scholarly journals Unmet Medical Needs in Ulcerative Colitis: An Expert Group Consensus

2019 ◽  
Vol 37 (4) ◽  
pp. 266-283 ◽  
Author(s):  
Silvio Danese ◽  
Matthieu Allez ◽  
Ad A. van Bodegraven ◽  
Iris Dotan ◽  
Javier P. Gisbert ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Unmet Needs ◽  
Unmet Need ◽  
Incidence Rates ◽  
Cochrane Library ◽  
Future Research ◽  
Extensive Literature ◽  
Expert Group ◽  
Medical Needs ◽  
Modified Delphi

Background: The authors aimed to conduct an extensive literature review and consensus meeting to identify unmet needs in ulcerative colitis (UC) and ways to overcome them. UC is a relapsing and remitting inflammatory bowel disease with varied, and changing, incidence rates worldwide. UC has an unpredictable disease course and is associated with a high health economic burden. During 2016 and 2017, a panel of experts was convened to identify, discuss and address areas of unmet need in UC. Methods: PubMed and Cochrane Library databases were searched for relevant articles describing studies performed in patients with UC. These findings were used to generate a set of statements relating to unmet needs in UC. Consensus on these statements was then sought from a panel of 9 expert gastroenterologists using a modified Delphi review process that consisted of anonymous surveys followed by live meetings. Results: In 2 literature reviews, over 5,000 unique records were identified and a total of 138 articles were fully reviewed. These were used to consider 26 areas of unmet need, which were explored in 2 face-to-face meetings, in which the statements were debated and amended, resulting in consensus on 30 final statements. The unmet needs identified were categorised into 7 areas: impact of UC on patients’ daily life; importance of early diagnosis and treatment; drawbacks of existing treatments; urgent need for new treatments; and disease-, practice- or patient-focused unmet needs. Conclusions: These expert group meetings found a number of areas of unmet needs in UC, which is an important first step in tackling them in the future. Future research and development should be focused in these areas for the management of patients with UC.

UNMET NEED FOR ADDITIONAL MEDICAL CARE FOR SICK CHILDREN IN MOTHER’S VIEW IN RURAL BANGLADESH: IMPLICATIONS FOR IMPROVING CHILD HEALTH SERVICES

2007 ◽  
Vol 39 (5) ◽  
pp. 769-778 ◽  
Author(s):  
NURUL ALAM
Keyword(s):  
Health Services ◽  
Medical Care ◽  
Unmet Needs ◽  
Unmet Need ◽  
Chronic Illnesses ◽  
Rural Bangladesh ◽  
Medical Needs ◽  
Poor Households ◽  
Sick Children ◽  
Unmet Medical Needs

SummaryWhile a country’s health policy aims to provide health services to all who need them, very little in known about unmet need for additional medical care from users’ perspectives in Bangladesh. This study examined unmet medical need (defined as whether a mother felt that, to manage sickness, her child had required medical care that was not available, regardless of reasons and medical care sought) of 2123 under-15 sick children by illness and child’s socioeconomic characteristics in rural Bangladesh. The 1996 Health and Socioeconomic Survey conducted in Matlab recorded children’s chronic (a disease or a condition lasting 3 months or more) and acute (a disease or a condition with a rapid onset and a short, severe course) morbidity, medical care sought to combat illness and unmet needs for additional medical services in mothers’ views to manage the illness. The survey also recorded household socioeconomic data. Logistic regression was used to examine the data. The results reveal that unmet needs for additional medical care were 5·4% for children with acute illnesses, and 30·2% for children with chronic illnesses. For chronic illnesses, seeking medical care to manage illness from any health provider outside the home reduced unmet medical needs. Economic inequalities existed for both acute and chronic illnesses: the odds ratio of unmet medical needs for sick children of the least poor households was 0·42 (95% CI: 0·28–0·64) times that for sick children of the very poor households. The critically high unmet needs for children’s chronic morbidity reveal that the chronic disease control programme in Bangladesh needs urgent revisiting and strengthening.

scholarly journals Unmet Medical Needs in the Management of Ulcerative Colitis: Results of an Italian Delphi Consensus

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Marco Daperno ◽  
Alessandro Armuzzi ◽  
Silvio Danese ◽  
Walter Fries ◽  
Giuseppina Liguori ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Unmet Needs ◽  
Clinical Symptoms ◽  
Negative Impact ◽  
Delphi Process ◽  
Delphi Consensus ◽  
Medical Needs

Background. The lifelong and remitting nature of ulcerative colitis results in considerable disability and a substantial negative impact on quality of life. The major goal of the therapy of ulcerative colitis is considered to be the modification of the course of the disease, so that the patient’s quality of life can be improved while minimising disease-related disability. Although considerable progress in understanding the molecular pathways involved in ulcerative colitis has led to improved treatment options, there is currently no definitive cure for ulcerative colitis, there remain considerable unmet needs in terms of long-term efficacy and safety, and there are many patients who continue to be burdened by physical and psychological symptoms. Defining unmet needs can help to increase the awareness of the shortcomings of current therapeutic management and highlight the need to achieve not only a control of clinical symptoms but also control of mucosal healing, in order to attain the best possible long-term outcomes. Methods. With the aim of providing a better understanding of the unmet needs of patients towards improving overall care, a Delphi process was used to obtain consensus among a group of Italian ulcerative colitis experts. The consensus group met with a major focus of delineating the unmet needs of current treatment strategies and overall management of ulcerative colitis, while also focusing on quality of life and patient care. Results. Three main areas were identified: (i) treatment, (ii) monitoring and risk management, and (iii) patient-related issues. A high level of consensus was reached on all but one of the statements identified. Conclusions. The findings arising from the Delphi process provide valuable insights into the unmet needs in the management of moderate-to-severe ulcerative colitis from the clinician’s perspective, while emphasising the benefits of therapeutic individualization and suggesting areas that need additional study with the aim of optimising the treatment of patients with ulcerative colitis.

scholarly journals 1770. The Association of Unmet Needs With Subsequent Retention in Care and HIV Suppression Among Hospitalized Patients With HIV Who Are Out of Care

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S65-S66
Author(s):  
Dima Dandachi ◽  
Sarah May ◽  
Jessica Davila ◽  
Jeffrey Cully ◽  
K Rivet Amico ◽  
...  
Keyword(s):  
Viral Load ◽  
Dental Care ◽  
Unmet Needs ◽  
Unmet Need ◽  
Retention In Care ◽  
Hospitalized Patients ◽  
Hiv Care ◽  
Medical Needs ◽  
Retention In Hiv Care ◽  
Housing Needs

Abstract Background Unmet needs among hospitalized patients with HIV may prevent engagement in HIV care leading to worse clinical outcomes. Our aim was to examine the role of unmet subsistence needs (e.g., housing, transportation, food) and medical needs (e.g., mental health, substance abuse treatment) as barriers for retention in HIV care and viral load (VL) suppression. Methods We utilized data from the Mentor Approach for Promoting Patients’ Self-Care intervention study, the enrolled hospitalized HIV-patients at a large publicly funded hospital between 2010 and 2013, who were out-of-care. We examined the effect of unmet needs on retention in HIV care (attended HIV appointments within 0–30 days and 30–180 days) and viral load suppression, 6 months after discharge. Results A total of 417 participants were enrolled, 78% reported having ≥1 unmet need at baseline, most commonly dental care (55%), financial (43%), or housing needs (34%). Participants with unmet needs at baseline, compared with those with no needs, were more likely to be African American, have an existing HIV diagnosis, and be uninsured. Among participants who completed a baseline and 3-month survey (n = 320), 45% reported a need for dental care, 42% reported financial needs, and 32% reported housing needs that were unmet at either time point (Figure 1). Having a dental care need at baseline that was met was significantly associated with higher odds of VL improvements at 6-month follow-up (OR: 2.2; 95% CI: 1.04–4.50, P = 0.03) and higher odds for retention in care (OR: 2.06; 95% CI: 1.05–4.07, P = 0.04). An unmet need for transportation was associated with lower odds of retention in care (OR: 0.5; 95% CI: 0.34–0.94, P = 0.03), even after adjusting for other factors. Compared with participants with no need, those who reported ≥3 unmet subsistence needs were less likely to demonstrate viral load improvement (OR: 0.51; 95% CI: 0.28–0.92; P = 0.03) and to be retained in care (OR: 0.52; 95% CI: 0.28–0.95; P = 0.03). Conclusion An important and novel finding in our study is that the number of unmet subsistence needs had a significant effect on retention in care and VL suppression. Broader access to programs that can assist in meeting subsistence needs among hospitalized patients could have significant individual and public health benefits. Disclosures All authors: No reported disclosures.

scholarly journals Clinical practice recommendations on the management of perioperative cardiac arrest: A report from the PERIOPCA Consortium

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Athanasios Chalkias ◽  
Nicolas Mongardon ◽  
Vladimir Boboshko ◽  
Vladimir Cerny ◽  
Anne-Laure Constant ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Task Force ◽  
Rare Complication ◽  
Healthcare Providers ◽  
Cochrane Library ◽  
Future Research ◽  
Delphi Consensus ◽  
Assessment Development ◽  
Modified Delphi ◽  
The Cochrane Library

Abstract Background Perioperative cardiac arrest is a rare complication with an incidence of around 1 in 1400 cases, but it carries a high burden of mortality reaching up to 70% at 30 days. Despite its specificities, guidelines for treatment of perioperative cardiac arrest are lacking. Gathering the available literature may improve quality of care and outcome of patients. Methods The PERIOPCA Task Force identified major clinical questions about the management of perioperative cardiac arrest and framed them into the therapy population [P], intervention [I], comparator [C], and outcome [O] (PICO) format. Systematic searches of PubMed, Embase, and the Cochrane Library for articles published until September 2020 were performed. Consensus-based treatment recommendations were created using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The strength of consensus among the Task Force members about the recommendations was assessed through a modified Delphi consensus process. Results Twenty-two PICO questions were addressed, and the recommendations were validated in two Delphi rounds. A summary of evidence for each outcome is reported and accompanied by an overall assessment of the evidence to guide healthcare providers. Conclusions The main limitations of our work lie in the scarcity of good quality evidence on this topic. Still, these recommendations provide a basis for decision making, as well as a guide for future research on perioperative cardiac arrest.

scholarly journals Unmet Needs and Behavioral Expressions: The Perspective of Individuals with Mild to Moderate Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 881-881
Author(s):  
Morgan Minyo ◽  
Katherine Judge
Keyword(s):  
Financial Services ◽  
Daily Living ◽  
Unmet Needs ◽  
Unmet Need ◽  
Well Being ◽  
Self Report ◽  
Future Research ◽  
Daily Living Activities ◽  
Moderate Dementia ◽  
Behavioral Expressions

Abstract Research examining the illness experience from the perspective of individuals with dementia (IWDs) has gained increased attention. Previous studies suggest many IWDs experience unmet needs and behaviors that can impact their well-being. Most research has assessed these constructs using caregiver proxy-reports, resulting in underestimation of the amount and type of unmet needs. Additionally, no published studies have assessed self-reported behavioral expressions. As part of a larger study conducted in a memory care unit, the current pilot study examined the reliability of these measures along with examining how IWD’s experienced unmet needs, behaviors, and behavioral distress. Results found that individuals with mild to moderate dementia (n=12) were able to provide reliable self-report data about their own unmet needs (∝=.96), unmet need-related distress (∝=.98), and behavioral expressions (∝=.91). Nearly all participants identified at least one unmet need (74.8%). The highest reported unmet needs concerned health information (75.0%) and findings/arranging services (41.7%). The least reported unmet needs concerned daily living activities (16.7%) and legal/financial services (33.2%). The highest unmet needs related-distress concerned emotional support (41.7%) and the least distressing concerned daily living activities (16.7%). The most frequently reported behaviors included agitation (66.7%) and complaining/criticizing things (58.3%) while the least reported behaviors were refusing to be left alone (8.3%) and yelling/swearing (8.3%). The highest behavioral distress reported was agitation (58.3%) while the least was wandering (8.3%). Discussion will highlight how these results fit within current literature, recommendations for future research in exploring these constructs using self-report methodology, and how well-being outcomes may be impacted.

scholarly journals 401 - The Costs of Agitation: A Literature Review

2020 ◽  
Vol 32 (S1) ◽  
pp. 117-117
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Literature Review ◽  
Service Use ◽  
Neuropsychiatric Symptoms ◽  
Unmet Need ◽  
Cochrane Library ◽  
Future Research ◽  
The Cost ◽  
The Impact

PRESENTING AUTHOR:Mary Michael, Vice President, Patient Advocacy and Stakeholder Management, Otsuka America Pharmaceutical, Inc.OBJECTIVE:To evaluate the extent to which the cost of both treated and untreated agitation in Alzheimer’s disease has been studied in order to inform future research and development of predictive models of the cost of untreated agitation in Alzheimer’s disease.BACKGROUND:There is inadequate understanding of the costs of agitation in Alzheimer’s disease in the scientific and academic literature. Agitation in Alzheimer’s disease contributes to negative social and financial outcomes for people with the condition, their care partners, and health systems. When left untreated, the impact of these outcomes is exacerbated, yet the scale of this impact is unknown. This gap in the literature both reflects and perpetuates the broader under-recognition of agitation as a serious unmet need in the Alzheimer’s community. Conversely, a better understanding of the costs can help elevate agitation within the global Alzheimer’s dialogue.METHODS:We used MEDLINE, PubMed, PsychINFO the Cochrane Library and Google Scholar databases to identify relevant articles published between 2000 until May 2020. We also reviewed reliable literature published outside of these databases. Keywords utilized in the search include agitation in Alzheimer’s, neuropsychiatric symptoms of Alzheimer’s, cost of informal and formal care, Medicare and Medicaid costs, economic costs associated to delirium, among others. Only articles in English were included. Inclusion and exclusion criteria were determined by study design, data source and population studied, number of cases included in analysis, source of health service use or cost data, statistical methods and agitation in Alzheimer’s attributable and/or incremental costs.RESULTS:Results will describe the breadth and depth to which costs of treated and untreated agitation in Alzheimer’s have been examined, indicating data and statistical methodology used.CONCLUSIONS:This literature review serves as the basis for understanding global costs of agitation in Alzheimer’s disease. From our analysis, we recommend that further cost modeling activities be conducted. We also urge the greater community to use these findings to elevate agitation to the top of the Alzheimer’s agenda.

A Circular Business Model for Cloud Computing Services Providers

10.31355/33 ◽  
2018 ◽  
Vol 2 ◽  
pp. 105-120
Author(s):  
Hamed Motaghi ◽  
Saeed Nosratabadi ◽  
Thabit Qasem Atobishi
Keyword(s):  
Cloud Computing ◽  
Business Model ◽  
Circular Economy ◽  
Service Providers ◽  
Sustainable Consumption ◽  
Future Research ◽  
Extensive Literature ◽  
Computing Services ◽  
Proposed Model ◽  
Cloud Computing Service

NOTE: THIS ARTICLE WAS PUBLISHED WITH THE INFORMING SCIENCE INSTITUTE. Aim/Purpose................................................................................................................................................................................................. The main objective of the current study is to develop a business model for service providers of cloud computing which is designed based on circular economy principles and can ensure the sustainable consumption. Background Even though the demand for cloud computing technology is increasing day by day in all over the world, the current the linear economy principles are incapable to ensure society development needs. To consider the benefit of the society and the vendors at the same time, the principles of circular economy can address this issue. Methodology................................................................................................................................................................................................. An extensive literature review on consumption, sustainable consumption, circular economic, business model, and cloud computing were conducted. the proposed model of Osterwalder, Pigneur and Tucci (2005) is admitted designing the circular business model. Contribution................................................................................................................................................................................................. The proposed model of the study is the contribution of this study where provides the guidelines for the cloud computing service providers to achieve both their economic profits and the society’ needs. Findings Finding reveals that if the cloud computing service providers design their business model based on the “access” principle of circular economy, they can meet their economic profits and the society’ needs at a same time. Recommendations for Practitioners.............................................................................................................................................................. It is recommended to the startup and the existing businesses to utilize the proposed model of this study to reach a sustainable development. Recommendation for Researchers................................................................................................................................................................ It proposes a new circular business model and its linkages with community building. Impact on Society............................................................................................................................................................................................ The proposed model of the study provides guidelines to the cloud computing service providers to design a business model which is able not only to meet their economic profit, but also to meet the society’s and customers’ benefits. Future Research............................................................................................................................................................................................... Future researches can build on this research model which proposed in this study to examine the limitations of this model by using empirical researches.

scholarly journals Systematic review with meta-analysis: effectiveness of hyperbaric oxygenation therapy for ulcerative colitis

2021 ◽  
Vol 14 ◽  
pp. 175628482110233
Author(s):  
Pingrun Chen ◽  
Yina Li ◽  
Xian Zhang ◽  
Yan Zhang
Keyword(s):  
Ulcerative Colitis ◽  
Combination Therapy ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygenation ◽  
Meta Analysis ◽  
Serum Levels ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Complementary Method ◽  
Standard Mean Difference

Background and aims: Hyperbaric oxygenation therapy has been used in the treatment of ulcerative colitis in the past few years. However, its efficacy still remains unclear. The aim of the study was to investigate the efficacy of hyperbaric oxygen combination therapy in patients with ulcerative colitis. Methods: We conducted a comprehensive study search up to September 2020, from the online databases Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, WanFang and VIP. Results: Thirteen studies comprising 780 patients were included. We found that compared with conventional therapy, hyperbaric oxygen combination therapy was superior in reaching clinical remission [risk ratio (RR)=1.62; 95% confidence interval (CI) 1.42 to 1.84; p < 0.001] and clinical response (RR=1.29; 95% CI 1.21 to 1.38; p < 0.001), with lower disease activity scores [standard mean difference (SMD)= −1.19; 95%CI −1.74 to −0.65; p < 0.001]. An obvious reduction of serum levels of tumor necrosis factor-α (SMD= −1.96; 95%CI −2.50 to −1.41; p < 0.001) and interleukin (IL)-6 (SMD= −2.49; 95% CI −2.84 to −2.15; p < 0.001), and elevation of IL-10 level (SMD=2.40; 95% CI 0.68 to 4.12; p = 0.006) were also observed. Conclusion: Hyperbaric oxygen combination therapy was effective in patients with ulcerative colitis, and has potential as a complementary method for its treatment.

scholarly journals Biomarkers predictive of treatment response in psoriasis and psoriatic arthritis: a systematic review

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110140
Author(s):  
Conor Magee ◽  
Hannah Jethwa ◽  
Oliver M. FitzGerald ◽  
Deepak R. Jadon
Keyword(s):  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Treatment Response ◽  
Unmet Need ◽  
Response To Treatment ◽  
Cochrane Library ◽  
Original Research ◽  
Eligibility Criteria ◽  
Psoriatic Disease ◽  
Subsequent Response

Aims: The ability to predict response to treatment remains a key unmet need in psoriatic disease. We conducted a systematic review of studies relating to biomarkers associated with response to treatment in either psoriasis vulgaris (PsV) or psoriatic arthritis (PsA). Methods: A search was conducted in PubMed, Embase and the Cochrane library from their inception to 2 September 2020, and conference proceedings from four major rheumatology conferences. Original research articles studying pre-treatment biomarker levels associated with subsequent response to pharmacologic treatment in either PsV or PsA were included. Results: A total of 765 articles were retrieved and after review, 44 articles (22 relating to PsV and 22 to PsA) met the systematic review’s eligibility criteria. One study examined the response to methotrexate, one the response to tofacitinib and all the other studies to biologic disease-modifying antirheumatic drugs (DMARDs). Whilst several studies examined the HLA-C*06 allele in PsV, the results were conflicting. Interleukin (IL)-12 serum levels and polymorphisms in the IL-12B gene show promise as biomarkers of treatment response in PsV. Most, but not all, studies found that higher baseline levels of C-reactive protein (CRP) were associated with a better clinical response to treatment in patients with PsA. Conclusion: Several studies have identified biomarkers associated with subsequent response to treatment in psoriatic disease. However, due to the different types of biomarkers, treatments and outcome measures used, firm conclusions cannot be drawn. Further validation is needed before any of these biomarkers translate to clinical practice.

scholarly journals Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Bongyoung Kim ◽  
◽  
Myung Jin Lee ◽  
Se Yoon Park ◽  
Song Mi Moon ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Quality Indicators ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Republic Of Korea ◽  
Cochrane Library ◽  
Surgical Prophylaxis ◽  
Modified Delphi ◽  
Stewardship Program ◽  
The Republic

Abstract Background An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. Methods A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. Conclusions We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.

Sign in / Sign up

Export Citation Format

Share Document