scholarly journals Innovation strategies in CKD prevention and treatment – challenges, opportunities and sharing best practice

2019 ◽  
pp. 3-12 ◽  
Author(s):  
M. Kolesnyk
Keyword(s):  
Best Practice ◽  
Scientific Evidence ◽  
Clinical Care ◽  
Cognitive Disorders ◽  
Public Health Problem ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Global Public Health ◽  
Early Screening ◽  
Self Testing

Abstract. Chronic kidney disease (CKD) is a global public health problem, with cardiovascular disease being the major cause of mortality in these patients. CKD is associated with elevated risks of all-cause mortality and other adverse outcomes. This review is highlighting the consistency of the evidence about the hazards that are associated with CKD. The challenge that clinicians now face is to search for CKD, to manage it aggressively, to evaluate novel means of detecting CKD and to expand the therapeutic strategies for patients with CKD. The evidence base for informing effective kidney care is limited, and the translation of existing knowledge to routine clinical care is slow. Innovative approaches are described – patient-oriented care, complex care individualization, early screening for cognitive disorders, anxiety, renal education including education aids & e-Kidney application, teletechnology approach and CKD-self-testing in rural area, novel therapeutic targets for innovative CKD-oriented drugs, etc. Trials with the aim of re-purposing of generic therapeutics should be prioritized if sufficient scientific evidence is available. Furthermore, strategies used to extend patent life of drugs, but without investment to assess re-purposing, should be discouraged. Finally, if the above goals are achieved, new therapies will certainly become available to stop, slow, or reverse CKD. These therapies should be made accessible to populations around the globe.

scholarly journals Gaps in tuberculosis control in Armenia: How to improve the care system?

2020 ◽  
Vol 14 (11.1) ◽  
pp. 133S-139S
Author(s):  
Hayk Davtyan ◽  
Ani Petrosyan ◽  
Garry Aslanyan ◽  
Seda Aghabekyan ◽  
Deborah De Basso ◽  
...  
Keyword(s):  
Scientific Evidence ◽  
Treatment Success ◽  
Treatment Guideline ◽  
Public Health Problem ◽  
People Living With Hiv ◽  
Global Public Health ◽  
Tb Treatment ◽  
Living With Hiv ◽  
Lost To Follow Up ◽  
Care System

Introduction: Tuberculosis (TB) continues to be a global public health problem. People with weakened immune systems are more vulnerable to TB. It is one of the top 10 causes of death worldwide and is a leading cause of death for people living with HIV (PLWH). The aim of the current study was to perform programmatic data analysis of TB cases treated with the first-line drugs, registered in Armenia for the period of January 2017 – August 2018, and to identify gaps in TB care system in Armenia. Methodology: A retrospective cohort study using programmatic data from National TB Program. Results: Overall treatment success rate for the period of study was 79%. HIV had impact only on “died” outcome with odds ratio (OR) of 20.9. More than a third (34%) of all HIV-positive patients died during TB treatment and 45% of patients who had non-Armenian citizenship were lost to follow-up during the treatment (OR = 3.3). Treatment duration for the 8% of all cases (mainly with brain or bone localization) was > 9 months and lasted up to 500 days. Conclusions: Better collaboration and partial integration of TB and HIV services in Armenia is required. The access to care for non-Armenian citizens needs to be improved. The national TB treatment guideline needs to be updated based on scientific evidence. This study demonstrates that continuous analysis of the available data and tailoring of the system is required to address the needs of key populations and achieve universal care coverage.

Presurgical orthopaedics/nasoalveolar moulding in cleft children: could you, should you, would you?

2013 ◽  
Vol 4 (3) ◽  
pp. 132-137
Author(s):  
Alexander C Cash
Keyword(s):  
Best Practice ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Plate Osteosynthesis ◽  
Scientific Evidence ◽  
Treatment Protocol ◽  
Evidence Base ◽  
Big Brother ◽  
Research Protocols ◽  
Mini Plate

‘Amalgam versus composite’, ‘wisdom tooth coronectomy versus extraction in toto’, ‘wet versus dry bonding’, ‘smooth versus rough implants’, ‘cortical screws versus Mini-plate osteosynthesis’ – there are controversies, myths and mystery in all areas of modern dentistry, even today, in this age of scientific evidence, best practice and big brother. In the cleft world, controversies also abound. In fact, fundamental questions remain unanswered: we still do not know what the best overall treatment protocol is for the child born with a complete unilateral bony cleft lip and palate.1 Little by little, however, the evidence base is enlarging. Centralised UK regional cleft services, knowledge of national and international outcomes, and research protocols all aid the plugging of these gaps in our knowledge, and help us to find the missing pieces of the cleft jigsaw.

Syphilis (Treponema pallidum)

2018 ◽  
Author(s):  
Mark N. Gilroy ◽  
Juan C. Salazar
Keyword(s):  
Congenital Syphilis ◽  
Transmitted Disease ◽  
Treponema Pallidum ◽  
Public Health Problem ◽  
Adverse Outcomes ◽  
Global Public Health ◽  
Serological Screening ◽  
Sexually Transmitted

Syphilis, a chronic, sexually transmitted disease caused by the extracellular spirochete Treponema pallidum, has exhibited a remarkable resurgence in recent years. Despite the existence of inexpensive, easily administered, and highly effective antibiotic treatments, maternal and neonatal syphilis infections continue to be a major global public health problem. In addition to its potential to cause morbidity in the mother, untreated gestational syphilis (GS) can lead to serious adverse outcomes in the offspring, including stillbirth, prematurity, low birth weight, and neonatal death. Congenital syphilis (CS) is regarded as a missed opportunity during the antenatal care of the mother, resulting from socioeconomic, demographic, and behavioral factors that promote mother-to-child transmission (MTCT) of syphilis. This chapter emphasizes emerging concepts about screening aimed at controlling the ongoing epidemic, including serological screening of mother and infant, newer paradigms of “reverse screening,” clinical presentation, therapy, and long-term neurodevelopmental disabilities that must be a component of follow-up care.

scholarly journals A Public Health Approach to Global Child Sex Trafficking

2020 ◽  
Vol 41 (1) ◽  
pp. 481-497 ◽  
Author(s):  
Jordan Greenbaum
Keyword(s):  
Public Health ◽  
Human Trafficking ◽  
Sex Trafficking ◽  
Scientific Evidence ◽  
Sexual Exploitation ◽  
Evidence Base ◽  
Public Health Approach ◽  
Global Public Health ◽  
Public Health Professionals ◽  
Child Sex Trafficking

Human trafficking and child sex trafficking and sexual exploitation in particular are global public health issues with widespread, lasting impacts on children, families, and communities. Traditionally, human trafficking has been treated as a law enforcement problem with an emphasis on the arrest and prosecution of traffickers. However, use of a public health approach focuses efforts on those impacted by exploitation: trafficked persons, their families, and the population at large. It promotes strategies to build a solid scientific evidence base that allows development, implementation, and evaluation of prevention and intervention efforts, informs policy and program development, and guides international efforts at eradication. This article uses the public health approach to address human trafficking, with a focus on child sex trafficking and exploitation. Recommendations are made for public health professionals to contribute to antitrafficking efforts globally.

Level of scientific evidence supporting NCCN guidelines: Is there evidence of progress?

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 14-14
Author(s):  
Aakash Desai ◽  
Ronald S. Go ◽  
Thejaswi Poonacha
Keyword(s):  
Scientific Evidence ◽  
Clinical Care ◽  
Uterine Cancer ◽  
Evidence Base ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Current Evidence Base ◽  
The Us ◽  
Therapeutic Recommendations

14 Background: National Comprehensive Cancer Network (NCCN) guidelines are the most comprehensive and widely used standard for clinical care in oncology by clinicians and payors in the US. The level of scientific evidence in NCCN guidelines has not been studied since it’s last review in 2010. We describe the categories of evidence and consensus (EC) among the 10 most common cancers in the US as of 2019 and compare them with 2010 guidelines. Methods: We obtained the 2019 version of NCCN guidelines. The definitions for various categories of EC used were: Category 1 (high level evidence such as randomized controlled trials with uniform consensus), 2A (lower level of evidence with uniform consensus), 2B (lower level of evidence without a uniform consensus but with no major disagreement) and 3 (any level of evidence but with major disagreement). We compared our results with previously published results from 2010 guidelines. Results: Total recommendations increased by 77% from 1023 (2010) to 1818 (2019). Of the 1818 recommendations, Category 1, 2A, 2B and 3 EC were 7%, 87%, 6% and 0% while in 2010 they were 5%, 85%, 9% and 1% respectively. Recommendations with category 1 EC were found in lung (13%), prostate (11%), melanoma (8%), breast (7%), NHL (5%), kidney (2%), bladder (2%) and colorectal (2%) guidelines. Pancreatic and uterine cancer guidelines had no recommendations with category 1 EC. 19% of therapeutic recommendations were category 1 EC with the majority (65%) pertaining to initial therapy. Guidelines with highest proportions of therapeutic recommendations with category 1 EC were breast (30%), lung (10%), and kidney (10%) cancers. No category 1 EC recommendations existed in screening or surveillance. Although we found an increase in the total number of recommendations, the distribution of different types of categories of EC are largely similar to 2010. Conclusions: Recommendations in 2019 NCCN guidelines are largely derived from lower levels of evidence with uniform expert opinion. Despite the major advances in oncology in the past decade, this is largely unchanged. Our study underscores the urgent need and available opportunities to expand the current evidence base in oncology which forms the platform for clinical practice guidelines.

scholarly journals Coastal drowning: A scoping review of burden, risk factors, and prevention strategies

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246034
Author(s):  
William Koon ◽  
Amy Peden ◽  
Jasmin C. Lawes ◽  
Robert W. Brander
Keyword(s):  
Risk Factors ◽  
Scoping Review ◽  
Public Health Problem ◽  
Evidence Base ◽  
Future Research ◽  
Global Public Health ◽  
Prevention Strategies ◽  
Research Gaps ◽  
Drowning Prevention ◽  
Safety Research

Objective Coastal drowning is a global public health problem which requires evidence to support safety initiatives. The growing multidisciplinary body of coastal drowning research and associated prevention countermeasures is diverse and has not been characterised as a whole. The objective of this scoping review was to identify key concepts, findings, evidence and research gaps in the coastal drowning literature to guide future research and inform prevention activities. Methods We conducted a scoping review to identify peer reviewed studies published before May 2020 reporting either (i) fatal unintentional coastal drowning statistics from non-boating, -disaster or -occupational aetiologies; (ii) risk factors for unintentional fatal coastal drowning; or (iii) coastal drowning prevention strategies. Systematic searches were conducted in six databases, two authors independently screened studies for inclusion and one author extracted data using a standardised data charting form developed by the study team. Results Of the 146 included studies, the majority (76.7%) were from high income countries, 87 (59.6%) reported coastal drowning deaths, 61 (41.8%) reported risk factors, and 88 (60.3%) reported prevention strategies. Populations, data sources and coastal water site terminology in the studies varied widely; as did reported risk factors, which most frequently related to demographics such as gender and age. Prevention strategies were commonly based on survey data or expert opinion and primarily focused on education, lifeguards and signage. Few studies (n = 10) evaluated coastal drowning prevention strategies. Discussion Coastal drowning is an expansive, multidisciplinary field that demands cross-sector collaborative research. Gaps to be addressed in coastal safety research include the lack of research from lower resourced settings, unclear and inconsistent terminology and reporting, and the lack of evaluation for prevention strategies. Advancing coastal drowning science will result in a stronger evidence base from which to design and implement effective countermeasures that ultimately save lives and keep people safe.

scholarly journals Ensuring Consistent European-Wide Urological Care by the Use of Evidence-Based Clinical Practice Guidelines: Can We Do Better

2017 ◽  
Vol 2 (Suppl. 1) ◽  
pp. 1-7
Author(s):  
Emma Jane Smith ◽  
Steven MacLennan ◽  
Anders Bjartell ◽  
Alberto Briganti ◽  
Thomas Knoll ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Evidence Based ◽  
Robust Methods ◽  
Practice Recommendations

The European Association of Urology (EAU) annually updates 21 clinical practice guidelines in which summaries of the evidence base and best practice recommendations are made. The methodology applied to achieve this and integrate stakeholder opinion is continuously improving. However, there is evidence to suggest wide variation in clinical practice indicating that many patients receive suboptimal and heterogeneous care. Studies from certain countries suggest that 2 out of 5 patients do not receive care according to the current scientific evidence, and in 1 out of 4 cases the care provided is potentially harmful. Clearly, the harmonisation of care in alignment with evidence-based best practice recommendations is something to strive for. Development of robust methods to disseminate and implement guideline recommendations and measure their impact is an objective the EAU is committed to improving. An important strategy for achieving harmonisation in urological care across Europe is to ensure the availability of high-quality clinical practice guidelines and to actively promote their implementation by clinicians and healthcare providers.

scholarly journals The Controversies, Challenges and Complexities of Lyme Disease: A Narrative Review

2018 ◽  
Vol 21 ◽  
pp. 429-436 ◽  
Author(s):  
Marie Claire Van Hout
Keyword(s):  
Public Health ◽  
Lyme Disease ◽  
Clinical Care ◽  
Evidence Base ◽  
Narrative Review ◽  
Health Concern ◽  
Future Research ◽  
Global Public Health ◽  
Broad Perspective ◽  
History Of

Purpose: Lyme disease has become an increasingly important global public health concern. Method: A narrative review was conducted and designed to present a broad perspective on Lyme disease, and describe its history and development in terms of clinical care and public health implications. A structured literature search was conducted based on the question; what is currently known about Lyme disease? Results: The narrative review is presented in chronological order in terms of a summary of the history of Lyme disease, the complexities of clinical diagnosis, the problematic interpretation of serologic testing, the conflicting guidelines for diagnosis, treatment and management of chronic Lyme, and benefits of antibiotic treatment. Conclusion: Despite growing global incidence of the Lyme disease, treatment has not attracted pharmaceutical investment, and the evidence base and international guidelines for treatment and management of chronic Lyme continue to be conflicting and controversial. The challenges of this immune mediated tick borne disease for public health policy and clinical practice are summarised, alongside directions for future research.

scholarly journals Early CPAP reduced mortality in covid-19 patients. Audit results from Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

2020 ◽  
Author(s):  
Abdul Ashish ◽  
Alison Unsworth ◽  
Jane Martindale ◽  
Luigi Sedda ◽  
Ramachandran Sundar ◽  
...  
Keyword(s):  
Best Practice ◽  
Small Sample Size ◽  
Clinical Care ◽  
Evidence Base ◽  
Good Evidence ◽  
Small Sample ◽  
Teaching Hospitals ◽  
Sufficient Evidence ◽  
Recent Experience ◽  
Common Clinical Practice

AbstractCOVID-19 infection typically causes pneumonia with bilateral changes on Chest radiograph. There is significant hypoxia and use of oxygen for patients admitted to hospital is standard. The use of Continuous Positive Airway Pressure (CPAP) in patients with COVID-19 has now become established as a common clinical practice based on recent experience. It is given as part of “best endeavours” treatment in the absence of sufficient evidence to guide best practice. The use of CPAP as a step up in clinical care is now common but has a poor evidence base.Using routinely collected data, the use of CPAP as a supportive non-invasive ventilatory treatment is described in 35 patients with COVID infection. Patients given early CPAP and in particular within 48 hours of admission, are shown to have a better outcome (a significant probability of lower mortality) than patients who received late CPAP (more than 48 hours after admission).Although the analysis is affected by a small sample size, the results have shown good evidence that supports the early use of CPAP in patients with COVID-19 infection.

scholarly journals SO080NOVEL EVIDENCE OF THE “PULMO-RENAL INTERACTION” AS A DISEASE DRIVER IN PATIENTS WITH CKD AND COPD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Stefan Schunk ◽  
Christoph Beisswenger ◽  
Christian Herr ◽  
Felix Ritzmann ◽  
Triem Sarah ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Kidney Injury ◽  
Public Health Problem ◽  
Adverse Outcomes ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Global Public Health ◽  
Kidney Fibrosis ◽  
Copd Patients

Abstract Background and Aims Chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) represent a global public health problem worldwide. As such, both conditions are associated with high disease-related morbidity and mortality. However, it is unclear whether the presence of CKD aggravates the clinical course of COPD and vice versa. Method In a novel murine model of cigarette smoke (CS)-induced lung injury combined with an adenine nephropathy model, kidney and lung inflammation, and fibrosis were studied. Moreover, in 2,314 patients with stable COPD enrolled in the prospective, multi-centre COSYCONET study, urinary Dickkopf-3 (DKK3), a biomarker of kidney injury and CKD progression was quantified. The association between urinary DKK3 and trajectories of forced expiratory pressure in 1 second (FEV1) and estimated glomerular filtration rate (eGFR) during a median follow-up of 37.1 months, exercise capacity, risk of exacerbation, and mortality was determined. Results In the CKD-COPD animal model, the presence of kidney injury was associated with increased systemic and pulmonary inflammation, impaired pulmonary function, as well as more severe damage of the lung architecture. Moreover, CS enhanced kidney fibrosis. Accordingly, in the COPD patients from the COSYCONET study, higher urinary DKK3 was associated with declining FEV1 during follow-up (OR 3.36, 95% CI 2.22-5.08). Moreover, high urinary DKK3 was associated with higher risk for exacerbation (OR 1.24, 95% CI 1.03-1.50), lower 6-minute walking distance, and higher all-cause mortality (HR 1.49, 95% CI 1.08-2.05). Importantly, high urinary DKK3 was associated with declining eGFR during follow-up (OR 2.23, 95% CI 1.22-4.07) independently from baseline kidney function and proteinuria, which was confirmed by a machine learning approach. Conclusion These data uncover a novel pathophysiological link between CKD and COPD. Patient with COPD and concomitant CKD are at high risk for worsening pulmonary function and adverse outcomes. Elevated urinary DKK3 allows identification of COPD patients with progressive CKD. Measurement of urinary DKK3 in patients with COPD may therefore represent a novel tool for risk stratification and the identification of patients, who might in particular benefit from preventive therapeutic strategies to prevent progression of COPD and CKD as well.

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