RESUMO
This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.
Assuntos
Assistência Ambulatorial , Prova Pericial , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Hospitalização , Obesidade/diagnóstico , Obesidade/terapia , Equipe de Assistência ao Paciente , Tratamento Domiciliar , Algoritmos , Assistência Ambulatorial/normas , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/terapia , Transtorno da Compulsão Alimentar/diagnóstico , Transtorno da Compulsão Alimentar/terapia , Bulimia Nervosa/diagnóstico , Bulimia Nervosa/terapia , Comorbidade , Consenso , Hospital Dia , Avaliação da Deficiência , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/reabilitação , Fidelidade a Diretrizes , Humanos , Itália , Atividade Motora , Programas Nacionais de Saúde , Estado Nutricional , Obesidade/fisiopatologia , Obesidade/psicologia , Obesidade/reabilitação , Guias de Prática Clínica como Assunto , Tratamento Domiciliar/normas , Fatores de Risco , Meio Social , CaminhadaRESUMO
The authors describe five consecutive patients with testicular non Hodgkin lymphoma, evaluate the clinical and histological characteristics and underline the importance of a chemotherapy approach both at diagnosis and at relapse. A review of the literature is carried on and particularly about the prognostic factors, the correlation with Ebstein Barr virus and the more recent integrated therapeutical approaches.
