scholarly journals Expert consensus on the use of sunscreen agents: Indian perspective

2021 ◽  
Vol 8 (1) ◽  
pp. 168
Author(s):  
Mansukh Ghalla ◽  
Rasya Dixit ◽  
K. Srinivasa Murthy ◽  
Tina Priscilla Katta
Keyword(s):  
Clinical Decision Making ◽  
Sun Exposure ◽  
Clinical Decision ◽  
Sun Protection ◽  
Current Evidence ◽  
Ultraviolet Rays ◽  
Protection Factor ◽  
Sunscreen Agents ◽  
Exposure Pattern ◽  
Physical And Chemical

<p class="abstract">Sunscreens have been widely known to play an integral part in photoprotection. Both physical and chemical sunscreens have been extensively used for prevention and management of several conditions induced by ultraviolet rays such as sunburn, photoaging, skin cancer, and phototoxic reactions. Currently, sunscreens are available in different formulations like creams, lotions, gels, sticks, and sprays. Forty experts in the field of clinical dermatology participated in the expert group meetings organized via teleconference webinar to discuss definitions, diagnoses, and management. Current evidence on the use of sunscreen agents along with clinical experience of experts was discussed. The application of an adequate amount of sunscreen with an appropriate sun protection factor is imperative, and must be in accordance to skin type and exposure pattern of an individual. As part of a complete sun protection regimen, the judicious use of sunscreens must be combined with avoidance of midday sun exposure and protective clothing. There is an undeniable need to improve public education and awareness regarding use of sunscreens. This review article provides a consensus clinical viewpoint of expert dermatologists on effective use of sunscreens to assist in clinical decision-making for healthcare professionals.</p>

Which Biomarkers Can Be Used as Diagnostic Tools for Infection in Suspected Sepsis?

2021 ◽  
Vol 42 (05) ◽  
pp. 662-671
Author(s):  
Pedro Póvoa ◽  
Luis Coelho
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Antimicrobial Treatment ◽  
Empiric Antibiotic Therapy ◽  
Current Evidence ◽  
Diagnostic Tools ◽  
Suspected Sepsis ◽  
Molecular Tests ◽  
Clinical Scenarios ◽  
Diagnosis Of Infection

AbstractThe diagnosis of infection in patients with suspected sepsis is frequently difficult to achieve with a reasonable degree of certainty. Currently, the diagnosis of infection still relies on a combination of systemic manifestations, manifestations of organ dysfunction, and microbiological documentation. In addition, the microbiologic confirmation of infection is obtained only after 2 to 3 days of empiric antibiotic therapy. These criteria are far from perfect being at least in part responsible for the overuse and misuse of antibiotics, in the community and in hospital, and probably the main drive for antibiotic resistance. Biomarkers have been studied and used in several clinical settings as surrogate markers of infection to improve their diagnostic accuracy as well as in the assessment of response to antibiotics and in antibiotic stewardship programs. The aim of this review is to provide a clear overview of the current evidence of usefulness of biomarkers in several clinical scenarios, namely, to diagnose infection to prescribe antibiotics, to exclude infection to withhold antibiotics, and to identify the causative pathogen to target antimicrobial treatment. In recent years, new evidence with “old” biomarkers, like C-reactive protein and procalcitonin, as well as new biomarkers and molecular tests, as breathomics or bacterial DNA identification by polymerase chain reaction, increased markedly in different areas adding useful information for clinical decision making at the bedside when adequately used. The recent evidence shows that the information given by biomarkers can support the suspicion of infection and pathogen identification but also, and not less important, can exclude its diagnosis. Although the ideal biomarker has not yet been found, there are various promising biomarkers that represent true evolutions in the diagnosis of infection in patients with suspected sepsis.

scholarly journals Precision Approaches in the Management of Colorectal Cancer: Current Evidence and Latest Advancements towards Individualizing the Treatment

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3481
Author(s):  
Rebecca A. Shuford ◽  
Ashley L. Cairns ◽  
Omeed Moaven
Keyword(s):  
Colorectal Cancer ◽  
Growth Factor ◽  
Metastatic Colorectal Cancer ◽  
Mismatch Repair ◽  
Clinical Decision Making ◽  
Growth Factor Receptor ◽  
Clinical Decision ◽  
Current Evidence ◽  
Therapeutic Modalities ◽  
Clinically Significant

The genetic and molecular underpinnings of metastatic colorectal cancer have been studied for decades, and the applicability of these findings in clinical decision making continues to evolve. Advancements in translating molecular studies have provided a basis for tailoring chemotherapeutic regimens in metastatic colorectal cancer (mCRC) treatment, which have informed multiple practice guidelines. Various genetic and molecular pathways have been identified as clinically significant in the pathogenesis of metastatic colorectal cancer. These include rat sarcoma (RAS), epithelial growth factor receptor (EGFR), vascular endothelial growth factor VEGF, microsatellite instability, mismatch repair, and v-raf murine sarcoma viral oncogene homolog b1 (BRAF) with established clinical implications. RAS mutations and deficiencies in the mismatch repair pathway guide decisions regarding the administration of anti-EGFR-based therapies and immunotherapy, respectively. Furthermore, there are several emerging pathways and therapeutic modalities that have not entered mainstream use in mCRC treatment and are ripe for further investigation. The well-established data in the arena of targeted therapies provide evidence-based support for the use or avoidance of various therapeutic regimens in mCRC treatment, while the emerging pathways and platforms offer a glimpse into the future of transforming a precision approach into a personalized treatment.

scholarly journals Ehlers-Danlos syndromes: state of the art on clinical practice guidelines

RMD Open ◽  
2018 ◽  
Vol 4 (Suppl 1) ◽  
pp. e000790 ◽  
Author(s):  
Alberto Sulli ◽  
Rosaria Talarico ◽  
Carlo Alberto Scirè ◽  
Tadej Avcin ◽  
Marco Castori ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Decision Making ◽  
Unmet Needs ◽  
Musculoskeletal Diseases ◽  
Clinical Decision ◽  
Current Evidence ◽  
Reference Network ◽  
Publication Type

ObjectiveTo report the effort of the European Reference Network for Rare and Complex CONnective tissue and musculoskeletal diseases NETwork working group on Ehlers-Danlos syndromes (EDS) and related disorders to assess current available clinical practice guidelines (CPGs) specifically addressed to EDS, in order to identify potential clinician and patient unmet needs.MethodsSystematic literature search in PUBMED and EMBASE based on controlled terms (MeSH and Emtree) and keywords of the disease and publication type (CPGs). All the published articles were revised in order to identify existing CPGs on diagnosis, monitoring and treatment of EDS.ResultsLiterature revision detected the absence of papers reporting good quality CPGs to optimise EDS patient care. The current evidence-based literature regarding clinical guidelines for the EDS was limited in size and quality, and there is insufficient research exploring the clinical features and interventions, and clinical decision-making are currently based on theoretical and limited research evidences.ConclusionsMany clinician and patient unmet needs have been identified.

scholarly journals Inner Speech in Aphasia: Current Evidence, Clinical Implications, and Future Directions

2020 ◽  
Vol 29 (1S) ◽  
pp. 560-573
Author(s):  
Mackenzie E. Fama ◽  
Peter E. Turkeltaub
Keyword(s):  
Clinical Practice ◽  
Subjective Experience ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Self Report ◽  
Inner Speech ◽  
Current Evidence ◽  
Future Directions ◽  
Language Tests ◽  
Aphasia Treatment

Purpose Typical language users can engage in a lively internal monologue for introspection and task performance, but what is the nature of inner speech among individuals with aphasia? Studying the phenomenon of inner speech in this population has the potential to further our understanding of inner speech more generally, help clarify the subjective experience of those with aphasia, and inform clinical practice. In this scoping review, we describe and synthesize the existing literature on inner speech in aphasia. Method Studies examining inner speech in aphasia were located through electronic databases and citation searches. Across the various studies, methods include both subjective approaches (i.e., asking individuals with aphasia about the integrity of their inner speech) and objective approaches (i.e., administering objective language tests as proxy measures for inner speech ability). The findings of relevant studies are summarized. Results Although definitions of inner speech vary across research groups, studies using both subjective and objective methods have established findings showing that inner speech can be preserved relative to spoken language in individuals with aphasia, particularly among those with relatively intact word retrieval and difficulty primarily at the level of speech output processing. Approaches that combine self-report with objective measures have demonstrated that individuals with aphasia are, on the whole, reliably able to report the integrity of their inner speech. Conclusions The examination of inner speech in individuals with aphasia has potential implications for clinical practice, in that differences in the preservation of inner speech across individuals may help guide clinical decision making around aphasia treatment. Although there are many questions that remain open to further investigation, studying inner speech in this specific population has also contributed to a broader understanding of the mechanisms of inner speech more generally.

scholarly journals Precision medicine in inflammatory bowel disease: concept, progress and challenges

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 54 ◽  
Author(s):  
Simon P. Borg-Bartolo ◽  
Ray Kiran Boyapati ◽  
Jack Satsangi ◽  
Rahul Kalla
Keyword(s):  
Precision Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Underlying Disease ◽  
Response To Therapy ◽  
Current Evidence ◽  
Disease Biology ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Individual

Crohn’s disease and ulcerative colitis are increasingly prevalent, relapsing and remitting inflammatory bowel diseases (IBDs) with variable disease courses and complications. Their aetiology remains unclear but current evidence shows an increasingly complex pathophysiology broadly centring on the genome, exposome, microbiome and immunome. Our increased understanding of disease pathogenesis is providing an ever-expanding arsenal of therapeutic options, but these can be expensive and patients can lose response or never respond to certain therapies. Therefore, there is now a growing need to personalise therapies on the basis of the underlying disease biology and a desire to shift our approach from “reactive” management driven by disease complications to “proactive” care with an aim to prevent disease sequelae. Precision medicine is the tailoring of medical treatment to the individual patient, encompassing a multitude of data-driven (and multi-omic) approaches to foster accurate clinical decision-making. In IBD, precision medicine would have significant benefits, enabling timely therapy that is both effective and appropriate for the individual. In this review, we summarise some of the key areas of progress towards precision medicine, including predicting disease susceptibility and its course, personalising therapies in IBD and monitoring response to therapy. We also highlight some of the challenges to be overcome in order to deliver this approach.

First-time Glenohumeral Dislocations: Current Evidence and Considerations in Clinical Decision Making

2020 ◽  
Vol 28 (4) ◽  
pp. 122-131
Author(s):  
Kyle N. Kunze ◽  
Matthew R. Cohn ◽  
Brady T. Williams ◽  
Grant Garrigues ◽  
Jorge Chahla
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Current Evidence ◽  
First Time

Evaluating the Use of Oral Trials for Inpatient Dysphagia Management: An Initial Cross-Sectional Database Study

2021 ◽  
pp. 1-12
Author(s):  
Rebecca Julier ◽  
Jacqueline K. Benfield
Keyword(s):  
Clinical Decision Making ◽  
Oral Intake ◽  
High Standard ◽  
Clinical Decision ◽  
Current Evidence ◽  
Language Therapy ◽  
Cross Sectional ◽  
Patient Demographics ◽  
Dysphagia Therapy ◽  
Effective Service

Purpose Oral trials, otherwise known as swallow trials or tasters, are widely used in dysphagia management. However, to date, no studies have investigated the effectiveness of oral trials or outlined how the approach is utilized in everyday practice. This article aims to start a dialogue regarding this much-used but little-evidenced dysphagia intervention by exploring three main aspects to (a) identify the patient demographics and environments in which oral trials are used in hospital, (b) explore clinical decision making around the approach, and (c) consider clinical implications around current findings and future areas for research. Method A cross-sectional examination of 118 patients on the dysphagia caseload of a United Kingdom–based inpatient speech and language therapy team was conducted. Statistical analysis explored demographic differences between oral trials groups and the rest of the dysphagia caseload. Results Twenty-three of 118 (19.5%) individuals on the caseload were or had been on oral trials during admission. Individuals in the oral trials group were significantly more likely to have a neurological diagnosis than the full oral intake group (78.3% vs. 30.5%, p < .001). There was a lack of uniformity in oral trials recommendations, and the rationale behind quantity and types of diet or fluids offered was unclear. Conclusions This study begins to evidence the use of a dysphagia therapy not previously explored within existing literature. It highlights the wide use of oral trials within the hospital trust observed. Based on current evidence, it would be difficult for clinicians to know how to implement oral trials as an intervention. Further research is required both to explore the effectiveness of this approach and also to develop a consensus within practice around how, why, and when oral trials are offered. This would ensure an equitable and effective service is offered and would ensure a high standard of evidence-based practice within dysphagia management.

scholarly journals Patent foramen ovale and cryptogenic stroke: diagnosis and updates in secondary stroke prevention

2018 ◽  
Vol 3 (2) ◽  
pp. 84-91 ◽  
Author(s):  
Kristy Yuan ◽  
Scott Eric Kasner
Keyword(s):  
Patient Selection ◽  
Stroke Prevention ◽  
Patent Foramen Ovale ◽  
Clinical Decision Making ◽  
Cryptogenic Stroke ◽  
Clinical Decision ◽  
Current Evidence ◽  
Secondary Stroke Prevention ◽  
Foramen Ovale ◽  
Pfo Closure

The patent foramen ovale (PFO), given its high prevalence in the general population and especially in patients with cryptogenic stroke, has long generated investigation and debate on its propensity for stroke by paradoxical embolism and its management for stroke prevention. The pendulum has swung for percutaneous PFO closure for secondary stroke prevention in cryptogenic stroke. Based on a review of current evidence, the benefit from PFO closure relies on careful patient selection: those under the age of 60 years with few to no vascular risk factors and embolic-appearing stroke deemed cryptogenic after thorough evaluation. As these data look towards influencing guideline statements and device approvals in the future, patient selection remains the crucial ingredient for clinical decision making and future trials.

scholarly journals Resurgence of Polymyxin B for MDR/XDR Gram-Negative Infections: An Overview of Current Evidence

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Suneel Kumar Garg ◽  
Omender Singh ◽  
Deven Juneja ◽  
Niraj Tyagi ◽  
Amandeep Singh Khurana ◽  
...  
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Current Evidence ◽  
Drug Resistant ◽  
Gram Negative

Polymyxin B has resurged in recent years as a last resort therapy for Gram-negative multidrug-resistant (MDR) and extremely drug resistant (XDR) infections. Understanding newer evidence on polymyxin B is necessary to guide clinical decision making. Here, we present a literature review of polymyxin B in Gram-negative infections with update on its pharmacology.

Sign in / Sign up

Export Citation Format

Share Document