Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data From the German Registry for Congenital Hypothyroidism (HypoDok)

Abstract Background: Neonatal screening for congenital primary hypothyroidism (CH) is mandatory in Germany but medical care thereafter remains inconsistent. Therefore, the multicentre database HypoDok was analysed to evaluate the implementation of evidence-based guidelines in the care of children with CH and to assess the number of patients in this registry of the German society of paediatric endocrinology and diabetology (DGKED).Methods: HypoDok includes the prospective documentation of 1,630 patients with CH from 50 centres in Germany and Austria. Inclusion criteria were (i) date of birth between 10/2001 and 05/2020 and (ii) increased TSH at screening and/or confirmation. Parameters regarding diagnosis, therapy and follow-up were extracted. The number of registered patients was compared to the number in the report of the German Society for Neonatal Screening (DGNS). The cohort was divided into 2 groups, before (A) and after (B) guideline publication in 02/2011, to assess guideline’s influence on medical care.Results: 659 patients (62% female) were eligible and analysed as group A (n=327) and group B (n=332) representing 17.5% and 6.7% of CH patients identified in the German and Austrian neonatal screening program during the respective time period. Treatment start and thyroxin doses were similar in both groups and consistent with recommendations. Regular follow-ups were documented in both groups including five appointments in the first and three in the second year of life. Ultrasound of the thyroid gland was performed in 92.6% (A) and 92.1% (B) of the patients. In the first three years of life, 46.4% (A) and 40.0% (B) of the patients underwent audiometry, EQ/IQ testing was performed in 49.3% (A) and 24.8% (B) (p<0.01), respectively.Summary: While documentation of care for patients with CH by paediatric endocrinologists seems to be established, only a minority of all affected patients is included in HypoDok. Thus, the care and outcome of the majority of patients with CH remains uncertain. Therefore, comprehensive documentation as an important instrument of quality assurance and evidence-based medicine should be legally enforced and officially funded in order to record, comprehend and optimize care and outcome in patients with rare diseases such as CH, irrespective of treatment provider.

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Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (HypoDok)

International Journal of Neonatal Screening ◽

10.3390/ijns7010010 ◽

2021 ◽

Vol 7 (1) ◽

pp. 10

Author(s):

Julia Thomann ◽

Sascha R. Tittel ◽

Egbert Voss ◽

Rudolf Oeverink ◽

Katja Palm ◽

...

Keyword(s):

Medical Care ◽

Neonatal Screening ◽

Screening Program ◽

German Society ◽

Thyroid Stimulating Hormone ◽

Primary Hypothyroidism ◽

Evidence Based ◽

Pediatric Endocrinology ◽

Group B ◽

Evidence Based Guidelines

Neonatal screening for congenital primary hypothyroidism (CH) is mandatory in Germany but medical care thereafter remains inconsistent. Therefore, the registry HypoDok of the German Society of Pediatric Endocrinology and Diabetology (DGKED) was analyzed to evaluate the implementation of evidence-based guidelines and to assess the number of included patients. Inclusion criteria were (i) date of birth between 10/2001 and 05/2020 and (ii) increased thyroid-stimulating hormone (TSH) at screening and/or confirmation. The cohort was divided into before (A) and after (B) guideline publication in 02/2011, to assess the guideline’s influence on medical care. A total of 659 patients were analyzed as group A (n = 327) and group B (n = 332) representing 17.5% and 10.3% of CH patients identified in the German and Austrian neonatal screening program during the respective time period. Treatment start and thyroxine doses were similar in both groups and consistent with recommendations. Regular follow-ups were documented. In the first three years of life, less than half of the patients underwent audiometry; developmental assessment was performed in 49.3% (A) and 24.8% (B) (p < 0.01). Documentation of CH patient care by pediatric endocrinologists seemed to be established, however, it reflected only a minority of the affected patients. Therefore, comprehensive documentation as an important instrument of quality assurance and evidence-based medicine should be legally enforced and officially funded in order to record, comprehend, and optimize care and outcome in patients with rare diseases such as CH.

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Application Effect of Medical Care Integration Combined with Family Intervention under the Evidence-Based Nursing Mode on Child Patients with Severe Hand-Foot-Mouth Disease and Its Influence on Intestinal Function

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/9599711 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Zhaofang Zhang ◽

Mei Dong ◽

Yuejiao Han ◽

Hui Lin ◽

Anying Li ◽

...

Keyword(s):

Medical Care ◽

Family Intervention ◽

Evidence Based ◽

Care Integration ◽

Oral Pain ◽

Child Patients ◽

Hand Foot Mouth Disease ◽

Group A ◽

Group B ◽

Evidence Based Nursing

Objective. To explore the application effect of medical care integration combined with family intervention under the evidence-based nursing mode on child patients with severe hand-foot-mouth disease (HFMD) and its influence on intestinal function. Methods. 120 child patients with severe HFMD admitted to Qilu Children’s Hospital of Shandong University from January 2019 to January 2020 were selected as the research object and randomly divided into group A and group B, with 60 cases each. Conventional nursing was performed on patients in group B, and medical care integration combined with family intervention under the evidence-based nursing mode was performed on patients in group A. Patients were assessed after the intervention using the hospital-made treatment adherence scale, PedsQLTM 4.0 (Pediatric Quality of Life Inventory Version 4.0) scale, and the faces pain scale-revised (FPS-R). The levels of gastrointestinal function indicators such as serum endotoxin (ET), diamine oxidase (DAO), and d-lactic acid (D-LA) were measured before and after the intervention, and recovery such as time to clear fever and time to relief of oral pain were recorded in both groups. Results. Children in group A had significantly higher compliance in diet, behaviour, exercise, and medication than group B ( P < 0.05 ); the time to clear fever, time to relief of oral pain, time to healing of oral ulcers, time to relief of skin herpes, time to hospitalization, and time to eating were shorter in group A than those in group B ( P < 0.001 ); all scores on the PedsQLTM 4.0 scale were higher in group A than those in group B after the intervention ( P < 0.001 ); ET, DAO, and D-LA levels decreased in both groups after the intervention, with group A having lower levels than group B ( P < 0.001 ), in addition, group A had lower eating pain scores after the intervention ( P < 0.05 ). Conclusion. Medical care integration combined with family intervention under the evidence-based nursing mode can effectively improve the treatment compliance of child patients with severe HFMD, accelerate their recovery progress, ensure a better prognostic quality of life and gastrointestinal tract function, and reduce the eating pain, indicating that such comprehensive nursing intervention mode should be promoted in practice.

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A Prospective Study Comparing Two-Time Points of Thyroid Hormone Replacement during the Holy Month of Ramadan

International Journal of Endocrinology ◽

10.1155/2019/9843961 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Zeinab Dabbous ◽

Buthaina Alowainati ◽

Sara Darwish ◽

Hamda Ali ◽

Seleena Farook ◽

...

Keyword(s):

Prospective Study ◽

Hormone Replacement ◽

Prospective Trial ◽

Primary Hypothyroidism ◽

Optimal Time ◽

Open Label ◽

Time Points ◽

Number Of Patients ◽

Group A ◽

Group B

Background. Muslims all over the world fast during the month of Ramadan from dawn until dusk. There is little data regarding the best timing of levothyroxine intake during the month of Ramadan where taking it on an empty stomach represents a challenge to most patients. Our study aims to compare two-time points of levothyroxine intake during Ramadan in terms of change in thyroid stimulating hormone (TSH), compliance, and convenience. Study Design and Methods. This was an open-label, randomized, prospective trial. Adult patients known to have primary hypothyroidism with stable TSH for the last 6 months who intended to fast during the month of Ramadan were invited to participate in this prospective study. The study took place during Ramadan of H1438 (May-June 2017). All patients were randomly assigned to two groups. In group A (n= 50) patients took levothyroxine 30 minutes before breaking the fast at sunset (iftar), and in group B (n= 46) patients took it 30 minutes before an early morning meal before sunrise (suhour). Results. TSH levels increased in both group A (from 1.99 to 3.28 mIU/L) and group B (from 1.54 to 3.28 mIU/L) after Ramadan fasting. There was no difference between the two groups. Compliance with intake instructions, all of the time, was reported in 41.6% of group A and 35.7% of group B patients. In both the groups, 95% of patients said it was convenient for them to take the medication at the assigned time. Conclusion. Choosing an optimal time for levothyroxine intake during the month of Ramadan remains a challenge. The current study did not provide any evidence on ideal time and dose of levothyroxine administration during fasting to manage hypothyroidism. Studies with a larger number of patients need to be done to further explore this issue.

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Living with HIV in the Time of COVID-19

Pakistan Journal of Public Health ◽

10.32413/pjph.v10i1.579 ◽

2020 ◽

Vol 10 (1) ◽

pp. 5-7

Author(s):

Muhammad Naveed Noor

Keyword(s):

Medical Care ◽

Developing Country ◽

People Living With Hiv ◽

Evidence Based ◽

Comorbid Conditions ◽

Increased Risk ◽

Associated Conditions ◽

Living With Hiv

This commentary foregrounds the need to examine how the coronavirus disease 2019 (COVID-19) pandemic and associated conditions may be affecting the lives of people living with HIV (PLWH) in a developing country context like Pakistan. It raises some important questions on medical care and updated information regarding PLWH in the time of COVID-19. Since PLWH are at an increased risk of developing comorbid conditions – something that makes them more vulnerable to COVID-19 – it is critical that timely research and evidence-based actions are undertaken to protect their health.

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Pubertal development and adult height in patients with congenital hypothyroidism detected by neonatal screening in southern Brazil

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0285 ◽

2020 ◽

Vol 33 (11) ◽

pp. 1449-1455

Author(s):

Suzana Nesi-França ◽

Rodrigo B. Silveira ◽

Juliana Cristina R. Rojas Ramos ◽

Adriane A. Cardoso-Demartini ◽

Monica N. Lima Cat ◽

...

Keyword(s):

Congenital Hypothyroidism ◽

Neonatal Screening ◽

Adult Height ◽

Screening Program ◽

Pubertal Development ◽

Z Score ◽

Normal Range ◽

Adequate Treatment ◽

Increased Risk ◽

Puberty Onset

AbstractObjectivesAdequate treatment of congenital hypothyroidism (CH) is required for normal growth and sexual development. To evaluate pubertal development in patients with permanent CH detected by a statewide Neonatal Screening Program of Paraná and, secondly, to evaluate adult height (AH) in a subgroup of patients.MethodsClinical, laboratory, and auxological data obtained from medical records of 174 patients (123 girls).ResultsMedian chronological age (CA) at treatment initiation was 24 days, and mean initial levothyroxine dose was 11.7 ± 1.9 μg/kg/day; mean CA at puberty onset was 11.5 ± 1.3 years (boys) and 9.7 ± 1.2 years (girls); mean CA in girls who underwent menarche (n=81) was 12.1 ± 1.1 years. Thyroid-stimulating hormone (TSH) values above the normal range were observed in 36.4% of the boys and 32.7% of the girls on puberty onset, and in 44.6% around menarche. Among 15 boys and 66 girls who had reached the AH, the median height z-score value was significantly greater than the target height (TH) z-score value in boys (p=0.01) and in girls (p<0.001). Boys with normal TSH values at puberty onset had greater mean AH z-score compared with boys with TSH values above the normal range (p=0.04).ConclusionsIn this group, pubertal development in girls with CH was not different from that reported in healthy girls in the general Brazilian population. Boys with higher TSH at puberty onset may have an increased risk of not reaching their potential height compared with those with normal TSH during this period. In a subgroup who attained AH, the median AH z-score was greater than the median TH z-score.

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Neonatal screening program for five conditions in Honduras

Journal of Community Genetics ◽

10.1007/s12687-021-00506-7 ◽

2021 ◽

Author(s):

Michelle Melissa Miralda Buckley ◽

Lindsay Borjas Aguilar ◽

Rosibel Colindres Lainez ◽

Hector Joaquin Alvarado Valenzuela ◽

Fernando Ponce ◽

...

Keyword(s):

Neonatal Screening ◽

Screening Program ◽

Neonatal Screening Program

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Remeex® System Effectiveness in Male Patients with Stress Urinary Incontinence

Journal of Clinical Medicine ◽

10.3390/jcm10102121 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2121

Author(s):

Gerardo-Alfonso Márquez-Sánchez ◽

Bárbara-Yolanda Padilla-Fernández ◽

Miguel Perán-Teruel ◽

Pedro Navalón-Verdejo ◽

Sebastián Valverde-Martínez ◽

...

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Surgical Techniques ◽

High Survival ◽

Complication Rates ◽

Exact Test ◽

Number Of Patients ◽

Male Stress Urinary Incontinence ◽

Group B

Background: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. Objectives: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. Materials and methods: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0–1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student’s t-test. Chi2, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. Results: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Conclusions: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

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Steps towards implementing evidence-based screening in family medicine in Ukraine: SWOT-analysis of an approach of multidimensional empowerment

BMC Family Practice ◽

10.1186/s12875-021-01367-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Pavlo Kolesnyk ◽

Thomas Frese ◽

Shlomo Vinker ◽

Ivanna Shushman ◽

Albina Zharkova ◽

...

Keyword(s):

Swot Analysis ◽

Screening Program ◽

Implementation Process ◽

Evidence Based ◽

National Guidelines ◽

Family Doctors ◽

External Threats ◽

The Family ◽

Gate Keeping ◽

Rapid Tests

Abstract Background The purpose of this study is to forward the implementation of an operational evidence-based state screening program of common diseases in Ukraine, where currently no state-based and evidence-based screening (EBS) exists. EBS should be performed by Family Doctors in a primary care setting and concern prevalent diseases in adults, such as: obesity (BMI), hypertension (BP measurement), diabetes (glycaemia), dyslipidemia (cholesterol/lipids), colon cancer (FOBT/colonoscopy), breast cancer (mammography), STIs (chlamydia, syphilis), HIV, HBV, HCV (i.e. serology or other rapid tests), HPV (swabs), cervical cancer (test Pap). depression (i.e., PHQ-9), and smoking (i.e., Fagerstrom). Methods Four needs-based research actions were led among citizens and healthcare professionals, based on multidimensional empowerment. Internal Strengths and Weaknesses of the ongoing implementation process were identified through these studies, whereas external Opportunities and Threats were determined by the present socio-cultural and political context. This SWOT analysis is likely to guide future state-based initiatives to accomplish EBS implementation in Ukraine. Results Internal Strengths are the bottom-up multidimensional empowerment approach, teaching of EBS and the development of an internet-based platform “Screening adviser” to assist shared decision making for person-centred EBS programs. Internal Weaknesses identified for the Family Doctors are a heterogeneous screening and the risk of decreasing motivation to screen. External Opportunities include the ongoing PHC reform, the existent WONCA and WHO support, and the existence of EBS programs in Europe. External Threats are the lack of national guidelines, not fully introduced gate keeping system, the vulnerable socio-economic situation, the war situation in the East of Ukraine and the Covid-19 pandemic. Conclusions We started EBS implementation through research actions, based on a multidimensional empowerment of citizens, HCP and in EBS pathways involved stakeholder teams, to foster a sustainable operational human resource to get involved in that new EBS pathway to implement. The presented SWOT-analysis of this ongoing implementation process allows to plan and optimize future steps towards a state based and supports EBS program in Ukraine.

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A Multi-Objective Optimization Method for Hospital Admission Problem—A Case Study on Covid-19 Patients

Algorithms ◽

10.3390/a14020038 ◽

2021 ◽

Vol 14 (2) ◽

pp. 38

Author(s):

Amr Mohamed AbdelAziz ◽

Louai Alarabi ◽

Saleh Basalamah ◽

Abdeltawab Hendawi

Keyword(s):

Medical Care ◽

Real Life ◽

Optimization Method ◽

Multi Objective Optimization ◽

Admission Process ◽

Multi Objective ◽

Admission Time ◽

King Faisal Specialist Hospital ◽

Number Of Patients ◽

Massive Number

The wide spread of Covid-19 has led to infecting a huge number of patients, simultaneously. This resulted in a massive number of requests for medical care, at the same time. During the first wave of Covid-19, many people were not able to get admitted to appropriate hospitals because of the immense number of patients. Admitting patients to suitable hospitals can decrease the in-bed time of patients, which can lead to saving many lives. Also, optimizing the admission process can minimize the waiting time for medical care, which can save the lives of severe cases. The admission process needs to consider two main criteria: the admission time and the readiness of the hospital that will accept the patients. These two objectives convert the admission problem into a Multi-Objective Problem (MOP). Pareto Optimization (PO) is a common multi-objective optimization method that has been applied to different MOPs and showed its ability to solve them. In this paper, a PO-based algorithm is proposed to deal with admitting Covid-19 patients to hospitals. The method uses PO to vary among hospitals to choose the most suitable hospital for the patient with the least admission time. The method also considers patients with severe cases by admitting them to hospitals with the least admission time regardless of their readiness. The method has been tested over a real-life dataset that consisted of 254 patients obtained from King Faisal specialist hospital in Saudi Arabia. The method was compared with the lexicographic multi-objective optimization method regarding admission time and accuracy. The proposed method showed its superiority over the lexicographic method regarding the two criteria, which makes it a good candidate for real-life admission systems.

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