European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack

The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. High risk TIA was defined based on clinical features in patients seen early after their event or having other features suggesting a high early risk of stroke (e.g. ABCD2 score of 4 or greater, or weakness or speech disturbance for greater than five minutes, or recurrent events, or significant ipsilateral large artery disease e.g. carotid stenosis, intracranial stenosis). Overall, we strongly recommend using dual antiplatelet treatment with clopidogrel and aspirin short term, in high-risk non-cardioembolic TIA patients, with an ABCD2 score of 4 or greater, as defined in randomised controlled trials (RCTs). We further recommend specialist review within 24 hours after the onset of TIA symptoms. We suggest review in a specialist TIA clinic rather than conventional outpatients, if managed in an outpatient setting. We make a recommendation to use either MRA or CTA in TIA patients for additional confirmation of large artery stenosis of 50% or greater, in order to guide further management, such as clarifying degree of carotid stenosis detected with carotid duplex ultrasound. We make a recommendation against using prediction tools (eg ABCD2 score) alone to identify high risk patients or to make triage and treatment decisions in suspected TIA patients as due to limited sensitivity of the scores, those with score value of 3 or less may include significant numbers of individual patients at risk of recurrent stroke, who require early assessment and treatment. These recommendations aim to emphasise the importance of prompt acute assessment and relevant secondary prevention. There are no data from randomised controlled trials on prediction tool use and optimal imaging strategies in suspected TIA.

European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack

The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. High risk TIA was defined based on clinical features in patients seen early after their event or having other features suggesting a high early risk of stroke (e.g. ABCD2 score of 4 or greater, or weakness or speech disturbance for greater than five minutes, or recurrent events, or significant ipsilateral large artery disease e.g. carotid stenosis, intracranial stenosis). Overall, we strongly recommend using dual antiplatelet treatment with clopidogrel and aspirin short term, in high-risk non-cardioembolic TIA patients, with an ABCD2 score of 4 or greater, as defined in randomised controlled trials (RCTs). We further recommend specialist review within 24 hours after the onset of TIA symptoms. We suggest review in a specialist TIA clinic rather than conventional outpatients, if managed in an outpatient setting. We make a recommendation to use either MRA or CTA in TIA patients for additional confirmation of large artery stenosis of 50% or greater, in order to guide further management, such as clarifying degree of carotid stenosis detected with carotid duplex ultrasound. We make a recommendation against using prediction tools (eg ABCD2 score) alone to identify high risk patients or to make triage and treatment decisions in suspected TIA patients as due to limited sensitivity of the scores, those with score value of 3 or less may include significant numbers of individual patients at risk of recurrent stroke, who require early assessment and treatment. These recommendations aim to emphasise the importance of prompt acute assessment and relevant secondary prevention. There are no data from randomised controlled trials on prediction tool use and optimal imaging strategies in suspected TIA.

Community-led Work and Its Impact on Deprofessionalization: The Case of Public Library Professionals

The objective of this empirical study was to explore the impact of community-led work on the (de-)professionalization process among public library professionals in Canada through the analyzation of transcripts from 11 semi-structured interviews and a guideline document. The results were analyzed and sensitized through Abbott’s professionalization theory (1988) and Bourdieu’s praxeology theory (1986; 1992). With the methodology of grounded theorization, the study found that the profession has changed, and is changing, into the direction of possible deprofessionalization, due to not only external but also internal factors in the form of a collegial conflict.

Pelvic radiation disease (part 3): identification, investigations, findings and management

Symptoms that develop following pelvic radiotherapy have become known as pelvic radiation disease (PRD). This article describes the common underlying gastrointestinal pathologies related to PRD and suggests ways to identify and investigate patients. Scoring systems available to support identification of people with possible PRD can be complex and time-consuming. The Assessment of Late Effects of Radiotherapy-Bowel (ALERT-B) tool, in which a positive answer triggers further enquiry, is simple and quick to use. A guideline document on the practical management of the gastrointestinal symptoms of PRD suggests a stepwise approach to both investigate and treat the symptoms.

Critical Update on the Third Edition of the Guidelines for Managing Severe Traumatic Brain Injury in Children

Background Severe traumatic brain injury (TBI) is associated with high rates of death and disability. As a result, the revised guidelines for the management of pediatric severe TBI address some of the previous gaps in pediatric TBI evidence and management strategies targeted to promote overall health outcomes. Objectives To provide highlights of the most important updates featured in the third edition of the guidelines for the management of pediatric severe TBI. These highlights can help critical care providers apply the most current and appropriate therapies for children with severe TBI. Methods and Results After a brief overview of the process behind identifying the evidence to support the third edition guidelines, both relevant and new recommendations from the guidelines are outlined to provide critical care providers with the most current management approaches needed for children with severe TBI. Recommendations for neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, ventilation therapies, temperature control/hypothermia, nutrition, and corticosteroids are provided. In addition, the complete guideline document and its accompanying algorithm for recommended therapies are available electronically and are referenced within this article. Conclusions The evidence base for treating pediatric TBI is increasing and provides the basis for high-quality care. This article provides critical care providers with a quick reference to the current evidence when caring for a child with a severe TBI. In addition, it provides direct access links to the comprehensive guideline document and algorithms developed to support critical care providers.

Female Leadership in the Fight Against Cancer

Background and context: According to INCA (National Cancer Institute), over 300,000 women would be diagnosed with cancer in 2017 in Brazil. There are many obstacles for full autonomy of Brazilian women. However, their contribution to the growth of the Brazilian GDP has been increasingly more significant. Access to prevention, diagnosis and health care have an impact on those levels because, the more healthy women are, the more they can be economically active. The engagement of female political leaders for the promotion of public policies is a major opportunity. Aim: Promoting the engagement of female political leaders in the fight against BC in terms of promoting local public policies and actions to provide access to diagnosis and treatment of the disease. Strategy/Tactics: Was established that, to participate in the event organized by the project, only teams comprised of NGOs and female political representatives from their respective locations could apply. Therefore, we can expect joint and combined actions in the long run. Program/Policy process: Planning: Define the schedule of the event and goals of the dynamics applied for collectively building a plan. Engagement: NGOs associated to Federação Brasileira de Instituições Filantrópicas de Apoio à Saúde da Mama (FEMAMA) organized local meetings to encourage political leaders to participate in the event. Implementation: Lectures to align knowledge and expertise on: female empowerment, social costs of cancer and advocacy; Collective construction dynamics to be used to draft a guideline document, specifying the main local issued regarding female cancer and actions proposed to solve those issues. Promotion: Social media and press. Feedback: Various improvements right after the event, due to the closeness established between the NGOs and political leaders. Main outcomes: Participation in the event: 36 NGOs from 15 states and 28 female political leaders (State Governors, Mayors, First Ladies, federal Congresswomen, City Councilor, etc.); 1 guideline document specifying the main local issued regarding female cancer and actions proposed to solve those issues; Reaching over 207,000 people, with key messages from the event posted on social media, as well as 100 insertions in the press; Drafting and proposing a bill, which is to be done by the federal Congresswoman who participated in the event, petitioning for the implementation of a Mandatory Cancer Registration service in the country (PL 8470/2017); Purchasing and repairing digital mammography devices for public hospitals in 2 Brazilian states; Implementing a cancer registration system (which was out of operation since 2013) and creating a Special Oncology Committee at the City Councils of cities in northeastern Brazil. What was learned: The engagement of female political leaders by the NGOs was essential to the success of the project. FEMAMA believes that this relationship needs to be maintained so that the actions proposed in the guideline document can actually be carried out.

The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines

Interest in the therapeutic potential of faecal microbiota transplant (FMT) has been increasing globally in recent years, particularly as a result of randomised studies in which it has been used as an intervention. The main focus of these studies has been the treatment of recurrent or refractory Clostridium difficile infection (CDI), but there is also an emerging evidence base regarding potential applications in non-CDI settings. The key clinical stakeholders for the provision and governance of FMT services in the UK have tended to be in two major specialty areas: gastroenterology and microbiology/infectious diseases. While the National Institute for Health and Care Excellence (NICE) guidance (2014) for use of FMT for recurrent or refractory CDI has become accepted in the UK, clear evidence-based UK guidelines for FMT have been lacking. This resulted in discussions between the British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS), and a joint BSG/HIS FMT working group was established. This guideline document is the culmination of that joint dialogue.