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2.
J Neuroimmunol ; 357: 577627, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34139567

RESUMO

In this consensus statement, we provide updated recommendations on multiple sclerosis (MS) management during the COVID-19 crisis and the post-pandemic period applicable to neurology services around the world. Statements/recommendations were generated based on available literature and the experience of 13 MS expert panelists using a modified Delphi approach online. The statements/recommendations give advice regarding implementation of telemedicine; use of disease-modifying therapies and management of MS relapses; management of people with MS at highest risk from COVID-19; management of radiological monitoring; use of remote pharmacovigilance; impact on MS research; implications for lowest income settings, and other key issues.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Internacionalidade , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/terapia , Guias de Prática Clínica como Assunto/normas , Gerenciamento Clínico , Humanos , Pandemias/prevenção & controle , Farmacovigilância , Telemedicina/normas , Telemedicina/tendências
3.
J Neuroimmunol ; 357: 577627, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: covidwho-1260801

RESUMO

In this consensus statement, we provide updated recommendations on multiple sclerosis (MS) management during the COVID-19 crisis and the post-pandemic period applicable to neurology services around the world. Statements/recommendations were generated based on available literature and the experience of 13 MS expert panelists using a modified Delphi approach online. The statements/recommendations give advice regarding implementation of telemedicine; use of disease-modifying therapies and management of MS relapses; management of people with MS at highest risk from COVID-19; management of radiological monitoring; use of remote pharmacovigilance; impact on MS research; implications for lowest income settings, and other key issues.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Internacionalidade , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/terapia , Guias de Prática Clínica como Assunto/normas , Gerenciamento Clínico , Humanos , Pandemias/prevenção & controle , Farmacovigilância , Telemedicina/normas , Telemedicina/tendências
4.
Am J Med Sci ; 362(1): 13-23, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34090669

RESUMO

Acute respiratory distress syndrome (ARDS) is a clinically and biologically heterogeneous disorder associated with a variety of disease processes that lead to acute lung injury with increased non-hydrostatic extravascular lung water, reduced compliance, and severe hypoxemia. Despite significant advances, mortality associated with this syndrome remains high. Mechanical ventilation remains the most important aspect of managing patients with ARDS. An in-depth knowledge of lung protective ventilation, optimal PEEP strategies, modes of ventilation and recruitment maneuvers are essential for ventilatory management of ARDS. Although, the management of ARDS is constantly evolving as new studies are published and guidelines being updated; we present a detailed review of the literature including the most up-to-date studies and guidelines in the management of ARDS. We believe this review is particularly helpful in the current times where more than half of the acute care hospitals lack in-house intensivists and the burden of ARDS is at large.


Assuntos
Gerenciamento Clínico , Oxigenação por Membrana Extracorpórea/normas , Guias de Prática Clínica como Assunto/normas , Respiração Artificial/normas , Síndrome do Desconforto Respiratório/terapia , Oxigenação por Membrana Extracorpórea/métodos , Humanos , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/normas , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/fisiopatologia
5.
Adv Skin Wound Care ; 34(6): 293-300, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1225635

RESUMO

GENERAL PURPOSE: To introduce the 15 recommendations of the International Ostomy Guideline (IOG) 2020, covering the four key arenas of education, holistic aspects, and pre- and postoperative care; and to summarize key concepts for clinicians to customize for translation into their practice. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Analyze supporting evidence for the education recommendations in the IOG 2020.2. Identify a benefit of the International Charter of Ostomate Rights.3. Distinguish concepts related to pre- and postoperative ostomy-related care.4. Select a potential barrier to IOG 2020 guideline implementation.


Assuntos
Pessoal de Saúde/educação , Estomia/reabilitação , Guias de Prática Clínica como Assunto/normas , Humanos , Equipe de Assistência ao Paciente/organização & administração , Higiene da Pele/métodos , Cicatrização
6.
Adv Skin Wound Care ; 34(6): 293-300, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33979817

RESUMO

GENERAL PURPOSE: To introduce the 15 recommendations of the International Ostomy Guideline (IOG) 2020, covering the four key arenas of education, holistic aspects, and pre- and postoperative care; and to summarize key concepts for clinicians to customize for translation into their practice. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Analyze supporting evidence for the education recommendations in the IOG 2020.2. Identify a benefit of the International Charter of Ostomate Rights.3. Distinguish concepts related to pre- and postoperative ostomy-related care.4. Select a potential barrier to IOG 2020 guideline implementation.


Assuntos
Pessoal de Saúde/educação , Estomia/reabilitação , Guias de Prática Clínica como Assunto/normas , Humanos , Equipe de Assistência ao Paciente/organização & administração , Higiene da Pele/métodos , Cicatrização
7.
Cancer Treat Rev ; 98: 102206, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33965893

RESUMO

BACKGROUND AND PURPOSE: Between 30% and 47% of patients treated with definitive radiotherapy (RT) for prostate cancer are at risk of intraprostatic recurrence during follow-up. Re-irradiation with stereotactic body RT (SBRT) is emerging as a feasible and safe therapeutic option. However, no consensus or guidelines exist on this topic. The purpose of this ESTRO ACROP project is to investigate expert opinion on salvage SBRT for intraprostatic relapse after RT. MATERIALS AND METHODS: A 40-item questionnaire on salvage SBRT was prepared by an internal committee and reviewed by a panel of leading radiation oncologists plus a urologist expert in prostate cancer. Following the procedure of a Delphi consensus, 3 rounds of questionnaires were sent to selected experts on prostate re-irradiation. RESULTS: Among the 33 contacted experts, 18 (54.5%) agreed to participate. At the end of the final round, participants were able to find consensus on 14 out of 40 questions (35% overall) and major agreement on 13 questions (32.5% overall). Specifically, the consensus was reached regarding some selection criteria (no age limit, ECOG 0-1, satisfactory urinary flow), diagnostic procedures (exclusion of metastatic disease, SBRT target defined on the MRI) and therapeutic approach (no need for concomitant ADT, consideration of the first RT dose, validity of Phoenix criteria for salvage SBRT failure). CONCLUSION: While awaiting the results of ongoing studies, our ESTRO ACROP Delphi consensus may serve as a practical guidance for salvage SBRT. Future research should address the existing disagreements on this promising approach.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Guias de Prática Clínica como Assunto/normas , Neoplasias da Próstata/cirurgia , Radiocirurgia/métodos , Terapia de Salvação/métodos , Consenso , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Neoplasias da Próstata/patologia
8.
Cancer Treat Rev ; 98: 102209, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33984606

RESUMO

Children and adolescents and young adults (AYAs) with cancer are often treated with a multidisciplinary approach. This includes use of radiotherapy, which is important for local control, but may also cause adverse events in the long term, including second cancer. The risks for limited growth and development, endocrine dysfunction, reduced fertility and second cancer in children and AYAs are reduced by proton beam therapy (PBT), which has a dose distribution that decreases irradiation of normal organs while still targeting the tumor. To define the outcomes and characteristics of PBT in cancer treatment in pediatric and AYA patients, this document was developed by the Japanese Society for Radiation Oncology (JASTRO) and the Japanese Society of Pediatric Hematology/Oncology (JSPHO).


Assuntos
Neoplasias/radioterapia , Guias de Prática Clínica como Assunto/normas , Terapia com Prótons/métodos , Adolescente , Adulto , Criança , Humanos , Neoplasias/patologia , Sociedades Médicas , Adulto Jovem
9.
Rev Gaucha Enferm ; 42(spe): e20200150, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34037178

RESUMO

OBJECTIVE: To summarize the knowledge about recommendations for the use of personal protective equipment necessary for the provision of care by health professionals to patients suspected or infected by the new coronavirus. METHOD: Scoping review with search for primary studies, reviews and preprints articles in English, Portuguese and Spanish, in the last 20 years on the bases WOS/ISI, SCOPUS, MEDLINE/PuBMed, CINAHL, LILACS and SciELO. Unpublished studies in journals were surveyed on bioRxiv and SciELO preprints. RESULTS: 23 studies were eligible. Experiences with coronavirus prior to SARS-CoV-2 revealed that the equipment was an essential barrier in preventing transmission and followed the recommendations for standard precautions, contact, droplet and aerosol. In 13 (57%) studies, this equipment complied international recommendations and in 10 (45%) local recommendations. CONCLUSION: The personal protective equipment used does not follow global standardization according to type, quality and adequate provision, exposing these professionals to the risk of contamination.


Assuntos
COVID-19/terapia , COVID-19/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamento de Proteção Individual/normas , Guias de Prática Clínica como Assunto/normas , Infecções por Coronavirus/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/normas
10.
Cancer Treat Rev ; 97: 102191, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34015728

RESUMO

Non-clear cell renal cell carcinomas (nccRCC) represent a highly heterogeneous group of kidney tumors, consisting of the following subtypes: papillary carcinomas, chromophobe renal cell carcinoma, so-called unclassified carcinomas or aggressive uncommon carcinomas such as Bellini carcinoma, renal cell carcinoma (RCC) with ALK rearrangement or fumarate hydratase-deficient RCC. Although non-clear cell cancers account for only 15 to 30% of renal tumors, they are often misclassified and accurate diagnosis continues to be an issue in clinical practice. Current therapeutic strategy of metastatic nccRCC is based primarily on guidelines established for clear cell tumors, the most common subtype, however this approach remains poorly defined. To date, published clinical trials for all histological nccRCC subtypes have been collectively characterized into one group, in contrast to clear cell RCC, and given the small numbers of cases, the interpretation of study results continues to be challenging. This review summarizes the available literature for each nccRCC subtype and highlights the lack of supportive evidence from prospective clinical trials and retrospective studies. Future trials should evaluate treatment approaches which focus on a specific histological subtype and progress in treating nccRCC will be contingent on understanding the unique biology of their individual histologies.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Guias de Prática Clínica como Assunto/normas , Carcinoma de Células Renais/classificação , Carcinoma de Células Renais/tratamento farmacológico , Humanos , Neoplasias Renais/classificação , Neoplasias Renais/tratamento farmacológico , Prognóstico
11.
BMC Pregnancy Childbirth ; 21(1): 322, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892640

RESUMO

BACKGROUND: Health professionals caring for women and infants experiencing difficulty with breastfeeding have reported deficiencies in evidence-based lactation knowledge. LactaMap is an online lactation care support system with more than 100 clinical practice guidelines to support breastfeeding care. Clinical practice guidelines support medical decision-making by summarising scientific evidence into systematically developed statements for specific clinical circumstances. Both common-sense and theory-based approaches have been used for guideline development and debate continues regarding which is superior. LactaMap clinical practice guidelines were created over the course of 5 years using a common-sense approach that was refined inductively. The aim of this study was to incorporate a theory-based framework approach into the methodology for ongoing update and review of LactaMap clinical practice guidelines. METHODS: The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was chosen as the framework-based approach to appraise LactaMap guideline quality. The study was conducted in two phases. The first phase appraised all 103 original LactaMap guidelines. The second phase appraised a subset of 15 updated LactaMap guidelines using improved methodology guided by phase 1, as well as 15 corresponding original (un-updated) guidelines. RESULTS: Mean Domain scores for 103 LactaMap original guidelines were above 75% in 3 of the 6 AGREE II quality Domains and no mean Domain score rated poorly. Update of guideline methodology was guided by phase 1 appraisals. Improved documentation of methods relating to questions in the Rigour of Development Domain resulted in improvement in mean Domain score from 39 to 72%. CONCLUSIONS: This study showed that a theory-based approach to guideline development methodology can be readily integrated with a common-sense approach. Factors identified by AGREE II theory-based framework provided practical guidance for changes in methodology that were integrated prior to LactaMap website publication. Demonstration of high quality in LactaMap clinical practice guideline methodology ensures clinicians and the public can have trust that the content founded on them is robust, scientific and of highest possible quality.


Assuntos
Aleitamento Materno/métodos , Cuidado do Lactente , Intervenção Baseada em Internet , Sistemas On-Line , Cuidado Pós-Natal , Guias de Prática Clínica como Assunto/normas , Adulto , Prática Clínica Baseada em Evidências , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Cuidado do Lactente/métodos , Cuidado do Lactente/normas , Recém-Nascido , Lactação , Determinação de Necessidades de Cuidados de Saúde , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Gravidez
12.
Maturitas ; 148: 55-61, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33896654

RESUMO

INTRODUCTION: Vulvovaginal atrophy (VVA) is a chronic condition caused by estrogen deficiency. It affects around 50% of postmenopausal women, reducing their general and sexual quality of life as well as the quality of their personal relationships. AIM: The aim of this clinical guide is to set out an individualized approach to the management of VVA with topical estrogens and non-hormonal preparations. MATERIALS AND METHODS: Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS: An individualized approach is required for the management of VVA. Topical low-dose estrogens are effective and also alleviate urinary incontinence and prevent recurrent urinary tract infections. Women should not be denied long-term use of topical estrogens as long as they feel that this treatment is of benefit to them, because the safety data are reassuring. Non-hormonal preparations (lubricants and moisturizers) should be the first-line treatment for VVA in women taking adjuvant endocrine therapies for cancers considered to be hormone-dependent. They can be used over the long term.


Assuntos
Atrofia/tratamento farmacológico , Estrogênios/administração & dosagem , Pós-Menopausa , Guias de Prática Clínica como Assunto/normas , Doenças Vaginais/tratamento farmacológico , Doenças da Vulva/tratamento farmacológico , Administração Intravaginal , Prova Pericial , Feminino , Humanos , Qualidade de Vida
13.
BMC Gastroenterol ; 21(1): 186, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882844

RESUMO

BACKGROUND: In contrast to adults, for whom guidelines on the cholelithiasis treatment exist, there is no consistent treatment of pediatric patients with cholelithiasis throughout national and international departments, most probably due to the lack of evidence-based studies. METHODS: We evaluated the German management of pediatric cholelithiasis in a dual approach. Firstly, a retrospective, inter-divisional study was established, comparing diagnostics and therapy of patients of the pediatric surgery department with the management of patients aged < 25 years of the visceral surgery department in our institution over the past ten years. Secondarily, a nation-wide online survey was implemented through the German Society of Pediatric Surgery. RESULTS: Management of pediatric patients with cholelithiasis was primarily performed by pediatricians in the retrospective analysis (p < 0.001). Pediatric complicated cholelithiasis was not managed acutely in the majority of cases with a median time between diagnosis and surgery of 22 days (range 4 days-8 months vs. 3 days in visceral surgery subgroup (range 0 days-10 months), p = 0.003). However, the outcome remained comparable. The hospital's own results triggered a nation-wide survey with a response rate of 38%. Primary pediatric medical management of patients was confirmed by 36 respondents (71%). In case of acute cholecystitis, 22% of participants perform a cholecystectomy within 24 h after diagnosis. Open questions revealed that complicated cholelithiasis is managed individually. CONCLUSIONS: The management of pediatric cholelithiasis differs between various hospitals and between pediatricians and pediatric surgeons. Evidence-based large-scale population studies as well as a common guideline may represent very important tools for treating this increasing diagnosis.


Assuntos
Colecistectomia Laparoscópica , Colecistite , Colelitíase , Guias de Prática Clínica como Assunto/normas , Adolescente , Adulto , Criança , Colecistite/complicações , Colecistite/diagnóstico , Colecistite/cirurgia , Colecistite/terapia , Colelitíase/complicações , Colelitíase/diagnóstico , Colelitíase/cirurgia , Colelitíase/terapia , Feminino , Alemanha , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pediatras , Estudos Retrospectivos , Cirurgiões , Adulto Jovem
14.
Lancet Glob Health ; 9(6): e875-e879, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33765437

RESUMO

To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middle-income countries through co-creation with end-users, and we encourage global sharing of these experiences.


Assuntos
COVID-19/terapia , Países em Desenvolvimento , Guias de Prática Clínica como Assunto/normas , COVID-19/epidemiologia , Humanos , Justiça Social
15.
J Neurointerv Surg ; 13(7): 674-678, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33722972

RESUMO

The purpose of this publication is to provide a review of social media usage by neurointerventionalists. Using published literature and available local, regional, and national guidelines or laws, we reviewed data on social media usage as it pertains to neurointerventional surgery. Recommendations are provided based on the quality of information and conformity of medico-legal precedent and law. Social media is a growing entity as it is used both promotionally and educationally. Neurointerventionalists may post de-identified radiographic images with discussions, but should be conscientious and adhere to applicable laws and regulations, strict ethical codes, and institutional policies.


Assuntos
Neurocirurgiões/normas , Procedimentos Neurocirúrgicos/normas , Guias de Prática Clínica como Assunto/normas , Relatório de Pesquisa , Mídias Sociais , Sociedades Médicas/normas , Humanos , Neurocirurgiões/tendências , Procedimentos Neurocirúrgicos/tendências , Mídias Sociais/tendências , Sociedades Médicas/tendências
16.
Lancet Glob Health ; 9(6): e875-e879, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1145020

RESUMO

To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middle-income countries through co-creation with end-users, and we encourage global sharing of these experiences.


Assuntos
COVID-19/terapia , Países em Desenvolvimento , Guias de Prática Clínica como Assunto/normas , COVID-19/epidemiologia , Humanos , Justiça Social
18.
Fertil Steril ; 115(4): 831-839, 2021 04.
Artigo em Inglês | MEDLINE | ID: covidwho-1131298

RESUMO

The coronavirus disease 2019 pandemic has resulted in many changes in how we interact in society, requiring that we protect ourselves and others from an invisible, airborne enemy called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Until a vaccine is developed, and it reaches high levels of distribution, everyone must continue to be diligent to limit the viral spread. The practice of assisted reproduction during this pandemic presents unique challenges in addition to the risks identified in general clinical care. The established good tissue practices employed in laboratories are not designed to protect gametes and embryos from an airborne virus, particularly one that may be shed by an asymptomatic staff member. Armed with theoretical risks but lacking direct evidence, assisted-reproduction teams must examine every aspect of their practice, identify areas at a risk of exposure to SARS-CoV-2, and develop a mitigation plan. Several professional fertility societies have created guidelines for the best practices in patient care during the coronavirus disease 2019 pandemic. As we learn more about SARS-CoV-2, updates have been issued to help adapt infection-control and -prevention protocols. This review discusses what is currently known about SARS-CoV-2 infection risks in assisted reproductive centers and recommends the implementation of specific mitigation strategies.


Assuntos
COVID-19/prevenção & controle , Pessoal de Saúde/normas , Controle de Infecções/normas , Equipamento de Proteção Individual/normas , Guias de Prática Clínica como Assunto/normas , Técnicas de Reprodução Assistida/normas , COVID-19/epidemiologia , COVID-19/transmissão , Humanos , Controle de Infecções/métodos , Medição de Risco/métodos , Medição de Risco/normas , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/prevenção & controle , Síndrome Respiratória Aguda Grave/transmissão
19.
Am J Clin Oncol ; 44(5): 210-223, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33710135

RESUMO

BACKGROUND: Although included in surveillance programmes for colorectal cancer (CRC) metastases, elderly patients are susceptible to declines in health and quality of life that may render them unsuitable for further surveillance. Deciding when to cease surveillance is challenging. METHODS: There are no publications focused on surveillance of elderly patients for CRC metastases. A systematic review of studies reporting treatment outcomes for CRC metastases in elderly patients was performed to assess the risk-benefit balance of the key objectives of surveillance; detecting and treating CRC metastases. RESULTS: Sixty-eight eligible studies reported outcomes for surgery and chemotherapy in the elderly. Liver resections and use of chemotherapy, including biologics, are more conservative and have poorer outcomes in the elderly compared with younger patients. Selected studies demonstrated poorer quality-of-life (QoL) following surgery and chemotherapy. Studies of ablation in elderly patients are limited. DISCUSSION: The survival benefit of treating CRC metastases with surgery or chemotherapy decreases with advancing age and QoL may decline in the elderly. The relatively lower efficacy and detrimental QoL impact of multimodal therapy options for detected CRC metastases in the elderly questions the benefit of surveillance in some elderly patients. Care of elderly patients should thus be customized based on their preference, formal geriatric assessment, natural life-expectancy, and the perceived risk-benefit balance of treating recurrent CRC metastases. Clinicians may consider surveillance cessation in patients aged 75 years and above if geriatric assessment is unsatisfactory, patients decline surveillance, or patient fitness deteriorates catastrophically.


Assuntos
Neoplasias Colorretais/terapia , Neoplasias Hepáticas/terapia , Guias de Prática Clínica como Assunto/normas , Qualidade de Vida , Conduta Expectante/normas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/patologia , Terapia Combinada , Hepatectomia , Humanos , Neoplasias Hepáticas/patologia , Prognóstico , Taxa de Sobrevida
20.
Best Pract Res Clin Anaesthesiol ; 35(1): 27-39, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33742575

RESUMO

Pediatric anesthesia is large part of anesthesia clinical practice. Children, parents and anesthesiologists fear anesthesia because of the risk of acute morbidity and mortality. Modern anesthesia in otherwise healthy children above 1 year of age in developed countries has become very safe due to recent advance in pharmacology, intensive education, and training as well as centralization of care. In contrast, anesthesia in these children in low-income countries is associated with a high risk of mortality due to lack of basic resources and adequate training of health care providers. Anesthesia for neonates and toddlers is associated with significant morbidity and mortality. Anesthesia-related (near) critical incidents occur in 5% of anesthetic procedures and are largely dependent on the skills and up-to-date knowledge of the whole perioperative team in the specific needs for children. An investment in continuous medical education of the perioperative staff is required and international standard operating protocols for common procedures and critical situations should be defined.


Assuntos
Anestesiologia/normas , Pesquisa Biomédica/normas , Pediatria/normas , Assistência Perioperatória/normas , Guias de Prática Clínica como Assunto/normas , Qualidade da Assistência à Saúde/normas , Anestesia/efeitos adversos , Anestesia/mortalidade , Anestesia/normas , Pesquisa Biomédica/métodos , Humanos , Assistência Perioperatória/mortalidade
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