Neuro-oncology management during the COVID-19 pandemic with a focus on WHO grades III and IV gliomas

Abstract Background Because of the increased risk in cancer patients of developing complications caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), physicians have to balance the competing risks of the negative impact of the pandemic and the primary tumor disease. In this consensus statement, an international group of experts present mitigation strategies and treatment guidance for patients suffering from high grade gliomas (HGGs) during the coronavirus disease 2019 (COVID-19) pandemic. Methods Sixteen international experts in the treatment of HGG contributed to this consensus-based practice recommendation, including neuro-oncologists, neurosurgeons, radiation oncologists, and a medical physicist. Generally, treatment of neuro-oncological patients cannot be significantly delayed and initiating therapy should not be outweighed by COVID-19. We present detailed interdisciplinary treatment strategies for molecular subgroups in 2 pandemic scenarios, a scale-up phase and a crisis phase. Conclusion This practice recommendation presents a pragmatic framework and consensus-based mitigation strategies for the treatment of HGG patients during the SARS-CoV-2 pandemic.

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APKASS Consensus Statement on Chronic Syndesmosis Injury, Part 1: Clinical Manifestation, Radiologic Examination, Diagnosis Criteria, Classification, and Nonoperative Treatment

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211021057 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110210

Author(s):

Chen Jiao ◽

Jianchao Gui ◽

Hiroaki Kurokawa ◽

Yasuhito Tanaka ◽

Patrick Yung ◽

...

Keyword(s):

Diagnostic Criteria ◽

Clinical Manifestation ◽

Sports Medicine ◽

Consensus Statement ◽

Treatment Strategies ◽

Nonoperative Treatment ◽

Radiologic Examination ◽

Syndesmosis Injury ◽

Strong Consensus ◽

International Experts

Background: Clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies regarding chronic syndesmosis injury remain unclear. Purpose: An international group of experts representing the fields of sports injuries in the foot and ankle area were invited to collaboratively advance toward consensus opinions based on the best available evidence regarding chronic syndesmosis injuries. All were members of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS). Study Design: Consensus statement. Methods: From November to December 2020, a total of 111 international experts on sports medicine or ankle surgery participated in a 2-stage Delphi process that included an anonymous online survey and an online meeting. A total of 13 items with 38 statements were drafted by 13 core authors. Of these, 4 items with 15 clinical questions and statements were related to the clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies for chronic syndesmosis injury and are presented here. Each statement was individually presented and discussed, followed by a general vote. The strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results: Of the 15 questions and statements, 5 reached unanimous support and 10 achieved strong consensus. Conclusion: This APKASS consensus statement, developed by international experts in the field, will assist surgeons and physical therapists with diagnosis, classification, and nonoperative treatment strategies for chronic syndesmosis injury.

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Treatment-induced mania in bipolar depression: Identifying at-risk bipolar patients

European Psychiatry ◽

10.1016/j.eurpsy.2013.09.260 ◽

2013 ◽

Vol 28 (S2) ◽

pp. 97-98

Author(s):

C. Brichant-Petitjean

Keyword(s):

At Risk ◽

Negative Impact ◽

Bipolar Depression ◽

Antidepressant Treatment ◽

Treatment Strategies ◽

Small Sample ◽

Consensus Definition ◽

Increased Risk ◽

Psychosocial Stability ◽

Bipolar Patients

The treatment of bipolar depression is still an important challenge for clinicians and the number of evidence based options is limited. Antidepressants are the most frequently prescribed drugs for bipolar depression in clinical practice, even though the relative risks and benefits of using this treatment strategy has been strongly debated over the past 25 years. One of the reasons is that several placebo-controlled studies have shown that antidepressants could induce manic or hypomanic episodes and accelerate the rate of cycling, worsening the course of the illness by increasing the number of mood episodes over time. Antidepressant-Induced Manias (AIM) have been reported in a subgroup of about 25 to 30% of bipolar patients. There is an increased risk of mood switch with tricyclic antidepressants (TCAs) and serotonin and noradrenaline reuptake inhibitors (SNRIs). The occurrence of mania during antidepressant treatment is a crucial issue in the clinical management of Bipolar Disorder (BD) since it greatly interferes with the establishment of an optimal treatment for bipolar depression. It can have substantial negative impact on overall mood and psychosocial stability in patients receiving treatment for bipolar depression, possibly leading to treatment resistance. Therefore, the identification of clinical correlates associated with AIM is essential to better identify at-risk subgroups of patients and propose specific individualized treatment strategies for bipolar depression. No risk factors has been replicated so far, mostly because studies are characterized by small sample sizes and by the absence of a consensus definition of AIM, showing conflicting results. In this study, patients were classified according to a restrictive definition, similar to that used by Rousseva et al. (2003). An AIM− group (n = 135) was compared to AIM+ patients (n = 75) for clinical and sociodemographic factors as well as for psychological dimensions.

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THE VALUE OF SKELETAL MUSCLE MASS IN PREDICTING SHORT-TERM OUTCOMES OF SURGICAL TREATMENT FOR KLATSKIN TUMOR

Problems in oncology ◽

10.37469/0507-3758-2018-64-5-564-569 ◽

2018 ◽

Vol 64 (5) ◽

pp. 564-569

Author(s):

Yuriy Zharikov ◽

Tatyana Zharikova ◽

Vladimir Nikolenko

Keyword(s):

Skeletal Muscle ◽

Surgical Treatment ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Negative Impact ◽

Treatment Algorithm ◽

Preoperative Treatment ◽

Klatskin Tumor ◽

Short Term ◽

Oncological Patients

The objective of this review study was to analyze the relationship between skeletal muscle mass and postoperative short-term outcomes morbidity in patients with Klatskin tumor who underwent surgical treatment. Low index skeletal muscle mass had a negative impact factor on postoperative morbidity following resection of Klatskin tumor and should therefore be considered as preoperative risk assessment. The further study of body composition in oncological patients allowed revealing the group of patients with high probability of postoperative complications and this factor needed to be added to future models predictive scale of short-term outcomes with the aim of making the most rational preoperative treatment algorithm.

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Dermatillomania: Strategies for Developing Protective Biomaterials/Cloth

Pharmaceutics ◽

10.3390/pharmaceutics13030341 ◽

2021 ◽

Vol 13 (3) ◽

pp. 341

Author(s):

Priusha Ravipati ◽

Bice Conti ◽

Enrica Chiesa ◽

Karine Andrieux

Keyword(s):

Alternative Treatment ◽

Negative Impact ◽

Treatment Strategies ◽

Current Treatment ◽

Primary Objective ◽

Neuropsychiatric Disorder ◽

Physical Barrier ◽

Physical Treatment ◽

Pubmed Database ◽

Prevention Of Infections

Dermatillomania or skin picking disorder (SPD) is a chronic, recurrent, and treatment resistant neuropsychiatric disorder with an underestimated prevalence that has a concerning negative impact on an individual’s health and quality of life. The current treatment strategies focus on behavioral and pharmacological therapies that are not very effective. Thus, the primary objective of this review is to provide an introduction to SPD and discuss its current treatment strategies as well as to propose biomaterial-based physical barrier strategies as a supporting or alternative treatment. To this end, searches were conducted within the PubMed database and Google Scholar, and the results obtained were organized and presented as per the following categories: prevalence, etiology, consequences, diagnostic criteria, and treatment strategies. Furthermore, special attention was provided to alternative treatment strategies and biomaterial-based physical treatment strategies. A total of six products with the potential to be applied as physical barrier strategies in supporting SPD treatment were shortlisted and discussed. The results indicated that SPD is a complex, underestimated, and underemphasized neuropsychiatric disorder that needs heightened attention, especially with regard to its treatment and care. Moreover, the high synergistic potential of biomaterials and nanosystems in this area remains to be explored. Certain strategies that are already being utilized for wound healing can also be further exploited, particularly as far as the prevention of infections is concerned.

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307 A systems approach to understanding biosecurity decision-making

Journal of Animal Science ◽

10.1093/jas/skaa278.078 ◽

2020 ◽

Vol 98 (Supplement_4) ◽

pp. 43-43

Author(s):

Scott C Merrill ◽

Christopher Koliba ◽

Gabriela Bucini ◽

Eric Clark ◽

Luke Trinity ◽

...

Keyword(s):

Decision Making ◽

Negative Impact ◽

Risk Mitigation ◽

African Swine Fever Virus ◽

The United States ◽

Mitigation Strategies ◽

Communication Strategy ◽

Livestock Industry ◽

Diarrhea Virus ◽

Operational Level

Abstract Disease and its consequences result in social and economic impacts to the US animal livestock industry, ranging from losses in human capital to economic costs in excess of a billion dollars annually. Impacts would dramatically escalate if a devastating disease like Foot and Mouth Disease or African Swine Fever virus were to emerge in the United States. Investing in preventative biosecurity can reduce the likelihood of disease incursions and their negative impact on our livestock industry, yet uncertainty persists with regards to developing an effective biosecurity structure and culture. Here we show the implications of human behavior and decision making for biosecurity effectiveness, from the operational level to the owner/managerial level and finally to the systems level. For example, adjustments to risk messaging strategies could double worker compliance with biosecurity practices at the operational level. The improvement of our risk communication strategy may increase willingness to invest in biosecurity. Furthermore, the adaptation of policies could nudge behavior so that we observe a short disease outbreak followed by a quick eradication instead of a pandemic. Our research shows how the emergence of now-endemic diseases, such as Porcine Epidemic Diarrhea virus, cannot be adequately modeled without the use of a human behavioral component. Focusing solely on any one sector or level of the livestock system is not sufficient to predict emergent disease patterns and their social and economic impact on livestock industries. These results provide insight toward developing more effective risk mitigation strategies and ways to nudge behavior toward more disease resilient systems.

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Maintaining paediatric cardiac services during the COVID-19 pandemic in a developing country in sub-Saharan Africa: guidelines for a “scale up” in the face of a global “scale down”

Cardiology in the Young ◽

10.1017/s1047951120003650 ◽

2020 ◽

Vol 30 (11) ◽

pp. 1588-1594

Author(s):

Ogochukwu J. Sokunbi ◽

Ogadinma Mgbajah ◽

Augustine Olugbemi ◽

Bassey O. Udom ◽

Ariyo Idowu ◽

...

Keyword(s):

Scale Up ◽

Global Scale ◽

International Travel ◽

Sub Saharan Africa ◽

African Continent ◽

Tertiary Centre ◽

The Face ◽

Scale Down ◽

Sub Saharan ◽

International Experts

AbstractThe COVID-19 pandemic is currently ravaging the globe and the African continent is not left out. While the direct effects of the pandemic in regard to morbidity and mortality appear to be more significant in the developed world, the indirect harmful effects on already insufficient healthcare infrastructure on the African continent would in the long term be more detrimental to the populace. Women and children form a significant vulnerable population in underserved areas such as the sub-Saharan region, and expectedly will experience the disadvantages of limited healthcare coverage which is a major fall out of the pandemic. Paediatric cardiac services that are already sparse in various sub-Saharan countries are not left out of this downsizing. Restrictions on international travel for patients out of the continent to seek medical care and for international experts into the continent for regular mission programmes leave few options for children with cardiac defects to get the much-needed care.There is a need for a region-adapted guideline to scale-up services to cater for more children with congenital heart disease (CHD) while providing a safe environment for healthcare workers, patients, and their caregivers. This article outlines measures adapted to maintain paediatric cardiac care in a sub-Saharan tertiary centre in Nigeria during the COVID-19 pandemic and will serve as a guide for other institutions in the region who will inadvertently need to provide these services as the demand increases.

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Online Opioid Stewardship Training for Long-Term Care Staff

Innovation in Aging ◽

10.1093/geroni/igaa057.1721 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 533-533

Author(s):

Linda Edelman ◽

Troy Andersen ◽

Cherie Brunker ◽

Nicholas Cox ◽

Jorie Butler ◽

...

Keyword(s):

Staff Training ◽

Long Term Care ◽

Treatment Strategies ◽

Care Staff ◽

Video Content ◽

Opioid Use ◽

Term Care ◽

Increased Risk ◽

Pain Management Strategy

Abstract Opioids are often the first-line chronic pain management strategy for long-term care (LTC) residents who are also at increased risk for opioid-related adverse events. Therefore, there is a need to train LTC providers and staff about appropriate opioid use and alternative treatment strategies. Our interdisciplinary team worked with LTC partners to identify staff educational needs around opioid stewardship. Based on this need’s assessment, we developed eight modules about opioid use and risks for older adults, including those with dementia, recommendations for de-prescribing including other pharmacological and non-pharmacological alternatives, SBIRT, and motivational interviewing to determine “what matters”. Each 20-minute module contains didactic and video content that is appropriate for group staff training or individuals and provides rural LTC facilities access to needed training in their home communities. Within the first month of launching online, the program received over 1100 hits and LTC partners are incorporating modules into clinical staff training schedules.

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Overt acts of perceived discrimination reported by British working-age adults with and without disability

Journal of Public Health ◽

10.1093/pubmed/fdz093 ◽

2019 ◽

Cited By ~ 1

Author(s):

Eric Emerson ◽

Allison Milner ◽

Zoe Aitken ◽

Lauren Krnjacki ◽

Cathy Vaughan ◽

...

Keyword(s):

Public Health ◽

Negative Impact ◽

Policy Research ◽

Secondary Analysis ◽

People With Disabilities ◽

Public Health Problem ◽

Health Staff ◽

Cross Sectional ◽

Increased Risk ◽

The Uk

Abstract Background Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. Methods Secondary analysis of de-identified cross-sectional data from the three waves of the UK’s ‘Life Opportunities Survey’. Results In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. Conclusions Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

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Impact of the COVID-19 Pandemic on the Patient’s Decision about Bariatric Surgery: Results of a National Survey

Medicina ◽

10.3390/medicina57080756 ◽

2021 ◽

Vol 57 (8) ◽

pp. 756

Author(s):

Maciej Walędziak ◽

Anna Różańska-Walędziak ◽

Paweł Bartnik ◽

Joanna Kacperczyk-Bartnik ◽

Andrzej Kwiatkowski ◽

...

Keyword(s):

Bariatric Surgery ◽

Online Survey ◽

Negative Impact ◽

Weight Loss Surgery ◽

General Information ◽

Open Questions ◽

Increased Risk ◽

Bariatric Patients ◽

The Moment ◽

The Impact

Background: the COVID-19 pandemic and the implemented restrictions have changed the functioning of healthcare systems worldwide. The purpose of the study was to evaluate the impact of the present epidemiological situation on patients’ decisions about undergoing weight loss surgery. Methods: data were collected from 906 bariatric patients by the means of a national online survey, the majority of whom were women (87.9%). The survey started on 9 April 2020 and was open until 28 April 2020. The questionnaire included multiple choice and open questions, divided into three chapters: general information about the patient, life during the COVID-19 pandemic, and bariatric care during the COVID-19 pandemic. Results: despite the pandemic and the associated risk of COVID-19 infection, 443 responders (48.9%) would have decided to undergo bariatric surgery. Awareness of the negative impact of obesity on the course of COVID-19 illness had only marginable impact on patients’ decision-making (76.6% vs. 75.3%; p < 0.80). Contact with COVID-19 prior to the survey had a negative impact on the willingness to undergo bariatric surgery (3.0% vs. 4.4%; p < 0.55). There was a positive correlation between the BMI and preference for bariatric surgery in the time of the pandemic (37.4 ± 9.0 vs. 34.9 ± 8.7; p < 0.001). Conclusions: the level of awareness about the advantages of operative treatment of obesity is high among bariatric patients. The majority of patients awaiting bariatric surgery at the moment of the survey were positive about undergoing bariatric surgery despite the increased risk of a serious course of COVID-19 infection. Therefore, a large proportion of patients was determined to have bariatric treatment even during the pandemic, being aware of the increased risk of worse pace of COVID-19 disease in case of obesity and related diseases.

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Abstract 5857: Low Operative Mortality with implantation of a Continuous Flow LVAD and Impact of Concurrent Cardiac Procedures

Circulation ◽

10.1161/circ.118.suppl_18.s_1017 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jay D Pal ◽

Charles T Klodell ◽

Ranjit John ◽

Francis Pagani ◽

Joseph G Rogers ◽

...

Keyword(s):

Aortic Valve ◽

Continuous Flow ◽

Operative Mortality ◽

Negative Impact ◽

Venous Pressure ◽

Heartmate Ii ◽

Cardiac Procedures ◽

Increased Risk ◽

The Impact ◽

Tricuspid Repair

Objective: Our goal was to determine the operative mortality of isolated implantation of the HeartMate II continuous flow LVAD and the impact of additional concurrent cardiac procedures on patient outcomes. Methods: In a multicenter trial, 279 patients at 33 clinical sites underwent implantation of the HeartMate II continuous flow LVAD as a bridge to transplantation from March 2005 to March 2007. HeartMate II implantation (HM II) was the only procedure required in 172 patients while 80 patients required concurrent cardiac procedures in conjunction with LVAD implantation (HM II+CCP). Results: Preoperative characteristics were similar, but central venous pressure (14.5 vs 11.6 mmHg) was greater for patients requiring concurrent cardiac procedures, suggesting worse right heart dysfunction. Mean cardiopulmonary bypass times increased from 97 to 120 minutes when a concurrent cardiac procedure was performed (p<0.001). Length of stay slightly increased from 23 to 26 days (p=0.17). Overall 30- and 180-day mortality was 5.8% and 13.3% for the HM II group, and 11.3% and 20.0% for the HM II+CCP group. Concurrent valvular procedures increased the risk to 8.5% and 19.1%. Patients who underwent an aortic valve replacement with cardioplegic arrest had a 30-day mortality of 25%, higher than for isolated concurrent mitral (0%) or tricuspid repair (3.3%). Other cardiac procedures were associated with a 30-day mortality of 27.8%. Survival at 180 days was 87% for HMII alone and 80% for HMII+CCP. Conclusion: There is a low 5.8% operative mortality for patients requiring uncomplicated HeartMate II implantation, with no apparent increased risk for concurrent PFO closure, mitral or tricuspid repair. However, concurrent aortic valve and other cardiac procedures are associated with a significantly decreased survival. The increased risk of these procedures must be balanced against the negative impact of uncorrected aortic insufficiency during VAD support.

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