scholarly journals Quality Requirements for gynecological ultrasound examinations of DEGUM level II – Recommendations of the Sections/Working Groups Gynecology and Obstetrics of DEGUM, ÖGUM and SGUM

2021 ◽  
Author(s):  
Markus Hoopmann ◽  
Boris Tutschek ◽  
Eberhard Merz ◽  
Karl-Heinz Eichhorn ◽  
Karl Oliver Kagan ◽  
...  
Keyword(s):  
Therapeutic Interventions ◽  
Quality Requirements ◽  
Gynecology And Obstetrics ◽  
Multi Stage ◽  
Level Ii ◽  
Technical Examination ◽  
Working Groups ◽  
Level I ◽  
Expert Status ◽  
Objective Basis

AbstractGynecological sonography is the central and most frequently used technical examination method used by gynecologists. Its focus is on the clarification of masses of the uterus and the adnexa, fertility diagnosis, clarification of bleeding disorders and chronic and acute pelvic problems, pelvic floor and incontinence diagnosis as well as the differential diagnosis of disturbed early pregnancy. The indication for diagnostic and therapeutic interventions, preoperative planning and postoperative controls are largely based on the findings of gynecological sonography. These examinations are particularly dependent on the experience of the examiner.Based on the proven multi-stage concept of obstetric diagnostics, gynecological sonography should primarily be performed by an experienced and specialized examiner in patients for whom the initial gynecological examinations have not yet led to a sufficient assessment of the findings. So that the expert status required for this has an objective basis, the Gynecology and Obstetrics Section of DEGUM in cooperation with ÖGUM and SGUM implemented the option of acquiring DEGUM Level II for gynecological sonography. The effectiveness of the care in the multi-level concept depends on the quality of the ultrasound examination at level I. Quality requirements for the basic examination and the differentiation between the basic and further examination have therefore already been defined by DEGUM/ÖGUM. The present work is intended to set out quality requirements for gynecological sonography of DEGUM level II and for the correspondingly certified gynecologists.Common pathologies from gynecological sonography and requirements for imaging and documentation are described.

scholarly journals Updated DEGUM Quality Requirements for the Basic Prenatal Screening Ultrasound Examination (DEGUM Level I) between 18 + 0 and 21 + 6 weeks of gestation

2020 ◽  
Vol 41 (05) ◽  
pp. 499-503
Author(s):  
Christiane Kähler ◽  
Thomas Schramm ◽  
Rainer Bald ◽  
Ulrich Gembruch ◽  
Eberhard Merz ◽  
...  
Keyword(s):  
Maternity Care ◽  
Ultrasound Examination ◽  
Standard Technique ◽  
Ultrasound Screening ◽  
Ultrasound Technique ◽  
Quality Requirements ◽  
Fetal Abnormalities ◽  
Level Ii ◽  
Level I ◽  
Screening Ultrasound

AbstractA precondition for the early detection of fetal abnormalities is the high quality of prenatal basic ultrasound (screening examination). The objective of ultrasound screening is the recognition of abnormal fetal growth and fetal anatomical anomalies. The prenatal detection of fetal abnormalities enables detailed prenatal counselling of parents, improved care at birth and potentially a reduction in morbidity and mortality. In the guidelines for maternity care in Germany (“Mutterschaftsrichtlinien”), the performance of basic ultrasound in pregnancy is not clearly defined. The required image documentation includes a few biometric measurements only. Therefore, adherence to a standard technique and the possibility of audit are limited, thus not necessarily resulting in high screening quality. In this update of the DEGUM quality requirements for level I screening ultrasound examination between 18 + 0 and 21 + 6 weeks of gestation, the required parameters, standard planes and required documentation are described in detail. The greater experience of gynecologists in the field of sonographic screening examinations and the use of a modern ultrasound technique allow improvement of the screening quality. This will improve the standard of basic ultrasound screening. Due to the enhanced standard of the DEGUM I examination, more pregnant women may benefit from a detailed ultrasound examination and specialized therapy in DEGUM level II and III centers. The required fetal structures are described in detail. This update of the requirements for level I DEGUM basic ultrasound examination between 18 + 0 and 21 + 6 weeks of gestation goes far beyond the guidelines for maternity care in Germany (the “Mutterschaftsrichtlinien”) thereby elevating standards.

scholarly journals Comprehensive Review of Therapeutic Interventions in Managing Chronic Spinal Pain

2009 ◽  
Vol 4;12 (4;7) ◽  
pp. E123-E198
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Facet Joint ◽  
Spinal Pain ◽  
Therapeutic Interventions ◽  
Lumbar Surgery ◽  
Epidural Injections ◽  
Level Ii ◽  
Level I ◽  
Chronic Spinal Pain

Background: Available evidence documents a wide degree of variance in the definition and practice of interventional pain management. Objective: To provide evidence-based clinical practice guidelines for interventional techniques in the treatment of chronic spinal pain. Design: Best evidence synthesis. Methods: Strength of evidence was assessed by the U.S. Preventive Services Task Force (USPSTF) criteria utilizing 5 levels of evidence ranging from Level I to III with 3 subcategories in Level II. Outcomes: Short-term pain relief was defined as relief lasting 6 months or less and long-term relief as longer than 6 months, except ≤ one year and > one year for intradiscal therapies, mechanical disc decompression, spinal cord stimulation, and intrathecal infusion systems. Results: The indicated evidence for therapeutic interventions is Level I for caudal epidural steroid injections in managing disc herniation or radiculitis, and discogenic pain without disc herniation or radiculitis. The evidence is Level I to II-1 for percutaneous adhesiolysis in management of pain secondary to post-lumbar surgery syndrome. The evidence is Level II-1 or II-2 for therapeutic cervical, thoracic, and lumbar facet joint nerve blocks; for caudal epidural injections in managing pain of post-lumbar surgery syndrome, and lumbar spinal stenosis, for cervical interlaminar epidural injections in managing cervical pain (Level II-1); for lumbar transforaminal epidural injections; and spinal cord stimulation for post-lumbar surgery syndrome. Limitations: The limitations of this guideline preparation included a paucity of literature, lack of updates, and lack of conflicts in preparation of systematic reviews and guidelines by various organizations. Conclusion: The indicated evidence for therapeutic interventions is variable from Level I to III. This comprehensive review includes the evaluation of evidence for therapeutic procedures in managing chronic spinal pain and recommendations. However, this review and recommendations do not constitute inflexible treatment recommendations or “standard of care.” Key words: Interventional techniques, chronic spinal pain, therapeutic interventions, facet joint interventions, epidural procedures, epidural adhesiolysis, radiofrequency, mechanical disc decompression, spinal cord stimulation, intrathecal implantable systems

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

scholarly journals Secondary prevention medication persistence and prognosis of acute ischaemic stroke or transient ischaemic attack

2021 ◽  
pp. svn-2020-000471
Author(s):  
Lei Zhang ◽  
Junfeng Shi ◽  
Yuesong Pan ◽  
Zixiao Li ◽  
Hongyi Yan ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Recurrent Stroke ◽  
Medication Persistence ◽  
Level Ii ◽  
Composite Events ◽  
Ischaemic Attack ◽  
Level I

IntroductionThe risk of disability and mortality is high among recurrent stroke, which highlights the importance of secondary prevention measures. We aim to evaluate medication persistence for secondary prevention and the prognosis of acute ischaemic stroke or transient ischaemic attack (TIA) in China.MethodsPatients with acute ischaemic stroke or TIA from the China National Stroke Registry II were divided into 3 groups based on the percentage of persistence in secondary prevention medication classes from discharge to 3 months after onset (level I: persistence=0%, level II: 0%<persistence<100%, level III: persistence=100%). The primary outcome was recurrent stroke. The secondary outcomes included composite events (stroke, myocardial infarction or death from cardiovascular cause), all-cause death and disability (modified Rankin Scale score=3–5) from 3 months to 1 year after onset. Recurrent stroke, composite events and all-cause death were performed using Cox regression model, and disability was identified through logistic regression model using the generalised estimating equation method.Results18 344 patients with acute ischaemic stroke or TIA were included, 315 (1.7%) of whom experienced recurrent strokes. Compared with level I, the adjusted HR of recurrent stroke for level II was 0.41 (95% CI 0.31 to 0.54) and level III 0.37 (0.28 to 0.48); composite events for level II 0.41 (0.32 to 0.53) and level III 0.38 (0.30 to 0.49); all-cause death for level II 0.28 (0.23 to 0.35) and level III 0.20 (0.16–0.24). Compared with level I, the adjusted OR of disability for level II was 0.89 (0.77 to 1.03) and level III 0.82 (0.72 to 0.93).ConclusionsPersistence in secondary prevention medications, especially in all classes of medications prescribed by the physician, was associated with lower hazard of recurrent stroke, composite events, all-cause death and lower odds of disability in patients with acute ischaemic stroke or TIA.

Source depth estimation using multi-station waveform data

1984 ◽  
Vol 74 (5) ◽  
pp. 1623-1643
Author(s):  
Falguni Roy
Keyword(s):  
Depth Estimation ◽  
The United States ◽  
Digital Data ◽  
United States Geological Survey ◽  
Travel Times ◽  
Source Depth ◽  
Time Data ◽  
Waveform Data ◽  
Level Ii ◽  
Level I

Abstract A depth estimation procedure has been described which essentially attempts to identify depth phases by analyzing multi-station waveform data (hereafter called level II data) in various ways including deconvolution, prediction error filtering, and spectral analysis of the signals. In the absence of such observable phases, other methods based on S-P, ScS-P, and SKS-P travel times are tried to get an estimate of the source depth. The procedure was applied to waveform data collected from 31 globally distributed stations for the period between 1 and 15 October 1980. The digital data were analyzed at the temporary data center facilities of the National Defense Research Institute, Stockholm, Sweden. During this period, a total number of 162 events in the magnitude range 3.5 to 6.2 were defined by analyzing first arrival time data (hereafter called level I data) alone. For 120 of these events, it was possible to estimate depths using the present procedure. The applicability of the procedure was found to be 100 per cent for the events with mb &gt; 4.8 and 88 per cent for the events with mb &gt; 4. A comparison of level I depths and level II depths (the depths as obtained from level I and level II data, respectively) with that of the United States Geological Survey estimates indicated that it will be necessary to have at least one local station (Δ &lt; 10°) among the level I data to obtain reasonable depth estimates from such data alone. Further, it has been shown that S wave travel times could be successfully utilized for the estimation of source depth.

scholarly journals Factors associated with interhospital transfer of children with respiratory failure from level II to level I pediatric intensive care units

2015 ◽  
Vol 30 (5) ◽  
pp. 1080-1084 ◽  
Author(s):  
Folafoluwa O. Odetola ◽  
Sarah J. Clark ◽  
James G. Gurney ◽  
Janet E. Donohue ◽  
Achamyeleh Gebremariam ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Intensive Care Units ◽  
Pediatric Intensive Care ◽  
Pediatric Intensive Care Units ◽  
Factors Associated ◽  
Interhospital Transfer ◽  
Level Ii ◽  
Level I

scholarly journals Design and implementation of an international, multi-arm, multi-stage platform master protocol for trials of novel SARS-CoV-2 antiviral agents: Therapeutics for Inpatients with COVID-19 (TICO/ACTIV-3)

2021 ◽  
pp. 174077452110498
Author(s):  
Daniel D Murray ◽  
Abdel G Babiker ◽  
Jason V Baker ◽  
Christina E Barkauskas ◽  
Samuel M Brown ◽  
...  
Keyword(s):  
Antiviral Agents ◽  
Safety Data ◽  
Target Population ◽  
Therapeutic Agents ◽  
Therapeutic Interventions ◽  
Global Network ◽  
Specific Information ◽  
Full Potential ◽  
Design And Implementation ◽  
Multi Stage

Background/aims Safe and effective therapies for COVID-19 are urgently needed. In order to meet this need, the Accelerating COVID-19 Therapeutic Interventions and Vaccines public–private partnership initiated the Therapeutics for Inpatients with COVID-19. Therapeutics for Inpatients with COVID-19 is a multi-arm, multi-stage platform master protocol, which facilitates the rapid evaluation of the safety and efficacy of novel candidate antiviral therapeutic agents for adults hospitalized with COVID-19. Five agents have so far entered the protocol, with rapid answers already provided for three of these. Other agents are expected to enter the protocol throughout 2021. This protocol contains a number of key design and implementation features that, along with challenges faced by the protocol team, are presented and discussed. Methods Three clinical trial networks, encompassing a global network of clinical sites, participated in the protocol development and implementation. Therapeutics for Inpatients with COVID-19 utilizes a multi-arm, multi-stage design with an agile and robust approach to futility and safety evaluation at 300 patients enrolled, with subsequent expansion to full sample size and an expanded target population if the agent shows an acceptable safety profile and evidence of efficacy. Rapid recruitment to multiple agents is enabled through the sharing of placebo, the confining of agent-specific information to protocol appendices, and modular consent forms. In collaboration with the Food and Drug Administration, a thorough safety data collection and Data and Safety Monitoring Board schedule was developed for the study of potential therapeutic agents with limited in-human data in hospitalized patients with COVID-19. Results As of 8 August 2021, five agents have entered the Therapeutics for Inpatients with COVID-19 master protocol and a total of 1909 participants have been randomized to one of these agents or matching placebo. There were a number of challenges faced by the study team that needed to be overcome in order to successfully implement Therapeutics for Inpatients with COVID-19 across a global network of sites. These included ensuring drug supply and reliable recruitment allowing for changing infection rates across the global network of sites, the need to balance the collection of data and samples without overburdening clinical staff and obtaining regulatory approvals across a global network of sites. Conclusion Through a robust multi-network partnership, the Therapeutics for Inpatients with COVID-19 protocol has been successfully used across a global network of sites for rapid generation of efficacy data on multiple novel antiviral agents. The protocol design and implementation features used in this protocol, and the approaches to address challenges, will have broader applicability. Mechanisms to facilitate improved communication and harmonization among country-specific regulatory bodies are required to achieve the full potential of this approach in dealing with a global outbreak.

scholarly journals Computerized testing as efficient form of objective knowledge monitoring in studying of technical subjects

2019 ◽  
pp. 11-11
Author(s):  
Vitaly Kuznetsov ◽  
Galina Polekhina ◽  
Yulia Shaposhnikova
Keyword(s):  
Computerized Testing ◽  
Efficient System ◽  
Academic Activity ◽  
Computer Testing ◽  
Level Ii ◽  
New Information ◽  
The Subject ◽  
Knowledge Monitoring ◽  
Level I ◽  
Problematic Situations

Introduction. Objective and regular students’ knowledge monitoring in technical subjects can be implemented by means of special tests allowing for the required mastering level of the matter and the reliable consolidation of the acquired knowledge. Various aspects of the application of tests in the academic activity were considered. Materials and methods. Tests used in practical studies should meet specific requirements, such as: validity, definiteness, simplicity, unambiguity, reliability. The identification of mastering levels makes it possible to “troubleshoot” and to improve the academic activity and the mastering degree of the competences by the students. Based on the assessment of the studying pattern of the forthcoming activity, one could point out four mastering levels of the subject matter. Level I tests include recognition, discrimination and classification. Level II tests monitor the mastering of the subject in the level of “reproduction” allowing for retrieval of information from the memory and its analysis, for routine assignment solutions. Level III tests impose special assignments challenging a student with quests for which no ready algorithms are catered, whereas the solutions found lead to obtaining of subjectively new information. Level IV tests reveal students’ capability to take decisions in new problematic situations, the solutions found, being a result of creative activity, are followed by obtaining of objectively new information. Results. To establish an efficient system of monitoring tests in a certain subject, a number of basic prerequisites is required, such as a data base, a sample group of with the required number of assignments, at least 30 and maximum 70, a time limit in accordance with the required labor intensity, assessment of the assignments and its criteria, the output of the results. Conclusions. If there is a required number of computers of at least one PC per two students, correctly arranged computer testing considerably reduces time demand of a monitoring event, increases the responsibility and the progress of the students, guarantees the objectiveness of the knowledge monitoring and helps to avoid conflicts.

scholarly journals Systematic Review of Diagnostic Utility and Therapeutic Effectiveness of Thoracic Facet Joint Interventions

2008 ◽  
Vol 5;11 (10;5) ◽  
pp. 611-629
Author(s):  
Sairam Atluri
Keyword(s):  
Back Pain ◽  
Local Anesthetic ◽  
Joint Pain ◽  
Facet Joint ◽  
Therapeutic Interventions ◽  
Medial Branch ◽  
Radiofrequency Neurotomy ◽  
Level I ◽  
Facet Joint Pain ◽  
Facet Joint Interventions

Background: Chronic mid back and upper back pain caused by thoracic facet joints has been reported in 34% to 48% of the patients based on the responses to controlled diagnostic blocks. Systematic reviews have established moderate evidence for controlled comparative local anesthetic blocks of thoracic facet joints in the diagnosis of mid back and upper back pain, moderate evidence for therapeutic thoracic medial branch blocks, and limited evidence for radiofrequency neurotomy of therapeutic facet joint nerves. Objectives: To determine the clinical utility of diagnostic and therapeutic thoracic facet joint interventions in diagnosing and managing chronic upper back and mid back pain. Study Design: Systematic review of diagnostic and therapeutic thoracic facet joint interventions. Methods: Review of the literature for utility of facet joint interventions in diagnosing and managing facet joint pain was performed according to the Agency for Healthcare Research and Quality (AHRQ) criteria for diagnostic studies and observational studies and the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by United States Preventive Services Task Force (USPSTF) for therapeutic interventions. Recommendations were based on the criteria developed by Guyatt et al. Data sources included relevant literature of the English language identified through searches of Medline and EMBASE from 1966 to July 2008 and manual searches of bibliographies of known primary and review articles. Results of the analysis were performed for diagnostic and therapeutic interventions separately. Outcome Measures: For diagnostic interventions, studies must have been performed utilizing controlled local anesthetic blocks. For therapeutic interventions, the primary outcome measure was pain relief (short-term relief = up to 6 months and long-term relief > 6 months) with secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: Based on the controlled comparative local anesthetic blocks, the evidence for the diagnosis of thoracic facet joint pain is Level I or II-1. The evidence for therapeutic thoracic medial branch blocks is Level I or II-1. The recommendation is IA or 1B/strong for diagnostic and therapeutic medial branch blocks. Conclusion: The evidence for the diagnosis of thoracic facet joint pain with controlled comparative local anesthetic blocks is Level I or II-1. The evidence for therapeutic facet joint interventions is Level I or II-1 for medial branch blocks. Recommendation is 1A or 1B/strong for diagnostic and therapeutic medial branch blocks. Key words: Chronic thoracic pain, mid back or upper back pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks, therapeutic thoracic medial branch blocks, thoracic radiofrequency neurotomy, thoracic intraarticular facet joint injections

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