scholarly journals On the use of sex steroids in women during the COVID-19 pandemic

2021 ◽  
pp. 9-16
Author(s):  
T.F. Tatarchuk ◽  
Z.M. Dubossarska ◽  
V.I. Pyrohova ◽  
N.Y. Pedachenko ◽  
T.M. Tutchenko ◽  
...  
Keyword(s):  
Professional Associations ◽  
Clinical Situation ◽  
Scientific Data ◽  
Individual Characteristics ◽  
Hormonal Contraceptives ◽  
Clinical Effects ◽  
Clinical Practices ◽  
Medical Associations ◽  
Bioidentical Hormones ◽  
Severity Of The Disease

The document was approved at an expanded meeting of the Ukrainian Society of Gynecological Endocrinology with the involvement of all board members and representatives of the Association of Obstetricians-Gynecologists of Ukraine, the Association of Pharmacologists of Ukraine, the Association of Anesthesiologists of Ukraine, as well during the Third Ukrainian School of Gynecological and Reproductive Endocrinology with international participation ISGE 19–20.03.21.The COVID-19 pandemic has significantly impacted medical practice, in terms of organizational and clinical practices, posing a number of complex and contradictory challenges for professionals.This document is the result of the systematization of scientific data available by March 2021 and recommendations of international medical and specialized professional societies on controversial clinical issues in gynecological practice caused by the COVID-19 pandemic, as well as certain issues of safety and ratio of using hormonal drugs. The involvement of experts from professional associations of the obstetric and gynecological field, pharmacology, anesthesiology and vascular surgery and phlebology in the working group made it possible to formulate clinically justified provisions of the position.The position includes three thematic sections: “On the use of estrogen-containing combined hormonal contraceptives (CHC) during the COVID-19 pandemic”; “On the use of menopausal hormone therapy (MHT) during the COVID-19 pandemic”; “On the issue of unregistered compounded bioidentical hormones”. At the beginning of each thematic section, the main conclusions of the consensus position of professional medical associations are presented. According to the data available by March 2021, there is no reason to limit the use of CHC or MHT in healthy women (currently not having COVID-19). The question of CHC or MHT discontinuing or switching to other forms by women with COVID-19 should be decided depending on the severity of the disease, the total set of risk factors for thromboembolic complications and other individual characteristics of the clinical situation. Further research will provide elaboration of more detailed algorithms. Physicians need to be vigilant about the safety of compounded Bioidentical Hormonal Therapy (cBHT) in any dosage form (including pellets), especially during the COVID-19 pandemic, given the unexplored systemic effects and therefore the potential risks. Preference should be given to officially licensed medicinal products with a well-studied safety profile and clinical effects, the use of which is authorized by doctor's prescription and supported by clinical protocols and guidelines.

scholarly journals Comparison of the Mayo Endoscopy Score and the Ulcerative Colitis Endoscopy Index of Severity and the Ulcerative Colitis Colonoscopy Index of Severity

2021 ◽  
Vol 09 (02) ◽  
pp. E130-E136
Author(s):  
María Belvis Jiménez ◽  
Pedro Hergueta-Delgado ◽  
Blas Gómez Rodríguez ◽  
Belén Maldonado Pérez ◽  
Luisa Castro Laria ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Interobserver Variability ◽  
Intraclass Correlation ◽  
Weighted Kappa ◽  
Clinical Situation ◽  
Kappa Index ◽  
Perfect Correlation ◽  
Index Of Severity ◽  
Severity Of The Disease ◽  
Normal Clinical Practice

Abstract Background and study aims: Endoscopy plays an essential role in managing patients with ulcerative colitis (UC), as it allows us to visualize and assess the severity of the disease. As such assessments are not always objective, different scores have been devised to standardize the findings. The main aim of this study was to assess the interobserver variability between the Mayo Endoscopy Score (MES), Ulcerative Colitis Endoscopy Index of Severity (UCEIS) and Ulcerative Colitis Colonoscopy Index of Severity (UCCIS) analyzing the severity of the endoscopic lesions in patients with ulcerative colitis. Patients and methods: This was a single-cohort observational study in which a colonoscopy was carried out on patients with UC, as normal clinical practice, and a video was recorded. The results from the video were classified according to the MES, UCEIS and UCCIS by three endoscopic specialists independently, and they were compared to each other. The Mayo Endoscopy Score (MES) was used to assess the clinical situation of the patient. The therapeutic impact was analyzed after colonoscopy was carried out. Results: Sixty-seven patients were included in the study. The average age was 51 (SD ± 16.7) and the average MES was 3.07 (SD ± 2.54). The weighted Kappa index between endoscopists A and B for the MES was 0.8; between A and C 0.52; and between B and C 0.49. The intraclass correlation coefficient for UCEIS was 0.92 among the three endoscopists (CI 95 %: 0.83–0.96) and 0.96 for UCCIS among the three endoscopists (CI 95 % 0.94–0.97). A change in treatment for 34.3 % of the patients was implemented on seeing the results of the colonoscopy. Conclusions: There was an adequate, but not perfect, correlation between the different endoscopists for MES, UCEIS, UCCIS. This was higher with the last two scores. Thus, there is still some subjectivity to be minimized through special training, on assessing the seriousness of the endoscopic lesions in patients with UC.

scholarly journals A narrative overview of utilizing biomaterials to recapitulate the salient regenerative features of dental-derived mesenchymal stem cells

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Sevda Pouraghaei Sevari ◽  
Sahar Ansari ◽  
Alireza Moshaverinia
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Tissue Regeneration ◽  
3D Structure ◽  
Three Dimensional ◽  
Scientific Data ◽  
Clinical Practices ◽  
Human Teeth ◽  
Innovative Strategies ◽  
Local Recruitment

AbstractTissue engineering approaches have emerged recently to circumvent many limitations associated with current clinical practices. This elegant approach utilizes a natural/synthetic biomaterial with optimized physiomechanical properties to serve as a vehicle for delivery of exogenous stem cells and bioactive factors or induce local recruitment of endogenous cells for in situ tissue regeneration. Inspired by the natural microenvironment, biomaterials could act as a biomimetic three-dimensional (3D) structure to help the cells establish their natural interactions. Such a strategy should not only employ a biocompatible biomaterial to induce new tissue formation but also benefit from an easily accessible and abundant source of stem cells with potent tissue regenerative potential. The human teeth and oral cavity harbor various populations of mesenchymal stem cells (MSCs) with self-renewing and multilineage differentiation capabilities. In the current review article, we seek to highlight recent progress and future opportunities in dental MSC-mediated therapeutic strategies for tissue regeneration using two possible approaches, cell transplantation and cell homing. Altogether, this paper develops a general picture of current innovative strategies to employ dental-derived MSCs combined with biomaterials and bioactive factors for regenerating the lost or defective tissues and offers information regarding the available scientific data and possible applications.

scholarly journals Electrical stimulation of the nucleus basalis of meynert: a systematic review of preclinical and clinical data

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Muhammad Nazmuddin ◽  
Ingrid H. C. H. M. Philippens ◽  
Teus van Laar
Keyword(s):  
Electrical Stimulation ◽  
Clinical Data ◽  
Animal Studies ◽  
Receptive Fields ◽  
Lewy Body Dementia ◽  
Clinical Situation ◽  
Nucleus Basalis ◽  
Nucleus Basalis Of Meynert ◽  
Clinical Effects ◽  
Stimulation Of

AbstractDeep brain stimulation (DBS) of the nucleus basalis of Meynert (NBM) has been clinically investigated in Alzheimer’s disease (AD) and Lewy body dementia (LBD). However, the clinical effects are highly variable, which questions the suggested basic principles underlying these clinical trials. Therefore, preclinical and clinical data on the design of NBM stimulation experiments and its effects on behavioral and neurophysiological aspects are systematically reviewed here. Animal studies have shown that electrical stimulation of the NBM enhanced cognition, increased the release of acetylcholine, enhanced cerebral blood flow, released several neuroprotective factors, and facilitates plasticity of cortical and subcortical receptive fields. However, the translation of these outcomes to current clinical practice is hampered by the fact that mainly animals with an intact NBM were used, whereas most animals were stimulated unilaterally, with different stimulation paradigms for only restricted timeframes. Future animal research has to refine the NBM stimulation methods, using partially lesioned NBM nuclei, to better resemble the clinical situation in AD, and LBD. More preclinical data on the effect of stimulation of lesioned NBM should be present, before DBS of the NBM in human is explored further.

scholarly journals Barriers to Evidence-Based Treatment of Serious Burns: The Impact of Implicit Bias on Clinician Perceptions of Patient Adherence

2020 ◽  
Vol 41 (6) ◽  
pp. 1297-1300
Author(s):  
Ian Litchfield ◽  
Naiem Moiemen ◽  
Sheila Greenfield
Keyword(s):  
Clinical Decision Making ◽  
Patient Adherence ◽  
Care Delivery ◽  
Implicit Bias ◽  
Treatment Compliance ◽  
Scientific Data ◽  
Individual Characteristics ◽  
Evidence Based ◽  
Underlying Assumption ◽  
The Impact

Abstract The underlying assumption of modern evidence-based practice is that treatment decisions made by healthcare providers are based solely on the best available scientific data. However, the connection between evidence informed care guidelines and the provision of care remains ambiguous. In reality, a number of contextual and nonclinical factors can also play a role, among which is the implicit bias that affects the way in which we approach or treat others based on irrelevant, individual characteristics despite conscious efforts to treat everyone equally. Influenced by the social and demographic characteristics of patients, this bias and its associated perceptions have been shown to affect clinical decision making and access to care across multiple conditions and settings. This summary article offers an introduction to how the phenomenon of implicit bias can impact on treatment compliance in multiple care contexts, its potential presence and impact in burns care and describes some of the strategies which offer possible solutions to reducing the disconnect between the conscious attempts to deliver equitable care and the discrepancies in care delivery that remain.

A Cognitive Approach to Scientific Data Mining for Syndrome Discovery

2012 ◽  
Vol 4 (1) ◽  
pp. 1-33 ◽  
Author(s):  
Francesco Gagliardi
Keyword(s):  
Machine Learning ◽  
Scientific Discovery ◽  
Human Mind ◽  
Scientific Data ◽  
Learning System ◽  
Prototype Theory ◽  
Clinical Practices ◽  
Cognitive Approach ◽  
Research Activities ◽  
Clinical Domain

The author introduces a machine learning system for cluster analysis to take on the problem of syndrome discovery in the clinical domain. A syndrome is a set of typical clinical features (a prototype) that appear together often enough to suggest they may represent a single, unknown, disease. The discovery of syndromes and relative taxonomy formation is therefore the critical early phase of the process of scientific discovery in the medical domain. The system proposed discovers syndromes following Eleanor Rosch’s prototype theory on how the human mind categorizes and forms taxonomies, and thereby to understand how humans perform these activities and to automate or assist the process of scientific discovery. The system implemented can be considered a scientific discovery support system as it can discover unknown syndromes to the advantage of subsequent clinical practices and research activities.

scholarly journals Interventional Algorithm in Gastrointestinal Bleeding—An Expert Consensus Multimodal Approach Based on a Multidisciplinary Team

2020 ◽  
Vol 26 ◽  
pp. 107602962093194
Author(s):  
Anabela Rodrigues ◽  
Alexandre Carrilho ◽  
Nuno Almeida ◽  
Cilénia Baldaia ◽  
Ângela Alves ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Multidisciplinary Team ◽  
Clinical Situation ◽  
Scientific Data ◽  
Transfusion Medicine ◽  
Multimodal Approach ◽  
The Real ◽  
Clinical Scenarios ◽  
Health Institutions ◽  
Personalized Approach

The approach to the patient with gastrointestinal bleeding (GIB) can be very complex. A multidisciplinary panel of physicians with expertise in Gastroenterology, Anesthesiology, and Transfusion Medicine worked together to provide the best knowledge and guide clinical practitioners in the real setting of health institutions, characterized by disparate availability of human and technical resources. The authors propose a global and personalized approach according to different clinical scenarios to improve the outcomes of patients with GIB, for whom the reduction of inappropriate transfusions is crucial. The goal of this document is to provide clear and objective guidance through interventional algorithms toward a goal-directed approach according to the clinical situation and supported by the latest available scientific data on GIB management in different settings.

scholarly journals Development and Validation of a questionnaire to describe behaviours and attitudes of physicians towards their own process of falling ill.

2020 ◽  
Author(s):  
Maria Pilar Astier Peña ◽  
Teresa Martínez Boyero ◽  
Barbara Gómez Marco ◽  
Candela Pérez Alvarez ◽  
Alba Gállego Royo ◽  
...  
Keyword(s):  
Negative Impact ◽  
Medical Profession ◽  
Self Care ◽  
Professional Associations ◽  
Healthcare Services ◽  
Related Data ◽  
Work Related ◽  
Medical Associations ◽  
Development And Validation

Abstract Background: Physicians have not learned their role as patients. Medical associations focused mainly on mental health programs for doctors in different countries. Nevertheless, the anomalous behaviours of ill doctors exist independently of their health problem. We described the development and validation of a questionnaire to describe Behaviours and Attitudes of Doctors towards their Own Illness (BADOI).Methods: Development of the questionnaire and appearance and content validation (ACV) by experts’ debriefings; construct validation by exploratory (EFA) and confirmatory factor analysis (CFA); reliability by Cronbach's alpha index (CAI) and feasibility by completion time (CT), accessibility to questionnaire platform and % of not answer items.Results: A Questionnaire with 56 items was developed with 3 sections: 1) socio-demographic, professional and work-related data. 2) Activities for self-care and work impact (sick leaves and presenteeism) and physicians’ healthcare pathways (Self-management and use of healthcare services). 3) Doctors of ill doctors and the role of medical associations. The validation sample size was of 4308 physicians’ answers. The factorial model presented 5 factors explaining 78.08% variance, a high value. Factor 1 explained 26.75% of the model describing the relationship between illness and work; Factor 2 explained 16.68%, with items regarding the negative impact of mental issues, toxic habits and the use of healthcare services; Factor 3 explained 15.06%, with items considering presenteeism and sick leaves; Factor 4 explained 9.95% regarding the handling of an ill colleague and medical associations. Finally, Factor 5 explained 9.64%, with items describing healthcare given to ill physicians and the revalidation of medical profession. Discussion: The factors grouped together items relating to self-care, impact on work and physicians’ healthcare pathways (F1-F2-F3) and the role of doctors of ill doctors and of the professional associations (F4-F5), being consistent with the 2 main perspectives: personal experience and caring for ill colleagues.Conclusion: A reliable Multidimensional Questionnaire on the process of physicians becoming ill has been validated in a large sample of registered doctors. It will help to identify and quantify physicians’ healthcare pathways allowing healthcare managers to set evidence-based interventions and formulate policies and ethical recommendations regarding the management of sick doctors.

Covid-19: An Insight over the Third Respiratory Global Emergency of the Century

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Sonali Batra ◽  
Sumit Sharma ◽  
Payal Verma ◽  
Nikhil Arora
Keyword(s):  
Scientific Data ◽  
Host Cells ◽  
Angiotensin Converting Enzyme 2 ◽  
The Third ◽  
Precautionary Measures ◽  
Severity Of The Disease ◽  
Novel Coronavirus ◽  
Diagnosis Of Infection ◽  
Global Data ◽  
Structural Aspects

Introduction: COVID-19 presents the global emergency in recent days and as a consequence the whole world is in a state of war. Continuous efforts by researchers are in process to establish sound scientific understanding regarding viral behavior and pathogenesis. Background: In recent days a lot of scientific data is published describing viral transfusion into host cells, comparing with SARS-CoV-1, viability of SARS-CoV-2, fatality and diagnosis of infection among infected patients. Thereby, motivating to take right decisions in order to treat and mitigate the COVID-19. Review results: Coronaviruses usually affect the respiratory tract and produce symptoms similar to pneumonia with varied complications. The spike protein on the surface of virus makes the SARS-CoV-2 phylogenetically different from other viruses of corona family. SARS-CoV-2 has an affinity for angiotensin converting enzyme-2 receptors present on human cells. The fatality of the disease is found to be low but the severity of the disease might vary from person to person. The incubation period is 14 days but the symptoms like dry cough and high fever are evident around 3-7 days. Already known anti inflammatory, immunomodulators and antiviral drugs are being tested and still under clinical trials. Conclusion: In this review, we are providing an insight over emergence, correlation with SARS-CoV-1 and interpretation of global data representing the severity of unexpected danger on humanity. Certain structural aspects and studies determining the viability of novel coronavirus have also been described. Moreover, case studies of recovered infected patients from COVID-19 explain the progression and patients pathophysiological conditions while suffering from infection. Clinical significance: There are many current strategies which are being tried and practiced to overcome this pandemic disease apart from precautionary measures. Although now, some decline has been seen, but the question still remain same standstill of whether the scientists are approaching towards the clinical solution, or still in midstream. This requires more study and intensive research to finally come to a concrete conclusion.

Abstract 17099: Implementation of a High Sensitivity Troponin-I Assay in an Academic Medical Center: A Qualitative and Quantitative Assessment

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David Winchester ◽  
Omkar Betageri ◽  
Patrick Perche ◽  
Brandon Allen ◽  
Ryan Theis
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Academic Medical Center ◽  
High Sensitivity ◽  
The United States ◽  
Individual Characteristics ◽  
Health Care Facilities ◽  
Clinical Practices ◽  
High Sensitivity Troponin ◽  
Academic Medical

Background: High sensitivity troponin assays (hsTn) have received regulatory approval for use in the United States and health care facilities are beginning to adopt these new assays. Questions remain about how to implement these assays and what affect they may have on demand for cardiovascular services. Methods and Results: We conducted a mixed-methods implementation science-based investigation of hsTn adoption at a single academic medical center. We designed the investigation based on the Consolidated Framework for Implementation Research, exploring clinicians’ perspectives on intervention characteristics, inner setting, individual characteristics, and process of implementation domains. Focus groups were conducted with clinicians from multiple service lines. Participants reported that the new hsTn assay did not fundamentally change processes of care such as cardiology consultations or inpatient admissions. Implementation was facilitated by leveraging the electronic medical record to provide useful suggestions for hsTn management at the point-of-care. Participants expressed satisfaction with the multidisciplinary and collaborative approach taken to educating clinicians prior to implementation. The use of case-based teaching was considered most effective. Emergency department clinicians expressed greater confidence about decisions to discharge to home with the hsTn assay, compared to the older assay. Areas of ongoing concern included management of high risk patients, outpatient follow-up, and feasibility of accelerated diagnostic protocols for early discharge from the emergency department. Deidentified quantitative data on cardiovascular service use were gathered from administrative sources and analyzed on runcharts. A decrease in the number of hsTn assays ordered was observed; no change was noted for admissions, cardiology consultations, or noninvasive cardiac imaging. Conclusions: A comprehensive educational campaign, based on multidisciplinary collaboration can effectively prepare clinicians for implementation of hsTn. New hsTn assays may not have any substantial effect of acute management of patients with cardiac complaints. Many questions remain about best clinical practices for hsTn assays.

Considerations for professionalism of nursing students in clinical practices

2018 ◽  
pp. 38-54 ◽  
Author(s):  
Esra Danaci ◽  
Esma Ayse Ozturk ◽  
Sevil Masat ◽  
Tugba Kavalali Erdogan ◽  
Cansu Atmaca Palazoglu ◽  
...  
Keyword(s):  
Nursing Students ◽  
Nursing Student ◽  
Professional Associations ◽  
Clinical Applications ◽  
Clinical Practices ◽  
Professional Behaviour ◽  
Factors Affecting ◽  
Department Of Health ◽  
The Mean ◽  
Nursing Department

This is a descriptive study that aims to determine the factors affecting the professional behaviour of nursing students in clinical applications. The survey was conducted between 20 September and 20 December 2017 with the participation of 274 students studying in the Nursing Department of Health Sciences Faculty of a University. The data were collected using a questionnaire consisting of 18 questions and Nursing Students Professional Behaviours Scale (NSPBS). The mean age of the nursing students participated in the study was 20.67 ± 1.88 years and 81.8% of the students were female while 18.2% were male. Of them, 78.5% loved their profession, 60.9% chose their profession willingly, 67.5% did not want to change their profession and 9.5% of them were members of professional associations and followed professional publications. The mean score of NSPBS was determined to be 122 (29–135). Hence, the nursing students’ ability to perform professional behaviours was found to be high.Keywords: Nursing, student, professional behaviour.

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