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2.
Laryngoscope ; 131 Suppl 4: S1-S42, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33729584

RESUMEN

OBJECTIVES/HYPOTHESIS: Facial nerve monitoring (FNM) has evolved into a widely used adjunct for many surgical procedures along the course of the facial nerve. Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high-level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications. STUDY DESIGN: Literature review and expert opinion. METHODS: Given the lack of standard references to serve as a resource for FNM, we assembled a multidisciplinary group of experts representing more than a century of combined monitoring experience to synthesize the literature and provide a rational basis to improve the quality of patient care during FNM. RESULTS: Over the years, two models of monitoring have become well-established: 1) monitoring by the surgeon using a stand-alone device that provides auditory feedback of facial electromyography directly to the surgeon, and 2) a team, typically consisting of surgeon, technologist, and interpreting neurophysiologist. Regardless of the setting and the number of people involved, the reliability of monitoring depends on the integration of proper technical performance, accurate interpretation of responses, and their timely application to the surgical procedure. We describe critical steps in the technical set-up and provide a basis for context-appropriate interpretation and troubleshooting of recorded signals. CONCLUSIONS: We trust this initial attempt to describe best practices will serve as a basis for improving the quality of patient care while reducing inappropriate variations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:S1-S42, 2021.


Asunto(s)
Electromiografía/métodos , Nervio Facial/fisiología , Nervio Facial/cirugía , Monitoreo Intraoperatorio/instrumentación , Guías de Práctica Clínica como Asunto/normas , Anciano , Lista de Verificación , Análisis Costo-Beneficio , Traumatismos del Nervio Facial/epidemiología , Traumatismos del Nervio Facial/prevención & control , Femenino , Humanos , Enfermedad Iatrogénica/epidemiología , Enfermedad Iatrogénica/prevención & control , Incidencia , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos , Neurofisiología/métodos , Neurofisiología/estadística & datos numéricos , Preceptoría/normas , Calidad de la Atención de Salud , Reproducibilidad de los Resultados
3.
Lancet Oncol ; 22(3): e105-e118, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33662288

RESUMEN

This Policy Review presents the International Myeloma Working Group's clinical practice recommendations for the treatment of relapsed and refractory multiple myeloma. Based on the results of phase 2 and phase 3 trials, these recommendations are proposed for the treatment of patients with relapsed and refractory disease who have received one previous line of therapy, and for patients with relapsed and refractory multiple myeloma who have received two or more previous lines of therapy. These recommendations integrate the issue of drug access in both low-income and middle-income countries and in high-income countries to help guide real-world practice and thus improve patient outcomes.


Asunto(s)
Antineoplásicos/uso terapéutico , Resistencia a Antineoplásicos/efectos de los fármacos , Mieloma Múltiple/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Guías de Práctica Clínica como Asunto/normas , Terapia Recuperativa , Humanos , Mieloma Múltiple/patología , Recurrencia Local de Neoplasia/patología
4.
Nutr Metab Cardiovasc Dis ; 31(4): 1209-1218, 2021 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-33618920

RESUMEN

BACKGROUND AND AIMS: Elevated serum uric acid (SUA) is associated with hypertension according to its traditional definition. We investigated the association between SUA and incident hypertension according to the European Society of Cardiology (ESC) and American Society of Cardiology (ACC) guidelines. METHODS AND RESULTS: In this retrospective cohort study, we enrolled 10,537 healthy individuals ≥30 years old who underwent a routine annual health examination with office blood pressure recorded at our hospital in 2016; of the participants, 7349 repeated the exam in 2017. According to the ESC and ACC guidelines, hypertension was defined as office BP ≥ 140/90 mmHg or ≥130/80 mmHg. Hyperuricemia (HUA) was defined as SUA ≥7 mg/dL in men and ≥6 mg/dL in women. The hypertension incidence was 5.8% among 6378 individuals in the ESC cohort and 19% among 4330 individuals in the ACC cohort. Incident hypertension was significantly more common in the hyperuricemic group than in the normouricemic group (ESC: 8.6% vs. 4.7%, P < 0.001; ACC: 25.5% vs. 16.9%, P < 0.001). In the fully adjusted multivariate logistic regression analyses, each increase in SUA was associated with an increase in incident hypertension risk (ESC: adjusted OR: 1.167, 95% CI: 1.061-1.284, P = 0.001; ACC: adjusted OR: 1.125, 95% CI: 1.044-1.213, P = 0.002). The association can be explained by a significant correlation of baseline SUA with the BP in the following year (r = 0.24, P < 0.001 for baseline SUA and SBP in the following year; r = 0.239, P < 0.001 for baseline SUA and DBP in the following year). CONCLUSION: Elevated SUA was associated with incident hypertension in healthy individuals according to various contemporary BP guidelines (ClinicalTrials.gov: NCT03473951). CLINICAL TRIALS: ClinicalTrials.gov with the identification number of NCT03473951.


Asunto(s)
Determinación de la Presión Sanguínea/normas , Presión Sanguínea , Hipertensión/epidemiología , Hiperuricemia/epidemiología , Guías de Práctica Clínica como Asunto/normas , Ácido Úrico/sangre , Adulto , Biomarcadores/sangre , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Hiperuricemia/sangre , Hiperuricemia/diagnóstico , Incidencia , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Taiwán/epidemiología , Factores de Tiempo , Regulación hacia Arriba
5.
J Nurs Adm ; 51(3): 162-167, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33570374

RESUMEN

A focused effort is needed to capture the utility and usability of the electronic health record for providing usable and reusable data while reducing documentation burden. A collaborative effort of nurse leaders and experts was able to generate national consensus recommendations on documentation elements related to admission history. The process used in this effort is summarized in a framework that can be used by other groups to develop content that reduces documentation burden while maximizing the creation of usable and reusable data.


Asunto(s)
Manejo de Datos/normas , Documentación/normas , Registros Electrónicos de Salud/normas , Colaboración Intersectorial , Objetivos Organizacionales , Guías de Práctica Clínica como Asunto/normas , Humanos , Estados Unidos
6.
J Evid Based Med ; 14(1): 40-55, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33565225

RESUMEN

OBJECTIVE: Since the beginning of the COVID-19 epidemic, a large number of guidelines on diagnosis and treatment of COVID-19 have been developed, but the quality of those guidelines and the consistency of recommendations are unclear. The objective of this study is to evaluate the quality of the diagnosis and treatment guidelines on COVID-19 and analyze the consistency of the recommendations of these guidelines. METHODS: We searched for guidelines on diagnosis and/or treatment of COVID-19 through PubMed, CBM, CNKI, and WanFang Data, from January 1, 2020 to August 31, 2020. In addition, we also searched official websites of the US CDC, European CDC and WHO, and some guideline collection databases. We included diagnosis and/or treatment guidelines for COVID-19, including rapid advice guidelines and interim guidelines. Two trained researchers independently extracted data and four trained researchers evaluated the quality of the guidelines using the AGREE II instruments. We extracted information on the basic characteristics of the guidelines, guideline development process, and the recommendations. We described the consistency of the direction of recommendations for treatment and diagnosis of COVID-19 across the included guidelines. RESULTS: A total of 37 guidelines were included. Most included guidelines were assessed as low quality, with only one of the six domains of AGREE II (clarity of presentation) having a mean score above 50%. The mean scores of three domains (stakeholder involvement, the rigor of development and applicability) were all below 30%. The recommendations on diagnosis and treatment were to some extent consistent between the included guidelines. Computed tomography (CT), X-rays, lung ultrasound, RT-PCR, and routine blood tests were the most commonly recommended methods for COVID-19 diagnosis. Thirty guidelines were on the treatment of COVID-19. The recommended forms of treatment included supportive care, antiviral therapy, glucocorticoid therapy, antibiotics, immunoglobulin, extracorporeal membrane oxygenation (ECMO), convalescent plasma, and psychotherapy. CONCLUSIONS: The methodological quality of currently available diagnosis and treatment guidelines for COVID-19 is low. The diagnosis and treatment recommendations between the included guidelines are highly consistent. The main diagnostic methods for COVID-19 are RT-PCR and CT, with ultrasound as a potential diagnostic tool. As there is no effective treatment against COVID-19 yet, supportive therapy is at the moment the most important treatment option.


Asunto(s)
/normas , /terapia , Guías de Práctica Clínica como Asunto/normas , Humanos
7.
Diabetes Metab Syndr ; 15(1): 391-395, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33571889

RESUMEN

BACKGROUND AND AIMS: Gestational diabetes (GDM) is one of the most common medical complications of pregnancy and associated with significant perinatal and long-term morbidity. Temporary changes to the diagnostic testing for GDM have been recommended for the COVID-19 pandemic. This study aims to identify what proportion of women with GDM would be missed by the COVID-19 GDM screening criteria. Secondly an analysis of the relationship between HbA1c, fasting blood glucose (FBG) and pregnancy outcomes will be completed. METHODS: This was a retrospective analysis of all GDM patients at an Australian secondary hospital between January 2019 and February 2020. The proportion of women with GDM who would have been missed using the COVID-19 guidelines was assessed. Patients were divided into groups according to how their GDM was managed during the pregnancy: Diet, Metformin (MF), Insulin and MF + Insulin groups. Differences between the groups were compared using one-way ANOVA and post-hoc analysis was completed using the Bonferroni test. Logistic regression was employed to further compare the differences between the groups. RESULTS: The study group comprised 237 patients. Sixty patients (25.3%) would not have had GDM detected in their pregnancy using the COVID-19 guidelines. FBG was the most significant predictor for intervention with medication for GDM (p = 0.001). CONCLUSION: HbA1c and FBG are poor screening tests for GDM. During the COVID-19 pandemic, the OGTT should be given clinical priority in high risk patients. Elevated FBG is a significant predictor for needing medical management and could be used in the future to better enable individualised treatment.


Asunto(s)
/diagnóstico , Diabetes Gestacional/diagnóstico , Tamizaje Masivo/normas , Guías de Práctica Clínica como Asunto/normas , Adulto , Australia/epidemiología , Glucemia/metabolismo , /epidemiología , Estudios de Cohortes , Diabetes Gestacional/sangre , Diabetes Gestacional/epidemiología , Femenino , Humanos , Tamizaje Masivo/métodos , Embarazo , Estudios Retrospectivos
8.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(2): 211-214, 2021 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-33626605

RESUMEN

Cancer screening is one of approaches to reduce cancer mortality. Standardized cancer screening technology guidelines are the main way to improve scientific standardization and internationalization. With the development of development methodology on guideline making, the number of local and international cancer screening guidelines increases, but the quality is still uneven. This article summarizes the progress of the quality of cancer screening guidelines. It promotes the opportunities and challenges of cancer screening guidelines to reference high-quality cancer screening services in the future in China.


Asunto(s)
Detección Precoz del Cáncer , Neoplasias , China , Consenso , Humanos , Neoplasias/diagnóstico , Guías de Práctica Clínica como Asunto/normas
9.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(2): 219-226, 2021 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-33626607

RESUMEN

Objective: To evaluate the quality of the published breast cancer screening guidelines to provide a reference for domestic studies in the future. Methods: PubMed, Embase, Cochrane Library, Web of Science, SinoMed, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched to identify breast cancer screening guidelines on until August 2020. Two reviewers screened literature and extracted data independently. The Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREEⅡ) and Reporting Items for Practice Guidelines in Healthcare(RIGHT) tools were used to evaluate the quality of the included guidelines. Results: A total of 15 breast cancer screening guidelines were included, of which seven were published in the United States, with publication years focusing on 2015 to 2019, and 11 guidelines had updated versions. "Rigour of development" (47.0%±22.1%) and "Applicability" (44.0%±15.1%) of AGREEⅡ scored lower than other domains. "Review and quality assurance" (46.7%±39.9%) and "Funding, declaration, and management of interests" (41.7%±24.4%) of RIGHT were reported poorer than others. There were six guidelines recommended and another nine recommended with modifications based on the overall AGREEⅡ score. There were four guidelines with a good level, and another 11 were with a moderate level of RIGHT. The National Comprehensive Cancer Network published the best overall quality guidelines in 2018 (AGREEⅡ: 83.3%, RIGHT: 80.0%) and by the American Cancer Society in 2015 (AGREEⅡ: 83.3%, RIGHT: 85.7%). Conclusion: The quality of breast cancer screening guidelines was predominantly of moderate quality, and greater attention should be paid to the guideline development process and quality control of the guidelines.


Asunto(s)
Neoplasias de la Mama , Detección Precoz del Cáncer , Salud Global , Guías de Práctica Clínica como Asunto , Neoplasias de la Mama/diagnóstico , Femenino , Humanos , Guías de Práctica Clínica como Asunto/normas
10.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(2): 227-233, 2021 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-33626608

RESUMEN

Objective: To systematically review the quality of clinical practice guidelines for prostate cancer screening to serve as a reference for developing prostate cancer screening guidelines in China. Methods: We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, and SinoMed with the term "prostate cancer" "prostate carcinoma" "prostate tumor" "screening" "early detection" "guideline" "recommendation" as keywords. The Appraisal of Guidelines for Research & Evaluation (AGREE) Ⅱ instrument and Reporting Items for Practice Guidelines in Healthcare (RIGHT) were used for critical appraisal. Results: A total of thirteen guidelines were included in this review. Evaluated by the AGREE Ⅱ instrument, ten were considered as A level. Two guidelines scored B level, and one was considered C level. Lowest mean domain scores were for stakeholder involvement (52.1%) and applicability (34.0%). Using the RIGHT checklist, we found that the low reporting quality of the thirteen guidelines could be attributable to incomplete disclosure of evidence (64.6%), funding, declaration and management of interest (44.2%), or other information (46.2%). Conclusions: No guidelines for prostate cancer screening was developed in China. The methodological quality of the guidelines in prostate cancer screening was good, which set a tone for the development of Chinese guidelines. However, all guidelines showed poor reporting quality.


Asunto(s)
Detección Precoz del Cáncer , Salud Global , Guías de Práctica Clínica como Asunto , Neoplasias de la Próstata , China , Humanos , Masculino , Guías de Práctica Clínica como Asunto/normas , Neoplasias de la Próstata/diagnóstico
11.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(2): 234-240, 2021 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-33626609

RESUMEN

Objective: To systematically assess the quality of guidelines/consensus on live cancer screening globally and provide references for the formulation of evidence-based guideline on liver cancer screening in China. Methods: PubMed, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, SinoMed, and other related guideline development institutions were searched to identify guidelines on live cancer screening before June 30, 2020. Two experienced reviewers screened literature and extracted data independently. The Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ) and Reporting Items for Practice Guideline in Healthcare (RIGHT) were used to evaluate the quality of guidelines. Results: A total of 19 guidelines/consensus issued between 2003 and 2019 were included in this study. The quality of these guidelines was high according to AGREE Ⅱ, nine of which were recommended as level A, and the other five were graded as level B. Each guidance scored higher in scope and purpose, stakeholder involvement, and clarity of presentation. The reporting quality of basic information with 56.1% reporting rate was the highest based on RIGHT. The reporting quality of background (37.5%) and recommendations (39.8%) were acceptable. However, evidence (35.8%), review and quality assurance (18.4%), funding and declaration and management of interests (22.4%) and other information (21.0%) still need to be improved. Conclusions: Although the quality of screening guidelines for liver cancer is acceptable, the evidence, review and quality assurance, and funding and declaration and management of interests still need to be strengthened. There is still a lack of solely evidence-based medical screening guidelines for liver cancer in China.


Asunto(s)
Detección Precoz del Cáncer , Salud Global , Neoplasias Hepáticas , Guías de Práctica Clínica como Asunto , China , Consenso , Humanos , Neoplasias Hepáticas/diagnóstico , Guías de Práctica Clínica como Asunto/normas
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(2): 241-247, 2021 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-33626610

RESUMEN

Objective: To understand the research progress and quality of lung cancer screening guidelines and consensus in China and abroad, and to provide reference for the formulation of high-quality lung cancer screening guidelines in China. Methods: Databases including PubMed, Medline, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, SinoMed, VIP and Wanfang Data were searched, websites and important references were also searched by hand retrieval. The Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ) and Reporting Items for Practice Guidelines in Healthcare (RIGHT) were used to assess the quality of newly published or updated guidelines and consensus. Results: A total of 9 guidelines and consensus published between 2015 and 2020 were included in this study, with countries including the United States, China, Canada, Saudi Arabia and South Africa. The field of scope and purpose and clarity of presentation scored relatively high but the rigor of development and applicability scored low. Five guidelines were judged to be A-level, all of which were published abroad, and the remaining four were B-level, including three guidelines and consensus issued by China and 1 guideline issued by South Africa. The report rate of RIGHT were higher in basic information and background, lower in review and quality assurance, funding and declaration and management of interests. There were 5 guidelines with a good level and 4 guidelines and consensus with a moderate level. The best overall quality guidelines were those published by the American College of Chest Physicians in 2018 and by the Canadian Task Force on Preventive Health Care in 2016. Conclusions: The number of countries and institutions that issue lung cancer screening guidelines and consensus had been increasing gradually, but the quality in China remained low. It is necessary to develop high-quality lung cancer screening guidelines suitable for China's national conditions in combination with evidence-based methods to guide practice.


Asunto(s)
Detección Precoz del Cáncer , Salud Global , Neoplasias Pulmonares , Guías de Práctica Clínica como Asunto , Consenso , Humanos , Neoplasias Pulmonares/diagnóstico , Guías de Práctica Clínica como Asunto/normas
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(2): 248-257, 2021 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-33626611

RESUMEN

Objective: To systematically evaluate the methodology and reporting quality of colorectal cancer (CRC) screening guidelines/consensus and provide lights for drafting CRC screening guidelines in China. Methods: The literature retrieval for all the Chinese and English guidelines published before September 1st, 2020 was conducted by using Chinese/English databases, such as China National Knowledge Infrastructure, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science, Cochrane Library, Guideline International Network, and supplement with the official website of multiple regions, such as the U.S. Preventive Services Task Force and American Cancer Society. We utilized The Appraisal of Guidelines for Research & Evaluation Ⅱ (AGREE Ⅱ) and Reporting Items for Practice Guidelines in Healthcare (RIGHT) approaches to assess the quality of CRC screening guidelines/consensus comprehensively. Results: After quality control, a total of 19 guidelines/consensus released by the United States, China, Australia, Canada, Britain, South Korea, and International organizations are successfully included, and strikingly, most of those belong to the United State(7). The results of the AGREE Ⅱ quality evaluation show that the average scores of scope and purpose (87.5%) and clarity of presentation (89.6%) are high. In contrast, there are deficient in stakeholder involvement (47.0%), the rigor of development (42.3%), applicability (47.5%), and editorial independence (50.2%). Among all the guidelines, there are 12 with an overall score of 50 or more, 13 with a recommendation level of "A", 2 with a rating of "B" and 4 with a rating of "C". Additionally, the RIGHT evaluation revealed that the average report rate in each field is necessary information (76.3%), background (77.0%), evidence (55.8%), recommendations (59.4%), review and quality assurance (26.3%), funding and declaration and management of interests (43.4%), other information (49.1%). Among all the guidelines, six have good reporting quality, whereas the additional 13 have general or weak evidence. Furthermore, subgroup analysis indicates that the quality of guidelines in developed countries is superior to that of China. Conclusion: The number of CRC screening guidelines/consensus is increasing gradually, and the overall quality of those is high, but the normative nature is warranted to be strengthened.


Asunto(s)
Neoplasias Colorrectales , Detección Precoz del Cáncer , Salud Global , Guías de Práctica Clínica como Asunto , Neoplasias Colorrectales/diagnóstico , Consenso , Humanos , Guías de Práctica Clínica como Asunto/normas
15.
Medicine (Baltimore) ; 100(5): e24559, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592911

RESUMEN

ABSTRACT: Numerous studies have reported the variable quality of clinical practice guidelines (CPGs) across various domains. The aim of this study was to systematically assess the quality, methodology, and consistency of recently developed traditional and conventional medicine CPGs that focus on the management of osteoporosis and provide helpful recommendations for patients with osteoporosis.From June 2020 to July 2020, CPGs with osteoporosis targeting any age were systematically retrieved. All CPGs of traditional and conventional medicine related to the assessment and diagnosis, management, and clinical therapeutic and pharmacological recommendations with osteoporosis were eligible for inclusion in this study. The excluded documents included guidelines without recommendations, secondary publications derived from CPGs, consensus statements, or consensus conferences based on the opinion of panelists, systematic reviews, editorials, clinical trials, and single-author documents. The quality of CPGs was independently examined by three assessors using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. AGREE II consists of 6 domains; scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Consequently, selected CPGs were graded as recommended (A), recommended with modifications (B), or not recommended (C), and the specific treatments and preventive recommendations in the CPGs were summarized.The quality of the 15 CPGs assessed varied across the AGREE II domains. The overall quality ranged from 3.0 to 6.0 out of 7. The domain that had the highest scores were "clarity of presentation," with a mean value of 69.0% (range 46%-83%); "editorial independence" had the lowest score of 30.2% (range 0%-75%). The conventional CPGs focused on pharmacological treatments, calcium and vitamin D intake, and prevention, while the traditional CPGs consistently emphasized on herbal medicine and non-pharmaceutical treatment and management.Further development of CPGs will require improvement in domains where low item scores have been obtained in the quality assessment in this present study. Further research is needed on alternative modalities for osteoporosis, especially complementary approaches, and higher quality CPGs are needed to facilitate evidence-based clinical practice.


Asunto(s)
Osteoporosis/tratamiento farmacológico , Osteoporosis/prevención & control , Guías de Práctica Clínica como Asunto/normas , Conservadores de la Densidad Ósea/uso terapéutico , Calcio/uso terapéutico , Práctica Clínica Basada en la Evidencia , Humanos , Osteoporosis/complicaciones , Osteoporosis/terapia , Factores de Riesgo , Vitamina D/uso terapéutico
18.
Lancet Oncol ; 22(3): e119-e130, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33545067

RESUMEN

In this Policy Review, the Bone Working Group of the International Myeloma Working Group updates its clinical practice recommendations for the management of multiple myeloma-related bone disease. After assessing the available literature and grading recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method, experts from the working group recommend zoledronic acid as the preferred bone-targeted agent for patients with newly diagnosed multiple myeloma, with or without multiple myeloma-related bone disease. Once patients achieve a very good partial response or better, after receiving monthly zoledronic acid for at least 12 months, the treating physician can consider decreasing the frequency of or discontinuing zoledronic acid treatment. Denosumab can also be considered for the treatment of multiple myeloma-related bone disease, particularly in patients with renal impairment. Denosumab might prolong progression-free survival in patients with newly diagnosed multiple myeloma who have multiple myeloma-related bone disease and who are eligible for autologous stem-cell transplantation. Denosumab discontinuation is challenging due to the rebound effect. The Bone Working Group of the International Myeloma Working Group also found cement augmentation to be effective for painful vertebral compression fractures. Radiotherapy is recommended for uncontrolled pain, impeding or symptomatic spinal cord compression, or pathological fractures. Surgery should be used for the prevention and restoration of long-bone pathological fractures, vertebral column instability, and spinal cord compression with bone fragments within the spinal route.


Asunto(s)
Enfermedades Óseas/tratamiento farmacológico , Mieloma Múltiple/complicaciones , Guías de Práctica Clínica como Asunto/normas , Conservadores de la Densidad Ósea , Enfermedades Óseas/etiología , Enfermedades Óseas/patología , Humanos
19.
Allergol. immunopatol ; 49(1): 87-94, ene.-feb. 2021. tab, graf
Artículo en Inglés | IBECS | ID: ibc-199230

RESUMEN

BACKGROUND: The Mexican Guidelines for the diagnosis and treatment of urticaria have been published. Just before their launch, physicians' knowledge was explored relating to key issues of the guidelines. OBJECTIVE: The aim of this study was to investigate the opinion of medical specialists concern­ing urticaria management. METHODS: A SurveyMonkey(R) survey was sent out to board-certified physicians of three medical specialties treating urticaria. Replies were analyzed per specialty against the evidence-based recommendations. RESULTS: Sixty-five allergists (ALLERG), 24 dermatologists (DERM), and 120 pediatricians (PED) sent their replies. As for diagnosis: ALERG 42% and PED 76% believe cutaneous mastocyto­sis, urticarial vasculitis, and hereditary angioedema are forms of urticaria, versus DERM 29% (P < 0.005). Most of the specialties find that the clinical history and physical examination are enough to diagnose acute urticaria, except DERM 45% (P < 0.01). DERM 45% believe laborato­ry-tests are necessary, as opposed to <15% ALLERG-PED (P < 0.005). However, PED 69% did not know that the most frequent cause of acute urticaria in children is infections, versus ALLERG- DERM 30% (P < 0.005). Many erroneously do laboratory testing in physical urticaria and ALLERG 51%, DERM 59%, and PED 37% do extensive laboratory testing in chronic spontaneous urticaria (CSU); many more PED 59% take Immunoglobulin G (IgG) against foods (P < 0.005). More than half of non-allergists do not know about autologous serum testing nor autoimmunity (P < 0.05). As for treatment, there were a few major gaps: when CSU was controlled, >75% prescribed antihistamines pro re nata, and > 85% gave first-generation antiH1 for insomnia. Finally, > 40% of DERM did not know that cyclosporine A, omalizumab, or other immunosuppressants could be used in recalcitrant cases. CONCLUSION: Specialty-specific continuous medical education might enhance urticaria management


No disponible


Asunto(s)
Humanos , Urticaria/diagnóstico , Urticaria/epidemiología , Educación Médica Continua/normas , Alergia e Inmunología/educación , Pediatría/educación , Dermatología/educación , Urticaria/inmunología , Guías de Práctica Clínica como Asunto/normas , Inmunoglobulina G/análisis , Inmunoglobulina G/inmunología , Comparación Transcultural , Urticaria/clasificación
20.
BMC Infect Dis ; 21(1): 92, 2021 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478412

RESUMEN

BACKGROUND: Echocardiography (echo) is the primary imaging modality for infective endocarditis (IE). However, the recommendations on timing and mode selection for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) vary across guidelines, which can be confusing for clinical decision makers. In this case, we aim to appraise the quality of recommendations by appraising the quality of various guidelines. METHODS: A search of guidelines containing recommendations for the appropriate use of echo in adult IE patients published in English between 2007 and 2019 was conducted. The APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument was applied independently by two reviewers to assess the integrated quality of the identified guidelines. The recommendations of concern are extracted from related chapters. RESULTS: A total of 9 guidelines met the criteria, with AGREE II scores ranging from 36 to 79%, and the domain of "stakeholder involvement" received the lowest score. The most contentious issue is whether a follow-up TEE is mandatory in uncomplicated native valve IE with an initial positive TTE. Conflicting recommendations are presented with a low evidence level based on little evidence. CONCLUSIONS: In general, the recommendations proposed in the 9 identified guidelines on the appropriate use of echo are satisfying. The guideline quality score can be taken into account by the clinicians when evaluating the recommendations for clinical decisions. Additional studies with high evidence level should be conducted on the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE.


Asunto(s)
Ecocardiografía/normas , Endocarditis/diagnóstico por imagen , Guías de Práctica Clínica como Asunto/normas , Adulto , Ecocardiografía/métodos , Ecocardiografía Transesofágica/métodos , Ecocardiografía Transesofágica/normas , Humanos
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