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Huang, Yasheng. "Administrative Monitoring in China." China Quarterly 143 (September 1995): 828–43. http://dx.doi.org/10.1017/s0305741000015071.
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During the reform era, there have been two important developments in China's administrative system. First, there has been a moderate degree of administrative decentralization in the area of cadre appointment. Prior to 1983, the central Party authorities – formally the central Organization Department (OD) – were responsible for appointing cadres down to the bureau level; the 1983–84 reforms delegated bureau-level appointments to ministries and provinces. As a result, the Centre is responsible for appointing fewer cadres than before; as of 1983, it had 7,000 cadres on its management list, a reduction of some 6,000 from the 1980 list. The second development is that the Centre has sought to regulate the appointment decisions that it no longer controls directly and to monitor officials’ performance and conduct. To this end, new and increasingly detailed procedures have been laid out to guide appointment decisions and there have been efforts to strengthen the specialized monitoring agencies.
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Lall, Ambika, Angela Hu, and Geneve Allison. "Follow-up Appointment Adherence of Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients." Open Forum Infectious Diseases 4, suppl_1 (2017): S332—S333. http://dx.doi.org/10.1093/ofid/ofx163.788.
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Abstract Background Outpatient parenteral antibiotic therapy (OPAT) is a safe and effective care delivery system that allows patients to receive intravenous (IV) antibiotic therapy outside of the hospital. OPAT patients require frequent follow-up appointments for clinical and laboratory monitoring of common adverse outcomes of any IV antibiotic administration such as line infections, adverse drug events, and reinfection. Despite the known importance of clinical monitoring, patient factors that influence adherence to OPAT appointments are unknown. The objective of this study was to identify factors that influence adherence to OPAT appointments, in order to improve the OPAT program and make adherence easier for patients if possible. Methods 80 patients undergoing OPAT between December 2014 and January 2016 were interviewed via telephone regarding the following: reasons for not showing up to appointments, when the first follow up appointment was scheduled, whether they received appointment reminders, transit time, and whether they had to make special arrangements to attend their appointments. Results Adherence to follow-up appointments was high (83.8%). 52.5% of initial follow-up appointments were made while patients were still in the hospital. 92% of patients received at least one reminder in the form of a letter (32%), call to cell phone (21%), call to landline (22%), email (17%), or other (1%). Participants mostly cited either transportation (23.4%) or other (30.4%), specifically not feeling well, and work as the reason for missing an appointment. Conclusion The majority of patients attended all appointments, and of those, almost all received an appointment reminder, suggesting this is an important factor contributing to appointment adherence. These data reveal some of the barriers some patients face. Future studies can examine whether decreased appointment adherence leads to worse clinical outcomes. Disclosures G. Allison, Merck: Grant Investigator and Speaker’s Bureau, Grant recipient and Salary
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Didenko, O. M., and O. Yu Salmanova. "Service in the State Bureau of Investigation of Ukraine bodies as a type of public service." Law and Safety 85, no. 2 (June 30, 2022): 61–70. http://dx.doi.org/10.32631/pb.2022.2.06.
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Public service in the bodies of the State Bureau of Investigation of Ukraine has been defined as the main mechanism of these bodies functioning, which is manifested in the multifaceted activities of the staff and employees of the Bureau. The application of the laws of Ukraine “On the State Bureau of Investigations” and “On the State Service” regarding service in the bodies of the State Bureau of Investigations of Ukraine has been analyzed. It has been concluded that the service in the bodies of the State Bureau of Investigation of Ukraine is a derived concept from the civil service in Ukraine.
A number of cases of using the Law of Ukraine “On State Service” rather than the specific Law of Ukraine “On the State Bureau of Investigation” have been given when it comes to service in the bodies of the State Bureau of Investigation of Ukraine. The following signs of service in the bodies of the State Bureau of Investigation of Ukraine have been identified: service focus on satisfying public interests; occupying a public position; the act of appointment to a position or the result of a competition is the basis for the emergence of legal relations (service); the professional basis of prevention, detection, termination, disclosure and investigation of criminal offenses.
It has been established that regulatory, organizational, personnel and other principles of service in the bodies of the State Bureau of Investigation of Ukraine have their own specifics compared to public service, although they are covered by this concept. Similar signs of service in the bodies of the State Bureau of Investigation of Ukraine and the public service have been given. Service in the bodies of the State Bureau of Investigation of Ukraine has been defined as a public, professional, politically impartial activity for the prevention, detection, termination, disclosure and investigation of criminal offenses within their competence, which is carried out by employees appointed to positions in the bodies of the State Bureau of Investigation of Ukraine.
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Cox, Antony. "Philip Graham." Child Psychology and Psychiatry Review 6, no. 2 (May 2001): 86–88. http://dx.doi.org/10.1017/s1360641701002568.
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When Philip Graham takes up the Chair of the Association next June, it will be his second term in an office he originally held in 1982. Although he would modestly deny it, he is not only one of the UK's leading child and adolescent psychiatrists, but also widely respected internationally. Outside this country his reputation is particularly strong in Europe where he was President of the European Society for Child and Adolescent Psychiatry from 1987 to 1991. His appointment to the Foundation Chair of Child Psychiatry at the Institute of Child Health in 1975 marked the establishment of the second such chair in the UK. The esteem in which he was held there led to his appointment as Dean of the Institute from 1985 to 1990. On retirement in 1994 he was elected to the Chair of the National Children's Bureau, reflecting his broad perspective on the welfare of children.
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Kotaki, Akira, and Fumio Takeda. "Study on the National Disaster Management Administration System Against Huge Disasters – A Discussion Based on the Initial and Emergency Responses to the Great East Japan Earthquake –." Journal of Disaster Research 14, no. 5 (August 1, 2019): 843–60. http://dx.doi.org/10.20965/jdr.2019.p0843.
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Based on Japan’s experience of establishing and operating the Extreme Disaster Management Headquarters following the Great East Japan Earthquake of 2011, the authors conclude that it is necessary to deepen the discussion on the following issues and identify a proper direction to be pursued for establishing a disaster management administration system capable of responding appropriately to huge disasters in the future: 1) Expansion and strengthening of the Disaster Management Bureau of the Cabinet Office; 2) Establishment of the Ministry of Disaster Management or Disaster Management Agency [(a) Its relation to the Cabinet Secretariat and Cabinet Office, (b) Jurisdiction (matters related to overall coordination and duties)]; 3) Organizational design that will contribute towards establishing an effective disaster management administration system [(a) Mandatory and full-time appointment of Minister of Disaster Management, (b) Staffing system of designated posts and higher-ranking senior officials, (c) Establishment of Regional Disaster Management Bureaus, (d) Staff size, (e) Desirable approaches to human resources management (accumulation and deepening of experience in disaster response, clarifying working conditions etc.)]; etc.
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SHIMIZU, Eihan. "A STUDY ON THE HISTORICAL DETAILS OF YOZO YAMAO'S APPOINTMENT AS PRESIDENT OF THE ARCHITECTURAL BUREAU." Journal of Japan Society of Civil Engineers, Ser. D3 (Infrastructure Planning and Management) 74, no. 5 (2018): I_1—I_18. http://dx.doi.org/10.2208/jscejipm.74.i_1.
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Thompson, Sarah, Tasneem Elnafie, Tatiana Elwes, Wilam Alfred, Alinane Munyenyembe, Kabir Mohammed, Bhupinder Sharma, et al. "The Value of Follow-up Following Complete Remission with Frontline Chemotherapy for DLBCL." Blood 136, Supplement 1 (November 5, 2020): 31–32. http://dx.doi.org/10.1182/blood-2020-141982.
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Introduction Following completion of chemotherapy with curative intent for DLBCL, for those in remission (CR), numerous national and international guidelines suggest on-going follow-up primarily to detect relapse of disease. For example, the NCCN guidelines suggest that clinical history, examination and blood investigations should be performed every 3-6 months for 5 years and as clinically indicated thereafter. This is essentially a "screening programme" for an at-risk population that continues based on historical routine rather than due to evidence it is of benefit to the patient. Numerous papers have been published suggesting that routine surveillance scans or bloods such as LDH are not useful in this setting. We sought to analyse whether the screening procedures that are performed in the follow-up setting are useful in the detection of relapse in patients followed up in a single centre. Uniquely, we examined each time point separately rather than group all follow-up events together. Methods Data was obtained retrospectively from electronic patient records for all patients in remission following treatment with frontline chemotherapy for DLBCL at the Royal Marsden Hospital between 2005-2016. Screening assessments analysed were symptoms check, clinical examination, LDH >upper limit of normal, lymphocyte: monocyte ratio (LMR) <2.8, routine CT scans. Time-points for analysis of routine clinic appointments were derived from the British guidelines which advise 3 monthly follow up in the first year, 6 months in year 2 and annually up to 5 years. True positives were defined as patients who had a positive result and relapsed within that specified time period or within 6 months, whereas false negatives were only considered for those patients who had a negative test within the time period that they relapsed. Results Complete data from 262 patients who achieved a CR and were followed up was available. Median age was 63 years (17-94) with 59 patients with stage 1 disease, and 100 with stage 4 disease. The relapse rate was 59/261 (23%), with a median time to relapse of 13 months (2-120). Of the 59, 52 had symptoms they had noted prior to clinic, of whom 28 requested an early appointment to clinic and 22 waited until their routine clinic appointment or sought advice from other health professionals initially. Only 7 patients were picked up only on investigations performed at the hospital, 1 with hypercalcemia and 6 on routine scan with no symptoms, 3 at 3-6months, 2 and 9-12months and 1 at 12-18 months. Of these, 4/7 patients achieved a CR with subsequent therapy. The remaining 202 patients had 2853 clinic appointments, median number per patient 13 (1-44). The negative predictive value of clinical history, examination, LDH, LMR and CT scan was consistently very high (>90%) at all time points. However, the positive predictive value was low for symptoms, 0-35% with the higher values being in the first year. Clinical examination had better PPV due to fewer positive results, including both true and false. LDH and LMR were associated with a poor PPV at all time points. PPV for CT scans was variable (Table 1). Conclusions The "screening" of patients who are in remission from DLBCL requires considerable health resources and cost and also leads to increased exposure of the patient to hospitals which during the COVID-19 pandemic is being discouraged. Likelihood of relapse (which decreases with time) has an impact on the effectiveness of a screening programme, the relapse rate in this cohort was 23% in keeping with other published data. Importantly, the majority of patients had symptoms suggestive of relapse and so the screening was not required. In the few that were asymptomatic when relapse was diagnosed, there was insufficient data to know whether this earlier detection led to a better outcome, however this has not been seen in other published cohorts. Finally the effectiveness of the screening is dependent on the predictive value of the "tests" being used and this dataset shows that whilst the negative predictive value is high, the positive predictive value is very variable and generally poor for all tools used. We propose that educating the patient regarding symptoms of relapse and having patient directed clinical follow-up rather than routine appointments would lead to marked savings in health resources, reduce hospital exposure of patients by eliminating unnecessary visits without compromising the outcome of the patients. Disclosures Cunningham: Lilly: Research Funding; MedImmune: Research Funding; Merck: Research Funding; AstraZeneca: Research Funding; Celgene: Research Funding; Bayer: Research Funding; Janssen: Research Funding; Merrimack: Research Funding; Amgen: Research Funding; 4SC: Research Funding; Clovis Oncology: Research Funding; Sanofi: Research Funding; OVIBIO: Membership on an entity's Board of Directors or advisory committees. Iyengar:Beigene: Consultancy; Janssen: Honoraria; Abbvie: Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Gilead: Consultancy, Honoraria, Speakers Bureau. El-Sharkawi:Abbvie: Consultancy, Honoraria, Speakers Bureau; AstraZeneca: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Takeda: Honoraria, Speakers Bureau; Innate: Consultancy.
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Kostka, Genia. "Environmental Protection Bureau Leadership at the Provincial Level in China: Examining Diverging Career Backgrounds and Appointment Patterns." Journal of Environmental Policy & Planning 15, no. 1 (March 2013): 41–63. http://dx.doi.org/10.1080/1523908x.2012.752184.
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Hockett, C. F. "Letters from bloomfield to Michelson and Sapir." Historiographia Linguistica 14, no. 1-2 (January 1, 1987): 39–60. http://dx.doi.org/10.1075/hl.14.1-2.07hoc.
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Summary Between 1919 and 1930, Leonard Bloomfield corresponded with the anthropologist Truman Michelson (1879–1938) concerning Algonquian linguistics, and between 1924 and 1925 with Edward Sapir (1884–1939), with regard to American Indian languages, linguistic theory, and Bloomfield’s appointment as field-worker for the Canadian Bureau of Mines. The surviving letters are enumerated and discussed, and non-technical portions of them are reproduced, for the light which they shed on three of Bloomfield’s professional concerns: his work in Algonquian; his move from Illinois to Ohio State in 1921 ; and the planning and founding of the Linguistic Society of America in 1924–25. They also afford a few glimpses of his (in general little known) personal life and attitudes.
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Meiriana, Meiriana, and Yatini Yatini. "KAJIAN HUKUM PENINGKATAN SERTIFIKAT HAK GUNA BANGUNAN MENJADI HAK MILIK DITINJAU DARI SURAT KEPUTUSAN GUBERNUR KEPALA DAERAH TINGKAT 1 KALIMANTAN TIMUR NOMOR 60 TAHUN 1990 TENTANG PENUNJUKAN DAN PENYERAHAN PENGUASAAN TANAH UNTUK MEMBANGUN PERUMAHAN PEGAWAI NEGERI DENGAN FASILITAS KPR-BTN DI LOA BAKUNG KECAMATAN SAMARINDA ULU KOTAMADYA SAMARINDA KEPADA PT. SEMANGGI SARANA REAL ESTATE (STUDI PADA PERUMAHAN KORPRI, LOA BAKUNG KOTA SAMARINDA)." Yuriska : Jurnal Ilmiah Hukum 8, no. 1 (September 6, 2017): 26. http://dx.doi.org/10.24903/yrs.v8i1.26.
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The Decree of the Governor as a first lauder in Bprneo No. 60 of 1990 February 13, 1990, on appointment and Transfer Tenure Land to Build Housing Servants with amenities KPR-BTN in Loa Bakung District of north Samarinda makes residents Housing KORPRI can’t do improvement of its original certificate certified Broking become Proprietary cases occurred in 2013 involving housing residents KORPRI Loa Bakung Samarinda apply for status change represented by the board to the Governor of Borneo Cq. Head of the Bureau of Supplies Regional Secretary by Statement of Claim number 845.1 / 284 / IV / 2013 dated 18 April 2013 in order to increase private property it is still no clarity and actions to date Throughout the absence of a decision or clarity by the Governor of East Kalimantan Cq. Head of the Bureau of Supplies Provincial Secretary east kalimantan and the National Land Agency (BPN) Samarinda, the improvement of the status of land rights in housing KORPRI Loa Bakung Samarinda City of Broking become right coupled with no standardization of fees to increase land rights of both the agency will be difficult to materialize.
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Jade, J., Z. Cox, E. Fox, R. Tattersall, and L. Dunkley. "POS1199-HPR IMPROVING THE UPTAKE OF ELECTRONIC PATIENT REPORTED OUTCOME MEASURES IN A SPECIALISED AXIAL SPONDYLOARTHROPATHY CLINIC." Annals of the Rheumatic Diseases 82, Suppl 1 (May 30, 2023): 932.1–932. http://dx.doi.org/10.1136/annrheumdis-2023-eular.582.
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BackgroundSheffield Teaching Hospitals (STH), UK, has a specialised axial spondyloarthropathy (axSpa) clinic run by a rheumatology consultant and physiotherapist with special interest in this area. BASDAI and BASFI patient reported outcome measures are used to assess disease activity and response to treatment, in line with national guidelines. STH has invested in MyPathway (MP), an electronic patient messaging system used for patient information, appointments and electronic patient reported outcome measures (ePROMs). The data can also be viewed at a system level on a clinician dashboard. Prior to 2020 the uptake of ePROMs was low in the axSpa clinic. The move primarily to telephone consultations in March 2020, due to the COVID-19 pandemic, created an opportunity for increasing the use of MP for ePROMs collection to enable improved remote monitoring of patients with axSpa.ObjectivesThis quality improvement project aimed to increase the use of electronic BASDAI and BASFI (ePROMs) in the axSpa clinic.MethodsA multi-pronged approach has been taken since March 2020 to increase ePROMs completion and improve their use. Each appointment was used as an opportunity to discuss and recruit patients to MP. Clinicians invited each patient to join MP and sent them a link after their appointment. QR codes were then added to all rheumatology patient letters encouraging patients to register. A pathway was set up that automatically sent a prompt to patients registered on MP to complete their BASDAI and BASFI questionnaires prior to clinic appointments. Clinicians began logging into MP to view scores during appointments to provide patients with real-time feedback.A mixed methods approach was used to assess the uptake of ePROMs over time. We tracked MP registration rates and BASDAI completion rates as the key outcome measures, using a run chart to assess special cause variation. We undertook a patient focus group to explore attitudes towards ePROMs, key barriers and opportunities for further improvement.ResultsThe total number of axSpa patients seen in the specialised clinic (named LADAS) who have registered with MP has increased from 56 (35.9%) in January 2019 to 200 (58.9%) in September 2022. There has been an improvement in the BASDAI completion rate, with 80% of patients completing more than one BASDAI in 2022, compared to 24% in 2019, as illustrated on a run chart (Figure 1). Patients can complete BASDAI forms sent to them in a previous month, therefore the completion rate some months exceeds 100%.In a dedicated focus group, patients reported that ePROMs were generally more convenient, and provided a useful record to refer back to. This could be further improved by development of a graph function to view scores over-time and the ability for patients to complete a questionnaire between appointments when they feel their disease is more active. A key theme for improving the use of ePROMs was the need for more discussion about their utility and around individual patient’s scores. There is concern that the BASDAI and BASFI scores are arbitrary and lack nuance, and that the importance of these scores at an individual patient level is not clear. This may be rectified by more discussion with clinicians in appointments, to add meaning to these scores. There was also concern that sleep and other generic health measures are not covered in the BASDAI or BASFI. The EQ-5D, a generic questionnaire, is also sent to axSpa patients, but there seems to be a lack of patient awareness regarding it. There is an appetite to improve and standardise the amount of patient information accessible on MP, for example disease information and links to patient support groups.ConclusionThere has been a clear improvement in the completion of ePROMs in the dedicated axSpa clinic at STH, over the last three years. Patient feedback has highlighted key areas for further improvement to maximise the potential of ePROMs, including more discussion around PROM scores to increase understanding and add individual patient meaning and nuance.Figure 1.AcknowledgementsI have no acknowledgements to declare.Disclosure of InterestsJudith Jade: None declared, Zoe Cox: None declared, Emily Fox: None declared, Rachel Tattersall Speakers bureau: honoraria as speaker for Abbvie, Lisa Dunkley Speakers bureau: honoraria as speaker/ teaching for UCB/ Abbvie/ Pfizer.
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Fedorko, O. O. "IMPROVEMENT OF THE PROCEDURE FOR THE SELECTION AND APPOINTMENT OF THE DIRECTOR OF THE NATIONAL ANTI-CORRUPTION BUREAU OF UKRAINE." Scientific notes of Taurida National V.I. Vernadsky University. Series: Juridical Sciences 5 (2019): 176–81. http://dx.doi.org/10.32838/2707-0581/2019.5/30.
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Chiu, S. Y. H., W. T. Song, J. Y. Yeh, and Y. P. Yeh. "Evaluation of Invitation Strategies for Community-Based Papanicolaou Test Screening: A Randomized Controlled Trial." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 44s. http://dx.doi.org/10.1200/jgo.18.43200.
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Background: In Taiwan, Papanicolaou test for cervical cancer screening has been implemented since 1995, previous study has shown that Papanicolaou test can substantially decrease the cervical cancer incidence and mortality rates. However, the regulated triennial participate rate, a policy key performance index, has never reached 70%, indicates the methods of inviting people to attend the Papanicolaou test still have room to improve. Aim: Our study aim was to evaluate the effectiveness of different invitation strategies stratified by frequency of clinic visiting per year using randomized controlled trial approach. Methods: The health bureau and local hospital collaborative program was initiated in Changhua County, the middle county in Taiwan. We enrolled the eligible women aged 30 or more who never attend to undergo cervical cancer screening in recent three years to initiate a randomized control trial based on different times of clinic visiting per year. Based on clinic visiting records in recent year as hospital loyalty, participants are classified into three levels, including no clinic visiting history, 1-3 times, and 4 times or more of clinic visiting in 2005, and then randomly allocated into no-intervention, postcard invitation, telephone call reminding only, and telephone call with reservation appointment. The study outcome was measured by whether the participant completes the Papanicolaou test within four months after the invitation was launched. We conducted univariate and multivariable Poisson regression models to evaluate the effectiveness in different strategies compared with no-invitation group, also used Cox proportional hazards regression taking hesitating period for participating the Papanicolaou test into account. Results: Using the intention-to-treat analysis, among those who without clinic visiting, compared with control group (no intervention), the result shows no significant benefit of postcard reminding. After adjustment for other potential factors, the results show the strategies of invitation were postcard (adj. RR=1.40, 95% CI: 1.22-1.61), telephone call reminding only (adj. RR=1.79, 95% CI: 1.52-2.10), and telephone call with scheduling appointment (adj. RR=1.90, 95% CI: 1.62-2.23). Regarding the different frequency of clinic visiting, compared with subjects without clinic visiting, those who were higher clinical visiting are tend to being attendee of screening and telephone call with scheduling appointment is higher effectiveness, respectively. Conclusion: Telephone-call reminding only and telephone-call with scheduling appointment significantly increased Papanicolaou test participation rates in those who were low and high loyalty patients as well.
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Demichelis, Roberta, Martha Alvarado, Jule F. Vasquez, Nancy Delgado, Cynthia Gómez, Karla Adriana Espinosa, Ana Cooke, et al. "Treating Acute Leukemia during the COVID-19 Pandemic: A Multicenter Latin American Registry." Blood 136, Supplement 1 (November 5, 2020): 41–42. http://dx.doi.org/10.1182/blood-2020-139018.
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Introduction The COVID-19 pandemic has affected the entire world. Health systems have been affected in such a way that patients with diseases other than COVID-19 have suffered serious consequences. In Latin America, the disease has emerged in a fragile system with more disparities, making our patients more vulnerable. Acute leukemia patients have a high risk of severe COVID-19 disease. Various expert recommendations have emerged with the aim of minimizing the risk of COVID-19 without affecting leukemia-related outcomes. However, multiple logistical issues tangentially associated with the pandemic have also appeared, potentially limiting the quality of management of these patients. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and its short-term consequences in Latin American countries. Methods We included patients older than 14 years, from 14 centers of 4 Latin American countries (Mexico, Peru, Guatemala and Panama), with the diagnosis of acute leukemia, who were on active treatment since the first case of COVID-19 was documented in each country. We documented their baseline characteristics and followed the patients prospectively until July 15, were data-cutoff for this pre-planned analysis was performed. The primary outcome was the incidence of COVID-19 disease and its complications. Secondary outcomes included treatment and consult modifications, and cause of death during the study period. Logistic regression was performed to determine factors associated with COVID-19 and all-cause mortality. Results We recorded the information of 635 patients: 58.1% Ph-negative ALL, 25.7% AML, 9% APL and 7.2% Ph+ALL. The median age was 35 years (14-90 years); 58.8% were consideredf high-risk patients. The majority were on CR (68.3%) receiving consolidation or maintenance therapy, while 14.5% were newly diagnosed and 17.2% with relapsed/refractory disease. The majority (91.8%) were treated in centers that were also receiving COVID-19 patients, 40.2% in centers were patients could not be electively hospitalized for leukemia treatment because of the COVID-19 pandemic. The COVID-pandemic led to treatment-modifications in 40.8% of the cases. Reasons for modifications were associated with logistical issues (22.4%), medical decisions (15.1%) or patient choice (3.3%). The most frequent modification was chemotherapy delay (17.3%) followed by regimen modification (13.4%) and dose-reductions (10.1%). (Figure 1) 83 patients (13.1%) developed COVID-19 disease, the majority mild-moderate disease (54.2%), 27.7% severe disease and 18.1% critically ill; 27.7% required mechanical ventilation and 37.7% died from COVID-19 disease, representing 4.9% of the entire cohort. We identify as risk factors for COVID-19 disease the presence of active leukemia (newly diagnosed or relapsed) (OR 3.46 [95% CI: 2.16-5.5], p<0.001), high-risk leukemia (OR 1.63 [95% CI: 1.54-4.52], p<0.001) and being treated in a center were elective hospitalization was possible (OR 2.17 [95% CI 1.29-3.67], p=0.004). Treatment modifications, appointment prolongations or the use of virtual consultation were not associated with a reduction in the risk of COVID-19. On the other hand, 16.7% of patients died during period analyzed due to leukemia (57.5%), COVID-19 (29.2%) or treatment related-mortality (13.2%). Independent factors associated with mortality were AML vs. ALL (OR 1.89 [95% CI: 1.12-3.18], p=0.016), relapsed-refractory disease (OR 8.34 [95% CI: 4.83-14.41], p<0.001), induction/consolidation vs. maintenance therapy (OR 2.20 [95% CI: 1.25-3.18], p<0.001) and the use of virtual consultation (OR 0.35 [95% CI: 0.13-0.94] p=0.037). (Table 1) Discussion/Conclusions The COVID-19 pandemic led to significant modifications in the standard of care treatment of patients with acute leukemia. The incidence of COVID-19 disease in acute leukemia patients was considerable and more than a third of the patients with acute leukemia and COVID-19 disease died. Despite a short-follow up, 16.7% of the patients died and leukemia-related deaths were the most frequent. In low- and middle-income countries with fragile health systems, the collateral damage for patients with acute leukemia may be just as important as the direct consequences of COVID-19. Disclosures Alvarado: Roche: Speakers Bureau; Novartis: Speakers Bureau; Amgen: Speakers Bureau; Celgene: Speakers Bureau; Alexion: Speakers Bureau. De la Peña-Celaya:Amgen: Speakers Bureau; Janssen: Speakers Bureau; Novartis: Speakers Bureau. Perez:Roche: Speakers Bureau; Celgene: Speakers Bureau; Novartis: Speakers Bureau. Gomez-Almaguer:Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
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Parker, Jacob, Katharine Farrow, Rosalie Brooks, Danielle Leonard, Fernanda Cortez, and Courtney D. Thornburg. "Electronic Health Record Tools to Promote Transition Readiness and Knowledge for Adolescents and Young Adults with Hemophilia." Blood 134, Supplement_1 (November 13, 2019): 4685. http://dx.doi.org/10.1182/blood-2019-124561.
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Introduction: Challenges to the transition of care for adolescents and young adults with bleeding disorders negatively impact clinical outcomes. Transition of care is a Healthy People 2020 measure, and many Hemophilia Treatment Centers (HTCs) in the United States are developing a systematic approach based on the Got TransitionTM framework, which includes six core elements designed to aid patients and their families during this vulnerable period. To improve the quality of care delivered to transition-aged individuals with hemophilia, we developed a quality improvement initiative (QI) to track and monitor transition, to assess transition readiness, and to provide education based on patient-centered goals. Our global aim is to improve transition readiness and rate of successful transfer to an adult hemophilia provider by age 18-21y. We report results for the specific aim to increase the percentage of transition-aged individuals who complete transition readiness assessments and receive patient-centered goals education at annual comprehensive clinic appointments over a six-month cycle from 0 to 80%. Methods: We developed metrics and reports in Epic (electronic health record system) to track patients with hemophilia aged 12y and older who are eligible to begin the transition process. We also developed a Transition Readiness Assessment and a 15-question hemophilia-specific Skills Practicum to be completed by the patient in EPIC during their appointment. Based on responses to the Transition Readiness Assessment, patients select 2-3 goals for the year. Each selected goal generates a corresponding education handout. The tools are completed by patients with hemophilia between the ages of 12-21y at the time of rooming by the medical assistant for the annual comprehensive clinic appointment. Patients are excluded if they have significant developmental delays. During the appointment, the child life specialist for the HTC reviews the results of the Skills Practicum with the patient, and the HTC nurse reviews the Transition Readiness Assessment and the education handouts with the patient. Descriptive statistics were used to analyze the population and the results. Results: During the QI cycle, 20 of 43 transition-aged patients attended a comprehensive clinic visit and 17/20 (85%) completed all age-appropriate assessments. Patient characteristics and transition readiness results are shown in Table 1. The most frequently selected patient goals were "know my doctors' and nurses' names and roles" (29%), "know my doctor's phone number and call my doctor's office to make or change an appointment" (65%), and "have access to MyChart account and check MyChart" (47%). Four questions on the Skills Practicum test how to read a prescription. Five patients (29%) correctly answered all four questions. Conclusions: In summary, the Epic transition tools were successfully integrated into the HTC comprehensive clinic workflow, and 85% of eligible patients completed the assigned assessments. Utilization of MyChart is low, and access to MyChart was a frequently selected goal. Further work is underway to increase MyChart utilization which would facilitate workflow changes such that assessments may be completed in MyChart before the visit and educational and other resources can be accessed in MyChart. Achievement of patient goals, improvements in knowledge (e.g. how to read a prescription), and successful transfer are being tracked over time. Disclosures Thornburg: Sanofi Genzyme: Other: Data Safety Monitoring Board; Sanofi Genzyme: Research Funding; NovoNordisk: Research Funding; Genentech: Speakers Bureau; Bluebird bio: Other: Data Safety Monitoring Board; Ironwood: Other: Data Safety Monitoring Board.
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Arroyan, Luhur, and Nurlaila Subekti. "Utilization of the Education Management Information System (EMIS) as a Decision Making Means in the Institutional Section of the Regional Office of the Ministry of Religion, Yogyakarta Special Region." AS-SABIQUN 3, no. 2 (October 30, 2021): 202–15. http://dx.doi.org/10.36088/assabiqun.v3i2.1451.
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This study was conducted to determine the utilization of the education management information system (EMIS) as a means of decision making in the institutional section at the Regional Office of the Ministry of Religion, Yogyakarta Special Region.This research is a qualitative research using data collection techniques in the form of interviews, observations, and documentation. Technical analysis of data using data reduction, data presentation, and drawing conclusions. This research focuses on objective results with research subjects who really know, experience, and understand in this case the head of the madrasa education sector, along with the operator and the head of the SIM institutional section. The results of the study show that the basis for decision making can be completed because it has been accumulated by regulations and adopted the opinion of top managers. If the alternative answers are not satisfactory, the analysis will continue with deliberation with stakeholders and elements of the madrasa.Decision-making and Utilization of EMIS data during the study showed that EMIS plays a role in the distribution of the budget contained in the PIP program (smart Indonesia program), Madrasah BOS, National Examination student data, transfer and appointment of principals, equitable distribution of teachers and madrasa infrastructure, and the contribution of data The EMIS is utilized by the People's and Community Welfare Bureau, and the Provincial Government Legal Bureau. In addition, EMIS also plays a role in providing infrastructure assistance. EMIS development needs to be improved with new innovations. Data updates must be done frequently, always input as long as there are dynamics of data changes so that they are up to date. Reports on development, development, performance improvement should be based on EMIS data. The dynamics in society continue to exist at all times, for example there are students who move, teachers who transfer, teachers who are appointed as acting. Then EMIS must be updated every day.
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Baraliakos, X., I. Redeker, M. Zacharopoulou, S. Tsiami, K. Tsiaousi, D. Morzeck, and J. Braun. "AB1144 DAILY CLINICAL CARE OF PATIENTS WITH MUSCULOSKELETAL COMPLAINTS – HOW HELPFUL IS A TRIAGE SYSTEM FOR EARLY RECOGNITION OF INFLAMMATORY RHEUMATIC DISEASES?" Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1862.2–1862. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6529.
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Background:Early diagnosis and treatment are important for the management of inflammatory rheumatic diseases (RMD). However, the availability of rheumatologists is limited in most European countries and selection strategies lack sensitivity and/or specificity.Objectives:To evaluate a triage strategy that offers the possibility to see patients within 4 weeks for short term appointments in order to check the probability of an inflammatory RMD and the necessity to further evaluate the patients in due time.Methods:Physician’s and patient’s information who called our tertiary rheumatology department´s outpatient clinic for a date in the triage system were included in this analysis. The time to first appointment as assessed by a nurse (Step 1), the short evaluation by a rheumatologist in the triage (Step 2) and the patient´s complaints and the diagnoses after an extensive diagnostic evaluation (Step 3) were documented.Results:In a period of 9 months in 2018, a total of 982 patients presented. A total of 62 patients (6.3%) were considered urgent (appointment within 3 days), while 240 (24.4%) were appointed within 4 weeks at Step 2. Of the former 46 (19.2%), and of the latter 151 patients (62.9%) were diagnosed with inflammatory RMD at Step 3.In total, 334 patients (34.0%) were diagnosed with inflammatory RMD at Step 3, including 126 with RA (37.7%), 71 with axSpA/PsA (21.3%), 95 with connective tissue disease/vasculitis (28.4%) and 20 with gout (6.0%). The diagnosis suspected in Step 2 was confirmed in Step 3 in 77.9% of cases. In 217 patients, the diagnosis suspected in Step 2 was not confirmed in Step 3. Of them, 34 (15.7%) had unclear findings at Step 2 but an inflammatory RMD was found at Step 3, while 148 (68.2%) had a suspected inflammatory RMD at Step 2 but this was not confirmed at Step 3.The most frequent musculoskeletal complaint at the time point of referral was pain in small peripheral joints (hands and/or feet) in 858 patients (87.4%), in large peripheral joints (knees, shoulders and/or hips) in 780 patients (79.4%) and back pain in 682 patients (69.5%). Fever, night sweats and unclear weight loss was reported by 50 patients (5.1%), while 210 patients (24.5%) presented with findings suspicious of inflammatory RMD such as elevated CRP of unclear origin, and 43 patients (4.8%) because of a threat of organ damage such as unclear elevation of creatinine, as reported by the referring physician. In addition, 167 patients (17.0%) had received glucocorticoids prior to referral, 87 (52.1%) of which finally did not receive the diagnosis of inflammatory RMD at Step 3, while 737 patients (75.1%) were receiving NSAIDs prior to referral.Conclusion:In this prospective evaluation of a triage system where all patients were pre-screened by a nurse and were seen within 4 weeks by a rheumatologist, clinical differentiation could be performed timely due to a successfully structured triage system. The initially suspected diagnosis was finally confirmed in ≥75% of cases, while ≥1/3 of patients had a definite inflammatory RMD.This work was supported by an unrestricted Grant from AbbvieDisclosure of Interests:Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Imke Redeker: None declared, Maria Zacharopoulou: None declared, Styliani Tsiami: None declared, Konstantia Tsiaousi: None declared, Doris Morzeck: None declared, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma
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Garrido-Cumbrera, M., H. Marzo-Ortega, J. Correa-Fernández, L. Christen, and V. Navarro-Compán. "AB1401 IMPACT OF THE COVID-19 PANDEMIC ON HEALTHCARE UTILIZATIONS OF RMD PATIENTS IN EUROPE. RESULTS FROM THE REUMAVID STUDY (PHASE 1 AND 2)." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1806. http://dx.doi.org/10.1136/annrheumdis-2022-eular.2701.
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BackgroundThe beginning of the COVID-19 pandemic led to a collapse of healthcare systems that was difficult to manage.ObjectivesThe aim of this study was to assess the impact of the COVID-19 pandemic on RMD patients’ healthcare utilization.MethodsREUMAVID is an international cross-sectional study collecting data through an online survey on RMD in seven European countries led by the Health & Territory Research group of the University of Seville, together with a multidisciplinary team including patient representatives, rheumatologists, and health researchers. Data were collected in two phases, the first (P1) between April-July 2020 and the second (P2) between February-April 2021. Demographics, health behaviours, employment status, access to healthcare services, disease characteristics, WHO-5 Well-Being Index and Hospital Anxiety and Depression Scale (HADS) were collected in the survey. Healthcare utilization includes scheduled appointments and attendance at the rheumatologist, consultation of possible treatment effects if COVID-19 is contracted with the rheumatologist, primary health care and psychological care. Descriptive analysis and Mann-Whitney test was used to explore association with healthcare utilization in both phases of REUMAVID.ResultsThere were a total of 2,002 participants across both phases with comparable demographic characteristics [mean age 52.6 (P1) vs. 55.0 years (P2); 80.2% female (P1) vs 83.7% (P2); 69.6% married (P1) vs 68.3% (P2), 48.6% university educated (P1) vs 47.8% (P2)]. Most prevalent RMD was axial spondyloarthritis in P1 (37.2%), and rheumatoid arthritis in P2 (53.1%).Only 39.2% could have a scheduled appointment with their rheumatologist during P1, compared to 72.5% of patients in P2 (p<0.001). In this sense, only 41.6% of participants in the P1 attended such an appointment while in P2 this figure was 61.5% (p<0.001). The majority of patients (83%) had their scheduled face-to-face appointment changed to an online or telephone phone in the P2, although this proportion was lower in the P1 (54.4%). The most frequent reason for canceling the face-to-face appointment was the alternative of making it by phone or online (54.4% in P1 vs. 83.0% in P2, p<0.001).Although, in P1, 38.1% of participants could contact with their rheumatologist by phone or online, this proportion was 64.3% in P2 (p<0.001). In P1, 64.0% of patients were able to consult with their rheumatologist about the possible effects of treatment in case of contracting COVID-19 (vs. 41.2% in P2; p<0.001). With respect to general practitioners, 57.6% of patients in P1 declared to had accessed primary care or general practitioner (vs. 77.5% in P2; p<0.001). Furthermore, in P2, a higher proportion of participants (63.2%) were able to continue their psychological or psychiatric therapy either online or by phone (vs. 48.3% in P1; p<0.001; Figure 1)ConclusionDuring the first year of COVID-19 pandemic, RMD patients had easier access to the healthcare system, specifically to their rheumatologist. This access was improved through phone and online care. In addition, access to primary care as well as psychological care improved during the second year of pandemic.Figure 1.Bivariate analysis of healthcare utilization in P1 and P2 of REUMAVIDAcknowledgementsThis study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League for People with Rheumatism (CYLPER) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of InterestsMarco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, José Correa-Fernández: None declared, Laura Christen Employee of: Novartis Pharma AG, Victoria Navarro-Compán Grant/research support from: AbbVie, BMS, Janssen, MSD, Novartis, Pfizer, Roche and UCB
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Phipps, Savannah, Manjari Lokender, Kali Konstantinopoulos, Bailey Johnson, Jane Ambro, Sandra K. Althouse, and Tarah Jean Ballinger. "Disparities in breast cancer prevention initiatives at a comprehensive cancer center: Who are we serving?" Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): 1615. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.1615.
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1615 Background: Despite advances in personalized breast cancer risk assessment and screening, populations at highest risk for cancer-related mortality are often excluded. At the IU Simon Comprehensive Cancer Center, a high-risk screening program (HRSP) identifies and serves women at increased risk of breast cancer. Risk assessment using Tyrer Cuzick v.8 and Gail models is performed in mammography; women at increased risk are navigated to a clinic appointment to discuss individualized screening and prevention services including MRI, chemoprevention, and/or genetic testing. We hypothesize gaps in the demographic and socioeconomic (SES) characteristics of women seen for a HRSP appointment, compared to women receiving a cancer diagnosis at the same mammography sites. Methods: Retrospective review was performed of women who met criteria for the HRSP (age ≤65 and Gail 5 yr risk ≥3% or TC v.8 10-yr risk ≥8%, or recommended by the radiologist) and subsequently accepted, scheduled, and attended an appointment from 6/2020 to 6/2022 (n=233). This population was compared to women who were diagnosed with breast cancer at the same clinical sites over the same dates, without history of being evaluated in the HRSP. Age was restricted to ≤65 to match the HRSP population (n=685). Zip codes were used to calculate area-based SES by median household income and percent poverty. CDC social vulnerability index (SVI) was evaluated using the U.S. Census Bureau and American Community Survey (0=least vulnerable, 1=most vulnerable). Comparisons across groups by age, race, insurance status, area SES and SVI were made using the Wilcoxon or Chi-square test. Results: Cancer cases were significantly older than those attending the HRSP (median age 54 vs 49 p < 0.001). Black patients represented 19.4% of participants diagnosed with cancer, versus 10.8% of participants attending the HRSP (p=0.0032). There was also a disparity in insurance coverage, with 83.8% of women seen in the HRSP being privately insured, versus 75.6% of women diagnosed with cancer (p=0.011). There was no statistical difference in SVI (0.64 vs 0.66 p=0.11) or area poverty rate (11.2 vs 12.0 p=0.26) between the groups; cancer cases came from areas with lower household income (69,611 vs 73,165 p=0.04). Conclusions: Women seen in the HRSP were more likely to be younger, White, privately insured, and from an area with higher household income, compared to women diagnosed with cancer in the same health system at the same mammography sites. This highlights disparities in access to individualized breast cancer interception such as chemoprevention, high-risk screening, and genetic testing, which may further existing disparities in breast cancer-related mortality based on race and SES. Further studies will investigate barriers and motivators to personalized breast cancer prevention in high-risk groups, and utilize community partnerships to develop equitable interventions.
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Czarnogorski, Maggie, Cindy Garris, Paul Wannamaker, Ronald D’Amico, Carolyn Selenski, Will Williams, Colleen A. McHorney, et al. "1037. Qualitative Findings from a Hybrid III Implementation-Effectiveness Study to Explore Perspectives of Health-care Staff on Early Implementation of Cabotegravir and Rilpivirine Long Acting (CAB+RPV LA) Injectable HIV treatment in the US (CUSTOMIZE)." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S549. http://dx.doi.org/10.1093/ofid/ofaa439.1223.
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Abstract Background CAB+RPV LA administered monthly for HIV treatment is non-inferior to daily oral ART at maintaining HIV suppression but concerns about implementation of this novel treatment paradigm remain. CUSTOMIZE, an implementation-effectiveness study, examined barriers and facilitators to successful implementation of CAB+RPV LA in US HIV clinics. Methods Semi-structured qualitative interviews were conducted with physicians, injectors, and administrators across diverse clinics in US without previous CAB+RPV LA experience at Baseline (BL) (N=26) and after patients received the 4th monthly injection of CAB + RPV LA (interim) (N=24). Consolidated Framework for Implementation Research (CFIR) guided the interviews to evaluate barriers and facilitators to implementation. Interviews were recorded, transcribed, and coded using ATLAS.ti then analyzed for trends. Results At BL, 58% of study staff expected CAB+RPV LA would meet the needs of patients. Staff reported perceived advantages for patients: reduced stigma of pill bottles (38%), ability to live/travel in a “carefree” manner (31%) and removing the daily reminder of HIV (20%). At BL, most administrators had resource concerns: additional refrigeration, transportation, and staffing. Some clinics (38%) needed to purchase a refrigerator to store CAB+RPV LA. Some physicians noted a potential need for improved parking or expanded hours. At interim, most staff (71%) reported no change in official clinic hours; but 50% of injectors and 38% of administrators reported changing work hours to accommodate injection visits before clinic or at lunchtime. Existing appointment reminder systems and transportation support were reported as facilitators to implementation. Many staff (46%) noted additional visits increased coordination of other care needs. Most staff (67%) noted high patient acceptance and positive attitudes facilitated successful implementation of CAB + RPV LA. Conclusion Some staff had concerns about implementation initially, but at study interim minimal practice changes were needed to operationalize CAB+RPV LA effectively. Patient interest heightened staff desire to implement CAB+RPV LA in their clinics. Staff are optimistic that monthly CAB+RPV LA is manageable with minimal disruption to routine care in US HIV care settings. Disclosures Maggie Czarnogorski, MD, MPH, ViiV Healthcare (Employee) Cindy Garris, MSPH, GlaxoSmithKline (Other Financial or Material Support, Stockholder)ViiV Healthcare (Employee) Paul Wannamaker, BA, ViiV Healthcare (Employee) Ronald D’Amico, DO, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Carolyn Selenski, PhD, GSK (Employee, Shareholder) Colleen A. McHorney, PhD, Evidera (Employee) Larissa Stassek, MPH, Evidera (Employee) Gary I. Sinclair, MD, ViiV (Speaker’s Bureau) Leandro A. Mena, MD, MPH, Binx Health (Grant/Research Support)Evofem (Grant/Research Support)Gilead Science (Consultant, Grant/Research Support, Speaker’s Bureau)GSK (Grant/Research Support)Janssen (Grant/Research Support)Merck (Consultant, Grant/Research Support)Roche Molecular (Consultant, Grant/Research Support)SpeedDx (Grant/Research Support)ViiV Healthcare (Consultant, Grant/Research Support, Speaker’s Bureau) David Margolis, MD, MPH, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)
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Bell, E., A. B. Gottlieb, P. J. Mease, G. Littman, and M. Via. "THU0578 ONLINE CME IMPROVES CLINICAL DECISION-MAKING IN THE MANAGEMENT OF PATIENTS WITH PSORIATIC DISEASE." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 530. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2290.
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Background:Psoriatic arthritis can be a challenging condition for rheumatologists to manage.Objectives:We assessed whether an online, virtual patient simulation (VPS) activity could improve the performance of rheumatologists in ordering appropriate tests, tailoring treatment options and selecting an evidence-based treatment for patients with PsA.Methods:This CME-certified VPS consisted of 2 patient cases presented in a platform that allowed physicians to assess the patients and complete open-field entries, choosing from an extensive database of diagnostic and treatment options reflecting the scope and depth of actual practice. After each decision, learners received clinical guidance (CG) based on current evidence and faculty recommendations. Clinical decisions were compared pre- and post-CG using a 2-tailed paired t-test to determinePvalues (P<.05 is significant). Rationales for clinical decisions were collected in real time. Data were collected between 28 February 2019 and 16 May 2019 and reported here as % relative improvement,Pvalue.Results:Case 1 (n=48 rheumatologists):45 yr old female patient diagnosed with PSO 5 years ago. Current treatment with MTX 15mg & folic acid once weekly plus ibuprofen. Experiencing nausea and increasing skin lesions. Recently showing signs and symptoms of PsA.Statistically significant changes were observed for:•Ordering appropriate tests to evaluate the patient (chemistry panel, 11%,P=.04; full blood count [FBC], 10%,P=.04; IFNƴ release assay for TB, 22%,P=.01; liver function tests [LFTs],13%,P=.02; rheumatology consult, 19%,P=.01 and viral hepatitis panel, 52%,P<.001)•Tailoring treatment options based on individual patient characteristics and available evidence (discontinue MTX [46%]and folic acid [140%], bothP<.001; order patient education, 24%,P=.006; guidance on lifestyle changes, 20%,P=.01; preventative vaccines prior to ant-TNF therapy, 38%,P=.002 and a followup appointment at an appropriate timescale, 26%,P=.006)•Selecting an evidence-based therapy for a patient newly diagnosed with PsA while on MTX therapy (adalimumab, 138%,P<.001)Case 2 (n=116 rheumatologists):55 yr old male who has had PSO for 9 years. Developed joint symptoms 1 year ago. Diagnosed with PsA & treated with MTX/folic acid. Elevated liver enzymes noted after 9 months; treatment switched to adalimumab. Skin lesions much improved but ongoing issues with pain and stiffness in hands. Current medications are citalopram, adalimumab, simvastatin and triamcinolone for skin flares.Statistically significant changes were observed for:•Ordering appropriate tests to evaluate the patient (C-reactive protein [9%], erythrocyte sedimentation rate [9%] and FBC [17%], all P<.01; Beck depression inventory [51%], BSAxPGA [21%], chemistry panel [15%], Global QoL 13%], Leeds enthesitis index [25%], LFTs [32%], PGA [21%], RAPID3 [63%], total BSA [137%]and X-ray of hands and feet [27%], allP<.001)•Tailoring treatment options based on individual patient characteristics and available evidence (discontinue biologic DMARD [67%], order patient education [22%], physical therapy [31%] and occupational therapy 27%], preventative vaccines [35%], psychosocial counselling [31%] and a follow-up appointment at an appropriate timescale [32%], allP<.001)•Selecting an evidence-based therapy for a patient with inadequate control of PsA on adalimumab (secukinumab, 152%,P<.001; ixekizumab, 167%,P=.01)Conclusion:These results demonstrate the success of immersive, online VPS education that engages physicians in a practical learning experience in improving their performance in managing patients with PsA.References:[1]https://www.medscape.org/viewarticle/902369Disclosure of Interests:Elaine Bell: None declared, Alice B Gottlieb Grant/research support from:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Consultant of:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Speakers bureau:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Gwen Littman: None declared, Mark Via: None declared
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Snyder, Joseph M. "The Fabianisation of the British Empire: Post-War Colonial Summer Conferences and Community Development in Kenya, 1948–1956." Britain and the World 13, no. 1 (March 2020): 69–89. http://dx.doi.org/10.3366/brw.2020.0338.
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This article examines the influence of the Fabian Society on post-war colonial development from 1948 to 1956. This study demonstrates that a primary vehicle for the ‘Fabianisation’ of the British Empire was the Cambridge Summer Conference series, particularly the conference convened in 1948. Held on the encouragement of initiative in African society, the conference devised a policy framework of community development based on a model of mass education long favoured by Arthur Creech Jones, secretary of state for the colonies and former chair of the Fabian Colonial Bureau (FCB). This article also looks at the practical outcomes of that influence through a case study of community development in Kenya. It demonstrates that, despite Creech Jones' appointment as secretary of state for the colonies, severe challenges remained for the realisation of Fabian-favoured designs, including those posed by inertia and resistance in the territories, which emanated from both colonial officialdom and indigenous populations. Moreover, the findings indicate that the fulfilment of British development goals was critically dependent on the translation of those goals through the medium of indigenous cultural institutions. While the findings attest that ‘Fabianisation’ during this period produced tangible development projects that concretely impacted social welfare in the colonies, the results suggest an ambiguity surrounding the relative success of ‘Fabianised’ development. The findings indicate that ‘Fabianisation’, dependent upon the processes of negotiation that transpired between the African communities being ‘developed’ and the agents responsible for change, and the ability of those agents to inspire and motivate the indigenous populations, was at best partial.
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Tempest, K., H. Reddy, S. Johns, K. Wright, and S. Sultan. "AB1397 WORK SMARTER NOT HARDER." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1804.1–1804. http://dx.doi.org/10.1136/annrheumdis-2022-eular.2263.
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BackgroundIn 2014 we were a small team with only 1 WTE (Whole Time Equivalent) CNS (Clinical Nurse Specialist) and 2 WTE consultants for a population of 220,000. Most CNS clinic appointments were taken up for drug counselling. Waiting times were approx. 6 weeks for drug counselling. Consultants would often counsel for DMARDs.That year at a national meeting a virtual group MDT (multidisciplinary) was presented by the team at Manchester Royal infirmary (MRI). They used a good quality presentation for patients starting bDMARDs as a tool for drug counselling.After having to put on an extra clinic to counsel 5 patients, all for rituximab, frustratingly I asked why can’t I get them all in the same room to save time? We needed to work smarter, not harder, utilise time & space to ensure best practice but also ensure gold standard, patient centered care continued. We modified the format used at MRI to a face to face group education and counselling of patients to improve waiting times and patient flow.ObjectivesReduce the amount of clinic appointments used to counsel patients for sDMARDs (synthetic disease modifying anti-rheumatic drugs) and bDMARDs (biologic).Free up clinic appointments for follow up/ review and flares.Standardise information given out to ensure they are all given the same gold standard information and education.MethodsWe visited the team at MRI to view the format of their virtual clinic. It didn’t meet the needs of our service so we modified and adapted the presentation.Set up a group education session to discuss the most common sDMARDs and bDMARDs used for Inflammatory Arthritis.I developed a power point presentation and booklet that can be used by CNS- ensuring the same information is given to every patient, both attending the group session and those not suitable for group session (ie Language barriers) who would be seen individually. We use a screening proforma to ensure safety of commencement for the individual prior to attending clinics which has a tick list for screening requirements.The session is undertaken in our education centre. Pre Covid the session could accommodate up to 10 patients per session per week, uptake on average 8-10 patients for sDMARDs and 5-6 for bDMARDs. We alternated biologic and sDMARD sessions, if demand required, we changed a session to accommodate. The room is booked for 1½ hours every week, the sDMARD presentation lasts approximately ½ an hour & bDMARD session 50 minutes, time is allowed for group & individual questions if required at the end. This contrasts with 25 minute appointment for sDMARD & 50 minute for bDMARD counselling 1:1.The booklet, along with information pack, is given at the group session to all patients. This includes all the information the patient requires (advice line information, blood forms). Prior to the group clinic admin team prepare the patient packs for the CNS to give to patients.ResultsWe received 102 anonymous responses back from 136 patients asked. (75% response)Following these sessions we found less calls to the advice line regarding medication queries, able to add in further cDMARDs or switch to alternate due to S/Es over the telephoneFeedback from patients.-120 comments received.Clear simple information about a number of possible drugs used to treat my condition not just the 1 I am prescribed. If my medication needs changing I already know about it.The lecture aspect of the types/contra-indications of meds was very useful & removed the ‘fear’ attached to these specialist drugs.The session with other patients present stopped me from feeling alone in this position. The booklet is brilliant as it includes everything that was in the session. Also it took away the ‘fear’ of the side effects.Conclusion7 years on we feel that Group Counselling has been a huge success, we noticed how successful this was once we had to deal with the pandemic and cancel the group sessions. Patients feedback proves that they like the session and find them valuable. Whilst being beneficial and impoving work productivity and streamling the service.AcknowledgementsThe Rheumatology Team at The Kellgren Centre Manchester Royal InfirmaryDisclosure of InterestsKelly Tempest Speakers bureau: AbbvieSanofiGalapogos, Hanu Reddy: None declared, Samantha Johns: None declared, Kathryn Wright: None declared, Shabina Sultan Speakers bureau: Amgen, Grant/research support from: lilly
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Zinenko, Yu V., and A. M. Bortnikov. "TO THE ISSUES RELATED TO APPOINTMENT AND ARRANGEMENT OF FORENSIC MEDICAL EXAMINATION ON DETERMINING THE DEGREE OF HARM TO HEALTH (ON ARCHIVE RECORDINGS KRASNOYARSK REGIONAL BUREAU OF FORENSIC MEDICAL EXAMINATION)." Вестник Сибирского юридического института МВД России, no. 2 (2019): 146–51. http://dx.doi.org/10.51980/2542-1735_2019_2_146.
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May, Tom W., Konstanze Bensch, David L. Hawksworth, James Lendemer, Scott A. Redhead, and Nicholas J. Turland. "(290–295) Proposals to amend Division III to create an “Editorial Committee for Fungi” and to shift the timing of appointment of the Deputy Secretary of the Fungal Nomenclature Bureau." TAXON 72, no. 3 (June 2023): 704–5. http://dx.doi.org/10.1002/tax.12960.
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Herrick-Reynolds, Kayleigh, Daniel Brooks, Gary Wind, Paula Jackson, and Kerry Latham. "Military Medicine and the Academic Surgery Gender Gap." Military Medicine 184, no. 9-10 (June 26, 2019): 383–87. http://dx.doi.org/10.1093/milmed/usz083.
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Abstract Introduction Gender disparity in academic medicine has been well described in the civilian sector. This has not yet been evaluated in the military health system where hundreds of female surgeons are practicing. Military service limits factors such as part time work and control over time spent away from family, which are often cited as contributors to the pay and promotion gap in civilian academic medicine. The military has explicit policies to limit discrimination based on gender. Pay between men and women is equal as it is based on rank and time in rank. One would expect to see less disparity in promotion through the academic ranks for military female surgeons given this otherwise equal treatment. This has not previously been objectively tracked or reported. It is beneficial to characterize the military academic medicine gender gap and benchmark against national data to define the academic gender gap and lay the groundwork for future work to identify factors contributing to the observed difference. Material and Methods This study was granted exemption from the Walter Reed National Military Medical Center (WRNMMC) Internal Review Board (IRB). The Uniformed Services University (USU) Department of Surgery academic appointment list was reviewed to assess female representation in the categories of Instructor, Assistant Professor, Associate Professor, Professor, and Other. Defense Manpower Data Center (DMDC) and the US Navy Bureau of Medicine and Surgery (BUMED) were assessed for total numbers of female surgeons on active duty, and numbers were compared with nationally published Association of American Medical Colleges (AAMC) data using a logistic regression model. Results There was a higher proportion of women in academic positions in the civilian cohort than in the military cohort (OR: 1.84; CI: 1.53–2.21, p < .0001). This difference was observed at every level of academic achievement. A higher percentage of women were observed at lower levels of professorship than at higher levels; instructors were more likely to be women than assistant professor (OR: 1.44, CI:1.16–1.79), associate professor (OR: 2.24, CI: 1.77–2.84), or full professor (OR:4.61, CI: 3.57–5.94). Conclusions Fewer female surgeons in military medicine hold academic appointment when compared with their counterparts in civilian medicine. Similar to the civilian sector, military academic surgery also demonstrates less likelihood of female representation in higher academic stations. This discrepancy in representation follows a linear trend over the different ranks. This discrepancy has not been previously documented. The military offers a unique opportunity to study the issue of gender imbalance in academic promotion practices given its otherwise equal treatment of males and females. Additional studies will be necessary to understand uniformed female surgeons’ barriers to academic advancement.
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MOUND, LAURENCE A. "Three new synonyms among Australian Thripinae (Insecta: Thysanoptera)." Zootaxa 3209, no. 1 (February 28, 2012): 67. http://dx.doi.org/10.11646/zootaxa.3209.1.4.
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The North American entomologist, A.A. Girault, arrived in Australia in late 1911 at the age of 28, to take up an appointment as economic entomologist to the Queensland Bureau of Sugar Experimental Stations near Cairns. He published extensively on the taxonomy of Australian parasitic Hymenoptera, but achieved particular notoriety through issuing a series of 63 privately published papers before his death in 1941. Gordh et al. (1979), in reproducing facsimile editions of each of these papers, provided an extensive overview of Girault’s life and opinions, many of which were expressed outrageously on a wide range of topics. In these papers Girault made available over 900 new species-group names, mostly Hymenoptera but with 139 that applied to Australian Thysanoptera. Unfortunately, the identity of these species has been a continuing problem. The publications include no biological information. Most species were described in three or four lines from single, often damaged specimens, and distinguished from each other on colour rather than structure. The original slide preparations are available in the Queensland Museum, Brisbane, but these are remarkably poor, with cover glasses broken, labels inadequate and scarcely legible, and many bearing multiple species. As a result of extensive studies on the Australian thrips fauna over the past 50 years, 77 of the 139 Girault Thysanoptera names are now placed into synonymy, including two new synonyms discussed below. The purpose of this note is to establish the nomenclatural validity of these synonyms, according to the Code of Zoological Nomenclature, so that they can be included in an expanded web-based account of Australian Terebrantia (Mound et al. 2012).
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Muravyeva, N., B. Belov, G. Tarasova, M. Cherkasova, and G. Lukina. "THU0563 IMMUNOGENICITY AND SAFETY OF 23-VALENT PNEUMOCOCCAL VACCINE IN PATIENTS WITH ANKYLOSING SPONDYLITIS (PRELIMINARY RESULTS)." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 522.2–523. http://dx.doi.org/10.1136/annrheumdis-2020-eular.909.
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Background:For the treatment of patients with ankylosing spondylitis (AS), biological drugs are widely used, which can effectively control the activity of the disease and radically change the prognosis. However, the use of these drugs is associated with an increasing risk of infections, some of which can probably be prevented by vaccination.Objectives:The aim of the study was to evaluate the immunogenicity and safety of the 23-valent pneumococcal vaccine (PPV-23) in patients with AS.Methods:The study included 18 patients with AS: 14 men, 4 women, age 38.7±11.5 years, duration of the disease 16.2±10.8 years. 5 patients had a history of more than 2 episodes of lower respiratory tract infections (pneumonia, bronchitis). At the time of inclusion in the study in 89% of patients, activity of diseases was assessed as high (median BASDAI was 5.1 [4; 6.2]). All patients received non-steroidal anti-inflammatory drugs, 6 patients - sulfasalazine, 4 - methotrexate, 1 - glucocorticoids, 1 – etanercept. PPV-23 was administered in an amount of 1 dose (0.5 ml) subcutaneously against the background of therapy. In 14 patients vaccination was performed before the appointment of secukinumab; 2 of them continued to take methotrexate, 3 - sulfasalazine. The level of antibodies to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clinical Diagnostics s.r.o., Czech Republic) before vaccination, 1 and 3 months after vaccination. The duration of follow-up was 6.7±4.9 months.Results:The dynamics of the concentration of antibodies to pneumococcal capsular polysaccharide is presented in the table.Table.Concentration of pneumococcal antibodies in patients with AS, U/ml, Me [25; 75 percentile]1 visit (initial)2 visit (after 1 month)3 visit (after 1 month)78.2 [35.2; 246.3]246.7 [148.6; 266.1]*261.1 [214.1; 273,4]***p=0.04 **p=0.008After 1 and 3 months after vaccination, the concentration of antibodies to pneumococcal capsular polysaccharide was significantly higher than the baseline values. None of the patients had lower respiratory tract infections. There was no exacerbation of disease. 83% of patients did not have any adverse effects of vaccination. Reactions at the injection site (pain, swelling and hyperemia of the skin up to 2 cm in diameter), resolved independently after 3-5 days, were noted in 2 patients. One patient registered a severe local reaction (infiltration and hyperemia of the skin up to 8 cm in diameter, pain in the arm), accompanied by low-grade fever for 2 days, which required the appointment of antihistamine drugs.Conclusion:Preliminary results indicate satisfactory immunogenicity and safety of the PPV-23 in patients with AS. Further research is needed to better assess the immunogenicity, efficacy and safety of the vaccine.Disclosure of Interests:Natalia Muravyeva: None declared, Boris Belov: None declared, Galina Tarasova: None declared, Maria Cherkasova: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche
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Patel, Akash R., Ryan Smith, Kavish Gupta, and Curtis Vandenberg. "Socioeconomic Status Impacts Outcomes Following Anterior Cruciate Ligament Reconstruction Status." Orthopaedic Journal of Sports Medicine 6, no. 7_suppl4 (July 1, 2018): 2325967118S0010. http://dx.doi.org/10.1177/2325967118s00104.
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Objectives: Delays in pediatric and adolescent anterior cruciate ligament reconstruction (ACLR) are associated with increased prevalence of concomitant knee injuries and worse post-operative outcomes. However, few studies have described the factors that may contribute to these delays and adverse events. This study seeks to determine the impact socioeconomic status has on outcomes following ACLR. Methods: Patients who underwent primary ACLR at a pediatric hospital between 2009 and 2015 were retrospectively reviewed. Variables included clinical outcomes and post-operative complications, as well as chronologic, demographic, and socioeconomic factors. Post-operative complication variables included graft failure, return to operating room, stiffness, and infection. Socioeconomic status was measured using health insurance type (commercial vs. government) and city block group level median household income levels derived from 2009-2015 U.S. Census Bureau data. Patients were excluded if they had multiligamentous knee injuries, prior ACLR, presented more than 365 days after injury, or had missing medical record data. Results: Overall, 127 patients (69 male, 58 female) were included in data analysis. The mean age at time of surgery was 15.0 ± 2.3 years (range = 9 to 21 years). There were 68 patients in the commercial insurance group and 59 patients in the government insurance group. Patients in the commercial insurance group had an average household median income of $87,767 (SD = $38,325) compared to $51,366 (SD = $25,330) in the government insurance group, p = < 0.0001. Patients in the government insurance group demonstrated greater delays in time from injury to first appointment (p = 0.0003), injury to MRI (p = 0.021), injury to surgery (p = < 0.0001), first appointment to surgery (p = 0.0036), and injury to return to play, p = 0.044 (Table 1). At time of surgery, 81% (48/59) of patients in the government insurance group presented with concomitant meniscal injuries compared 65% (44/68) of patients in the commercial insurance group, p = 0.034 (Odds Ratio = 2.38). Post-operatively, 22% (13/58) of patients in the government insurance group experienced decreased knee range of motion (“stiffness”) compared to 9% (6/68) in the commercial insurance group, p = 0.033 (Odds Ratio = 2.99). No significant differences were found between insurance types for rates of concomitant chondral injuries, graft failure, re-operation, or post-operative infection. Conclusion: Pediatric patients with government health insurance may experience delays in receiving definitive knee injury management and be at risk for complications and diminished outcomes. These delays are likely multifactorial, and may be attributed to decreased access to care, familial resources, and social support. Of note, our findings suggest a significant discrepancy in time to treatment as well as rates of concomitant knee injuries and post-operative complications between government and commercial insurance types. [Table: see text]
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Penford, R., E. Wren, and K. Mackay. "AB0909-HPR COVID 19 CRISIS: RAPID DEVELOPMENT OF REMOTE RHEUMATOLOGY MEDICATION CLINICS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1476.2–1477. http://dx.doi.org/10.1136/annrheumdis-2021-eular.4029.
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Background:We used to initiate DMARD(s) and Biologic therapies via nurse-led shared medical appointments (Group clinics) and could see up to 30 patients per week, with a maximum of 6 patients per group. We did this to start patients on their medications efficiently and safely and to manage the increase in workload.However, with the onset of the COVID 19 pandemic, we had to stop these clinics immediately, but, we did not have capacity to start everyone on their medications in a timely manner by telephone. Telephoning each individual took > 9 hours per week, whereas previously it took 3-4 haours.Objectives:We wanted to start patients on their all rheumatology medications safely and efficiently (within 10 days).Methods:By April 2202, we had organised the filming of 10 short healthcare videos to give patients all the information they required to start a range of DMARDs and biologics.We developed a new protocol (fig 1); patients are asked to view the relevant video, contact our department to confirm they understand the safety monitoring, risks, potential side effects, dose increases etc. As soon as they confirm by email they are happy to start treatment, a prescription is generated and emailed to the hospital outpatient pharmacy, where it is dispensed and delivered to the patient’s home. We send a follow up reminder letter about blood test monitoring etc (copy to GP) and a ‘shared care agreement’ to GP. They are given the option to have a telephone clinic appointment with a specialist nurse if required.Figure 1.Results:Of those requiring DMARDs, 62% reviewed the video, completed the checklist and confirmed by email they were happy to start treatment, within 24-hours. 88% had completed within 7 days.Over half the patients (56%) were starting DMARDs for the first time, of those 8% requested a telephone consultation to discuss treatment further with the Rheumatology nurses. Of the 44% of patients already taking a DMARD and due to start a second medication 24% required a telephone clinic appointment.As this is a new service, we asked for feedback, receiving replies from 34%, all scoring between 9/10 and 10/10.We have released > 7 hours of specialist nurse time for telephone/helpline clinics.Conclusion:The development of digital / remote medication clinics has been a success and we will continue with this approach. We have limited face-to-face appointments, started patients on rheumatology medications more quickly and efficiently than previously (but maintained safety), allowed the nursing staff time to spend more time working in our telephone clinics and have had excellent patient feedback. Although, we are aware, this is at a cost of no peer-to-peer interaction, which has been of value in the past.Disclosure of Interests:Rian Penford: None declared, Elaine Wren: None declared, Kirsten Mackay Speakers bureau: I have been paid as a speaker for Roche within the last 12 months, Consultant of: I have worked as a paid consultant for Novartis, Janssen and Lilly within the last 12 moths, Grant/research support from: Novartis have assisted in the development of our Rheumatology App - Connect Plus - developed for rheumatology patients attending our department.
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Tinsley-Vance, Sara M., Brent J. Small, Susan C. McMillan, Rami S. Komrokji, and Jeffrey E. Lancet. "Determining Treatment for Older Patients with High-Risk MDS and AML: Which Factors Predict Optimal Quality of Life?" Blood 128, no. 22 (December 2, 2016): 2361. http://dx.doi.org/10.1182/blood.v128.22.2361.2361.
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Abstract CONTEXT: Evidence is lacking to guide patients diagnosed with acute myeloid leukemia and high-risk myelodysplastic syndrome in selecting the best treatment for improving quality of life. A model is needed to determine best choice for improving quality of life based on individual characteristics including age, comorbidities, and functional status. OBJECTIVE: The aim of this study was to determine whether age, comorbidity, or fatigue, had a moderating effect on quality of life at two different intensities of therapy; intense or non-intense. Intense therapy included any induction chemotherapy which required an inpatient hospitalization. Non-intense chemotherapy was active disease treatment in an outpatient setting, and included hypomethylating agents and clinical trials. DESIGN: The study design was an exploratory design with repeated measures comparing quality of life between two treatment groups, intensive and non-intensive prior to start of new treatment and again one month post treatment. Enrollment of participants began in 12/2013, and ended 3/2015. Patients were followed for one month. Linear regression was performed to determine the moderating effect of treatment on age, comorbidity, and fatigue on the second quality of life score. SETTING: The setting was Moffitt Cancer Center. Participants were recruited in both the inpatient and outpatient settings. PATIENTS OR OTHER PARTICIPANTS: Patients with pathology confirmed high risk myelodysplastic syndrome and acute myeloid leukemia, 60 years of age and older who were starting a new treatment were approached for participation. Recruitment of 85 patients occurred at the time of appointment in the Hematology Clinic or during admission to Moffitt Cancer Center for treatment. Patients were able to read, write, and speak English, were orientedto person, place, and time, and werewilling to participate. High-risk MDS and AML were treatedas one group. The sample was predominantly white, male, retired, and middle class. Seventy-nine percent of participants completed both quality of life measurements. INTERVENTIONS: This was not an intervention study. Quality of life was measured in individuals with a focus on individual variables to see if the variables were correlated with a different quality of life score based on intensity of therapy. MAIN OUTCOMES MEASURES: The main outcome of this study was quality of life, measured using the Functional Assessment of Cancer Therapy-Leukemia version. This was measured at two times with the second measurement used in the regression analysis. Comorbities, fatigue and age were entered into regression, with intensity of treatment used as a moderator variable. Comorbities was calculated with the Charlson comorbidity index. Fatigue was measured with the Brief Fatigue Inventory. Age was measured in years. RESULTS: Linear regression was performed to determine the moderating effect of treatment on age, comorbidity, and fatigue on the second QOL score. The results were statistically significant, indicating that when combining all three variables, the model predicts QOL (p=0.049). Type of treatment was significant (p=.043). This indicates the main effects of treatment on QOL scores. The intensive treatment group had an improvement in the second measure of quality of life. Charlson comorbidity index and age did not moderate the quality of life score for intensity of treatment. The main effect of fatigue was significant (p = .014). CONCLUSIONS: Intensive chemotherapy, regardless of age and comorbidity, was associated with improved quality of life score at one month. Age was not helpful in discriminating between intensity of therapy with quality of life as an outcome, at the one month mark. A larger sample size with more diverse demographic characteristics would enhance future studies. This study was supported by an American Cancer Society Doctoral Degree in Nursing Science Scholarship Disclosures Tinsley-Vance: Ariad: Consultancy; Celgene: Speakers Bureau; Teva: Membership on an entity's Board of Directors or advisory committees; Novartis: Speakers Bureau. Komrokji:Novartis: Consultancy, Speakers Bureau; Boehringer-Ingelheim: Research Funding; Incyte: Consultancy; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Guilhot, François, John Coombs, Oleg Zernovak, Tomasz Szczudlo, and Gianantonio Rosti. "A Global Retrospective and Physician-Based Analysis of Adherence to Tyrosine Kinase Inhibitor (TKI) Therapies for Chronic Myeloid Leukemia (CML)." Blood 116, no. 21 (November 19, 2010): 1514. http://dx.doi.org/10.1182/blood.v116.21.1514.1514.
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Abstract Abstract 1514 Background: TKIs have proven to be highly effective in the treatment of CML. Several studies have demonstrated that adherence to TKI therapy is a predictor of achieving optimal outcomes. Since chronic phase CML is now becoming more of a long-term disease state in many patients, it is critical that patients understand the importance of adhering to their prescribed drug regimen to maximize and sustain efficacy over many years. This study aimed to establish the key determinants of adherence, and to establish a typical adherence rate to be used as a baseline for future comparison. Methods: Overall, 405 CML-treating physicians in Brazil, France, Italy, Spain and Russia participated in a quantitative online survey and 1,155 patient treatment histories and compliance records were retrospectively analyzed. Results: In this study, although the majority of physicians discussed adherence with patients at each appointment and agreed that evidence suggests there is a link between adherence and progression, only approximately half of the physicians prioritized adherence to therapy or viewed non-adherence as a major driver of disease progression. Overall, the survey of CML-treating physicians demonstrated that their perceptions of adherence closely matched the actual rates of adherence. Physicians believed that patient forgetfulness is the major reason behind non-adherence and it was found that physicians most frequently learn about non-compliance through conversations with their patients rather than through other means, such as the frequency of writing prescription refills. Physicians believe they take on an appropriate amount of responsibility on adherence education and that nurses and pharmacists could play a more active role in adherence management. The study also found that physicians tend to be more reactive at utilizing adherence interventions and perceived the use of blood level monitoring as an effective tool to evaluate non-adherence to therapy. Similarly, the patient record review showed patients are significantly (P = .014) more likely to be adherent to TKI therapy if physicians have a proactive and focused approach to utilizing adherence interventions and enroll patients in a program. Data from the patient records within the European region (France, Italy and Spain) closely matched a previously published US healthcare claims data analysis addressing adherence to imatinib. Across the five countries studied, 43%-53% of the patients were fully adherent to therapy. However, overall, > 10% of patients missed ≥ 10% of their prescribed daily dose, with Russia having the highest percentage of patients (23%) and Brazil the lowest percentage of patients (8%) regularly non-adherent to therapy. Of patients in the European region with a known response (n = 363), greater adherence to therapy was significantly correlated with achievement of better therapeutic milestones (P = .04); however, this factor was not significant across all five countries (P = .082). Additionally in the subset of patients from the European region, adherence correlated (P = .027) with the use of individual patient counseling on adherence performed by a nurse and/or hematologist, or if the institution had established adherence protocols (P = .012). Factors not found to significantly influence adherence in all five countries were patient co-morbidities (P = .344), patient age (P = .533), or concomitant non-CML prescription medications (P = .519). Conclusions: Information from this study demonstrated that adherence can be improved through greater patient-physician interactions and provides strong support for the implementation of early, proactive, and focused interventions in combating non-adherence to maximize patient outcomes. Disclosures: Guilhot: Novartis: Equity Ownership, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding. Coombs:Novartis: Employment, Equity Ownership. Zernovak:Novartis: Employment, Equity Ownership. Szczudlo:Novartis: Employment, Equity Ownership. Rosti:Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Bristol-Myers Squibb: Honoraria, Speakers Bureau; Roche: Speakers Bureau.
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Martin, Karlyn A., Caroline Laub, Lindsey Kalhagen, Iwona Boska, Mark Attilio, Anaadriana Zakarija, and Brady L. Stein. "Improving Hematology Clinic Access for Patients with Cancer-Associated Thrombosis." Blood 138, Supplement 1 (November 5, 2021): 1885. http://dx.doi.org/10.1182/blood-2021-151152.
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Abstract Background : Venous thromboembolism (VTE) is a common consequence for patients with malignancy, and adversely impacts quality of life, morbidity and mortality. While historically low-molecular weight heparin (LMWH) was considered standard of care for treatment of cancer-associated thrombosis (CAT), more recent data support the safety and efficacy of direct oral anticoagulants (DOACs). However, management of CAT remains complex, and a national shortage of non-malignant hematologists limits access to thrombosis experts. Our non-malignant hematology group developed a pilot program to expedite referrals for oncology patients with CAT to aid in management and selection of appropriate therapies. Methods: With guidance from the Process Improvement team at Northwestern Medicine, the Cancer-Associated Thrombosis clinic was established in April 2020. Information about the clinic was disseminated via administrative meetings and e-mails from the clinical practice director. Patients were referred from the Robert H. Lurie Comprehensive Cancer Center for either: (1) newly diagnosed ("acute") venous thromboembolic event (VTE) that could be managed in an outpatient setting, or (2) "ongoing management" of an established VTE diagnosis. We aimed to see acute referrals within 24 business hours and ongoing management referrals within 2 weeks. Patients were seen initially by an advanced practice provider, with case discussion with an attending non-malignant hematologist and pharmacist review for anticoagulant eligibility and teaching. Patients were to be scheduled for follow-up with an attending hematologist within 3 months. Decision-making regarding anticoagulant choice was based on perceived bleeding risk, tumor type, drug interactions, and patient preferences. Herein we report our experience during the first year (April 2020-April 2021) of the CAT clinic. Results Sixty-three patients were seen in the first year, of whom 59% were women, with a median age of 63 years (range 30-90 years). 20.6% of patients had a prior history of VTE, and 6.3% had a prior history of bleeding. Tumor types from nine oncology sites were represented, of which gastrointestinal (33.3%); gynecological (22.2%); hematological malignancies (14.2%), and breast (7.9%) were the most common. Among 18 patients (28.5%) referred for acute VTE, the median time to appointment was 0 days, and among 45 patients (71.4%) referred for ongoing VTE management, the median time to appointment was 10 days. The most common VTE was pulmonary embolism (PE) (25.4%), followed by proximal deep vein thrombosis (DVT) (20.6%), concurrent PE and DVT (14.3%) and upper extremity DVT (11.1%). Additionally, 7.9% of thrombotic events involved splanchnic vein and 4.8% cerebral veins (1 isolated, 2 together with DVT and/or PE). DOACs were recommended in 29 (46%) of patients (19 apixaban, 9 rivaroxaban, 1 edoxaban), whereas enoxaparin was advised in 28 patients (44.4%). Four patients were advised to discontinue anticoagulation and 1 was advised to continue warfarin given prior DOAC failure and preference for an oral anticoagulant. Of 28 patients advised to use enoxaparin over a DOAC, the most common reasons included perceived bleeding risk/tumor type (50%), DOAC failure (21.4%), and drug-drug interactions (17.8%). Thirteen patients (21%) switched to a different anticoagulant (7 to a DOAC) in follow-up after the initial recommendation. Thirty-seven patients (59.7%) had a follow-up visit in the CAT clinic. During follow-up, 5 patients (7.9%) experienced recurrent or progressive VTE, and 7 (11.1%) patients had bleeding events. Fifteen patients (24.2%) died during follow-up. Conclusions The aim of this process improvement project was to improve access and assist with anticoagulant choice and management of CAT. Compared to a historical 3 month wait time for non-malignant hematology appointments at our institution, most acute CAT patients were scheduled within 24 hours, and patients requiring ongoing management were seen within 10 days. While DOACs are increasingly prescribed for treatment of CAT, we found that DOACs were not our recommended anticoagulant in over half of patients referred to our clinic, largely due to perceived risk of bleeding/tumor type. This highlights the complexity of management of CAT, and demonstrates the benefit of dedicated thrombosis expertise to aid in management of CAT. Disclosures Martin: Janssen: Research Funding; Penumbra: Other: Scientific Advisory Board. Kalhagen: Harborside: Other: Consulting; Incyte: Speakers Bureau. Zakarija: Bayer: Other: Consultancy Advisory Board. Stein: Pharmassentia: Other: Advisory Board and Steering Committee; Constellation Pharmaceuticals: Other: Advisory Board x 1.
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Bukrieieva, Olha, and Yana Medvedovska. "The formation of metrology as government regulated activity in France." History of science and technology 11, no. 2 (December 12, 2021): 274–83. http://dx.doi.org/10.32703/2415-7422-2021-11-2-274-283.
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The article has discussed the historical process of development of metrological activity in France. It was revealed that the history of metrology is considered as an auxiliary historical and ethnographic discipline from a social and philosophical point of view as the evolution of scientific approaches to the definition of individual units of physical quantities and branches of metrology. However, in the scientific literature, the little attention is paid to the process of a development of a centralized institutional metrology system that is the organizational basis for ensuring the uniformity of measurements. It was shown that traditionally there are two periods of development of metrology based on the unification of weights and measures: the association under Charlemagne and the introduction of the decimal metric system during the French Revolution. Because this division has a mixed scientific and organizational basis, a new periodization of the development of French metrology from the position of state regulation was proposed. The highlighted stages include the primitive period and the first city-states, the time of the domination of the Roman Empire, the era of the coexistence of many measures, the chapters of Charlemagne, the feudal practices of the Middle Ages, the creation of royal standards under Henry II, the introduction and dissemination of the decimal metric system, the emergence of metrological institutes, laboratories, centers. At the State level the first step in organizing a centralized institutional metrology system was the creation of a testing laboratory, the second was the creation of National Metrological Bureau, national bodies for metrology, and the third was reorganization of the system and appointment of the National Testing Laboratory as the governing metrological body of France. Thus, the French metrology system has experienced many crises and upheavals in the process of its formation. However, France today is one of the most experienced and respected countries in the field of metrology, and at the international level, it was the one who laid the foundations for new metrological agreements, as well as the social, philosophical, scientific, political and geographical area of the new system of measures and weights.
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Dreher, M., R. E. Schmidt, T. Witte, G. Assmann, K. Hoeper, K. Triantafyllias, J. Zeidler, H. Binder, and A. Schwarting. "AB1298-HPR RHEUMA-VOR: A PROOF-OF-CONCEPT NETWORK STUDY FOR THE IMPROVEMENT OF RHEUMATOLOGICAL HEALTH CARE THROUGH COORDINATED COOPERATION." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1939.2–1940. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5559.
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Background:Rheumatoid arthritis (RA), psoriasis arthritis (PsA) and spondyloarthritis (SpA) are the most common chronic inflammatory rheumatic diseases. For all three diseases, the so-called “window of opportunity” [1,2,4] has been identified as the decisive factor affecting the outcome.Objectives:The aim of the prospective study is to improve the early diagnosis of RA, PsA and SpA and thus positively impact the quality of care for patients with the support of coordinating centers.Methods:Primary care providers are given access to screening questionnaires to document potential early cases of RA, PsA, and SpA, based on characteristic symptoms. These are evaluated by multidisciplinary teams at the regional coordinating centers. If they fulfill the criteria for referral, patients get an appointment at a cooperating rheumatology specialist within weeks. If a rheumatic disease is diagnosed, physicians and patients receive questionnaires about sociodemographic, physilogical and psychological parameters.In order to increase the quality of referrals, a 15-minute rheumatological consultation at the ACURA Rheumatology Center was implemented for all patients from Rhineland-Palatinate whose suspected diagnosis was confirmed by the coordination centre. In course of this, the Rheuma-VOR Screening-App will also be developed and optimized. The cooperating partners and additional information are already published [5].Results:Preliminary data (31 Dec 2019) are presented. In Rhineland-Palatinate, Saarland and Lower Saxony, 4942 suspected diagnoses of 1526 different referring physicians have now been reported. A total of 2578 patients were referred by the three coordination centres to one of the 49 participating rheumatological specialists. 1004 patients were diagnosed with one of the three diseases. About 306 patients have already taken the follow-up appointment after one year.In course of a screening consultation 736 patients have been screened to date. The patients have to wait in average about 42 days from the suspected diagnosis to the rejected or confirmed rheumatological diagnosis.Conclusion:Although the average waiting time for all three diseases is currently almost twice as long as the 23.9 days in the Rhineland-Palatinate predecessor project ADAPTHERA which just focuses on RA, the current results are very positive compared to the national average [3]. The aim is to further increase the screening quality and screening numbers, especially in the 1-year follow-up.Current data will be presented at the conference.References:[1]Boehncke WH, Menter A (2013) Burden of disease: psoriasis and psoriatic arthritis. Am J Clin Dermatol 14:377-388[2]Claudepierre P (2014) Spondyloarthritis: a window of opportunity? Joint Bone Spine 81:197-199[3]Lauter A, Triantafyllias K, Leiß R et al. (2019) ADAPTHERA—Statewide cross-sectoral care network for patients with early rheumatoid arthritis shows sustained remission in standard care. ZRheumatol. 78 (7): 660–669[4]O’dell JR (2002) Treating rheumatoid arthritis early: a window of opportunity? Arthritis Rheum 46:283-285[5]Schwarting A (2018) From ADAPTHERA to Rheuma-VOR: Concept of Coordinated Cooperation to Improve the Quality of Rheumatology Care Akt Rheumatol 43 (05): 406-409Acknowledgments:The authors thank all partners and participants of Rheuma-VORDisclosure of Interests:Matthias Dreher: None declared, Reinhold E. Schmidt: None declared, Torsten Witte: None declared, Gunter Assmann: None declared, Kirsten Hoeper Consultant of: AbbVie, Celgene,, Speakers bureau: Abbvie, Chugai, Novartis, Lilly, Celgene, Sandoz Hexal, Konstantinos Triantafyllias: None declared, Jan Zeidler: None declared, Harald Binder: None declared, Andreas Schwarting: None declared
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Seol, Paehwan. "The Warehousing System and the Great Qan’s Financial Geography in the Mongol Empire." Korean Association for Mongolian Studies 76 (February 28, 2024): 121–70. http://dx.doi.org/10.17292/kams.2024.76.121.
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This study explores when and how the warehousing system 倉庫制 in the Mongol Empire (1206~1370) had been established, developed, and administered. The warehouse, as an administrative service to accumulate and redistribute treasures, shows the relationship between the procurement of imperial materials and the circulation of commodities as well as the great Qan’s financial geography. The study examines the way in which the Mongol Emperor of Qa’an procured and controlled materials and treasures, and therefore to characterize the Mongol’s development of its own, especially in the fiscal finance.
The first Mongol warehouses, balaqat in Mongol, were set up by Ögödei Qa’an in Mongolia in 1229. They consist of grain-houses (倉 cang in Chinese, anbār in Persian) and treasuries (庫 ku in Chinese, khazāna in Persian). Since Qubilai Qa’an sat on the throne in 1260, warehouses were increasingly built up. The number of grain-houses increased with the consolidation of the Southern Song in 1279. While land taxes 稅糧 traveled from Jiangnan provinces on the sea route to a capital city of Dadu 大都, the main base of grain supply was moved from Qiansicang 千斯倉 in the northeast to Wansinancang 萬斯南倉 in the south. Four Imperial Treasuries of Trillion 萬億四庫 beside Jishuitan 積水潭 storing valuables such as paper money, jade wares and others, served as the leading treasuries of the Empire.
The warehouses were located along the middle and lower part of the Yellow River, the streams in Jianghui 江淮, as well as next to the canal in Huabei 華北 area. Geopolitically speaking, they mostly belonged to the central domain of Fuli 腹裏 (qol-un ulus in Mongol), supervised by the Central Secretariat 中書省. The fact that Large grain-houses and state treasuries were intensively stationed in the capital cities of Qara Qorum 和林, Dadu and Shangdu 上都, and their vicinities demonstrates their relevance to the Qa’an’s seasonal journey sites. The Qa’an stood in the center of collection, control, and consumption of imperial materials and treasures.
In staffing, warehouse officials 倉庫官 (khazāna-chī in Persian) were originated from balaqači 八剌哈赤 and sangči 倉赤 in Mongol respectively. They came from keshig 怯薛, the Mongol imperial guards. Balaqači was appointed as a treasury official 庫官 or a gatekeeper general 封門官員, and sangči as an official of treasuries or grain-houses by the Qa’an in person to the warehouses in Dadu and nearby. This is called belge selection 別里哥選, or imperial appointment 宣授.
The expansion of warehouses caused shortage of staffing in the Mongols. Considering staff’s personality and richness, the Yüan Dynasty appointed officials such as directors of collection 監納 or commissioners 大使 among Central Asians 色目人 and Chinese 漢人 through the selection process of the Secretarial or Presidential Councils 尙書省, called general selection 常選, or imperial decree appointment 勅授. And Bureau clerks 司吏 with richness, working career, governmental salaries, and mature age could be advanced to lower staffs in charge, or deputies 副使 in district warehouses 各路倉庫.
Warehouse officials from the Mongols, Central Asians and Chinese show a ratio of 1 to 3 to 6. While more Mongols and Central Asians worked in Qara Qorum, the Chinese staffing grew larger particularly in grain-houses as time went by to the late period of the Empire.
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Weng, Julius, Shane Mesko, Prajnan Das, Gregory Chronowski, Percy Lee, Seungtaek Choi, Albert C. Koong, et al. "Optimizing outpatient oncology consult workflow using time-driven activity-based costing: Efficiency and financial impacts." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 9. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.009.
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9 Background: Clinical efficiency is a key component of value-based healthcare, patient satisfaction, staff burnout, and institutional operational capacity. The objective of this study was to identify clinic inefficiencies using time driven activity-based costing (TDABC) and evaluate the implementation of a new clinical workflow in high volume, outpatient radiation oncology clinics. Methods: We conducted an IRB-approved quality improvement study in the Gastrointestinal (GI), Genitourinary (GU), and Thoracic Radiation (TRO) Oncology departments at a large academic cancer center and four additional network sites (HALs). TDABC methodology was used to create process maps and optimize consult workflow. Patient encounter metrics were captured utilizing a real-time status function in the electronic medical record (Epic Systems). Anonymous patient satisfaction telephone surveys were administered to patients at the HALs. Hourly wages were determined based on 2021 U.S. Bureau of Labor Statistics. Pre- vs post-implementation metrics were compared using the Mann-Whitney U test. Results: Consult data for 1328 patients pre-intervention and 1234 post-intervention across all sections was included. Median overall cycle time was reduced by 21% in GI (19 min, p < 0.001), 18% in GU (16 min, p < 0.001), and 12% in HALs (9 min, p < 0.001). The median interval between rooming and being seen by the attending physician decreased by 13% in GI (7 min, p < 0.001), 16% in GU (9 min, p < 0.001), 21% in TRO (10 min, p < 0.001), and 9% in HALS (4 min, p < 0.005). For each consult, there was a median financial savings of $29 for GI, $24 for GU, $5 for TRO, and $14 for HALs per consult. From patient satisfaction surveys (95/177), 99% of patients reported their providers spent adequate time with them, 85% reported their appointment began on time, and 91% reported being seen by a care provider in a timely manner. Conclusions: TDABC is a successful method to identify opportunities to improve clinical efficiency. Implementing workflow changes based upon these findings led to substantial reduction in overall encounter cycle times and patient wait times across multiple departments. Furthermore, patient satisfaction was high and there were significant financial savings with the new workflow. These findings may also have implications for reducing staff burnout and expanding clinical capacity across the magnitude of clinical enterprise.[Table: see text]
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Klochkov, Victor, Veronica Nazarova, and Igor Uznarodov. "Catholic Emancipation in the Great Britain and Irish Policy of Sir Robert Peel (1812–1829)." Vestnik Volgogradskogo gosudarstvennogo universiteta. Serija 4. Istorija. Regionovedenie. Mezhdunarodnye otnoshenija, no. 5 (November 2023): 116–26. http://dx.doi.org/10.15688/jvolsu4.2023.5.9.
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Introduction. The subject of research in this work is a historical and historiographical review of the Irish policy of one of the Tory leaders, Sir R. Peel (1788–1850), from the moment of his appointment as Secretary for Ireland in 1812 to the political crisis associated with the Catholic Emancipation in 1829. The relevance of the work is determined by the fact that the Irish policy of R. Peel is investigated here not only in the traditional problem-chronological way but also in a biographical context. Methods. The broad research context of the work is provided by the use of the prosopographic method and the historical-critical method of data processing of sources, some of which (archival sources from the Library of the University of Southampton and the Archive Bureau of Northamptonshire) are introduced into scientific circulation for the first time. Analysis. The aim of this work is to revise the thesis established in traditional British historiography, according to which the Irish policy of R. Peel in the period from 1812 to 1829 was based on the principles of “Orangism,” whereas after the Catholic Emancipation of 1829, R. Peel became “emancipated.” The analysis of R. Peel’s political strategy in the Irish question carried out in the article shows that none of these definitions fully reflects his actual position. Results. The result of the study is the thesis that R. Peel’s Irish policy turned out to be the personification of a conservative approach to problems, in solving which he was forced to concede in detail while preserving the basics. It is shown that R. Peel’s position on the issue of Catholic emancipation was not a rejection of Anglicanism, as it often seemed to contemporaries, but a rejection of anti-Catholicism. This circumstance makes it possible today to avoid extreme assessments of R. Peel as an unprincipled politician in favor of a more moderate assessment of his Irish policy. Authors’ contribution. V.V. Klochkov determined the basic concept of the article and the methodological foundations of the study, as well as identified unpublished sources from the regional archives of Great Britain; V.S. Nazarova prepared the introduction of the article, created its structural composition, and analyzed the historiography of the problem; I.M. Uznarodov carried out general editing of the text and formulated the main results of the study.
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Halimeh, Susan, Sylvia Von Mackensen, Lina Lourak, June Schwarzbach, and Manuela Siebert. "Treatment of Women with Heavy Menstrual Bleeding with a Combination Therapy of Agnus Castus and Tranexamic Acid - Experiences of a German Single Centre." Blood 138, Supplement 1 (November 5, 2021): 1043. http://dx.doi.org/10.1182/blood-2021-153644.
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Abstract Background: Heavy menstrual bleeding (HMB) is a common gynaecological problem and is the reason for 18-30% of gynaecological visits. In a European study in 4,502 women, 27.2% were diagnosed with HMB (Fraser et al., 2015). On the other hand, HMB is often associated with bleeding disorders (Shankar et al., 2004). The definition of HMB has different perspectives; from a subjective perspective HMB is defined as e excessive menstrual blood loss impacting on women's physical, social, emotional and/or mental quality of life, whereas from an objective perspective it is defined as excessive blood loss >80 ml per cycle (Munro et al., 2012). There are different approaches for treating HMB such as the administration of non-steroidal drugs, Desmopressin, herbal Vitex Agnus Castus (VAC), Tranexamic acid (TXA) or a hormonal therapy; moreover, HMB can also be treated surgically. The aim of this study was to test the efficacy of the specific HMB management used in our center: Women with HMB are treated usually with VAC, which optimizes the relation of estrogen to progesterone in the female body (Yavarikia et al., 2013). VAC can be used without using any hormones (Shahnazi et al, 2016), providing a treatment with a low impact on women's bodies. Additionally, TXA is given during the menstruation due to its antifibrinolytic effect. Furthermore, the "Pictural Blood-Loss-Assessment- Chart" (PBAC Score) is administered to analyze the menstrual blood loss. Methods: Two ad hoc patient-reported questionnaires were developed to test the efficacy of the HMB management in our center The baseline questionnaire includes the following aspects: menarche, duration, regularity, number of sanitary products, pain level, medical background and family history. During the first visit in our center women with HMB filled in the baseline questionnaire. In addition, laboratory tests are done including a comprehensive coagulation test and the examination of iron and hemoglobin levels. Moreover, we presented an application called "My Flow Score" to the patients, which calculates the PBAC score as a result of all entered sanitary products women use during their period. Women are prescribed VAC and/or TXA for the management of their HMB. After four months patients are scheduled for a follow up appointment. At that time they complete the follow-up questionnaire including the following aspects: compliance with the medication or the reason for the non-compliance, health complaints due to the medication, duration of the period, improvement, pain level, PBAC score if the patient did use the APP "My Flow Score" or if not the number of sanitary products. A blood test was taken and the HMB management was adapted to the patients' needs. Results: So far, 100 women with HMB with a median age of 14 years (range 9-50) were enrolled in our study. They had their menarche with a median age of 12 years (range 8-17). Diagnosis of women ranged from iron or folic acid deficiency to different forms of bleeding disorders; with the majority suffering from von Willebrand disease (43/100) followed by iron deficiency (14/100). One fifth of the patients had more than one diagnosis. 1/3 of patients received a treatment for the HMB previously, mainly contraceptives, TXA or VAC. 49% reported anomalies with regard to previous other bleeding; 25.8% had increased hematomas and 19.6% recurrent epistaxis. Most of them reported anomalies already in the family (60.2%). Before treatment women had a median PBAC Score of 169 (range 77-800) and reported a median pain level of 6.5 during menstruation on a scale ranging from 1 (low pain) to 10 (extreme pain). 87/100 women received VCA, of these 75.4% regularly and 85/100 women received TXA, of these 84.6% regularly. 81% of them received a combination of both medicines. Compared to before 28.8% of patients reported shorter duration of menstruation and reduced bleeding with treatment, 11.9% did not experience any improvement; the PBAC score decreased significantly (p<.0001). Conclusions: Although the type of diagnosis in women suffering from HMB had a great variation, these patients had a high disease burden with a relatively high level of pain and a high loss of blood assessed with the PBAC score. Thanks to a combination of VAC and TXA the disease burden in these women could be reduced, especially for the time of menstruation and amount of bleeding. VAC proved to be highly accepted by women due to its low treatment burden. Disclosures Von Mackensen: University Medical Centre Hamburg-Eppendorf: Current Employment; Sobi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Consultancy; Novo Nordisk: Consultancy; Biomarin: Speakers Bureau; CSL Behring: Speakers Bureau; Chugai/Roche: Membership on an entity's Board of Directors or advisory committees.
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May, Tom W., Scott A. Redhead, Lorenzo Lombard, and Amy Y. Rossman. "XI International Mycological Congress: report of Congress action on nomenclature proposals relating to fungi." IMA Fungus 9, no. 2 (December 2018): xxii—xxvii. http://dx.doi.org/10.1007/bf03449448.
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Abstract Procedures, appointments and outcomes of the Fungal Nomenclature Session (FNS) of the 11th International Mycological Congress (IMC11) are summarized, including the composition of the Fungal Nomenclature Bureau and the Nominating Committee of the IMC. Nearly 150 mycologists attended the FNS, at which formal proposals to amend Chapter F of the International Code of Nomenclature for algae, fungi, and plants (ICN) were debated. The 18 proposals considered included 10 “from the floor”. Four proposals were withdrawn, two were sent to the Editorial Committee, five were sent to two Special-purpose Committees, four were rejected, and three were accepted (concerning: using the identifier in place of the author citation; mis-citation of identifiers; and indication of sanctioning). Proposals to amend Division III of the ICN were deemed out of scope of the FNS because they did not relate to Chapter F. The two Special-purpose Committees authorized were: “DNA Sequences as Types for Fungi” and “Names of Fungi with the Same Epithet”. Appointments made by the FNS included the Secretary of the Fungal Nomenclature Bureau for IMC12, and officers and members of the Permanent Nomenclature Committee for Fungi. Decisions and appointments of the FNS were ratified in a resolution accepted by the plenary session of the Congress.
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Machado, Kendra Lys Calixto, Taina Araujo, Joao Pedro Ribeiro Baptista, Ivan Schneider Boettcher, and Marcelo Pitombeira de Lacerda. "Primary Care Physician-Based Telemedicine in Non-Malignant Hematology: Prospective Analysis of 790 Consecutive Cases." Blood 138, Supplement 1 (November 5, 2021): 2973. http://dx.doi.org/10.1182/blood-2021-154100.
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Abstract Introduction: In-person hematology appointments (IHA) are not available in most hospitals and outpatient centers in the state of Santa Catarina, Brazil. Primary care physician (PCP) based hematology telemedicine consultation (HTC) has the potential of being a valuable and cost-effective tool for patients and PCPs. While it has not been previously assessed in our country, it may avoid unnecessary IHA, which frequently require traveling to major cities, reduce waiting times for an IHA, and advise PCPs on better assessing patients that may need a hematology referral. Methods: Sistema Integrado Catarinense de Telemedicina is a statewide online tool to which all public health system PCPs have access. It enables PCPs to set up asynchronous HTCs that are randomly distributed to reference hematology treatment centers. HEMOSC Joinville is one such center and is responsible for approximately one fifth of all HTCs. We prospectively assessed all HTC requests in non-malignant hematology between August 2019 and July 2021 for main clinical features that prompted a hematology referral. All cases with confirmed or likely diagnosis of hematological malignancy under the 2017 World Health Organization (WHO) classification were excluded. WHO anemia definition and severity classification was observed. Severe neutropenia and thrombocytopenia required counts below 500 and 50,000 per microliter. For every HTC, a single diagnostic hypothesis in hematology (DHH) was established based on patient data provided by the PCP. Results: Seven hundred and ninety consecutive patients aged 15 or older were included. Median age at HTC was 55 years (interquartile range, IQR: 39-70), with 282 patients (36%) aged 60 or more. Sixty percent of patients (n=472) were women, with 26 pregnant women (3%) at a median gestational age of 15 weeks (IQR: 12-21). Major DHHs were iron deficiency anemia (n=123, 16%), anemia of undetermined cause (n=107, 14%) and unexplained thrombocytopenia (n=102, 13%). Cytopenias accounted for 499 (63%) of all DHHs. Abnormal complete blood count (CBC) or coagulation tests were the sole reason for HTC, in the absence of any attributable clinical finding, in 597 cases (76%). DHHs were adequately formulated by PCP in 140 cases (18%). CBC information was provided in 594 cases (75%), with mild anemia (n=188, 32%) being the most frequent finding. Median hemoglobin when anemia was the DHH was 10 g/dL (IQR: 8.7 - 11.1). Absence of red blood cell (RBC) indices, differential leukocyte counts and platelet counts were seen in 261 (44%), 441 (74%) and 251 (42%) cases. CBC was collected in excess of 60 days prior to HTC in 118 patients (20%) and no CBC information was provided for 196 patients (25%), 31% of which (n=60) had a cytopenia as DHH. Blood transfusions were reported within 60 days of HTC in 49 patients (6%), and an emergency department evaluation was suggested by the hematology specialist for 72 patients (9%). One hundred and ninety (24%) patients were referred to an IHA after HTC, of which 21 (3%), 115 (15%) and 54 (7%) received low, intermediate and high priority for an appointment. Conclusions: Over the reported two-year period, HTC has prevented 3 in every 4 IHA in our patient population. This is especially relevant considering the need for social distancing and the socioeconomic impacts of the COVID-19 pandemic. Follow-up analyses of these patients to identify IHA at a later date and the confirmation of hematological diagnosis are in order. This study also uncovers inappropriate CBC interpretation and reporting, and failure to associate clinical symptoms and patient history to laboratory findings, which in turn demands providing PCPs with continued medical education in hematology. Figure 1 Figure 1. Disclosures Boettcher: Novartis: Speakers Bureau.
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Travis, S., A. P. Bleakman, D. Rubin, M. C. Dubinsky, R. Panaccione, T. Hibi, T. H. Gibble, et al. "A216 BOWEL URGENCY COMMUNICATION GAP BETWEEN HEALTH CARE PROFESSIONALS AND PATIENTS WITH ULCERATIVE COLITIS IN THE US AND EUROPE: COMMUNICATING NEEDS AND FEATURES OF IBD EXPERIENCES (CONFIDE) SURVEY." Journal of the Canadian Association of Gastroenterology 6, Supplement_1 (March 1, 2023): 52–54. http://dx.doi.org/10.1093/jcag/gwac036.216.
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Abstract Background The Communicating Needs and Features of IBD Experiences (CONFIDE) study aims to increase understanding of the impact of symptoms on patients with moderate to severe UC and Crohn’s disease and to investigate gaps in communication with healthcare professionals (HCPs) in the United States (US), Europe (EUR), and Japan. Purpose This report focuses on patients with moderate to severe UC and HCPs from the US and EUR. Method Online, quantitative, cross-sectional surveys of patients with UC and HCPs were conducted in the US and EUR (France, Germany, Italy, Spain, and UK). HCP surveys included physicians and non-physician HCPs responsible for making prescribing decisions. Moderate to severe UC was defined based on treatment, steroid use, and/or hospitalization history. Data collected included perspectives on the experience of patients with UC. Result(s) A total of 200 US (62% male, mean age 40.4 years) and 556 EUR patients (57% male, mean age 38.9 years), and 200 US and 503 EUR HCPs completed the survey. According to US and EUR patients, the top 3 symptoms currently (past month) experienced were diarrhoea (63% and 50%), bowel urgency (47% and 30%) and increased stool frequency (39% and 30%). Blood in stool was reported as currently experienced by 27% and 24% of US and EUR patients, respectively. Among patients currently experiencing bowel urgency, 47% of US and 27% of EUR patients discuss this symptom at every appointment. Among those who do not discuss bowel urgency at every appointment, 74% and 75% of US and EUR patients would like to discuss this symptom more frequently with their HCP. A total of 30% and 43% of US and EUR patients that ever experienced bowel urgency were not comfortable reporting it to their HCP, with 62% and 58% of these US and EUR patients feeling embarrassed talking about this symptom (Table). HCPs in both the US and EUR ranked diarrhoea (74% and 65%), blood in stool (69% and 65%) and increased stool frequency (38% and 34%) as the top 3 symptoms most reported by patients. According to US and EUR HCPs, the top 4 symptoms proactively discussed in routine appointments were blood in stool (93% and 94%), diarrhoea (90% and 91%), increased stool frequency (82% and 82%) and bowel urgency (76% and 82%). Among HCPs who did not proactively discuss bowel urgency, 47% of US and 40% of EUR HCPs expect patients to bring this up if it is an issue. Image Conclusion(s) Communication gaps were similar between US and EUR patients and HCPs. Bowel urgency is the second-most reported symptom by patients with moderate to severe UC. However, this symptom is not among the HCP-perceived top 3 most reported symptoms. Although a substantial proportion of patients reported a desire to discuss bowel urgency more frequently with their HCP, some patients reported feeling embarrassed talking about it. Many HCPs who do not proactively discuss this symptom expect patients to bring this up. A communication gap was identified and highlights the under-appreciation of bowel urgency as an important symptom of UC. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Eli Lilly and Company Disclosure of Interest S. Travis Grant / Research support from: AbbVie, BUHLMANN Diagnostics, ECCO, Eli Lilly and Company, Ferring Pharmaceuticals, International Organization for the Study of Inflammatory Bowel Disease, Janssen, Merck Sharp & Dohme, Normal Collision Foundation, Pfizer, Procter & Gamble, Schering-Plough, Takeda, UCB Pharma, Vifor Pharma, and Warner Chilcott, A. Bleakman Employee of: Eli Lilly and Company, D. Rubin Grant / Research support from: Takeda, Consultant of: AbbVie, Allergan, AltruBio, American College of Gastroenterology, Arena Pharmaceuticals, Athos Therapeutics, Bellatrix Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene/Syneos Health, Cornerstones Health (non-profit), Eli Lilly and Company, Galen/Atlantica, Genentech/Roche, Gilead Sciences, GoDuRn, InDex Pharmaceuticals, Ironwood Pharmaceuticals, Iterative Scopes, Janssen, Materia Prima, Pfizer, Prometheus Therapeutics and Diagnostics, Reistone Biopharma, Takeda, and TechLab, M. Dubinsky Shareholder of: Trellus Health, Grant / Research support from: AbbVie, Janssen, Pfizer, and Prometheus Biosciences, Consultant of: AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly and Company, F. Hoffmann-La Roche, Genentech, Gilead Sciences, Janssen, Pfizer, Prometheus Therapeutics and Diagnostics, Takeda, and UCB Pharma, R. Panaccione Grant / Research support from: AbbVie, Ferring Pharmaceuticals, Janssen, Pfizer, and Takeda, Consultant of: Abbott, AbbVie, Alimentiv, Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Cosmo Pharmaceuticals, Eisai, Elan Pharma, Eli Lilly and Company, Ferring Pharmaceuticals, Galapagos NV, Genentech, Gilead Sciences, GlaxoSmithKline, Janssen, Merck, Mylan, Oppilan Pharma, Pandion Therapeutics, Pfizer, Progenity, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Takeda, Theravance Biopharma, and UCB Pharma, T. Hibi Grant / Research support from: AbbVie, Activaid, Alfresa Pharma, Bristol Myers Squibb, Eli Lilly Japan K.K., Ferring Pharmaceuticals, Gilead Sciences, Janssen Pharmaceutical K.K., JMDC, Nippon Kayaku, Mochida Pharmaceutical, Pfizer Japan, and Takeda, Consultant of: AbbVie, Apo Plus Station, Bristol Myers Squibb, Celltrion, EA Pharma, Eli Lilly and Company, Gilead Sciences, Janssen, Kyorin, Mitsubishi Tanabe Pharma, Nichi-Iko Pharmaceutical, Pfizer, Takeda, and Zeria Pharmaceutical, Speakers bureau of: AbbVie, Aspen Japan K.K., Ferring Pharmaceuticals, Gilead Sciences, Janssen, JIMRO, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Pfizer, and Takeda, T. Gibble Employee of: Eli Lilly and Company, C. Kayhan Employee of: Eli Lilly and Company, E. Flynn Employee of: Eli Lilly and Company, C. Sapin Employee of: Eli Lilly and Company, C. Atkinson Consultant of: Eli Lilly and Company in connection with the development of this publication, Employee of: Adelphi Real World, S. Schreiber Grant / Research support from: personal fees and/or travel support from: AbbVie, Amgen, Arena Pharmaceuticals, Biogen, Bristol Myers Squibb, Celgene, Celltrion, Eli Lilly and Company, Dr. Falk Pharma, Ferring Pharmaceuticals, Fresenius Kabi, Galapagos NV, Gilead Sciences, I-MAB Biopharma, Janssen, Merck Sharp & Dohme, Mylan, Novartis, Pfizer, Protagonist Therapeutics, Provention Bio, Roche, Sandoz/Hexal, Shire, Takeda, Theravance Biopharma, and UCB Pharma, J. Jones: None Declared
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Milner, Jordan, Deborah Friedman, Marise D'Souza, Krishnan Sankaran, Liana Klejmont, Erin Morris, Harshini Mahanti, et al. "Preliminary Results of a Phase II Study to Determine the Safety of Defibrotide in Children and Adolescents with Sickle Cell Disease-Associated Acute Chest Syndrome (IND 127812)." Blood 136, Supplement 1 (November 5, 2020): 8–9. http://dx.doi.org/10.1182/blood-2020-139617.
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Background: Sickle cell disease (SCD) is a vasculopathy resulting in recurrent vaso-occlusive crises leading to endothelial dysfunction, chronic end-organ damage, poor quality of life, early mortality and the major curative therapy to date is allogeneic stem cell transplantation (AlloSCT) (Talano/Cairo, EJH, 2015). Acute chest syndrome (ACS) can result in pulmonary hypertension and is the leading cause of morbidity and mortality in patients with SCD (Gladwin et al, NEJM, 2008). ACS accounts for 25% of deaths (Vichinsky et al, Blood, 1997). Clinical definition of ACS is chest pain, fever, cough, dyspnea, and new pulmonary infiltrate on chest radiography. Defibrotide was approved in the US for the treatment of severe sinusoidal obstructive syndrome (SOS) with renal or pulmonary dysfunction following HSCT (Cairo et al, BJH, 2020). Defibrotide primarily targets endothelium in microvascular beds and has anti-inflammatory and anti-coagulant activity, which can treat the underlying pathophysiology of ACS (Falanga et al, Leukemia, 2003 and Scallia et al, Clin Pharm, 1996 and Pescador et al, Vasc Pharm, 2013). Objective: To determine the safety and toxicity of defibrotide in children, adolescents, and young adults with SCD-associated ACS. Design/Methods: Patients with SCD aged 2 to 40 years meeting ACS criteria (at least two of the following: fever, chest pain, cough, dyspnea, tachypnea, pulmonary infiltrate on chest imaging, decreased oxygen saturation with or without supplemental oxygen requirements) and eligibility were enrolled within 72 hours of diagnosis after consent was obtained (NCT03805581). Baseline studies comprised of chest radiograph, CT chest angiogram, echocardiography with TRJ velocity and brachial artery reactivity, pulmonary function tests, and biomarkers (IFN-a and -g, TNF-a, IL-6, 8, and 10, sCD163, TSP-1, secretory phospholipase A(2), sVCAM-1, sTNFR1, Ang2, sTei-2, PAI-1, sICAM-1, sP-and sE-selectin, sPECAM-1, VEGF-A, C, D and sVEGFR1 and 2). Defibrotide was administered at 6.25mg/kg IV q6 hours and continued for 7 days or until time of discharge, whichever occurred earlier and patients were followed until day +30 following defibrotide. Dose limiting toxicities include Grade III/IV infusion/allergic reaction or hemorrhage probably or directly related to defibrotide. Results: We have enrolled thirteen patients aged 3 to 18 years with a gender ratio (M/F) of 4/9. Patients' genotypes are as follows: hemoglobin SS disease in nine patients, hemoglobin SC disease in two patients, and hemoglobin Sb0/+ thalassemia in two patients. Presenting symptoms included fever, chest pain, cough, dyspnea, tachypnea, pulmonary infiltrate on imaging, and hypoxia.Eight patients completed seven days of treatment, one patient received 6 days of treatment, three patients were discharged after three days of treatment, and one patient withdrew due to recurrent fevers unrelated to defibrotide. All but one patient had resolution of fevers prior to end of treatment. Patients required an average of 1.15 days of oxygen support, with one patient requiring high flow nasal cannula, and no patients required mechanical ventilation. There were no adverse events possibly, probably, or directly related to defibrotide. There was no evidence of hemorrhage in any patient despite four patients receiving concomitant ketorolac or ibuprofen. Of the eleven patients who had pulmonary infiltrates on imaging, eight were evaluated on day +30, two had complete resolution of infiltrate, five had improvements, and one had no change. Seven patients did not follow-up for echocardiography or pulmonary function testing and two of those patients were unable to be evaluated at day +30 due to COVID-19. Discussion: The preliminary data suggest defibrotide is safe and well tolerated in patients with SCD-related ACS. All patients at diagnosis have had baseline studies, which included biomarkers; however, only eight of the thirteen patients have completed all required observations due to poor compliance. After four patients were enrolled and three failed to follow-up, changes to appointment schedules were made with detailed information on all follow-ups. Efforts at improving compliance post therapy are ongoing. Further accrual is needed to determine clinical significance of improvements in cardiac and/or pulmonary function. This study was funded in part by a grant from Jazz Pharmaceuticals. Disclosures Cooke: Jazz Pharmaceuticals: Consultancy, Honoraria, Research Funding, Speakers Bureau. Cairo:Nektar Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; Technology Inc/Miltenyi Biotec: Research Funding; Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Miltenyi: Research Funding. OffLabel Disclosure: Defibrotide is utilized in patients with acute chest syndrome to decrease the amount of time they are hospitalized and to assist in alleviating symptoms. Defibrotide is approved in the US for sinusoidal obstructive syndrome with renal or pulmonary dysfunction.
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Howell, Wallace. "The Precipitation Stimulation Project of the City of New York, 1950." Journal of Weather Modification 13, no. 1 (October 3, 2012): 89–107. http://dx.doi.org/10.54782/jwm.v13i1.40.
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World War II upset New York City’s plans for water supply development, and by 1946 demand exceeded minimum safe yield. Through 3 years of normal rainfall the city stayed lucky. Then in 1949 drought struck. LIFE ran a photograph showing stone walls on the bottom of Croton Reseroir that had been covered since 1852. By Christmas, Cardinal Spellman had asked the faithful to pray for rain, Mayor O’Dwyer had outlawed car-washing, and Water Commissioner Steve Carney had launched Shaveless Fridays. Restaurants served water only on request. On January 25, 1950, when Irving Langmuir read a paper at a New York meeting of the American Meteerological Society, reporters were ready. Could cloud seeding help the city? "Highly probable," said Langmuir. "* * * ought to be consulted," said a New York Times editorial. In mid-February, Langmuir came to visitCarney. When they emerged from the Commissioner’s office to face the reporters, they were smiling. No, for liabilityreasons General Electric would not seed the city’s clouds, but they would recommend "a meteorologist of the new school of thinking." That day Vince Schaefer telephoned me. ."You might get a call from NewYork City," he said. I called Ken Spengler for advice, not knowing at the time that he had been in close touch with Dr. Reichelderfer, Chief of the Weather Bureau, about how to keep the city’s enthusiasm from going off the track. "It might as well be you," he told me, and added "It would benefit the profession if you asked a top fee, $100 a day." The LaGuardia terminal had just opened. When I got off the airplane there a few days later, I hurried through its cold, sagging arms where the fill was still settling, unaware that a red-carpet delegation with reporters in attendance was waiting to conduct me to the Mayor’s office. By bus and subway, I beat them to City Hall. On February 21st O’Dwyer announced my appointment as special rainmaking consultant, and by March 15th a plan of action had been agreed upon and funds appropriated. Weather modification turned over a new leaf. Exactly a week later, a process server handed O’Dwyer a summons a suit to keep the in city from spoiling the tourist season in the Catskills. No restraining order was issued, so the city would go ahead anyway. For once, justice moved swiftly. On May llth,Justice Pecora for the NewYork Appeals Court handed down the first weather modification decision in history. "This Court must balance the conflicting interestsbetween a remote possibility of inconvenience to the plaintiffs’resort and its guests with the problem of maintaining and supplying the inhabitants of the city of New York and surrounding areas, with a population of 10 million inhabitants, with an adequate supply of pure and wholesome water. The relief which the plaintiffsask is opposed to the general welfare and the public good; and thedangers which plaintiffs apprehend are purely speculative. This Court will not prevent a possible private injury at the expense of a possible public advantage." Then the Palisades Amusement Park offered me $200 a day to quit.
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Эйлер Алексей, Андреевич. "THE FIGHT AGAINST THE EPIDEMIC DESEASES IN TAURIDIAN PROVINCE IN 1860–1890S." Medicine and health care organization 9, no. 1 (March 26, 2024): 69–80. http://dx.doi.org/10.56871/mhco.2024.37.24.007.
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Статья характеризует уровень развития медицины в Российской Империи в 1860–1890- х годах на основе сведений Таврической губернии, отмечает основные заболевания, с которыми приходилось сталкиваться врачам и фельдшерам, приводит конкретные факты и статистические данные. Ее основная цель — подчеркнуть позитивные и негативные явления борьбы сразличными болезнями; обратить особое внимание на передовые новшества, способствовавшие успешной борьбе с ними. Ее основная задача — показать на конкретных примерах, что медицинскому персоналу зачастую приходилось противостоять заражениям почти в одиночку, ежедневно подвергать опасности свои жизнь и здоровье, соприкасаться с инертностью и равнодушием масс обывателей. В работе предпринята попытка выявить причины возникновения высокой смертности населения, показать конкретные меры, предпринимаемые медиками для снижения катастрофических последствий эпидемий. Публикация делает более наглядными методы борьбы с различными острыми болезнями, рассказывает о многочисленных успехах, которых удалось достичь таврическому медицинскому персоналу. Среди новшеств, широко внедрявшихся на практике в конце XIX века, — вакцинация от оспы, привлечение к проведению прививок и уходу за больными женского медицинского персонала, меры по изоляции зараженных в отдельные помещения, регулярная дезинфекция отдельных домов и целых населенных пунктов, назначение особых попечителей для надзора за санитарным состоянием улиц и дворов. Начало 1890-х годов ознаменовалось созданием в Симферополе при Таврической губернской земской управе особых координирующих органов (Таврического врачебного совета и санитарного бюро), облегчивших сбор и обработку статистических данных, составление годовых отчетов, проведение мер по борьбе с болезнями в масштабах всей губернии. Научную ценность статьи подчеркивает использование документов Государственного архива Республики Крым, почти не внедренных в поле зрения исследователей. The paper characterizes the level of the development of medicine in the Russian Empire in 1860-th — 1890-th on the basis of information from the Tauridian Province, marks the main diseases that doctors and paramedics had to deal with, provides specific facts and statistic data. Its main task is to show by concrete examples that medical personnel often had to resist infections almost alone, endanger their lives and health on a diary basis, come into contact with the inertia and indifference of the majority of ordinary people. It making an attempt to identify the causes of high mortality of the population, to show particular measures, which had been taken by physicians for reducing of the catastrophic consequences of epidemics. The publication highlights the methods of combating various acute diseases, tells about numerous achievements that the Tauridian medical staff managed to succeed. Among the innovations that were widely implemented in practice at the end of the XIXth century were vaccination against smallpox, involvement of female medical personnel in inoculations and patient care, measures for isolation infected people in separate spaces, regular disinfection of individual houses and entire settlements, the appointment of special trustees to monitor the sanitary condition of streets and courtyards. The beginning of the 1890-th was marked by the creation of special coordinating institutions (the Tauridian Medical Council and the Sanitary Bureau) in Simferopol under the Tauridian Provincial Zemstvo Authority, which facilitated the collection and processing of statistical data, preparing annual reports and the implementation of measures to combat diseases throughout the region. The scientific value of the research is emphasized by the integration of rarely used materials from the documents of the Crimean Republic State Archive, being almost not introduced into the view point of researchers.
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Anderson, Gerald. "Peter Parker and the Introduction of Western Medicine in China Peter Parker et l'introduction de la médecine occidentale en Chine Peter Parker und die Einführung westlicher Medizin in China Peter Parker y la Introducción de Medicina Occidental en China." Mission Studies 23, no. 2 (2006): 203–38. http://dx.doi.org/10.1163/157338306778985776.
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AbstractIn the context of the life and missionary career of Peter Parker, M.D., a graduate of Yale who went to China in 1834, this article looks first at three issues: Who was the first medical missionary? Who was the first medical missionary in China? Who first introduced Western medicine in China?It also considers the tensions in the emerging understanding of the role of a medical missionary in the mid-nineteenth century, and the problems this caused for Parker, which led to his dismissal by the American Board of Commissioners for Foreign Missions.It then assesses the role of Parker as an American diplomat, when he became involved, first as a part-time secretary and interpreter, and confidential advisor, for the U.S. Commissioner to China, and helped to negotiate the first treaty between China and the United States in 1844. And later when Parker himself was appointed as the US Commissioner, and proposed aggressive military action against China, which led to his recall by the US State Department.Finally, in retirement for 30 years in Washington, DC, Parker received numerous honors and recognition, including appointment as a corporate member of the American Board, which earlier had terminated him as a missionary. Jetant un regard sur la vie et la carrière missionnaire de Peter Parker, M.D., diplômé de Yale parti en Chine en 1834, cet article pose d'abord trois questions: Qui a été le premier missionnaire médecin? Qui a été le premier missionnaire médecin en Chine? Qui a le premier introduit la médecine occidentale en Chine?Il considère aussi les tensions à l'œuvre dans la conception progressive du rôle d'un missionnaire médecin au milieu du dix-neuvième siècle, et les problèmes que cela a causé à Parker, allant jusqu'à la démission de ses fonctions par le Bureau américain des Missions étrangères.Il évalue ensuite le rôle de Parker comme diplomate américain lorsqu'il entra en scène d'abord comme secrétaire-interprète à temps partiel et conseiller particulier du Haut-commissaire américain pour la Chine, et qu'il aida à négocier le premier traité entre la Chine et les Etats-Unis en 1844. Et plus tard, lorsque Parker fut lui-même nommé Haut-commissaire américain et proposa une action militaire agressive contre la Chine, ce qui conduit à son rappel par le Département d'Etat américain.Finalement, retiré pendant trente ans à Washington, D.C., Parker reçut reconnaissance et de nombreux honneurs, y compris sa nomination au Bureau américain qui l'avait démis comme missionnaire quelques années auparavant. Im Zusammenhang mit dem Leben und der Missionslaufbahn des Arztes Peter Parker, einem Absolventen von Yale, der 1834 nach China ging, beleuchtet dieser Artikel eingangs drei Fragen: Wer war der erste ärztliche Missionar? Wer war der erste ärztliche Missionar in China? Wer hat die westliche Medizin als erster in China eingeführt?Der Artikel behandelt auch die Spannung zwischen dem damals entstehenden Begriff der Aufgabe eines ärztlichen Missionars Mitte des 19. Jahrhunderts und den Problemen, die er für Parker bedeutete und die zu seiner Entlassung vom American Board of Commissioners für auswärtige Mission führte.Dann bewertet der Artikel die Rolle Parkers als amerikanischer Diplomat, als er zuerst als Teilzeit Sekretär, Übersetzer und geheimer Berater für den US Commissioner in China arbeitete und ihm half, 1844 den ersten Vertrag zwischen China und den USA auszuhandeln. Und später, als Parker selbst zum US Commissioner bestellt wurde und eine aggressive militärische Vorgangsweise gegen China vorschlug, was zu seiner Abberufung durch das US State Department führte.Schließlich, über 30 Jahre im Ruhestand in Washington D.C., erhielt Parker zahlreiche Ehren und Anerkennung, eingeschlossen seine Berufung als Vollmitglied des American Board, das ihn früher als Missionar abgesetzt hatte. En el contexto de la vida y carrera misionera de Peter Parker, M.D., un graduado de la universidad Yale que fue a China en 1834, este artículo examina primero tres asuntos: ¿Quién era el primero misionero médico? ¿Quién era el primero misionero médico en China? ¿Quién era el primero para introducir medicina Occidental en China?También considera las tensiones en el entendimiento desallorrando del papel de un misionero médico en el siglo medio-decimonono, y los problemas éstas causó para Parker, que llevó a su despido por el Junta Norteamericano de Comisionados de las Misiones Extranjeras.Luego el articulo evalúa el papel de Parker como un diplomático norteamericano, cuando llegó a ser ocupado, primero como una secretaria de la jornada incompleta e intérprete, y consejero confidencial, para el EE.UU. Comisionado a China, y ayudó negociar el primer tratado entre China y los Estados Unidos en 1844. Y más tarde cuando Parker que se fijó como el Comisionado estadounidense, y se propuso acción agresiva militar contra China, que resultó en su revocación por el EE.UU. Departamento Estatal.Finalmente, durante su jubilación de 30 años en Washington, D.C., Parker recibió honores numerosos y reconocimiento, incluso su nombramiento como un miembro corporativo de la Junta Norteamericana, que más temprano lo había terminado como un misionero.
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Bhurani, M., S. Hall, A. Ostor, and A. Gibson. "FRI0200 TIME TO FLARE IN GIANT CELL ARTERITIS AND POLYMYALGIA RHEUMATICA AND REVIEW OF THE LITERATURE." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 683.1–683. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2421.
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Background:Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are two closely related inflammatory rheumatic diseases of the elderly. While glucocorticoid treatment leads to a dramatic initial improvement, the course of the diseases remains unpredictable and multifarious. Flare and relapses are common, however, data on this is limited[1][2].Objectives:We set out to evaluate the flare rate, time to first flare and steroid dose during flare of patients diagnosed with GCA and PMR in our practice. The aim was to identify optimal timing for clinical review and contribute towards best practice.Methods:A total of 218 patients diagnosed with GCA (38) and PMR (180) seen between 2015 and 2020 were audited. Demographic data was collected. Relapse rate, time to initial flare and steroid dose during flares were the primary endpoints for our analysis. Steroid sparing agent use was also documented.Results:Our cohort comprised of 38 GCA patients (M=15; F=23) and 180 PMR patients (M=71; F=99) who were diagnosed between January 2015 and January 2020.The mean age of diagnosis for patients with GCA and PMR was 73 years and 71 years respectively. 10 patients (4.6%) with PMR later progressed to develop Rheumatoid Arthritis and hence, were excluded from subsequent analyses. Most patients received an initial treatment of corticosteroid therapy for both diseases with a mean dose of 39.74mg for GCA and 18.23mg for PMR. During a mean follow up time of 13.8 months, 75 patients (36%) (GCA= 6; PMR =69) experienced at least one flare which was determined by clinical diagnosis either by unremitting reversion of initial symptoms and/or elevated inflammatory markers. While 13 patients (6%) (GCA = 2; PMR =11) had a flare following completion of initial steroid therapy, 62 patients (30%) (GCA = 4; PMR = 58) experienced flares during steroid tapering, the mean steroid dose observed during disease flare for the latter was 5.25 mg for GCA and 4.67 for PMR. Majority of relapses/flares for PMR patients occurred within the first year of diagnosis (mean = 8.38 months) and after the first year of diagnosis in GCA patients (mean = 15 months). Methotrexate was the most common traditional DMARD trialed as a steroid sparing alternative (GCA = 4; PMR =23) mostly introduced post flare/relapse. The mean appointment intervals for flares/relapses in our cohort was noticed to be during the 5thand 6thscheduled clinical review for GCA and between the 3rdand 4thclinical review for PMR patients.Conclusion:A flaring and relapsing course is common to both GCA and PMR especially during steroid dose tapering. Increased clinical surveillance and more gradual steroid tapering, particularly at the time when most flares/relapses are observed may help improve clinical outcomes and reduce glucocorticoid requirements in patients.References:[1]Martinez-Lado L, Calviño-Díaz C, Piñeiro A, Dierssen T, Vazquez-Rodriguez T, Miranda-Filloy J et al. Relapses and Recurrences in Giant Cell Arteritis. Medicine. 2011;90(3):186-193.[2]Kim H, Lee J, Ha Y, Kim S, Lee C, Choi H et al. Induction of Remission is Difficult due to Frequent Relapse during Tapering Steroids in Korean Patients with Polymyalgia Rheumatica. Journal of Korean Medical Science. 2012;27(1):22.Disclosure of Interests:Mansi Bhurani: None declared, Stephen Hall Grant/research support from: Abbvie, UCB, Janssen, Merck, Andrew Ostor Consultant of: MSD, Pfizer, Lilly, Abbvie, Novartis, Roche, Gilead and BMS, Speakers bureau: MSD, Pfizer, Lilly, Abbvie, Novartis, Roche, Gilead and BMS, Andrew Gibson: None declared
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Jain, N., N. Reddy, and A. Moorthy. "AB0953 CANNABINOIDS: FRIEND OR FOE OR A BYSTANDER?" Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1774.2–1774. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6449.
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Background:Cannabinoids has recently gained popularity for use in chronic pain. There is a lot of inquisitiveness among our patients wherein health care professionals are asked about its efficacy, side effects and sometimes even ask for a prescription! As there is paucity of data and research about its use in rheumatology, patient reported outcome(PROM) can guide ahead in expanding our knowledge and experience.Objectives:To study usage of cannabinoids by rheumatology patientsTo study awareness among primary physicians regarding Cannabinoid usage in rheumatology.Methods:Cross sectional survey with two arms. Arm 1 Information from patients attending tertiary rheumatology clinic,including perception regarding the use of Cannabinoids.Arm 2 consisted of collecting data via web-based survey with20-question from 100 GPs of Leicestershire. Questions on demographics, perspectives on and knowledge of cannabinoid use. Statistical analysis SPSS software.Results:Arm1 Total 102 rheumatology patients with 60%were females and 45% secondary education. 48% were unemployed. 75% Caucasians, 18% Asians. RA most common diagnosis followed by OA and FMS. 40 % depression and anxiety in addition to Rheumatic disease. 94% reported ongoing pain with 6-8 on a VAS scale. 79% were satisfied with their current therapy. 65% had heard about complementary medicine and 15% reported using cannabinoids.Most common form Cannabinoids oil 60% followed by smoking 20%. 56% reported using >3 months and majority 72% use daily. Median age 55 years. 88% users Caucasians. Mean disease duration 6.25 years among users indicates chronicity of disease has a direct proportion in usage. All users had ongoing pain of 7 on VAS. 87% believed it helps them managing pain effectively with a pain free state. On an average spends between 50-100 pounds per week. More than half believe cannabinoids should be available as a prescription drug in NHS and 30% interested to know more about it.In Arm 2 consisting of Primary care physicians, response rate 50%. Average clinical experience 5 years. Only 20% heard about usage of complementary medicine by rheumatology patient. Most replied that 10% of their patients use Cannabinoids for pain management. Most did not believe use of cannabinoids benefited the patients. Only 4% recommend its usage. 25% think it should be available as prescription. 40% experienced patients asking about cannabinoids during appointment. 88% of respondents did not know much about cannabinoid usage in rheumatology and have never prescribed it in their practice.Conclusion:Cannabinoids widely used by the rheumatology patients with PROM favouring its efficacy for control of chronic pain. Preclinical data suggest that cannabinoids might have a therapeutic potential RA1, OA, FMS2. Clinical data regarding cannabinoid treatment for rheumatic diseases are scarce, therefore, recommendations concerning cannabinoid treatment cannot be made. All patients who reported using it suffered from moderate to severe chronic pain. Thus main indication of usage was pain rather than recreational purpose. Although a small survey it clearly highlights lack of knowledge among primary physicians. These results emphasise the need for further research regarding the benefits and risks of cannabinoids in rheumatology.References:[1]RichardsonD. etal Characterisation ofthe cannabinoid receptor system in synovial tissue andfluid in patients with OA and RA Arthritis Res.Ther. 10, R43 (2008).[2]Walitt, B etal Cannabinoids for fibromyalgia. Cochrane DatabaseSyst. Rev. 7, CD011694 (2016).Disclosure of Interests:Nibha Jain: None declared, Neelima Reddy: None declared, Arumugam Moorthy Speakers bureau: Abbvie, Novartis,UCB,MSD
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Shevchenko, Zhanna. "FEATURES OF PRACTICAL EDUCATION OF SOCIAL EMPLOYEES IN PRACTICE IN HIGH SCHOOL OF POLAND." Scientific bulletin of KRHPA, no. 11 (2019): 22–35. http://dx.doi.org/10.37835/2410-2075-2019-11-3.
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The article is devoted to the practical component of the professional training of a social worker in a Polish high school. Conceptual approaches are considered in relation to professional preparation of development workers and experience actualized by them with practical preparation at higher school of Poland. It is found out, that preparation of development workers in Poland is a difficult and dynamic process, that permanently changes in accordance with international standards, normative requirements, social changes and necessities on this type of services. As a result of scientific research, the tendency to introduce professional training in the practice of Polish social workers on the progressive approaches of practical experience in the social sphere of European countries and the United States has been traced. It is noted that the model of structured learning is based on the use of a curriculum on a modular basis. Different teaching methods, especially simulation and activity (training in the "team") are used. Equally important is the acquisition of skills, and the assimilation of the value basis of the student's work. Assessment is based on the criteria of competence. The student works under the direct supervision and supervision of the practice leader. Emphasis is placed on the theory of practical learning through experience. According to the results of the study, the organizational and pedagogical conditions of the organization and content of practical training of social workers in practice in Poland are set out: legislative regulation of general principles of practice and internship in Polish universities; the removal of a significant part of the study load (from 40% to 60%) into the obligatory volume of the organization of students' practice directly at the workplace; continuity of the practical orientation of the educational process to practical learning through experience in practice; compliance of modules of practical training programs in practice under the Framework Program for the qualification of a social worker: knowledge, skills, social competences; the variability of the proposals for places of practice for students and the proposed contact letters at the information stands of the departments of social work (pedagogy); provision of means for checking the implementation of modules by trainees through the electronic network, depending on the form of training and the student's capabilities (stationary, correspondence, distance, etc.); providing support for practical training of future social workers in practice (contact hours, independent work, literature to silabases (programs) of practice, etc.); consistency of the procedure for managing and controlling individual programs of student practice from the university and social institution; Settlement of the appointment of students responsible for passing the practice: the coordinator (for bachelors, mainly masters), a mentor, a representative from the practice institution and the manager of the management of the career bureau. The study concluded that the practical component of the program for the training of future social workers in Ukraine should be based on familiarizing students with the European forms, methods and techniques of work, and also involving them in direct and continuous practical activities, under the guidance of experienced mentors and consultants. The exposure of progressive ideas of experience of practical aspect of preparation of development workers in Poland will assist the scientific ground of strategy of development of professional preparation of specialists of social sphere in Ukraine on the stage of her transformation and integration in European and world educational space. The prospects of research of directions of co-operation of establishments of education are certain with employers and other social partners in the process of professional preparation and passing of types of practices by the future specialists of social work.
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Garrido-Cumbrera, M., H. Marzo-Ortega, J. Correa-Fernández, S. Sanz-Gómez, L. Christen, and V. Navarro-Compán. "POS1175 ASSESSMENT OF THE COVID-19 PANDEMIC FROM THE PERSPECTIVE OF PEOPLE WITH RHEUMATIC MUSCULOSKELETAL DISEASES IN EUROPE. RESULTS FROM THE REUMAVID STUDY (PHASE 1)." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 868–69. http://dx.doi.org/10.1136/annrheumdis-2021-eular.956.
Full textAbstract:
Background:The COVID-19 pandemic is an unprecedented public health crisis affecting people worldwide, including those with rheumatic and musculoskeletal diseases (RMDs).Objectives:REUMAVID aims to assess the impact of the COVID-19 pandemic and lockdown on the wellbeing, mental health, disease activity and function, access to health care and treatment, support services, and hopes and fears of people RMDs.Methods:REUMAVID is an international collaboration led by the Health & Territory Research group at University of Seville, Spain, together with a multidisciplinary team including patient organization and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain and the United Kingdom. Participants are recruited by patient organizations. Data is collected in two phases: 1) during the first peak of the COVID-19 pandemic (Spring 2020), and 2) as a follow-up to the pandemic (Winter 2020). This analysis presents descriptive results of the aggregated data, summarizing continuous and categorical variables.Results:A total of 1,800 RMD patients have participated in the first wave of the COVID-19 pandemic (from early April to mid-June 2020). The most frequent reported diagnosis were axial spondyloarthritis (37.2%), rheumatoid arthritis (29.2%) and osteoarthritis (17.2%). Mean age was 52.6±13.2, 80.1% were female, 69.6% were in a relationship or married and 48.6% had university studies. In total, 1.1% had tested positive for COVID-19, 10.8 % reported symptoms but were not tested, while 88.1% did not experience any symptoms. 46.6% reported worsening health during the pandemic. 63.9% perceived their health status to be “fair to very bad”. Access to care was limited with 58.4% being unable to keep the rheumatologist appointment, of which, 35.2% were cancelled by the provider and 54.4% was attended by phone or online. 15.8% changed their medication, for which 65.5% were changed by the provider and 24.6% by own decision. Reported wellbeing and psychological health during the pandemic was poor, with 49.0% reporting poor wellbeing according to the WHO-5 scale, 57.3% marking as anxiety and 45.8% as depression in the HADS scale. During the pandemic, 24.6% smoked and 18.2% drank more than before and 54.5% were unable to exercise at home.Conclusion:Results from the first phase of REUMAVID show disturbance of the healthcare quality, substantial changes in harmful health behaviors and an unprecedented impairment of mental health in REUMAVID participants. REUMAVID will continue to collect information in order to assess the impact of the COVID-19 pandemic in people affected by RMDs across Europe.Acknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations, the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Laura Christen Employee of: Novartis Pharma AG, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.