Systemic Treatments for Adult Patients with Moderate-to-Severe Psoriasis: Consensus Statements for the United Arab Emirates

2021 ◽  
Vol 02 ◽  
Author(s):  
Anwar Al. Hammadi ◽  
Muna Al. Murrawi ◽  
Huda R. Ali ◽  
Ashraf M. Reda ◽  
Hussein A. Dayem ◽  
...  
Keyword(s):  
United Arab Emirates ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Severe Psoriasis ◽  
Collective Agreement ◽  
Systemic Treatments ◽  
Consensus Statements ◽  
Set Up ◽  
Systemic Therapies

Background: Psoriasis is a chronic, immune-mediated disease characterized by mild localized plaques to severe plaques involving any part of the skin; it has a pronounced effect on patients’ quality of life. In the United Arab Emirates (UAE), there are limited local guidelines for the management of patients with psoriasis in daily clinical practice. Objectives: The study aimed to develop consensus statements for the evaluation and management of moderate-to-severe psoriasis in the UAE. Methods: To develop consensus statements, the Emirates Dermatology Society set up advisory board meetings in which local key opinion leaders (KOLs), including dermatologists from the UAE, participated. A targeted literature review was conducted to review current international and regional guidelines on the management of psoriasis, based on which the statements were formulated. A final consensus on each statement was reached based on collective agreement among the KOLs. Results : Consensus statements were generated with the intention of supporting physicians in clinical decision-making with respect to the classification of disease severity, treatment options including biologic and non-biologic systemic therapies, transitioning and adjusting of systemic therapies, and monitoring and management of psoriasis in special populations. Conclusion: These consensus statements could provide useful, practical guidance on the diagnosis and management of patients with moderate-to-severe psoriasis and would cater to the needs of physicians in the UAE.

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

Aortoiliac Reconstruction

2017 ◽  
Author(s):  
Mark K. Eskandari ◽  
Michael J Nooromid
Keyword(s):  
Clinical Decision Making ◽  
Preoperative Evaluation ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Clinical Decision ◽  
Occlusive Disease ◽  
Aortobifemoral Bypass ◽  
Aortoiliac Occlusive Disease ◽  
Atherosclerotic Occlusive Disease ◽  
Aortoiliac Reconstruction

This review outlines the preoperative evaluation, clinical decision making, and surgical treatment options for patients with aortoiliac occlusive disease. It also details the open surgical techniques for the treatment of aortoiliac occlusive disease and reviews endovascular treatment options. The discussion of treatment options includes the potential complications and expected outcomes, as well as steps that can be taken to optimize surgical results. Key words: aortobifemoral bypass, aortoiliac reconstruction, atherosclerotic occlusive disease, endovascular reconstruction, femoral endarterectomy, iliac angioplasty, iliac stenting, peripheral vascular disease 

Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment

2020 ◽  
Vol 91 (8) ◽  
pp. 879-888 ◽  
Author(s):  
Clemens Gstoettner ◽  
Johannes A Mayer ◽  
Stephanie Rassam ◽  
Laura A Hruby ◽  
Stefan Salminger ◽  
...  
Keyword(s):  
High Resolution ◽  
Peripheral Nerve ◽  
Clinical Decision Making ◽  
Current Knowledge ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Clinical Decision ◽  
Neuralgic Amyotrophy ◽  
Positive Effects ◽  
Nerve Surgery

Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes. These views, however, have been challenged in the last years. Improved imaging methods in MRI and high-resolution ultrasound have led to the identification of structural peripheral nerve pathologies in NA, most notably hourglass-like constrictions. These pathognomonic findings have paved the way for more accurate diagnosis through high-resolution imaging. Furthermore, surgery has shown to improve clinical outcomes in such cases, indicating the viability of peripheral nerve surgery as a valuable treatment option in NA. In this review, we present an update on the current knowledge on this disease, including pathophysiology and clinical presentation, moving on to diagnostic and treatment paradigms with a focus on recent radiological findings and surgical reports. Finally, we present a surgical treatment algorithm to support clinical decision making, with the aim to encourage translation into day-to-day practice.

A Multiscale Specimen-Specific Data Set to Enable Comprehensive Modeling and Simulation of the Tibiofemoral Joint

2013 ◽  
Author(s):  
Snehal Chokhandre ◽  
Ahmet Erdemir
Keyword(s):  
Clinical Decision Making ◽  
Mechanical Response ◽  
Multiple Scales ◽  
Treatment Options ◽  
Complex Structure ◽  
Clinical Decision ◽  
Fe Analysis ◽  
Data Set ◽  
Tibiofemoral Joint ◽  
Joint Biomechanics

The tibiofemoral joint is a complex structure and its overall mechanical response is dictated by its numerous substructures at both macro and micro levels. An in-depth understanding of the mechanics of the joint is necessary to develop preventative measures and treatment options for pathological conditions and common injuries. Finite element (FE) analysis is a widely used tool in joint biomechanics studies focused on understanding the underlying mechanical behavior at joint, tissue and cell levels [1]. Studies, regardless of their purpose (descriptive or predictive), when employing FE analysis, require anatomical and mechanical data at single or multiple scales. It is also critical that FE representations are validated and closely represent specifics of the joint of interest, anatomically and mechanically. This is an utmost need if these models are intended to be used to support clinical decision making (in surgery or for rehabilitation) and for the development of implants.

scholarly journals Orthodontic treatment time: can it be shortened?

2018 ◽  
Vol 23 (6) ◽  
pp. 90-105 ◽  
Author(s):  
Ricardo Moresca
Keyword(s):  
Orthodontic Treatment ◽  
Clinical Decision Making ◽  
Tooth Movement ◽  
Treatment Time ◽  
Treatment Options ◽  
Clinical Decision ◽  
Orthodontic Appliances ◽  
Factors Influencing ◽  
Determining Factors ◽  
Major Factors

Abstract Introduction: In the literature, no consensus has been reached about orthodontic treatment time. Similarly, the determining factors of the latter have not yet been completely elucidated. Objective: The aim of the present article was to deepen the discussion on the major factors influencing orthodontic treatment time, as well as to present some strategies that have proven effective in controlling and shortening it. Method: Based on evidences found in the literature, the method focussed in providing the basis for clinical decision-making. Conclusions: Treatment time varies according to the type of malocclusion and treatment options. Orthodontist’s influence, patient’s characteristics and compliance are all decisive in determining treatment time, while the effects provided by orthodontic appliances and methods used to speed tooth movement up seem little effective.

scholarly journals How Much? How Frequent? How Long? A Clinical Guide to New Therapies in Myelodysplastic Syndromes

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 314-321 ◽  
Author(s):  
William Blum
Keyword(s):  
Quality Of Life ◽  
Myelodysplastic Syndromes ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Improve Quality ◽  
Substantial Impact ◽  
History Of

AbstractAdvances in the treatment of myelodysplastic syndromes (MDSs) over the last decade have given patients and their hematologists a multitude of treatment options. Therapeutic options now exist that reduce disease-related symptoms, improve quality of life, and alter the natural history of the disease. Three drugs are now specifically Food and Drug Administration-approved for treatment of MDS: (1) azacitidine, (2) decitabine, and (3) lenalidomide. Clinical results with each of these agents, plus results with immunosuppressive therapy, are reviewed to guide clinical decision making. Although each therapy has made a substantial impact in improving the care of patients with MDS, unfortunately MDS treatment in 2010 ultimately fails in most patients, but these therapies provide a foundation on which we can build to further improve outcomes.

Mutation landscape of Chinese melanoma patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 9563-9563
Author(s):  
Fuxue Huang ◽  
Dandan Li ◽  
Xizhi Wen ◽  
Fang Wang ◽  
Xiaoshi Zhang ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Genomic Profiling ◽  
Primary Tumors ◽  
Positive Correlation ◽  
Mutation Burden ◽  
Frequent Mutations ◽  
Melanoma Patients

9563 Background: Treatment options for melanoma, which has the highest mutation burden among common cancers, has proliferated in the past decade. Genomic profiling has becoming essential to clinical decision making. However, limited studies have interrogated the genomic landscape of Chinese melanoma patients. We also investigated the correlation between tumor mutation burden (TMB) and clinical outcomes of immunotherapy (IO). Methods: In this study, we retrospectively surveyed the genomic profiling of primary tumors of 81 (40 males, 41 females) metastatic Chinese melanoma patients with a median age of 52, using a panel consisting of 295 cancer-related genes, spanning 2.02MB of human genome. Patients used IO as first line treatment (n = 25) were enrolled for survival analyses. Results: In this cohort, 15, 24 and 42 were acral, mucosal and cutaneous melanoma, respectively. Collectively, we identified 1,114 mutations, spanning 248 genes, with BRAF, MYC and NBN being the most frequently mutated genes, occurring in 40%, 27% and 21% of patients, respectively. Mutation spectrum varied significantly by subtypes. BRAF (57%) and LRP1B (26%) were the most frequently mutated genes in cutaneous melanoma (CM). KIT and NRAS, reported to be frequently mutated in CM, each occurred in only 12% patients in this cohort. MYC amplification was the most commonly seen mutation in acral and mucosal melanoma (MM). Other frequent mutations in MM included: NBN (38%) RUNX1T1(29%) and TP53 (29%). In acral melanoma (AM), CCND1, FGF3/19, NF1and NBN were frequently mutated. It is interesting to note that no TP53 mutation was observed in AM. AM and MM had significantly more CNVs than CM. Of the 25 patients underwent IO, our data revealed a positive correlation between TMB and PFS (p = 0.007). Such correlation also exited in each subtype. Furthermore, we derived a cutoff of 15, which can effectively distinguish clinical response. Patients with TMB > 15 mut/Mb had a significantly longer PFS than patients harboring TMB < 15 mut/Mb (P = 0.02). Patients with CM had a longer PFS than patients with AM or MM (p = 0.018). No correlation between PDL1 expression and PFS was observed. Conclusions: Our study revealed a distinctive mutation landscape for each subtype. Furthermore, we also revealed a positive correlation between TMB and PFS as well as a lack of correlation between PDL1 expression and PFS.

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

scholarly journals Communication of Pharmacogenomic Test Results and Treatment Plans in Pediatric Oncology: Deliberative Stakeholder Consultations with Parents

2020 ◽  
Author(s):  
Cristina Longo ◽  
Vasiliki Rahimzadeh ◽  
Gillian Bartlett
Keyword(s):  
Small Group ◽  
Brain Cancer ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Effective Communication ◽  
Clinical Decision ◽  
Current Treatment ◽  
Communication Strategy ◽  
Communication Preferences ◽  
Care Experience

Abstract Background: Effective communication in support of clinical decision-making is central to the pediatric cancer care experience for families. A new laboratory derived pharmacogenetic test (LDT) that can diagnose difficult-to-treat brain cancers has been developed to stratify children based on their ability to respond to available treatment; however, the potential implementation of the LDT may make effective communication challenging since it can potentially remove the option for curative treatment in those children identified as non-responders, i.e. those with a catastrophic diagnosis. Objective: We solicited the perspectives of parents of children with difficult-to-treat brain cancer on communication preferences surrounding the potential implementation of the LDT in standard care using deliberative stakeholder consultations.Methods: Eight bereaved parents of children who succumbed to difficult-to-treat brain cancer, and four parents of children currently undergoing treatment for similar cancers attended separate small-group deliberative consultations – a stakeholder engagement method that enables the co-creation of recommendations following the consideration of competing arguments and diverse opinions of parents with different experiences. In the small-group consultations (Phase I), parents discussed four questions about potential communication issues that may arise with the LDT in practice. In Phase II, a total of five parents from both stakeholder groups (4 bereaved and 1 in current treatment) attended a consultation, known as the ‘mixed’ consultation, with the purpose of co-developing concrete recommendations for implementation of the LDT.Results: Explaining the risks, benefits, and accuracy of the LDT were considered essential to parents. Once an LDT-based diagnosis/prognosis can be made, parents valued honesty, empathy, and clarity in communication. Parents also requested that all results and treatment options be presented to them in measured doses, and in an unbiased manner over the course of several meetings. This communication strategy allowed sufficient time to understand and accept the diagnosis/prognosis, particularly if it was catastrophic. Continuous access to the appropriate psychological and social support or counselling at and post-diagnosis was also strongly recommended.Conclusions: Deliberants co-created family-centered recommendations surrounding communication issues of the LDT, providing guidance to pediatric oncologists that could implement the test in practice.

scholarly journals Deep Learning of Markov Model Based Machines for Determination of Better Treatment Option Decisions for Infertile Women

2019 ◽  
Author(s):  
Arni S.R. Srinivasa Rao ◽  
Michael P. Diamond
Keyword(s):  
Mathematical Modeling ◽  
Machine Learning ◽  
Deep Learning ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Infertile Women ◽  
Learning Techniques ◽  
Technical Article

AbstractIn this technical article, we are proposing ideas those we have been developing of how machine learning and deep learning techniques can potentially assist obstetricians / gynecologists in better clinical decision making using infertile women in their treatment options in combination with mathematical modeling in pregnant women as examples.

Sign in / Sign up

Export Citation Format

Share Document