statement for the establishment of high-dose-rate brachytherapy programs for gynecological malignancies in low- and middle-income countries. Brachytherapy 2023; 22:716-727. [PMID: 37704540 DOI: 10.1016/j.brachy.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/17/2023] [Accepted: 07/03/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE The global cervical cancer burden is disproportionately high in low- and middle-income countries (LMICs), and outcomes can be governed by the accessibility of appropriate screening and treatment. High-dose-rate (HDR) brachytherapy plays a central role in cervical cancer treatment, improving local control and overall survival. The American Brachytherapy Society (ABS) and Indian Brachytherapy Society (IBS) collaborated to provide this succinct consensus statement guiding the establishment of brachytherapy programs for gynecological malignancies in resource-limited settings. METHODS AND MATERIALS ABS and IBS members with expertise in brachytherapy formulated this consensus statement based on their collective clinical experience in LMICs with varying levels of resources. RESULTS The ABS and IBS strongly encourage the establishment of HDR brachytherapy programs for the treatment of gynecological malignancies. With the consideration of resource variability in LMICs, we present 15 minimum component requirements for the establishment of such programs. Guidance on these components, including discussion of what is considered to be essential and what is considered to be optimal, is provided. CONCLUSIONS This ABS/IBS consensus statement can guide the successful and safe establishment of HDR brachytherapy programs for gynecological malignancies in LMICs with varying levels of resources.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.
| | - Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Anna Likhacheva
- Department of Radiation Oncology, Sutter Health Sacramento, Sacramento, CA
| | - Joanne W Jang
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Matthew S Ning
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tyler P Robin
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Rajat J Kudchadker
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jamema Swamidas
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bhavana Rai
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dutt Sharma
- Department of Radiation Oncology, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Daya N Sharma
- Department of Radiation Oncology, Department of Radiation Oncology, National Cancer Institute, AIIMS, New Delhi, India
| | - Thayalan Kuppusamy
- Department of Radiation Oncology, Dr Kamakshi Memorial Hospital, Chennai, Tamil Nadu, India
| | - Ruijie Yang
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, China
| | - Daniel Berger
- Department of Nuclear Sciences and Division of Human Health, Section of Dosimetry and Medical Radiation Physics, International Atomic Energy Agency, Vienna, Austria
| | - Lisbeth Cordero Mendez
- Division of Human Health, Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Delnora L Erickson
- Department of Radiation Oncology, Walter Reed National Military Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Junzo Chino
- Deptartment of Radiation Oncology, Duke Cancer Center, Durham, NC
| | - Firas Mourtada
- Department of Radiation Oncology, Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Sidney Kimmel Cancer Center, Newark, DE
| | - May Abdel-Wahab
- Department of Nuclear Sciences and Division of Human Health, Section of Applied Radiation Biology and Radiotherapy, International Atomic Energy Agency, Vienna, Austria
| | - Anuja Jhingran
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hannah Simonds
- Department of Radiation Oncology, Stellenbosch University, Stellenbosch, South Africa
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Popenhagen MP, Genovese P, Blishen M, Rajapakse D, Diem A, King A, Chan J, Pellicer Arasa E, Baird S, Ferreira da Rocha AC, Stitt G, Badger K, Zmazek V, Ambreen F, Mackenzie C, Price H, Roberts T, Moore Z, Patton D, Murphy P, Mayre-Chilton K. Consensus-based guidelines for the provision of palliative and end-of-life care for people living with epidermolysis bullosa. Orphanet J Rare Dis 2023; 18:268. [PMID: 37667330 PMCID: PMC10476410 DOI: 10.1186/s13023-023-02870-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) is a cluster of rare, genetic skin and mucosal fragility disorders with multi-system and secondary effects, in which blistering and erosions occur in response to friction/mechanical trauma. Considering the incurable and potentially life-limiting nature of the condition and the challenges posed by its symptoms, a palliative approach to EB-related care is necessary. However, knowledge and experience related to the provision of EB palliative care is minimal. Evidence-based, best care guidelines are needed to establish a base of knowledge for practitioners to prevent or ease suffering while improving comfort at all stages of the illness, not just the end of life. METHODS This consensus guideline (CG) was begun at the request of DEBRA International, an international organization dedicated to improvement of care, research, and dissemination of knowledge for EB patients, and represents the work of an international panel of medical experts in palliative care and EB, people living with EB, and people who provide care for individuals living with EB. Following a rigorous, evidence-based guideline development process, the author panel identified six clinical outcomes based on the results of a survey of people living with EB, carers, and medical experts in the field, as well as an exhaustive and systematic evaluation of literature. Recommendations for the best clinical provision of palliative care for people living with EB for each of the outcomes were reached through panel consensus of the available literature. RESULTS This article presents evidence-based recommendations for the provision of palliative healthcare services that establishes a base of knowledge and practice for an interdisciplinary team approach to ease suffering and improve the quality of life for all people living with EB. Any specific differences in the provision of care between EB subtypes are noted. CONCLUSIONS Because there is yet no cure for EB, this evidence-based CG is a means of optimizing and standardizing the IDT care needed to reduce suffering while improving comfort and overall quality of life for people living with this rare and often devastating condition.
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Affiliation(s)
- Mark P Popenhagen
- Department of Anesthesiology B090, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, 13123 E 16Th Ave, Aurora, CO, 80045, USA.
- Section of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, CO, USA.
| | | | - Mo Blishen
- DEBRA New Zealand, Newtown, Wellington, New Zealand
| | | | - Anja Diem
- EB House Austria, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | | | - Jennifer Chan
- Lucile Packard Children's Hospital, Stanford, Menlo Park, CA, USA
| | | | - Simone Baird
- DEBRA Australia, Pittsworth, QLD, Australia
- , Melbourne, Australia
| | | | - Gideon Stitt
- Division of Clinical Pharmacology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Faiza Ambreen
- DEBRA Pakistan, Lahore, Punjab, Pakistan
- , London, UK
| | - Caroline Mackenzie
- Guys and St Thomas' Foundation NHS Foundation Trust, EB Adult Service, East Hampshire, England, UK
| | | | - Toni Roberts
- DEBRA South Africa, Western Cape, Cape Town, South Africa
- , Cape Town, South Africa
| | - Zena Moore
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Murphy
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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Martz N, Salleron J, Dhermain F, Vogin G, Daisne JF, Mouttet-Audouard R, Tanguy R, Noel G, Peyre M, Lecouillard I, Jacob J, Attal J, Charissoux M, Veresezan O, Hanzen C, Huchet A, Latorzeff I, Coutte A, Doyen J, Stefan D, Feuvret L, Garcia GCTE, Royer P. Target volume delineation for radiotherapy of meningiomas: an ANOCEF consensus guideline. Radiat Oncol 2023; 18:113. [PMID: 37408055 DOI: 10.1186/s13014-023-02300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE Radiotherapy is, with surgery, one of the main therapeutic treatment strategies for meningiomas. No prospective study has defined a consensus for the delineation of target volumes for meningioma radiotherapy. Therefore, target volume definition is mainly based on information from retrospective studies that include heterogeneous patient populations. The aim is to describe delineation guidelines for meningioma radiotherapy as an adjuvant or definitive treatment with intensity-modulated radiation therapy and stereotactic radiation therapy techniques. This guideline is based on a consensus endorsed by a multidisciplinary group of brain tumor experts, members of the Association of French-speaking Neuro-oncologists (ANOCEF). MATERIALS AND METHODS A 3-step procedure was used. First, the steering group carried out a comprehensive review to identify divergent issues on meningiomas target volume delineation. Second, an 84-item web-questionnaire has been developed to precisely define meningioma target volume delineation in the most common clinical situations. Third, experts members of the ANOCEF were requested to answer. The first two rounds were completed online. A third round was carried out by videoconference to allow experts to debate and discuss the remaining uncertain questions. All questions remained in a consensus. RESULTS Limits of the target volume were defined using visible landmarks on computed tomography and magnetic resonance imaging, considering the pathways of tumor extension. The purpose was to develop clear and precise recommendations on meningiomas target volumes. CONCLUSION New recommendations for meningiomas delineation based on simple anatomic boundaries are proposed by the ANOCEF. Improvement in uniformity in target volume definition is expected.
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Affiliation(s)
- Nicolas Martz
- Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine - Alexis-Vautrin Cancer Center, 6 avenue de Bourgogne - CS 30 519, Vandoeuvre Les Nancy, France.
| | - Julia Salleron
- Cellule Data-biostatistiques, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-lés-Nancy, France
| | - Frédéric Dhermain
- Department of Radiation Oncology, Gustave Roussy University Hospital, Villejuif, France
| | - Guillaume Vogin
- Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine - Alexis-Vautrin Cancer Center, 6 avenue de Bourgogne - CS 30 519, Vandoeuvre Les Nancy, France
- Department of Radiation Therapy, Baclesse Radiation Therapy Centre, Esch/Alzette, Luxembourg
| | - Jean-François Daisne
- Department of Radiation Oncology, University Hospitals Leuven, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | | | - Ronan Tanguy
- Department of Radiotherapy, Léon Bérard Cancer Centre, Lyon, France
| | - Georges Noel
- Radiation Oncology Department, Paul Strauss Cancer Centre, Strasbourg, France
| | - Matthieu Peyre
- Department of Neurosurgery, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Julian Jacob
- Department of Radiation Oncology, Hôpital Pitié-Salpêtrière Charles Foix, APHP, Paris, France
| | - Justine Attal
- Radiotherapy Department, Institut Claudius Regaud, Toulouse University Institute for Cancer (IUCT-Oncopole), Toulouse, France
| | - Marie Charissoux
- Radiation Oncology Department, Centre Val d'Aurelle, Montpellier, France
| | - Ovidiu Veresezan
- Department of Radiation Oncology, Cancer Centre Henri Becquerel, Rouen, France
| | - Chantal Hanzen
- Department of Radiation Oncology, Centre Hospitalier et Universitaire, Bordeaux, France
| | - Aymeri Huchet
- Department of Radiation Oncology, Centre Hospitalier et Universitaire, Bordeaux, France
| | - Igor Latorzeff
- Department of Radiotherapy, Groupe ONCORAD Garonne and Clinique Pasteur, Toulouse, France
| | | | - Jérôme Doyen
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Nice- Sophia, Nice, France
| | - Dinu Stefan
- Department of Radiation Oncology, François Baclesse Cancer Centre, Caen, France
| | - Loic Feuvret
- Department of Radiation Oncology, Hôpital Pitié-Salpêtrière Charles Foix, APHP, Paris, France
| | | | - Philippe Royer
- Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine - Alexis-Vautrin Cancer Center, 6 avenue de Bourgogne - CS 30 519, Vandoeuvre Les Nancy, France
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Chu CY, Lee CH, Lee HE, Cho YT, Hsu CK, Chan TC, Hsieh SC, Wei KC. Taiwanese dermatological association (TDA) consensus for the management of pemphigus. J Formos Med Assoc 2023; 122:540-548. [PMID: 36564301 DOI: 10.1016/j.jfma.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/14/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Pemphigus is an uncommon but life-threatening autoimmune blistering disease characterized by the presence of antibodies against desmogleins. Without effective treatment, pemphigus can result in significant morbidity and mortality. Existing consensus statements on pemphigus management from international medical groups provide varying guidelines, especially on treatment. Thus, on January 4, 2020, a panel of seven dermatology experts from the Taiwanese Dermatological Association (TDA) and one rheumatology expert convened to develop a consensus for the management of pemphigus. These experts with extensive experience in pemphigus management were recommended by their respective teaching hospitals and primary care clinics in Taiwan and by the TDA. The meeting reviewed the available consensus statements from international dermatology groups, including the European Dermatology Forum (EDF), the European Academy of Dermatology and Venereology (EADV), and the International Bullous Diseases Consensus Group. Using these guidelines as a basis for discussion and consensus formulation, these experts formulated their consensus statement that provides practical, concise but comprehensive recommendations as to the diagnosis, treatment, and monitoring of pemphigus patients in Taiwan. This consensus serves as a clinical reference for physicians for the management of pemphigus in Taiwan or wherever it may be applicable.
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Affiliation(s)
- Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hua-En Lee
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei Branch, Taiwan
| | | | - Chao-Kai Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tom C Chan
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Song-Chou Hsieh
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Froom P, Shimoni Z, Dusseldorp N, Benbassat J. Asymptomatic Microscopic Hematuria in Inpatient Nonsurgical Adults. Am J Clin Pathol 2023; 159:221-224. [PMID: 36694371 DOI: 10.1093/ajcp/aqac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/16/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study sought to determine the proportion of nonsurgical inpatients with asymptomatic microscopic hematuria (AMH) who qualified for urologic investigation according to consensus guidelines. METHODS The study population included all patients acutely admitted to the internal medicine departments of Israeli regional hospitals between 2014 and 2017. RESULTS Of 29,086 consecutive admissions, 10,116 (34.8%) underwent dipstick urinalysis and 8,389 (28.8%) underwent reflex microscopic urinalysis. After the exclusion of patients with a urethral catheter or a positive urine culture, 2,206 had 3 or more RBCs per high-power field, and as many as 2,052 (7.1% of the entire cohort and 24.4% of all patients undergoing microscopic urinalysis) met the criteria for a urologic workup. CONCLUSIONS We conclude that according to the consensus guidelines, an unreasonably high proportion of hospitalized nonsurgical patients would be referred for a urologic workup of uncertain clinical utility because of an incidental AMH finding.
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Affiliation(s)
- Paul Froom
- Clinical Utility Department, Laniado Hospital, Netanya, Israel.,School of Public Health, University of Tel Aviv, Tel Aviv, Israel
| | - Zvi Shimoni
- Office of the Chief Medical Officer, Laniado Hospital, Netanya, Israel
| | - Nathan Dusseldorp
- Office of the Chief Information Officer, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Jochanan Benbassat
- Department of Medicine (retired), Hadassah University Hospital, Jerusalem, Israel
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Al Qassimi N, Kozak I, Al Karam M, Neri P, Aduriz-Lorenzo PM, Attawan A, Awadalla M, El Khashab A, Abdul-Nabi M, Safar A, Al Shamsi H, Rao P, Rao M, Farid A, Gurbaxani A. Management of Diabetic Macular Edema: Guidelines from the Emirates Society of Ophthalmology. Ophthalmol Ther 2022; 11:1937-1950. [PMID: 35896888 PMCID: PMC9437198 DOI: 10.1007/s40123-022-00547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022] Open
Abstract
In the United Arab Emirates, retinopathy has been shown to be present in 19% of the diabetic population, with diabetes identified in up to 40% of individuals aged over 55 years. Despite the prevalence of diabetic retinal diseases, there are no unified national guidelines on the management of diabetic macular edema (DME). These published guidelines are based on evidence taken from the literature and published trials of therapies, and consensus opinion of a representative expert panel with an interest in this condition, convened by the Emirates Society of Ophthalmology. The aim is to provide evidence-based, clinical guidance for the best management of different aspects of DME, with a special focus on vision-threatening diabetic retinopathy. Treatment should be initiated in patients with best-corrected visual acuity 20/30 or worse, and/or features of DME as seen on optical coherence tomography (OCT) with central retinal thickness (CRT) of at least 300 μm or in symptomatic patients with vision better than 20/25, and/or CRT less than 300 μm where there are OCT features consistent with center-involving macular edema. The treatment of DME is effective irrespective of glycated hemoglobin (HbA1c) level, and treatment must not be denied or delayed in order to optimize systemic parameters. All ophthalmic treatment options should be discussed with the patient for better compliance and expectations. Non-center-involving DME can be initially observed until progression toward the center is documented. Macular laser no longer has a primary role in center-involving DME, and anti-vascular endothelial growth factor (anti-VEGF) therapy should be considered as first-line treatment for all patients, unless contraindicated. If anti-VEGF is contraindicated, a steroid dexamethasone implant can be considered for first-line treatment. Recommendations for the treatment of DME in special circumstances and in relapsing and refractory DME are also discussed.
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Affiliation(s)
| | - Igor Kozak
- Moorfields Eye Hospital, Abu Dhabi, United Arab Emirates
| | | | - Piergiorgio Neri
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Khalifa University, Abu Dhabi, United Arab Emirates
| | | | | | | | | | - Mohamed Abdul-Nabi
- Sheikh Shakhbout Medical City in Association With Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Ammar Safar
- Moorfields Eye Hospital, Dubai, United Arab Emirates
| | | | - Prasan Rao
- Medcare Eye Centre, Dubai, United Arab Emirates
| | - Madhav Rao
- Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Amr Farid
- Magrabi Eye Hospital, Dubai, United Arab Emirates
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8
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Akbar F, Siddiqui Z, Waheed MT, Ehsan L, Ali SI, Wiquar H, Valimohammed AT, Khan S, Vohra L, Zeeshan S, Rashid Y, Moosajee M, Jabbar AA, Zahir MN, Zahid N, Soomro R, Ullah NN, Ahmad I, Haider G, Ansari U, Rizvi A, Mehboobali A, Sattar A, Kirmani S. Spectrum of germline pathogenic variants using a targeted next generation sequencing panel and genotype-phenotype correlations in patients with suspected hereditary breast cancer at an academic medical centre in Pakistan. Hered Cancer Clin Pract 2022; 20:24. [PMID: 35710434 PMCID: PMC9204946 DOI: 10.1186/s13053-022-00232-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background Breast cancer is the most common malignancy in women, affecting over 1.5 million women every year, which accounts for the highest number of cancer-related deaths in women globally. Hereditary breast cancer (HBC), an important subset of breast cancer, accounts for 5–10% of total cases. However, in Low Middle-Income Countries (LMICs), the population-specific risk of HBC in different ethnicities and the correlation with certain clinical characteristics remain unexplored. Methods Retrospective chart review of patients who visited the HBC clinic and proceeded with multi-gene panel testing from May 2017 to April 2020. Descriptive and inferential statistics were used to analyze clinical characteristics of patients. Fisher’s exact, Pearson’s chi-squared tests and Logistic regression analysis were used for categorical variables and Wilcoxon rank-sum test were used for quantitative variables. For comparison between two independent groups, Mann-Whitney test was performed. Results were considered significant at a p value of < 0.05. Results Out of 273 patients, 22% tested positive, 37% had a VUS and 41% had a negative genetic test result. Fifty-five percent of the positive patients had pathogenic variants in either BRCA1 or BRCA2, while the remaining positive results were attributed to other genes. Patients with a positive result had a younger age at diagnosis compared to those having a VUS and a negative result; median age 37.5 years, IQR (Interquartile range) (31.5–48). Additionally, patients with triple negative breast cancer (TNBC) were almost 3 times more likely to have a positive result (OR = 2.79, CI = 1.42–5.48 p = 0.003). Of all patients with positive results, 25% of patients had a negative family history of breast and/or related cancers. Conclusions In our HBC clinic, we observed that our rate of positive results is comparable, yet at the higher end of the range which is reported in other populations. The importance of expanded, multi-gene panel testing is highlighted by the fact that almost half of the patients had pathogenic or likely pathogenic variants in genes other than BRCA1/2, and that our test positivity rate would have only been 12.8% if only BRCA1/2 testing was done. As the database expands and protocol-driven referrals are made across the country, our insight about the genetic architecture of HBC in our population will continue to increase. Supplementary Information The online version contains supplementary material available at 10.1186/s13053-022-00232-2.
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Affiliation(s)
- Fizza Akbar
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Lubaina Ehsan
- Medical College, Aga Khan University, Karachi, Pakistan.,School of Medicine, Western Michigan University Stryker, Kalamazoo, MI, USA
| | - Syed Ibaad Ali
- School of Medicine, Western Michigan University Stryker, Kalamazoo, MI, USA
| | - Hajra Wiquar
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Shaista Khan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Lubna Vohra
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Sana Zeeshan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Yasmin Rashid
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Munira Moosajee
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | | | | | - Naila Zahid
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Rufina Soomro
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | - Imran Ahmad
- Cancer Foundation Hospital, Karachi, Pakistan
| | | | - Uzair Ansari
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arif Mehboobali
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Abida Sattar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
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Kuper-Hommel MJJ, Little Z, Gautier A. New Zealand experience with implementation of the ESO-ESMO consensus guidelines for advanced breast cancer-report of achievements and lessons learned. Breast 2022; 63:108-112. [PMID: 35366504 PMCID: PMC8976117 DOI: 10.1016/j.breast.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with advanced breast cancer (ABC) in New Zealand (NZ) have a poorer five-year survival than their peers in other developed countries. Comparisons of ABC care in NZ with other countries suggest that NZ is sometimes out of line with international standards and that inequities exist within the NZ healthcare system. Our aim was to develop nationwide consensus guidelines for diagnosis and treatment of ABC that are uniquely suited for the NZ context and can be applied across the nation. We describe the process of creating, voting on, and disseminating the guidelines, and provide insight into how we can better optimize these processes for the NZ context in the future. METHODS The ABC5 ESO-ESMO consensus guidelines were used and adapted to the NZ clinical context. A panel of breast cancer clinicians voted on these guidelines using the same model of membership representation as ABC5. OUTCOME Overall consensus was equally high between ABC5 and ABC-NZ. Four NZ specific guidelines were introduced. The European-style panel discussion needs some adaptations for the NZ situation and a wider and more thorough consultation process, before voting begins, is preferred. The NZ Breast Special Interest Group has endorsed and agreed to take ownership of these and future guidelines and to facilitate the next iteration of the ABC-NZ guidelines meeting. CONCLUSIONS The process was successful in creating the guidelines but can be improved in future meetings to streamline the process of creating and updating guidelines in the manner most suited to the NZ context and audience.
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Affiliation(s)
- M J J Kuper-Hommel
- Department of Oncology, Waikato District Health Board, Private Bag 3200, Hamilton, 3240, New Zealand.
| | - Z Little
- School of Psychology, Victoria University of Wellington, New Zealand.
| | - A Gautier
- Breast Cancer Foundation NZ, PO Box 99650, Newmarket, Auckland, 1149, New Zealand.
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10
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Henry A, Pieters BR, André Siebert F, Hoskin P. GEC-ESTRO ACROP prostate brachytherapy guidelines. Radiother Oncol 2022; 167:244-251. [PMID: 34999134 DOI: 10.1016/j.radonc.2021.12.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023]
Abstract
This is an evidence-based guideline for prostate brachytherapy. Throughout levels of evidence quoted are those from the Oxford Centre for Evidence based Medicine (https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009). Prostate interstitial brachytherapy using either permanent or temporary implantation is an established and evolving treatment technique for non-metastatic prostate cancer. Permanent brachytherapy uses Low Dose Rate (LDR) sources, most commonly I-125, emitting photon radiation over months. Temporary brachytherapy involves first placing catheters within the prostate and, on confirmation of accurate positioning, temporarily introducing the radioactive source, generally High Dose Rate (HDR) radioactive sources of Ir-192 or less commonly Co-60. Pulsed dose rate (PDR) brachytherapy has also been used for prostate cancer [1] but few centres have adopted this approach. Previous GEC ESTRO recommendations have considered LDR and HDR separately [2-4] but as there is considerable overlap, this paper provides updated guidance for both treatment techniques. Prostate brachytherapy allows safe radiation dose escalation beyond that achieved using external beam radiotherapy alone as it has greater conformity around the prostate, sparing surrounding rectum, bladder, and penile bulb. In addition there are fewer issues with changes in prostate position during treatment delivery. Systematic review and randomised trials using both techniques as boost treatments demonstrate improved PSA control when compared to external beam radiotherapy alone [5-7].
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Affiliation(s)
- Ann Henry
- St James University Hospital, Leeds, UK
| | - Bradley R Pieters
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank André Siebert
- University of Kiel/University Hospital Schleswig-Holstein Campus Kiel, Germany
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; University of Manchester, Manchester, UK.
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11
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Oladega A, Mojdami D, Hope A, Watson E, Glogauer M. THE PROCESS OF DEVELOPING CONSENSUS GUIDELINES BY DENTAL ONCOLOGISTS FOR PRE-RADIOTHERAPY DENTAL CARE IN HEAD AND NECK CANCER PATIENTS USING THE MODIFIED DELPHI TECHNIQUE. J Evid Based Dent Pract 2021; 21:101620. [PMID: 34922716 DOI: 10.1016/j.jebdp.2021.101620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a range of pre-radiation therapy (RT) dental care strategies used to prevent the side effects associated with the use of RT in the treatment of head and neck cancer. However, there is a paucity of evidence-based, prospectively tested clinical practice guidelines for dentists to utilize in the provision of care prior to RT. PURPOSE The aim of this study is to describe the process of creating consensus guidelines for dental care in head and neck cancer patients undergoing RT using the Modified Delphi Technique. PROCEDURE We invited 44 dental oncologists to participate as panelists in the study. Three rounds of iterative structured surveys were completed within eight months, followed by a virtual meeting to conclude the modified Delphi process. Questions were divided into six main domains and patients were categorized as low, moderate, and high-risk based on factors identified by panelists and agreed upon during the first round. The threshold value set for each round of the Delphi process was a 70% response rate and 75% Consensus level. FINDINGS Eighteen panelists out of the forty-four (41% overall response rate) completed the study. The number of questions that achieved the set consensus level in rounds 1,2,3 and the virtual meeting were 24%, 62%,61% and 81%, respectively. A confidence level of 95% and a response rate of >75% were reached throughout the process. CONCLUSION Consensus was attained in most of the questions in all domains, which will be utilized to develop guidelines for dental care in head and neck cancer patients before the commencement of RT.
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Affiliation(s)
- Afisu Oladega
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Canada; Faculty of Dentistry, University of Toronto, Canada
| | | | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation medicine program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Erin Watson
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Michael Glogauer
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Canada; Faculty of Dentistry, University of Toronto, Canada
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12
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Sawaya GF, Holt HK, Lamar R, Perron-Burdick M, Smith-McCune K. Prioritizing cervical cancer screening services during the COVID-19 pandemic: Response of an academic medical center and a public safety net hospital in California. Prev Med 2021; 151:106569. [PMID: 34217411 PMCID: PMC8241652 DOI: 10.1016/j.ypmed.2021.106569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 12/17/2022]
Abstract
The expeditious diagnosis and treatment of high-grade cervical precancers are fundamental to cervical cancer prevention. However, during the COVID-19 pandemic healthcare systems have at times restricted in-person visits to those deemed urgent. Professional societies provided some guidance to clinicians regarding ways in which traditional cervical cancer screening might be modified, but many gaps remained. To address these gaps, leaders of screening programs at an academic medical center and an urban safety net hospital in California formed a rapid-action committee to provide guidance to its practitioners. Patients were divided into 6 categories corresponding to various stages in the screening process and ranked by risk of underlying high-grade cervical precancer and cancer. Tiers corresponding to the intensity of the local pandemic were constructed, and clinical delays were lengthened for the lowest-risk patients as tiers escalated. The final product was a management grid designed to escalate and de-escalate with changes in the local epidemiology of the COVID-19 pandemic. While this effort resulted in substantial delays in clinical screening services as mandated by the healthcare systems, the population effects of delaying on both cervical cancer outcomes as well as the beneficial effects related to decreasing transmission of severe acute respiratory coronavirus 2 have yet to be elucidated.
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Affiliation(s)
- George F Sawaya
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco (UCSF), United States of America; Obstetrics, Midwifery and Gynecology Clinic, Zuckerberg San Francisco General Hospital and Trauma Center, United States of America.
| | - Hunter K Holt
- Department of Family and Community Medicine, UCSF, United States of America
| | - Robyn Lamar
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco (UCSF), United States of America
| | - Misa Perron-Burdick
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco (UCSF), United States of America; Obstetrics, Midwifery and Gynecology Clinic, Zuckerberg San Francisco General Hospital and Trauma Center, United States of America
| | - Karen Smith-McCune
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco (UCSF), United States of America
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Feeney T, Madiedo A, Knapp PE, Gupta A, McAneny D, Drake FT. Incidental Adrenal Masses: Adherence to Guidelines and Methods to Improve Initial Follow-Up, A Systematic Review. J Surg Res 2021; 269:18-27. [PMID: 34508918 DOI: 10.1016/j.jss.2021.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/09/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Incidental adrenal masses (IAMs) are detected in approximately 1%-2% of abdominal computed tomography (CT) scans. Recent estimates suggest that more than 70-million relevant CT scans are performed annually in the United States; thus, IAMs represent a significant clinical entity. Most clinical guidelines recommend an initial follow-up evaluation that includes imaging and biochemical testing after index IAM detection. METHODS Systematic review of literature in the PubMed, EMBASE and Web of Science databases to determine whether guidelines regarding IAM evaluation are followed and to identify effective management strategies. Our initial search was in January 2018 and updated in November, 2019. RESULTS 31 studies met inclusion criteria. In most institutions, only a minority of patients with IAMs undergo initial follow-up imaging (median 34%, IQR 20%-50%) or biochemical testing (median 18%, IQR 15%-28%). 2 interventions shown to improve IAM evaluation are IAM-specific recommendations in radiology reports and dedicated multi-disciplinary teams. Interventions focused solely on alerting the ordering clinician or primary care provider to the presence of an IAM have not demonstrated effectiveness. Patients who are referred to an endocrinologist are more likely to have a complete IAM evaluation, but few are referred. DISCUSSION Most patients with an IAM do not have an initial evaluation. The radiology report has been identified as a key component in determining whether IAMs are evaluated appropriately. Care teams dedicated to management of incidental radiographic findings also improve IAM follow-up. Although the evidence base is sparse, these interventions may be a starting point for further inquiry into optimizing care in this common clinical scenario.
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14
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Wenger N, Sebastian T, Engelberger RP, Kucher N, Spirk D. Pulmonary embolism and deep vein thrombosis: Similar but different. Thromb Res 2021; 206:88-98. [PMID: 34454241 DOI: 10.1016/j.thromres.2021.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/08/2021] [Accepted: 08/16/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Pulmonary embolism (PE) and deep vein thrombosis (DVT), the two clinical manifestations of venous thromboembolism (VTE), constitute a major global burden of cardiovascular disease. They are often referred to as one disease but several patient characteristics, risk factors, real-world treatment, and clinical outcomes may differ substantially between PE and DVT alone. MATERIALS AND METHODS We conducted a narrative review of the state-of-the-art literature on the topic of PE and DVT alone using PubMed, Google scholar, and MEDLINE databases and the most established international consensus statement guidelines for the management of VTE, focusing on the recommendations for diagnosis and treatment but also including epidemiological and clinical characteristics of VTE, highlighting similarities and differences between PE and DVT alone. RESULTS Several patient characteristics, risk factors, clinical manifestations, and outcomes differ substantially between PE versus DVT alone. Nevertheless, recommendations for both diagnosis and treatment are strikingly similar in the current guidelines for the management of DVT and PE, except for the indication for advanced reperfusion therapies. CONCLUSIONS The differences in risk factors, clinical manifestations, and clinical outcomes between patients with PE versus DVT alone are only marginally addressed in the current consensus guidelines. More data is needed allowing proposal of evidence-based adjustments in the diagnostic and therapeutic strategies for these two manifestations of VTE. Tailored risk stratification and individualized management strategies for patients with PE and DVT alone may lead to a better prognosis, less recurrence and complications, and possibly to a gain of quality-adjusted life years in patients with VTE.
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15
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Bleicher J, Stokes SM, Brooke BS, Glasgow RE, Huang LC. Patient-centered Opioid Prescribing: Breaking Away From One-Size-Fits-All Prescribing Guidelines. J Surg Res 2021; 264:1-7. [PMID: 33744772 PMCID: PMC8222090 DOI: 10.1016/j.jss.2021.01.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Procedure-based opioid-prescribing guidelines have reduced the amount of opioids prescribed after surgery; however, many patients are still overprescribed opioids. The 24-h predischarge opioid consumption (PDOC) metric has been proposed to guide patient-centered prescribing. MATERIALS AND METHODS This is a single-institution, retrospective study of patients who underwent major abdominal surgery. We assessed the correlation between inpatient opioid use and discharge prescriptions using morphine milligram equivalents (MMEs). The adequacy of discharge prescriptions for individual patients was assessed using 2 models, one assuming constant opioid use (based on 24-h PDOC) and the other assuming a linear taper. RESULTS Of 596 included patients, gastric bypass and colectomy were the most common operations. Median length of stay was 3.5 d. Inpatient opioid use and discharge prescriptions were weakly correlated (r = 0.35). Patients with no opioid use 24 h before discharge (n = 133, 22.3%) were frequently discharged with opioid prescriptions. Patients with high opioid use (24-h PDOC >60 MME) were often discharged with prescriptions that would have lasted <48 h (164/200, 82%). Assuming constant opioid use, discharge prescriptions would have lasted patients a median of 5.1 d. With linear opioid tapering, 440 (72.9%) patients would have had leftover pills. A theoretical discharge prescription of 4 times 24-h PDOC would reduce the median prescription by 130 MMEs and allow a linear taper for 97.6% of patients. CONCLUSIONS At our institution, opioid prescribing was rarely patient-centered, with little correlation between patient's inpatient opioid use and discharge prescriptions. This leads to overprescribing for most patients and underprescribing for others.
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Affiliation(s)
- Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - Sean M Stokes
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | | | | | - Lyen C Huang
- Department of Surgery, University of Utah, Salt Lake City, Utah
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16
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Kim HJ, Bang CH, Kim HO, Lee DH, Ko JY, Park EJ, Son SW, Ro YS. 2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema. Ann Dermatol 2021; 33:351-360. [PMID: 34341637 PMCID: PMC8273322 DOI: 10.5021/ad.2021.33.4.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients' quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. Objective These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. Methods A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. Results Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. Conclusion These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.
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Affiliation(s)
- Hee Joo Kim
- Department of Dermatology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Sang Wook Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Young Suk Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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Dressler D, Altavista MC, Altenmueller E, Bhidayasiri R, Bohlega S, Chana P, Chung TM, Colosimo C, Fheodoroff K, Garcia-Ruiz PJ, Jeon B, Jin L, Kanovsky P, Milanov I, Micheli F, Orlova O, Pandey S, Pirtosek Z, Relja M, Rosales R, Sagástegui-Rodríguez JA, Shahidi GA, Timerbaeva S, Wan X, Walter U, Saberi FA. Consensus guidelines for botulinum toxin therapy: general algorithms and dosing tables for dystonia and spasticity. J Neural Transm (Vienna) 2021; 128:321-335. [PMID: 33635442 PMCID: PMC7969540 DOI: 10.1007/s00702-021-02312-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/22/2021] [Indexed: 12/01/2022]
Abstract
Botulinum toxin (BT) therapy is a complex and highly individualised therapy defined by treatment algorithms and injection schemes describing its target muscles and their dosing. Various consensus guidelines have tried to standardise and to improve BT therapy. We wanted to update and improve consensus guidelines by: (1) Acknowledging recent advances of treatment algorithms. (2) Basing dosing tables on statistical analyses of real-life treatment data of 1831 BT injections in 36 different target muscles in 420 dystonia patients and 1593 BT injections in 31 different target muscles in 240 spasticity patients. (3) Providing more detailed dosing data including typical doses, dose variabilities, and dosing limits. (4) Including total doses and target muscle selections for typical clinical entities thus adapting dosing to different aetiologies and pathophysiologies. (5) In addition, providing a brief and concise review of the clinical entity treated together with general principles of its BT therapy. For this, we collaborated with IAB—Interdisciplinary Working Group for Movement Disorders which invited an international panel of experts for the support.
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | | | - Eckart Altenmueller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hannover, Germany
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre for Excellence on Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Saeed Bohlega
- Department of Neurology, King Faisal Specialist Hospital, Riyyad, Kingdom of Saudi Arabia
| | - Pedro Chana
- Department of Neurology, University de Santiago de Chile, Santiago de Chile, Chile
| | | | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | | | | | - Beomseok Jeon
- Department of Neurology, Seoul National University, Seoul, Republic of Korea
| | - Lingjing Jin
- Department of Neurology, Tongji University School of Medicine, Shanghai, China
| | - Petr Kanovsky
- Department of Neurology, Palacky University, Olomouc, Czech Republic
| | - Ivan Milanov
- Department of Neurology, Medical University of Sofia, Sofia, Bulgaria
| | - Federico Micheli
- Department of Neurology, Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Zvezdan Pirtosek
- Department of Neurology, Ljubljana University, Ljubljana, Slovenia
| | - Maja Relja
- Department of Neurology, University of Zagreb, Zagreb, Croatia
| | - Raymond Rosales
- Department of Neurology, University of Santo Tomas, Manila, Philippines
| | | | - Gholam Ali Shahidi
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | | | - Xinhua Wan
- Department of Neurology, Peking Union Medical College, Beijing, China
| | - Uwe Walter
- Department of Neurology, Rostock University, Rostock, Germany
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McCarthy CE, Fedele S, Ho M, Shaw R. UK consensus recommendations on the management of oral epithelial dysplasia during COVID-19 pandemic outbreaks. Oral Oncol 2021; 112:105110. [PMID: 33232878 PMCID: PMC7674996 DOI: 10.1016/j.oraloncology.2020.105110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Oral Epithelial Dysplasia (OED) is associated with an increased risk of oral cancer development. The SARS-CoV-2 pandemic is necessitating the suspension or dramatic reduction of face-to-face non-urgent elective services, including OED clinics. Little is known regarding the potential impact of elective services suspension upon the risk of OED progression, and whether alternative strategies (e.g. remote consultations) may be introduced to ensure OED surveillance. The aim of this paper is to provide expert-opinion consensus recommendations for the management of OED during the current and future pandemic outbreaks. MATERIALS AND METHODS A working group of nine UK-based senior clinicians and academics in Oral and Maxillofacial Surgery and Oral Medicine was created and twelve consensus statements were developed using a modified-Delphi process. Greater than 80% agreement was considered a consensus. RESULTS Consensus was achieved for all twelve statements (89-100% agreement). The group agreed that, during the temporary suspension of elective services associated with COVID-19 pandemic outbreaks, patients with OED can be risk stratified to determine the length of accepted delay in face-to-face consultation. Remote consultations with patient-provided clinical photographs may be a useful way of maintaining a level of surveillance in this group of patients. CONCLUSIONS Using an expert working group methodology, we have developed consensus recommendations for the monitoring of individuals with OED during pandemic outbreaks associated with temporary suspension of elective services. This has identified areas of future research and highlighted the need for a stronger evidence base to inform the set-up and delivery of surveillance regimens for patients with OED.
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Affiliation(s)
- Caroline Elizabeth McCarthy
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Roy Castle Building, 200 London Road, Liverpool L3 9TA, UK.
| | - Stefano Fedele
- University College London, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK; NIHR UCLH Biomedical Research Centre, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Michael Ho
- Leeds Teaching Hospitals NHS Trust, Clarendon Way, LS2 9LU Leeds, UK
| | - Richard Shaw
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Roy Castle Building, 200 London Road, Liverpool L3 9TA, UK
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Combs SE, Baumert BG, Bendszus M, Bozzao A, Brada M, Fariselli L, Fiorentino A, Ganswindt U, Grosu AL, Lagerwaard FL, Niyazi M, Nyholm T, Paddick I, Weber DC, Belka C, Minniti G. ESTRO ACROP guideline for target volume delineation of skull base tumors. Radiother Oncol 2020; 156:80-94. [PMID: 33309848 DOI: 10.1016/j.radonc.2020.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE For skull base tumors, target definition is the key to safe high-dose treatments because surrounding normal tissues are very sensitive to radiation. In the present work we established a joint ESTRO ACROP guideline for the target volume definition of skull base tumors. MATERIAL AND METHODS A comprehensive literature search was conducted in PubMed using various combinations of the following medical subjects headings (MeSH) and free-text words: "radiation therapy" or "stereotactic radiosurgery" or "proton therapy" or "particle beam therapy" and "skull base neoplasms" "pituitary neoplasms", "meningioma", "craniopharyngioma", "chordoma", "chondrosarcoma", "acoustic neuroma/vestibular schwannoma", "organs at risk", "gross tumor volume", "clinical tumor volume", "planning tumor volume", "target volume", "target delineation", "dose constraints". The ACROP committee identified sixteen European experts in close interaction with the ESTRO clinical committee who analyzed and discussed the body of evidence concerning target delineation. RESULTS All experts agree that magnetic resonance (MR) images with high three-dimensional spatial accuracy and tissue-contrast definition, both T2-weighted and volumetric T1-weighted sequences, are required to improve target delineation. In detail, several key issues were identified and discussed: i) radiation techniques and immobilization, ii) imaging techniques and target delineation, and iii) technical aspects of radiation treatments including planning techniques and dose-fractionation schedules. Specific target delineation issues with regard to different skull base tumors, including pituitary adenomas, meningiomas, craniopharyngiomas, acoustic neuromas, chordomas and chondrosarcomas are presented. CONCLUSIONS This ESTRO ACROP guideline achieved detailed recommendations on target volume definition for skull base tumors, as well as comprehensive advice about imaging modalities and radiation techniques.
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany; German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Germany
| | - Alessandro Bozzao
- Dipartimento NESMOS, Università Sapienza Roma, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Michael Brada
- Department of Radiation Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
| | - Laura Fariselli
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle fonti, Italy
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anca L Grosu
- Department of Radiation Oncology, Medical Faculty, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany
| | - Frank L Lagerwaard
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, The Netherlands
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Tufve Nyholm
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; IRCCS Neuromed, Pozzilli, Italy.
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20
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Herth MM, Ametamey S, Antuganov D, Bauman A, Berndt M, Brooks AF, Bormans G, Choe YS, Gillings N, Häfeli UO, James ML, Kopka K, Kramer V, Krasikova R, Madsen J, Mu L, Neumaier B, Piel M, Rösch F, Ross T, Schibli R, Scott PJH, Shalgunov V, Vasdev N, Wadsak W, Zeglis BM. On the consensus nomenclature rules for radiopharmaceutical chemistry - Reconsideration of radiochemical conversion. Nucl Med Biol 2020; 93:19-21. [PMID: 33232876 DOI: 10.1016/j.nucmedbio.2020.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
Radiochemical conversion is an important term to be included in the "Consensus nomenclature rules for radiopharmaceutical chemistry". Radiochemical conversion should be used to define reaction efficiency by measuring the transformation of components in a crude reaction mixture at a given time, whereas radiochemical yield is better suited to define the efficiency of an entire reaction process including, for example, separation, isolation, filtration, and formulation.
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Affiliation(s)
- Matthias M Herth
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Simon Ametamey
- Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zürich, Switzerland
| | - Dmitrii Antuganov
- Almazov Northwest Federal Medical Research Center, Ministry of Health of the Russian Federation, ul. Akkuratova 2, St. Petersburg 197341, Russia
| | - Andreas Bauman
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Mathias Berndt
- Life Molecular Imaging GmbH, Tegeler Str. 6-7, D-13353 Berlin, Germany
| | - Allen F Brooks
- Department of Radiology, University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI 48109, USA
| | - Guy Bormans
- Laboratory for Radiopharmaceutical Research, KU Leuven, Herestraat 49, box 821, 3000 Leuven, Belgium
| | - Yearn Seong Choe
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Nic Gillings
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Urs O Häfeli
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | - Michelle L James
- Department of Radiology and Department of Neurology and Neurological Sciences Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 1201 Welch Road, P-206, Stanford, CA 94305, USA
| | - Klaus Kopka
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Bautzner Landstraße 400, D-01328 Dresden, Germany
| | - Vasko Kramer
- Positronpharma SA, Providencia, 7500921 Santiago, Chile
| | - Raisa Krasikova
- N.P. Bechtereva Institute of Human Brain, Russian Academy of Science, Laboratory of Radiochemistry, 9 Ak. Pavlova St., 197376 St. Petersburg, Russia
| | - Jacob Madsen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Linjing Mu
- Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zürich, Switzerland
| | - Bernd Neumaier
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, D-52425 Jülich, Germany
| | - Markus Piel
- Department of Chemistry, Johannes Gutenberg-Universität Mainz, Fritz-Strassmann-Weg 2, D-55128 Mainz, Germany
| | - Frank Rösch
- Department of Chemistry, Johannes Gutenberg-Universität Mainz, Fritz-Strassmann-Weg 2, D-55128 Mainz, Germany
| | - Tobias Ross
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625 Hannover, Germany
| | - Roger Schibli
- Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zürich, Switzerland
| | - Peter J H Scott
- Department of Radiology, University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI 48109, USA
| | - Vladimir Shalgunov
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100 Copenhagen, Denmark
| | - Neil Vasdev
- Azrieli Centre for Neuro-Radiochemistry, Brain Health Imaging Centre, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, 250 College St., Toronto M5T-1R8, ON, Canada
| | - Wolfgang Wadsak
- Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Brian M Zeglis
- Department of Chemistry, Hunter College of the City University of New York, New York, NY, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Knudsen GM, Ganz M, Appelhoff S, Boellaard R, Bormans G, Carson RE, Catana C, Doudet D, Gee AD, Greve DN, Gunn RN, Halldin C, Herscovitch P, Huang H, Keller SH, Lammertsma AA, Lanzenberger R, Liow JS, Lohith TG, Lubberink M, Lyoo CH, Mann JJ, Matheson GJ, Nichols TE, Nørgaard M, Ogden T, Parsey R, Pike VW, Price J, Rizzo G, Rosa-Neto P, Schain M, Scott PJ, Searle G, Slifstein M, Suhara T, Talbot PS, Thomas A, Veronese M, Wong DF, Yaqub M, Zanderigo F, Zoghbi S, Innis RB. Guidelines for the content and format of PET brain data in publications and archives: A consensus paper. J Cereb Blood Flow Metab 2020; 40:1576-1585. [PMID: 32065076 PMCID: PMC7370374 DOI: 10.1177/0271678x20905433] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is a growing concern that outcomes of neuroimaging studies often cannot be replicated. To counteract this, the magnetic resonance (MR) neuroimaging community has promoted acquisition standards and created data sharing platforms, based on a consensus on how to organize and share MR neuroimaging data. Here, we take a similar approach to positron emission tomography (PET) data. To facilitate comparison of findings across studies, we first recommend publication standards for tracer characteristics, image acquisition, image preprocessing, and outcome estimation for PET neuroimaging data. The co-authors of this paper, representing more than 25 PET centers worldwide, voted to classify information as mandatory, recommended, or optional. Second, we describe a framework to facilitate data archiving and data sharing within and across centers. Because of the high cost of PET neuroimaging studies, sample sizes tend to be small and relatively few sites worldwide have the required multidisciplinary expertise to properly conduct and analyze PET studies. Data sharing will make it easier to combine datasets from different centers to achieve larger sample sizes and stronger statistical power to test hypotheses. The combining of datasets from different centers may be enhanced by adoption of a common set of best practices in data acquisition and analysis.
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Affiliation(s)
- Gitte M Knudsen
- Neurobiology Research Unit, Rigshospital and University of Copenhagen, Copenhagen, Denmark
| | - Melanie Ganz
- Neurobiology Research Unit, Rigshospital and University of Copenhagen, Copenhagen, Denmark
| | - Stefan Appelhoff
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Guy Bormans
- Laboratory for Radiopharmaceutical Research, KU, Leuven, Belgium
| | - Richard E Carson
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, USA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Department of Radiology, Boston, MA, USA
| | - Doris Doudet
- Department of Medicine/Neurology, Pacific Parkinson Research Center, Vancouver, Canada
| | - Antony D Gee
- Clinical PET Centre, King's College London, London, UK
| | - Douglas N Greve
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Department of Radiology, Boston, MA, USA
| | - Roger N Gunn
- Invicro and Division of Brain Sciences, Imperial College London, London, UK
| | - Christer Halldin
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden
| | - Peter Herscovitch
- Department of Positron Emission Tomography, National Institutes of Health, Bethesda, USA
| | - Henry Huang
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, USA
| | - Sune H Keller
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria
| | - Jeih-San Liow
- Molecular Imaging Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, USA
| | | | - Mark Lubberink
- Uppsala University, Department of Surgical Sciences/Radiology and Nuclear Medicine, Uppsala University Hospital, Department of Medical Physics, Sweden
| | - Chul H Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - J John Mann
- Department of Psychiatry, Molecular Imaging and Neuropathology Division, Columbia University, New York, USA
| | - Granville J Matheson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden
| | - Thomas E Nichols
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, UK
| | - Martin Nørgaard
- Neurobiology Research Unit, Rigshospital and University of Copenhagen, Copenhagen, Denmark
| | - Todd Ogden
- Columbia Mailman School of Public Health, Columbia University, New York, USA
| | - Ramin Parsey
- Department of Psychiatry, School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Victor W Pike
- Molecular Imaging Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, USA
| | - Julie Price
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Department of Radiology, Boston, MA, USA
| | - Gaia Rizzo
- Invicro and Division of Brain Sciences, Imperial College London, London, UK
| | - Pedro Rosa-Neto
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada.,Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, Douglas Mental Health University Institute, Montreal, Canada
| | - Martin Schain
- Columbia Mailman School of Public Health, Columbia University, New York, USA
| | - Peter Jh Scott
- Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Graham Searle
- Invicro and Division of Brain Sciences, Imperial College London, London, UK
| | - Mark Slifstein
- Department of Psychiatry, School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Tetsuya Suhara
- Institute for Quantum Life Science, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Peter S Talbot
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Adam Thomas
- National Institute of Mental Health, Bethesda, USA
| | - Mattia Veronese
- Centre for Neuroimaging Sciences, King's College London, London, UK
| | - Dean F Wong
- Department of Radiology, Johns Hopkins Hospital, Baltimore, USA
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Sami Zoghbi
- Molecular Imaging Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, USA
| | - Robert B Innis
- Molecular Imaging Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, USA
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22
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Opladen T, López-Laso E, Cortès-Saladelafont E, Pearson TS, Sivri HS, Yildiz Y, Assmann B, Kurian MA, Leuzzi V, Heales S, Pope S, Porta F, García-Cazorla A, Honzík T, Pons R, Regal L, Goez H, Artuch R, Hoffmann GF, Horvath G, Thöny B, Scholl-Bürgi S, Burlina A, Verbeek MM, Mastrangelo M, Friedman J, Wassenberg T, Jeltsch K, Kulhánek J, Kuseyri Hübschmann O. Consensus guideline for the diagnosis and treatment of tetrahydrobiopterin (BH 4) deficiencies. Orphanet J Rare Dis 2020; 15:126. [PMID: 32456656 PMCID: PMC7251883 DOI: 10.1186/s13023-020-01379-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Tetrahydrobiopterin (BH4) deficiencies comprise a group of six rare neurometabolic disorders characterized by insufficient synthesis of the monoamine neurotransmitters dopamine and serotonin due to a disturbance of BH4 biosynthesis or recycling. Hyperphenylalaninemia (HPA) is the first diagnostic hallmark for most BH4 deficiencies, apart from autosomal dominant guanosine triphosphate cyclohydrolase I deficiency and sepiapterin reductase deficiency. Early supplementation of neurotransmitter precursors and where appropriate, treatment of HPA results in significant improvement of motor and cognitive function. Management approaches differ across the world and therefore these guidelines have been developed aiming to harmonize and optimize patient care. Representatives of the International Working Group on Neurotransmitter related Disorders (iNTD) developed the guidelines according to the SIGN (Scottish Intercollegiate Guidelines Network) methodology by evaluating all available evidence for the diagnosis and treatment of BH4 deficiencies. CONCLUSION Although the total body of evidence in the literature was mainly rated as low or very low, these consensus guidelines will help to harmonize clinical practice and to standardize and improve care for BH4 deficient patients.
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Affiliation(s)
- Thomas Opladen
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany.
| | - Eduardo López-Laso
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, IMIBIC and CIBERER, Córdoba, Spain
| | - Elisenda Cortès-Saladelafont
- Inborn errors of metabolism Unit, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
- Unit of Pediatric Neurology and Metabolic Disorders, Department of Pediatrics, Hospital Germans Trias i Pujol, and Faculty of Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Toni S Pearson
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - H Serap Sivri
- Department of Pediatrics, Section of Metabolism, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
| | - Yilmaz Yildiz
- Department of Pediatrics, Section of Metabolism, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
| | - Birgit Assmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Manju A Kurian
- Developmental Neurosciences, UCL Great Ormond Street-Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Vincenzo Leuzzi
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Simon Heales
- Neurometabolic Unit, National Hospital, Queen Square, London, UK
| | - Simon Pope
- Neurometabolic Unit, National Hospital, Queen Square, London, UK
| | - Francesco Porta
- Department of Pediatrics, AOU Città della Salute e della Scienza, Torino, Italy
| | - Angeles García-Cazorla
- Inborn errors of metabolism Unit, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Tomáš Honzík
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Roser Pons
- First Department of Pediatrics of the University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - Luc Regal
- Department of Pediatric, Pediatric Neurology and Metabolism Unit, UZ Brussel, Brussels, Belgium
| | - Helly Goez
- Department of Pediatrics, University of Alberta Glenrose Rehabilitation Hospital, Edmonton, Canada
| | - Rafael Artuch
- Clinical biochemistry department, Institut de Recerca Sant Joan de Déu, CIBERER and MetabERN Hospital Sant Joan de Déu, Barcelona, Spain
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Gabriella Horvath
- Department of Pediatrics, Division of Biochemical Genetics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Beat Thöny
- Division of Metabolism, University Children's Hospital Zurich, Zürich, Switzerland
| | - Sabine Scholl-Bürgi
- Clinic for Pediatrics I, Medical University of Innsbruck, Anichstr 35, Innsbruck, Austria
| | - Alberto Burlina
- U.O.C. Malattie Metaboliche Ereditarie, Dipartimento della Salute della Donna e del Bambino, Azienda Ospedaliera Universitaria di Padova - Campus Biomedico Pietro d'Abano, Padova, Italy
| | - Marcel M Verbeek
- Departments of Neurology and Laboratory Medicine, Alzheimer Centre, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Mario Mastrangelo
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Jennifer Friedman
- UCSD Departments of Neuroscience and Pediatrics, Rady Children's Hospital Division of Neurology; Rady Children's Institute for Genomic Medicine, San Diego, USA
| | - Tessa Wassenberg
- Department of Pediatric, Pediatric Neurology and Metabolism Unit, UZ Brussel, Brussels, Belgium
| | - Kathrin Jeltsch
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Jan Kulhánek
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Oya Kuseyri Hübschmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
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Santosh V, Sravya P, Gupta T, Muzumdar D, Chacko G, Suri V, Epari S, Balasubramaniam A, Radotra BD, Chatterjee S, Sarkar C, Jalali R. ISNO consensus guidelines for practical adaptation of the WHO 2016 classification of adult diffuse gliomas. Neurol India 2019; 67:173-182. [PMID: 30860119 DOI: 10.4103/0028-3886.253572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Recent advances in the molecular biology of adult diffuse gliomas have brought about a paradigm shift in their diagnostic criteria, as witnessed in the World Health Organization (WHO) 2016 guidelines for central nervous system tumors. It is now mandatory to perform several molecular tests to reach a definitive integrated diagnosis in most of the cases. This comes with additional cost and higher turnaround time, which is not always affordable in developing countries like India. In addition, the non-uniform distribution of advanced research and diagnostic testing centers adds to the difficulty. Methods The Indian Society of Neuro-oncology (ISNO) multidisciplinary expert panel consisting of neuropathologists, neurosurgeons, and radiation/medical oncologists convened to prepare the national consensus guidelines for approach to diagnosis of adult diffuse gliomas. Results Algorithms for arriving at an integrated diagnosis of adult diffuse gliomas predominantly using immunohistochemistry and with minimum possible additional molecular testing were agreed upon, thus addressing the problems of cost, accessibility, and turnaround time. Mandatory and optional tests were proposed for each case scenario. Conclusion This document represents the consensus of the various neuro-oncology disciplines involved in diagnosis and management of patients with adult diffuse gliomas. The article reflects a practical adaptation of the WHO recommendations to suit a resource constrained setup.
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Affiliation(s)
- Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Palavalasa Sravya
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Dattatraya Muzumdar
- Department of Neurosurgery, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Geeta Chacko
- Department of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anandh Balasubramaniam
- Department of Neurosurgery, Yashoda Superspeciality Hospitals, Secunderabad, Telangana, India
| | - Bishan Dass Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandip Chatterjee
- Department of Neurosurgery, Park Clinic, Kolkata, West Bengal, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
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24
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Depypere M, Morgenstern M, Kuehl R, Senneville E, Moriarty TF, Obremskey WT, Zimmerli W, Trampuz A, Lagrou K, Metsemakers WJ. Pathogenesis and management of fracture-related infection. Clin Microbiol Infect 2020; 26:572-8. [PMID: 31446152 DOI: 10.1016/j.cmi.2019.08.006] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Both fracture-related infections (FRIs) and periprosthetic joint infections (PJIs) include orthopaedic implant-associated infections. However, key aspects of management differ due to the bone and soft tissue damage in FRIs and the option of removing the implant after fracture healing. In contrast to PJIs, research and guidelines for diagnosis and treatment in FRIs are scarce. OBJECTIVES This narrative review aims to update clinical microbiologists, infectious disease specialists and surgeons on the management of FRIs. SOURCES A computerized search of PubMed was performed to identify relevant studies. Search terms included 'Fracture' and 'Infection'. The reference lists of all retrieved articles were checked for additional relevant references. In addition, when scientific evidence was lacking, recommendations are based on expert opinion. CONTENT Pathogenesis, prevention, diagnosis and treatment of FRIs are presented. Whenever available, specific data of patients with FRI are discussed. IMPLICATIONS Management of patients with FRI should take into account FRI-specific features. Treatment pathways should implement a multidisciplinary approach to achieve a good outcome. Recently, international consensus guidelines were developed to improve the quality of care for patients suffering from this severe complication, which are highlighted in this review.
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25
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Gomez DR, Rimner A, Simone CB, Cho BCJ, de Perrot M, Adjei AA, Bueno R, Gill RR, Harpole DH, Hesdorffer M, Hirsch FR, Jackson AA, Pass HI, Rice DC, Rusch VW, Tsao AS, Yorke E, Rosenzweig K. The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation. J Thorac Oncol 2019; 14:1172-1183. [PMID: 31125736 DOI: 10.1016/j.jtho.2019.03.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Detailed guidelines regarding the use of radiation therapy for malignant pleural mesothelioma (MPM) are currently lacking because of the rarity of the disease, the wide spectrum of clinical presentations, and the paucity of high-level data on individual treatment approaches. METHODS In March 2017, a multidisciplinary meeting of mesothelioma experts was cosponsored by the U.S. National Cancer Institute, International Association for the Study of Lung Cancer Research, and Mesothelioma Applied Research Foundation. Among the outcomes of this conference was the foundation of detailed, multidisciplinary consensus guidelines. RESULTS Here we present consensus recommendations on the use of radiation therapy for MPM in three discrete scenarios: (1) hemithoracic radiation therapy to be used before or after extrapleural pneumonectomy; (2) hemithoracic radiation to be used as an adjuvant to lung-sparing procedures (i.e., without pneumonectomy); and (3) palliative radiation therapy for focal symptoms caused by the disease. We discuss appropriate simulation techniques, treatment volumes, dose fractionation regimens, and normal tissue constraints. We also assess the role of particle beam therapy, specifically, proton beam therapy, for MPM. CONCLUSION The recommendations provided in this consensus statement should serve as important guidelines for developing future clinical trials of treatment approaches for MPM.
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Affiliation(s)
- Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - B C John Cho
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marc de Perrot
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alex A Adjei
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David H Harpole
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Fred R Hirsch
- Department of Medicine, University of Colorado, Denver, Colorado; Department of Pathology, University of Colorado, Denver, Colorado
| | | | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Valerie W Rusch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne S Tsao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
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Masterson-Algar P, Burton CR, Rycroft-Malone J. The generation of consensus guidelines for carrying out process evaluations in rehabilitation research. BMC Med Res Methodol 2018; 18:180. [PMID: 30594133 PMCID: PMC6311071 DOI: 10.1186/s12874-018-0647-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although in recent years there has been a strong increase in published research on theories (e.g. realist evaluation, normalization process theory) driving and guiding process evaluations of complex interventions, there is limited guidance to help rehabilitation researchers design and carry out process evaluations. This can lead to the risk of process evaluations being unsystematic. This paper reports on the development of new consensus guidelines that address the specific challenges of conducting process evaluations alongside clinical trials of rehabilitation interventions. METHODS A formal consensus process was carried out based on a modified nominal group technique, which comprised two phases. Phase I was informed by the findings of a systematic review, and included a nominal group meeting with an expert panel of participants to rate and discuss the proposed statements. Phase II was an in depth semi-structured telephone interviews with expert panel participants in order to further discuss the structure and contents of the revised guidelines. Frequency of rating responses to each statement was calculated and thematic analysis was carried out on all qualitative data. RESULTS The guidelines for carrying out process evaluations within complex intervention rehabilitation research were produced by combining findings from Phase I and Phase II. The consensus guidelines include recommendations that are grouped in seven sections. These sections are theoretical work, design and methods, context, recruitment and retention, intervention staff, delivery of the intervention and results. These sections represent different aspects or stages of the evaluation process. CONCLUSION The consensus guidelines here presented can play a role at assisting rehabilitation researchers at the time of designing and conducting process evaluations alongside trials of complex interventions. The guidelines break new ground in terms of concepts and theory and works towards a consensus in regards to how rehabilitation researchers should go about carrying out process evaluations and how this evaluation should be linked into the proposed trials. These guidelines may be used, adapted and tested by rehabilitation researchers depending on the research stage or study design (e.g. feasibility trial, pilot trial, etc.).
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Affiliation(s)
- P. Masterson-Algar
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
| | - C. R. Burton
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
| | - J. Rycroft-Malone
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
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Danese S, Banerjee R, Cummings JF, Dotan I, Kotze PG, Leong RWL, Paridaens K, Peyrin-Biroulet L, Scott G, Assche GV, Wehkamp J, Yamamoto-Furusho JK. Consensus recommendations for patient-centered therapy in mild-to-moderate ulcerative colitis: the i Support Therapy-Access to Rapid Treatment (iSTART) approach. Intest Res 2018; 16:522-528. [PMID: 30321913 PMCID: PMC6223445 DOI: 10.5217/ir.2018.00073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/28/2018] [Indexed: 12/21/2022] Open
Abstract
Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy–Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations. These were informed by evidence from systematic reviews on the epidemiology, mesalazine (5-ASA) treatment, and patient use criteria for second-line therapy in UC. Optimized 5-ASA is the first-line treatment in all clinical guidelines, but may not be sufficient to induce remission in all patients. Corticosteroids should be prescribed as second-line therapy when needed, with budesonide MMX® being a preferred steroid option. Active involvement of suitable patients in management of UC flares has the potential to improve therapy, with patients able to show good accuracy for flare self-assessment using validated tools. There is a place in the UC treatment pathway for an approach such as iSTART, which has the potential to provide patient, clinical and economic benefits.
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Affiliation(s)
- Silvio Danese
- Inflammatory Bowel Disease Clinical and Research Unit, Istituto Clinico Humanitas, Milan, Italy
| | - Rupa Banerjee
- Inflammatory Bowel Diseases Clinic, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jr Fraser Cummings
- Department of Gastroenterology, Southampton General Hospital, Southampton, UK
| | - Iris Dotan
- Division of Gastroenterology at the Rabin Medical Center, Petah-Tikva, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Paulo G Kotze
- Colorectal Surgery Unit, Hospital Universitário Cajuru, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | | | - Laurent Peyrin-Biroulet
- Inserm U954, Department of Gastroenterology, Nancy University Hospital, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Glyn Scott
- East Kent Hospitals Trust, Canterbury, UK
| | | | - Jan Wehkamp
- Department of Hepatology, Gastroenterology & Infectious Diseases, University Hospital Tuebingen, Tübingen, Germany
| | - Jesús K Yamamoto-Furusho
- IBD Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
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Coenen HH, Gee AD, Adam M, Antoni G, Cutler CS, Fujibayashi Y, Jeong JM, Mach RH, Mindt TL, Pike VW, Windhorst AD. Consensus nomenclature rules for radiopharmaceutical chemistry - Setting the record straight. Nucl Med Biol 2017; 55:v-xi. [PMID: 29074076 DOI: 10.1016/j.nucmedbio.2017.09.004] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Abstract
Over recent years, within the community of radiopharmaceutical sciences, there has been an increased incidence of incorrect usage of established scientific terms and conventions, and even the emergence of 'self-invented' terms. In order to address these concerns, an international Working Group on 'Nomenclature in Radiopharmaceutical Chemistry and related areas' was established in 2015 to achieve clarification of terms and to generate consensus on the utilisation of a standardised nomenclature pertinent to the field. Upon open consultation, the following consensus guidelines were agreed, which aim to.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Thomas L Mindt
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
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Kousoula K, Farmaki K, Skoglund T, Olsson DS, Johannsson G, Trimpou P, Ragnarsson O. The impact of adjustments to the diagnostic criteria for biochemical remission in surgically treated patients with acromegaly. Growth Horm IGF Res 2017; 36:16-21. [PMID: 28846862 DOI: 10.1016/j.ghir.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The suggested criteria for biochemical remission in patients treated for acromegaly were recently modified. The aim of this project was to study to what extent this modification influences remission rates. DESIGN, PATIENTS AND METHODS This was a retrospective study of 55 consecutive patients [29 men; median age 47years (interquartile range 38-68)] diagnosed with acromegaly between 2003 and 2014. After treatment serum IGF-I and/or GH was measured according to a standardized protocol. The biochemical remission status was defined according to the clinical guidelines from 2010 and2014. RESULTS Out of 55 patients, 44 patients were primarily operated. Of these, 33 (75%) were evaluated 3-12months postoperatively by measuring serum IGF-I and GH during an oral glucose tolerance test. According to the 2010 guidelines, 11 patients (33%) were in biochemical remission, 15 patients (46%) were not and 7 patients (21%) had discordant results (normal IGF-I and high GH or vice versa). Applying the 2014 guidelines in the same group, 16 patients (49%) were in biochemical remission, 7 patients (21%) were not and 10 patients (30%) had discordant results. Thus, by using the most recent criteria for biochemical control, more patients were considered to be in remission, or with discordant results, and fewer patients not in remission (P<0.05). CONCLUSION An apparently minor adjustment of the criteria for biochemical control has a significant impact on remission status in patients treated for acromegaly, eventually affecting follow-up and treatment strategies.
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Affiliation(s)
- Konstantina Kousoula
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden
| | - Katerina Farmaki
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden
| | - Thomas Skoglund
- Department of Neurosurgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Daniel S Olsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden
| | - Penelope Trimpou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden.
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30
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Tang SSK, Kaptanis S, Haddow JB, Mondani G, Elsberger B, Tasoulis MK, Obondo C, Johns N, Ismail W, Syed A, Kissias P, Venn M, Sundaramoorthy S, Irwin G, Sami AS, Elfadl D, Baggaley A, Remoundos DD, Langlands F, Charalampoudis P, Barber Z, Hamilton-Burke WLS, Khan A, Sirianni C, Merker LAMG, Saha S, Lane RA, Chopra S, Dupré S, Manning AT, St John ER, Musbahi A, Dlamini N, McArdle CL, Wright C, Murphy JO, Aggarwal R, Dordea M, Bosch K, Egbeare D, Osman H, Tayeh S, Razi F, Iqbal J, Ledwidge SFC, Albert V, Masannat Y. Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland. Eur J Cancer 2017; 84:315-324. [PMID: 28865259 DOI: 10.1016/j.ejca.2017.07.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is variation in margin policy for breast conserving therapy (BCT) in the UK and Ireland. In response to the Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) margin consensus ('no ink on tumour' for invasive and 2 mm for ductal carcinoma in situ [DCIS]) and the Association of Breast Surgery (ABS) consensus (1 mm for invasive and DCIS), we report on current margin practice and unit infrastructure in the UK and Ireland and describe how these factors impact on re-excision rates. METHODS A trainee collaborative-led multicentre prospective study was conducted in the UK and Ireland between 1st February and 31st May 2016. Data were collected on consecutive BCT patients and on local infrastructure and policies. RESULTS A total of 79 sites participated in the data collection (75% screening units; average 372 cancers annually, range 70-900). For DCIS, 53.2% of units accept 1 mm and 38% accept 2-mm margins. For invasive disease 77.2% accept 1 mm and 13.9% accept 'no ink on tumour'. A total of 2858 patients underwent BCT with a mean re-excision rate of 17.2% across units (range 0-41%). The re-excision rate would be reduced to 15% if all units applied SSO-ASTRO guidelines and to 14.8% if all units followed ABS guidelines. Of those who required re-operation, 65% had disease present at margin. CONCLUSION There continues to be large variation in margin policy and re-excision rates across units. Altering margin policies to follow either SSO-ASTRO or ABS guidelines would result in a modest reduction in the national re-excision rate. Most re-excisions are for involved margins rather than close margins.
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MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Consensus
- Female
- Guideline Adherence/standards
- Healthcare Disparities/standards
- Humans
- Ireland
- Margins of Excision
- Mastectomy, Segmental/adverse effects
- Mastectomy, Segmental/methods
- Mastectomy, Segmental/standards
- Practice Guidelines as Topic/standards
- Practice Patterns, Physicians'/standards
- Prospective Studies
- Quality Indicators, Health Care/standards
- Reoperation
- Treatment Outcome
- United Kingdom
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Affiliation(s)
- Sarah Shuk-Kay Tang
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, England SW17 0QT, UK.
| | - Sarantos Kaptanis
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK.
| | - James B Haddow
- Queen Mary University of London, Garrod Building, Turner Street, London, England E1 2AD, UK.
| | | | - Beatrix Elsberger
- Ninewells Hospital, James Arrott Drive, Dundee, Scotland DD1 9SY, UK.
| | | | - Christine Obondo
- Stobhill Hospital, 133 Balornock Road, Glasgow, Scotland G21 3UW, UK.
| | - Neil Johns
- Edinburgh Breast Unit, Western General Hospital, Crewe Road South, Edinburgh, Scotland EH42XU, UK.
| | - Wisam Ismail
- Bradford Royal Infirmary, Duckworth Lane, Bradford, England BD9 6RJ, UK.
| | - Asim Syed
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK.
| | | | - Mary Venn
- Ipswich Hospital, Heath Road, Ipswich, England IP4 5PD, UK.
| | | | - Gareth Irwin
- Ulster Hospital, Upper Newtownards Road, Belfast, Northern Ireland BT16 1RH, UK.
| | - Amtul S Sami
- Lincoln County Hospital, Greetwell Road, Lincoln, England LN2 5QY, UK.
| | - Dalia Elfadl
- Royal Marsden Hospital, Downs Road, Sutton, England SM2 5PT, UK.
| | - Alice Baggaley
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK.
| | | | - Fiona Langlands
- Castle Hill Hospital, Castle Road, Cottingham, Hull, England HU16 5JQ, UK.
| | | | - Zoe Barber
- Neville Hall Hospital, Brecon Road, Abergavenny, Wales NP7 7EG, UK.
| | | | - Ayesha Khan
- Royal Surrey County Hospital, Egerton Road, Guildford, England GU2 7XX, UK.
| | - Chiara Sirianni
- Betsi Cadwaladr University Local Health Board, Town Hall Newry Street, Holyhead, Wales LL65 1HN, UK.
| | | | - Sunita Saha
- Broomfield Hospital, Court Road, Chelmsford, England CM1 7ET, UK.
| | - Risha Arun Lane
- Darent Valley Hospital, Darenth Wood Road, Dartford, England DA2 8DA, UK.
| | - Sharat Chopra
- Abertawe Bro Morgannwg University Health Board, 1 Talbot Gateway, Port Talbot, Wales SA12 7BR, UK.
| | - Sophie Dupré
- Guy's Hospital, Great Maze Pond, London, England SE1 9RT, UK.
| | - Aidan T Manning
- University Hospital Waterford, Dunmore Road, Waterford, Ireland.
| | - Edward R St John
- Charing Cross Hospital, Fulham Palace Road, London, England W6 8RF, UK.
| | - Aya Musbahi
- University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, England TS19 8PE, UK.
| | - Nokwanda Dlamini
- James Paget Hospital, Lowestoft Road, Great Yarmouth, England NR31 6LA, UK.
| | | | - Chloe Wright
- Bolton Breast Unit, Royal Bolton Hospital, Farnworth, Bolton, England BL4 0JR, UK.
| | - James O Murphy
- University Hospital Waterford, Dunmore Road, Waterford, Ireland.
| | - Ravi Aggarwal
- Hillingdon Hospital, Pield Heath Road, Uxbridge, England UB8 3NN, UK.
| | - Matei Dordea
- University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, England TS19 8PE, UK.
| | - Karen Bosch
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Donna Egbeare
- Cardiff and Vale University Health Board, Heath Park, Cardiff, Wales CF14 4XW, UK.
| | - Hisham Osman
- Frimley Park Hospital, Portsmouth Road, Camberley, England GU16 7UJ, UK.
| | - Salim Tayeh
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK.
| | - Faraz Razi
- North Hampshire Hospital, Aldermaston Road, Basingstoke, England RG24 9NA, UK.
| | - Javeria Iqbal
- Diana Princess of Wales Hospital, Scartho Road, Grimsby, England DN33 2BA, UK.
| | | | - Vanessa Albert
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK
| | - Yazan Masannat
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK; University of Aberdeen, Aberdeen, Scotland AB24 3FX, UK; University of East Anglia, Norwich, England NR4 7TJ, UK
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Mitchell P, Åkesson K, Chandran M, Cooper C, Ganda K, Schneider M. Implementation of Models of Care for secondary osteoporotic fracture prevention and orthogeriatric Models of Care for osteoporotic hip fracture. Best Pract Res Clin Rheumatol 2017; 30:536-558. [PMID: 27886945 DOI: 10.1016/j.berh.2016.09.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/09/2016] [Accepted: 09/10/2016] [Indexed: 12/29/2022]
Abstract
As the world's population ages, the prevalence of osteoporosis and its resultant fragility fractures is set to increase dramatically. This chapter focuses on current frameworks and major initiatives related to the implementation of fracture liaison services (FLS) and orthogeriatrics services (OGS), Models of Care designed to reliably implement secondary fracture prevention measures for individuals presenting to health services with fragility fractures. The current evidence base regarding the impact and effectiveness of FLS and OGS is also considered.
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Affiliation(s)
- Paul Mitchell
- Synthesis Medical NZ Limited, Pukekohe, New Zealand; University of Notre Dame Australia, Sydney, Australia; Osteoporosis New Zealand, Wellington, New Zealand.
| | - Kristina Åkesson
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, ACADEMIA, 20 College Road, 169856, Singapore
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute of Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, The Botnar Research Centre, University of Oxford, Oxford, UK
| | - Kirtan Ganda
- The University of Sydney, Concord Clinical School and Concord Repatriation General Hospital, 1A Hospital Road, Concord Hospital, NSW, 2139, Australia
| | - Muriel Schneider
- International Osteoporosis Foundation, 9, Rue Juste-Olivier, 1260, Nyon, Switzerland
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Hidalgo M, Álvarez R, Gallego J, Guillén-Ponce C, Laquente B, Macarulla T, Muñoz A, Salgado M, Vera R, Adeva J, Alés I, Arévalo S, Blázquez J, Calsina A, Carmona A, de Madaria E, Díaz R, Díez L, Fernández T, de Paredes BG, Gallardo ME, González I, Hernando O, Jiménez P, López A, López C, López-Ríos F, Martín E, Martínez J, Martínez A, Montans J, Pazo R, Plaza JC, Peiró I, Reina JJ, Sanjuanbenito A, Yaya R, Carrato A. Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic cancer in Spain. Clin Transl Oncol 2017; 19:667-681. [PMID: 27995549 PMCID: PMC5427095 DOI: 10.1007/s12094-016-1594-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/24/2016] [Indexed: 12/12/2022]
Abstract
The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.
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Affiliation(s)
- M Hidalgo
- Spanish National Cancer Centre, C/Melchor Fernández Almagro, 3, 28029, Madrid, Spain.
- Beth Israel Deaconess Medical Center, Boston, USA.
| | - R Álvarez
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - J Gallego
- University Hospital of Elche, Elche, Spain
| | - C Guillén-Ponce
- Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, 28034, Madrid, Spain
| | - B Laquente
- Institut Català d´Oncologia, Duran y Reynals Hospital, Hospitalet Llobregat, Barcelona, Spain
| | - T Macarulla
- Vall d'Hebrón University Hospital, Barcelona, Spain
| | - A Muñoz
- University Hospital Gregorio Marañón, Madrid, Spain
| | - M Salgado
- University Hospital of Ourense, Ourense, Spain
| | - R Vera
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - J Adeva
- University Hospital 12 de Octubre, Madrid, Spain
| | - I Alés
- Hospital Carlos Haya, Málaga, Spain
| | - S Arévalo
- University Hospital Donostia, San Sebastián, Spain
| | - J Blázquez
- Department of Radiology, University Hospital Ramón y Cajal, Madrid, Spain
- MD Anderson Hospital, Madrid, Spain
| | - A Calsina
- Department of Palliative Care, Hospital Germans Trias I Pujol, Institut Catalá d´Oncologia, Badalona, Spain
| | - A Carmona
- Department of Medical Oncology and Hematology, University Hospital Morales Messeguer, Murcia, Spain
| | - E de Madaria
- Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
| | - R Díaz
- Department of Medical Oncology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - L Díez
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - T Fernández
- Department of Medical Oncology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | | | - M E Gallardo
- Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - I González
- Complejo Hospitalario de Granada, Granada, Spain
| | - O Hernando
- Department of Radiotherapy, University Hospital HM Sanchinarro, Madrid, Spain
- University Hospital HM Puerta del Sur, Madrid, Spain
| | - P Jiménez
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Asturias, Spain
| | - A López
- Hospital Universitario de Burgos, Burgos, Spain
| | - C López
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - F López-Ríos
- Department of Pathology, University Hospital HM Sanchinarro, Madrid, Spain
| | - E Martín
- Department of Surgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - J Martínez
- Department of Medical Oncology, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - J Montans
- Department of Pathology, Centro Anatomopatológico, Madrid, Spain
| | - R Pazo
- Department of Medical Oncology, University Hospital Miguel Servet, Saragossa, Spain
| | - J C Plaza
- Department of Pathology, University Hospital HM Sanchinarro, Madrid, Spain
| | - I Peiró
- Department of Endocrinology, Instituto Catalán de Oncología, Hospital Duran I Reynals, Hospitalet de Llobregat, Barcelona, Spain
| | - J J Reina
- Department of Medical Oncology, University Hospital Virgen de la Macarena, Seville, Spain
| | - A Sanjuanbenito
- Department of Surgery, University Hospital Ramón y Cajal, Madrid, Spain
| | - R Yaya
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Alfredo Carrato
- Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, 28034, Madrid, Spain.
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Engelborghs S, Niemantsverdriet E, Struyfs H, Blennow K, Brouns R, Comabella M, Dujmovic I, van der Flier W, Frölich L, Galimberti D, Gnanapavan S, Hemmer B, Hoff E, Hort J, Iacobaeus E, Ingelsson M, Jan de Jong F, Jonsson M, Khalil M, Kuhle J, Lleó A, de Mendonça A, Molinuevo JL, Nagels G, Paquet C, Parnetti L, Roks G, Rosa-Neto P, Scheltens P, Skårsgard C, Stomrud E, Tumani H, Visser PJ, Wallin A, Winblad B, Zetterberg H, Duits F, Teunissen CE. Consensus guidelines for lumbar puncture in patients with neurological diseases. Alzheimers Dement (Amst) 2017; 8:111-126. [PMID: 28603768 PMCID: PMC5454085 DOI: 10.1016/j.dadm.2017.04.007] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction Cerebrospinal fluid collection by lumbar puncture (LP) is performed in the diagnostic workup of several neurological brain diseases. Reluctance to perform the procedure is among others due to a lack of standards and guidelines to minimize the risk of complications, such as post-LP headache or back pain. Methods We provide consensus guidelines for the LP procedure to minimize the risk of complications. The recommendations are based on (1) data from a large multicenter LP feasibility study (evidence level II-2), (2) systematic literature review on LP needle characteristics and post-LP complications (evidence level II-2), (3) discussion of best practice within the Joint Programme Neurodegenerative Disease Research Biomarkers for Alzheimer's disease and Parkinson's Disease and Biomarkers for Multiple Sclerosis consortia (evidence level III). Results Our consensus guidelines address contraindications, as well as patient-related and procedure-related risk factors that can influence the development of post-LP complications. Discussion When an LP is performed correctly, the procedure is well tolerated and accepted with a low complication rate.
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Affiliation(s)
- Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Ellis Niemantsverdriet
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Raf Brouns
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irena Dujmovic
- Clinic of Neurology, Clinical Centre of Serbia, Department of Neurology, Faculty of Medicine, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Wiesje van der Flier
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty, Mannheim/Heidelberg University, Mannheim, Germany
| | - Daniela Galimberti
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy
| | - Sharmilee Gnanapavan
- Department of Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Bernhard Hemmer
- Department of Neurology, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Erik Hoff
- Department of Neurology, Atrium Medisch Centrum Parkstad, Heerlen, The Netherlands
| | - Jakub Hort
- Memory Disorders Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Frank Jan de Jong
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michael Jonsson
- Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Michael Khalil
- Department of Neurology, Medical University Graz, Graz, Austria
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red en enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Alexandre de Mendonça
- Laboratory of Neurosciences, Department of Molecular Medicine and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - José Luis Molinuevo
- Alzheimer's disease and other cognitive disorders unit, Neurology Service, Hospital Clinic i Universitari, IDIBAPS, Barcelona, Spain
| | - Guy Nagels
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Faculté de Psychologie et des sciences de l'éducation, UMons, Mons, Belgium.,National MS Center Melsbroek, Brussels, Belgium
| | - Claire Paquet
- Research Memory Center Lariboisière Hospital University Paris Diderot INSERMU942, Paris, France
| | - Lucilla Parnetti
- Section of Neurology, Centre for Memory Disturbances, Department of Medicine, University of Perugia, Perugia, Italy
| | - Gerwin Roks
- Department of Neurology, St Elisabeth Ziekenhuis, Tilburg, The Netherlands
| | - Pedro Rosa-Neto
- Departments of Neurology & Neurosurgery and Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada.,Departments of Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada
| | - Philip Scheltens
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hayrettin Tumani
- CSF Laboratory and Multiple Sclerosis Outpatient Unit, Department of Neurology, University of Ulm, Ulm, Germany
| | - Pieter Jelle Visser
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Anders Wallin
- Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Bengt Winblad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,UCL Institute of Neurology, Department of Molecular Neuroscience, London, United Kingdom
| | - Flora Duits
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Suneja G, Brown D, Chang A, Erickson B, Fidarova E, Grover S, Mahantshetty U, Nag S, Narayan K, Bvochora-Nsingo M, Viegas C, Viswanathan AN, Lin MY, Gaffney D. American Brachytherapy Society: Brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries. Brachytherapy 2016; 16:85-94. [PMID: 27919654 DOI: 10.1016/j.brachy.2016.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings. METHODS AND MATERIALS A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC. RESULTS Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article. CONCLUSIONS Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up.
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Affiliation(s)
| | - Derek Brown
- University of California San Diego, San Diego, CA
| | - Amy Chang
- Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA; Princess Marina Hospital, Gaborone, Botswana
| | | | | | | | | | - Celia Viegas
- Instituto Nacional de Cancer- INCA, Rio de Janeiro, Brazil
| | | | - Ming Yin Lin
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Valentini V, Gambacorta MA, Barbaro B, Chiloiro G, Coco C, Das P, Fanfani F, Joye I, Kachnic L, Maingon P, Marijnen C, Ngan S, Haustermans K. International consensus guidelines on Clinical Target Volume delineation in rectal cancer. Radiother Oncol 2016; 120:195-201. [PMID: 27528121 DOI: 10.1016/j.radonc.2016.07.017] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/07/2016] [Accepted: 07/23/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The delineation of Clinical Target Volume (CTV) is a critical step in radiotherapy. Several guidelines suggest different subvolumes and anatomical boundaries in rectal cancer (RC), potentially leading to a misunderstanding in the CTV definition. International consensus guidelines (CG) are needed to improve uniformity in RC CTV delineation. MATERIAL AND METHODS The 7 radiation oncologist experts defined a roadmap to produce RC CG. Step 1: revision of the published guidelines. Step 2: selection of RC cases with different clinical stages. Step 3: delineation of cases using Falcon following previously published guidelines. Step 4: meeting in person to discuss the initial delineation outcome, followed by a CTV proposal based on revised and if needed, adapted anatomical boundaries. Step 5: peer review of the agreed consensus. Step 6: peer review meeting to validate the final outcome. Step 7: completion of RC delineation atlases. RESULTS A new ontology of structure sets was defined and the related table of anatomical boundaries was generated. The major modifications were about the lateral lymph nodes and the ischio-rectal fossa delineation. Seven RC cases were made available online as consultation atlases. CONCLUSION The definition of international CG for RC delineation endorsed by international experts might support a future homogeneous comparison between clinical trial outcomes.
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Affiliation(s)
- Vincenzo Valentini
- Università Cattolica del Sacro Cuore, Radiation Oncology Department, Rome, Italy.
| | | | - Brunella Barbaro
- Università Cattolica del Sacro Cuore, Department of Radiological Sciences, Rome, Italy.
| | - Giuditta Chiloiro
- Università Cattolica del Sacro Cuore, Radiation Oncology Department, Rome, Italy.
| | - Claudio Coco
- Università Cattolica del Sacro Cuore, Department of Surgical Science, Rome, Italy.
| | - Prajnan Das
- University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA.
| | - Francesco Fanfani
- University G. D'Annunzio, Gynecologic Oncology Department of Medicine and Aging Sciences, Chieti, Italy.
| | - Ines Joye
- KU Leuven - University of Leuven, Department of Oncology and University Hospitals Leuven, Radiation Oncology, Belgium.
| | - Lisa Kachnic
- Boston Medical Center, Department of Radiation Oncology, USA.
| | - Philippe Maingon
- Centre Georges-François Leclerc, Department of Radiation Oncology, Dijon, France.
| | - Corrie Marijnen
- Leiden University Medical Center, Department of Radiation Oncology, The Netherlands.
| | - Samuel Ngan
- Peter MacCallum Cancer Centre, Division of Radiation Oncology and Cancer Imaging, Melbourne, Australia.
| | - Karin Haustermans
- KU Leuven - University of Leuven, Department of Oncology and University Hospitals Leuven, Radiation Oncology, Belgium.
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Goh BKP, Teo JY, Allen JC, Tan DMY, Chan CY, Lee SY, Tai DWM, Thng CH, Cheow PC, Chow PKH, Ooi LLPJ, Chung AYF. Preoperative platelet-to-lymphocyte ratio improves the performance of the international consensus guidelines in predicting malignant pancreatic cystic neoplasms. Pancreatology 2016; 16:888-92. [PMID: 27421563 DOI: 10.1016/j.pan.2016.06.660] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/08/2016] [Accepted: 06/24/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To determine if neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were predictive of malignancy in pancreatic cystic neoplasms (PCN) and if these improved the performance of the international consensus guidelines (ICG) in the initial triage of these patients. METHODS 318 patients with surgically-treated suspected PCN were retrospectively reviewed. Malignant neoplasms were defined as neoplasms harbouring invasive carcinoma. The optimal cut-off for NLR and PLR were determined by plotting the receiver operating characteristics (ROC) curves of NLR/PLR in predicting malignant PCN and utilizing the Youden index. RESULTS The optimal NLR and PLR cut-offs were determined to be 3.33 and 205, respectively. Univariate analyses demonstrated that symptomatic PCNs, age, obstructive jaundice, presence of solid component, dilatation of main pancreatic duct ≥10 mm, high NLR and high PLR were predictive of a malignant PCN. Multivariate analyses demonstrated that obstructive jaundice, presence of solid component, MPD ≥10 mm and high PLR but not NLR were independent predictors of a malignant PCN. A high PLR significantly predicted invasive carcinoma in patients classified within the ICG(HR) group. Comparison between the ROC curves of the ICG versus ICG plus high PLR in predicting malignant PCN demonstrated a significant improvement in the accuracy of the ICG when PLR was included [AUC 0.784 (95% CI: 0.740-0.829) vs AUC 0.822 (95% CI: 0.772-0.872) (p = 0.0032)]. CONCLUSIONS High PLR is an independent predictor of malignancy in PCN. The addition of PLR as a criterion to the ICG improved the accuracy of these guidelines in detecting invasive neoplasms.
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Affiliation(s)
- Brian K P Goh
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, Singapore.
| | - Jin-Yao Teo
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | | | - Damien M Y Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Ser-Yee Lee
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - David W M Tai
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Choon-Hua Thng
- Department of Diagnostic Imaging, National Cancer Centre, Singapore
| | - Peng-Chung Cheow
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Pierce K H Chow
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - London L P J Ooi
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Alexander Y F Chung
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
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Tan WS, Rodney S, Lamb B, Feneley M, Kelly J. Management of non-muscle invasive bladder cancer: A comprehensive analysis of guidelines from the United States, Europe and Asia. Cancer Treat Rev 2016; 47:22-31. [PMID: 27231966 DOI: 10.1016/j.ctrv.2016.05.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 11/21/2022]
Abstract
Bladder cancer is the 8th most common cancer with 74,000 new cases in the United States in 2015. Non-muscle invasive bladder cancer (NMIBC) accounts for 75% of all bladder cancer cases. Transurethral resection and intravesical treatments remain the main treatment modality. Up to 31-78% of cases recur, hence the need for intensive treatment and surveillance protocols which makes bladder cancer one of the most expensive cancers to manage. The purpose of this review is to compare contemporary guidelines from Europe, (European Association of Urology), the United States (National Comprehensive Cancer Network), the United Kingdom (National Institute for Health and Care Excellence), Japan (Japanese Urological Association) and the International Consultation on Bladder Cancer (ICUD). We compare and contrast the different guidelines and the evidence on which their recommendations are based.
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Buzás GM. Fate of meta-analyses: The case of Helicobacter pylori. World J Meta-Anal 2015; 3:20-25. [DOI: 10.13105/wjma.v3.i1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/10/2014] [Accepted: 12/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To overview the current diversity of meta-analysis and the implementation of their results in international guidelines.
METHODS: Relevant meta-analysis were identified from PubMed/Medline. The topics of meta-analyses were determined. Some topics (genetics, extragastric tumors) were analysed separately. Core journals publishing meta-analyses on Helicobacter pylori were ranked. The rate of citation of meta-analysis in major guidelines was calculated.
RESULTS: Between 1992 and 2014, some 356 meta-analyses were published on PubMed. These mainly appeared in core journals, but were also found in 128 other journals. Eradicating of the infection was the most addressed topic with 134 articles. Meta-analyses were rarely used in formulating statements and recommendations in the international guidelines. In other topics - genetics, extraintestinal manifestations - meta-analyses were rather overused.
CONCLUSION: The implementation of meta-analysis in current guidelines is rather rare, while other topics benefit from many studies. A more extensive use of meta-analyses in evidence-based medicine is recommended in the future, otherwise their continuous proliferation will lose reason and scientific significance.
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Björck M, Wanhainen A. Management of abdominal compartment syndrome and the open abdomen. Eur J Vasc Endovasc Surg 2014; 47:279-87. [PMID: 24447530 DOI: 10.1016/j.ejvs.2013.12.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The management of the abdominal compartment syndrome (ACS) and the open abdomen (OA) are important to improve survival after major vascular surgery, in particular ruptured abdominal aortic aneurysm (RAAA). The aim is to summarize contemporary knowledge in this field. METHODS The consensus definitions of the World Society of the Abdominal Compartment Syndrome (WSACS) that were published in 2006 and the clinical practice guidelines published in 2007 were updated in 2013. Structured clinical questions were formulated (modified Delphi method), and the evidence base to answer those questions was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines. RESULTS Most of the previous definitions were kept untouched, or were slightly modified. Four new definitions were added, including a definition of OA and of lateralization of the abdominal wall, an important clinical problem to approach during prolonged OA treatment. A classification system of the OA was added. Seven recommendations were formulated, in summary: Trans-bladder intra-abdominal pressure (IAP) should be monitored in patients at risk. Protocolized monitoring and management are recommended, and decompression laparotomy if ACS. When OA, protocolized efforts to obtain an early abdominal fascial closure, and strategies utilizing negative pressure wound therapy should be used, versus not. In most cases the evidence was graded as weak or very weak. In six of the structured clinical questions, no recommendation could be made. CONCLUSION This review summarizes changes in definitions and management guidelines of relevance to vascular surgery, and data on the incidence of ACS after open and endovascular aortic surgery.
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Affiliation(s)
- M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
| | - A Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Ruemmele FM, Turner D. Differences in the management of pediatric and adult onset ulcerative colitis--lessons from the joint ECCO and ESPGHAN consensus guidelines for the management of pediatric ulcerative colitis. J Crohns Colitis 2014; 8:1-4. [PMID: 24230969 DOI: 10.1016/j.crohns.2013.10.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 10/19/2013] [Indexed: 02/08/2023]
Abstract
An expert panel of the European Crohn's and Colitis Organisation (ECCO) and European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) initiated a consensus process to produce the first pediatric specific ulcerative colitis (UC) guidelines based on a systematic literature review. Treatment strategies must reflect that pediatric-onset UC has a slightly different phenotype than adult-onset disease with more often extensive (pancolitis) and more aggressive disease course. Other pediatric-specific aspects include growth, puberty, bone density accrual and emotional development and body image acquisition. These differences and others influenced the development of pediatric treatment algorithms. It is recommended that virtually all children with UC must be treated with some maintenance therapy and 5-ASA requirement and dosing are often higher in children. A larger number of children are at risk for steroid-dependency, and this should not be tolerated; steroid sparing strategies with early use of immunosuppressors are recommended in high-risk patients. On the other hand, the safety profile of immunosuppressive therapy in children includes the rare forms of lymphomas and many future treatment years. Colectomy and pouch formation should be balanced in the treatment algorithms against the higher rate of future infertility in girls. The acute and on-going management of pediatric UC should be guided by evidence- and consensus-based balanced decisions, reflecting a vision of long-term treatment goals.
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Affiliation(s)
- Frank M Ruemmele
- Université Sorbonne Paris Cité, Paris Descartes, Paris, France; APHP, Hôpital Necker Enfants Malades, Service de Gastroentérologie, Pediatric IBD Program, Paris, France.
| | - Dan Turner
- Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
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Albright KC, Martin-Schild S, Bockholt HJ, Howard G, Alexandrov A, Alexandrov A, Sline MR, Grotta JC, Savitz SI. No consensus on definition criteria for stroke registry common data elements. Cerebrovasc Dis Extra 2011; 1:84-92. [PMID: 22566986 PMCID: PMC3343760 DOI: 10.1159/000334146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Stroke registries contribute to the conduct of clinical research and to the assessment of health care quality control. Efforts to compare clinical outcomes and quality indicators between centers are dependent on standardized data elements, but it is unknown how stroke physicians define common data elements, such as hypertension or diabetes, when collecting data for registries at their centers. METHODS We conducted an internet-based survey of 91 centers affiliated with a university to assess their definitions of common data elements (CDEs) and compared their responses with standardized definitions, including those from the American College of Cardiology (ACC). RESULTS More than half (52%) of centers completed the survey. There was only modest agreement among respondents regarding definitions of CDEs in the survey and even less agreement on how the respondents' definitions compared to ACC standards. CONCLUSIONS Surveyed respondents do not agree on the definitions of CDEs, making comparisons between centers problematic. Standardized definitions of CDEs are needed to improve data collection for patient care and clinical research.
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Affiliation(s)
- Karen C. Albright
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - Sheryl Martin-Schild
- Department of Neurology, Tulane University School of Medicine-New Orleans, New Orleans, La., USA
| | | | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - Andrei Alexandrov
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - Anne Alexandrov
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Ala., USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - M. Rick Sline
- Department of Neurology, University of Texas at Houston, Houston, Tex., USA
| | - James C. Grotta
- Department of Neurology, University of Texas at Houston, Houston, Tex., USA
| | - Sean I. Savitz
- Department of Neurology, University of Texas at Houston, Houston, Tex., USA
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