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Bayram F, Sonmez A, Kiyici S, Akbas F, Yetgin MK, Yazici D, Cingi A, Sargin M, Unal S, Iseri C, Mahmutoglu FS, Yumuk VD. Expert Opinion on the Utility of Telemedicine in Obesity Care: Recommendations on a Hybrid Multidisciplinary Integrated Care Follow-Up Algorithm. Curr Obes Rep 2024; 13:167-182. [PMID: 38172478 DOI: 10.1007/s13679-023-00541-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW The proposed expert opinion was prepared by a panel of obesity and law specialists from Turkey to review the utility of telemedicine in obesity care and to provide a guidance document with recommendations on a hybrid multidisciplinary integrated care follow-up algorithm and the legislation governing telemedicine practice to assist obesity specialists in practicing the telemedicine. RECENT FINDINGS The efficacy and feasibility of telemedicine interventions in supporting obesity management programs even during pandemics confirm that obesity is a particularly well-suited field for telemedicine, emphasizing the strong likelihood of continued utilization of telemedicine in obesity management, beyond the pandemic period. Telemedicine has great potential to address several barriers to ongoing weight-management care, such as challenges of access to specialized care, cost, and time limitations as well as patient adherence to treatment. However, telemedicine practice should complement rather than replace the in-person visits which are unique in building rapport and offering social support. Accordingly, the participating experts recommend the use of a hybrid integrated care model in the management of obesity, with the use of telemedicine, as an adjunct to in-person visits, to enable the provision of suggested intensive obesity management via frequent visits by a multidisciplinary team of obesity specialists. Further research addressing the utility of telemedicine in terms of optimal modality and duration for successful long-term obesity management outcomes is necessary to develop specific guidelines on telemedicine practice. In addition, the legislation governing the norms and protocols on confidentiality, privacy, access, and liability needs to be improved.
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Affiliation(s)
- Fahri Bayram
- Department of Endocrinology and Metabolism, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Alper Sonmez
- Department of Endocrinology and Metabolism, Ankara Guven Hospital, Ankara, Turkey
| | - Sinem Kiyici
- Department of Endocrinology and Metabolism, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Feray Akbas
- Department of Internal Medicine, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Meral Kucuk Yetgin
- Department of Coaching Education, Sport Health Sciences, Marmara University Faculty of Sports Science, Istanbul, Turkey
| | - Dilek Yazici
- Department of Endocrinology and Metabolism, Koc University Faculty of Medicine, Istanbul, Turkey
| | - Asim Cingi
- Department of General Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Sargin
- Department of Family Medicine, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Seniz Unal
- Private Clinical Psychology Office, Istanbul, Turkey
| | - Ceren Iseri
- Department of Internal Medicine, Nutrition Science, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fatih Selami Mahmutoglu
- Department of Criminal Law and Criminal Procedure Law, Turkish-German University Faculty of Law, Istanbul, Turkey
| | - Volkan Demirhan Yumuk
- Department of Endocrinology and Metabolism, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
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Kojima M, Sugihara T, Kawahito Y, Kojima T, Kaneko Y, Ishikawa H, Abe A, Matsui K, Hirata S, Kishimoto M, Tanaka E, Morinobu A, Hashimoto M, Matsushita I, Hidaka T, Matsui T, Nishida K, Asai S, Ito H, Harada R, Harigai M. Consensus statement on the management of late-onset rheumatoid arthritis. Mod Rheumatol 2024:roae011. [PMID: 38511322 DOI: 10.1093/mr/roae011] [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: 01/19/2024] [Accepted: 02/08/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Late-onset rheumatoid arthritis (LORA), which has been increasing in recent years, lacks evidence for initial treatment. Japanese rheumatology experts recognized this gap and addressed it by developing consensus statements on the first clinical application of LORA. METHODS These statements were created following an introductory discussion about treatment fundamentals, which included a review of existing literature and cohort data. The steering committee created a draft, which was refined using a modified Delphi method that involved panel members reaching a consensus. The panel made decisions based on input from geriatric experts, clinical epidemiologists, guideline developers, patient groups, and the LORA Research Subcommittee of the Japan College of Rheumatology. RESULTS The consensus identified four established facts, three basic approaches, and six expert opinions for managing LORA. Methotrexate was recommended as the primary treatment, with molecular-targeted agents being considered if treatment goals cannot be achieved. An emphasis was placed on assessing the lives of older patients due to challenges in risk management and methotrexate accessibility caused by comorbidities or cognitive decline. CONCLUSIONS The experts substantiated and refined 13 statements for the initial treatment of LORA. To validate these claims, the next is to conduct a registry study focusing on new LORA cases.
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Affiliation(s)
- Masayo Kojima
- Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
- Department of Frailty Research, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takahiko Sugihara
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Ishikawa
- Department of Rheumatology, Niigata Rheumatic Center, Shibata, Niigata, Japan
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, Shibata, Niigata, Japan
| | - Kazuo Matsui
- Department of Rheumatology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Eiichi Tanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Isao Matsushita
- Department of Rehabilitation Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Toshihiko Hidaka
- Institute of Rheumatology, Miyazaki-Zenjinkai Hospital, Miyazaki, Japan
| | - Toshihiro Matsui
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | | | - Shuji Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Ryozo Harada
- Department of Orthopaedic Surgery, Kurashiki Sweet Hospital, Kurashiki, Okayama, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Ditonno F, Licari LC, Franco A, Bologna E, Manfredi C, Soputro NA, Ramos R, Antonelli A, Nelson RJ, Ahmed M, Stifelman M, Badani K, Kaouk J, Crivellaro S, Autorino R. Current Expectations and Opinions on Single-port Robotic Surgery: A Survey Among European Experts by the SPARC Collaborative Group. EUR UROL SUPPL 2024; 60:54-57. [PMID: 38327978 PMCID: PMC10847014 DOI: 10.1016/j.euros.2024.01.007] [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] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Single-port (SP) robotic surgery is a relatively new technology that is expected to become available on the European market within a year. We investigated the current expectations of robotic surgery experts and opinion leaders practicing in Europe. A 17-item online questionnaire was sent to 120 participants identified as "experts" on the basis of their general contributions to the field of robotic surgery. Overall, 90 responses were registered, with a response rate of 75%. Italy (30%), France (15%), and the UK (12%) provided the most participants, who worked mainly in academic-either public (60%) or private (20%)-hospitals. Most respondents (79%) had no previous experience with "single site" surgery, and attendance at scientific meetings (79%) and perusal of the literature (65%) were the sources of SP knowledge most frequently reported. The perceived advantages of SP robotic surgery included lower invasiveness (61%), easier access to the retroperitoneal or extraperitoneal space (53%), better cosmetic results (44%), and lower postoperative pain (44%). The most "appealing" SP procedures were retroperitoneal partial nephrectomy via an anterior approach (43%) and transvesical simple prostatectomy (43%). Within the limitations of this type of analysis, our findings suggest high interest and a positive attitude towards SP technology overall. Patient summary Technology for single-port (SP) robotic surgery, in which just one skin incision is made in the abdomen to perform the operation, will soon be available in Europe. We conducted a survey on SP surgery among European experts in urological robotic surgery. The results show that there is high interest in and a positive attitude to SP surgery. The SP approach could result in better cosmetic results and lower postoperative pain for patients.
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Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Urology Unit, Department of Maternal-Child and Urological Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Urology Unit, Department of Maternal-Child and Urological Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University, Naples, Italy
| | - Nicolas A. Soputro
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Roxana Ramos
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ryan J. Nelson
- Department of Urology, McLaren Macomb Hospital, Mount Clemens, MI, USA
- Department of Urology, Henry Ford Macomb Hospital, Clinton Township, MI, USA
- Michigan Institute of Urology, Livonia, MI, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Micheal Stifelman
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Ketan Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jihad Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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Del Rosso J, Baldwin H, Bhatia N, Chavda R, York JP, Harper J, Hougeir FG, Jackson JM, Noor O, Rodriguez DA, Schlesinger T, Weiss J. A Review of the Diagnostic and Therapeutic Gaps in Rosacea Management: Consensus Opinion. Dermatol Ther (Heidelb) 2024; 14:271-284. [PMID: 38194021 PMCID: PMC10891023 DOI: 10.1007/s13555-023-01087-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
Rosacea is a common, chronic inflammatory disease characterized by both fluctuating and fixed heterogeneous signs such as facial erythema, papules/pustules, telangiectasia, acute vasodilation (flushing), and phymatous changes, and symptoms such as cutaneous stinging and burning. The shift to a phenotype-based approach to rosacea management has improved the consistency of recommendations across recent published guidelines. Consistent and thorough guidance for the classification, diagnosis, and management of the disease is difficult, as the mechanisms underlying the development of rosacea are still not completely understood nor universally accepted. Here, we provide a critical review of current published guidance, and gaps in the knowledge and management of rosacea. We present the recently approved microencapsulated benzoyl peroxide as an effective topical treatment option for papulopustular rosacea. Benzoyl peroxide (BPO) has been used in acne management for many years; however, many clinicians perceive treatment of rosacea with any BPO formulation to be counterintuitive because of concerns of potential skin irritation, while the lack of an accepted mechanism of action on rosacea pathophysiology means that others may be hesitant to use BPO as a treatment. Minocycline foam 1.5% is also an option for the treatment of inflammatory lesions in rosacea, with a decreased risk of systemic adverse events compared with oral minocycline.
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Affiliation(s)
- James Del Rosso
- Touro University Nevada, Henderson, NV, USA.
- JDR Dermatology Research, 9080 West Post Road, Suite 100, Las Vegas, NV, 89149, USA.
- Advanced Dermatology and Cosmetic Surgery, Maitland, FL, USA.
| | - Hilary Baldwin
- Robert Wood Johnson Medical Center, New Brunswick, NJ, USA
- The Acne Treatment and Research Center, Brooklyn, NY, USA
| | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, CA, USA
| | | | | | - Julie Harper
- Dermatology and Skin Care Center of Birmingham, Birmingham, AL, USA
| | | | | | | | - David A Rodriguez
- Research Dadeland Dermatology Group, University of Miami, Coral Gables, FL, USA
| | | | - Jonathan Weiss
- Georgia Dermatology Partners, Snellville, GA, USA
- Gwinnett Clinical Research Center, Snellville, GA, USA
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van Ede AFTM, Stein KV, Bruijnzeels MA. Assembling a population health management maturity index using a Delphi method. BMC Health Serv Res 2024; 24:110. [PMID: 38243278 PMCID: PMC10799527 DOI: 10.1186/s12913-024-10572-5] [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: 02/20/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Although local initiatives commonly express a wish to improve population health and wellbeing using a population health management (PHM) approach, implementation is challenging and existing tools have either a narrow focus or lack transparency. This has created demand for practice-oriented guidance concerning the introduction and requirements of PHM. METHODS Existing knowledge from scientific literature was combined with expert opinion obtained using an adjusted RAND UCLA appropriateness method, which consisted of six Dutch panels in three Delphi rounds, followed by two rounds of validation by an international panel. RESULTS The Dutch panels identified 36 items relevant to PHM, in addition to the 97 items across six elements of PHM derived from scientific literature. Of these 133 items, 101 were considered important and 32 ambiguous. The international panel awarded similar scores for 128 of 133 items, with only 5 items remaining unvalidated. Combining literature and expert opinion gave extra weight and validity to the items. DISCUSSION In developing a maturity index to help assess the use and progress of PHM in health regions, input from experts counterbalanced a previous skewedness of item distribution across the PHM elements and the Rainbow Model of Integrated Care (RMIC). Participant expertise also improved our understanding of successful PHM implementation, as well as how the six PHM elements are best constituted in a first iteration of a maturity index. Limitations included the number of participants in some panels and ambiguity of language. Further development should focus on item clarity, adoption in practice and item interconnectedness. CONCLUSION By employing scientific literature enriched with expert opinion, this study provides new insight for both science and practice concerning the composition of PHM elements that influence PHM implementation. This will help guide practices in their quest to implement PHM.
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Affiliation(s)
- A F T M van Ede
- Health Campus The Hague / Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, The Netherlands.
| | - K V Stein
- Health Campus The Hague / Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, The Netherlands
| | - M A Bruijnzeels
- Health Campus The Hague / Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, The Netherlands
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Fazio N, Falconi M, Foglia E, Bartolomei M, Berruti A, D'Onofrio M, Ferone D, Giordano A, Grimaldi F, Milione M, Panzuto F, Santimaria M, Schillaci O, Seregni E, Stasi M, Volante M, Lastoria S. Optimising Radioligand Therapy for Patients with Gastro-Entero-Pancreatic Neuroendocrine Tumours: Expert Opinion from an Italian Multidisciplinary Group. Adv Ther 2024; 41:113-129. [PMID: 37987917 PMCID: PMC10796590 DOI: 10.1007/s12325-023-02714-8] [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: 07/24/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
Radioligand therapy (RLT) with lutetium (177Lu) oxodotreotide is an approved therapy in combination with somatostatin analogues (SSAs) for patients with advanced, well-differentiated G1-G2, gastro-entero-pancreatic neuroendocrine tumours (GEP-NETs) that progress on SSAs. We conducted a series of round table meetings throughout Italy to identify issues related to RLT delivery to patients with GEP-NETs. Four key issues were identified: (1) the proper definition of tumour progression prior to RLT initiation; (2) the impact of RLT in patients with bone metastases and/or high hepatic tumour burden; (3) the optimal follow-up protocol after RLT; and (4) organisational issues related to RLT use and managerial implications. This article reviews the literature relating to the aforementioned issues and makes recommendations based on available evidence and Italian NET experts' opinions. In particular, the group recommends the development of a diagnostic-therapeutic care pathway (DTCP) for patients undergoing RLT which provides systematic guidance but can still be individualised for each patient's clinical and psychosocial needs. A DTCP may clarify the diagnostic, therapeutic and post-treatment monitoring process, and improve communication and the coordination of care between hub and spoke centres. The DTCP may also contribute to changes in the care process related to the 2013/59/EURATOM Directive and to the definition of costs when planning for future or updated reimbursement of RLT in Italy.
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Affiliation(s)
- Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, Istituto Europeo di Oncologia (IEO) IRCCS, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuela Foglia
- School of Industrial Engineering and HD LAB-Carlo Cattaneo-LIUC University, Castellanza, Italy
| | - Mirco Bartolomei
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, ASST Spedali Civili, Brescia, Italy
- Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Mirko D'Onofrio
- Radiology, GB Rossi University Hospital, University of Verona, Verona, Italy
| | - Diego Ferone
- Endocrinology, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova and Endocrinology Clinic, IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Giordano
- Nuclear Medicine Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Section of Nuclear Medicine, Dipartimento Universitario di Scienze Radiologiche ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Franco Grimaldi
- Endocrinology and Diseases of Metabolism Unit, University Hospital Santa Maria Misericordia, Udine, Italy
| | - Massimo Milione
- Anatomia Patologica 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University and Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - Monica Santimaria
- Nuclear Medicine Unit, S. Bortolo Hospital, AULSS 8 Berica, Vicenza, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Ettore Seregni
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Stasi
- Medical Physics Department, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | - Marco Volante
- Department of Oncology, University of Turin, and Pathology Unit, San Luigi Hospital, Turin, Orbassano, Italy
| | - Secondo Lastoria
- Nuclear Medicine and Therapy with Radionuclides, Cyclotron and Radiopharmacy Units, IRCCS National Cancer Institute, Fondazione Senatore G. Pascale, Via M. Semmola, 80131, Naples, Italy.
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Chung SP, Sohn Y, Lee J, Cho Y, Cha KC, Heo JS, Kim ARE, Kim JG, Kim HS, Shin H, Ahn C, Woo HG, Lee BK, Jang YS, Choi YH, Hwang SO. Expert opinion on evidence after the 2020 Korean Cardiopulmonary Resuscitation Guidelines: a secondary publication. Clin Exp Emerg Med 2023; 10:382-392. [PMID: 37620035 PMCID: PMC10790069 DOI: 10.15441/ceem.23.102] [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: 08/02/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023] Open
Abstract
Considerable evidence has been published since the 2020 Korean Cardiopulmonary Resuscitation Guidelines were reported. The International Liaison Committee on Resuscitation (ILCOR) also publishes the Consensus on CPR and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) summary annually. This review provides expert opinions by reviewing the recent evidence on CPR and ILCOR treatment recommendations. The authors reviewed the CoSTR summary published by ILCOR in 2021 and 2022. PICO (patient, intervention, comparison, outcome) questions for each topic were reviewed using a systemic or scoping review methodology. Two experts were appointed for each question and reviewed the topic independently. Topics suggested by the reviewers for revision or additional description of the guidelines were discussed at a consensus conference. Forty-three questions were reviewed, including 15 on basic life support, seven on advanced life support, two on pediatric life support, 11 on neonatal life support, six on education and teams, one on first aid, and one related to COVID-19. Finally, the current Korean CPR Guideline was maintained for 28 questions, and expert opinions were suggested for 15 questions.
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Affiliation(s)
- Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Youdong Sohn
- Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Youngsuk Cho
- Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ju Sun Heo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, Korea University, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, CHA University Ilsan Medical Center, Goyang, Korea
| | - Jae Guk Kim
- Department of Emergency Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Soo Jang
- Department of Emergency Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Yu Hyeon Choi
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - on behalf of the Guideline Committee of the Korean Association of Cardiopulmonary Resuscitation (KACPR)
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, Korea University, Seoul, Korea
- Department of Pediatrics, CHA University Ilsan Medical Center, Goyang, Korea
- Department of Emergency Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
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8
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Robert L, Rousselière C, Beuscart JB, Gautier S, Delporte L, Lafci G, Gerard E, Négrier L, Mary A, Johns E, Payen A, Ducommun R, Ferret L, Voirol P, Skalafouris C, Ade M, Potier A, Dufay E, Beney J, Frery P, Drouot S, Feutry F, Corny J, Odou P, Décaudin B. [First French-speaking days of users of decision support system in clinical pharmacy: Feedback and perspectives]. Ann Pharm Fr 2023; 81:1018-1030. [PMID: 37391030 DOI: 10.1016/j.pharma.2023.06.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
Clinical decision support systems (CDSS) are tools that have been used for several years by clinical pharmacy teams to support pharmaceutical analysis, with a perspective of contributing to the quality of care in collaboration with the other health care team members. These tools require both technical, logistical and human resources. The growing use of these systems in different establishments in France and in Europe gave birth to the idea of meeting to share our experiences. The days organized in Lille in September 2021 aimed at proposing a time of exchange and reflection on the use of these CDSS in clinical pharmacy. A first session was devoted to feedback from each establishment. These tools are essentially used to optimize pharmaceutical analysis and to secure patient medication management. This session outlined the clear advantages and common limitations of these CDSS. Two research projects were also presented to put the use of these tools into perspective. The second session of these days, in the form of workshops, addressed 4 themes that surround the implementation of CDSS: their usability, the legal aspect, the creation of rules and their possible valorization. Common problems were raised, the resolution of which requires close collaboration. This is a first step proposing a beginning of harmonization and sharing that should be deepened in order not to lose the dynamics created between the different centers. This event ended with the proposal to set up two working groups around these systems: the creation and structuring of rules for the detection of risk situations and the common valorization of the work.
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Affiliation(s)
- L Robert
- Institut de pharmacie, CHU de Lille, 59000 Lille, France.
| | - C Rousselière
- Institut de pharmacie, CHU de Lille, 59000 Lille, France
| | - J-B Beuscart
- CHU de Lille, université Lille, ULR 2694-METRICS : évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France
| | - S Gautier
- Centre régional de pharmacovigilance, CHU de Lille, université Lille, Inserm U1171, 59000 Lille, France
| | - L Delporte
- Institut de pharmacie, CHU de Lille, 59000 Lille, France
| | - G Lafci
- Institut de pharmacie, CHU de Lille, 59000 Lille, France
| | - E Gerard
- Institut de pharmacie, CHU de Lille, 59000 Lille, France
| | - L Négrier
- Institut de pharmacie, CHU de Lille, 59000 Lille, France
| | - A Mary
- Département de pharmacie, CHU d'Amiens-Picardie, 80000 Amiens, France
| | - E Johns
- Qualité, de la performance et de l'innovation, agence régionale de santé Grand-Est, 67000 Strasbourg, France
| | - A Payen
- CHU de Lille, université Lille, ULR 2694-METRICS : évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France
| | - R Ducommun
- Service de pharmacie, réseau hospitalier neuchâtelois (RHNe), 2300 La Chaux-de-Fonds, Suisse
| | - L Ferret
- Département de pharmacie, hôpital de Valenciennes, 59300 Valenciennes, France
| | - P Voirol
- Service de pharmacie, hôpital universitaire de Lausanne, université de Lausanne, 1011 Lausanne, Suisse
| | - C Skalafouris
- Service de pharmacie, hôpitaux universitaires de Genève, 1205 Genève, Suisse
| | - M Ade
- Service de pharmacie, centre psychothérapique de Nancy, 54520 Laxou, France
| | - A Potier
- Service de pharmacie, CH de Lunéville, 54300 Lunéville, France
| | - E Dufay
- Service de pharmacie, CH de Lunéville, 54300 Lunéville, France
| | - J Beney
- Service de pharmacie, hôpital du Valais, institut central des hôpitaux (ICH), 1951 Sion, Suisse
| | - Pauline Frery
- Département de pharmacie, hôpital Bel Air, centre hospitalier régional Metz-Thionville, 57100 Metz-Thionville, France
| | - Sylvain Drouot
- Service pharmacie, hôpital Bicêtre, GH Paris Saclay, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - F Feutry
- Département de pharmacie, centre Oscar-Lambret, 59000 Lille, France
| | - J Corny
- Service pharmacie, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - P Odou
- CHU de Lille, université Lille, ULR 7365-GRITA : Groupe de recherche sur les formes injectables et les technologies associées, 59000 Lille, France
| | - B Décaudin
- CHU de Lille, université Lille, ULR 7365-GRITA : Groupe de recherche sur les formes injectables et les technologies associées, 59000 Lille, France
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9
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Santini D, Banna GL, Buti S, Isella L, Stellato M, Roberto M, Iacovelli R. Navigating the Rapidly Evolving Advanced Urothelial Carcinoma Treatment Landscape: Insights from Italian Experts. Curr Oncol Rep 2023; 25:1345-1362. [PMID: 37855848 PMCID: PMC10640402 DOI: 10.1007/s11912-023-01461-x] [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] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE OF REVIEW To discuss recent advances in the treatment of advanced urothelial carcinoma (UC) and how best to incorporate new therapies into clinical practice. RECENT FINDINGS There have been several recent practice-changing phase 2 and 3 trials of immune checkpoint inhibitors (ICIs), antibody-drug conjugates (ADCs), and targeted agents in advanced UC. Based on data from these trials, ICIs can be used as first-line maintenance therapy in patients who do not progress on platinum-based chemotherapy, second-line therapy for those with progression, and first-line therapy in cisplatin-ineligible patients with PD-L1 expression; ADCs and targeted agents provide later-line treatment options. Despite substantial progress in the treatment of advanced UC, there are still many uncertainties, including the optimal treatment sequence for novel agents, and reliable predictive biomarkers to aid in treatment selection. There is also an unmet need for effective treatment options in patients unfit for any platinum-based chemotherapy.
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Affiliation(s)
- Daniele Santini
- Medical Oncology A, University of Rome, Policlinico Umberto I, "La Sapienza, Rome, Italy
| | - Giuseppe Luigi Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, PO6 3LY, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, PO1 2UP, UK
| | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy.
- Oncology Unit, University Hospital of Parma, Viale A. Gramsci 14, 43126, Parma, Italy.
| | - Luca Isella
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Marco Stellato
- Medical Oncology Department, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Michela Roberto
- UOC Oncology A, Department of Radiological, Oncological and Anatomo-Pathological Science, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Roberto Iacovelli
- UOC Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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10
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Lardy R, Botreau R, de Boyer des Roches A, van Eerdenburg FJCM, de Graaf S, Haskell MJ, Kirchner MK, Mounier L, Kjosevski M, Tuyttens FAM, Veissier I. Improvement of the Welfare Quality scoring model for dairy cows to fit experts' opinion. Animal 2023; 17:101018. [PMID: 37948890 DOI: 10.1016/j.animal.2023.101018] [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: 07/05/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
After several years of implementation, the original Welfare Quality scoring model for dairy cows appears to be highly sensitive to the number and cleanliness of drinkers and not enough to the prevalence of diseases, and as a consequence may not fit the opinion of some animal welfare experts. The present paper aims to improve the Welfare Quality calculations for the criteria 'Absence of prolonged thirst' and 'Absence of disease' in dairy cows, so that the results are more sensitive to input data and better fit experts' opinion. First, we modified the calculation of 'Absence of prolonged thirst' by linearising the calculation for drinkers' availability to avoid threshold effects. Second, we modified the calculation of 'Absence of disease' by applying a Choquet integral on the three lowest spline-based scores for each health disorder to limit compensation between health disorders. Third, we performed a global sensitivity analysis of the original and the alternative scoring models. Fourth, we compared the results obtained with the original and the alternative models with eight experts' opinions on two subsets composed of 44 and 60 farms, respectively, inspected using the Welfare Quality protocol and on which experts gave their opinion on the overall level of animal welfare. Results show that the alternative model significantly reduced the 'threshold effects' related to the number of drinkers and the compensation between health disorders. On the first subset, the alternative model fits the experts' opinion slightly better than the original model (P = 0.061). On the second subset, the models performed equally. In conclusion, the proposed refinements for calculating scores are validated since they significantly reduced 'threshold effects' and the influence of measures related to drinkers. It also reduced the compensation between health disorders by considering only the three lowest scores and thus increasing the influence of measures related to health disorders, and slightly improve at overall score level the accordance with experts' opinion.
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Affiliation(s)
- R Lardy
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR Herbivores, 63122 Saint-Genès-Champanelle, France.
| | - R Botreau
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR Herbivores, 63122 Saint-Genès-Champanelle, France
| | - A de Boyer des Roches
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR Herbivores, 63122 Saint-Genès-Champanelle, France
| | - F J C M van Eerdenburg
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - S de Graaf
- Flanders Research Institute for Agriculture, Fisheries and Food (ILVO), Burgemeester van Gansberghelaan 92, 9820 Merelbeke, Belgium
| | - M J Haskell
- SRUC, West Mains Road, Edinburgh EH9 3JG, UK
| | - M K Kirchner
- FOUR PAWS International, Linke Wienzeile 236, 1150 Vienna, Austria
| | - L Mounier
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR Herbivores, 63122 Saint-Genès-Champanelle, France
| | - M Kjosevski
- Animal Welfare Center, Faculty of Veterinary Medicine, Ss Cyril and Methodius University in Skopje, Lazar Pop-Trajkov 5-7, 1000 Skopje, Republic of Macedonia
| | - F A M Tuyttens
- Flanders Research Institute for Agriculture, Fisheries and Food (ILVO), Burgemeester van Gansberghelaan 92, 9820 Merelbeke, Belgium; Department of Veterinary and Biosciences, Faculty of Veterinary Medicine, Ghent University, Heidestraat 19, 9820 Merelbeke, Belgium
| | - I Veissier
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR Herbivores, 63122 Saint-Genès-Champanelle, France
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11
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Murphy K, Denieffe S, Kehoe B, Hacking D, Fairman CM, Harrison M. Designing effective exercise intervention trials for prostate cancer cohorts: a qualitative study on experiences and views of exercise oncology researchers. BMC Sports Sci Med Rehabil 2023; 15:145. [PMID: 37904240 PMCID: PMC10614306 DOI: 10.1186/s13102-023-00756-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/21/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Exercise intervention research has shown promising results in preventing and reversing the side effects caused by prostate cancer and its' treatment. However, there are still unanswered questions and the need for additional research. As the field of exercise oncology in the context of prostate cancer presents unique challenges and complexities, seeking the advice of experienced exercise oncology researchers before initiating a similar trial could help to design more effective and efficient studies and help avoid pitfalls. METHODS A qualitative descriptive study design and a nonprobability, purposive sampling method was employed. An interview guide was developed and included topics such as recruitment, retention, programme goals, research design, health considerations, treatment considerations, adverse events, exercise prescription and outcome tools. Individual semi-structured interviews were conducted and interviews were transcribed and analysed using thematic analysis. RESULTS Eight individuals with extensive experience working with prostate cancer patients in exercise oncology research settings were interviewed. Four main themes and seven subthemes were generated and supported by the data. Theme 1 highlighted the critical role of recruitment, with associated subthemes on recruitment barriers and recruitment methods. Theme 2 explored the positives and negatives of home-based programmes. Theme 3 focused on specific health characteristics, exercise prescription and outcome measure factors that must be considered when working with prostate cancer cohorts. Finally, theme 4 centered around the emotional dimensions present in exercise oncology trials, relating to both researchers and study participants. CONCLUSION Exercise oncology remains a challenging area in which to conduct research. Learning from experienced personnel in the field offers valuable information and guidance that could impact the success of future trials.
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Affiliation(s)
- Kira Murphy
- Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
- UPMC Hillman Cancer Center, Whitfield Hospital, Waterford, Ireland
| | - Suzanne Denieffe
- School of Humanities, South East Technological University, College Street Campus, Waterford, Ireland.
| | - Bróna Kehoe
- Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
| | - Dayle Hacking
- UPMC Hillman Cancer Center, Whitfield Hospital, Waterford, Ireland
| | - Ciaran M Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michael Harrison
- Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
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12
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Arai H, Maeda K, Wakabayashi H, Naito T, Konishi M, Assantachai P, Auyeung WT, Chalermsri C, Chen W, Chew J, Chou M, Hsu C, Hum A, Hwang IG, Kaido T, Kang L, Kamaruzzaman SB, Kim M, Lee JSW, Lee W, Liang C, Lim WS, Lim J, Lim YP, Lo RS, Ong T, Pan W, Peng L, Pramyothin P, Razalli NH, Saitoh M, Shahar S, Shi HP, Tung H, Uezono Y, von Haehling S, Won CW, Woo J, Chen L. Diagnosis and outcomes of cachexia in Asia: Working Consensus Report from the Asian Working Group for Cachexia. J Cachexia Sarcopenia Muscle 2023; 14:1949-1958. [PMID: 37667992 PMCID: PMC10570088 DOI: 10.1002/jcsm.13323] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/05/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
Chronic diseases often lead to metabolic disorders, causing anabolic resistance and increased energy consumption, which result in cachexia. Cachexia, in turn, can lead to major clinical consequences such as impaired quality of life, shortened life expectancy, and increased healthcare expenditure. Existing international diagnostic criteria for cachexia employ thresholds derived from Western populations, which may not apply to Asians due to differing body compositions. To address this issue, the Asian Working Group for Cachexia (AWGC) was initiated. The AWGC comprises experts in cachexia research and clinical practice from various Asian countries and aims to develop a consensus on diagnostic criteria and significant clinical outcomes for cachexia in Asia. The AWGC, composed of experts in cachexia research and clinical practice from several Asian countries, undertook three-round Delphi surveys and five meetings to reach a consensus. Discussions were held on etiological diseases, essential diagnostic items for cachexia, including subjective and objective symptoms and biomarkers, and significant clinical outcomes. The consensus highlighted the importance of multiple diagnostic factors for cachexia, including chronic diseases, either or both weight loss or low body mass index, and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>5 mg/L [0.5 mg/dL]). The AWGC proposed a significant weight change of 2% or more over a 3-6 month period and suggested a tentative cut-off value of 21 kg/m2 for low body mass index in diagnosing cachexia. Critical clinical outcomes were determined to be mortality, quality of life as assessed by tools such as EQ-5D or the Functional Assessment of Anorexia/Cachexia Therapy, and functional status as measured by the Clinical Frailty Scale or Barthel Index, with significant emphasis on patient-reported outcomes. The AWGC consensus offers a comprehensive definition and user-friendly diagnostic criteria for cachexia, tailored specifically for Asian populations. This consensus is set to stimulate future research and enhance the multidisciplinary approach to managing cachexia. With plans to develop further guidelines for the optimal treatment, prevention, and care of cachexia in Asians, the AWGC criteria are expected to drive research across chronic co-morbidities and cancer in Asia, leading to future refinement of diagnostic criteria.
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Affiliation(s)
- Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
| | - Keisuke Maeda
- Nutrition Therapy Support CenterAichi Medical University HospitalNagakuteJapan
- Department of Geriatric MedicineNational Center for Geriatrics and GerontologyObuJapan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation MedicineTokyo Women's Medical University HospitalTokyoJapan
| | - Tateaki Naito
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Masaaki Konishi
- Department of CardiologyYokohama City University School of MedicineYokohamaJapan
| | | | - Wai Tung Auyeung
- Jockey Club Institute of AgeingThe Chinese University of Hong KongShatinHong KongChina
| | - Chalobol Chalermsri
- Department of Preventive and Social Medicine, Division of Geriatric Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Wei Chen
- Department of Clinical Nutrition, Department of Health MedicinePeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Justin Chew
- Department of Geriatric MedicineTan Tock Seng HospitalSingapore
- Institute of Geriatrics and Active AgeingTan Tock Seng HospitalSingapore
| | - Ming‐Yueh Chou
- Center for Geriatrics and GerontologyKaohsiung Veterans General HospitalKaohsiung CityTaiwan
| | - Chih‐Cheng Hsu
- National Center for Geriatrics and Welfare ResearchMiaoli CountyTaiwan
| | - Allyn Hum
- Department of Geriatrics and Palliative CareTan Tock Seng HospitalSingapore
| | - In Gyu Hwang
- Department of Internal MedicineChung‐Ang University Hospital, Chung‐Ang University College of MedicineSeoulRepublic of Korea
| | - Toshimi Kaido
- Department of Gastroenterological and General SurgerySt. Luke's International HospitalTokyoJapan
| | - Lin Kang
- Department of Geriatric MedicinePeking Union Medical College HospitalBeijingChina
| | | | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East‐West Medical Research InstituteKyung Hee UniversitySeoulRepublic of Korea
| | - Jenny Shun Wah Lee
- Institute of AgingThe Chinese University of Hong Kong, Department of Medicine, Alice Ho Miu Ling Nethersole HospitalTai PoHong Kong
| | - Wei‐Ju Lee
- Aging and Health Research CenterNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Chih‐Kuang Liang
- Center for Geriatrics and GerontologyKaohsiung Veterans General HospitalKaohsiung CityTaiwan
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatric MedicineTan Tock Seng HospitalSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Jae‐Young Lim
- Department of Rehabilitation MedicineSeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Yen Peng Lim
- Department of Nutrition and DieteticsTan Tock Seng HospitalSingapore
| | - Raymond See‐Kit Lo
- Department of Medicine and TherapeuticsChinese University of Hong Kong, Shatin HospitalMa On ShanHong Kong
| | - Terence Ong
- Department of Medicine, Faculty of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Wen‐Harn Pan
- Institute of Biomedical SciencesAcademia Sinica, TaiwanTaipei CityTaiwan
| | - Li‐Ning Peng
- Aging and Health Research CenterNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Pornpoj Pramyothin
- Division of Nutrition, Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Nurul Huda Razalli
- Centre for Healthy Aging and Wellness (H‐CARE), Faculty of Health SciencesUniversiti Kebangsaan Malaysia, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul AzizKuala LumpurMalaysia
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health ScienceJuntendo UniversityTokyoJapan
| | - Suzana Shahar
- Center for Healthy Aging and Wellness, Faculty Health SciencesUniversiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Han Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan HospitalCapital Medical University of ChinaBeijingChina
| | - Heng‐Hsin Tung
- National Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Yasuhito Uezono
- Department of Pain Control ResearchThe Jikei University School of MedicineTokyoJapan
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Goettingen Medical Center, Georg‐August‐University GoettingenGoettingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Chang Won Won
- Department of Family MedicineCollege of Medicine, Kyung Hee UniversitySeoulRepublic of Korea
| | - Jean Woo
- Department of Medicine & TherapeuticsThe Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SARChina
| | - Liang‐Kung Chen
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
- Center for Geriatrics and GerontologyTaipei Veterans General Hospital; Taipei Municipal Gan‐Dau HospitalTaipei CityTaiwan
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13
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Urruticoechea-Arana A, Sanz J, Ginard D, González-Lama Y, Juanola X, Almirall M, Borruel N, Gratacós J, Loza E. Implementation of the recommendations for the psychological management of patients with spondyloarthritis and inflammatory bowel disease. Reumatol Clin (Engl Ed) 2023; 19:423-429. [PMID: 37805255 DOI: 10.1016/j.reumae.2023.03.007] [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] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/07/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To assess and improve the level of implementation of the recommendations for the psychological management of patients with spondyloarthritis (SpA) and associated inflammatory bowel disease (IBD). METHODS Qualitative study. We performed a narrative literature review to identify the recommendations for the psychological management of SpA and associated IBD and to explore their level of implementation. Based on the findings, we developed a national survey to assess: (1) current level of knowledge and implementation of the recommendations; (2) attitudes towards the recommendations; and (3) barriers and facilitators to their implementation. The results of the review and survey were discussed by a multidisciplinary group of 9 expert rheumatologists and gastroenterologists, who defined implementation strategies to increase the uptake of the recommendations. RESULTS The review included 4 articles, 2 of them included direct recommendations on the identification and management of psychological problems in patients with SpA and IBD. None assessed the level of implementation of the recommendations in routine clinical practice. Our survey showed a great lack of awareness and implementation of the recommendations, even though psychological issues are very relevant for health professionals. Lack of time, resources, and knowledge are considered the main barriers to adherence to the recommendations. We propose several implementation strategies related to educational activities, clinical practice, and others to increase the uptake of reported recommendations. CONCLUSIONS Further research and efforts are required to achieve behaviour changes in clinical practice to improve the identification and management of psychological problems and needs in patients with SpA and IBD.
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Affiliation(s)
| | - Jesús Sanz
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Daniel Ginard
- Servicio de Gastroenterología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Yago González-Lama
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario Bellvitge, IDIBELL, Barcelona, Spain
| | - Miriam Almirall
- Servicio de Reumatología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Natalia Borruel
- Unidad de atención Crohn-Colitis (UACC), Servicio del Aparato Digestivo, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Gratacós
- Servicio de Reumatología, Hospital Universitario Parc Taulí Sabadell, I3PT, Departamento de Medicina UAB, Barcelona, Spain
| | - Estíbaliz Loza
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain.
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14
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Park SY, Moon SM, Kim B, Lee MJ, Song KH, Kim ES, Kim TH, Kim HB. Applicability and limitations of quality indicator-based assessment of appropriateness in antimicrobial use: a comparison with expert opinion. J Hosp Infect 2023; 139:93-98. [PMID: 37419187 DOI: 10.1016/j.jhin.2023.06.023] [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: 04/12/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The effective implementation of antimicrobial stewardship requires an a-priori assessment of the appropriateness of antimicrobial prescriptions. AIM To evaluate the effectiveness of quality indicators (QIs) in determining the appropriateness of antimicrobial prescriptions compared to that of expert opinions. METHODS The study assessed antimicrobial use in 20 hospitals in Korea, with infectious disease specialists rating the appropriateness based on QIs and expert opinions. The selected QIs were (1) taking two blood cultures, (2) taking cultures from suspected sites of infection, (3) prescribing empirical antimicrobials according to guidelines, and (4) changing from empirical to pathogen-directed therapy for hospitalized patients and (2, 3, and 4) for ambulatory patients. Applicability, compliance with QIs, and agreement between QIs and expert opinions were investigated. FINDINGS Overall, 7999 therapeutic uses of antimicrobials were investigated at the study hospitals. The experts rated 20.5% (1636/7999) as inappropriate use. For hospitalized patients, antimicrobial use was assessed based on all four QIs in 28.8% (1798/6234) of the cases. For ambulatory care patients, only 7.5% (102/1351) of the antimicrobial use cases were assessed using all three QIs. The agreement between expert opinions and all four QIs for hospitalized patients was minimal (κ = 0.332), whereas that between expert opinions and all three QIs for ambulatory patients was weak (κ = 0.598). CONCLUSION QIs have limitations in determining the appropriateness of antimicrobial use, and the degree of agreement with expert opinions was low. Therefore, these QI limitations should be considered when determining the appropriateness of antimicrobial use.
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Affiliation(s)
- S Y Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea; Centres for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - S M Moon
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - B Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - M J Lee
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - K-H Song
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - E S Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - T H Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea.
| | - H B Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
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Golia Pernicka JS, Rauch GM, Gangai N, Bates DDB, Ernst R, Hope TA, Horvat N, Sheedy SP, Gollub MJ. Imaging of Anal Squamous Cell Carcinoma: Survey Results and Expert Opinion from the Rectal and Anal Cancer Disease-Focused Panel of the Society of Abdominal Radiology. Abdom Radiol (NY) 2023; 48:3022-3032. [PMID: 36932225 PMCID: PMC10929685 DOI: 10.1007/s00261-023-03863-8] [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: 01/09/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/19/2023]
Abstract
The role and method of image-based staging of anal cancer has evolved with the rapid development of newer imaging modalities and the need to address the rising incidence of this rare cancer. In 2014, the European Society of Medical Oncology mandated pelvic magnetic resonance imaging (MRI) for anal cancer and subsequently other societies such as the National Comprehensive Cancer Network followed suit with similar recommendations. Nevertheless, great variability exists from center to center and even within individual centers. Notably, this is in stark contrast to the imaging of the anatomically nearby rectal cancer. As participating team members for this malignancy, we embarked on a comprehensive literature review of anal cancer imaging to understand the relative merits of these new technologies which developed after computed tomography (CT), e.g., MRI and positron emission tomography/computed tomography (PET/CT). The results of this literature review helped to inform our next stage: questionnaire development regarding the imaging of anal cancer. Next, we distributed the questionnaire to members of the Society of Abdominal Radiology (SAR) Rectal and Anal Disease-Focused Panel, a group of abdominal radiologists with special interest, experience, and expertise in rectal and anal cancer, to provide expert radiologist opinion on the appropriate anal cancer imaging strategy. In our expert opinion survey, experts advocated the use of MRI in general (65% overall and 91-100% for primary staging clinical scenarios) and acknowledged the superiority of PET/CT for nodal assessment (52-56% agreement for using PET/CT in primary staging clinical scenarios compared to 30% for using MRI). We therefore support the use of MRI and PET and suggest further exploration of PET/MRI as an optimal combined evaluation. Our questionnaire responses emphasized the heterogeneity in imaging practice as performed at numerous academic cancer centers across the United States and underscore the need for further reconciliation and establishment of best imaging practice guidelines for optimized patient care in anal cancer.
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Affiliation(s)
- Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- , 530 E 74th St, Room 07118, New York, NY, 10021, USA.
| | - Gaiane M Rauch
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Randy Ernst
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Hope
- Departments of Radiology and Biomedical Imaging and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, CA, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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16
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Hassel JC, Berking C, Forschner A, Gebhardt C, Heinzerling L, Meier F, Ochsenreither S, Siveke J, Hauschild A, Schadendorf D. Practical guidelines for the management of adverse events of the T cell engager bispecific tebentafusp. Eur J Cancer 2023; 191:112986. [PMID: 37595494 DOI: 10.1016/j.ejca.2023.112986] [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: 06/12/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 08/20/2023]
Abstract
Tebentafusp is a new T cell receptor bispecific fusion protein and the first approved treatment option for human leucocyte antigen-A*02:01 (HLA-A*02:01) metastatic uveal melanoma, with a proven benefit in overall survival versus the investigator's choice. As a first-in-class therapeutic option, this Immune mobilising monoclonal T cell receptor Against Cancer (ImmTAC) is associated with a new adverse event (AE) profile. Based on clinical experience, a national expert group discussed recommendations for tebentafusp treatment, focusing on AE management. Further topics included prerequisites for initiating tebentafusp treatment, appropriate treatment setting, and patient selection criteria. To provide guidance for treating physicians, the resulting recommendations are summarised including a model standard operating procedure for AE management. Patients in good clinical condition and with a low tumour burden are good candidates for tebentafusp treatment, particularly if treated as early as possible after the diagnosis of metastatic disease. The safety profile of tebentafusp is manageable and includes two major pathologies: cytokine release syndrome (CRS) and skin-related events. Postdose monitoring should thus focus on pyrexia and hypotension as the first symptoms of cytokine release. To minimise the risk of hypotension associated with CRS, patients should receive intravenous fluids before starting treatment. The monitoring of liver values is crucial, as patients may experience an increase in transaminases, which can even manifest as tumour lysis syndrome.
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Affiliation(s)
- Jessica C Hassel
- Department of Dermatology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany.
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Ulmenweg 18, 91054 Erlangen, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
| | - Christoffer Gebhardt
- Department of Dermatology and Venereology, Skin Cancer Center, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany
| | - Lucie Heinzerling
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; Department of Dermatology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases and Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Sebastian Ochsenreither
- Department of Hematology, Oncology and Tumor Immunology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Charité-Comprehensive Cancer Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Jens Siveke
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Medicine Essen, Hufelandstr. 55, 45147 Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Comprehensive Cancer Center (Westdeutsches Tumorzentrum), German Cancer Consortium (DKTK, partner site Essen) and University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany
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17
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Chen EQ. [Imperatives to strengthen HBsAg screening and expand antiviral therapy indications on hepatitis B among the general population]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:646-648. [PMID: 37400392 DOI: 10.3760/cma.j.cn501113-20220521-00271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- E Q Chen
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China
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18
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Rigutto-Farebrother J, Ahles S, Cade J, Murphy KJ, Plat J, Schwingshackl L, Roche HM, Shyam S, Lachat C, Minihane AM, Weaver C. Perspectives on the application of CONSORT guidelines to randomised controlled trials in nutrition. Eur J Nutr 2023:10.1007/s00394-023-03137-5. [PMID: 37099211 DOI: 10.1007/s00394-023-03137-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/21/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Reporting guidelines facilitate quality and completeness in research reporting. The CONsolidated Standards Of Reporting Trials (CONSORT) statement is widely applied to dietary and nutrition trials but has no extension specific to nutrition. Evidence suggests poor reporting in nutrition research. The Federation of European Nutrition Societies led an initiative to make recommendations for a nutrition extension to the CONSORT statement towards a more robust reporting of the evidence base. METHODS An international working group was formed of nutrition researchers from 14 institutions in 12 different countries and on five continents. Using meetings over a period of one year, we interrogated the CONSORT statement specifically for its application to report nutrition trials. RESULTS We provide a total of 28 new nutrition-specific recommendations or emphasised recommendations for the reporting of the introduction (three), methods (twelve), results (five) and discussion (eight). We also added two additional recommendations that were not allocated under the standard CONSORT headings. CONCLUSION We identify a need to provide guidance in addition to CONSORT to improve the quality and consistency of the reporting and propose key considerations for further development of formal guidelines for the reporting of nutrition trials. Readers are encouraged to engage in this process, provide comments and conduct specific studies to inform further work on the development of reporting guidelines for nutrition trials.
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Affiliation(s)
- Jessica Rigutto-Farebrother
- Human Nutrition Laboratory, Institute for Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland.
- Laboratory for Nutrition and Metabolic Epigenetics, Institute for Food, Nutrition and Health, LFV E14.1, Schmelzbergstrasse 7, 8092, Zurich, Switzerland.
- Global Center for the Development of the Whole Child, University of Notre Dame, South Bend, USA.
| | - Sanne Ahles
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- BioActor BV, Maastricht, The Netherlands
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Karen J Murphy
- Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Helen M Roche
- Nutrigenomics Research Group, UCD Conway Institute, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Institute for Global Food Security, School of Biological Sciences, Queens University Belfast, Belfast, UK
| | - Sangeetha Shyam
- Centre for Translational Research, Institute for Research, Development, and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia
- Departament de Bioquímica i Biotecnologia, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Universitat Rovira i Virgili, Unitat de Nutrició Humana, Instituto de Salud Carlos III (ISCIII), Reus, Spain
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Anne-Marie Minihane
- Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia (UEA), Norwich, UK
- Norwich Institute of Healthy Ageing, UEA, Norwich, UK
| | - Connie Weaver
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, USA
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Filippi M, Cecchetti G, Cagnin A, Marra C, Nobili F, Parnetti L, Agosta F. Redefinition of dementia care in Italy in the era of amyloid-lowering agents for the treatment of Alzheimer's disease: an expert opinion and practical guideline. J Neurol 2023. [PMID: 36892630 DOI: 10.1007/s00415-023-11642-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/10/2023]
Abstract
No disease-modifying therapies are currently available for Alzheimer's disease (AD) in Europe. Current evidence from clinical trials testing anti-beta amyloid (Aβ) monoclonal antibodies (mAbs) in patients with early AD, though, suggests a likely marketing authorization in the next years. Since the implementation of disease-modifying therapies for AD in the clinical practice will evidently require a huge change of dementia care in all countries, a group of prominent AD clinical experts in Italy met to discuss patients' selection and management strategies. The current diagnostic-therapeutic standard of care in Italy was taken as the starting point. The prescription of new therapies cannot ignore the definition of a biological diagnosis through the assessment of both amyloid- and tau-related biomarkers. The high risk/benefit ratio of anti-Aβ immunotherapies, moreover, needs a highly specialized diagnostic work-up and a thorough exclusion criteria assessment, which should be provided by a neurology specialist. The Expert Panel also suggests a reorganization of the Centers for dementia and cognitive decline in Italy into 3 levels of increasing complexity: community center, first- and second-level center. Tasks and requirements for each level were defined. Finally, specific characteristics of a center deputed to prescribe anti-Aβ mAbs were discussed.
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Ratti M, Milicia O, Rescinito R, Coeckelberghs E, Seys D, Vanhaecht K, Panella M. The determinants of expert opinion in the development of care pathways: insights from an exploratory cluster analysis. BMC Health Serv Res 2023; 23:211. [PMID: 36869326 PMCID: PMC9983158 DOI: 10.1186/s12913-023-09139-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/01/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND We performed a secondary exploratory cluster analysis on the data collected from the validation phase of the study leading to the development of the model care pathway (CP) for Myasthenia Gravis (MG), in which a panel of 85 international experts were asked some characteristics about themselves and their opinion about the model CP. Our aim was to identify which characteristics of the experts play a role in the genesis of their opinion. METHODS We extracted the questions probing an opinion and those describing a characteristic of the expert from the original questionnaire. We performed a multiple correspondence analysis (MCA) and a subsequent hierarchical clustering on principal component (HCPC) on the opinion variables, integrating the characteristic variables as supplementary (predicted). RESULTS After reducing the dimensionality of the questionnaire to three dimensions we noticed that the not-appropriateness judgement of the clinical activities may overlap with the completeness one. From the HCPC it seems that the working setting of the expert may play a crucial role in determining the opinion about the setting of the sub-processes of MG: shifting from a cluster where the experts do not work in sub-specialist settings to one where the experts are working in them, the opinion changes accordingly from a mono-disciplinary setting to a multi-disciplinary one. Another interesting result is that the experience in neuromuscular diseases (NMD) measured in years and the expert typology (whether general neurologist or NMD expert) seem not to contribute significantly to the opinions. CONCLUSIONS These findings might indicate a poor ability of the expert to discriminate what is not appropriate from what is not complete. Also, the opinion of the expert might be influenced by the working setting, but not by the experience in NMD (as measured in years).
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Affiliation(s)
- Matteo Ratti
- Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UNIUPO), Via Solaroli,17, 28100, Novara, Italy.
| | - Osvaldo Milicia
- Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UNIUPO), Via Solaroli,17, 28100, Novara, Italy
| | - Riccardo Rescinito
- Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UNIUPO), Via Solaroli,17, 28100, Novara, Italy
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Louvain-University of Leuven, Leuven, Belgium
- European Pathway Association, Louvain, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Louvain-University of Leuven, Leuven, Belgium
- European Pathway Association, Louvain, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Louvain-University of Leuven, Leuven, Belgium
- European Pathway Association, Louvain, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UNIUPO), Via Solaroli,17, 28100, Novara, Italy
- European Pathway Association, Louvain, Belgium
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21
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Enzmann T, Albrecht K. [Fatal complications after urological interventions-connection between error, damage and causality]. Urologie 2023; 62:252-255. [PMID: 36810700 DOI: 10.1007/s00120-023-02032-5] [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] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
Case studies from the clinic outline the connection between error, damage and causality. If the three "categories" mentioned are to be affirmed, recourse claims of the payers and the patients or their relatives are enforced in practice.
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Affiliation(s)
- T Enzmann
- Klinik für Urologie und Kinderurologie, Universitätsklinik Brandenburg an der Havel, Hochstr. 29, 14770, Brandenburg an der Havel, Deutschland.
| | - K Albrecht
- Brandenburgisches Landesinstitut für Rechtsmedizin (BLR), Potsdam, Deutschland.,Medizinische Hochschule Brandenburg (MHB), Neuruppin, Deutschland
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22
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Steffens F, Steffens J, Kranz J, Enzmann T. [Experiences from the commission of experts]. Urologie 2023; 62:256-60. [PMID: 36820845 DOI: 10.1007/s00120-023-02034-3] [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] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
The task of the commission of experts on medical errors is to provide a neutral and independent assessment of a treatment for which a physician is responsible and evaluate the liability issue. The objective evaluation is intended to make it easier for the person whose health has been damaged by a treatment error to assert justified claims and for the physician to reject unfounded accusations. The aim is to promote amicable dispute resolution. For the legal classification of the term "complication", a definition is necessary. The physician understands this to mean a deviation from the actual course and consequences of treatment. The lawyer sees a complication as an undesirable consequence of incorrect patients' information or treatment. One-third of all court cases end with a finding of medical malpractice. This rate corresponds to the medical malpractice rate in medical malpractice litigation. If medical malpractice is found, the physician's liability insurance is contacted to settle the claim. If the commission of experts denies medical malpractice, the patient usually refrains from taking legal action.
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Mohan JC, Sathyamurthy I, Panja M, Agarwala R, Ponde CK, Kumar AS, Mahala BK, Kolapkar V, Kumar RVL, Patel K. Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India. Curr Cardiol Rev 2023; 19:97-106. [PMID: 36941812 PMCID: PMC10518888 DOI: 10.2174/1573403x19666230320105623] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 03/23/2023] Open
Abstract
Heart rate is an important indicator of health and disease and the modulation of heart rate can help to improve cardiovascular outcomes. Besides β-blockers, Ivabradine is a wellestablished heart rate modulating drug that reduces heart rate without any hemodynamic effects. This consensus document was developed with the help of expert opinions from cardiologists across India on effective heart rate management in routine clinical practice and choosing an appropriate Ivabradine-based therapy considering the available scientific data and guideline recommendations. Based on the discussion during the meetings, increased heart rate was recognized as a significant predictor of adverse cardiovascular outcomes among patients with chronic coronary syndromes and heart failure with reduced ejection fraction making heart rate modulation important in these subsets. Ivabradine is indicated in the management of chronic coronary syndromes and heart failure with reduced ejection fraction for patients in whom heart rate targets cannot be achieved despite guideline-directed β-blocker dosing or having contraindication/intolerance to β-blockers. A prolonged release once-daily dosage of Ivabradine can be considered in patients already stabilized on Ivabradine twice-daily. Ivabradine/β-blocker fixed-dose combination can also be considered to reduce pill burden. Two consensus algorithms have been developed for further guidance on the appropriate usage of Ivabradine-based therapies. Ivabradine and β-blockers can provide more pronounced clinical improvement in most chronic coronary syndromes and heart failure with reduced ejection fraction patients with a fixed-dose combination providing an opportunity to improve adherence.
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Affiliation(s)
- J C Mohan
- Head of Department & Senior Consultant Cardiology, Jaipur Golden Hospital, Delhi, India
| | - I Sathyamurthy
- Senior Interventional Cardiologist, Apollo Hospitals, Chennai, India
| | - Monotosh Panja
- Senior Interventional Cardiologist, AMRI Hospitals, Kolkata, India
| | - Rajeev Agarwala
- Head of Department and Consultant Cardiologist, Jaswant Rai Speciality Hospital, Meerut, India
| | - C K Ponde
- Head of Department and Consultant Cardiologist, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | - A Sreenivas Kumar
- Director Cardiology & Clinical Research, Apollo Health City, Hyderabad, India; Apollo Hospitals, Hyderabad, India
| | - Bijay Kumar Mahala
- Senior Consultant Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
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Lus G, Bassano MA, Brescia Morra V, Bonavita S, Gallo A, Maimone D, Malerba L, Maniscalco GT, Saccà F, Salemi G, Turrini R, Cottone S, Sessa E, Buccafusca M, Grimaldi LME. Unmet needs and gaps in the identification of secondary progression in multiple sclerosis: a Southern Italy healthcare professionals' perspective. Neurol Sci 2023; 44:45-58. [PMID: 36114980 PMCID: PMC9483292 DOI: 10.1007/s10072-022-06402-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/09/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a chronic disease with different clinical courses and a tendency to worsening. The relapsing-remitting MS presents acute onset and relapses of neurological symptoms, followed by their remission. This form can convert to secondary progressive MS (SPMS) with irreversible neurological worsening and disability. The identification of signs, symptoms, markers of progression, and strategies to manage MS patients is mandatory to allow early identification of those at higher risk of conversion to SPMS, for prompt intervention to cope with the progression of the disease. METHODS A panel of Italian experts from Southern Italy have reviewed the current knowledge on MS and its management and identified the crucial tools for SPMS recognition. RESULTS More effective communication between patients and clinicians should be established, with the support of digital tools. Moreover, the improvement in the clinical use of biomarkers for progression (cellular structures and tissue organization, such as neurofilaments and chitinase 3-like 1, axonal and neurons density) and of instrumental analyses for recognition of whole-brain atrophy, chronic active lesions, spinal cord lesions and atrophy, and the improvement the combination of the Expanded Disability Status Scale and the evaluation of cognitive dysfunction are discussed. CONCLUSION Given the availability of a pharmacological option, adequate education both for patients, regarding the evolution of the disease and the specific treatment, and for professionals, to allow more effective and sensitive communication and the best use of diagnostic and management tools, could represent a strategy to improve patient management and their quality of life.
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Affiliation(s)
- Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, II Division of Neurology, Multiple Sclerosis Center, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Vincenzo Brescia Morra
- Department of Neurosciences Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, Università Della Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, Università Della Campania Luigi Vanvitelli, Naples, Italy
| | - Davide Maimone
- Unità Operativa Complessa Neurology, Multiple Sclerosis Center, ARNAS Garibaldi, Catania, Italy
| | | | | | - Francesco Saccà
- Department of Neurosciences Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Giuseppe Salemi
- UOC of Neurology and Multiple Sclerosis Center, DAI of Diagnostic and Interventistic Radiology and Stroke, AOIP "P. Giaccone", Palermo, Italy
| | | | - Salvatore Cottone
- Neurology and Stroke Unit, Multiple Sclerosis Center, ARNAS CIVICO, Palermo, Italy
| | - Edoardo Sessa
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Maria Buccafusca
- Neurology and Neuromuscular Unit, Multiple Sclerosis Centre, "G. Martino" University Hospital, Messina, Italy
| | - Luigi Maria Edoardo Grimaldi
- Neurology and Multiple Sclerosis Center, Unità Operativa Complessa (UOC), Foundation Institute "G. Giglio", Cefalù, PA, Italy
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Oreja-Guevara C, Brownlee W, Celius EG, Centonze D, Giovannoni G, Hodgkinson S, Kleinschnitz C, Havrdova EK, Magyari M, Selchen D, Vermersch P, Wiendl H, Van Wijmeersch B, Salloukh H, Yamout B. Expert opinion on the long-term use of cladribine tablets for multiple sclerosis: Systematic literature review of real-world evidence. Mult Scler Relat Disord 2023; 69:104459. [PMID: 36565573 DOI: 10.1016/j.msard.2022.104459] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 10/07/2022] [Revised: 11/20/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment with cladribine tablets (CladT), an immune reconstitution therapy for relapsing multiple sclerosis (RMS), involves two short courses of treatment in Year 1 and Year 2. Most patients achieve sustained efficacy with CladT, but a small proportion may experience new disease activity (DA). Following completion of the indicated dose, physicians may have questions relating to the long-term management of these patients. Since the EU approval of CladT over 5 years ago, real-world evidence (RWE) is increasing and may provide some insights and guidance for clinical practice. We describe a systematic literature review (SLR) of RWE and provide expert opinions relating to six questions regarding the long-term use of CladT. METHODS Pertinent clinical questions were developed by a steering committee (SC) of 14 international multiple sclerosis (MS) experts regarding breakthrough DA in Year 1, new DA after 2 years or more of treatment, long-term management of stable patients, and whether additional courses of CladT may be required or safe. An SLR was performed in EMBASE and PubMed using the population, intervention, comparators, outcomes, study design (PICOS) framework to identify relevant studies within the last 15 years. Searches of key congress proceedings for the last 2-3 years were also performed. Following review of the results and RWE, the SC drafted and agreed on expert opinion statements for each question. RESULTS A total of 35 publications reporting RWE for CladT were included in this review. In the real world, breakthrough DA in Year 1 is of low incidence (1.1-21.9%) but can occur, particularly in patients switching from anti-lymphocyte trafficking agents. In most patients, this DA did not lead to treatment discontinuation. Reported rates of DA after the full therapeutic effect of CladT has been achieved (end of Year 2, 3 or 4) range from 12.0 to 18.7% in the few studies identified. No RWE was identified to support management decisions for stable patients in Year 5 or later. Views among the group were also diverse on this question and voting on expert opinion statements was required. Only two studies reported the administration of additional courses of CladT, but detailed safety outcomes were not provided. CONCLUSIONS RWE for the long-term use of CladT in the treatment of RMS is increasing, however, gaps in knowledge remain. Where possible, the RWE identified through the SLR informed expert statements, but, where RWE is still lacking, these were based solely on experiences and opinion, providing some guidance on topics and questions that occur in daily clinical practice. More real-world studies with longer-term follow-up periods are needed and highly anticipated.
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Affiliation(s)
- Celia Oreja-Guevara
- Neurology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain; Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Spain
| | - Wallace Brownlee
- Queen Square MS Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Diego Centonze
- Department of Systems Medicine, Tor Vergata University, Rome, Italy; Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Suzanne Hodgkinson
- Department of Neurology, Liverpool Hospital, and UNSW Sydney, New South Wales, Australia
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational and Behavioural Neurosciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Daniel Selchen
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Heinz Wiendl
- Department of Neurology, Institute of Translational Neurology, University of Münster, Münster, Germany
| | | | - Hashem Salloukh
- Ares Trading SA, Eysins, Switzerland (An Affiliate of Merck KGaA)
| | - Bassem Yamout
- Neurology Institute, Harley Street Medical Center, Abu Dhabi, UAE; American University of Beirut, Lebanon.
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Society of Obstetrics and Gynecology of Zhejiang Medical Association SOOAGOZMA, Society of Urology of Zhejiang Medical Association SOUOZMA, Committee of Breast Cancer of Zhejiang Anticancer Association COBCOZAA, Committee of Clinical Pharmacy on Oncology of Zhejiang Anticancer Association (preparation) COCPOOOZAA(, Committee of Urology of Zhejiang Society for Mathematical Medicine COUOZSFMM. Guidance on the management of adverse reactions induced by poly(ADP-ribose) polymerase inhibitors. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:765-774. [PMID: 36915979 PMCID: PMC10262009 DOI: 10.3724/zdxbyxb-2022-0284] [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: 06/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
The common adverse reactions caused by poly (ADP-ribose) polymerase (PARP) inhibitors include hematological toxicity, gastrointestinal toxicity and fatigue. The main prevention and treatment of hematological toxicity include: regular blood tests, referral to hematology department when routine treatment is ineffective, and being alert of myelodysplastic syndrome/acute myeloid leukemia. The key points to deal with gastrointestinal toxicity include: taking medicine at the right time, light diet, appropriate amount of drinking water, timely symptomatic treatment, prevention of expected nausea and vomiting, and so on. For fatigue, full assessment should be completed before treatment because the causes of fatigue are various; the management includes massage therapy, psychosocial interventions and drugs such as methylphenidate and Panax quinquefolius according to the severity. In addition, niraparib and fluzoparib can cause hypertension, hypertensive crisis and palpitation. Blood pressure and heart rate monitoring, timely symptomatic treatment, and multidisciplinary consultation should be taken if necessary. When cough and dyspnea occur, high resolution CT and bronchoscopy should be performed to exclude pneumonia. If necessary, PARP inhibitors should be stopped, and glucocorticoid and antimicrobial therapy should be given. Finally, more attention should be paid to drug interaction management, patient self-management and regular monitoring to minimize the risk and harm of adverse reactions of PARP inhibitors.
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Manti F, Caviglia S, Cazzorla C, Dicintio A, Pilotto A, Burlina AP. Expert opinion of an Italian working group on the assessment of cognitive, psychological, and neurological outcomes in pediatric, adolescent, and adult patients with phenylketonuria. Orphanet J Rare Dis 2022; 17:443. [PMID: 36544165 PMCID: PMC9769037 DOI: 10.1186/s13023-022-02488-2] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/15/2022] [Indexed: 12/24/2022] Open
Abstract
Phenylketonuria (PKU) is an inherited metabolic disease characterized by a defective conversion of phenylalanine (Phe) to tyrosine, potentially leading to Phe accumulation in the brain. Dietary restriction since birth has led to normal cognitive development. However, PKU patients can still develop cognitive or behavioral abnormalities and subtle neurological deficits. Despite the increasing evidence in the field, the assessment of neurocognitive, psychopathological, and neurological follow-up of PKU patients at different ages is still debated. The high interindividual variability in the cognitive outcome of PKU patients makes the specificity of the neurocognitive and behavioral assessment extremely challenging. In the present paper, a multidisciplinary panel of Italian PKU experts discussed different tools available for cognitive, psychopathological, and neurological assessment at different ages based on the existing literature and daily clinical practice. This study aims to provide evidence and a real-life-based framework for a specific clinical assessment of pediatric, adolescent, and adult patients affected by PKU.
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Affiliation(s)
- Filippo Manti
- grid.7841.aUnit of Child Neurology and Psychiatry, Department of Human Neuroscience, University of Rome La Sapienza, Rome, Italy
| | - Stefania Caviglia
- grid.414125.70000 0001 0727 6809Unit of Clinical Psychology, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Chiara Cazzorla
- grid.411474.30000 0004 1760 2630Division of Inborn Metabolic Diseases, Department of Pediatrics, University Hospital, Padua, Italy
| | - Annamaria Dicintio
- grid.488556.2Department of Metabolic Diseases and Clinical Genetics, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale Policlinico, 70126 Bari, Italy
| | - Andrea Pilotto
- grid.7637.50000000417571846Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Wagner S, Renner N, Krause J, Perl M. [Distortion of the cervical spine : Pathophysiology, diagnostics, treatment and assessment]. Unfallchirurgie (Heidelb) 2022; 125:983-994. [PMID: 36376757 DOI: 10.1007/s00113-022-01248-y] [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] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Distortion or whiplash trauma of the cervical spine is an injury pattern associated with motor vehicle collisions and typically occurs after rear impact collisions, but is not limited to this type of collision and accident. The vast majority of these injuries are low-grade injuries according to the Quebec Task Force (QTF) classification, whereby no objective morphological correlates can be determined in clinical and radiological examinations. The prognosis is predominantly favorable and the condition is self-limiting; however, care must be taken with respect to complex courses with chronic pain and the manifestation of neuropsychiatric complaints. Due to the mechanism of the accident this injury pattern is particularly frequent in accidents associated with third party liability insurance claims. The discrepancy between subjective complaints and the presence of objective findings is a particular challenge for the assessment by the medical expert.
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Affiliation(s)
- S Wagner
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - N Renner
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - J Krause
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - M Perl
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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Al Achkar M, Basu Roy U, Manley E, Standifer M, Baik C, Walsh CA. A qualitative study of interactions with oncologists among patients with advanced lung cancer. Support Care Cancer 2022; 30:9049-9055. [PMID: 35948849 PMCID: PMC9365681 DOI: 10.1007/s00520-022-07309-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION To support the care of lung cancer patients, oncologists have needed to stay current on treatment advancements and build relationships with a new group of survivors in an era where lung cancer survivorship has been re-defined. The objectives of the study were to (1) understand the perspectives of advanced lung cancer patients whose tumors have oncogenic alterations about their care experiences with their oncologist(s) and (2) describe the perceptions of advanced lung cancer patients about seeking second opinions and navigating care decisions. METHODS In this qualitative study, patients with advanced lung cancer (n = 25) on targeted therapies were interviewed to discuss their ongoing experience with their oncologists. We used deductive and inductive qualitative approaches in the coding of the data. We organized the data using the self-determination framework. RESULTS Patients described both positive and negative aspects of their care as related to autonomy, provider competency, and connectedness. Patients sought second opinions for three primary reasons: expertise, authoritative advice, and access to clinical trial opportunities. When there is disagreement in the treatment plan between the primary oncologist and the specialist, there can be confusion and tension, and patients have to make difficult choices about their path forward. CONCLUSIONS Patients value interactions that support their autonomy, demonstrate the competency of their providers, and foster connectedness. To ensure that patients receive quality and goal-concordant care, developing decision aids and education materials that help patients negotiate recommendations from two providers is an area that deserves further attention.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, School of Medicine, Box 356390, Seattle, WA, 98195, USA.
| | | | | | - Maisha Standifer
- LUNGevity Foundation, Chicago, IL, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Christina Baik
- Department of Family Medicine, University of Washington, School of Medicine, Box 356390, Seattle, WA, 98195, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Casey A Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Ayers D, Cope S, Towle K, Mojebi A, Marshall T, Dhanda D. Structured expert elicitation to inform long-term survival extrapolations using alternative parametric distributions: a case study of CAR T therapy for relapsed/ refractory multiple myeloma. BMC Med Res Methodol 2022; 22:272. [PMID: 36243687 PMCID: PMC9569052 DOI: 10.1186/s12874-022-01745-z] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Our aim was to extend traditional parametric models used to extrapolate survival in cost-effectiveness analyses (CEAs) by integrating individual-level patient data (IPD) from a clinical trial with estimates from experts regarding long-term survival. This was illustrated using a case study evaluating survival of patients with triple-class exposed relapsed/refractory multiple myeloma treated with the chimeric antigen receptor (CAR) T cell therapy idecabtagene vicleucel (ide-cel, bb2121) in KarMMa (a phase 2, single-arm trial). Methods The distribution of patients expected to be alive at 3, 5, and 10 years given the observed survival from KarMMa (13.3 months of follow-up) was elicited from 6 experts using the SHeffield ELicitation Framework. Quantities of interest were elicited from each expert individually, which informed the consensus elicitation including all experts. Estimates for each time point were assumed to follow a truncated normal distribution. These distributions were incorporated into survival models, which constrained the expected survival based on standard survival distributions informed by IPD from KarMMa. Results Models for ide-cel that combined KarMMa data with expert opinion were more consistent in terms of survival as well as mean survival at 10 years (survival point estimates under different parametric models were 29–33% at 3 years, 5–17% at 5 years, and 0–6% at 10 years) versus models with KarMMa data alone (11–39% at 3 years, 0–25% at 5 years, and 0–11% at 10 years). Conclusion This case study demonstrates a transparent approach to integrate IPD from trials with expert opinion using traditional parametric distributions to ensure long-term survival extrapolations are clinically plausible. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01745-z.
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Affiliation(s)
- Dieter Ayers
- Evidence Synthesis & Decision Modeling, PRECISIONheor, 1505 West 2nd Ave #300, Vancouver, BC, V6H3Y4, Canada
| | - Shannon Cope
- Evidence Synthesis & Decision Modeling, PRECISIONheor, 1505 West 2nd Ave #300, Vancouver, BC, V6H3Y4, Canada.
| | - Kevin Towle
- Evidence Synthesis & Decision Modeling, PRECISIONheor, 1505 West 2nd Ave #300, Vancouver, BC, V6H3Y4, Canada
| | - Ali Mojebi
- Evidence Synthesis & Decision Modeling, PRECISIONheor, 1505 West 2nd Ave #300, Vancouver, BC, V6H3Y4, Canada
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Meca-Lallana V, García Domínguez JM, López Ruiz R, Martín-Martínez J, Arés Luque A, Hernández Pérez MA, Prieto González JM, Landete Pascual L, Sastre-Garriga J. Expert-Agreed Practical Recommendations on the Use of Cladribine. Neurol Ther 2022; 11:1475-1488. [PMID: 36068429 PMCID: PMC9447968 DOI: 10.1007/s40120-022-00394-0] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/03/2022] [Indexed: 12/13/2022] Open
Abstract
Cladribine is a disease-modifying selective immune reconstitution oral therapy for adult patients with highly active relapsing multiple sclerosis (RMS). It was approved in the USA in 2019 and in Europe in 2017, thus there are still gaps in existing guidelines for using cladribine tablets in clinical practice. Nine experts with extensive experience in managing patients with multiple sclerosis in Spain identified some of the unanswered questions related to the real-life use of cladribine tablets. They reviewed the available clinical trial data and real-world evidence, including their own experiences of using cladribine, over the course of three virtual meetings held between November 2020 and January 2021. This article gathers their practical recommendations to aid treatment decision-making and optimise the use of cladribine tablets in patients with RMS. The consensus recommendations cover the following areas: candidate patient profiles, switching strategies (to and from cladribine), managing response to cladribine and safety considerations.
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Affiliation(s)
- Virginia Meca-Lallana
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario "La Princesa", Madrid, Spain.
| | | | - Rocío López Ruiz
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Adrián Arés Luque
- Neurology Department, Complejo Asistencial Universitario de León, León, Spain
| | | | | | | | - Jaume Sastre-Garriga
- Neurology Department, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Mandel R, Bracke MBM, Nicol CJ, Webster JA, Gygax L. Dairy vs beef production - expert views on welfare of cattle in common food production systems. Animal 2022; 16:100622. [PMID: 36109300 DOI: 10.1016/j.animal.2022.100622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/29/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/15/2022] Open
Abstract
Consumers' views and concerns about the welfare of farm animals may play an important role in their decision to consume dairy, meat and/or plants as their primary protein source. As animals are killed prematurely in both dairy and beef industries, it is important to quantify and compare welfare compromises in these two sectors before the point of death. Seventy world-leading bovine welfare experts based in 23 countries were asked to evaluate the likelihood of a bovine to experience 12 states of potential welfare concern, inspired by the Welfare Quality® protocol. The evaluation focused on the most common beef and dairy production systems in the experts' country and was carried out separately for dairy/beef calves raised for red meat, dairy/beef calves raised for veal, dairy/beef calves raised as a replacement, and for dairy/beef cows. The results show experts rated the overall likelihood of a negative welfare state (i.e. welfare risk) to be higher in animals from dairy herds than from beef herds, for all animal categories, regardless of whether they were used to produce milk, red meat or veal. These findings suggest that consuming food products derived from common dairy production systems (dairy or meat) may be more harmful to the welfare of animals than consuming products derived from common beef production systems (i.e. from animals solely raised for their meat). Raising awareness about the linkage between dairy and meat production, and the toll of milk production on the welfare state of animals in the dairy industry, may encourage a more sustainable and responsible food consumption.
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Affiliation(s)
- Roi Mandel
- Section of Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark; Behavioural Ecology Group, Section for Ecology & Evolution, Department of Biology, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Marc B M Bracke
- Wageningen Livestock Research, Wageningen University and Research, 6708 WD Wageningen, The Netherlands
| | | | - John A Webster
- Professor Emeritus at the University of Bristol and Former Head of the Bristol Vet School, BS40 5DU Langford, United Kingdom
| | - Lorenz Gygax
- Animal Husbandry & Ethology, Albrecht Daniel Thaer-Institute of Agricultural and Horticultural Sciences, Humboldt-University of Berlin, 10099 Berlin. Germany
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Savarirayan R, Baratela W, Butt T, Cormier-Daire V, Irving M, Miller BS, Mohnike K, Ozono K, Rosenfeld R, Selicorni A, Thompson D, White KK, Wright M, Fredwall SO. Literature review and expert opinion on the impact of achondroplasia on medical complications and health-related quality of life and expectations for long-term impact of vosoritide: a modified Delphi study. Orphanet J Rare Dis 2022; 17:224. [PMID: 35698202 PMCID: PMC9195406 DOI: 10.1186/s13023-022-02372-z] [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: 12/17/2021] [Accepted: 05/29/2022] [Indexed: 11/26/2022] Open
Abstract
Background Achondroplasia is associated with disproportionate short stature and significant and potentially severe medical complications. Vosoritide is the first medicine to treat the underlying cause of achondroplasia and data from phase 3 and phase 2 extension studies showed effects on growth and body proportions. However, there are currently no long-term data available on the direct impact on endpoints such as medical complications and health-related quality of life (HRQoL). This study explored the perceived impact of achondroplasia on medical complications, HRQoL, healthcare resource use and mortality, and potential modifying effects of vosoritide, based on published evidence and expert opinion. Structured expert opinion was obtained by an international modified Delphi study among 14 experts in managing achondroplasia performed on a virtual platform and consisting of an explorative phase followed by an anonymous individual rating round. Results Overall, the panelists expect that in individuals starting long-term treatment between 2 years of age and puberty, growth velocity increases observed in the clinical trials will be maintained until final height is reached (92% agreement) and will likely result in clinically meaningful improvements in upper-to-lower body segment ratio (85%). Earlier treatment initiation will likely result in a greater final height (100%) and more likely improve proportionality (92%) than later treatment. Although current data are limited, ≥ 75% of panelists find it conceivable that the earlier long-term treatment is started, the greater the probability of a positive effect on the lifetime incidence of symptomatic spinal stenosis, kyphosis, obstructive sleep apnea, and foramen magnum stenosis. These are among the most clinically important complications of achondroplasia because of their high impact on comorbidity, mortality, and/or HRQoL. A positive effect of vosoritide on the incidence of surgeries through lifetime was considered more likely with earlier long-term treatment (90%). Conclusions This explorative study, based on international expert opinion, provides further insight into the medical and functional impacts of achondroplasia and how these might be modified through long-term use of vosoritide. The results can be used to guide the direction and design of future research to validate the assumptions and to discuss potential treatment outcomes with disease modifying therapies with families and clinicians.
Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02372-z.
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Affiliation(s)
- Ravi Savarirayan
- Murdoch Children's Research Institute, and University of Melbourne, Parkville, Melbourne, VIC, 3052, Australia.
| | | | | | - Valérie Cormier-Daire
- Université de Paris, Reference Center for Skeletal Dysplasia, Hôpital Necker-Enfants Malades, Paris, France
| | - Melita Irving
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Klaus Mohnike
- Universitätskinderklinik, Otto-Von-Guericke Universität, Magdeburg, Germany
| | - Keiichi Ozono
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ron Rosenfeld
- Oregon Health and Science University, Portland, OR, USA
| | | | - Dominic Thompson
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Klane K White
- University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Michael Wright
- Northern Genetics Service, Institute of Human Genetics, Newcastle-Upon-Tyne Hospitals, NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Svein O Fredwall
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesodden, Norway
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Gillmore JD, Reilly MM, Coats CJ, Cooper R, Cox H, Coyne MRE, Green AJ, McGowan R, Moody WE, Hawkins PN. Clinical and Genetic Evaluation of People with or at Risk of Hereditary ATTR Amyloidosis: An Expert Opinion and Consensus on Best Practice in Ireland and the UK. Adv Ther 2022; 39:2292-301. [PMID: 35419651 DOI: 10.1007/s12325-022-02139-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 11/01/2022]
Abstract
Hereditary transthyretin-mediated amyloidosis (hATTR) is challenging to diagnose early owing to the heterogeneity of clinical presentation, which differs according to the TTR gene variant and its penetrance in each individual. The TTR variants seen most frequently in the UK and Ireland (T80A, V142I and V50M) differ to those commonly occurring in other geographic locations and warrant a specific consideration for diagnosis and genetic testing. In addition, recent availability of treatment for this condition has reinforced the need for a more consistent approach to the management of patients, including access to specialist services, genetic testing and counselling, and clinical investigation for families living in the UK and Ireland. A multidisciplinary panel of experts from the UK and Ireland was convened to identify the current challenges, provide recommendations, and develop a consensus for the diagnosis and screening of people with, or at risk of, hATTR. Over a series of meetings, experts shared their current practices and drafted, refined and approved a consensus statement. This consensus statement provides recommendations for three different groups: (1) people with symptoms raising a possibility of hATTR amyloidosis; (2) people with biopsy-confirmed hATTR amyloidosis; and (3) people without symptoms who may have hATTR amyloidosis (i.e. relatives of people with identified TTR variants). For each group, recommendations are made for the required steps for the diagnosis and follow-up of symptomatic patients, and for guidance on the specialist support for counselling and pre-symptomatic genetic testing of at-risk individuals. This guidance is intended to be practical and based on available evidence. The aim is for regional amyloid specialist centres to provide timely diagnosis, clinical screening, and treatment for individuals and their families with hATTR amyloidosis.
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de Rijk FEM, van Veldhuisen CL, Besselink MG, van Hooft JE, van Santvoort HC, van Geenen EJM, Hegyi P, Löhr JM, Dominguez-Munoz JE, de Jonge PJF, Bruno MJ, Verdonk RC. Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study. Pancreatology 2022; 22:457-465. [PMID: 35346599 DOI: 10.1016/j.pan.2022.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore, the aim of this study is to provide insight into the current opinion and clinical decision-making of international pancreatologists regarding the management of exocrine pancreatic insufficiency. METHODS An online survey and case vignette study was sent to experts in chronic pancreatitis and members of various pancreatic associations: EPC, E-AHPBA and DPSG. Experts were selected based on publication record from the past 5 years. RESULTS Overall, 252 pancreatologists participated of whom 44% had ≥ 15 years of experience and 35% treated ≥ 50 patients with chronic pancreatitis per year. Screening for exocrine pancreatic insufficiency as part of the diagnostic work-up for chronic pancreatitis is performed by 69% and repeated annually by 21%. About 74% considers nutritional assessment to be part of the standard work-up. Patients are most frequently screened for deficiencies of calcium (47%), iron (42%), vitamin D (61%) and albumin (59%). In case of clinically steatorrhea, 71% prescribes enzyme supplementation. Of all pancreatologists, 40% refers more than half of their patients to a dietician. Despite existing guidelines, 97% supports the need for more specific and tailored instructions regarding the management of exocrine pancreatic insufficiency. CONCLUSION This survey identified a lack of consensus and substantial practice variation among international pancreatologists regarding guidelines pertaining the management of exocrine pancreatic insufficiency. These results highlight the need for further adaptation of these guidelines according to current expert opinion and the level of available scientific evidence.
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Affiliation(s)
- Florence E M de Rijk
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands.
| | - Charlotte L van Veldhuisen
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Erwin J M van Geenen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Hegyi
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - J-Matthias Löhr
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Juan E Dominguez-Munoz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pieter Jan F de Jonge
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
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Abstract
Expert assessment of traumatic damage in the head and neck area by the adjuster broadly comprises two main questions: does a causal relationship between the complaint and the specific insured event exist, and what is the extent of the damage? A relationship is probable if the trauma is quantitively and qualitatively suitable to have caused the existent damage. A particularly difficult scenario is represented by cases lacking pre-accident findings or when the claimant claims that pre-existing hearing loss or tinnitus has been worsened by the event or that the accident was the cause of the impairment. It must also be taken into account that claimants frequently relate their complaints to an insured event due to causal thinking. Comprehensive tables are available for evaluation of the extent of the damage in otorhinolaryngology. In statutory accident insurance, the health damage is "considerable" if it leads to a reduced earning capacity of at least 10%. In private accident insurance, physical damage is financially regulated at below 10% invalidity, e.g., 2-3%, although this is hardly possible to calculate using conventional tables. These and other difficulties are discussed in the article based on examples.
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Abstract
Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to a multiorgan disease and subsequently to very different clinical manifestations of coronavirus disease 2019 (COVID-19). In addition to acute symptoms, the long-term complaints in the context of the infection, known as long or post-COVID syndrome, are increasingly attracting attention. With respect to social insurance systems, expert opinions of such problems will become more and more important, whereby neurological and psychiatric symptoms are the most frequent complaints. In addition to the legal principles of the medico-legal assessment with a focus on statutory accident insurance, this overview article discusses the principles of expert assessment and presents landmarks for the expert opinion of the most frequent neurological and psychiatric symptoms occurring in the context of post-COVID syndrome.
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Affiliation(s)
- M Tegenthoff
- Neurologische Klinik und Poliklinik, BG-Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Deutschland.
| | - C Drechsel-Schlund
- Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, Hamburg, Deutschland
| | - B Widder
- Neurowissenschaftliche Gutachtenstelle, Bezirkskrankenhaus Günzburg, Günzburg, Deutschland
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Charles S, Jonckheere A. The use and understanding of forensic reports by judicial actors-The field of gunshot residue expertise as an example. Forensic Sci Int 2022; 335:111312. [PMID: 35468575 DOI: 10.1016/j.forsciint.2022.111312] [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: 02/02/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 11/17/2022]
Abstract
A comprehensive review was conducted on 42 closed court cases for which at least one gunshot residue (GSR) expertise had been requested. The aim of this study is to examine the use and understanding of the GSR findings by criminal justice professionals, the contribution to/relationship with other (forensic) elements of the case, and ultimately to assess the place of the GSR expertise in judicial decisions. The study shows that, in the vast majority of cases, the court appeared to interpret and use the GSR findings correctly, although some minor misuses were identified, mainly when the court incorrectly mentioned the expert's words, using the prosecutor's fallacy. In the end, a higher percentage of conviction rate (+23% points) was observed when incriminating GSR findings were obtained. Surprisingly, in half of the cases examined in which a guilty verdict was reached, GSR evidence was the only forensic evidence in the file.
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Affiliation(s)
- Sébastien Charles
- National Institute of Criminalistics and Criminology, Brussels, Belgium.
| | - Alexia Jonckheere
- National Institute of Criminalistics and Criminology, Brussels, Belgium
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Drijfhout M, Kendal D, Green P. Mind the gap: Comparing expert and public opinions on managing overabundant koalas. J Environ Manage 2022; 308:114621. [PMID: 35134692 DOI: 10.1016/j.jenvman.2022.114621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 08/29/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
Management decisions that do not adequately align with the values and opinions of the public-at-large can lead to controversy and conflict. In conservation and natural resource management, knowledge of the public's values and opinions are often assumed or based on the personal perceptions of experts, rather than on empirical evidence. Mismatches can occur, and in Australia, an ongoing debate about how to best manage overabundant koalas has divided experts and members of the public for decades. On several occasions, experts have recommended culling of overabundant koalas, and yet culls are rarely conducted by managers. Anecdotally this is due to perceived public opposition to the culling of koalas, but there is little empirical evidence to evaluate this assessment. Using a nationwide survey, we investigated the social acceptability of different options for koala management in a population of experts and the general public, and how underlying environmental values and basic beliefs about human-wildlife relationships can explain differences of opinion. We found significant differences in the acceptability of management options between experts and the general public, although the polarity of acceptability was mostly the same. However, the lethal management options of culling and indigenous hunting elicited opposing opinions. Consistent with previous research, beliefs about human-wildlife relationships and belief profiles were found to be useful in explaining differences in acceptability of lethal control among the public, but not among experts. Biospheric values and increased experience and knowledge could play a greater role in the formation of experts' acceptability judgements. Due consideration of evidence-based knowledge of people's opinions can avoid reactive decision-making based on the opinions of a vocal minority. Where differences of opinion exist between experts and the general public, reconciling these divergent views should lead to better conservation outcomes with reduced conflict over potentially controversial management actions.
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Affiliation(s)
- Margreet Drijfhout
- La Trobe University, Department of Ecology, Environment and Evolution, Plenty Road & Kingsbury Drive, Bundoora, VIC, 3086, Australia.
| | - Dave Kendal
- University of Melbourne, School of Ecosystem and Forest Sciences, 500 Yarra Boulevard, Richmond, VIC, 3121, Australia.
| | - Pete Green
- La Trobe University, Department of Ecology, Environment and Evolution, Plenty Road & Kingsbury Drive, Bundoora, VIC, 3086, Australia.
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Duran-Llacer I, Arumí JL, Arriagada L, Aguayo M, Rojas O, González-Rodríguez L, Rodríguez-López L, Martínez-Retureta R, Oyarzún R, Singh SK. A new method to map groundwater-dependent ecosystem zones in semi-arid environments: A case study in Chile. Sci Total Environ 2022; 816:151528. [PMID: 34762961 DOI: 10.1016/j.scitotenv.2021.151528] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
Groundwater (GW) use has intensified in recent decades, threatening the ecological integrity of groundwater-dependent ecosystems (GDEs). The study of GDEs is limited; therefore, integrated, interdisciplinary environmental approaches that guarantee their monitoring and management amid current climate and anthropogenic changes are needed. A new geospatial method with an integrated and temporal approach was developed through a multicriteria approximation, taking into account expert opinion, remote sensing-GIS, and fieldwork to map groundwater-dependent ecosystem zones (GDEZ). A survey of experts (N = 26) was conducted to assign degrees of importance to the various geospatial parameters, and the mapping was carried out using 14 parameters. The reclassified parameters were normalized on a scale of 1 to 5 according to the degree of probability of the presence of GDE. The validation was carried out through fieldwork and statistical analysis. Then, the spatio-temporal changes amid changing GW levels were assessed using the summer season normalized difference vegetation index (NDVI). Two GDEZ maps were obtained, for 2002 and 2017, between which the high- and very-high-probability zones of GDEs decreased by 31,887 ha (~ 38%). The most sensitive temporal parameters that most influenced the spatio-temporal changes on GDEs were precipitation and land use, with rain exerting a slightly the greatest influence. It was also demonstrated that identified ecosystems decreased in area or were affected by aquifer depletion (NDVI-GW, r Pearson ≥0.74). This validated method allows spatio-temporal changes in GDEs to be mapped and analyzed at an annual scale and is transferable to other arid and semi-arid environments.
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Affiliation(s)
- Iongel Duran-Llacer
- Facultad de Ciencias Ambientales y Centro EULA-Chile, Universidad de Concepción, Víctor Lamas 1290, Concepción 4070386, Chile; Centro de Recursos Hídricos para la Agricultura y la Minería (CRHIAM), Universidad de Concepción, Concepción 4070411, Chile.
| | - José Luis Arumí
- Centro de Recursos Hídricos para la Agricultura y la Minería (CRHIAM), Universidad de Concepción, Concepción 4070411, Chile
| | - Loretto Arriagada
- Centro de Recursos Hídricos para la Agricultura y la Minería (CRHIAM), Universidad de Concepción, Concepción 4070411, Chile; Facultad de Ingeniería, Universidad del Desarrollo, Avenida plaza 680, Las Condes, Chile
| | - Mauricio Aguayo
- Facultad de Ciencias Ambientales y Centro EULA-Chile, Universidad de Concepción, Víctor Lamas 1290, Concepción 4070386, Chile
| | - Octavio Rojas
- Facultad de Ciencias Ambientales y Centro EULA-Chile, Universidad de Concepción, Víctor Lamas 1290, Concepción 4070386, Chile
| | - Lisdelys González-Rodríguez
- Facultad de Ciencias Ambientales y Centro EULA-Chile, Universidad de Concepción, Víctor Lamas 1290, Concepción 4070386, Chile
| | - Lien Rodríguez-López
- Facultad de Ingeniería y Tecnología, Universidad San Sebastián, Lientur 1457, Concepción 4030000, Chile
| | - Rebeca Martínez-Retureta
- Facultad de Ciencias Ambientales y Centro EULA-Chile, Universidad de Concepción, Víctor Lamas 1290, Concepción 4070386, Chile; Centro de Recursos Hídricos para la Agricultura y la Minería (CRHIAM), Universidad de Concepción, Concepción 4070411, Chile
| | - Ricardo Oyarzún
- Centro de Recursos Hídricos para la Agricultura y la Minería (CRHIAM), Universidad de Concepción, Concepción 4070411, Chile; Departamento Ingeniería de Minas, Universidad de La Serena, Benavente 980, La Serena, Chile; Centro de Estudios Avanzados en Zonas Áridas (CEAZA), Raúl Bitrán 1305, La Serena, Chile
| | - Sudhir Kumar Singh
- K. Banerjee Centre of Atmospheric and Ocean Studies, University of Allahabad, Prayagraj 211002, India
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Manouchehri E, Taghipour A, Ebadi A, Homaei Shandiz F, Latifnejad Roudsari R. Understanding breast cancer risk factors: is there any mismatch between laywomen perceptions and expert opinions. BMC Cancer 2022; 22:309. [PMID: 35321682 PMCID: PMC8941798 DOI: 10.1186/s12885-022-09372-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/04/2022] [Indexed: 01/21/2023] Open
Abstract
Background Women’s perception and knowledge of breast cancer signs, symptoms, and risk factors could be conducive to breast cancer risk management and interventions. The present study aimed to explore Iranian laywomen perceptions and expert opinions regarding breast cancer risk factors. Methods This qualitative study was conducted from March to November 2019 in Mashhad, northeast of Iran. Through purposive sampling, 24 laywomen (women with and without BC) and 10 experts of different fields including oncology, surgery, gynecology and reproductive health were selected. Data collection was carried out using semi-structured interviews, which was mainly focused on the participants’ understanding and perception of BC risk factors. The data was analyzed utilizing conventional content analysis developed by Graneheim & Lundman. Components of trustworthiness, including credibility, dependability, confirmability, and transferability were considered. Results The main category of risk factors, which emerged from the lay participants’ data analysis, were “unhealthy lifestyle and habits” , “hormonal influences”, “environmental exposures”, “Individual susceptibility “and “belief in supernatural powers”. The experts had similar perspectives for certain risk factors, yet not for all. The category of “Individual history of disease” was emerged only from experts’ interviews. Conclusion In the present study, the lay participants’ perception concerning BC risk factors was found to be a mixture of cultural beliefs and the scientific knowledge dispersed by the media, internet, and health services. Primary prevention approaches, including awareness of breast cancer risk factors, are required for women to make improved health-related choices.
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Affiliation(s)
- E Manouchehri
- Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran.,Department of Midwifery, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Taghipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Epidemiology, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Ebadi
- Behavioral Sciences Research Center, Life style Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
| | - F Homaei Shandiz
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - R Latifnejad Roudsari
- Department of Midwifery, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. .,Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Cheng CK, Chen SJ, Chen JT, Chen LJ, Chen SN, Chen WL, Hsu SM, Lai CH, Sheu SJ, Wu PC, Wu WC, Wu WC, Yang CM, Yeung L, Chen TC, Yang CH. Optimal approaches and criteria to treat-and-extend regimen implementation for Neovascular age-related macular degeneration: experts consensus in Taiwan. BMC Ophthalmol 2022; 22:25. [PMID: 35033037 PMCID: PMC8760882 DOI: 10.1186/s12886-021-02231-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/01/2021] [Accepted: 12/23/2021] [Indexed: 11/12/2022] Open
Abstract
The management of neovascular age-related macular degeneration (nAMD) has taken a major stride forward with the advent of anti-VEGF agents. The treat-and-extend (T&E) approach is a refined management strategy, tailoring to the individual patient’s disease course and treatment outcome. To provide guidance to implementing anti-VEGF T&E regimens for nAMD in resource-limited health care systems, an advisory board was held to discuss and generate expert consensus, based on local and international guidelines, current evidence, as well as local experience and reimbursement policies. In the experts’ opinion, treatment of nAMD should aim to maximize and maintain visual acuity benefits while minimizing treatment burden. Based on current evidence, treatment could be initiated with 3 consecutive monthly injections. After the initial period, treatment interval may be extended by 2 or 4 weeks each time for the qualified patients (i.e. no BCVA loss ≥5 ETDRS letters and dry retina), and a maximum interval of 16 weeks is permitted. For patients meeting the shortening criteria (i.e. any increased fluid with BCVA loss ≥5 ETDRS letters, or presence of new macular hemorrhage or new neovascularization), the treatment interval should be reduced by 2 or 4 weeks each time, with a minimal interval of 4 weeks. Discontinuation of anti-VEGF may be considered for those who have received 2–3 consecutive injections spaced 16 weeks apart and present with stable disease. For these individuals, regular monitoring (e.g. 3–4 months) is recommended and monthly injections should be reinstated upon signs of disease recurrence.
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Affiliation(s)
- Cheng-Kuo Cheng
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Ophthalmology, School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Ophthalmology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Lee-Jen Chen
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan.,Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Hsiung Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.,Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chang Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Chuan Wu
- Department of Ophthalmology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.,Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, No.8, Chung Shan S. Rd. (Zhongshan S. Rd.), Zhongzheng Dist., Taipei, 100226, Taiwan
| | - Ling Yeung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, No.8, Chung Shan S. Rd. (Zhongshan S. Rd.), Zhongzheng Dist., Taipei, 100226, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, No.8, Chung Shan S. Rd. (Zhongshan S. Rd.), Zhongzheng Dist., Taipei, 100226, Taiwan.
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Weedn VW. Bases of Forensic Pathology Expert Testimony With Emphasis on Iowa v Tyler. Acad Forensic Pathol 2022; 11:185-195. [PMID: 35003450 DOI: 10.1177/19253621211060961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
Judicial scrutiny of the forensic sciences is increasing. This scrutiny targets the bases for expert opinions. Forensic pathologists must understand that when they express an opinion it must have an articulable underlying basis. Iowa v Tyler provides a cautionary tale where testimony from a forensic pathologist on the cause and manner of death based exclusively on police reports and audio and video recordings of police interviews of the suspect rather than on medical evidence were held to be inadmissible. Tyler has an odd and distinguishable set of facts, but has been widely cited as an example of problematic forensic pathology testimony.
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Leibbrandt D, Louw Q. Assessing biomechanics and associated factors in individuals with patellofemoral pain in a clinical setting: A qualitative study based on interviews with expert clinicians. Knee 2022; 34:178-186. [PMID: 34933238 DOI: 10.1016/j.knee.2021.11.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore the perspectives of ten clinicians from different medical disciplines with experience in managing PFP on how to conduct biomechanical assessments in individuals with PFP in a clinical setting. METHODS An explorative qualitative design was used to explore the perspectives of ten clinicians with at least five years of experience managing patients with patellofemoral pain. A series of semi-structured interviews were done over Zoom video chat. The participants were from six different medical disciplines (physiotherapy, biokinetics, podiatry, sport science, sports medicine, orthopaedic surgery). Data was analysed thematically. RESULTS Four main themes emerged from the data. These were: 1) biomechanical contributing factors that clinicians routinely screen for in patients with PFP; 2) relevant functional activities for biomechanical screening in patients with PFP; 3) conducting gait analysis assessments in a clinical setting; and 4) challenges of biomechanical assessment in patients with PFP. The clinicians expressed conflicting opinions on the usefulness of clinical gait analysis. The clinicians questioned the clinical applicability of some of the biomechanical factors identified as important in the evidence. CONCLUSIONS It is important for clinicians to include the biomechanical assessment of functional activities linked to pain when managing patients with PFP. However, some of the biomechanical factors identified in the evidence are too difficult to observe without 3D movement analysis equipment and should not be considered clinically relevant. Expert clinical opinion is important to provide contextual information when addressing biomechanics in individuals with PFP.
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Affiliation(s)
- Dominique Leibbrandt
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa.
| | - Quinette Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
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Awada A, Berghmans T, Clement PM, Cuppens K, De Wilde B, Machiels JP, Pauwels P, Peeters M, Rottey S, Van Cutsem E. Belgian expert consensus for tumor-agnostic treatment of NTRK gene fusion-driven solid tumors with larotrectinib. Crit Rev Oncol Hematol 2021;:103564. [PMID: 34861380 DOI: 10.1016/j.critrevonc.2021.103564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
Fusions of NTRK (neurotrophic tyrosine receptor kinase) genes with 5' partner genes can result in the expression of chimeric proteins that drive oncogenesis through ligand-independent kinase activation. Despite variable frequencies of NTRK fusions in different tumor types, the fact that they are common to a wide range of cancers raises the possibility of developing tumor-agnostic treatments specifically targeting NTRK fusion products, irrespective of tumor type. The first-generation Trk (tropomyosin receptor kinase) inhibitor, larotrectinib, was the first tumor-agnostic treatment of NTRK fusion-positive cancers in adults and children, to be approved in the European Union. This consensus, developed by a Belgian multidisciplinary expert panel, aims to highlight the unmet medical need associated to NTRK fusion-driven cancer treatment and, based on current knowledge of NTRK fusions and larotrectinib treatment outcome and safety, provide comprehensive guidance to oncologists regarding NTRK fusion-driven cancer diagnostics and the best use of larotrectinib in real-world clinical settings. Larotrectinib; NTRK gene fusion; Trk inhibitor; Tumor-agnostic; Expert opinion; Oncogene proteins; Protein kinase inhibitors.
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Thomson LJ, Gordon-Nesbitt R, Elsden E, Chatterjee HJ. The role of cultural, community and natural assets in addressing societal and structural health inequalities in the UK: future research priorities. Int J Equity Health 2021; 20:249. [PMID: 34819080 PMCID: PMC8611639 DOI: 10.1186/s12939-021-01590-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing health inequalities in the UK has been a policy priority for over 20 years, yet, despite efforts to create a more equal society, progress has been limited. Furthermore, some inequalities have widened and become more apparent, particularly during the Covid-19 pandemic. With growing recognition of the uneven distribution of life expectancy and of mental and physical health, the current research was commissioned to identify future research priorities to address UK societal and structural health inequalities. METHODS An expert opinion consultancy process comprising an anonymous online survey and a consultation workshop were conducted to investigate priority areas for future research into UK inequalities. The seven-question survey asked respondents (n = 170) to indicate their current role, identify and prioritise areas of inequality, approaches and evaluation methods, and comment on future research priorities. The workshop was held to determine areas of research priority and attended by a closed list of delegates (n = 30) representing a range of academic disciplines and end-users of research from policy and practice. Delegates self-selected one of four breakout groups to determine research priority areas in four categories of inequality (health, social, economic, and other) and to allocate hypothetical sums of funding (half, one, five, and ten million pounds) to chosen priorities. Responses were analysed using mixed methods. RESULTS Survey respondents were mainly 'academics' (33%), 'voluntary/third sector professionals' (17%), and 'creative/cultural professionals'(16%). Survey questions identified the main areas of inequality as 'health' (58%), 'social care' (54%), and 'living standards' (47%). The first research priority was 'access to creative and cultural opportunities' (37%), second, 'sense of place' (23%), and third, 'community' (17%). Approaches seen to benefit from more research in relation to addressing inequalities were 'health/social care' (55%), 'advice services' (34%), and 'adult education/training' (26%). Preferred evaluation methods were 'community/participatory' (76%), 'action research' (62%), and 'questionnaires/focus groups' (53%). Survey respondents (25%) commented on interactions between inequalities and issues such as political and economic decisions, and climate. The key workshop finding from determining research priorities in areas of inequality was that health equity could only be achieved by tackling societal and structural inequalities, environmental conditions and housing, and having an active prevention programme. CONCLUSIONS Research demonstrates a clear need to assess the impact of cultural and natural assets in reducing inequality. Collaborations between community groups, service providers, local authorities, health commissioners, GPs, and researchers using longitudinal methods are needed within a multi-disciplinary approach to address societal and structural health inequalities.
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Affiliation(s)
- L J Thomson
- Genetics, Evolution and Environment, UCL Division of Biosciences, University College London, London, UK
| | | | - E Elsden
- UCL Epidemiology and Public Health, University College London, London, UK
| | - H J Chatterjee
- Genetics, Evolution and Environment, UCL Division of Biosciences, University College London, London, UK.
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Graham K, Gilligan D, Brown P, van Klinken RD, McColl KA, Durr PA. Use of spatio-temporal habitat suitability modelling to prioritise areas for common carp biocontrol in Australia using the virus CyHV-3. J Environ Manage 2021; 295:113061. [PMID: 34348430 DOI: 10.1016/j.jenvman.2021.113061] [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] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/09/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
Common carp (Cyprinus carpio) are an invasive species of the rivers and waterways of south-eastern Australia, implicated in the serious decline of many native fish species. Over the past 50 years a variety of control options have been explored, all of which to date have proved either ineffective or cost prohibitive. Most recently the use of cyprinid herpesvirus 3 (CyHV-3) has been proposed as a biocontrol agent, but to assess the risks and benefits of this, as well as to develop a strategy for the release of the virus, a knowledge of the fundamental processes driving carp distribution and abundance is required. To this end, we developed a novel process-based modelling framework that integrates expert opinion with spatio-temporal datasets via the construction of a Bayesian Network. The resulting weekly networks thus enabled an estimate of the habitat suitability for carp across a range of hydrological habitats in south-eastern Australia, covering five diverse catchment areas encompassing in total a drainage area of 132,129 km2 over a period of 17-27 years. This showed that while suitability for adult and subadult carp was medium-high across most habitats throughout the period, nevertheless the majority of habitats were poorly suited for the recruitment of larvae and young-of-year (YOY). Instead, high population abundance was confirmed to depend on a small number of recruitment hotspots which occur in years of favourable inundation. Quantification of the underlying ecological drivers of carp abundance thus makes possible detailed planning by focusing on critical weaknesses in the population biology of carp. More specifically, it permits the rational planning for population reduction using the biocontrol agent, CyHV-3, targeting areas where the total population density is above a "damage threshold" of approximately 100 kg/ha.
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Affiliation(s)
- K Graham
- CSIRO Australian Centre for Disease Preparedness (ACDP), Geelong, VIC, Australia
| | - D Gilligan
- NSW Department of Primary Industries - Fisheries NSW, NSW, Australia
| | - P Brown
- Centre for Freshwater Ecosystems, School of Life Sciences, La Trobe University, Mildura, VIC, Australia; Fisheries and Wetlands Consulting, Portarlington, VIC, Australia
| | | | - K A McColl
- CSIRO Health and Biosecurity, Geelong, VIC, Australia
| | - P A Durr
- CSIRO Australian Centre for Disease Preparedness (ACDP), Geelong, VIC, Australia.
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Kalema RN, Duhig SJ, Williams MD, Donaldson A, Shield AJ. Sprinting technique and hamstring strain injuries: A concept mapping study. J Sci Med Sport 2021; 25:209-215. [PMID: 34600821 DOI: 10.1016/j.jsams.2021.09.007] [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: 01/30/2021] [Revised: 09/09/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to explore expert opinion to identify the components of sprinting technique they believed to be risk factors for hamstring strain injuries (HSI). DESIGN Mixed-method research design. METHODS The Concept Systems groupwisdom™ web platform was used to analyse and collect data. Participants brainstormed, sorted and rated the components of sprinting technique to consider in a HSI prevention strategy. RESULTS Twenty-three experts (academic/researcher, physiotherapist, strength and conditioning coaches and sprint coaches) brainstormed 66 statements that were synthesised and edited to 60 statements. Nineteen participants sorted the statements into clusters and rated them for relative importance and confidence they could be addressed in a hamstring injury prevention program. Multidimensional scaling and cluster analysis identified a 8-cluster solution modified to a 5-cluster solution by the research team: Training prescription (10 statements, mean importance: 3.79 out of 5 and mean confidence: 3.79); Neuromuscular and tendon properties (9, 3.09, 3.08); Kinematics parameters/Technical skills (27, 2.99, 2.98); Kinetics parameters (10, 2.85, 2.92); and Hip mechanics (4, 2.70, 2.63). The statement: "low exposure to maximal sprint running" located in the cluster "Training prescription" received the highest mean importance (4.55) and confidence ratings (4.42) of all statements. CONCLUSION The five clusters of components of sprinting technique believed to be risk factors for HSIs in order of most to least important were: training prescription, neuromuscular and tendon properties, kinematics parameters/technical drills, kinetics parameters and hip mechanics.
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Affiliation(s)
- Rudy N Kalema
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Australia.
| | - Steven J Duhig
- School of Allied Health Sciences - Exercise and Sport, Griffith University, Australia.
| | - Morgan D Williams
- Faculty of life Sciences and Education, University of South Wales, United Kingdom.
| | - Alex Donaldson
- Centre for Sport and Social Impact, La Trobe University, Australia.
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Australia.
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Beiderbeck D, Frevel N, von der Gracht HA, Schmidt SL, Schweitzer VM. Preparing, conducting, and analyzing Delphi surveys: Cross-disciplinary practices, new directions, and advancements. MethodsX 2021; 8:101401. [PMID: 34430297 PMCID: PMC8374446 DOI: 10.1016/j.mex.2021.101401] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [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: 04/13/2021] [Accepted: 05/26/2021] [Indexed: 01/02/2023] Open
Abstract
Delphi is a scientific method to organize and structure an expert discussion aiming to generate insights on controversial topics with limited information. The technique has seen a rise in publication frequency in various disciplines, especially over the past decades. In April 2021, the term Delphi method yielded 28,200 search hits in Google Scholar for the past five years alone. Given the increasing level of uncertainty caused by rapid technological and social change around the globe, collective expert opinions and assessments are likely to gain even more importance. Therefore, the paper at hand presents technical recommendations derived from a Delphi study that was conducted amid the outbreak of the COVID-19 pandemic in 2020.The paper comprehensively demonstrates how to prepare, conduct, and analyze a Delphi study. In this regard, it combines several methodological advancements of the recent past (e.g., dissent analyses, scenario analyses) with state-of-the-art impulses from other disciplines like strategic management (e.g., fuzzy clustering), psychology (e.g., sentiment analyses), or clinical trials (e.g., consensus measurement). By offering insights on the variety of possibilities to exploit Delphi-based data, we aim to support researchers across all disciplines in conducting Delphi studies and potentially expand and improve the method's field of application.
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Affiliation(s)
- Daniel Beiderbeck
- Center for Sports and Management, WHU, Otto Beisheim School of Management, Erkrather Str. 224a, 40233 Düsseldorf, Germany
- Corresponding author. Tel.: +491753187918
| | - Nicolas Frevel
- Center for Sports and Management, WHU, Otto Beisheim School of Management, Erkrather Str. 224a, 40233 Düsseldorf, Germany
| | - Heiko A. von der Gracht
- School of International Business and Entrepreneurship, Steinbeis University, Kalkofenstr. 53, 71083 Herrenberg, Germany
| | - Sascha L. Schmidt
- Center for Sports and Management, WHU, Otto Beisheim School of Management, Erkrather Str. 224a, 40233 Düsseldorf, Germany
| | - Vera M. Schweitzer
- Chair of Leadership, WHU, Otto Beisheim School of Management, Erkrather Str. 224a, 40233 Düsseldorf, Germany
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Williams N, Boumans N, Luymes N, White NE, Lemonde M, Guthrie DM. What should be measured to assess the quality of community-based palliative care? Results from a collaborative expert workshop. Palliat Support Care 2021;:1-7. [PMID: 34154690 DOI: 10.1017/S1478951521000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The need for palliative care (PC) will continue to increase in Canada with population aging. Many older adults prefer to "age in place" and receive care in their own homes. Currently, there is a lack of standardized quality indicators (QIs) for PC delivered in the community in Canada. METHODS A one-day workshop collected expert opinions on what should be measured to capture quality PC. Three brainstorming sessions were focused on addressing the following questions: (1) what is important to measure to support quality PC, regardless of setting? (2) Of the identified measures, are any of special importance to care provided in the home? (3) What are the challenges, barriers, and opportunities for creating these measures? The National Consensus Project (NCP) for Quality Palliative Care framework was used as a guide to group together important comments into key themes. RESULTS The experts identified four themes that are important for measuring quality, regardless of care setting, including access to care in the community by a multidisciplinary team, care for the individual with PC needs, support for the informal caregiver (e.g., family, friends), and symptom management for individuals with PC needs. Two additional themes were of special importance to measuring quality PC in the home, including spiritual care for individuals with PC needs and home as the preferred place of death. The challenges, barriers, and potential opportunities to these quality issues were also discussed. SIGNIFICANCE OF RESULTS PC experts, through this collaborative process, made a substantial contribution to the creation of a standardized set of QIs for community-based PC. Having a standardized set of QIs will enable health care professionals and decision makers to target areas for improvement, implement interventions to improve the quality of care, and ultimately, optimize the health and well-being of individuals with a serious illness.
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