Clinical guidelines «Children with diabetes mellitus type 1, 2020”: what a pediatrician needs to know

A group of experts, leading Russian specialists in the field of pediatric endocrinology prepared updated clinical guidelines for the diagnosis and treatment of type 1 diabetes mellitus in children. The article presents the main provisions of clinical guidelines for diagnosis and differential diagnosis, treatment, organization of medical care, specific and acute complications in children with type 1 diabetes mellitus. These clinical recommendations and concerted actions in practical work will allow pediatricians and pediatric endocrinologists to improve the diagnosis, treatment and quality of medical care for children with type 1 diabetes.

Abstract MP19: Reimbursement of Mobile Stroke Units in the United States: A Survey by the Prehospital Stroke Treatment Organization (PRESTO)

Background: Mobile Stroke Units (MSU) provide hyperacute diagnosis and treatment in the prehospital setting and are growing in number around the world. However, USA MSU reimbursement limits program proliferation and increases dependency on grants to support program costs. Therefore, we aimed to understand the USA MSU reimbursement paradigm. Methods: IRB approval was obtained for the conduct of an anonymous national MSU survey. Survey items were developed by MSU leaders experienced with reimbursement models and disseminated to all USA MSU programs. Returned data were entered and analyzed in SPSS using descriptive statistics. Results: Of the 20 existing USA MSU programs, 19 (95%) returned surveys. Programs work 26 + 6 (median 30) days per month serving a median 240 sq. mile radius with a median 600 dispatches per year; 47% describe their service area as metropolitan, 16% as rural, with 37% serving both. A median 4 people staff the MSU with 37% including an MD and 16% including an APP as the expert on board; the remaining programs use telemedicine MD coverage. Two programs are classified as “virtual ED” with 1 of these not classified as an EMS vehicle; 1 MSU is classified as an “outpatient clinic” with all other programs classified as EMS vehicles; 21% are certified CT Mobile Laboratories. During the last 12 months, overall the 19 responding programs gave on average 72 + 78 (median 30) alteplase tPA treatments. Of the 15 programs providing billing practices, 47% bill EMS ALS charges; supplemental billing included CT (53%), critical care (5%), telemedicine (53%), tPA (21%), and labs (5%), however, collection was poor. Overall, programs described their financial performance as negative, with only 1 program (outpatient clinic) defining it as positive; 100% rely in part or totally on grants, philanthropy, or institutional support to sustain the program. Conclusion: USA billing restrictions challenge MSU financial sustainability limiting reimbursement to traditional EMS ambulance services. Given the importance of early MSU treatment to reduce disability and death, new financial models are needed to ensure the viability of MSU services.

Reflexões sobre o patrimônio digital a partir da experiência do projeto Arquigrafia │ Digital heritage: reflections on the Arquigrafia project

RESUMO Este artigo propõe uma reflexão crítica sobre os desafios documentários e tecnológicos relativos à conservação, digitalização, catalogação e difusão web de imagens a partir da experiência do projeto multidisciplinar Arquigrafia (www.arquigrafia.org.br). O Arquigrafia é desenvolvido como um ambiente colaborativo de compartilhamento de imagens na web, aberto a fotografias de acervos institucionais e também de coleções particulares de seus usuários. O artigo apresenta a necessidade de que esse conjunto informacional seja organizado e disponibilizado, bem como as especificidades da representação descritiva e temática para a recuperação eficaz do patrimônio digital. Além de questões relacionadas aos financiamentos dos projetos de digitalização dos acervos e preservação dos originais e arquivos digitais, o artigo discute a necessidade do estabelecimento de uma política pública, que incorpore as normas mais recentes e a metodologia mais adequada para o tratamento, organização e recuperação da informação, referente ao patrimônio digital que vem sendo gerado nas instituições de memória, como as bibliotecas, arquivos e museus das universidades públicas brasileiras.Palavras-chave: Imagem; Patrimônio Digital: Ambiente Colaborativo; Web. ABSTRACT This paper proposes a critical reflection on documental and technological challenges regarding conservation, digitization, cataloguing and web dissemination of images in the experience of the Arquigrafia multidisciplinary project (www.arquigrafia.org.br). Arquigrafia is a collaborative web image sharing environment open to photographic institutional archives and users' private collections. The need to organize and share this information set, as well as the specificities of descriptive and thematic representation for effective retrieval of this digital heritage are also presented. Besides the issues issues related to the financing of digitization projects of collections and the preservation of documents and digital files, this article discuss the need to establish a public policy that incorporates the latest standards and the most appropriate methodology for the treatment, organization and retrieval information concerning the digital heritage that has been produced by Brazilian public institutions such as university libraries, archives and museums.Keywords: Image; Digital Heritage; Collaborative Environment; Web.

Stepped care treatment delivery for depression: a systematic review and meta-analysis

BackgroundIn stepped care models patients typically start with a low-intensity evidence-based treatment. Progress is monitored systematically and those patients who do not respond adequately step up to a subsequent treatment of higher intensity. Despite the fact that many guidelines have endorsed this stepped care principle it is not clear if stepped care really delivers similar or better patient outcomes against lower costs compared with other systems. We performed a systematic review and meta-analysis of all randomized trials on stepped care for depression.MethodWe carried out a comprehensive literature search. Selection of studies, evaluation of study quality and extraction of data were performed independently by two authors.ResultsA total of 14 studies were included and 10 were used in the meta-analyses (4580 patients). All studies used screening to identify possible patients and care as usual as a comparator. Study quality was relatively high. Stepped care had a moderate effect on depression (pooled 6-month between-group effect size Cohen'sdwas 0.34; 95% confidence interval 0.20–0.48). The stepped care interventions varied greatly in number and duration of treatment steps, treatments offered, professionals involved, and criteria to step up.ConclusionsThere is currently only limited evidence to suggest that stepped care should be the dominant model of treatment organization. Evidence on (cost-) effectiveness compared with high-intensity psychological therapy alone, as well as with matched care, is required.

Cooptation of Peer Support Staff: Quantitative Evidence

Objective In 2007, the Centers for Medicare and Medicaid Services (CMS) sent a letter to state Medicaid directors outlining requirements for implementing peer-based recovery support services (P-BRSS) as a Medicaid-funded service. Since then, 30 states have implemented these services. Although the literature describing implementation of P-BRSS has identified the cooptation of peer support staff (PSS) as a barrier to the effective provision of P-BRSS, the evidence for it remains anecdotal. This study attempts to determine if the context of employment in either a treatment organization or peer organization affected cooptation. Methods We conducted a survey of PSS in the fall of 2013. In all, 92 of the 181 respondents were working as PSS at the time, 53 in treatment organizations. Chi-square analysis was used to determine if the context of employment had an effect on the cooptation of peer staff. Results Peer staff working in treatment organizations reported that they were supervised by treatment staff and participated in employment-related training to improve their skills at providing treatment services more frequently than their counterparts in peer organizations. Peer staff working in treatment organizations also participated in training and education to prepare for employment as treatment professionals more frequently than peer staff working in peer organizations. Conclusions and Implications for Practice Peer staff members working in treatment organizations are subject to processes of acculturation into professional cultures that peer staff working in peer organizations are not. Effective implementation of P-BRSS should include specific efforts to minimize the cooptation of peer staff.

Characteristics in treatment organization of chronic hepatitis in Hungary: Hepatitis Registry and Priority Index

Hepatitis Registry was developed by the Hepatology Section of the Hungarian Gastroenterology Society with the contribution of the Foundation for Liver Patients. The main task was to register all interferon based treatments of chronic hepatitis C and B and to facilitate the preauthorization process. The registry helped to clarify the number and characteristics of hepatitis C patients waiting for triple therapy; 3000 previously failed patients are still eligible for protease inhibitor therapy, 40% of them already developed cirrhosis stage and 40% are null responders to the previous therapy. As a file is created for treatment authorization, the system counts automatically the Priority Index according to the calculation set in the guideline. Priority Index reflects the urgency of treatment. The most prominent parameter of the Index is the degree of fibrosis, but it also takes into account the progression rate, prognostic factors, and special situations. Orv. Hetil., 2013, 154, 1151–1155.

ISSUES OF ANTICOAGULANT TREATMENT MANAGEMENT

The review provides information about various aspects of anticoagulant treatment organization. The recommendations concerning the organization of a specialized anticoagulant service are discussed. The rules of patient education, the choice of anticoagulant dosage control are described. Authors provide data of the cost-effectiveness of anticoagulants.