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Addition of the Fleischner Society guidelines to Chest CT Examination Interpretive Reports Improves Adherence to Recommended Follow-up Care for Incidental Pulmonary Nodules

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ACADEMIC RADIOLOGY 2017年第3期24卷 337-344页

作者： McDonald, Jennifer S. Koo, Chi Wan White, Darin Hartman, Thomas E. Bender, Claire E. Sykes, Anne-Marie G. Mayo Clin Dept Radiol 200 1st St SW Rochester MN 55905 USA

Rationale and Objectives: The study aimed to determine whether the addition of the Fleischner Society guidelines to chest computed tomography (CT) reports identifying incidental pulmonary nodules affects follow-up care. Patients and Methods: Beginning in 2008, a template containing the Fleischner Society guidelines was added at the interpreting radiologist's discretion to chest CT reports describing incidental solid pulmonary nodules at our institution. The records of all medical centers in Olmsted county were used to capture the complete medical history of local patients >35 years old diagnosed with a pulmonary nodule from April 1, 2008 to October 1, 2011. Patients with a history of cancer or previously diagnosed nodule, or who died before follow-up, were excluded. Patients were categorized according to whether they did ("template group") or did not ("control group") have the template added. Nodule size and smoking history were used to determine recommended follow-up care. Differences in follow-up were compared between groups using Pearson's chi-square test. Results: A total of 510 patients (276 in the template group, 234 in the control group) were included in the study. Only 198 patients (39%) received their recommended follow-up care. Template group patients were significantly more likely to receive recommended follow-up care compared to control group patients (45% vs 31%, P =.0014). Most patients whose management did not adhere to Fleischner Society guidelines did not receive a recommended follow-up chest CT (210 out of 312, 67%). Conclusions: The addition of the Fleischner Society guidelines to chest CT reports significantly increases the likelihood of receiving recommended follow-up care for patients with incidental pulmonary nodules. Additional education is needed to improve appropriate guideline utilization by radiologists and adherence by ordering providers.

关键词： Pulmonary nodule radiology report Fleischner Society management guidelines

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Development of the World Federation of Hemophilia Shared Decision-Making Tool

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HAEMOPHILIA 2024年第6期30卷 1298-1308页

作者： Coffin, Donna Skinner, Mark W. Thornburg, Courtney D. Hayes, Brendan K. Sannie, Thomas Kaeser, Gwendolyn E. Chadwick, Julia Naccache, Mayss Pierce, Glenn F. World Federat Hemophilia Montreal PQ Canada Inst Policy Advancement Ltd Washington DC USA McMaster Univ Hamilton ON Canada Rady Childrens Hosp Hemophilia & Thrombosis Treatment Ctr San Diego DC USA Natl Bleeding Disorders Fdn New York NY USA Assoc Francaise Hemophiles Paris France Gwen Kaeser Med Writing LLC Bend OR USA

IntroductionThe use of shared decision-making (SDM) in clinical settings is becoming more prevalent. The evolving and increasingly complex treatment landscape of haemophilia management has augmented the need and desire for SDM between patients and their healthcare team. SDM tools have been used in other chronic conditions and can be an effective form of education for patients and *** World Federation of Hemophilia (WFH) partnered with people with haemophilia (PWH), patient advocacy groups, and healthcare practitioners to form an expert working group to develop an educational tool for PWH and their caregivers. The primary objectives included educating PWH on the available prophylactic treatments and facilitating discussion between PWH and their healthcare *** tool was proposed and developed by the expert working group, workshopped at conference round tables, and evaluated in two focus *** interactive WFH SDM Tool guides users through the SDM treatment journey and provides an opportunity for reflection on current disease impact and treatment preferences, educational fact sheets and videos, and a comparison between treatment classes. Two forms of the SDM Tool are available: an online platform with a summary page that may be printed and shared and a printable workbook. All evidence in the tool is based on the prescribing information or phase III clinical trial publications. The Tool will be updated twice each *** WFH SDM Tool is the first available resource that translates published guidance on SDM in haemophilia into a practical, user-friendly tool aimed at facilitating patient-centred treatment decisions.

关键词： bleeding disorders haemophilia management guidelines SDM tool shared decision-making treatment decisions

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Low Adherence of HIV Providers to Practice guidelines for Hepatocellular Carcinoma Screening in HIV/Hepatitis B Coinfection

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CLINICAL INFECTIOUS DISEASES 2015年第11期61卷 1742-1748页

作者： Hearn, Bevin Chasan, Rachel Bichoupan, Kian Suprun, Maria Bagiella, Emilia Dieterich, Douglas T. Perumalswami, Ponni Branch, Andrea D. Huprikar, Shirish Carolinas HealthCare Syst Dept Med Div Infect Dis Charlotte NC 28203 USA Icahn Sch Med Mt Sinai Dept Med Div Infect Dis New York NY 10029 USA Icahn Sch Med Mt Sinai Dept Med Div Liver Dis New York NY 10029 USA Icahn Sch Med Mt Sinai Dept Hlth Evidence & Policy New York NY 10029 USA

Background. In the era of combination therapy for human immunodeficiency virus (HIV), liver disease, and hepatocellular carcinoma (HCC) are major causes of death for patients coinfected with HIV and hepatitis B virus (HBV). This study compared HIV provider and hepatologist awareness of and adherence to the American Association for the Study of Liver Diseases (AASLD) practice guidelines for chronic HBV management. The primary end-point of HIV provider adherence to HCC screening recommendations was compared to that of hepatologists at a large metropolitan academic medical center. Methods. Medical record database searches by ICD-9 codes were used to identify HIV/HBV coinfected (n = 144) and HBV monoinfected (n = 225) patients who were seen at least twice over a 2-year period in outpatient clinics. Adherence to AASLD guidelines was assessed by chart review. Provider awareness was evaluated through a voluntary anonymous survey with knowledge-based questions. Results. Over a 2-year period, only 36.0% of HIV/HBV coinfected patients seen in HIV practices completed HCC screening compared to 81.8% of HBV monoinfected patients in hepatology practices (P < .00001). Similarly, HIV providers less frequently monitored HBV viral load (P < .0001), HBeAg/anti-HBe (P < .00001), HBsAg/anti-HBs (P < .00001) than hepatologists but screened more often for hepatitis A immunity (P = .028). Self-reported adherence and knowledge scores were similar among 19 HIV providers and 16 hepatologists. Conclusions. HIV providers ordered significantly fewer HCC screening and HBV monitoring tests than hepatologists within a single academic medical center. In the setting of increased reliance on quality indicators for care, both patients and providers will benefit from greater adherence to established guidelines.

关键词： hepatitis B virus HIV/HBV coinfection management guidelines hepatocellular carcinoma

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Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection

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INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS 2020年第2期149卷 130-136页

作者： Chen, Dunjin Yang, Huixia Cao, Yun Cheng, Weiwei Duan, Tao Fan, Cuifang Fan, Shangrong Feng, Ling Gao, Yuanmei He, Fang He, Jing Hu, Yali Jiang, Yi Li, Yimin Li, Jiafu Li, Xiaotian Li, Xuelan Lin, Kangguang Liu, Caixia Liu, Juntao Liu, Xinghui Pan, Xingfei Pang, Qiumei Pu, Meihua Qi, Hongbo Shi, Chunyan Sun, Yu Sun, Jingxia Wang, Xietong Wang, Yichun Wang, Zilian Wang, Zhijian Wang, Cheng Wu, Suqiu Xin, Hong Yan, Jianying Zhao, Yangyu Zheng, Jun Zhou, Yihua Zou, Li Zeng, Yingchun Zhang, Yuanzhen Guan, Xiaoming Guangzhou Med Univ Affiliated Hosp 3 Dept Obstet & Gynecol Guangzhou Guangdong Peoples R China Peking Univ Hosp 1 Dept Obstet & Gynecol Beijing Peoples R China Fudan Univ Childrens Hosp Affiliated Dept Neonatol Shanghai Peoples R China Shanghai Jiao Tong Univ Int Peace Matern & Child Hlth Hosp Sch Med Dept Obstet Shanghai Peoples R China Shanghai First Matern & Infant Hosp Dept Obstet & Gynecol Shanghai Peoples R China Wuhan Univ Dept Obstet & Gynecol Renmin Hosp Wuhan Hubei Peoples R China Peking Univ Dept Obstet & Gynecol Shenzhen Hosp Shenzhen Guangdong Peoples R China Huazhong Univ Sci & Technol Tongji Hosp Tongji Med Coll Dept Perinatal Med Wuhan Hubei Peoples R China Guangzhou Med Univ Affiliated Hosp 3 Dept Crit Care Unit Guangzhou Guangdong Peoples R China Zhejiang Univ Womens Hosp Sch Med Dept Obstet & Gynecol Hangzhou Zhejiang Peoples R China Nanjing Univ Nanjing Drum Tower Hosp Sch Med Dept Obstet & GynecolAffiliated Hosp Nanjing Jiangsu Peoples R China Peking Univ Hosp 1 Dept Pediat Beijing Peoples R China Guangzhou Med Univ Affiliated Hosp 1 Dept Crit Care Unit Guangzhou Guangdong Peoples R China Wuhan Univ Zhongnan Hosp Dept Obstet & Gynecol Wuhan Hubei Peoples R China Hosp Fudan Univ Dept Obstet Obstet & Gynecol Shanghai Peoples R China Xi An Jiao Tong Univ Affiliated Hosp 1 Dept Obstet & Gynecol Xian Shanxi Peoples R China Guangzhou Med Univ Brain Hosp Affiliated Dept Affect Disorder Guangzhou Guangdong Peoples R China China Med Univ Shengjing Hosp Dept Obstet & Gynecol Shenyang Liaoning Peoples R China Chinese Acad Med Sci & Peking Union Med Coll Hosp Dept Obstet & Gynecol Beijing Peoples R China Sichuan Univ Dept Obstet & Gynecol West China Second Univ Hosp Chengdu Sichuan Peoples R China Guangzhou Med Univ Affiliated Hosp 3 Dept Infect Dis Guangzhou Guangdong Peoples R China Capital Med Univ Youan Hosp Dept Obstet & Gynecol Beijing Peoples R China Peking Univ Hosp 3 Dept Pediat Beijing Pe

Objective To provide clinical management guidelines for novel coronavirus (COVID-19) in pregnancy. Methods On February 5, 2020, a multidisciplinary teleconference comprising Chinese physicians and researchers was held and medical management strategies of COVID-19 infection in pregnancy were discussed. Results Ten key recommendations were provided for the management of COVID-19 infections in pregnancy. Conclusion Currently, there is no clear evidence regarding optimal delivery timing, the safety of vaginal delivery, or whether cesarean delivery prevents vertical transmission at the time of delivery;therefore, route of delivery and delivery timing should be individualized based on obstetrical indications and maternal-fetal status.

关键词： COVID-19 Expert consensus management guidelines Neonates Pregnant women

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Optimizing the debarking and cutting schedule of cork oak stands

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ANNALS OF FOREST SCIENCE 2018年第2期75卷 1-11页

作者： Pasalodos-Tato, Maria Pukkala, Timo Canellas, Isabel Sanchez-Gonzalez, Mariola Inst Nacl Invest & Tecnol Agr & Aliment INIA CIFO Ctr Invest Forestal Dept Selvicultura & Gest Sistemas Forestales Km 7-5 Madrid Spain Univ Eastern Finland Joensuu 80101 Finland

Key message Optimal management of cork oak forest stands was analyzed for different site indices and cork growth rates. Optimal debarking intervals varied during the rotation and were sometimes shorter or longer than the officially recommended range of 9-14 years. Context Quercus suber L. is one of the most important multipurpose tree species in the Mediterranean area. Its main product is cork, appreciated for its elasticity, impermeability, and thermal insulation properties. Cork oaks are debarked at constant intervals, which vary from 9 to 14 years depending on the area. However, since the growth rate of cork is not constant during the rotation, it may be optimal to use variable debarking intervals. Aims This study optimized the debarking and cutting schedules of Quercus suber stands and analyzed the influence of economic and stand-related factors on optimal management. Methods The study employed a simulation system where the existing growth and yield models for Quercus suber were used with a non-linear derivative-free optimization algorithm. Discount rates and cork prices were tested as economic factors and cork growth rate and site productivity as stand-related factors. Results The optimal debarking interval varied during the rotation. Increasing cork growth rate increased the optimal number of debarkings and shortened their interval. Decreasing discount rate increased the optimal number of debarkings during rotation while decreasing cork price decreased the number of debarkings. Conclusion The profitability of the management of cork oak stands depends on site fertility and stand density;management is not profitable on poor sites or at high discount rates. This study is the first that simultaneously optimizes the cutting and debarking schedule of cork oak stands, allowing the debarking interval to vary.

关键词： Non-wood forest products Debarking interval Cork weight management guidelines

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Variability in management Recommendations for Incidental Thyroid Nodules Detected on CT of the Cervical Spine in the Emergency Department

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JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY 2014年第7期11卷 681-685页

作者： Lehnert, Bruce E. Sandstrom, Claire K. Gross, Joel A. Dighe, Manjiri Linnau, Ken F. Univ Washington Harborview Med Ctr Dept Radiol Seattle WA 98104 USA Univ Washington Med Ctr Dept Radiol Seattle WA 98195 USA

Purpose: Incidental thyroid nodules are common on CT. Variability in management recommendations for these nodules due to a lack of accepted CT base guidelines has not been demonstrated. Methods: Consecutive CT cervical spine radiology reports describing thyroid nodules performed in an emergency department from January 1, 2009, to December 31, 2011, were retrospectively reviewed. Number of nodules, nodule size, and type of recommended management were recorded. Results: Three hundred fifteen examinations met the inclusion criteria. The mean study age was 64 +/- 20 years. Fifty-eight percent were women. Thirty percent (n = 95) of thyroid nodules measured <10 mm, 20% (n = 63) were >= 10 but <15 mm, 11% (n = 36) were >= 15 but <20 mm, and 15.5% (n = 49) were >= 20 mm. Size was not reported for 22.9% (n = 72). Two hundred twenty-seven recommendations were made in 181 (57.5%) studies. Recommendations were made for 51.6% (49 of 95) of nodules <10 mm, for 52.4% (33 of 63) of those >= 10 but <15 mm, for 83.3% (30 of 36) of those >= 15 but <20 mm, and for 81.6% (40 of 49) of those >= 20 mm. management was recommended in 40.0% (29 of 72) of nodules with no size reported. Fifty-four percent (123 of 227) of recommendations were for ultrasound, followed by no follow-up recommended (17.2% [39 of 227]), clinical correlation (13.7% [31 of 227]), thyroid serology (6.2% [14 of 227]), clinical follow-up (4.8% [11 of 227]), comparison with prior studies (2.2% [5 of 227]), fine-needle aspiration (1.3% [3 of 227]), and nuclear scintigraphy (0.4% [1 of 227]). Nodule size was significantly associated with the likelihood of recommendation (odds ratio, 1.79;95% confidence interval, 1.37-2.35). Conclusions: management recommendations for incidental thyroid nodules detected on cervical spine CT are made inconsistently, and the type of management recommended is variable.

关键词： Incidental thyroid nodule management recommendations CT emergency department cervical spine practice variability management guidelines

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Improving outcomes and quality of life for patients with transfusion-dependent β-thalassemia: recommendations for best clinical practice and the use of novel treatment strategies

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EXPERT REVIEW OF HEMATOLOGY 2021年第10期14卷 897-909页

作者： Taher, Ali T. Bou-Fakhredin, Rayan Kattamis, Antonis Viprakasit, Vip Cappellini, Maria Domenica Amer Univ Beirut Dept Internal Med Med Ctr Beirut Lebanon Natl & Kapodistrian Univ Athens Dept Pediat 1 Athens Greece Mahidol Univ Siriraj Hosp Fac Med Siriraj Ctr Excellence Adv Gene & Cellular Therap Bangkok Thailand Mahidol Univ Siriraj Hosp Fac Med Dept Pediat Bangkok Thailand Univ Milan Fdn IRCCS Ca Granda Policlin Hosp Milan Italy

Introduction: beta-thalassemia is one of the most common inherited monogenic diseases. Many patients are dependent on a lifetime of red blood cell (RBC) transfusions and iron chelation therapy. Although treatments have a significant impact on quality of life (QoL), life expectancy, and long-term health outcomes have improved in recent decades through safer RBC transfusion practices and better iron chelation strategies. Advances in the understanding of the pathology of beta-thalassemia have led to the development of new treatment options that have the potential to reduce the RBC transfusion burden in patients with transfusion-dependent (TD) beta-thalassemia and improve QoL. Areas covered: This review provides an overview of currently available treatments for patients with TD beta-thalassemia, highlighting QoL issues, and providing an update on current clinical experience plus important practical points for two new treatments available for TD beta-thalassemia: betibeglogene autotemcel (beti-cel) gene therapy and the erythroid maturation agent luspatercept, an activin ligand trap. Expert opinion: : Approved therapies, including curative gene therapies and supportive treatments such as luspatercept, have the potential to reduce RBC transfusion burden, and improve clinical outcomes and QoL in patients with TD beta-thalassemia. Cost of treatment is, however, likely to be a significant barrier for payors and patients.

关键词： beti-cel beta-thalassemia gene therapy iron chelation therapy luspatercept management guidelines quality of life transfusion transfusion-dependent

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management of parapneumonic effusions in pediatrics: Current practice

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JOURNAL OF HOSPITAL MEDICINE 2008年第3期3卷 263-270页

作者： McBride, Sarah C. Harvard Univ Childrens Hosp Sch Med Boston MA 02115 USA

Pneumonia with associated complex pleural disease is a cause of significant morbidity among hospitalized children. The management of this patient population continues to be a challenge and varies even among single institutions. The article presented here reviews the management goals for pediatric patients hospitalized with complex parapneumonic effusions and provides updated summaries of both medical and surgical therapies.

关键词： pediatrics pneumonia effusion management guidelines

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Changing clinical practice: management of paediatric community-acquired pneumonia

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JOURNAL OF EVALUATION IN CLINICAL PRACTICE 2014年第1期20卷 94-99页

作者： Elemraid, Mohamed A. Rushton, Stephen P. Thomas, Matthew F. Spencer, David A. Eastham, Katherine M. Gennery, Andrew R. Clark, Julia E. Newcastle Upon Tyne Hosp NHS Trust Dept Paediat Infect Dis & Immunol Newcastle Upon Tyne Tyne & Wear England Newcastle Univ Inst Cellular Med Newcastle Upon Tyne NE1 7RU Tyne & Wear England Newcastle Univ Sch Biol Newcastle Upon Tyne NE1 7RU Tyne & Wear England Newcastle Upon Tyne Hosp NHS Trust Dept Resp Paediat Newcastle Upon Tyne Tyne & Wear England Sunderland Royal Hosp Dept Paediat Sunderland Tyne & Wear England

Rationale and aimTo compare clinical features and management of paediatric community-acquired pneumonia (PCAP) following the publication of UK pneumonia guidelines in 2002 with data from a similar survey at the same hospitals in 2001-2002 (pre-guidelines). MethodsA prospective survey of 11 hospitals in Northern England was undertaken during 2008-2009. Clinical and laboratory data were recorded on children aged 16 years who presented with clinical and radiological features of pneumonia. Results542 children were included. There was a reduction in all investigations performed (P<0.001) except C-reactive protein (P=0.448) between surveys. These included full blood count (76% to 61%);blood culture (70% to 53%) and testing of respiratory secretions for viruses (24% to 12%) and bacteria (18% to 8%). Compared to pre-guidelines, there was a reduction in the use of intravenous antibiotics as a proportion of the total prescribed from 47% to 36% (P<0.001) and a change in the route of antibiotic administration with increasing preference for oral alone (16% pre-compared to 50% post-guidelines, P<0.001). ConclusionApart from the acute phase reactants that should not be measured routinely, these changes are in line with the guideline recommendations. Improvements in antibiotic use are possible and have implications for future antimicrobial stewardship programmes. Further work using cost-effectiveness analysis may also demonstrate a financial benefit to health services from adoption of guidelines.

关键词： antibiotics stewardship antibiotics children investigations management guidelines pneumonia

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Pompe disease diagnosis and management guideline

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GENETICS IN MEDICINE 2006年第5期8卷 267-288页

作者： Kishnani, Priya S. Steiner, Robert D. Bali, Deeksha Berger, Kenneth Byrne, Barry J. Case, Laura Crowley, John F. Downs, Steven Howell, R. Rodney Kravitz, Richard M. Mackey, Joanne Marsden, Deborah Martins, Anna Maria Millington, David S. Nicolino, Marc O'Grady, Given Patterson, Marc C. Rapoport, David M. Slonim, Alfred Spencer, Carolyn T. Tifft, Cynthia J. Watson, Michael S. Duke Univ Med Ctr Durham NC 27706 USA Oregon Hlth & Sci Univ Portland OR 97201 USA NYU Sch Med New York NY USA Univ Florida Coll Med Powell Gene Therapy Ctr Gainesville FL 32611 USA Indiana Univ Bloomington IN 47405 USA Univ Miami Miller Sch Med Coral Gables FL 33124 USA Harvard Univ Childrens Hosp Sch Med Cambridge MA 02138 USA Univ Fed Sao Paulo Sao Paulo Brazil Columbia Univ New York NY 10027 USA NYU Bellevue Hosp Sch Med New York NY USA Columbia Univ Med Ctr New York NY 10027 USA

ACMG standards and guidelines are designed primarily as an educational resource for physicians and other health care providers to help them provide quality medical genetic services. Adherence to these standards and guidelines does not necessarily ensure a successful medical outcome. These standards and guidelines should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining the same results. In determining the propriety of any specific procedure or test, the geneticist should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. It may be prudent, however, to document in the patient's record the rationale for any significant deviation from these standards and guidelines.

关键词： Pompe disease acid maltase deficiency lysosomal storage disease glycogen storage disease type II management guidelines

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