scholarly journals An Online Application for Retinoblastoma Surveillance

2020 ◽  
Vol 6 (5) ◽  
pp. 376-380
Author(s):  
Nakul Singh ◽  
Meghan J. DeBenedictis ◽  
Arun D. Singh
Keyword(s):  
Best Practice ◽  
Consensus Guidelines ◽  
Rb1 Gene ◽  
Online Application ◽  
Mutation Status ◽  
Clinical Scenarios ◽  
Specialized Care ◽  
Life Threatening ◽  
Tumor Phenotype ◽  
Clinical Best Practice

Background: Retinoblastoma (RB) is a potentially heritable childhood cancer that is vision- and life-threatening. Assessing the risk of inheriting RB is important for structuring ophthalmic and genetic screening of family members. Purpose: To create a free online application that integrates phenotypic, genetic, and familial relationships with clinical best practice surveillance guidelines for families with RB. Methods: The risk of germline RB1 gene mutation was assessed for first- and second-degree relatives of a proband under variable clinical scenarios, integrating age, phenotype, relationship data, and genotype (germline RB1 mutation status: detected, undetected, not tested). Based on the assessed risk of a germline RB1 mutation, recommendations regarding further genetic testing as well as ophthalmic surveillance were derived from consensus guidelines. Results: The recommendations depend on the RB1 germline mutation status (detected, undetected, not tested), which were further subcategorized by the results of tumor phenotype, relationship to proband, age of the relative, and family structure. The online application is available at https://nakul-singh.shinyapps.io/RB_Screening_rec/. Conclusions: The assessed risk of germline RB1 mutation determines ophthalmic surveillance recommendations. The tool may have most value in regions where access to specialized care is limited.

Mitigating Chronic Diseases during Archaeological Fieldwork

2021 ◽  
Vol 9 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Carla Klehm ◽  
Elisabeth Hildebrand ◽  
Maureen S. Meyers
Keyword(s):  
Chronic Diseases ◽  
Best Practice ◽  
Cultural Norms ◽  
Group Leaders ◽  
Group Awareness ◽  
Team Members ◽  
Emergency Situations ◽  
Raising Awareness ◽  
Life Threatening ◽  
Preexisting Conditions

ABSTRACTChronic diseases and preexisting conditions shape daily life for many archaeologists both in and out of the field. Chronic issues, however, can be overlooked in safety planning, which more often focuses on emergency situations because they are considered mundane, or they are imperceptible to project directors and crews until a serious problem arises. This article focuses on asthma, diabetes, and depression as common medical conditions that impact otherwise healthy archaeologists during fieldwork, with the goal of raising awareness of these conditions in particular, and the need to be more attentive to chronic diseases in general. Archaeological fieldwork presents novel situations that put those with chronic diseases and preexisting conditions at risk: environmental hazards, remoteness from medical and social resources and networks, lack of group awareness, and varying cultural norms. As a result, if chronic diseases are not attended to properly in the field, they can lead to life-threatening situations. Managing the risk presented by these conditions requires a group culture where team members are aware of issues, as appropriate, and collaborate to mitigate them during fieldwork. Descriptions of how chronic diseases affect archaeologists in the field are followed by “best practice” recommendations for self-management and for group leaders.

scholarly journals Making your geriatric and palliative programs a strength: TQIP guideline implementation and the VRC perspective

2021 ◽  
Vol 6 (1) ◽  
pp. e000677
Author(s):  
Vanessa P Ho ◽  
Sasha D Adams ◽  
Kathleen M O'Connell ◽  
Christine S Cocanour ◽  
Saman Arbabi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Best Practice ◽  
Guideline Implementation ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Best Practice Guidelines ◽  
American College Of Surgeons ◽  
Specialized Care ◽  
The Usa

BackgroundOlder patients compose approximately 30% of trauma patients treated in the USA but make up nearly 50% of deaths from trauma. To help standardize and elevate care of these patients, the American College of Surgeons (ACS) Trauma Quality Improvement Program’s best practice guidelines for geriatric trauma management was published in 2013 and that for palliative care was published in 2017. Here, we discuss how palliative care and geriatrics quality metrics can be tracked and used for performance improvement and leveraged as a strength for trauma verification.MethodsWe discuss the viewpoint of the ACS Verification, Review, and Consultation and three case studies, with practical tips and takeaways, of how these measures have been implemented at different institutions.ResultsWe describe the use of (1) targeted educational initiatives, (2) development of a consultation tool based on institutional resources, and (3) application of a nurse-led frailty screen.DiscussionSpecialized care and attention to these vulnerable populations is recommended, but the implementation of these programs can take many shapes.Level of evidence V

Acute Asthma in Adults: Controversies and Best Practice

2009 ◽  
Vol 8 (1) ◽  
pp. 10-16
Author(s):  
Maren Schuhmann ◽  
◽  
Fraser Brims ◽  
Anoop J Chauhan ◽  
◽  
...  
Keyword(s):  
Emergency Care ◽  
Best Practice ◽  
Care Setting ◽  
Acute Asthma ◽  
British Thoracic Society ◽  
International Guidelines ◽  
Life Threatening

Asthma in the emergency care setting is common and may be life-threatening. Last year the British Thoracic Society updated their guidelines for the management of asthma, however some treatments remain controversial and there is variation in adherence to these and other national and international guidelines.

Thoracics

2020 ◽  
pp. 215-246
Author(s):  
James Bennett ◽  
Gerard Gould
Keyword(s):  
Best Practice ◽  
Bronchopleural Fistula ◽  
Management Strategies ◽  
Lung Ventilation ◽  
Bronchial Obstruction ◽  
Dynamic Hyperinflation ◽  
One Lung Ventilation ◽  
Cardiac Herniation ◽  
Life Threatening ◽  
Practice Methods

In this chapter on life-threatening thoracic problems in anaesthesia, the authors offer their guidance and expertise on the best-practice methods of dealing with each of these. These problems include tracheal/bronchial obstruction, inhaled foreign body, tracheal injury or laceration, bronchopleural fistula, hypoxia/pneumothorax/high airway pressure during one-lung ventilation, dynamic hyperinflation, cardiac herniation postpneumonectomy, major airway bleeding, and bleeding during mediastinoscopy. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential thoracically related situation are given and elaborated upon. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.

scholarly journals The Complexity of Diabetic Foot Management: From Common Care to Best Practice. The Italian Expert Opinion by Delphi Survey

2019 ◽  
Vol 19 (1) ◽  
pp. 34-43 ◽  
Author(s):  
Elisabetta Salutini ◽  
Enrico Brocco ◽  
Roberto Da Ros ◽  
Luca Monge ◽  
Luigi Uccioli ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Diabetic Foot ◽  
Best Practice ◽  
Diabetes Complications ◽  
Public Health Issue ◽  
Life Threatening ◽  
Foot Lesions ◽  
Diabetic Foot Lesions ◽  
Wound Bed Preparation ◽  
Leg Amputation

Diabetic foot is a major public health issue, driven by diabetes complications (neuropathy, peripheral vascular disease, foot deformity, and abnormal leucocyte function), which may lead to leg amputation, thus resulting in severe disability, reduced quality of life, and high health costs. The prevention of diabetes complications and the early detection and proper management of diabetic foot wounds are the milestones to avoid major amputations. Unfortunately, in many areas, the prevention of diabetic foot lesions is inadequate and wounds may proceed toward infection and chronicity, with limb- and life-threatening results. Using the Delphi method, we conducted a survey on diabetic foot among Italian experts, selected across different Italian clinical centers. This method was used to achieve a consensus on current opinion and clinical leanings on the diagnosis and management of diabetic foot ulcers. Specifically, the aim of the survey was to evaluate the current management of the diabetic foot syndrome; highlight the differences in the approach among a group of experts; evaluate the role of wound bed preparation and antisepsis; and discuss any areas of disagreement in which evidences are sparse and the clinical judgment plays a crucial role in the decision-making process.

scholarly journals Guidelines for experimental models of myocardial ischemia and infarction

2018 ◽  
Vol 314 (4) ◽  
pp. H812-H838 ◽  
Author(s):  
Merry L. Lindsey ◽  
Roberto Bolli ◽  
John M. Canty ◽  
Xiao-Jun Du ◽  
Nikolaos G. Frangogiannis ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Best Practice ◽  
Ischemia Reperfusion ◽  
Experimental Models ◽  
Myocardial Ischemia And Infarction ◽  
Clinical Scenarios ◽  
Permanent Occlusion ◽  
Myocardial Ischemia Reperfusion ◽  
Underlying Mechanisms ◽  
And Function

Myocardial infarction is a prevalent major cardiovascular event that arises from myocardial ischemia with or without reperfusion, and basic and translational research is needed to better understand its underlying mechanisms and consequences for cardiac structure and function. Ischemia underlies a broad range of clinical scenarios ranging from angina to hibernation to permanent occlusion, and while reperfusion is mandatory for salvage from ischemic injury, reperfusion also inflicts injury on its own. In this consensus statement, we present recommendations for animal models of myocardial ischemia and infarction. With increasing awareness of the need for rigor and reproducibility in designing and performing scientific research to ensure validation of results, the goal of this review is to provide best practice information regarding myocardial ischemia-reperfusion and infarction models. Listen to this article’s corresponding podcast at ajpheart.podbean.com/e/guidelines-for-experimental-models-of-myocardial-ischemia-and-infarction/.

scholarly journals Adherence to best practice consensus guidelines for implant-based breast reconstruction: Results from the iBRA national practice questionnaire survey

2018 ◽  
Vol 44 (5) ◽  
pp. 708-716 ◽  
Author(s):  
Senthurun Mylvaganam ◽  
Elizabeth J. Conroy ◽  
Paula R. Williamson ◽  
Nicola L.P. Barnes ◽  
Ramsey I. Cutress ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Questionnaire Survey ◽  
Best Practice ◽  
Consensus Guidelines ◽  
National Practice

scholarly journals Telemedicine-Based Specialized Care Improves the Outcome of Anticoagulated Individuals with Venous Thromboembolism—Results from the thrombEVAL Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3281
Author(s):  
Karsten Keller ◽  
Sebastian Göbel ◽  
Vincent ten Cate ◽  
Marina Panova-Noeva ◽  
Lisa Eggebrecht ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Vitamin K Antagonists ◽  
Computer Assisted ◽  
Thromboembolic Events ◽  
Specialized Care ◽  
Life Threatening ◽  
Multi Center Study ◽  
Reported Data ◽  
Mortality Hazard Ratio

Venous thromboembolism (VTE) is a life-threatening disease with risk of recurrence. Oral anticoagulation (OAC) with vitamin K antagonists (VKA) is effective to prevent thromboembolic recurrence. We aimed to investigate the quality of OAC of VTE patients in regular medical care (RMC) compared to a telemedicine-based coagulation service (CS). The thrombEVAL study (NCT01809015) is a prospective, multi-center study to investigate OAC treatment (recruitment: January 2011–March 2013). Patients were evaluated using clinical visits, computer-assisted personal interviews, self-reported data and laboratory measurements according to standard operating procedures. Overall, 360 patients with VTE from RMC and 254 from CS were included. Time in therapeutic range (TTR) was higher in CS compared to RMC (76.9% (interquartile range [IQR] 63.2–87.1%) vs. 69.5% (52.3–85.6%), p < 0.001). Crude rate of thromboembolic events (rate ratio [RR] 11.33 (95% confidence interval [CI] 1.85–465.26), p = 0.0015), clinically relevant bleeding (RR 6.80 (2.52–25.76), p < 0.001), hospitalizations (RR 2.54 (1.94–3.39), p < 0.001) and mortality under OAC (RR 5.89 (2.40–18.75), p < 0.001) were consistently higher in RMC compared with CS. Patients in RMC had higher risk for primary outcome (clinically relevant bleedings, thromboembolic events and mortality, hazard ratio [HR] 5.39 (95%CI 2.81–10.33), p < 0.0001), mortality (HR 5.54 (2.22–13.84), p = 0.00025), thromboembolic events (HR 6.41 (1.51–27.24), p = 0.012), clinically relevant bleeding (HR 5.31 (1.89–14.89), p = 0.0015) and hospitalization (HR 1.84 (1.34–2.55), p = 0.0002). Benefits of CS care were still observed after adjusting for comorbidities and TTR. In conclusion, anticoagulation quality and outcome of VTE patients undergoing VKA treatment was significantly better in CS than in RMC. Patients treated in CS had lower rates of adverse events, hospitalizations and lower mortality. CS was prognostically relevant, beyond providing advantages of improved international ratio (INR) monitoring.

scholarly journals Clinical Best Practice Advice for Hepatology and Liver Transplant Providers During the COVID‐19 Pandemic: AASLD Expert Panel Consensus Statement

Hepatology ◽  
2020 ◽  
Vol 72 (1) ◽  
pp. 287-304 ◽  
Author(s):  
Oren K. Fix ◽  
Bilal Hameed ◽  
Robert J. Fontana ◽  
Ryan M. Kwok ◽  
Brendan M. McGuire ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Best Practice ◽  
Consensus Statement ◽  
Expert Panel ◽  
Clinical Best Practice
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