Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.872
Filtrar
1.
Eur J Cancer ; 147: 154-160, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33676266

RESUMEN

The worldwide spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated infectious coronavirus disease (COVID-19) has posed a unique challenge to medical staff, patients and their families. Patients with cancer, particularly those with haematologic malignancies, have been identified to be at high risk to develop severe COVID-19. Since publication of our previous guideline on evidence-based management of COVID-19 in patients with cancer, research efforts have continued and new relevant data has come to light, maybe most importantly in the field of vaccination studies. Therefore, an update of our guideline on several clinically important topics is warranted. Here, we provide a concise update of evidence-based recommendations for rapid diagnostics, viral shedding, vaccination and therapy of COVID-19 in patients with cancer. This guideline update was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology by critically reviewing the currently available data on these topics applying evidence-based medicine criteria.


Asunto(s)
/normas , Neoplasias , Esparcimiento de Virus/fisiología , Antivirales/uso terapéutico , /epidemiología , /virología , Medicina Basada en la Evidencia/normas , Medicina Basada en la Evidencia/estadística & datos numéricos , Alemania/epidemiología , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/epidemiología , Neoplasias Hematológicas/terapia , Neoplasias Hematológicas/virología , Hematología/organización & administración , Hematología/normas , Humanos , Inmunización Pasiva/métodos , Inmunización Pasiva/normas , Infectología/organización & administración , Infectología/normas , Oncología Médica/organización & administración , Oncología Médica/normas , Neoplasias/diagnóstico , Neoplasias/epidemiología , Neoplasias/terapia , Neoplasias/virología , Sociedades Médicas/normas , Vacunación/métodos , Vacunación/normas
2.
Allergol. immunopatol ; 49(1): 32-39, ene.-feb. 2021. tab
Artículo en Inglés | IBECS | ID: ibc-199223

RESUMEN

BACKGROUND: Asthma control is the goal of asthma management. A nationwide study on this aspect was launched by the Italian Society of Paediatric Allergy and Immunology (ControL'Asma study). OBJECTIVE: To define variables associated with different asthma control grades in a nationwide population of asthmatic children and adolescents. METHODS: This cross-sectional real-world study included 480 asthmatic children and adoles­cents (333 males, median age 11.2 years) consecutively enrolled in 10 third level pediatric allergy clinics. According to the Global Initiative for Asthma (GINA) document, history, med­ication use, perception of asthma symptoms assessed by visual analog scale (VAS), clinical examination, lung function, childhood asthma control test (cACT)/asthma control test (ACT), and asthma control level were evaluated. RESULTS: Considering GINA criteria, asthma was well controlled in 55% of patients, partly con­trolled in 32.4%, and uncontrolled in 12.6%. Regarding cACT/ACT, asthma was uncontrolled in 23.2%. Patients with uncontrolled asthma had the lowest lung function parameters and VAS scores, more frequent bronchial obstruction and reversibility, and used more oral and inhaled corticosteroids (CS). CONCLUSIONS: The ControL'Asma study, performed in a real-world setting, showed that asthma in Italian children and adolescents was usually more frequent in males. Asthmatic patients had an early onset and allergic phenotype with very frequent rhinitis comorbidity. Uncontrolled and partly controlled asthma affected about half of the subjects, and the assessment of asthma symptom perception by VAS could be a reliable tool in asthma management


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Asma/epidemiología , Asma/prevención & control , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/prevención & control , Escala Visual Analógica , Sociedades Médicas/normas , Estudios Transversales , Consentimiento Informado/normas , Encuestas y Cuestionarios , Rinitis/epidemiología , Guías de Práctica Clínica como Asunto
4.
Value Health ; 24(2): 227-235, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518029

RESUMEN

OBJECTIVES: This study aims to estimate the national impact and cost-effectiveness of the 2018 American College of Physicians (ACP) guidance statements compared to the status quo. METHODS: Survey data from the 2011-2016 National Health and Nutrition Examination were used to generate a national representative sample of individuals with diagnosed type 2 diabetes in the United States. Individuals with A1c <6.5% on antidiabetic medications are recommended to deintensify their A1c level to 7.0% to 8.0% (group 1); individuals with A1c 6.5% to 8.0% and a life expectancy of <10 years are recommended to deintensify their A1c level >8.0% (group 2); and individuals with A1c >8.0% and a life expectancy of >10 years are recommended to intensify their A1c level to 7.0% to 8.0% (group 3). We used a Markov-based simulation model to evaluate the lifetime cost-effectiveness of following the ACP recommended A1c level. RESULTS: 14.41 million (58.1%) persons with diagnosed type 2 diabetes would be affected by the new guidance statements. Treatment deintensification would lead to a saving of $363 600 per quality-adjusted life-year (QALY) lost for group 1 and a saving of $118 300 per QALY lost for group 2. Intensifying treatment for group 3 would lead to an additional cost of $44 600 per QALY gain. Nationally, the implementation of the guidance would add 3.2 million life-years and 1.1 million QALYs and reduce healthcare costs by $47.7 billion compared to the status quo. CONCLUSIONS: Implementing the new ACP guidance statements would affect a large number of persons with type 2 diabetes nationally. The new guidance is cost-effective.


Asunto(s)
Diabetes Mellitus Tipo 2/sangre , Sociedades Médicas/normas , Adulto , Anciano , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/economía , Hemoglobina A Glucada , Guías como Asunto , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Humanos , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Esperanza de Vida , Persona de Mediana Edad , Modelos Económicos , Estados Unidos
5.
Support Care Cancer ; 29(4): 1713-1718, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33484357

RESUMEN

This paper chronicles the third decade of MASCC from 2010. There was a generational change in this decade, building on the solid foundation of the founders. It included the first female President, and a new Executive Director with a background in strategy and business development and operations as applied to healthcare. The headquarters moved from Copenhagen to Toronto. The first meeting to be held outside of Europe or North America was held in Adelaide, Australia, and the membership in the Asia Pacific region expanded. A program of international affiliates saw national supportive care organisations formally link with MASCC. In cancer supportive care, there was a raft of new toxicities to manage as immunotherapies were added to conventional cytotoxic treatment. There was also a greater emphasis on the psychosocial needs of patients and families. New MASCC groups were formed to respond to this evolution in cancer management. The MASCC journal, Supportive Care in Cancer, continued to grow in impact, and MASCC published two editions of a textbook of supportive care and survivorship. The decade ended with the challenge of the COVID-19 pandemic, but that served to highlight the importance of good supportive care to patients with cancer.


Asunto(s)
Neoplasias/terapia , Cuidados Paliativos/historia , Cuidados Paliativos/tendencias , Sociedades Médicas/historia , /epidemiología , Congresos como Asunto/historia , Congresos como Asunto/tendencias , Consejo Directivo/historia , Consejo Directivo/tendencias , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Agencias Internacionales/historia , Agencias Internacionales/organización & administración , Agencias Internacionales/normas , Agencias Internacionales/tendencias , Cooperación Internacional/historia , Neoplasias/historia , Cuidados Paliativos/organización & administración , Pandemias , Publicaciones/historia , Publicaciones/tendencias , Sociedades Médicas/organización & administración , Sociedades Médicas/normas , Sociedades Médicas/tendencias
6.
Clin Microbiol Infect ; 27(3): 389-395, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33359375

RESUMEN

SCOPE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become pandemic, reaching almost one million death worldwide. At present standard treatment for coronavirus disease 2019 (COVID-19) is not well defined because the evidence, either from randomized or observational studies, with conflicting results, has led to rapid changes in treatment guidelines. Our aim was to narratively summarize the available literature on the management of COVID-19 in order to combine current evidence and interpretation of the data by experts who are treating patients in the frontline setting. METHODS: The panel conducted a detailed review of the literature and eventual press releases from randomized clinical trials for each possible available treatment. Inductive PubMed search waws performed for publications relevant to the topic, including all clinical trials conducted. The result was a flowchart with treatment indications for patients with COVID-19. IMPLICATIONS: After 6 months of a pandemic situation and before a possible second coronavirus wave descends on Europe, it is important to evaluate which drugs proved to be effective while also considering that results from many randomized clinical trials are still awaited. Indeed, among treatments for COVID-19, only glucocorticoids have resulted in an association with a significant decrease in mortality in published randomized controlled trials. New therapeutic strategies are urgently needed.


Asunto(s)
/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Sociedades Médicas/normas , /diagnóstico , /terapia , Humanos , Italia/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Nivel de Atención
7.
J Formos Med Assoc ; 120(1 Pt 1): 78-82, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32682701

RESUMEN

Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection with SARS-CoV may cause coronary plaque instability and lead to acute coronary syndrome (ACS). Management of ACS in patients with COVID-19 needs more consideration of the balance between clinical benefit and transmission risk of virus. This review provides recommendations of management strategies for ACS in patients with suspected or confirmed COVID-19 in Taiwan.


Asunto(s)
Síndrome Coronario Agudo , Transmisión de Enfermedad Infecciosa/prevención & control , Infarto del Miocardio , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , /prevención & control , Cardiología/métodos , Cardiología/normas , Comorbilidad , Consenso , Humanos , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Manejo de Atención al Paciente/métodos , Medición de Riesgo , Sociedades Médicas/normas , Taiwán
8.
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
9.
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
10.
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
11.
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
13.
J Urol ; 205(1): 165-173, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32648808

RESUMEN

PURPOSE: In 2018 the American Association for the Surgery of Trauma revised renal injury grading. One change was inclusion of segmental kidney infarction under grade IV injuries. We aimed to assess how segmental kidney infarction will change the scope of grade IV injuries and compare bleeding control interventions in those with and without isolated segmental kidney infarction. METHODS: We used high grade renal trauma data from 7 level 1 trauma centers from 2013 to 2018 as part of the Multi-institutional Genito-Urinary Trauma Study. Initial computerized tomography scans were reviewed to regrade the injuries. Injuries were categorized as isolated segmental kidney infarction if segmental parenchymal infarction was the only reason for inclusion under grade IV injury. All other grade IV injuries (including combined injury patterns) were categorized as without isolated segmental kidney infarction. Bleeding interventions were compared between those with and without isolated segmental kidney infarction. RESULTS: From 550 patients with high grade renal trauma and available computerized tomography, 250 (45%) were grade IV according to the 2018 American Association for the Surgery of Trauma grading system. Of these, 121 (48%) had isolated segmental kidney infarction. The majority of patients with isolated segmental kidney infarction (88%) would have been assigned a lower grade using the original 1989 grading system. Rate of bleeding control interventions was lower in isolated segmental kidney infarction compared to other grade IV injuries (7% vs 21%, p=0.002). Downgrading all patients with isolated segmental kidney infarction to grade III did not change the grading system's associations with bleeding interventions. CONCLUSIONS: Approximately half of the 2018 American Association for the Surgery of Trauma grade IV injuries have isolated segmental kidney infarction. Including isolated segmental kidney infarction in grade IV injuries increases the heterogeneity of these injuries without increasing the grading system's ability to predict bleeding interventions. In future iterations of the American Association for the Surgery of Trauma renal trauma grading isolated segmental kidney infarction could be reclassified as grade III injury.


Asunto(s)
Infarto/diagnóstico , Puntaje de Gravedad del Traumatismo , Riñón/irrigación sanguínea , Riñón/lesiones , Adulto , Procedimientos Endovasculares/estadística & datos numéricos , Femenino , Humanos , Infarto/etiología , Infarto/cirugía , Riñón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Sociedades Médicas/normas , Tomografía Computarizada por Rayos X , Centros Traumatológicos/normas , Centros Traumatológicos/estadística & datos numéricos , Estados Unidos , Adulto Joven
15.
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
16.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(6): 289-298, nov.-dic. 2020.
Artículo en Español | IBECS | ID: ibc-197923

RESUMEN

INTRODUCCIÓN: El tratamiento de los glioblastomas (GMB) comienza en la mayor parte de los pacientes con una cirugía, ya sea para la extirpación tumoral, ya sea para la obtención de tejido con el que determinar un diagnóstico histológico. Con el fin de obtener el máximo beneficio de estos tratamientos cada paciente debe ser valorado de forma individualizada por un equipo multidisciplinar, constituido por aquellas especialidades involucradas tanto en el diagnóstico como en el tratamiento. MATERIAL Y MÉTODOS: El objetivo de este trabajo es elaborar unas recomendaciones de tratamiento para los pacientes con GBM, para lo cual un experto en cada campo ha descrito lo más relevante de dicha área basado tanto en su experiencia como en la literatura. RESULTADOS: Se han desarrollado los distintos apartados sobre el tratamiento de los GBM y al final de cada apartado se concluye la recomendación del GTNO. CONCLUSIONES: A pesar de que los GBM son tumores agresivos y el pronóstico es malo, los pacientes se pueden beneficiar de tratamientos que mejoren no solo la supervivencia global sino también la calidad de vida. El neurocirujano debe conocer las distintas opciones de tratamientos, sus indicaciones y riesgos para poder participar activamente en la toma de decisiones y ofrecer un tratamiento neuroquirúrgico oportuno a cada situación


INTRODUCTION: Glioblastoma (GBM) treatment starts in most patients with surgery, either resection surgery or biopsy, to reach a histology diagnose. Multidisciplinar team, including specialists in brain tumors diagnose and treatment, must make an individualize assessment to get the maximum benefit of the available treatments. MATERIAL AND METHODS: Experts in each GBM treatment field have briefly described it based in their experience and the reviewed of the literature. RESULTS: Each area has been summarized and the consensus of the brain tumor group has been included at the end. CONCLUSIONS: GBM are aggressive tumors with a dismal prognosis, however accurate treatments can improve overall survival and quality of life. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case


Asunto(s)
Humanos , Conferencias de Consenso como Asunto , Retinoblastoma/terapia , Grupo de Atención al Paciente/normas , Neoplasias Encefálicas/cirugía , Toma de Decisiones , Sociedades Médicas/normas , Glioma/radioterapia , Glioma/cirugía , Glioma/tratamiento farmacológico , Monitorización Neurofisiológica Intraoperatoria/normas , Inmunoterapia/normas
17.
Gastroenterol. hepatol. (Ed. impr.) ; 43(10): 589-597, dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-197973

RESUMEN

INTRODUCCIÓN: En un estudio previo demostramos que un pequeño programa de formación mejoraba los indicadores de calidad de la esofagogastroduodenoscopia (EGD) que llegaban a los estándares recomendados. Sin embargo, desconocemos el efecto de esta formación a largo plazo. El objetivo de este estudio fue valorar la calidad de las EGD después de 3años de haber realizado un programa de mejora. MATERIAL Y MÉTODOS: Estudio comparativo de 2 cohortes: EGD posteriores a un programa de formación realizado en 2016 (grupo A) y EGD en enero-marzo de 2019 (grupo B). El grupo B se dividió en 2 subgrupos: endoscopistas que habían participado en el programa de formación previo (B1) y los que no (B2). Se utilizaron los indicadores de calidad intraprocedimiento recomendados por la ASGE-ACG. RESULTADOS: Se analizaron un total de 1.236 EGD, 600 en el grupo A y 636 en el B (439 subgrupo B1 y 197 subgrupo B2). El número de exploraciones completas fue inferior en el grupo B (566 [94,3%] vs. 551 [86,6%]; p < 0,001). Se observó una disminución significativa en prácticamente todos los indicadores de calidad que, además, no alcanzaron los estándares recomendados: retroversión gástrica (96% vs. 81%; p < 0,001); protocolo de biopsias de Seattle (86% vs. 50%; p = 0,03), descripción de la lesión en la hemorragia (100% vs. 62%; p < 0,01), toma de ≥4 biopsias en sospecha de celiaquía (92,5% vs. 18%; p < 0,001), fotodocumentación de lesión (94% vs. 90%; p < 0,05). Cuando consideramos el global de la prueba (incluyendo la actuación correcta y la fotodocumentación adecuada), también se observó una disminución significativa (90,5% vs. 62%; p < 0,001). No hubo diferencias entre los subgrupos B1 y B2. CONCLUSIONES: La mejora observada en 2016 tras un programa de formación no perdura a los 3años. Es necesario hacer programas de formación continuados para mantener la calidad de la EGD por encima de los estándares recomendados


INTRODUCTION: In a previous study we demonstrated that a simple training programme improved quality indicators of Oesophagogastroduodenoscopy (OGD) achieving the recommended benchmarks. However, the long-term effect of this intervention is unknown. The aim of this study was to assess the quality of OGDs performed 3 years after of having completed a training programme. MATERIAL AND METHODS: A comparative study of 2 cohorts was designed as follows: Group A included OGDs performed in 2016 promptly after a training programme and Group B with OGDs performed from January to March 2019, this group was also divided into 2 subgroups: subgroup B1 of Endoscopists who had participated in the previous training programme and subgroup B2 of Endoscopists who had not. The intra-procedure quality indicators proposed by ASGE-ACG were used. RESULTS: A total of 1236 OGDs were analysed, 600 from Group A and 636 from Group B (439 subgroup B1 and 197 subgroup B2). The number of complete examinations was lower in Group B (566 [94.3%] vs. 551 [86.6%]; p < 0.001). A significant decrease was observed in nearly all quality indicators and they did not reach the recommended benchmarks: retroflexion in the stomach (96% vs. 81%; p < 0.001); Seattle biopsy protocol (86% vs. 50%; p = 0.03), description of the upper GI bleeding lesion (100% vs. 62%; p < 0.01), sufficient intestinal biopsy specimens (at least 4) in suspected coeliac disease (92.5% vs. 18%; p < 0.001), photo documentation of the lesion (94% vs. 90%; p < 0.05). Regarding the overall assessment of the procedure (including correct performance and adequate photo documentation), a significant decrease was also observed (90.5% vs. 62%; p < 0.001). There were no differences between subgroups B1 and B2. CONCLUSIONS: The improvement observed in 2016 after a training programme did not prevail after 3 years. In order to keep the quality of OGDs above the recommended benchmarks, it is necessary to implement continuous training programmes


Asunto(s)
Humanos , Indicadores de Calidad de la Atención de Salud/normas , Endoscopía del Sistema Digestivo/métodos , Endoscopía del Sistema Digestivo/normas , Estudios de Cohortes , Atención al Paciente/normas , Indicadores de Calidad de la Atención de Salud/organización & administración , Atención al Paciente/métodos , Sociedades Médicas/normas , Estudios Prospectivos , Estudios Retrospectivos , Endoscopía/normas
18.
Emergencias (Sant Vicenç dels Horts) ; 32(6): 416-426, dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-197994

RESUMEN

Casi la mitad de los nuevos diagnósticos de infección por el virus de la inmunodeficiencia humana (VIH) se realizan de forma tardía, lo cual provoca un aumento en la morbimortalidad, una mayor expansión de la epidemia y un in-cremento en los costes sanitarios públicos. En los servicios de urgencias se atiende a muchos de los pacientes que presentan situaciones indicadoras de infección por VIH o que comparten su misma vía de transmisión. Por lo tanto, pueden ser clave en una estrategia que mejore las tasas de diagnóstico precoz mediante la promoción de la solicitud de serologías frente al VIH durante la atención de determinados perfiles clínicos. Sin embargo, esto en la actualidad se produce escasamente a no ser que el resultado de la serología vaya a modificar el manejo del proceso agudo que ha motivado la consulta en urgencias. Las presentes recomendaciones se han desarrollado por un grupo de expertos designados por la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) en base a la identificación y revisión de la evidencia científica más reciente. El objetivo de este documento es dar soporte a los médicos de urgencias en la toma de decisiones, promoviendo el cribado del VIH y la derivación de los pacientes al especialista adecuado para su seguimiento posterior en seis entidades clínicas seleccionadas por su elevada prevalencia en pacientes VIH positivos y la alta frecuencia con la que son atendidas en urgencias: 1) infecciones de transmisión sexual; 2) profilaxis post exposición; 3) herpes zoster; 4) práctica del chemsex; 5) neumonía adquirida en la comunidad, y 6) síndrome mononucleósico. Las recomendaciones incluyen indicaciones sobre en qué pacientes debe realizarse una serología, el proceso de derivación y herramientas para ayudar a los médicos de urgencias en la toma de decisiones


Almost half of new diagnoses of human immunodeficiency virus (HIV) infection are made late, leading to increased morbidity and mortality, greater spread of infection, and higher public health care costs. Emergency services care for many patients who share behaviors associated with HIV transmission risk who arrive in clinical situations that are associated with HIV infection. A strategy to increase the rates of early diagnosis by promoting serology for HIV when caring for patients with certain clinical profiles might therefore be the key to improvement. This approach ishardly used at present, however, unless the result of serology would change the management of the acute complaint that led to the visit. These recommendations based on evidence from a search and review of recent publications were developed by a group of experts appointed by the Spanish Society of Emergency Medicine (SEMES). The resulting statement aims to support decision-making by emergency physicians and promote HIV screening and referral to appropriate specialists for follow-up in patients with certain conditions (sexually transmitted infections, herpes zoster, community-acquired pneumonia) or reporting certain scenarios (practice of chemsex, need for post-exposure prophylaxis). These 6 settings were selected because they are often seen in emergency departments and are common in patients with HIV-positive tests. The recommendations address when to order serology for HIV and how to manage the referral process. Included are decision-making tools foremergency physicians


Asunto(s)
Humanos , Consenso , Servicio de Urgencia en Hospital/normas , Diagnóstico Precoz , Infecciones por VIH/diagnóstico , Derivación y Consulta/normas , Toma de Decisiones , Diagnóstico Tardío/prevención & control , Diagnóstico Tardío/estadística & datos numéricos , Sociedades Médicas/normas , Infecciones por VIH/epidemiología
20.
Farm. hosp ; 44(6): 288-296, nov.-dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-197697

RESUMEN

OBJETIVO: Dar a conocer los resultados referentes a características generales, recursos humanos, materiales y sistemas de información de la encuesta nacional de la Sociedad Española de Farmacia Hospitalaria (SEFH) 2019 sobre la situación de los Servicios de Farmacia Hospitalaria españoles. MÉTODO: Se envió un cuestionario on line a los responsables de los 368 Servicios de Farmacia Hospitalaria españoles registrados en el directorio de socios de la SEFH. El cuestionario incluía 77 preguntas agrupadas en ocho dimensiones. La información se recogió entre marzo y septiembre de 2019. RESULTADOS: La tasa global de respuesta fue del 54,3%. El 69% de los hospitales eran de titularidad pública y el tamaño más representado de 101-250 camas. El 9% permanecía abierto durante las 24 horas y el 57,5% no disponía de ninguna modalidad de atención continuada. La dispensación a pacientes externos durante la tarde se realizaba en el 41,9% de los centros. El 52,7% de los Servicios de Farmacia estaban acreditados por una norma de calidad. La media de farmacéuticos especialistas por Servicio de Farmacia fue 5,34 (desviación estándar [DE]: 6,22). El 47% de los farmacéuticos trabajaban al menos media jornada en las unidades clínicas. En cuanto a los sistemas automatizados rotativos de almacenamiento y dispensación, de media los Servicios de Farmacia disponían de 0,3 (DE: 0,7) y 0,9 (DE: 1,4) según fueran de tipo horizontal o vertical, respectivamente. El 16,1% de las camas hospitalarias estaban asistidas por sistemas automatizados de dispensación, llegando al 33,5% en hospitales con > 1.000 camas. El 3% de los Servicios de Farmacia Hospitalaria disponía de un sistema robotizado para la preparación de quimioterapia y el 24,8% de un sistema de trazabilidad y seguridad. Las bombas de infusión inteligentes se utilizaban en el 21,4% de los centros. La prescripción electrónica estaba implantada en el 98,8% de los hospitales para pacientes ingresados y en el 62% para pacientes ambulantes. CONCLUSIONES: En los Servicios de Farmacia Hospitalaria españoles existe una infradotación de farmacéuticos especialistas, a pesar de haberse duplicado su incorporación a las unidades clínicas. Destaca un crecimiento en la automatización de las actividades logísticas de dispensación, pero existe un importante margen de mejora en sistemas robotizados y de trazabilidad de las preparaciones. Conocer estos resultados puede resultar de gran utilidad para establecer planes de actuación


OBJECTIVE: To publicize the results regarding the general characteristics, human resources, materials and information systems of Spanish hospital pharmacy departments arising from SEFH's 2019 Survey on the Situation of Spanish Hospital Pharmacy Departments. METHOD: An online questionnaire was sent to the heads of the 368 hospital pharmacy departments affiliated to SEFH. The questionnaire included 77 questions grouped into 8 dimensions. The information was collected between March and September 2019. RESULTS: The overall response rate was 54.3%. Sixty-nine percent of hospitals were public and the most commonly reported hospital size was 101-250 beds. Nine percent of responding hospitals remained open round the clock and 57.5% did not offer a continued care service. A total of 41.9% of hospitals dispensed medications to outpatients in the afternoon and 52.7% of hospital pharmacy departments were accredited to some quality standard. The mean number of specialist pharmacists per pharmacy Department was 5.34 (SD: 6.22); 47% of pharmacists spent at least half their working day in a clinical unit. Hospital pharmacy departments had a mean of 0.3 (SD: 0.7) or 0:9 (SD: 1.4) automated storage and dispensing carousels, depending on whether they were horizontal or vertical, respectively. A total of 16.1% of beds were assisted by automated dispensing systems, a figure that reached 33.5% in hospitals with more than 1,000 beds. Three percent of hospital pharmacy departments had a robotized system for compounding chemotherapy medications and 24.8% had a traceability and safety system. Smart infusion pumps were used by 21.4% of hospitals. Electronic prescriptions were implemented in 98.8% of hospitals for inpatients and in 62% for outpatients. CONCLUSIONS: Spanish hospital pharmacy departments face a shortage of specialist pharmacists, although incorporation of such professionals to clinical units has doubled in the last few years. There has been an increase in the level of automation of the logistic processes involved in medication dispensing, but there is still significant room for improvement in the area of robotized dispensing and compounding traceability systems. This data could play an invaluable role in the design of future action plans


Asunto(s)
Humanos , Servicio de Farmacia en Hospital , Encuestas y Cuestionarios/normas , Sistemas de Información/organización & administración , Sistemas de Información/normas , Sociedades Médicas/normas , Robótica , Prescripción Electrónica , Medicamentos del Componente Especializado de los Servicios Farmacéuticos , Medicamentos con Supervisión Farmacéutica/normas
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...