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Ticks
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
Other tick species may be involved in the ecology of Lyme borreliosis in the United States. Also, there may be several, as yet undescribed, Borrelia species that cause Lyme-like illness, such as one recently described.25 In the southern United States, there have been reports for years about an LB-like illness of unknown etiology which has associated EM lesions.26 The Centers for Disease Control and Prevention (CDC) often just classifies these cases as southern tick-associated rash illness (STARI) (see text box).
Reporting the study of your improvement
Published in David P. Stevens, Writing to Improve Healthcare, 2018
Think carefully about the underlying theory for your improvement initiative. At the risk of being overly formulaic, another way to test your rationale is to hold it up to the criteria suggested by the authors of SQUIRE 2.0 AND StaRI Publication Guidelines. The authors of the StaRI Guidelines ask for your hypothesis with particular attention to background information and a rationale for how the implementation might work [10]. The authors of SQUIRE 2.0 offer a somewhat more granular mini-checklist to define your rationale—“informal or formal frameworks, models, concepts and/or theories used to explain the problem, any reason or assumptions that were used to develop the intervention and reason why the intervention(s) was expected to work” [2].
Ticks
Published in Jerome Goddard, Public Health Entomology, 2022
Lyme disease. Lyme disease or Lyme borreliosis (LB), caused by the spiro-chete Borreliella burgdorferi, is a systemic tickborne illness with many clinical manifestations that occurs over much of the world in temperate zones (Figure 10.7). NOTE: Recently, researchers have moved all LB-producing bacterial species into the genus Borreliella, leaving the tick-borne relapsing fever-producing species in the genus Borrelia, causing some confusion (see textbox).1,2 Although rarely fatal, Lyme borreliosis may be long and debilitating with cardiac, neurologic, and joint involvement. The most recognizable clinical sign of LB is an expanding bull’s eye rash called erythema migrans (Figure 10.8). The number of reported LB cases in the United States continues on an upward trend. There were 33,666 cases reported to the CDC in 2018,3,4 but an estimate based on insurance claims data is 476,000 cases per year.5 In the United States, the vast majority of cases are from the northeastern and north-central states (Figure 10.7) and are transmitted by the deer tick, Ixodes scapularis. Other Lyme-like illnesses have been described in the medical literature and this causes confusion. In the southern United States, for example, the Centers for Disease Control often labels these Lyme-like illnesses as Southern Tick-associated Rash Illness (STARI) (Figure 10.9). Cases of STARI may be due to allergic reactions to tick saliva or other (as yet) unknown causes.6 Many physicians still persist in diagnosing such lesions resulting from tick bites as the erythema migrans lesion of Lyme borreliosis.6 However, there are reports of erythema migrans in humans without any evidence of infection with the LB agent.7 Diagnosis of Lyme borreliosis is generally based upon clinical presentation which can be more or less accurately confirmed (depends on who you ask) by a two-step procedure: a sensitive enzyme-linked immunosorbent assay followed by immunoblot (IgM and IgG) if reactive. There have been proposals to change this recommended 2-tier algorithm to one consisting of two different types of ELISA tests (and eliminate the Western blot).8 This approach would make the tests easier to perform, reduce subjectivity in interpreting Western blots, and be cheaper. It should be noted that there are a number of tests for LB which are unreliable and not recommended, such as various tests of bodily fluids, polymerase chain reaction (PCR) of urine, and lymphocyte transformation tests.9–11
Diagnosis and management of Lyme neuroborreliosis
Published in Expert Review of Anti-infective Therapy, 2018
Determining the likelihood the patient has Lyme borreliosis requires presence of a finding with high positive predictive value for the diagnosis. Typical EM occurs almost exclusively with Lyme borreliosis – the ‘almost’ reflecting the occurrence of Southern tick-borne rash illness (STARI) – a rash that follows tick bites, is visually indistinguishable from EM, but is not attributable to any identified microorganism and is not associated with any systemic involvement. Fortunately, its geographic distribution is largely different from EM so differentiating between the two is not typically a concern.
Implementation of an integrated multidisciplinary Movement Disorders Clinic: applying a knowledge translation framework to improve multidisciplinary care
Published in Disability and Rehabilitation, 2021
However, a strength of this study was that it was informed by behaviour change theory, thus allowing clear methodological rationales and potentially replicable results [50,51]. Furthermore, the StaRI Statement [33] were followed, which is important to ensure quality and transparent reporting. An additional strength was the triangulation of the quantitative and qualitative data [52], which increased the understanding of the audit results and gave insight into the implementation process from multiple stakeholders’ perspectives.
Implementing enhancements in supervised group exercise for people with axial spondyloarthritis: a hybrid effectiveness–implementation study
Published in Scandinavian Journal of Rheumatology, 2023
B Hilberdink, F van der Giesen, T Vliet Vlieland, L van Bodegom-Vos, S Van Weely
The study complies with the Declaration of Helsinki and obtained ethical approval from the Leiden University Hospital Ethical committee [P14.326]. The guidelines of the Standards for Reporting Implementation Studies (StaRI) initiative were followed for the reporting of this pilot implementation study (36).