scholarly journals Therapeutic Adherence in Hypertension: Current evidence and expert opinion from India

2021 ◽  
Author(s):  
Jamshed J. Dalal ◽  
Prafulla Kerkar ◽  
Santanu Guha ◽  
Arup Dasbiswas ◽  
J.P.S. Sawhney ◽  
...  
Keyword(s):  
Expert Opinion ◽  
Current Evidence ◽  
Therapeutic Adherence

scholarly journals Expert Opinion on COVID-19 Vaccination and the Use of Cladribine Tablets in Clinical Practice

2021 ◽  
Author(s):  
Peter Rieckmann ◽  
Diego Centonze ◽  
Gavin Giovannoni ◽  
Le H Hua ◽  
Celia Oreja-Guevara ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Expert Opinion ◽  
Steering Committee ◽  
Current Evidence ◽  
Clinical Recommendations ◽  
Before And After ◽  
Agreement Score ◽  
Clinical Questions ◽  
Practice Methods ◽  
Current Guidelines

Background: Gaps in current evidence and guidance leave clinicians with unanswered questions on the use of cladribine tablets for the treatment of multiple sclerosis (MS) in the era of the COVID 19 pandemic, in particular relating to COVID 19 vaccination. Objective: We describe a consensus-based programme led by international MS experts with the aim of supplementing current guidelines and treatment labels by providing timely recommendations relating to COVID 19 vaccination and the use of cladribine tablets in clinical practice. Methods: A steering committee (SC) of 10 international MS experts identified 7 clinical questions to answer concerning the use of cladribine tablets and COVID 19 vaccination, which addressed issues relating to patient selection, timing and efficacy, and safety. Clinical recommendations to address each question were drafted using available evidence combined with expert opinion from the SC. An extended faculty of 28 MS experts, representing 19 countries, in addition to the SC members, voted on the recommendations. Consensus on recommendations was achieved when more than or equal to 75% of respondents expressed an agreement score of 7 to 9, on a 9 point scale. Results: Consensus was achieved on all 13 recommendations. Clinical recommendations are provided on whether all patients with MS receiving cladribine tablets should be vaccinated against COVID 19, and whether they should be prioritized; the timing of vaccination around dosing of cladribine tablets (i.e., before and after a treatment course); and the safety of COVID 19 vaccination for these patients. Conclusions: These expert recommendations provide timely guidance on COVID 19 vaccination in patients receiving cladribine tablets, which is relevant to everyday clinical practice.

scholarly journals Refining clinical algorithms for a neonatal digital platform for low-income countries: a modified Delphi technique

2020 ◽  
Author(s):  
Mari Evans ◽  
Mark H. Corden ◽  
Caroline Crehan ◽  
Felicity Fitzgerald ◽  
Michelle Heys
Keyword(s):  
Expert Opinion ◽  
Low Income ◽  
Delphi Technique ◽  
High Income ◽  
Low Income Countries ◽  
Current Evidence ◽  
Digital Platform ◽  
Modified Delphi ◽  
Modified Delphi Technique ◽  
Clinical Algorithms

ABSTRACTObjectivesTo determine whether a panel of neonatal experts could address evidence gaps in neonatal guidelines by reaching a consensus on four clinical decision algorithms for a neonatal digital platform (NeoTree).DesignTwo-round, modified Delphi technique.Setting and participantsParticipants were neonatal experts from high-income and low-income countries (LICs).MethodsThis was a consensus-generating study. In round one, experts rated items for four clinical algorithms (neonatal sepsis, hypoxic ischaemic encephalopathy, respiratory distress of the newborn, hypothermia) and justified their responses. Items meeting consensus (≥80% agreement) were included. Items not meeting consensus were either excluded, included following revisions or included if they contained core elements of evidence-based guidelines. In round two, experts rated items from round one that did not reach consensus.ResultsFourteen experts participated in round one, ten in round two. Nine were from high-income countries, five from LICs. Experts included physicians and nurse practitioners with an average neonatal experience of 20 years, 12 in LICs. After two rounds, a consensus was reached on 43 of 84 items (52%). Experts consistently stated that items must be in line with local and WHO guidelines (irrespective of the level of supporting evidence or expert opinion). As a result, the final algorithms included 53 items (62%).ConclusionFour algorithms in a neonatal digital platform were reviewed and refined by consensus expert opinion. Revisions to the NeoTree application were made in response to these findings and will be clinically validated in an imminent study.STRENGTHS AND LIMITATIONS OF THIS STUDY➢In this study, a large number of algorithm items were reviewed and evaluated, and half met consensus for inclusion in the management pathways.➢The review was conducted with experts from a broad range of countries and neonatal experience who simultaneously refined the algorithms and highlighted gaps in current evidence, emphasising the need for future research to support international neonatal guidelines.➢Our study method meant that experts were not able to meet in person, which might have promoted dialogue that would have allowed greater clarity in their collective opinion.➢The representation of neonatal experts from LICs was not as robust as from high-income countries, which may have led to an uneven evaluation of the algorithms.

Running retraining in the management of lower limb injury: Combining current evidence with international expert opinion

2014 ◽  
Vol 18 ◽  
pp. e111-e112
Author(s):  
C. Barton ◽  
J. Carr ◽  
D. Bonanno ◽  
B. Neal ◽  
A. Franklyn-Miller ◽  
...  
Keyword(s):  
Expert Opinion ◽  
Lower Limb ◽  
Current Evidence ◽  
International Expert ◽  
Lower Limb Injury ◽  
Limb Injury

scholarly journals Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course

2020 ◽  
Vol 26 (12) ◽  
pp. 1459-1469 ◽  
Author(s):  
Rosalind Kalb ◽  
Theodore R Brown ◽  
Susan Coote ◽  
Kathleen Costello ◽  
Ulrik Dalgas ◽  
...  
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Expert Opinion ◽  
Healthcare Providers ◽  
Current Evidence ◽  
Early Evaluation ◽  
Exercise Rehabilitation ◽  
Physical Activity Recommendations ◽  
Lifestyle Physical Activity ◽  
Activity Recommendations

Objectives: To provide clinicians who treat multiple sclerosis (MS) patients with evidence-based or expert opinion–based recommendations for promoting exercise and lifestyle physical activity across disability levels. Methods: The National MS Society (“Society”) convened clinical and research experts in the fields of MS, exercise, rehabilitation, and physical activity to (1) reach consensus on optimal exercise and lifestyle physical activity recommendations for individuals with MS at disability levels 0–9.0 on the Expanded Disability Status Scale (EDSS) and (2) identify and address barriers/facilitators for participation. Recommendations: Based on current evidence and expert opinion, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers: Healthcare providers should endorse and promote the benefits/safety of exercise and lifestyle physical activity for every person with MS. Early evaluation by a physical or occupational therapist or exercise or sport scientist, experienced in MS (hereafter referred to as “specialists”), is recommended to establish an individualized exercise and/or lifestyle physical activity plan. Taking into account comorbidities and symptom fluctuations, healthcare providers should encourage ⩾150 min/week of exercise and/or ⩾150 min/week of lifestyle physical activity. Progress toward these targets should be gradual, based on the person’s abilities, preferences, and safety. If disability increases and exercise/physical activity becomes more challenging, referrals to specialists are essential to ensure safe and appropriate prescriptions. When physical mobility is very limited, exercise should be facilitated by a trained assistant.

Fall-Risk-Increasing Drugs

2021 ◽  
pp. 67-76
Author(s):  
Lotta Seppala ◽  
Nathalie van der Velde
Keyword(s):  
Expert Opinion ◽  
Systematic Reviews ◽  
Delphi Study ◽  
Fall Risk ◽  
Current Evidence ◽  
Finish Group

This chapter provides a summary of current evidence on fall-risk increasing drugs from the literature (recent systematic reviews) and expert opinion on this topic (statement paper of EuGMS Task & Finish group on FRIDs and results of Delphi study of the group). Furthermore, deprescribing of FRIDs is being discussed.

scholarly journals Expert opinion on COVID-19 vaccination and the use of cladribine tablets in clinical practice

2021 ◽  
Vol 14 ◽  
pp. 175628642110582
Author(s):  
Peter Rieckmann ◽  
Diego Centonze ◽  
Gavin Giovannoni ◽  
Le H. Hua ◽  
Celia Oreja-Guevara ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Expert Opinion ◽  
Steering Committee ◽  
Current Evidence ◽  
Clinical Recommendations ◽  
Before And After ◽  
Agreement Score ◽  
Clinical Questions ◽  
Current Guidelines ◽  
Expert Recommendations

Background: Gaps in current evidence and guidance leave clinicians with unanswered questions on the use of cladribine tablets for the treatment of multiple sclerosis (MS) in the era of the COVID-19 pandemic, in particular relating to COVID-19 vaccination. Objective: We describe a consensus-based program led by international MS experts with the aim of supplementing current guidelines and treatment labels by providing timely recommendations relating to COVID-19 vaccination and the use of cladribine tablets in clinical practice. Methods: A steering committee (SC) of 10 international MS experts identified 7 clinical questions to answer concerning the use of cladribine tablets and COVID-19 vaccination, which addressed issues relating to patient selection, timing and efficacy, and safety. Clinical recommendations to address each question were drafted using available evidence combined with expert opinion from the SC. An extended faculty of 28 MS experts, representing 19 countries, in addition to the 10 SC members, voted on the recommendations. Consensus on recommendations was achieved when ⩾75% of respondents expressed an agreement score of 7–9, on a 9-point scale. Results: Consensus was achieved on all 13 recommendations. Clinical recommendations are provided on whether all patients with MS receiving cladribine tablets should be vaccinated against COVID-19, and whether they should be prioritized; the timing of vaccination around dosing of cladribine tablets (i.e. before and after a treatment course); and the safety of COVID-19 vaccination for these patients. Conclusion: These expert recommendations provide timely guidance on COVID-19 vaccination in patients receiving cladribine tablets, which is relevant to everyday clinical practice.

scholarly journals Levosimendan in the light of the results of the recent randomized controlled trials: an expert opinion paper

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Bernard Cholley ◽  
Bruno Levy ◽  
Jean-Luc Fellahi ◽  
Dan Longrois ◽  
Julien Amour ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trials ◽  
Expert Opinion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Current Evidence ◽  
Controlled Trials ◽  
Pharmacological Properties ◽  
Ventricular Ejection Fraction ◽  
Randomized Controlled

AbstractDespite interesting and unique pharmacological properties, levosimendan has not proven a clear superiority to placebo in the patient populations that have been enrolled in the various recent multicenter randomized controlled trials. However, the pharmacodynamic effects of levosimendan are still considered potentially very useful in a number of specific situations.Patients with decompensated heart failure requiring inotropic support and receiving beta-blockers represent the most widely accepted indication. Repeated infusions of levosimendan are increasingly used to facilitate weaning from dobutamine and avoid prolonged hospitalizations in patients with end-stage heart failure, awaiting heart transplantation or left ventricular assist device implantation. New trials are under way to confirm or refute the potential usefulness of levosimendan to facilitate weaning from veno-arterial ECMO, to treat cardiogenic shock due to left or right ventricular failure because the current evidence is mostly retrospective and requires confirmation with better-designed studies. Takotsubo syndrome may represent an ideal target for this non-adrenergic inotrope, but this statement also relies on expert opinion. There is no benefit from levosimendan in patients with septic shock. The two large trials evaluating the prophylactic administration of levosimendan (pharmacological preconditioning) in cardiac surgical patients with poor left ventricular ejection fraction could not show a significant reduction in their composite endpoints reflecting low cardiac output syndrome with respect to placebo. However, the subgroup of those who underwent isolated CABG appeared to have a reduction in mortality. A new study will be required to confirm this exploratory finding.Levosimendan remains a potentially useful inodilator agent in a number of specific situations due to its unique pharmacological properties. More studies are needed to provide a higher level of proof regarding these indications.

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