therapeutic recommendations
Recently Published Documents


TOTAL DOCUMENTS

235
(FIVE YEARS 97)

H-INDEX

21
(FIVE YEARS 3)

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Zong-xiu Yin ◽  
Chun-yan Xing ◽  
Guan-hua Li ◽  
Long-bin Pang ◽  
Jing Wang ◽  
...  

Abstract Background Sepsis is a highly heterogeneous syndrome with stratified severity levels and immune states. Even in patients with similar clinical appearances, the underlying signal transduction pathways are significantly different. To identify the heterogeneities of sepsis from multiple angles, we aimed to establish a combined risk model including the molecular risk score for rapid mortality prediction, pathway risk score for the identification of biological pathway variations, and immunity risk score for guidance with immune-modulation therapy. Methods We systematically searched and screened the mRNA expression profiles of patients with sepsis in the Gene Expression Omnibus public database. The screened datasets were divided into a training cohort and a validation cohort. In the training cohort, authentic prognostic predictor characteristics (differentially expressed mRNAs, pathway activity variations and immune cells) were screened for model construction through bioinformatics analysis and univariate Cox regression, and a P value less than 0.05 of univariate Cox regression on 28-day mortality was set as the cut-off value. The combined risk model was finally established by the decision tree algorithm. In the validation cohort, the model performance was assessed and validated by C statistics and the area under the receiver operating characteristic curve (AUC). Additionally, the current models were further compared in clinical value with traditional indicators, including procalcitonin (PCT) and interleukin-8 (IL-8). Results Datasets from two sepsis cohort studies with a total of 585 consecutive sepsis patients admitted to two intensive care units were downloaded as the training cohort (n = 479) and external validation cohort (n = 106). In the training cohort, 15 molecules, 20 pathways and 4 immune cells were eventually enrolled in model construction. These prognostic factors mainly reflected hypoxia, cellular injury, metabolic disorders and immune dysregulation in sepsis patients. In the validation cohort, the AUCs of the molecular model, pathway model, immune model, and combined model were 0.81, 0.82, 0.62 and 0.873, respectively. The AUCs of the traditional biomarkers (PCT and IL-8) were 0.565 and 0.585, respectively. The survival analysis indicated that patients in the high-risk group identified by models in the current study had a poor prognosis (P < 0.05). The above results indicated that the models in this study are all superior to the traditional biomarkers for the predicting the prognosis of sepsis patients. Furthermore, the current study provides some therapeutic recommendations for patients with high risk scores identified by the three submodels. Conclusions In summary, the present study provides opportunities for bedside tests that could quantitatively and rapidly measure heterogeneous prognosis, underlying biological pathway variations and immune dysfunction in sepsis patients. Further therapeutic recommendations for patients with high risk scores could improve the therapeutic system for sepsis.


2021 ◽  
Vol 8 (1) ◽  
pp. 39
Author(s):  
Shishira R. Jartarkar ◽  
Anant Patil ◽  
Yaser Goldust ◽  
Clay J. Cockerell ◽  
Robert A. Schwartz ◽  
...  

Dermatophytic infections of the skin and appendages are a common occurrence. The pathogenesis involves complex interplay of agent (dermatophytes), host (inherent host defense and host immune response) and the environment. Infection management has become an important public health issue, due to increased incidence of recurrent, recalcitrant or extensive infections. Recent years have seen a significant rise in incidence of chronic infections which have been difficult to treat. In this review, we review the literature on management of dermatophytoses and bridge the gap in therapeutic recommendations.


Hematology ◽  
2021 ◽  
Vol 2021 (1) ◽  
pp. 361-367
Author(s):  
Brian T. Fisher

Abstract Children, adolescents, and young adults receiving intensive chemotherapy for acute myeloid leukemia or high-risk or relapsed acute lymphoblastic leukemia sustain prolonged periods of neutropenia that predispose them to invasive fungal disease (IFD). For many decades the standard of care for these patients was to initiate empirical antifungal therapy after a period of prolonged fever and neutropenia. Recent publications have yielded important evidence on the utility of different diagnostic and therapeutic approaches aimed at reducing the impact of IFD among these patients during these vulnerable periods. This case-based review highlights and interprets the published data to provide context for the IFD diagnostic and therapeutic recommendations proposed in multiple published guidelines. Personalized approaches are offered at points where evidence is lacking. Time points where specific knowledge gaps exist are identified along the clinical trajectory of the prolonged neutropenic period to illustrate areas for future investigation.


2021 ◽  
pp. 1-13
Author(s):  
Daniela Gesell ◽  
Eva Lehmann ◽  
Sonja Gauder ◽  
Marie Wallner ◽  
Steffen Simon ◽  
...  

Abstract Objective The care of seriously ill and dying people is an important task, especially in times of pandemics and regardless of the patients’ infection status. Before the SARS-CoV-2 pandemic, healthcare systems were not sufficiently prepared for the challenges of palliative and end-of-life care during a pandemic. The aim was to identify and synthesize relevant aspects and non-therapeutic recommendations of palliative and end-of-life care of seriously ill and dying people, infected and uninfected, and their relatives after one year into the pandemic to outline what actions, practices, and procedures were taken to deal with the pandemic and its consequences. Method A scoping literature review following the methods of the PRISMA-ScR. The electronic literature search was conducted in 09/2020 and updated in 02/2021 using MEDLINE (Pubmed), with no restriction of publication date and eligibility criteria. In addition, a manual search was carried out. Results A total of 280 studies met the inclusion criteria and three main aspects have emerged. The reduction of physical contact due to the risk of infection severely limited the work of palliative care professionals and solutions had to be found to maintain palliative and end-of-life care structures. This has been accompanied by strict visitor restrictions and the need to support patients, relatives, and enable contact. The third relevant aspect is the integration of specialist palliative care expertise into other clinical settings. Significance of results This scoping review demonstrates the need for basic palliative care training for every healthcare professional. It supports the importance of developing a national strategy for palliative care in pandemic times in every country, including the digitalization of the healthcare sector to offer telecommunication/telemedicine.


2021 ◽  
Vol 5 (6) ◽  
pp. s93
Author(s):  
Shari Lipner ◽  
Warren Josepth ◽  
Tracy Vlahovic ◽  
Richard Scher ◽  
Phoebe Rich ◽  
...  

N/A


2021 ◽  
Vol 15 ◽  
Author(s):  
Rosa Michaelis ◽  
Sabine Schlömer ◽  
Anja Lindemann ◽  
Vanessa Behrens ◽  
Wenke Grönheit ◽  
...  

Background: Anxiety and depression remain underdiagnosed in routine clinical practice in up to two thirds of epilepsy patients despite significant impact on medical and psychosocial outcome. Barriers to adequate mental health care for epilepsy and/or psychogenic non-epileptic seizures (PNES) include a lack of integrated mental health specialists and standardized procedures. This naturalistic study outlines the procedures and outcome of a recently established psychotherapeutic service.Methods: Routine screening included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E, cut-off value &gt; 13) and Generalized Anxiety Disorder scale (GAD-7, cut-off value &gt; 5). Positively (above cut-off in at least one questionnaire) screened patients were seen for a standardized interview for mental health disorders and the development of a personalized treatment plan. PNES patients were seen irrespective of their screening score. Resources were provided to support self-help and access to psychotherapy. Patients were contacted 1 month after discharge to evaluate adherence to therapeutic recommendations.Results: 120 patients were screened. Overall, 56 of 77 positively screened patients (77%) were found to have a psychiatric diagnosis through standardized interview. More epilepsy patients with an anxiety disorder had previously been undiagnosed compared to those with a depressive episode (63% vs. 30%); 24 epilepsy patients (62%) with a psychiatric comorbidity and 10 PNES patients (59%) were not receiving any mental health care. At follow-up, 16/17 (94%) epilepsy patients and 7/7 PNES patients without prior psychiatric treatment were adhering to therapeutic recommendations.Conclusion: Integrating mental health specialists and establishing standardized screening and follow-up procedures improve adherence to mental health care recommendations in epilepsy and PNES patients.


2021 ◽  
Vol 6 (3) ◽  
pp. 230-236
Author(s):  
Ewa Laskowska ◽  
Piotr Michalski ◽  
Łukasz Pietrzykowski ◽  
Michał Kasprzak ◽  
Agata Kosobucka ◽  
...  

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 150-150
Author(s):  
Roxana Elena Rusu ◽  
◽  
Beatrice Gabriela Ioan ◽  
◽  
◽  
...  

"Nowadays, the traditional relationship between doctors and patients is changed by the artificial intelligence (AI) and its involvement in the medical act – ranging from diagnosis to therapeutic recommendations or personalized treatment. The balance in this triangular relationship is hard to find especially in a digitalized world, in which patients have access to unfiltered information that may lead to inaccurate self-diagnosis. When it comes to the diverse background of a disease, only a doctor will be able to draw the right conclusion. It is hard to imagine that AI will soon be able to recognize problems such as domestic violence or mental illness. Ultimately, this means that AI is only a means to an end and the responsibility of any taken decision lies with the doctor. Doctors are more than decision making machines and the emotional intelligence cannot be replaced, but the advantages of using AI in the medical field are widely recognized and ultimately the goal is to ensure the best care for the patient. The purpose of this paper is to point out ethical aspects that rise from the involvement of AI in the doctor-patient relationship and to describe the new roles of the doctor and the patient in the era of AI. "


2021 ◽  
Vol 97 (4) ◽  
pp. 183-191
Author(s):  
Ágnes Kinyó ◽  

Bullous pemphigoid is the most common autoimmune subepidermal blistering disease in elderly people. The disease typically manifests on the skin and the mucosa with tense bullae or erosions with surrounding erythema, but in up to 20% of afected patients, bullae may be completely absent. The localized or generalized skin lesions usually present with itch. The author presents the rare, atypical forms of the disease, the most common triggering and predisposing factors, and the new therapeutic recommendations according to the European guidelines.


Sign in / Sign up

Export Citation Format

Share Document