Current Concepts In Management Research Articles

Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management.

Temporomandibular disorders (TMD) is a collective term for a group of musculoskeletal conditions involving pain and/or dysfunction in the masticatory muscles, temporomandibular joints (TMJ) and associated structures. It is the most common type of non-odontogenic orofacial pain and patients can present with pain affecting the face/head, TMJ and or teeth, limitations in jaw movement, and sounds in the TMJ during jaw movements. Comorbid painful and non-painful conditions are also common among individuals with TMD. The diagnosis of TMD have significantly improved over time with the recent Diagnostic Criteria for TMD (DC/TMD) being reliable and valid for most common diagnoses, and an efficient way to communicate in multidisciplinary settings. This classification covers 12 most common TMD, including painful (myalgia, arthralgia and headache attributed to TMD) as well as the non-painful (disc displacements, degenerative joint disease and subluxation) TMD diagnoses. Recent studies have demonstrated that the pathophysiology of common painful TMD is biopsychosocial and multifactorial, where no one factor is responsible for its development. Importantly, research has suggested different predisposing, initiating and perpetuating factors, including both peripheral and central mechanisms. This is an active field of investigation and future studies will not only seek to clarify specific causal pathways but translate this knowledge into mechanism-directed diagnosis and treatment. In accordance with this complex aetiology, current evidence supports primarily conservative multidisciplinary treatment including self-management strategies, behavioural therapy, physical therapy and pharmacotherapy. The aim of this review is to present an overview of most recent developments in aetiology, pathophysiology, diagnosis and management of TMD.

Current Concepts in Management of Lipid Abnormalities in Patients With Coronary Artery Disease

Lipid disorders play a major pathogenic role in the development of coronary artery disease, which is the major cause of mortality worldwide. In this review, the authors discuss the role of various lipid abnormalities in the causation of coronary artery disease and also highlight the ways to manage them. The roles of a healthy lifestyle and dietary patterns have been emphasized in this regard besides the significant role of drug treatment, which mostly revolves around the statin therapy.

RESTRICTIVE HUT LUNG: A CASE OF DOMESTICALLY-ACQUIRED PNEUMOCONIOSIS WITH A SEVERE RESTRICTIVE PATTERN

SESSION TITLE: Medical Student/Resident Occupational and Environmental Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Domestically acquired particulate lung disease (DAPLD) or “hut lung” is a mixed-dust pneumoconiosis that develops secondary to the inhalation of biomass fuels in poorly ventilated domestic settings (1). DAPLD has largely been considered to be an obstructive lung disease, with only a minority of cases reporting mild restrictive or mixed patterns of disease (1). To our knowledge, this is the first case report of DAPLD with a severe restrictive pattern. CASE PRESENTATION: A 76 year old Hispanic woman presented with worsening shortness of breath for one year, associated with reduced exercise tolerance, nonproductive cough, chest tightness, and wheezing. She spends majority of the year in Honduras, but travels to the United States for the summer months. She denied smoking tobacco and occupational exposures, but admitted to using a wood burning stove for cooking while living in Honduras for many years. CXR was notable for bilateral patchy infiltrates. HRCT showed large patchy and confluent areas of ground glass attenuation in association with linear and reticular opacities, and peripheral honeycombing with cystic changes. Small calcified bilateral hilar lymph nodes were also observed. Quantiferon testing was positive, but serial cultures were negative for tuberculosis. PFTs showed a restrictive pattern: FEV1 82%, FVC 59%, FEV1/FVC 95%, TLC 46%, DLCO 7%. Bronchoscopy showed multiple flat anthracotic plaques; transbronchial biopsy of these lesions demonstrated focal chronic inflammation. BAL cytology and cultures were unremarkable. DISCUSSION: Although the prevalence of DAPLD is unknown, inhalation of particulate residue of biomass fuels used for domestic energy is common in several parts of the world (2). Cooking with biomass fuels may be associated with fine particle carbon dispersion (2). Deposition of biomass fine particles along alveolar surfaces and macrophage activation initiates an inflammatory response (2). Discourse on biomass inhalation and tobacco smoking has focused on the development of COPD, however both of these exposures may also result in ILD (3). Type 2 alveolar epithelial stem cells, which may function as both type I and type II alveolar cells, have been proposed to play a central role in predisposing patients with tobacco and biomass exposure, to both COPD and ILD phenotypes (2,3). Tobacco and biomass have been proposed to induce cellular senescence, which allows for genetic remodeling and profibrotic cellular changes (2,3). Predisposition of these stem cells to senescence would make certain patients susceptible to COPD or ILD based on the chosen behavior of the stem cell (3). CONCLUSIONS: While the body of research on the hazards of exposure to biomass continues to grow, the restrictive phenotype of DAPLD remains a rare condition that requires further research. Reference #1: Dulku, G, Gupta, N, Perera, R, et al. 2017. Hut Lung Disease: A Radiological and Pathological Correlation. J Med Imaging Case Rep 1(1): 1-4. Reference #2: Kunal S, Pilaniya V, Shah A. 2016. Bronchial Anthracofibrosis with Interstitial Lung Disease: An Association Yet to be Highlighted. BMJ Case Rep bcr2015213940. Reference #3: Kumar, A, Cherian, SV, Vassallo, R, et al. 2018. Current Concepts in Pathogenesis, Diagnosis, and Management of Smoking-Related Interstitial Lung Diseases. Chest 154(2): 394-408. DISCLOSURES: No relevant relationships by Rose Flores, source=Web Response No relevant relationships by Johnathan Kirupakaran, source=Web Response No relevant relationships by Chioma Madu, source=Web Response No relevant relationships by Alice Yau, source=Web Response

Traumatic Musculotendinous Avulsion of the Flexor Pollicis Longus Tendon: Current Concepts in Strategic Management

Traumatic Musculotendinous Avulsion of the Flexor Pollicis Longus Tendon: Current Concepts in Strategic Management

Posterior Labral Injury and Glenohumeral Instability in Overhead Athletes: Current Concepts for Diagnosis and Management.

Posterior glenohumeral instability in overhead athletes presents a unique set of challenges for both diagnosis and treatment. Although a great deal of attention has been focused on the management of injuries to the biceps-labrum complex and rotator cuff in throwers, comparatively less has been written about posterior glenohumeral instability within this unique cohort. Historically, posterior instability has been observed secondary to either acute trauma or repetitive microtrauma, usually among collision athletes, weight lifters, and rowers. However, posterior glenohumeral instability resulting from pathology of the posterior capsulolabral tissues in throwers is a different entity, and the clinical assessment begins with an accurate differentiation between adaptive capsular laxity and labral injury with pathologic instability. Some posterior capsule labrum tears confirmed on arthroscopy will require nothing more than débridement. However, for more extensive lesions, surgical treatment must balance the necessity to repair torn capsulolabral tissues with the tendency to over constrain the shoulder. The literature provides mixed results regarding the likelihood of overhead athletes with posterior glenohumeral instability and labral injury treated surgically returning to their preinjury level of sport performance.

Doctor’s Transformational Leadership

Leadership is a current management concept, including change management which presupposes not a job level but an authority level. The current times see leadership to be not somebody’s special feature. Today each employee can be a leader or have such feeling and be a role model in his/her sphere. Leadership is an important socio-personal competence because it includes both a component of social influence and a personal resource allowing a person to take on a leadership role.Transformational leadership is directed to individual relations formed between the leader and each follower separately. It includes some leader’s basic behavior features as worker’s hobbies promotion, supporting and self-esteem growth, creativity stimulation, comfort zone destruction, the will to team goals changes.The study involved 40 doctors. All participants were offered a multidisciplinary questionnaire by Bass–Avolio, which allows you to assess the characteristics of the individual in relation to leadership. This questionnaire includes 21 transformational and transactional leader’s characteristics statements. Doctors have estimated leadership factors really high. Meanwhile, our doctors have demonstrated a mismatch between transformational and transactional leadership characteristics and have to continue further leader sip learning.

Agitation after traumatic brain injury: a review of current and future concepts in diagnosis and management

ABSTRACT Objectives Agitation and aggression are common following traumatic brain injury. The challenges related to these disorders affect all stages of recovery, from the acute hospital to the community setting. The aim of this literature review is to provide an updated overview of the current state of post-traumatic agitation research. Methods We performed a PubMed literature review which included recent confirmatory and novel research as well as classic and historical studies to integrate past and future concepts. Results Areas explored include the personal and societal effects of post-traumatic agitation, methods for defining and diagnosing several neurobehavioral disorders, and pathophysiology and management of agitation and aggression. Target areas for future study are identified and discussed. Discussion While much progress has been made in understanding post-traumatic agitation, there remain several key areas that require further elucidation to support the care and treatment for people with traumatic brain injury.

Coronary microvascular disease: current concepts of pathophysiology, diagnosis and management.

Coronary microvascular disease (CMD) is present in 30% of patients with angina and is associated with increased morbidity and mortality. We now have an improved understanding of the pathophysiology of CMD and the invasive and noninvasive tests that can be used to make the diagnosis. Recent studies have shown that management of CMD guided by physiological testing yields better results than empirical treatment. Despite major advances in diagnosing and stratifying this condition, therapeutic strategies remain limited and poorly defined. This review article discusses recent advances in understanding the pathophysiology of CMD, the modalities that are available to diagnose it clinically, current management options and a look at what is in store for the future.

Aplastic anaemia: Current concepts in diagnosis and management.

Aplastic anaemia is a rare, previously fatal condition with a significantly improved survival rate owing to advances in understanding of the pathophysiology and improved treatment strategies including haematopoietic stem cell transplantation. Although a rare condition, aplastic anaemia continues to present a high burden for affected patients, their families and the health system due to the prolonged course of disease often associated with high morbidity and the uncertainty regarding clinical outcome. Modern molecular and genetic techniques including next-generation sequencing have contributed to a better understanding of this heterogeneous group of conditions, albeit at a cost of increased complexity of clinical decision-making regarding prognosis and choice of treatment for individual patients. Here we present a concise and comprehensive review of aplastic anaemia and closely related conditions based on extensive literature review and long-standing clinical experience. The review takes the reader across the complex pathophysiology consisting of three main causative mechanisms of bone marrow destruction resulting in aplastic anaemia: direct injury, immune mediated and bone marrow failure related including inherited and clonal disorders. A comprehensive diagnostic algorithm is presented and an up-to-date therapeutic approach to acquired immune aplastic anaemia, the most represented type of aplastic anaemia, is described. Overall, the aim of the review is to provide paediatricians with an update of this rare, heterogeneous and continuously evolving condition.

Perioperative management of patients with undergoing durable mechanical circulatory support.

Durable mechanical circulatory support (MCS) devices revolutionized the treatment options for patients with end-stage heart failure (HF). Implantation of durable mechanical support has become an integral treatment modality in end-stage HF patients and it is associated with improved quality of life and survival. There is no doubt that this needs an interdisciplinary and interprofessional approach of cardiac surgeons, cardiologists, cardiac anesthesiologists, perfusionists, intensivists, psychologists, assist device coordinators as well as physiotherapists and intensive care. Implantation of durable MCS is a challenging procedure for the anesthesiologist due to the patient’s characteristics and comorbid diseases. It demands comprehensive training, high vigilance and quick response during the acute hemodynamic changes occurring during the surgery. Preoperative risk stratification is of major importance to guide perioperative medical treatment strategies. Most of these patients have several comorbidities and multiple medications. Therefore, to anticipate postoperative end-organ dysfunction such as cognitive dysfunction, pulmonary or renal failure, an interdisciplinary approach is necessary to optimize patient’s prior surgery. Transthoracic and transesophageal echocardiography (TTE and TEE), both play an invaluable role in diagnosing the cause and guiding the management in different unstable clinical situations. Especially prevention of postoperative right HF with subsequent necessity of temporary MCS is important as it is associated with higher mortality. The aim of this review is to provide an overview about the current concepts of perioperative management for durable MCS. A multimodal standard operating procedure supports early recovery after surgery and intensive care stay. Standardized perioperative care helps to ensure optimal medical treatment. This review focusses on several major skills of perioperative management of these high-risk surgical patients.

Propuesta metodológica de aplicación de los espacios de Hilbert al manejo integral de cuencas

The current watershed management concept is ambivalent. On the one hand, it was generated as a proposal for a systemic vision of a territory, the watershed, and it addresses complex development issues in that territory. On the other hand, the most widespread application of the concept has been reductionist in nature, since it focuses on one or some aspects of the watershed components and their relationships. Recently, the adjective integrated was added to the term watershed management, which reflects the concern to apply a holistic and systemic vision in the interventions of the physical, biological, social and economic subsystems of the watershed. However, the use of the adjective has been more conceptual than pragmatic, and there has been a lack of discussion about its implications and the challenges associated with its operationalization. This paper proposes the application of Hilbert spaces as a methodological alternative to support the planning and monitoring of watershed management intervention proposals. Hilbert spaces, which have been used in other disciplines, are considered to be an option to support the analysis and management of the watershed as a complex system.

Innovation Research on Financial Reimbursement of Colleges and Universities Based on Big Data Technology

With the development of The Times, the financial reimbursement business volume of colleges and universities increases year by year. The traditional financial reimbursement has many repetitive work, low efficiency and complicated approval procedures. The current financial management concept of colleges and universities cannot keep up with the pace of big data technology development. This paper studies the innovation of big data technology on financial reimbursement of colleges and universities, discusses the positive impact of big data technology on financial reimbursement of colleges and universities, as well as new policy suggestions on financial reimbursement of colleges and universities, in order to solve the contradiction between the two sides of financial reimbursement, and the smooth development of financial reimbursement. With the promotion of the new big data technology, colleges and universities should also strengthen the construction of the talent team of financial informatization and open up the path of financial development featured by information.

High-Grade Spondylolisthesis in Adults: Current Concepts in Evaluation and Management.

Information regarding the treatment of high-grade spondylolisthesis (HGS) in adults has been previously described; however, previous descriptions of the evaluation and surgical management of HGS do not represent more recent and now established approaches. The purpose of the current review is to discuss current concepts in the evaluation and management of patients with HGS. Literature review. HGS is diagnosed in up to 11.3% of adults with spondylolisthesis and typically presents as nonspecific lower back pain. Regarding evaluation, a thorough history and physical examination should be performed, which may help predict the presence of HGS. Diagnostic imaging, and specifically the use of spino-pelvic parameters, are now commonly implicated in guiding treatment course and prognosis. When surgical intervention is indicated, surgical approaches include in situ fusion variations, reduction and partial reduction with fusion, and vertebrectomy. Although the majority of studies suggest improvements with these approaches, the literature is limited by a low level of evidence with regards to the superiority of one technique when compared with others. HGS is a unique cause of low back pain in adults that carries considerable morbidity, but rarely presents with neurologic symptoms. Although the definitions, classifications, and methods of diagnosis of this spinal deformity have been established and accepted, the ideal surgical management of this deformity remains highly debated. Fusion in situ techniques are often technically easier to perform and provide lower risk of neurologic complications, whereas reduction and fusion techniques offer greater restoration of global spino-pelvic balance. Preoperative spino-pelvic parameters may have utility in assisting in procedural selection; however, future, higher-quality and longer-term studies are warranted to determine the optimal surgical intervention among the widely available techniques currently used, and to better define the indications for these interventions.

Current controversies in management of fracture neck femur in children: A review

Paediatric femur neck fracture is an uncommon injury and is known for high rate of complications. This in turn, can have significant impact on development of hip and overall function of the child. Controversy prevails in many areas of management and it still remains a difficult injury to manage. Through this paper, an attempt has been made to summarize the current concepts in management and suggest current recommendations regarding the controversies so that these injuries can be managed judiciously. A systematic review was done as per PRISMA guidelines using pre-defined inclusion and exclusion criteria. 18 studies with better scientific evidence after quality assessment were included in the systematic review. Current trends and Controversial issues in management were then identified and discussed. It was observed that existing literature is inconclusive regarding several aspects of management of this injury with no clear guideline available. However, certain recommendations useful for decision making could be made. These injuries should be managed aggressively with operative fixation at the earliest and one should not hesitate to open reduce if acceptable alignment is not obtained after one or two gentle closed manipulations. Choice of implant and their configuration in neck can vary depending on age and weight of patient, type of injury and surgeon’s preference. Initial fracture displacement could be considered to be most predictive for development of osteonecrosis of the femoral head, whereas, role of surgical decompression, type of fixation and timing of surgery is still debatable. Functional outcome is primarily affected by osteonecrosis of the femoral head, nonunion and severe coxa vara, whereas mild coxa vara, shortening, and premature closure of physis when considered alone, don’t have significant influence on functional outcome in short term. Treatment of fracture neck femur in children is still controversial in many aspects and needs further research. It should be understood that complications can occur regardless of the method of treatment and might reveal their full impact many years after injury. Hence, a guarded prognosis should be explained to the parents and care-givers at the time of injury.

Unicystic Ameloblastoma of Mandible- Imaging Features: A Case Report and Literature Review

AbstractAmeloblastoma are benign tumors whose importance lies in its potential to grow into enormous size with resulting bone deformity. They are typically classified as unicystic, multicystic, peripheral, and malignant subtypes. Unicystic ameloblastoma (UA) refers to those cystic lesions that show clinical, radiographic, or gross features of an odontogenic cyst but on histological examination show a typical ameloblastomatous epithelium lining, with or without luminal and/or mural tumor growth. We present a very rare case of unicystic ameloblastoma in a girl child with an age of 10 years; clinical and radiographic features of UCA, its differential diagnosis, histopathology, and current concepts of management have also been discussed in the present paper.

Current Concepts in Management of Postmastectomy Lymphedema

Lymphedema is associated with irreversible changes in the lymphatic system. For this reason, it is difficult to develop a radical treatment due to the dermal sclerosis and the volume increase of fibrous and adipose tissues. Complex decongestive therapy (CDT) is the gold standard in every therapeutic protocol. However, in cases that conventional therapy is inadequate or unsuccessful, new surgical treatments are available nowadays combining microvascular reconstructive techniques: Lympho-Venous Anastomosis (LVA), Vascularized Lymph Node Transfer (VLNT), Lympho-Lymphatic Bypass (LL-Bypass). Finally, for simultaneous breast reconstruction and restoration of lymphedema, chimeric Diep Inferior Epigastric Perforator flap (DIEP flap) can be combined with vascularised lymph node transfer (VLNT) from the inguinal area. Retrospective review of the literature referred to the diagnosis and the treatment of primary or secondary lymphedema. Conventional, as well as microvascular techniques are shown with detailed description of each procedure. Worldwide interest in using microsurgical reconstructive techniques to treat lymphedema is gaining momentum. However, there is no consensus on the indications for which procedure to perform, when to intervene, and/or how to comparatively grade outcomes. Currently there is no cure for lymphedema. For this reason, further research and better understanding of lymphatic anatomy and lymphedema pathophysiology are needed in order to improve further the conventional as well as the surgical methods.

AB011. Sepsis in pediatrics: current concepts of terminology and management

: Sepsis is one of the leading causes of mortality among children worldwide. Although the diagnosis and management of sepsis in infants and children is largely influenced by studies done in adults, there are important considerations relevant for pediatrics and we wanted to highlights pediatric-specific issues related to the definition of sepsis and its epidemiology and management. The definition of pediatric sepsis is currently in a state of evolution. For the past two decades, sepsis has been defined as “systemic inflammatory response syndrome (SIRS) caused by infection” both for adults and children. International pediatric sepsis consensus conference in 2015 revised the adult SIRS criteria for children. New sepsis criteria were advocated as “Sepsis-3” in 2017, which redefined “as life-threatening organ dysfunction caused by a dysregulated host response to infection”. Unfortunately, this change in the definition of sepsis is applied to adult population at this moment, consensus definition in children are not well established. The epidemiology of pediatric sepsis varies from study to study probably because of their different era, population, and diagnostic criteria. Sepsis is often diagnosed too late, because the clinical symptoms and laboratory signs that are currently used for the diagnosis of sepsis, like raised temperature, increased pulse or breathing rate, or white blood cell count are unspecific. In children, the signs and symptoms may be subtle and deterioration rapid. Early sepsis treatment is cost effective, reducing hospital and Critical Care bed days for patients. The current management of pediatric sepsis is largely based on adaptations from adult sepsis treatment. New knowledge was added regarding the hemodynamic management and the timely use of antimicrobials. The early administration of antibiotics and hemodynamic stabilization with fluid resuscitation and inotropic/vasopressor support are like both wheels of a vehicle for the initial management of sepsis. The management of pediatric sepsis must be tailored to the child’s age and immune capacity, and to the site, severity, and source of the infection. The management of pediatric sepsis would be expected to make further progress.

Food Protein-Induced Enterocolitis Syndrome

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy that manifests with projectile, repetitive emesis that can be followed by diarrhea and may be accompanied by lethargy, hypotonia, hypothermia, hypotension, and metabolic derangements. FPIES usually starts in infancy although onset at older ages is being increasingly recognized. FPIES is not rare, with the cumulative incidence of FPIES in infants estimated to be 0.015% to 0.7%, whereas the population prevalence in the US infants was 0.51%. FPIES diagnosis is challenging and might be missed because of later (1-4 hours) onset of symptoms after food ingestion, lack of typical allergic skin and respiratory symptoms, and food triggers that are perceived to be hypoallergenic. Diagnosis is based on the recognition of symptoms because there are no biomarkers of FPIES. The pathophysiology remains obscure although activation of the innate immune compartment has been detected. Management relies of avoidance of food triggers, treatment of accidental exposures, and periodic re-evaluations with supervisedoral food challenges to monitor for resolution. There are no strategies to accelerate development of tolerance in FPIES.Herewe review the most important current concepts in epidemiology,pathophysiology, diagnosis, and management of FPIES.

On the nature of risk in the safety management of structurally complex systems

Aim. In the general case, a risk-oriented approach encompasses probabilistic methods of emergency processes and events simulation as well as deterministic methods. The use of probabilistic and deterministic estimations has been the focus of research aiming to improve safety and operational procedures. However, the experience of using probabilistic analysis only (essentially, one-criterium tool) has shown that this approach does not encompass all the required aspects of safety. The aim of the paper is to introduce (update) the definitions of the very concepts of “analysis” and “synthesis” as regards the risks for the purpose of research of safety of structurally complex systems (SCS) and design of systems for monitoring hazards and threats to their stable development thereof.Method. The paper examines – from the point of view of systems science – the method of analysis and synthesis of risks as a development tool of advanced systems for monitoring SCS safety threats. The paper compares the primary current concepts of risk management in SCS and has shown that they should be developed and improved. A type of risk functionality is proposed that allows defining a safety solution by the value of mathematical expectation of losses, with appropriate corrections taken into account.Result. The concept of “risks synthesis” is introduced as a scientific tool integrated with analysis that takes into consideration the existing connections between the elements of considered SCS in terms of a whole system in its entirety. Principles are formulated for the collection of comprehensive sets of data required for decision-making.Conclusion. The proposed approach paves the way for the development of the method of risks synthesis and suggests the development of advanced expert systems to support decision-making regarding the safety of SCS as multifunctional and multilevel systems intended for both recording and analysis of each individual case (event), and prediction of trends and preparation of prevention measures as necessary.

Carcinoid Heart Disease: a Comprehensive Review

Carcinoid heart disease is a rare disorder that is associated with significant morbidity and mortality. In this review of the literature, we will present current concepts in diagnosis and management of carcinoid heart disease. Recent expert consensus guidelines highlight the role of echocardiography and screening with NT-proBNP for the evaluation of carcinoid heart disease. Advances in medical therapy along with better surgical outcomes highlight the experience and expertise that has been gained in the treatment of carcinoid heart disease. Carcinoid heart disease occurs in patients with neuroendocrine tumors who have carcinoid syndrome. Serotonin appears to play a central role in the development of carcinoid heart disease. Cardiac biomarkers and multimodality imaging can be used to aid in screening and diagnosis. The mainstay of treatment of carcinoid heart disease is surgery.