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Simon GE, Richards JE, Boggs JM. Effect of Care Management or Online Dialectical Behavior Therapy Skills Training vs Usual Care on Self-harm Among Adults With Suicidal Ideation-Reply. JAMA 2022; 327:2246-2247. [PMID: 35699708 DOI: 10.1001/jama.2022.5883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle
| | | | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Denver
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Das L, Bhadada SK, Sood A. Post-COVID-vaccine autoimmune/inflammatory syndrome in response to adjuvants (ASIA syndrome) manifesting as subacute thyroiditis. J Endocrinol Invest 2022; 45:465-467. [PMID: 34585363 PMCID: PMC8478264 DOI: 10.1007/s40618-021-01681-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/18/2021] [Indexed: 01/31/2023]
Affiliation(s)
- L Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, 1008, Nehru Extension Block, Chandigarh, 160012, India
| | - S K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, 1008, Nehru Extension Block, Chandigarh, 160012, India.
| | - A Sood
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
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Stukalin I, Olaiya OR, Naik V, Wiebe E, Kekewich M, Kelly M, Wilding L, Halko R, Oczkowski S. Medications and dosages used in medical assistance in dying: a cross-sectional study. CMAJ Open 2022; 10:E19-E26. [PMID: 35042691 PMCID: PMC8920593 DOI: 10.9778/cmajo.20200268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is little evidence describing the technical aspects of medical assistance in dying (MAiD) in Canada, such as medications, dosages and complications. Our objective was to describe clinical practice in providing MAiD in Ontario and Vancouver, Canada, and explore relations between medications used, time until death and complications. METHODS We conducted a retrospective cohort study of a sample of adult (age ≥ 18 yr) patients who received MAiD in Ontario between 2016 and 2018, and patients who received MAiD in 1 of 3 Canadian academic hospitals (in Hamilton and Ottawa, Ontario, and Vancouver, British Colombia) between 2019 and 2020. We used de-identified data for 2016-2018 from the Office of the Chief Coroner for Ontario MAiD Database and chart review data for 2019-2020 from the 3 centres. We used multivariable parametric survival analysis to identify relations between medications, dosages and time from procedure start until death. RESULTS The sample included 3557 patients (1786 men [50.2%] and 1770 women [49.8%] with a mean age of 74 [standard deviation 13] yr). The majority of patients (2519 [70.8%]) had a diagnosis of cancer. The medications most often used were propofol (3504 cases [98.5%]), midazolam (3251 [91.4%]) and rocuronium (3228 [90.8%]). The median time from the first injection until death was 9 (interquartile range 6) minutes. Standard-dose lidocaine (40-60 mg) and high-dose propofol (> 1000 mg) were associated with prolonged time until death (prolonged by a median of 1 min and 3 min, respectively). Complications occurred in 41 cases (1.2%), mostly related to venous access or need for administration of a second medication. INTERPRETATION In a large sample of patients who died with medical assistance, certain medications were associated with small differences in time from injection to death, and complications were rare. More research is needed to identify the medication protocols that predict outcomes consistent with patient and family expectations for a medically assisted death.
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Affiliation(s)
- Igor Stukalin
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Oluwatobi R Olaiya
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Viren Naik
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Ellen Wiebe
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Mike Kekewich
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Michaela Kelly
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Laura Wilding
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Roxanne Halko
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Simon Oczkowski
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont.
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Bounajem MT, Campbell RA, Denorme F, Grandhi R. Paradigms in chronic subdural hematoma pathophysiology: Current treatments and new directions. J Trauma Acute Care Surg 2021; 91:e134-e141. [PMID: 34538825 DOI: 10.1097/ta.0000000000003404] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT Chronic subdural hematomas (CSDHs) are an increasingly common pathology encountered in a neurosurgical trauma practice. Although the operative and nonoperative management of CSDH has been studied extensively, the recurrence rate of CSDH remains high, with no significant decrease in recent years. We undertook a detailed assessment of the known pathophysiological mechanisms by which CSDHs recur to improve our ability to treat patients with this disease successfully. In this review of the literature from the PubMed and Scopus databases, we used the search terms "(pathophysiology) AND chronic subdural hematoma [tiab]" to identify pertinent reviews and articles in English. The results demonstrated a complex inflammatory response to subdural blood, which begins with the formation of a collagen neomembrane around the clot itself. Proinflammatory mediators, such as vascular endothelial growth factor, interleukin-6, interleukin-8, tissue necrosis factor α, matrix metalloproteinases, and basic fibroblast growth factor, then contribute to chronic microbleeding by promoting the formation of fragile, leaky blood vessels, and widening of gap junctions of existing vessels. It is evident that the lack of improvement in recurrence rate is due to pathological factors that are not entirely alleviated by simple subdural evacuation. Targeted approaches, such as middle meningeal artery embolization and anti-inflammatory therapies, have become increasingly common and require further prospective analysis to aid in the determination of their efficacy.
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Affiliation(s)
- Michael T Bounajem
- From the Department of Neurosurgery, Clinical Neurosciences Center (M.T.B., R.G.), Molecular Medicine Program (R.A.C., F.D.); and Department of Internal Medicine (R.A.C.), University of Utah, Salt Lake City, Utah
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5
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Dagan M, Dinh DT, Stehli J, Zaman S, Brennan A, Tan C, Liew D, Reid CM, Stub D, Kaye DM, Lefkovits J, Duffy SJ. Impact of Age and Sex on Treatment and Outcomes Following Myocardial Infarction. J Am Coll Cardiol 2021; 78:1934-1936. [PMID: 34736569 DOI: 10.1016/j.jacc.2021.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
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Brettel JH, Manuwald U, Hornstein H, Kugler J, Rothe U. Chronic-Care-Management Programs for Multimorbid Patients with Diabetes in Europe: A Scoping Review with the Aim to Identify the Best Practice. J Diabetes Res 2021; 2021:6657718. [PMID: 34796236 PMCID: PMC8595013 DOI: 10.1155/2021/6657718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
AIM This scoping review is aimed at providing a current descriptive overview of care programs based on the chronic care model (CCM) according to E. H. Wagner. The evaluation is carried out within Europe and assesses the methodology and comparability of the studies. METHODS A systematic search in the databases PubMed, Embase, and MEDLINE via OVID was conducted. In the beginning, 2309 articles were found and 48 full texts were examined, 19 of which were incorporated. Included were CCM-based programs from Belgium, Cyprus, Germany, Italy, Switzerland, and the Netherlands. All 19 articles were presented descriptively whereof 11 articles were finally evaluated in a checklist by Rothe et al. (2020). In this paper, the studies were tabulated and evaluated conforming to the same criteria. RESULTS Due to the complexity of the CCM and the heterogeneity of the studies in terms of setting and implementation, a direct comparison proved difficult. Nevertheless, the review shows that CCM was successfully implemented in various care situations and also can be useful in single practices, which often dominate the primary care sector in many European health systems. The present review was able to provide a comprehensive overview of the current care situation of chronically ill patients with multimorbidities. CONCLUSIONS A unified nomenclature concerning the distinction between disease management programs and CCM-based programs should be aimed for. Similarly, homogeneous quality standards and a Europe-wide evaluation strategy would be necessary to identify best practice models and to provide better care for the steadily growing number of chronically multimorbid patients.
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Affiliation(s)
- Julia Heike Brettel
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ulf Manuwald
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
| | - Henriette Hornstein
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
| | - Joachim Kugler
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ulrike Rothe
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
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7
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Wouk N. End-Stage Renal Disease: Medical Management. Am Fam Physician 2021; 104:493-499. [PMID: 34783494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. Primary care clinicians should refer people at risk of ESRD to nephrology to optimize disease management. Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. The decision to initiate dialysis is best made through shared decision-making. Because most patients with ESRD elect to receive hemodialysis, the preservation of peripheral veins is important for those with stage III to V chronic kidney disease. A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. For patients with ESRD, vaccination against seasonal influenza, tetanus, hepatitis B, human papillomavirus (through 26 years of age), and Streptococcus pneumoniae is advised. Routine cancer screening for patients not receiving kidney transplantation is discouraged. Controlling blood pressure in patients receiving dialysis improves mortality. Volume control through adequate dialysis and sodium restriction can help optimize hypertension treatment in these patients. Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. Patients should be monitored for signs of protein-energy wasting and malnutrition. Clinicians must be aware of the many medical complications associated with ESRD.
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Affiliation(s)
- Noah Wouk
- Piedmont Health Services, Prospect Hill, NC, USA
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8
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Goel K, Maleki-Fischbach M, George MP, Kim D, Richards J, Wise RA, Serban KA. A 56-Year-Old Man With Emphysema, Rash, and Arthralgia. Chest 2021; 160:e513-e518. [PMID: 34743855 PMCID: PMC8727885 DOI: 10.1016/j.chest.2021.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/03/2021] [Accepted: 06/23/2021] [Indexed: 11/22/2022] Open
Abstract
CASE PRESENTATION A 56-year-old man presented to the pulmonary clinic with dyspnea and hypoxemia on exertion. He was an avid biker and skier who had noticed a significant decrease in high-level physical activity over the past 3 years. He reported dyspnea, desaturations at altitudes higher than 9,000 feet, dry cough, tachycardia, and palpitations with exercise. Review of systems was also notable for gluten-intolerance, Raynaud's phenomenon, recurrent skin lesions and joint swelling, pain, and stiffness in the areas overlying the jaw, wrists, knees, and ankles (after capsaicin exposure). He denied fever, chills, anorexia, weight loss, hair loss, ocular symptoms, jaw claudication, chest pain, or lower extremity swelling. He had a five pack-year smoking history, no history of prematurity, childhood asthma, recurrent infections, or environmental and occupational exposure. Based on pulmonary function tests from an outside provider, he had received a diagnosis of exercise-induced asthma and had been prescribed an albuterol inhaler to use on an as-needed basis, which failed to improve his symptoms. He was later prescribed a mometasone-formoterol inhaler, still with no symptomatic improvement.
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Affiliation(s)
- Khushboo Goel
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Department of Medicine, Division of Pulmonary and Critical Care, National Jewish Health, Denver, CO.
| | | | - M Patricia George
- Department of Medicine, Division of Pulmonary and Critical Care, National Jewish Health, Denver, CO
| | - Darlene Kim
- Department of Medicine, Division of Cardiology, National Jewish Health, Denver, CO
| | - John Richards
- Department of Radiology, National Jewish Health, Denver, CO
| | - Robert A Wise
- Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins, Baltimore, MD
| | - Karina A Serban
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Department of Medicine, Division of Pulmonary and Critical Care, National Jewish Health, Denver, CO
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Veauthier B, Hornecker JR, Thrasher T. Recent-Onset Altered Mental Status: Evaluation and Management. Am Fam Physician 2021; 104:461-470. [PMID: 34783500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Potential precipitating factors for the recent onset of altered mental status (AMS) include primary central nervous system insults, systemic infections, metabolic disturbances, toxin exposure, medications, chronic systemic diseases, and psychiatric conditions. Delirium is also an important manifestation of AMS, especially in older people who are hospitalized. Clinicians should identify and treat reversible causes of the AMS, some of which require urgent intervention to minimize morbidity and mortality. A history and physical examination guide diagnostic testing. Laboratory testing, chest radiography, and electrocardiography help diagnose infections, metabolic disturbances, toxins, and systemic conditions. Neuroimaging with computed tomography or magnetic resonance imaging should be performed when the initial evaluation does not identify a cause or raises concern for intracranial pathology. Lumbar puncture and electroencephalography are also important diagnostic tests in the evaluation of AMS. Patients at increased risk of AMS benefit from preventive measures. The underlying etiology determines the definitive treatment. When intervention is needed to control patient behaviors that threaten themselves or others, nonpharmacologic interventions are preferred to medications. Physical restraints should rarely be used and only for the shortest time possible. Medications should be used only when nonpharmacologic treatments are ineffective.
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Affiliation(s)
- Brian Veauthier
- University of Wyoming Family Medicine Residency Program, Casper, WY, USA
| | - Jaime R Hornecker
- University of Wyoming Family Medicine Residency Program, Casper, WY, USA
| | - Tabitha Thrasher
- University of Wyoming Family Medicine Residency Program, Casper, WY, USA
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Horton R, Pharoah P, Hayward J, Lucassen A. Care of men with cancer-predisposing BRCA variants. BMJ 2021; 375:n2376. [PMID: 34649841 PMCID: PMC7612259 DOI: 10.1136/bmj.n2376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rachel Horton
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Paul Pharoah
- Department of Public Health and Primary Care, Department of Oncology, Cambridge Cancer Centre, University of Cambridge, UK
| | - Judith Hayward
- Yorkshire Regional Genetics Service, Leeds, UK
- Shipley Medical Practice, Affinity Care, Shipley, UK
| | - Anneke Lucassen
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
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Abstract
Sleep disturbances are commonly observed in schizophrenia, including in chronic, early-course, and first-episode patients. This has generated considerable interest, both in clinical and research endeavors, in characterizing the relationship between disturbed sleep and schizophrenia. Sleep features can be objectively assessed with EEG recordings. Traditionally, EEG studies have focused on sleep architecture, which includes non-REM and REM sleep stages. More recently, numerous studies have investigated alterations in sleep-specific rhythms, including EEG oscillations, such as sleep spindles and slow waves, in individuals with schizophrenia compared with control subjects. In this article, the author reviews state-of-the-art evidence of disturbed sleep in schizophrenia, starting from the relationship between sleep disturbances and clinical symptoms. First, the author presents studies demonstrating abnormalities in sleep architecture and sleep-oscillatory rhythms in schizophrenia and related psychotic disorders, with an emphasis on recent work demonstrating sleep spindles and slow-wave deficits in early-course and first-episode schizophrenia. Next, the author shows how these sleep abnormalities relate to the cognitive impairments in patients diagnosed with schizophrenia and point to dysfunctions in underlying thalamocortical circuits, Ca+ channel activity, and GABA-glutamate neurotransmission. Finally, the author discusses some of the next steps needed to further establish the role of altered sleep in schizophrenia, including the need to investigate sleep abnormalities across the psychotic spectrum and to establish their relationship with circadian disturbances, which in turn will contribute to the development of novel sleep-informed treatment interventions.
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Affiliation(s)
- Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh School of Medicine Pittsburgh, PA, 15213
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Grandinetti M, Di Molfetta A, Graziani F, Delogu AB, Lillo R, Perri G, Pavone N, Bruno P, Aspromonte N, Amodeo A, Crea F, Massetti M. Telemedicine for adult congenital heart disease patients during the first wave of COVID-19 era: a single center experience. J Cardiovasc Med (Hagerstown) 2021; 22:706-710. [PMID: 33882538 DOI: 10.2459/jcm.0000000000001195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To summarize our experience on the implementation of a telemedicine service dedicated to adult congenital heart disease (ACHD) patients during the lockdown for the first wave of Coronavirus disease 2019 (COVID-19). METHODS This is a prospective study enrolling all ACHD patients who answered a questionnaire dedicated telematic cardiovascular examination. RESULTS A total of 289 patients were enrolled, 133 (47%) were male, 25 (9%) were affected by a genetic syndrome. The median age was 38 (29-51) years, whereas the median time interval between the last visit and the telematic follow-up was 9.5 (7.5-11.5) months. Overall, 35 patients (12%) reported a worsening of fatigue in daily life activity, 17 (6%) experienced chest pain, 42 (15%) had presyncope and 2 (1%) syncope; in addition, 28 patients (10%) presented peripheral edema and 14 (5%) were orthopneic. A total of 116 (40%) patients reported palpitations and 12 had at least one episode of atrial fibrillation and underwent successful electrical (8) or pharmacological (4) cardioversion. One patient was admitted to the emergency department for uncontrolled arterial hypertension, five for chest pain, and one for heart failure. Two patients presented fever but both had negative COVID-19 nasal swab. CONCLUSION During the COVID-19 pandemic, the use of telemedicine dramatically increased and here we report a positive experience in ACHD patients. The postpandemic role of telemedicine will depend on permanent regulatory solutions and this early study might encourage a more systematic telematic approach for ACHD patients.
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Affiliation(s)
- Maria Grandinetti
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Arianna Di Molfetta
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Francesca Graziani
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Angelica Bibiana Delogu
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Catholic University of the Sacred Heart
| | - Rosa Lillo
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery - Bambino Gesù Hospital, Rome, Italy
| | - Natalia Pavone
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Piergiorgio Bruno
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Nadia Aspromonte
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Catholic University of the Sacred Heart
| | - Antonio Amodeo
- Catholic University of the Sacred Heart
- Department of Pediatric Cardiology and Cardiac Surgery - Bambino Gesù Hospital, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Catholic University of the Sacred Heart
| | - Massimo Massetti
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Catholic University of the Sacred Heart
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Abstract
AIMS We performed a systematic review to summarize the clinical features, diagnostic methods, treatment, and outcomes of coronavirus disease 2019 (COVID-19) patients with pericarditis. METHODS We searched electronic databases from inception to 17 December 2020. Studies that reported clinical data on patients with COVID-19 and pericarditis were included. Descriptive statistics were used for categorical and continuous variables [mean ± standard deviation or median (interquartile range)]. As an exploratory analysis, differences between patients with acute pericarditis and myopericarditis were compared. RESULTS A total of 33 studies (32 case reports and 1 case series) involving 34 patients were included. The mean age was 51.6 ± 19.5 years and 62% of patients were men. Sixty-two percentage of patients were diagnosed with myopericarditis. The most frequent electrocardiographic pattern (56%) was diffuse ST-elevation and PR depression. Pericardial effusion and cardiac tamponade were reported in 76 and 35% of cases, respectively. The median values of C-reactive protein [77 mg/dl (12-177)] and white blood cells [12 335 cells/μl (5625-16 500)] were above the normal range. Thirty-eight percent and 53% of patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine, respectively. These drugs were more frequently used in patients with acute pericarditis compared with myopericarditis. The in-hospital mortality was 6% without a significant difference between both groups. CONCLUSION Our review shows that COVID-19 patients with pericarditis had similar clinical features to other viral cardiotropic infections. However, NSAIDs and colchicine were used in half or less of the cases. Overall, the short-term prognosis was good across groups.
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Affiliation(s)
- Carlos Diaz-Arocutipa
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
- Programa de Atención Domiciliaria (PADOMI), EsSalud, Lima, Peru
| | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
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14
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Sahin S, Acari C, Sonmez HE, Kilic FZ, Sag E, Dundar HA, Adrovic A, Demir S, Barut K, Bilginer Y, Sozeri B, Unsal E, Ozen S, Kasapcopur O. Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER. Pediatr Rheumatol Online J 2021; 19:134. [PMID: 34425847 PMCID: PMC8383412 DOI: 10.1186/s12969-021-00613-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/13/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA), is the most common pediatric rheumatologic disorder with unknown etiology. Currently, no population-based data are available regarding the distribution of categories and frequency of uveitis in patients with JIA in Turkey. The purpose of this study was to evaluate the frequency of JIA-associated uveitis (JIAU) and distribution of JIA categories in a Turkish JIA cohort. METHODS This was a retrospective study of 500 randomized patients in four pediatric rheumatology clinics in Turkey. RESULTS Oligoarticular JIA (oJIA) was the most common JIA disease category in this study cohort (38.8%). The frequencies of the other categories were as follows: enthesitis-related arthritis (ERA), 23.2%; rheumatoid factor (RF)-negative polyarthritis, 15.6%; systemic arthritis, 12.2%; juvenile psoriatic arthritis, 5.2%; undifferentiated arthritis, 2.8%; and RF-positive polyarthritis, 2.2%. JIA-associated uveitis was observed in 6.8% of patients at a mean (Standard Deviation, SD) age of 9.1 (3.8) years over a mean JIA disease duration of 4 (1.9) years. Uveitis developed after joint disease, with a mean (SD) duration of 1.8 (1.9) years. Patients with oJIA had the highest rate of uveitis (12.9%) followed by patients with ERA (5.2%) and polyarticular RF-negative disease (3.8%). Compared with persistent oJIA, the extended oJIA category had a > 3-fold higher risk of uveitis (11.3% vs 27.7%; odds ratio, 3.38 [95% Confidence Interval, 1.09-10.4]). The most frequently administered drug after development of uveitis was tumor necrosis factor-alpha inhibitors (38.2%). Five patients (14.7%) had uveitis-related complications that required surgical intervention. CONCLUSIONS Turkish pediatric patients with JIA experience a lower frequency of oJIA and higher frequency of ERA than their white European counterparts; the occurrence of uveitis is also somewhat lower than expected. Geographic and ethnic factors may affect these differences and need further investigation.
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Affiliation(s)
- Sezgin Sahin
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey
| | - Ceyhun Acari
- Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | | | | | - Erdal Sag
- Hacettepe University, School of Medicine, Ankara, Turkey
| | | | - Amra Adrovic
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey
| | - Selcan Demir
- Hacettepe University, School of Medicine, Ankara, Turkey
| | - Kenan Barut
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey
| | - Yelda Bilginer
- Hacettepe University, School of Medicine, Ankara, Turkey
| | - Betul Sozeri
- Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Erbil Unsal
- Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Seza Ozen
- Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ozgur Kasapcopur
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey.
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15
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Lee YC, Lu F, Colls J, Luo D, Wang P, Dunlop DD, Muhammad LN, Song J, Michaud K, Solomon DH. Outcomes of a Mobile App to Monitor Patient-Reported Outcomes in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Rheumatol 2021; 73:1421-1429. [PMID: 33559338 PMCID: PMC8330418 DOI: 10.1002/art.41686] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/04/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine the effects of a smartphone application (app) to monitor longitudinal electronic patient-reported outcomes (ePROs) on patient satisfaction and disease activity in patients with rheumatoid arthritis (RA). METHODS We conducted a 6-month randomized controlled trial of care coordination along with an app (intervention) versus care coordination alone (control) in 191 RA patients. Participants in the intervention group were prompted to provide information daily using ePROs. In both the intervention and control groups, a care coordinator contacted participants at 6 and 18 weeks to assess for flares. The main outcome measures were the global satisfaction score from the Treatment Satisfaction Questionnaire for Medication (TSQM), the score from the Perceived Efficacy in Patient-Physician Interactions (PEPPI) Questionnaire, and the Clinical Disease Activity Index (CDAI) score. RESULTS Groups were similar at baseline. The median TSQM score at 6 months was 83.3 in both groups, and the median PEPPI score at 6 months was 50 in both groups. The median CDAI score at 6 months was 8 in the intervention group versus 10 in the control group. No statistically significant group differences in the medians of TSQM, PEPPI, or CDAI scores at 6 months were detected. Of the 67 intervention participants who completed the exit survey, 90% rated their likelihood of recommending the app as ≥7 of 10. Of the 11 physicians who completed the exit survey, 73% agreed/strongly agreed that they wanted to continue offering the app to patients. CONCLUSION A mobile app designed to collect ePRO data on RA symptoms did not significantly improve patient satisfaction or disease activity compared to care coordination alone. However, both patients and physicians reported positive experiences with the app.
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Affiliation(s)
- Yvonne C. Lee
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fengxin Lu
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Joshua Colls
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Dee Luo
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Penny Wang
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Dorothy D. Dunlop
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lutfiyya N. Muhammad
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jing Song
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kaleb Michaud
- Division of Rheumatology and Immunology, University of Nebraska, Omaha, NE, USA, & FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Daniel H. Solomon
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
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16
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Prosso I, Oren N, Livshits G, Lakstein D. Incidence and Mortality Rate of Hip Fractures in Different Age Groups during the First Wave of the COVID-19 Pandemic. Isr Med Assoc J 2021; 23:475-478. [PMID: 34392620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) pandemic had enormous impact on many aspects of our society, including huge medical, social, and economic challenges. OBJECTIVES To evaluate the impact of the first wave of the COVID-19 pandemic and the related movement restrictions on the incidence of hip fractures in different age groups. METHODS This single center retrospective observational study included all patients over 60 years old admitted to our hospital with the diagnosis of hip fracture during March and April 2020. Exclusion criteria were periprosthetic or pathologic fractures and multitrauma. We collected the same data on all patients with hip fractures admitted during March and April of 2018 and 2019. RESULTS Mean patient age increased from 81.7 to 85.0 years. Only two of 49 patients tested positive for COVID-19. The data show a decrease of 38% in fracture load, but a striking decrease of 85% and 59% among sexagenarians and septuagenarian, respectively. There was no decrease among nonagenarians. Early mortality, both at 30 days and 90 days, was twice as common during the pandemic. However, stratification by age group demonstrated that the risks of early mortality were the same as previous years. Mean waiting time for surgery decreased from 27.5 to 18.9 hours. Patient discharge to home over a rehabilitation facility increased from 9% to 17. CONCLUSIONS The COVID-19 pandemic affected the epidemiology of hip fractures in the elderly. The incidence of fractures and age distribution were significantly different from other years. Discharge destinations were also affected. The management of hip fracture patients was not compromised.
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Affiliation(s)
- Ilia Prosso
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
| | - Nugzar Oren
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
| | - Gilad Livshits
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
| | - Dror Lakstein
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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DuMontier C, Driver JA. Advancing Survivorship in Older Adults With Cancer. J Gerontol A Biol Sci Med Sci 2021; 76:1444-1446. [PMID: 34156074 PMCID: PMC8277077 DOI: 10.1093/gerona/glab126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Clark DuMontier
- New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jane A Driver
- New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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18
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Kus KJB, LaChance AH, Vleugels RA. Recognition and Management of Cutaneous Connective Tissue Diseases. Med Clin North Am 2021; 105:757-782. [PMID: 34059249 DOI: 10.1016/j.mcna.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Connective tissue diseases (CTDs) encompass a broad spectrum of clinical presentations that involve multidisciplinary management. Cutaneous findings are common in CTD and careful examination of these features aids in appropriate diagnosis and subsequent evaluation. Thorough work-up of CTD is crucial to properly identify disease subtypes and systemic involvement. Management plans can be developed based on diagnosis and systemic manifestations of disease. Disease management often requires treatment with pharmacotherapies with potential for toxicities, further underscoring the importance of diagnostic accuracy in this patient population. Evolving research strives to better elucidate the pathogenic mechanisms of CTDs allowing for more targeted treatment modalities.
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MESH Headings
- Adult
- Comorbidity
- Connective Tissue Diseases/complications
- Connective Tissue Diseases/diagnosis
- Connective Tissue Diseases/drug therapy
- Connective Tissue Diseases/pathology
- Dermatomyositis/diagnosis
- Dermatomyositis/etiology
- Dermatomyositis/pathology
- Diagnosis, Differential
- Drug Therapy/methods
- Drug Therapy/statistics & numerical data
- Drug-Related Side Effects and Adverse Reactions
- Early Diagnosis
- Female
- Humans
- Interdisciplinary Communication
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/etiology
- Lupus Erythematosus, Cutaneous/pathology
- Lupus Erythematosus, Discoid/diagnosis
- Lupus Erythematosus, Discoid/etiology
- Lupus Erythematosus, Discoid/pathology
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/etiology
- Lupus Erythematosus, Systemic/pathology
- Male
- Patient Care Management/methods
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/etiology
- Scleroderma, Systemic/pathology
- Vasculitis/diagnosis
- Vasculitis/etiology
- Vasculitis/pathology
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Affiliation(s)
- Kylee J B Kus
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309-4482, USA
| | - Avery H LaChance
- Connective Tissue Disease Clinic, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
| | - Ruth Ann Vleugels
- Autoimmune Skin Disease Program, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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19
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Silber MH, Buchfuhrer MJ, Earley CJ, Koo BB, Manconi M, Winkelman JW. The Management of Restless Legs Syndrome: An Updated Algorithm. Mayo Clin Proc 2021; 96:1921-1937. [PMID: 34218864 DOI: 10.1016/j.mayocp.2020.12.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 01/26/2023]
Abstract
Restless legs syndrome (RLS) is a common disorder. The population prevalence is 1.5% to 2.7% in a subgroup of patients having more severe RLS with symptoms occurring 2 or more times a week and causing at least moderate distress. It is important for primary care physicians to be familiar with the disorder and its management. Much has changed in the management of RLS since our previous revised algorithm was published in 2013. This updated algorithm was written by members of the Scientific and Medical Advisory Board of the RLS Foundation based on scientific evidence and expert opinion. A literature search was performed using PubMed identifying all articles on RLS from 2012 to 2020. The management of RLS is considered under the following headings: General Considerations; Intermittent RLS; Chronic Persistent RLS; Refractory RLS; Special Circumstances; and Alternative, Investigative, and Potential Future Therapies. Nonpharmacologic approaches, including mental alerting activities, avoidance of substances or medications that may exacerbate RLS, and oral and intravenous iron supplementation, are outlined. The choice of an alpha2-delta ligand as first-line therapy for chronic persistent RLS with dopamine agonists as a second-line option is explained. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS and describe management approaches, including combination therapy and the use of high-potency opioids. Treatment of RLS in pregnancy and childhood is discussed.
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Affiliation(s)
- Michael H Silber
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - Mark J Buchfuhrer
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA
| | - Christopher J Earley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian B Koo
- Department of Neurology, Yale University, New Haven, CT
| | - Mauro Manconi
- Sleep Medicine, Neurocenter of Southern Switzerland, Ospedale Civico, and Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - John W Winkelman
- Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Cambridge, MA
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20
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Abstract
As SARS-CoV-2 stunned and overtook everyone's lives, multiple daily briefings, protocols, policies and incident command committees were mobilized to provide frontline staff with the tools, supplies and infrastructure needed to address the COVID-19 pandemic. Medical resources were immediately shifted. In light of the necessity for self-isolation, telemedicine was expanded, although there has been concern than non-pandemic disorders were being ignored. Ambulatory care services such as bone densitometry and osteoporosis centered clinics came to a near halt. Progress with fracture prevention has been challenged. Despite the prolonged pandemic and the consequent sense of exhaustion, we must re-engage with chronic bone health concerns and fracture prevention. Creating triaging systems for bone mineral testing and in person visits, treating individuals designated as high risk of fracture using fracture risk assessment tools such as FRAX, maintaining telemedicine, leveraging other bone health care team members to monitor and care for osteoporotic patients, and re-engaging our primary care colleagues will remain paramount but challenging. The pandemic persists. Thus, we will summarize what we have learned about COVID-19 and bone health and provide a framework for osteoporosis diagnosis, treatment, and follow-up with the extended COVID-19 pandemic. The goal is to preserve bone health, with focused interventions to sustain osteoporosis screening and treatment initiation/maintenance rates.
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Affiliation(s)
- R R Narla
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
- Division of Endocrinology, Metabolism and Nutrition, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - R A Adler
- Endocrinology and Metabolism Section (111P), McGuire Veterans Affairs Medical Center, Central Virginia Veterans Affairs Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA.
- Division of Endocrinology, Metabolism, and Diabetes Mellitus, Virginia Commonwealth University, Richmond, VA, USA.
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21
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Yoo SW, Baek SJ, Kim DC, Doo AR. A case report of malignant hyperthermia in a patient with myotonic dystrophy type I: A CARE-compliant article. Medicine (Baltimore) 2021; 100:e25859. [PMID: 34114984 PMCID: PMC8202553 DOI: 10.1097/md.0000000000025859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Several hereditary myopathies that can predispose to malignant hyperthermia (MH) are reported. However, the risk of MH in myotonic dystrophy type I (DM1) has been suggested equal to general population, although the evidence is limited to only a few case reports. PATIENT CONCERNS We encountered a rare case of MH during anesthesia induction with sevoflurane in a male adolescent with previously undiagnosed DM1. DIAGNOSES After the event, genetic testing revealed the presence of a previously unknown heterozygous missense mutation in ryanodine receptor 1 (RYR1) associated with MH (c.6898T > C; p.ser2300Pro). Concomitantly, the patient was diagnosed with DM1 with abnormal cytosine-thymine-guanine triplet expansion in the DMPK gene. INTERVENTIONS Dantrolene was administered to treat the hypermetabolic manifestations in 20 minutes after the identification of MH. OUTCOMES The patient was successfully treated and discharged without any complications. Laboratory abnormalities were recovered to baseline at postoperative 4 days. LESSONS The authors suggest that possible MH susceptibility in DM1 patients may be refocused. Genetic testing can be a screening tool for MH susceptibility in these population, prior to receiving general anesthesia.
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Affiliation(s)
- Seon Woo Yoo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Seon Ju Baek
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School
| | - Dong-Chan Kim
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - A Ram Doo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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22
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Guo JL, Wang HB, Wang H, Le Y, He J, Zheng XQ, Zhang ZH, Duan GR. Transesophageal echocardiography detection of air embolism during endoscopic surgery and validity of hyperbaric oxygen therapy: Case report. Medicine (Baltimore) 2021; 100:e26304. [PMID: 34115039 PMCID: PMC8202586 DOI: 10.1097/md.0000000000026304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism. PATIENT CONCERNS We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers. DIAGNOSES Based on ETCO2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made. INTERVENTIONS The patients received symptomatic supportive therapy including CPR, 100% O2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation. OUTCOMES Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities. CONCLUSIONS While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.
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Affiliation(s)
- Ji-ling Guo
- Guangdong Medical University. Wenming East Road No.2, Zhanjiang
- Department of Anesthesiology
| | | | | | - Yue Le
- Department of Anesthesiology
| | - Jian He
- Department of Anesthesiology
| | | | | | - Guang-rong Duan
- Department of Information, The First People's Hospital of Foshan, North of Ling Nan Road No. 81, Foshan, Guangdong, China
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23
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Kaswa R, Yogeswaran P, Cawe B. Clinical outcomes of hospitalised COVID-19 patients at Mthatha Regional Hospital, Eastern Cape, South Africa: A retrospective study. S Afr Fam Pract (2004) 2021; 63:e1-e5. [PMID: 34212748 PMCID: PMC8252182 DOI: 10.4102/safp.v63i1.5253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a public health crisis that threatens the current health system. The sudden expansion in the need for inpatient and intensive care facilities raised concerns about optimal clinical management and resource allocation. Despite the pressing need for evidence to make context-specific decisions on COVID-19 management, evidence from South Africa remained limited. This study aimed to describe the clinical characteristics and outcomes of COVID-19 hospitalised patients. METHODS A retrospective cross-sectional study design was used to evaluate the clinical outcomes of hospitalised adult patients (≥ 18 years old) with laboratory-confirmed COVID-19 illness at Mthatha Regional Hospital (MRH), Eastern Cape. RESULTS Of the 1814 patients tested for COVID-19 between 20 March 2020 and 31 July 2020 at MRH, two-thirds (65.4%) were female. About two-thirds (242) of the 392 patients (21.6%) who tested positive for this disease were hospitalised and one-third (150) were quarantined at home. The mean age of the patients tested for COVID-19 was 42.6 years and there was no difference between males and females. The mean age of hospitalised patients was 55.5 years and the mean age of hospitalised patients who died (61.3 years) was much higher than recovered (49.5 years). Overall, 188 (77.6%) hospitalised patients had clinical comorbidity on admission. Diabetes (36.8%) and hypertension (33.1%) were the most common comorbidities amongst COVID-19 hospitalised patients. CONCLUSION The majority of the patients who were hospitalised for COVID-19 were elderly and had high baseline comorbidities. Advance age and underlying comorbidities (diabetes, hypertension and HIV) were associated with high mortality in hospitalised COVID-19 patients.
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Affiliation(s)
- Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha.
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24
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Hansen R, Meade S, Beattie RM, Auth MK, Croft N, Davies P, Devadason D, Doherty C, Epstein J, Howarth L, Kiparissi F, Muhammed R, Shivamurthy V, Spray C, Stanton MP, Torrente F, Urs A, Wilson D, Irving PM, Samaan M, Kammermeier J. Adaptations to the current ECCO/ESPGHAN guidelines on the management of paediatric acute severe colitis in the context of the COVID-19 pandemic: a RAND appropriateness panel. Gut 2021; 70:1044-1052. [PMID: 32873696 PMCID: PMC7470179 DOI: 10.1136/gutjnl-2020-322449] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Paediatric acute severe colitis (ASC) management during the novel SARS-CoV-2/COVID-19 pandemic is challenging due to reliance on immunosuppression and the potential for surgery. We aimed to provide COVID-19-specific guidance using the European Crohn's and Colitis Organisation/European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for comparison. DESIGN We convened a RAND appropriateness panel comprising 14 paediatric gastroenterologists and paediatric experts in surgery, rheumatology, respiratory and infectious diseases. Panellists rated the appropriateness of interventions for ASC in the context of the COVID-19 pandemic. Results were discussed at a moderated meeting prior to a second survey. RESULTS Panellists recommended patients with ASC have a SARS-CoV-2 swab and expedited biological screening on admission and should be isolated. A positive swab should trigger discussion with a COVID-19 specialist. Sigmoidoscopy was recommended prior to escalation to second-line therapy or colectomy. Methylprednisolone was considered appropriate first-line management in all, including those with symptomatic COVID-19. Thromboprophylaxis was also recommended in all. In patients requiring second-line therapy, infliximab was considered appropriate irrespective of SARS-CoV-2 status. Delaying colectomy due to SARS-CoV-2 infection was considered inappropriate. Corticosteroid tapering over 8-10 weeks was deemed appropriate for all. After successful corticosteroid rescue, thiopurine maintenance was rated appropriate in patients with negative SARS-CoV-2 swab and asymptomatic patients with positive swab but uncertain in symptomatic COVID-19. CONCLUSION Our COVID-19-specific adaptations to paediatric ASC guidelines using a RAND panel generally support existing recommendations, particularly the use of corticosteroids and escalation to infliximab, irrespective of SARS-CoV-2 status. Consideration of routine prophylactic anticoagulation was recommended.
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Affiliation(s)
- Richard Hansen
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK
| | - Susanna Meade
- Department of Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Marcus Kh Auth
- Department of Paediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Nick Croft
- Blizard Institute, Queen Mary's University of London, Barts and the London School of Medicine, London, UK
- Department of Paediatric Gastroenterology, Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Philip Davies
- Department of Paediatric Respiratory Medicine, Royal Hospital for Children, Glasgow, UK
| | - David Devadason
- Department of Paediatric Gastroenterology, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Conor Doherty
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
| | - Jenny Epstein
- Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lucy Howarth
- Department of Paediatric Gastroenterology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Fevronia Kiparissi
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
| | - Rafeeq Muhammed
- Department of Paediatric Gastroenterology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| | - Vinay Shivamurthy
- Department of Paediatric Rheumatology, Evelina London Children's Hospital, London, UK
| | - Christine Spray
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, Bristol Royal Hospital for Children, Bristol, UK
| | - Michael P Stanton
- Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Franco Torrente
- Department of Paediatric Gastroenterology, Addenbrookes Hospital, Cambridge, UK
| | - Arun Urs
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - David Wilson
- Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Mark Samaan
- Department of Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Jochen Kammermeier
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, London, UK
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David P, Dotan A, Mahroum N, Shoenfeld Y. Immune Thrombocytopenic Purpura (ITP) Triggered by COVID-19 Infection and Vaccination. Isr Med Assoc J 2021; 23:378-380. [PMID: 34155853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Paula David
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Arad Dotan
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Naim Mahroum
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Ariel University, Ariel, Israel
- Laboratory of the Mosaics of Autoimmunity, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Insaf TZ, Sommerhalter KM, Jaff TA, Farr SL, Downing KF, Zaidi AN, Lui GK, Van Zutphen AR. Access to cardiac surgery centers for cardiac and non-cardiac hospitalizations in adolescents and adults with congenital heart defects- a descriptive case series study. Am Heart J 2021; 236:22-36. [PMID: 33636136 PMCID: PMC8097661 DOI: 10.1016/j.ahj.2021.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/19/2021] [Indexed: 01/14/2023]
Abstract
Background Individuals with congenital heart defects (CHDs) are recommended to receive all inpatient cardiac and noncardiac care at facilities that can offer specialized care. We describe geographic accessibility to such centers in New York State and determine several factors associated with receiving care there. Methods We used inpatient hospitalization data from the Statewide Planning and Research Cooperative System (SPARCS) in New York State 2008–2013. In the absence of specific adult CHD care center designations during our study period, we identified pediatric/adult and adult-only cardiac surgery centers through the Cardiac Surgery Reporting System to estimate age-based specialized care. We calculated one-way drive and public transit time (in minutes) from residential address to centers using R gmapsdistance package and the Google Maps Distance Application Programming Interface (API). We calculated prevalence ratios using modified Poisson regression with model-based standard errors, fit with generalized estimating equations clustered at the hospital level and subclustered at the individual level. Results Individuals with CHDs were more likely to seek care at pediatric/adult or adult-only cardiac surgery centers if they had severe CHDs, private health insurance, higher severity of illness at encounter, a surgical procedure, cardiac encounter, and shorter drive time. These findings can be used to increase care receipt (especially for noncardiac care) at pediatric/adult or adult-only cardiac surgery centers, identify areas with limited access, and reduce disparities in access to specialized care among this high-risk population.
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Affiliation(s)
- Tabassum Z Insaf
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
| | | | - Treeva A Jaff
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
| | - Sherry L Farr
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Ali N Zaidi
- Adult Congenital Heart Disease Center, Mount Sinai Heart/Icahn School of Medicine at Mount Sinai, New York, NY
| | - George K Lui
- Stanford University School of Medicine, Stanford, CA
| | - Alissa R Van Zutphen
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
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Lewinski AA, Crowley MJ, Miller C, Bosworth HB, Jackson GL, Steinhauser K, White-Clark C, McCant F, Zullig LL. Applied Rapid Qualitative Analysis to Develop a Contextually Appropriate Intervention and Increase the Likelihood of Uptake. Med Care 2021; 59:S242-S251. [PMID: 33976073 PMCID: PMC8132894 DOI: 10.1097/mlr.0000000000001553] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Rapid approaches to collecting and analyzing qualitative interview data can accelerate discovery timelines and intervention development while maintaining scientific rigor. We describe the application of these methods to a program designed to improve care coordination between the Veterans Health Administration (VHA) and community providers. METHODS Care coordination between VHA and community providers can be challenging in rural areas. The Telehealth-based Coordination of Non-VHA Care (TECNO Care) intervention was designed to improve care coordination among VHA and community providers. To ensure contextually appropriate implementation of TECNO Care, we conducted preimplementation interviews with veterans, VHA administrators, and VHA and community providers involved in community care. Using both a rapid approach and qualitative analysis, an interviewer and 1-2 note-taker(s) conducted interviews. RESULTS Over 5 months, 18 stakeholders were interviewed and we analyzed these data to identify how best to deliver TECNO Care. Responses relevant to improving care coordination include health system characteristics; target population; metrics and outcomes; challenges with the current system; and core components. Veterans who frequently visit VHA or community providers and are referred for additional services are at risk for poor outcomes and may benefit from additional care coordination. Using these data, we designed TECNO Care to include information on VHA services and processes, assist in the timely completion of referrals, and facilitate record sharing. CONCLUSION Rapid qualitative analysis can inform near real-time intervention development and ensure relevant content creation while setting the stage for stakeholder buy-in. Rigorous and timely analyses support the delivery of contextually appropriate, efficient, high-value patient care.
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Affiliation(s)
- Allison A. Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
- School of Nursing, Duke University
| | - Matthew J. Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
- Division of Endocrinology, Diabetes, and Metabolism, Duke University School of Medicine, Durham, NC
| | - Christopher Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Hayden B. Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine
- Department of Psychiatry and Behavioral Sciences, School of Nursing, Duke University, Durham, NC
| | - George L. Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine
| | - Karen Steinhauser
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine
| | - Courtney White-Clark
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
| | - Felicia McCant
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
| | - Leah L. Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
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Yánez Benítez C, Ribeiro MAF, Alexandrino H, Koleda P, Baptista SF, Azfar M, Di Saverio S, Ponchietti L, Güemes A, Blas JL, Mesquita C. International cooperation group of emergency surgery during the COVID-19 pandemic. Eur J Trauma Emerg Surg 2021; 47:621-629. [PMID: 33047158 PMCID: PMC7550249 DOI: 10.1007/s00068-020-01521-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/26/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE The COVID-19 pandemic has changed working conditions for emergency surgical teams around the world. International surgical societies have issued clinical recommendations to optimize surgical management. This international study aimed to assess the degree of emergency surgical teams' adoption of recommendations during the pandemic. METHODS Emergency surgical team members from over 30 countries were invited to answer an anonymous, prospective, online survey to assess team organization, PPE-related aspects, OR preparations, anesthesiologic considerations, and surgical management for emergency surgery during the pandemic. RESULTS One-hundred-and-thirty-four questionnaires were returned (N = 134) from 26 countries, of which 88% were surgeons, 7% surgical trainees, 4% anesthetists. 81% of the respondents got involved with COVID-19 crisis management. Social media were used by 91% of the respondents to access the recommendations, and 66% used videoconference tools for team communication. 51% had not received PPE training before the pandemic, 73% reported equipment shortage, and 55% informed about re-use of N95/FPP2/3 respirators. Dedicated COVID operating areas were cited by 77% of the respondents, 44% had performed emergency surgical procedures on COVID-19 patients, and over half (52%), favored performing laparoscopic over open surgical procedures. CONCLUSION Surgical team members have responded with leadership to the COVID-19 pandemic, with crisis management principles. Social media and videoconference have been used by the vast majority to access guidelines or to communicate during social distancing. The level of adoption of current recommendations is high for organizational aspects and surgical management, but not so for PPE training and availability, and anesthesiologic considerations.
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Affiliation(s)
- Carlos Yánez Benítez
- General and GI Surgery Department, Royo Villanova Hospital, SALUD, Av. de San Gregorio s/n. 50015, Zaragoza, Spain
| | - Marcelo A. F. Ribeiro
- Department of General Surgery and Trauma Surgery, Catholic University of São Paulo PUC-Sorocaba and Hospital Moriah, Avenida Victor Civita, Sao Paulo, 235 Brazil
| | - Henrique Alexandrino
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045 Coimbra, Portugal
| | - Piotr Koleda
- Department of Medical Simulation, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Mohammad Azfar
- Department of General Surgery, Al Rahba Hospital, Abu Dhabi, UAE
| | - Salomone Di Saverio
- Department of General Surgery, Varese University Hospital, ASST Sette Laghi, University of Insubria, Regione Lombardia, Varese, Italy
| | - Luca Ponchietti
- Department of General Surgery, San Jorge University Hospital, Av. Martínez de Velasco, 36, 22004 Huesca, Spain
| | - Antonio Güemes
- Department of General Surgery, Lozano Blesa University Hospital, Av. San Juan Bosco, 15, 50009 Zaragoza, Spain
| | - Juan L. Blas
- General and GI Surgery Department, Royo Villanova Hospital, SALUD, Av. de San Gregorio s/n. 50015, Zaragoza, Spain
| | - Carlos Mesquita
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045 Coimbra, Portugal
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Screening for Asymptomatic Carotid Artery Stenosis: Recommendation Statement. Am Fam Physician 2021; 103:614-7. [PMID: 33982995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Mills J, Molchan S. Screening for Asymptomatic Carotid Artery Stenosis. Am Fam Physician 2021; 103:623-624. [PMID: 33982997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Justin Mills
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
| | - Sonia Molchan
- Uniformed Services University of the Health Sciences, USA
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Hill DA, Taylor CA. Dyspareunia in Women. Am Fam Physician 2021; 103:597-604. [PMID: 33983001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dyspareunia is recurrent or persistent pain with sexual intercourse that causes distress. It affects approximately 10% to 20% of U.S. women. Dyspareunia may be superficial, causing pain with attempted vaginal insertion, or deep. Women with sexual pain are at increased risk of sexual dysfunction, relationship distress, diminished quality of life, anxiety, and depression. Because discussing sexual issues may be uncomfortable, clinicians should create a safe and welcoming environment when taking a sexual history, where patients describe the characteristics of the pain (e.g., location, intensity, duration). Physical examination of the external genitalia includes visual inspection and sequential pressure with a cotton swab, assessing for focal erythema or pain. A single-digit vaginal examination may identify tender pelvic floor muscles, and a bimanual examination can assess for uterine retroversion and pelvic masses. Common diagnoses include vulvodynia, inadequate lubrication, vaginal atrophy, postpartum causes, pelvic floor dysfunction, endometriosis, and vaginismus. Treatment is focused on the cause and may include lubricants, pelvic floor physical therapy, topical analgesics, vaginal estrogen, cognitive behavior therapy, vaginal dilators, modified vestibulectomy, or onabotulinumtoxinA injections.
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Affiliation(s)
- D Ashley Hill
- AdventHealth Obstetrics and Gynecology, Department of Graduate Medical Education, Orlando, FL, USA
| | - Chantel A Taylor
- AdventHealth Orlando Family Medicine Residency Program, Orlando, FL, USA
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Affiliation(s)
- Cheryl K Lee
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Khalilah L Gates
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Sansone A, Aversa A, Corona G, Fisher AD, Isidori AM, La Vignera S, Limoncin E, Maggi M, Merico M, Jannini EA. Management of premature ejaculation: a clinical guideline from the Italian Society of Andrology and Sexual Medicine (SIAMS). J Endocrinol Invest 2021; 44:1103-1118. [PMID: 33128158 DOI: 10.1007/s40618-020-01458-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/20/2020] [Indexed: 12/25/2022]
Abstract
Premature ejaculation (PE) is the most prevalent male sexual dysfunction, and the most recently defined. PE is often mistakenly considered a purely psychosexological symptom by patients: the lacking awareness in regards to the pathophysiology and treatments often lead to resignation from the patients' side, making PE the most underdiagnosed sexual complaint. However, an ever-growing body of evidence supporting several organic factors has been developed in the last decades and several definitions have been suggested to encompass all defining features of PE. In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), we propose 33 recommendations concerning the definition, pathophysiology, treatment and management of PE aimed to improve patient care. These evidence-based clinical guidelines provide the necessary up-to-date guidance in the context of PE secondary to organic and psychosexological conditions, such as prostate inflammation, endocrine disorders, and other sexual dysfunctions, and suggest how to associate pharmacotherapies and cognitive-behavioral therapy in a couple-centered approach. New therapeutic options, as well as combination and off-label treatments, are also described.
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Affiliation(s)
- A Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Azienda-Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - A D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - E Limoncin
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - M Merico
- Department of Medicine, Operative Unit of Andrology and Medicine of Human Reproduction, University of Padova, Padua, Italy
| | - E A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
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Abstract
BACKGROUND Familial non-medullary thyroid carcinoma (FNMTC), mainly of papillary histotype (FPTC), is defined by the presence of the disease in two or more first-degree relatives in the absence of other known familial syndromes. With the increasing incidence of PTC in the recent years, the familial form of the disease has also become more common than previously reported and constitutes nearly 10% of all thyroid cancers. Many aspects of FNMTC are debated, concerning both clinical and genetic aspects. Several studies reported that, in comparison with sporadic PTCs, FPTCs are more aggressive at disease presentation, while other authors reported no differences in the clinical behavior of sporadic and familial PTCs. For this reason, recent guidelines do not recommend screening of family members of patients with diagnosis of differentiated thyroid cancer (DTC). FNMTC is described as a polygenic disorder associated with multiple low- to moderate-penetrance susceptibility genes and incomplete penetrance. At the moment, the genetic factors contributing to the development of FNMTC remain poorly understood, though many putative genes have been proposed in the recent years. PURPOSE Based on current literature and our experience with FNMTC, in this review, we critically discussed the most relevant controversies, including its definition, the genetic background and some clinical aspects as screening and treatment.
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Affiliation(s)
- M Capezzone
- Section of Endocrinology and Metabolism, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - E Robenshtok
- Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Cantara
- Section of Endocrinology and Metabolism, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - M G Castagna
- Section of Endocrinology and Metabolism, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100, Siena, Italy.
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Ravi A, Gorelick J, Pal H. Identifying and Addressing Vicarious Trauma. Am Fam Physician 2021; 103:570-572. [PMID: 33929175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Anita Ravi
- PurpLE Health Foundation, New York, NY, USA
| | | | - Harika Pal
- PurpLE Health Foundation, New York, NY, USA
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Marra J, Law AMY, Conlon E. Clinical Considerations in Caring for Transgender Athletes. Am Fam Physician 2021; 103:518-520. [PMID: 33929173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Kanayama K, Oba J, Yoshii K, Tomioka Y, Kurita M, Miyamoto S, Okazaki M. Potentially serious incidental findings on medical imaging in plastic surgery patients: A single-institution retrospective cohort study. J Plast Reconstr Aesthet Surg 2021; 74:2776-2820. [PMID: 33972200 DOI: 10.1016/j.bjps.2021.03.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/23/2021] [Accepted: 03/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Koji Kanayama
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
| | - Jun Oba
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Kengo Yoshii
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Yoko Tomioka
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Masakazu Kurita
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Shimpei Miyamoto
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Mutsumi Okazaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
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Puglisi S, Rossini A, Tabaro I, Cannavò S, Ferrau' F, Ragonese M, Borretta G, Pellegrino M, Dughera F, Parisi A, Latina A, Pia A, Terzolo M, Reimondo G. What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study. J Endocrinol Invest 2021; 44:865-872. [PMID: 32779106 PMCID: PMC7946659 DOI: 10.1007/s40618-020-01386-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The impact of patient's characteristics on glucocorticoid (GC) replacement therapy in adrenal insufficiency (AI) is poorly evaluated. Aims of this study were to assess the influence of sex and body weight on GC dosing and to describe the choice of GC in AI of different etiologies. METHODS We retrospectively evaluated hydrocortisone (HC) equivalent total daily dose (HC-TDD) and per-kg-daily dose (HC-KDD) in 203 patients (104 primary AI [pAI], 99 secondary AI [sAI]) followed up for ≥ 12 months. They were treated with HC, modified-release HC (MRHC) or cortisone acetate (CA) and fludrocortisone acetate (FCA) in pAI. RESULTS At baseline, CA was preferred both in pAI and sAI; at last visit, MRHC was most used in pAI (49%) and CA in sAI (73.7%). Comparing the last visit with baseline, in pAI, HC-TDD and HC-KDD were significantly lower (p = 0.04 and p = 0.006, respectively), while FCA doses increased during follow-up (p = 0.02). The reduction of HC-TDD and HC-KDD was particularly relevant for pAI women (p = 0.04 and p = 0.002, respectively). In sAI patients, no change of HC-KDD and HC-TDD was observed, and we found a correlation between weight and HC-TDD in males (r 0.35, p = 0.02). CONCLUSIONS Our real-life study demonstrated the influence of etiology of AI on the type of GC used, a weight-based tailoring in sAI, a likely overdosage of GC treatment in pAI women at the start of treatment and the possibility to successfully increase FCA avoiding GC over-treatment. These observations could inform the usual clinical practice.
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Affiliation(s)
- S Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy.
| | - A Rossini
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - I Tabaro
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
| | - S Cannavò
- Department of Human Pathology 'G.Barresi', University of Messina, Messina, Italy
| | - F Ferrau'
- Department of Human Pathology 'G.Barresi', University of Messina, Messina, Italy
| | - M Ragonese
- Department of Human Pathology 'G.Barresi', University of Messina, Messina, Italy
| | - G Borretta
- Division of Endocrinology, AO S. Croce E Carle, Cuneo, Italy
| | - M Pellegrino
- Division of Endocrinology, AO S. Croce E Carle, Cuneo, Italy
| | - F Dughera
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
| | - A Parisi
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
| | - A Latina
- Division of Endocrinology, AO S. Croce E Carle, Cuneo, Italy
| | - A Pia
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
| | - M Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
| | - G Reimondo
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
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Pettrone K, Burnett E, Link-Gelles R, Haight SC, Schrodt C, England L, Gomes DJ, Shamout M, O'Laughlin K, Kimball A, Blau EF, Ladva CN, Szablewski CM, Tobin-D'Angelo M, Oosmanally N, Drenzek C, Browning SD, Bruce BB, da Silva J, Gold JAW, Jackson BR, Morris SB, Natarajan P, Fanfair RN, Patel PR, Rogers-Brown J, Rossow J, Wong KK, Murphy DJ, Blum JM, Hollberg J, Lefkove B, Brown FW, Shimabukuro T, Midgley CM, Tate JE, Killerby ME. Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients, Atlanta, Georgia, USA, March-April 2020. Emerg Infect Dis 2021; 27:1164-1168. [PMID: 33754981 PMCID: PMC8007327 DOI: 10.3201/eid2704.204709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient’s age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes.
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Gąsecka A, Borovac JA, Guerreiro RA, Giustozzi M, Parker W, Caldeira D, Chiva-Blanch G. Thrombotic Complications in Patients with COVID-19: Pathophysiological Mechanisms, Diagnosis, and Treatment. Cardiovasc Drugs Ther 2021; 35:215-229. [PMID: 33074525 PMCID: PMC7569200 DOI: 10.1007/s10557-020-07084-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Emerging evidence points to an association between severe clinical presentation of COVID-19 and increased risk of thromboembolism. One-third of patients hospitalized due to severe COVID-19 develops macrovascular thrombotic complications, including venous thromboembolism, myocardial injury/infarction and stroke. Concurrently, the autopsy series indicate multiorgan damage pattern consistent with microvascular injury. PROPHYLAXIS, DIAGNOSIS AND TREATMENT COVID-19 associated coagulopathy has distinct features, including markedly elevated D-dimers concentration with nearly normal activated partial thromboplastin time, prothrombin time and platelet count. The diagnosis may be challenging due to overlapping features between pulmonary embolism and severe COVID-19 disease, such as dyspnoea, high concentration of D-dimers, right ventricle with dysfunction or enlargement, and acute respiratory distress syndrome. Both macro- and microvascular complications are associated with an increased risk of in-hospital mortality. Therefore, early recognition of coagulation abnormalities among hospitalized COVID-19 patients are critical measures to identify patients with poor prognosis, guide antithrombotic prophylaxis or treatment, and improve patients' clinical outcomes. RECOMMENDATIONS FOR CLINICIANS Most of the guidelines and consensus documents published on behalf of professional societies focused on thrombosis and hemostasis advocate the use of anticoagulants in all patients hospitalized with COVID-19, as well as 2-6 weeks post hospital discharge in the absence of contraindications. However, since there is no guidance for deciding the intensity and duration of anticoagulation, the decision-making process should be made in individual-case basis. CONCLUSIONS Here, we review the mechanistic relationships between inflammation and thrombosis, discuss the macrovascular and microvascular complications and summarize the prophylaxis, diagnosis and treatment of thromboembolism in patients affected by COVID-19.
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Affiliation(s)
- Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| | - Josip A Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
| | | | - Michela Giustozzi
- Internal Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy
| | - William Parker
- Cardiovascular Research Unit, University of Sheffield, Sheffield, UK
| | - Daniel Caldeira
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Univerisdade de Lisboa, Lisbon, Portugal
- Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - Gemma Chiva-Blanch
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Spanish Biomedical Research Network in Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII, Madrid, Spain
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Clark CE, McDonagh STJ, McManus RJ, Martin U. COVID-19 and hypertension: risks and management. A scientific statement on behalf of the British and Irish Hypertension Society. J Hum Hypertens 2021; 35:304-307. [PMID: 33483621 PMCID: PMC7821986 DOI: 10.1038/s41371-020-00451-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/13/2020] [Accepted: 11/13/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Christopher E Clark
- Primary Care Research Group, Institute of Health Services Research, College of Medicine & Health, University of Exeter Medical School, Smeall Building, St Luke's Campus, Magdalen Road, Exeter, Devon, England, EX1 2LU, UK.
| | - Sinead T J McDonagh
- Primary Care Research Group, Institute of Health Services Research, College of Medicine & Health, University of Exeter Medical School, Smeall Building, St Luke's Campus, Magdalen Road, Exeter, Devon, England, EX1 2LU, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, England, OX2 6GG, UK
| | - Una Martin
- Birmingham Medical School, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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Kapuria D, Bollipo S, Rabiee A, Ben‐Yakov G, Kumar G, Siau K, Lee H, Congly S, Turnes J, Dhanasekaran R, Lui RN. Roadmap to resuming care for liver diseases after coronavirus disease-2019. J Gastroenterol Hepatol 2021; 36:885-892. [PMID: 32656794 PMCID: PMC7404933 DOI: 10.1111/jgh.15178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/27/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022]
Abstract
The global pandemic of coronavirus disease-2019 (COVID-19) has led to significant disruptions in healthcare delivery. Patients with chronic liver diseases require a high level of care and are therefore particularly vulnerable to disruptions in medical services during COVID-19. Recent data have also identified chronic liver disease as an independent risk factor for COVID-19 related hospital mortality. In response to the pandemic, national and international societies have recommended interim changes to the management of patients with liver diseases. These modifications included the implementation of telehealth, postponement or cancelation of elective procedures, and other non-urgent patient care-related activities. There is concern that reduced access to diagnosis and treatment can also lead to increased morbidity in patients with liver diseases and we may witness a delayed surge of hospitalizations related to decompensated liver disease after the COVID-19 pandemic has receded. Therefore, it is paramount that liver practices craft a comprehensive plan for safe resumption of clinical operations while minimizing the risk of exposure to patients and health-care professionals. Here, we provide a broad roadmap for how to safely resume care for patients with chronic liver disease according to various phases of the pandemic with particular emphasis on outpatient care, liver transplantation, liver cancer care, and endoscopy.
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Affiliation(s)
- Devika Kapuria
- Division of Gastroenterology and HepatologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Steven Bollipo
- Department of GastroenterologyJohn Hunter HospitalNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Atoosa Rabiee
- Gastroenterology and Hepatology SectionVeterans Affairs HospitalWashingtonDistrict of ColumbiaUSA
| | - Gil Ben‐Yakov
- Center for Liver DiseaseSheba Medical CenterTel HaShomerIsrael
| | - Goutham Kumar
- Department of Liver Diseases and TransplantationManipal HospitalsBangaloreIndia
| | - Keith Siau
- Liver UnitQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Hye‐Won Lee
- Division of GastroenterologyDepartment of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
| | - Stephen Congly
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Juan Turnes
- Gastroenterology and HepatologyPontevedra University Hospital ComplexPontevedraSpain
- Galicia Sur Health Research InstituteVigoSpain
| | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong KongChina
- Institute of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
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Higgins V, White-Al Habeeb N, Venner AA, Bailey D, Collier C, Adeli K. A Snapshot of Lipid-Reporting Practices in Canadian Clinical Laboratories: An Urgent Need for Harmonisation. Can J Cardiol 2021; 37:933-937. [PMID: 33775880 DOI: 10.1016/j.cjca.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 12/31/2022] Open
Abstract
To effectively implement the Canadian Cardiovascular Society (CCS) guidelines for dyslipidemia management into clinical laboratories, clear recommendations for lipid reporting are essential. In this study, the Canadian Society of Clinical Chemists Working Group on Reference Interval Harmonisation surveyed Canadian laboratories on adult lipid reporting practices to set a foundation for the development and implementation of harmonised lipid reporting across Canada. Key aspects of the survey asked laboratories: what reporting parameters were in place to assess lipid results; what interpretative comments were provided; whether nonfasting lipids were permitted and, if so, what strategy was used to document fasting status; and whether there was interest in implementing a harmonised lipid report. A total of 101 laboratories were represented by 24 respondents, as many responses were submitted by laboratory networks that included more than 1 laboratory. There was at least 1 response from 9 Canadian provinces and representation across 5 testing platforms. Upper and lower limits for lipid parameters and referenced source of limits varied substantially across laboratories, with only 56% of laboratories (9 respondents) referencing the 2016 CCS guidelines. Eighty-six percent of laboratories (19 respondents) report nonfasting lipids, although the method of documenting nonfasting status varied. Overall, 36% of laboratories (8 respondents) reported interest in implementing a harmonised lipid report. Assessment of current lipid-reporting practices supports the need for harmonised lipid reporting across Canada. Development of a harmonised lipid report for the adult population, consistent with up-to-date Canadian guidelines, will improve continuity of lipid test interpretation across Canada and improve clinical decision making.
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Affiliation(s)
- Victoria Higgins
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Allison A Venner
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Christine Collier
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Khosrow Adeli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew Knight
- West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK
- West Hertfordshire Respiratory Service-Central London Community Healthcare, Hertfordshire, UK
| | - Matt Inda-Kim
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
- NHS England, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
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Mapelli M, Mantegazza V, Agostoni P. The semantic of a pandemic: Are cardiovascular patients dying "with" or "from" COVID-19? Reflections from a case report. Medicine (Baltimore) 2021; 100:e25072. [PMID: 33655986 PMCID: PMC7939151 DOI: 10.1097/md.0000000000025072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Northern Italy has been particularly hit by the current Covid-19 pandemic. Italian deceased patients have a mean age of 78.5 years and only 1.2% have no comorbidities. These data started a public debate whether patients die "with" or "from" Covid-19. If on one hand the public opinion has been persuaded to believe that Covid-19 infection has poor outcomes just in elderly and/or fragile subjects, on the other hand, hospitals are admitting an increasing number of healthy young patients needing semi-intensive or intensive care units. PATIENT CONCERNS At the end of March 2020, a 79-year-old patient (M.G.) was admitted to the emergency department of our hospital with a 5 days history of fever, dyspnea, and cough. He was known for hypertension and coronary artery disease with a previous coronary artery stenting. Both the comorbidities were carried out without complications and the patient was previously asymptomatic and in good health. At admission, he was febrile and showed signs of respiratory failure with hypoxia and hypocapnia at blood gas analysis. DIAGNOSIS The day after, he was tested for SARS-CoV-2 with a real-time reverse transcriptase-polymerase chain reaction assay of nasopharyngeal swab, which turned positive and a chest CT-Scan was consistent with the diagnosis of interstitial pneumonia. INTERVENTIONS He was treated with i.v. diuretics, paracetamol, prolonged noninvasive ventilation (CPAP), and empiric antibiotic therapy on top of his chronic treatment. OUTCOMES A treatment with heparin and corticosteroids was started; however, he developed irreversible respiratory failure. Invasive ventilation was not considered appropriate due to his comorbidities, low chances of recovery, and intensive care unit overcrowding. The patient died 9 days after admission. LESSONS Health conditions that are most reported as risk factors are common cardiovascular diseases that can be managed in modern clinical practice. Through a brief illustrative clinical case, we would like to underline how Covid-19 can be per se the cause of death in patients that would otherwise have had an acceptable life expectancy.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino IRCCS
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Plumb L, Benoy-Deeney F, Casula A, Braddon FEM, Tse Y, Inward C, Marks S, Steenkamp R, Medcalf J, Nitsch D. COVID-19 in children with chronic kidney disease: findings from the UK renal registry. Arch Dis Child 2021; 106:e16. [PMID: 32709685 DOI: 10.1136/archdischild-2020-319903] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Lucy Plumb
- UK Renal Registry, The Renal Association, Bristol, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Anna Casula
- UK Renal Registry, The Renal Association, Bristol, UK
| | | | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Carol Inward
- Department of Paediatric Nephrology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Stephen Marks
- Faculty of Population Health Sciences, University College London Institute of Child Health, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - James Medcalf
- UK Renal Registry, The Renal Association, Bristol, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, The Renal Association, Bristol, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Schrager SB. Care Management and the Quadruple Aim. Fam Pract Manag 2021; 28:5. [PMID: 33687185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Abstract
Fibromyalgia is a chronic pain condition manifested by chronic generalized pain, fatigue, disordered sleep, and cognitive difficulties, persistent for at least 3 months. Other common complaints/conditions include symptoms of irritable bowel syndrome, headaches, intermittent paresthesias, and various mood disorders. Women are more commonly affected than men. The treatment approach should be individualized and focused on associated mood disorders, sleep, exercise, correction of maladaptive responses to pain, and coping with stress.
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Affiliation(s)
- Carmen E Gota
- Case Western Reserve Cleveland Clinic School of Medicine, Cleveland, OH, USA.
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50
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Brull JL, Hodge KS. Care Management in the Real World: A Small, Private Practice's Journey. Fam Pract Manag 2021; 28:33-36. [PMID: 33687184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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