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2.
JAMA Netw Open ; 4(7): e2120295, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34236416

RESUMEN

Importance: The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. Objective: To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. Evidence Review: A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. Findings: The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. Conclusions and Relevance: Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.


Asunto(s)
COVID-19 , Personal de Salud , Liderazgo , Pandemias , Consenso , Planificación en Desastres , Personal de Salud/legislación & jurisprudencia , Personal de Salud/organización & administración , Humanos , Modelos Organizacionales , SARS-CoV-2
3.
BMC Bioinformatics ; 22(1): 361, 2021 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-34229612

RESUMEN

BACKGROUND: Facing the diversity of omics data and the difficulty of selecting one result over all those produced by several methods, consensus strategies have the potential to reconcile multiple inputs and to produce robust results. RESULTS: Here, we introduce ClustOmics, a generic consensus clustering tool that we use in the context of cancer subtyping. ClustOmics relies on a non-relational graph database, which allows for the simultaneous integration of both multiple omics data and results from various clustering methods. This new tool conciliates input clusterings, regardless of their origin, their number, their size or their shape. ClustOmics implements an intuitive and flexible strategy, based upon the idea of evidence accumulation clustering. ClustOmics computes co-occurrences of pairs of samples in input clusters and uses this score as a similarity measure to reorganize data into consensus clusters. CONCLUSION: We applied ClustOmics to multi-omics disease subtyping on real TCGA cancer data from ten different cancer types. We showed that ClustOmics is robust to heterogeneous qualities of input partitions, smoothing and reconciling preliminary predictions into high-quality consensus clusters, both from a computational and a biological point of view. The comparison to a state-of-the-art consensus-based integration tool, COCA, further corroborated this statement. However, the main interest of ClustOmics is not to compete with other tools, but rather to make profit from their various predictions when no gold-standard metric is available to assess their significance. AVAILABILITY: The ClustOmics source code, released under MIT license, and the results obtained on TCGA cancer data are available on GitHub: https://github.com/galadrielbriere/ClustOmics .


Asunto(s)
Algoritmos , Neoplasias , Análisis por Conglomerados , Consenso , Humanos , Neoplasias/genética , Programas Informáticos
4.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 38(7): 613-619, 2021 Jul 10.
Artículo en Chino | MEDLINE | ID: mdl-34247362

RESUMEN

Genomic disorders caused by pathogenic copy number variation (pCNV) have proven to underlie a significant proportion of birth defects. With technological advance, improvement of bioinformatics analysis procedure, and accumulation of clinical data, non-invasive prenatal screening of pCNV (NIPS-pCNV) by high-throughput sequencing of maternal plasma cell-free DNA has been put to use in clinical settings. Specialized standards for clinical application of NIPS-pCNV are required. Based on the discussion, 10 pCNV-associated diseases with well-defined conditions and 5 common chromosomal aneuploidy syndromes are recommended as the target of screening in this consensus. Meanwhile, a standardized procedure for NIPS-pCNV is also provided, which may facilitate propagation of this technique in clinical settings.


Asunto(s)
Ácidos Nucleicos Libres de Células , Variaciones en el Número de Copia de ADN , Aneuploidia , Ácidos Nucleicos Libres de Células/genética , Consenso , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Embarazo , Diagnóstico Prenatal
5.
BMC Med Educ ; 21(1): 386, 2021 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-34271892

RESUMEN

BACKGROUND: History courses are "required" elements among the didactic elements of the medical and pharmacy curricula in many schools around the world. The aim of this study was to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods of a history of medicine and pharmacy course for medical and pharmacy students in the Arab World. METHODS: A systematic search of PubMed, ScienceDirect, SpringerLink, Scopus, and Google Scholar was conducted to identify course aims, contents, intended learning outcomes from the literature. The search was supplemented by semi-structured in-depth interviews with 5 educators/academicians, 3 pharmacists, and 3 physicians. The Delphi technique was used among panelists (10 educators/academicians, 4 physicians, and 4 pharmacists) to develop consensus-based course aims, contents, intended learning outcomes, teaching, and evaluation methods. RESULTS: The vast majority of the panelists agreed on the 10 items (agreement ≥88.9%) on the importance of teaching history to medical and pharmacy students. Consensus-based aims (n = 4) and intended learning outcomes (n = 13) were developed in the 1st and 2nd iterative Delphi rounds. The panelists suggested that 16 dedicated meeting hours (1 credit hour) would be required to cover the course. Bloom's verbs were used to target the lower and higher orders of the cognitive domain. The course could be taught through face-to-face lectures, provision of reading materials, video documentaries, case studies, group discussions and debates. Multiple-choice questions, written reflections, portfolios, group projects, and engagement in discussions and debates might be used to evaluate performance of students. CONCLUSION: Consensus-based course of history of medicine and pharmacy course was developed for medical and pharmacy students in the Arab World. Well-designed course aims, contents, intended learning outcomes, teaching, and evaluation methods are more likely to meet the accreditation requirements and might improve performance of medical and pharmacy students. Future studies are still needed to investigate if such consensus-based courses can improve performance of the students.


Asunto(s)
Educación en Farmacia , Farmacia , Estudiantes de Farmacia , Mundo Árabe , Consenso , Curriculum , Técnica Delfos , Historia de la Medicina , Humanos , Enseñanza
6.
BMC Bioinformatics ; 22(1): 373, 2021 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-34273961

RESUMEN

BACKGROUND: SARS-CoV-2 related research has increased in importance worldwide since December 2019. Several new variants of SARS-CoV-2 have emerged globally, of which the most notable and concerning currently are the UK variant B.1.1.7, the South African variant B1.351 and the Brazilian variant P.1. Detecting and monitoring novel variants is essential in SARS-CoV-2 surveillance. While there are several tools for assembling virus genomes and performing lineage analyses to investigate SARS-CoV-2, each is limited to performing singular or a few functions separately. RESULTS: Due to the lack of publicly available pipelines, which could perform fast reference-based assemblies on raw SARS-CoV-2 sequences in addition to identifying lineages to detect variants of concern, we have developed an open source bioinformatic pipeline called HAVoC (Helsinki university Analyzer for Variants of Concern). HAVoC can reference assemble raw sequence reads and assign the corresponding lineages to SARS-CoV-2 sequences. CONCLUSIONS: HAVoC is a pipeline utilizing several bioinformatic tools to perform multiple necessary analyses for investigating genetic variance among SARS-CoV-2 samples. The pipeline is particularly useful for those who need a more accessible and fast tool to detect and monitor the spread of SARS-CoV-2 variants of concern during local outbreaks. HAVoC is currently being used in Finland for monitoring the spread of SARS-CoV-2 variants. HAVoC user manual and source code are available at https://www.helsinki.fi/en/projects/havoc and https://bitbucket.org/auto_cov_pipeline/havoc , respectively.


Asunto(s)
COVID-19 , SARS-CoV-2 , Brasil , Biología Computacional , Consenso , Humanos
7.
Zhonghua Yi Xue Za Zhi ; 101(27): 2107-2110, 2021 Jul 20.
Artículo en Chino | MEDLINE | ID: mdl-34275245

RESUMEN

Acromegaly is a rare disease, and multidisciplinary collaboration is essential for its diagnosis, treatment, and follow-up.In recent years, a series of novel findings have been echieved in clinical studies on acromegaly.Therefore, the China Pituitary Adenoma Specialist council has convened Chinese specialists in neurosurgery, endocrinology, radiology, and radiotherapy to release the Chinese Consensus for the Diagnosis and Treatment of Acromegaly (2021), which aims to promote the standardized and individualized management of acromegaly.Looking back to the past, the consensuses and guidelines have played vital roles in establishing the widely recognized biochemical remission criteria, promoting new drugs and novel therapeutic strategies which are of significance for standardized treatment, and emphasizing the need to focus on the systemic complications of acromegaly and the long-term quality of life. In this editorial, we briefly reviewed the expert consensuses and clinical guidelines on acromegaly at home and abroad, and discussed their important roles in promoting standardized disease management from three aspects including biochemical remission standards, medical treatment, and the diagnosis and treatment of systemic complications.


Asunto(s)
Acromegalia , Neoplasias Hipofisarias , Acromegalia/diagnóstico , Acromegalia/terapia , China , Consenso , Humanos , Calidad de Vida
8.
Zhonghua Yi Xue Za Zhi ; 101(27): 2111-2114, 2021 Jul 20.
Artículo en Chino | MEDLINE | ID: mdl-34275246

RESUMEN

Led by the China Pituitary Adenoma Specialist Council, the Chinese Consensus for the Diagnosis and Treatment of Acromegaly (2021 Edition) is developed combined with the research progress of pituitary growth hormone (GH)-secreting adenoma both at home and abroad, evidence-based evidence of the diagnosis and treatment of acromegaly, and China's national conditions. Based on the guideline for acromegaly (2013 Edition), the new version of consensus emphasizes the importance of multidisciplinary team (MDT) and individual therapy. The criteria for control of acromegaly is discussed. Pathological criteria for the diagnosis of pituitary GH-secreting adenoma is updated. New developments in surgery, drug and radiotherapy are introduced. Meanwhile, the diagnosis and treatment of acromegaly patients concurrent with other particular scenarios, including pregnancy and refractory pituitary GH-secreting adenoma is suggested. This article aims to describe the updated key points of the new version of the consensus, and thus facilitate the clinical implementation of standardized diagnosis and treatment for acromegaly patients.


Asunto(s)
Acromegalia , Adenoma , Neoplasias Hipofisarias , Acromegalia/diagnóstico , Acromegalia/terapia , Adenoma/diagnóstico , Adenoma/terapia , China , Consenso , Humanos , Factor I del Crecimiento Similar a la Insulina , Estudios Retrospectivos
9.
Trials ; 22(1): 388, 2021 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-34098998

RESUMEN

BACKGROUND: Therapeutic exercise is recommended as a core treatment for hip osteoarthritis (HOA). Whilst it is widely accepted that exercise can improve pain and disability, optimal type and dose of exercise are yet to be agreed upon. This may, in part, be attributed to the wide variation and inadequate reporting of interventions within the literature. This study evaluates the quality of intervention reporting among trials of therapeutic exercise in HOA. METHODS: Randomised controlled trials (RCTs) were sourced in a systematic review, completed in August 2020. Two raters independently used the Template for Intervention Description and Replication (TIDieR) and Consensus on Exercise Reporting Template (CERT) to evaluate intervention reporting. Correlations between quality assessment scores and CERT and TIDieR scores evaluated the relationship between internal validity and external applicability. The year of publication was compared to the quality of reporting scores. RESULTS: Fourteen RCTs were included in the analysis. On average, studies were awarded 9.43 ± 1.95 out of 12 points for the TIDieR checklist (range 4-12) and 13.57 ± 4.01 out of 19 points for the CERT (range 5-19). Pearson's correlation coefficient suggested that the quality of reporting had improved over time and that there was a fair, positive relationship between internal validity and external applicability. DISCUSSION: Whilst the quality of intervention reporting is improving, many RCTs of therapeutic exercise in HOA lack the detail necessary to allow accurate evaluation and replication. Researchers are encouraged to utilise the standardised reporting guidelines to increase the translation of effective interventions into clinical practice.


Asunto(s)
Osteoartritis de la Cadera , Lista de Verificación , Consenso , Ejercicio Físico , Terapia por Ejercicio , Humanos , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Cadera/terapia
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(6): 467-472, 2021 Jun 25.
Artículo en Chino | MEDLINE | ID: mdl-34148310

RESUMEN

In 1982, total mesorectal excision(TME) was proposed by Professor R. J. Heald, which was a milestone-style for rectal cancer surgery. The concept of TME has reduced the local recurrence rate of mid-low rectal cancer (MLRC) significantly, thus becomes the gold standard for MLRC surgery. However, the incidence of urogenital dysfunction after TME remains high, among which urinary dysfunction reaches 30%-60%, and sexual dysfunction reaches 50%-70%. In recent years, studies have shown that the removal of Denonvilliers' fascia (DVF) during TME is an important cause of postoperative urination and sexual dysfunction. Therefore, DVF preserving total mesorectal excision (iTME) has been recognized by more and more surgical experts. On the basis of existing literature and clinical practice, we organize experts to discuss and vote, put forward recommendations for several issues of iTME, and finally formulate this expert consensus. The formulation of this consensus aims to increase surgeons' awareness of the value and functional protection of DVF during TME surgery, clarify the indications and contraindications of iTME, and standardize the procedure of iTME, so as to reduce postoperative urination and sexual dysfunction and improve the quality of life of patients with MLRC. The level of evidence and recommendation of this consensus is determined by Grading Recommendations, Assessment, Development and Evaluation (GRADE), and the consensus content is determined through expert voting and Delphi method.


Asunto(s)
Calidad de Vida , Neoplasias del Recto , China , Consenso , Fascia , Humanos , Recurrencia Local de Neoplasia , Neoplasias del Recto/cirugía , Recto/cirugía
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(6): 473-479, 2021 Jun 25.
Artículo en Chino | MEDLINE | ID: mdl-34148311

RESUMEN

Colorectal cancer is the second most common malignant tumor in China. The FOLFOXIRI regimen, which combines 5-fluorouracil/leucovorin, oxaliplatin, and irinotecan, is a high-intensity and highly effective chemotherapy regimen. However, the original regimen is poorly tolerated in Chinese patients. In order to promote the standardized and rational application of FOLFOXIRI regimen by clinicians in China, "Chinese Expert Consensus on the Clinical Application of the Chinese Modified Triplet Combination with Irinotecan, Oxaliplatin, and Continuous Infusional 5-Fluorouracil/Leucovorin for Colorectal Cancer" was formulated by the Committee of Colorectal Cancer in Chinese Southwest Oncology Group. Based on the mechanism underlying the combined three drugs and toxicity profile, the dosage of Chinese modified FOLFOXIRI (cmFOLFOXIRI) regimen and the management of related adverse reactions is proposed. This consensus recommended that the FOLFOXIRI regimen be used in neoadjuvant, conversion, and palliative therapy for colorectal cancer under specific conditions. This consensus aimed to drive the application of cmFOLFOXIRI in the field of colorectal cancer, in order to bring benefits to CRC patients and improve the treatment efficacy.


Asunto(s)
Camptotecina , Neoplasias Colorrectales , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Camptotecina/uso terapéutico , China , Neoplasias Colorrectales/tratamiento farmacológico , Consenso , Fluorouracilo/uso terapéutico , Humanos , Irinotecán/uso terapéutico , Leucovorina/uso terapéutico , Compuestos Organoplatinos/uso terapéutico , Oxaliplatino , Resultado del Tratamiento
12.
Orphanet J Rare Dis ; 16(1): 257, 2021 06 04.
Artículo en Inglés | MEDLINE | ID: mdl-34088339

RESUMEN

BACKGROUND: This research aimed to establish recommendations on the clinical and genetic characteristics necessary to confirm patient eligibility for gene supplementation with voretigene neparvovec. METHODS: An expert steering committee comprising an interdisciplinary panel of Italian experts in the three fields of medical specialisation involved in the management of RPE65-associated inherited retinal disease (IRD) (medical retina, genetics, vitreoretinal surgery) proposed clinical questions necessary to determine the correct identification of patients with the disease, determine the fundamental clinical and genetics tests to reach the correct diagnosis and to evaluate the urgency to treat patients eligible to receive treatment with voretigene neparvovec. Supported by an extensive review of the literature, a series of statements were developed and refined to prepare precisely constructed questionnaires that were circulated among an external panel of experts comprising ophthalmologists (retina specialists, vitreoretinal surgeons) and geneticists with extensive experience in IRDs in Italy in a two-round Delphi process. RESULTS: The categories addressed in the questionnaires included clinical manifestations of RPE65-related IRD, IRD screening and diagnosis, gene testing and genotyping, ocular gene therapy for IRDs, patient eligibility and prioritisation and surgical issues. Response rates by the survey participants were over 90% for the majority of items in both Delphi rounds. The steering committee developed the key consensus recommendations on each category that came from the two Delphi rounds into a simple and linear diagnostic algorithm designed to illustrate the patient pathway leading from the patient's referral centre to the retinal specialist centre. CONCLUSIONS: Consensus guidelines were developed to guide paediatricians and general ophthalmologists to arrive at the correct diagnosis of RPE65-associated IRD and make informed clinical decisions regarding eligibility for a gene therapy approach to RPE65-associated IRD. The guidelines aim to ensure the best outcome for the patient, based on expert opinion, the published literature, and practical experience in the field of IRDs.


Asunto(s)
Terapia Genética , Enfermedades de la Retina , Consenso , Humanos , Italia , Retina
14.
Best Pract Res Clin Obstet Gynaecol ; 74: 159-167, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34119435

RESUMEN

Considerable differences exist in the management of gestational trophoblastic disease (GTD) both nationally and internationally despite numerous efforts to harmonise patient care. This partly reflects differences in healthcare systems and availability of resources. However, even in first world equivalent economies with similar healthcare systems differences remain, which appear to impact survival. Recently, new international guidelines have been established in Europe through a series of consensus meetings. Improvement of outcomes will depend on the establishment of dedicated centres with appropriate patient pathways according to these guidelines. This review will highlight some of the differences and efforts to unify the management of GTD across the globe and discuss areas for future development.


Asunto(s)
Enfermedad Trofoblástica Gestacional , Consenso , Europa (Continente) , Femenino , Humanos , Embarazo
16.
Br J Radiol ; 94(1123): 20210252, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34142869

RESUMEN

Shielding, particularly of the gonads, has been a routine part of diagnostic radiographic imaging for many years. However, recent thinking suggests that such shielding may offer little benefit, and in some cases may actually cause harm, e.g. by obscuring anatomy or paradoxically increasing patient radiation dose secondary to the need for repeat imaging. This thinking has led many institutions in the West to abandon routine shielding. However, in Asia, shielding is still commonplace. It was felt that the Asia-Pacific Forum on Quality and Safety in Medical Imaging (APQS) was an ideal place to discuss the merits of shielding and deliver a pan-Asian consensus. The APQS is an annual meeting that convenes radiation safety and imaging quality experts from all of the major Asian regions. During the 2020 APQS meeting, radiation safety experts from each region discussed their opinions of shielding during a dedicated session. These experts' views were mostly in line with the views of Western radiologists. However, important country specific and cultural factors were noted by each of the experts. A pan-Asian consensus was issued by the forum. It is hoped that this consensus will guide the development of future shielding policies throughout Asia.


Asunto(s)
Diagnóstico por Imagen , Protección Radiológica/métodos , Asia , Congresos como Asunto , Consenso , Características Culturales , Humanos , Dosis de Radiación
17.
Biomed Khim ; 67(3): 268-277, 2021 May.
Artículo en Ruso | MEDLINE | ID: mdl-34142534

RESUMEN

RAGE signal transduction via the RAGE-NF-κB signaling pathway is one of the mechanisms of inflammatory reactions that cause severe complications in diabetes mellitus. RAGE inhibitors are promising pharmacological compounds that require the development of new predictive models. Based on the methodology of artificial neural networks, consensus ensemble neural network multitarget model has been constructed. This model describes the dependence of the level of the RAGE inhibitory activity on the affinity of compounds for 34 target proteins of the RAGE-NF-κB signal pathway. For this purpose an expanded database of valid three-dimensional models of target proteins of the RAGE-NF-κB signal chain was created on the basis of a previously created database of three-dimensional models of relevant biotargets. Ensemble molecular docking of known RAGE inhibitors from a verified database into the sites of added models of target proteins was performed, and the minimum docking energies for each compound in relation to each target were determined. An extended training set for neural network modeling was formed. Using seven variants of sampling by the method of artificial multilayer perceptron neural networks, three ensembles of classification decision rules were constructed to predict three level of the RAGE-inhibitory activity based on the calculated affinity of compounds for significant target proteins of the RAGE-NF-κB signaling pathway. Using a simple consensus of the second level, the predictive ability of the created model was assessed and its high accuracy and statistical significance were shown. The resultant consensus ensemble neural network multitarget model has been used for virtual screening of new derivatives of different chemical classes. The most promising substances have been synthesized and sent for experimental studies.


Asunto(s)
FN-kappa B , Redes Neurales de la Computación , Consenso , Simulación del Acoplamiento Molecular , FN-kappa B/genética , FN-kappa B/metabolismo , Transducción de Señal
18.
Zhonghua Yan Ke Za Zhi ; 57(6): 406-414, 2021 Jun 11.
Artículo en Chino | MEDLINE | ID: mdl-34098689

RESUMEN

Day surgery is currently a rapidly developing medical service mode. Ophthalmology is more suitable for day surgery due to its disease characteristics. To promote the healthy development of ophthalmic day surgery in China, and to improve its standardized management to ensure the medical quality and patients' safety, the Ophthalmology Committee of the Chinese Medical Education Association, the Ophthalmology Branch of the Chinese Geriatrics Society, and the Ophthalmology Professional Committee of PLA Medical Science and Technology Association developed the present expert consensus on management of ophthalmic day surgery after serious, comprehensive, and full discussions, focusing on the facility construction, organization and management model, specific implementation, quality and safety management for ophthalmic day surgery. (Chin J Ophthalmol, 2021, 57: 406-414).


Asunto(s)
Oftalmología , Procedimientos Quirúrgicos Ambulatorios , China , Consenso , Humanos
19.
BMC Musculoskelet Disord ; 22(1): 514, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34088302

RESUMEN

BACKGROUND: The 2013 Malaysian Clinical Practice Guidelines on the Management of Osteoarthritis (OA) recommend a linear step-up approach to manage knee OA. However, patients with knee OA often require a multimodal approach to address OA-related pain symptoms and functional limitations. This consensus aimed to provide doctors with an updated set of evidence-based, clinical experience-guided recommendations to manage knee OA. METHODS: A multi-speciality expert panel consisting of nine Malaysian physicians from different healthcare settings who manage a diverse OA patient population was convened. Using a combination of the ADAPTE process and modified Delphi method, the panel reviewed current evidence on the management of knee OA and synthesised a set of nine recommendations on the management of knee OA, supported by an algorithm that summarises the consensus' core messages. RESULTS: A multimodal intervention strategy is the mainstay of OA management and the choice of any single or multimodal intervention may vary over the course of the disease. Overall, a non-pharmacological core treatment set of patient education, weight loss and exercise is recommended for all patients. When pharmacotherapy is indicated, symptomatic slow-acting drugs for osteoarthritis are recommended at the early stage of disease, and they can be paired with physical therapy as background treatment. Concurrent advanced pharmacotherapy that includes non-steroidal anti-inflammatory drugs, intraarticular injections and short-term weak opioids can be considered if patients do not respond sufficiently to background treatment. Patients with severe symptomatic knee OA should be considered for knee replacement surgery. Management should begin with specific treatments with the least systemic exposure or toxicity, and the choice of treatment should be determined as a shared decision between patients and their team of healthcare providers. CONCLUSIONS: This consensus presents nine recommendations that advocate an algorithmic approach in the management of patients living with knee OA. They are applicable to patients receiving treatment from primary to tertiary care providers in Malaysia as well as other countries.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Consenso , Humanos , Inyecciones Intraarticulares , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/terapia , Pérdida de Peso
20.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 38(6): 513-520, 2021 Jun 10.
Artículo en Chino | MEDLINE | ID: mdl-34096016

RESUMEN

The use of whole exome sequencing (WES) for the detection of disease-causing variants of genetic diseases and for non-invasive prenatal screening (NIPS) of fetal aneuploidies are two major clinical applications of next generation sequencing (NGS). This article has summarized the official documents developed and updated by the American College of Medical Genetics and Genomics (ACMG) on governing WES and NIPS. These include the development of expert consensus policies and position statements on an ongoing basis to guide clinical application of NGS technology and variant analysis, establish evidence-based practical resources, as well as standards and guidelines to govern diagnosis and screening. These ACMG documents are valuable references to Chinese geneticists, but direct adoption of these standards and guidelines may not be practical due to the differences in disease-associated variant frequencies in Chinese population, socioeconomic status, and medical practice between the two countries. It is hoped that this review could facilitate the development of NGS and NIPS standards and guidelines that are consistent with international standards and concordant with medical genetics practice in China to provide high-quality, efficient and safe clinical services for patients and their families with genetic diseases.


Asunto(s)
Genómica , Secuenciación de Nucleótidos de Alto Rendimiento , China , Consenso , Femenino , Humanos , Embarazo , Tecnología , Estados Unidos
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