scholarly journals Factors to consider in pregnancy of unknown location

2017 ◽  
Vol 13 (2) ◽  
pp. 27-33 ◽  
Author(s):  
Shabnam Bobdiwala ◽  
Maya Al-Memar ◽  
Jessica Farren ◽  
Tom Bourne
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Ectopic Pregnancy ◽  
Management Strategies ◽  
Evidence Base ◽  
Final Outcome ◽  
Everyday Clinical Practice ◽  
Pregnancy Of Unknown Location ◽  
In Pregnancy

The management of women with a pregnancy of unknown location (PUL) can vary significantly and often lacks a clear evidence base. Intensive follow-up is usually required for women with a final outcome of an ectopic pregnancy. This, however, only accounts for a small proportion of women with a pregnancy of unknown PUL location. There remains a clear clinical need to rationalize the follow-up of PUL so women at high risk of having a final outcome of an ectopic pregnancy are followed up more intensively and those PUL at low risk of having an ectopic pregnancy have their follow-up streamlined. This review covers the main management strategies published in the current literature and aims to give clinicians an overview of the most up-to-date evidence that they can take away into their everyday clinical practice when caring for women with a PUL.

scholarly journals A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk

2019 ◽  
Vol 110 (1) ◽  
pp. 221-232 ◽  
Author(s):  
Stefanie N Hinkle ◽  
Shristi Rawal ◽  
Anne Ahrendt Bjerregaard ◽  
Thor I Halldorsson ◽  
Mengying Li ◽  
...  
Keyword(s):  
High Risk ◽  
Liver Fat ◽  
Sensitivity Analyses ◽  
Cardiometabolic Health ◽  
Cross Sectional ◽  
Reverse Causation ◽  
Clinical Exam ◽  
Prepregnancy Bmi ◽  
In Pregnancy

ABSTRACT Background Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals. Objective The aim of this study was to examine associations of ASB intake and cardiometabolic health among high-risk women with prior gestational diabetes mellitus (GDM). Methods We included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996–2002) who completed a clinical exam 9–16 y after the DNBC pregnancy for the Diabetes & Women's Health (DWH) Study (2012–2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed. Results In pregnancy and at follow-up, 30.4% and 36.4% of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5%; 95% CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation. Conclusions Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.

Intensive care

2016 ◽  
Keyword(s):  
Intensive Care ◽  
Clinical Practice ◽  
Evidence Base ◽  
Cutting Edge ◽  
Direct Impact ◽  
Independent Research ◽  
Everyday Clinical Practice ◽  
Distinct Distance ◽  
Short Space ◽  
The Uk

In the last two decades, intensive care has progressed significantly. The phenomenal developments clinically, academically, organizationally, and professionally during this relatively short space of time have all helped to define a specialty that has not only come of age, but also has established a distinct distance from its parent specialties. Intensive care in the UK now has an established Faculty and continues to forge ahead in expanding an independent research and evidence base. The field is rapidly changing, with cutting-edge ideas driving clinical progress. Through the papers considered in this chapter, various innovations are described that have had a direct impact on everyday clinical practice.

scholarly journals Possibility of usage of a homeopathic remedy heparsulfuris in the therapy of endoperiodontal lesion

2002 ◽  
Vol 49 (1-2) ◽  
pp. 53-56
Author(s):  
Tatjana Brkanic ◽  
Slavoljub Zivkovic
Keyword(s):  
Clinical Practice ◽  
Calcium Hydroxide ◽  
Root Canal ◽  
Apical Periodontitis ◽  
Endodontic Treatment ◽  
Root Canal Preparation ◽  
Everyday Clinical Practice ◽  
Homeopathic Remedy ◽  
Periodontal Tissues

The aim of this paper was to, on the basis of everyday clinical practice analize the effect of a homeopathic remedy, as a complementary remedy in endodontic therapy of endoperiodontal lesions and chronic apical periodontitis and to radiologically check its effect on the flow and speed of reparation of damaged periodontal tissues. Endodontic therapy was done according to the usual protocol for the therapy of infectious canals with root canal preparation, medication with calcium hydroxide points and hermetic obturation with AH-26 paste. During endodontic treatment patients were taking homeophatic remedy Hepar sulfuris per os three times daily. The remedy stimulates the natural defences mechanism of the organism. Radiological follow up after three months period showed obvious reductiont of radiologic radiolucency in periapical region.

scholarly journals 151 Improving the Systematic Use of Pharmacogenetic Testing for Depression Prescribing

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 93-94
Author(s):  
Lauren Thomann Hughes
Keyword(s):  
Clinical Practice ◽  
Evidence Base ◽  
Practice Change ◽  
Health Clinic ◽  
Baseline Survey ◽  
Pharmacogenetic Testing ◽  
Included Patient ◽  
Key Barrier ◽  
Key Parameter

AbstractStudy ObjectivesThe purpose of this project was to systematize the use of pharmacogenetic testing (PGT) among psychiatric prescribers. The use of PGT in clinical practice is inconsistent despite the evidence supporting its efficacy (Burke, Love, Jones, & Fife, 2016). The question to be answered is: In patients with major depressive disorder (MDD), how is PGT currently used in clinical practice compared to use after implementation of practice change interventions?MethodThis study was conducted among 4 psychiatric prescribers in a behavioral health clinic. 3 interventions were utilized to change practice. An educational in-service was delivered to address the PGT knowledge gap. A protocol for identifying patients that may benefit from PGT was developed, indicating PGT was warranted for patients with non-remitting moderate to severe MDD and at least 2 medication failures from 2 different classes. Next, a medication failure documentation template and the PGT report were integrated into the EHR. A baseline survey was administered before the in-service, assessing prescriber PGT perceptions and current parameters and barriers for use. Follow-up surveys were administered 3 months post-implementation. Project processes were measured by assessing the rate of medication failure template usage, as well as thePGT EHR upload rate.ResultsA comparison of baseline and follow-up surveys indicated there was little change in prescriber view of test utility, receptiveness, and likelihood of use. This may be attributed to previous experience with testing and to PGT manufacturer education. View of parameters and barriers for use did change. Key parameter for use changes included patient experience of adverse reaction (increase) and only 2 medication failures from the same class (decrease). Key barrier to use changes included time to results (decrease). 3 PGT were completed during the project. All patients met the protocol criteria for testing. None of these patients had medication failures documented using theEHR template; all of the patients did have documentation using each prescriber’s preferred method. 2 of the 3 tests were uploaded to the EHR. The first test completed was not integrated, likely due to support staff becoming accustomed to the new workflow. 117 historical PGT were also integrated into the EHR.ConclusionsWhile 16 to 20% of the population meets the criteria for MDD, available treatments achieve symptom remission only 40% of the time (Singh, 2014). Patients who do not achieve remission experience relapse more quickly and are more likely to develop chronic non-remitting MDD (Gaynes, 2016). While the PGT evidence base is still evolving, its use in clinical practice has the potential to improve depression treatment outcomes. This study highlighted continued barriers to PGT use in a practice setting, while implementing key interventions, including PGT use guidelines and EHR integration, to improve its systematic and appropriate use.Funding AcknowledgementsNo funding.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS—2020 UPDATE EXECUTIVE SUMMARY

2020 ◽  
Author(s):  
Pauline M. Camacho ◽  
Steven M. Petak ◽  
Neil Binkley ◽  
Dima L. Diab ◽  
Leslie S. Eldeiry ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Postmenopausal Osteoporosis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Decision Making ◽  
American Association ◽  
Clinical Decision ◽  
Evidence Base ◽  
Executive Summary

Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPG). Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) EL 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very high-risk features, a new dual action therapy option, and transitions from therapeutic options. Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of postmenopausal osteoporosis.

scholarly journals Psychopathic personality in young people

2004 ◽  
Vol 10 (6) ◽  
pp. 466-473 ◽  
Author(s):  
Mairead Dolan
Keyword(s):  
Clinical Practice ◽  
Criminal Justice ◽  
High Risk ◽  
Young People ◽  
Predictive Validity ◽  
Justice System ◽  
Risk Groups ◽  
Evidence Base ◽  
Psychopathic Personality ◽  
Limited Evidence

This article is an overview of developments in psychopathy and their application to children and adolescents. A key question is whether or not psychopathy is stable throughout the lifespan. Some characteristics indicate phenotypic similarities with adult psychopathy, and current instruments appear to be measuring similar constructs across the age ranges. Although the literature on developmental aspects of psychopathy in young people is limited, a number of instruments have been designed to measure the construct. These tools appear to have reasonable construct, concurrent and predictive validity, but we cannot yet recommend their routine use in clinical practice or in the criminal justice system, given the limited evidence base on their predictive validity. At best, they should be viewed as a means of subtyping potentially high-risk groups with a view to treatment planning.

scholarly journals Obstetric medicine

2013 ◽  
pp. 15-22
Author(s):  
L. Balbi ◽  
V. Donvito ◽  
A. Maina
Keyword(s):  
High Risk ◽  
Severe Disease ◽  
Maternal Deaths ◽  
Perioperative Morbidity ◽  
Excellent Outcome ◽  
Risk Pregnancy ◽  
Obstetric Medicine ◽  
Elective Termination ◽  
In Pregnancy

BACKGROUND Obstetric assistance made major advances in the last 20 years: improved surgical technique allows quicker caesarean sections, anaesthesiology procedures such as peripheral anaesthesia and epidural analgesia made safer operative assistance, remarkably reducing perioperative morbidity and mortality, neonatology greatly improved the results of assistance to low birth weight newborns. A new branch of medicine called “obstetric medicine” gained interest and experience after the lessons of distinguished physicians like Michael De Swiet in England. All together these advances are making successful pregnancies that 20 years ago would have been discouraged or even interrupted: that’s what we call high risk pregnancy. High risk of what? Either complications of pregnancy on pre-existing disease or complications of pre-existing disease on pregnancy. Nowadays, mortality in pregnancy has a medical cause in 80% of cases in Western countries (Confidential Enquiry on Maternal Deaths, UK, 2004). DISCUSSION The background is always changing and we have to take in account of: increase of maternal age; widespread use of assisted fertilization techniques for treatment of infertility; social feelings about maternity desire with increasing expectations from medical assistance; immigration of medically “naive” patients who don’t know to have a chronic disease, but apt and ready to conceive; limited knowledge of feasibility of drug use in pregnancy which may induce both patients and doctors to stopping appropriate drug therapy in condition of severe disease. Preconception counseling, planning the pregnancy, wise use of drugs, regular follow-up throughout the pregnancy and, in selected cases, preterm elective termination of pregnancy may result in excellent outcome both for mother and foetus. CONCLUSIONS Highly committed and specifically trained physicians are required to counsel these patients and to plan their treatment before and during pregnancy.

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