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3.
6.
Anticancer Res ; 39(9): 4589-4596, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519555

RESUMO

Despite recent advances in the treatment of gastric cancer, mortality related to this disease is still substantial. Surgery and chemotherapy represent the cornerstones of patient management. Targeted treatments that include anti-angiogenic agents and the advent of immunotherapies can contribute to improved patient prognosis. Herein, we present an Austrian consensus on the systemic treatment of patients with gastric adenocarcinoma and lower gastroesophageal junction, including those with human epidermal growth factor receptor 2 (HER2)-positive disease. The consensus considers the curative setting, as well as first-line to late-line systemic treatment options in the palliative setting. For HER2-positive disease, first-line and second-line therapies are discussed, as well as HER2 testing. Potential future therapies are also listed, with a focus on anti-angiogenic treatments and checkpoint inhibition, that might provide a further step forward in the management of patients with gastric cancer.


Assuntos
Adenocarcinoma/terapia , Algoritmos , Neoplasias Gástricas/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/etiologia , Áustria , Terapia Combinada , Consenso , Gerenciamento Clínico , Humanos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/etiologia
8.
Einstein (Sao Paulo) ; 17(3): eAE4510, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432891

RESUMO

OBJECTIVE: To standardize the investigation and clinical management of women with laboratory and/or clinical abnormalities suggestive of thrombophilia, in order to optimize antithrombotic approach and indication of laboratory tests. METHODOLOGY: A discussion was carried out among 107 physicians (gynecologists/obstetricians, hematologists and vascular surgeons) present at a forum held at the Hospital Israelita Albert Einstein, in São Paulo (SP), Brazil. As a minimum criterion, 80% agreement was established in the voting to each recommendation of conduct in the final document. The cases in which there was agreement below 80% were discussed again, reaching a consensual agreement of conduct for the document writing. CONCLUSION: The standardization of an institutional consensus of suggestions of clinical approach contributes to a better management of the group to be evaluated and minimizes risks of intercurrent events. This was the first national consensus on the investigation of thrombophilia in women.


Assuntos
Trombofilia , Brasil , Consenso , Feminino , Humanos , Programas de Rastreamento , Gravidez , Trombofilia/diagnóstico , Trombofilia/tratamento farmacológico , Trombofilia/etiologia
9.
J Urol ; 202(3): 475-483, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31412438

RESUMO

PURPOSE: Renal colic is common and CT (computerized tomography) is frequently utilized when the diagnosis of kidney stone is suspected. CT is accurate, but exposes patients to ionizing radiation and has not been shown to alter either interventional approaches or hospital admission rates. This multi-organizational transdisciplinary collaboration sought evidence-based, multispecialty consensus on optimal imaging across different clinical scenarios in patients with suspected renal colic in the acute setting. MATERIALS AND METHODS: In conjunction with the ACEP (American College of Emergency Physicians®) E-QUAL (Emergency Quality Network) we formed a nine-member panel with three physician representatives each from the ACEP, the ACR® (American College of Radiology) and the AUA (American Urological Association). A systematic literature review was used as the basis for a 3-step modified Delphi process to seek consensus on optimal imaging in 29 specific clinical scenarios. RESULTS: From an initial search yielding 6,337 records there were 232 relevant articles of acceptable evidence quality to guide the literature summary. At the completion of the Delphi process consensus, agreement was rated as perfect in 15 (52%), excellent in 8 (28%), good in 3 (10%) and moderate in 3 (10%) of the 29 scenarios. There were no scenarios where at least moderate consensus was not reached. CT was recommended in 7 scenarios (24%) with ultrasound in 9 (31%) and no further imaging needed in 13 (45%). CONCLUSIONS: Evidence and multispecialty consensus support ultrasound or no further imaging in specific clinical scenarios, with reduced-radiation dose CT to be employed when CT is needed in patients with suspected renal colic.


Assuntos
Consenso , Cólica Renal/diagnóstico por imagem , Sociedades Médicas/normas , Tomografia Computadorizada por Raios X/normas , Ultrassonografia/normas , Técnica Delfos , Medicina de Emergência/normas , Humanos , Comunicação Interdisciplinar , Radiologia/normas , Tomografia Computadorizada por Raios X/efeitos adversos , Estados Unidos , Urologia/normas
10.
Bone Joint J ; 101-B(8): 891-896, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362555

RESUMO

There is good scientific rationale to support the use of growth factors to promote musculoskeletal tissue regeneration. However, the clinical effectiveness of platelet-rich plasma (PRP) and other blood-derived products has yet to be proven. Characterization and reporting of PRP preparation protocols utilized in clinical trials for the treatment of musculoskeletal disease is highly inconsistent, and the majority of studies do not provide sufficient information to allow the protocols to be reproduced. Furthermore, the reporting of blood-derived products in orthopaedics is limited by the multiple PRP classification systems available, which makes comparison of results between studies challenging. Several attempts have been made to characterize and classify PRP; however, no consensus has been reached, and there is lack of a comprehensive and validated classification. In this annotation, we outline existing systems used to classify preparations of PRP, highlighting their advantages and limitations. There remains a need for standardized universal nomenclature to describe biological therapies, as well as a comprehensive and reproducible classification system for autologous blood-derived products. Cite this article: Bone Joint J 2019;101-B:891-896.


Assuntos
Regeneração Tecidual Guiada/métodos , Doenças Musculoesqueléticas/terapia , Procedimentos Ortopédicos/métodos , Plasma Rico em Plaquetas , Consenso , Humanos , Guias de Prática Clínica como Assunto , Terminologia como Assunto
11.
Ophthalmologe ; 116(9): 838-849, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31388757

RESUMO

PURPOSE: To define unmet needs in ophthalmology which can realistically be addressed in the next years (2019-2025) and to describe potential avenues for research to address these challenges. METHODS: Outcomes of a consensus process within the European Vision Institute (EVI, Brussels) are outlined. Disease areas which are discussed comprise glaucoma, retinal dystrophies, diabetic retinopathy, dry eye disease, corneal diseases, cataract and refractive surgery. RESULTS: Unmet needs in the mentioned disease areas are discussed and realistically achievable research projects outlined. CONCLUSION: Considerable progress can be made in the field of ophthalmology and patient-relevant outcomes in the near future.


Assuntos
Catarata , Glaucoma , Oftalmologia , Consenso , Humanos , Visão Ocular
12.
J Vasc Access ; 20(5): 457-460, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31416409

RESUMO

Long peripheral catheters are 6-15 cm peripheral dwelling catheters that are inserted via a catheter-over-needle or direct Seldinger (catheter-over-guidewire) technique. When inserted in the upper extremity, the distal tip terminates before reaching the axilla, typically no further than the mid-upper arm. This is distinct from a midline catheter, which is inserted via a modified Seldinger technique and terminates at the axilla. The nomenclature of this catheter is confusing and inconsistent. We have identified over a dozen labels in the literature, all describing the same device. These include '15 cm catheter', 'catheter inserted with a Seldinger method', 'extended dwell/midline peripheral catheter', 'Leaderflex line', 'long catheter', 'long IV catheter', 'long peripheral cannula', 'long peripheral catheter', 'long peripheral venous catheter', 'long polyurethane catheter', 'midline cannula', 'mini-midline', 'peripheral intravenous catheter', 'Seldinger catheter', 'short midline catheter', 'short long line' and 'ultrasound-guided peripheral intravenous catheter'. The purpose of this editorial is to achieve some level of standardisation in the nomenclature of this device. Is it time to address the confusion? We suggest adopting 'long peripheral catheter'. However, we encourage discussion and debate in reaching a consensus.


Assuntos
Cateterismo Periférico/instrumentação , Cateteres de Demora/classificação , Terminologia como Assunto , Extremidade Superior/irrigação sanguínea , Dispositivos de Acesso Vascular/classificação , Consenso , Desenho de Equipamento , Humanos
15.
Tijdschr Psychiatr ; 61(7): 477-487, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31372969

RESUMO

BACKGROUND: Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur in adults. Together, they complicate diagnosis and can negatively influence treatment outcome.
AIM: To develop a practical guide to assist professionals with the screening, diagnosis and treatment of adult patients with SUD and ADHD.
METHOD: A literature search and a consensus procedure between several international scientific and clinical experts. This manuscript is an adapted and summarized Dutch version of the International consensus statement on screening, diagnosis and treatment of patients with SUD and comorbid ADHD.
RESULTS: The routine use of adequate screening tools enables ADHD to be detected earlier in adults with SUD. The diagnostic process for ADHD should be initiated as soon as possible in patients with SUD. Integrated treatment, involving a combination of pharmacotherapy and psychotherapy, is preferred. Long-acting stimulants with up-titration to higher dosages may be considered.
CONCLUSION: Early detection of ADHD in patients with SUD is essential for adequate diagnosis and more effective treatment and follow-up for these patients.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Comorbidade , Consenso , Humanos , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
16.
Cancer Radiother ; 23(6-7): 523-525, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31444077

RESUMO

The Centre Finistérien de radiothérapie et d'oncologie, based in Brest (France), wanted to expand its activity by offering intracranial stereotactic radiation therapy to improve patient care. The desire of the Centre was to invest in this innovative and efficient technique and thus modernize its technical platform and its offer of care. The introduction of intracranial stereotactic radiation therapy requires vigilance for the technical and human organization. Therefore, the Centre prepared the implementation of this technique upstream by a structured and timed preliminary project management.


Assuntos
Institutos de Câncer , Consenso , Irradiação Craniana/métodos , Implementação de Plano de Saúde , Radiocirurgia/métodos , Irradiação Craniana/instrumentação , França , Humanos , Educação de Pacientes como Assunto , Projetos Piloto , Radiocirurgia/educação , Radiocirurgia/instrumentação , Medição de Risco
17.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(8): 761-803, 2019 Aug 06.
Artigo em Chinês | MEDLINE | ID: mdl-31378039

RESUMO

Human papillomavirus (HPV)-related diseases such as cervical cancer have become a public health problem that seriously threatens human health. In response to the action plan for the elimination of cervical cancer, this consensus, on the basis of the World Health Organization position paper on HPV vaccine (2017) and the latest advances in research at home and abroad, provides an overview of HPV pathogens and the clinical, epidemiological and vaccine aspects of HPV related diseases. Through a comprehensive and systematic introduction of HPV disease-related knowledge, we aim to improve the level of prevention and control of HPV related diseases, especially to provide systematic and comprehensive evidence-based basis for professionals to use HPV vaccine scientificly.


Assuntos
Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Neoplasias do Colo do Útero/prevenção & controle , Consenso , Feminino , Humanos , Papillomaviridae , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/virologia , Vacinação
19.
Rev Panam Salud Publica ; 43, August 2019
Artigo em Espanhol | PAHO-IRIS | ID: phr-51470

RESUMO

[RESUMEN]. Se presenta un consenso latinoamericano que permite estandarizar las definiciones de los diferentes niveles de resistencia a los antimicrobianos en bacterias de importancia en salud pública. Se describen los criterios de inclusión y exclusión para las metodologías a utilizar y para los antibióticos a incluir (por disponibilidad, relevancia y existencia de puntos de corte). Como propuesta piloto se eligieron tres microorganismos gramnegativos de gran impacto en el ambiente hospitalario (Klebsiella pneumoniae, Pseudomonas aeruginosa y Acinetobacter spp.). La falta de puntos de corte para ciertos antibióticos (por ejemplo, tigeciclina, fosfomicina y colistina), claves para el tratamiento de infecciones causadas por estos patógenos que presentan multirresistencia o resistencia extendida, llevó a la necesidad de discutir y consensuar puntos de corte provisorios para la vigilancia de la resistencia a estos fármacos. Se abordó y consensuó también el uso de pruebas de sensibilidad alternativas a los métodos aprobados por las guías internacionales, de aplicación más sencilla como pruebas de rutina en los laboratorios de bacteriología clínica. El principal beneficio de este documento es proporcionar a los laboratorios latinoamericanos un marco estandarizado y consensuado para la identificación y la vigilancia constante y unificada de microorganismos resistentes. Las recomendaciones incluidas en este documento son el resultado consensuado por los representantes de los laboratorios nacionales de referencia de los países que integran la Red Latinoamericana de Vigilancia de la Resistencia a los Antibióticos coordinada por la Organización Panamericana de la Salud


[ABSTRACT]. This document presents a Latin American consensus to standardize definitions of different levels of antimicrobial resistance in bacteria of public health importance. Inclusion and exclusion criteria are described for antibiotics to include (availability, relevance, and existence of cut-off values) and for methodologies to use. Three gram-negative microorganisms with a great impact in the hospital environment (Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp.) were selected as a pilot proposal. The lack of cut-off values for certain antibiotics (e.g., tigecycline, fosfomycin, and colistin), crucial in treating infections caused by multi-drug resistant or extensively drug-resistant pathogens, led to the need to discuss and agree on provisional cut-off values for monitoring resistance to these drugs. The work team also addressed and reached consensus on easier-to-use alternative susceptibility tests, other than methods approved by international guidelines, for routine testing in clinical bacteriology laboratories. The main benefit of this document is to provide Latin American laboratories with a standardized and consensual framework for the identification and constant and unified surveillance of resistant microorganisms. The recommendations included in this document are the result of consensus among representatives of the national reference laboratories in the countries belonging to the Latin American Surveillance Network of Antimicrobial Resistance, coordinated by the Pan American Health Organization.


[RESUMO]. É apresentado um consenso latino-americano para padronizar a definição dos graus de resistência antimicrobiana em bactérias de importância em saúde pública. São descritos os critérios de inclusão e exclusão para os antibióticos a serem incluídos (disponibilidade, relevância e pontos de corte de sensibilidade) e metodologias a serem usadas. Como proposta-piloto, foram selecionados três microrganismos Gram-negativos de grande impacto no ambiente hospitalar (Klebsiella pneumoniae, Pseudomonas aeruginosa e Acinetobacter spp.). Diante da falta de pontos de corte para alguns antibióticos (como tigeciclina, fosfomicina e colistina), essenciais para o tratamento de infecções causadas por patógenos com multirresistência ou resistência ampliada, foram debatidos e aprovados pela maioria pontos de corte provisórios para a vigilância da resistência a estes fármacos. Também foi discutido e aprovado o uso de testes de suscetibilidade alternativos aos métodos aprovados pelas diretrizes internacionais, mais simples de serem realizados como testes de rotina nos laboratórios de bacteriologia clínica. A principal contribuição deste documento é oferecer aos laboratórios latino-americanos um sistema padronizado e consensual para a identificação de microrganismos resistentes e a vigilância contínua e uniforme destes patógenos. As recomendações aqui contidas foram feitas por consenso por representantes dos laboratórios nacionais de referência dos países que integram a Rede Latino-Americana de Vigilância da Resistência Antimicrobiana, coordenada pela Organização Pan-Americana da Saúde (OPAS).


Assuntos
Anti-Infecciosos , Farmacorresistência Bacteriana , Bactérias Gram-Negativas , Consenso , América Latina , Anti-Infecciosos , Resistência a Medicamentos , Bactérias Gram-Negativas , Consenso , América Latina , Anti-Infecciosos , Resistência Microbiana a Medicamentos , Bactérias Gram-Negativas
20.
Surg Clin North Am ; 99(4): 667-679, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31255198

RESUMO

Parathyroidectomy (PTx) is the only definitive treatment for primary hyperparathyroidism (PHPT), but is commonly underutilized. Most patients are medically observed, whereas approximately 30% of patients are treated operatively. PTx is a low-risk surgical procedure and the most cost-effective treatment option. An international consensus statement was published in 1990 to guide clinicians in the management of patients with PHPT, particularly those with asymptomatic disease. Most patients with PHPT and low perioperative risk benefit from surgical treatment, regardless of whether they meet consensus criteria, due to fracture risk reduction, health-related quality-of-life improvements, and prevention or mitigation of disease progression.


Assuntos
Consenso , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/métodos , Qualidade de Vida , Humanos , Resultado do Tratamento
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