Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 366
Filtrar
1.
Diagnostics (Basel) ; 14(13)2024 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-39001212

RESUMEN

In recent years, preoperative planning has undergone significant advancements, with a dual focus: improving the accuracy of implant placement and enhancing the prediction of functional outcomes. These breakthroughs have been made possible through the development of advanced processing methods for 3D preoperative images. These methods not only offer novel visualization techniques but can also be seamlessly integrated into computer-aided design models. Additionally, the refinement of motion capture systems has played a pivotal role in this progress. These "markerless" systems are more straightforward to implement and facilitate easier data analysis. Simultaneously, the emergence of machine learning algorithms, utilizing artificial intelligence, has enabled the amalgamation of anatomical and functional data, leading to highly personalized preoperative plans for patients. The shift in preoperative planning from 2D towards 3D, from static to dynamic, is closely linked to technological advances, which will be described in this instructional review. Finally, the concept of 4D planning, encompassing periarticular soft tissues, will be introduced as a forward-looking development in the field of orthopedic surgery.

2.
Artículo en Inglés | MEDLINE | ID: mdl-39073903

RESUMEN

OBJECTIVES: To elicit and quantify expert opinion concerning the relative merits of two treatments for a rare inflammatory disease: Juvenile dermatomyositis (JDM). The formal expression of expert opinion reported in this paper will be used in a Bayesian analysis of a forthcoming randomised controlled trial known as BARJDM (baricitinib for juvenile dermatomyositis). METHODS: A Bayesian prior elicitation meeting was convened, following a previously described methodological template. Opinion was sought on the probability that a patient in the BARJDM trial would achieve clinically inactive disease, off glucocorticoids (GC) within a 12-month period with either methotrexate (standard of care); or baricitinib (a Janus kinase inhibitor, JAKi), with GC schedules identical in both arms of the trial. Experts' views were discussed and refined following presentation and further discussion of summated published data regarding efficacy of methotrexate or JAKi for JDM. RESULTS: Ten UK paediatric rheumatology consultants (including one adolescent paediatric rheumatologist) participated in the elicitation meeting. All had expertise in JDM, leading active National Health Service clinics for this disease. Consensus expert prior opinion was that the most likely probability of clinically inactive disease off GC within 12 months was 0.55 on baricitinib and 0.23 on methotrexate, with a greater degree of uncertainty for baricitinib. CONCLUSION: Experts currently think that baricitinib is superior to MTX for the treatment of JDM, although there is uncertainty around this. BARJDM will therefore integrate randomised trial data with this expert prior opinion to derive a posterior distribution for the relative efficacy of baricitinib compared with MTX.

3.
Mar Pollut Bull ; 205: 116660, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38981192

RESUMEN

Plastic and microplastic contamination in the environment receive global attention, with calls for the synthesis of scientific evidence to inform actionable strategies and policy-relevant practices. We provide a systematic literature review on microplastic research across Australian coastal environments in water, sediment and biota, highlighting the main research foci and gaps in information. At the same time, we conducted surveys and workshops to gather expert opinions from multiple stakeholders (including researchers, industry, and government) to identify critical research directions to meet stakeholder needs across sectors. Through this consultation and engagement process, we created a platform for knowledge exchange and identified three major priorities to support evidence-based policy, regulation, and management. These include a need for (i) method harmonisation in microplastic assessments, (ii) information on the presence, sources, and pathways of plastic pollution, and (iii) advancing our understanding of the risk of harm to individuals and ecosystems.


Asunto(s)
Monitoreo del Ambiente , Microplásticos , Contaminantes Químicos del Agua , Australia , Microplásticos/análisis , Contaminantes Químicos del Agua/análisis , Ecosistema , Investigación , Plásticos/análisis
4.
Autoimmun Rev ; : 103582, 2024 Jul 27.
Artículo en Inglés | MEDLINE | ID: mdl-39074630

RESUMEN

BACKGROUND: The early detection and management of (progressive) interstitial lung disease in patients with connective tissue diseases requires the attention and skills of a multidisciplinary team. However, there are currently no well-established standards to guide the daily practice of physicians treating this heterogenous group of diseases. RESEARCH QUESTION: This paper aimed to identify gaps in scientific knowledge along the journey of patients with connective tissue disease-related interstitial lung disease and to provide tools for earlier identification of interstitial lung disease and progressive disease. STUDY DESIGN AND METHODS: The opinions of an international expert panel, which consisted of pulmonologists and rheumatologists were collected and interpreted in the light of peer-reviewed data. RESULTS: Interstitial lung disease is a common complication of connective tissue diseases, but prevalence estimates vary by subtype. Screening and monitoring by means of clinical examination, chest radiography, pulmonary function testing, and disease-specific biomarkers provide insight into the disease activity of patients presenting with connective tissue diseases in a routine setting. Multiple phenotypic and genotypic characteristics have been identified as predictors of the development and progression of interstitial lung disease. However, these risk factors differ between subtypes. To ensure earlier diagnosis of rapidly progressive phenotypes, a risk-based method is necessary for determining the need for HRCT and additional testing. INTERPRETATION: To reduce the underdiagnosis of CTD-ILDs in clinical practice, a standardized and systematic multidisciplinary risk-based approach is suggested. Collaboration across disciplines is essential for the management of CTD-ILD.

5.
Dermatol Ther (Heidelb) ; 14(7): 1767-1785, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38907876

RESUMEN

Hyaluronic acid (HA) dermal fillers, generally considered low-risk, can lead to rare late-onset reactions (LORs) manifesting between 3 and 4 months postinjection, occasionally even as early as 24 h postinjection. The Complication Assessment and Risk Evaluation (CARE) board was established to review these reactions. In this publication, the authors aims to explore the etiological hypotheses underlying LORs, associated risk factors, prevention, and management approaches suggested by the CARE board. The CARE board identified three etiological hypotheses contributing to LORs. Firstly, the physicochemical structure of the filler, particularly low molecular weight HA, which may trigger an immune response. Secondly, infection, potentially introduced during injection or by dormant biofilm activation. Lastly, an imbalance in the host immune system, caused by factors like autoimmune diseases or viral infections, may lead to extended foreign body reactions, delayed type IV hypersensitivity, or adjuvant-based reactions. Based on these hypotheses, the board categorized various risk factors as patient-related (e.g., recent dental treatment, current medical status, active autoimmune disease), product-related (e.g., molecular weight), and procedure-related (e.g., aseptic technique and trauma). To reduce the risk of LORs, the CARE board recommends diligent patient selection, including comprehensive medical history assessment and informed consent. Practitioners should maintain an effective aseptic technique, and choose an appropriate product and injection depth for the anatomical location. Post-procedure, patients should receive education on proper filler care. Management of LORs depends on the suspected etiology, and the CARE board has proposed an algorithm to determine the most appropriate treatment. Hyaluronidase is recommended for noninflammatory reactions in the absence of active infection, while watchful waiting and/or steroid treatment may be preferred for inflammatory reactions. Hyaluronidase is not recommended as a first-line treatment for infections, which require drainage, bacterial culture, and antibiotic treatment. However, the board emphasizes the need for individualized evaluation and treatment in all cases.

6.
Cancers (Basel) ; 16(11)2024 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-38893233

RESUMEN

Studies on chronic myeloid leukemia (CML) in the Gulf region are scarce, consisting of a survey and expert meeting that included 15 experts in 2023 which discussed CML diagnosis, testing, treatment objectives, toxicities, and discontinuation in the Gulf region. Most patients were reported to be in first-line therapy, and the most common treatments were imatinib/imatinib generic in first-line and dasatinib in second- and third-lines. Mutation analysis was not reported to be routinely performed at the time of diagnosis but rather in case of progression to accelerated/blast phase or any sign of loss of response. While all participants were aware that BCR-ABL should be monitored every three months during the first year of treatment, 10% reported monitoring BCR-ABL every six months in practice due to test cost and lab capability. The most important first-line therapy objective was "achievement of major molecular response" (MMR) in younger patients and "overall survival" in older ones. The most important treatment objectives were "MMR" and "early molecular response followed by prolongation of overall survival" in the short term and "treatment-free remission" in the long term. The current practices in CML in the Gulf region appear to be similar to global figures.

7.
Artículo en Inglés | MEDLINE | ID: mdl-38748211

RESUMEN

PURPOSE: The evaluation and management of Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) lacks standardized guidelines. This study aimed to investigate the real-world practices of neuro-ophthalmologists in the evaluation and management of typical NAION cases. METHODS: A national survey, conducted between 2019 and 2021, involved all practicing neuro-ophthalmologists. A structured questionnaire assessed their approach to risk factor evaluation and treatment of NAION, with 19 questions about risk factors and six questions concerning treatment and prevention of fellow-eye involvement. RESULTS: Thirty-six out of 37 neuro-ophthalmologists participated. Most physicians referred patients for evaluation of the following risk factors: obstructive sleep apnea (83.3%), diabetes mellitus (83.3%), hypertension (77.7%), dyslipidemia (72.2%), and optic disc drusen (38.8%). However, there was considerable variation in the choice of diagnostic tests recommended. Furthermore, nearly 47% recommended an embolism workup. Regarding treatment, the majority (91%) did not recommend routine treatment for NAION, although in 16.7%, high-dose corticosteroids were occasionally prescribed. Secondary prevention with aspirin (80.6%), smoking cessation advice (86.1%), and advising against erectile dysfunction medications for men (80.6%) were common recommendations. CONCLUSION: While the risk factors associated with NAION are well-reported, there is a lack of uniformity on which tests should be ordered to evaluate these risk factors. Most neuro-ophthalmologists concur that routine treatment for NAION is not warranted, but not unanimously. Future studies to develop a consensus guideline for post-NAION work-up and management recommendations may assist in the detection and management of preventable risk factors.

8.
Forensic Sci Int ; 359: 112034, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38704924

RESUMEN

Commentators have recommended that forensic scientists' reports contain various disclosures to facilitate comprehension. However, little research has explored whether following best practice recommendations for disclosure impacts on receivers' impressions of the evidence. We examined whether forensic science reports that are more compliant with these best practice recommendations reduced overvaluing of the evidence and sensitized legal and community decision-makers to evidence quality. Across three experiments, 240 legal practitioners/trainees and 566 community decision-makers were presented with a fingerprint or footwear report that was either compliant or non-compliant with best practice recommendations. Participants were then asked to make evaluations and decisions based on the report. We found mixed effects of report compliance. Report compliance affected community participant's evaluations of the persuasiveness of the evidence but had limited impact on the judgments of legal practitioners/trainees. When presented with compliant reports, we found that community participants regarded unknown reliability evidence as less reliable and less persuasive than high reliability evidence, suggesting disclosures helped reduce overvaluing of the evidence and create sensitivity to differences in evidence quality. These results suggest compliance with reporting recommendations does affect community impressions, while only minimally influencing legal impressions of forensic science evidence. The costs and/or benefits of this outcome require further examination.


Asunto(s)
Ciencias Forenses , Humanos , Ciencias Forenses/legislación & jurisprudencia , Masculino , Adhesión a Directriz , Femenino , Revelación/legislación & jurisprudencia , Adulto , Toma de Decisiones , Guías de Práctica Clínica como Asunto , Dermatoglifia , Reproducibilidad de los Resultados , Persona de Mediana Edad
9.
J Oral Rehabil ; 2024 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-38736044

RESUMEN

BACKGROUND: The importance of incorporating patient and medical professional perspectives in medical research is increasingly recognized. However, formal platforms for these voices are limited. OBJECTIVE: To address this gap, this study proposes a novel manuscript type, the Personal Scoping Review, within the Journal of Oral Rehabilitation. MATERIALS AND METHODS: Personal Scoping Reviews utilize a qualitative design with semi-structured interviews to gather patient and professional perspectives. This approach offers flexibility and depth, allowing authors to explore diverse insights. The reviews focus on care, education and research agendas related to the topic, using the voices of individuals as primary evidence. RESULTS & CONCLUSION: Personal Scoping Reviews highlight concerns in patient care, educational needs and research gaps, offering a comprehensive view. By integrating diverse perspectives, these reviews provide valuable insights for improving medical research and practice. They facilitate the formulation of agendas to address key issues in care, education and research. By amplifying individual perspectives, these reviews aim to enhance the relevance and impact of research, ultimately benefiting patients and healthcare providers alike.

10.
J Shoulder Elbow Surg ; 33(8): e415-e421, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38734126

RESUMEN

BACKGROUND: Physical therapy (PT) is a described first-line treatment option for glenohumeral arthritis, but its efficacy for treating this spectrum of disease is not well understood. The purpose of this study is to evaluate the opinions of expert providers-orthopedic surgeons and physical therapists-regarding the utility of PT in treating glenohumeral arthritis in different stages of radiographic severity. Our goal is to identify areas of interprofessional majority agreement as well as areas without agreement that warrant further investigation. METHODS: A 35-question survey was created and distributed via email to members of the American Shoulder and Elbow Surgeons and the American Society of Shoulder and Elbow Therapists, collecting information on demographics, professional experience, and the perceived benefit of PT for patients with different stages of glenohumeral arthritis based on radiographic severity. Survey responses were analyzed for inter-professional differences in distribution of answer choices as well as for majority agreement statements. Items with >50% agreement from a professional group were considered statements of majority agreement. RESULTS: One hundred and ninety surgeons and 39 physical therapists completed the survey. Surgeons and therapists demonstrated different distribution of answer choices in 25 of the 29 nondemographic related questions (86%). Surgeons and therapists reached the same majority statement in 8 items (28%) and reached disagreeing majority statements in 4 items (14%). They agreed on the benefits of PT for mild arthritis, the benefits of corticosteroid injections, the frequency of strengthening exercises, and that PT failure should not be required for surgical approval in patients with severe arthritis. They disagreed on the whether PT exacerbates symptoms in patients with moderate arthritis, and whether preoperative PT influences postoperative outcomes. CONCLUSION: Both surgeons and therapists agreed that PT may be less beneficial for patients with more advanced radiographic arthritis and that PT failure should not be required for insurance approval for surgical intervention in patients with severe glenohumeral arthritis. Further research is needed to determine the efficacy of PT for patients with moderate arthritis as well as the utility of preoperative PT for improving postoperative outcomes.


Asunto(s)
Artritis , Modalidades de Fisioterapia , Articulación del Hombro , Humanos , Articulación del Hombro/cirugía , Artritis/terapia , Masculino , Femenino , Encuestas y Cuestionarios , Fisioterapeutas , Actitud del Personal de Salud , Cirujanos Ortopédicos , Resultado del Tratamiento , Persona de Mediana Edad
11.
Proc Biol Sci ; 291(2023): 20240172, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38772418

RESUMEN

Tests for the role of species' relative dispersal abilities in ecological and biogeographical models rely heavily on dispersal proxies, which are seldom substantiated by empirical measures of actual dispersal. This is exemplified by tests of dispersal-range size relationships and by metacommunity research that often features invertebrates, particularly freshwater insects. Using rare and unique empirical data on dispersal abilities of caddisflies, we tested whether actual dispersal abilities were associated with commonly used dispersal proxies (metrics of wing size and shape; expert opinion). Across 59 species in 12 families, wing morphology was not associated with actual dispersal. Within some families, individual wing metrics captured some dispersal differences among species, although useful metrics varied among families and predictive power was typically low. Dispersal abilities assigned by experts were either no better than random or actually poorer than random. Our results cast considerable doubt on research underpinned by dispersal proxies and scrutiny of previous research results may be warranted. Greater progress may lie in employing innovative survey and experimental design to measure actual dispersal in the field.


Asunto(s)
Distribución Animal , Insectos , Alas de Animales , Animales , Alas de Animales/anatomía & histología , Alas de Animales/fisiología , Insectos/fisiología
12.
Perspect Psychol Sci ; : 17456916241234837, 2024 Apr 18.
Artículo en Inglés | MEDLINE | ID: mdl-38635239

RESUMEN

Experimental psychologists investigating eyewitness memory have periodically gathered their thoughts on a variety of eyewitness memory phenomena. Courts and other stakeholders of eyewitness research rely on the expert opinions reflected in these surveys to make informed decisions. However, the last survey of this sort was published more than 20 years ago, and the science of eyewitness memory has developed since that time. Stakeholders need a current database of expert opinions to make informed decisions. In this article, we provide that update. We surveyed 76 scientists for their opinions on eyewitness memory phenomena. We compared these current expert opinions to expert opinions from the past several decades. We found that experts today share many of the same opinions as experts in the past and have more nuanced thoughts about two issues. Experts in the past endorsed the idea that confidence is weakly related to accuracy, but experts today acknowledge the potential diagnostic value of initial confidence collected from a properly administered lineup. In addition, experts in the past may have favored sequential over simultaneous lineup presentation, but experts today are divided on this issue. We believe this new survey will prove useful to the court and to other stakeholders of eyewitness research.

13.
Front Public Health ; 12: 1292475, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38584925

RESUMEN

Background: The World Health Organization (WHO) plays a crucial role in producing global guidelines. In response to previous criticism, WHO has made efforts to enhance the process of guideline development, aiming for greater systematicity and transparency. However, it remains unclear whether these changes have effectively addressed these earlier critiques. This paper examines the policy process employed by WHO to inform guideline recommendations, using the update of the WHO Consolidated HIV Testing Services (HTS) Guidelines as a case study. Methods: We observed guideline development meetings and conducted semi-structured interviews with key participants involved in the WHO guideline-making process. The interviews were recorded, transcribed, and analysed thematically. The data were deductively coded and analysed in line with the main themes from a published conceptual framework for context-based evidence-based decision making: introduction, interpretation, and application of evidence. Results: The HTS guideline update was characterized by an inclusive and transparent process, involving a wide range of stakeholders. However, it was noted that not all stakeholders could participate equally due to gaps in training and preparation, particularly regarding the complexity of the Grading Recommendations Assessment Development Evaluation (GRADE) framework. We also found that WHO does not set priorities for which or how many guidelines should be produced each year and does not systematically evaluate the implementation of their recommendations. Our interviews revealed disconnects in the evidence synthesis process, starting from the development of systematic review protocols. While GRADE prioritizes evidence from RCTs, the Guideline Development Group (GDG) heavily emphasized "other" GRADE domains for which little or no evidence was available from the systematic reviews. As a result, expert judgements and opinions played a role in making recommendations. Finally, the role of donors and their presence as observers during GDG meetings was not clearly defined. Conclusion: We found a need for a different approach to evidence synthesis due to the diverse range of global guidelines produced by WHO. Ideally, the evidence synthesis should be broad enough to capture evidence from different types of studies for all domains in the GRADE framework. Greater structure is required in formulating GDGs and clarifying the role of donors through the process.


Asunto(s)
Medicina Basada en la Evidencia , Política de Salud , Medicina Basada en la Evidencia/métodos , Formulación de Políticas , Revisiones Sistemáticas como Asunto , Organización Mundial de la Salud , Guías de Práctica Clínica como Asunto
14.
Arch Cardiovasc Dis ; 117(6-7): 450-456, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38677940

RESUMEN

In France, mexiletine - a class I antiarrhythmic drug - can be prescribed for the symptomatic treatment of myotonia of the skeletal muscles in adult patients with myotonic dystrophy under a compassionate use programme. Mexiletine is used according to its summary of product characteristics, which describes its use for myotonia treatment in adult patients with non-dystrophic myotonia, a different neuromuscular condition without cardiac involvement. A cardiac assessment is required prior to initiation and throughout treatment due to potential proarrhythmic effects. The presence of conduction system disease, the most common cardiac manifestation of myotonic dystrophy, mandates repeated cardiac evaluations in patients with this condition, and becomes even more important when they are given mexiletine. A group of experts, including three neurologists and five cardiologists from French neuromuscular reference centres, were involved in a task force to develop a treatment algorithm to guide mexiletine use in myotonic dystrophy. The recommendations are based on data from a literature review of the safety of mexiletine-treated patients with myotonic dystrophy, the compassionate use protocol for mexiletine and the personal clinical experience of the experts. The main conclusion of the expert group is that, although existing safety data in mexiletine-treated patients with myotonic dystrophy are reassuring, cardiac assessments should be reinforced in such patients compared with mexiletine-treated patients with non-dystrophic myotonia. This expert opinion to guide mexiletine treatment in patients with myotonic dystrophy should help to reduce the risk of severe adverse events and facilitate interactions between specialists involved in the routine care of patients with myotonic dystrophy.


Asunto(s)
Mexiletine , Distrofia Miotónica , Adulto , Humanos , Algoritmos , Antiarrítmicos/uso terapéutico , Antiarrítmicos/efectos adversos , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiología , Arritmias Cardíacas/inducido químicamente , Toma de Decisiones Clínicas , Ensayos de Uso Compasivo , Consenso , Francia , Mexiletine/uso terapéutico , Mexiletine/efectos adversos , Distrofia Miotónica/tratamiento farmacológico , Distrofia Miotónica/diagnóstico , Distrofia Miotónica/fisiopatología , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Bloqueadores del Canal de Sodio Activado por Voltaje/uso terapéutico , Bloqueadores del Canal de Sodio Activado por Voltaje/efectos adversos
15.
Mod Rheumatol ; 2024 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-38511322

RESUMEN

OBJECTIVES: Late-onset rheumatoid arthritis (LORA), which has been increasing in recent years, lacks evidence for initial treatment. Japanese rheumatology experts recognized this gap and addressed it by developing consensus statements on the first clinical application of LORA. METHODS: These statements were created following an introductory discussion about treatment fundamentals, which included a review of existing literature and cohort data. The steering committee created a draft, which was refined using a modified Delphi method that involved panel members reaching a consensus. The panel made decisions based on input from geriatric experts, clinical epidemiologists, guideline developers, patient groups, and the LORA Research Subcommittee of the Japan College of Rheumatology. RESULTS: The consensus identified four established facts, three basic approaches, and six expert opinions for managing LORA. Methotrexate was recommended as the primary treatment, with molecular-targeted agents being considered if treatment goals cannot be achieved. An emphasis was placed on assessing the lives of older patients due to challenges in risk management and methotrexate accessibility caused by comorbidities or cognitive decline. CONCLUSIONS: The experts substantiated and refined 13 statements for the initial treatment of LORA. To validate these claims, the next is to conduct a registry study focusing on new LORA cases.

16.
Anim Welf ; 33: e17, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38510423

RESUMEN

In the UK and Republic of Ireland, the European badger (Meles meles) is considered the most significant wildlife reservoir of the bacterium Mycobacterium bovis, the cause of bovine tuberculosis (bTB). To expand options for bTB surveillance and disease control, the Animal and Plant Health Agency developed a bespoke physical restraint cage to facilitate collection of a small blood sample from a restrained, conscious badger in the field. A key step, prior to pursuing operational deployment of the novel restraint cage, was an assessment of the relative welfare impacts of the approach. We used an established welfare assessment model to elicit expert opinion during two workshops to compare the impacts of the restraint cage approach with the only current alternative for obtaining blood samples from badgers in the field, which involves administration of a general anaesthetic. Eleven panellists participated in the workshops, comprising experts in the fields of wildlife biology, animal welfare science, badger capture and sampling, and veterinary science. Both approaches were assessed to have negative welfare impacts, although in neither case were overall welfare scores higher than intermediate, never exceeding 5-6 out of a possible 8. Based on our assessments, the restraint cage approach is no worse for welfare compared to using general anaesthesia and possibly has a lower overall negative impact on badger welfare. Our results can be used to integrate consideration of badger welfare alongside other factors, including financial cost and efficiency, when selecting a field method for blood sampling free-living badgers.

17.
BMC Med Educ ; 24(1): 331, 2024 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-38519899

RESUMEN

BACKGROUND: Many applied postgraduate pain training programs are monodisciplinary, whereas interdisciplinary training programs potentially improve interdisciplinary collaboration, which is favourable for managing patients with chronic pain. However, limited research exists on the development and impact of interdisciplinary training programs, particularly in the context of chronic pain. METHODS: This study aimed to describe the development and implementation of an interdisciplinary training program regarding the management of patients with chronic pain, which is part of a type 1 hybrid effectiveness-implementation study. The targeted groups included medical doctors, nurses, psychologists, physiotherapists, occupational therapists, dentists and pharmacists. An interdisciplinary expert panel was organised to provide its perception of the importance of formulated competencies for integrating biopsychosocial pain management with a cognitive behavioural approach into clinical practice. They were also asked to provide their perception of the extent to which healthcare professionals already possess the competencies in their clinical practice. Additionally, the expert panel was asked to formulate the barriers and needs relating to training content and the implementation of biopsychosocial chronic pain management with a cognitive behavioural approach in clinical practice, which was complemented with a literature search. This was used to develop and adapt the training program to the barriers and needs of stakeholders. RESULTS: The interdisciplinary expert panel considered the competencies as very important. Additionally, they perceived a relatively low level of healthcare professionals' possession of the competencies in their clinical practice. A wide variety of barriers and needs for stakeholders were formulated and organized within the Theoretical Domain Framework linked to the COM-B domains; 'capability', 'opportunity', and 'motivation'. The developed interdisciplinary training program, including two workshops of seven hours each and two e-learning modules, aimed to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioural approach into clinical practice. CONCLUSION: We designed an interdisciplinary training program, based on formulated barriers regarding the management of patients with chronic pain that can be used as a foundation for developing and enhancing the quality of future training programs.


Asunto(s)
Dolor Crónico , Humanos , Dolor Crónico/terapia , Manejo del Dolor , Personal de Salud , Atención a la Salud , Cognición
18.
Mult Scler ; : 13524585241228103, 2024 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-38456514

RESUMEN

BACKGROUND: Current guidance on the selection of appropriate contraception for people with multiple sclerosis (PwMS) is lacking. OBJECTIVE: To address this gap, an expert-led consensus program developed recommendations to support clinicians in discussing family planning and contraception with women and men with multiple sclerosis (MS). METHODS: A multidisciplinary steering committee (SC) of 13 international clinical experts led the program, supported by an extended faculty of 32 experts representing 18 countries. A modified Delphi methodology was used for decision-making and consensus-building. The SC drafted 15 clinical questions focused on patient-centered care, selection of contraception, and timing of stopping/starting contraception and disease-modifying therapies (DMTs). Statements addressing each question were drafted based on evaluation of published evidence and the experts' clinical experience. Consensus was reached if ⩾75% of respondents agreed (scoring 7-9 on a 9-point scale) with each recommendation. RESULTS: Consensus was reached on 24 of 25 proposed recommendations, including how and when to discuss contraception, types and safety of contraceptives, and how to evaluate the most appropriate contraceptive options for specific patient groups, including those with significant disability or being treated with DMTs. CONCLUSION: These expert recommendations provide the first practical, relevant, and comprehensive guidance for clinicians on the selection of contraception in PwMS.

19.
J Psychopharmacol ; 38(4): 318-323, 2024 04.
Artículo en Inglés | MEDLINE | ID: mdl-38494873

RESUMEN

As Faculty of the British Association for Psychopharmacology course on child and adolescent psychopharmacology, we present here what we deem are the most common pitfalls, and how to avoid them, in child and adolescent psychopharmacology. In this paper, we specifically addressed common pitfalls in the pharmacological treatment of autism and intellectual disability, eating disorders, neuropsychiatric correlates of epilepsy, and psychosis. Pitfalls in relation to the treatment of other disorders are addressed in a separate paper (Part I).


Asunto(s)
Trastorno Autístico , Trastornos de Alimentación y de la Ingestión de Alimentos , Discapacidad Intelectual , Psicofarmacología , Trastornos Psicóticos , Niño , Adolescente , Humanos
20.
J Psychopharmacol ; 38(4): 311-317, 2024 04.
Artículo en Inglés | MEDLINE | ID: mdl-38494948

RESUMEN

As Faculty of the British Association for Psychopharmacology course on child and adolescent psychopharmacology, we present here what we deem are the most common pitfalls, and how to avoid them, in child and adolescent psychopharmacology. In this paper, we specifically addressed common pitfalls in the pharmacological treatment of attention-deficit/hyperactivity disorder, anxiety, bipolar disorder, depression, obsessive-compulsive disorder and related disorders, and tic disorder. Pitfalls in the treatment of other disorders are addressed in a separate paper (part II).


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Trastorno Obsesivo Compulsivo , Psicofarmacología , Trastornos de Tic , Niño , Humanos , Adolescente , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Trastorno Obsesivo Compulsivo/epidemiología , Trastornos de Ansiedad/tratamiento farmacológico , Trastornos de Tic/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Comorbilidad
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA