Fertility in Adolescents With Klinefelter Syndrome: A Survey of Current Clinical Practice

2019 ◽  
Vol 105 (4) ◽  
pp. e1883-e1891 ◽  
Author(s):  
Andrew Zganjar ◽  
Ajay Nangia ◽  
Rebecca Sokol ◽  
Anna Ryabets ◽  
Mary K Samplaski
Keyword(s):  
Clinical Practice ◽  
Management Practices ◽  
Klinefelter Syndrome ◽  
Testicular Biopsy ◽  
Male Reproduction ◽  
Adolescent Males ◽  
Future Research ◽  
Testosterone Replacement Therapy ◽  
Endocrine Society ◽  
Current Practices

Abstract Context Progress has been made in determining the fertility timeline and potential in adolescents with Klinefelter syndrome; however, medical professionals are currently without protocols to guide treatment. Objective To evaluate the current practices regarding fertility and andrology care in adolescent males with Klinefelter syndrome. Design A 24-question survey was developed to elicit practitioner background/expertise and management practices. This was distributed to members of the Society for the Study of Male Reproduction, the Pediatric Endocrine Society, and the Endocrine Society. Setting N/A. Patients Adolescent males with Klinefelter syndrome. Intervention None. Main Outcome Measured Current practices regarding fertility and andrology care. Results 232 responses were received from 133 (57%) adult endocrinologists, 60 (26%) pediatric endocrinologists, and 39 (17%) urologists. Among these, 69% of respondents were in academics, 62% practiced for > 10 years, and 65% received formal training in Klinefelter syndrome. All specialties encouraged sperm banking in late puberty, however most disagreed with the practice in early puberty. Seventy-eight percent agreed that testicular biopsy should be offered if no sperm was found in the ejaculate. The perceived optimal age for testicular biopsy varied among specialists. Clinical symptoms of hypogonadism (28%), rising gonadotropin levels (15%), and testosterone levels (15%) were the most commonly cited reasons for initiation of testosterone replacement therapy. Conclusion Fertility preservation practices in adolescents with Klinefelter syndrome vary greatly within and among the specialties caring for these patients. These findings should guide future research and highlight the importance of establishing clinical practice guidelines.

scholarly journals Optimizing Pest Management Practices to Conserve Pollinators in Turf Landscapes: Current Practices and Future Research Needs

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Jonathan L. Larson ◽  
Adam Dale ◽  
David Held ◽  
Benjamin McGraw ◽  
Douglas S. Richmond ◽  
...  
Keyword(s):  
Pest Management ◽  
Management Practices ◽  
Future Research ◽  
Research Needs ◽  
Current Practices

Management of testosterone therapy in adolescents and young men with hypogonadism: are we following adult clinical practice guidelines?

2015 ◽  
Vol 28 (5-6) ◽  
Author(s):  
Leena Nahata ◽  
Richard N. Yu ◽  
Shalender Bhasin ◽  
Laurie E. Cohen
Keyword(s):  
Clinical Practice ◽  
Bone Density ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Tertiary Care ◽  
Testosterone Replacement Therapy ◽  
Male Hypogonadism ◽  
Testosterone Therapy ◽  
Endocrine Society ◽  
Testosterone Levels

AbstractMale hypogonadism is a common disorder that is associated with low bone density, poor muscle mass, anemia, and sexual dysfunction. The Endocrine Society recently published a Clinical Practice Guideline for testosterone therapy in androgen-deficient men. Because treatment is frequently initiated in adolescence, the goal of this quality improvement initiative was to assess whether pediatric endocrinologists at a large tertiary care center follow these guidelines and to identify opportunities for improvement.We performed a retrospective chart review at Boston Children’s Hospital. Inclusion criteria were as follows: current age ≥16 years, diagnosis of hypogonadism, and testosterone replacement therapy. Data were collected about current age, age at treatment initiation, diagnoses, pre- and on-treatment testosterone levels, route of testosterone administration and dose, bone density, hematocrit levels, and adherence with therapy.Fifty-nine patients were included. Fourteen (24%) were prescribed lower testosterone doses than those recommended in the Clinical Practice Guideline. Seven (12%) had no pre-treatment testosterone levels, and 10 (17%) had no on-treatment levels. In 49 patients with on-treatment testosterone levels, 36 had at least one value that was lower than the adult reference range. Ten (28%) of the 36 men with low testosterone levels had no dose adjustments. Thirty-seven (63%) of the 59 patients had no dual-energy X-ray absorptiometry scans, and 18 (31%) did not have hematocrit levels.Pediatric endocrinologists in this review did not consistently follow the Clinical Practice Guideline for testosterone therapy in hypogonadal adult males. Strategies that improve adherence to guidelines could help maximize the benefits of therapy and minimize treatment-associated risks.

Women And Depression: Future Research, Clinical Practice, And Public Policy

2002 ◽  
Author(s):  
Carolyn M. Mazure ◽  
Laura J. Bierut ◽  
Steven D. Hollon ◽  
Susan G. Kornstein ◽  
Charlotte Brown
Keyword(s):  
Public Policy ◽  
Clinical Practice ◽  
Future Research

scholarly journals Advantages and potential challenges of data management in e-maintenance

2019 ◽  
Vol 25 (3) ◽  
pp. 378-396 ◽  
Author(s):  
Arian Razmi-Farooji ◽  
Hanna Kropsu-Vehkaperä ◽  
Janne Härkönen ◽  
Harri Haapasalo
Keyword(s):  
Data Management ◽  
Design Methodology ◽  
Management Practices ◽  
Future Research ◽  
Conceptual Approach ◽  
Content Type ◽  
Different Types ◽  
Maintenance Systems ◽  
Industry Leader ◽  
Practical Implications

Purpose The purpose of this paper is twofold: first, to understand data management challenges in e-maintenance systems from a holistically viewpoint through summarizing the earlier scattered research in the field, and second, to present a conceptual approach for addressing these challenges in practice. Design/methodology/approach The study is realized as a combination of a literature review and by the means of analyzing the practices on an industry leader in manufacturing and maintenance services. Findings This research provides a general understanding over data management challenges in e-maintenance and summarizes their associated proposed solutions. In addition, this paper lists and exemplifies different types and sources of data which can be collected in e-maintenance, across different organizational levels. Analyzing the data management practices of an e-maintenance industry leader provides a conceptual approach to address identified challenges in practice. Research limitations/implications Since this paper is based on studying the practices of a single company, it might be limited to generalize the results. Future research topics can focus on each of mentioned data management challenges and also validate the applicability of presented model in other companies and industries. Practical implications Understanding the e-maintenance-related challenges helps maintenance managers and other involved stakeholders in e-maintenance systems to better solve the challenges. Originality/value The so-far literature on e-maintenance has been studied with narrow focus to data and data management in e-maintenance appears as one of the less studied topics in the literature. This research paper contributes to e-maintenance by highlighting the deficiencies of the discussion surrounding the perspectives of data management in e-maintenance by studying all common data management challenges and listing different types of data which need to be acquired in e-maintenance systems.

scholarly journals SAT0623-HPR THE LIVED EXPERIENCES OF COGNITIVE DYSFUNCTION IN ADULTS WITH FIBROMYALGIA: A QUALITATIVE SYSTEMATIC REVIEW

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1271.1-1272
Author(s):  
S. Derham ◽  
J. Lewis ◽  
E. Dures ◽  
F. Cramp
Keyword(s):  
Clinical Practice ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Lived Experiences ◽  
Critical Appraisal ◽  
Negative Impact ◽  
Practice Research ◽  
Future Research ◽  
Poor Sleep ◽  
Cognitive Changes

Background:Adults with fibromyalgia frequently report symptoms of cognitive dysfunction, often referred to as fibrofog. However primary research exploring cognitive dysfunction in the lives of adults with fibromyalgia is very limited (Kravitz and Katz, 2015).Objectives:The aim of this review was to (i) synthesise the qualitative literature on the lived experiences of cognitive dysfunction in adults with fibromyalgia, (ii) develop common themes through thematic analysis and (iii) identify knowledge gaps to inform future research and clinical practice in this area.Methods:Seven electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Amed, Scopus and OpenGrey), reference lists of key articles and two high impact qualitative journals were searched from 1990 to November 2018. Articles were eligible for inclusion if they reported primary qualitative data exploring the experiences of cognitive dysfunction in adults with fibromyalgia. Included studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist and extracted data analysed using narrative synthesis. SD conducted critical appraisal and data extraction on all included studies. FC, JL and ED reviewed five papers each. All papers were reviewed by two co-authors. Of the 1413 records identified, 15 studies were selected for inclusion.Results:These studies included 208 women and 22 men with fibromyalgia, aged 18 to 72 years and representing seven different countries. Duration of diagnosis was four months to 34 years. Fourteen studies used interviews and one used focus groups. None of the included studies focussed exclusively on cognitive function in adults with fibromyalgia. Three studies identified themes specific to cognitive dysfunction and fibromyalgia symptoms. The remaining 12 studies presented relevant data intertwined with the overall lived experiences of fibromyalgia.Cognitive dysfunction, as a part of fibromyalgia, was often unpredictable. Problems with memory and concentration that were most commonly reported were emotionally distressing and affected functional and vocational activities. Participants found communication effortful, with a negative impact on work, leisure and social activities. Stress, fear and worry around perceived cognitive changes were commonly expressed. Lost employment or changed work roles and relationships, due to cognitive difficulties, had negative impacts for many participants. The terms cognitive dysfunction and fibrofog were used interchangeably within the studies, but lacked common definition. This introduced uncertainty around whether participants and authors were describing the same phenomenon.Conclusion:Adults with fibromyalgia experience unpredictable and emotionally impactful difficulties related to cognitive dysfunction. Functional impact was broad-reaching, particularly around work ability and lost employment opportunities. It is unclear how cognitive symptoms in fibromyalgia related to co-morbid symptoms such as pain, fatigue and poor sleep. Further research focusing on the full impact of cognitive function on the lives of adults with fibromyalgia is recommended to inform clinical practice. Research to establish clarity of definition of the terms cognitive dysfunction and fibrofog within fibromyalgia is highly recommended.References:[1]Kravitz H, Katz R. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatology International. 2015;35(7):1115-25.Acknowledgments:This work is supported by the National Institute for Heath Research [ICA-PCAF-2018-01-078 to SD]Disclosure of Interests:Sandra Derham: None declared, Jenny Lewis: None declared, Emma Dures Grant/research support from: Independent Learning Grant from Pfizer, combined funding for a research fellow from Celgene, Abbvie and Novartis, Paid instructor for: A fee from Novartis to deliver training to nurses., Fiona Cramp: None declared

scholarly journals Organizational Commitment and Lean Sustainability: Literature Review and Directions for Future Research

2021 ◽  
Vol 13 (6) ◽  
pp. 3357 ◽  
Author(s):  
Amal Benkarim ◽  
Daniel Imbeau
Keyword(s):  
Organizational Commitment ◽  
Literature Review ◽  
Lean Manufacturing ◽  
Affective Commitment ◽  
Management Practices ◽  
Employee Commitment ◽  
Future Research ◽  
Comprehensive Overview ◽  
Narrative Literature Review ◽  
Key Aspects

The vast majority of works published on Lean focus on the evaluation of tools and/or the strategies needed for its implementation. Although many authors highlight the degree of employee commitment as one of the key aspects of Lean, what has gone largely unnoticed in the literature, is that few studies have examined in-depth the concept of organizational commitment in connection with Lean. With this narrative literature review article, our main objective is (1) to identify and analyze an extensive body of literature that addresses the Lean Manufacturing approach and how it relates to employee commitment, emphasizing affective commitment as the main type of organizational commitment positively associated with Lean, and (2) to highlight the management practices required to encourage this kind of commitment and promote the success and sustainability of Lean. This paper aims to provide a comprehensive overview that can help researchers and practitioners interested in Lean better understand the importance of employee commitment in this type of approach, and as well, to identify related research questions.

Sign in / Sign up

Export Citation Format

Share Document