scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and pregnancy: a contemporary review

2017 ◽  
Vol 177 (1) ◽  
pp. R1-R12 ◽  
Author(s):  
Julio Abucham ◽  
Marcello D Bronstein ◽  
Monike L Dias
Keyword(s):  
Drug Exposure ◽  
Somatostatin Analogs ◽  
Treatment Interruption ◽  
Relevant Information ◽  
Evidence Based ◽  
Preconception Counseling ◽  
Endocrine Disease ◽  
Aggressive Disease ◽  
Individual Decisions ◽  
Somatotrophic Axis

Although fertility is frequently impaired in women with acromegaly, pregnancy is apparently becoming more common due to improvement in acromegaly treatment as well as in fertility therapy. As a result, several studies on pregnancy in patients with acromegaly have been published in recent years adding new and relevant information to the preexisting literature. Also, new GH assays with selective specificities and the knowledge of the expression of the various GH genes have allowed a better understanding of somatotrophic axis function during pregnancy. In this review, we show that pregnancy in women with acromegaly is generally safe, usually with tumoral and hormonal stability. Although the paucity of data limits evidence-based recommendations for preconception counseling and pregnancy surveillance, controlling tumor size and hormonal activity before pregnancy is highly recommended to ensure better outcomes, and surgical control should be attempted when feasible. Treatment interruption at pregnancy confirmation has also proven to be safe, as drugs are not formally allowed to be used during pregnancy. Drug exposure (somatostatin analogs) during early or whole pregnancy might increase the chance of a lower birth weight. Aggressive disease is uncommon and may urge individual decisions such as surgery or drug treatment during pregnancy or lactation.

Patients’ Perceptions and Attitudes Regarding the Pre-Anesthesia Clinic (PAC) at the National Guard Hospital in Riyadh, Saudi Arabia: An Exploratory Study (Preprint)

2020 ◽  
Author(s):  
Ghdeer Tashkandi ◽  
Samina Abidi
Keyword(s):  
Saudi Arabia ◽  
Exploratory Study ◽  
National Guard ◽  
Active Role ◽  
Relevant Information ◽  
Educational Interventions ◽  
Evidence Based ◽  
Quantitative Research Methods ◽  
Perceptions And Attitudes ◽  
Educational Information

BACKGROUND Preoperative services and education allow patients to take an active role in their recovery and reduce the risk of post-operative complications. Exploring patients’ perceptions and attitudes regarding pre-anesthesia services and education helps reveal gaps in patients’ uptake of them so that targeted educational interventions can be designed and implemented. OBJECTIVE This is an exploratory study aimed at increasing the understanding of patients’ perceptions and concerns about and the adequacy of the pre-anesthesia services and educational content provided to them at the pre-anesthesia clinic (PAC) of the National Guard Hospital (NGH) in Riyadh, Saudi Arabia. The information gathered will be used to design and develop an electronic patient education system that will allow patients to access personalized, evidence-based pre-anesthesia information relevant to their upcoming surgeries. METHODS Quantitative research methods are used to collect relevant information from patients using a closed-ended questionnaire. The questionnaire includes items on demographics, patients’ perceptions and concerns regarding anesthesia, and the assessment of pre-anesthesia information adequacy. RESULTS Our results showed that 94% of the participants consider the PAC very important, and more than half of the participants (56%) were interested in receiving additional educational information about anesthesia via mobile applications. While 100% of the participants were satisfied with the information and services provided at the clinic, the assessment of this information and service adequacy indicated that participants were not adequately informed about anesthesia. Among the most common anesthesia-related concerns were the inability to wake up after anesthesia, becoming paralyzed after spinal anesthesia, the possibility of staying in the ICU after the surgery and developing back pain. CONCLUSIONS This gathered information will be used to design and develop an educational intervention that will deliver evidence-based, personalized and easy to understand educational instructions to patients to better prepare them for their upcoming surgery. The proposed system will overcome the problems of (i) the spread of generalized unrelated educational information and instructions, (ii) patients forgetting or misunderstanding the given instructions, (iii) issues with the accessibility of information, and (iv) a lack of communication and interaction between patients and their anesthetist.

CAN BAYESIAN METHODS MAKE DATA AND ANALYSES MORE RELEVANT TO DECISION MAKERS?

2001 ◽  
Vol 17 (1) ◽  
pp. 114-122 ◽  
Author(s):  
Steven H. Sheingold
Keyword(s):  
Decision Making ◽  
Bayesian Methods ◽  
Paradigm Shift ◽  
Relevant Information ◽  
Decision Makers ◽  
Evidence Based ◽  
Critical Importance ◽  
Bayesian Approaches ◽  
Bayesian Analyses ◽  
And Performance

Decision making in health care has become increasingly reliant on information technology, evidence-based processes, and performance measurement. It is therefore a time at which it is of critical importance to make data and analyses more relevant to decision makers. Those who support Bayesian approaches contend that their analyses provide more relevant information for decision making than do classical or “frequentist” methods, and that a paradigm shift to the former is long overdue. While formal Bayesian analyses may eventually play an important role in decision making, there are several obstacles to overcome if these methods are to gain acceptance in an environment dominated by frequentist approaches. Supporters of Bayesian statistics must find more accommodating approaches to making their case, especially in finding ways to make these methods more transparent and accessible. Moreover, they must better understand the decision-making environment they hope to influence. This paper discusses these issues and provides some suggestions for overcoming some of these barriers to greater acceptance.

SCAN Fact Sheets: Current, Accurate, Evidence-Based, and Relevant Information now and in the Future

2015 ◽  
Vol 115 (9) ◽  
pp. A54
Author(s):  
S. Stastny ◽  
S. Chaffee ◽  
K. Kester ◽  
A. Clark ◽  
R. Gonzalez
Keyword(s):  
Relevant Information ◽  
Evidence Based ◽  
The Future

Ethics and law in paramedic practice: boundaries of capacity and interests

2020 ◽  
Vol 12 (10) ◽  
pp. 1-8
Author(s):  
Hamish Carver ◽  
Dominique Moritz ◽  
Phillip Ebbs
Keyword(s):  
Decision Making ◽  
End Of Life Care ◽  
Clinical Care ◽  
Relevant Information ◽  
Best Interests ◽  
Evidence Based ◽  
Ethical Standards ◽  
Healthcare Ethics ◽  
The Everyday ◽  
The Relationship

Decision-making is central to the everyday practice of paramedicine. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedics are required to make these decisions within settings that are often disordered, uncontrolled and unpredictable, where all the relevant information and circumstances are not fully known. Decision-making in this environment is intended to provide care and treatment in the best interests of the patient. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient's own wishes? More speci∼cally, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.

Comments on Yaruss, LaSalle, and Conture (1998)

2000 ◽  
Vol 9 (2) ◽  
pp. 162-165 ◽  
Author(s):  
Anne K. Cordes
Keyword(s):  
Relevant Information ◽  
Treatment Recommendations ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Training Clinic ◽  
Minimal Information ◽  
Assessment And Diagnosis

In summary, Yaruss et al. have contributed to the literature a set of “recommendation categories” that were based on retrospective analyses of minimal information from children who might have stuttered, gathered originally by student clinicians in one training clinic who were entirely unaware that their data would be used to develop recommendations for other children in other clinics. These categories and recommendations might have led to inaccurate decisions about a significant minority of the children involved in this study (Yaruss et al.’s Footnote 1), but “suggested treatment recommendations” are nevertheless presented as “useful for clinicians to consider” (p. 73).Given some indications that delaying treatment for children who stutter may reduce the effectiveness of any eventual treatment (R. J. Ingham & Cordes, 1999), the decision not to recommend treatment after an initial stuttering evaluation is an important one. The evidence used to support such a decision should be strong, developed from well-designed, carefully executed, and conservatively interpreted studies. Yaruss et al. (1998) presented some information for clinicians to consider, and other relevant information has been presented in other recent forums (e.g., Curlee & Yairi, 1997, and commentaries). I suggest only that clinicians might also want to consider that the literature on stuttering assessment and diagnosis is already full of data-based information and some relatively carefully developed recommendations (see Adams, 1980; Costello & R. J. Ingham, 1984; Culatta & Goldberg, 1995; Curlee, 1993; J. C. Ingham & Riley, 1998; Ryan, 1992). It is critical to note, as well, that essentially all of these sources would recommend treatment for more children sooner than the recommendations presented by Yaruss et al. would do. The phrase “evidence-based treatment” has become popular in the time since Yaruss et al.’s (1998) article was published; the point for children who stutter, and for all of our other clients, is that all of our decisions and recommendations should always

NICE LESSONS TO BE LEARNED

2001 ◽  
Vol 17 (2) ◽  
pp. 222-235 ◽  
Author(s):  
Jane Farmer ◽  
Rosemary Chesson
Keyword(s):  
Cost Effectiveness ◽  
Implementation Strategies ◽  
Relevant Information ◽  
Policy Implications ◽  
Health Board ◽  
Evidence Based ◽  
Apparent Lack ◽  
Information Centre ◽  
Two Stages ◽  
The Impact

Objectives: This study examined users' perceptions of the role and value of the Scottish Health Purchasing Information Centre (SHPIC) from 1995 to 1998.Methods: Questionnaires and interviews were used to gather data from Scottish GP fundholders and health board managers at two stages.Results: Initially, purchasers sought help in identifying the most relevant information. By 1997, while some appreciated the clinical and cost-effectiveness information produced, others were critical of lack of timely production and apparent lack of cooperation between agencies.Conclusions: New U.K. agencies can learn from SHPIC's problems, specifically in producing clear, coordinated, timely, independent, and well-marketed information with implementation strategies.Policy Implications: It is important to evaluate the impact of agencies to produce and disseminate evidence-based information, even if this has to be done pragmatically rather than as an outcomes-based assessment. Evidence from evaluations can inform direction and strategy for existing and new agencies.

Spotlight on Children and Young People with Complex Special Needs

2019 ◽  
pp. 754-788
Author(s):  
Helen Farrell
Keyword(s):  
Young People ◽  
Music Education ◽  
Special Needs ◽  
Relevant Information ◽  
Evidence Based ◽  
Children And Young People ◽  
The World ◽  
Known Unknowns ◽  
Donald Rumsfeld ◽  
Time And Energy

As Donald Rumsfeld, former US Secretary of Defense stated in February 2002, “there are known knowns … there are things we know that we know … there are known unknowns … that is to say, there are things that we now know we don’t know.” There are an estimated 1 billion persons around the world who live with complex special needs. Multidisciplinary special music education practitioner teams devote extraordinary time and energy to nurture musical communities that are inclusive of diverse cohorts of children and young people. In this chapter, Allan, Laurence, Catherine, Karen, Mary, and Brigit help tell the story. The chapter focuses on this question: What and where are the challenging, sometimes-controversial dilemmas, cultures, and big issues for those who share a common mission and vision of quality musical experiences and activities for all? The chapter undertakes a systematic review of some of the relevant information and scholarly evidence-based research in a diversity of disciplines. There appears to be cause for cautious optimism despite noisy contests of challenging, sometimes controversial dilemmas, cultures, and big issues. Provision of quality musical experiences and activities for benefit of all students appears to have progressed.

Evidence Of Therapeutic Drug Monitoring (TDM) In The Treatment Of Invasive Aspergillosis (IA) With Voriconazole (VCZ) In Cancer Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2977-2977
Author(s):  
Meinolf Karthaus ◽  
Thomas Lehrnbecher ◽  
Dieter Buchheidt
Keyword(s):  
Invasive Aspergillosis ◽  
Cancer Patients ◽  
Plasma Levels ◽  
Drug Exposure ◽  
Pediatric Population ◽  
Serum Levels ◽  
Therapeutic Drug ◽  
Evidence Based ◽  
Double Blind ◽  
Intervention Thresholds

Abstract Introduction Invasive aspergillosis is a life-threatening complication in hematological cancer patients (pts). VCZ is the established first-line standard treatment of IA. Failure of VCZ therapy in IA due to lack of efficacy or adverse events (AEs) occurs in 30-40% of treated pts. VCZ has a nonlinear pharmacokinetic profile and exhibits considerable variability of drug exposure. Therefore, TDM of VCZ may help to improve treatment results in pts with IA. While TDM is recommended by some authors, evidence-based data on the clinical use of TDM in pts treated with VCZ for IA are scarce. Our present analysis assessed published studies for evidence-based criteria guiding TDM of VCZ to improve efficacy and safety of IA therapy in cancer pts. Evidence-based guidance is needed to support decisions on the use of TDM in clinical routine VCZ therapy of IA. Patients and methods Literature searches of Medline, Cochrane database and conference abstracts were performed. We identified 25 clinical studies (comprising a total of 3822 pts, range 5 - 1091) reporting on the use of TDM for VCZ. For each study, strength of recommendation and quality of evidence was categorized according to criteria defined by Kish et al. (Clin Infect Dis 2001). Each trial was was assessed separately.for the categories efficacy, toxicity, timing of TDM and dose adjustment. The majority of trials included cancer pts. Two trials reported on a pediatric population (>0 - < 12 yrs of age), 21 trials reported on adults only, while the remaining 5 trials reported on children and adults. Evaluable TDM data were reported for 3313 pts, whereas 509 pts were not included for TDM for various reasons. VCZ plasma levels were determined by HPLC in 23 trials. A total of 8266 VCZ serum levels were reported. Of the 7 prospective studies, 1 randomized prospective, double-blind trial included pts treated with VCZ or fluconazole. The primary endpoint of a significant AE reduction by TDM of VCZ versus no TDM was not reached (CI), while efficacy was higher in pts managed with TDM (BI). The other studies were observational or retrospective cohort studies. 18 reports provided data on both intravenous and oral use of VCZ, 4 trials reported on intravenous VCZ and 3 on oral VCZ only. 13/25 trials were evaluable for evidence on TDM regarding efficacy, 10/25 for toxicity. High inter- and intra-study variability was observed for timepoints of VCZ measurement (day 1 to >day 210) and number of VCZ plasma levels (n = 2 to >40). Across the studies, VCZ levels >5-5.5 mg/L were found to be associated with toxicity (BII), while reaching minimum levels of >1-2 mg/L appeared to improve efficacy (BII). Timing (CIII), frequency (CIII) and intervention thresholds (CIII) of VCZ TDM remain an open question. Conclusion Although a substantial number of studies is published on TDM in VCZ therapy of IA, there is still no robust evidence for recommendations in clinical practice. VCZ levels >5-5.5 mg/L were reported to be associated with toxicity (BII), while minimum levels of >1-2 mg/L may improve efficacy (BII). However, timing (CIII) and frequency (CIII) of TDM als well as intervention thresholds (CIII) and dosage increments for adjustment of VCZ plasma levels need to be established in a multicenter randomized clinical trial to provide a scientifically adequate basis for guidance on TDM of VCZ for IA in cancer pts. Disclosures: Karthaus: Pfizer: Honoraria; MSD: Honoraria; Gilead: Honoraria; Astellas: Honoraria. Lehrnbecher:Gilead: Honoraria; MSD: Honoraria; Pfizer: Honoraria; Astellas: Honoraria. Buchheidt:Gilead: Honoraria; MSD: Honoraria; Astellas: Honoraria; Pfizer: Honoraria.

Sign in / Sign up

Export Citation Format

Share Document