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1.
Ann Otol Rhinol Laryngol ; 129(1): 55-62, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31801377

RESUMEN

OBJECTIVE: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). STUDY DESIGN: Online survey. METHOD: A sample of pediatric anesthesiologists received the survey by email. RESULTS: 110 respondents were included. 46.4% worked in a free-standing children's hospital and 32.7% worked in a children's facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children's hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). CONCLUSION: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.


Asunto(s)
Analgésicos/uso terapéutico , Anestesiología , Anestésicos/uso terapéutico , Antieméticos/uso terapéutico , Pediatría , Pautas de la Práctica en Medicina , Apnea Obstructiva del Sueño/cirugía , Tonsilectomía , Acetaminofén/uso terapéutico , Adenoidectomía , Extubación Traqueal/métodos , Antiinflamatorios no Esteroideos/uso terapéutico , Dexametasona/uso terapéutico , Fentanilo/uso terapéutico , Humanos , Midazolam/uso terapéutico , Morfina/uso terapéutico , Óxido Nitroso/uso terapéutico , Ondansetrón/uso terapéutico , Guías de Práctica Clínica como Asunto , Encuestas y Cuestionarios
2.
Zhonghua Nei Ke Za Zhi ; 59(1): 18-22, 2020 Jan 01.
Artículo en Chino | MEDLINE | ID: mdl-31887831

RESUMEN

The prevalence of dyslipidemia in Chinese adult is increasing dramatically, which poses a severe challenge to the prevention and treatment of atherosclerotic cardiovascular diseases. In recent years, a series of new research results have been published, providing a lot of new information for the management strategy of dyslipidemia. In order to apply these new research results to clinical practice for the further prevention and treatment of dyslipidemia more reasonably and effectively, the China Cholesterol Education Program (CCEP) Working Committee organized joint expert meeting and revised the "Expert Advice on Prevention and Treatment of Dyslipidemia in China Cholesterol Education Program 2014", in which a new classification standard for cardiovascular risk stratification has been proposed, and the target value of lipid-lowering therapy has been updated.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Dislipidemias , Guías de Práctica Clínica como Asunto , Adulto , China , Dislipidemias/prevención & control , Dislipidemias/terapia , Humanos , Factores de Riesgo
3.
Equine Vet J ; 52(1): 13-27, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31657050

RESUMEN

Primary care guidelines provide a reference point to guide clinicians based on a systematic review of the literature, contextualised by expert clinical opinion. These guidelines develop a modification of the GRADE framework for assessment of research evidence (vetGRADE) and applied this to a range of clinical scenarios regarding use of analgesic agents. Key guidelines produced by the panel included recommendations that horses undergoing routine castration should receive intratesticular local anaesthesia irrespective of methods adopted and that horses should receive NSAIDs prior to surgery (overall certainty levels high). Butorphanol and buprenorphine should not be considered appropriate as sole analgesic for such procedures (high certainty). The panel recommend the continuation of analgesia for 3 days following castration (moderate certainty) and conclude that phenylbutazone provided superior analgesia to meloxicam and firocoxib for hoof pain/laminitis (moderate certainty), but that enhanced efficacy has not been demonstrated for joint pain. In horses with colic, flunixin and firocoxib are considered to provide more effective analgesia than meloxicam or phenylbutazone (moderate certainty). Given the risk of adverse events of all classes of analgesic, these agents should be used only under the control of a veterinary surgeon who has fully evaluated a horse and developed a therapeutic, analgesic plan that includes ongoing monitoring for such adverse events such as the development of right dorsal colitis with all classes of NSAID and spontaneous locomotor activity and potentially ileus with opiates. Finally, the panel call for the development of a single properly validated composite pain score for horses to allow accurate comparisons between medications in a robust manner.


Asunto(s)
Analgesia/veterinaria , Enfermedades de los Caballos/tratamiento farmacológico , Dolor/veterinaria , Guías de Práctica Clínica como Asunto , Sociedades Científicas/normas , Medicina Veterinaria/normas , Animales , Caballos , Dolor/tratamiento farmacológico , Reino Unido
4.
J Clin Ethics ; 30(4): 347-355, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31851626

RESUMEN

Most professional guidelines advocate family presence during resuscitation (FPDR). Many clinicians, however, are still reluctant to implement this recommendation. In this article I present the most comprehensive case for FPDR to date. I review the little that has been written about the ethics of FPDR, as well as the available empirical evidence. More importantly, I present and defend three arguments for FPDR: adherence to professional guidelines, benefit to patients and relatives, and patients' autonomy. I conclude with suggestions for future research.


Asunto(s)
Reanimación Cardiopulmonar/ética , Cuidados Críticos/ética , Familia , Relaciones Profesional-Familia/ética , Actitud del Personal de Salud , Reanimación Cardiopulmonar/psicología , Cuidados Críticos/psicología , Familia/psicología , Humanos , Guías de Práctica Clínica como Asunto
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1118-1123, 2019 Dec 25.
Artículo en Chino | MEDLINE | ID: mdl-31874526

RESUMEN

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Atención al Paciente/normas , Guías de Práctica Clínica como Asunto/normas , Proctectomía/normas , Anciano , Canal Anal/cirugía , Humanos , Recto/cirugía
6.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(12): 954-958, 2019 Dec 07.
Artículo en Chino | MEDLINE | ID: mdl-31887827

RESUMEN

For a long time, the diagnosis and treatment of pediatric thyroid nodules and cancer (PTNC) are mainly referred to adults. In recent years, it has been found that there are great differences between PTNC and TNC in adults. In 2015, the American Thyroid Association released the first Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. In the guidelines, the characteristics of PTNC were described, and clear management strategies were provided. In this paper, we mainly interpret the surgical part of the guidelines and also review the associated research progress in recent years.


Asunto(s)
Adenocarcinoma , Neoplasias de la Tiroides , Nódulo Tiroideo , Adenocarcinoma/terapia , Niño , Humanos , Guías de Práctica Clínica como Asunto , Neoplasias de la Tiroides/terapia , Nódulo Tiroideo/terapia , Estados Unidos
8.
MMWR Morb Mortal Wkly Rep ; 68(46): 1062-1068, 2019 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-31751320

RESUMEN

An estimated 219 million cases of malaria occurred worldwide in 2017, causing approximately 435,000 deaths (1). Malaria is caused by intraerythrocytic protozoa of the genus Plasmodium transmitted to humans through the bite of an infective Anopheles mosquito. Five Plasmodium species that regularly cause illness in humans are P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi (2). The parasite first develops in the liver before infecting red blood cells. Travelers to areas with endemic malaria can prevent malaria by taking chemoprophylaxis. However, most antimalarials do not kill the liver stages of the parasite, including hypnozoites that cause relapses of disease caused by P. vivax or P. ovale. Therefore, patients with these relapsing species must be treated with two medications: one for the acute infection, and another to treat the hypnozoites (antirelapse therapy). Until recently, primaquine was the only drug available worldwide to kill hypnozoites. Tafenoquine, a long-acting 8-aminoquinoline drug related to primaquine, was approved by the Food and Drug Administration (FDA) on July 20, 2018, for antirelapse therapy (Krintafel) and August 8, 2018, for chemoprophylaxis (Arakoda) (3,4). This report reviews evidence for the efficacy and safety of tafenoquine and provides CDC guidance for clinicians who prescribe chemoprophylaxis for travelers to areas with endemic malaria and treat malaria.


Asunto(s)
Aminoquinolinas/uso terapéutico , Antimaláricos/uso terapéutico , Malaria/prevención & control , Guías de Práctica Clínica como Asunto , Prevención Secundaria , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Medicina del Viajero , Estados Unidos
9.
MMWR Morb Mortal Wkly Rep ; 68(46): 1081-1086, 2019 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-31751322

RESUMEN

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). CDC has published recommendations for health care providers regarding EVALI (2-4). Recently, researchers from Utah and New York published proposed diagnosis and treatment algorithms for EVALI (5,6). EVALI remains a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis, and evaluation should be guided by clinical judgment. Because patients with EVALI can experience symptoms similar to those associated with influenza or other respiratory infections (e.g., fever, cough, headache, myalgias, or fatigue), it might be difficult to differentiate EVALI from influenza or community-acquired pneumonia on initial assessment; EVALI might also co-occur with respiratory infections. This report summarizes recommendations for health care providers managing patients with suspected or known EVALI when respiratory infections such as influenza are more prevalent in the community than they have been in recent months (7). Recommendations include 1) asking patients with respiratory, gastrointestinal, or constitutional symptoms about the use of e-cigarette, or vaping, products; 2) evaluating those suspected to have EVALI with pulse oximetry and obtaining chest imaging, as clinically indicated; 3) considering outpatient management for clinically stable EVALI patients who meet certain criteria; 4) testing patients for influenza, particularly during influenza season, and administering antimicrobials, including antivirals, in accordance with established guidelines; 5) using caution when considering prescribing corticosteroids for outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections; 6) recommending evidence-based treatment strategies, including behavioral counseling, to help patients discontinue using e-cigarette, or vaping, products; and 7) emphasizing the importance of annual influenza vaccination for all persons aged ≥6 months, including patients who use e-cigarette, or vaping products.


Asunto(s)
Brotes de Enfermedades , Lesión Pulmonar/terapia , Guías de Práctica Clínica como Asunto , Vapeo/efectos adversos , Humanos , Lesión Pulmonar/epidemiología , Estados Unidos/epidemiología
11.
BMJ ; 367: l5887, 2019 11 05.
Artículo en Inglés | MEDLINE | ID: mdl-31690574

RESUMEN

Diabetes is a major and costly health concern worldwide, with high morbidity, disability, mortality, and impaired quality of life. The vast majority of people living with diabetes have type 2 diabetes. Historically, the main strategy to reduce complications of type 2 diabetes has been intensive glycemic control. However, the body of evidence shows no meaningful benefit of intensive (compared with moderate) glycemic control for microvascular and macrovascular outcomes important to patients, with the exception of reduced rates of non-fatal myocardial infarction. Intensive glycemic control does, however, increase the risk of severe hypoglycemia and incurs additional burden by way of polypharmacy, side effects, and cost. Additionally, data from cardiovascular outcomes trials showed that cardiovascular, kidney, and mortality outcomes may be improved with use of specific classes of glucose lowering drugs largely independently of their glycemic effects. Therefore, delivering evidence based, patient centered care to people with type 2 diabetes requires a paradigm shift and departure from the predominantly glucocentric view of diabetes management. Instead of prioritizing intensive glycemic control, the focus needs to be on ensuring access to adequate diabetes care, aligning glycemic targets to patients' goals and situations, minimizing short term and long term complications, reducing the burden of treatment, and improving quality of life.


Asunto(s)
Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Calidad de Vida , Glucemia/análisis , Glucemia/efectos de los fármacos , Complicaciones de la Diabetes/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Humanos , Hiperglucemia/sangre , Hiperglucemia/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Incidencia , Metaanálisis como Asunto , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Guías de Práctica Clínica como Asunto , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
12.
Zhonghua Shao Shang Za Zhi ; 35(11): 769-771, 2019 Nov 20.
Artículo en Chino | MEDLINE | ID: mdl-31775463

RESUMEN

At the beginning of 2009, the 38th principle of the Administrative Measures for Clinical Application of Medical Technology, issued by the former Ministry of Health, clearly pointed out that medical institutions should establish a hierarchical management system for surgery. Then the Trial of Administrative Measures for Surgical Classification of Medical Institutions was published and implemented in 2012, but the official introduction of surgical classification catalogue in the national level has not been seen. Therefore, the writing group of this expert consensus has organized numerous well-known experts and scholars in China, taking the three elements of the 38th principle of the Administrative Measures for Clinical Application of Medical Technology issued by the Ministry of Health--risk coefficient, complexity, and technical difficulty as the basic norm to grade scientifically through the four indicators of burn index, surgical area, surgical repair method, and anesthesia risk (each indicator with 4 grades and scores). The total score is then accumulated to divide four grades of operations. The Expert Consensus on Classification Evaluation Methods of Burn Surgery in China (2019 Version) is strategized together expecting to provide academic reference for the government departments to issue or further improve and perfect surgical classification catalogue in the national level as soon as possible, and lay a foundation for the stable development of burn discipline with the significance of national strategic reserve.


Asunto(s)
Quemaduras/cirugía , Guías de Práctica Clínica como Asunto/normas , China , Consenso , Humanos
13.
Zhonghua Gan Zang Bing Za Zhi ; 27(10): 748-753, 2019 Oct 20.
Artículo en Chino | MEDLINE | ID: mdl-31734987

RESUMEN

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in China. To provide evidence-based and updated practical recommendations for clinician, this expert recommendations have updated the diagnosis and treatment of NAFLD in five aspects as follows: (1) the framework of NAFLD treatment centre or clinic; (2) screening and evaluation: who should be screened, initial evaluation items, non-invasive assessment of steatohepatitis and advanced fibrosis, when to obtain a liver biopsy in patients with NAFLD, and other metabolic disorders and cardiovascular risk assessment; (3) managements of patient with NAFLD: lifestyle intervention (dietary, exercise and weight loss), drug treating metabolic co-morbidities such as hyperlipidemia, type 2 diabetes mellitus and hypertension, and steatohepatitis and fibrosis; (4) management of special populations with NAFLD: children, pregnant or lactating women, patients co-existence with alcoholic liver disease, chronic HBV and/or HCV infection, and autoimmune disorders; (5) monitoring and follow-up. This consensus aims to modify the optimizing management process and guide physicians make correct and reasonable decisions in the diagnosis and treatment for patients with NAFLD.


Asunto(s)
Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/terapia , Biopsia , Niño , China , Comorbilidad , Diabetes Mellitus Tipo 2 , Femenino , Humanos , Hiperlipidemias , Hipertensión , Lactancia , Estilo de Vida , Guías de Práctica Clínica como Asunto
14.
Z Gastroenterol ; 57(11): 1309-1320, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31739377

RESUMEN

INTRODUCTION: Lynch syndrome (LS) is the most common hereditary colorectal cancer syndrome and accounts for ~3 % of all CRCs. This autosomal dominant disorder is caused by germline mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2, and EPCAM). One in 300 individuals of the general population are considered to be mutation carriers (300 000 individuals/Germany). Mutation carriers are at a high CRC risk of 15-46 % till the age of 75 years. LS also includes a variety of extracolonic malignancies such as endometrial, small bowel, gastric, urothelial, and other cancers. METHODS: The German Consortium for Familial Intestinal Cancer consists of 14 university centers in Germany. The aim of the consortium is to develop and evaluate surveillance programs and to further translate the results in clinical care. We have revisited and updated the clinical management guidelines for LS patients in Germany. RESULTS: A surveillance colonoscopy should be performed every 12-24 months starting at the age of 25 years. At diagnosis of first colorectal cancer, an oncological resection is advised, an extended resection (colectomy with ileorectal anastomosis) has to be discussed with the patient. The lifetime risk for gastric cancer is 0.2-13 %. Gastric cancers detected during surveillance have a lower tumor stage compared to symptom-driven detection. The lifetime risk for small bowel cancer is 4-8 %. About half of small bowel cancer is located in the duodenum and occurs before the age of 35 years in 10 % of all cases. Accordingly, patients are advised to undergo an esophagogastroduodenoscopy every 12-36 months starting by the age of 25 years. CONCLUSION: LS colonic and extracolonic clinical management, surveillance and therapy are complex and several aspects remain unclear. In the future, surveillance and clinical management need to be more tailored to gene and gender. Future prospective trials are needed.


Asunto(s)
Neoplasias Colorrectales Hereditarias sin Poliposis/patología , Reparación de la Incompatibilidad de ADN , Endoscopía del Sistema Digestivo/métodos , Guías de Práctica Clínica como Asunto , Conducta de Reducción del Riesgo , Neoplasias Colorrectales , Neoplasias Colorrectales Hereditarias sin Poliposis/genética , Alemania , Humanos , Vigilancia de la Población , Factores de Tiempo
15.
Orv Hetil ; 160(48): 1894-1903, 2019 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-31760773

RESUMEN

Introduction: According to the Hungarian law, placental examination is not mandatory, although it is known from the international practice that it can give valuable information in cases of stillbirth or in conditions, where the neonate has difficulty in the postnatal adaptation. Aim: It can be useful in the early detection of diseases, which otherwise would have gone undetected until late in life. This article is unique in Hungary, as no similar guideline exists in Hungarian language. Method: The recommendation of the Royal College of Pathologists (United Kingdom) determines those conditions where essential information can be obtained from the placental examination in not normal pregnancies. It serves as a useful guide in the medical practice. The journal titled "Placenta", first published in 1980 with impact factor above two, just underlines this statement. Results: In this article, the authors present the recent guideline of the RCPath and finish with the presentation of established clinicopathological association that might help clinicians to get the most valuable information from placental examination. Conclusion: The present article aims to summarise updated recommendations and present clinicopathological correlations. Orv Hetil. 2019; 160(48): 1894-1903.


Asunto(s)
Placenta/patología , Guías de Práctica Clínica como Asunto , Mortinato , Femenino , Humanos , Hungría , Recién Nacido , Embarazo , Sociedades Médicas , Cordón Umbilical/patología , Reino Unido
16.
Pan Afr Med J ; 33: 306, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692846

RESUMEN

Introduction: An effective referral system is considered as a key to saving mothers' and children's lives. The aims of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian tertiary care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme (NPP) guidelines. Methods: A descriptive study was undertaken among women referred to Farhat Hached University Hospital in Sousse, Tunisia with antenatal complications requiring urgent delivery and those referred while in labour or with immediate post partum complications. The ICD-10 was used to code recorded indications and diagnoses for referrals. Results: Referrals represents 15.23% of the obstetric activity in this facility. There were 32 reasons for referrals with the most common being premature rupture of membranes (14.1%) and fetal distress (13.5%). A fifth of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (95.8%) did not conform to the list of referral indications of the NPP. Twenty eight diagnoses were retained after referrals: the most common of which were prolonged pregnancy (29.5%) and premature rupture of membranes (19.3%). In 41% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital. Conclusion: The current referral system in the region of Sousse still faces several challenges that need to be addressed in order to make it more effective.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Complicaciones del Embarazo/epidemiología , Derivación y Consulta/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Adhesión a Directriz , Humanos , Trabajo de Parto , Guías de Práctica Clínica como Asunto , Embarazo , Atención Terciaria de Salud , Túnez , Adulto Joven
18.
Anticancer Res ; 39(11): 5853-5859, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31704809

RESUMEN

BACKGROUND/AIM: The objective of the study was to propose clinical guidelines for the use of minimally invasive surgery (MIS) in pediatric oncology. PATIENTS AND METHODS: Two groups of experts, including pediatric surgeons and pediatric oncologists were created in order to establish strategies of diagnostic and therapeutic surgical management in pediatric oncology. RESULTS: On the basis of the analysis of the existing literature, we elaborated guidelines that were graded according to the simple practical clinical system: yes/no. This project was dedicated to the following topics: adrenal tumors including neuroblastoma, renal tumors including Wilms tumor (nephroblastoma), ovarian tumors and pulmonary nodules and metastases (osteosarcoma). CONCLUSION: Although existing data do not allow the recommendation of the use of MIS for all indications, this technique should currently be regarded as a standard of care in several areas of pediatric oncology.


Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Neoplasias/cirugía , Guías de Práctica Clínica como Asunto/normas , Niño , Humanos
19.
Gan To Kagaku Ryoho ; 46(11): 1683-1685, 2019 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-31748472

RESUMEN

For anti-emetic therapy, the first guideline was published 2010, following second version was open for public in 2015. The latest guideline for anti-emetic therapy in Japan, version 2.2 was disclosed on web site of Japan Society of Clinical Oncology. The point of new version were included 3 points which were a new categorization of moderately emetic chemotherapy, improvement of olanzapine for anti-emetic drug, and steroid spearing for MEC.


Asunto(s)
Antieméticos/uso terapéutico , Guías de Práctica Clínica como Asunto , Antineoplásicos , Humanos , Japón , Náusea , Vómitos
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