The document summarizes discussions from an IPF/ILD Working Group meeting. It provides updates on several studies, including one characterizing the clinical features and healthcare utilization of IPF patients in the years before diagnosis. The study found increased healthcare resource use in the 2 years prior to an IPF diagnosis. Another study aims to evaluate diagnostic agreement across global sites. The working group discussed priorities for future research, including a Phase II study using digitized patient cases to assess diagnostic accuracy across different healthcare settings.
Child Health Working Group and Small Airways Study Group Joint MeetingZoe Mitchell
Slides from meeting of Respiratory Effectiveness Group Child Health Working Group and Small Airways Study Group joint meeting, held in London during ERS 2016 Congress
An overview of the work and initial results of the REG-EAACI Taskforce assessing the quality of literature in the field of real-world respiratory medicine.
Child Health Working Group and Small Airways Study Group Joint MeetingZoe Mitchell
Slides from meeting of Respiratory Effectiveness Group Child Health Working Group and Small Airways Study Group joint meeting, held in London during ERS 2016 Congress
An overview of the work and initial results of the REG-EAACI Taskforce assessing the quality of literature in the field of real-world respiratory medicine.
Presentation_Thesis defense _Thi Ha VO. 16.12.2015HA VO THI
In times of limited resources allocation, it is necessary for pharmacists to justify the added value of their pharmacist interventions (PIs) made during medication review (MR). The purpose of this thesis work is to research on methodologies of evaluation of value of PIs as well as development and validation of a new tool for assessing potential impacts of PIs. The work consists of 3 major parties: (i) context in which MR locates, characteristics of practice of MR, and methodologies of evaluation of impacts of PIs, (ii) systematic review of tools for assessing the potential significance of PIs in literature , (iii) process of development and validation of the new multidimensional tool - named CLEO for assessing potential impacts of PIs. The whole results of this research are useful to evaluate and demonstrate the value of PIs in efforts to expand clinical pharmacy services.
Presentation from the European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE), published by the European Centre for Disease Prevention and Control (ECDC)
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Agenda
• Working group progress update
o ILD-MDT phase II
• Priorities for future research
o Research ideas
– Relevant, feasible, valid and a priority
o Setting priorities
• Additional items
3. Attendees
• Kevin Flaherty (chair)
• A Azuma
• P Rottoli
• V Cottin
• J Behr
• A Niimi
• F Luppi
• S Andarini
• C Youakim
• P Rivera Ortega
4. Progress update
• Published studies
o Martinez FJ, Chisholm A, Collard H R, et al 2017. The diagnosis of
idiopathic pulmonary fibrosis: current and future approaches. Lancet Resp
Med: 5 (1), 61-71
5. Active study update (1)
• REG-RES1510: Characterisation of the path to idiopathic
pulmonary fibrosis (IPF) and potential missed diagnostic
opportunities
o Presented at Working Group meeting at ERS 2016
o Final report complete December 2016
6. Study Aims
• With a view to identifying potential opportunities for earlier referral to
specialists and (ultimately) earlier diagnosis of IPF, the study aims
to:
1. Characterise the clinical features of patients at the time of their IPF
diagnosis
2. Evaluate patients’ patterns of HRU in the years preceding their IPF
diagnosis
3. Develop optimum code lists for IPF database research, i.e. variation in 1 & 2
for sensitive versus specific code lists
7. Methods
INCLUSION CRITERIA
• A diagnostic Read code for IPF
• Diagnosed with IPF between
1990 and 2015.
• A minimum of 2 years continuous
clinical records in the years
immediately preceding their
index diagnosis
• Aged 40 years or older at index
date
8. Clinical features of patients at the
time of their IPF diagnosis
• In this routine care IPF population from the UK:
o Demographics
– Mean age: 72-73 years
– Men accounted for 62-65% of the population
– Approximately 1/3 were never smokers; 2/3 current or ex-smokers
o Comorbidities
– 13-25% had obstructive lung disease (13-15% asthma; 19-25% COPD)
– Approximately 50% of patients:
Had cardiovascular disease (46-53%)
Consulted for cough (40-52%; ~10% in the 2 years preceding IPF diagnosis)
o Respiratory therapies
– 18-26% of patients received ≥1 prescription for SABA in the year preceding IPF diagnosis
– Prescribing of all other obstructive lung disease therapies (ICS, LABA, LAMA,
combinations) was low (<10%)
9. Patterns of HRU in the years
preceding their IPF diagnosis
• All markers of respiratory health resource use (HRU) increased
annually over the 10-years and quarterly within the last 2 years
leading up to patient’s IPF diagnosis:
o Primary care events
– LR consultations, LR antibiotics and oral steroids (acute and
maintenance)
o Secondary care attendances
– Hospital admissions, Out patient department attendances, Accident &
emergency attendances
o Other:
– Cough events, Chest X-rays, Incidence of pneumonia
10. Code lists: specific vs broad
• Compared with patients with a “specific” IPF diagnostic code, those with a
“broad” diagnostic label were similar in terms of their:
o Demographic presentation at the time of diagnosis
o Escalating trends in HRU in the years preceding IPF diagnosis
o Lung function: Similar mean(SD) FVC: 3.1(6.8) vs. 2.5(0.9) (p=0.405)
• Comorbidities broad IPF patients had:
o Similar burden of:
– Chronic respiratory conditions (incl. asthma; excl COPD); heart failure,
rhinitis, bronchiectasis, eczema, osteoporosis, cerebrovascular disease,
sleep apnoea, depression and anxiety
o Higher burden of :
– COPD, cardiovascular disease, ischaemic heart disease, Hypertension,
diabetes, myocardial infraction, GERD,CKD, lung cancer, cough
• Drug usage: broad IPF patients had higher use of short-acting
bronchodilator therapy in the year preceding IPF diagnosis (26 vs 18%)
11. Next steps
• Final report has been published
• No control group
o Write up without control group or secure funding to conduct
supplementary study with controls?
• Potential to publish comparison of specific vs. broad IPF
definitions
12. Active study update (2)
• REG-RES1505: Characterisation of interstitial lung disease (ILD)
diagnostic practice around the world and implications on
diagnostic agreement and access to licensed therapies
o Phase I:
– Presented at REG summit 2017 and ATS 2017
– Final report out for comments
– Poster presentation: 12.50pm-2pm on 12th September
o Phase II: Protocol under development
13. Centre type by economic status*
*Economic status: World Bank List of Economies, March 2017
Centre Type
High Income,
n (%)
Upper middle
income, n(%)
Lower middle
income, n(%)
Low income,
n(%)
ILD Academic Centre 148 (48.4) 49 (40.2) 6 (22.2) 2 (100)
Non-ILD Academic
Centre
83 (27.1) 42 (34.4) 8 (29.6) 0 (0.0)
Non Academic Centre 75 (24.5) 31 (25.4) 13 (48.1) 0 (0.0)
TOTAL 306 122 27 2
570 responses, of
which 457 were
unique and valid
14. Academic ILD centres
reported a higher caseloads
of both IPF-ILD and non-IPF
ILD than academic non-ILD or
non-academic centres
(Kruskal Wallis: p<0.001)
Caseload characteristic
ILD Academic
Centre (n=205)
Non-ILD
Academic
Centre (n=133)
Non Academic
Centre
(n=119)
All Centres
(n=457)
IPF ILD cases/
month
Median(IQR) 5.0(3.0-10.0) 4.0(2.0-5.0) 3.0(2.0-5.0) 4.0(2.0-7.0)
Range 0-50 0-35 0-50 0-50
Non-IPF ILD
cases / month
Median(IQR) 16.0(10.0-27.0) 10.0(5.0-20.0) 10.0(5.0-15.0) 11.0(6.0-20.0)
Range 1-130 1-101 0-200 0-200
Where, box=25th percentile, median and 75th percentile; whiskers= values
within 1.5 interquartile ranges of the 25th and 75th percentile.
Caseload of centre
16. Access to anti-fibrotic agents
• Anti-fibrotic agents were available to 81.4% (n=372) of centres, of which 31.7% (n=118)
required the permission of a multi-disciplinary team to access them.
• Access was more frequently reported in academic ILD centres (n=180, 87.8%) than
academic non-ILD (100, 75.2%) or non-academic centres (92, 77.3%).
• Neither of the two centres in low income countries had access to anti-fibrotics.
17. Conclusions
• While there were some differences in practice based on the
centre type, region of the world or the economic status of the
country the centre was located in, practice was broadly similar.
18. Objective
• Evaluate agreement of ILD MDT diagnosis across
a range of global sites and healthcare settings
• Evaluate accuracy of ILD MDT diagnosis across a
range of global sites and healthcare settings,
considering in particular agreement in IPF
diagnosis
• Identify features of current MDT diagnostic practice
associated with accurate diagnosis (including the
effect of bronchoscopic sampling for diagnosis)
• Produce a series of recommendations as to how
best to optimise the pathway to accurate ILD
diagnosis in real-world practice.
Proposed methodology
Design: Digitised reference ILD cases (including pathology data) will
be presented to participating centres.
Outcomes: Descriptive analysis of participating MDTs and MDT
diagnostic accuracy. Concordance across centres, and between
reported practice (phase I) and observed practice (phase II). Analysis
of independent MDT features associated with diagnostic accuracy.
Recommendations associated with optimising the diagnostic process
Next steps: Phase II
Tier 3:
Agrees with diagnostic
inference of available
follow-up data
Tier 2: Agrees with
diagnosis as assigned
by Study MDT
Tier 1: Agrees with
diagnosis as assigned
by reference case
provider
Reference
Case Review
Diagnosis assigned
by participating
centre
Yes
Yes
Yes
No
No
No
Accuracy appraisal of diagnosis
19. Next steps: Phase II questions
• How will cases be digitised, what platform, what
prompts/questions
• What cases
o Source of cases and case-mix
• Which centres
o 464 individuals from 394 (86.2%) centres in phase I stated the would be
happy to participate in phase II
• MDT definition
o How should we define an MDT?
20. Active study update (3)
• REG_P040: Characterise the natural history of IPF vs non-IPF
ILD in terms of FVC lung function decline
o Final report written
o Results presented at REG summit 2017
o A manuscript may be in development?
21. ≥18-month Study
Period
Index Date:
date of ILD diagnosis
Prospective Observational
Outcome Period ≥6 months
Cohort 1: IPF only (reference)
Cohort 2: IPF + non-IPF progressive
fibrotic lung diseases, only
Cohort 3: Non-IPF progressive fibrotic
lung diseases, only
Cohort 4: Non-IPF progressive fibrotic
lung diseases
Historical evaluation of healthcare
resource utilisation.
Period ≥12 months
Study Design
Inclusion criteria:
• Received their IPF diagnosis between
1991 and 2016
• Have a minimum of:
• 12 months of continuous clinical
records immediately preceding
index date
• 6 months’ continuous records
immediately following index date
• Aged 40 years or older at index date
Exclusion criteria:
None
• Electronic
medical records
from both the
Optimum
Patient Care
Research
Database
(OPCRD) and
the Clinical
Practice
Research
Datalink
(CPRD)
25. Conclusions
• Individuals diagnosed with diseases compatible with ILD have
very similar demographic and clinical characterizes at the time of
or before diagnosis when compared to with those with IPF only
• A consistent increase in the use of healthcare resources 2-3 years
prior to diagnosis was observed in all 4 cohorts
26. Future research
• Phase II of the ILD-MDT project
• Is there another, smaller, project that could run at the same time?
o Relevant?
o Feasible?
o Valid?
o A priority?
• How do we set priorities in IPF/ILD research?
• How to we ensure these priorities are pursued?
Very few low or lower middle income countries. The effects of income on practice are therefore hard to determine. All centres in low income countries are academic ILD centres.
Questions: Do you work in an academic or university medical centre?
Do you work at an ILD centre?
Questions: Approximately how many new cases/referrals of IPF does your centre diagnose in an average month?
Approximately how many new cases/referrals of IPF does your centre diagnose in an average month?
Mean has been taken out as data were massively skewed – so median is the better presentable number
Questions: Do you have access to the anti-fibrotic agents nintedanib and/or pirfenidone at your centre?
Is the MDT permission required to access nintedanib and/or pirfenidone?