Spanish collaborative study: Description of usual clinical practice in infant obesity

2018 ◽  
Vol 88 (6) ◽  
pp. 340-349
Author(s):  
Alfonso Lechuga Sancho ◽  
Enrique Palomo Atance ◽  
María José Rivero Martin ◽  
Mercedes Gil-Campos ◽  
Rosaura Leis Trabazo ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Collaborative Study ◽  
Usual Clinical Practice ◽  
Infant Obesity

scholarly journals Weight Loss and Weight Regain in Usual Clinical Practice: Results From the TARGET-NASH Observational Cohort

2021 ◽  
Author(s):  
Miguel H. Malespin ◽  
Alfred Sidney Barritt ◽  
Stephanie E. Watkins ◽  
Cheryl Schoen ◽  
Monica A. Tincopa ◽  
...  
Keyword(s):  
Weight Loss ◽  
Clinical Practice ◽  
Weight Regain ◽  
Usual Clinical Practice ◽  
Observational Cohort

scholarly journals EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies

2019 ◽  
Vol 79 (1) ◽  
pp. 3-18 ◽  
Author(s):  
Manuel Ramos-Casals ◽  
Pilar Brito-Zerón ◽  
Stefano Bombardieri ◽  
Hendrika Bootsma ◽  
Salvatore De Vita ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Task Force ◽  
Systemic Disease ◽  
Immunosuppressive Agents ◽  
Collaborative Study ◽  
Muscarinic Agonists ◽  
Eular Recommendations ◽  
Logical Sequence ◽  
Patient Representatives ◽  
Saliva Substitutes

The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed at developing the first EULAR evidence and consensus-based recommendations for the management of patients with SjS with topical and systemic medications. The aim was to develop a rational therapeutic approach to SjS patients useful for healthcare professionals, physicians undergoing specialist training, medical students, the pharmaceutical industry and drug regulatory organisations following the 2014 EULAR standardised operating procedures. The Task Force (TF) included specialists in rheumatology, internal medicine, oral health, ophthalmology, gynaecology, dermatology and epidemiology, statisticians, general practitioners, nurses and patient representatives from 30 countries of the 5 continents. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previous sets of criteria was considered and extrapolated. The TF endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic disease. The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab). For each recommendation, levels of evidence (mostly modest) and TF agreement (mostly very high) are provided. The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the management of primary 2002 SjS patients and on discussions between a large and broadly international TF. The recommendations synthesise current thinking on SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations.

Bleeding and Perforation After Outpatient Colonoscopy and Their Risk Factors in Usual Clinical Practice

2008 ◽  
Vol 135 (6) ◽  
pp. 1899-1906.e1 ◽  
Author(s):  
Linda Rabeneck ◽  
Lawrence F. Paszat ◽  
Robert J. Hilsden ◽  
Refik Saskin ◽  
Des Leddin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Usual Clinical Practice

scholarly journals Predictors of Serious Complications Associated with Lower Gastrointestinal Endoscopy in a Major City-Wide Health Region

2010 ◽  
Vol 24 (7) ◽  
pp. 425-430 ◽  
Author(s):  
Harminder Singh ◽  
Robert B Penfold ◽  
Carolyn De Coster ◽  
Wendy Au ◽  
Charles N Bernstein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Hospital Admissions ◽  
Patient Age ◽  
Index Procedure ◽  
Gi Endoscopy ◽  
Patient Âgé ◽  
Usual Clinical Practice ◽  
Low Volume ◽  
And Performance

BACKGROUND: There are limited data regarding complications associated with colonoscopy and flexible sigmoidoscopy in usual clinical practice in Canada.OBJECTIVE: To determine the risk factors for lower gastrointestinal (GI) endoscopy-associated complications in usual clinical practice.METHODS: All outpatient lower GI endoscopies performed in Winnipeg (Manitoba) between April 1, 2004 and March 31, 2006, were identified from the provincial physicians’ claims database. All subsequent hospital admissions within 30 days that documented potential complications associated with lower GI endoscopies were identified from the electronic hospital discharges database and reviewed. Multivariate generalized estimating equation regression analysis was performed to determine independent factors (patient, endoscopist and procedure) associated with the risk of developing complications.RESULTS: There were 29,990 outpatient lower GI endoscopies performed in Winnipeg during the years studied. Seventy-seven (0.26%) procedures were associated with complications requiring hospitalization within 30 days of the index procedure. Stricture dilation (rate ratio [RR] 23.14; 95% CI 6.70 to 76.51), polypectomy (RR 5.93; 95% CI 3.66 to 9.62), increasing patient age (for each year increase in age, RR 1.03; 95% CI 1.01 to 1.05) and performance of endoscopy by low-volume endoscopists (fewer than 200 procedures per year, RR 2.28; 95% CI 1.18 to 4.42) and family physicians (RR 2.23; 95% CI 1.39 to 3.58) were independently associated with complications.CONCLUSIONS: The results of the present study suggest that increasing patient age, complex procedures and performance of the index procedure by low-volume endoscopists are independent risk factors for lower GI endoscopy-associated complications in usual clinical practice. This suggests that it may be time to consider implementing minimum volume requirements for endoscopists performing non-screening lower GI endoscopies.

scholarly journals Evaluation of the adherence to subcutaneous immunotherapy in patients with pollen allergy in usual clinical practice: The CITY study

2019 ◽  
Vol 19 (4) ◽  
Author(s):  
Francisco Javier Solá Martínez ◽  
María Luisa González Gutiérrez ◽  
María Teresa Palomeque Rodríguez ◽  
Emilio Funes Vera ◽  
Ana Montoro De Francisco ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Pollen Allergy ◽  
Subcutaneous Immunotherapy ◽  
Usual Clinical Practice ◽  
The City

Effectiveness of a conversational chatbot in the smartphone to cease smoking in the adult population: pragmatic, controlled, randomized clinical trial in primary care (Dejal@). (Preprint)

2021 ◽  
Author(s):  
EDUARDO OLANO-ESPINOSA ◽  
Jose Francisco Avila-Tomas ◽  
Cesar Minue-Lorenzo ◽  
Blanca Matilla Pardo ◽  
Encarnación Serrano-Serrano ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Clinical Practice ◽  
Randomized Clinical Trial ◽  
Control Group ◽  
Evidence Based ◽  
Intention To Treat ◽  
Usual Clinical Practice ◽  
Treat Analysis

BACKGROUND The magnitude and severity of smoking, the benefits of quitting, and the existence of effective and efficient interventions make it a priority problem. Health professionals intervene less than they should, and the most effective interventions are more expensive, require specific training and more time, which is a disadvantage for the service provider and for the accessibility of the services. Information and communication technologies avoid these problems thanks to their accessibility, privacy, customization possibilities, access to social support, and scalability. OBJECTIVE To assess the effectiveness of an evidence-based intervention to cease smoking via a chatbot in the smartphone compared to usual clinical practice in primary care. METHODS Pragmatic randomized clinical trial in 34 primary healthcare centers within the Madrid Health Service (Spain). Smokers over 18 years of age who attended on-site consultation and accepted help to quit tobacco were recruited by their doctor or nurse and randomly allocated to receive usual care (control group, CG) or an evidence-based chatbot intervention (intervention group, IG). The interventions in both arms were based on the 5A´s by the US clinical practice guideline, which combines behavioral and pharmacological treatments and is structured in several follow-up appointments. The primary outcome was continuous abstinence from smoking that was biochemically validated after 6 months by the collaborators. The outcome analysis was blinded to allocation of subjects although participants were unblinded to group assignment. An intention-to-treat analysis, entering the basal observation carried forward in cases of missing data, and logistic regression models with robust estimators were employed for assessing the primary outcomes. RESULTS The trial was conducted between October 1st of 2018 and March 31st of 2019. The sample comprised 513 patients (242 in the IG and 271 in the CG), with an average age of 49.8 years (SD 10.82) and gender ratio of 59.3% women and 40.7% men. Of them, 232 patients (45.2%) completed the follow-up, 104 (42.9%) in the IG and 128 (47.2%) in the CG. Main outcome: In the intention-to-treat analysis, the biochemically-validated abstinence rate at 6 months was higher in the IG with 26.03% (63/242) versus 18.82% (51/271) in the CG (odds ratio (OR)=1.52, 95% CI: 1.00–2.31, P=.05). After adjusting for basal CO-oxymetry and bupropion intake, no substantial changes were observed (OR=1.52, 95% CI 0.99–2.33 P= .053; pseudo R2=0.045). In the IG, 61.16% (148/242) of users accessed the chatbot, average bot-patient interaction time was 121 minutes (CI 95% 121.1–140.0), and average number of contacts was 45.56 (SD 36.32). CONCLUSIONS A treatment including a chatbot for helping in tobacco cessation was more effective than usual clinical practice in primary care. CLINICALTRIAL ClinicalTrials.gov, reference number NCT 03445507.

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