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1.
MMWR Morb Mortal Wkly Rep ; 70(35): 1183-1190, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34473682

RESUMEN

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents aged 11-12 years routinely receive tetanus, diphtheria, and acellular pertussis (Tdap); meningococcal conjugate (MenACWY); and human papillomavirus (HPV) vaccines. Catch-up vaccination is recommended for hepatitis B (HepB); hepatitis A (HepA); measles, mumps, and rubella (MMR); and varicella (VAR) vaccines for adolescents whose childhood vaccinations are not current. Adolescents are also recommended to receive a booster dose of MenACWY vaccine at age 16 years, and shared clinical decision-making is recommended for the serogroup B meningococcal vaccine (MenB) for persons aged 16-23 years (1). To estimate coverage with recommended vaccines, CDC analyzed data from the 2020 National Immunization Survey-Teen (NIS-Teen) for 20,163 adolescents aged 13-17 years.* Coverage with ≥1 dose of HPV vaccine increased from 71.5% in 2019 to 75.1% in 2020. The percentage of adolescents who were up to date† with HPV vaccination (HPV UTD) increased from 54.2% in 2019 to 58.6% in 2020. Coverage with ≥1 dose of Tdap, ≥1 dose (and among adolescents aged 17 years, ≥2 doses) of MenACWY remained similar to coverage in 2019 (90.1%, 89.3%, and 54.4% respectively). Coverage increased for ≥2 doses of HepA among adolescents aged 13-17 years and ≥1 dose of MenB among adolescents aged 17 years. Adolescents living below the federal poverty level§ had higher HPV vaccination coverage than adolescents living at or above the poverty level. Adolescents living outside a metropolitan statistical area (MSA)¶ had lower coverage with ≥1 MenACWY and ≥1 HPV dose, and a lower proportion being HPV UTD than adolescents in MSA principal cities. In 2020, the COVID-19 pandemic disrupted routine immunization services. Results from the 2020 NIS-Teen reflect adolescent vaccination coverage before the COVID-19 pandemic. The 2020 NIS-Teen data could be used to assess the impact of the COVID-19 pandemic on catch-up vaccination but not on routine adolescent vaccination because adolescents included in the survey were aged ≥13 years, past the age when most routine adolescent vaccines are recommended, and most vaccinations occurred before March 2020. Continued efforts to reach adolescents whose routine medical care has been affected by the COVID-19 pandemic are necessary to protect persons and communities from vaccine-preventable diseases and outbreaks.


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas Meningococicas/administración & dosificación , Vacunas contra Papillomavirus/administración & dosificación , Cobertura de Vacunación/estadística & datos numéricos , Adolescente , Comités Consultivos , COVID-19/epidemiología , Centers for Disease Control and Prevention, U.S. , Femenino , Encuestas de Atención de la Salud , Humanos , Esquemas de Inmunización , Masculino , Guías de Práctica Clínica como Asunto , Factores Socioeconómicos , Estados Unidos/epidemiología , Vacunas Conjugadas/administración & dosificación
2.
Pan Afr Med J ; 39: 89, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34466191

RESUMEN

Coronavirus disease 2019 (COVID-19), a severe acute respiratory syndrome caused by SARS-CoV-2 was declared a global pandemic by the World Health Organization (WHO) in March 2020. As of 21st April 2021, the disease had affected more than 143 million people with more than 3 million deaths worldwide. Urgent effective strategies are required to control the scourge of the pandemic. Rapid sample collection and effective testing of appropriate specimens from patients meeting the suspect case definition for COVID-19 is a priority for clinical management and outbreak control. The WHO recommends that suspected cases be screened for SARS-CoV-2 virus with nucleic acid amplification tests such as real-time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR). Other COVID-19 screening techniques such as serological and antigen tests have been developed and are currently being used for testing at ports of entry and for general surveillance of population exposure in some countries. However, there are limited testing options, equipment, and trained personnel in many African countries. Previously, positive patients have been screened more than twice to determine viral clearance prior to discharge after treatment. In a new policy directive, the WHO now recommends direct discharge after treatment of all positive cases without repeated testing. In this review, we discuss COVID-19 testing capacity, various diagnostic methods, test accuracy, as well as logistical challenges in Africa with respect to the WHO early discharge policy.


Asunto(s)
Prueba de COVID-19/métodos , COVID-19/diagnóstico , Guías de Práctica Clínica como Asunto , África , Humanos , Tamizaje Masivo/métodos , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Manejo de Especímenes , Organización Mundial de la Salud
3.
Nutrients ; 13(7)2021 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-34371817

RESUMEN

Headaches are among the most prevalent and disabling neurologic disorders and there are several unmet needs as current pharmacological options are inadequate in treating patients with chronic headache, and a growing interest focuses on nutritional approaches as non-pharmacological treatments. Among these, the largest body of evidence supports the use of the ketogenic diet (KD). Exactly 100 years ago, KD was first used to treat drug-resistant epilepsy, but subsequent applications of this diet also involved other neurological disorders. Evidence of KD effectiveness in migraine emerged in 1928, but in the last several year's different groups of researchers and clinicians began utilizing this therapeutic option to treat patients with drug-resistant migraine, cluster headache, and/or headache comorbid with metabolic syndrome. Here we describe the existing evidence supporting the potential benefits of KDs in the management of headaches, explore the potential mechanisms of action involved in the efficacy in-depth, and synthesize results of working meetings of an Italian panel of experts on this topic. The aim of the working group was to create a clinical recommendation on indications and optimal clinical practice to treat patients with headaches using KDs. The results we present here are designed to advance the knowledge and application of KDs in the treatment of headaches.


Asunto(s)
Dieta Cetogénica/métodos , Cefalea/dietoterapia , Guías de Práctica Clínica como Asunto , Dieta Cetogénica/normas , Humanos
4.
MMWR Recomm Rep ; 70(5): 1-28, 2021 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-34448800

RESUMEN

This report updates the 2020-21 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2020;69[No. RR-8]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used. ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. During the 2021-22 influenza season, the following types of vaccines are expected to be available: inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4).The 2021-22 influenza season is expected to coincide with continued circulation of SARS-CoV-2, the virus that causes COVID-19. Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient visits, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at https://www.cdc.gov/vaccines/pandemic-guidance/index.html. Recommendations for the use of COVID-19 vaccines are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html, and additional clinical guidance is available at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.Updates described in this report reflect discussions during public meetings of ACIP that were held on October 28, 2020; February 25, 2021; and June 24, 2021. Primary updates to this report include the following six items. First, all seasonal influenza vaccines available in the United States for the 2021-22 season are expected to be quadrivalent. Second, the composition of 2021-22 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09 and influenza A(H3N2) components. U.S.-licensed influenza vaccines will contain hemagglutinin derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/588/2019 (H1N1)pdm09-like virus (for cell culture-based and recombinant vaccines), an influenza A/Cambodia/e0826360/2020 (H3N2)-like virus, an influenza B/Washington/02/2019 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus. Third, the approved age indication for the cell culture-based inactivated influenza vaccine, Flucelvax Quadrivalent (ccIIV4), has been expanded from ages ≥4 years to ages ≥2 years. Fourth, discussion of administration of influenza vaccines with other vaccines includes considerations for coadministration of influenza vaccines and COVID-19 vaccines. Providers should also consult current ACIP COVID-19 vaccine recommendations and CDC guidance concerning coadministration of these vaccines with influenza vaccines. Vaccines that are given at the same time should be administered in separate anatomic sites. Fifth, guidance concerning timing of influenza vaccination now states that vaccination soon after vaccine becomes available can be considered for pregnant women in the third trimester. As previously recommended, children who need 2 doses (children aged 6 months through 8 years who have never received influenza vaccine or who have not previously received a lifetime total of ≥2 doses) should receive their first dose as soon as possible after vaccine becomes available to allow the second dose (which must be administered ≥4 weeks later) to be received by the end of October. For nonpregnant adults, vaccination in July and August should be avoided unless there is concern that later vaccination might not be possible. Sixth, contraindications and precautions to the use of ccIIV4 and RIV4 have been modified, specifically with regard to persons with a history of severe allergic reaction (e.g., anaphylaxis) to an influenza vaccine. A history of a severe allergic reaction to a previous dose of any egg-based IIV, LAIV, or RIV of any valency is a precaution to use of ccIIV4. A history of a severe allergic reaction to a previous dose of any egg-based IIV, ccIIV, or LAIV of any valency is a precaution to use of RIV4. Use of ccIIV4 and RIV4 in such instances should occur in an inpatient or outpatient medical setting under supervision of a provider who can recognize and manage a severe allergic reaction; providers can also consider consulting with an allergist to help identify the vaccine component responsible for the reaction. For ccIIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency or any component of ccIIV4 is a contraindication to future use of ccIIV4. For RIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency or any component of RIV4 is a contraindication to future use of RIV4. This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2021-22 influenza season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used according to Food and Drug Administration-licensed indications. Updates and other information are available from CDC's influenza website (https://www.cdc.gov/flu); vaccination and health care providers should check this site periodically for additional information.


Asunto(s)
Inmunización/normas , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Guías de Práctica Clínica como Asunto , Adolescente , Adulto , Comités Consultivos , Anciano , COVID-19/epidemiología , Centers for Disease Control and Prevention, U.S. , Niño , Preescolar , Femenino , Humanos , Esquemas de Inmunización , Lactante , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Embarazo , Estaciones del Año , Estados Unidos/epidemiología , Adulto Joven
5.
J Nurs Adm ; 51(7-8): 355-358, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34405973

RESUMEN

Organizations across the country are redesigning care delivery to improve quality and outcomes, enhance the patient experience, reduce costs, and, ultimately, produce better population health. Leaders from the American Organization for Nursing Leadership engaged key stakeholders to discuss the role nursing can play and the toolkit that will be introduced this year to guide nurse leaders in striving for value.


Asunto(s)
Benchmarking/organización & administración , Liderazgo , Enfermeras Administradoras/organización & administración , Competencia Profesional , Sociedades de Enfermería/organización & administración , Humanos , Guías de Práctica Clínica como Asunto , Estados Unidos
6.
Obstet Gynecol Surv ; 76(8): 493-503, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34449852

RESUMEN

Importance: Ten years have passed since the Institute of Medicine (IOM) released its recommendations for gestational weight gain (GWG), based on a woman's prepregnancy body mass index. Despite this, the majority of women do not gain the appropriate gestational weight; most women gain too much weight, and a small but substantial number gain too little. Objective: We review the literature concerning GWG, the opinions and practices of clinicians in managing their patients' weight, and how these practices are perceived by patients. We also review several randomized control trials that investigate the efficacy of clinical intervention in managing GWG. Evidence Acquisition: A literature review search was conducted with no limitations on the number of years searched. Results: The number of clinicians who are aware of and use the IOM recommendations has increased, but the prevalence of inappropriate GWG has not decreased. Clinicians report feeling less than confident in their ability to have an impact on their patients' weight gain, and there are discrepancies between what clinicians and patients report regarding counseling. Many randomized control trials demonstrate a beneficial impact of clinical intervention, highlighting the importance of collaboration and technology to provide educational information and support throughout a pregnancy. Conclusions: Pregnancy provides an opportunity for clinicians to have open and direct conversations with their patients about their weight. Providing clinicians with the tools, skillset, and confidence to assist in the management of GWG is essential to the health of women and their children, and warrants further investigation.


Asunto(s)
Manejo de la Enfermedad , Ganancia de Peso Gestacional , Rol del Médico , Guías de Práctica Clínica como Asunto/normas , Terapia Conductista , Consejo , Grupos Étnicos , Femenino , Humanos , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Embarazo , Factores Raciales , Tecnología , Estados Unidos/epidemiología
8.
BMJ ; 374: n1493, 2021 08 11.
Artículo en Inglés | MEDLINE | ID: mdl-34380627

RESUMEN

Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.


Asunto(s)
Enfermedades Cardiovasculares/tratamiento farmacológico , Costos de los Medicamentos/legislación & jurisprudencia , Cumplimiento de la Medicación/estadística & datos numéricos , Educación del Paciente como Asunto/métodos , Fármacos Cardiovasculares/economía , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Ensayos Clínicos como Asunto , Terapia Cognitivo-Conductual/estadística & datos numéricos , Comorbilidad , Humanos , Grupo de Atención al Paciente/ética , Polifarmacia , Guías de Práctica Clínica como Asunto , Rol Profesional/psicología , Sistemas Recordatorios/instrumentación
10.
J Fam Pract ; 70(4): 182-188, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-34339361

RESUMEN

Assess risk factors, then work to address modifiable ones, such as wearing the right running shoes and building up slowly. Don't let overweight or OA dampen enthusiasm.


Asunto(s)
Lesiones Accidentales/prevención & control , Medicina Familiar y Comunitaria/normas , Guías de Práctica Clínica como Asunto , Medicina Preventiva/normas , Carrera/lesiones , Carrera/normas , Zapatos/normas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estados Unidos
11.
J Fam Pract ; 70(4): 189-204, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-34339362

RESUMEN

The Task Force has expanded the age range for screening for hepatitis C virus infection in adolescents and adults, and now endorses behavioral counseling for all adults with any CVD risk factors.


Asunto(s)
Terapia Conductista/normas , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/terapia , Hepatitis C/diagnóstico , Tamizaje Masivo/normas , Guías de Práctica Clínica como Asunto , Medicina Preventiva/normas , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estados Unidos , Adulto Joven
12.
NASN Sch Nurse ; 36(5): 292-299, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34340585

RESUMEN

The COVID-19 pandemic altered traditional education models and school nursing practice during the 2020-2021 school year. As schools plan to reopen for the 2021-2022 school year, school nurses must arm themselves with the most recent evidence-based knowledge and tools to promote the health and safety of the school community. Schools will need to continue infection control measures and strategies to support the social emotional needs of students and staff to promote a safe and healthy learning environment on return to school. Partnered with local health departments, school nurses are vital to mitigation measures such as on-site viral testing and vaccination. A successful school year depends on strong nursing leadership.


Asunto(s)
COVID-19/prevención & control , COVID-19/psicología , Personal de Enfermería/psicología , Pandemias/prevención & control , Guías de Práctica Clínica como Asunto , Prevención Primaria/normas , Servicios de Enfermería Escolar/normas , Adolescente , Adulto , Actitud del Personal de Salud , COVID-19/epidemiología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , SARS-CoV-2 , Estados Unidos/epidemiología , Vacunación
14.
Cancer Treat Res Commun ; 28: 100445, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34425469

RESUMEN

INTRODUCTION: Over half of the 1.5 million individuals globally who are diagnosed with colorectal cancer (CRC) present with stage II-III disease. Understanding clinician attitudes towards treatment for this group is paramount to contextualise real-world outcomes and plan future trials. The aim of this study was to assess clinician awareness of trials assessing the optimal duration of CRC adjuvant therapy, their attitudes towards shorter treatment and their self-reported practice. METHODS: A survey was developed using OnlineSurveys® and distributed to clinicians in April 2019, with a follow-up survey disseminated to a subset of respondents in August 2020. Microsoft Excel® and Stata® were used for analysis. RESULTS: 265 clinicians replied to the first survey, with the majority aware of findings from the International Duration Evaluation of Adjuvant Therapy collaboration and contributory trials. Practice change was greatest for patients under 70 with low-risk stage III CRC, with most uncertainty around using 3-months of doublet chemotherapy for high-risk stage II disease. In August 2020, clinicians (n = 106) were more likely to use 3-months of FOLFOX for low-risk stage III disease and 3-months of CAPOX for stage II disease compared to April 2019. There was no indication that the COVID-19 pandemic had enduring changes on treatment decisions beyond those made in response to trial evidence. DISCUSSION: Clinicians use a risk-stratified approach to treat CRC the adjuvant setting. Lower utilisation of doublet chemotherapy for older and stage II patients has affected the extent of trial implementation. Active dialogue regarding how trial results apply to these groups may improve consensus.


Asunto(s)
Ensayos Clínicos como Asunto , Neoplasias Colorrectales/tratamiento farmacológico , Pautas de la Práctica en Medicina , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , COVID-19 , Quimioterapia Adyuvante , Neoplasias Colorrectales/patología , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Estudios Longitudinales , Oncólogos , Compuestos Organoplatinos/uso terapéutico , Guías de Práctica Clínica como Asunto , Autoinforme , Encuestas y Cuestionarios , Factores de Tiempo
15.
Transfus Apher Sci ; 60(4): 103207, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34353706

RESUMEN

Blood transfusions come with risks and high costs, and should be utilized only when clinically indicated. Decisions to transfuse are however not always well informed, and lack of clinician knowledge and education on good clinical transfusion practices contribute to the inappropriate use of blood. Low and middle-income countries in particular take much strain in their efforts to address blood safety challenges, demand-supply imbalances, high blood costs as well as high disease burdens, all of which impact blood usage and blood collections. Patient blood management (PBM), which is a patient-focused approach aimed at improving patient outcomes by preemptively diagnosing and correcting anaemia and limiting blood loss by cell salvage, coagulation optimization and other measures, has become a major approach to addressing many of the challenges mentioned. The associated decrease in the use of blood and blood products may be perceived as being in competition with blood conservation measures, which is the more traditional, but primarily product-focused approach. In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immediately and beyond.


Asunto(s)
Bancos de Sangre/organización & administración , Transfusión Sanguínea , Procedimientos Médicos y Quirúrgicos sin Sangre , Anemia/terapia , Bancos de Sangre/economía , Pérdida de Sangre Quirúrgica , Seguridad de la Sangre , Transfusión Sanguínea/economía , Infecciones de Transmisión Sanguínea/prevención & control , Procedimientos Médicos y Quirúrgicos sin Sangre/economía , COVID-19 , Toma de Decisiones Clínicas , Países en Desarrollo , Selección de Donante/economía , Medicina Basada en la Evidencia , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Pandemias , Hemorragia Posparto/terapia , Guías de Práctica Clínica como Asunto , Embarazo , Prevalencia , Utilización de Procedimientos y Técnicas , SARS-CoV-2 , Sudáfrica/epidemiología , Medicina Transfusional/educación
16.
Front Health Serv Manage ; 38(1): 4-13, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34431813

RESUMEN

SUMMARY: Across the healthcare landscape, the COVID-19 pandemic has been incredibly challenging. It also has been a catalyst for change. It has ignited a redesign of the US health system and presented opportunities in areas such as caregiver and patient communication, digital practice, telehealth and virtual care, and more. Notably, the pandemic also has shined a new light on caregiver well-being. As executive leaders of Cleveland Clinic's Caregiver Office, our top priority throughout the pandemic has been to support our caregivers professionally and personally-to help them be their best for themselves and for their fellow caregivers, our patients, our organization, and our communities. Today, Cleveland Clinic is realizing the profound impact of many of the strategies put in place during the pandemic and seeing how COVID-19 accelerated our organization's unified vision for caregiver well-being. This article offers insight into Cleveland Clinic's commitment to caregiver well-being, highlights actions we undertook during the pandemic, shares the resulting lessons we learned, and showcases how those lessons are shaping our future caregiver well-being strategy.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , COVID-19 , Cuidadores/normas , Atención a la Salud/organización & administración , Personal de Salud/normas , Salud Holística , Guías de Práctica Clínica como Asunto , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ohio , Cultura Organizacional , Objetivos Organizacionales , Pandemias , SARS-CoV-2
17.
Eur J Endocrinol ; 185(3): G1-G33, 2021 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-34425558

RESUMEN

Pregnancies are rare in women with pituitary adenomas, which may relate to hormone excess from secretory subtypes such as prolactinomas or corticotroph adenomas. Decreased fertility may also result from pituitary hormone deficiencies due to compression of the gland by large tumours and/or surgical or radiation treatment of the lesion. Counselling premenopausal women with pituitary adenomas about their chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conception treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy need to be considered when interpreting endocrine tests in women with pituitary adenomas. Dose adjustments in hormone substitution therapies may be needed across the trimesters. When medical therapy is used for pituitary hormone excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some pituitary adenomas also enlarge during pregnancy, there is a risk of visual impairment, especially in women with macroadenomas or tumours near the optic chiasm. Pituitary apoplexy represents a rare acute complication of adenomas requiring surveillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagnostic tests and treatments from the pre-conception stage until after delivery, taking into account adenoma size, location and endocrine activity. In most cases, pregnant women with pituitary adenomas should be managed by a multidisciplinary team in a centre specialised in the treatment of such tumours.


Asunto(s)
Neoplasias Hipofisarias/terapia , Complicaciones Neoplásicas del Embarazo/terapia , Adulto , Femenino , Humanos , Grupo de Atención al Paciente , Hormonas Hipofisarias/metabolismo , Neoplasias Hipofisarias/diagnóstico , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnóstico
18.
Lancet Glob Health ; 9(9): e1262-e1272, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34363766

RESUMEN

BACKGROUND: Quality of care is consistently shown to be inadequate in health-care settings in many low-income and middle-income countries, including in private facilities, which are rapidly growing in number but often do not have effective quality stewardship mechanisms. The SafeCare programme aims to address this gap in quality of care, using a standards-based approach adapted to low-resource settings, involving assessments, mentoring, training, and access to loans, to improve clinical quality and facility business performance. We assessed the effect of the SafeCare programme on quality of patient care in faith-based and private for-profit facilities in Tanzania. METHODS: In this cluster-randomised controlled trial, health facilities were eligible if they were dispensaries, health centres, or hospitals in the faith-based or private for-profit sectors in Tanzania. We randomly assigned facilities (1:1) using computer-generated stratified randomisation to receive the full SafeCare package (intervention) or an assessment only (control). Implementing staff and participants were masked to outcome measurement and the primary outcomes were measured by fieldworkers who had no knowledge of the study group allocation. The primary outcomes were health worker compliance with infection prevention and control (IPC) practices as measured by observation of provider-patient interactions, and correct case management of undercover standardised patients at endline (after a minimum of 18 months). Analyses were by modified intention to treat. The trial is registered with ISRCTN, ISRCTN93644888. FINDINGS: Between March 7 and Nov 30, 2016, we enrolled and randomly assigned 237 health facilities to the intervention (n=118) or control (n=119). Nine facilities (seven intervention facilities and two control facilities) closed during the trial and were not included in the analysis. We observed 29 608 IPC indications in 5425 provider-patient interactions between Feb 7 and April 5, 2018. Health facilities received visits from 909 standardised patients between May 3 and June 12, 2018. Intervention facilities had a 4·4 percentage point (95% CI 0·9-7·7; p=0.015) higher mean SafeCare standards assessment score at endline than control facilities. However, there was no evidence of a difference in clinical quality between intervention and control groups at endline. Compliance with IPC practices was observed in 8181 (56·9%) of 14 366 indications in intervention facilities and 8336 (54·7%) of 15 242 indications in control facilities (absolute difference 2·2 percentage points, 95% CI -0·2 to -4·7; p=0·071). Correct management occurred in 120 (27·0%) of 444 standardised patients in the intervention group and in 136 (29·2%) of 465 in the control group (absolute difference -2·8 percentage points, 95% CI -8·6 to -3·1; p=0·36). INTERPRETATION: SafeCare did not improve clinical quality as assessed by compliance with IPC practices and correct case management. The absence of effect on clinical quality could reflect a combination of insufficient intervention intensity, insufficient links between structural quality and care processes, scarcity of resources for quality improvement, and inadequate financial and regulatory incentives for improvement. FUNDING: UK Health Systems Research Initiative (Medical Research Council, Economic and Social Research Council, UK Department for International Development, Global Challenges Research Fund, and Wellcome Trust).


Asunto(s)
Certificación , Instituciones de Salud/normas , Control de Infecciones/normas , Mejoramiento de la Calidad/organización & administración , Calidad de la Atención de Salud/estadística & datos numéricos , Organizaciones Religiosas , Adhesión a Directriz/estadística & datos numéricos , Humanos , Guías de Práctica Clínica como Asunto , Sector Privado , Evaluación de Programas y Proyectos de Salud , Tanzanía
19.
J Orthop Sports Phys Ther ; 51(8): 382, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34338003

RESUMEN

When we experience an injury or illness, it can affect our ability to work. Work rehabilitation helps people return to work after an illness or injury. When possible, work rehabilitation can also help people stay at work as they manage their illness or injury. To understand how physical therapists can best support people as they return to work, experts in work rehabilitation reviewed all the available research and discussed what the research means. These experts shared their findings and recommendations in "Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists," published in JOSPT in August 2021. J Orthop Sports Phys Ther 2021;51(8):382. doi:10.2519/jospt.2021.0506.


Asunto(s)
Enfermedades Profesionales/terapia , Salud Laboral , Traumatismos Ocupacionales/terapia , Modalidades de Fisioterapia , Reinserción al Trabajo , Humanos , Guías de Práctica Clínica como Asunto
20.
J Orthop Sports Phys Ther ; 51(8): 380-381, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34338004

RESUMEN

Work rehabilitation refers to the process of assisting workers to remain at work or return to work (RTW) in a safe and productive manner, while limiting the negative impact of work restriction, unemployment, and work disability. The clinical practice guideline (CPG) published in the August 2021 issue of JOSPT provides guidance for physical therapy clinicians when evaluating, treating, and managing individuals who experience limitations in the ability to participate in work following injury or illness. J Orthop Sports Phys Ther 2021;51(8):380-381. doi:10.2519/jospt.2021.0505.


Asunto(s)
Medicina Basada en la Evidencia , Enfermedades Profesionales/terapia , Salud Laboral , Traumatismos Ocupacionales/terapia , Modalidades de Fisioterapia , Reinserción al Trabajo , Humanos , Guías de Práctica Clínica como Asunto , Factores de Riesgo
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