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2.
Med Clin North Am ; 104(1): 15-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757233

RESUMO

Urticaria is a common presenting problem to the primary care provider. Acute urticaria lasting less than 6 weeks may be associated with a drug or food allergens. Chronic urticaria lasting more than 6 weeks is often associated without a known underlying cause. Inducible stimuli causing hives should be excluded using specific provocation testing. Treatment follows a standardized algorithmic approach as outlined by the Joint Task Force Practice Parameter and/or International Urticaria guidelines. Patients not responsive to steps 1 or 2 should be referred to an urticaria specialist for further evaluation and treatment. The prognosis and outcome of urticaria is generally very favorable for most patients.


Assuntos
Atenção Primária à Saúde/métodos , Urticária/diagnóstico , Doença Aguda , Comitês Consultivos/normas , Doença Crônica , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/diagnóstico , Humanos , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Prognóstico , Encaminhamento e Consulta , Urticária/etiologia
5.
Creat Nurs ; 25(2): 176-181, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31085673

RESUMO

The Institute of Medicine (2001) identifies equity as one of six essential components of health-care quality. However, many health-care organizations lack a formal method to deeply understand and evaluate diverse patient and family experiences. Understanding care experiences of patients and families from minority racial and ethnic groups is essential to improving pervasive health disparities and to making health care more equitable. This article describes the creation of a toolkit aimed at strengthening health-care organizations' abilities to advance health equity through patient and family advisory councils (PFACs). This resource, cocreated with representatives from diverse PFACs, identifies and promotes strategies to recruit and retain diverse representation in advisory councils.


Assuntos
Comitês Consultivos/normas , Grupos Étnicos , Família , Equidade em Saúde/normas , Grupos Minoritários , Defesa do Paciente/normas , Pacientes , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
6.
Am J Clin Dermatol ; 20(4): 527-538, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30949881

RESUMO

Acne patients may have significant quality-of-life (QoL) impairment, therefore assessment of health-related QoL (HRQoL) in acne patients is recommended by several national and international guidelines as an integral part of acne management. The inclusion of QoL assessment in core outcome sets is now a popular idea. Several acne-specific QoL questionnaires are available but none cover all topics presented in other instruments. The impact of acne on different aspects of QoL may vary between patients from different age groups. The European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes has initiated a study on the relevance of the different QoL topics in acne patients. Detailed recommendations on treatment goals and changes of treatment approaches based on a validated banding system and a minimal clinically important difference in HRQoL questionnaires (such as the Dermatology Life Quality Index) may be an important and promising approach.


Assuntos
Acne Vulgar/psicologia , Dermatologia/tendências , Qualidade de Vida , Inquéritos e Questionários/normas , Acne Vulgar/diagnóstico , Comitês Consultivos/normas , Dermatologia/normas , Europa (Continente) , Humanos , Guias de Prática Clínica como Assunto , Índice de Gravidade de Doença , Sociedades Médicas/normas , Inquéritos e Questionários/estatística & dados numéricos
10.
Mod Rheumatol ; 29(1): 119-129, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29996690

RESUMO

OBJECTIVES: To provide evidence for the revision of clinical practice guideline (CPG) for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) by the Japan Research Committee for Intractable Vasculitis. METHODS: PubMed, CENTRAL, and the Japan Medical Abstracts Society were searched for articles published between January 1994 and January 2015 to conduct systematic review (SR), and the quality of evidence was assessed with GRADE approach. RESULTS: Nine randomized controlled trials (RCTs) and two non-RCTs were adopted for remission induction therapy, three RCTs and two non-RCTs for plasma exchange, and five RCTs and one non-RCT for remission maintenance therapy. A significant difference was found in efficacy and safety for the following comparisons. In the non-RCT adopted for remission induction therapy, glucocorticoid (GC) + cyclophosphamide (CY) was significantly superior to GC monotherapy regarding remission. GC + intravenous CY for remission induction therapy was superior to GC + oral CY regarding death at one year, serious adverse events, and serious infection. Concomitant use of plasma exchange for remission induction therapy of AAV with severe renal dysfunction reduced risk of end-stage renal disease versus non-users at month 3. CONCLUSION: This SR provided necessary evidence for developing CPG for the management of ANCA-associated vasculitis.


Assuntos
Comitês Consultivos/normas , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Imunossupressores/uso terapêutico , Guias de Prática Clínica como Assunto , Órgãos Governamentais/normas , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Japão , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Eur J Emerg Med ; 26(5): 366-372, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30308574

RESUMO

OBJECTIVE: The National Advisory Committee for Aeronautics (NACA) score is used by many emergency medical services to assess the severity of prehospital patients. Little is known about its discriminative performance regarding short-term mortality. PARTICIPANTS AND METHODS: We retrospectively included adult missions between 2008 and 2014 in a Swiss ground and air-based emergency medical services. We excluded uninjured or dead-on-scene patients. Primary outcome was assessment of the discriminative performance of the NACA score to classify the 48-h vital status of patients. Overall discrimination was quantified using the area under receiver operating characteristic curve (AUC). We also explored the influence of epidemiological characteristics (age and sex), mechanism (trauma or nontrauma) and clinical parameters (respiratory rate, oxygen saturation, heart rate, systolic blood pressure, capillary refill time, and Glasgow Coma Scale) on its discriminative performance. We then assessed the incremental value of these variables in the classification accuracy of a rule based on these variables in addition to the NACA score. RESULTS: We included 11 567 patients out of 11 639 (72 exclusions for missing data). Overall AUC was 0.86. The score was more discriminant for trauma (AUC = 0.95 vs. 0.83), and for younger patients (AUC = 0.91 for 16-59 vs. 0.78 for 84-104 years). Adding age, sex, mechanism, and clinical parameters resulted in a classification rule with higher discriminative performance than NACA score alone (AUC of 0.92 vs. 0.86; P < 0.001). CONCLUSION: The NACA score is an efficient way to discriminate victims regarding short-term mortality. Its performance can be enhanced by also integrating epidemiological and clinical parameters into an extended classification rule.


Assuntos
Comitês Consultivos/normas , Serviços Médicos de Emergência/organização & administração , Sobreviventes/estatística & dados numéricos , Triagem/métodos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Adulto , Resgate Aéreo/estatística & dados numéricos , Ambulâncias/estatística & dados numéricos , Área Sob a Curva , Bases de Dados Factuais , Feminino , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Taxa de Sobrevida , Suíça , Análise e Desempenho de Tarefas , Sinais Vitais , Ferimentos e Lesões/mortalidade
12.
Toxicology ; 413: 13-23, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30500381

RESUMO

The Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) has provided advice in relation to the Chemical Weapons Convention on assistance and protection. We present the SAB's response to a request from the OPCW Director-General in 2014 for information on the best practices for preventing and treating the health effects from acute, prolonged, and repeated organophosphorus nerve agent (NA) exposure. The report summarises pre- and post-exposure treatments, and developments in decontaminants and adsorbing materials, that at the time of the advice, were available for NAs. The updated information provided could assist medics and emergency responders unfamiliar with treatment and decontamination options related to exposure to NAs. The SAB recommended that developments in research on medical countermeasures and decontaminants for NAs should be monitored by the OPCW, and used in assistance and protection training courses and workshops organised through its capacity building programmes.


Assuntos
Comitês Consultivos/normas , Substâncias para a Guerra Química/toxicidade , Descontaminação/normas , Contramedidas Médicas , Agentes Neurotóxicos/toxicidade , Antídotos/uso terapêutico , Descontaminação/métodos , Humanos , Países Baixos , Compostos Organofosforados/toxicidade , Resultado do Tratamento
13.
Vaccine ; 37(3): 430-434, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30545715

RESUMO

BACKGROUND: National Immunisation Technical Advisory Groups (NITAGs) are multi-disciplinary expert groups that provide policy-makers with independent, evidence-based advice on vaccination. Between 2008 and 2017, the SIVAC Initiative supported establishment and strengthening of NITAGs in low and lower-middle income countries though its impact was never assessed quantitatively. AIM: To quantitatively assess whether SIVAC support is associated with a faster rate at which NITAGs became functional based on six performance indicators. METHODS: Data from the World Health Organization/Unicef Joint Reporting Form (JRF) from 77 low and lower-middle-income countries were used to examine the time delay between the start of SIVAC support and NITAG functionality using a Cox proportional hazards model. RESULTS: Countries receiving SIVAC support took a mean of 2.00 (95% CI 1.40-2.60) years to reported functionality compared to 2.82 (95% CI 2.05-3.59) years for countries without SIVAC support. We found evidence that SIVAC support is associated with reduced time until NITAG functionality, and this association cannot fully be explained by GDP per capita, percentage of GDP spent on healthcare, or NITAG functionality score at the start of the study period. However, quality of JRF data for the questions used to calculate NITAG functionality were poor, particularly for countries not receiving SIVAC support. CONCLUSION: SIVAC support is likely to have enabled many countries to more rapidly achieve NITAG functionality.


Assuntos
Comitês Consultivos/normas , Tomada de Decisões , Países em Desenvolvimento/estatística & dados numéricos , Política de Saúde , Programas de Imunização , Vacinação/estatística & dados numéricos , Pessoal Administrativo , Humanos , Programas de Imunização/organização & administração , Programas de Imunização/normas , Modelos de Riscos Proporcionais , Nações Unidas , Organização Mundial da Saúde
14.
Anesth Analg ; 128(1): 33-42, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30550473

RESUMO

Postoperative atrial fibrillation (poAF) is the most common adverse event after cardiac surgery and is associated with increased morbidity, mortality, and hospital and intensive care unit length of stay. Despite progressive improvements in overall cardiac surgical operative mortality and postoperative morbidity, the incidence of poAF has remained unchanged at 30%-50%. A number of evidence-based recommendations regarding the perioperative management of atrial fibrillation (AF) have been released from leading cardiovascular societies in recent years; however, it is unknown how closely these guidelines are being followed by medical practitioners. In addition, many of these society recommendations are based on patient stratification into "normal" and "elevated" risk groups for AF, but criteria for that stratification have not been clearly defined. In an effort to improve the perioperative management of AF, the Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement Committee developed a multidisciplinary Atrial Fibrillation Working Group that created a summary of current best practice based on a distillation of recent guidelines from professional societies involved in the care of cardiac surgical patients. An evidence-based set of survey questions was then generated to describe the current practice of perioperative AF management. Through collaboration with the European Association of Cardiothoracic Anaesthetists (EACTA), that survey was distributed to the combined memberships of both the SCA and EACTA, yielding 641 responses and resulting in the most comprehensive understanding to date of perioperative AF management in North America, Europe, and beyond. The survey data demonstrated the broad range of therapies utilized for the prevention and treatment of poAF, as well as a spectrum of adherence to published guidelines. With the goal of improving adherence, a graphical advisory tool was created with an easily accessible format that could be utilized for bedside management. Finally, given that no evidence-based threshold currently exists to differentiate patients at normal risk to develop poAF from those at elevated risk, the SCA/EACTA AF working group created a list of poAF risk factors using expert opinion and based on published risk score models for poAF. This approach allows stratification of patients into risk groups and facilitates adherence to the evidence-based recommendations summarized in the graphical advisory tool. It is our hope that these new additions to the clinical toolkit for the management of perioperative AF will improve the evidence-based care and outcomes of cardiac surgical patients worldwide.


Assuntos
Anestesiologistas/normas , Anestesiologia/normas , Fibrilação Atrial/terapia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Assistência Perioperatória/normas , Padrões de Prática Médica/normas , Comitês Consultivos/normas , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Benchmarking/normas , Consenso , Medicina Baseada em Evidências/normas , Fidelidade a Diretrizes/normas , Humanos , Medição de Risco , Fatores de Risco , Sociedades Médicas/normas
17.
J Am Coll Cardiol ; 72(23 Pt A): 2915-2931, 2018 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-30522654

RESUMO

Dual antiplatelet therapy (DAPT) is the cornerstone of pharmacological treatment aimed at preventing the atherothrombotic complications in patients with a variety of coronary artery disease (CAD) manifestations. Prescribers of DAPT are confronted with a number of challenges that include selecting the appropriate P2Y12 inhibitor and determining the optimal duration of DAPT with the scope of minimizing the risk of ischemic and bleeding complications in light of each patient's clinical characteristic and circumstance. Recently, a guideline writing committee from the American College of Cardiology/American Heart Association (ACC/AHA) and a task force from the European Society of Cardiology (ESC) released their respective focused update recommendations on "Duration of DAPT in Patients with CAD" (ACC/AHA) and "DAPT in CAD" (ESC). This paper aims to review the ACC/AHA and ESC updates for DAPT to delineate common domains, consistent messages, and differences in recommended management strategies across the Atlantic.


Assuntos
American Heart Association , Cardiologia/normas , Doenças Cardiovasculares/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Comitês Consultivos/normas , Cardiologia/métodos , Doenças Cardiovasculares/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Estados Unidos/epidemiologia
20.
Presse Med ; 47(11-12 Pt 1): 943-949, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30217365

RESUMO

Endocrine disruptors commonly make the headlines of newscasts and magazines, which is not without generating questions, even anxieties, with the general public. In a recent survey, 90% of French people considered it desirable to set up regulations concerning endocrine disruptors. However, under pressure from the lobbies of the chemical industry, and also due to scientific conflicts, the European Union is slow to legislate and has even been condemned before the European Court for failing to fulfill its obligations. This article does not intend to be exhaustive on the issue of endocrine disrupters, but rather to give the reader a certain number of keys enabling him to understand why national or European regulators are slow to establish specific regulation.


Assuntos
Disruptores Endócrinos , Legislação Médica/tendências , Comitês Consultivos/normas , Comportamento do Consumidor , Europa (Continente) , França , Humanos , Legislação Médica/organização & administração , Legislação Médica/normas , Opinião Pública
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