Official Guidelines Research Articles

Survey of common deep brain stimulation programming practices by experts in Parkinson's Disease.

Identify consensus and variability in deep brain stimulation (DBS) programming practices for Parkinson's disease. DBS programming relies on the personal experience and skills of programmers. Despite consensus statements, there aren't official guidelines for DBS programming, making it likely for protocols to vary among providers. We administered an online survey to the Functional Neurosurgery Working Group of the Parkinson's Study Group to capture those actively programming DBS patients. We performed descriptive statistics and comparisons of responses based on career stage: early (0-10years) versus later (>10years). Boston Scientific (n=15/31, 48%) and Medtronic (n=14/35, 40%) are the two DBS systems ranked as most used, with less reported frequency of Abbott devices (n=4/32, 12.5). Traditional monopolar review ranked as the most common initial programming strategy by 23/29 (79%) respondents, regardless of the device type implanted. Monopolar omnidirectional testing was the most often used approach for contact configuration at initial programming (24/33, 73%).For treating dyskinesia, tremor, bradykinesia, rigidity, speech-related side effects, non-motor adverse effects, or swallowing-related side effects, the most likely optimization strategy selected was to modify amplitude of the active contact. When treating freezing of gait, there was a divergence between first modifying amplitude (n=11/29, 38%) or frequency (n=12/33, 36%). Initial programming practices generally align with published recommendations, which can reassure less experienced clinicians in practices with near consensus and allow them to devote more time to areas with wider variety of practice. Our data also highlights aspects of DBS programming with less consensus, demonstrating the need for future evidence.

Every bit of language we accrue throughout life matters-Multilingual education

Monolingual ideologies remain alive in mainstream education, though the amount of evidence pointing to the benefits of multilingualism is increasing. Against this background, this paper aims to explore the importance of multilingual practices in multilingual classrooms, teacher input in enhancing multilingual practices in classrooms and assessment in multilingual classrooms. A systematic review of the literature was done to gather data. The findings revealed that the use of dominant national languages and/or colonial languages does not sufficiently account for the multilingual nature of the learners in the classrooms and their respective communities. Teachers need to allow any references to languages by their learners of which they have only basic knowledge or no knowledge at all. One way is to leave the role of expert to learners with home languages while taking on the role of learners of new languages. Also, in linguistically and culturally diverse classrooms, unintended bias in any assessment aspect can negatively affect learners whose home language is not the language of assessment. The study recommends that policymakers should establish official guidelines on interpreting competence aims for multilingual education, ensuring clarity and consistency across schools. Teachers should adopt collaborative teaching strategies that encourage learners to use their home languages in classroom activities. Partnerships between researchers and educators are essential for evaluating the effectiveness of multilingual pedagogies and refining teaching approaches. Assessment practices should be adapted to reflect learners’ diverse linguistic backgrounds, ensuring fair and valid evaluations of their competencies. Teacher training programmes should include modules on multilingual education, equipping educators with the necessary tools to manage linguistically diverse classrooms.

Методические рекомендации по маршрутизации, мониторингу и тактике ведения иммунокомпрометированных детей групп риска и пациентов с врожденными ошибками иммунитета [Рецензенты: О.В. Зайцева, Н.И. Захарова, О.В. Калюжин. Утверждены в качестве методических рекомендаций Учебно-методической комиссией ФГБУЗ МО НИКИ Детства МЗ МО. Протокол № 8 от 20.11.2024 г.

A.P. Prodeus, N.D. Odinayeva, S.V. Voronin, I.N. Zakharova, I.A. Tuzankina, N.N. Volodin, K.V. Zhdanov, A.N. Pampura, D.I. Sadykova, E.I. Kondratyeva, A.A. Korsunskiy, E.A. Degtyareva, K.V. Savostyanov, S.A. Trusova, A.Yu. Lobenskaya, Ye.S. Nikonova, A.S. Lebedeva, E.V. Loshkova, V.D. Denisova, A.G. Rumyantsev. Guidelines for routing, monitoring and management tactics of immunocompromised children at risk and patients with congenital immune defects. Pediatria n.a. G.N. Speransky. 2024; 103 (6): 218-245. DOI: 10.24110/0031-403X-2024-103-6-218-245. [Reviewed by Drs. O.V. Zaytseva, N.I. Zakharova and O.V. Kalyuzhin. Approved as official Guidelines for Practitioners by the Educational and Methodological Commission of the Research and Clinical Institute of Childhood with the Moscow Oblast Healthcare Ministry (Mytishchi, Moscow Oblast, Russia), Record No. 8 dated Nov. 11, 2024]

Treatment of Invasive Pulmonary Aspergillosis and Preventive and Empirical Therapy for Invasive Candidiasis in Adult Pulmonary and Critical Care Patients. An Official American Thoracic Society Clinical Practice Guideline

Treatment of Invasive Pulmonary Aspergillosis and Preventive and Empirical Therapy for Invasive Candidiasis in Adult Pulmonary and Critical Care Patients. An Official American Thoracic Society Clinical Practice Guideline

Heat Index Levels and Heat – Related Risks in the Philippines

Using a systematic literature review, this study determined and establish the Health Index Levels and Heat – Related Health Risks in the Philippines.  Background. The heat index which is also called as the visible temperature is well-defined as a personalized, subjective experience of a person when comparative humidity is correlated with the temperature of the air. The incidence and intensity of life-threatening incidents especially escalated heat index are growing all around the world which ultimately poses a serious risk to the health of people.  Aim. The aim of this review was to explore and deliberate the relationship between the heat index, a measure that combines air temperature and relative humidity to approximate the apparent temperature, and the risk of heat-related health issues in the Philippines from published articles between 2019 – 2024.  Data Sources. A systematic search of primary articles on numerous electronic databases that included Google Scholar and other related engines. Grey literature was also connected based on the references available and bibliographies from the different articles were also included in the pooling of literature of data.  Method. The article included two (2) or more of the key search terms identified: heat exhaustion, heat stroke, health related risks, heat index , and lastly published from years 2019-2024.  Results. Analysis of the research articles were used to answer the effect of the heat index in the risk of heat exhaustion, the effect of the heat index in the risk of stroke and formulation of research - based recommendations on Heat Index Levels and Heat - Related Health Risks in the Philippines.  Acknowledgment: The authors of this systematic literature review thanks and recognize all the writers of the variety of references that were used in this review paper. The proponents these data sources used in this paper are both cited in the text and in the reference lists.  Disclaimer: The beliefs and point of view manifested in this paper are those of the authors and do necessarily indicate the official guidelines or stand of any affiliated institution, organization or agency of the authors.  Conflict of Interest: The authors have not anything to proclaim. This paper is a collaborative effort of the authors mentioned above.

Interventional Strategies for Children with Progressive Pulmonary Hypertension Despite Optimal Therapy. An Official American Thoracic Society Clinical Practice Guideline.

Pulmonary hypertension in children often progresses despite optimal therapy. This document provides an evidence-based clinical practice guideline for the management of children with progressive pulmonary hypertension despite optimal therapy. A multidisciplinary panel identified pertinent questions regarding the management of children with pulmonary hypertension that has progressed despite optimal therapy, conducted systematic reviews of the relevant literature, and applied the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to develop clinical recommendations. After reviewing the research evidence, the panel considered the balance of desirable (benefits) and undesirable (harms and burdens) effects of the interventions in each proposed question. Valuation of our main outcomes was also considered, along with resources required, equity, acceptability, and feasibility. Recommendations were developed for or against interventional strategies specific to children with pulmonary hypertension that has progressed despite optimal therapy. Although there is a growing population of children with pulmonary hypertension, there is a striking lack of empirical evidence regarding management of those whose disease has progressed despite optimal pharmacotherapy. The panel formulated and provided the rationale for clinical recommendations for or against interventional strategies based on this limited empirical evidence, coupled with expert opinion, to aid clinicians in the management of these complex pediatric patients. In addition, we identified important areas for future research.

The use of Language ENvironment Analysis in autism research: A systematic review.

In research, language ability has historically been measured using structured tasks in laboratory settings. In recent years, there has been a growing emphasis on the need to instead capture language ability in an individual's natural setting (i.e. through social interaction or in their home). Considering natural language may be particularly important for the autistic population, as an autistic child's language ability can be very different depending on the setting. One common tool for capturing natural language is the LENA recording system, which takes audio recordings over long periods of time and provides estimates of children's and caregivers' speech. The purpose of this systematic review is to summarize the use of LENA in autism research, to highlight the strengths and limitations of the system as identified by researchers, and to provide recommendations for future research and clinical use. We identified 42 autism studies that used LENA in a variety of ways and settings. Most studies used LENA within the guidelines put forth by its creators, and it was most commonly used to understand speech or speech development for autistic children. LENA is a useful tool for clinicians and caregivers to gain some insights into child speech, but those considering using it should be aware of concerns about its accuracy and limitations about the information it provides. In this review, we supplement the official LENA guidelines with specific suggestions for use with the autistic population.

Cost-effectiveness of strengthening blood pressure classification in South Korea: comparing the 2017 ACC/AHA and KSH guidelines

BackgroundHypertension is a significant risk factor for cardiovascular disease (CVD), with hypertension-related deaths increasing annually. While South Korea uses the Korean Society of Hypertension (KSH) guideline of 140/90 mmHg, the American College of Cardiology (ACC) and American Heart Association (AHA) updated their guidelines in 2017 to 130/80 mmHg. This study evaluates the cost-effectiveness of transitioning to the 2017 ACC/AHA guidelines by estimating early treatment impacts and potential CVD risk reduction.MethodsA Markov state-transition simulation model with a 10-year horizon was used to estimate cost-effectiveness, focusing on strengthening target blood pressure. Quality-adjusted life years (QALYs) served as the measure of effectiveness. Cohorts of 10,000 individuals representing South Koreans in their 20s through 80s were compared in scenario analyses from the healthcare system perspective. A 4.5% annual discount rate was applied to costs and effectiveness. Primary outcomes were incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The willingness-to-pay (WTP) threshold was < KRW 30,000,000/QALY gained. Probabilistic sensitivity analyses (PSAs) addressed model input parameter uncertainties.ResultsThe base-case analysis showed an ICER value of KRW 1,328,395/QALY gained across all populations. ICER values increased with age, from − KRW 3,138,071/QALY for 20-year-olds to KRW 16,613,013/QALY for individuals over 80. The 60s age group showed the greatest benefit with an incremental QALY gain of 0.46. All scenarios had ICERs below the WTP threshold, with a PSA probability of 98.0% that strengthening blood pressure classification could be cost-effective.ConclusionsThis economic evaluation found that adopting the 2017 ACC/AHA guidelines may result in early treatment, reduce the potential incidence of CVD events, and be cost-effective across all age groups. The study findings have implications for policymakers deciding whether and when to revise official guidelines regarding target blood pressure levels, considering the impacts on public health and budgetary concerns.

Psoriasis in Childbearing Age: A Real-Life, Retrospective, Single-Center Study on Anti-IL17 and IL-23 Agents.

Background: Psoriasis (PSO) involves about 1-3% of the population, and around 75% of women develop PSO before the age of 40. Official guidelines on the treatment of woman with anti-IL17 and anti-IL23 during this potential childbearing time are not currently available. Objective: To investigate the effectiveness and safety of biologic treatments in women of childbearing age. Methods: At the Dermatology Clinic of the University of Turin, Italy, 172 women aged 20-55 years underwent IL-17 and IL-23 inhibitor therapy for moderate-severe PSO and were followed up to 52 weeks in a real-life, retrospective, single-center study. Results: Overall, 40% of patients achieved PASI 100 at week 16, and 72% at week 52. A similar trend was observed for PASI 90 and PASI < 3 with almost 80% and 90% of patients achieving the target at 52 weeks. As for PASI 100, a statistically significant difference (p = 0.004) was found at 16 weeks, with 23.84% of patients achieving PASI 100, with IL-17 and 15.70% with the IL-23 inhibitor. No statistically significant differences were found at 28 and 52 weeks. No statistically significant differences in PASIs at any time points were recorded across the different biologic agents. Forty-six patients discontinued treatment. The most reported side effects were headache, nausea, asthenia, injection site pain, and rhinitis. Conclusions: This study showed that biologic drugs are effective and safe in women of childbearing age, with negligible side effects.

The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study.

In Taiwan's public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. This study aimed to investigate (1) Taiwanese pharmacists' knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19-related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual's KAP and corresponding perspectives toward the NBRS. A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists' KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument's internal consistency reliability was ascertained using Cronbach α (0.819), and its content validity was verified by field experts. Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58% (201/343) and 39% (136/343) held positive and neutral attitudes toward COVID-19-related policies, respectively; and 77% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19-testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan's COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises.

Controversial issues in social study subjects: conveying values and facilitating critical thinking

ABSTRACT This study explores the practical implications of the paradox of moral education, focusing on how Swedish social study teachers (civics, geography, history, and religious education) navigate conflicting responsibilities to convey values and facilitate critical thinking when addressing controversial issues in their classrooms. Through qualitative interviews and observations, teachers were found to often lead by example, maintaining neutrality and presenting diverse perspectives. This approach appears to foster students towards embracing liberal values, promoting independent decision-making and personal responsibility, but it may come at the cost of critically evaluating these very ideals, norms, and values. The absence of official guidelines in the Swedish school system underscores the significance of understanding how teachers balance these conflicting responsibilities in their pedagogical practices. The study sheds light on the practical strategies employed by teachers, contributing valuable insights to a discourse traditionally centred on theoretical solutions to the paradox of moral education.

Pioneering simultaneous determination of breast cancer medications and metformin through sustainable micellar electrokinetic chromatographic method

The current study is the first report for the capillary electrophoretic simultaneous determination of five breast cancer medications, including febuxostat, quercetin, letrozole and doxorubicin in addition to metformin which is frequently co-administered with these drugs. The studied drugs are frequently purchased in different co-formulations used for breast cancer patients. A green micellar electrokinetic chromatographic (MEKC) method is proposed and optimized assisted by factorial design. The factors optimized include pH and concentration of buffer, surfactant concentration, as well as the applied voltage and injection time. The experimental results prove the optimum separation of the five drugs at pH 9.7 and buffer concentration of 10 mM with sodium dodecyl sulfate (SDS) concentration of 40 mM with +25 kV applied voltage. The developed method is validated considering linearity, precision, accuracy, and robustness adopting official guidelines. Good linearity is observed for all drugs, with correlation coefficients greater than 0.99. The range of percentage recoveries was from 98% to 102% with less than 2% relative standard deviation demonstrating the precision and accuracy of the established method. The study includes in-vitro assay of febuxostat, metformin, and doxorubicin in spiked human plasma. In addition, Accurate determination of the analytes under study in a variety of pharmaceutical dosage forms is accomplished by application of the proposed MEKC method. The greenness profile of the investigated method is confirmed using analytical eco-scale in addition to green analytical procedure index (GAPI) approaches.

Profile and telehealth usability of patients attending a telepsychiatry unit in south India during pandemic: a prospective observational study

Telepsychiatry, which refers to the delivery of mentalhealth services throughvideo-based conferencing, has immense potential to resolve the mental health disparities. Era of telepsychiatry came into full force during the COVID -19 pandemic in the year 2020 in India. The literature on profile of patients attending a telepsychiatry unit is limited as the official guidelines for Telemedicine was released by the government of India in March 2020. This article provides a state-of-art analysis on the profile, telehealth usability, diagnosis, drug treatments of patients attending a telepsychiatry unit in a Union Territory in south India. 1. To profile the telepsychiatry usability by using standard questionnaire. 2. To compare the telepsychiatry usage between 2020 and 2021 (during lockdown 1 &amp; lockdown 2). A retrospective analysis of the profile of patients attending a telepsychiatry unit in south India during the consecutive years of 2020 and 2021 was made. Demographic data regarding the age, sex, marital status, occupation, location, number of online consultations made were collected. Diagnosis was made in accordance with the International Classification of diseases tenth edition. Various groups of drugs used like antidepressants, antipsychotics, mood stabilisers, benzodiazepines. Comparison of data between the two years was made. In the year 2020, 147 teleconsultations were made and in the year 2021 46 consultations were done. Among the study participants, 62% were female. In the year 2020, psychosis was found to be the reported more(34%) and in 2021, adjustment disorder was higher (35%). Among the medications, antidepressants (35%) were the commonly prescribed group followed by antipsychotics(13%). Telepsychiatry is a budding phenomenon in India and this study is the first of its kind to throw light on the profile, drug treatment of patients attending a telepsychiatry set up.

Pathologist Workload Assessment in Gastrointestinal Subspecialty: A Pilot comparative study in an academic setting

Abstract Introduction/Objective There are no official guidelines regarding the workload to be received by pathologists, and it is challenging to distribute equivalent workloads across subspecialties. This study aims to determine whether slide count is a reliable workload metric in gastrointestinal (GI) pathology. Additionally, we seek to compare the time allocation differences between GI pathologists involved in medical resident teaching and those dedicated only to anatomical pathology duties. Methods/Case Report This is an observational retrospective cohort study. We recorded the first two hours of a workday of three experienced GI pathologists at Stanford Healthcare in 2022, two of whom were engaged in teaching. The authors carefully retrospectively reviewed the recorded videos to extract relevant information: teaching activities, number of histological slides, specimens, types of tissues analyzed, and resultant diagnosis. Results (if a Case Study enter NA) Two attendings (2 and 3) signed out with residents, while only one worked alone (1). The mean time spent on each case was 199 and 486 seconds different between attendings 1 and 2 and 1 and 3, respectively (p&amp;lt;.01). There was a strong positive correlation between the number of slides and time spent analyzing each case, r =.607. The number of slides per case statistically explained 36.8% of the time spent per case, p &amp;lt;.001. Conclusion In conclusion, the slide count metric only explains 36.8% of the time expenditure, suggesting that more sophisticated workload assessment methods must be developed, particularly if used for workload distribution purposes. Also, GI pathologists involved in medical training take longer to sign out cases than GI pathologists who are not, suggesting that this is an essential factor that should be considered when distributing workloads.

Optimizing Hepatitis C Treatment Monitoring: Is Sustained Virologic Response at 4 Weeks Becoming the New Standard?

This study, conducted at two university-based infectious disease clinics, included 216 patients with chronic hepatitis C. The primary objective was to assess the positive and negative predictive values, sensitivity, and specificity of achieving a sustained virological response (SVR) at 4 weeks compared to 12 weeks post-therapy. The results demonstrated a maximum sensitivity of 100% for achieving SVR at 12 weeks after reaching SVR at 4 weeks for all analyzed genotypes, except for genotype 1b treated with EBR/GZR therapy, where the specificity was 75%. Additionally, younger age and less advanced liver fibrosis were identified as independent predictors of achieving a sustained virological response at both 4 and 12 weeks. The significant normalization of various biochemical parameters was observed after treatment, indicating an overall improvement in liver function. This study suggests that shortening the monitoring period to 4 weeks might be effective for younger patients without significant fibrosis, potentially reducing loss to follow-up, which is a critical issue in HCV treatment. These findings align with the "test and treat" approach. Further research is needed to confirm these findings and incorporate them into official guidelines, which could simplify and enhance the effectiveness of HCV treatment protocols, aiding global efforts to eliminate HCV as a public health issue by 2030.

Women’s challenges and gender inequality implications in the UK Home Office’s streamlined asylum process

This conceptual article scrutinises the challenges faced by women seeking asylum in the UK, focusing on the impact of the Home Office’s streamlined asylum process. Despite mention of gender-based issues in official guidelines, the system exhibits hostility and inadequacy in addressing the unique obstacles women encounter. Through a posthuman, practice-based theoretical framework, the article examines recent gender-based concerns raised about the Home Office’s use of questionnaires, machine translation, and informal linguistic assistance in lieu of interpreted asylum interviews for selected nationalities. It also highlights the implications of technologisation and bureaucratisation on linguistic access, arguing that the revised asylum-seeking process not only reinforces women’s marginalised position but also diminishes crucial resources like interpreting, in turn contributing to gendered power asymmetries between asylum seekers and the justice system. The article contends that this approach transfers the burden of language understanding to women, contributing to a climate of sociomaterial exclusion that curtails the rights of female asylum seekers to be adequately heard.

Implementation of a Clinical Decision Support System for Antimicrobial Prescribing in Sub-Saharan Africa: Multisectoral Qualitative Study.

Suboptimal use of antimicrobials is a driver of antimicrobial resistance in West Africa. Clinical decision support systems (CDSSs) can facilitate access to updated and reliable recommendations. This study aimed to assess contextual factors that could facilitate the implementation of a CDSS for antimicrobial prescribing in West Africa and Central Africa and to identify tailored implementation strategies. This qualitative study was conducted through 21 semistructured individual interviews via videoconference with health care professionals between September and December 2020. Participants were recruited using purposive sampling in a transnational capacity-building network for hospital preparedness in West Africa. The interview guide included multiple constructs derived from the Consolidated Framework for Implementation Research. Interviews were transcribed, and data were analyzed using thematic analysis. The panel of participants included health practitioners (12/21, 57%), health actors trained in engineering (2/21, 10%), project managers (3/21, 14%), antimicrobial resistance research experts (2/21, 10%), a clinical microbiologist (1/21, 5%), and an anthropologist (1/21, 5%). Contextual factors influencing the implementation of eHealth tools existed at the individual, health care system, and national levels. At the individual level, the main challenge was to design a user-centered CDSS adapted to the prescriber's clinical routine and structural constraints. Most of the participants stated that the CDSS should not only target physicians in academic hospitals who can use their network to disseminate the tool but also general practitioners, primary care nurses, midwives, and other health care workers who are the main prescribers of antimicrobials in rural areas of West Africa. The heterogeneity in antimicrobial prescribing training among prescribers was a significant challenge to the use of a common CDSS. At the country level, weak pharmaceutical regulations, the lack of official guidelines for antimicrobial prescribing, limited access to clinical microbiology laboratories, self-medication, and disparity in health care coverage lead to inappropriate antimicrobial use and could limit the implementation and diffusion of CDSS for antimicrobial prescribing. Participants emphasized the importance of building a solid eHealth ecosystem in their countries by establishing academic partnerships, developing physician networks, and involving diverse stakeholders to address challenges. Additional implementation strategies included conducting a local needs assessment, identifying early adopters, promoting network weaving, using implementation advisers, and creating a learning collaborative. Participants noted that a CDSS for antimicrobial prescribing could be a powerful tool for the development and dissemination of official guidelines for infectious diseases in West Africa. These results suggest that a CDSS for antimicrobial prescribing adapted for nonspecialized prescribers could have a role in improving clinical decisions. They also confirm the relevance of adopting a cross-disciplinary approach with participants from different backgrounds to assess contextual factors, including social, political, and economic determinants.

Coding rules for uncertain and “ruled out” diagnoses in ICD-10 and ICD-11

The International Classification of Diseases, 11th Revision (ICD-11) has significantly improved the ability to navigate coding challenges beyond prior iterations of the ICD. Commonly encountered sources of complexity in clinical documentation include coding of uncertain and “ruled out” diagnoses. Assessing official international guidelines and rules, this paper documents extensive variation across countries in existing practices for coding and reporting unconfirmed and “ruled out” clinical concepts in ICD-10 (and modifications thereof). The design of ICD-11 is intended to mitigate these coding challenges by introducing postcoordination, expanding the range of codable clinical concepts, and offering clearer guidance in the ICD-11 Reference Guide. ICD-11 offers substantial progress towards more precise capture of uncertain and “ruled out” diagnoses, including international consensus on coding rules for these historically challenging clinical concepts. However, we identify the need for further clarification of the concepts of “provisional diagnosis” and “differential diagnosis.”

Iatrogenic atrial septal defects in structural heart interventions: Opening the Pandora's box

AbstractIn the modern era of structural heart interventions, the total number of transseptal procedures is growing exponentially, thus increasing the rate and need for management of iatrogenic atrial septal defects (iASDs). To date, there are no official guidelines on the assessment and management of iASDs, due to inconclusive evidence on whether patients benefit more from the percutaneous closure of iASD than from conservative management and vigorous follow‐up. Despite the abundance of observational studies on iASDs, there is still a lack of randomized studies. Evidence so far show that percutaneous closure is no superior over conservative treatment in patients with iASDs, however, it has been demonstrated that patients with spontaneous closure of iASDs experience less heart failure (HF) hospitalizations. On the other hand, researchers have investigated the beneficial nature of interatrial shunt therapy in patients with HFpEF and, more recently, with HFrEF, due to the presumed hemodynamic benefits. Herein, we provide an updated review of relevant literature, focusing on iASD persistence rates, predicting factors for their persistence, and clinical outcomes of iASD persistence, to summarize available evidence and discuss future directions in the field.

Experience of socio-psychological rehabilitation of patients suffering from schizophrenia spectrum disorders using the Therapy with Creative Self-Expression by M. E. Burno

Socio-psychological rehabilitation is an essential component of modern complex therapy of schizophrenia spectrum disorders. Psychotherapy is one of the main forms of such rehabilitation, and Therapy with Creative Self-Expression by M. E. Burno (TCSE) is one of psychotherapeutic techniques suitable for use in this area. This domestic method is actively applied today in various regions of the Russian Federation, but its official recognition is still insufficient. The purpose of the study: to supplement the available information on the effectiveness of TCSE in the field of socio-psychological rehabilitation of patients with schizophrenia spectrum disorders based on summarizing many years of experience in the practical use of this method. Materials and methods. The study was conducted on the basis of the Republican Clinical Mental Health Center (Izhevsk), where group TCSE has been used for the past 25 years. In total, 270 patients with schizophrenia spectrum disorders passed through the TCSE groups during this period; of these, 240 patients received short-term TCSE (4 months) and 30 patients — long-term TCSE (2–5 years or more). To assess the rehabilitation effect of the method, two study samples corresponding to the two variants of TCSE were formed, with 30 participants in each. Results. The use of short-term TCSE in patients significantly reduced the severity of most psychopathological symptoms assessed on the SCL-90‑R scale (the decrease in the overall symptom severity index was 16.67 %) and considerably increased the indicators of 7 out of 13 subscales of schizophrenia patients' quality of life questionnaire by V. L. Kozlovsky and S. Yu. Maslovsky. The use of long-term TCSE reduced the average annual rate of hospitalization to a mental health hospital by 71.4 % and the average duration of one hospitalization by 21.5 %. Conclusion. The TCSE method is quite effective in the field of socio-psychological rehabilitation of patients with schizophrenia spectrum disorders. It is proposed to include this technique in official clinical guidelines for the treatment of the specified disorders.