scholarly journals International consensus guidance for management of myasthenia gravis

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011124 ◽  
Author(s):  
Pushpa Narayanaswami ◽  
Donald B. Sanders ◽  
Gil Wolfe ◽  
Michael Benatar ◽  
Gabriel Cea ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Task Force ◽  
Majority Vote ◽  
Simple Majority ◽  
International Consensus ◽  
Consensus Recommendations ◽  
International Panel ◽  
Simple Majority Vote ◽  
Consensus Guidance ◽  
International Experts

ObjectiveTo update the 2016 formal consensus-based guidance for the management of myasthenia gravis (MG) based on the latest evidence in the literature.MethodsIn October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness method was used to develop consensus recommendations pertaining to 7 treatment topics. In February 2019, the international panel was reconvened with the addition of one member to represent South America. All prior recommendations were reviewed for currency, and new consensus recommendations were developed on topics that required inclusion or updates based on recent literature. Up to 3 rounds of anonymous e-mail votes were used to reach consensus, with modifications to recommendations between rounds based on panel input. A simple majority vote (80% of panel members voting “yes”) was used to approve minor changes in grammar and syntax to improve clarity.ResultsThe previous recommendations for thymectomy were updated. New recommendations were developed for the use of rituximab, eculizumab and methotrexate as well as for the following topics: early immunosuppression in ocular MG and MG associated with immune checkpoint inhibitor treatment.ConclusionThis updated formal consensus guidance of international MG experts, based on new evidence, provides recommendations to clinicians caring for MG patients worldwide.

The handling of the proposal to conserve the name Acacia at the 17th International Botanical Congress—an attempt at minority rule

Bothalia ◽  
2007 ◽  
Vol 37 (1) ◽  
pp. 109-118 ◽  
Author(s):  
G. Moore
Keyword(s):  
Majority Vote ◽  
Fundamental Principle ◽  
Botanical Nomenclature ◽  
Simple Majority ◽  
International Code ◽  
International Botanical ◽  
International Botanical Congress ◽  
Simple Majority Vote ◽  
Parliamentary Procedure ◽  
The Right

The handling of controversial Proposal 1584 to conserve the name Acacia with a conserved type for the Australian acacias during the Nomenclature Section meeting at the 17th International Botanical Congress (Vienna) in 2005 is reviewed. Through a simple majority vote, this Section adopted rules requiring a 60% majority of votes to approve any proposal to modify the International Code of Botanical Nomenclature and a simple majority to approve all other motions; motions not receiving the required majority were to be rejected. However, for the motion addressing Proposal 1584, 45.1% voted to conserve the type of the name Acacia for Australian acacias, and 54.9% voted to retain the current African type for the name Acacia. Even though this motion failed to get a 60% majority either way as required by the Section’s own rules, Section officials have concluded that the name Acacia is to be conserved for Australian acacias. Treating a motion as approved, even though it received only minority support, also violates the fundamental principle of standard parliamentary procedure—the right of the majority to approve proposals. For Acacia to be formally conserved, the Nomenclature Section needed to approve a motion addressing Proposal 1584 with a majority vote, and this never happened in Vienna. Recommendations are made on how this process might be improved.

The Making of a Watchdog

Watchdog ◽  
2020 ◽  
pp. 40-54
Author(s):  
Richard Cordray
Keyword(s):  
Credit Card ◽  
Student Loans ◽  
Majority Vote ◽  
The Political ◽  
Financial Protection ◽  
Simple Majority ◽  
Financial Industry ◽  
Political Opposition ◽  
President Obama ◽  
Simple Majority Vote

The Consumer Financial Protection Bureau’s strategy was to push through the political opposition by acting aggressively for consumers. Early on, the bureau worked to make the terms of financial products more understandable for consumers, creating streamlined forms for mortgages, student loans, and credit cards. It took major enforcement actions against credit card companies for deceptive marketing, returning billions of dollars to consumers. As Cordray’s nomination languished in the Senate, President Obama made an extraordinary recess appointment to install him on a temporary basis. The financial industry immediately challenged the appointment in court, and Republicans pushed back hard in tough oversight hearings. In July 2013, the Democratic Senate majority leader, Harry Reid, moved to invoke the “nuclear option” to approve nominations by a simple majority vote. The Republicans yielded, and Cordray was confirmed in a bipartisan vote of sixty-six to thirty-four. In a tough two-year battle, the bureau prevailed over the strenuous opposition.

scholarly journals Application Prospect of Artificial Intelligence in Rehabilitation and Management of Myasthenia Gravis

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ying Zhang ◽  
Hongmei Yu ◽  
Rui Dong ◽  
Xuan Ji ◽  
Fujun Li
Keyword(s):  
Artificial Intelligence ◽  
Myasthenia Gravis ◽  
Physical Training ◽  
Acute Stage ◽  
Current Status ◽  
International Consensus ◽  
Training Exercise ◽  
Data Collection And Analysis ◽  
Consensus Guidance ◽  
Chronic Autoimmune Disease

Myasthenia gravis (MG) is a chronic autoimmune disease of the nervous system, which is still incurable. In recent years, with the progress of immunosuppressive and supportive treatment, the therapeutic effect of MG in the acute stage is satisfactory, and the mortality rate has been greatly reduced. However, there is still no consensus on how to conduct long-term management of stable MG, such as guiding patients to identify relapses, practice exercise, return to work and school, etc. In the international consensus guidance for management of myasthenia gravis published by the Myasthenia Gravis Foundation of America (MGFA) in 2020, for the first time, “the role of physical training/exercise in MG” was identified as the topic of discussion. Finally, due to a lack of high-quality evidence on physical training/exercise in patients with MG, the topic was excluded after the literature review. Therefore, this paper reviewed the current status of MG rehabilitation research and the difficulties faced by stable MG patients in self-management. It is suggested that we should take advantage of artificial intelligence (AI) and leverage it to develop the data-driven decision support platforms for MG management which can be used for adverse event monitoring, disease education, chronic management, and a wide variety of data collection and analysis.

scholarly journals COVID-19: guidance on palliative care from a European Respiratory Society international task force

2020 ◽  
Vol 56 (3) ◽  
pp. 2002583 ◽  
Author(s):  
Daisy J.A. Janssen ◽  
Magnus Ekström ◽  
David C. Currow ◽  
Miriam J. Johnson ◽  
Matthew Maddocks ◽  
...  
Keyword(s):  
Palliative Care ◽  
Online Survey ◽  
Task Force ◽  
Psychosocial Care ◽  
Indirect Evidence ◽  
European Respiratory Society ◽  
Consensus Recommendations ◽  
Life Threatening ◽  
Advance Care ◽  
Consensus Guidance

BackgroundMany people are dying from coronavirus disease 2019 (COVID-19), but consensus guidance on palliative care in COVID-19 is lacking. This new life-threatening disease has put healthcare systems under pressure, with the increased need of palliative care provided to many patients by clinicians who have limited prior experience in this field. Therefore, we aimed to make consensus recommendations for palliative care for patients with COVID-19 using the Convergence of Opinion on Recommendations and Evidence (CORE) process.MethodsWe invited 90 international experts to complete an online survey including stating their agreement, or not, with 14 potential recommendations. At least 70% agreement on directionality was needed to provide consensus recommendations. If consensus was not achieved on the first round, a second round was conducted.Results68 (75.6%) experts responded in the first round. Most participants were experts in palliative care, respiratory medicine or critical care medicine. In the first round, consensus was achieved on 13 recommendations based upon indirect evidence and clinical experience. In the second round, 58 (85.3%) out of 68 of the first-round experts responded, resulting in consensus for the 14th recommendation.ConclusionThis multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician–patient communication; remote clinician–family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations.

scholarly journals International consensus guidance for management of myasthenia gravis

Neurology ◽  
2016 ◽  
Vol 87 (4) ◽  
pp. 419-425 ◽  
Author(s):  
Donald B. Sanders ◽  
Gil I. Wolfe ◽  
Michael Benatar ◽  
Amelia Evoli ◽  
Nils E. Gilhus ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
International Consensus ◽  
Consensus Guidance

scholarly journals Fetal Surveillance in Pregnancies with Myasthenia Gravis

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1277
Author(s):  
Brîndușa Ana Cimpoca-Raptis ◽  
Anca Marina Ciobanu ◽  
Nicolae Gica ◽  
Gheorghe Peltecu ◽  
Dan Mitrea ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Reproductive Age ◽  
Adult Women ◽  
Women Of Reproductive Age ◽  
International Consensus ◽  
Fetal Surveillance ◽  
Improve Pregnancy Outcome ◽  
Autoimmune Condition ◽  
Consensus Guidance ◽  
Receptor Antibodies

Myasthenia gravis (MG) is an autoimmune condition, that commonly impacts adult women of reproductive age. Myasthenia gravis in pregnancy is rare, but the incidence is higher in different geographical areas. Pregnancies in mothers with MG can have an unfortunate outcome. Acetylcholine receptor antibodies may pass into the fetal circulation and can affect the fetal neuromuscular junction, generating transient MG or even fetal arthrogryposis. The 2016 and 2021 International Consensus Guidance for Management of Myasthenia Gravis issued by Myasthenia Gravis Foundation of America is lacking in recommendation for fetal surveillance for pregnancies in women with MG. The aim of this paper is to highlight fetal and neonatal complications in mothers with MG and to offer antenatal care insights. Close maternal and pregnancy monitoring can improve pregnancy outcome. Patients with MG should be encouraged to conceive, to avoid triggers for exacerbations of the disease during pregnancy and a multidisciplinary team should be established to ensure the optimal support and therapy.

scholarly journals Developing an international consensus guidance for myasthenia gravis using RAND/UCLA appropriateness method

2017 ◽  
Vol 4 (3) ◽  
pp. 54
Author(s):  
Wei-Bin Liu ◽  
Hao Ran ◽  
Chuang-Yi Ou ◽  
Li Qiu ◽  
Zhi-Dong Huang ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
International Consensus ◽  
Consensus Guidance
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