Preface: treatment optimization in schizophrenia through active patient management - proceedings from two European consensus meetings.

Diagnosis of drug-induced liver injury in Japanese patients by criteria of Consensus Meetings in Europe

No. 628 Active interventional radiology drainage catheter management reduces drain dwell time and increases percentage of drains removed by interventional radiology

Background: In term PROM, labour is likely to follow soon afterwards, but in preterm PROM, about 35-50% cases labour starts within 24 hours, 70% cases starts within 72 hours, about 90% delivery occurs usually within 7 days. Perinatal morbidity and mortality is increased while rupture occurs prior to term resulting in delivery of premature foetus. Approximately 80% of patients with PROM at term go into labour within 24 hours and 95% within 72 hours. The incidence of PROM, is variable, most studies report an incidence of 2-18% with an avg. Of 10%. In 70%of cases, it occurs in pregnancies at term (Williams 23rd edition.); Aim:1) The active versus expectant management in women with Premature rupture of membranes at term pregnancy 2) The maternal outcome in active as well as expectant management in patients with premature rupture of membrane at term pregnancy.3) The neonatal outcome in active as well as expectant management in patients with premature rupture of membrane at term pregnancy.Methods: 200 patients were selected after confirming foetal maturity and rupture of membrane by history and clinical examination. Foetal well-being was assessed by clinical examination and ultrasonography. Informed consent was taken from every patient included in this study. Results: Duration of labour between both groups observed no significant variation. Selected patients with favourable Bishop’s score (>6) may be the cause of no incidence of undue delay or complications. In Group 1, 44% delivery occurred within 6 hours, 52% within >6-12 hours, 4% took more than 12 hours for delivery. In Group 2, 40% delivered within 6 hours, 56% in the span of >6-12 hours, 4% took more than 12 hours for delivery. In Expectant group (Group 2) duration of labour is significantly lower in multigravida whereas no such difference is seen in Active Management (Group 1) Group in relation to gravida.Conclusions: In case of premature Rupture of Membranes at term –both expectant and active management leads to similar maternal and neonatal outcome. Since outcome of active and expectant management may not be very different5, women need to have appropriate monitoring and counselling to make informed choices.

Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension

Treatment optimisation in schizophrenia through active patient management, proceedings from two European consensus meetings. Epilogue.

Concurrent irinotecan and 5-fluorouracil plus levo-folinic acid given every other week in the first-line management of advanced colorectal carcinoma: A phase I study of the Southern Italy Cooperative Oncology Group

The European Competence Network on Mastocytosis (ECNM) was initiated in 2002 as a multidisciplinary and multinational cooperative approach to increase awareness and to improve diagnosis and therapy of mastocytosis. The network is composed of local centers, physicians, and scientists who have dedicated their work to patients with mastocytosis. A strategic goal of the ECNM is to provide the best available information about the disease to patients and physicians. During the past 10 years, the ECNM has expanded to various countries and contributed successfully to the development of markers, definitions, and standards in the field of mastocytosis. Members of the ECNM organized Annual Meetings in Europe and two Working Conferences on Mastocytosis in Vienna (in 2005 and 2010), and initiated and supported several preclinical and clinical trials. In all these activities, representatives of the ECNM cooperate closely with their US colleagues, with patient-organizations in Europe and in the USA, and with other scientific networks. The ECNM also launched a mastocytosis registry that has been activated in 2012. Using the central database of this registry, cooperative multicenter studies, which should include sufficient numbers of patients and robust evaluations, will be conducted. These studies will increase our knowledge about optimal management and therapy of patients with mastocytosis in the future.

How did general practitioners (GPs) (family physicians) manage infertility in females and males in primary care between 2000 and 2016? The number of GP infertility consultations for females increased 1.6 folds during the study period, with 42.9% of consultations resulting in a referral to a fertility clinic or specialist, compared to a 3-fold increase in the number of consultations for men, with 21.5% of consultations resulting in a referral. Infertility affects one in six couples and is expected to increase with the trend to later childbearing and reports of declining sperm counts. Despite GPs often being the first contact for infertile people, very limited information is available on the management of infertility in primary care. Data from the Bettering the Evaluation and Care of Health programme were used, which is a national study of Australian primary care (general practice) clinical activity based on 1000 ever-changing, randomly selected GPs involved in 100 000 GP-patient consultations per year between 2000 and 2016. Females and males aged 18-49years attending GPs for the management of infertility were included in the study. Details recorded by GPs included patient characteristics, problems managed and management actions (including counselling/education, imaging, pathology, medications and referrals to specialists and fertility clinics). Analyses included trends in the rates of infertility consultations by sex of patient, descriptive and univariate analyses of patient characteristics and management actions and multivariate logistic regression to determine which patient and GP characteristics were independently associated with increased rates of infertility management and referrals. The rate of infertility consultations per capita increased 1.6 folds for women (17.7-28.3 per 1000 women aged 18-49years) and 3 folds for men over the time period (3.4-10.2 per 1000 men aged 18-49years). Referral to a fertility clinic or relevant specialist occurred in 42.9% of female infertility consultations and 21.5% of male infertility consultations. After controlling for age and other patient characteristics, being aged in their 30s, not having income assistance, attending primary care in later years of the study and coming from a non-English-speaking background, were associated with an increased likelihood of infertility being managed in primary care. In female patients, holding a Commonwealth concession card (indicating low income), living in a remote area and having a female GP all indicated a lower adjusted odds of referral to a fertility clinic or specialist. Data are lacking for the period of infertility and infertility diagnosis, which would provide a more complete picture of the epidemiology of treatment-seeking behaviour for infertility. Australia's universal insurance scheme provides residents with access to a GP, and therefore these findings may not be generalizable to other settings. This study informs public policy on how infertility is managed in primary care in different patient groups. Whether the management actions taken and rates of secondary referral to a fertility clinic or specialist are appropriate warrants further investigation. The development of clinical practice guidelines for the management of infertility would provide a standardized approach to advice, investigations, treatment and referral pathways in primary care. This paper is part of a study being funded by an Australian National Health and Medical Research Council project grant APP1104543. G.C. reports that she is an employee of The University of New South Wales (UNSW) and Director of the National Perinatal Epidemiology and Statistics Unit (NPESU), UNSW. The NPESU manages the Australian and New Zealand Assisted Reproductive Technology Database on behalf of the Fertility Society of Australia. W.L. reports being a part-time paid employee and minor shareholder of Virtus Health, a fertility company. R.N. reports being a small unitholder in a fertility company, receiving grants for research from Merck and Ferring and speaker travel grants from Merck. NA.

Objective: Moderation of alcohol consumption is one of the six lifestyle changes recommended in the 2013 ESH/ESC hypertension guidelines for the treatment of hypertensive patientswith class I evidence level A. Thus, the guidelines recommend a maximum alcohol consumption of 20–30 g/day in hypertensive men and 10–20 g/day in hypertensive women. Within a survey assessing the level of awareness and implementation of the 2013 ESH/ESC guideline recommendations on lifestyle changes we specifically investigated the role of alcohol consumption in the management of hypertensive patients among European physicians. Design and method: The complete survey included a total of 16 questions covering demographic data and questions that aimed to assess the level of awareness and implementation of the 2013 guideline recommendations. It included six questions explicitly related to medical history of alcohol consumption, advice on alcohol intake and/ or management of hypertensive patients with alcohol consumption. The survey was conducted at two national meetings in Germany (2015 annual meetings of the German Society of Cardiology and the German Society of Internal Medicine) and at two European meetings (ESH meeting in Milan 2015 and ESC meeting in London 2015). Results: Overall, 1064 participated. Overall, 81.9% of participating physicians reported to quantify alcohol consumption in their hypertensive patients. The medical history of alcohol consumption was taken mostly in the context of newly detected hypertension (28.6%), rather than in patients with hypertension and very high blood pressure (BP) (17.5%) or in patients with treatment resistant hypertension (14.5%). Physicians recommend a mean maximum amount of alcohol intake of 13.1 ± 11.7 g/day for women (range: 0–150) and 19.7 ± 14.9 g/day for men (range: 0–125). Conclusions: Although more than 80% of participating physicians reported to quantify alcohol consumption in their hypertensive patients, less than a third of physicians acknowledged to determine a history on alcohol intake in case of newly detected hypertension, very high BP or treatment resistant BP. The mean maximum amount of alcohol per day recommended did not exceed the recommended guidelines threshold. Awareness campaigns emphasizing the relationship between alcohol consumption and high BP, e.g. in patients with resistant hypertension, might improve currently unsatisfactory BP control rates.

Magnetic Resonance Imaging for the Detection, Localisation, and Characterisation of Prostate Cancer: Recommendations from a European Consensus Meeting

Eschar removal by bromelain based enzymatic debridement (Nexobrid®) in burns: An European consensus

A six-year retrospective study of patient outcomes following involved or close margin basal cell carcinoma excision.

Kidney transplant wait-list management is becoming increasingly complex. We introduced a novel wait-list management strategy at our center, the Transplant Readiness Assessment Clinic (TRAC), whereby patients whose Kidney Allocation Scores surpass a threshold are actively managed. From January 1, 2016 through June 30, 2017, we evaluated 195 patients through TRAC. Compared to pre-TRAC systems at our institution, TRAC resulted in a higher proportion of activation at 18months (38% vs 22%-26%, P<0.0001), despite being enriched in patients with long dialysis duration. TRAC also resulted in a higher proportion of wait-list removal (15% vs 8%-9%, P<0.05) although combined wait-list removal and death on wait-list did not differ (18% vs 16%-17%). Median time to activation was 356days from TRAC evaluation. Of the transplant barriers, need for cardiovascular studies was the most common (31%), followed by other medical issues (23%), poor functional status (13%), and psychosocial issues (10%). By concentrating center resources on patients most likely to be transplanted after activation and performing active patient management close to the time of transplant, TRAC has the potential to significantly enhance kidney transplant success in regions with long wait-times.

BackgroundThe usefulness of routine electrocardiograms (ECGs) in cardiovascular risk management (CVRM) and diabetes care is doubted.ObjectivesTo assess the performance of general practitioners (GPs) in embedding ECGs in CVRM and diabetes care.MethodsWe collected 852 ECGs recorded by 20 GPs (12 practices) in the context of CVRM and diabetes care. Of all abnormal (n = 265) and a sample of the normal (n = 35) ECGs, data on the indications, interpretations and management actions were extracted from the corresponding medical records. An expert panel consisting of one cardiologist and one expert GP reviewed these 300 ECG cases.ResultsGPs found new abnormalities in 13.0% of all 852 ECGs (12.0% in routinely recorded ECGs versus 24.3% in ECGs performed for a specific indication). Management actions followed more often after ECGs performed for specific indications (17.6%) than after routine ECGs (6.0%). The expert panel agreed with the GPs’ interpretations in 67% of the 300 assessed cases. Most often misinterpreted relevant ECG abnormalities were previous myocardial infarction, R‑wave abnormalities and typical/atypical ST-segment and T‑wave (ST-T) abnormalities. Agreement on patient management between GP and expert panel was 74%. Disagreement in most cases concerned additional diagnostic testing.ConclusionsIn the context of programmatic CVRM and diabetes care by GPs, the yield of newly found ECG abnormalities is modest. It is higher for ECGs recorded for a specific reason. Educating GPs seems necessary in this field since they perform less well in interpreting and managing CVRM ECGs than in ECGs performed in symptomatic patients.Electronic supplementary materialThe online version of this article (10.1007/s12471-020-01376-3) contains supplementary material, which is available to authorized users.

Editorial introductions