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2.
Klin Monbl Augenheilkd ; 237(9): 1045-1059, 2020 Sep.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-32967029

RESUMO

The ophthalmologic assessment of causal relationships is subject to formal guidelines, depending on the legal field (social law in the statutory accident insurance, civil law in the private accident insurance). After determining all objective and subjective findings of the individual case with complete recording of the medical facts, the ophthalmologist has the task of making a summarizing assessment of the existing cause-and-effect relationship. With regard to the distinction between retinal damage caused by an accident or retinal disease not caused by an accident, it is necessary to weigh up the natural causality according to the state of medical experience on the basis of the criteria strength of association, consistency, specificity, temporal sequence, dose dependence, agreement with previous findings, experimental reliability and analogous consideration. All records of medical findings from the patient's medical history and the individual description of the accident must be included in the expert opinion. In the case of several competing causes (often accident and pre-existing damage), the social law in the statutory accident insurance must present the causal contributions with roughly estimated probabilities. In civil law, valid for the private accident insurance, the existence of partial causality (approx. 25, 50, 75%) must be evaluated.


Assuntos
Avaliação da Deficiência , Doenças Retinianas , Prova Pericial , Humanos , Seguro de Acidentes , Reprodutibilidade dos Testes
3.
JCO Clin Cancer Inform ; 4: 794-798, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32897736

RESUMO

PURPOSE: COVID-19 is a rapidly emerging worldwide pandemic that has drastically changed health care across the United States. Oncology patients are especially vulnerable. Novel point-of-care resources may be useful to rapidly disseminate peer-reviewed information from oncology experts nationwide. We describe our initial experience with distributing this information through a private, curated, virtual collaboration question-and-answer (Q&A) platform for oncologists. METHODS: The Q&A database was queried for a 2-month period from March 12 to May 12, 2020. We collected the total number of views and unique viewers for the questions. We classified the questions according to their emphasis (practice management, clinical management, both) and disease type across radiation oncology, medical oncology, gynecologic oncology, and pediatric oncology. RESULTS: Seventy-nine questions were approved, 67 of which were answered and generated 49,494 views with 5,148 unique viewers. Most discussions covered clinical management, with breast cancer being the most active disease site. Ten questions covered pediatric oncology and gynecologic oncology. Forty-seven percent of the 11,010 users of the platform visited the website during the 2-month period. CONCLUSION: Discussions on the Q&A platform reached a substantial number of oncologists throughout the nation and may help oncologists to modify their treatment in real time with the rapidly evolving COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Prova Pericial , Disseminação de Informação , Oncologia , Neoplasias/terapia , Pandemias , Pneumonia Viral , Administração da Prática Médica , Betacoronavirus , Humanos , Internet , Oncologistas , Sistemas Automatizados de Assistência Junto ao Leito
4.
J Environ Manage ; 271: 110924, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32778261

RESUMO

Scientific evidence should inform environmental policy, but rapid environmental change brings high ecological uncertainty and associated barriers to the science-management dialogue. Biological invasions of aquatic plants are a worldwide problem with uncertain ecological and economic consequences. We demonstrate that the discrete choice method (DCM) can serve as a structured expert elicitation alternative to quantify expert opinion across a range of possible but uncertain environmental outcomes. DCM is widely applied in the social sciences to better understand and predict human preferences and trade-offs. Here we apply it to Alaska's first submersed invasive aquatic freshwater plant, Elodea spp. (elodea), and its unknown effects on salmonids. While little is known about interactions between elodea and salmonids, ecological research suggests that aquatic plant invasions can have positive and negative, as well as direct and indirect, effects on fish. We use DCM to design hypothetical salmonid habitat scenarios describing elodea's possible effect on critical environmental conditions for salmonids: prey abundance, dissolved oxygen, and vegetation cover. We then observe how experts choose between scenarios that they believe could support persistent salmonid populations in elodea-invaded salmonid habitat. We quantify the relative importance of habitat characteristics that influence expert choice and investigate how experts trade off between habitat characteristics. We take advantage of Bayesian techniques to estimate discrete choice models for individual experts and to simulate expert opinion for specific environmental management situations. We discuss possible applications and advantages of the DCM approach for expert elicitation in the ecological context. We end with methodological questions for future research.


Assuntos
Hydrocharitaceae , Salmonidae , Alaska , Animais , Teorema de Bayes , Prova Pericial , Humanos
5.
Int J Law Psychiatry ; 71: 101595, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768117

RESUMO

Due to the present COVID-19 pandemic, forensic mental telehealth assessment (FMTA) is an increasingly utilized means of conducting court-sanctioned psychiatric and psychological evaluations. FMTA is not a novel development, and studies have been published during the past two decades that opine on the positive and negative implications of conducting testing and interview procedures online, in forensic and traditionally clinical matters alike. The present article examines prospects for eventual legal challenges to FMTA, describes considerations for conducting FMTA in both institutional and residential settings, and concludes that FMTA is now-due to predicted accommodations on the part of courts, attorneys, institutions, and professional guilds-a permanent part of the forensic evaluation landscape, even once the present COVID-19 pandemic has subsided.


Assuntos
Infecções por Coronavirus/epidemiologia , Psiquiatria Legal/legislação & jurisprudência , Transtornos Mentais/diagnóstico , Pneumonia Viral/epidemiologia , Telemedicina/legislação & jurisprudência , Betacoronavirus , Prova Pericial/legislação & jurisprudência , Humanos , Pandemias
6.
Curr Med Sci ; 40(4): 602-607, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32767261

RESUMO

This study aims to develop the expert consensus on nurse's human caring for Corona Virus Disease 2019 (COVID-19) patients in different sites, and thus provide a guideline on providing whole process and systematic caring for COVID-19 patients. Based on the frontline experiences of human caring for COVID-19 patients and the review of literature, the initial draft of consensus was made and finalized after online meeting and revisions. The experts reached consensus on the following parts: terms and definitions, principles of human caring for COVID-19 patients, and human caring measures for COVID-19 patients in different sites. The expert consensus is practical, concise, and reasonable for guiding the nurses providing human caring for COVID-19 patients, as well as other similar infectious diseases.


Assuntos
Betacoronavirus , Infecções por Coronavirus/enfermagem , Cuidados de Enfermagem/métodos , Pneumonia Viral/enfermagem , China/epidemiologia , Consenso , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Prova Pericial , Humanos , Pandemias , Planejamento de Assistência ao Paciente , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Padrões de Prática em Enfermagem , Quarentena , Enfermagem em Reabilitação
7.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(6): 641-645, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32684205

RESUMO

As the ability of treating coronavirus disease 2019 (COVID-19) improves, the theory and method of diagnosis and treatment of COVID-19 need to be further enriched and perfected. In the clinical treatment of COVID-19, the theoretical system of "three syndromes and three methods" for treating critical diseases based on syndrome differentiation by integrated traditional Chinese medicine (TCM) and Western medicine has been recognized by the majority of clinical respiratory and critical disease experts. Xuebijing injection, which was developed based on "three syndromes and three methods", has been repeatedly recommended in the national diagnosis and treatment guidelines. In order to facilitate the clinical practitioners better understanding the "three syndromes and three methods", and apply the theory into the treatment of COVID-19, Expert opinion on diagnosis and treatment of coronavirus disease 2019 with traditional Chinese medicine based on "three syndromes and three methods" was organized by experts from China Association of Integrative Medicine Emergency Medicine Committee, which could make references for clinical practice.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Medicamentos de Ervas Chinesas/uso terapêutico , Pandemias , Pneumonia Viral , China , Infecções por Coronavirus/tratamento farmacológico , Prova Pericial , Humanos , Medicina Tradicional Chinesa , Pneumonia Viral/tratamento farmacológico
8.
PLoS One ; 15(7): e0235905, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697809

RESUMO

BACKGROUND: Whole-body vibration (WBV) is a method utilizing vibrating platforms to expose individuals to mechanical vibration. In its various applications, it has been linked to improved muscular, skeletal, metabolic, or cognitive functioning, quality of life, and physiological parameters such as blood pressure. Most evidence concerning WBV is inconclusive and meta-analytical reviews may not readily produce insights since the research has a risk of misunderstandings of vibration parameters and incomplete reporting occurs. This study aims at laying an empirical foundation for reporting guidelines for human WBV studies to improve the quality of reporting and the currently limited comparability between studies. METHOD: The Delphi methodology is employed to exploit the integrated knowledge of WBV experts to distil the specific aspects of WBV methodology that should be included in such guidelines. Over three rounds of completing online questionnaires, the expert panel (round 1/2/3: 51/40/37 experts respectively from 17 countries with an average of 19.4 years of WBV research experience) rated candidate items. RESULTS: A 40-item list was established based on the ratings of the individual items from the expert panel with a large final consensus (94.6%). CONCLUSION: The final consensus indicates comprehensiveness and valuableness of the list. The results are in line with previous guidelines but expand these extensively. The present results may therefore serve as a foundation for updated guidelines for reporting human WBV studies in order to improve the quality of reporting of WBV studies, improve comparability of studies and facilitate the development of WBV study designs.


Assuntos
Modalidades de Fisioterapia , Vibração/uso terapêutico , Adulto , Idoso , Técnica Delfos , Prova Pericial , Feminino , Corpo Humano , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa , Inquéritos e Questionários
9.
Siglo cero (Madr.) ; 51(2): 99-117, abr.-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193114

RESUMO

La asistencia personal para personas con discapacidad intelectual puede contribuir a la aplicación de los nuevos paradigmas de autodeterminación e inclusión social y a una mejora de la calidad de vida. Mediante revisión de la literatura y un análisis con expertos profesionales, expertos por experiencia y potenciales usuarios, se elaboró un modelo breve de asistencia personal para ser ejecutado por agentes comunitarios con supervisión profesional. El modelo considera actividades en los espacios habituales de las personas y sus familias, con apoyo para el uso de recursos formales e informales de la comunidad y el refuerzo de redes de apoyo que continúen operando una vez que termine la intervención. Con una duración de 9 meses, el modelo se desarrolla mediante un proceso de 3 etapas: 1) establecimiento de vínculo y elaboración de un plan individualizado, 2) implementación del plan y 3) refuerzo de los aprendizajes de los participantes y traspaso a redes de apoyo. Se discute la factibilidad de la aplicación del modelo en países latinoamericanos y la necesidad de realizar estudios que evalúen su implementación


Personal assistance for people with intellectual disabilities can contribute to the application of the new paradigms of self-determination and social inclusion and to an improvement in the quality of life. Through a literature review and analysis with professional experts, experts from experience and potential users, a brief model of personal assistance was developed to be executed by community agents with professional supervision. The model considers activities in the usual spaces of people and their families, with support for the use of community formal and informal resources and the reinforcement of social support networks that continue operating once the intervention ends. With duration of 9 months, the model is developed through a 3-stage process: 1) engagement and formulation of an individualized plan, 2) implementation of the plan, and 3) participants' learning reinforcement and transfer to support networks. The feasibility of the model in Latin American countries and the need for studies to evaluate its implementation are discussed


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Deficiência Intelectual/reabilitação , Deficiência Intelectual/psicologia , Qualidade de Vida , Desejabilidade Social , Apoio Social , Política Pública , Políticas Públicas Antidiscriminatórias , Prova Pericial , Chile
10.
Kardiol Pol ; 78(6): 642-646, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32515570

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic affects anticoagulation not only in those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but also in most patients who require daily anticoagulant therapy and are facing substantial limitations in medical care these days. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has frequently been reported in patients with COVID-19, but its management is still challenging due to the complexity between antithrombotic therapy and hematological alterations. In the era of COVID-19 pandemic, it is highly recommended for patients who require chronic anticoagulation to continue therapy to prevent thromboembolic events. To avoid regular and frequent blood tests and unnecessary exposure to SARS-CoV-2 during contacts with medical personnel, direct oral anticoagulants should be strongly preferred whenever possible. Current evidence is insufficient to recommend routine pharmacological antithrombotic prophylaxis in all hospitalized patients with COVID-19. In patients with COVID-19 who are suspected of VTE or in whom the diagnosis is confirmed, parenteral therapy with low-molecular-weight heparin should be initiated in the absence of contraindications. If heparin-induced thrombocytopenia is suspected, nonheparin anticoagulants should be used such as bivalirudin or fondaparinux. In case of confirmed acute pulmonary embolism, treatment should be guided by risk stratification as defined in the current guidelines.


Assuntos
Anticoagulantes/uso terapêutico , Infecções por Coronavirus/complicações , Prova Pericial , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Tromboembolia Venosa/tratamento farmacológico , Betacoronavirus , Coagulação Sanguínea , Infecções por Coronavirus/terapia , Hospitalização/estatística & dados numéricos , Humanos , Pandemias , Pneumonia Viral/terapia , Polônia , Embolia Pulmonar/complicações , Fatores de Risco , Sociedades Médicas
11.
Lancet Haematol ; 7(8): e601-e612, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32563283

RESUMO

The ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 is a global public health crisis. Multiple observations indicate poorer post-infection outcomes for patients with cancer than for the general population. Herein, we highlight the challenges in caring for patients with acute leukaemias and myeloid neoplasms amid the COVID-19 pandemic. We summarise key changes related to service allocation, clinical and supportive care, clinical trial participation, and ethical considerations regarding the use of lifesaving measures for these patients. We recognise that these recommendations might be more applicable to high-income countries and might not be generalisable because of regional differences in health-care infrastructure, individual circumstances, and a complex and highly fluid health-care environment. Despite these limitations, we aim to provide a general framework for the care of patients with acute leukaemias and myeloid neoplasms during the COVID-19 pandemic on the basis of recommendations from international experts.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Controle de Infecções/normas , Leucemia/terapia , Transtornos Mieloproliferativos/terapia , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto/normas , Adulto , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Gerenciamento Clínico , Prova Pericial , Humanos , Leucemia/virologia , Transtornos Mieloproliferativos/virologia , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Alocação de Recursos
12.
Neurogastroenterol Motil ; 32(7): e13930, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32525249

RESUMO

BACKGROUND: During the peak of the COronaVIrus Disease 2019 (COVID-19) pandemic, care for patients with gastrointestinal motility and functional disorders was largely suspended. In the recovery phases of the pandemic, non-urgent medical care is resumed, but there is a lack of guidance for restarting and safely conducting motility and function testing. Breath tests and insertion of manometry and pH-monitoring probes carry a risk of SARS-CoV-2 spread through droplet formation. METHODS: A panel of experts from the European Society for Neurogastroenterology and Motility (ESNM) evaluated emerging national and single-center recommendations to provide the best current evidence and a pragmatic approach to ensure the safe conduct of motility and function testing for both healthcare professionals and patients. RESULTS: At a general level, this involves evaluation of the urgency of the procedure, evaluation of the infectious risk associated with the patient, the investigation and the healthcare professional(s) involved, provision of the test planning and test units, education and training of staff, and use of personnel protection equipment. Additional guidance is provided for specific procedures such as esophageal manometry, pH monitoring, and breath tests. CONCLUSIONS AND INFERENCES: The ESNM guidelines provide pragmatic and appropriate guidance for the safe conduct of motility and function testing in the COVID-19 pandemic and early recovery phase.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Gastroenterologia/normas , Motilidade Gastrointestinal/fisiologia , Neurologia/normas , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto/normas , Recuperação de Função Fisiológica/fisiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Europa (Continente)/epidemiologia , Prova Pericial/métodos , Prova Pericial/normas , Pessoal de Saúde/normas , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Roupa de Proteção/normas , Sociedades Médicas/normas
13.
J Allergy Clin Immunol ; 146(2): 300-306, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32561389

RESUMO

The coronavirus disease 2019 (COVID-19) (caused by severe acute respiratory syndrome coronavirus 2) pandemic has massively distorted our health care systems and caused catastrophic consequences in our affected communities. The number of victims continues to increase, and patients at risk can only be protected to a degree, because the virulent state may be asymptomatic. Risk factors concerning COVID-19-induced morbidity and mortality include advanced age, an impaired immune system, cardiovascular or pulmonary diseases, obesity, diabetes mellitus, and cancer treated with chemotherapy. Here, we discuss the risk and impact of COVID-19 in patients with mastocytosis and mast cell activation syndromes. Because no published data are yet available, expert opinions are, by necessity, based on case experience and reports from patients. Although the overall risk to acquire the severe acute respiratory syndrome coronavirus 2 may not be elevated in mast cell disease, certain conditions may increase the risk of infected patients to develop severe COVID-19. These factors include certain comorbidities, mast cell activation-related events affecting the cardiovascular or bronchopulmonary system, and chemotherapy or immunosuppressive drugs. Therefore, such treatments should be carefully evaluated on a case-by-case basis during a COVID-19 infection. In contrast, other therapies, such as anti-mediator-type drugs, venom immunotherapy, or vitamin D, should be continued. Overall, patients with mast cell disorders should follow the general and local guidelines in the COVID-19 pandemic and advice from their medical provider.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Mastocitose Cutânea/tratamento farmacológico , Mastocitose Sistêmica/tratamento farmacológico , Pandemias , Pneumonia Viral/epidemiologia , Betacoronavirus/imunologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/patologia , Difosfonatos/uso terapêutico , Prova Pericial , Glucocorticoides/efeitos adversos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Mastócitos/efeitos dos fármacos , Mastócitos/imunologia , Mastócitos/patologia , Mastocitose Cutânea/diagnóstico , Mastocitose Cutânea/epidemiologia , Mastocitose Cutânea/patologia , Mastocitose Sistêmica/diagnóstico , Mastocitose Sistêmica/epidemiologia , Mastocitose Sistêmica/patologia , Agonistas Mieloablativos/efeitos adversos , Pneumonia Viral/diagnóstico , Pneumonia Viral/patologia , Medicina de Precisão/métodos , Fatores de Risco , Vitamina D/uso terapêutico
15.
Pediatrics ; 145(Suppl 3): S269-S284, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32482739

RESUMO

OBJECTIVES: Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians, balancing and contextualizing evidence with current practice through a multidisciplinary panel of experts. METHODS: The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop miniMAGIC, which included the following sequential phases: definition of scope and key terms, information synthesis and literature review, expert multidisciplinary panel selection and engagement, case scenario development, and appropriateness ratings by an expert panel via 2 rounds. RESULTS: The appropriateness of the selection, characteristics, and insertion technique of intravenous catheters commonly used in pediatric health care across age populations (neonates, infants, children, and adolescents), settings, diagnoses, clinical indications, insertion locations, and vessel visualization devices and techniques was defined. Core concepts including vessel preservation, insertion and postinsertion harm minimization (eg, infection, thrombosis), undisrupted treatment provision, and inclusion of patient preferences were emphasized. CONCLUSIONS: In this study, we provide evidence-based criteria for intravenous catheter selection (from umbilical catheters to totally implanted venous devices) in pediatric patients across a range of clinical indications. miniMAGIC also highlights core vascular access practices in need of collaborative research and innovation.


Assuntos
Cateterismo Venoso Central/normas , Prova Pericial/normas , Pediatria/normas , Guias de Prática Clínica como Assunto/normas , Dispositivos de Acesso Vascular/normas , Adolescente , Cateterismo Venoso Central/métodos , Criança , Pré-Escolar , Prova Pericial/métodos , Humanos , Lactente , Recém-Nascido , Michigan , Pediatria/métodos
18.
Neurology ; 95(5): e488-e498, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32546652

RESUMO

OBJECTIVE: To explore the accuracy of combined neurology expert forecasts in predicting primary endpoints for trials. METHODS: We identified one major randomized trial each in stroke, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS) that was closing within 6 months. After recruiting a sample of neurology experts for each disease, we elicited forecasts for the primary endpoint outcomes in the trial placebo and treatment arms. Our main outcome was the accuracy of averaged predictions, measured using ordered Brier scores. Scores were compared against an algorithm that offered noncommittal predictions. RESULTS: Seventy-one neurology experts participated. Combined forecasts of experts were less accurate than a noncommittal prediction algorithm for the stroke trial (pooled Brier score = 0.340, 95% subjective probability interval [sPI] 0.340 to 0.340 vs 0.185 for the uninformed prediction), and approximately as accurate for the MS study (pooled Brier score = 0.107, 95% confidence interval [CI] 0.081 to 0.133 vs 0.098 for the noncommittal prediction) and the ALS study (pooled Brier score = 0.090, 95% CI 0.081 to 0.185 vs 0.090). The 95% sPIs of individual predictions contained actual trial outcomes among 44% of experts. Only 18% showed prediction skill exceeding the noncommittal prediction. Independent experts and coinvestigators achieved similar levels of accuracy. CONCLUSION: In this first-of-kind exploratory study, averaged expert judgments rarely outperformed noncommittal forecasts. However, experts at least anticipated the possibility of effects observed in trials. Our findings, if replicated in different trial samples, caution against the reliance on simple approaches for combining expert opinion in making research and policy decisions.


Assuntos
Prova Pericial , Previsões , Neurologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Humanos
19.
Hautarzt ; 71(8): 613-623, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32494841

RESUMO

BACKGROUND: Person-to-person transmitted infectious diseases can cause occupational diseases (OD). These are subsumed as BK-No. 3101 in the German list of OD which applies for individuals with a considerably higher risk for infection as a consequence of their professional activity compared to the general population. OBJECTIVES: The special medical and insurance law aspects of a work-related MRSA colonization are presented using the example of an expert opinion case and an evaluation of the BK reports of suspected occupational disease (BK No. 3101) of the German Social Accident Insurance (DGUV). PATIENTS AND METHODS: The BK documentation of the DGUV from 2007-2012 and the patient cohort from the Department of Dermatology, University Hospital Erlangen, presenting for expert assessment from 2007-2012 were retrospectively analysed for human-to-human transmitted infectious diseases of the skin (BK-No. 3101). RESULTS: Person-to-person transmission of infectious diseases of the skin is rare in the field of occupational dermatology. In the DGUV cohort, suspected BK-No. 3101cases amounted to 2.6% of all notified cases; recognized BK-No. 3101 cases accounted for 4.2% of all recognized cases, amongst which 9 were caused by MRSA. In contrast to a symptomatic infection, an asymptomatic MRSA colonization is not being recognized as BK-No. 3101. Bacterial superantigens can trigger atopic dermatitis (AD). In particular cases, occupationally acquired MRSA can elicit AD and may justify classification as an OD (BK-No. 3101). CONCLUSIONS: Early detection of MRSA colonization and eradication are necessary for rehabilitation. Management of skin diseases due to infectious diseases within the framework of OD is presented.


Assuntos
Dermatite Ocupacional/diagnóstico , Dermatologia/normas , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Doenças Profissionais/epidemiologia , Infecções Estafilocócicas/diagnóstico , Dermatite Atópica , Dermatite Ocupacional/epidemiologia , Documentação , Prova Pericial , Alemanha/epidemiologia , Humanos , Doenças Profissionais/diagnóstico , Doenças Profissionais/microbiologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia
20.
Expert Opin Pharmacother ; 21(11): 1377-1387, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32511032

RESUMO

INTRODUCTION: Neuropathic pain (NP) is caused by a lesion or disease of the somatosensory system, which can severely impact patients' quality of life. The current-approved treatments for NP comprise of both centrally acting agents and topical drugs, including capsaicin 8% dermal patches, which is approved for the treatment of peripheral NP. AREAS COVERED: The authors summarize literature data regarding capsaicin use in patients who suffer from NP and discuss the clinical applications of this topical approach. EXPERT OPINION: Overall, the capsaicin 8% dermal patch is as effective in reducing pain intensity as other centrally active agents (i.e. pregabalin). Some studies have also reported fewer systemic side effects, a faster onset of action and superior treatment satisfaction compared with systemic agents. In our opinion, capsaicin 8% dermal patches also present additional advantages, such as a good systemic tolerability, the scarcity of adverse events, the possibility to combine it with other agents, and a good cost-effective profile. It is important to note that, as the mechanism of action of capsaicin 8% is the 'defunctionalization' of small afferent fibers through interaction with TRPV1 receptors, the peripheral expression of this receptor on nociceptor fibers, is crucial to predict patient's response to treatment.


Assuntos
Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Capsaicina/administração & dosagem , Capsaicina/uso terapêutico , Neuralgia/tratamento farmacológico , Administração Tópica , Analgésicos/efeitos adversos , Capsaicina/efeitos adversos , Análise Custo-Benefício , Prova Pericial , Humanos , Neuralgia/metabolismo , Pregabalina/administração & dosagem , Pregabalina/efeitos adversos , Pregabalina/uso terapêutico , Qualidade de Vida , Canais de Cátion TRPV/metabolismo , Adesivo Transdérmico
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