9 research outputs found
Egyptian consensus on treat-to-target approach for osteoporosis: a clinical practice guideline from the Egyptian Academy of bone health and metabolic bone diseases
Background: This study was carried out to achieve an Egyptian expert consensus on a treat-to-target managementstrategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15
clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service.
Results: The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested.
Conclusion: A wide and representative panel of experts established a consensus regarding the management of
osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management
Consensus evidence-based recommendations for treat-to-target management of immunoglobulin A vasculitis
IgA vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is the most common cause of systemic vasculitis in childhood. Given its potential life-threatening systemic
complications, early and accurate diagnosis as well as management of IgAV represent a major challenge for health care professionals. This study was carried out to attain an evidence-based expert consensus on a treat-to-target management approach for IgAV using Delphi technique.
The preliminary scientific committee identified a total of 16 key clinical questions according to the patient, intervention, comparison, and outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the IgAV management.
The core leadership team identified researchers and clinicians with expertise in IgAV management in Egypt upon which experts were gathered from different governorates and health centers across Egypt. Delphi process was implemented (two rounds) to reach a consensus. An online questionnaire was sent to expert panel (n = 26) who participated in the two rounds. After completing round 2, a total of 20 recommendation items, categorized into two sections were
obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%.
Consensus was reached (i.e. â©ľ75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the diagnosis and management have been suggested. This was an expert, consensus recommendations for the diagnosis and treatment of IgAV and IgA vasculitic nephritis, based on best available evidence and expert opinion. The guideline presented a strategy of care with a pathway to achieve a state of remission as early as possible
001 Egyptian consensus-based recommendations for the diagnosis and targeted management of Kawasaki disease. An initiative by the Egyptian College of Pediatric Rheumatology
Abstract Background Kawasaki disease (kDa) is a self-limiting acute vasculitis that affects small and medium-sized vessels, and is the most common cause of acquired heart disease in children. It is also an important reason for long-term cardiac disease into adulthood. Rapid diagnosis and management of kDa is challenging due to the heterogeneity of the disease, yet is vital for improving outcome. To date, there are no Egyptian nationally agreed, evidence-based guidelines concerning the diagnosis and management of kDa in children. Consequently, treatment regimens vary broadly. Objectives To develop a consensus, evidence-based recommendations for the diagnosis, evaluation and management of children living with kDa. Methods This study was carried out to achieve an Egyptian expert consensus on a management strategy for kDa using Delphi technique. A multistep process strategy was adopted, which started by developing 16 key clinical questions by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Time (PICOT) approach. The core leadership team identified clinicians and researchers with expertise in pediatric rheumatology all over Egypt. An evidence-based, systematic, literature review was conducted to compile evidence for the kDa management. Delphi process was implemented (3-rounds) to reach a consensus. Results Twenty-five expert panel participated in the 3 rounds with response rate 100%. A total of 21 recommendations, categorized into 9 domains (Definition, disease activity, predicting the development of coronary disease, assessment and monitoring (lab, imaging), treatment (acute and after acute attack), management of resistant cases, management of complications (cardiac complications, MAS and arthritis), vaccination and long term follow up. The Agreement with the recommendations (rank 7–9) ranged from 83.6–95.7%. The Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on all the clinical standards. Algorithm for management has also been developed. Conclusion This was an expert, consensus recommendations for the diagnosis and treatment of kDa, based on best available evidence and expert opinion. The recommendations provided a management approach based on easy-to-use algorithm and with the support of complementary tests. The implication to policy, practice, research and advocacy to provide updated recommendations for better management of kDa
43 Egyptian evidence-based consensus recommendations for diagnosis and targeted management of childhood-onset systemic lupus erythematosus. An initiative by the Egyptian College of Pediatric Rheumatology
Abstract Background Childhood-onset systemic lupus erythematosus (cSLE) is a rare prototype of a multi-systemic, inflammatory, heterogeneous and potentially life-threatening autoimmune condition with quite significant linked morbidity. To date, there are no Egyptian nationally agreed, evidence-based guidelines concerning the diagnosis and management of kDa in children and treatment is often based on clinical expertise. Consequently, treatment regimens vary broadly. This work was an initiative by the Egyptian College of Paediatric Rheumatology aiming at optimising the management approaches for children and young adults with cSLE. Objective To provide evidence-based consensus recommendations for diagnosis and management of cSLE Methods This study was carried out to achieve an Egyptian expert consensus on a management strategy for cSLE using Delphi technique. A multistep process strategy was adopted, which started by developing 18 key clinical questions by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Time (PICOT) approach. The core leadership team identified clinicians and researchers with expertise in pediatric rheumatology all over Egypt. An evidence-based, systematic, literature review was conducted to compile evidence for the cSLE management. Delphi process was implemented (3-rounds) to reach a consensus. Results Twenty-five expert panel participated in the 3 rounds with response rate 100%. A total of 24 recommendations, categorized into 14 domains (Targeted population, criteria for classification, definition of disease activity status, definition of flare up, lab tests, treatment targets, monitoring, treatment, recommendations for specific organ system, prognostic markers, refractory condition, vaccination and transition program. The Agreement with the recommendations (rank 7–9) ranged from 84.8–94.8%. The Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on all the clinical standards. Algorithm for management has also been developed. Conclusion This work provided an updated management approach for cSLE patients. This evidence-based informed consensus process is expected to support uniform, high quality standards of care for children with cSLE in Egypt The implication to policy, practice, research and advocacy: to provide updated recommendations for better management of cSLE
Consensus evidence-based recommendations for transition of care for adolescents with juvenile idiopathic arthritis: meeting patients’, parents’, and rheumatologists’ perspectives
Abstract Background Transition of care means the process of educating and empowering adolescents and young adults to take an active role in their own healthcare, develop decision-making skills, and eventually transition from paediatric to adult healthcare providers. Most people do not switch doctors until they are young adults, but it can be beneficial to start preparing children earlier. We aimed to develop a specific toolkit tailored to paediatric and adult rheumatologists to assist them in transitioning of care of young people with juvenile onset rheumatic musculoskeletal diseases from the paediatric to adult rheumatology care. Results The expert panel was confined to an online survey (n = 18), all the experts completed the two rounds. At the conclusion of round 2, a total of 10 points were gathered. The range of respondents (ranks 7–9) who agreed with the recommendations was 88.9 to 100%. All 10 clinical standards identified by the scientific committee were written in the same way. Based on the answers to the structured key questions and the literature review, a structured template was developed presenting transition of care integrated pathway. Conclusion The developed rheumatology-specific guideline offers adolescents and young adults a focussed, multidisciplinary transition of care approach with equity of access, quality of care and flexibility and set up standards for transitional care for young adults with juvenile rheumatological diseases
Egyptian consensus on treat-to-target approach for osteoporosis: a clinical practice guideline from the Egyptian Academy of bone health and metabolic bone diseases
Abstract Background This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15 clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service. Results The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested. Conclusion A wide and representative panel of experts established a consensus regarding the management of osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management
Egyptian recommendations for the management of systemic lupus erythematosus: a consensus, evidence-based, clinical practice guidelines for treat-to-target management
Abstract Background Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by having varying clinical presentation, severity, unpredictable course as well as outcomes. Recent disease-modifying conventional and biologic agents have enhanced rates of attaining both short- and long-term management goals, including minimization of glucocorticoid dose and use. This study was carried out to develop an up-to-date evidence-based, consensus on clinical practice guidelines for treat-to-target management of systemic lupus erythematosus in adults. Results The response rate to the online questionnaires, sent to the expert panel who participated in the three rounds, was 95.5%. At the end of round 3, a total of 14 recommendation sections were proposed for the T2T management of patients with SLE. Agreement with the recommendations (rank 7–9) ranged from 90.9–100%. Consensus was reached (i.e., ≥ 80% of respondents strongly agreed or agreed) on the proposed statements. Conclusion These recommendations provide a consensus on the treat-to-target management of patients with SLE. They provide strategies to reach optimal outcomes in common clinical scenarios, based on a combination of evidence and expert opinion
La naturaleza colonizada : ecologĂa polĂtica y minerĂa en AmĂ©rica Latina
El libro que presentamos ahora se concentra en la publicaciĂłn de los trabajos y testimonios que se dedicaron a la exposiciĂłn y análisis de conflictos vinculados con el extractivismo de la gran minerĂa. Dos de esos artĂculos, los de Horacio Machado Aráoz y Maristella Svampa, están dedicados a una ecologĂa polĂtica de la gran
minerĂa, mientras los demás se dedican a la presentaciĂłn de estudios de
caso en Argentina, Chile y MĂ©xico.ĂŤndice
PresentaciĂłn
HĂ©ctor Alimonda 11
La colonialidad de la naturaleza. Una
aproximaciĂłn a la EcologĂa PolĂtica Latinoamericana.
HĂ©ctor Alimonda 21
Lecturas de EcologĂa PolĂtica
EcologĂa PolĂtica de la globalidad y la diferencia
Arturo Escobar 61
Suelo, Subsuelo y Vuelo: los previsibles desafĂos
ecopolĂticos para la regiĂłn amazĂłnica colombiana
Germán Palacio Castañeda 93
Ese comunismo estéril en que vegetan: el
individualismo agrario frente a las formas
ancestrales de propiedad y los usos
tradicionales de la tierra
MarĂa VerĂłnica Secreto 113
ĂŤndice
Para una EcologĂa PolĂtica de la gran minerĂa
Matéria, Espaço, Tempo e Globalização:
o Caso de Carajás na Amazônia Brasileira
Stephen Bunker 127
El auge de la MinerĂa transnacional en AmĂ©rica
Latina. De la ecologĂa polĂtica del neoliberalismo
a la anatomĂa polĂtica del colonialismo
Horacio Machado Aráoz 135
Modelos de desarrollo, cuestiĂłn ambiental y giro
eco-territorial
Maristella Svampa 181
Testimonios de la resistencia anti-minerĂa
en el PerĂş
MinerĂa y Territorio en el PerĂş:
conflictos, resistencias y propuestas
en tiempos de globalizaciĂłn
Marco Arana (Tierra y Libertad) 219
MinerĂa y Territorio en el PerĂş: casos,
temas y propuestas
Mario Tabra (CONACAMI, Ayabaca); Juan Aste
(asesor parlamentario) 223
El escenario actual: tendencias, desafĂos
y posibilidades
JosĂ© de Echave C. (CooperAcciĂłn); Miguel PalacĂn
Quispe (CAOI/CONACAMI); Margarita PĂ©rez
(CONACAMI, San Mateo) 235
Estudios de casos
El proyecto minero Potasio RĂo Colorado:
conflicto socioambiental, impactos regionales y
falta de integralidad en la evaluaciĂłn ambiental
Lucrecia S. Wagner y Marcelo Giraud 257
MinerĂa, agroindustria y agricultura tradicional;
conflictos socioambientales en el semiárido
chileno, el caso de la comuna de Alto del Carmen
Pablo Romero 285
Una lucha a cielo abierto. El caso del Frente
Amplio Opositor a Minera San Xavier.
MarĂa Julieta Lamberti 30