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Introduction/objectives Multiple modes of administration are available for systemic lupus erythematosus (SLE) treatments. This study examined patient and physician characteristics associated with the choice of weekly subcutaneous (SC) injection or monthly intravenous (IV) infusion for an unspecified SLE treatment. Methods This was a cross-sectional, US web-based survey using a direct elicitation, stated-preference methodology (HO-16-16706). Two hundred patients and 200 physicians were asked to choose between IV or SC administration in a hypothetical scenario. Pairwise and multivariate analyses estimated the odds ratio (OR) for the likelihood of choosing SC over IV for respondent characteristics. Results Among patients, taking non-steroidal anti-inflammatory drugs increased the likelihood of choosing SC injection (OR 3.884), whilst having SLE-related skin problems, a fear of needles or self-injection, and never needing help around the house decreased the likelihood (OR 0.28, 0.13, 0.12, respectively; all p ≤ 0.05). Among physicians, > 95% recommended SC injection for patients who live or work far from an infusion center, prefer SC administration, and never or rarely miss medication doses. Physician characteristics including age and treatment practice also influenced choice. Conclusions Patient and physician characteristics influence choice of SC versus IV therapy for SLE. These findings might inform shared decision-making, which could lead to improved patient outcomes. Key Points• Data regarding patient and physician preference for different modes of administration of SLE therapy are sparse.• This cross-sectional, US web-based study showed that patient and physician characteristics influence choice of SC versus IV therapy for SLE.• A degree of disconnect exists between how factors influence patients’ choice and how those characteristics influence physicians’ choice of SLE treatment mode of administration.• The findings from this study might inform shared decision-making, which could improve alignment between treatment choice and patient preferences, treatment satisfaction, adherence, and improved patient outcomes.

Background There are numerous non-biologic and biologic disease-modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA). Typical sequences of bDMARDs are not clear. Future treatment policies and trials should be informed by quantitative estimates of current treatment practice. Methods We used data from Corrona, a large real-world RA registry, to develop a method for quantifying sequential patterns in treatment with bDMARDs. As a proof of concept, we study patients who eventually use tocilizumab monotherapy (TCZm), an IL-6 antagonist with similar benefits used as monotherapy or in combination. Patients starting a bDMARD were included and were followed using a discrete-state Markov model, observing changes in treatments every 6 months and determining whether they used TCZm. A supervised machine learning algorithm was then employed to determine longitudinal patient factors associated with TCZm use. Results 7300 patients starting a bDMARD were followed for up to 5 years. Their median age was 58 years, 78% were female, median disease duration was 5 years, and 57% were seropositive. During follow-up, 287 (3.9%) reported use of TCZm with median time until use of 25.6 (11.5, 56.0) months. Eighty-two percent of TCZm use began within 3 years of starting any bDMARD. Ninety-three percent of TCZm users switched from TCZ combination, a TNF inhibitor, or another bDMARD. Very few patients are given TCZm as their first DMARD (0.6%). Variables associated with the use of TCZm included prior use of TCZ combination therapy, older age, longer disease duration, seronegative, higher disease activity, and no prior use of a TNF inhibitor. Conclusions Improved understanding of treatment sequences in RA may help personalize care. These methods may help optimize treatment decisions using large-scale real-world data.

During the outbreak of novel coronavirus pneumonia (NCP) in Wuhan, public hospitals have played an important role in intensive care, case guidance and scheme optimization. At the same time, it also faces unprecedented challenges and tests. Based on the treatment of severe patients in Wuhan, combined with the treatment practice in Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, this paper puts forward the urgency of further strengthening the construction of public hospitals, discusses the feasible path for promoting the development of public hospitals, so as to meet the growing medical needs of the people, improve the ability to respond to major public health emergencies, and effectively guarantee the safety of people's lives and the promotion of a healthy China construction.

Evidence-based guidelines, published in 2010, equate the efficacy of oral and intravenous antibiotics and recommend treatment duration of 2 weeks in early Lyme neuroborreliosis (LNB) without encephalitis or myelitis. Further, the Norwegian health authorities give a general advice to choose oral rather than intravenous administration when proven effective, due to lower costs, fewer risks, and reduced patient inconvenience. In this study we aimed to chart LNB treatment practice in Norway and compare it to these recommendations. Adult patients diagnosed with definite LNB between 2007 and 2013 in 11 different hospitals in the four health regions in Norway were invited to answer a questionnaire regarding duration and administration of antibiotic treatment. A total of 253 patients answered. Median age at diagnosis was 59 years (range 19-83), and 125 (49%) were women. Duration of treatment was 1 week in 7 (3%) patients, 2 weeks in 81 (32%), 3 weeks in 62 (25%), 4 weeks in 48 (19%), 5 weeks in 12 (5%), ≥6 weeks in 29 (12%), and unknown in 14 (6%). Treatment was given orally in 77 (30%) patients, intravenously in 110 (44%), both orally and intravenously in 65 (26%), and unknown in one. Treatment practices differed between the health regions (p = 0.002). During the study period, there were no significant time trend neither with respect to proportion of patients treated for only 2 weeks (OR 0.899, p = 0.109) nor with respect to proportion of patients treated exclusively with oral antibiotics (OR 1.131, p = 0.074). In conclusion, there seem to be a gap between evidence-based recommendations and treatment practice of LNB in Norway.

Psychische und Verhaltenssymptome bei Patienten mit Demenz und Delir sind mit wesentlichen Beeintrachtigungen der Lebensqualitat der Erkrankten und ihrer Angehorigen verbunden. Fur das medizinische Personal stellen sie eine enorme Herausforderung dar. Nach pharmakoepidemiologischen Untersuchungen geht die Anwendung von Psychopharmaka in der ambulanten und der stationaren Versorgung signifikant uber die Empfehlungen aktueller Leitlinien hinaus. Die Analyse dieser Diskrepanz steht im Fokus des vorliegenden Beitrags. Selektive Literaturubersicht unter besonderer Berucksichtigung deutsch- und englischsprachiger Behandlungsleitlinien. Die Empfehlungen fur den Einsatz von Psychopharmaka bei Demenzkranken sind in der deutschen S3-Leitlinie speziell fur Antipsychotika eng gefasst. Diese stellt daruber hinaus fest, dass fur bestimmte Storungsbilder evidenzbasierte Aussagen derzeit nicht moglich sind. Fur das Delir existieren verschiedene, teilweise auf unterschiedliche Kontexte bezogene Behandlungsempfehlungen. Wie in der S3-Leitlinie „Demenzen“ wird hier eine Priorisierung allgemeinmedizinischer und nichtmedikamentoser Masnahmen gefordert. Die Indikation zur Therapie mit Psychopharmaka bei deliranten Patienten wird z. T. enger, z. T. weiter gefasst. Aktuelle Leitlinien empfehlen, gut begrundet, eine zuruckhaltende Verordnung von Psychopharmaka bei Patienten mit Demenz und Delir. Dass die Verordnungsraten in der Versorgungspraxis deutlich daruber hinaus gehen, erklart sich neben dem Fehlen evidenzbasierter Empfehlungen fur bestimmte Storungsbilder v. a. auch durch eine mit erheblichen Risiken verbundene Uber- und Dauerbehandlung bei einem substanziellen Anteil der Betroffenen. Dieser nichtakzeptablen Situation sollte durch die konsequente Umsetzung etablierter Prinzipien guter altersmedizinischer Praxis entgegengewirkt werden.

Background In 2011 the legal foundations of coercive treatment in German forensic psychiatric clinics were declared to be unconstitutional. In the present study we analyzed the frequency of coercive procedures in forensic psychiatric hospitals before and after 2011, the consequences for medical care as well as the ethical assessments by attending chief physicians. Methods By a questionnaire-based survey of views of attending chief physicians in forensic psychiatric clinics in 2013, data on the current state of patient care were collected and analyzed from an ethical perspective. These were compared with treatment data from a large forensic psychiatric clinic collected over the period 2007-2013. Results Even after 2011 coercive forms of treatment were applied in forensic psychiatric hospitals. In practice, there is a high degree of legal uncertainty regarding the limits of coercive treatment. Of all patients treated in forensic psychiatric clinics in 2012, on average 13 % had been in isolation at least once, approximately 3 % had been treated under fixation at least once and 2.2 % had been subjected to coercive medical treatment at least once. Conclusion From an ethical perspective an open debate about the practice of coercive treatment is urgently required. Legal regulations, ethical guidelines and treatment standards have to be developed for the special situation of patient care in forensic psychiatric hospitals.

Long-acting (LA) preparations of methylphenidate allow for once-daily dosing; however, pharmacokinetics may vary and depend on food intake. The objective was to evaluate effectiveness of a two-phase release formulation (Ritalin(®) LA) under daily practice conditions. This was a prospective, multicenter, observational study in Germany. Eligibility and dosing were determined by the physician based on the drug label. Outcomes included changes over 3 months of treatment in assessments of effect duration, clinical global impression (CGI), and quality of life (ILK). In 101 sites, 262 patients (197 boys, 63 girls, and two unknown) with a mean age of 10.9 years were enrolled; 50 were treated for the first time; 212 switched medication to Ritalin(®) LA. After 3 months, CGI improved in 59.4 % of patients, and well-being overall was rated as good by 61.0 % of parents and 63.7 % of children. Based on parents' assessment, the proportion of children suffering from strong disease burden decreased from 40.7 to 15.1 %. In 123 insufficient responders to previous ADHD medications, benefit from Ritalin(®) LA was above average and effect duration was significantly prolonged as compared to pretreatment. Overall, 28 patients (10.7 %) had treatment-related adverse events with one case being serious; 23 patients (8.8 %) discontinued therapy, 7 (2.7 %) due to poor treatment response; and 212 patients (81 %) continued treatment beyond the study. In line with clinical trial data, Ritalin(®) LA provides significant benefit also under routine practice conditions.

The use of instructional rounds in education, ‘‘an adaptation and extension of the medical rounds model, which is used routinely in medical schools and teaching hospitals to develop the diagnostic and treatment practice of physicians’’ (City et al. 2009, p. 3), has recently emerged as a means to effect school improvements. Instructional rounds consist of systematic classroom observations conducted by teams in conjunction with pre-classroom visit preparation and post-classroom visit debriefings. Elizabeth City et al. (2009) were first to clearly define this process for education with Instructional Rounds in Education. Thomas Fowler-Finn builds on the scholarship established by City et al. in his companion volume, Leading Instructional Rounds in Education: A Facilitator’s Guide. This book, reviewed here, accomplishes a logical next step in establishing a detailed guidebook for those facilitating a rounds network. While City et al. (ibid.) and others (Chew 2013; Del Prete 1997; Marzano 2011; Thompson and Cooner 2001; Virtue 2006–2007; Zenger 2003) have outlined basic parameters for conducting rounds, none has addressed specifically the role of the instructional rounds facilitator, which is the primary focus of Fowler-Finn’s volume. The book is comprehensive in scope and adeptly aligns the author’s personal experiences with practical applications. Importantly, Fowler-Finn provides sample agendas, lists of needed materials, practice exercises and evaluative protocols throughout, which provide the reader with clear and explicit guidelines to ease implementation during each stage of the instructional rounds process. In the Introduction, Fowler-Finn describes how he first came into contact with the Harvard team and the instructional rounds process as the school superintendent

The cryogenic treatment of tool steels has transformed over centuries from black art to science, but the metallurgical principles responsible for increase in wear resistance, tensile strength, toughness, and stability are still disputed. Metallurgists comprehend how tool steels respond to cryogenic treatment, but they also understand that for many years, the cryogenic treatment of tool steels had the reputation of being a quick fix for poor heat treatment practice. During the cryogenic treatment of tool steels, the process modifies the carbon present in the tool steels. However, cryogenic treatment has not been widely adopted by the cutting tools industry due to lack of understanding of the fundamental metallurgical mechanisms and due to the wide variation in reported research findings. In the present paper, an attempt has been made to review the literature on metallurgical changes that occurred during the cryogenic treatment of tool steels to benefit the cutting tools industry. The prominent reasons found to be responsible for improving the mechanical properties of tool steels are transformation of retained austenite to martensite and precipitation of fine carbides.

AIM: To compare diagnosis and treatment between German and Dutch children with asthmatic symptoms at the age of 5–6 and 7–8 years, and the use of anti-asthma medication at 7–8 years of age. METHODS: Parents of 4462 children participated in two surveys, in 1995 and 1997. All 465 children identified with current asthmatic symptoms at the age of 5–6 (May 1995) or at 7–8 years of age (May 1997) were sent a third more detailed questionnaire (October 1997). RESULTS: Asthma diagnosis was more prevalent in Dutch children with current asthmatic complaints (50–60%), whereas over 90% of the German children with current asthmatic complaints had been diagnosed with bronchitis. Inhaled β(2)-agonists were more frequently used by Dutch children compared to German children (67.3% vs. 45.6% p < 0.01) as were inhaled steroids (38.9% vs. 7.0% p < 0.01). Instead, German children more often used sodium cromoglycate or nedocromil as anti-inflammatory medication as compared with Dutch children (42.1% vs. 11.5% p < 0.01). CONCLUSIONS: Differences in diagnosis rates for asthma and bronchitis between German and Dutch children most likely result from differential labelling of complaints, and probably lead to differences in treatment practice, indicating possible under-treatment of German children with inhaled steroids.

This report presents an analysis of National Treatment Improvement Evaluation Study data describing the characteristics and treatment experiences of clients entering treatment for alcohol problems. Three client groups were contrasted—those entering treatment for alcohol only, for alcohol plus other drugs, or for other drugs only. Clients using alcohol only were more often white, male, and currently employed. Alcohol only clients were treated predominantly in outpatient settings. Alcohol only clients were frequently referred to treatment by the criminal justice system, and less often self-referred. In all 3 study groups, employment, general health, and mental health outcomes were improved following treatment. Illicit drug use increased marginally for the alcohol only group following treatment. No significant posttreatment reductions in reports of total abstinencefrom alcohol were found for any of the groups. Findings are discussed as they relate to research, treatment practice, and policyareas.

Background Intestinal failure is the outcome of a number of gastrointestinal diseases and characterized by significant reduction in functional gut mass. If not resolved patients often face long-term nutritional support. This study gathered information about how patients referred with intestinal failure are managed in specialised European centres. Methods A questionnaire was circulated in 7 European countries via representatives of the ESPEN-HAN working group to seek information about experience in treating patients with intestinal failure. We asked about clinical outcome, information about structure and organisation of the department, referral criteria, treatment procedures and guidelines. Results 17 centres in 6 European countries completed the questionnaire: UK, n = 6, France, n = 4, Spain, n = 3, Denmark, n = 2, Italy, n = 1, Poland, n = 1. The experience of the centres in treating patients was in the range 12–30 years. The total number of patients on HPN in all centres was 590. The number of patients referred to centres with intestinal failure during the period January to December 2000 was n = 882: UK, n = 375 (range 2–175), France, n = 308 (range 24–182), Italy and Spain, n = 43 (range 9–52), Denmark n = 51 (range 14–37), the centre in Poland included 53 patients. Comparing all centres the following distribution among patients (median % (range%)) with regard to the endpoints were reported: Oral nutrition 32% (23–50%), enteral/tube feeding 11% (4–23%), HPN 36% (15–57%), lost to follow up 10% (0–35%), dead 9% (5–18%). No patients had an intestinal transplant. Conclusion The study provides information about how patients with intestinal failure are managed across Europe and the data indicates that treatment practice varies between countries.

The approval of Betaseron® has drawn attention to the potential of immune modulation as a means of treating multiple sclerosis (MS). The implications of this approval to further research in MS, and to current treatment practice, were discussed at the 15th World Congress of Neurology held in Vancouver, Canada, last month, and at an affiliated symposium sponsored by the International Federation of MS Societies.

The beliefs about causes of disease, orientations to medical problems, and the treatment practices of relatively small and elementary societies are reviewed and analyzed. Selected published reports of this problem area of ethnomedicine serve as source material. An attempt is made to induce generalizations which will serve as a possible baseline for studies dealing with related material pertaining to more advanced societies.

In comparing the trends prevailing abroad in the field of heat treatment of steel and cast iron parts with the situation in the Soviet Union, it can be concluded that they are identical.