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1.
Khirurgiia (Mosk) ; (1): 93-97, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33395519

RESUMEN

It is very difficult to find certain surgical field in which surgeon's decision is absolutely evidence-based. The objective of evidence-based medicine (and surgery) is offering the best treatment for each patient that should encourage conducting the randomized trials (RT) as the highest level of evidence. The results of RTs often contradict the existing clinical experience, and experience per se does not always confirm the significance of the results obtained. One cannot make any conclusions based on RT data. Treatment strategy for a particular patient remains unclear. The authors have analyzed the results of large-scale RTs devoted to laparoscopic cholecystectomy, rectal surgery, lung cancer surgery, postoperative care, treatment of pulmonary emphysema. It was shown that RT data as the highest level of evidence are not always true for surgery. In most clinical situations, the decision is not based on RT results. The desire of surgeons to master a new technique is often more significant than patient care, while clinical experience and the laws of the market are more important than science. There is no doubt that knowledge of RT results are essential in training period, but this means quite a bit for a particular patient. The best decision can be made during discussion and conversation with colleagues, where an experience of each specialist will have the same value as the best evidence.


Asunto(s)
Medicina Basada en la Evidencia/normas , Medicina de Precisión/normas , Práctica Profesional/normas , Calidad de la Atención de Salud/normas , Ensayos Clínicos Controlados Aleatorios como Asunto , Procedimientos Quirúrgicos Operativos , Colecistectomía Laparoscópica , Competencia Clínica/normas , Toma de Decisiones , Procedimientos Quirúrgicos del Sistema Digestivo , Medicina Basada en la Evidencia/métodos , Humanos , Relaciones Interprofesionales , Cuidados Posoperatorios/normas , Enfisema Pulmonar/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Procedimientos Quirúrgicos Operativos/métodos , Procedimientos Quirúrgicos Operativos/normas
2.
Br J Anaesth ; 126(2): 423-432, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33413977

RESUMEN

Delirium and postoperative neurocognitive disorder are the commonest perioperative complications in patients more than 65 yr of age. However, data suggest that we often fail to screen patients for preoperative cognitive impairment, to warn patients and families of risk, and to take preventive measures to reduce the incidence of perioperative neurocognitive disorders. As part of the American Society of Anesthesiologists (ASA) Perioperative Brain Health Initiative, an international group of experts was invited to review published best practice statements and guidelines. The expert group aimed to achieve consensus on a small number of practical recommendations that could be implemented by anaesthetists and their partners to reduce the incidence of perioperative neurocognitive disorders. Six statements were selected based not only on the strength of the evidence, but also on the potential for impact and the feasibility of widespread implementation. The actions focus on education, cognitive and delirium screening, non-pharmacologic interventions, pain control, and avoidance of antipsychotics. Strategies for effective implementation are discussed. Anaesthetists should be key members of multidisciplinary perioperative care teams to implement these recommendations.


Asunto(s)
Anestesiología/normas , Anestesistas/normas , Encéfalo/fisiopatología , Cognición , Delirio/prevención & control , Grupo de Atención al Paciente/normas , Atención Perioperativa/normas , Complicaciones Cognitivas Postoperatorias/prevención & control , Factores de Edad , Anciano , Antipsicóticos/efectos adversos , Consenso , Delirio/fisiopatología , Delirio/psicología , Medicina Basada en la Evidencia/normas , Humanos , Liderazgo , Persona de Mediana Edad , Complicaciones Cognitivas Postoperatorias/fisiopatología , Complicaciones Cognitivas Postoperatorias/psicología , Medición de Riesgo , Factores de Riesgo
3.
Am J Respir Crit Care Med ; 203(1): 14-23, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33385220

RESUMEN

Rationale: Decisions in medicine are made on the basis of knowledge and reasoning, often in shared conversations with patients and families in consideration of clinical practice guideline recommendations, individual preferences, and individual goals. Observational studies can provide valuable knowledge to inform guidelines, decisions, and policy.Objectives: The American Thoracic Society (ATS) created a multidisciplinary ad hoc committee to develop a research statement to clarify the role of observational studies-alongside randomized controlled trials (RCTs)-in informing clinical decisions in pulmonary, critical care, and sleep medicine.Methods: The committee examined the strengths of observational studies assessing causal effects, how they complement RCTs, factors that impact observational study quality, perceptions of observational research, and, finally, the practicalities of incorporating observational research into ATS clinical practice guidelines.Measurements and Main Results: There are strengths and weakness of observational studies as well as RCTs. Observational studies can provide evidence in representative and diverse patient populations. Quality observational studies should be sought in the development of ATS clinical practice guidelines, and medical decision-making in general, when 1) no RCTs are identified or RCTs are appraised as being of low- or very low-quality (replacement); 2) RCTs are of moderate quality because of indirectness, imprecision, or inconsistency, and observational studies mitigate the reason that RCT evidence was downgraded (complementary); or 3) RCTs do not provide evidence for outcomes that a guideline committee considers essential for decision-making (e.g., rare or long-term outcomes; "sequential").Conclusions: Observational studies should be considered in developing clinical practice guidelines and in making clinical decisions.


Asunto(s)
Investigación Biomédica/normas , Toma de Decisiones Clínicas , Cuidados Críticos/normas , Prestación de Atención de Salud/normas , Medicina Basada en la Evidencia/normas , Estudios Observacionales como Asunto/normas , Enfermedades Torácicas/terapia , Humanos , Guías de Práctica Clínica como Asunto , Sociedades Médicas , Estados Unidos
6.
J Urol ; 205(1): 22-29, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32960678

RESUMEN

PURPOSE: The summary presented herein represents Part II of the two-part series dedicated to Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline discussing prognostic and treatment recommendations for patients with castration-resistant disease. Please refer to Part I for discussion of the management of patients with biochemical recurrence without metastatic disease after exhaustion of local treatment options as well as those with metastatic hormone-sensitive prostate cancer. RESULTS: The Advanced Prostate Cancer Panel created evidence- and consensus-based guideline statements to aid clinicians in the management of patients with advanced prostate cancer. Such statements are summarized in figure 1[Figure: see text] and detailed herein. MATERIALS AND METHODS: The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. A research librarian conducted searches in Ovid MEDLINE (1998 to January Week 5 2019), Cochrane Central Register of Controlled Trials (through December 2018), and Cochrane Database of Systematic Reviews (2005 through February 6, 2019). An updated search was conducted prior to publication through January 20, 2020. The methodology team supplemented searches of electronic databases with the studies included in the prior AUA review and by reviewing reference lists of relevant articles. CONCLUSIONS: This guideline attempts to improve a clinician's ability to treat patients diagnosed with advanced prostate cancer. Continued research and publication of high-quality evidence from future trials will be essential to improve the level of care for these patients.


Asunto(s)
Oncología Médica/normas , Osteoporosis/prevención & control , Fracturas Osteoporóticas/prevención & control , Neoplasias de la Próstata Resistentes a la Castración/terapia , Urología/normas , Técnicas de Ablación/métodos , Técnicas de Ablación/normas , Antagonistas de Andrógenos/administración & dosificación , Antagonistas de Andrógenos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Quimioterapia Adyuvante/efectos adversos , Quimioterapia Adyuvante/métodos , Quimioterapia Adyuvante/normas , Consenso , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Humanos , Masculino , Oncología Médica/métodos , Clasificación del Tumor , Estadificación de Neoplasias , Osteoporosis/diagnóstico , Osteoporosis/etiología , Fracturas Osteoporóticas/etiología , Pronóstico , Prostatectomía/normas , Neoplasias de la Próstata Resistentes a la Castración/diagnóstico , Neoplasias de la Próstata Resistentes a la Castración/mortalidad , Neoplasias de la Próstata Resistentes a la Castración/patología , Radioterapia Ayuvante/efectos adversos , Radioterapia Ayuvante/métodos , Radioterapia Ayuvante/normas , Sociedades Médicas/normas , Resultado del Tratamiento , Estados Unidos/epidemiología , Urología/métodos
7.
J Urol ; 205(1): 14-21, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32960679

RESUMEN

PURPOSE: The summary presented herein represents Part I of the two-part series dedicated to Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline discussing prognostic and treatment recommendations for patients with biochemical recurrence without metastatic disease after exhaustion of local treatment options as well as those with metastatic hormone-sensitive prostate cancer. Please refer to Part II for discussion of the management of castration-resistant disease. MATERIALS AND METHODS: The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. A research librarian conducted searches in Ovid MEDLINE (1998 to January Week 5 2019), Cochrane Central Register of Controlled Trials (through December 2018), and Cochrane Database of Systematic Reviews (2005 through February 6, 2019). An updated search was conducted prior to publication through January 20, 2020. The methodology team supplemented searches of electronic databases with the studies included in the prior AUA review and by reviewing reference lists of relevant articles. RESULTS: The Advanced Prostate Cancer Panel created evidence- and consensus-based guideline statements to aid clinicians in the management of patients with advanced prostate cancer. Such statements are summarized in figure 1[Figure: see text] and detailed herein. CONCLUSIONS: This guideline attempts to improve a clinician's ability to treat patients diagnosed with advanced prostate cancer. Continued research and publication of high-quality evidence from future trials will be essential to improve the level of care for these patients.


Asunto(s)
Oncología Médica/normas , Neoplasias de la Próstata/terapia , Urología/normas , Técnicas de Ablación/métodos , Técnicas de Ablación/normas , Antagonistas de Andrógenos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante/métodos , Quimioterapia Adyuvante/normas , Consenso , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Humanos , Masculino , Oncología Médica/métodos , Clasificación del Tumor , Estadificación de Neoplasias , Pronóstico , Prostatectomía/normas , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Radioterapia Ayuvante/métodos , Radioterapia Ayuvante/normas , Sociedades Médicas/normas , Resultado del Tratamiento , Estados Unidos/epidemiología , Urología/métodos
8.
J Urol ; 205(1): 30-35, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33053308

RESUMEN

PURPOSE: The authors of this guideline reviewed the urologic trauma literature to guide clinicians in the appropriate methods of evaluation and management of genitourinary injuries. MATERIALS AND METHODS: The Panel amended the Guideline in 2020 to reflect additional literature published through February 2020. When sufficient evidence existed, the Panel assigned the body of evidence a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, the Panel provided additional information as Clinical Principles and Expert Opinions (See table 1[Table: see text]). RESULTS: The Panel updated a total of six existing statements on renal, ureteral, bladder, urethra, and genital trauma. Additionally, four new statements were added based on literature released since the 2017 amendment. Statement 5b was added based on new evidence for treatment of hemodynamically unstable patients with renal trauma. Statement 20b was added based on new literature for percutaneous or open suprapubic tube placement following pelvic fracture urethral injury. Statements 30a and 30b were also added to provide guidance on ultrasonography for blunt scrotal injuries suggestive of testicular rupture and for performing surgical exploration with repair or orchiectomy for penetrating scrotal injuries respectively. CONCLUSIONS: These evidence-based updates to the AUA Guidelines further inform the treatment of urotrauma.


Asunto(s)
Medicina Basada en la Evidencia/normas , Sistema Urogenital/lesiones , Urología/normas , Heridas y Traumatismos/terapia , Medicina Basada en la Evidencia/métodos , Humanos , Sociedades Médicas/normas , Estados Unidos/epidemiología , Urología/métodos , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/epidemiología
9.
J Urol ; 205(1): 36-43, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33295257

RESUMEN

PURPOSE: The summary presented herein represents Part I of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part I outlines the appropriate evaluation of the male in an infertile couple. Recommendations proceed from obtaining an appropriate history and physical exam (Appendix I), as well as diagnostic testing, where indicated. MATERIALS/METHODS: The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed®, Embase®, and Medline from January, 2000 through May, 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table 1[Table: see text]). This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology. RESULTS: This Guideline provides updated, evidence-based recommendations regarding evaluation of male infertility as well as the association of male infertility with other important health conditions. The detection of male infertility increases the risk of subsequent development of health problems for men. In addition, specific medical conditions are associated with some causes for male infertility. Evaluation and treatment recommendations are summarized in the associated algorithm (figure[Figure: see text]). CONCLUSION: The presence of male infertility is crucial to the health of patients and its effects must be considered for the welfare of society. This document will undergo updating as the knowledge regarding current treatments and future treatment options continues to expand.


Asunto(s)
Infertilidad Masculina/diagnóstico , Medicina Reproductiva/normas , Urología/normas , Consejo/normas , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Humanos , Infertilidad Masculina/etiología , Infertilidad Masculina/terapia , Estilo de Vida , Masculino , Medicina Reproductiva/métodos , Escroto/diagnóstico por imagen , Análisis de Semen , Sociedades Médicas/normas , Ultrasonografía , Estados Unidos , Urología/métodos
10.
J Urol ; 205(1): 44-51, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33295258

RESUMEN

PURPOSE: The summary presented herein represents Part II of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part II outlines the appropriate management of the male in an infertile couple. Medical therapies, surgical techniques, as well as use of intrauterine insemination (IUI)/in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are covered to allow for optimal patient management. Please refer to Part I for discussion on evaluation of the infertile male and discussion of relevant health conditions that are associated with male infertility. MATERIALS/METHODS: The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed®, Embase®, and Medline from January 2000 through May 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table[Table: see text]). This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology. RESULTS: This Guideline provides updated, evidence-based recommendations regarding management of male infertility. Such recommendations are summarized in the associated algorithm (figure[Figure: see text]). CONCLUSION: Male contributions to infertility are prevalent, and specific treatment as well as assisted reproductive techniques are effective at managing male infertility. This document will undergo additional literature reviews and updating as the knowledge regarding current treatments and future treatment options continues to expand.


Asunto(s)
Infertilidad Masculina/terapia , Medicina Reproductiva/normas , Urología/normas , Varicocele/terapia , Consejo/normas , Suplementos Dietéticos , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Fertilización In Vitro/métodos , Fertilización In Vitro/normas , Humanos , Infertilidad Masculina/diagnóstico , Infertilidad Masculina/etiología , Masculino , Medicina Reproductiva/métodos , Escroto/diagnóstico por imagen , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Análisis de Semen , Sociedades Médicas/normas , Recuperación de la Esperma/normas , Resultado del Tratamiento , Estados Unidos , Urología/métodos , Varicocele/complicaciones , Varicocele/diagnóstico
11.
Tech Vasc Interv Radiol ; 23(3): 100695, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33308532

RESUMEN

Medically refractory benign prostatic hyperplasia induced lower urinary tract symptoms is an extremely prevalent issue in older men. The current gold standard therapy transurethral resection of the prostate does produce urologic improvements but is also associated with higher than desired morbidity. This has led to the need to develop new minimally invasive means to treat this disease; prostate artery embolization (PAE) has emerged as one minimally invasive treatment option for these patients. The body of evidence which supports the use of PAE has grown quickly and substantially over the last decade. The goal of this review is to introduce and summarize the published urologic outcomes for PAE when utilized to treat benign prostatic hyperplasia induced lower urinary tract symptoms as well as document the established complication profile. Finally, the paper reviews current societal recommendations as they relate to PAE.


Asunto(s)
Embolización Terapéutica/normas , Medicina Basada en la Evidencia/normas , Síntomas del Sistema Urinario Inferior/terapia , Guías de Práctica Clínica como Asunto/normas , Próstata/irrigación sanguínea , Hiperplasia Prostática/terapia , Radiografía Intervencional/normas , Embolización Terapéutica/efectos adversos , Humanos , Síntomas del Sistema Urinario Inferior/diagnóstico por imagen , Síntomas del Sistema Urinario Inferior/fisiopatología , Masculino , Hiperplasia Prostática/diagnóstico por imagen , Hiperplasia Prostática/fisiopatología , Calidad de Vida , Radiografía Intervencional/efectos adversos , Recuperación de la Función , Resultado del Tratamiento , Urodinámica
12.
Am J Respir Crit Care Med ; 202(10): e121-e141, 2020 11 15.
Artículo en Inglés | MEDLINE | ID: mdl-33185464

RESUMEN

Background: Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations.Recommendations: The panel found varying quality and availability of evidence and made the following judgments: 1) strong recommendations for long-term oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe chronic resting hypoxemia, 2) a conditional recommendation against long-term oxygen use in patients with COPD with moderate chronic resting hypoxemia, 3) conditional recommendations for ambulatory oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe exertional hypoxemia, 4) a conditional recommendation for ambulatory liquid-oxygen use in patients who are mobile outside the home and require >3 L/min of continuous-flow oxygen during exertion (very-low-quality evidence), and 5) a recommendation that patients and their caregivers receive education on oxygen equipment and safety (best-practice statement).Conclusions: These guidelines provide the basis for evidence-based use of home oxygen therapy in adults with COPD or ILD but also highlight the need for additional research to guide clinical practice.


Asunto(s)
Medicina Basada en la Evidencia/normas , Servicios de Atención de Salud a Domicilio/normas , Enfermedades Pulmonares Intersticiales/terapia , Terapia por Inhalación de Oxígeno/métodos , Terapia por Inhalación de Oxígeno/normas , Guías de Práctica Clínica como Asunto , Enfermedad Pulmonar Obstructiva Crónica/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sociedades Médicas , Estados Unidos
13.
J Thromb Haemost ; 18(11): 3099-3105, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33174388

RESUMEN

BACKGROUND: Observational studies indicate that children hospitalized with COVID-19-related illness, like adults, are at increased risk for venous thromboembolism (VTE). A multicenter phase 2 clinical trial of anticoagulant thromboprophylaxis in children hospitalized with COVID-19-related illness has recently been initiated in the United States. To date, there remains a paucity of high-quality evidence to inform clinical practice world-wide. Therefore, the objective of this scientific statement is to provide consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses, and to identify priorities for future research. METHODS: We surveyed 20 pediatric hematologists and pediatric critical care physicians from several continents who were identified by Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee leadership as having experience and expertise in the use of anticoagulant thromboprophylaxis and/or the management of COVID-19-related illness in children. A comprehensive review of the literature on COVID-19 in children was also performed. RESULTS: Response rate was 90%. Based on consensus of expert opinions, we suggest the administration of low-dose low molecular weight heparin subcutaneously twice-daily as anticoagulant thromboprophylaxis (in the absence of contraindications, and in combination with mechanical thromboprophylaxis with sequential compression devices, where feasible) in children hospitalized for COVID-19-related illness (including the multisystem inflammatory syndrome in children [MIS-C]) who have markedly elevated D-dimer levels or superimposed clinical risk factors for hospitalassociated VTE. For children who are clinically unstable or have severe renal impairment, we suggest the use of unfractionated heparin by continuous intravenous infusion as anticoagulant thromboprophylaxis. In addition, continued efforts to characterize VTE risk and risk factors in children with COVID-19, as well as to evaluate the safety and efficacy of anticoagulant thromboprophylaxis strategies in children hospitalized with COVID-19-related illness (including MIS-C) via cooperative multicenter trials, were identified among several key priorities for future research. CONCLUSION: These consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses and priorities for future research will be updated as high-quality evidence emerges.


Asunto(s)
Anticoagulantes/administración & dosificación , Infecciones por Coronavirus/tratamiento farmacológico , Medicina Basada en la Evidencia/normas , Hospitalización , Neumonía Viral/tratamiento farmacológico , Investigación/normas , Tromboembolia Venosa/prevención & control , Adolescente , Factores de Edad , Anticoagulantes/efectos adversos , Niño , Preescolar , Toma de Decisiones Clínicas , Consenso , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Encuestas de Atención de la Salud , Humanos , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Tromboembolia Venosa/sangre , Tromboembolia Venosa/etiología , Adulto Joven
14.
JCO Glob Oncol ; 6: 1455-1460, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32997540

RESUMEN

The core pillars of multimodal care of patients with cancer are surgical, radiation, and medical oncology. The global pandemic of coronavirus disease 2019 (COVID-19) has suddenly resurrected a new pillar in oncology care: teleoncology. With oncologists reaching out to patients through telemedicine, it is possible to evaluate and fulfill patients' needs; triage patients for elective procedures; screen them for influenza-like illness; provide them with guidance for hospital visits, if needed; and bridge oral medications and treatments when a hospital visit is not desirable because of any high risk-benefit ratio. Teleoncology can bring great reassurance to patients at times when reaching an oncology center is challenging, and more so in resource-constrained countries. Evidence-based treatment protocols, dispensable by teleoncology, already exist for many sites of cancer and they can provide a bridge to treatment when patients are unable to reach cancer centers for their standard treatment. The young pillar of teleoncology is going to remain much longer than COVID-19.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Control de Infecciones/organización & administración , Oncología Médica/organización & administración , Neoplasias/diagnóstico , Pandemias/prevención & control , Neumonía Viral/prevención & control , Telemedicina/organización & administración , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/organización & administración , Medicina Basada en la Evidencia/normas , Medicina Basada en la Evidencia/tendencias , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Oncología Médica/métodos , Oncología Médica/normas , Oncología Médica/tendencias , Neoplasias/terapia , Selección de Paciente , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Telemedicina/normas , Telemedicina/tendencias , Triaje/métodos , Triaje/organización & administración , Triaje/normas
15.
Sports Health ; 12(6): 540-546, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32936058

RESUMEN

CONTEXT: With increased use of cannabis-based products by the public for both recreational and medical use, sports medicine clinicians should be informed of historical context, current legal considerations, and existing evidence with regard to efficacy, safety, and risks in the athletic community. EVIDENCE ACQUISITION: A review of ClinicalTrials.gov, MEDLINE, and CINAHL from 2015 to present was conducted with emphasis on the most recent literature using search terms, cannabis, nabiximols, cannabinoids, pain management, THC, CBD, and marijuana. Bibliographies based on original search were utilized to pursue further literature search. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: At present, limited high-quality studies exist for use of cannabinoids for acute pain, chronic pain, or concussion. None of the trials involving cannabinoids included the athletic population. Thus, results from this clinical review are extrapolated to conditions of the sports medicine population. For acute pain, 2 small-randomized double-blinded crossover trials concluded no immediate effect of cannabinoid therapy. More robust evidence exists for treatment of chronic pain conditions through meta-analysis and systemic reviews. Cannabinoid therapy exhibits moderate efficacy as a treatment for some chronic pain conditions. Investigations included a broad spectrum of chronic pain conditions, including neuropathic, musculoskeletal, inflammatory, and central pain conditions, and reveal reduction in pain and improvement of quality of life with limited adverse effects. For concussion, evidence is based on preclinical in vitro and animal models revealing possible neuroprotective effects as well as 2 clinical studies involving the presence of cannabinoids for concussion (some sports-related), but there are no high-quality trials evaluating efficacy for treatment with cannabinoids at this time. CONCLUSION: Although various biochemical explanations exist on the use of cannabinoid therapy through modulation of the endocannabinoid system for several medical issues affecting athletes, recommendations from clinicians must be extrapolated from a majority of research done in the nonathletic population. Lack of strong-quality clinical evidence, coupled with inconsistent federal and state law as well as purity issues with cannabis-based products, make it difficult for the sports medicine clinician to widely recommend cannabinoid therapeutics at present. Future larger, higher quality clinical research studies with standardized pure extracts will better guide appropriate medical use going forward. At present, evidence for a multitude of therapeutic applications is emerging for cannabinoid treatment approaches. With emphasis placed on patient-centered clinical decisions, cannabinoids hold promise of treatment for athletes with chronic pain conditions. Clinicians who treat the athletic community must consider legal and ethical issues when discussing and recommending the use of cannabinoids, with acknowledgment of inconsistencies in purity of various formulations and concerns of drug testing.


Asunto(s)
Traumatismos en Atletas/complicaciones , Cannabinoides/uso terapéutico , Marihuana Medicinal/uso terapéutico , Manejo del Dolor/métodos , Dolor Agudo/tratamiento farmacológico , Traumatismos en Atletas/tratamiento farmacológico , Conmoción Encefálica/tratamiento farmacológico , Cannabinoides/efectos adversos , Dolor Crónico/tratamiento farmacológico , Medicina Basada en la Evidencia/normas , Humanos , Uso de la Marihuana/legislación & jurisprudencia , Marihuana Medicinal/efectos adversos , Estados Unidos
16.
Eur J Cancer ; 137: 235-239, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32805640

RESUMEN

The outbreak of the Coronavirus disease (COVID-19) pandemic has deeply challenged healthcare systems and care of patients with cancer. Phase 1 studies are among the most complicated clinical trials and require thorough patient selection, as well as intensive patient monitoring. In this perspective, we discuss the key factors that should be considered for the conduct of phase 1 trials and management of COVID-19-positive patients with cancer enrolled in such trials. We notably present the risks and challenges raised by COVID-19-infected phase 1 patients, in terms of safety, toxicity causality assessment, drug efficacy evaluation and clinical research priorities. We finally propose some guidelines for the conduct of phase 1 trials and management of COVID-19-infected patients in a pandemic time.


Asunto(s)
Antineoplásicos/efectos adversos , Ensayos Clínicos Fase I como Asunto/normas , Infecciones por Coronavirus/terapia , Neoplasias/tratamiento farmacológico , Selección de Paciente , Neumonía Viral/terapia , Betacoronavirus/inmunología , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Medicina Basada en la Evidencia/normas , Humanos , Control de Infecciones/normas , Oncología Médica/normas , Neoplasias/inmunología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/virología , Guías de Práctica Clínica como Asunto , Resultado del Tratamiento
17.
Stroke Vasc Neurol ; 5(3): 270-278, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32792457

RESUMEN

AIM: Cerebrovascular disease is the leading cause of death and disability in China, causing a huge burden among patients and their families. Hence, stroke prevention is critical, especially in the high-risk population. Here, we present the evidence-based guideline suitable for the Chinese population. METHODS: Literature search of PubMed and Cochrane library (from January 1964 to June 2019) was done. After thorough discussion among the writing group members, recommendations were listed and summarised. This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association's Stroke. RESULTS: This evidence-based guideline was written in three parts: controlling the risk factors of stroke, utilisation of antiplatelet agents and assessing the risks of first-ever stroke. All recommendations were listed along with the recommending classes and levels of evidence. CONCLUSIONS: This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China. Controlling related risk factors, appropriately using antiplatelet agents, assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.


Asunto(s)
Trastornos Cerebrovasculares/prevención & control , Medicina Basada en la Evidencia/normas , Neurología/normas , Inhibidores de Agregación Plaquetaria/uso terapéutico , Prevención Primaria/normas , Conducta de Reducción del Riesgo , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/epidemiología , China/epidemiología , Consenso , Evaluación de la Discapacidad , Humanos , Inhibidores de Agregación Plaquetaria/efectos adversos , Recuperación de la Función , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
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