Olfaction in Parkinson’s Disease – A Clinical Approach

Repeated clinical assessments surpass a laboratory test screening approach for early onset sepsis

The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, or ATP III) presents the National Cholesterol Education Program's (NCEP's) updated recommendations for cholesterol testing and management. It is similar to Adult Treatment Panel II (ATP II)1,2 in general outline and fundamental approach to therapy. It focuses on the role of the clinical approach to prevention of coronary heart disease (CHD).* This report continues to identify low-density lipoprotein (LDL) as the primary target of cholesterol-lowering therapy. Since ATP II, a number of controlled clinical trials with newer cholesterol-lowering drugs have been reported. These trials demonstrated remarkable reductions in risk for CHD, in both primary and secondary prevention. Their results enrich the evidence base upon which the new guidelines are founded. The ATP III panel extensively analyzed the results of recent clinical trials whose findings strongly influenced the development of the new guidelines. The panel's major goals were to review the literature objectively and to document and display the scientific evidence for ATP III recommendations. Prior to the appointment of the ATP III panel, the NCEP Coordinating Committee developed a list of important issues for the panel's consideration. This list was presented to the panel, discussed, and modified appropriately. The literature pertaining to each defined issue was identified by the panel members and by a MEDLINE search. Panel members produced a series of issue papers that carefully reviewed the literature; these issue papers became the foundation for writing the first draft of the report. Modifications of drafts were made following review and discussion of additional evidence arising from the literature search. ATP III contains both evidence statements and specific recommendations based on these statements. Each evidence statement is qualified according to category of evidence (A—D) and strength …

Although osteoporosis and its related fractures are common in patients with COPD, patients at high risk of fracture are poorly identified, and consequently, undertreated. Since there are no fracture prevention guidelines available that focus on COPD patients, we developed a clinical approach to improve the identification and treatment of COPD patients at high risk of fracture. We organised a round-table discussion with 8 clinical experts in the field of COPD and fracture prevention in the Netherlands in December 2013. The clinical experts presented a review of the literature on COPD, osteoporosis and fracture prevention. Based on the Dutch fracture prevention guideline, they developed a 5-step clinical approach for fracture prevention in COPD. Thereby, they took into account both classical risk factors for fracture (low body mass index, older age, personal and family history of fracture, immobility, smoking, alcohol intake, use of glucocorticoids and increased fall risk) and COPD-specific risk factors for fracture (severe airflow obstruction, pulmonary exacerbations and oxygen therapy). Severe COPD (defined as postbronchodilator FEV1 < 50% predicted) was added as COPD-specific risk factor to the list of classical risk factors for fracture. The 5-step clinical approach starts with case finding using clinical risk factors, followed by risk evaluation (dual energy X-ray absorptiometry and imaging of the spine), differential diagnosis, treatment and follow-up. This systematic clinical approach, which is evidence-based and easy-to-use in daily practice by pulmonologists, should contribute to optimise fracture prevention in COPD patients at high risk of fracture.

Introduction. Attention Deficit Hyperactivity Disorder (ADHD) is a chronic neuropsychiatric condition characterized by inattention, hyperactivity, and impulsivity, which significantly impacts the academic, professional, and social lives of affected individuals. In addition to clinical aspects, psychosocial factors such as stigmatization, interpersonal difficulties, and low self-esteem aggravate the condition, making its management a multidimensional challenge.Objectives. To analyze ADHD from a clinical and psychosocial perspective, identifying the main symptoms, associated comorbidities, daily life impacts, and the most appropriate therapeutic strategies, with a special focus on the adult population. Justification. This research is relevant as it addresses a highly prevalent and underdiagnosed condition that directly interferes with individuals’ quality of life and functional performance. By integrating clinical and psychosocial aspects, the study contributes to a broader understanding of the disorder, reinforcing the importance of public policies, professional training, and interdisciplinary therapeutic strategies in addressing ADHD. Methodology. A systematic review was conducted using the PubMed and SciELO databases, covering publications from 2020 to 2025. The following descriptors were used: "ADHD", "attention disorder", "clinical approach", "psychosocial impact", and "treatment". Articles addressing both clinical manifestations and the social and emotional impacts of ADHD, particularly in adults, were included.Results and discussion. The analysis of the studies revealed that adult ADHD is frequently associated with anxiety, depression, academic difficulties, and interpersonal conflicts. Factors such as lack of early diagnosis, low treatment adherence, and social stigma further worsen the condition.Conclusion. Therefore, ADHD is a complex disorder that requires an integrated clinical and psychosocial approach. Early diagnosis, access to multidisciplinary treatment, and awareness-raising actions are essential to reduce the disorder’s negative impacts and improve patients’ quality of life.

Chapter Twelve - Clinical approaches and managements of sleep-related movement disorders

Leucodermies chez l’enfant : revue de la littérature

Despite the high prevalence of bilingualism in the United Kingdom, few speech and language therapists (SLTs) are bilingual themselves. Most SLT research on bilingualism has generated knowledge to inform service delivery for bilingual clients, but few studies have investigated how being a bilingual SLT influences one's professional experiences and practices. Better understanding the unique positionality of bilingual SLTs can yield critical insights to meaningfully address issues of diversity, inclusion and equity in the profession. To investigate the experiences and practices of bilingual paediatric SLTs in the United Kingdom through the lens of Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF), a new theoretical framework developed to conceptualise the activities of professionals working in the field of disability. In this qualitative study, 19 bilingual paediatric SLTs practising in the United Kingdom were interviewed individually. Participants were recruited through a snowball sampling strategy, and semi-structured interviews conducted online. The data were analysed using reflexive thematic analysis and following a hybrid inductive-deductive approach to map the results onto the CHAT-ICF framework. Six overarching components of the CHAT-ICF framework hosted the 12 sub-themes identified to capture the experiences and practices of bilingual SLTs: (1) Subject (intersectionality); (2) Tools (language skills, education, clinical resources); (3) Rules (systemic barriers, sense of responsibility); (4) Community (sense of inclusion); (5) Division of labour (parents, colleagues); and (6) Practice (empathy with children, holistic mindset, flexible approaches). The use of the CHAT-ICF theoretical lens revealed two fundamental structural phenomena: (1) the distribution of sub-themes across many components of CHAT-ICF demonstrated that being a bilingual SLT is a multifactorial experience; and (2) the chain reactions between sub-themes illustrated the dynamic nature of bilingual SLTs' experiences which can be harnessed to challenge marginalisation and promote equity in the profession. This is the first qualitative study to date to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. These insights can be mobilised to inform the meaningful inclusion of bilingual SLTs in workforce planning efforts and service development. Recommendations include using intersectional lenses, providing cultural and anti-racism awareness training to SLTs, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in recruitment processes and increasing accountability at the leadership level. Research giving voice to bilingual SLTs, and other underrepresented demographics in the SLT workforce, can catalyse action to promote a more diverse and inclusive profession in line with the Royal College of Speech and Language Therapists' strategic vision 2022-2027. What is already known on the subject Most research on bilingualism in speech and language therapy is focused on issues related to service provision and delivery for bilingual clients with little consideration for bilingual speech and language therapists' (SLTs) unique positionality. A few survey studies have shown that bilingual SLTs report significantly higher competency and greater confidence when working with clients who speak multiple languages, but there are significant gaps in understanding how bilingualism impacts other aspects of their professional experiences. What this paper adds to existing knowledge This is the first study to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. We show that being bilingual profoundly impacts many aspects of their professional experiences, including their clinical identity, skillset, sense of inclusion in the workplace, work relationships and clinical approaches. Bilingual SLTs expressed developing trust relationships with bilingual families and adopting flexible approaches to account for their clients' environmental factors, all of which can contribute to more equitable SLT services. This study also makes a novel contribution by proposing and using the Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF) framework to conceptualise and investigate SLTs' experiences and practices. What are the potential or actual clinical implications of this work? This study provides evidence-based recommendations to inform progress towards the Royal College of Speech and Language Therapists' strategic vision 2022-2027 and the diversification of the profession. Actions to support bilingual SLTs and diversify the profession include shifting a rigid mindset of linguistic and cultural `competence' to self-growth and awareness, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in SLT recruitment processes and career progression and increasing accountability and leadership around issues of diversity in the workplace. The novel CHAT-ICF framework has the potential to be used to support therapists' reflexivity in their practice or structure audits of rehabilitation services. Intersectionality theories and transformative processes can catalyse positive change in clinical services and research around bilingualism.

Measurements of gingival recession changes: Comparison of the conventional clinical and direct digital approach

Integrative Cases for Preclinical Medical Students: Connecting Clinical, Basic Science, and Public Health Approaches

Based on the description above, it is necessary to make efforts to improve the teacher's ability to understand the quality of teaching materials, as a strategy to optimize quality achievement results in the learning process. One of the efforts that can be made to improve the teacher's ability to understand the quality of teaching materials is to use a clinical supervision approach. The clinical approach is considered to have advantages because supervision supervision emphasizes efforts to develop teacher abilities based on teacher needs. Thus the awareness to develop skills in understanding teaching materials using a clinical supervision approach is based on the need for teachers to voluntarily come to supervisors to be fostered and develop their potential in mastering teaching materials.The results of observations on Civics teachers at SMP Negeri 2 Kwandangshows that the teacher's ability to understand teaching materials is not optimal. The tendency is that some teachers cannot carry out learning activities properly because they lack good mastery of teaching materials. Teachers are often only fixated on one source or book as a reference in developing student abilities. This is what makes learning activities less qualified and students only get limited material that is mastered by the teacher and the book that is the reference

Early diagnosis of deep venous thrombosis is essential for reducing complications, such as recurrent pulmonary embolism and venous thromboembolism. There are numerous studies on enhancing efficiency of computer-aided diagnosis, but clinical diagnostic approaches have never been considered. In this study, we evaluated the performance of an artificial intelligence (AI) algorithm in the detection of iliofemoral deep venous thrombosis on computed tomography angiography of the lower extremities to investigate the effectiveness of using the clinical approach during the feature extraction process of the AI algorithm. To investigate the effectiveness of the proposed method, we created synthesized images to consider practical diagnostic procedures and applied them to the convolutional neural network-based RetinaNet model. We compared and analyzed the performances based on the model’s backbone and data. The performance of the model was as follows: ResNet50: sensitivity = 0.843 (± 0.037), false positives per image = 0.608 (± 0.139); ResNet152 backbone: sensitivity = 0.839 (± 0.031), false positives per image = 0.503 (± 0.079). The results demonstrated the effectiveness of the suggested method in using computed tomography angiography of the lower extremities, and improving the reporting efficiency of the critical iliofemoral deep venous thrombosis cases.

Novel approach to improve molecular imaging research: Correlation between macroscopic and molecular pathological findings in patients

Diabetic Retinopathy (DR) is an eye disease due to complication of diabetes. Early screening and treatment of DR disease is crucial to prevent blindness. This paper presents a comparison of different approaches for automated DR grading. In the current development of automated system for DR grading, generally there are two approaches; clinical and textural. Clinical approach is based on the clinical study that refer to the abnormalities exist in retina such as microaneurysm, haemorhage, exudates and cotton wool spot. While textural approach is based on the visual or texture features of retina image. In this work we compare both approaches for performance analysis. Both approaches were applied to a standard dataset and the results show that both approaches capable to classify the severity of DR disease. This is based on the average classification accuracy obtained using support vector machine (SVM) with 82.74% and 83.87% for clinical and textural approach respectively. The pros and cons for each approach based on the experimental study also discussed in this paper.

BackgroundTime Limited Eating (TLE) is an effective strategy for management of obesity in adults, but there is a paucity of data that have examined its use in the clinical management of children with obesity. A TLE approach involves interspersing normal daily caloric intake with periods of prolonged calorie restriction several times per week. TLE may actually be more feasible, non-stigmatizing, flexible and effective in children, especially for adolescents, compared to alternatives like daily caloric or macronutrient restriction. This is because TLE removes the need for intensive counting of daily calorie intake or macronutrient content and focuses on a straightforward task of consuming food during a pre-specified time period. Also it avoids periods of extended caloric restriction which may interfere with growth and/or risk evoking development of eating behaviors. This case series describes four patients who trialed a TLE approach in a clinical weight management clinic and describes BMI reduction at 4 months.Case PresentationTo date, 4 patients, ages 5–15, with varying underlying pathologies (i.e. Bardet Biedl Syndrome (BBS), previously healthy, craniopharyngioma and epilepsy) have tried a TLE type approach (16-hour fast/8-hour feed for 3–5 days per week) for 4 months and have demonstrated an average decrease in their BMI z-score compared to baseline of −0.24 SD. Patients and their families reported high degrees of satisfaction with this dietary approach.ConclusionsFamilies were very satisfied with the TLE intervention and reported it was feasible, flexible and sustainable to implement in a real life setting and associated with decreased zBMI. Further investigation is required to determine if this approach is effective in both the short and long term as a weight management technique.

Dyspnoea, also known as shortness of breath or breathlessness, is a subjective awareness of the sensation of uncomfortable breathing. It may be of physiological, pathological or social origin. The pathophysiology of dyspnoea is complex, and involves the activation of several pathways that lead to increased work of breathing, stimulation of the receptors of the upper or lower airway, lung parenchyma, or chest wall, and excessive stimulation of the respiratory centre by central and peripheral chemoreceptors. Activation of these pathways is relayed to the central nervous system via respiratory muscle and vagal afferents, which are consequently interpreted by the individual in the context of the affective state, attention, and prior experience, resulting in the awareness of breathing. The clinical evaluation and approach to the management of dyspnoea are directed by the clinical presentation and underlying cause. The causes of dyspnoea are manifold, and include a spectrum of disorders, from benign to serious and life-threatening entities. The pathophysiology, aetiology, clinical presentation and management of dyspnoea are reviewed.