Everyday Routine Practice Research Articles

Treating to target in multiple sclerosis: Do we know how to measure whether we hit it?

The rapidly evolving landscape of effective treatment options in multiple sclerosis has led to a shift of treatment objectives towards a treat-to-target approach aiming to suppress disease activity below the level of detectability early during the disease. To enable treat-to-target, a thorough reappraisal of available outcome measures with respect to their ability in this regard is required. To that end, we conducted a comprehensive systematic literature review of more than 1000 studies using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 methodology focusing on underlying evidence as well as utility and implementability in clinical practice. From there, we propose a set of measurable outcomes for everyday routine clinical practice as well as advanced/aspirational measurables requiring additional resources. We also outline remaining knowledge/technology gaps that need to be overcome to enable a treat-to-target approach. This work provides the basis for an evidence-based definition of outcome targets for relevant stakeholders and regulatory authorities.

Evaluation of magnetic resonance imaging to detect cholesteatoma in clinical healthcare

Background Non-Echo-Planar Diffusion Weighed Magnetic Resonance Imaging (non-EPI DW MRI) plays a role in the planning of cholesteatoma surgery. Objectives To outline the usage of Non-EPI DW MRI in cholesteatoma diagnostics and to determine its accuracy, using otosurgery diagnostics as reference standard. Material and Methods A retrospective descriptive study. All subjects operated, with suspicion of cholesteatoma as indication, that had a preceding examination with non-EPI DW MRI, between October 2010 and March 2019. Calculating sensitivity, specificity, predicative values, and likelihood ratios, using non-EPI DW MRI as index test and diagnosis from otosurgery as reference standard. Results Fifty-two subject episodes were included. Non-EPI DW MRI had a sensitivity of 0.50, specificity of 0.75, positive and negative predictive values of 0.74 and 0.52 and, positive and negative likelihood ratios of 2.0 and 0.67 respectively. Conclusions and Significance There is a clear annual trend with increased numbers of executed examinations during the study period. The diagnostic accuracy of non-EPI DW MRI does not reach acceptable levels in the existing everyday routine practice conditions. The accuracy of the examination increases when interpreted by an experienced radiologist and when using the definition of cholesteatoma recommended by EAONO/JOS.

Decision Making in Severe Equine Asthma-Diagnosis and Monitoring.

Decision making consists of gathering quality data in order to correctly assess a situation and determine the best course of action. This process is a fundamental part of medicine and is what enables practitioners to accurately diagnose diseases and select appropriate treatment protocols. Despite severe equine asthma (SEA) being a highly prevalent lower respiratory disease amongst equids, clinicians still struggle with the optimization of routine diagnostic procedures. The use of several ancillary diagnostic tests has been reported for disease identification and monitoring, but many are only suitable for research purposes or lack practicality for everyday use. The aim of this paper is to assist the equine veterinarian in the process of decision making associated with managing SEA-affected patients. This review will focus on disease diagnosis and monitoring, while also presenting a flow-chart which includes the basic data that the clinician must obtain in order to accurately identify severely asthmatic horses in their everyday routine practice. It is important to note that European and American board-certified specialists on equine internal medicine can provide assistance in the diagnosis and treatment plan of SEA-affected horses.

ПРОЕКТ «ШКОЛА ОБРАБОТКИ ДАННЫХ» КАК ИНСТРУМЕНТ ПОВЫШЕНИЯ ГРАМОТНОСТИ СТУДЕНТОВ В ПРИКЛАДНЫХ АСПЕКТАХ НАУКИ О ДАННЫХ

The digitalization of all spheres of society dwelling has spurred a deep transformation of everyday activities and routine practices both in professional and private life fields. Data science applications (including data processing and statistical analysis) have spread far beyond the limits of mathematical and natural sciences; they are actively used in humanities and social sciences, to analyze data as well as to generate prognosis given those data with application of information technologies and computer tools. This paper aims at presenting a training project “Data Processing and Analyzing School” as a tool for upscaling students’ literacy in applied fields of data science. The project has reached its goal, to train intensively and within a short term the students who are going to develop their own research projects in the applied fields of methods, models, tools of data science intended for collection, storing, pro-cessing and analyzing the data, results interpretation in research projects of humanities and social sciences. The paper is intended for specialists and faculty staff of educational institutions as well as for managers who organize digital sciences departments.

Benefits and Limitations of OCT-A in the Diagnosis and Follow-Up of Posterior Intraocular Inflammation in Current Clinical Practice: A Valuable Tool or a Deceiver?

Purpose: Optical coherence tomography angiography (OCT-A) has been applied to uveitis and intraocular inflammation since its availability after 2014. The imaging of retinal and choroidal vascularization without the use of dyes was a major development and represented a potentially valuable tool in ocular research. In addition to such use, OCT-A is often put forward as being able to potentially replace invasive methods needing dye injection, such as fluorescein angiography (FA) and indocyanine green angiography (ICGA). The aim of this review was to establish whether OCT-A was sufficiently useful in everyday routine clinical practice to monitor disease evolution and to perform treatment adjustments to the extent that it could reliably replace the standard dye methods. Methods: Selective literature review and analysis of own data and experience. Results: OCT-A is a technologically high-grade imaging modality allowing to analyze retinal circulation in inflammatory diseases of the posterior pole with a high sensitivity useful for research purposes. However, there is no evidence that it reaches equal effectiveness in the routine management of posterior uveitis involving the retina. OCT-A is unable to show leakage. In choriocapillaritis involving pre-capillary vessels, it shows capillary drop-out but does not seem to have an advantage over ICGA except that it can be repeated easily, not being invasive, and so allows a closer follow-up. It is, however, less useful in end-choriocapillary non-perfusion, such as in MEWDS. For choroidal stromal inflammation, OCT-A is ill-suited as it only shows inconsistent secondary circulatory changes produced by choroidal foci. OCT-A seems to be useful in the diagnosis and follow-up of inflammatory chorioneovascularisation (iCNV), although dye exams are more precise in showing the activity of the iCNV. Conclusion: In summary, OCT-A is a very sensitive modality for the retinal circulation in uveitis for research purposes; it is sometimes useful for close follow of choriocapillary drop-out but not in end-capillary non-perfusion. Its use for monitoring purposes in stromal choroiditis, however, is questionable. Its claim to possibly replace classical angiographic work-up for the practical management of posterior uveitis is largely overrated.

Optical coherence tomography in the diagnosis and monitoring of congenital and juvenile glaucoma

Optical coherence tomography (OCT) in everyday routine practice is the method of choice for the instrumental diagnosis of glaucoma in adults. As a non-invasive and safe method of visualizing structural changes in the retina and the optic nerve, the method is of particular value in pediatric practice. At the same time, OCT diagnostics in children is associated with certain difficulties, both during the study and when interpreting the scan results.This review summarizes the data from the literature and our own research in the diagnosis and monitoring of congenital and juvenile glaucoma from the standpoint of our own long-term clinical experience in using optical coherence tomography. We consider the physiological changes of the retina and optic nerve, attention is focused on the need to create a pediatric regulatory database of retinal thickness, the factors that determine the normal range of the data obtained and allow distinguishing physiological processes from pathological ones are identified. Clinical cases confirming the value of OCT in combined pathology are presented as examples.

The upcoming role of Artificial Intelligence (AI) for retinal and glaucomatous diseases

In recent years, the role of artificial intelligence (AI) and deep learning (DL) models is attracting increasing global interest in the field of ophthalmology. DL models are considered the current state-of-art among the AI technologies. In fact, DL systems have the capability to recognize, quantify and describe pathological clinical features. Their role is currently being investigated for the early diagnosis and management of several retinal diseases and glaucoma. The application of DL models to fundus photographs, visual fields and optical coherence tomography (OCT) imaging has provided promising results in the early detection of diabetic retinopathy (DR), wet age-related macular degeneration (w-AMD), retinopathy of prematurity (ROP) and glaucoma.In this review we analyze the current evidence of AI applied to these ocular diseases, as well as discuss the possible future developments and potential clinical implications, without neglecting the present limitations and challenges in order to adopt AI and DL models as powerful tools in the everyday routine clinical practice.

Clinical outcomes in stage III non-small cell lung cancer patients treated with durvalumab after sequential or concurrent platinum-based chemoradiotherapy - single institute experience.

BackgroundChemoradiotherapy (ChT-RT) followed by 12-month durvalumab is the new standard treatment for unresectable stage III non-small cell lung cancer. Survival data for patients from everyday routine clinical practice is scarce, as well as potential impact on treatment efficacy of sequential or concomitant chemotherapy and the usage of gemcitabine.Patients and methodsWe retrospectively analysed unresectable stage III NSCLC patients who were treated with durvalumab after radical concurrent or sequential chemotherapy (ChT) from December 2017 and completed treatment until December 2020. We assessed progression free survival (PFS), overall survival (OS) and toxicity regarding baseline characteristic of patients.ResultsEighty-five patients with median age of 63 years of which 70.6% were male, 56.5% in stage IIIB and 58.8% with squamous cell carcinoma, were included in the analysis. Thirty-one patients received sequential ChT only, 51 patients received induction and concurrent ChT and 3 patients received concurrent ChT only. Seventy-nine patients (92.9%) received gemcitabine and cisplatin as induction chemotherapy and switched to etoposide and cisplatin during concurrent treatment with radiotherapy (RT). Patients started durvalumab after a median of 57 days (range 12–99 days) from the end of the RT and were treated with the median of 10.8 (range 0.5–12 months) months. Forty-one patients (48.2%) completed treatment with planned 12-month therapy, 25 patients (29.4%) completed treatment early due to the toxicity and 16 patients (18.8%) due to the disease progression. Median PFS was 22.0 months, 12- and estimated 24-month PFS were 71% (95% CI: 61.2–80.8%) and 45.8% (95% CI: 32.7–58.9%). With the median follow-up time of 23 months (range 2–35 months), median OS has not been reached. Twelve- and estimated 24-month OS were 86.7% (95% CI: 79.5–93.9%) and 68.6% (95% CI: 57.2–79.9%).ConclusionsOur survival data are comparable with published research as well as with recently published real-world reports. Additionally, the regimen with gemcitabine and platinum-based chemotherapy as induction treatment was efficient and well tolerated.

Применение методов инфракрасной визуализации в современном источниковедении

The paper gives a brief overview of infrared (IR) imaging techniques and the cases of their applying to the study of ancient manuscripts and objects of cultural heritage. The method of IR reflectography is used in fine art research, which allows the visualization of details hidden by the paint layers with the help of a scanner. There are also the cases, when IR reflectography is implemented into papyrology with the purpose to make ancient papyri, that turned dark-brown, more legible. Thermography is also used both in studies of cultural heritage and written documents, such as research of bookbinding and supports. Multispectral analysis is a well-proven method of text visualization and digital restoration of ancient manuscripts, which usually is applied in palimpsest decipher. Then the paper considers the method that includes part of IR spectrum is hyperspectral analysis. It is also used in papyrology. Finally, the author observed method of near-infrared imaging (NIRI) and its use for different purposes of the source studies. The paper concludes by arguing the relevance of near-infrared analysis of paper-based historical documents as a key-element of source study. NIRI allows researchers to obtain digital copies of watermarks and investigate corrections of the text made with different inks. The paper provides reader with the technical recommendations on basic NIRI equipment. To sum up, the author declares that there is a possibility for NIRI to become an everyday routine practice for researchers in near future due to its ability to provide a basic analysis of paper, watermarks and ink.

Variant and Specific Forms of Autoimmune Cholestatic Liver Diseases.

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are the main autoimmune cholestatic liver diseases. IgG4-associated sclerosing cholangitis is another distinct immune-mediated cholestatic disorder of unknown aetiology that is frequently associated with autoimmune pancreatitis or other IgG4-related diseases. Although the majority of PBC and PSC patients have a typical presentation, there are common and uncommon important variants or specific subgroups that observed in everyday routine clinical practice. In this updated review, we summarize the published data giving also our own experience on the variants and specific groups of autoimmune cholestatic liver diseases. Actually, we give in detail the underlining difficulties and the rising dilemmas concerning the diagnosis and management of these special conditions in the clinical spectrum of autoimmune cholestatic liver diseases including the IgG4-associated sclerosing cholangitis highlighting also the uncertainties and the potential new eras of the research agenda.

Sustainable Incremental Organizational Change—A Case of the Textile and Apparel Industry

The article is aimed at working out a comprehensive perspective on sustainable incremental change in organizations from a practice-based approach. That perspective presents everyday routine organizational practices as loci of sustainable organizational change. The research conducted reveals sustainability aspects that influence incremental change in the product development cycle in textile and apparel enterprises. The short life cycle of textile and apparel products challenges the multiplicity of sustainability aspects in that industry. The sequential procedure of mixing quantitative and qualitative methods was applied. A quantitative study was followed by qualitative research that was aimed at gaining an idiographic perspective. The statistical procedure was applied to determine the associative relationships between sustainable dynamizing factors and practice variability in textile and apparel enterprises. The influence factors were further explored as part of in-depth qualitative research. The qualitative research referred to three main aspects of sustainable practices at the initial production stage (sustainable water use), the last stages of the textile and garment life cycle (disposal and recycling of unwanted materials), and value (co)creation in the apparel industry. The results put emphasis on spontaneous vs. purposive activities in sustainable practice.

КОНЦЕПТ ПОТОКОВИХ ВЗАЄМОДІЙ В СОЦІОЛОГІЧНОМУ ДОСЛІДЖЕННІ ПОВСЯКДЕННОСТІ

The article is devoted to analysis of the ways of using the "flow interaction" concept in sociological everyday-life studies and to development a definition of the concept. In particular for achievement the theoretical research aim, the author applies a set of fundamental sociological theories such as: the social practices theory, J. Alexander's cultural sociology, B. Latour's actor-network theory which have significant heuristic value for everyday-life sociology. The article argues that in modern society spread practices of temporal daily life structures development. Upgrading the theories of social order constitution on a basis of concepts of network and flow structures allows to develop the sociological knowledge about every-day life and routine practices.

Examining commissioners' leadership behaviour

Clinical commissioning groups (CCGs) now control around two-thirds of the NHS budget, influencing healthcare provider priorities and playing a key role in implementing the NHS plan. However, significant failures in healthcare have highlighted a dissonance between expressed values of leaders and everyday routine practices. This research explores the leadership behaviour of commissioners and the role it plays in determining quality and safety in healthcare. The research took a two phase approach: phase 1 used focused video ethnography to observe commissioners in a mock board room setting; phase 2 employed a quantative questionnaire to determine the leadership behaviours that subordinates would expect their commissioners to adopt. The findings of this research identified that the leadership style most prevalent within the commissioners was transactional in nature. The questionnaire to subordinates of commissioners identified that transformational leadership had the best outcome on staff performance if this was linked to positive leadership style. In addition, commissioners appear to lack consistency when analysing risks effectively and holding providers to account, citing issues such as ‘professional drift’ and concerns over further scrutiny, as validation for this approach. This confusion of leadership behaviours, allied with poor analyse of risk leaves commissioners prone to repeating previous healthcare failures.

EPA-0230 - A nation-wide staff training program for family psychoeducation in severe mental illness

'A nation-wide staff training program for family psychoeducation in severe mental illness' Despite all the evidence regarding its cost-effectiveness, psychoeducational family interventions for non-organic psychotic disorders are still not steadily applied in everyday routine practice. In Portugal, these interventions are seldom used, even in well-staffed psychiatric departments. Following the recommendations of the Portuguese National Mental Health Plan, a psychoeducational training program has been prepared by the Ministry of Health. a) to conduct a psychoeducational training program on a national basis and b) to evaluate obstacles to implementation in routine practice. Professionals from public mental health services across the Country attended a 3 days full-time program in which they were trained in the psychoeducational intervention through presentation of guidelines, demonstrative audios and role-playing. The trainees' acquisition of skills was found very satisfactory. The most prevlent barriers in the implementation of the intervention included work overload, the difficulty to integrate family work with other duties, and the poor allowance of time from the service to run the intervention on a regular basis. Measures should be taken in order to cope with obstacles limiting the use of family interventions in practice, including changes in the services governance and increased autonomy for professionals involved in the process.

Die Ejaculatio praecox in der urologischen Praxis

Premature ejaculation is a frequent male sexual complaint or sexual disturbance found in urological practices and outpatient units. The frequency in the individual practices varies considerably. In large studies the prevalence is strongly dependent on the definition and ranges between 3% and 25%. Subjectively, the inability to delay ejaculation and the distress resulting from it, is relevant for the patient and his partner. Intravaginal ejaculation latency time (IELT) is used as an objective parameter. Nevertheless, in the everyday routine practice this objective parameter is not practical. Clinically 2 questionnaires have asserted themselves (Premature Ejaculation Profile and Index of Premature Ejaculation). Studies have shown that the self-assessment of patients correlates relatively well with the objective IELT measured by means of a stopwatch. Beside topical anaesthetics and elective serotonin reuptake inhibitors (SSRI), especially Dapexetine which has been approved in Germany since 2009, are treatment options. These drugs differ particularly in their use (daily or on-demand) and their effectiveness (measured by x-fold increase of IELT). This article deals with the clinical approach to EP. Beside the definition, prevalence, aetiology and neurophysiology of EP, the different pharmacological therapies as well as the guidelines of the International Society for Sexual Medicine are discussed.

What Kind of Place is this?

The lives of nearly one million migrants in Qatar are in a ‘state of exception’ (Agamben). Distanced from mainstream society, they live in labour camps situated in desolate areas. In a space designed to render low qualified migrants invisible, Nepalese people are among those who try to make theirs a temporary place. Spatial strategies of appropriation, from the camp to the bed in the room, are nevertheless limited by the structures of domination that migrants live in. Through the study of the everyday routine and spatial practices, I show that the camp does indeed bear ambivalent values, associated with jail, with village-like feelings or with the achievements made possible by migration.

Unilateral Sudden Hearing Loss Due to Otosyphilis

The differential diagnosis of sudden hearing loss is very extensive. However, in most patients, no underlying pathology will be found and the patient is consequently diagnosed with idiopathic sudden hearing loss. Nevertheless, it is important that one stays alert in everyday routine practice to less common but potentially treatable pathology. We report a case of a 53-year old patient with sudden unilateral hearing loss and tinnitus caused by otosyphilis. Diagnosis, therapy and the incidence of (oto)syphilis are discussed. Also, as ENT-surgeons, it is important to realise that syphilis is still with us, and that its prevalence might well increase in the near future.

Cultural models in communication with infants: Lessons from Kikaikelaki, Cameroon and Muenster, Germany

Child rearing is a universal task, yet there are differing solutions according to the dynamics of socio-cultural milieu in which children are raised. Cultural models of what is considered good or bad parenting become explicit in everyday routine practices. Focusing on early mother–infant interactions in this article we examine the discursive practices and strategies that foster cultural values such as autonomy and relatedness. Drawing on micro-analysis of videotaped mother–infant interactions from middle-class families in Muenster, Germany and farming Nso families in Kikaikelaki, Cameroon, we aim at illustrating how diverse discursive strategies construct alternative versions of the child’s experience of self and self-in-relation-to-others. In each case, mothers draw on discursive practices that convey cultural norms and values that fit the relevant cultural context.

Changes in psychiatric nurse attitudes towards legal representation of inpatients at District Psychiatric Board hearings in Israel: a pilot study

Aims: To compare the initial attitudes of nurses and other professional groups in a psychiatric hospital towards the legal representation (LR) of involuntary admitted psychiatric patients before District Psychi- atric Boards (DPB), and to assess how these attitudes changed after LR had become an everyday routine practice in the hospital. Background: LR of hospital- ized psychiatric patients before DPB has been intro- duced into mental health system worldwide, include- ing Israel. Attitudes of psychiatric staff towards LR and their changes over time are a very important -though unstudied issue. Methods: Thirty seven psy- chiatric nurses employed in the Tirat Carmel Mental Health Center, Israel and 30 other mental health professionals (comparison group) completed the At- titudes to Legal Representation Questionnaire before LR has been instituted in the Center (November 1, 2006) and one year later. Baseline differences be- tween the groups were tested using one-way ANOVA, and pre-post differences in the attitude scores were tested by paired t-tests. Results: Baseline psychiatric nurses attitudes towards LR were significantly more negative than those of the comparison group (F67,3 = 6.87, p < 0.0001), but they significantly improved over the study period (t37 = 2.56, p = 0.015). Conclu- sion: Yearlong, routine exposure to the LR of invol- untarily admitted psychiatric patients may attenuate negative nurse beliefs and attitudes towards LR of such patients at DPB hearings. The more positive attitudes may enhance the nurses' ability to present information about patients without jeopardizing their human and civil rights, and help patients to attain a greater sense of control over their illness manage- ment and satisfaction with the services received.

Treatment of stable angina pectoris by ivabradine in every day practice: The REDUCTION Study

The antianginal efficacy of ivabradine was studied in controlled clinical trials. Strict patient selection criteria may cause a discrepancy between the results of highly controlled clinical trials and everyday routine practice. The objective of this study was to evaluate the efficacy and safety of ivabradine in everyday routine practice. In this multicenter study, 4,954 patients with stable angina pectoris received ivabradine in everyday routine practice and underwent follow-up for 4 months. The heart rate (HR), angina pectoris attacks, nitrate consumption, overall efficacy, and tolerance were evaluated. Within 4 months of treatment with ivabradine, HR was reduced by 12.4 +/- 12.2 beat/min from 82.9 +/- 15.3 to 70.4 +/- 9.2 beat/min (P < .0001). Angina pectoris attacks were reduced from 2.4 +/- 3.1 to 0.4 +/- 1.5 per week (P < .0001). Consumption of short-acting nitrates was reduced from 3.3 +/- 4.4 to 0.6 +/- 1.6 U/wk (P < .0001). Seventy-eight cases of adverse drug reactions were reported. The most common adverse drug reactions were nausea (n = 11, 0.22%) and dizziness (n = 9, 0.18%). Efficacy and tolerance were graded by physicians as being "excellent/very good" for 97% and 98% of the patients treated. Ivabradine reduces the HR and is highly effective and well tolerated in the treatment of patients with symptomatic coronary artery disease. The results confirm the findings of controlled clinical trials in a broad patient population in everyday routine practice.