scholarly journals Methotrexate in the therapeutic pathway of patients with psoriasis. Analysis of clinical practice data and comparison with guidelines

2021 ◽  
Author(s):  
V. Corazza ◽  
F. Cusano ◽  
O. De Pità ◽  
L. Rossi ◽  
G. Virno
Keyword(s):  
Clinical Practice ◽  
Working Group ◽  
Epidemiological Data ◽  
Position Statement ◽  
Biological Drugs ◽  
Biologic Drugs ◽  
Adequate Model ◽  
Critical Elements ◽  
Suitable Treatment ◽  
Current Guidelines

Introduction Psoriasis is an inflammatory skin disease with a chronic-relapsing course. It is estimated that the prevalence in Italy is 3%. An adequate model of taking care of the patient with psoriasis allows the patient to benefit from the most suitable treatment option for his health needs. In this position statement the observations, criticalities and proposals for improvement of the Pso-Path Working Group, composed by health economists, clinicians and patients, on the diagnostic-therapeutic pathway of the patient with psoriasis have been collected. In particular, the deviation of clinical practice from the current Guidelines for the management of patients with psoriasis, which recommend the use of biologic drugs in case of non-response, intolerance or contraindication to Methotrexate or Cyclosporine, was evaluated. Method A Working Group was convened whose participants were asked to express their thoughts on the diagnostic and therapeutic pathway of the patient with psoriasis, bringing out critical elements and proposals for improvement, based on their experiences. Conclusion This position statement summarizes the experiences and consensus between clinicians and patients on actions to optimize the management of patients with psoriasis undergoing biological treatment. Compared to the epidemiological data currently available, it is believed that only a small percentage of patients with psoriasis are treated with systemic drugs. The perception of clinicians, according to their experience, confirms the data emerging from the National Report "National Observatory on the Use of Medicines" (Osmed) compiled by AIFA in 2015, according to which more than 77% of patients with psoriasis are started to treatment with biological drugs without a previous use of Methotrexate or Cyclosporine for at least 3 months. The Pso-Path Working Group came to the conclusion that it would be desirable to incentivize, through the formalization of regional guidelines, the creation of a network system that promotes not only a greater awareness, at the territorial level, of the importance and impact of the disease and the possible paths, but also the collaboration and connection between all the actors involved in the overall care of the patient.

Controversial issues in CKD clinical practice: position statement of the CKD-treatment working group of the Italian Society of Nephrology

2016 ◽  
Vol 30 (2) ◽  
pp. 159-170 ◽  
Author(s):  
Vincenzo Bellizzi ◽  
◽  
Giuseppe Conte ◽  
Silvio Borrelli ◽  
Adamasco Cupisti ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Working Group ◽  
Position Statement ◽  
Italian Society ◽  
Controversial Issues

scholarly journals Emergency management of the paediatric patient with convulsive status epilepticus

2021 ◽  
Vol 26 (1) ◽  
pp. 50-57
Author(s):  
Kyle C McKenzie ◽  
Cecil D Hahn ◽  
Jeremy N Friedman
Keyword(s):  
Clinical Practice ◽  
Status Epilepticus ◽  
Emergency Management ◽  
Treatment Algorithm ◽  
Position Statement ◽  
Convulsive Status Epilepticus ◽  
Pharmacological Management ◽  
The Past ◽  
New Treatment ◽  
New Evidence

Abstract This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.

scholarly journals BSPGHAN Motility Working Group position statement: paediatric multichannel intraluminal pH impedance monitoring—indications, methods and interpretation

2017 ◽  
Vol 8 (3) ◽  
pp. 156-162 ◽  
Author(s):  
Mohamed Mutalib ◽  
David Rawat ◽  
Keith Lindley ◽  
Osvaldo Borrelli ◽  
Steve Perring ◽  
...  
Keyword(s):  
Working Group ◽  
Position Statement ◽  
Group Position ◽  
Impedance Monitoring

scholarly journals The Pediatrics Milestones: Conceptual Framework, Guiding Principles, and Approach to Development

2010 ◽  
Vol 2 (3) ◽  
pp. 410-418 ◽  
Author(s):  
Patricia J. Hicks ◽  
Daniel J. Schumacher ◽  
Bradley J. Benson ◽  
Ann E. Burke ◽  
Robert Englander ◽  
...  
Keyword(s):  
Conceptual Framework ◽  
Working Group ◽  
Iterative Process ◽  
Program Effectiveness ◽  
Medical Literature ◽  
Relevant Literature ◽  
Performance Standards ◽  
Good Doctor ◽  
Critical Elements ◽  
Rigorous Study

Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Pediatrics (ABP) have partnered to initiate the Pediatrics Milestone Project to further refine the 6 ACGME competencies and to set performance standards as part of the continued commitment to document outcomes of training and program effectiveness. Intervention Members of the Pediatrics Milestone Project Working Group searched the medical literature and beyond to create a synopsis of models and evidence for a developmental ontogeny of the elements for 52 subcompetencies. For each subcompetency, we created a series of Milestones, grounded in the literature. The milestones were vetted with the entire working group, engaging in an iterative process of revisions until reaching consensus that their narrative descriptions (1) included all critical elements, (2) were behaviorally based, (3) were properly sequenced, and (4) represented the educational continuum of training and practice. Outcomes We have completed the first iteration of milestones for all subcompetencies. For each milestone, a synopsis of relevant literature provides background, references, and a conceptual framework. These milestones provide narrative descriptions of behaviors that represent the ontogeny of knowledge, skill, and attitude development across the educational continuum of training and practice. Discussion The pediatrics milestones take us a step closer to meaningful outcome assessment. Next steps include undertaking rigorous study, making appropriate modifications, and setting performance standards. Our aim is to assist program directors in making more reliable and valid judgments as to whether a resident is a “good doctor” and to provide outcome evidence regarding the program's success in developing doctors.

scholarly journals Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on ‘Nutrition and autoimmune disease’ Nutrition in Crohn's disease

2009 ◽  
Vol 68 (2) ◽  
pp. 127-134 ◽  
Author(s):  
Maria O'Sullivan
Keyword(s):  
Vitamin D ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Hospital Admissions ◽  
Epidemiological Data ◽  
Overweight And Obesity ◽  
Micronutrient Deficiencies ◽  
Hospital Stays ◽  
Current Guidelines

The exact aetiology of Crohn's disease remains unknown. The consensus is that the disease results from a complex interaction between genes, immunity and environmental factors. Diet is attractive, in theory, as an environmental risk factor in the aetiology of the disease. The epidemiological data, often impeded by methodological issues, have failed to confirm a direct link between pre-diet illness and the development of Crohn's disease. Once diagnosed, however, nutrition has an important role in disease management. Among the nutritional issues are malnutrition, weight loss and suboptimal nutritional status; these outcomes may be present at any stage of the disease but are likely to be overt during acute illness and hospitalisation. Malnutrition has been identified in approximately 40% of hospital admissions with Crohn's disease and is associated with higher mortality, longer hospital stays and higher healthcare costs. Patients in remission may indeed be overweight and appear to be influenced by the general population trends toward overweight and obesity. Irrespective of BMI, patients are at risk of micronutrient deficiencies. Vitamin D deficiency, for example, is common in Crohn's disease and has important implications for bone health. Moreover, newer evidence suggests that vitamin D has potential anti-inflammatory effects. Dietary approaches, in the form of enteral nutrition, have previously been shown to reduce inflammation and treat the active disease. Current guidelines now recommend that corticosteroids are more effective than enteral nutrition for treating adults. Enteral nutrition has important growth and developmental benefits and continues to be a recommended therapy for children with Crohn's disease.

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