Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic reviewof the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review.Atotal of 44 globally representativegroupmembersmet in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents

Serum haptoglobin levels in ocular Behcet disease and acute phase proteins in the course of Behcet disease

WOS: 000263246000020PubMed: 18850559PURPOSE. Changes in concentrations of acute phase proteins in the serum of patients might be significant in the pathogenesis of Behcet disease. This report investigates the association between ocular disease activity and serum haptoglobin levels in patients with Behcet disease, and summarizes the current understanding of the correlation between acute phase proteins and Behcet disease based on both personal studies and data from the literature. METHODS. Thirty patients with Behcet disease with ocular involvement and 15 healthy subjects were included in the study. Of the 30 patients, 14 had acute uveitis and 16 had inactive ocular involvement at the time of enrollment. RESULTS. There was a significant difference in haptoglobin levels between the patients with active ocular disease and controls (p=0.0005). There was also a significant difference in haptoglobin levels between the patients with inactive ocular disease and control subjects (p<0.0001). However, no significant difference was observed among patients with active versus inactive uveitis with regard to serum haptoglobin levels. CONCLUSIONS. Higher serum haptoglobin levels in patients with Behcet disease compared to control subjects were obtained. However, elevated serum haptoglobin levels do not seem to be a risk factor for uveitis activity. Behcet disease is generally diagnosed by physical examinations and no laboratory marker has been widely accepted for follow-up of disease activity. (Eur J Ophthalmol 2008; 18: 787-91

Human Resource Scheduling and Routing Problem in Home HealthCare Context: A Literature Review

Home Health Care (HHC) service is an alternative to the conventional hospitalization. The goal is to deliver medical, paramedical and social services to patients at their homes, which help them to improve and keep their best clinical, psychological and social conditions. As a large number of resources (i.e., material and human) contribute to delivering the HHC service, there are many issues that should be considered. Among these, the resource scheduling and routing problem (i.e., deciding in which sequence each operator will visit patients assigned to him/her) is one of the most important issues to be addressed while planning HHC resources. In this paper, we review studies in the literature that address the scheduling and routing problem as a Traveling Salesman Problem (TSP) or Vehicle Routing Problem (VRP) in the HHC context. We analyze each study according to four main categories: i) study characteristics, ii) modeling characteristics, iii) network characteristics, and iv) data characteristics. The objective of this review is to highlight the unexplored issues in researches dealing with the resource scheduling and routing problem, formulated as either TSP or VRP in the HHC context

A Two-Stage Approach for Solving Assignment and Routing Problems in Home Health Care Services

Human resource planning in Home Health Care (HHC) services is a critical activity that may also affect the quality of the delivered care. The assignment of the patient to operators together with their routing in the served territory are relevant problems that service providers have to deal with on a daily frequency. These problems can be either solved with a two-stage approach or with a simultaneous approach. The simultaneous approach enables to hold both assignment and routing decisions at the same time, however solving this problem is computationally difficult. The two-stage approach is the easier way of solving the assignment and routing problems, but an estimation of travel times is required to properly decompose the simultaneous approach into the two stages. This paper presents a new method to estimate operator travel times based on the Kernel Regression technique. Estimation is made on the basis of the operator travel times observed from previous periods. Numerical results based on realistic problem instances show that the proposed estimation method performs better than the classical Average Value method and that the whole approach is promising to construct realistic schedules

Ocular Behcet's disease presenting with retinal tear and panuveitis

WOS: 000260917500017PubMed: 18344955