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1.
Anticancer Res ; 39(11): 5853-5859, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704809

RESUMO

BACKGROUND/AIM: The objective of the study was to propose clinical guidelines for the use of minimally invasive surgery (MIS) in pediatric oncology. PATIENTS AND METHODS: Two groups of experts, including pediatric surgeons and pediatric oncologists were created in order to establish strategies of diagnostic and therapeutic surgical management in pediatric oncology. RESULTS: On the basis of the analysis of the existing literature, we elaborated guidelines that were graded according to the simple practical clinical system: yes/no. This project was dedicated to the following topics: adrenal tumors including neuroblastoma, renal tumors including Wilms tumor (nephroblastoma), ovarian tumors and pulmonary nodules and metastases (osteosarcoma). CONCLUSION: Although existing data do not allow the recommendation of the use of MIS for all indications, this technique should currently be regarded as a standard of care in several areas of pediatric oncology.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias/cirurgia , Guias de Prática Clínica como Assunto/normas , Criança , Humanos
2.
Medicine (Baltimore) ; 98(40): e17132, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577704

RESUMO

BACKGROUND: Evidence-based guidelines are expected to provide clinicians with explicit recommendations on how to manage health conditions and bridge the gap between research and clinical practice. However, the existing practice guidelines(CPGs) vary in quality. This study aimed to evaluate the quality of CPGs of kidney cancer. METHODS: We systematically searched PubMed, Embase, China Biology Medicine disc, and relevant guideline websites from their inception to April, 2018. We identified CGPs that provided recommendations on kidney cancer; 4 independent reviewers assessed the eligible CGPs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. The consistency of evaluations was calculated using intraclass correlation coefficients (ICC). RESULTS: A total of 13 kidney cancer CGPs were included. The mean scores for each AGREEII domain were as follows: scope and purpose-76.9%; clarity and presentation-76.4%; stakeholder involvement-62.8%; rigor of development-58.7%; editorial independence-53.7%; and applicability-49.4%. Two CPGs were rated as "recommended"; 8 as "recommended with modifications"; and 3 as "not recommended." Seven grading systems were used by kidney cancer CGPs to rate the level of evidence and the strength of recommendation. CONCLUSIONS: Overall, the quality of CPGs of kidney cancer is suboptimal. AGREE II assessment results highlight the need to improve CPG development processes, editorial independence, and applicability in this field. It is necessary to develop a standardized grading system to provide clear information about the level of evidence and the strength of recommendation for future kidney cancer CGPs.


Assuntos
Neoplasias Renais/terapia , Guias de Prática Clínica como Assunto/normas , Humanos
3.
Zhonghua Nei Ke Za Zhi ; 58(10): 713-735, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31594170

RESUMO

National handbook for the prevention and control of diabetes in primary care (2019) is made for the use in combination with the national guidelines for the prevention and control of diabetes in primary care (2018). It provides detailed information and supplementary for the contents involved in the guidelines.


Assuntos
Assistência à Saúde/normas , Diabetes Mellitus Tipo 2/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Atenção Primária à Saúde/normas , Humanos
4.
Zhonghua Nei Ke Za Zhi ; 58(10): 736-744, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31594171

RESUMO

The patients with colorectal cancer in Chinese population are increasing, which is a serious threat to human life and health. In order to improve the high incidence, high mortality and low early diagnosis rate of colorectal cancer and promote cancer screening program in China, leading by the National Clinical Research Center for Digestive Disease (Shanghai), relying on Gastrointestinal-Cancer Prevention & Treatment Center Alliance, in conjunction with a number of related societies, we organized multidisciplinary experts including gastroenterology, digestive endoscopy, oncology, health management and endoscopic quality control to jointly develop this consensus. This consensus aims to establish and refine early colorectal cancer screening protocol adapting to our national conditions and guide the screening practice.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Programas de Rastreamento , Guias de Prática Clínica como Assunto/normas , China , Consenso , Humanos
5.
Zhonghua Nei Ke Za Zhi ; 58(10): 745-750, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31594172

RESUMO

With the improvement of people's living conditions and the prolonged lifespan, gout and hyperuricemia have increasingly become common chronic diseases in daily clinical practice for other physicians in addition to rheumatologists, even including general practitioners and primary care doctors. The European League Against Rheumatism (EULAR) firstly issued recommendations on gout diagnosis and management in 2006, which has been updated several times. Using a Delphi consensus approach, 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout finally formulated eight main recommendations, which was published online in June 2019. Not only does this edition emphasize the role of specialists, joint puncture or tophus aspirates and ultrasound in diagnosis, but also calls on all clinicians to pay more attention to risk factors of gout and associated comorbidities.


Assuntos
Medicina Baseada em Evidências , Gota/diagnóstico , Hiperuricemia/diagnóstico , Guias de Prática Clínica como Assunto/normas , Humanos , Fatores de Risco
6.
BMC Infect Dis ; 19(1): 769, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481123

RESUMO

BACKGROUND: Health-workers in developing countries rely on clinical algorithms, such as the Integrated Management of Childhood Illnesses (IMCI), for the management of patients, including diagnosis of serious bacterial infections (SBI). The diagnostic accuracy of IMCI in detecting children with SBI is unknown. Prediction rules and guidelines for SBI from well-resourced countries at outpatient level may help to improve current guidelines; however, their diagnostic performance has not been evaluated in resource-limited countries, where clinical conditions, access to care, and diagnostic capacity differ. The aim of this study was to estimate the diagnostic accuracy of existing prediction rules and clinical guidelines in identifying children with SBI in a cohort of febrile children attending outpatient health facilities in Tanzania. METHODS: Structured literature review to identify available prediction rules and guidelines aimed at detecting SBI and retrospective, external validation on a dataset containing 1005 febrile Tanzanian children with acute infections. The reference standard, SBI, was established based on rigorous clinical and microbiological criteria. RESULTS: Four prediction rules and five guidelines, including IMCI, could be validated. All examined rules and guidelines had insufficient diagnostic accuracy for ruling-in or ruling-out SBI with positive and negative likelihood ratios ranging from 1.04-1.87 to 0.47-0.92, respectively. IMCI had a sensitivity of 36.7% (95% CI 29.4-44.6%) at a specificity of 70.3% (67.1-73.4%). Rules that use a combination of clinical and laboratory testing had better performance compared to rules and guidelines using only clinical and or laboratory elements. CONCLUSIONS: Currently applied guidelines for managing children with febrile illness have insufficient diagnostic accuracy in detecting children with SBI. Revised clinical algorithms including simple point-of-care tests with improved accuracy for detecting SBI targeting in tropical resource-poor settings are needed. They should undergo careful external validation against clinical outcome before implementation, given the inherent limitations of gold standards for SBI.


Assuntos
Infecções Bacterianas/diagnóstico , Febre/diagnóstico , Técnicas Microbiológicas/normas , Testes Imediatos/normas , Guias de Prática Clínica como Assunto , Idade de Início , Algoritmos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Feminino , Febre/microbiologia , Humanos , Lactente , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estatística & dados numéricos , Testes Imediatos/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Tanzânia/epidemiologia
7.
Dis Colon Rectum ; 62(10): 1186-1194, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31490827

RESUMO

BACKGROUND: Many patients with rectal cancer are treated at small, low-volume hospitals despite evidence that better outcomes are associated with larger, high-volume hospitals. OBJECTIVES: This study aims to examine trends of patients with rectal cancer who are receiving care at large hospitals, to determine the patient characteristics associated with treatment at large hospitals, and to assess the relationships between treatment at large hospitals and guideline-recommended therapy. DESIGN: This study was a retrospective cohort analysis to assess trends in rectal cancer treatment. SETTINGS: Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Patterns of Care studies were used. PATIENTS: The study population consisted of adults diagnosed with stages II/III rectal cancer in 1990/1991, 1995, 2000, 2005, 2010, and 2015. MAIN OUTCOME MEASURES: The primary outcome was treatment at large hospitals (≥500 beds). The receipt of guideline-recommended preoperative chemoradiation therapy and postoperative chemotherapy was assessed for patients diagnosed in 2005+. RESULTS: Two thousand two hundred thirty-one patients were included. The proportion treated at large hospitals increased from 19% in 1990/1991 to 27% in 2015 (ptrend < 0.0001). Black race was associated with treatment at large hospitals (vs white) (OR, 1.73; 95% CI, 1.30-2.31), as was being 55 to 64 years of age (vs 75+), and diagnosis in 2015 (vs 1990/1991). Treatment in large hospitals was associated with twice the odds of preoperative chemoradiation, as well as younger age and diagnosis in 2010 or 2015 (vs 2005). LIMITATIONS: The study did not account for the change in the number of large hospitals over time. CONCLUSIONS: Results suggest that patients with rectal cancer are increasingly being treated in large hospitals where they receive more guideline-recommended therapy. Although this trend is promising, patients receiving care at larger, higher-volume facilities are still the minority. Initiatives increasing patient and provider awareness of benefits of specialized care, as well as increasing referrals to large centers may improve the use of recommended treatment and ultimately improve outcomes. See Video Abstract at http://links.lww.com/DCR/A994. QUIMIORRADIACIÓN RECOMENDADA EN GUÍAS PARA PACIENTES CON CÁNCER RECTAL EN HOSPITALES DE GRAN TAMAÑO: UNA TENDENCIA EN LA DIRECCIÓN CORRECTA: Muchos pacientes con cáncer rectal se tratan en hospitales pequeños y de bajo volumen a pesar de evidencia de que los mejores resultados se asocian con hospitales más grandes y de gran volumen. OBJETIVOS: Examinar las tendencias en los pacientes con cáncer rectal que reciben atención en hospitales de gran tamaño, determinar las características de los pacientes asociadas con el tratamiento en hospitales grandes y evaluar la relación entre el tratamiento en hospitales grandes y la terapia recomendada en guías. DISEÑO:: Este estudio fue un análisis de cohorte retrospectivo para evaluar las tendencias en el tratamiento del cáncer de recto. ESCENARIO: Se utilizaron datos de los estudios del programa Patrones de Atención, Vigilancia, Epidemiología y Resultados Finales (SEER) del Instituto Nacional de Cáncer (NIH). PACIENTES: La población de estudio consistió en adultos diagnosticados con cáncer rectal en estadio II / III en 1990/1991, 1995, 2000, 2005, 2010 y 2015. PRINCIPALES MEDIDAS DE RESULTADO: El resultado primario fue el tratamiento en hospitales grandes (≥500 camas). La recepción de quimiorradiación preoperatoria recomendada según las guías y la quimioterapia posoperatoria se evaluaron para los pacientes diagnosticados en 2005 y posteriormente. RESULTADOS: Se incluyeron 2,231 pacientes. La proporción tratada en los hospitales grandes aumentó del 19% en 1990/1991 al 27% en 2015 (ptrend < 0.0001). La raza afroamericana se asoció con el tratamiento en hospitales grandes (vs. blanca) (OR, 1.73; IC 95%, 1.30-2.31), al igual que 55-64 años de edad (vs ≥75) y diagnóstico en 2015 (vs 1990/1991). El tratamiento en los hospitales grandes se asoció con el doble de probabilidad de quimiorradiación preoperatoria, así como con una edad más temprana y diagnóstico en 2010 o 2015 (vs 2005). LIMITACIONES: El estudio no tomó en cuenta el cambio en el número de hospitales grandes a lo largo del tiempo. CONCLUSIONES: Los resultados sugieren que los pacientes con cáncer rectal reciben cada vez más tratamiento en hospitales grandes donde reciben terapia recomendada por las guías mas frecuentemente. Aunque esta tendencia es prometedora, los pacientes que reciben atención en hospitales más grandes y de mayor volumen siguen siendo una minoría. Las iniciativas que aumenten la concientización del paciente y del proveedor de servicios médicos sobre los beneficios de la atención especializada, así como el aumento de las referencias a centros grandes podrían mejorar el uso del tratamiento recomendado y, en última instancia, mejorar los resultados. Vea el Resumen en video en http://links.lww.com/DCR/A994.


Assuntos
Antineoplásicos/uso terapêutico , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Estadiamento de Neoplasias , Guias de Prática Clínica como Assunto/normas , Neoplasias Retais/terapia , Programa de SEER , Adolescente , Adulto , Idoso , Quimiorradioterapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Retais/diagnóstico , Neoplasias Retais/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Adulto Jovem
8.
J Surg Oncol ; 120(6): 932-939, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31448820

RESUMO

BACKGROUND/OBJECTIVE: Staging and type of resection for rectal neuroendocrine tumors (R-NETS) relies on preoperative identification of lymph node (LN) involvement. Study objective was to develop a Preoperative Rectal Stratification Score (PReSS) for LN-positivity and to assess the association of PReSS with overall survival (OS). METHODS: All patients in the National Cancer Database (2004-2014) with non-metastatic/nonfunctional R-NETS were included. Tumor size was divided into three categories (<1, 1-2, and ≥2 cm). RESULTS: Among 383 patients, median age was 57 years, 52% were male (n = 200), median tumor size was 1.4 cm, 43% had positive LNs (n = 163). On univariate analysis, age > 60, poorly differentiated grade, depth of invasion past submucosa, and size >1 cm were associated with LN positivity. On multivariable analysis, depth of invasion past submucosa, and increasing tumor size >1 cm remained associated with LN positivity. As these can be determined preoperatively, incidence of LN positivity was determined for each combination of tumor size and depth of invasion. Each variable was assigned a score to create a PReSS of four groups (0-3) associated with an increasing rate of LN-positivity (PReSS group 0: 11%, 1: 38%, 2: 50%, 3: 78%, P < .01). PReSS correlated with 10-year OS (PReSS 0: 90%; 1: 81%; 2: 59%; 3: 41%). CONCLUSION: For R-NETS, depth of invasion and tumor size predict LN positivity and both can be obtained preoperatively. PReSS incorporates both variables and stratifies tumors into four risk groups of progressively increasing LN positivity and should be used to guide surgical approach.


Assuntos
Excisão de Linfonodo , Linfonodos/patologia , Tumores Neuroendócrinos/patologia , Guias de Prática Clínica como Assunto/normas , Cuidados Pré-Operatórios , Neoplasias Retais/patologia , Feminino , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgia , Valor Preditivo dos Testes , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Fatores de Risco
10.
Int Braz J Urol ; 45(5): 889-900, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408290

RESUMO

INTRODUCTION: Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. MATERIALS AND METHODS: The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. RESULTS AND DISCUSSION: Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.


Assuntos
Consenso , Enurese/diagnóstico , Enurese/terapia , Guias de Prática Clínica como Assunto/normas , Algoritmos , Antidepressivos Tricíclicos/uso terapêutico , Antidiuréticos/uso terapêutico , Terapia Comportamental/métodos , Criança , Antagonistas Colinérgicos/uso terapêutico , Desamino Arginina Vasopressina/uso terapêutico , Enurese/classificação , Humanos
11.
Z Evid Fortbild Qual Gesundhwes ; 144-145: 90-99, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31399391

RESUMO

BACKGROUND: Guideline developers can: (1) adopt existing recommendations from others; (2) adapt existing recommendations to their own context; or (3) create recommendations de novo. Monetary and nonmonetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes. OBJECTIVES: To describe a potentially efficient model for guideline production based on adoption, adaptation, and/or de novo development of recommendations utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks. STUDY DESIGN AND SETTING: We applied the model in a new national guideline program producing 22 practice guidelines. We searched for relevant evidence that informs the direction and strength of a recommendation. We then produced GRADE EtDs for guideline panels to develop recommendations. RESULTS: In two waves, a total of 80 EtD frameworks was produced approximately 4 months and 146 EtDs in about 6 months. Use of the EtD frameworks allowed panel members to understand judgments of other guideline groups about the criteria that bear on guideline recommendations and then make their own judgments about those criteria in a systematic approach. CONCLUSION: The "GRADE-ADOLOPMENT" approach to guideline production combines adoption, adaptation, and, as needed, de novo development of recommendations. If guideline developers apply EtD criteria more widely and make their work publically available, this approach should prove even more useful.


Assuntos
Tomada de Decisões , Medicina Baseada em Evidências , Guias de Prática Clínica como Assunto , Técnicas de Apoio para a Decisão , Assistência à Saúde , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Alemanha , Recursos em Saúde , Humanos , Guias de Prática Clínica como Assunto/normas
12.
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
13.
Crit Care Resusc ; 21(3): 162-170, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462203

RESUMO

BACKGROUND: The Standard versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial is a multinational randomised controlled trial that will enrol a minimum of 2866 patients comparing two strategies for initiating renal replacement therapy in critically ill patients with acute kidney injury. OBJECTIVE: To describe a pre-specified statistical analysis plan (SAP) for the STARRT-AKI trial before completion of patient recruitment and data collection. METHODS: The SAP was designed by the principal investigators and statisticians and approved by the international STARRT-AKI Steering Committee. The primary and secondary outcomes are defined, the approach to safety monitoring and data collection are summarised, and a detailed description of the planned statistical analyses, including pre-specified subgroup and secondary analyses, is described. RESULTS: We have developed the SAP for the STARRT-AKI trial, including a mock CONSORT diagram, figures and tables. The primary outcome is 90-day all-cause mortality. The primary analysis will be reported as a relative risk (95% CI), absolute risk difference (95% CI), and tested with the χ2 test. Secondary analyses of the primary outcome will include adjustment for baseline covariates and site, and evaluation for heterogeneity in treatment effect. Pre-specified subgroups will include patient sex, baseline kidney function, illness acuity, surgical status, presence of sepsis, and geographic location. CONCLUSION: To align with best practice standards for rigour, internal validity and transparency, we have developed a SAP for the STARRT-AKI trial before trial completion. The analysis will adhere to the SAP to avoid bias arising from knowledge of trial results. REGISTRATION: ClinicalTrials.gov identifier: NCT02568722 (6 October 2015).


Assuntos
Lesão Renal Aguda/terapia , Seleção de Pacientes , Terapia de Substituição Renal , Estatística como Assunto , Estado Terminal , Coleta de Dados , Humanos , Guias de Prática Clínica como Assunto/normas , Sepse
15.
J Stroke Cerebrovasc Dis ; 28(9): 2434-2441, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301984

RESUMO

BACKGROUND AND AIM: In recent years, interest in the quality of medical care has rapidly increased worldwide. However, quality indicators that contribute to establishing standard treatment in stroke medicine, especially rehabilitation, are not well-developed in Japan. Japan has established Kaifukuki (convalescent) rehabilitation wards, and the development of quality indicators for stroke rehabilitation in the convalescent phase is an urgent issue. METHODS: We first reviewed the literature regarding quality indicators for stroke rehabilitation. Next, we extracted candidate indicators from identified reports and guidelines and surveyed educational hospitals certified by the Japanese Association of Rehabilitation Medicine. On the basis of the survey results, we reevaluated the suitability of the proposed indicators in discussions with an expert panel. RESULTS: The questionnaire survey highlighted several important items that revealed there is room for improvement in adherence. For stroke rehabilitation in the convalescent phase, we adopted 15 indicators that were feasible as indicators to be used for comparisons between facilities, based on scoring by and opinions of the expert panel. These indicators measured structure (2 indicators), process (5 indicators), and outcome (8 indicators). CONCLUSION: This is the first study to establish quality indicators to standardize stroke rehabilitation in Japan. We developed this set of 15 indicators using an evidence-based approach. However, many tasks remain for continuous quality improvement.


Assuntos
Fidelidade a Diretrizes/normas , Avaliação de Processos e Resultados (Cuidados de Saúde)/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , Avaliação da Deficiência , Pesquisas sobre Serviços de Saúde , Nível de Saúde , Humanos , Japão/epidemiologia , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
16.
J Infus Nurs ; 42(4): 183-192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283660

RESUMO

Infusion-associated medication errors have the potential to cause the greatest patient harm. A 21-year review of errors and near-miss reports from a national medication error-reporting program found that infusion-associated medication errors resulted in the identification of numerous best practices that support patient safety. A content analysis revealed that most errors involved improper dosage, mistaken drug choice, knowledge-based mistakes, skill-based slips, and memory lapses. The multifaceted nature of administering medications via infusions was highlighted. Opportunities for improvements include best practices such as developing learning cultures and reinforcing the independent double-check process on medications. Staff will likely benefit from education on specific medications, prescription details, and smart pump technology.


Assuntos
Infusões Intravenosas/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Segurança do Paciente , Guias de Prática Clínica como Assunto/normas , Humanos , Near Miss , Recursos Humanos de Enfermagem no Hospital/educação
17.
Implement Sci ; 14(1): 71, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288828

RESUMO

BACKGROUND: Evidence-based clinical practice guidelines (CPGs) are relevant sources for generating quality indicators (QIs). The objective of this study was to compare guideline-based QIs of German and international CPGs and their underlying methodological approaches. METHODS: We conducted systematic searches in the guideline databases of G-I-N (Guidelines International Network) and NGC (National Guideline Clearinghouse) between February and June 2017 to identify international CPGs matching the topics of German evidence-based CPGs (n = 35) that report QIs, which were identified in a preceding study. Additionally, we searched the websites of the particular CPG providers for separate documents with regard to QIs. We included evidence-based CPGs which report QIs. Reported QIs, the underlying guideline recommendations, and information on methods of development were extracted. The selection and extraction of CPGs were conducted by one reviewer and checked by another. For each matched pair of CPGs, we assessed whether the suggested QIs matched or were not directly comparable. RESULTS: Twenty-five international CPGs, originating from seven CPG providers in total, met the criteria for inclusion. They matched the topics of 18 German CPGs. This resulted in 30 CPG pairs for the comparison of QIs (some of the international CPGs matched the topic of more than one German CPG). We found 27 QI pairs with QIs "not different or slightly different", corresponding to 13% (27 of 212) of the QIs in German CPGs and 16% (27 of 166) in international CPGs. Only two QI pairs were judged to be "different/inconsistent". For 183 of 212 (86%) QIs from German CPGs and 137 of 166 (83%) QIs from international CPGs, no direct comparison could be made. An explicit link to one or more guideline recommendations was found for 136 of 152 (89%) QIs from German CPGs and 82 of 166 (49%) QIs from international CPGs. Some information on methods for the development of QIs existed for 12 of 18 (67%) German CPGs and 8 of 25 (32%) international CPGs. CONCLUSIONS: The majority of QIs in German and international CPGs were not comparable. Various reasons for this are conceivable. More transparent reporting of the underlying methods for generating guideline-based QIs is needed.


Assuntos
Assistência à Saúde/normas , Guias de Prática Clínica como Assunto/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Bases de Dados Factuais , Alemanha , Humanos , Internacionalidade
18.
BMC Infect Dis ; 19(1): 601, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291899

RESUMO

BACKGROUND: Despite effective antiretroviral therapy developed over the last decade, HIV infection remains a major worldwide public health problem. Recently, a promising preventive treatment has been made available for HIV prophylaxis, PrEP for pre-ExPosure Prophylaxis. Indeed, it was shown to significantly reduce the risk of HIV infection in patients exposed to high risk of infection such as men having sex with men (MSM), heterosexuals and people who inject drugs. Several issues pertaining to PrEP remain uncertain including short and long-term adverse events, drug resistance, risk compensation and resurgence of other sexually transmitted infections. CASE PRESENTATION: We report a case of a 52-year-old MSM eligible for PrEP as he was exposed to a high risk of HIV infection, presented no clinical symptoms of HIV primary infection and was seronegative for HIV. PrEP therapy was then initiated with fixed association of emtricitabine-tenofovir disoproxil. One month later, HIV tests using two different assays were positive, despite perfect compliance reported by the patient and confirmed by plasma drug level. A retrospective search for plasma viral RNA in the blood sample before PrEP initiation turned out positive. Genotyping and treatment sensitivity performed on sample after one month of PrEP showed a virus resistance to lamivudine and emtricitabine. Similar cases in the literature and pivotal studies have reported HIV infections in patients initiating or undergoing PrEP. These patients where either infected but still seronegative, displaying no clinical symptoms upon enrollment, or became infected during PrEP. Reasons are mainly poor compliance to treatment, resistance to PrEP, and lack of diagnosis before PrEP. Guidelines advocate safe sex behavior before initiation, search for clinical signs of HIV primary infection and two different serologic tests performed with one-month interval. DISCUSSION AND CONCLUSIONS: Our patient newly HIV infected received PrEP as he was still seronegative. Current recommendations fail to screen recently HIV infected, but still seronegative patients who are initiating PrEP. This issue raises strong concerns regarding the lack of adequate selection for eligibility to PrEP and may contribute to exposing partners to HIV infection and select viral mutations. Infection risk could be minimized by search for plasma viral HIV RNA at pre-inclusion, at least for patients suspected of unsafe behaviors such as non-respect of the non-exposure period before PrEP initiation.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Profilaxia Pré-Exposição/normas , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral/efeitos dos fármacos , Farmacorresistência Viral/genética , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , RNA Viral/genética
19.
J Neurointerv Surg ; 11(6): 535-538, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31152058

RESUMO

BACKGROUND: Mechanical thrombectomy (MT) has become the cornerstone of acute ischemic stroke management in patients with large vessel occlusion (LVO). The aim of this guideline document is to assist physicians in their clinical decisions with regard to MT. METHODS: These guidelines were developed based on the standard operating procedure of the European Stroke Organisation, and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 15 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. RESULTS: We found high quality evidence to recommend MT plus best medical management (BMM, including intravenous thrombolysis whenever indicated) to improve functional outcome in patients with LVO related acute ischemic stroke within 6 hours after symptom onset. We found moderate quality of evidence to recommend MT plus BMM in the 6-24 hour time window in patients meeting the eligibility criteria of published randomized trials. These guidelines further detail aspects of prehospital management, patient selection based on clinical and imaging characteristics, and treatment modalities. CONCLUSIONS: MT is the standard of care in patients with LVO related acute stroke. Appropriate patient selection and timely reperfusion are crucial. Further randomized trials are needed to inform clinical decision making with regard to the mothership and drip-and-ship approaches, anesthaesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.


Assuntos
Isquemia Encefálica/terapia , Trombólise Mecânica/normas , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Acidente Vascular Cerebral/terapia , Administração Intravenosa , Isquemia Encefálica/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Trombólise Mecânica/métodos , Seleção de Pacientes , Reperfusão/métodos , Reperfusão/normas , Acidente Vascular Cerebral/epidemiologia
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