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J Clin Pathol ; 72(9): 573-578, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31300532


The International Collaboration on Cancer Reporting (ICCR) has developed a suite of detailed datasets for international implementation. These datasets are based on the reporting protocols developed by the Royal College of Pathologists (UK), The Royal College of Pathologists of Australasia and the College of American Pathologists, with modifications undertaken by international expert groups appointed according to ICCR protocols. The dataset for the reporting of renal biopsy for tumour is designed to provide a structured reporting template containing minimum data recording key elements suitable for international use. In formulating the dataset, the ICCR panel incorporated recommendations from the 2012 Vancouver Consensus Conference of the International Society of Urological Pathology (ISUP) and the 2016 edition of the WHO Bluebook on tumours of the urinary and male genital systems. Reporting elements were divided into Required (Core) and Recommended (Non-core) components of the report. Required elements are as follows: specimen laterality, histological tumour type, WHO/ISUP histological tumour grade, sarcomatoid morphology, rhabdoid morphology, necrosis, lymphovascular invasion and coexisting pathology in non-neoplastic kidney. Recommended reporting elements are as follows: operative procedure, tumour site(s), histological tumour subtype and details of ancillary studies. In particular, it is noted that fluorescence in situ hybridisation studies may assist in diagnosing translocation renal cell carcinoma (RCC) and in distinguishing oncocytoma and eosinophilic chromophobe RCC. It is anticipated that the implementation of this dataset into routine clinical practice will facilitate uniformity of pathology reporting worldwide. This, in turn, should have a positive impact on patient treatment and the quality of demographic information held by cancer registries.

Biópsia/normas , Confiabilidade dos Dados , Bases de Dados Factuais/normas , Conjuntos de Dados como Assunto/normas , Cooperação Internacional , Neoplasias Renais/patologia , Consenso , Comportamento Cooperativo , Guias como Assunto/normas , Humanos , Neoplasias Renais/epidemiologia , Neoplasias Renais/cirurgia , Gradação de Tumores/normas , Nefrectomia/normas , Valor Preditivo dos Testes
Int J Evid Based Healthc ; 17 Suppl 1: S3-S5, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283567


Currently in the Czech Republic, there does not exist such an institution as a 'National Centre for Clinical Practice Guidelines'. In 2017, there were about 123 professional medical organizations which developed about 1909 'guidelines' until 2017. However, the majority of these guidelines are 'expert opinion' or 'consensual' based 'guidance' or rather recommendations in the most cases missing a systematic approach that reflects evidence-based medicine principles and methods. The project is led by the Czech Health Research Council, the first partner is the Ministry of Health of the Czech Republic and the second partner is the Institute of Health Information and Statistics of the Czech Republic with support from policy makers, academics, clinicians and members of the Czech National Centre for Evidence-Based Healthcare and Knowledge Translations. This centre is an umbrella for three very important international collaborations which play a key role in Evidence-Based Healthcare, Evidence Synthesis, Evidence Implementation and trustworthy guidelines development. These are Cochrane Czech Republic, Masaryk University Grade Centre and the Czech Republic Centre for Evidence-Based Healthcare: The Joanna Briggs Institute Centre of Excellence.The main aim of this article is to present the Czech National Methodology of the Trustworthy Clinical Practice Guideline (CPG) development and the first results of the project 'Clinical Practice Guidelines'.A pilot phase of the project was realized during the first year of the project from January to December 2018. As the first step, there were established managing authorities including a Guarantee Committee and an Appraisal (Methodological) Committee. The Members of the Appraisal Committee developed a pilot version of the National Methodology of CPG development based on the best available approaches to Trustworthy CPGs development followed by testing on the first five pilot CPGs.

Medicina Baseada em Evidências/normas , Guias como Assunto/normas , República Tcheca , Medicina Baseada em Evidências/métodos , Humanos
Int J Evid Based Healthc ; 17 Suppl 1: S6-S8, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283568


The current article provides an overview of an approach to incorporating a range of evidence, including qualitative research findings, which the authors piloted when developing a clinical guideline on epilepsies in children and young people. We describe methods used for incorporating literature types not usually included in Scottish Intercollegiate Guidelines Network guidelines, including critical appraisal, and establishing dependability and credibility of qualitative findings. We highlight limitations encountered and make suggestions for future work.

Medicina Baseada em Evidências/normas , Guias como Assunto/normas , Adolescente , Criança , Pré-Escolar , Epilepsia/terapia , Medicina Baseada em Evidências/métodos , Humanos , Pesquisa Qualitativa , Escócia
Int J Evid Based Healthc ; 17 Suppl 1: S12-S14, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283570


BACKGROUND: According to the report published by the National Chamber of Physicians, currently the guideline development process in Poland is not coordinated and there is no document setting the standards for the process or methods of guideline production in Poland or institution assessing guideline quality on a regular basis. We postulated that adaptation of good-quality guidelines can improve the quality of the guidelines available and serve as a first step in translating evidence into practice by making physicians aware of the evidence. AIMS: To discuss methodological challenges and lessons learned during the project lead by the National Chamber of Physicians regarding guideline adaptation in Poland as a first step in evidence implementation. METHODS: The National Chamber of Physicians set up a project that involved adaptation of the guidelines with the use of a systematic approach suggested by the ADAPTE Collaboration. The guideline development team involved methodologist, clinical experts, specialists, primary care physician and patient representative. The process followed the framework established by the ADAPTE Toolkit. RESULTS/DISCUSSION: The topic in one the groups was management of depression in primary care. Key lesson learned during the process of defining clinical questions included the importance of cooperation between all involved groups due to differences in their point of views. Since several guideline documents were identified, one of the important lessons learned during the development of inclusion and exclusion criteria was to define a minimal set of methodological inclusion criteria because the documents found varied in the methods used and in the thoroughness of the description of the process. CONCLUSION: Well defined inclusion criteria, systematic use of available methods for the assessment of guideline quality and tools provided by the ADAPTE Toolkit refined to the needs of the guideline development groups facilitated the process of guideline adaptation in Poland as a first step in evidence implementation.

Medicina Baseada em Evidências/normas , Guias como Assunto/normas , Depressão/terapia , Humanos , Polônia , Atenção Primária à Saúde/métodos
Int J Evid Based Healthc ; 17 Suppl 1: S15-S17, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283571


BACKGROUND: The Spanish Best Practice Guidelines (BPG) Implementation Project is part of the Best Practice Spotlight Organizations international program, coordinated by the Registered Nurses' Association of Ontario (RNAO). AIMS: To influence the uptake of nursing BPG across healthcare organizations, to enable practice excellence and positive client outcomes. METHODS: After translating the RNAO's BPG into Spanish, the Host Organization published a formal call for proposals to select healthcare settings in Spain to implement the RNAO's BPG and evaluate the results. The approach is nursing-led and multidisciplinary; context specific; and involving a wide range of stakeholders. The implementation of BPG Toolkit guides the process: cascade training, selection of recommendations to be implemented, 3 years of planned implementation activities, monitoring of process and outcome results for patients discharged 60 days every year. The Host Organization supports healthcare settings selected. RESULTS/DISCUSSION: The first call was launched in 2012. Eight healthcare settings (11 sites), serving 1.3 million people, were selected (hospitals and primary healthcare centers). They chose 10 BPG, according to their needs. In 2015 and 2018, 16 more healthcare settings have joined the program with a total of 263 sites. And in 2019, three complete regions will join the program as a regional host. Currently, more than 3200 nurses and 40 other healthcare professionals have been trained, evidence-based protocols have been developed or updated, patient education has been promoted, and international Best Practice Spotlight Organizations indicators have been evaluated in an electronic platform. CONCLUSION: The results obtained acknowledge that the RNAO implementation method could be replicated with success internationally. The strategies based on local context have worked and we have consolidated a network that shares knowledge and strategies and promotes evidence-based culture among Spanish healthcare settings and evidence-based care to patients.

Enfermagem Baseada em Evidências/normas , Guias como Assunto/normas , Administração Hospitalar , Hospitais , Humanos , Educação de Pacientes como Assunto , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Espanha , Traduções
Int J Evid Based Healthc ; 17 Suppl 1: S68-S71, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283587


In 2016, the Belgian Minister for Social Affairs and Public Health decided to set up a central governance structure for evidence-based practice (EBP). The underlying model, consisting of six EBP life cycle cells (prioritization, development, validation, dissemination, implementation and evaluation) and a bipolar governance layer was developed in 2017. Based on the characteristics of the Belgian EBP landscape, a network administrative organization was chosen to coordinate and facilitate the operational processes in the EBP life cycle and act as intermediate between the two forces: stakeholders and funders/policy makers. Scientific processes remain the responsibility of the EBP experts in the cells. As organizational change can result in resistance, building trust and consensus is a very important success factor for the setup of the network. The process is now in an advanced stage and in 2019 the EBP governance structure will be operationalized.

Prática Clínica Baseada em Evidências/organização & administração , Bélgica , Guias como Assunto/normas , Humanos , Inovação Organizacional , Desenvolvimento de Programas/métodos
ABC., imagem cardiovasc ; 32(3): 157-197, jul.-set. 2019. ilus, tab
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1006549
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3): 249-254, jul.-set. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1023040


Nesta breve análise crítica, discutiremos três estudos com potencial de alterar a prática clínica e as principais diretrizes internacionais no que tange à doença valvar. O estudo PARTNER III foi um estudo que randomizou 1000 pacientes de baixo risco cirúrgico entre troca valvar transcateter e cirurgia convencional, com superioridade da técnica transcateter em um desfecho primário combinado de mortalidade de todas as causas, acidente vascular cerebral (AVC) e re-hospitalização em doze meses de seguimento (8,5%vs.15,1%, p = 0,001). Já o estudo Evolut Low Risk randomizou 1468 pacientes entre as duas técnicas, com um desfecho primário de mortalidade ou AVC incapacitante ao final de dois anos de seguimento que atingiu não-inferioridade na comparação Bayesiana (5,3% transcateter vs . 6,7% cirurgia). Finalmente, discutimos também o estudo COAPT, no qual 614 pacientes foram randomizados entre o dispositivo edge-to-edge MitraClip e o tratamento clínico da insuficiência mitral secundária. Nesses pacientes selecionados, a taxa anualizada de hospitalizações por insuficiência cardíaca foi de 35,8% por paciente-ano no grupo MitraClip, comparado com 67,9% no grupo controle (HR 0,53, IC 95% 0,4-0,7).Nas novas diretrizes, pode-se razoavelmente esperar uma indicação I para a troca valvar transcateter em pacientes de baixo risco e uma indicação IIa para a técnica edge-to-edge em pacientes com características semelhantes aos do COAPT. Esses procedimentos devem ser considerados no contexto do Heart Team para que sejam atingidos os melhores resultados

In this short critical review, we will discuss three trials with the potential to alter clinical practice and the main international guidelines regarding valvular heart disease. The PARTNER III trial was a study of 1000 low surgical risk patients randomized between transcatheter aortic valve replacement (TAVR) and conventional surgery, showing the superiority of the transcatheter technique with a combined primary endpoint of all-cause mortality, stroke and rehospitalization over twelve months of follow-up (8.5%vs. 15.1%, p = 0.001). The Evolut Low Risk trial randomized 1468 patients between the two techniques with a primary endpoint of death or incapacitating stroke at the end of two years of follow-up, achieving non-inferiority in a Bayesian comparison (5.3% TAVR vs. 6.7% surgery). Finally, we also will discuss the COAPT study, in which 614 patients were randomized between the edge-to-edge MitraClip device and clinical treatment for secondary mitral regurgitation. Among these selected patients, the annual rate of hospitalizations for heart failure was 35.8% per patient-year in the MitraClip group, compared with 67.9% in the control group (HR 0.53, 95% CI 0.4-0.7). Under the new guidelines, we may reasonably expect a class I indication for transcatheter valvular replacement in low-risk patients and a class IIa indication for the edge-to-edge technique in patients with characteristics similar to those of the COAPT study. These procedures should be considered within the context of the Heart Team so that the best results are achieved

Humanos , Masculino , Feminino , Idoso , Guias como Assunto/normas , Prática Clínica Baseada em Evidências , Doenças das Valvas Cardíacas/terapia , Valva Aórtica , Estenose da Valva Aórtica , Fatores de Risco , Substituição da Valva Aórtica Transcateter/métodos , Valva Mitral , Insuficiência da Valva Mitral/terapia
Artigo em Português | LILACS | ID: biblio-1023043


Os maiores avanços no tratamento das arritmias cardíacas, que geraram propostas de mudança e/ou incorporação de novas tecnologias de tratamento medicamentoso ou intervencionista, referem-se à fibrilação atrial, arritmia sustentada mais frequente na prática clínica, razão pela qual demos maior ênfase a essa análise. Os últimos estudos que têm proporcionado revisões, atualizações e perspectivas das principais diretrizes mundiais são os que envolvem as comparações dos esquemas de combinações de anticoagulação e antiagregação plaquetária em pacientes com fibrilação atrial no contexto da doença arterial coronariana com intervenção planejada ou imediata, bem como os que envolvem a estratégia de ablação por cateteres com opção no início do tratamento da fibrilação atrial nos pacientes com insuficiência cardíaca com fração de ejeção reduzida

The greatest advances in the treatment of cardiac arrhythmias, which have led to proposals of change and/or the incorporation of new drug or intervention treatment technologies, relate to atrial fibrillation, the most common sustained arrhythmia in medical practice, which is why we have placed more emphasis on it in this analysis. The latest studies to have revised, updated, and offered new perspectives on the principal global guidelines are those that involve comparisons of regimens that combine anticoagulation and antiaggregation of platelets in patients with atrial fibrillation within the context of coronary artery disease with planned or immediate intervention, as well of those that involve a catheter ablation strategy as an option at the beginning of treatment for atrial fibrillation in patients with heart failure with reduced ejection fraction

Humanos , Masculino , Feminino , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Fibrilação Atrial , Varfarina/uso terapêutico , Doença da Artéria Coronariana , Stents , Aspirina/uso terapêutico , Guias como Assunto/normas , Ablação por Cateter/métodos , Hemorragia , Anticoagulantes
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3): 261-267, jul.-set. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1023048


Os três estudos que tiveram importante influência na prática clínica de quem trabalha com hipertensão arterial foram os estudos SIMPLICITY HTN-3, PATHWAY 2 e SPRINT. O estudo SIMPLICITY HTN-3 pôs a dúvida um procedimento que já estava sendo utilizado na prática clínica, qual seja, denervação do nervo simpático renal através de ablação por ondas de radiofrequência. Foi o primeiro estudos com grupo controle que não mostrou diferença entre os desfechos específicos de controle da pressão arterial em pacientes com hipertensão resistente. Portanto, o estudo SIMPLICITY HTN 3 modificou a prática clínica no sentido de que todas as diretrizes de hipertensão são unânimes em afirmar que tal procedimento atualmente deva ser reservado para laboratórios específicos de investigação clínica do método e não deve ser empregado como opção estabelecida de tratamento. O estudo PATHWAY 2 consolida o uso do bloqueador de receptor de mineralocorticoides (espironolactona) como o quarto medicamento no fluxograma de tratamento da hipertensão arterial resistente. Os resultados foram tão impactantes que a diretriz europeia de hipertensão arterial mudou substancialmente a orientação da sequência farmacológica do tratamento. Por fim, o estudo SPRINT demonstrou a necessidade de intervenção em pacientes com hipertensão arterial com valores pressóricos abaixo de 140/90 mmHg na dependência da quantidade de risco adicional dos pacientes. Os resultados do estudo SPRINT motivaram alterações ou inclusões de seus dados em várias diretrizes nacionais e internacionais, tais como Sociedade Brasileira de Cardiologia, American Heart Association e European Society of Cardiology

The three studies that have had an important influence on the clinical practice of who works with arterial hypertension were the SIMPLICITY HTN-3, PATHWAY 2 and SPRINT studies. The SIMPLICITY HTN-3 study raised doubts around a procedure that was already being used in clinical practice, the denervation of the sympathetic renal nerve through radiofrequency wave ablation. It was the first study with a control group that did not show a difference between the specific blood pressure control outcomes in patients with resistant hypertension. Therefore, the Simplicity HTN 3 Study modified clinical practice in the sense that all hypertension guidelines are unanimous in stating that currently such a procedure should be reserved for specific clinical investigation laboratories researching the method and should not be used as an established treatment option. The PATHWAY2 study consolidated the use of the mineralocorticoid receptor blocker (spironolactone) as the fourth drug in the resistant arterial hypertension treatment flowchart. The results were so impactful that the European guideline for arterial hypertension changed its orientation around the pharmacological sequence of resistant hypertension treatment substantially. Finally, the SPRINT study demonstrated the need for intervention in patients with arterial hypertension with pressure values below 140/90 mmHg, depending on the amount of additional cardiovascular risk in those patients. The results of the SPRINT study promoted changes to or inclusions of its data in various national and international guidelines, such as the Brazilian Society of Cardiology, the American Heart Association and the European Society of Cardiology

Humanos , Masculino , Feminino , Prática Clínica Baseada em Evidências/métodos , Hipertensão/terapia , Espironolactona , Guias como Assunto/normas , Doxazossina , Bisoprolol , Monitorização Ambulatorial da Pressão Arterial/métodos , Medicina Baseada em Evidências/métodos , Pressão Arterial , Anti-Hipertensivos
Zhonghua Gan Zang Bing Za Zhi ; 27(5): 343-346, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31177657


Oral nucleos(t)ide analogues (NAs) is one of the main and efficient way for the treatment of chronic hepatitis B (CHB). Considering the antiviral potency and drug resistance of domestic and foreign guidelines, NAs are divided into first-line and non-first-line drugs. "An Expert Consensus for the Adjustment of Treatment Strategies in Patients with Chronic Hepatitis B Treated with Non-first-line Nucleos(t)ide Analogues," is mainly aimed at those patients who are currently using non-first-line NAs drugs. In addition, how to standardize the adjustment to first-line NAs drugs of choice, which can strengthen the effectiveness of initial antiviral treatment to obtain better antiviral efficacy, and improve patient compliance, coinciding with the avoidance of occurrence of serious drug adverse reactions in patients with CHB is presented.

Antivirais/uso terapêutico , Guias como Assunto/normas , Hepatite B Crônica/tratamento farmacológico , Nucleosídeos/uso terapêutico , /métodos , Guias de Prática Clínica como Assunto , Consenso , Vírus da Hepatite B , Humanos , Resultado do Tratamento
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 302-309, May-June 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1002221


This paper is about the Guideline for Ventilation / Perfusion Scintigraphy. It has been developed by the Brazilian Society of Nuclear Medicine to be a best practices guide used in Nuclear Medicine. Its function is to be an educational tool to help the Nuclear Medicine Services in Brazil to guarantee a quality care to the patients

Humanos , Masculino , Feminino , Relação Ventilação-Perfusão , Guias como Assunto/normas , Artéria Pulmonar/patologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Cintilografia/métodos , Medicina Nuclear/normas
Nurs Leadersh (Tor Ont) ; 32(SP): 98-107, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31099750


A commitment to best practice guidelines (BPGs) is crucial for ensuring the safety of patients. Recognizing the power of information technology, Humber River Hospital has integrated BPGs into the electronic medical record (EMR) infrastructure. The large-scale implementation institutes a uniform standard of care and ensures adherence to BPGs through a forcing function designed to require nurses to complete and document the necessary assessments. The initiative strengthens the audit process and provides the opportunity to identify long-term trends. The implications of the quality improvement initiative are discussed. Due to the widespread use of EMRs, the replication of this initiative is economically feasible in other healthcare settings.

Registros Eletrônicos de Saúde/normas , Guias como Assunto/normas , Processo de Enfermagem/normas , Registros Eletrônicos de Saúde/tendências , Humanos , Guias de Prática Clínica como Assunto/normas