Pneumocystis jirovecii Pneumonia in Patients with Rheumatic Diseases: Risk Assessment and Prophylaxis

Pneumocystis jirovecii pneumonia (PJP) is an uncommon opportunistic infection in patients with rheumatic diseases with high mortality. Unlike other non-HIV conditions, international guideline for PJP prophylaxis in rheumatic diseases is currently lacking. Recent evidence regarding the risk of PJP and effectiveness of prophylaxis has been accumulating. This Review provides an update on the information about risk factors associated with PJP in patients with rheumatic diseases based on rheumatic diagnoses, use of immunosuppressive agents and other disease-related factors. The second part of the article summarizes evidence regarding the effectiveness of PJP prophylaxis by considering both disease-related and therapy-related factors. Finally, the Review outlined the currently available disease-specific recommendations and local guidelines, and appreciate the factors that influence physicians’ decision.

新興人體胚胎研究技術、 十四天規則和胚胎的特殊地位

LANGUAGE NOTE | Document text in English ; abstract also in Chinese. 胚胎研究的＂十四天規則＂已經在國際上實施了幾十年。當前，很多科學家正在挑戰這一限制，因為技術進步使得人類胚胎和胚胎的細胞模型可以培養到其早期發育階段的後期。一些學者質疑人們長期以來持有的胚胎研究應該受到限制的信念，即超過十四天的胚胎研究是不道德的，他們開始提出替代性指導方針。本文通過回顧“十四天規則”的歷史和受這一規則影響的新興研究領域的情況，審查一項新的關於人類胚胎和類胚胎的指南。我們表明社會和政治哲學、形而上學和倫理學所關注的問題對於解釋和應用新的建議或開發替代方案具有核心作用。至關重要的是，科學家在突破十四天的限制去做任何研究之前，應該制訂明確的、深思熟慮的、且有文化敏感性的指導方針，包括具體限制和監督程式，以確保科學能夠適當地回應社會的需求和價值判斷。 After 40 years of abiding by an international guideline that barred human embryo research beyond day 14 of embryonic development, many scientists are now challenging this limit due to technological advances suggesting that embryos and cell-based models of embryos can be cultured to later points in early development. Some scholars have questioned the long-held belief that research beyond 14 days is unethical and have begun proposing alternative guidelines for research. In this paper, we examine a proposal for new human embryo and embryoid guidelines by reviewing the history of the 14-day limit and emerging areas of research that are impacted by these guidelines. We then show how social and political philosophy, metaphysics, and ethics are central to interpreting and applying these new recommendations or developing alternatives. Before conducting any research beyond day 14, scientists must develop clear, thoughtful, and culturally sensitive guidelines that include limitations and oversight procedures to ensure that science responds to societal needs and values.

Company Cost Accuracy Benchmark toward Industry Practice and International Guidelines at Project Phases Gate

Research in the last decade is confirming that Oil & Gas Company consistently executes the project with an optimist cost estimate and an aggressive schedule. Cost accuracy of an Oil and Gas Company is benchmarked toward Industry Practices of Independent Project Analysis (IPA) research result and International Guideline of Association for the Advancement of Cost Engineering (AACE) & Guild of Project Control (GPC). Relationship of cost accuracy versus project definition deliverables, spent in % of Facility Installed Cost and End Usage are graph presented and assessed. Company authorizes the project with minimum project definition deliverables within International Guideline with an average of 30% less cost than Industry Practices. Company cost accuracy is on average 30% wider than Industry Practice and within International Guideline. Company cost accuracy remains strongly supports Company business performance in current oil & gas business environment.

Does Ginsburg’s Judicial Voice Get the International Level?

In several civil law systems of justice, the judiciary’s role traditionally gives rise to an institutional debate due to the absence of precedent as a source of formal law. The courts’ ability to operate thus depends, among other matters, upon public acceptance of their function. However, in the U.S. system, Justice Ginsburg, as a “judge’s judge,” properly sustained the role of the judiciary’s legitimacy by defining her considerations of “substitutes of consent”: deference to precedent, judicial restraint, collegiality, judicial interdependence, and procedural accountability. Among these factors, deference to precedent played a crucial role that emerged from Ginsburg’s “measured motion” of decision-making. Should her values framework thus have an impact on civil law systems of justice? To answer this question, we will examine two civil law procedure institutions, along with their jurisprudence, through the lens of Justice’s Ginsburg judicial philosophy. The results show how the traditional debate concerning these institutions must move from the institutions themselves to the judiciary’s role and its “motions”, following the path traced by Ginsburg’s judicial voice. Thus, her judicial philosophy now represents an international guideline to delineate those “substitutes of consent” and the courts’ decision-making approach to enhance the courts’ judicial legitimacy.

Steroid-refractory ulcerative colitis: a critical review of national and international guideline recommendations

ZusammenfassungEs gibt zahlreiche nationale und internationale Leitlinien zu chronisch entzündlichen Darmerkrankungen, die auf vergleichbarer Evidenz sowie ähnlichen Prozeduren beruhen und daher homogen sein sollten. In dieser kritischen Übersicht wurden die Leitlinienempfehlungen aus Europa (ECCO), Deutschland, Großbritannien, Kanada, den USA und Japan zur Therapie der steroidrefraktären Colitis ulcerosa verglichen. Die meisten Leitlinien unterschieden zwischen moderater/schwerer (ambulanter) und schwerer/fulminanter Colitis in der Klinik. Die Empfehlungen zur ersten Kategorie weisen gravierende Unterschiede auf, während zur Behandlung des stationären Patienten weitgehende Übereinstimmung herrscht. Verschiedene Erklärungen für die Inkonsistenzen werden diskutiert.

The inguinal hernia management in Costa Rica according to a survey between surgeons: result comparison with 2018 International Groin Hernia Guidelines

Background Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied. Purpose Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline’s recommendations. Method Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June–December 2019. Results 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein’s technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially. Conclusions The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica’s national situation.

Prevention of postpartum venous thromboembolism (VTE)

Venous thromboembolism (VTE) is a leading cause of maternal mortality in developed countries. The baseline pregnancy-associated VTE (PA-VTE) risk is further increased by additional maternal, pregnancy, and delivery characteristics. In a recently developed risk prediction model for postpartum VTE, emergency caesarean section, stillbirth, postpartum haemorrhage, pre-eclampsia/eclampsia, infection, and medical comorbidities were the strongest VTE predictors. While the evidence base supporting optimal strategies for reducing the risk of postpartum VTE in general is weak, for women with prior VTE it appears that this risk may be reduced by up to 75% with low-molecular-weight heparin (LMWH). VTE prevention in women with more common VTE risk factors is a knowledge gap in 2020, with widely varying international guideline recommendations. However, there is no debate surrounding the requirement to perform systematic VTE risk assessment in pregnant and postpartum women.

Epidemiology of infective endocarditis before versus after change of international guidelines: a systematic review

Introduction: All major international guidelines for the management of infective endocarditis (IE) have undergone major revisions, recommending antibiotic prophylaxis (AP) restriction to high-risk patients or foregoing AP completely. We performed a systematic review to investigate the effect of these guideline changes on the global incidence of IE. Methods: Electronic database searches were performed using Ovid Medline, EMBASE and Web of Science. Studies were included if they compared the incidence of IE prior to and following any change in international guideline recommendations. Relevant studies fulfilling the predefined search criteria were categorized according to their inclusion of either adult or pediatric patients. Incidence of IE, causative microorganisms and AP prescription rates were compared following international guideline updates. Results: Sixteen studies were included, reporting over 1.3 million cases of IE. The crude incidence of IE following guideline updates has increased globally. Adjusted incidence increased in one study after European guideline updates, while North American rates did not increase. Cases of IE with a causative pathogen identified ranged from 62% to 91%. Rates of streptococcal IE varied across adult and pediatric populations, while the relative proportion of staphylococcal IE increased (range pre-guidelines 16–24.8%, range post-guidelines 26–43%). AP prescription trends were reduced in both moderate and high-risk patients following guideline updates. Discussion: The restriction of AP to only high-risk patients has not resulted in an increase in the incidence of streptococcal IE in North American populations. The evidence of the impact of AP restriction on IE incidence is still unclear for other populations. Future population-based studies with adjusted incidence of IE, AP prescription rates and accurate pathogen identification are required to delineate findings further in these other regions.