Management of patients with interstitial lung disease (ILD) requires subspecialized, comprehensive, multidisciplinary care. The Pulmonary Fibrosis Foundation established the Care Center Network (CCN) ...in 2013 with identified criteria to become a designated CCN site. Despite these criteria, the essential components of an ILD clinic remain unknown.
How are ILD clinics within the CCN structured? What are the essential components of an ILD clinic according to ILD physician experts, patients, and caregivers?
This study had three components. First, all 68 CCN sites were surveyed to determine the characteristics of their current ILD clinics. Second, an online, three-round modified Delphi survey was conducted between October and December 2019 with 48 ILD experts participating in total. Items for round 1 were generated using expert interviews. During rounds 1 and 2, experts rated the importance of each item on a 5-point Likert scale. The a priori threshold for consensus was more than 75% of experts rating an item as important or very important. In round 3, experts graded items that met consensus and ranked items deemed essential for an ILD clinic. Third, ILD patient and caregiver focus groups were conducted and analyzed for content to determine their perspectives of an ideal ILD clinic.
Forty items across four categories (members, infrastructure, resources, and multidisciplinary conference) achieved consensus as essential to an ILD clinic. Patient and caregiver focus groups identified three major themes: comprehensive, patient-centered medical care; expanded access to care; and comprehensive support for living and coping with ILD.
The essential components of an ILD clinic are well-aligned between physician experts and patients. Future research can use these findings to evaluate the impact of these components on patient outcomes and to inform best practices for ILD clinics throughout the world.
Management of patients with interstitial lung disease (ILD) requires subspecialized, comprehensive, multidisciplinary care. The Pulmonary Fibrosis Foundation established the Care Center Network (CCN) ...in 2013 with identified criteria to become a designated CCN site. Despite these criteria, the essential components of an ILD clinic remain unknown.
How are ILD clinics within the CCN structured? What are the essential components of an ILD clinic according to ILD physician experts, patients, and caregivers?
This study had three components. First, all 68 CCN sites were surveyed to determine the characteristics of their current ILD clinics. Second, an online, three-round modified Delphi survey was conducted between October and December 2019 with 48 ILD experts participating in total. Items for round 1 were generated using expert interviews. During rounds 1 and 2, experts rated the importance of each item on a 5-point Likert scale. The a priori threshold for consensus was more than 75% of experts rating an item as important or very important. In round 3, experts graded items that met consensus and ranked items deemed essential for an ILD clinic. Third, ILD patient and caregiver focus groups were conducted and analyzed for content to determine their perspectives of an ideal ILD clinic.
Forty items across four categories (members, infrastructure, resources, and multidisciplinary conference) achieved consensus as essential to an ILD clinic. Patient and caregiver focus groups identified three major themes: comprehensive, patient-centered medical care; expanded access to care; and comprehensive support for living and coping with ILD.
The essential components of an ILD clinic are well-aligned between physician experts and patients. Future research can use these findings to evaluate the impact of these components on patient outcomes and to inform best practices for ILD clinics throughout the world.
The Alzheimer Precision Medicine Initiative Hampel, Harald; Vergallo, Andrea; Perry, George ...
Journal of Alzheimer's disease,
01/2019, Letnik:
68, Številka:
1
Journal Article
Recenzirano
Precision medicine (PM) is an evolving scientific renaissance movement implementing key breakthrough technological and scientific advances to overcome the limitations of traditional symptom- and ...sign-based phenotypic diagnoses and clinical "one-size-fits-all, magic bullet drug development" in these largely heterogeneous target populations. It is a conceptual shift from ineffective treatments for biologically heterogeneous "population averages" to individually-tailored biomarker-guided targeted therapies. PM is defining which therapeutic approach will be the most effective for a specific individual, at a determined disease stage, across multiple medical research fields, including neuroscience, neurology and psychiatry. The launch of the Alzheimer Precision Medicine Initiative (APMI) and its associated cohort program in 2016-facilitated by the academic core coordinating center run by the Sorbonne University Clinical Research Group in Alzheimer Precision Medicine (Sorbonne University GRC n°21 APM)"-is geared at transforming healthcare, conventional clinical diagnostics, and drug development research in Alzheimer's disease. Ever since the commencement of the APMI, the international interdisciplinary research network has introduced groundbreaking translational neuroscience programs on the basis of agnostic exploratory genomics, systems biology, and systems neurophysiology applying innovative "big data science", including breakthrough artificial intelligence-based algorithms. Here, we present the scientific breakthrough advances and the pillars of the theoretical and conceptual development leading to the APMI.
Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort ...and identify their clinical consequences.
We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe NECTARINE) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes.
Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval CI) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality.
The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event.
NCT02350348.
Systems pharmacology is a novel framework for drug research that models traditional and innovative pharmacological parameters and provides the overall efficacy and safety profile of a drug across ...body systems and complex, non-linear, molecular interactions. Lithium chloride, a pharmacological compound approved for the therapy of psychiatric disorders, represents a poorly explored compound for the treatment of Alzheimer's disease (AD). Lithium has been shown to reduce downstream effects associated with the aberrant overactivation of certain molecular pathways, such as glycogen synthase kinase 3 subunit β (GSK3-β)-related pathways, involved in AD-related pathophysiology. It seems that overactivation and overexpression of GSK3-β lead to an impairment of long-term potentiation and amyloid-β induced neurotoxicity that can be normalized using lithium. Moreover, a growing body of evidence has demonstrated that lithium's GSK3-β inhibitory effect prevents tau phosphorylation in mouse models of tauopathies. Clinical data have been inconclusive, partly due to methodological limitations. The lack of studies exploring the dynamics of protein misfolding in AD and investigating the specific tau-isoforms appearing prior to the accumulation of neurofibrillary tangles calls for new and optimized clinical trials. Advanced computer modeling based on a formal implementation of quantitative parameters and basic enzymatic insights into a mechanism-based model would present a good start to tackle these non-linear interactions. This innovative approach will pave the way for developing "molecularly" biomarker-guided targeted therapies, i.e., treatments specifically adapted ("tailored") to the individual, consistently with the primary objectives and key conceptual points of precision medicine and precision pharmacology.
Long past the time when philosophers from different perspectives had joined the funeral procession that declared the death of God, a renewed interest has arisen in regard to the questions of God and ...religion in philosophy. The turn to secularization has produced its own opposing force. Although they declared themselves from the start as not being religious, thinkers such as Derrida, Vattimo, Zizek, and Badiou have nonetheless maintained an interest in religion. This book brings some of these philosophical views together to present an overview of the philosophical scene in its dealings with religion, but also to move beyond the outsider's perspective. Reflecting on these philosophical interpretations from a fundamental theological perspective, the authors discover in what way these interpretations can challenge an understanding of today's faith. Bringing together thinkers with an established reputation - Kearney, Caputo, Ward, Desmond, Hart, Armour - along with young scholars, this book challenges a range of perspectives by putting them in a new context.
Contents: Introduction, Lieven Boeve and Christophe Brabant; Part 1 Overcoming Onto-Theology: Richard Kearney's Messianism: between the narrative theology of hermeneutics and the negative theology of deconstructionism, Lieven Boeve; Introduction to the thinking of John Caputo: religion without religion is the way out of religion, Stefan Stofanik; The sense of God: a theology of the event with special reference to Christianity, John D. Caputo; Jean-Luc Nancy's deconstruction of Christianity, Joeri Schrijvers. Part 2 Re-Constructive Philosophy for Religion: Introduction to the thinking of Graham Ward, Maarten Wisse; De Certeau and an enquiry into believing, Graham Ward; The between and the liturgy: on rendering W. Desmond’s philosophy fruitful for theology, Joris Geldhof; On God and the between, William Desmond; Religious experience and the phenomenality of God, Kevin Hart. Part 3 Philosophical Interpretations with Political Theological Consequences: René Girard's contribution to political theology: overcoming deadlocks of competition and enmity, Wolfgang Palaver; Introduction to Ellen Armour's thinking: race, sex and religion in postmodernity, Kristien Justaert; Visual theology: diagnosing postmodernity, Ellen T. Armour; Christianity and politics: a biographical-theoretical reading of Gianni Vattimo and Alain Badiou, Frederiek Depoortere. Conclusion: Lessons from philosophy for theology and vice versa, Christophe Brabant and Lieven Boeve; Indexes.
Lieven Boeve is professor of fundamental theology and Dean of the Faculty of Theology, K.U. Leuven. He also serves as the co-ordinator of the Research Group Theology in a Postmodern Context. His research concerns theological epistemology, religious experience, truth in faith and theology, tradition development and hermeneutics. He is the author of Interrupting Tradition. An Essay on Christian Faith in a Postmodern Context, and God Interrupts History. Theology in a Time of Upheaval. He was the international president of the European Society for Catholic Theology (2005-2009). Christophe Brabant is a postdoctoral researcher at the K.U. Leuven. He is a member of the Research Group Theology in a Postmodern Context of the Faculty of Theology, K.U. Leuven. His research interests include, among others, the influence of postmodern thinking on theology, the hermeneutical turn in theology and especially the work of Paul Ricœur.
Thanks to a comparison of social and educational characteristics of elites in France, Germany and UK at the end of the nineteenth century, this contribution shows the specificities of the French ...case: a mixture of persistent traditional elites, akin to British and German ones, and the growing domination of a more recent economic and meritocratic bourgeoisie pushing for liberalism and democracy. Nevertheless, evolutions in the same direction as France are also perceptible in the two monarchies and give birth to a new divergence when after WWI the democratization of elites go faster in UK and Germany than in France where the law bourgeoisie remain dominant and blocks the reforms asked by more popular or petit bourgeois groups present in the political parties on the left.
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