scholarly journals Stopping anti-TNF in CD remitters: pros and cons

2021 ◽  
Author(s):  
Edouard Louis
Keyword(s):  
High Risk ◽  
Health Care Providers ◽  
Negative Impact ◽  
Treatment Strategies ◽  
Treatment Withdrawal ◽  
Care Providers ◽  
Disease Evolution ◽  
Medium Risk ◽  
Pros And Cons ◽  
Risk Of Relapse

Background: There is no cure for Crohn’s disease. Available treatments and treatment strategies, particularly anti-TNF, allow to heal intestinal lesions and maintain steroid-free remission in a subset of patients. Having in mind the remitting/relapsing nature of the disease, patients and health care providers often ask themselves whether the treatment could be withdrawn. Several studies have demonstrated a risk of relapse of CD after anti-TNF withdrawal, which varies from 20 to 50% at one year and from 50 to 80% beyond 5 years. These numbers clearly highlight that stopping therapy should not be a systematically proposed strategy in those remitting patients. Summary: Nobody would argue for anti-TNF withdrawal in patients with a high risk of short term relapse. Nevertheless, they also indicate that a minority of patients may not relapse over mid-term and that those who have relapsed may have benefited from a drug-free period before being again treated for a new cycle of treatment. The most relevant question is thus whether in those patients with a low to medium risk of disease relapse, treatment withdrawal could be contemplated. In this specific setting, there may be pros and cons for anti-TNF withdrawal. Amongst the pros are the potential side effects and toxicity of anti-TNF, the risk of loss of response over time, the patient preference allowing the patient to regain control of one’s health and investing in it, also improving adherence, the absence of negative impact on disease evolution of a transient anti-TNF withdrawal and finally the cost. Key messages: Although anti-TNF withdrawal in patients with sustained clinical remission is associated with a high risk of relapse, this risk seems to be much lower in a subgroup of patients, particularly in endoscopic and biologic remission. Stopping anti-TNF in this subgroup of patients may be associated with a favorable benefit/risk ratio.

Clinical and Autopsy Analysis of Delayed Diagnosis and Missed Injuries in Trauma Patients

2006 ◽  
Vol 72 (2) ◽  
pp. 174-179
Author(s):  
Om P. Sharma ◽  
Diane M. Scala-Barnett ◽  
Michael F. Oswanski ◽  
Amy Aton ◽  
Shekhar S. Raj
Keyword(s):  
Health Care Providers ◽  
Negative Impact ◽  
Delayed Diagnosis ◽  
P Value ◽  
Care Providers ◽  
Missed Injuries ◽  
Impact On Survival ◽  
Group 2 ◽  
Trauma Deaths ◽  
Group 1

Delayed diagnosis of injury (DDI) during hospitalization and missed injuries (MI) on autopsy in trauma deaths result in untoward outcomes. Autopsy is an effective educational tool for health care providers to evaluate trauma care. A retrospective study of trauma registry patients and coroner's records was categorized into groups 1 (alive patients) and 2 (trauma deaths) and analyzed. DDI incidence was similar in group 1 (1.8%) and group 2 (1.9%). Autopsy analysis (163 patients) yielded 139 MI in 94 patients (57.6%), <3 per cent of MI had negative impact on survival. Bony injuries comprised 68 per cent of DDI and 19 per cent of MI. Group 1 DDI patients were sicker with higher injury severity score (ISS: 16.07) than their cohorts (ISS 7.13, P value <0.05). These patients had higher Glasgow Coma Scale (14.41) and lower ISS (16.07) as compared with group 2 MI patients (ISS: 33.49, GCS: 6.45, P value <0.05). Autopsy rate was 99.5 per cent in trauma deaths, 57 per cent for nontrauma deaths, and 79 per cent for all deaths. Less than 3 per cent of MI had negative impact on survival. Routine ongoing patient assessment with pertinent diagnostic workup is essential in reducing DDI. Trauma autopsies reveal MI, which aid performance improvement (PI).

scholarly journals What Lies Ahead for Young Hearts in the 21st Century – Is It Double Trouble of Acute Rheumatic Fever and Kawasaki Disease in Developing Countries?

2021 ◽  
Vol 8 ◽  
Author(s):  
Aaqib Zaffar Banday ◽  
Sanjib Mondal ◽  
Prabal Barman ◽  
Archan Sil ◽  
Rajni Kumrah ◽  
...  
Keyword(s):  
Developing Countries ◽  
Heart Disease ◽  
High Risk ◽  
Kawasaki Disease ◽  
Rheumatic Fever ◽  
Health Care Providers ◽  
Acute Rheumatic Fever ◽  
Pediatric Population ◽  
Care Providers ◽  
Incidence Trends

Rheumatic heart disease (RHD), the principal long-term sequel of acute rheumatic fever (ARF), has been a major contributor to cardiac-related mortality in general population, especially in developing countries. With improvement in health and sanitation facilities across the globe, there has been almost a 50% reduction in mortality rate due to RHD over the last 25 years. However, recent estimates suggest that RHD still results in more than 300,000 deaths annually. In India alone, more than 100,000 deaths occur due to RHD every year (Watkins DA et al., N Engl J Med, 2017). Children and adolescents (aged below 15 years) constitute at least one-fourth of the total population in India. Besides, ARF is, for the most part, a pediatric disorder. The pediatric population, therefore, requires special consideration in developing countries to reduce the burden of RHD. In the developed world, Kawasaki disease (KD) has emerged as the most important cause of acquired heart disease in children. Mirroring global trends over the past two decades, India also has witnessed a surge in the number of cases of KD. Similarly, many regions across the globe classified as “high-risk” for ARF have witnessed an increasing trend in the incidence of KD. This translates to a double challenge faced by pediatric health care providers in improving cardiac outcomes of children affected with ARF or KD. We highlight this predicament by reviewing the incidence trends of ARF and KD over the last 50 years in ARF “high-risk” regions.

scholarly journals A Global Perspective on Psychologists' and Their Organizations' Response to a World Crisis

2021 ◽  
Vol 55 (2) ◽  
pp. e1713
Author(s):  
Germán Gutiérrez ◽  
Oscar Barbarin ◽  
Martina Klicperová-Baker ◽  
Prakash Padakannaya ◽  
Ava Thompson ◽  
...  
Keyword(s):  
Public Health ◽  
High Risk ◽  
Health Care Providers ◽  
General Public ◽  
Risk Groups ◽  
Global Perspective ◽  
Care Providers ◽  
Health Crisis ◽  
Social And Emotional ◽  
World Crisis

Around the world, individual psychologists have stepped up to deliver essential services to address the social and emotional sequelae of the COVID-19 pandemic. Many psychological organizations have also responded to this public health crisis, though their efforts may be less widely recognized. Psychological organizations engaged in preventive and mitigation efforts targeted, among others, the general public, local communities, and high-risk groups such as health care providers. They disseminated mental health information to the general public, trained laypersons to provide psychological first aid, and used research to design and evaluate public health responses to the pandemic. In some countries, psychological organizations contributed to the design and implementation of public health policies and practices. The nature of these involvements changed throughout the pandemic and evolved from reactive to proactive, from local to international. Several qualities appear key to the value, impact, and success of these efforts. These include organizational agility and adaptability, the ability to overcome their political inertia and manage conflict, recognizing the need to address cultural differences, and allocating limited resources to high-risk and resource-depleted constituencies where it was needed most.

scholarly journals Worry from contracting COVID-19 infection and its stigma among Egyptian health care providers

2022 ◽  
Vol 97 (1) ◽  
Author(s):  
Doaa Mohamed Osman ◽  
Fatma R. Khalaf ◽  
Gellan K. Ahmed ◽  
Ahmed Y. Abdelbadee ◽  
Ahmed M. Abbas ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Health Care ◽  
High Risk ◽  
Health Care Providers ◽  
High Impact ◽  
Severe Illness ◽  
Care Providers ◽  
Internalized Shame ◽  
High Discrimination

Abstract Backgrounds Healthcare providers (HCPs) in COVID-19 epidemic face stressful workload of disease management, shortage of protective equipment and high risk of infection and mortality. These stressors affect greatly their mental health. The aim is to identify working conditions among Egyptian HCPs during COVID-19 epidemic as well as stigma and worry perceptions from contracting COVID-19 infection and their predictors. Methods A cross-sectional study was conducted among 565 HCPs. Data was collected through Google online self-administered questionnaire comprised seven parts: demographics characteristics, knowledge and attitude of COVID-19, working condition, worry of contracting COVID-19 at work, discrimination intention at work for COVID-19 patients, stigma assessment using impact stigma, and internalized shame scales. Results The vast majority of HCPs (94.7%) were worried from contracting COVID-19 at work. Risk factors for perceiving severe worry from contracting COVID-19 were expecting infection as a severe illness, believing that infection will not be successfully controlled, improbability to continue working during the pandemic even if in a well/fit health, high discrimination intention and impact stigma scales. Significantly high impact stigma scores were detected among those aged < 30 years, females, workers primarily in sites susceptible for contracting COVID-19 infection, those had severe worry from contracting infection at work, and high internalized shame scale. The risk factors for perceiving higher internalized shame scores were not having a previous experience in working during a pandemic, high discrimination intention towards COVID-19 patients and high impact stigma scale. Conclusions Considerable levels of worry and stigma were detected among Egyptian HCPs during COVID-19 outbreak. The psychological aspect of health care providers should not be overlooked during epidemic; appropriate institutional mental health support should be provided especially for young HCPs, those without previous work experience in epidemic and those who work in high-risk units. Raising the community awareness about contribution of HCPs in fighting the epidemic might decrease stigmatization action toward HCPs.

scholarly journals They Say, “If You Don’t Relax…You’re Going to Make Something Bad Happen”: Women’s Emotion Management During Medically High-Risk Pregnancy

2019 ◽  
Vol 44 (1) ◽  
pp. 117-129 ◽  
Author(s):  
Judith L. M. McCoyd ◽  
Laura Curran ◽  
Shari Munch
Keyword(s):  
Health Care ◽  
High Risk ◽  
Health Care Providers ◽  
Emotional Labor ◽  
Emotional Reactions ◽  
Emotion Management ◽  
High Risk Pregnancy ◽  
Care Providers ◽  
Risk Pregnancy ◽  
And Coping

Little is known about how women with medically high-risk pregnancy manage their emotions while worried about their pregnancies. This study aimed to phenomenologically explore 16 hospitalized women’s emotional reactions and coping during medically high-risk pregnancy with a focus on how emotion management techniques were utilized and what rationales women used for employing them, along with their interpretations of health care providers’ and family members’ advice regarding emotional expression. Respondents universally feared that experienced stress and the resulting distress (negative emotions such as anxiety, sadness, and anger) could harm their fetus. They experienced double binds including believing they must “be positive” to enhance fetal health, despite anxiety and sadness; feeling responsible for housework yet being told not to do it; and needing medical treatments they feared would harm their fetus. In attempting to avoid tears and fears, they expended tremendous energy, leaving themselves depleted and less able to cope. Ubiquitous “think positive” messages amplify women’s sense of failure when distress due to the medically high-risk pregnancy spills over. With little attention to women’s emotional experiences, even to the point of complimenting them as “good incubators,” health care providers may unintentionally shift emotional labor onto vulnerable women. Understanding women’s needs for assistance with emotion management during medically high-risk pregnancy provides important guidance for development of best practices for this population.

scholarly journals Creating a Trauma-Sensitive Practice: A Health Care Response to Interpersonal Violence

2015 ◽  
Vol 11 (6) ◽  
pp. 451-465 ◽  
Author(s):  
Jon A. Davies ◽  
Jeff Todahl ◽  
Anna E. Reichard
Keyword(s):  
Health Care ◽  
Violence Prevention ◽  
Health Care Providers ◽  
Interpersonal Violence ◽  
Universal Screening ◽  
Health Care Organizations ◽  
Negative Impact ◽  
Care Providers ◽  
Screening Practices ◽  
Care Response

Interpersonal violence has a profoundly negative impact on individuals and our society. Health care providers are in a unique position to identify interpersonal violence, support survivors, and to contribute to violence prevention. The purpose of this article is to describe the nature, scope, and impact of interpersonal violence, its subsequent trauma on individuals, families, and society, and to delineate how providers can apply trauma-sensitive practice. The authors provide definitions, examples and prevalence rates and review theories of violence and violence prevention. They describe how to create a trauma-sensitive practice by being aware of the trauma that accompanies violence, the barriers to violence prevention, and how to intervene with patients about violence. Providers are urged to adopt universal screening practices, educate themselves on the nature of interpersonal violence and engage in screening, education, collaboration, and social justice activities to reduce interpersonal violence. Resources are provided to assist health care organizations, providers, and patients in addressing interpersonal violence.

scholarly journals Prevalence and determinants of psychological insulin resistance among type 2 diabetic patients in Kinshasa, Democratic Republic of Congo

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Shomba L. Rita ◽  
Fina J.-P. Lubaki ◽  
Lepira F. Bompeka ◽  
Gboyega A. Ogunbanjo ◽  
Lukanu P. Ngwala
Keyword(s):  
Insulin Resistance ◽  
Health Care Providers ◽  
Negative Impact ◽  
Therapeutic Education ◽  
Diabetic Patients ◽  
Care Providers ◽  
Type 2 Diabetic Patients ◽  
Female Ratio ◽  
Type 2 Diabetic

Background: Psychological insulin resistance (PIR) is a common but unappreciated phenomenon by health care providers with a negative impact on the control of type 2 diabetes mellitus.Aim: To determine the frequency of PIR and its determinants in patients with type 2 diabetes.Setting: This study was conducted in Kinshasa in three health centres providing management of diabetic patients.Methods: This study was a multicentric, cross-sectional study conducted from 01 November 2017 to 31 March 2018 in Kinshasa among 213 type 2 diabetic patients who were taking oral anti-diabetic drugs. A standardised questionnaire, the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ), was used for data collection.Results: The average age of participants was 59.8 ± 11.1 years with a male to female ratio of 1.5. The prevalence of PIR was 42.7%; and its main determinants were 50 years of age (odds ratios [OR] adjusted 2.05; 95% confidence interval [CI] 1.98–4.27; p = 0.045), the presence of complications (OR adjusted 3.33; 95% CI 1.68–6.60; p = 0.001), lack of knowledge about insulin therapy (OR adjusted 1.96; 95% CI 1.03–3.71; p = 0.040) and the high cost of insulin (OR adjusted 2.32; 95% CI 1.08–4.95; p = 0.030).Conclusion: The study showed that almost half of type 2 diabetic patients had PIR with the main determinant factors related to the patient and the health system. The establishment of a therapeutic education programme, improved ‘provider–patient’ communication and the development of approaches to increase access to drugs are crucial to reduce the prevalence of PIR.

scholarly journals Syphilis Screening

2017 ◽  
Vol 33 (2) ◽  
pp. 53-59 ◽  
Author(s):  
Mitchell Goza ◽  
Ben Kulwicki ◽  
Julie M. Akers ◽  
Michael E. Klepser
Keyword(s):  
Public Health ◽  
High Risk ◽  
Health Care Providers ◽  
Health Check ◽  
Immunochromatographic Test ◽  
Health Departments ◽  
Care Providers ◽  
Vast Number ◽  
Public Health Departments ◽  
Syphilis Screening

Objective: To provide a review on the use, percent positive agreement (PPA), percent negative agreement (PNA), and utilization of Syphilis Health Check for syphilis screening in community pharmacies (in coordination with public health departments) in an effort to increase overall syphilis screening in high-risk populations. Data Sources: PubMed was searched for the following keywords: syphilis, sexually transmitted diseases, diagnosis, public health, point-of-care tests. The search included all dates up to December 2016. Study Selection: Data from studies including the use of the Syphilis Health Check Rapid Immunochromatographic Test were included. Data Synthesis: There are many existing tests to aid in the diagnosis of syphilis. The Syphilis Health Check was compared with these assays using PPA and PNA, where it demonstrated a high level of accuracy in the detection of syphilis antibodies. Conclusion: The Syphilis Health Check Rapid Immunochromatographic Test is a Clinical Laboratory Improvement Amendments–waived assay that has been shown to be easy to use and produces results in minutes. As one of the most accessible health care providers, pharmacists have an opportunity to join the fight against syphilis, and in collaboration with public health departments, screen a vast number of high-risk patients and deliver follow-up care as needed.

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