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1.
MMWR Morb Mortal Wkly Rep ; 68(33): 718-723, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31437143

RESUMO

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of persons aged 11-12 years to protect against certain diseases, including human papillomavirus (HPV)-associated cancers, meningococcal disease, and pertussis (1). A booster dose of quadrivalent meningococcal conjugate vaccine (MenACWY) is recommended at age 16 years, and serogroup B meningococcal vaccine (MenB) may be administered to persons aged 16-23 years (1). To estimate vaccination coverage among adolescents in the United States, CDC analyzed data from the 2018 National Immunization Survey-Teen (NIS-Teen) which included 18,700 adolescents aged 13-17 years.* During 2017-2018, coverage with ≥1 dose of HPV vaccine increased from 65.5% to 68.1%, and the percentage of adolescents up-to-date† with the HPV vaccine series increased from 48.6% to 51.1%, although the increases were only observed among males. Vaccination coverage increases were also observed for ≥1 MenACWY dose (from 85.1% to 86.6%) and ≥2 MenACWY doses (from 44.3% to 50.8%). Coverage with tetanus and reduced diphtheria toxoids and acellular pertussis vaccine (Tdap) remained stable at 89%. Disparities in coverage by metropolitan statistical area (MSA)§ and health insurance status identified in previous years persisted (2). Coverage with ≥1 dose of HPV vaccine was higher among adolescents whose parents reported receiving a provider recommendation; however, prevalence of parents reporting receiving a recommendation for adolescent HPV vaccination varied by state (range = 60%-91%). Supporting providers to give strong recommendations and effectively address parental concerns remains a priority, especially in states and rural areas where provider recommendations were less commonly reported.


Assuntos
Cobertura Vacinal/estatística & dados numéricos , Vacinas/administração & dosagem , Adolescente , Comitês Consultivos , Centers for Disease Control and Prevention (U.S.) , Vacina contra Varicela/administração & dosagem , District of Columbia , Feminino , Pesquisas sobre Serviços de Saúde , Vacinas contra Hepatite B/administração & dosagem , Humanos , Esquemas de Imunização , Masculino , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Vacinas Meningocócicas/administração & dosagem , Vacinas contra Papillomavirus/administração & dosagem , Guias de Prática Clínica como Assunto , Estados Unidos , Vacinação/normas , Vacinas Conjugadas/administração & dosagem
6.
J Laryngol Otol ; 133(8): 704-712, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31370911

RESUMO

OBJECTIVES: The National Institute for Health and Care Excellence referral guidelines prompting urgent two-week referrals were updated in 2015. Additional symptoms with a lower threshold of 3 per cent positive predictive values were integrated. This study aimed to examine whether current pan-London urgent referral guidelines for suspected head and neck cancer lead to efficient and accurate referrals by assessing frequency of presenting symptoms and risk factors, and examining their correlation with positive cancer diagnoses. METHODS: The risk factors and symptoms of 984 consecutive patients (over a six-month period in 2016) were collected retrospectively from urgent referral letters to University College London Hospital for suspected head and neck cancer. RESULTS: Only 37 referrals (3.76 per cent) resulted in a head and neck cancer diagnosis. Four of the 23 recommended symptoms demonstrated statistically significant results. Nine of the 23 symptoms had a positive predictive value of over 3 per cent. CONCLUSION: The findings indicate that the current referral guidelines are not effective at detecting patients with cancer. Detection rates have decreased from 10-15 per cent to 3.76 per cent. A review of the current head and neck cancer referral guidelines is recommended, along with further data collection for comparison.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Adulto Jovem
7.
Medicine (Baltimore) ; 98(31): e16629, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374031

RESUMO

OBJECTIVES: The purpose of this study was to evaluate the quality of guidelines for rehabilitation of post-stroke aphasia using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument and identify consistency of different guidelines. METHODS: A systematic search was undertaken from inception to October 2018. Two reviewers independently screened all titles and abstracts, and assessed eligible guidelines using the AGREE-II. Agreement among reviewers was measured by using intra-class correlation coefficient (ICC). RESULTS: From 5008 records screened, 8 guidelines met the inclusion criteria. The quality of guidelines was heterogeneous. Three guidelines were rated high (6.5) across; the highest rated domain was "scope and purpose' (median score 95.8%); the lowest rated domain was "rigor of development' (median score 67.2%). An overall high degree of agreement among reviewers to each domain was observed (ICC ranged from 0.60 to 0.99). The speech language therapy was recommended in 3 guidelines. Four guidelines described group treatment was beneficial for the continuum of care. However, other therapies for aphasia varied in the level of detail across guidelines. CONCLUSIONS: Our study indicated the quality of guidelines for post-stroke aphasia needed to be improved. Moreover, the treatment recommendations of aphasia existed discrepancy among the included guidelines. Therefore, it is suggested to pay more attention on the rigor of methodology and applicability during the process of the formulation of guideline. Future research should focus on the effectiveness, intensity, and duration of treatment measures.


Assuntos
Afasia/reabilitação , Guias de Prática Clínica como Assunto/normas , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/normas , Humanos
8.
Medicine (Baltimore) ; 98(32): e16795, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393409

RESUMO

BACKGROUND: Most clinical guidelines recommend a restrictive red-blood-cell (RBC) transfusion threshold. However, indications for transfusion in patients with a hip fracture have not been definitively evaluated or remain controversial. We compared the pros and cons of restrictive versus liberal transfusion strategies in patients undergoing hip fracture surgery. METHODS: Electronic databases were searched to identify randomized controlled trials (RCTs) and retrospective cohort studies (RCSs) to investigate the effects of a restrictive strategy versus its liberal counterpart in patients undergoing hip fracture surgery. The main clinical outcomes included delirium, mortality, infections, cardiogenic complications, thromboembolic events, cerebrovascular accidents, and length of hospital stay. The meta-analysis program of the Cochrane Collaboration (RevMan version 5.3.0) was used for data analysis. Statistical heterogeneity was assessed by both Cochran chi-squared test (Q test) and I test. Both Begg and Egger tests were used to assess potential publication bias. RESULTS: We identified 7 eligible RCTs and 2 eligible RCSs, involving 3,575 patients in total. In patients undergoing hip fracture surgery, we found no differences in frequency of delirium, mortality, the incidence rates of all infections, pneumonia, wound infection, all cardiovascular events, congestive heart failure, thromboembolic events or length of hospital stay between restrictive and liberal thresholds for RBC transfusion (P >.05). However, we found that the use of restrictive transfusion thresholds is associated with higher rates of acute coronary syndrome (P <.05) while liberal transfusion thresholds increase the risk of cerebrovascular accidents (P <.05). CONCLUSION: In patients undergoing hip fracture surgery, clinicians should evaluate the patient's condition in detail and adopt different transfusion strategies according to the patient's specific situation rather than merely using a certain transfusion strategy.


Assuntos
Transfusão de Eritrócitos/métodos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Doenças Cardiovasculares/epidemiologia , Delírio/epidemiologia , Humanos , Complicações Pós-Operatórias/mortalidade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia
9.
Medicine (Baltimore) ; 98(33): e16874, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415427

RESUMO

To expand our prior statewide analysis of care distribution for locally advanced cervical cancer in Virginia to include 2 more states and to develop a tool for predicting quality of care. Complete treatment was defined as receiving chemotherapy (CT), brachytherapy (BT), and external beam radiotherapy.State cancer registry databases yielded a three-state cohort of 3197 women diagnosed with locally advanced cervical cancer from 2000 to 2013. A logistic regression evaluated predictors for receipt of BT, CT, and high (2-3 modalities received) versus low (0-1 modalities received) quality care. A Cox proportional hazards models determined predictors of survival. Finally, a predictive model was developed and preliminarily validated using our cohort.Only 35.3% of the cohort received complete treatment and only 57.3% received BT. Significant predictors of lower odds of receiving high quality care varied by state but included: 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; public insurance with supplement as compared to private; treatment at a low volume facility; and closer distance quintiles to a high volume treatment center as compared to the furthest quintile. Significant predictors of worse survival varied by state but included: low quality score (0-1 modalities received); 2000 to 2004 or 2005 to 2009 year of diagnosis as compared to 2010 to 2013; 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; treatment at a low volume facility; and unmarried/unknown marital status as compared to married. Our treatment quality prediction tool included age, age, treatment at high volume facility, and cancer stage and demonstrated 78.2% sensitivity and a 62.9% specificity.Only 35.3% of patients received complete guidelines-concordant treatment. Additionally, in 2/3 states it appeared that BT usage may have decreased during the study period. Our predictive model may help identify patients/regions at risk of receiving low quality care to target interventions aimed at improving cervical cancer treatment quality and survival.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Segunda Neoplasia Primária/terapia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Braquiterapia/estatística & dados numéricos , Feminino , Humanos , Kentucky , Pessoa de Meia-Idade , Estadiamento de Neoplasias , North Carolina , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Virginia , Adulto Jovem
10.
Medicine (Baltimore) ; 98(33): e16884, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415432

RESUMO

BACKGROUND: Patients with coronary heart disease (CHD) angina pectoris are in critical condition, which can cause sudden death, myocardial infarction, and other adverse events, and bring serious burden to families and society. Timely treatment should be given to improve the condition. Western medicine treatment of angina pectoris failed to meet the demand of angina symptom control. OBJECTIVE: It is hoped that the research method with higher evidential value will be adopted to compare the short-term, medium-term, and long-term effects of Chinese patent medicine combined with conventional western medicine and conventional western medicine alone in the treatment of CHD angina pectoris, so as to tap the clinical efficacy advantages of traditional Chinese medicine (TCM) and provide reliable data support for its clinical application. METHODS: A prospective cohort study was conducted among patients with CHD angina pectoris who were treated with oral Chinese patent medicine and conventional western medicine. The patients were divided into exposed group and nonexposed group according to whether or not the patients with CHD angina pectoris were treated with Chinese patent medicine. The exposed group was treated with TCM combined with conventional western medicine, while the nonexposed group was treated with conventional western medicine alone. Patients need to be hospitalized for 2 weeks as the introduction period and whether to enter the group is determined according to the treatment and medication conditions of the patients. The follow-up time points were 0th, 4th, 12th, 24th, and 48th weeks. The main events and secondary events were used as the evaluation criteria for clinical efficacy of CHD angina pectoris. In the experimental study, we will use strict indicators to detect standard operation procedure for multinomics and bacterial flora detection. CONCLUSION: This study will provide evidence for the clinical efficacy advantages of Chinese patent medicine and reliable support for its clinical application through test data.


Assuntos
Angina Pectoris/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Projetos de Pesquisa , Resultado do Tratamento
12.
Rech Soins Infirm ; 137(2): 91-98, 2019 06.
Artigo em Francês | MEDLINE | ID: mdl-31453676

RESUMO

Introduction : Nursing care for a venous ulcer includes repairing the dressing and applying the medical compression bandage (MCB). Nurses use the application technique found in the guidelines to achieve the required pressure level. There are wide disparities in the way an MCB is applied.Methodology : An observational study combining quantitative and qualitative components was conducted to evaluate the application of MCBs and to explore the elements that nurses take into account when applying MCBs.Results : Of the 261 patients, 27% had MCBs applied according to the guidelines. The main variation found was that the heel was left out of the bandage for 48% of patients. The private nurses interviewed expressed that the patient's opinion was taken into account in order to promote compliance.Discussion : Regarding the nursing knowledge used to perform the application of an MCB, it appears that the empirical knowledge proposed by Carper is not the only element taken into account. Patient participation in the choice of the application technique, which could be linked with a sense of artistry allows nurses to guide their practice.


Assuntos
Bandagens Compressivas , Úlcera Varicosa/enfermagem , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem , Participação do Paciente , Guias de Prática Clínica como Assunto , Pesquisa Qualitativa
13.
Stud Health Technol Inform ; 264: 1690-1691, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438295

RESUMO

The learning health system depends on a cycle of evidence generation, translation to practice, and continuous practice-based data collection. Clinical practice guidelines (CPGs) represent medical evidence, translated into recommendations on appropriate clinical care. The FAIR guiding principles offer a framework for publishing the extensive knowledge work of CPGs and their resources. In this narrative literature review, we propose that FAIR CPGs would lead to more efficient production and dissemination of CPG knowledge to practice.


Assuntos
Programas Governamentais , Sistemas de Informação em Saúde , Guias de Prática Clínica como Assunto , Confiabilidade dos Dados
14.
Zhonghua Nei Ke Za Zhi ; 58(9): 636-655, 2019 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-31461815

RESUMO

Allergic asthma is an important phenotype of asthma, accounting for sixty to eighty percent of the whole asthma population. This guideline was divided into 15 chapters, which provided a detailed introduction to epidemiology, pathogenesis, common allergens, clinical manifestation and the principles of diagnosis, treatment and prevention of allergic asthma, and highlighted the similarities and differences of allergic and non-allergic asthma. According to the principles of international and national asthma guidelines, this guideline placed special emphasis on allergen specific immunotherapy, anti-IgE therapy, anti-allergy therapy, management of allergic comorbidities and tertiary prevention. Based on the evidence-based medicine and clinical practice in China, the guideline made recommendations to guide the diagnosis, treatment and management of allergic asthma in China.


Assuntos
Antialérgicos/uso terapêutico , Asma , Guias de Prática Clínica como Assunto , Rinite Alérgica , Alérgenos , Asma/diagnóstico , Asma/terapia , China , Dessensibilização Imunológica , Humanos
15.
Med Clin North Am ; 103(5): 847-862, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378330

RESUMO

Oral anticoagulation significantly reduces the risk of stroke in patients with atrial fibrillation (AF), and the decision to initiate therapy is based on assessing the patient's yearly risk of stroke. Although warfarin remains the drug of choice in patients with AF and artificial mechanical valves, the novel anticoagulation agents are becoming the drug of choice for all other patients with AF, because of their efficacy, safety, and ease of use. This article summarizes the current evidence for stroke prevention in AF, including valvular AF, subclinical AF, AF in patients with renal insufficiency, as well as stroke prevention around AF cardioversion.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Ensaios Clínicos como Assunto , Humanos , Guias de Prática Clínica como Assunto , Acidente Vascular Cerebral/etiologia , Varfarina/administração & dosagem , Varfarina/efeitos adversos
16.
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
18.
Medicine (Baltimore) ; 98(33): e16698, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415362

RESUMO

BACKGROUND: Urinary incontinence is a common complaint in all parts of the world, cause of distress, as well as significant costs for both individuals and society. The aim of this study will be to evaluate the rigor of the development of clinical practice guidelines and to identify the recommendations of interventions for urinary incontinence in adult women. METHODS: In this systematic review, clinical practice guidelines will be identified using a prospective protocol through a systematic search of: MEDLINE (via Ovid); EMBASE (Excerpt Medical Database, via Ovid); Web of Science and Virtual Health Library. Specific databases of guidelines for clinical practice will also be searched (National Institute for Health and Care Excellence, American Urological Association, and others). Reviewers, independently and in duplicate, will assess the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II). The results will be checked for discrepancies. Differences between the scores equal to or greater than 2 will be considered as discrepant and the final result will be decided by consensus. A comparison of the recommendations of interventions and information about the level of evidence, the degree of recommendation, the level of agreement and the level of acceptance will be described. This step will also be done independently and in duplicate, and the result will be decided by consensus. The results will be presented in tables and the descriptive statistics will be calculated for all domains of the AGREE II instrument as mean (standard deviation) and median (interquartile range). RESULTS: The results derived from this study will increase the knowledge about the development of recommendations guidelines for urinary incontinence of high methodological rigor. This study may also identify key areas for future research. CONCLUSION: This study may guide health professionals, policy makers, and health policy managers in choosing the guidelines for recommendation in clinical practice. PROTOCOL REGISTRATION: PROSPERO - CRD42018116517.


Assuntos
Guias de Prática Clínica como Assunto , Incontinência Urinária , Urologia/normas , Feminino , Humanos , Masculino , Projetos de Pesquisa , Revisão Sistemática como Assunto
19.
Lancet ; 394(10196): 420-431, 2019 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-31379333

RESUMO

Developments in high-throughput microbial genomic sequencing and other systems biology techniques have given novel insight into the potential contribution of the gut microbiota to health and disease. As a result, an increasing number of diseases have been characterised by distinctive changes in the composition and functionality of the gut microbiota; however, whether such changes are cause, consequence, or incidental to the disease in question remains largely uncertain. Restoration of the gut microbiota to a premorbid state is a key novel therapeutic approach of interest, and faecal microbiota transplantation-the transfer of prescreened stool from healthy donors into the gastrointestinal tract of patients-is gaining increasing importance in both the clinical and research settings. At present, faecal microbiota transplantation is only recommended in the treatment of recurrent Clostridioides difficile infection, although a large number of trials are ongoing worldwide exploring other potential therapeutic indications.


Assuntos
Infecções por Clostridium/terapia , Transplante de Microbiota Fecal/tendências , Microbioma Gastrointestinal , Humanos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
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