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Rheumatoid Arthritis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Brent A. Luedders, Ted R. Mikuls, James R. O’Dell, Bryant R. England
The incidence of most extra-articular RA features is on the decline due to improved treatment, but that is not the case for RA-ILD, which dramatically reduces the longevity of RA patients. Furthermore, there is a paucity of evidence (and as a result no clinical practice guidelines) to guide management of RA-ILD. Therefore, prevention efforts must not stop with articular disease but also include efforts to prevent extra-articular features of disease beyond the current practice of tightly controlling articular disease. Factors associated with RA-ILD risk have included seropositivity, older age, male sex, cigarette smoking history, and more severe RA.171 Unfortunately, none of these risk factors alone or together is able to predict RA-ILD with an adequate sensitivity or specificity. Improved risk stratification is needed to guide prevention efforts and could be achieved by combining genetic and peripheral biomarker data with relevant clinical data. RA-ILD risk stratification will then need applied systematically across RA patients, both clinically apparent and preclinical RA. Recognizing the variability in the timing of RA-ILD onset in the RA disease course, risk stratification will need to be performed serially throughout the disease course.
An Approach to Oculomotor Anomalies in a Child
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Oculomotor anomalies in a child can present a challenge to physicians. A good rule of thumb is to consider a workup, including neuroimaging, for all acquired anomalies. Risk stratification should include patient-specific data such as age, onset of abnormality, characteristics of the oculomotor findings, duration of symptoms, comorbid neurological signs and symptoms, and the specific type of anomaly. After risk stratification, urgency of further evaluation and treatment can be considered.
Creating Value Today with AI
Published in Tom Lawry, Hacking Healthcare, 2022
Chronic condition management is an area where AI can assist clinicians in providing better intuitive care management. AI solutions can transform the status quo, which is characterized by data non-interoperability, provider burnout, and care leakages. Integration of lifestyle data with AI platforms can provide compelling near-term benefits for preventive care practice. General focus areas include population health risk stratification, predictive analytics for preventative care, and guidance for optimal disease management.
Neuroimaging in professional combat sports: consensus statement from the association of ringside physicians
Published in The Physician and Sportsmedicine, 2023
If the recommended imaging shows evidence that suggests a brain abnormality, evidence of prior/chronic TBI or change from baseline, the decision to medically clear a combat sports athlete to compete should be made on a case-by-case basis. Ringside physicians/commissions may request additional neuroimaging (as detailed above) and a formal neurocognitive evaluation of the combat sports athlete. Specific neuroimaging consideration needs to be given to the development or progression of cavum septum pellucidum and cavum vergae. The ongoing Professional Fighters Brain Health Study has demonstrated an association between these two findings and decreased cognitive performance [35]. Risk stratification is the process of identifying the individual risk of a combat sports athlete suffering from a particular condition after careful review of history, laboratory, and clinical tests. Some combat sports athletes may warrant disqualification and denial of license to compete, and others may be medically cleared to compete after careful review of all relevant history, neurocognitive examination, and imaging findings.
Should we be reluctant to perform pancreatectomy in patients with chronic liver disease? A single center 10-year experience
Published in Acta Chirurgica Belgica, 2023
Woo-Hyoung Kang, Young-Dong Yu, Kyung-chul Yoon, Hye-Sung Jo, Dong-Sik Kim
Therefore although portal hypertension in the presence of established liver disease is considered a significant surgical risk for intra-abdominal surgery, pancreatic surgery may be done safely in patients with well-compensated liver disease [14]. However, there are no reported series or evidence-based guidelines on the management of patients with cirrhosis and resectable pancreatic cancer, although there are reports about sealing devices to achieve hemostasis and the use of a transjugular intrahepatic portosystemic shunt preoperatively to decrease the portal pressure [12,24,25]. As a result, risk stratification of these patients is important. CTP score is helpful in predicting the likelihood of postoperative complications and mortality, although this is disputed [7,26,27]. MELD score is correlated with postoperative mortality in patients with cirrhosis undergoing nontransplant surgical procedures [26,28].
A model for predicting the overall survival of gastroenteropancreatic neuroendocrine neoplasms after surgery
Published in Scandinavian Journal of Gastroenterology, 2022
Lu-Huai Feng, Tingting Su, Yang Lu, Shuang Ren, Lina Huang, Xiuyu Qin, Tianbao Liao
Another strength of the present study is that we considered a diverse range of previously documented factors related to the survival of GEP-NEN patients [1,20,26]. Although prognostic factors for GEP-NENs have been widely documented, the Ki-67 proliferation index and TNM staging system are still the most widely used [5,7]. Nonetheless, much controversy surrounds the Ki-67 proliferation index, with no consensus on Ki-67 threshold values for prognosis stratification. While the latest WHO 2017 classification for neuroendocrine neoplasms suggests a new threshold value, a growing body of evidence recommends modifying the cut-off values of the Ki-67 index to better stratify patients for predicting prognosis and design of treatment plan [27–30]. In addition, several studies have assessed the prognostic value of the TNM staging in GEP-NENs patients and found that both the AJCC and ENETS TNM classifications have overlapping stages, explaining the considerable variability in survival rates [31–34]. Accordingly, these risk stratification systems have limited ability to predict the survival of an individual patient.