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1.
G Ital Cardiol (Rome) ; 23(6): 408-413, 2022 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-35674028

RESUMO

Vaccine-associated myocarditis and pericarditis usually develop within 14 days of COVID-19 vaccination, are exceptionally rare, manifest with mild clinical pictures and are commonly characterized by a favorable evolution. Young men inoculated with two doses of an mRNA vaccine are the subgroup at higher risk. Recent epidemiological studies evaluated the incidence and risk of vaccine-associated myocarditis and pericarditis among men and women, in different ranges of age and specific types of vaccines. Long-term population analyses demonstrated that the cardiovascular risk conferred by COVID-19 extends beyond the acute phase, representing the rationale for implementing prevention strategies for SARS-CoV-2 infection, monitoring specific populations at higher risk and pursuing the completion of the vaccination campaign. This document provides an update on the most recent scientific evidence and critical interpretation of available data in constant evolution towards personalized strategies of immunization.


Assuntos
COVID-19 , Cardiologia , Miocardite , Pericardite , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Prova Pericial , Feminino , Humanos , Itália/epidemiologia , Masculino , Miocardite/complicações , Pericardite/etiologia , SARS-CoV-2 , Vacinação , Vacinas Sintéticas
2.
Orphanet J Rare Dis ; 17(1): 224, 2022 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-35698202

RESUMO

BACKGROUND: Achondroplasia is associated with disproportionate short stature and significant and potentially severe medical complications. Vosoritide is the first medicine to treat the underlying cause of achondroplasia and data from phase 3 and phase 2 extension studies showed effects on growth and body proportions. However, there are currently no long-term data available on the direct impact on endpoints such as medical complications and health-related quality of life (HRQoL). This study explored the perceived impact of achondroplasia on medical complications, HRQoL, healthcare resource use and mortality, and potential modifying effects of vosoritide, based on published evidence and expert opinion. Structured expert opinion was obtained by an international modified Delphi study among 14 experts in managing achondroplasia performed on a virtual platform and consisting of an explorative phase followed by an anonymous individual rating round. RESULTS: Overall, the panelists expect that in individuals starting long-term treatment between 2 years of age and puberty, growth velocity increases observed in the clinical trials will be maintained until final height is reached (92% agreement) and will likely result in clinically meaningful improvements in upper-to-lower body segment ratio (85%). Earlier treatment initiation will likely result in a greater final height (100%) and more likely improve proportionality (92%) than later treatment. Although current data are limited, ≥ 75% of panelists find it conceivable that the earlier long-term treatment is started, the greater the probability of a positive effect on the lifetime incidence of symptomatic spinal stenosis, kyphosis, obstructive sleep apnea, and foramen magnum stenosis. These are among the most clinically important complications of achondroplasia because of their high impact on comorbidity, mortality, and/or HRQoL. A positive effect of vosoritide on the incidence of surgeries through lifetime was considered more likely with earlier long-term treatment (90%). CONCLUSIONS: This explorative study, based on international expert opinion, provides further insight into the medical and functional impacts of achondroplasia and how these might be modified through long-term use of vosoritide. The results can be used to guide the direction and design of future research to validate the assumptions and to discuss potential treatment outcomes with disease modifying therapies with families and clinicians.


Assuntos
Acondroplasia , Qualidade de Vida , Acondroplasia/complicações , Acondroplasia/tratamento farmacológico , Técnica Delfos , Prova Pericial , Humanos , Motivação , Peptídeo Natriurético Tipo C/análogos & derivados
3.
Antimicrob Resist Infect Control ; 11(1): 87, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35725502

RESUMO

Healthcare-associated infections (HAIs) represent a relevant problem for all healthcare facilities, because they involve both the care aspect and the economic management of the hospital. Most HAIs are preventable through effective Infection Prevention and Control (IPC) measures. Implementation and improvement of IPC programs are critical to reducing the impact of these infections and the spread of multi-resistant microorganisms. The purpose of this Expert Opinion statement was to provide a practical guide for healthcare organizations, physicians, and nursing staff on the optimal implementation of the core components of Infection Prevention and Control, as recommended by a board of specialists after in-depth discussion of the available evidence in this field. According to their independent suggestions and clinical experiences, as well as evidence-based practices and literature review, this document provides a practical bundle of organizational, structural, and professional requirements necessary to promote, through multimodal strategies, the improvement of the quality and safety of care with respect to infectious risk in order to protect the patient, facilities, and healthcare providers.


Assuntos
Infecção Hospitalar , Prova Pericial , Infecção Hospitalar/prevenção & controle , Atenção à Saúde , Hospitais , Humanos , Controle de Infecções/métodos
4.
J Med Life ; 15(4): 570-578, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35646171

RESUMO

The next frontier in hemophilia A management has arrived. However, questions remain regarding the broader applicability of new and emerging hemophilia A therapies, such as the long-term safety and efficacy of non-factor therapies and optimal regimens for individual patients. With an ever-evolving clinical landscape, it is imperative for physicians to understand how available and future hemophilia A therapies could potentially be integrated into real-life clinical practice to improve patient outcomes. Against this background, nine hemophilia experts from Central European countries participated in a pre-advisory board meeting survey. The survey comprised 11 multiple-choice questions about current treatment practices and future factor and non-factor replacement therapies. The survey questions were developed to reflect current unmet needs in hemophilia management reflected in the literature. The experts also took part in a follow-up advisory board meeting to discuss the most important unmet needs for hemophilia management as well as the pre-meeting survey results. All experts highlighted the challenge of maintaining optimal trough levels with prophylaxis as their most pressing concern. Targeting trough levels of ≥30-50 IU/L or even higher to achieve less bleeding was highlighted as their preferred strategy. However, the experts had an equal opinion on how this could be achieved (i.e., more efficacious non-factor therapies or factor therapy offering broader personalization possibilities such as targeting trough levels to individual pharmacokinetic data). In summary, our study favors personalized prophylaxis to individual pharmacokinetic data rather than a "one-size-fits-all" approach to hemophilia A management to maintain optimal trough levels for individual patients.


Assuntos
Hemofilia A , Europa (Continente) , Prova Pericial , Hemofilia A/tratamento farmacológico , Hemofilia A/prevenção & controle , Hemorragia/prevenção & controle , Humanos
5.
Psychother Psychosom Med Psychol ; 72(6): 258-271, 2022 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-35679854

RESUMO

The diagnostic criteria of PTSD differ in the ICD-10, ICD-11 and DSM-5 manuals. The main diagnostic criteria are presented. The psychopathological findings obtained in a structured interview are essential for the diagnosis. Three case studies are used to illustrate the expert assessment in criminal law, accident insurance and victim compensation law.


Assuntos
Classificação Internacional de Doenças , Transtornos de Estresse Pós-Traumáticos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Prova Pericial , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico
6.
PLoS One ; 17(6): e0269453, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35666738

RESUMO

INTRODUCTION: People with schizophrenia spectrum disorder diagnoses commonly have poor sleep, which predicts various negative outcomes. The problems are diverse, including substantial circadian dysregulation, sleep-wake timing issues, hypersomnia (excessive sleep), and more classic insomnia. METHODS: This paper reports on a mixed methods expert opinion study based on the principles of Delphi methodology. The study examines and explores opinion on the optimal contents and format for an occupational therapy intervention to improve poor sleep in this population. Views of clinical and academic topic experts (n = 56), were elicited, examined and explored in three rounds, views from previous rounds being presented back to participants in subsequent rounds. Participants with relevant personal experience (n = 26) then rated and commented on suggestions, with a focus on acceptability. Descriptive statistics and graphs of ratings were triangulated with qualitative content analysis of free-text. RESULTS: Participants emphasised the central importance of intervention personalisation, although the manner and extent of personalisation suggested varied. Many components and domains were acknowledged as important, with the challenge being how to keep such an intervention simple, brief, and feasible for end-users, for sustainable implementation. The strongest consensus was to address evening routine, daytime activity, and environmental interventions. Relaxation, mindfulness, thermoregulation, sensory factors, and cognitive or psychological approaches were rated as less important. There was disagreement on whether to include time in bed restriction, and how to address napping, as well as how far to address medication timing. Clinicians and researchers advocated some version of stimulus control, but participants with personal experience reported low levels of acceptability for this, describing entirely negative experiences using 'the 15-minute rule' (part of stimulus control). CONCLUSION: These results are informative for clinicians treating sleep problems in people with schizophrenia and related conditions, as well as for decision makers considering the potential contribution of the profession of occupational therapy toward sleep treatment.


Assuntos
Terapia Ocupacional , Esquizofrenia , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Prova Pericial , Humanos , Esquizofrenia/terapia , Sono , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos do Sono-Vigília/psicologia
7.
J Empir Res Hum Res Ethics ; 17(3): 346-361, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35617114

RESUMO

Individual informed consent is a central requirement for clinical research on human subjects, yet whether and how consent requirements should apply to health policy experiments (HPEs) remains unclear. HPEs test and evaluate public health policies prior to implementation. We interviewed 58 health experts in Tanzania, Bangladesh and Germany on informed consent requirements for HPEs. Health experts across all countries favored a strong evidence base, prior information to the affected populations, and individual consent for 'risky' HPEs. Differences pertained to individual risk perception, how and when consent by group representatives should be obtained and whether HPEs could be treated as health policies. The study adds to representative consent options for HPEs, yet shows that more research is needed in this field - particularly in the present Covid-19 pandemic which has highlighted the need for HPEs nationally and globally.


Assuntos
COVID-19 , Prova Pericial , Política de Saúde , Humanos , Consentimento Livre e Esclarecido , Pandemias
9.
Mol Genet Metab ; 136(2): 94-100, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35589496

RESUMO

Phenylketonuria (PKU) is a metabolic inherited disorder in which transition from infancy to adult care is particularly difficult and not sufficiently regulated. According to the scientific literature, only few medical centers offer healthcare assistance for adult patients with PKU that are therefore still treated in pediatric settings. This generates psychological, emotional, and organizational discomfort among patients, leading them to discontinue the follow-up. European guidelines and national consensus documents underline this unmet need and the lack of practical recommendations for a structured transitional pathway in PKU. The aim of this review and expert opinion is to propose good practices for managing the transition period of PKU patients, based on the literature and the experience of a panel of Italian experts in PKU. The consensus of the experts was obtained through the administration of three rounds of surveys and one structured interview. The result is the first proposal of a pathway for an efficient transition of PKU patients. Key steps of the proposed pathway are the "a priori" planning involving the pediatric and adult teams, the acceptance of the patient and his/her family to the process, the preliminary definition of appropriate spaces in the structure, the organization of meetings with the joint team, and the appointment of a transition coordinator. For the first time, the involvement of decision makers and patient associations is proposed.


Assuntos
Fenilcetonúrias , Cuidado Transicional , Adulto , Criança , Prova Pericial , Feminino , Humanos , Itália , Masculino , Fenilcetonúrias/terapia , Inquéritos e Questionários
10.
Artigo em Inglês | MEDLINE | ID: mdl-35627768

RESUMO

Separation of siblings is one of the most difficult diagnostic problems faced by psychologists. Such situations are happening more often in the face of the increasing number of divorces and breakdown of relationships. Therefore, a diagnostic task becomes an in-depth assessment of intra-family relationships, ties connecting family members, the preferences of individual people and predicting the long-term consequences of the proposed solutions. The article is dedicated to this problem, and the issue is addressed through the theoretical perspective and the analysis of two cases, i.e., the situation of separated siblings. In the study of children, we present a relatively new method, based on the authors' clinical experience, which could be used to diagnose the family situation of children. The first goal was to analyze the reasons for the separation of siblings whose parents were in conflict during the separation (first case study) and after the separation (second case study), as well as to assess the functioning of the children resulting from the family breakdown, and the decision to separate them from siblings. The analysis allowed identifying the areas of sibling functioning, which should become the subject of diagnosis when working on expert opinions in divorce cases, or cases establishing contact between parents and children. The second aim of the report was to assess the effectiveness of using play as a diagnostic method in a situation that is a source of stress for the child (family breakdown) and causes tension (the diagnostic process in which this topic is discussed).


Assuntos
Divórcio , Irmãos , Criança , Prova Pericial , Relações Familiares , Humanos
11.
Stud Health Technol Inform ; 294: 920-924, 2022 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-35612243

RESUMO

mHealth use for people with dementia is fraught with factors influencing its implementation in care and daily life. A better understanding of these factors may provide guidelines to inclusive design. This study aimed to assess whether factors gathered in a literature-based model could be validated by opinions of experts. On basis of a questionnaire as part of a larger study, experts identified barriers that they considered to be related to aging and dementia influencing mHealth use. Nineteen barriers that were mentioned by the dementia experts were covered in our literature-based model. No adaptions to the model were required. The dementia experts acclaimed three barriers to mHealth use that could not be mapped onto the framework: the unavailability of (informal) caregivers to support the mHealth use, the stage and type of dementia of an mHealth user, and the fear of the unknown. These should be considered as prerequisites in the implementation phase of mHealth and explored more in future research.


Assuntos
Demência , Aplicativos Móveis , Telemedicina , Cuidadores , Demência/terapia , Prova Pericial , Humanos
12.
Eur J Clin Pharmacol ; 78(7): 1177-1184, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35501476

RESUMO

PURPOSE: To assess the feasibility and acceptance of the semi-automated meta-analysis (SAMA). The objectives are twofold, namely (1) to compare expert opinion on the quality of protocols, methods, and results of one conventional meta-analysis (CMA) and one SAMA and (2) to compare the time to execute the CMA and the SAMA. METHODS: Experts evaluated the protocols and manuscripts/reports of the CMA and SAMA conducted independently on the safety of metronidazole in pregnancy. Expert opinion was collected using AMSTAR 2 checklist. Time spent was recorded using case report forms. RESULTS: The overall scores of the opinion of all experts for protocols, methods, and results for SAMA (6.75) and CMA (6.87) were not statistically different (p = 0.88). The experts' confidence in the results of each MA was 7.89 ± 1.17 and 8.11 ± 0.92, respectively. The time to completion was 14 working days for SAMA and 24.7 for CMA. MA tasks such as calculation of effect estimates, subgroup/sensitivity analysis, and publication bias investigation required no investment in time for SAMA. CONCLUSION: In conclusion, our study demonstrated the feasibility of SAMA and suggests acceptance for risk assessment by an expert committee. Our results suggest that SAMA reduces the time required for a MA without altering expert confidence in the methodological and scientific rigor. As our study was limited to one example, the generalization of our results requires confirmation by other studies.


Assuntos
Prova Pericial , Estudos de Viabilidade , Feminino , Humanos , Gravidez
14.
Int Braz J Urol ; 48(4): 696-705, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35363459

RESUMO

BACKGROUND: The da Vinci SP robot consists of an innovative single port trocar that houses a flexible camera and three biarticulated arms, which minimizes the number of incisions to assess the surgical site, allowing a less invasive procedure. However, due to its recent release in the market, the current literature reporting SP-RARP is still restricted to a few centers. In this scenario, after performing a literature search with all available techniques of SP-RARP, our objective is to report a multicentric opinion of referral centers on different techniques to approach SP-RARP. RESULTS: The SP literature is provided by only a few centers due to the limited number of this new console in the market. Five different approaches are available: transperitoneal, extraperitoneal, Retzius-Sparing, transperineal and transvesical. None of the current studies describe long-term functional or oncological outcomes. However, all approaches had satisfactory operative performance with minimum complication rates. CONCLUSIONS: Several techniques of SP-RARP have been reported in the literature. We performed a multicentric collaboration describing and illustrating the most challenging steps of this surgery. We believe that the details provided in this article are useful teaching material for new centers willing to adopt the SP technology.


Assuntos
Procedimentos Cirúrgicos Robóticos , Prova Pericial , Humanos , Masculino , Próstata/cirurgia , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos
16.
Front Public Health ; 10: 841013, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35372226

RESUMO

Background: In the Euregio-Meuse-Rhine (EMR), cross-border collaboration is essential for resource-saving and needs-based patient care within the emergency medical service (EMS) systems and interhospital transport (IHT). However, at the onset of the novel coronavirus SARS-COV-2 (COVID-19) pandemic, differing national measures highlighted the fragmentation within the European Union (EU) in its various approaches to combating the pandemic. To assess the consequences of the pandemic in the EMR border area, the aim of this study was to analyze the effects and "lessons learned" regarding cross-border collaboration in EMS and IHT. Method: A qualitative study with 22 semi-structured interviews was carried out. Experts from across the EMR area, including the City of Aachen, the City region of Aachen, the District of Heinsberg (Germany), South Limburg (The Netherlands), and the Province of Limburg, as well as Liège (Belgium), took part. The interviews were coded and analyzed according to changes in cross-border collaboration before and during the pandemic, as well as lessons learned and recommendations. Results: Each EU member country within the EMR area, addressed the pandemic individually with national measures. Cross-border collaboration between regional actors was hardly or not at all addressed at the national level during political decision- or policymaking. Previous direct communication at the personal level was replaced by national procedures, which made regular cross-border collaboration significantly more difficult. The cross-border transfer regulations of patients with COVID-19 proved to be complex and led, among other things, to patients being transported to hospitals far outside the border region. Collaboration continues to be seen as valuable and Euregional emergency services including hospitals work well together, albeit to different degrees. The information and data exchange should, however, be more transparent to use resources more efficiently. Conclusion: Effective Euregional collaboration of emergency services is imperative for public safety in a multi-border region with strong economic, cultural, and social cross-border links. Our findings indicate that existing (pre-pandemic) structures which included regular meetings of senior managerial staff in the region and a number of thematic working groups were helpful to deal with and to compensate for the disruptions during the crisis. Regional cross-border agreements that are currently based on mutual but more or less informal arrangements need to be formalized and better promoted and recognized also at the national and EU level to increase resilience. The continuous determination of synergies and good and best practices are further approaches to support cross-border collaboration especially in preparation for future crises.


Assuntos
COVID-19 , Serviços Médicos de Emergência , COVID-19/epidemiologia , União Europeia , Prova Pericial , Humanos , SARS-CoV-2
17.
Adv Ther ; 39(6): 2292-2301, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35419651

RESUMO

Hereditary transthyretin-mediated amyloidosis (hATTR) is challenging to diagnose early owing to the heterogeneity of clinical presentation, which differs according to the TTR gene variant and its penetrance in each individual. The TTR variants seen most frequently in the UK and Ireland (T80A, V142I and V50M) differ to those commonly occurring in other geographic locations and warrant a specific consideration for diagnosis and genetic testing. In addition, recent availability of treatment for this condition has reinforced the need for a more consistent approach to the management of patients, including access to specialist services, genetic testing and counselling, and clinical investigation for families living in the UK and Ireland. A multidisciplinary panel of experts from the UK and Ireland was convened to identify the current challenges, provide recommendations, and develop a consensus for the diagnosis and screening of people with, or at risk of, hATTR. Over a series of meetings, experts shared their current practices and drafted, refined and approved a consensus statement. This consensus statement provides recommendations for three different groups: (1) people with symptoms raising a possibility of hATTR amyloidosis; (2) people with biopsy-confirmed hATTR amyloidosis; and (3) people without symptoms who may have hATTR amyloidosis (i.e. relatives of people with identified TTR variants). For each group, recommendations are made for the required steps for the diagnosis and follow-up of symptomatic patients, and for guidance on the specialist support for counselling and pre-symptomatic genetic testing of at-risk individuals. This guidance is intended to be practical and based on available evidence. The aim is for regional amyloid specialist centres to provide timely diagnosis, clinical screening, and treatment for individuals and their families with hATTR amyloidosis.


Assuntos
Neuropatias Amiloides Familiares , Pré-Albumina , Neuropatias Amiloides Familiares/diagnóstico , Neuropatias Amiloides Familiares/genética , Neuropatias Amiloides Familiares/terapia , Prova Pericial , Humanos , Irlanda , Pré-Albumina/genética , Reino Unido
18.
Am J Ther ; 29(3): e287-e297, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35482399

RESUMO

BACKGROUND: Advances in drug therapy for primary (or essential) arterial hypertension have contributed to a significant decrease in the frequency and severity of strokes, coronary artery disease and heart failure, and chronic renal insufficiency. STUDY QUESTION: What are the milestones of the changes in the expert approach to the pharmacological management of arterial hypertension in the past century? STUDY DESIGN: To determine the changes in the experts' approach to the management of arterial hypertension, as presented in a widely used textbook in the United States. DATA SOURCES: The chapters presenting the management of arterial hypertension in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. RESULTS: The pharmacological management of arterial hypertension has had 3 overlapping eras in the timeframe subject to our investigation. In the empiric era (1927-1947), experts were recommending nonspecific interventions for sedation. The premodern era (1955-1963) relied on ganglion blockers, sympathetic blockers, and direct vasodilators. The modern era (1967-2020), which includes drugs used in current clinical practice, saw the introduction of diuretics (1967), beta-blockers (1971), alpha-blockers (1982), calcium channel blockers (1985), angiotensin-converting enzyme inhibitors (1985), angiotensin receptor blockers (2000), and direct renin inhibitors (2008). CONCLUSIONS: The pharmacological management of arterial hypertension has been the focus of intense and successful research and development in the second half of the 20th century.


Assuntos
Prova Pericial , Hipertensão , Antagonistas Adrenérgicos beta/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Diuréticos/uso terapêutico , Humanos , Hipertensão/tratamento farmacológico
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