Pierwotna małopłytkowość immunologiczna u dzieci w świetle współczesnych definicji

BackgroundPrimary immune thrombocytopenia (ITP) is one of the most common hematologic disorders in pediatric population. In 2009 the new unified terminology regarding: definition, clinical classification of the disease and response to treatment was proposed. The main study objective was the comparative analysis of clinical aspects of primary ITP in children regarding the contemporary definitions and historical criteria.MethodsData were collected through medical chart review of subjects identified from hospitalization records (Pediatrics, Hematology and Oncology Department) from the period of 2002–2011.ResultsData of 209 subjects were analyzed. According to recent definitions 206/209 patients (98.6%) could be defined. Using the historical criteria 86.12% were classified as acute and 13.88% as chronic ITP. Newly diagnosed primary immune thrombocytopenia was confirmed in 166/206 cases, persistent ITP in 20/206, and chronic ITP in 20/206 of subjects. Depending on applied criteria we noticed significant differences in acute ITP patient number. Regardless of adjusted definitions, the response rates were higher among treated patients (p < 0.0001). Historical criteria allowed to recognize lower response rate in patients treated with intravenous immunoglobulins (p = 0.009) or steroids (p = 0.033).ConclusionsContemporary definitions allow for more adequate categorization on most of the patients with primary immune thrombocytopenia considering the specific clinical aspects and different natural history of primary ITP in children.     

Ordalie,recherche de sensations et impulsivité. Analyse critique des définitions

BackgroundIn the fields of psychology and psychiatry, the use of the terms impulsivity, sensation-seeking and ordalie to refer to risk-taking behaviors can sometimes be confusing.ObjectiveThe objective of this study was to establish a clinical definition of the concepts of ordalie, sensation-seeking and impulsivity, in order to analyze the similarities and differences between these concepts.MethodsWe prioritized literature review articles with or without meta-analysis from the Medline database and supplemented with the Google-Scholar database. The articles were included in this review if their objectives were in line with ours. The research was conducted in November 2018.ResultsTwenty-seven articles were selected. There are similarities in the clinical definitions of these concepts with measurable heterogeneous constructions, and an exacerbation in adolescence for engagement in harmful behaviors, but there are also nuances that highlight their differences.ConclusionWe were able to describe areas of divergence and convergence between these three concepts but not to establish a quantitative diagram of the areas of divergence and convergence. It would seem that the coexistence of sensation-seeking and impulsivity in the same individual could explain that individual's involvement in ordalique behaviors. Further studies approaching this hypothesis would seem useful in terms of preventing risk-taking behaviors such as addictive behaviors.     

Investigating Clinically and Scientifically Useful Cut Points on the Compulsive Sexual Behavior Inventory

IntroductionOne of the major obstacles to conducting epidemiologic research and determining the incidence and prevalence of compulsive sexual behavior (CSB) has been the lack of relevant empirically derived cut points on the various instruments that have been used to measure the concept.AimTo further develop the Compulsive Sexual Behavior Inventory (CSBI) through exploring predictive validity and developing an empirically determined and clinically useful cut point for defining CSB.MethodsA sample of 242 men who have sex with men was recruited from various sites in a moderate-size Midwestern city. Participants were assigned to a CSB group or a control group using an interview for the diagnosis that was patterned after the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition. The 22-item CSBI was administered as part of a larger battery of self-report inventories.Main Outcome MeasuresReceiver operating characteristic analyses were used to compute area-under-the-curve measurements to ascertain the predictive validity of the total scale, the control subscale, and the violence subscale. Cut points were determined through consensus of experts balancing sensitivity and specificity as determined by receiver operating characteristic curves.ResultsAnalyses indicated that the 22-item CSBI was a good predictor of group membership, as was the 13-item control subscale. The violence subscale added little to the predictive accuracy of the instrument; thus, it likely measures something other than CSB. Two relevant cut points were found, one that minimized false negatives and another, more conservative cut point that minimized false positives.ConclusionThe CSBI as currently configured measures two different constructions and only the control subscale is helpful in diagnosing CSB. Therefore, we decided to eliminate the violence subscale and move forward with a 13-item scale that we have named the CSBI-13. Two cut points were developed from this revised scale, one that is useful as a clinical screening tool and the other, more conservative measurement that is useful for etiologic and epidemiologic research.Miner MH, Raymond N, Coleman E, Swinburne Romine R. Investigating Clinically and Scientifically Useful Cut Points on the Compulsive Sexual Behavior Inventory. J Sex Med 2017;14:715–720.     

An overview of electronic personal health records

Electronic Personal Health Record systems are providing health consumers with greater access and control to their health records by shifting these records from being a health provider-centred Electronic Health Record, to a patient-centred, Electronic Personal Health Record (ePHR). Based on the delivery system, ePHR systems are classified into standalone, tethered, and integrated or unified ePHRs. While national approaches of implementing integrated ePHR vary, the middle out method has been recognised as the ideal approach. It is worth considering the adoption of ePHRs has been slow due to several factors, including technical, individual, environmental, social, and legal factors. This paper provides a representative overview of an ePHR system, outlining its definition, types, architectures, and nationwide approaches of its implementation. Additionally, the drivers and hindrances to health consumer adoption are discussed.     

The challenge of multicenter studies in diabetic patients with foot infections

Background: A complexity of factors determines outcome of foot ulcer infections in diabetic subjects. Variations in patient characteristics, treatment strategies and differences in health care systems may influence outcome. Objective: To evaluate the homogeneity in patients with diabetic foot ulcer infections of sufficient severity to warrant antibiotic treatment in three different European foot care centres. Method: A prospective, observational data collection study with agreed on definitions and the same inclusion and exclusion criteria according to a standardised protocol. Patient and wound characteristics, laboratory tests and physical measurements, antibiotic and surgical treatment during 28 days were recorded in 93 patients. Results: We found significant differences in patient and wound characteristics, in rate and duration of hospitalisation, in antibiotic and surgical treatment, in rate of resolution of infection and in wound healing between centres. Conclusions: Despite using agreed on definitions and the same inclusion and exclusion criteria according to a standardized protocol the heterogeneity between centres of included patients, wound characteristics, management and outcome were surprising. In future multicenter studies, evaluating the effects of a specific treatment of infected foot ulcers in diabetic patients, clear definitions, algorithm for decision making, treatment strategy protocols and knowledge about variations in treatment strategies and healthcare/reimbursement systems in participating centres are needed.     

Sepsis

Sepsis is a clinical syndrome that requires prompt recognition and control in order to optimize clinical outcomes in patients. It is very relevant to surgical practice, as it can affect perioperative patients and those recovering on surgical wards. A working knowledge of sepsis is essential to any medical or surgical practitioner, and here we cover the topic with relevance to surgery and the MRCS examination.