scholarly journals Pilot study for the registry of complications in rheumatic diseases from the German Society of Surgery (DGORh): evaluation of methods and data from the first 1000 patients

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e015987 ◽  
Author(s):  
Tanja Kostuj ◽  
Stefan Rehart ◽  
Ronald Matta-Hurtado ◽  
Christoph Biehl ◽  
Roland E Willburger ◽  
...  
Keyword(s):  
Pilot Study ◽  
Rheumatic Diseases ◽  
Best Practice ◽  
German Society ◽  
National Registry ◽  
Practice Recommendations ◽  
Different Types ◽  
Relevant Variables ◽  
Surgical Treatments ◽  
Descriptive Statistical Analysis

ObjectiveMost patients suffering with rheumatic diseases who undergo surgical treatment are receiving immune-modulating therapy. To determine whether these medications affect their outcomes a national registry was established in Germany by the German Society of Surgery (DGORh). Data from the first 1000 patients were used in a pilot study to identify relevant corisk factors and to determine whether such a registry is suitable for developing accurate and relevant recommendations.Design and participantsData were collected from patients undergoing surgical treatments with their written consent. A second consent form was used, if complications occurred. During this pilot study, in order to obtain a quicker overview, risk factors were considered only in patients with complications. Only descriptive statistical analysis was employed in this pilot study due to limited number of observed complications and inhomogeneous data regarding the surgery and the medications the patients received. Analytical statistics will be performed to confirm the results in a future outcome study.ResultsComplications occurred in 26 patients and were distributed equally among the different types of surgeries. Twenty one of these patients were receiving immune-modulating therapy at the time, while five were not. Infections were observed in 2.3% of patients receiving and in 5.1% not receiving immunosuppression.ConclusionsDue to the low number of cases, inhomogeneity in the diseases and the treatments received by the patients in this pilot study, it is not possible to develop standardised best-practice recommendations to optimise their care. Based on this observation we conclude that in order to be suitable to develop accurate and relevant recommendations a national registry must include the most important and relevant variables that impact the care and outcomes of these patients.

scholarly journals Best Practice Guideline – DEGUM Recommendations on Breast Ultrasound – Part I – Examination technique, DEGUM ultrasound criteria, and documentation

2021 ◽  
Author(s):  
Werner Bader ◽  
Claudia Maria Vogel-Minea ◽  
Jens-Uwe Blohmer ◽  
Volker Duda ◽  
Christian Eichler ◽  
...  
Keyword(s):  
Practice Guideline ◽  
Working Group ◽  
Best Practice ◽  
Interdisciplinary Communication ◽  
German Society ◽  
Breast Ultrasound ◽  
Practice Recommendations ◽  
Expert Working Group ◽  
A Current

AbstractFor many years, breast ultrasound has been used in addition to mammography as an important method for clarifying breast findings. However, differences in the interpretation of findings continue to be problematic 1 2. These differences decrease the diagnostic accuracy of ultrasound after detection of a finding and complicate interdisciplinary communication and the comparison of scientific studies 3. In 1999, the American College of Radiology (ACR) created a working group (International Expert Working Group) that developed a classification system for ultrasound examinations based on the established BI-RADS classification of mammographic findings under consideration of literature data 4. Due to differences in content, the German Society for Ultrasound in Medicine (DEGUM) published its own BI-RADS-analogue criteria catalog in 2006 3. In addition to the persistence of differences in content, there is also an issue with formal licensing with the current 5th edition of the ACR BI-RADS catalog, even though the content is recognized by the DEGUM as another system for describing and documenting findings. The goal of the Best Practice Guideline of the Breast Ultrasound Working Group of the DEGUM is to provide colleagues specialized in senology with a current catalog of ultrasound criteria and assessment categories as well as best practice recommendations for the various ultrasound modalities.

Pediatric Benign Vocal Fold Lesions: A Team Approach

2009 ◽  
Vol 19 (3) ◽  
pp. 105-112 ◽  
Author(s):  
Geralyn Harvey Woodnorth ◽  
Roger C. Nuss
Keyword(s):  
Vocal Fold ◽  
Evaluation Process ◽  
Team Approach ◽  
Speech Language Pathologist ◽  
Benign Vocal Fold Lesions ◽  
Different Types ◽  
Team Evaluation ◽  
Surgical Treatments ◽  
Review Current ◽  
Vocal Fold Nodules

Abstract Many children with dysphonia present with benign vocal fold lesions, including bilateral vocal fold nodules, cysts, vocal fold varices, and scarring. Evaluation and treatment of these children are best undertaken in a thoughtful and coordinated manner involving both the speech-language pathologist and the otolaryngologist. The goals of this article are (a) to describe the team evaluation process based on a “whole system” approach; (b) to discuss etiological factors and diagnosis; and (c) to review current medical, behavioral, and surgical treatments for children with different types of dysphonia.

Illuminating the decision-making strategies of anesthesia providers in challenging cases

2020 ◽  
Vol 64 (1) ◽  
pp. 653-657
Author(s):  
Joshua Biro ◽  
David M. Neyens ◽  
Candace Jaruzel ◽  
Catherine D. Tobin ◽  
Myrtede Alfred ◽  
...  
Keyword(s):  
Decision Making ◽  
Work Environment ◽  
Medication Errors ◽  
Information Seeking ◽  
Best Practice ◽  
Practice Recommendations ◽  
Medication Delivery ◽  
Anesthesia Providers ◽  
Healthcare Work ◽  
Realistic View

Medication errors and error-related scenarios in anesthesia remain an important area of research. Interventions and best practice recommendations in anesthesia are often based in the work-as-imagined healthcare system, remaining under-used due to a range of unforeseen complexities in healthcare work-as- done. In order to design adaptable anesthesia medication delivery systems, a better understanding of clinical cognition within the context of anesthesia work is needed. Fourteen interviews probing anesthesia providers’ decision making were performed. The results revealed three overarching themes: (1) anesthesia providers find cases challenging when they have incomplete information, (2) decision-making begins with information seeking, and (3) attributes such as expertise, experience, and work environment influence anesthesia providers’ information seeking and synthesis of tasks. These themes and the context within this data help create a more realistic view of work-as-done and generate insights into what potential medication error reducing interventions should look to avoid and what they could help facilitate.

Different Types of Auricular Keloids and Treatment by Intralesional Cryosurgery: Best Practice for Obtaining Long-Lasting Clinical Results

Dermatology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Yaron Har-Shai ◽  
Lior Har-Shai ◽  
Viktor A. Zouboulis ◽  
Christos C. Zouboulis
Keyword(s):  
Quality Of Life ◽  
Body Image ◽  
Recurrence Rate ◽  
Best Practice ◽  
Clinical Results ◽  
Psychosocial Impact ◽  
Aesthetic Outcome ◽  
The Past ◽  
Different Types

<b><i>Background:</i></b> Auricular keloids belong to the most perplexing medical conditions, which have significant psychosocial impact on the patient’s body image and quality of life. <b><i>Summary:</i></b> The article is purposed to provide dermatologists and plastic surgeons with the best proven practice using intralesional cryosurgery for the treatment of the different auricular keloid types in order to obtain superior clinical results by minimizing the probability of recurrence. In the past 20 years, the authors have developed novel procedures in order to increase the effectiveness of intralesional cryosurgery on auricular keloids, including hydrodissection, warm gauze technique, and excision of dangling skin. Long-lasting clinical results with a low recurrence rate and a satisfactory aesthetic outcome are achieved with no deformation of the ear framework.

scholarly journals P052 Leflunomide and severe COVID-19 outcome: a cautionary observation from the COVID-19 Scottish Registry of Autoimmune Rheumatic Diseases (SCAR-19)

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Maira Karabayas ◽  
James Brock ◽  
Gillian Fordyce ◽  
Neil Basu
Keyword(s):  
Rheumatic Diseases ◽  
Clinical Characteristics ◽  
National Registry ◽  
Favourable Outcome ◽  
Non Invasive ◽  
Autoimmune Rheumatic Diseases ◽  
Non Invasive Ventilation ◽  
Pcr Diagnosis ◽  
Related Symptom ◽  
Disease Modifying

Abstract Background/Aims  Leflunomide, a conventional disease modifying drug (csDMARD), is used in a variety of autoimmune rheumatic diseases (ARD) due to its immunomodulating, immunosuppressive and antiproliferative properties. This agent does however confer a greater infection risk and, due to its long half-life, drug washout procedures are often advised in the context of serious infections. Interestingly, Leflunomide is currently being tested as a potential therapy for COVID-19 in the general population. It is unknown whether leflunomide therapy is associated with a poor or favourable outcome among ARD patients infected with COVID-19. Methods  A Scottish-wide registry was rapidly developed in March 2020. Clinical characteristics and outcomes of infected cases were collated across all Scottish health boards. Eligible patients included any adult leflunomide treated ARD patients with a confirmed (clinically or PCR) diagnosis of COVID-19. Results  Of the 69 cases included in the registry, n = 4 were treated with leflunomide (75% female; mean age 61, SD 4.2). N = 2 were treated with combination baricitinib or hydroxychloroquine respectively, whilst n = 1 received recent corticosteroid therapy (intramuscular Kenalog). Comorbidities observed in this sub-cohort include diabetes mellitus n = 3, hypertension n = 2, cardiovascular disease n = 1, lung disease n = 1 and latent TB n = 1. At presentation, all patients (n = 4) experienced the established COVID-19 related symptom triad of dyspnoea, cough and fever and promptly developed acute respiratory syndrome. Diarrhoea was also recorded in n = 2 and constitutional upset n = 3. All patients suffered a serious COVID-19 disease outcome (defined as a requirement of invasive or non-invasive ventilation (n = 4) and/ or death (n = 2). P052 Table 1:Patient demographics, clinical characteristics and outcomesPatient 1Patient 2Patient 3Patient 4Age58635766SexFemaleFemaleMaleFemaleRheumatic diagnosisRheumatoid arthritisPsoriatic arthritisPsoriatic arthritisRheumatoid ArthritisComorbiditiesDiabetesHypertension Diabetes COPDNilIschaemic heart disease Hypertension Diabetes Latent TBClinical presentationDyspnoea Cough Fever Confusion Constitutional upsetDyspnoea Cough Fever Diarrhoea Constitutional upsetDyspnoea Cough Fever Constitutional upsetDyspnoea Cough Fever Diarrhoea Constitutional upsetAdditional csDMARD*NilNilNilHydroxychloroquinebDMARD**/ tsDMARD***BaricitinibNilNilNilSteroid therapyNilNilNilIM KenalogInvasive or non-invasive ventilationYesYesYesYesDeathNoNoYesYes* conventional disease modifying drug,**biologic disease modifying drug,***targeted synthetic disease modifying drug. Conclusion  Preliminary data from this Scotland-wide registry has identified only a small number of leflunomide treated ARD patients infected with COVID-19. However, it is concerning that all cases experienced a serious outcome. Given the relatively infrequent prescription of this drug, combining similar national registry data is necessary to ensure this observation is not spurious. If confirmed, leflunomide washout procedures should be encouraged among such patients when they first present with COVID-19. Disclosure  M. Karabayas: None. J. Brock: None. G. Fordyce: None. N. Basu: None.

scholarly journals Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020

2021 ◽  
pp. 1-69
Author(s):  
David J. Gladstone ◽  
M. Patrice Lindsay ◽  
James Douketis ◽  
Eric E Smith ◽  
Dar Dowlatshahi ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Best Practice ◽  
Practice Recommendations

scholarly journals POS1155 INFECTIOUS RISK DURING BIOLOGIC THERAPY FOR INFLAMMATORY RHEUMATIC DISEASES: DATA FROM THE TUNISIAN BINAR REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 856.2-856
Author(s):  
S. Boussaid ◽  
R. Ben Aissa ◽  
S. Kochbati ◽  
M. Elleuch ◽  
L. Abdelmoula ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Infectious Agent ◽  
National Registry ◽  
Inflammatory Rheumatic Diseases ◽  
Infection Frequency ◽  
Necrosis Factor Alpha ◽  
Infectious Episode ◽  
Infectious Risk ◽  
Systemic Rheumatic Diseases ◽  
Factor Alpha

Background:The development of biologics for the treatment of systemic rheumatic diseases increased the risk of infections. The management of this complication deserves particular attention since it remains a major cause of morbidity and mortality.Objectives:The aim of our study was to determine infection frequency under biological treatment and consequences on the therapeutic management.Methods:Patients included in the Biological National Registry (BINAR) from 2016 to 2020. Data related to the disease, biological agents, and infections occurring under biologic disease-modifying antirheumatic drugs (bDMARDs) were collected.Results:The study included 298 patients with a mean age of 49.2 years [18-79] 175 patients with rheumatoid arthritis and 123 with spondyloarthritis (Axial Spondyloarthritis=48, Enteropathic Arthritis=41, Psoriatic Arthritis=34). Anti Tumor necrosis factor-alpha (Anti-TNF) agents were the most prescribed bDMARDs in 87.9% (n=263) of patients: Infliximab 20.4% (n=61),Etanercept 23.1%(n=69), Adalimumab 24.6%(n=74) and Certolizumab (n=79). No patients were treated with Golimumab. Tocilizumab and Rituximab were prescribed respectively in 10.4% (n=31) and 5% (n=15) of patients. Infections occured in 9 patients (3.1%) with a total of 13 infectious episodes 12 bacterial and a viral one. The site of infections was: respiratory (38%), urinary (15%), cutaneous (23%), ORL (8%), infective endocarditis (8%), and other (8%). The infectious agent was identified in only 3 patients. The outcomes were favorable in most cases except in one patient where there was a definitive interruption of bDMARDs. The patient was hospitalized for sepsis complicating a cutaneous infection with favorable outcomes under antibiotics within a week. The biological agent with higher risk of infections was Tocilizumab (p = 0.056), unlike Rituximab (p = 0.483) and Anti-TNF (p = 0.082). All patients who had an infectious episode were under corticosteroids.Conclusion:Our results confirm that bDMARDs are predisposing to infections, but data from BINAR showed that most infections were trivial with no serious outcomes. Therefore, infections should be assessed in patients under bDMARDs for an early therapeutic intervention.Disclosure of Interests:None declared.

Best Practice Recommendations for Optimizing Care in Structural Heart Programs: Planning Efficient and Resource Leveraging Systems (PEARLS)

2021 ◽  
Author(s):  
Elizabeth M. Perpetua ◽  
Kimberly A. Guibone ◽  
Patricia A. Keegan ◽  
Roseanne Palmer ◽  
Martina K. Speight ◽  
...  
Keyword(s):  
Best Practice ◽  
Practice Recommendations ◽  
Resource Leveraging
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