Consensus Articles Research Articles

Executive summary. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK

The European Paediatric Pulmonary Vascular Disease (PVD) Network is a registered, non-profit organisation that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of...

Update on eosinophilic esophagitis.

The prevalence of eosinophilic esophagitis (EoE) is increasing. It is important for practitioners to be aware of the disease and its presenting symptoms. It is important to distinguish EoE from proton-pump inhibitor (PPI)-responsive esophageal eosinophilia. Patients with PPI-responsive esophageal eosinophilia exhibit symptoms of esophageal dysfunction (often with endoscopic findings suggestive of EoE) with esophageal eosinophilia that responds to PPI treatment. EoE was identified as a 'new disease' over 20 years ago. Two consensus articles have since been published (as well as an evidence-based approach to the diagnosis and management) highlighting diagnostic criteria, treatment options and potential complications of untreated disease. There is still much that needs to be learned and there are still many controversies left unanswered. No cure has been identified for EoE. Current therapy revolves around diet restriction and use of steroids to reduce the number of eosinophils in the esophagus and improve symptom control. Possibly future research will identify new targets for treatment that hopefully will lead to new treatment options for patients suffering with this disease as well as nonendoscopic methods to monitor treatment response.

Resource Material for Ethical Psychological Assessment of Symptom and Performance Validity, Including Malingering

The present paper offers resource material for evaluation of malingering, response bias, and symptom and performance validity. The material mostly consists of noncontroversial, paraphrased excerpts from relevant consensus statements, guidelines, codes, books, and articles. The five principles of the American Psychological Association (APA) ethics code were used to integrate the material. In addition, five other principles were needed (e.g., on science). The companion article on a new consensus statement on the ethical use of symptom and performance validity written for the Association for Psychological Advancement in Psychological Injury and Law (ASAPIL) in the journal Psychological Injury and Law (PIL; Bush, Ruff, & Heibronner, 2014) was instigated by and written partly based on the resources described in the present paper. The resources offered in the present paper are divided into the following sections: I. Malingering; II. Related Terms; III. APA Ethics Code; IV. Other Ethics Guidelines; V. Practice Guidelines; VI. Assessment Guidelines; VII. Other Ethical Sources; IX. Biases, Fallacies, Errors; X. Prior SVT-M/PVT-M Statements; XI. A New Ethical Model of Ten Principles; and XII. Instrumentation, and followed by Conclusions. The ten principles of the present ethical guidelines could be used to help revise the APA ethics code. The companion statement constitutes a major advance in the field and the present resource material facilitates its use.

Analysis of pediatrics expert consensus citation from 2009 to 2012

Objective To explore the expert consensus on pediatric literature citation.Method By the method of bibliometrics,experts' citation from2009 to2012 were statistically analyzed with bibliometrics.Result 18 expert consensus articles were identified,of which16 have citations.The citation rate is 88.89％,with an average citation of 21.47.The sources are mainly journals; the cited articles are mainly in foreign language (65.73％); ; the price index is 57.30％.Conclusion Expert consensus citation is novel,mainly from periodicals,and primarily in foreign language.But the citation quality needs to be improved further. Key words: Bibliometrics; Expert consensus ; Pediatrics; Citation analysis

Indications and contraindications of dental implants in medically compromised patients: Update

The aim of this study was to review the current scientific literature in order to analyse the indications and contraindications of dental implants in medically compromised patients. A reference research was carried out on PubMed using the key words “implant” AND (oral OR dental) AND (systemic disease OR medically compromised), in articles published between 1993 and 2013. The inclusion criteria were the following: clinical studies in which, at least, 10 patients were treated, consensus articles, reviewed articles and meta-analysis performed in humans treated with dental implants, and which included the disease diagnosis. A total of 64 articles were found, from which 16 met the inclusion criteria. Cardiac systemic diseases, diabetic endocrine pathologies or controlled metabolic disorders do not seem to be a total or partial contraindication to the placement of dental implants. Tobacco addiction, and head and neck radiotherapy are correlated to a higher loss of dental implants. Patients suffering from osteoporosis undergoing biphosphonates therapy show an increased risk of developing bone necrosis after an oral surgery, especially if the drugs are administered intravenously or they are associated to certain concomitant medication. Key words:Dental implants, medically compromised patient, systemic diseases.

The role of Botulinum toxin injection in the management of achalasia

Botulinum toxin injection into the lower esophageal sphincter is an established therapy for the treatment of achalasia. This review will highlight recent studies that shed light on the role of Botulinum toxin injection in the management of achalasia. Recent studies have shown that Botulinum toxin injection is the most common initial endoscopic therapy for achalasia, most likely due to its safety and ease of administration. However, this trend represents a deviation from recent guidelines which consider Botulinum toxin injection less efficacious than alternative treatments like pneumatic dilation and laparoscopic Heller myotomy. Over the past decade, multiple commercial formulations of Botulinum toxin injection have been introduced, but the techniques, indications, and therapeutic efficacy for Botulinum toxin have largely remained unchanged. This review will evaluate recent guidelines, consensus articles, meta-analyses, and landmark studies to expound on the short and long-term efficacy of Botulinum toxin, injection dosages, and technique, as well as its efficacy compared to pneumatic dilation, myotomy, and combination therapy. Despite its relatively poor long-term efficacy, Botulinum toxin injection continues to play an important role in elderly patients with comorbidities and as salvage therapy for achalasia.

Revisión sistemática sobre coordinación terapéutica entre atención primaria y atención especializada

Objectives To evaluate existing information on questions of therapy coordination between primary and hospital care and to identify activities with positive results that could be adapted at the local level. Design Systematic review. Data sources MEDLINE, SIETES, and Cochrane systematic review databases were searched for articles published between January 1990 and August 2005. Selection of studies Those conducted in countries with a National Health Service. Thirty-six studies were included: a) observational studies on drug prescription for patients moving between primary and specialist care (18 studies); b) studies of the views of health professionals: review and consensus articles and editorials (7 articles); qualitative studies (4 articles); c) intervention studies (7 studies). Four-hundred and thirtyone studies were excluded. Results The most common problems were: lack of information for patient follow-up, disagreement in drug selection, increases in costs due to hospital stays and difficulties in assuming clinical responsibilities. The solution put forward was that a unified policy of common medicines and budgets is essential. Little information was available on the studies that posed or evaluated interventions to improve therapy coordination. Conditions with the most information available were heart failure, diabetes mellitus, asthma, high blood pressure, and anticoagulant treatment. Conclusions The creation of pharmacotherapy committees, involving professionals belonging to both primary and specialist care, was proposed. These committees would adapt for local use protocols and clinical practice guidelines, in line with the prescription quality standards of primary care.

Deep brain stimulation: Neuropsychological and neuropsychiatric issues

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor, cognitive, neuropsychiatric, autonomic, and other nonmotor symptoms. The efficacy of deep brain stimulation (DBS) for the motor symptoms of advanced PD is well established. However, the effects of DBS on the cognitive and neuropsychiatric symptoms are less clear. The neuropsychiatric aspects of DBS for PD have recently been of considerable clinical and pathophysiological interest. As a companion to the preoperative and postoperative sections of the DBS consensus articles, this article reviews the published literature on the cognitive and neuropsychiatric aspects of DBS for PD. The majority of the observed neuropsychiatric symptoms are transient, treatable, and potentially preventable. Outcome studies, methodological issues, pathophysiology, and preoperative and postoperative management of the cognitive and neuropsychiatric aspects and complications of DBS for PD are discussed.

Patient desires: A model for assessment of patient preferences for care of severe or terminal illness

Patient-centered care is better achieved through a comprehensive understanding of patients' preferences for how they want to live their life and how they want to influence their own death. Though much has been written on identifying goals of care, it is often difficult for clinicians to articulate patient goals to guide care planning. We explored the literature on patient's preferences for their care in chronic or life-limiting illness to develop a model for assessment of patient perspectives. We then illustrated our model with composite patients from our clinics and we provide questions to guide patient discussion. We searched MEDLINE from 1986 to 2004 for primary research articles that relate primarily to a patient's preferences for his or her care. We reviewed over 3500 titles, abstracts, and research papers. Hundreds of articles described patients' quality of life, health status, or satisfaction. We excluded consensus guidelines, non-English papers, reviews, and articles focused on medical professional perspectives. Forty-eight studies focused primarily on patient preferences. Using an iterative process, we identified unique issues and broader themes in patients' desires for their care. Studies focused on patients with cancer, those in hospice or those with terminal disease. Three domains emerged: patient feelings about disease, feelings about suffering, and feelings about the circumstances of death. Attention was given to the differences between patients in terms of the strength and persistence of feelings in each domain. Based on existing data, there are three fundamental domains of patient perspective that influence preferences for care. These domains can be assessed by the care team to guide the development of a plan of care and to identify areas of conflict. Our review identifies gaps in the end-of-life literature and areas for future work in patient preferences.

Botulinum toxin A injections in children: technique and dosing issues.

Information is presented on the current state of administering botulinum toxin A injections in the pediatric population based on review of scientific publications cited in MEDLINE and PubMed that involved the use of botulinum toxin A in patients under the age of 19. Studies were selected if they contained nearly complete information on botulinum toxin dosing and injection technique within the article. In addition, consensus articles from pediatric task forces were selected for review. Information regarding botulinum toxin A dosing and injection technique was gathered from the material and method sections of the selected studies or from tables in consensus articles. Information was collected in regard to the total amount of botulinum toxin used, commercial brand of botulinum toxin used, dilution of the toxin, volume of toxin preparation, needle size, localization technique, adverse reactions, and whether sedation was used. There is currently a range of dosing and injections techniques in the literature when using botulinum toxin A in children. Body weight, muscle size, location of muscle, and degree of spasticity are all considered to determine total amount of botulinum toxin injected. Concentration and volume of the diluted toxin can affect the amount of spread of the toxin after injection. Injection techniques also vary and are not well reported. Use of electromyographic, electrical stimulation, or ultrasound guidance is employed in children for difficult to locate individual muscle groups. Use of sedation also varies between medical centers.

Red cell transfusion therapy in the critical care setting

According to our own experience and published reports the frequency of red cell transfusion in intensive care units is in the range of 0.2 to 0.4 units per patient per day and is dependent upon the local strategy, the patients involved and the kind of surgery performed. The rationale for red cell transfusion is to maintain or restore the oxygen carrying capacity of the blood to avoid tissue hypoxia which occurs when oxygen delivery drops below a certain critical value. Besides bleeding, phlebotomy is also a significant source of blood loss in critically ill patients. According to several recent reviews and consensus articles there is no basis for a fixed indicator for transfusion, such as a haemoglobin concentration of <100gL −1. The decision to transfuse has to be made according to the patients individual status. The major adaptive mechanism in response to acute anaemia is an increase in cardiac output and hence blood flow to tissues. As a consequence even moderate degrees of acute anaemia may not be tolerated by patients with cardiac disease, whilst marked anaemia carries a considerable risk of ischaemia in patients with brain lesions or cerebral arterial stenoses. In critically ill patients it has been postulated that supply dependency of oxygen consumption occurs over a wide range of oxygen delivery, far above the critical values of oxygen delivery seen under normal conditions. Maximising oxygen delivery was therefore formulated as a goal in these patients. However, whether pathological supply dependency of oxygen delivery really exists in critically ill patients is still under discussion and recent studies found no benefit in maximising oxygen delivery to this patient group. However, individualised triggers for red blood cell transfusion are adequate for critically ill patients considering their co-morbidities and severity of disease. Finally, the decision to transfuse must also take into account the potential risks (infectious and non-infectious), as well as benefits for the individual patient. In the future, the level of transfusions may be reduced by using blood sparring techniques such as blood withdrawal in closed systems, bedside microchemistry, intravascular monitors, or autotransfusion of drainage blood in intensive care units.