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1.
Isr Med Assoc J ; 22(1): 60-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927808

RESUMO

BACKGROUND: In this review, the authors re-examine the role of aspirin in the primary prevention of cardiovascular disease. They discuss the history of the use of aspirin in primary prevention, the current guidelines, and the recent evidence surrounding aspirin use as primary prevention in special populations such as those with moderate cardiovascular risk, diabetes mellitus, and the elderly.


Assuntos
Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Fibrinolíticos/uso terapêutico , Aspirina/efeitos adversos , Fibrinolíticos/efeitos adversos , Humanos , Guias de Prática Clínica como Assunto , Prevenção Primária/métodos
3.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 18-20, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914564

RESUMO

With the acceleration of the population aging in China, the health problems and the demands of health services such as health check-up for rural residents should attract the attention of the whole society. The group standard entitled Health check-up guide for rural residents (T/CHAA 005-2019), was written by experienced researchers from Chinese Center for Disease Control and Prevention and other professional institutes coordinated by Chinese Health Association. The standard aims to establish a service model that takes health information collection as a means, health risk assessment, health risk intervention and information services as the core, improving the health of rural residents as the target.


Assuntos
Exame Físico/normas , Guias de Prática Clínica como Assunto/normas , População Rural , China , Humanos
4.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 37-38, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914566

RESUMO

This standard stipulates the principles, institutional requirements, inspection items, service modes, data management and utilization requirements for carrying out the health check-up for rural residents. It is applicable to the standardized management of the health check-up for rural residents aged 15 years old and above under the relevant national laws and regulations.


Assuntos
Exame Físico/normas , Guias de Prática Clínica como Assunto/normas , População Rural , Adolescente , Adulto , China , Humanos , Padrões de Prática Médica/legislação & jurisprudência
5.
Ann Otol Rhinol Laryngol ; 129(1): 55-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31801377

RESUMO

OBJECTIVE: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). STUDY DESIGN: Online survey. METHOD: A sample of pediatric anesthesiologists received the survey by email. RESULTS: 110 respondents were included. 46.4% worked in a free-standing children's hospital and 32.7% worked in a children's facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children's hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). CONCLUSION: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.


Assuntos
Analgésicos/uso terapêutico , Anestesiologia , Anestésicos/uso terapêutico , Antieméticos/uso terapêutico , Pediatria , Padrões de Prática Médica , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Acetaminofen/uso terapêutico , Adenoidectomia , Extubação/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Dexametasona/uso terapêutico , Fentanila/uso terapêutico , Humanos , Midazolam/uso terapêutico , Morfina/uso terapêutico , Óxido Nitroso/uso terapêutico , Ondansetron/uso terapêutico , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
6.
Zhonghua Nei Ke Za Zhi ; 59(1): 18-22, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31887831

RESUMO

The prevalence of dyslipidemia in Chinese adult is increasing dramatically, which poses a severe challenge to the prevention and treatment of atherosclerotic cardiovascular diseases. In recent years, a series of new research results have been published, providing a lot of new information for the management strategy of dyslipidemia. In order to apply these new research results to clinical practice for the further prevention and treatment of dyslipidemia more reasonably and effectively, the China Cholesterol Education Program (CCEP) Working Committee organized joint expert meeting and revised the "Expert Advice on Prevention and Treatment of Dyslipidemia in China Cholesterol Education Program 2014", in which a new classification standard for cardiovascular risk stratification has been proposed, and the target value of lipid-lowering therapy has been updated.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Colesterol/sangue , Dislipidemias , Guias de Prática Clínica como Assunto , Adulto , China , Dislipidemias/prevenção & controle , Dislipidemias/terapia , Humanos , Fatores de Risco
7.
Equine Vet J ; 52(1): 13-27, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31657050

RESUMO

Primary care guidelines provide a reference point to guide clinicians based on a systematic review of the literature, contextualised by expert clinical opinion. These guidelines develop a modification of the GRADE framework for assessment of research evidence (vetGRADE) and applied this to a range of clinical scenarios regarding use of analgesic agents. Key guidelines produced by the panel included recommendations that horses undergoing routine castration should receive intratesticular local anaesthesia irrespective of methods adopted and that horses should receive NSAIDs prior to surgery (overall certainty levels high). Butorphanol and buprenorphine should not be considered appropriate as sole analgesic for such procedures (high certainty). The panel recommend the continuation of analgesia for 3 days following castration (moderate certainty) and conclude that phenylbutazone provided superior analgesia to meloxicam and firocoxib for hoof pain/laminitis (moderate certainty), but that enhanced efficacy has not been demonstrated for joint pain. In horses with colic, flunixin and firocoxib are considered to provide more effective analgesia than meloxicam or phenylbutazone (moderate certainty). Given the risk of adverse events of all classes of analgesic, these agents should be used only under the control of a veterinary surgeon who has fully evaluated a horse and developed a therapeutic, analgesic plan that includes ongoing monitoring for such adverse events such as the development of right dorsal colitis with all classes of NSAID and spontaneous locomotor activity and potentially ileus with opiates. Finally, the panel call for the development of a single properly validated composite pain score for horses to allow accurate comparisons between medications in a robust manner.


Assuntos
Analgesia/veterinária , Doenças dos Cavalos/tratamento farmacológico , Dor/veterinária , Guias de Prática Clínica como Assunto , Sociedades Científicas/normas , Medicina Veterinária/normas , Animais , Cavalos , Dor/tratamento farmacológico , Reino Unido
8.
Zhongguo Zhong Yao Za Zhi ; 44(20): 4354-4359, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31872645

RESUMO

The formation of expert consensus statement is an indispensable part in the process of developing clinical practice guidelines. The Guidelines International Network believes that experts make group decisions for different stages and issues,and the process of gathering expert opinions is the process of reaching the consensus. GRADE system also requires that recommendations should be formed based on expert consensus in consideration of the risk and bias,patients' preferences and values,resources and other factors. At present,the main method for reaching consensus is the formal consensus method. According to the published clinical guidelines,most of them failed to report the specific methods and process of reaching expert consensus. Therefore,it is impossible to obtain an objective evaluation. This phenomenon is more common in the field of clinical practice guidelines of traditional Chinese medicine( TCM). There are two main reasons for this phenomenon. For one thing,the developers of the guidelines neglect the importance of transparency and objectivity in the implementation of expert consensus. For another,they know little about the methods and technical specifications for the formation of expert consensus. To solve them,based on the internationally recognized consensus-building methods,as well as the specific stages in the process of developing clinical practice guidelines of traditional Chinese medicine,it is of great significance to put forward the technical norms for TCM researchers to develop the expert consensus. This guide will provide detailed guidance for forming the expert consensus for TCM clinical practice guideline. This guideline has been approved and published by the Chinese Association of Traditional Chinese Medicine( No. T/CACM 1049-2017).


Assuntos
Medicina Tradicional Chinesa , Guias de Prática Clínica como Assunto , Consenso , Humanos
10.
Medicine (Baltimore) ; 98(52): e18521, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876744

RESUMO

Genetic testing of children is faced with numerous problems. High-quality clinical practice guidelines (CPGs) are needed to ensure its safe, and appropriate use. This study aimed to systematically identify the current CPGs for genetic testing in children, and to assess the methodological quality of these CPGs.We searched 6 databases, 3 guideline clearinghouses, and 9 web sites of relevant academic agencies from inception to February 2019. CPGs focused on genetic testing in children were included. Four reviewers independently appraised the quality of the eligible CPGs using the appraisal of guidelines for research, and evaluation (AGREE) II instrument.Seventeen CPGs meeting our inclusion criteria were included. Among them, 16 CPGs were focused on the genetic diagnosis/evaluation of diseases, while only 1 CPG was focused on pharmacogenetics. The median domain scores from highest to lowest were: scope and purpose 80.56% (range: 56.95%-87.50%), clarity of presentation 72.22% (range: 45.83%-88.89%), stakeholder involvement 45.83% (range: 27.78%-55.56%), applicability 31.25% (range: 19.79%-54.17%), rigor of development 21.88%, (range: 13.02%-71.88%), and editorial independence 18.75% (range: 0%-83.33%). According to the overall quality, 6 (35%) CPGs were "not recommended," 8 (47%) CPGs were "recommended with modifications," and only 3 (18%) CPGs were "recommended." The clinical topics of the "recommended" CPGs were warfarin, familial Mediterranean fever, and pediatric pulmonary arterial hypertension.The quality of CPGs for genetic testing in children was generally low, and variable across different CPGs and different AGREE II domains. In future guideline development, more attention should be paid to the aspects of stakeholder involvement, rigor of development, applicability, and editorial independence. Not only will guideline users benefit from our results when determining whether to adopt related CPGs to guide genetic testing in children, but guideline developers could also take into account our results to improve the quality of future CPGs.


Assuntos
Testes Genéticos/normas , Guias de Prática Clínica como Assunto/normas , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Farmacogenética/normas
11.
J Clin Ethics ; 30(4): 347-355, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851626

RESUMO

Most professional guidelines advocate family presence during resuscitation (FPDR). Many clinicians, however, are still reluctant to implement this recommendation. In this article I present the most comprehensive case for FPDR to date. I review the little that has been written about the ethics of FPDR, as well as the available empirical evidence. More importantly, I present and defend three arguments for FPDR: adherence to professional guidelines, benefit to patients and relatives, and patients' autonomy. I conclude with suggestions for future research.


Assuntos
Reanimação Cardiopulmonar/ética , Cuidados Críticos/ética , Família , Relações Profissional-Família/ética , Atitude do Pessoal de Saúde , Reanimação Cardiopulmonar/psicologia , Cuidados Críticos/psicologia , Família/psicologia , Humanos , Guias de Prática Clínica como Assunto
13.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(12): 954-958, 2019 Dec 07.
Artigo em Chinês | MEDLINE | ID: mdl-31887827

RESUMO

For a long time, the diagnosis and treatment of pediatric thyroid nodules and cancer (PTNC) are mainly referred to adults. In recent years, it has been found that there are great differences between PTNC and TNC in adults. In 2015, the American Thyroid Association released the first Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. In the guidelines, the characteristics of PTNC were described, and clear management strategies were provided. In this paper, we mainly interpret the surgical part of the guidelines and also review the associated research progress in recent years.


Assuntos
Adenocarcinoma , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Adenocarcinoma/terapia , Criança , Humanos , Guias de Prática Clínica como Assunto , Neoplasias da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/terapia , Estados Unidos
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1118-1123, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874526

RESUMO

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto/normas , Protectomia/normas , Idoso , Canal Anal/cirurgia , Humanos , Reto/cirurgia
15.
MMWR Morb Mortal Wkly Rep ; 68(46): 1062-1068, 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31751320

RESUMO

An estimated 219 million cases of malaria occurred worldwide in 2017, causing approximately 435,000 deaths (1). Malaria is caused by intraerythrocytic protozoa of the genus Plasmodium transmitted to humans through the bite of an infective Anopheles mosquito. Five Plasmodium species that regularly cause illness in humans are P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi (2). The parasite first develops in the liver before infecting red blood cells. Travelers to areas with endemic malaria can prevent malaria by taking chemoprophylaxis. However, most antimalarials do not kill the liver stages of the parasite, including hypnozoites that cause relapses of disease caused by P. vivax or P. ovale. Therefore, patients with these relapsing species must be treated with two medications: one for the acute infection, and another to treat the hypnozoites (antirelapse therapy). Until recently, primaquine was the only drug available worldwide to kill hypnozoites. Tafenoquine, a long-acting 8-aminoquinoline drug related to primaquine, was approved by the Food and Drug Administration (FDA) on July 20, 2018, for antirelapse therapy (Krintafel) and August 8, 2018, for chemoprophylaxis (Arakoda) (3,4). This report reviews evidence for the efficacy and safety of tafenoquine and provides CDC guidance for clinicians who prescribe chemoprophylaxis for travelers to areas with endemic malaria and treat malaria.


Assuntos
Aminoquinolinas/uso terapêutico , Antimaláricos/uso terapêutico , Malária/prevenção & controle , Guias de Prática Clínica como Assunto , Prevenção Secundária , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medicina de Viagem , Estados Unidos
16.
MMWR Morb Mortal Wkly Rep ; 68(46): 1081-1086, 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31751322

RESUMO

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). CDC has published recommendations for health care providers regarding EVALI (2-4). Recently, researchers from Utah and New York published proposed diagnosis and treatment algorithms for EVALI (5,6). EVALI remains a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis, and evaluation should be guided by clinical judgment. Because patients with EVALI can experience symptoms similar to those associated with influenza or other respiratory infections (e.g., fever, cough, headache, myalgias, or fatigue), it might be difficult to differentiate EVALI from influenza or community-acquired pneumonia on initial assessment; EVALI might also co-occur with respiratory infections. This report summarizes recommendations for health care providers managing patients with suspected or known EVALI when respiratory infections such as influenza are more prevalent in the community than they have been in recent months (7). Recommendations include 1) asking patients with respiratory, gastrointestinal, or constitutional symptoms about the use of e-cigarette, or vaping, products; 2) evaluating those suspected to have EVALI with pulse oximetry and obtaining chest imaging, as clinically indicated; 3) considering outpatient management for clinically stable EVALI patients who meet certain criteria; 4) testing patients for influenza, particularly during influenza season, and administering antimicrobials, including antivirals, in accordance with established guidelines; 5) using caution when considering prescribing corticosteroids for outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections; 6) recommending evidence-based treatment strategies, including behavioral counseling, to help patients discontinue using e-cigarette, or vaping, products; and 7) emphasizing the importance of annual influenza vaccination for all persons aged ≥6 months, including patients who use e-cigarette, or vaping products.


Assuntos
Surtos de Doenças , Lesão Pulmonar/terapia , Guias de Prática Clínica como Assunto , Vaping/efeitos adversos , Humanos , Lesão Pulmonar/epidemiologia , Estados Unidos/epidemiologia
18.
BMJ ; 367: l5887, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690574

RESUMO

Diabetes is a major and costly health concern worldwide, with high morbidity, disability, mortality, and impaired quality of life. The vast majority of people living with diabetes have type 2 diabetes. Historically, the main strategy to reduce complications of type 2 diabetes has been intensive glycemic control. However, the body of evidence shows no meaningful benefit of intensive (compared with moderate) glycemic control for microvascular and macrovascular outcomes important to patients, with the exception of reduced rates of non-fatal myocardial infarction. Intensive glycemic control does, however, increase the risk of severe hypoglycemia and incurs additional burden by way of polypharmacy, side effects, and cost. Additionally, data from cardiovascular outcomes trials showed that cardiovascular, kidney, and mortality outcomes may be improved with use of specific classes of glucose lowering drugs largely independently of their glycemic effects. Therefore, delivering evidence based, patient centered care to people with type 2 diabetes requires a paradigm shift and departure from the predominantly glucocentric view of diabetes management. Instead of prioritizing intensive glycemic control, the focus needs to be on ensuring access to adequate diabetes care, aligning glycemic targets to patients' goals and situations, minimizing short term and long term complications, reducing the burden of treatment, and improving quality of life.


Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Qualidade de Vida , Glicemia/análise , Glicemia/efeitos dos fármacos , Complicações do Diabetes/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Hiperglicemia/sangue , Hiperglicemia/tratamento farmacológico , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Incidência , Metanálise como Assunto , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Revisão Sistemática como Assunto , Resultado do Tratamento
19.
Zhonghua Shao Shang Za Zhi ; 35(11): 769-771, 2019 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-31775463

RESUMO

At the beginning of 2009, the 38th principle of the Administrative Measures for Clinical Application of Medical Technology, issued by the former Ministry of Health, clearly pointed out that medical institutions should establish a hierarchical management system for surgery. Then the Trial of Administrative Measures for Surgical Classification of Medical Institutions was published and implemented in 2012, but the official introduction of surgical classification catalogue in the national level has not been seen. Therefore, the writing group of this expert consensus has organized numerous well-known experts and scholars in China, taking the three elements of the 38th principle of the Administrative Measures for Clinical Application of Medical Technology issued by the Ministry of Health--risk coefficient, complexity, and technical difficulty as the basic norm to grade scientifically through the four indicators of burn index, surgical area, surgical repair method, and anesthesia risk (each indicator with 4 grades and scores). The total score is then accumulated to divide four grades of operations. The Expert Consensus on Classification Evaluation Methods of Burn Surgery in China (2019 Version) is strategized together expecting to provide academic reference for the government departments to issue or further improve and perfect surgical classification catalogue in the national level as soon as possible, and lay a foundation for the stable development of burn discipline with the significance of national strategic reserve.


Assuntos
Queimaduras/cirurgia , Guias de Prática Clínica como Assunto/normas , China , Consenso , Humanos
20.
Zhonghua Gan Zang Bing Za Zhi ; 27(10): 748-753, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31734987

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in China. To provide evidence-based and updated practical recommendations for clinician, this expert recommendations have updated the diagnosis and treatment of NAFLD in five aspects as follows: (1) the framework of NAFLD treatment centre or clinic; (2) screening and evaluation: who should be screened, initial evaluation items, non-invasive assessment of steatohepatitis and advanced fibrosis, when to obtain a liver biopsy in patients with NAFLD, and other metabolic disorders and cardiovascular risk assessment; (3) managements of patient with NAFLD: lifestyle intervention (dietary, exercise and weight loss), drug treating metabolic co-morbidities such as hyperlipidemia, type 2 diabetes mellitus and hypertension, and steatohepatitis and fibrosis; (4) management of special populations with NAFLD: children, pregnant or lactating women, patients co-existence with alcoholic liver disease, chronic HBV and/or HCV infection, and autoimmune disorders; (5) monitoring and follow-up. This consensus aims to modify the optimizing management process and guide physicians make correct and reasonable decisions in the diagnosis and treatment for patients with NAFLD.


Assuntos
Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/terapia , Biópsia , Criança , China , Comorbidade , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Hiperlipidemias , Hipertensão , Lactação , Estilo de Vida , Guias de Prática Clínica como Assunto
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