Applying Personality-Informed Treatment Strategies to Clinical Practice

2020 ◽  
Author(s):  
Bradley G. Nevins
Keyword(s):  
Clinical Practice ◽  
Treatment Strategies ◽  
Informed Treatment

Diverse Dimensions of the Cotard’s Syndrome - an Approach Towards a Clear Classification of the Phenomenon

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Nagy ◽  
V. Voros ◽  
T. Tenyi
Keyword(s):  
Clinical Practice ◽  
Diagnostic Category ◽  
Treatment Strategies ◽  
Differential Diagnostics ◽  
Dimensional System ◽  
Central Feature ◽  
Scientific Databases ◽  
Search Terms ◽  
The One

Aim:The authors present the Cotard's syndrome, a rare psychiatric condition, pointing out the latest results in terms of psychoneurology and classification of the phenomenon. The central feature of the syndrome is a nihilistic delusion, in which the patient denies his or her own existence and that of the external world.Method:We searched electronic scientific databases using the appropriate search terms; relevant articles were carefully reviewed. We also present three cases from our clinical practice.Results:After the overview of the latest biological and neuropsychological findings, the terminology, the nosology, the classification and the differential diagnostics are discussed. To sum up with useful information for the clinical practice, the possible treatment strategies, the course and the prognosis of the disease are also presented.Conclusions:The reported cases together with the reviewed literature suggest that a dimensional system of classifying Cotard's syndrome is preferable. At the one end of the spectrum is the presence of the pure nihilistic delusions, appearing as a symptom of an underlying psychiatric or neurological condition. The full-blown, classical syndrome as a diagnostic category forms the other end of the spectrum. The presented theoretical and practical aspects give a lead on deeper understanding, easier recognition and more adequate therapy of the Cotard's syndrome.

scholarly journals Biomarkers for sepsis: past, present and future

2016 ◽  
Vol 10 (4) ◽  
pp. 301 ◽  
Author(s):  
Giuseppe Chesi ◽  
Natale Vazzana ◽  
Claudio Giumelli
Keyword(s):  
Clinical Practice ◽  
Risk Stratification ◽  
Supportive Care ◽  
Early Identification ◽  
Antibiotic Stewardship ◽  
Treatment Strategies ◽  
Severe Infection ◽  
Antibiotic Use ◽  
Evidence Based ◽  
Drug Resistant

Sepsis is a complication of severe infection associated with high mortality and open diagnostic issues. Treatment strategies are currently limited and essentially based on prompt recognition, aggressive supportive care and early antibiotic treatment. In the last years, extensive antibiotic use has led to selection, propagation and maintenance of drug-resistant microorganisms. In this context, several biomarkers have been proposed for early identification, etiological definition, risk stratification and improving antibiotic stewardship in septic patient care. Among these molecules, only a few have been translated into clinical practice. In this review, we provided an updated overview of established and developing biomarkers for sepsis, focusing our attention on their pathophysiological profile, advantages, limitations, and appropriate evidence-based use in the management of septic patients.

The OASIS study: Therapeutic management of acromegaly in standard clinical practice. Assessment of the efficacy of various treatment strategies

2011 ◽  
Vol 58 (9) ◽  
pp. 478-486 ◽  
Author(s):  
Manuel Luque-Ramírez ◽  
Ágata Carreño ◽  
Cristina Álvarez Escolá ◽  
Carlos del Pozo Picó ◽  
César Varela da Costa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Treatment Strategies ◽  
Therapeutic Management ◽  
Standard Clinical Practice ◽  
Practice Assessment

National German Audit of Diagnosis, Treatment, and Teaching in Secondary Adrenal Insufficiency

2017 ◽  
Vol 49 (08) ◽  
pp. 580-588 ◽  
Author(s):  
Stephan Petersenn ◽  
Jürgen Honegger ◽  
Marcus Quinkler
Keyword(s):  
Clinical Practice ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Diagnostic Testing ◽  
Treatment Strategies ◽  
Serum Cortisol ◽  
National Audit ◽  
Secondary Adrenal Insufficiency ◽  
Endocrine Society ◽  
Great Heterogeneity

AbstractGreat heterogeneity seems to exist regarding diagnosis, therapy, and teaching of patients with secondary adrenal insufficiency (SAI) across Germany resulting in different diagnosis and treatment strategies. The aim of the work was to present the first national audit on diagnosis, treatment, and patient teaching of SAI reflecting common clinical practice in Germany. A self-designed questionnaire was sent via e-mail to all members of the German Endocrine Society (approx. 120 centers). Returned questionnaires (response rate 38.3%) were checked for duplicity of institutions and analyzed. Diagnostic testing focuses on those patients with relevant risk for adrenal insufficiency. Basal serum cortisol is mostly used as screening test. Short synacthen and CRH tests are the preferred confirmatory tests, however, cut-off values vary due to different assays used. Patients with radiation, second surgery, progressive disease or new symptoms are followed by serial re-testing. Perioperative management and frequency of postoperative re-evaluations differ among centers. Hydrocortisone is the preferred glucocorticoid for replacement therapy, but daily doses vary considerably (10–30 mg/day). Some centers perform hormone measurements for dose adjustment of glucocorticoid replacement therapy whereas others rely on clinical judgement. Patients’ teaching is done in 84% of centers, but only half of the centers include patients’ relatives. Homogeneity exists in patients’ teaching regarding intercurrent illnesses (fever, diarrhoea). Recommendations regarding dose adaptations in situations such as sport-activities, dental-procedures, or coughing are highly variable. This first national audit reveals great heterogeneity among German centers and could improve patients’ care in SAI, for example, by initiating new trials and developing clinical practice guidelines.

scholarly journals Underestimated Value of Sarcopenia in Gastric Cancer Surgery

2020 ◽  
Vol 19 (1-2) ◽  
pp. 12-19
Author(s):  
Martynas Lukšta ◽  
Raminta Lukšaitė-Lukštė ◽  
Augustinas Baušys ◽  
Kęstutis Strupas
Keyword(s):  
Gastric Cancer ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Treatment Strategies ◽  
Significant Risk ◽  
Bioelectrical Impedance ◽  
Significant Risk Factor ◽  
Impedance Analysis ◽  
Routine Clinical Practice ◽  
Gastric Cancer Treatment

Surgery remains the only potentially curative option for gastric cancer, although it is related to high postoperative morbidity and mortality rate. Approximately every second gastric cancer patient is diagnosed with sarcopenia, which is a significant risk factor for postoperative complications and poor long-term outcomes. However, sarcopenia is underestimated in routine clinical practice, since it remains the interest of clinical trials. Sarcopenia diagnostic criteria are not fully standardized, but it consists of tests for muscle strength, quantity and quality. They include grip strength, chair stand test, computed tomography, magnetic resonance imaging, ultrasound, bioelectrical impedance analysis and densitometry tests. Regarding the growing evidence for sarcopenia impact on surgical gastric cancer treatment results, it is a high probability that sarcopenia assessment will come to routine clinical practice. Although, until then there is a need for further clinical trials to standardize the diagnostic and to find effective treatment strategies.

scholarly journals Valuing new medicines in the early 21:st century

2017 ◽  
Vol 5 (1) ◽  
pp. 7-22
Author(s):  
Katarina Steen Carlsson ◽  
Bengt Jönsson
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Real World ◽  
Patent Protection ◽  
New Technologies ◽  
New Technology ◽  
Treatment Strategies ◽  
Real World Data ◽  
Study Results ◽  
Pricing And Reimbursement

What is the actual value of new medicines? The answer to this question is the key to rational use of new technologies in health care and for design of appropriate incentives for innovation. In this paper we present methods, data and study results for valuing new medical technologies in a life cycle perspective, relevant for development of a new approach to contract and payment for innovation that can replace present systems for pricing and reimbursement.   Focus is on value in clinical practice, and on the data needs and methods needed for the development of outcome-based payment systems that balances risks and rewards for innovation in health care. We provide an overview of studies from the Swedish context on the value of new medicines introduced in the treatment of diabetes, cancer, cardiovascular disease and rheumatoid arthritis. These studies using national health data and quality registers emphasise the importance of continuing efforts to collect relevant data for assessment of value after a medicine reaches the market and starts to be used in clinical practice. It is only when medicines are used in clinical practice that the benefits for real-world patient populations can be identified, measured and valued. Analyses of real-world data will also assist further development and tailoring of treatment strategies to optimize the value of the new technology. While an effective patent system rewards innovation for a limited period of time, many innovations may continue to provide value to society long after patent protection, and these values must be included in the assessment of value of innovation.

Psychiatry Board Review

2017 ◽  
Keyword(s):  
Clinical Practice ◽  
Treatment Strategies ◽  
The United States ◽  
Certification Examination ◽  
Board Examination ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Psychotherapeutic Techniques ◽  
Board Review

The field of psychiatry is rapidly evolving, specifically in the areas of psychopharmacology, psychotherapeutic strategies, and the classification of many major psychiatric disorders with the implementation of the Diagnostic and Statistical Manual of Mental Disorders: DSM-5 in 2013. A new board review textbook is imperative to address these changes in order to prepare board-eligible psychiatrists for the certification examination as well as for clinical practice in general. Additionally, the American Board of Psychiatry and Neurology is in the process of phasing in the DSM-5 criteria to the board examination, such that by 2017 the examination material will exclusively reflect the new manual. The book is aimed primarily at board-eligible psychiatrists preparing for their Initial certification in psychiatry. It will be a useful study tool for psychiatrists renewing certification as well, which in the United States is required every ten years. Furthermore the text will also be a useful reference for all psychiatrists in clinical practice to familiarize themselves with the new diagnostic classifications of DSM-5, the latest psychopharmacologic treatment strategies, and psychotherapeutic techniques.

Combining Multimodal Wavefront Examination and Digital Refraction to Create a Rapid and Accurate Approach (XFraction) for a Total Visual System Assessment for Intraocular Lens Selection

2013 ◽  
Vol 06 (02) ◽  
pp. 110
Author(s):  
Farrell C Tyson ◽  
Mitchell A Jackson ◽  
Jonathan D Solomon ◽  
◽  
◽  
...  
Keyword(s):  
Clinical Practice ◽  
Visual System ◽  
Intraocular Lens ◽  
Treatment Strategies ◽  
Relevant Information ◽  
Patient Diagnosis ◽  
System Assessment ◽  
Practice Efficiency ◽  
Diagnostic Technologies ◽  
Optical Pathway

Following advances in intraocular lens technology in recent years, greatly increased options are now available to the ophthalmic surgeon. However, there is a need for improved diagnostic technologies to optimize outcomes and select the best treatment strategies. A process combining multimodal wavefront examination and digital refraction, wavefront optimized refraction or ‘XFractionSM,’ has been recently developed to address this requirement. This novel fusion of techniques increases the amount of data that can be captured from each eye by orders of magnitude and is completed in much less time than former separate methods or manual refraction alone. The result is a process that enhances current procedures, provides superior patient diagnosis over previous techniques through the full optical pathway, and provides multiple benefits to both the patient and physician. The process enables the collection of a large amount of relevant information that makes available new levels of understanding about each patient’s unique visual system. Its use in clinical practice has been further associated with increased practice efficiency, enhanced optimized refractions, improved diagnostic surgical outcomes, and higher levels of patient satisfaction.

scholarly journals Management of Neovascular Age-Related Macular Degeneration in Clinical Practice: Initiation, Maintenance, and Discontinuation of Therapy

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Pearse A. Keane ◽  
Adnan Tufail ◽  
Praveen J. Patel
Keyword(s):  
Clinical Practice ◽  
Macular Degeneration ◽  
Treatment Strategies ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Future Directions ◽  
Age Related ◽  
Endothelial Growth Factor ◽  
Current Guidelines ◽  
Review Current

Neovascular age-related macular degeneration (AMD) is a leading cause of irreversible visual loss in elderly populations. In recent years, pharmacological inhibition of vascular endothelial growth factor (VEGF), via intravitreal injection of ranibizumab (Lucentis) or bevacizumab (Avastin), has offered the first opportunity to improve visual outcomes in patients diagnosed with this disorder. In this paper, we provide recommendations on how bevacizumab and ranibizumab may be best applied in current clinical practice, with an emphasis on their underlying pharmacology and efficacy. In addition, we review current guidelines for the initiation, maintenance, and discontinuation of anti-VEGF therapies, as well as emerging treatment strategies and future directions in the field.

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