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  • 1
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    Online Resource
    Egyptian consensus on treat-to-target approach for osteoporosis: a clinical practice guideline from the Egyptian Academy of bone health and metabolic bone diseases
    Springer Science and Business Media LLC ; 2021
    In:  Egyptian Rheumatology and Rehabilitation Vol. 48, No. 1 ( 2021-12)
    Details
    In: Egyptian Rheumatology and Rehabilitation, Springer Science and Business Media LLC, Vol. 48, No. 1 ( 2021-12)
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 1110-161X , 2090-3235
    URL: Article
    DOI: 10.1186/s43166-020-00056-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 2
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    Egyptian evidence-based consensus on clinical practice recommendations for the management of lupus nephritis
    Springer Science and Business Media LLC ; 2022
    In:  Egyptian Rheumatology and Rehabilitation Vol. 49, No. 1 ( 2022-12)
    Details
    In: Egyptian Rheumatology and Rehabilitation, Springer Science and Business Media LLC, Vol. 49, No. 1 ( 2022-12)
    Abstract: Lupus nephritis (LN) affects a substantial number of the patients living with Systemic lupus erythematosus (SLE), representing a major cause of morbidity and mortality. Patients with lupus nephritis should be referred to a lupus nephritis expert who can confirm the diagnosis, assess the level of disease activity, and offer guidance on treatment and monitoring of the disease, as well as its consequences and side effects. The aim of this guideline was to develop recommendations for the management of adult lupus patients, including lupus nephritis diagnosis, assessment, and monitoring. Nineteen key clinical questions were identified by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for LN. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 2-round Delphi process was conducted with 24 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the two rounds (response rate 100%). At the end of round 2, a total of 19 recommendation items, categorized into 11 sections to address the main LN categories, were obtained. The percentage of those who agreed with the recommendations (ranks 7–9) ranged from 90.5 to 100%. The phrasing of all 19 clinical standards identified by the scientific committee was agreed upon (i.e., 75% of respondents strongly agreed or agreed). Conclusion These recommendations provide an updated consensus on the pharmacological treatment of lupus nephritis and strategies to reach optimal treat to target outcomes in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.
    Type of Medium: Online Resource
    ISSN: 1110-161X , 2090-3235
    URL: Article
    DOI: 10.1186/s43166-022-00146-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2998313-7
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  • 3
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    Egyptian guidelines for the treatment of Rheumatoid Arthritis — 2022 update
    Springer Science and Business Media LLC ; 2022
    In:  Egyptian Rheumatology and Rehabilitation Vol. 49, No. 1 ( 2022-12)
    Details
    In: Egyptian Rheumatology and Rehabilitation, Springer Science and Business Media LLC, Vol. 49, No. 1 ( 2022-12)
    Abstract: Busy rheumatologists, and busy patients as well as policy makers, require accurate, succinct, transparent, easily digested summaries of evidence and recommendations for management. Our objective was to develop an up-to-date evidence-based, consensus, clinical practice guidelines for treat-to-target management of rheumatoid arthritis in adults. Results Ninety-four (94.7%) of the expert committee completed the 2-round e-Delphi surveys. A total of 33 recommendation items, addressing the main rheumatoid arthritis (RA) domains, were identified. The level of agreement (rate 7–9), for the statements which reached consensus, ranged from 85 to 100%. Consensus was achieved on the wording of all the clinical practice guidelines identified by the scientific committee. A management algorithm for the management of rheumatoid arthritis have been developed. Conclusion These updated recommendations reflect the most recent evidence for the management of RA. It also outlines the multidisciplinary team role in enhancing the RA patients’ care. The recommendations offer strategies to achieve optimum treat-to-target outcomes. However, standards of care are defined based on the clinical data obtained for individual patients and are prone to modification. High-quality, broad scope evidence-based clinical practice guidelines offer a path for bridging the gap between best practice, policy, local settings and patients’ choice.
    Type of Medium: Online Resource
    ISSN: 1110-161X , 2090-3235
    URL: Article
    DOI: 10.1186/s43166-022-00153-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 4
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    The identification, goals and principles of difficult-to-treat inflammatory arthritis: a consensus statement
    Springer Science and Business Media LLC ; 2023
    In:  Egyptian Rheumatology and Rehabilitation Vol. 50, No. 1 ( 2023-11-09)
    Details
    In: Egyptian Rheumatology and Rehabilitation, Springer Science and Business Media LLC, Vol. 50, No. 1 ( 2023-11-09)
    Abstract: Despite the recent advances in the management of inflammatory arthritis, a considerable proportion of arthritis patients remain symptomatic. This cohort has recently been identified as ‘difficult to treat’ (D2T). In view of the limited evidence base, management of these patients has been a challenge particularly in view of its associated significant economic health burden. A better understanding of the D2T may help recognise or develop new therapeutic targets and facilitate earlier intervention in the disease course to prevent the progression of such condition. The aim of this work is to address the unmet needs in the management of D2T arthritis and develop a comprehensive approach towards the identification and proper assessment of those patients. Results At the completion of round 3 Delphi process, a total of 20 items were obtained and divided into 5 domains. From 88.9 to 100% of respondents agreed with the recommendations (ranks 7–9). All 20 of the clinical standards that the scientific committee identified were agreed upon in terms of wording, recommendation grade, and level of evidence (i.e. 75% of respondents strongly agreed or agreed). Conclusion D2T inflammatory arthritis remains a relevant clinical challenge, despite the endorsement of the treat-to-target approach and the availability of a broad range of targeted arthritis medications. This study provided a comprehensive definition of the condition to facilitate the identification of this patients’ group. It also highlighted the goals and principles aiming at providing an effective framework for D2T assessment, closely monitor and set up a strategy to intervene in standard clinical practice.
    Type of Medium: Online Resource
    ISSN: 2090-3235
    URL: Article
    DOI: 10.1186/s43166-023-00221-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2998313-7
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  • 5
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    Psoriatic arthritis treatment to the target: a consensus, evidence-based clinical practice recommendations for the management of psoriatic arthritis and its concomitant clinical manifestations
    Springer Science and Business Media LLC ; 2022
    In:  Egyptian Rheumatology and Rehabilitation Vol. 49, No. 1 ( 2022-12)
    Details
    In: Egyptian Rheumatology and Rehabilitation, Springer Science and Business Media LLC, Vol. 49, No. 1 ( 2022-12)
    Abstract: We aimed to provide up-to-date, evidence-based and consensus-based recommendations for Treat-to-Target management of psoriatic arthritis (PsA) and associated clinical manifestations. In this recommendations, 14 key clinical questions were identified by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature Review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and non-pharmacologic therapies for psoriatic arthritis. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 19 experts whom were drawn from different governorates and health centers across Egypt with diverse in their experiences, including private, governmental workplace, tertiary university hospitals, and insurance hospitals. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of 51 recommendation items, categorized into 6 sections to address the main 6 psoriatic arthritis categories, were obtained. Agreement with the recommendations (rank 7–9) ranged from 89.5 to 100%. Consensus was reached (i.e., ≥ 75%of respondents strongly agreed or agreed) on the wording of all the 51 clinical standards identified by the scientific committee. Algorithms for the management of psoriatic arthritis have been suggested. Conclusion These recommendations provide an updated consensus on the pharmacological treatment of psoriatic arthritis and strategies to reach optimal treat-to-target outcomes in in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.
    Type of Medium: Online Resource
    ISSN: 1110-161X , 2090-3235
    URL: Article
    DOI: 10.1186/s43166-022-00128-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2998313-7
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  • 6
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    Egyptian evidence-based consensus on clinical practice recommendations for the management of Kawasaki disease
    Springer Science and Business Media LLC ; 2023
    In:  Egyptian Rheumatology and Rehabilitation Vol. 50, No. 1 ( 2023-04-10)
    Details
    In: Egyptian Rheumatology and Rehabilitation, Springer Science and Business Media LLC, Vol. 50, No. 1 ( 2023-04-10)
    Abstract: Kawasaki disease (KD) is an acute, self-limited febrile disease of unidentified cause that mostly affects children less than 5 years of age. This work aimed to provide an appropriate Egyptian evidence-based consensus on clinical practice recommendations for the management of Kawasaki disease. The main objective of this study, which employed the Delphi method, was to reach a consensus among experts on a treat-to-target management approach for KD. Results The expert panel was confined to an online survey ( n =26), and all the expert completed the three rounds. At the conclusion of round 3, a total of 17 recommendation items were gathered, which were divided into two sections. The range of respondents (ranks 7–9) who agreed with the recommendations was 92.3 to 100%. All 17 clinical standards identified by the scientific committee were written in the same way. There have been algorithms proposed for managing various KD conditions. Conclusion The developed evidence-based consensus recommendations for the diagnosis and management of KD represent an up-to-date document that focuses on clinical management questions which are generally posed to health care professionals involved in the management of KD. This guideline was developed considering experience with and availability of treatment and diagnostic options in Egypt.
    Type of Medium: Online Resource
    ISSN: 2090-3235
    URL: Article
    DOI: 10.1186/s43166-023-00180-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 7
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    E07 Development of a coordinated transitional care program on adolescents with juvenile idiopathic arthritis: looking through the patient lens
    Oxford University Press (OUP) ; 2023
    In:  Rheumatology Vol. 62, No. Supplement_3 ( 2023-08-10)
    Details
    In: Rheumatology, Oxford University Press (OUP), Vol. 62, No. Supplement_3 ( 2023-08-10)
    Abstract: 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 don't switch doctors until they are young adults, but it can be beneficial to start preparing children earlier. Objectives To provide a toolset specifically suited for adult and paediatric rheumatologists to help them transition the care of children with rheumatic diseases from adult to paediatric rheumatology care. Methods The preliminary scientific committee identified a total of ten major clinical questions in this study, which was conducted to obtain expert consensus. To reach consensus on the transition of care for young adults and adolescents with rheumatic diseases, the core leadership team sought out researchers and clinicians with expertise in both paediatric and adult rheumatic diseases management. Results The expert panel's participation was restricted to an online survey (n = 18); each expert completed both rounds. After round 2, a total of 10 points had been collected. 88.9% to100% of respondents (ranks 7–9) indicated they agreed with the recommendations. The scientific committee's 10 clinical standards were all prepared in the same style. A structured template describing the integrated pathway for transition of care was developed using the responses to the structured key questions and the results of the literature review. Conclusion The created rheumatology-specific guideline provides young adults with juvenile rheumatic diseases with a focused, multidisciplinary transition of care strategy with equity of access, quality of care, and flexibility and establishes standards for transitional care. Ethics This study was performed in accordance with the Helsinki Declaration. The ‘Clinical, Evidence-based, Guidelines’ (CEG) initiative protocol was approved the local ethical committee: ethical approval code: 34842/8/21, ethical board Tanta University.
    Type of Medium: Online Resource
    ISSN: 1462-0324 , 1462-0332
    URL: Article
    DOI: 10.1093/rheumatology/kead323.007
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1464822-2
    detail.hit.zdb_id: 1474143-X
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  • 8
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    Consensus evidence-based recommendations for treat-to-target management of immunoglobulin A vasculitis
    SAGE Publications ; 2021
    In:  Therapeutic Advances in Musculoskeletal Disease Vol. 13 ( 2021-01), p. 1759720X2110596-
    Details
    In: Therapeutic Advances in Musculoskeletal Disease, SAGE Publications, Vol. 13 ( 2021-01), p. 1759720X2110596-
    Abstract: 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. ⩾75% 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. Plain Language Summary Given its potential life-threatening systemic complications, early and accurate diagnosis of immunoglobulin A vasculitis represents a major challenge for health care professionals. This work provided cornerstone principles for the management of the condition. Adopting PICO approach and implementing Delphi process a consensus was reached on evidence-based treat-to-target treatment recommendations. This will endorse enhancement and consistency of care of this cohort of patients in standard practice.
    Type of Medium: Online Resource
    ISSN: 1759-720X , 1759-7218
    URL: Article
    DOI: 10.1177/1759720X211059610
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2516075-8
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  • 9
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    Consensus Evidence-Based Clinical Practice Recommendations for the Diagnosis and Treat-To-Target Management of Osteoporosis in Chronic Kidney Disease Stages G4-G5D and Post-transplantation: An Initiative of Egyptian Academy of Bone Health
    S. Karger AG ; 2022
    In:  Kidney Diseases Vol. 8, No. 5 ( 2022), p. 392-407
    Details
    In: Kidney Diseases, S. Karger AG, Vol. 8, No. 5 ( 2022), p. 392-407
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts’ suggestions, and the percent agreement was calculated. Statements receiving rates of 7–9 by more than 75% of experts’ votes were considered as achieving consensus. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The surveys were sent to an expert panel ( 〈 i 〉 n 〈 /i 〉 = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7–9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management.
    Type of Medium: Online Resource
    ISSN: 2296-9381 , 2296-9357
    URL: Article
    DOI: 10.1159/000526492
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 2817963-8
    detail.hit.zdb_id: 2789480-0
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  • 10
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    Egyptian recommendations for the management of systemic lupus erythematosus: a consensus, evidence-based, clinical practice guidelines for treat-to-target management
    Springer Science and Business Media LLC ; 2023
    In:  Egyptian Rheumatology and Rehabilitation Vol. 50, No. 1 ( 2023-04-06)
    Details
    In: Egyptian Rheumatology and Rehabilitation, Springer Science and Business Media LLC, Vol. 50, No. 1 ( 2023-04-06)
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 2090-3235
    URL: Article
    DOI: 10.1186/s43166-023-00187-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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