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Falandry C, Bacchetta J, Doret-Dion M, Ferraro-Peyret C, Confavreux CB, Douplat M, Feugier P, Friggeri A, Bolze PA, Dargaud Y, Messager A, Wallon M, Geffroy L, Matillon Y, Bradwejn J. Tailoring a specific medical leadership development program for faculty members: the Lyon-Ottawa experience. Med Educ Online 2024; 29:2308955. [PMID: 38290044 PMCID: PMC10829808 DOI: 10.1080/10872981.2024.2308955] [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: 08/21/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
The development of leadership skills has been the topic of several position statements over recent decades, and the need of medical leaders for a specific training was emphasized during the COVID-19 crisis, to enable them to adequately collaborate with governments, populations, civic society, organizations, and universities. However, differences persist as to the way such skills are taught, at which step of training, and to whom. From these observations and building on previous experience at the University of Ottawa, a team of medical professors from Lyon (France), Ottawa, and Montreal (Canada) universities decided to develop a specific medical leadership training program dedicated to faculty members taking on leadership responsibilities. This pilot training program was based on a holistic vision of a transformation model for leadership development, the underlying principle of which is that leaders are trained by leaders. All contributors were eminent French and Canadian stakeholders. The model was adapted to French faculty members, following an inner and outer analysis of their specific needs, both contextual and related to their time constraints. This pilot program, which included 10 faculty members from Lyon, was selected to favor interactivity and confidence in older to favor long-term collaborations between them and contribute to institutional changes from the inner; it combined several educational methods mixing interactive plenary sessions and simulation exercises during onescholar year. All the participants completed the program and expressed global satisfaction with it, validating its acceptability by the target. Future work will aim to develop the program, integrate evaluation criteria, and transform it into a graduating training.
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Affiliation(s)
- Claire Falandry
- Service de Gériatrie, Centre Hospitalier de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Laboratoire CarMeN de l’Université de Lyon, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Pierre-Bénite, France
| | - Justine Bacchetta
- Néphrologie Rhumatologie Dermatologie Pédiatrique, Hopital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
- UMR 1033, INSERM, Lyon, France
| | - Muriel Doret-Dion
- Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Faculté De Médecine Et De Maïeutique Lyon Sud - Charles Mérieux, Université Lyon 1, Oullins, France
| | - Carole Ferraro-Peyret
- Centre de biopathologie des tumeurs, Hôpitaux Est, Hospices Civils de Lyon, Bron, France
- ISPB Faculté de pharmacie, INSERM 1052, CNRS5286, Centre de Recherche sur le Cancer de Lyon, Université de Lyon, Lyon, France
| | - Cyrille B. Confavreux
- Service de Rhumatologie Sud, Hôpital Lyon Sud, Hospices Civils de LyonPierre-Bénite, France
- Université Lyon 1, UFR médecine Lyon Est, INSERM UMR 1033, Lyon, France
| | - Marion Douplat
- Service des Urgences, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université de Lyon, Laboratoire RESHAPE - Research on Healthcare Performance, Université Lyon 1, Lyon, France
| | - Patrick Feugier
- Service de Chirurgie Vasculaire et Endovasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de LyonPierre-Bénite, France
- Université de Lyon, UFR médecine Lyon Est, Université Lyon1, Pierre-Bénite, France
| | - Arnaud Friggeri
- Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université de Lyon, Faculté De Médecine Et De Maïeutique Lyon Sud - Charles Mérieux, Université Lyon 1, Oullins, France
| | - Pierre-Adrien Bolze
- Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hôpital Lyon Sud, Hospices Civils de LyonPierre-Bénite, France
- Centre pour l’Innovation en Cancérologie de Lyon (CICLY EA3738), Université Lyon 1, Oullins, France
| | - Yesim Dargaud
- Centre d’Hémophilie de Lyon, Unité d’Hémostase clinique, Hôpital Louis Pradel, Bron, France
- Université de Lyon, Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
| | - Alexandre Messager
- Human Resources and Faculty/Clinical Leadership Development, Ottawa University, Ottawa, Canada
| | - Martine Wallon
- Service de Parasitologie et de Mycologie Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Waking Team, Centre de Recherche en Neurosciences de Lyon, Bron, France
| | - Loïc Geffroy
- Stratégie et management des organisations, Université Lyon 1, Lyon, France
| | - Yves Matillon
- Laboratoire Parcours Santé Systémique, Université Lyon 1, Lyon, France
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Antza C, Grassi G, Weber T, Persu A, Jordan J, Nilsson PM, Redon J, Stabouli S, Kreutz R, Kotsis V. Assessment and Management of Patients with Obesity and Hypertension in European Society of Hypertension Excellence Centres. A survey from the ESH Working Group on Diabetes and Metabolic Risk Factors. Blood Press 2024; 33:2317256. [PMID: 38407195 DOI: 10.1080/08037051.2024.2317256] [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: 01/03/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs). METHODS We conducted a cross-sectional, international 30-item survey through e-mails. RESULTS In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors. CONCLUSION Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.
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Affiliation(s)
- Christina Antza
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Guido Grassi
- Clinical Medica, School of Medicine and Surgery, Milano-Bicocca University
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Medical Faculty, University of Cologne, Cologne, Germany
- University Hypertension Center, Cologne, Germany
| | - Peter M Nilsson
- Department of Clinical Sciences, Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Josep Redon
- Cardiometabolic Renal Risk Research Group, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
- CIBEROBN, ISCIII, Madrid, Spain
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin. - Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Vasilios Kotsis
- Clinical Medica, School of Medicine and Surgery, Milano-Bicocca University
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Hueffer K. Rabies management structures and challenges in the North in a One Health framework. Int J Circumpolar Health 2024; 83:2318059. [PMID: 38369781 PMCID: PMC10878328 DOI: 10.1080/22423982.2024.2318059] [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: 11/17/2023] [Accepted: 02/08/2024] [Indexed: 02/20/2024] Open
Abstract
Rabies is often described as the quintessential One Health problem, linking especially animal health to human health. I examined how rabies is managed in the circumpolar North through semi-structured interviews of key informants in three cases: Alaska, Northwest Territories, and Svalbard. While rabies is controlled at the territorial or state level in the Northwest Territories and Alaska, respectively, the perception of where authority lies in rabies management is less evident in Norway concerning Svalbard than in the other two cases. Respondents generally characterised the working relationship between sectors and scales of governments as positive. However, coordination remains one of the main challenges to rabies management, with harsh environmental conditions and small remote communities adding additional challenges in all three cases. Rabies managers in Svalbard also face unique conditions, such as risks associated with hunting and the particular administrative structure of Svalbard. Due to limited veterinary services in dispersed small and remote communities, dogs present challenges to rabies management in Alaska and the Northwest Territories. Personal relationships are important in disease management across agencies, and the unique challenges in the far North will likely pose challenges in adopting approaches to disease management from temperate climates.
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Affiliation(s)
- Karsten Hueffer
- Department of Veterinary Medicine and Arctic and Northern Studies Program, University of Alaska Fairbanks
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Wang W, Yu Y, Li X, Chen J, Zhang L, Wen J. Significance of Arterial Spin Labeling for Reducing Biopsies in Patients With Kidney Allograft Dysfunction. J Magn Reson Imaging 2024; 59:1777-1784. [PMID: 37515309 DOI: 10.1002/jmri.28926] [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: 05/16/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Although biopsy is often entailed for managing patients with kidney allograft dysfunction, it is associated with potential complications of severe hemorrhage. Arterial spin labeling (ASL) is a non-invasive technique that assesses tissue perfusion. PURPOSE To assess the utility of ASL for the discrimination of patients with post-transplant allograft dysfunction who do not need biopsy from those who need. STUDY TYPE Prospective. SUBJECTS Forty-six patients (34 males/12 females, aged 38.8 ± 9.5 years) with kidney allograft dysfunction, including 31 in which biopsy directly lead to changes in management (NECESSARY group) and 15 in which clinical management did not alter after biopsy (UNNECESSARY group). FIELD STRENGTH/SEQUENCE 3.0 T and 3D fast-spin echo sequence. ASSESSMENT All patients underwent both ASL scan and biopsies. The serum creatinine, proteinuria, pathologic results, and cortical ASL readings were obtained and compared between the two groups. STATISTICAL ANALYSES Chi-square test, independent student t-test, Mann-Whitney U test, receiver-operating characteristic curve. A two-tailed P < 0.05 denoted statistical significance. RESULTS The NECESSARY group presented with significantly elevated serum creatinine as compared with the UNNECESSARY group (1.87 ± 0.56 mg/dL vs. 1.31 ± 0.37 mg/dL). The acute composite score was significantly higher in the NECESSARY group than that in the UNNECESSARY group (7 [4-8] vs. 1 [0-2]). Cortical ASL in the NECESSARY group was significantly decreased as compared with the UNNECESSARY group (108.06 [69.96-134.92] mL/min/100 g vs. 153.48 [113.19-160.37] mL/min/100 g). Serum creatinine differentiated UNNCESSARY group from the NECESSARY group with an area under the curve (AUC) and specificity of 0.79 and 54.84%, respectively. By comparison, the cortical ASL yielded an AUC of 0.75 and a specificity of 70.97%. Notably, the specificity was increased to 90.30% by combined use of serum creatinine and cortical ASL. DATA CONCLUSION The combined use of ASL and serum creatinine yielded a high specificity for selecting patients who may not need allograft biopsy. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Wei Wang
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Nephrology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yuanmeng Yu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Southern University, Nanjing, China
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xue Li
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinsong Chen
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiqiu Wen
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Lukac S, Hancke K, Janni W, Pfister K, Schäffler H, Schmid M, Ebner F, Kloss T, Dayan D. Three-dimensional model for improvement of endometriosis care (3D-E). Int J Gynaecol Obstet 2024; 165:416-423. [PMID: 37795648 DOI: 10.1002/ijgo.15165] [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: 07/10/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Endometriosis affects approximately 10% of women of reproductive age and leads to significant morbidity and financial burden. Consequently, countries such as France and Germany are formulating strategies to combat endometriosis. In this study, we propose the implementation of our three-dimensional model (3D-E) to raise awareness about endometriosis and enhance timely diagnosis, treatment, and long-term care for affected patients. METHODS Based on the adapted Six Sigma Principle and the modified recommendation of Sales et al. for implementing evidence-based findings into a clinical routine, we first conducted a comprehensive investigation to identify risk factors leading to diagnostic delay of endometriosis. After identifying improvable factors, the applicable options were selected due to defined criteria such as integrability in the clinical routine, cost-effectiveness, and evidence-based-principle. Finally, solutions feasible for health care providers were integrated and the 3D-E model was established. RESULTS Some of the main risk factors contributing to diagnostic delays are symptoms acceptance and misinterpreted symptoms, especially if presenting to nongynecologists in cases of extragenital endometriosis with atypical presentation. Therefore, we tried to sensitize colleagues (first dimension) with a review paper in Germany's largest medical journal and started an elective for medical students (second dimension) at our university. In order to involve additional health care professionals in endometriosis care (third dimension), we are preparing the concept of the EndoNurse. CONCLUSION The 3D-E model is a relatively low-cost, comprehensive, and worldwide adaptable approach for facilitating knowledge transfer, sensitizing health care providers, and improving endometriosis diagnostics and therapy for patients with endometriosis who are in the center of the model.
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Affiliation(s)
- Stefan Lukac
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Katharina Hancke
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Kerstin Pfister
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Henning Schäffler
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Marinus Schmid
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Florian Ebner
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
- Gynäkologische Gemeinschaftspraxis Freising & Moosburg, Munich, Germany
| | - Tabea Kloss
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Davut Dayan
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
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Muadtongon K, Rattanaburi A, Ajimakul T, Suphasynth Y, Jiamset I, Nantamongkolkul K, Suntharasaj T, Suwanrath C, Pruksanusak N, Petpichetchian C, Suksai M, Chainarong N, Sawaddisan R, Pranpanus S. Successful multidisciplinary team management of placenta accreta spectrum disorder: A referral center model in a middle-income country. Int J Gynaecol Obstet 2024; 165:813-822. [PMID: 38189162 DOI: 10.1002/ijgo.15339] [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: 04/26/2023] [Revised: 08/12/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The aim of the study was to evaluate the outcomes of placenta accreta spectrum (PAS) disorder managed by a multidisciplinary care team (MCT) compared with a conventional care team (CCT) in a PAS referral center in Thailand. METHODS This retrospective single-center cohort study analyzed PAS management outcomes in the PSU PAS Center between January 2010 and December 2022. The incidence of hemorrhage ≥3500 mL and the composite maternal and neonatal outcomes of PAS were compared before and after the introduction of an MCT in 2016. RESULTS Of 227 PAS cases, 219 (96.5%) had pathological confirmation. There were 52 (22.9%) cases of placenta accreta, 119 (52.4%) cases of placenta increta, and 56 (24.7%) cases of placenta percreta. The incidence of estimated blood loss (EBL) ≥3500 mL decreased from 61.8% to 34.3% (P < 0.001) after the establishment of the MCT. The median EBL decreased from 4000 (IQR: 2600,7250) mL to 2250 (1300, 4750) mL (P < 0.001). EBL reduction was statistically significant in the accreta and increta groups (P < 0.001). Red blood cell transfusions decreased from five (3, 9) to two (1, 6) units (P < 0.001) per patient. The length of maternal hospital stays and ICU admissions were statistically shorter when PAS was managed by an MCT (P < 0.001). The length of newborn hospital and ICU stays decreased significantly (P < 0.001). CONCLUSION The incidence of massive postpartum hemorrhage and a composite of maternal and neonatal morbidities in pregnant women with PAS disorder improved significantly after the establishment of an MCT to manage PAS in a middle-income country setting.
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Affiliation(s)
- Kan Muadtongon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Athithan Rattanaburi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thiti Ajimakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Yuthasak Suphasynth
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ingporn Jiamset
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kulisara Nantamongkolkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thitima Suntharasaj
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ninlapa Pruksanusak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chusana Petpichetchian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Manaphat Suksai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Natthicha Chainarong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Rapphon Sawaddisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Savitree Pranpanus
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Herbst AC, Coleman MC, Macon EL, Brokman A, Stromberg AJ, Harris PA, Adams AA. Retirement risk factors, exercise management and muscle mass in US senior horses. Equine Vet J 2024; 56:522-534. [PMID: 37341387 DOI: 10.1111/evj.13958] [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: 06/27/2022] [Accepted: 05/05/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Information on the management and health of US senior horses (≥15 years of age) is currently limited. OBJECTIVES Provide information on (1) primary use of US senior horses, (2) reasons and risk factors for horse retirement, (3) exercise management, (4) prevalence of low muscle mass and (5) risk factors for, and owner-perceived consequences of, low muscle mass. STUDY DESIGN Online survey. METHODS Survey responses from 2717 owners of U.S.-resident senior horses (≥15 years of age) were analysed descriptively and inferentially, using ordered and binomial logistic regression, ANOVA and the Kruskal-Wallis test. RESULTS The most frequently reported primary uses were pleasure riding/driving (38.5%) and full retirement (39.8%). Most horses (61.5%) were retired between 15 and 24 years of age, with health problems being the main reason. Age, female sex, Thoroughbred breed and various medical conditions were identified as risk factors for retirement. In working horses (i.e., those not retired or semi-retired), exercise intensity was negatively associated with age. The owner-reported prevalence of low muscle mass in all horses was 17.2% (95%CI = 15.7-18.7). In those affected by low muscle mass, the ability to work and welfare-related aspects were commonly perceived to be impaired. Increasing age, sex (gelding), pituitary pars intermedia dysfunction, osteoarthritis, laminitis and primary use (retired and semi-retired vs. use for competition) were identified as risk factors for owner-reported low muscle mass. MAIN LIMITATIONS Potential response, recall and sampling bias. Causal relationships cannot be established. CONCLUSIONS Although structured exercise into old age may provide health benefits (as seen in elderly people), a large proportion of horses were fully retired in the current study. Senior horses were mainly retired for health problems and characterising these problems may aid in extending their work/active life. Low muscle mass was perceived to affect horses' welfare and ability to work, and identification of prevention and treatment strategies is therefore warranted.
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Affiliation(s)
- Alisa C Herbst
- M. H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
| | - Michelle C Coleman
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Erica L Macon
- M. H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
| | - Aviv Brokman
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - Arnold J Stromberg
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - Pat A Harris
- Equine Studies Group, Waltham Petcare Science Institute, Leicestershire, UK
| | - Amanda A Adams
- MARS EQUESTRIAN™ Research Fellow, M. H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
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Hammarén M, Pölkki T, Kanste O. The management of digital competence sharing in health care: A qualitative study of managers' and professionals' views. J Adv Nurs 2024; 80:2051-2064. [PMID: 37975297 DOI: 10.1111/jan.15963] [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: 06/21/2023] [Revised: 09/14/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
AIM To describe managers' and professionals' views on the management of digital competence sharing in health care. DESIGN A qualitative descriptive study. METHODS Managers (n = 22) and professionals (n = 12) from two public primary, one public special and one private health care organization in Finland participated in semi-structured individual interviews between February and May 2022. Data were analysed using inductive content analysis. RESULTS Managers' and professionals' views formed six main categories: providing resources and opportunities for digital competence sharing, creating methods and practices for digital competence sharing, managing digital competence, implementing intergenerational learning, creating a friendly and safe digital organizational atmosphere, and promoting digital competence sharing through leadership. CONCLUSION The support of management is significant in promoting the sharing of digital competence in health care organizations. The management of digital competence sharing requires a both resources and a commitment to continuous training and development. It also requires the creation of a collaborative culture to promote mutual learning between professionals and people of different generations. IMPACT Due to rapid technological advancements and the resulting load, it is important to focus on the development and sharing of digital competence among health care professionals. The study indicated that managers should have the ability to identify the strengths of professionals' digital competence and be able to utilize them in promoting digital competence sharing. It also highlighted the specific competency requirements for managers in this context. The results can be applied to the training of health care managers and professionals, particularly around digital competence. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. REPORTING METHOD The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in the reporting.
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Affiliation(s)
- Mira Hammarén
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Tarja Pölkki
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Outi Kanste
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
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Subramanian T, Levyn H, Eagan A, Katabi N, Scholfield D, Shah JP, Wong RJ, Ganly I, Patel SG. Analysis of growth rate and safety of observation for pleomorphic adenomas in pregnancy: A retrospective case series. Clin Otolaryngol 2024; 49:349-352. [PMID: 38246661 DOI: 10.1111/coa.14144] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/13/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Tejas Subramanian
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Helena Levyn
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alana Eagan
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nora Katabi
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel Scholfield
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jatin P Shah
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard J Wong
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Snehal G Patel
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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10
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Price EJ, Benjamin S, Bombardieri M, Bowman S, Carty S, Ciurtin C, Crampton B, Dawson A, Fisher BA, Giles I, Glennon P, Gupta M, Hackett KL, Larkin G, Ng WF, Ramanan AV, Rassam S, Rauz S, Smith G, Sutcliffe N, Tappuni A, Walsh SB. British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease. Rheumatology (Oxford) 2024:keae152. [PMID: 38621708 DOI: 10.1093/rheumatology/keae152] [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: 11/06/2023] [Accepted: 03/02/2024] [Indexed: 04/17/2024] Open
Abstract
Sjögren disease (SD) is a chronic, autoimmune disease of unknown aetiology with significant impact on quality of life. Although dryness (sicca) of the eyes and mouth are the classically described features, dryness of other mucosal surfaces and systemic manifestations are common. The key management aim should be to empower the individual to manage their condition-conserving, replacing and stimulating secretions; and preventing damage and suppressing systemic disease activity. This guideline builds on and widens the recommendations developed for the first guideline published in 2017. We have included advice on the management of children and adolescents where appropriate to provide a comprehensive guideline for UK-based rheumatology teams.
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Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Stuart Benjamin
- The Academy Library and Information Service, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Barts Health NHS Trust, London, UK
- Centre for Experimental Medicine and Rheumatology, The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Simon Bowman
- Department of Rheumatology, Milton Keynes University Hospital, Milton Keynes, UK
- Department of Rheumatology, University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sara Carty
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Coziana Ciurtin
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Bridget Crampton
- Patient Representative, Sjogren's UK Helpline Lead, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Annabel Dawson
- Patient Representative, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Peter Glennon
- General Practice, NHS Staffordshire & Stoke on Trent ICB, Stafford, UK
| | - Monica Gupta
- Department of Rheumatology, Gartnavel General Hospital, Glasgow, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - Wan-Fai Ng
- Translational and Clinical Research Institute & Newcastle NIHR Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Department of Rheumatology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Saad Rassam
- Haematology and Haemato-Oncology, KIMS Hospital, Maidstone, Kent, UK
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Guy Smith
- Department of Ophthalmology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | | | - Anwar Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, University College London, London, UK
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11
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Sarridou DG, Gkiouliava A, Argiriadou H, Mouratoglou SA, Mitchell JB, Walker CP. Perioperative management of a double valve replacement and coronary artery bypass graft in a patient with carcinoid syndrome; a case report and literature review. Perfusion 2024:2676591241247977. [PMID: 38626318 DOI: 10.1177/02676591241247977] [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] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Carcinoid tumors are rare neuroendocrine tumors; about 5% of patients develop the carcinoid syndrome. We present the case of a patient with carcinoid syndrome undergoing cardiac surgery. CASE REPORT A 74-year-old patient with carcinoid heart disease and hepatic metastases underwent double valve replacement and CABG. The patient was on octreotide therapy and antihypertensive medication. An octreotide infusion was commenced perioperatively. Pharmaceutical agents that could potentially precipitate histamine release or exacerbate catecholamine secretion and carcinoid crises were avoided. Postoperatively, recovery was complicated by atrial fibrillation, chest infection, pleural effusions, acute kidney injury and delirium. DISCUSSION Hepatic metastases cause systemic hormones' secretion, which cause a carcinoid crisis. Perioperative administration of octreotide is used, while vigilance is required to differentiate between hemodynamic effects related to the operation or disease specific factors. CONCLUSION No carcinoid crisis was evident perioperatively. High vigilance with appropriate monitoring, aggressive management combined with meticulous choice of pharmaceutical agents led to this outcome.
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Affiliation(s)
- Despoina G Sarridou
- Department Anaesthesia and Intensive Care, AHEPA Hospital, Thessaloniki, Greece
- King's College London, London, UK
- Department of Anaesthesia, Intensive Care and Pain, The Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Anna Gkiouliava
- Department Anaesthesia and Intensive Care, AHEPA Hospital, Thessaloniki, Greece
| | - Helena Argiriadou
- Department Anaesthesia and Intensive Care, AHEPA Hospital, Thessaloniki, Greece
| | | | - Jeremy B Mitchell
- Department of Anaesthesia, Intensive Care and Pain, The Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Christopher P Walker
- Department of Anaesthesia, Intensive Care and Pain, The Royal Brompton & Harefield NHS Foundation Trust, London, UK
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12
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Heaton J, Alshami A, Imburgio S, Mararenko A, Schoenfeld M, Sealove B, Asif A, Almendral J. Current Trends in Hypertension Identification and Management: Insights from the National Health and Nutrition Examination Survey (NHANES) Following the 2017 ACC/AHA High Blood Pressure Guidelines. J Am Heart Assoc 2024; 13:e034322. [PMID: 38563377 DOI: 10.1161/jaha.123.034322] [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] [Received: 01/05/2024] [Accepted: 02/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hypertension is a global health issue associated with increased cardiovascular morbidity and mortality. This study aimed to investigate contemporary hypertension identification and management trends following the 2017 American College of Cardiology/American Heart Association guidelines. METHODS AND RESULTS Data from the National Health and Nutrition Examination Survey conducted from 2017 to 2020 were analyzed. Participants between 20 and 79 years of age were included. Participants were stratified into different treatment groups based on indication and guideline adherence. Descriptive statistics were used to compare medication use, diagnosis rates, and blood pressure control. A total of 265 402 026 people met the inclusion criteria, of which 19.0% (n=50 349 209) were undergoing guideline antihypertensive management. In the guideline antihypertensive management group, a single antihypertensive class was used to treat 45.7% of participants, and 55.2% had uncontrolled blood pressure. Participants not undergoing guideline antihypertensive management qualified for primary prevention in 11.5% (n=24 741 999) of cases and for secondary prevention in 2.4% (n=5 070 044) of cases; of these, 66.3% (n=19 774 007) did not know they may have hypertension and were not on antihypertensive medication. CONCLUSIONS Adherence to guidelines for antihypertensive management is suboptimal. Over half of patients undergoing guideline treatment had uncontrolled blood pressure. One-third of qualifying participants may not be receiving treatment. Education and medical management were missing for 2 in 3 qualifying participants. Addressing these deficiencies is crucial for improving blood pressure control and reducing cardiovascular event outcomes.
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Affiliation(s)
- Joseph Heaton
- Department of Medicine Jersey Shore University Medical Center Neptune City NJ
| | - Abbas Alshami
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Steven Imburgio
- Department of Medicine Jersey Shore University Medical Center Neptune City NJ
| | - Anton Mararenko
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Matthew Schoenfeld
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Brett Sealove
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Arif Asif
- Department of Medicine Jersey Shore University Medical Center Neptune City NJ
| | - Jesus Almendral
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
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13
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Lu Y, Wang J, Ma L. A successful surgical management for a thrombosed giant left coronary aneurysm with right ventricular fistula in a young patient. Cardiol Young 2024:1-3. [PMID: 38618865 DOI: 10.1017/s1047951124000854] [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] [Indexed: 04/16/2024]
Abstract
Giant coronary aneurysm with ventricular fistula is rare. Due to the limited data from randomised clinical trials, therapeutic strategies for coronary aneurysms predominantly rely on on case series and anecdotal evidences. Reporting cases that provide practical experience in managing these aneurysms is therefore crucial. In this article, we report a rare case of a successful surgical management for a thrombosed giant left coronary aneurysm with right ventricular fistula, which is larger than any previously reported cases.
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Affiliation(s)
- Yunyi Lu
- Department of Medical Imaging, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Jing Wang
- Department of Medical Imaging, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Liheng Ma
- Department of Medical Imaging, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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14
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Mintzberg H. Reorganising our heads for the care of our health. BMJ Lead 2024:leader-2023-000912. [PMID: 38408841 DOI: 10.1136/leader-2023-000912] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Henry Mintzberg
- Desautels School of Management, McGill University, Montreal, Quebec, Canada
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15
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Pan Q, Liu Y, Wei S. Design of a multi-category drug information integration platform for intelligent pharmacy management: A needs analysis study. Medicine (Baltimore) 2024; 103:e37591. [PMID: 38608092 PMCID: PMC11018220 DOI: 10.1097/md.0000000000037591] [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] [Received: 10/31/2023] [Accepted: 02/22/2024] [Indexed: 04/14/2024] Open
Abstract
A drug store was never just an area to fill personal solution. Patients considered drug specialists to be counsels, somebody who could help them pick an over-the-counter treatment or understanding the portion and directions for a solution. Drug stores, similar to the remainder of the medical services business, are going through changes. Nowadays, one of the main highlights of any structure is the board. The executives give the refinement needed to wrap up any responsibility in a particular way. The executive framework of a drug store can be utilized to deal with most drug store related errands. This report has provided data on the best way to fabricate and execute a Pharmacy Management System. The primary objective of this system is to expand exactness, just as security and proficiency, in the drug shop. This undertaking is focused on the drug store area, determined to offer engaging and reasonable programming answers to assist them with modernizing to rival shops (helping out other equal modules in a similar examination program). This study will clarify the system's thoughts concerning the board issues and arrangements of a drug store. Likewise, this study covers the main parts of the Pharmacy application's investigation, execution, and look.
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Affiliation(s)
- Qihong Pan
- College of Traditional Chinese Medicine, Nanchang Medical College, Nanchang, China
| | - Yang Liu
- Organization Department of the Party Committee, Nanchang Medical College, Nanchang, China
| | - Shaofeng Wei
- College of Pharmacy, Nanchang Medical College, Nanchang, China
- Key laboratory, Jiangxi University of Chinese Medicine, Nanchang, China
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16
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Toledo LM, Rodriguez R, Sivesind TE, Vakirlis E, Kojima R, Dellavalle RP. From the Cochrane Library: Leukotriene Receptor Antagonists for Eczema. JMIR Dermatol 2024; 7:e50434. [PMID: 38607671 DOI: 10.2196/50434] [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: 06/30/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
| | - Ramiro Rodriguez
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Torunn E Sivesind
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Efstratios Vakirlis
- Department of Dermatology and Venereology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Reiji Kojima
- Department of Health Sciences, School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Robert P Dellavalle
- University of Colorado School of Medicine, Aurora, CO, United States
- Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
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17
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Catford SR, Katz D, McLachlan RI. Use of empirical medical therapies for idiopathic male infertility in Australia and New Zealand. Clin Endocrinol (Oxf) 2024. [PMID: 38606557 DOI: 10.1111/cen.15059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/01/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Idiopathic male infertility is common, yet there is no approved treatment. This study aimed to understand practice patterns towards empirical medical therapy (EMT) for idiopathic male infertility in Australia and New Zealand (NZ). DESIGN Clinical members of the Endocrine Society of Australia, Fertility Society of Australia & NZ, and Urological Society of Australia & NZ were invited to complete a survey. Questions included demographics, EMT practice habits, and thoughts regarding infertility case scenarios. Unadjusted group differences between specialists, those with and without additional training in male infertility, and frequency of managing it were evaluated. RESULTS Overall, 147 of 2340 members participated (6.3%); majority were endocrinologists and gynaecologists. Participants were experienced; 35% had completed additional training in male infertility and 36.2% reported they frequently manage male infertility. Gynaecologists were more likely to manage male infertility and attend education courses than endocrinologists and urologists. Beliefs about the effect of EMT on sperm concentration and pregnancy did not differ between speciality types. Many respondents considered all patient scenarios suitable for EMT. Of medications, hCG and clomiphene were selected most. Two respondents indicated they would use testosterone to treat male infertility. CONCLUSIONS This study demonstrates common use of EMT in Australia and NZ for idiopathic male infertility. The breadth of responses reflects a lack of consensus within the current literature, highlighting the need for further research to clarify their role in the management of idiopathic male infertility.
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Affiliation(s)
- Sarah R Catford
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Reproductive Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
| | - Darren Katz
- Men's Health Melbourne, Melbourne, Victoria, Australia
- Department of Urology, Western Health, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert I McLachlan
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Monash IVF Group Pty Ltd, Melbourne, Victoria, Australia
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18
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Wang Y, Chen Y, Song Y, Chen H, Guo X, Ma L, Liu H. The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e47012. [PMID: 38623741 DOI: 10.2196/47012] [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: 03/06/2023] [Revised: 12/23/2023] [Accepted: 01/23/2024] [Indexed: 04/17/2024] Open
Abstract
Background In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid (SUA) levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for patients with gout requires significant labor and time costs, and its efficiency and coverage remain low. Mobile health (mHealth) may be able to address these issues. Objective This study aimed to explore the impact of mHealth-based continuous care on improving gout knowledge and treatment compliance and reducing SUA levels. Methods This study was a single-center, single-blind, and parallel-group randomized controlled trial. Participants were recruited at the West China Hospital of Sichuan University in Chengdu, China, between February 2021 and July 2021 and were randomly assigned to the intervention and control groups. The intervention group received continuous care via an mHealth app, which includes modules for health records, 24 weeks of gout-related health education materials, and interactive support. The control group received routine continuous care, including face-to-face health education, paper-based health education materials consistent with the content for the intervention group, and telephone consultations initiated by the patient. Follow-up was conducted at 6 months. Participants' gout knowledge levels and treatment compliance were measured at baseline and the 12th and 24th weeks, and participants' SUA levels were measured at baseline and the 24th week. The intention-to-treat principle and a generalized estimating equation model were used to test the effect of the intervention. Results Overall, 258 potential participants underwent eligibility assessments, and 120 were recruited and randomized into the intervention (n=60, 50%) and control (n=60, 50%) groups. Of the 120 participants, 93 (77.5%) completed the 24-week study. The 2 groups had no significant differences in sociodemographic or clinical characteristics, and the baseline measurements were comparable (all P>.05). Compared with the control group, the intervention group exhibited a significant improvement in gout knowledge levels over time (β=0.617, 95% CI 0.104-1.129; P=.02 and β=1.300, 95% CI 0.669-1.931; P<.001 at the 12th and 24th weeks, respectively). There was no significant difference in treatment adherence between the 2 groups at the 12th week (β=1.667, 95% CI -3.283 to 6.617; P=.51), while a statistical difference was observed at the 24th week (β=6.287, 95% CI 1.357-11.216; P=.01). At the 24th week, SUA levels in both the intervention and control groups were below baseline, but there was no significant difference in SUA changes between the 2 groups (P=.43). Conclusions Continuous care based on the mHealth app improved knowledge levels and treatment compliance among patients with gout. We suggest incorporating this intervention modality into standard continuous care for patients with gout.
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Affiliation(s)
- Ying Wang
- Department of Rheumatology and Immunology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yanling Chen
- Department of Rheumatology and Immunology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yuqing Song
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hong Chen
- West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xin Guo
- Department of Rheumatology and Immunology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Ling Ma
- Department of Rheumatology and Immunology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Huan Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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19
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Duren JV, Puttgen HA, Martinez J, Murray NM. Poisson Modeling Predicts Acute Telestroke Patient Call Volume. Telemed J E Health 2024. [PMID: 38603583 DOI: 10.1089/tmj.2023.0614] [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] [Indexed: 04/13/2024] Open
Abstract
Background: Predicting the frequency of calls for telestroke and emergency teleneurology consultation is essential to prepare staffing for the immediate management of time-sensitive strokes. In this study, we evaluate Poisson distribution count data using a generalized linear model that predicts the volume of hourly telestroke calls over a 24-h period. Methods: We performed an Institutional Review Board approved retrospective cohort review of patients (January 2019-December 2022) from an institutional telestroke database at a large nonprofit multihospital system in the United States. All patients ≥18 years with a telestroke activation were included. Telestroke calls were quantified in frequency per day and analyzed by multiple time and date intervals. Poisson probability mass function (PMF) and cumulative distribution function (CDF) were used to predict call probabilities. A univariable Poisson regression model was fit to predict call volumes. Results: A total of 8,499 patients at 21 hospitals met inclusion criteria, the mean calls/day were 5.82 ± 2.54, and mean calls/day within each hour increment ranged from a minimum of 0.07 from 5 a.m. to 6 a.m. to a maximum of 0.45 from 7 p.m. to 8 p.m. The Poisson distribution was the most appropriate parametric probability model for these data, confirmed by the fit of the data to the expected distributions corresponding to the calculated means. The predicted probabilities of call frequencies by hour were calculated using the Poisson PMF and CDF; the probability of two or fewer calls/day by hour ranged from 98.9% to 99.9%. Univariable Poisson regression modeled an increase of future calls/day from 6.7 calls/day in July 2023 to 7.6 calls/day in October 2025. Conclusion: Poisson modeling closely fits telestroke call volumes, predicts the future volumes, and can be applied to any health system in which the mean call volume is known, which may inform the number of physicians needed to cover calls in real-time.
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Affiliation(s)
- Joe Van Duren
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
| | - H Adrian Puttgen
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
| | - Julie Martinez
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
| | - Nick M Murray
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
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20
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Walton ZE, Frigault MJ, Maus MV. Current and emerging pharmacotherapies for cytokine release syndrome, neurotoxicity, and hemophagocytic lymphohistiocytosis-like syndrome due to CAR T cell therapy. Expert Opin Pharmacother 2024:1-17. [PMID: 38588525 DOI: 10.1080/14656566.2024.2340738] [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: 12/12/2023] [Accepted: 03/01/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Chimeric antigen receptor (CAR) T cells have revolutionized the treatment of multiple hematologic malignancies. Engineered cellular therapies now offer similar hope to transform the management of solid tumors and autoimmune diseases. However, toxicities can be serious and often require hospitalization. AREAS COVERED We review the two chief toxicities of CAR T therapy, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), and the rarer immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome. We discuss treatment paradigms and promising future pharmacologic strategies. Literature and therapies reviewed were identified by PubMed search, cited references therein, and review of registered trials. EXPERT OPINION Management of CRS and ICANS has improved, aided by consensus definitions and guidelines that facilitate recognition and timely intervention. Further data will define optimal timing of tocilizumab and corticosteroids, current foundations of management. Pathophysiologic understanding has inspired off-label use of IL-1 receptor antagonism, IFNγ and IL-6 neutralizing antibodies, and janus kinase inhibitors, with data emerging from ongoing clinical trials. Further strategies to reduce toxicities include novel pharmacologic targets and safety features engineered into CAR T cells themselves. As these potentially curative therapies are used earlier in oncologic therapy and even in non-oncologic indications, effective accessible strategies to manage toxicities are critical.
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Affiliation(s)
- Zandra E Walton
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Division of Rheumatology, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Matthew J Frigault
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Marcela V Maus
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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21
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Potestio L, Martora F, Lauletta G, Vallone Y, Battista T, Megna M. The Role of Interleukin 23/17 Axis in Psoriasis Management: A Comprehensive Review of Clinical Trials. Clin Cosmet Investig Dermatol 2024; 17:829-842. [PMID: 38616886 PMCID: PMC11016251 DOI: 10.2147/ccid.s462797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
Psoriasis pathogenesis is influenced by genetic factors and characterized by a complex interplay between genetic predisposition and various environmental triggers. These triggers set off metabolic processes involving inflammation, cell signaling, immune response dysregulation, and antigen presentation. Several types of innate and adaptive immune cells are involved in psoriasis. Among the cytokine cascade which leads to psoriasis development, the interleukin (IL)-23/Th17 axis, especially IL-17 production, emerges as crucial. Recognizing the pivotal role of this axis has facilitated the development of selective and effective biological drugs, such as anti-IL17 and anti-IL23 monoclonal antibodies. These drugs aim to achieve the complete or near-complete disappearance of psoriatic lesions, as indicated by PASI100 and PASI90 responses, respectively. In this context, the aim of our review was to delve into the functioning of the IL-23/Th17 axis, its dysregulation in psoriasis pathogenesis, and the therapeutic potential of its inhibition. Currently, 4 anti-IL17 (secukinumab, ixekizumab, bimekizumab and brodalumab) and 3 anti-IL23 (guselkumab, risankizumab and tildrakizumab) have been approved. All these drugs showed high levels of effectiveness in both clinical trials and real-life experiences, with an excellent profile in terms of safety. Certainly, furthers studies will allow for better characterization of biologics' profile, in order to administer the right drug for the right patients at the right moment.
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Affiliation(s)
- Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giuseppe Lauletta
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Ylenia Vallone
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Teresa Battista
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Chen J, Dai L, Guo M, Huang H, He R, Jin H, Jin X, Li X, Li Y, Liu Y, Wang C, Wang Y, Wu L, Xing Z, Fujitani J, Sugiura Y, Hinohara C, Tang W. A multidisciplinary collaborative diagnosis and rehabilitation program for dysphagia in general hospitals. Biosci Trends 2024:2024.01076. [PMID: 38599879 DOI: 10.5582/bst.2024.01076] [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] [Indexed: 04/12/2024]
Abstract
Dysphagia is a common complication of various clinical conditions, with an increased incidence as age advances. Complications such as aspiration, malnutrition, and aspiration pneumonia caused by dysphagia significantly affect the overall treatment outcomes of patients. Scholars both domestically and internationally are increasingly focusing on early rehabilitation for dysphagia. This article summarizes common conditions causing dysphagia, clinical manifestations, complications, screening assessment, diagnosis, rehabilitation, and nutritional support related to dysphagia. It emphasizes the arrival at a multidisciplinary collaborative diagnosis and formulation of a rehabilitation management plan for dysphagia in general hospitals in order to provide strategic suggestions for establishing a multidisciplinary collaborative model for swallowing disorder management in general hospitals.
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Affiliation(s)
- Juan Chen
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Lili Dai
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Min Guo
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Hui Huang
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Rongfen He
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Hui Jin
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Xin Jin
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Xiaoxiao Li
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Yumin Li
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Yonggang Liu
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Chao Wang
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Yukai Wang
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Li Wu
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Zhongcheng Xing
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Junko Fujitani
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuo Sugiura
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Wei Tang
- National Center for Global Health and Medicine, Tokyo, Japan
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23
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Wurcel AG, Suzuki J, Schranz AJ, Eaton EF, Cortes-Penfield N, Baddour LM. Strategies to Improve Patient-Centered Care for Drug Use-Associated Infective Endocarditis: JACC Focus Seminar 2/4. J Am Coll Cardiol 2024; 83:1338-1347. [PMID: 38569764 DOI: 10.1016/j.jacc.2024.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 04/05/2024]
Abstract
Drug use-associated infective endocarditis (DUA-IE) is a major cause of illness and death for people with substance use disorder (SUD). Investigations to date have largely focused on advancing the care of patients with DUA-IE and included drug use disorder treatment, decisions about surgery, and choice of antibiotics during the period of hospitalization. Transitions from hospital to outpatient care are relatively unstudied and frequently a key factor of uncontrolled infection, continued substance use, and death. In this paper, we review the evidence supporting cross-disciplinary care for people with DUA-IE and highlight domains that need further clinician, institutional, and research investment in clinicians and institutions. We highlight best practices for treating people with DUA-IE, with a focus on addressing health disparities, meeting health-related social needs, and policy changes that can support care for people with DUA-IE in the hospital and when transitioning to the community.
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Affiliation(s)
- Alysse G Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Asher J Schranz
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ellen F Eaton
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | | | - Larry M Baddour
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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24
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Chesdachai S, Esquer Garrigos Z, DeSimone CV, DeSimone DC, Baddour LM. Infective Endocarditis Involving Implanted Cardiac Electronic Devices: JACC Focus Seminar 1/4. J Am Coll Cardiol 2024; 83:1326-1337. [PMID: 38569763 DOI: 10.1016/j.jacc.2023.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 09/22/2023] [Revised: 10/26/2023] [Accepted: 11/13/2023] [Indexed: 04/05/2024]
Abstract
Cardiac implantable electronic device-related infective endocarditis (CIED-IE) encompasses a range of clinical syndromes, including valvular, device lead, and bloodstream infections. However, accurately diagnosing CIED-IE remains challenging owing in part to diverse clinical presentations, lack of standardized definition, and variations in guideline recommendations. Furthermore, current diagnostic modalities, such as transesophageal echocardiography and [18F]-fluorodeoxyglucose positron emission tomography-computed tomography have limited sensitivity and specificity, further contributing to diagnostic uncertainty. This can potentially result in complications and unnecessary costs associated with inappropriate device extraction. Six hypothetical clinical cases that exemplify the diverse manifestations of CIED-IE are addressed herein. Through these cases, we highlight the importance of optimizing diagnostic accuracy and stewardship, understanding different pathogen-specific risks for bloodstream infections, guiding appropriate device extraction, and preventing CIED-IE, all while addressing key knowledge gaps. This review both informs clinicians and underscores crucial areas for future investigation, thereby shedding light on this complex and challenging syndrome.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Zerelda Esquer Garrigos
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Baddour LM, Fuster V. Today's Infective Endocarditis: Not What You Learned in Medical School. J Am Coll Cardiol 2024; 83:1324-1325. [PMID: 38569762 DOI: 10.1016/j.jacc.2024.02.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Health, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA.
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
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Brüggen MC, Traidl S, Mitamura Y, Walsh S, French LE, Gulati N, Phillips E, Maverakis E, Ingen-Housz-Oro S. Medical algorithm: Diagnosis and treatment of drug reaction with eosinophilia and systemic symptoms in adult patients. Allergy 2024. [PMID: 38587051 DOI: 10.1111/all.16122] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/15/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Marie-Charlotte Brüggen
- Faculty of Medicine, University Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
- ToxiTEN group of the ERN-skin
| | - Stephan Traidl
- Faculty of Medicine, University Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF) Davos, Davos, Switzerland
| | - Sarah Walsh
- ToxiTEN group of the ERN-skin
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Lars E French
- ToxiTEN group of the ERN-skin
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Nicholas Gulati
- The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, California, USA
| | - Saskia Ingen-Housz-Oro
- ToxiTEN group of the ERN-skin
- Department of Dermatology, Henri Mondor Hospital, Univ Paris Est Créteil EpidermE, Créteil, Paris, France
- Reference center for severe drug reactions TOXIBUL, Créteil, France
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Awindaogo F, Acheamfour-Akowuah E, Doku A, Kokuro C, Agyekum F, Owusu IK. Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry. JMIR Res Protoc 2024; 13:e52616. [PMID: 38588528 DOI: 10.2196/52616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/23/2023] [Accepted: 12/24/2023] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care. OBJECTIVE This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana. METHODS We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring. RESULTS This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024. CONCLUSIONS This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research. TRIAL REGISTRATION ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52616.
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Affiliation(s)
| | | | - Alfred Doku
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Francis Agyekum
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Isaac Kofi Owusu
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Yang Q, Huang X, Lin Y, Chen K, Lu Q, Lin W, Wang X, Teng Y, Jiang P, Patil S, Zheng Y. Exploring the Multifaceted Landscape of Pediatric Obstructive Sleep Apnea: Insights into Prevalence, Severity, and Coexisting Conditions. Nat Sci Sleep 2024; 16:359-368. [PMID: 38617037 PMCID: PMC11012695 DOI: 10.2147/nss.s452221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
Background Pediatric obstructive sleep apnea (OSA) is a multifaceted disorder marked by recurrent upper airway obstruction during sleep, often coexisting with various medical conditions. This study, aimed to comprehensively analyze the Multifaceted Landscape of Pediatric Insights into Prevalence, Severity, and Coexisting Conditions. With a sample of 1928 participants, our study sought to determine the prevalence, severity, and associations between OSA and diverse conditions. Methods Conducted retrospectively from February 2019 to April 2023, the study included pediatric patients. Data were collected through electronic health records, involving clinical assessments, medical histories, and diagnostic tests to establish OSA and coexisting condition diagnoses. Relationships between sleep parameters, apnea types, and severity indices were evaluated. Results High OSA prevalence was evident across age groups, with severity peaking between 3 to 12 years. Among the participants, coexisting conditions included allergic rhinitis (59.6%), tonsillar hypertrophy (49.7%), adenoid hypertrophy (28.4%), and obesity (15.3%). Analysis revealed intriguing relationships between different sleep parameters and apnea types. Notable associations were observed between Obstructive Apnea (OA) and Central Apnea (CA), and Mixed Apnea (MA) displayed associations with both OA and CA. Hypopnea correlated directly with the Apnea-Hypopnea Index (AHI), reflecting its role in OSA severity. Conclusion This study provides a comprehensive understanding of the intricate dynamics between pediatric OSA and coexisting conditions. The prevalence of OSA and its coexistence with various conditions underscore the need for comprehensive evaluation and management strategies. By revealing associations between different sleep parameters and apnea types, the study emphasizes the complexity of OSA diagnosis and management. These findings hold the potential to enhance clinical approaches, ultimately leading to improved care and outcomes for affected children.
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Affiliation(s)
- Qin Yang
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Department of Sleep Centre, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Xiao Huang
- Department of Sleep Centre, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yanhong Lin
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Ke Chen
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Qinghua Lu
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Weinan Lin
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Xing Wang
- Department of Sleep Centre, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yishu Teng
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Peng Jiang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Sandip Patil
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yuejie Zheng
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
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Zheng H, Fan X, Liu Y, Wu Y, Liu Y, Xu Y, Zhi J, Yang C, Liao J. How dyadic appraisal moderate the association between dyadic coping and diabetes management efficacy. J Health Psychol 2024:13591053241240735. [PMID: 38584333 DOI: 10.1177/13591053241240735] [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] [Indexed: 04/09/2024] Open
Abstract
To explore the moderating role of dyadic appraisal in the association between dyadic coping and diabetes management efficacy. Two hundred seventy six middle-aged and older couple pairs with one spouse who had diabetes were recruited from 14 community healthcare centers across Guangzhou. The moderating role of dyadic appraisal was investigated using the actor-partner interdependence moderation model. When both couples considered diabetes to be a shared condition, statistically-significant associations were found between patients' negative (β = -22.7, p = 0.008) and neutral behaviors (β = 13.6, p = 0.017), plus spouses' positive behaviors (β = 22.8, p = 0.009) on their own diabetes management efficacy, respectively (i.e. actor effects); as well as between spouses' positive (β = 16.8, p = 0.028), negative (β = -28.5, p < 0.001), and neutral behaviors (β = 16.9, p = 0.006) on patient's diabetes management efficacy (i.e. partner effects). Dyadic appraisal moderates the association between dyadic coping and diabetes management efficacy.
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Affiliation(s)
| | | | - Yuyang Liu
- Sun Yat-sen University, China
- Shenzhen Health Development Research and Data Management Center, China
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30
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Leonardi MC, Zerella MA, Lazzeroni M, Fusco N, Veronesi P, Galimberti VE, Corso G, Dicuonzo S, Rojas DP, Morra A, Gerardi MA, Lorubbio C, Zaffaroni M, Vincini MG, Orecchia R, Jereczek-Fossa BA, Magnoni F. Tools to Guide Radiation Oncologists in the Management of DCIS. Healthcare (Basel) 2024; 12:795. [PMID: 38610216 PMCID: PMC11011767 DOI: 10.3390/healthcare12070795] [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: 02/01/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Similar to invasive breast cancer, ductal carcinoma in situ is also going through a phase of changes not only from a technical but also a conceptual standpoint. From prescribing radiotherapy to everyone to personalized approaches, including radiotherapy omission, there is still a lack of a comprehensive framework to guide radiation oncologists in decision making. Many pieces of the puzzle are finding their place as high-quality data mature and are disseminated, but very often, the interpretation of risk factors and the perception of risk remain very highly subjective. Sharing the therapeutic choice with patients requires effective communication for an understanding of risks and benefits, facilitating an informed decision that does not increase anxiety and concerns about prognosis. The purpose of this narrative review is to summarize the current state of knowledge to highlight the tools available to radiation oncologists for managing DCIS, with an outlook on future developments.
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Affiliation(s)
- Maria Cristina Leonardi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
| | - Maria Alessia Zerella
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
| | - Matteo Lazzeroni
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (N.F.); (P.V.); (G.C.)
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Paolo Veronesi
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (N.F.); (P.V.); (G.C.)
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.E.G.); (F.M.)
| | - Viviana Enrica Galimberti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.E.G.); (F.M.)
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (N.F.); (P.V.); (G.C.)
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.E.G.); (F.M.)
| | - Samantha Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
| | - Damaris Patricia Rojas
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
| | - Anna Morra
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
| | - Marianna Alessandra Gerardi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
| | - Chiara Lorubbio
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (N.F.); (P.V.); (G.C.)
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
| | - Roberto Orecchia
- Scientific Directorate, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.L.); (S.D.); (D.P.R.); (A.M.); (M.A.G.); (C.L.); (M.Z.); (M.G.V.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (N.F.); (P.V.); (G.C.)
| | - Francesca Magnoni
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.E.G.); (F.M.)
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Obeagu EI, Obeagu GU, Ubosi NI, Uzoma IC, Tayrab EMA. Concurrent management of HIV and malaria: A comprehensive review of strategies to enhance quality of life. Medicine (Baltimore) 2024; 103:e37649. [PMID: 38579091 PMCID: PMC10994515 DOI: 10.1097/md.0000000000037649] [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] [Received: 11/21/2023] [Accepted: 02/27/2024] [Indexed: 04/07/2024] Open
Abstract
The co-occurrence of human immunodeficiency virus and malaria presents a complex medical scenario, significantly impacting the quality of life for affected individuals. This comprehensive review synthesizes current knowledge, challenges, and strategies concerning the concurrent management of these infections to improve overall well-being. Epidemiological insights reveal the prevalence and demographic trends, highlighting geographical areas of concern and socioeconomic factors contributing to the burden of co-infection. Pathophysiological interactions elucidate the compounding effects, altering disease progression and treatment outcomes. Healthcare challenges underscore the necessity for integrated care models, evaluating existing healthcare frameworks and their efficacy in addressing dual infections. In-depth analysis of interventions explores pharmacological, behavioral, and preventive measures, evaluating their efficacy and safety in co-infected individuals. Additionally, the review assesses psychosocial support mechanisms, emphasizing community-based interventions and peer networks in enhancing holistic care. Consideration is given to the role of antiretroviral therapy, malaria prevention strategies, and the evolving landscape of healthcare delivery in optimizing outcomes for this vulnerable population. The paper concludes by emphasizing the significance of multidisciplinary approaches and integrated care models, stressing the need for continued research and collaborative efforts to advance interventions and improve the quality of life for those navigating the complexities of human immunodeficiency virus and malaria co-infection.
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Affiliation(s)
| | | | - Nwanganga Ihuoma Ubosi
- Department of Medical Laboratory Science, Kampala International University, Kampala, Uganda
- Department of Public Health Sciences, Faculty of Health Sciences, National Open University of Nigeria, Jabi, Abuja, Nigeria
| | - Ijeoma Chinwe Uzoma
- Molecular-Hematology and Immuno Genetics Unit, Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Eltayeb Mohamed Ahmed Tayrab
- Chemical Pathology, Department of Pathology, Faculty of Medicine and Dentistry, Kampala International University, Kampala, Uganda
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Mancuso M, Papadopoulou MT, Ng YS, Ardissone A, Bellusci M, Bertini E, Di Vito L, Evangelista T, Fons C, Hikmat O, Horvath R, Klopstock T, Kornblum C, Lamperti C, Licchetta L, Molnar MJ, Varhaug KN, O'Callaghan M, Pressler RM, Schiff M, Servidei S, Szabo N, Gorman GS, Cross JH, Rahman S. Management of seizures in patients with primary mitochondrial diseases: consensus statement from the InterERNs Mitochondrial Working Group. Eur J Neurol 2024:e16275. [PMID: 38576261 DOI: 10.1111/ene.16275] [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: 10/31/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND PURPOSE Primary mitochondrial diseases (PMDs) are common inborn errors of energy metabolism, with an estimated prevalence of one in 4300. These disorders typically affect tissues with high energy requirements, including heart, muscle and brain. Epilepsy may be the presenting feature of PMD, can be difficult to treat and often represents a poor prognostic feature. The aim of this study was to develop guidelines and consensus recommendations on safe medication use and seizure management in mitochondrial epilepsy. METHODS A panel of 24 experts in mitochondrial medicine, pharmacology and epilepsy management of adults and/or children and two patient representatives from seven countries was established. Experts were members of five different European Reference Networks, known as the Mito InterERN Working Group. A Delphi technique was used to allow the panellists to consider draft recommendations on safe medication use and seizure management in mitochondrial epilepsy, using two rounds with predetermined levels of agreement. RESULTS A high level of consensus was reached regarding the safety of 14 out of all 25 drugs reviewed, resulting in endorsement of National Institute for Health and Care Excellence guidelines for seizure management, with some modifications. Exceptions including valproic acid in POLG disease, vigabatrin in patients with γ-aminobutyric acid transaminase deficiency and topiramate in patients at risk for renal tubular acidosis were highlighted. CONCLUSIONS These consensus recommendations describe our intent to improve seizure control and reduce the risk of drug-related adverse events in individuals living with PMD-related epilepsy.
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Affiliation(s)
- Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Maria T Papadopoulou
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospital of Lyon, Member of the ERN EpiCARE, Lyon, France
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute AND National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anna Ardissone
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marcello Bellusci
- Reference Center for Inherited Metabolic Disorders MetabERN, Mitochondrial Disorders Research Group (imas12), '12 de Octubre' University Hospital, Madrid, Spain
| | - Enrico Bertini
- Research Unit of Neuromuscular Disease, Translational Pediatrics and Clinical Genetics, Bambino Gesu' Children's Research Hospital, IRCCS, Rome, Italy
| | - Lidia Di Vito
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Teresinha Evangelista
- Department of Neuropathology, Functional Unit of Neuromuscular pathology and Department of Neuromyology, Institute of Myology, EURO-NMD coordination, Pitié-Salpêtrière Hospital, APHP Sorbonne University, Paris, France
| | - Carmen Fons
- Epilepsy and Neurometabolics Units, Pediatric Neurology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Omar Hikmat
- Department of Paediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen and Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur-Institute, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Cornelia Kornblum
- Department of Neurology, Section of Neuromuscular Diseases, University Hospital Bonn, Bonn, Germany
| | | | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Kristin N Varhaug
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Mar O'Callaghan
- Epilepsy and Neurometabolics Units, Pediatric Neurology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Ronit M Pressler
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - Manuel Schiff
- Reference Center for Mitochondrial Disorders (CARAMMEL) and Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris-Cité, MetabERN, Paris, France
- INSERM UMRS_1163, Imagine Institute, Paris, France
| | - Serenella Servidei
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nora Szabo
- Saint John's Hospital, Child Epilepsy Centre, Budapest, Hungary
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute AND National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Helen Cross
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - Shamima Rahman
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
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Price B. Understanding and investigating potential problematic behaviour towards colleagues. Nurs Manag (Harrow) 2024; 31:34-41. [PMID: 38240040 DOI: 10.7748/nm.2024.e2115] [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] [Accepted: 11/15/2023] [Indexed: 04/05/2024]
Abstract
Behaviour towards colleagues within the nursing team that undermines teamwork and conflicts with standards and policies can be described as problematic. It is important that nurse managers understand and investigate potential problematic behaviour towards colleagues, particularly in today's healthcare environment where team cohesion and morale are constantly under threat. In this article, the author highlights the challenges for nurse managers and describes the sensitive and respectful exploratory process they need to undertake. Nurses' behaviours are underpinned by beliefs, values and attitudes so investigating potential problematic behaviour warrants an exploration of these aspects with individual nurses and with the nursing team. Therefore, the author also suggests a way for nurse managers to conduct a collective exploration of the team's values.
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Forbes J, Arrieta A. Comparing hospital leadership and front-line workers' perceptions of patient safety culture: an unbalanced panel study. BMJ Lead 2024:leader-2023-000922. [PMID: 38569892 DOI: 10.1136/leader-2023-000922] [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: 10/06/2023] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIM This article examines the relationships between workers' hospital leadership status, hospital front-line status and patient safety culture in hospitals throughout the USA. By identifying possible disparities in perception, targeted interventions can aim at decreasing differences between the two groups to increase the quality of healthcare. METHOD Data from 1 739 083 individuals, spreading across 1810 hospitals between 2008 and 2017 were collected. 115 228 (6.63%) self-identified as leaders, and 772 505 (44.42%) self-identified as front-line workers. The participants also filled in information describing their demographics in reference to the hospital, such as how long they have worked at the facility, their working unit and their occupation. RESULTS Results showed that leaders responded more positively to items that are directly related to management, such as 'my supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures' (0.33, p<0.01), where 0.33 signifies that leaders had an average response more positive by 0.33 compared with all other occupations on a Likert scale of 1-5. Based on multiple F-tests, all items have shown a statistical significance between leadership and front-line groups. CONCLUSION The findings highlight a compelling link between leadership roles and patient safety culture in hospitals, as well as between front-line worker status and patient safety culture. Moreover, a pronounced divergence in viewpoints regarding patient safety culture exists between hospital leaders and front-line staff. An in-depth investigation is necessary to comprehend the ramifications of these outcomes.
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Affiliation(s)
- Jayson Forbes
- Nova Southeastern University - Fort Lauderdale/Davie Campus, Fort Lauderdale, Florida, USA
| | - Alejandro Arrieta
- Department of Global Health, Florida International University, Miami, Florida, USA
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Day FJ. How the 'Health Leader-as-Coach' benefits health leaders, their teams, peers, organisation and the system. BMJ Lead 2024:leader-2023-000870. [PMID: 38569891 DOI: 10.1136/leader-2023-000870] [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: 07/10/2023] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
One of the main ways in which health leaders at all levels can be developed on a daily basis has been neglected by clinical leadership research, and by the research community generally, relating to the leader consciously using evidence-based coaching skills to positively impact their direct reports, team members, peers, organisations and the wider system in the context of their vocational role, as 'Leader-as-Coach'.This paper summarises the research on the role of 'Leader-as-Coach', and translates the learning from this into the practice of clinical leadership development.Line managers are increasingly expected to use a coaching approach and are in an ideal position to do so. While there are many similarities with professional external coaching, the behaviours of the 'Leader-as-Coach' are also not identical and multiple ethical issues can arise.There is no consistent academic definition to describe the behaviours of coaching in the context of a leader's vocational role, nor yet specific competencies for training or supervision purposes.The outcomes are summarised from the known literature in this field. Individual and system challenges are then discussed and conclusions are drawn about what this research means in practice for clinical leaders and their systems.
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Wang YH, Yang J, Zhong H, Wu JJ, Wu K, Hu A, Wu JY, Zhu JH. Prevalence, characteristics, evaluation, and management of carotid body tumors: Systematic analysis based on available evidence. J Vasc Surg 2024:S0741-5214(24)00930-3. [PMID: 38580159 DOI: 10.1016/j.jvs.2024.03.443] [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: 11/21/2023] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Although carotid body tumors (CBTs) are rare, they attract particular attention because of their propensity for malignant transformation and the high surgical risk. Because data are scarce and as it is difficult to achieve a large sample size, no study has yet comprehensively analyzed the characteristics, management, or operative complications of CBTs. Therefore, we collected and analyzed all currently available information on CBTs and used the pooled data to derive quantitative information on disease characteristics and management. METHODS We systematically searched PubMed, Embase, the Cochrane Library, and the Web of Science up to 1 December 2022 for studies that investigated the characteristics and management of CBTs. The primary objective was to identify the prevalence of the various characteristics and the incidence of complications. The secondary objective was to compare patients who underwent preoperative embolization (PE) and those who did not (non-PE), as well as to compare patients with different Shamblin grades and those with and without succinate dehydrogenase (SDH) mutations in terms of CBT characteristics and complications. Two reviewers selected studies for inclusion and independently extracted data. All statistical analyses were performed using the standard statistical procedures of Review Manager 5.2 and Stata 12.0. RESULTS A total of 155 studies with 9,291 patients and 9,862 tumors were identified. The pooled results indicated that the median age of CBT patients was 45.72 years and 65% were female. The proportion of patients with bilateral lesions was 13%. In addition, 16% of patients had relevant family histories, and the proportion of those with SDH gene mutations was 36%. 16% patients experienced multiple paragangliomas and 12% CBTs had catecholamine function. The incidence of cranial nerve injury (CNI) was 27%, and 14% of patients suffered from permanent CNI. The incidence rates of operative mortality and stroke were both 1%, and 4% of patients developed transient ischemic attacks. Of all CBTs, 6% were malignant or associated with metastases or recurrences. The most common metastatic locations were the lymph nodes (3%) and bone (3%), followed by the lungs (2%). Compared to non-PE, PE reduced the estimated blood loss (EBL) (standardized mean difference [SMD] -0.95; 95% confidence interval [CI] -1.70, -0.20) and the operation time (SMD -0.56; 95% CI -1.03, -0.09), but it increased the incidence of stroke (odds ratio 2.44; 95% CI 1.04‒ 5.73). Higher Shamblin grade tumors were associated with more operative complications. SDH gene mutation-positive patients were more likely to have a relevant family history and had more symptoms. CONCLUSIONS CBT was most common in middle-aged females, and early surgical resection was feasible; there was a low incidence of serious operative complications. Routine PE is not recommended because this may increase the incidence of stroke, although PE somewhat reduced the EBL and operation time. Higher Shamblin grade tumors increased the incidence of operative complications. SDH gene mutation-positive patients had the most relevant family histories and symptoms.
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Affiliation(s)
- Yong-Hong Wang
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning 810000; Medical College of Qinghai University, Qinghai University, Xi'ning 810000
| | - Jia Yang
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning 810000; Medical College of Qinghai University, Qinghai University, Xi'ning 810000
| | - Hao Zhong
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning 810000; Medical College of Qinghai University, Qinghai University, Xi'ning 810000
| | - Jun-Jie Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning 810000; Medical College of Qinghai University, Qinghai University, Xi'ning 810000
| | - Kai Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning 810000; Medical College of Qinghai University, Qinghai University, Xi'ning 810000
| | - Anguo Hu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning 810000; Medical College of Qinghai University, Qinghai University, Xi'ning 810000
| | - Jian-Ying Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning 810000; Medical College of Qinghai University, Qinghai University, Xi'ning 810000
| | - Ji-Hai Zhu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning 810000; Medical College of Qinghai University, Qinghai University, Xi'ning 810000.
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Cernega A, Nicolescu DN, Meleșcanu Imre M, Ripszky Totan A, Arsene AL, Șerban RS, Perpelea AC, Nedea MI(I, Pițuru SM. Volatility, Uncertainty, Complexity, and Ambiguity (VUCA) in Healthcare. Healthcare (Basel) 2024; 12:773. [PMID: 38610195 PMCID: PMC11011466 DOI: 10.3390/healthcare12070773] [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: 02/29/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Our professional activity is constantly under pressure from a multitude of elements and factors that can be classified into the four components of the VUCA phenomenon-volatility, uncertainty, complexity, and ambiguity-components that define the turbulence and challenges of the external environment. Considering the general elements of this phenomenon, we designed a new VUCA dimension specific to the healthcare field within which we have identified and analyzed all the factors that can influence the main actors of the doctor-patient relationship and the effects that can occur within the healthcare system in which this relationship is born. In this context, we generated the VUCA treatment in healthcare capable of mitigating the impact of this phenomenon; this treatment involves essential elements in overcoming possible crises and vulnerabilities of the medical profession. The VUCA treatment in healthcare requires combating volatility, uncertainty, complexity, and ambiguity through vision, understanding, clarity, and agility, which are grounded in the doctor's need to acquire cross-functional competencies (soft skills). These competencies are applicable by using functional mechanisms and techniques that support the doctor in developing adaptability and anticipation skills, understanding the patient's needs and addressing them, and ensuring the functionality and efficiency of the healthcare system by transferring these elements from micro-management to macro-management levels.
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Affiliation(s)
- Ana Cernega
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Dragoș Nicolae Nicolescu
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Marina Meleșcanu Imre
- Department of Prosthodontics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Calea Plevnei, 010221 Bucharest, Romania;
| | - Alexandra Ripszky Totan
- Department of Biochemistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania;
| | - Andreea Letiția Arsene
- Departament of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (A.L.A.); (M.-I.N.)
| | - Robert Sabiniu Șerban
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Anca-Cristina Perpelea
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Marina-Ionela (Ilie) Nedea
- Departament of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (A.L.A.); (M.-I.N.)
| | - Silviu-Mirel Pițuru
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
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Francis E. Exploring the professional nurse advocate role and restorative clinical supervision. Nurs Older People 2024; 36:22-27. [PMID: 38323475 DOI: 10.7748/nop.2024.e1456] [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] [Accepted: 09/20/2023] [Indexed: 02/08/2024]
Abstract
The professional nurse advocate (PNA) role is the key enabler of delivery of the NHS England Advocating and Educating for Quality Improvement (A-EQUIP) model of professional nursing leadership and clinical supervision. The aim of the PNA role is to provide clinical, educational and well-being support to nurses through restorative clinical supervision. This article describes the PNA role and the A-EQUIP model and discusses some of the challenges experienced by nurses in relation to delivering care to older people and current workforce pressures. The author suggests that restorative clinical supervision may support nurses to manage these challenges and enhance their practice in the care of older people, and describes part of a workforce improvement project to illustrate this in practice. Finally, the author considers some of the barriers to implementation of restorative clinical supervision.
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Affiliation(s)
- Elaine Francis
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, England
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Kerashvili N, Gutmann DH. The management of neurofibromatosis type 1 (NF1) in children and adolescents. Expert Rev Neurother 2024; 24:409-420. [PMID: 38406862 DOI: 10.1080/14737175.2024.2324117] [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: 01/05/2024] [Accepted: 02/23/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Neurofibromatosis type 1 (NF1) is a rare neurogenetic disorder characterized by multiple organ system involvement and a predisposition to benign and malignant tumor development. With revised NF1 clinical criteria and the availability of germline genetic testing, there is now an opportunity to render an early diagnosis, expedite medical surveillance, and initiate treatment in a prompt and targeted manner. AREAS COVERED The authors review the spectrum of medical problems associated with NF1, focusing specifically on children and young adults. The age-dependent appearance of NF1-associated features is highlighted, and the currently accepted medical treatments are discussed. Additionally, future directions for optimizing the care of this unique population of children are outlined. EXPERT OPINION The appearance of NF1-related medical problems is age dependent, requiring surveillance for those features most likely to occur at any given age during childhood. As such, we advocate a life stage-focused screening approach beginning in infancy and continuing through the transition to adult care. With early detection, it becomes possible to promptly institute therapies and reduce patient morbidity. Importantly, with continued advancement in our understanding of disease pathogenesis, future improvements in the care of children with NF1 might incorporate improved risk assessments and more personalized molecularly targeted treatments.
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Affiliation(s)
- Nino Kerashvili
- Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Setyawan E, Erdmann MV, Mambrasar R, Ambafen O, Hasan AW, Izuan M, Mofu I, Putra MIH, Sianipar AB, Constantine R, Stevenson BC, Jaine FRA. Spatial connectivity of reef manta rays across the Raja Ampat archipelago, Indonesia. R Soc Open Sci 2024; 11:230895. [PMID: 38601035 PMCID: PMC11004681 DOI: 10.1098/rsos.230895] [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] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/22/2023] [Accepted: 02/05/2024] [Indexed: 04/12/2024]
Abstract
The reef manta ray Mobula alfredi is present throughout most island groups that form the Raja Ampat archipelago, Indonesia. The species is protected regionally and nationally and is currently managed as a single homogeneous population within the 6.7 million ha archipelago. However, scientific evidence is currently lacking regarding the spatial connectivity and population structure of M. alfredi within this archipelago. Using network analysis and an array of 34 acoustic receivers deployed throughout Raja Ampat between February 2016 and September 2021, we examined the movements of 72 subadult and adult M. alfredi tagged in seven regions of Raja Ampat. A total of 1094 M. alfredi movements were recorded and were primarily concentrated between nearby receiver stations, highlighting frequent local movements within, and limited long-distance movements between regional acoustic receiver arrays. Network analysis revealed highly connected nodes acting as hubs important for M. alfredi movements. A community detection algorithm further indicated clusters within the network. Our results suggest the existence of a metapopulation comprising three demographically and geographically distinct subpopulations within the archipelago. They also reveal the importance of Eagle Rock as a critical node in the M. alfredi movement network, justifying the urgent inclusion of this site within the Raja Ampat marine protected area network.
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Affiliation(s)
- Edy Setyawan
- Institute of Marine Science, University of Auckland, Auckland1010, New Zealand
| | - Mark V. Erdmann
- Conservation International Aotearoa, University of Auckland, Auckland1010, New Zealand
| | - Ronald Mambrasar
- West Papua Program, Konservasi Indonesia, Sorong, Papua Barat98417, Indonesia
| | - Orgenes Ambafen
- BLUD UPTD Pengelolaan KKP Kepulauan Raja Ampat, Waisai, Papua Barat98417, Indonesia
| | - Abdi W. Hasan
- West Papua Program, Konservasi Indonesia, Sorong, Papua Barat98417, Indonesia
| | - Muhamad Izuan
- West Papua Program, Konservasi Indonesia, Sorong, Papua Barat98417, Indonesia
| | - Imanuel Mofu
- BLUD UPTD Pengelolaan KKP Kepulauan Raja Ampat, Waisai, Papua Barat98417, Indonesia
| | - Mochamad I. H. Putra
- Elasmobranch and Charismatic Species Program, Konservasi Indonesia, Jakarta12550, Indonesia
| | - Abraham B. Sianipar
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia6150, Australia
| | - Rochelle Constantine
- Institute of Marine Science, University of Auckland, Auckland1010, New Zealand
- School of Biological Sciences, University of Auckland, Auckland1010, New Zealand
| | - Ben C. Stevenson
- Department of Statistics, University of Auckland, Auckland1010, New Zealand
| | - Fabrice R. A. Jaine
- Integrated Marine Observing System (IMOS) Animal Tracking Facility, Sydney Institute of Marine Science, Mosman, New South Wales2088, Australia
- School of Natural Sciences, Macquarie University, Sydney, New South Wales2109, Australia
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41
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Paskaš S, Miočinović J, Savić M, Djukić-Stojčić M, Pihler I, Becskei Z. Welfare Assessment on Different-Sized Dairy Goat Farms in the Northern Serbian Province of Vojvodina. J APPL ANIM WELF SCI 2024; 27:210-222. [PMID: 34994251 DOI: 10.1080/10888705.2022.2025537] [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] [Indexed: 10/19/2022]
Abstract
This research aimed for the first time to identify the essential welfare problems on 46 goat dairy farms in Vojvodina,based on the goat AWIN welfare protocol. The study showed that space allowance per goat was 1.55, 1.86 and 2.50 m2/goat (large, medium, small-sized farms, respectively). Most farms possessed the soil floor and straw as a flooring material. The small and medium farms more allowed access to the outdoor area. Contrary, large-sized farms mostly kept goats in fully housed systems with reduced opportunities for the goats to express their natural behavior. Management procedures were significantly different (p < 0.05) between the investigated farms. Differences were mainly in bedding, feeding and culling strategies. Low productivity was the main cause of culling in all farm types. Small-sized farms carried out more often disbudding (42.9%) in comparison with medium (21.4%) and large-sized ones (14.3%). Group level observation showed that the main areas of concern were associated with hair coat condition and kneeling at the feeding rack (p < 0.05). Inadequate BCS, udder asymmetry and claw overgrowth were frequently recorded. The prevalence of thin and fat goats was highest in large-sized farms All farm size categories and management systems showed certain welfare weaknesses. Thus, the findings highlighted the need for higher implementation of animal welfare principles and improvement of management techniques to meet the welfare requirements of dairy goats.
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Affiliation(s)
- Snežana Paskaš
- Department of Animal Science, Faculty of Agriculture, University of Novi Sad, Novi Sad, Serbia
| | - Jelena Miočinović
- Department of Animal Science of Food Technology, Faculty of Agriculture, University of Belgrade, Belgrade-Zemun, Serbia
| | - Mila Savić
- Department of Animal Breeding and Genetics, Faculty of Veterinary Medicine, University of Belgrade, Belgrade, Serbia
| | - Mirjana Djukić-Stojčić
- Department of Animal Science, Faculty of Agriculture, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Pihler
- Department of Animal Science, Faculty of Agriculture, University of Novi Sad, Novi Sad, Serbia
| | - Zsolt Becskei
- Department of Animal Breeding and Genetics, Faculty of Veterinary Medicine, University of Belgrade, Belgrade, Serbia
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42
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Bhargava Odak D, Saffwan M, Hanif S, Visca A, Eldridge P. Management of poor grade sub-arachnoid haemorrhage - clinical judgement v/s a formal model. Br J Neurosurg 2024; 38:433-438. [PMID: 33650920 DOI: 10.1080/02688697.2021.1885621] [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: 12/24/2019] [Revised: 08/13/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The poor grade subarachnoid haemorrhage patients represent a unique cohort with lack of clear treatment protocol. Most neurosurgical units in the UK will manage them at local hospital until they make a significant recovery, this period can put them at higher risk of rebleed while with aggressive treatment a significant subset can achieve a favourable outcome. Identification of this subset is difficult and decision to treat them is associated with significant commitment of neurosurgical and ITU resources. Recent paper by Szklener has come up with a scale for prognostication in this subgroup of patients. We wanted to check the validity of this scale in our patient population and see if this scale can be used to guide early patient transfer and aggressive management at the Neurosurgical unit. METHODS We retrospectively reviewed our referral database for all poor grade subarachnoid patients referred over 2 years. Demographic information, Fisher and WFNS scores, admitting leucocyte count and outcome information as per MRS were obtained. These were scored as per the scale suggested by Szklener. RESULTS A total of 115 poor grade subarachnoid patients were referred over the study time frame. 47 of them were accepted for admission . 18/47 patients achieved a favourable outcome (GOS4-5). Only 1 patient managed in peripheral hospital had a good outcome. There was a significant association between Szklener's score and achieving a favourable outcome p = 0.002. CONCLUSION A selective admission policy could work specially with current economic climate, achieving outcomes comparable to admit-all. However, to optimise outcomes for all patients an aggressive standardised management at peripheral hospitals and a uniform admission policy assisted by Szklener score may be adopted. Szklener's model predicts the outcome better than WFNS and age but more validation is needed.
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Affiliation(s)
- Deepti Bhargava Odak
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Mohamed Saffwan
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Shahid Hanif
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Anna Visca
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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Nurok M, Flynn BC, Pineton de Chambrun M, Kazemian M, Geiderman J, Nunnally ME. A Review and Discussion of Full-Time Equivalency and Appropriate Compensation Models for an Adult Intensivist in the United States Across Various Base Specialties. Crit Care Explor 2024; 6:e1064. [PMID: 38533294 PMCID: PMC10965199 DOI: 10.1097/cce.0000000000001064] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES Physicians with training in anesthesiology, emergency medicine, internal medicine, neurology, and surgery may gain board certification in critical care medicine upon completion of fellowship training. These clinicians often only spend a portion of their work effort in the ICU. Other work efforts that benefit an ICU infrastructure, but do not provide billing opportunities, include education, research, and administrative duties. For employed or contracted physicians, there is no singular definition of what constitutes an intensive care full-time equivalent (FTE). Nevertheless, hospitals often consider FTEs in assessing hiring needs, salary, and eligibility for benefits. DATA SOURCES Review of existing literature, expert opinion. STUDY SELECTION Not applicable. DATA EXTRACTION Not applicable. DATA SYNTHESIS Not applicable. CONCLUSIONS Understanding how an FTE is calculated, and the fraction of an FTE to be assigned to a particular cost center, is therefore important for intensivists of different specialties, as many employment models assign salary and benefits to a base specialty department and not necessarily the ICU.
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Affiliation(s)
- Michael Nurok
- Departments of Anesthesiology, Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brigid C Flynn
- Division of Critical Care, Department of Anesthesiology, University of Kansas Health System, Kansas City, KS
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, APHP, Sorbonne Université, Paris, France
- INSERM-UMRS 1166, iCAN Institute of Cardiometabolism/Nutrition, Sorbonne Université, Paris, France
| | - Mina Kazemian
- Department of Anesthesiology, Riverside University, Riverside, CA
| | - Joel Geiderman
- Ruth and Harry Roman Emergency Department, Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark E Nunnally
- Department of Anesthesiology, Perioperative Care and Pain Medicine, Neurology, Surgery and Medicine, NYU Langone Health, NYU School of Medicine, New York, NY
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Kumar A, Kumar N, Pattanayak A, Kumar A, Palavesam S, Manigowdanahundi Nagaraju P, Das R. Comparative evaluation of tocilizumab and itolizumab for treatment of severe COVID-19 in India: a retrospective cohort study. Acute Crit Care 2024:acc.2023.00983. [PMID: 38556909 DOI: 10.4266/acc.2023.00983] [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: 08/01/2023] [Accepted: 02/04/2024] [Indexed: 04/02/2024] Open
Abstract
Background Itolizumab downregulates the synthesis of proinflammatory cytokines and adhesion molecules by inhibiting CD6 leading to lower levels of interferon-γ, interleukin-6, and tumor necrotic factor-α and reduced T-cell infiltration at inflammatory sites. This study aims to compare the effects of tocilizumab and itolizumab in the management of severe coronavirus disease 2019 (COVID-19). Methods The study population was adults (>18 years) with severe COVID-19 pneumonia admitted to the intensive care unit receiving either tocilizumab or itolizumab during their stay. The primary outcome was clinical improvement (CI), defined as a two-point reduction on a seven-point ordinal scale in the status of the patient from initiating the drug or live discharge. The secondary outcomes were time until CI, improvement in PO2/FiO2 ratio, best PO2/FiO2 ratio, need for mechanical ventilation after administration of study drugs, time to discharge, and survival days. Results Of the 126 patients included in the study, 92 received tocilizumab and 34 received itolizumab. CI was seen in 46.7% and 61.7% of the patients in the tocilizumab and itolizumab groups, respectively and was not statistically significant (P=0.134). The PO2/FiO2 ratio was significantly better with itolizumab compared to tocilizumab (median [interquartile range]: 315 [200-380] vs. 250 [150-350], P=0.043). The incidence of serious adverse events due to the study drugs was significantly higher with itolizumab compared to tocilizumab (14.7% vs. 3.3%, P=0.032). Conclusions The CI with itolizumab is similar to tocilizumab. Better oxygenation can be achieved with itolizumab and it can be a substitute for tocilizumab in managing severe COVID-19.
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Affiliation(s)
- Abhyuday Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS) Patna, Patna, India
| | - Neeraj Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS) Patna, Patna, India
| | - Arunima Pattanayak
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS) Bhubaneswar, Bhubaneswar, India
| | - Ajeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS) Patna, Patna, India
| | - Saravanan Palavesam
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS) Patna, Patna, India
| | | | - Rekha Das
- Department of Anaesthesiology, Acharya Hariharihar PGI, Cuttack, India
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45
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Wolfe C, Jnah A. Tracheoesophageal Fistula With Esophageal Atresia: A Case Series. Neonatal Netw 2024; 43:65-75. [PMID: 38599775 DOI: 10.1891/nn-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) results from maldevelopment of the trachea and esophagus during maturation of the primitive foregut. EA/TEF commonly presents shortly after birth because of increased oral secretions and the inability to advance a nasogastric or orogastric tube to the proper depth. Given that prenatal diagnosis is uncommon and early intervention is important to reduce morbidity and mortality risk, early recognition and diagnosis are imperative. We present a case series of two neonates diagnosed with EA/TEF, type "C" and type "E," born at low-acuity centers, who required transport to a tertiary center for surgical support. The pathophysiology as well as types of TEFs, symptomology, stabilization goals, corrective treatment, and long-term implications will be examined. Finally, the educational needs of parents and caregivers will be discussed.
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46
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Levin A, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Robinson KA, Wilson L, Wilson RF, Kasiske BL, Cheung M, Earley A, Stevens PE. Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. Kidney Int 2024; 105:684-701. [PMID: 38519239 DOI: 10.1016/j.kint.2023.10.016] [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: 10/11/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 03/24/2024]
Abstract
The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) updates the KDIGO 2012 guideline and has been developed with patient partners, clinicians, and researchers around the world, using robust methodology. This update, based on a substantially broader base of evidence than has previously been available, reflects an exciting time in nephrology. New therapies and strategies have been tested in large and diverse populations that help to inform care; however, this guideline is not intended for people receiving dialysis nor those who have a kidney transplant. The document is sensitive to international considerations, CKD across the lifespan, and discusses special considerations in implementation. The scope includes chapters dedicated to the evaluation and risk assessment of people with CKD, management to delay CKD progression and its complications, medication management and drug stewardship in CKD, and optimal models of CKD care. Treatment approaches and actionable guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence and the strength of recommendations which followed the "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE) approach. The limitations of the evidence are discussed. The guideline also provides practice points, which serve to direct clinical care or activities for which a systematic review was not conducted, and it includes useful infographics and describes an important research agenda for the future. It targets a broad audience of people with CKD and their healthcare, while being mindful of implications for policy and payment.
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Affiliation(s)
- Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Sofia B Ahmed
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bethany Foster
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Anna Francis
- Department of Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Rasheeda K Hall
- Division of Nephrology, Duke School of Medicine, Durham, North Carolina, USA
| | - Will G Herrington
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Edmund Lamb
- Department of Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Peter Lin
- Director of Primary Care Initiatives, Canadian Heart Research Center, Toronto, Ontario, Canada
| | - Magdalena Madero
- Division of Nephrology, Instituto Nacional de Cardiología Ignacio Chavéz, Mexico City, Mexico
| | - Natasha McIntyre
- London Health Sciences Centre-Victoria Hospital, Western University, London, Ontario, Canada
| | - Kelly Morrow
- Department of Nutrition and Exercise Science, Bastyr University, Kenmore, Washington, USA; Osher Center for Integrative Medicine, University of Washington, Kenmore, Washington, USA
| | - Glenda Roberts
- UW Center for Dialysis Innovation & Kidney Research Institute, Seattle, Washington, USA
| | | | - Elke Schaeffner
- Division of Nephrology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Shlipak
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rukshana Shroff
- Department of Paediatric Nephrology, UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Navdeep Tangri
- Division of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Ifeoma Ulasi
- Department of Medicine, Ituku-Ozalla Campus, University of Nigeria, Enugu, Nigeria
| | - Germaine Wong
- Western Renal Service, University of Sydney, Sydney, New South Wales, Australia
| | - Chih-Wei Yang
- Division of Nephrology, Chang Gung University, Taoyuan, Taiwan
| | - Luxia Zhang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Karen A Robinson
- The Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa Wilson
- The Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Renee F Wilson
- The Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bertram L Kasiske
- Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Paul E Stevens
- Department of Nephrology, Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK.
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47
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Hancock G, Martin R, Bell L, Broderick J, Dawson M. Infection in osteotomy around the knee: Incidence, management and outcomes in a high-volume case series. Knee Surg Sports Traumatol Arthrosc 2024; 32:1000-1007. [PMID: 38469916 DOI: 10.1002/ksa.12119] [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: 12/05/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Current evidence around the management of osteotomy-related infection is insufficient to robustly underpin the expert statements formulated by a recent European consensus statement. We present a review of a large case series in a high-volume osteotomy practice to contribute to the understanding of the incidence, management and outcome of infection in this subspecialty area. METHODS Analyses of two prospectively collected databases for all osteotomy around the knee and infections related to osteotomy were performed, along with a review of hospital readmission data to capture all osteotomy-related infections. Clinical notes were reviewed to assess patient demographics, incidence of infection, how infection was managed and clinical outcome. RESULTS In a series of 822 osteotomies in 755 patients, there were 21 (2.8%) cases of suspected infection. Twelve (1.6%) were contemporaneously deemed 'superficial' and nine confirmed 'deep' infections (1.2%). Deep infections were all successfully managed with wound debridement, with or without plate removal, depending on union and time from initial surgery. One of these infections was noted during a revision procedure, but no revision was carried out as a direct result of infection, no external fixation was required and no infected nonunions were experienced. CONCLUSION All of the cases in this series were managed successfully with debridement ± removal of the plate, without the need for revision or external fixation. Any potential signs of infection around an osteotomy, especially in the case of medial high tibial osteotomy, should raise awareness for deep infection and the need for further surgery due to the limited overlying soft tissue cover. This evidence supports the recent European Society of Sports Traumatology, Knee Surgery and Arthroscopy algorithm. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Graeme Hancock
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - Rebecca Martin
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - Lucy Bell
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - James Broderick
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - Matt Dawson
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
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Panzuto F, Partelli S, Campana D, de Braud F, Spada F, Cives M, Tafuto S, Bertuzzi A, Gelsomino F, Bergamo F, Marcucci S, Mastrangelo L, Massironi S, Appetecchia M, Filice A, Badalamenti G, Bartolomei M, Amoroso V, Landoni L, Rodriquenz MG, Valente M, Colao A, Isidori A, Fanciulli G, Bollina R, Ciola M, Butturini G, Marconcini R, Arvat E, Cinieri S, Berardi R, Baldari S, Riccardi F, Spoto C, Giuffrida D, Gattuso D, Ferone D, Rinzivillo M, Bertani E, Versari A, Zerbi A, Lamberti G, Lauricella E, Pusceddu S, Fazio N, Dell'Unto E, Marini M, Falconi M. Epidemiology of gastroenteropancreatic neuroendocrine neoplasms: a review and protocol presentation for bridging tumor registry data with the Italian association for neuroendocrine tumors (Itanet) national database. Endocrine 2024; 84:42-47. [PMID: 38175391 PMCID: PMC10987336 DOI: 10.1007/s12020-023-03649-4] [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] [Received: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
Neuroendocrine neoplasms (NENs) are rare tumors with diverse clinical behaviors. Large databases like the Surveillance, Epidemiology, and End Results (SEER) program and national NEN registries have provided significant epidemiological knowledge, but they have limitations given the recent advancements in NEN diagnostics and treatments. For instance, newer imaging techniques and therapies have revolutionized NEN management, rendering older data less representative. Additionally, crucial parameters, like the Ki67 index, are missing from many databases. Acknowledging these gaps, the Italian Association for Neuroendocrine Tumors (Itanet) initiated a national multicenter prospective database in 2019, aiming to gather data on newly-diagnosed gastroenteropancreatic neuroendocrine (GEP) NENs. This observational study, coordinated by Itanet, includes patients from 37 Italian centers. The database, which is rigorously maintained and updated, focuses on diverse parameters including age, diagnostic techniques, tumor stage, treatments, and survival metrics. As of October 2023, data from 1,600 patients have been recorded, with an anticipation of reaching 3600 by the end of 2025. This study aims at understanding the epidemiology, clinical attributes, and treatment strategies for GEP-NENs in Italy, and to introduce the Itanet database project. Once comprehensive follow-up data will be acquired, the goal will be to discern predictors of treatment outcomes and disease prognosis. The Itanet database will offer an unparalleled, updated perspective on GEP-NENs, addressing the limitations of older databases and aiding in optimizing patient care. STUDY REGISTRATION: This protocol was registered in clinicaltriasl.gov (NCT04282083).
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Affiliation(s)
- Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy.
| | - Stefano Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Campana
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Milan, Italy
| | - Francesca Spada
- Gastrointestinal and Neuroendocrine Tumors Oncology Unit - ENETS Center of Excellence, European Institute of Oncology (IEO) - IRCCS, Milan, Italy
| | - Mauro Cives
- Dipartimento Interdisciplinare di Medicina, Università di Bari "Aldo Moro", Bari, Italy
| | - Salvatore Tafuto
- S.C. Sarcomi e Tumori Rari, Istituto Nazionale Tumori, I.R.C.C.S. - Fondazione "G. Pascale", ENETS Center of Excellence, Napoli, Italy
| | - Alexia Bertuzzi
- Sezione Sarcomi/NET e Oncologia del Giovane Adulto (AYA-Adolescent Young Adult) Humanitas Research Hospital-IRCCS Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Fabio Gelsomino
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, Modena, Italy
| | | | - Stefano Marcucci
- Department of Surgery & Hepato-Biliary and Pancreatic Unit Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Laura Mastrangelo
- UO Chirurgia Generale e d'Urgenza IRCCS Azienda Ospedaliera Universitaria Sant'Orsola Malpighi c/o Ospedale Maggiore, Bologna, Italy
| | - Sara Massironi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, and University of Milano-Bicocca, School of Medicine, Monza, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, Regina Elena National Cancer Institutre - IFO IRCCS, Roma, Italy
| | - Angelina Filice
- Servizio di Medicina Nucleare, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Mirco Bartolomei
- Nuclear Medicine Unit, Azienda Ospedaliera Universitaria-Ferrara, Ferrara, Italy
| | - Vito Amoroso
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia at Spedali Civili Hospital, Brescia, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, ENETS Center of Excellence, Verona, Italy
| | - Maria Grazia Rodriquenz
- Oncology Unit - Ospedale IRCCS Casa Sollievo della Sofferenza - San Giovanni Rotondo, Foggia, Italy
| | - Monica Valente
- Center for Immuno-Oncology, Oncology Department, University Hospital of Siena, Siena, Italy
| | - Annamaria Colao
- Department of Endocrinology University of Naples, Azienda Ospedaliera Universitaria "Federico II", ENETS CEnter of Excellence, Napoli, Italy
| | - Andrea Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Fanciulli
- Endocrine Oncology Program, Endocrine Unit, University Hospital (AOU) of Sassari, Sassari, Italy
| | | | | | | | - Riccardo Marconcini
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences University of Turin, Turin, Italy
| | | | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti Delle Marche, Ancona, Italy
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Chiara Spoto
- Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy
| | - Dario Giuffrida
- Medical Oncology Department, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | | | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine & Medical Specialties (DiMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Maria Rinzivillo
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Emilio Bertani
- Digestive Surgery, European Institute of Oncology IRCCS, ENETS Center of Excellence, Milan, Italy
| | - Annibale Versari
- Servizio di Medicina Nucleare, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Zerbi
- Humanitas Research Hospital -IRCCS, Pancreatic Surgery Unit, Rozzano, and Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
| | - Giuseppe Lamberti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eleonora Lauricella
- Dipartimento Interdisciplinare di Medicina, Università di Bari "Aldo Moro", Bari, Italy
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Milan, Italy
| | - Nicola Fazio
- Gastrointestinal and Neuroendocrine Tumors Oncology Unit - ENETS Center of Excellence, European Institute of Oncology (IEO) - IRCCS, Milan, Italy
| | - Elisabetta Dell'Unto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Marco Marini
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Johnson FA, Eraud C, Francesiaz C, Zimmerman GS, Koneff MD. Using the R package popharvest to assess the sustainability of offtake in birds. Ecol Evol 2024; 14:e11059. [PMID: 38571795 PMCID: PMC10985383 DOI: 10.1002/ece3.11059] [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: 09/29/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 04/05/2024] Open
Abstract
The R package popharvest was designed to help assess the sustainability of offtake in birds when only limited demographic information is available. In this article, we describe some basics of harvest theory and then discuss several considerations when using the different approaches in popharvest to assess whether observed harvests are unsustainable. Throughout, we emphasize the importance of distinguishing between the scientific and policy aspects of managing offtake. The principal product of popharvest is a sustainable harvest index (SHI), which can indicate whether the harvest is unsustainable but not the converse. SHI is estimated based on a simple, scalar model of logistic population growth, whose parameters may be estimated using limited knowledge of demography. Uncertainty in demography leads to a distribution of SHI values and it is the purview of the decision-maker to determine what amounts to an acceptable risk when failing to reject the null hypothesis of sustainability. The attitude toward risk, in turn, will likely depend on the decision-maker's objective(s) in managing offtake. The management objective as specified in popharvest is a social construct, informed by biology, but ultimately it is an expression of social values that usually vary among stakeholders. We therefore suggest that any standardization of criteria for management objectives in popharvest will necessarily be subjective and, thus, hard to defend in diverse decision-making situations. Because of its ease of use, diverse functionalities, and a minimal requirement of demographic information, we expect the use of popharvest to become widespread. Nonetheless, we suggest that while popharvest provides a useful platform for rapid assessments of sustainability, it cannot substitute for sufficient expertise and experience in harvest theory and management.
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Affiliation(s)
| | - Cyril Eraud
- Office Français de la Biodiversité, Direction de la Recherche et de l'Appui Scientifique, Service Conservation et Gestion des Espèces à EnjeuxVilliers‐en‐BoisFrance
| | - Charlotte Francesiaz
- Office Français de la Biodiversité, Direction de la Recherche et de l'Appui Scientifique, Service Conservation et Gestion des Espèces ExploitéesJuvignacFrance
| | - Guthrie S. Zimmerman
- Division of Migratory Bird ManagementU.S. Fish and Wildlife ServiceSacramentoCaliforniaUSA
| | - Mark D. Koneff
- Division of Migratory Bird ManagementU.S. Fish and Wildlife ServiceOronoMaineUSA
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Ludington-Hoe SM, Addison C. Sudden Unexpected Postnatal Collapse: Review and Management. Neonatal Netw 2024; 43:76-91. [PMID: 38599773 DOI: 10.1891/nn-2023-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.
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