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1.
Khirurgiia (Mosk) ; (1): 93-97, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395519

RESUMO

It is very difficult to find certain surgical field in which surgeon's decision is absolutely evidence-based. The objective of evidence-based medicine (and surgery) is offering the best treatment for each patient that should encourage conducting the randomized trials (RT) as the highest level of evidence. The results of RTs often contradict the existing clinical experience, and experience per se does not always confirm the significance of the results obtained. One cannot make any conclusions based on RT data. Treatment strategy for a particular patient remains unclear. The authors have analyzed the results of large-scale RTs devoted to laparoscopic cholecystectomy, rectal surgery, lung cancer surgery, postoperative care, treatment of pulmonary emphysema. It was shown that RT data as the highest level of evidence are not always true for surgery. In most clinical situations, the decision is not based on RT results. The desire of surgeons to master a new technique is often more significant than patient care, while clinical experience and the laws of the market are more important than science. There is no doubt that knowledge of RT results are essential in training period, but this means quite a bit for a particular patient. The best decision can be made during discussion and conversation with colleagues, where an experience of each specialist will have the same value as the best evidence.


Assuntos
Medicina Baseada em Evidências/normas , Medicina de Precisão/normas , Prática Profissional/normas , Qualidade da Assistência à Saúde/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Operatórios , Colecistectomia Laparoscópica , Competência Clínica/normas , Tomada de Decisões , Procedimentos Cirúrgicos do Sistema Digestório , Medicina Baseada em Evidências/métodos , Humanos , Relações Interprofissionais , Cuidados Pós-Operatórios/normas , Enfisema Pulmonar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas
2.
Urology ; 147: 21-26, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32979378

RESUMO

OBJECTIVES: To explore the perspective of urological patients on the possibility to defer elective surgery due to the fear of contracting COVID-19. METHODS: All patients scheduled for elective urological procedures for malignant or benign diseases at 2 high-volume centers were administered a questionnaire, through structured telephone interviews, between April 24 and 27, 2020. The questionnaire included 3 questions: (1) In light of the COVID-19 pandemic, would you defer the planned surgical intervention? (2) If yes, when would you be willing to undergo surgery? (3) What do you consider potentially more harmful for your health: the risk of contracting COVID-19 during hospitalization or the potential consequences of delaying surgical treatment? RESULTS: Overall, 332 patients were included (51.5% and 48.5% in the oncology and benign groups, respectively). Of these, 47.9% patients would have deferred the planned intervention (33.3% vs 63.4%; P < .001), while the proportion of patients who would have preferred to delay surgery for more than 6 months was comparable between the groups (87% vs 80%). These answers were influenced by patient age and American Society of Anesthesiologists score (in the Oncology group) and by the underlying urological condition (in the benign group). Finally, 182 (54.8%) patients considered the risk of COVID-19 potentially more harmful than the risk of delaying surgery (37% vs 73%; P < .001). This answer was driven by patient age and the underlying disease in both groups. CONCLUSIONS: Our findings reinforce the importance of shared decision-making before urological surgery, leveraging patients' values and expectations to refine the paradigm of evidence-based medicine during the COVID-19 pandemic and beyond.


Assuntos
/prevenção & controle , Procedimentos Cirúrgicos Eletivos/normas , Pandemias/prevenção & controle , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Idoso , Idoso de 80 Anos ou mais , /transmissão , Tomada de Decisão Compartilhada , Medicina Baseada em Evidências/normas , Feminino , Hospitais com Alto Volume de Atendimentos/normas , Humanos , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Masculino , Pessoa de Meia-Idade , Preferência do Paciente/estatística & dados numéricos , Estudos Prospectivos , Inquéritos e Questionários/estatística & dados numéricos , Tempo para o Tratamento/normas , Urologia/normas
4.
Tech Vasc Interv Radiol ; 23(3): 100695, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308532

RESUMO

Medically refractory benign prostatic hyperplasia induced lower urinary tract symptoms is an extremely prevalent issue in older men. The current gold standard therapy transurethral resection of the prostate does produce urologic improvements but is also associated with higher than desired morbidity. This has led to the need to develop new minimally invasive means to treat this disease; prostate artery embolization (PAE) has emerged as one minimally invasive treatment option for these patients. The body of evidence which supports the use of PAE has grown quickly and substantially over the last decade. The goal of this review is to introduce and summarize the published urologic outcomes for PAE when utilized to treat benign prostatic hyperplasia induced lower urinary tract symptoms as well as document the established complication profile. Finally, the paper reviews current societal recommendations as they relate to PAE.


Assuntos
Embolização Terapêutica/normas , Medicina Baseada em Evidências/normas , Sintomas do Trato Urinário Inferior/terapia , Guias de Prática Clínica como Assunto/normas , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/normas , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Radiografia Intervencionista/efeitos adversos , Recuperação de Função Fisiológica , Resultado do Tratamento , Urodinâmica
5.
Am J Respir Crit Care Med ; 202(10): e121-e141, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-33185464

RESUMO

Background: Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations.Recommendations: The panel found varying quality and availability of evidence and made the following judgments: 1) strong recommendations for long-term oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe chronic resting hypoxemia, 2) a conditional recommendation against long-term oxygen use in patients with COPD with moderate chronic resting hypoxemia, 3) conditional recommendations for ambulatory oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe exertional hypoxemia, 4) a conditional recommendation for ambulatory liquid-oxygen use in patients who are mobile outside the home and require >3 L/min of continuous-flow oxygen during exertion (very-low-quality evidence), and 5) a recommendation that patients and their caregivers receive education on oxygen equipment and safety (best-practice statement).Conclusions: These guidelines provide the basis for evidence-based use of home oxygen therapy in adults with COPD or ILD but also highlight the need for additional research to guide clinical practice.


Assuntos
Medicina Baseada em Evidências/normas , Serviços de Assistência Domiciliar/normas , Doenças Pulmonares Intersticiais/terapia , Oxigenoterapia/métodos , Oxigenoterapia/normas , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sociedades Médicas , Estados Unidos
6.
J Thromb Haemost ; 18(11): 3099-3105, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33174388

RESUMO

BACKGROUND: Observational studies indicate that children hospitalized with COVID-19-related illness, like adults, are at increased risk for venous thromboembolism (VTE). A multicenter phase 2 clinical trial of anticoagulant thromboprophylaxis in children hospitalized with COVID-19-related illness has recently been initiated in the United States. To date, there remains a paucity of high-quality evidence to inform clinical practice world-wide. Therefore, the objective of this scientific statement is to provide consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses, and to identify priorities for future research. METHODS: We surveyed 20 pediatric hematologists and pediatric critical care physicians from several continents who were identified by Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee leadership as having experience and expertise in the use of anticoagulant thromboprophylaxis and/or the management of COVID-19-related illness in children. A comprehensive review of the literature on COVID-19 in children was also performed. RESULTS: Response rate was 90%. Based on consensus of expert opinions, we suggest the administration of low-dose low molecular weight heparin subcutaneously twice-daily as anticoagulant thromboprophylaxis (in the absence of contraindications, and in combination with mechanical thromboprophylaxis with sequential compression devices, where feasible) in children hospitalized for COVID-19-related illness (including the multisystem inflammatory syndrome in children [MIS-C]) who have markedly elevated D-dimer levels or superimposed clinical risk factors for hospitalassociated VTE. For children who are clinically unstable or have severe renal impairment, we suggest the use of unfractionated heparin by continuous intravenous infusion as anticoagulant thromboprophylaxis. In addition, continued efforts to characterize VTE risk and risk factors in children with COVID-19, as well as to evaluate the safety and efficacy of anticoagulant thromboprophylaxis strategies in children hospitalized with COVID-19-related illness (including MIS-C) via cooperative multicenter trials, were identified among several key priorities for future research. CONCLUSION: These consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses and priorities for future research will be updated as high-quality evidence emerges.


Assuntos
Anticoagulantes/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Medicina Baseada em Evidências/normas , Hospitalização , Pneumonia Viral/tratamento farmacológico , Pesquisa/normas , Tromboembolia Venosa/prevenção & controle , Adolescente , Fatores Etários , Anticoagulantes/efeitos adversos , Criança , Pré-Escolar , Tomada de Decisão Clínica , Consenso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Pesquisas sobre Serviços de Saúde , Humanos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/sangue , Tromboembolia Venosa/etiologia , Adulto Jovem
7.
Injury ; 51(12): 2757-2762, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33162011

RESUMO

AIMS: Approximately 75% of fractures are simple, stable injuries which are often unnecessarily immobilised with subsequent repeated radiographs at numerous fracture clinic visits. In 2014, the Glasgow Fracture Pathway offered an alternative virtual fracture clinic (VFC) pathway with the potential to reduce traditional fracture clinic visits, waiting times and overall costs. Many units have implemented this style of pathway in the non-operative management of simple, undisplaced fractures. This study aims to systematically review the clinical outcomes, patient reported outcomes and cost analyses for VFCs. MATERIALS AND METHODS: Two independent reviewers performed the literature search based on PRISMA guidelines, utilizing the MEDLINE, EMBASE and COCHRANE Library databases. Studies reporting outcomes following the use of VFC were included. Outcomes analysed were: 1) clinical outcomes, 2) patient reported outcomes, and 3) cost analysis. RESULTS: Overall, 15 studies involving 11,921 patients with a mean age of 41.1 years and mean follow-up of 12.6 months were included. In total, 65.7% of patients were directly virtually discharged with protocol derived conservative management, with 9.1% using the Helpline and 15.6% contacting their general practitioner for advice or reassurance. A total of 1.2% of patients experienced fracture non-unions and 0.4% required surgical intervention. The overall patient satisfaction rate was 81.0%, with only 1.3% experiencing residual pain at the fracture site. Additionally, the mean cost per patient for VFC was £71, with a mean saving of £53 when compared to traditional clinic models. Subgroup analysis found that for undisplaced fifth metatarsal or radial head/neck fractures, the rates of discharge from VFC to physiotherapy or general practitioners were 81.2% and 93.7% respectively. DISCUSSION AND CONCLUSION: This study established that there is excellent evidence to support virtual fracture clinic for non-operative management of fifth metatarsal fractures, with moderate evidence for radial head and neck fractures. However, the routine use of virtual fracture clinics is presently not validated for all stable, undisplaced fracture patterns. LEVEL OF EVIDENCE: IV; Systematic Review of all Levels of Evidence.


Assuntos
/prevenção & controle , Medicina Baseada em Evidências/métodos , Fraturas Ósseas/diagnóstico , Ortopedia/métodos , Consulta Remota/métodos , /epidemiologia , Controle de Doenças Transmissíveis/normas , Análise Custo-Benefício , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/normas , Fraturas Ósseas/terapia , Humanos , Ortopedia/economia , Ortopedia/organização & administração , Ortopedia/normas , Satisfação do Paciente , Consulta Remota/economia , Consulta Remota/organização & administração , Consulta Remota/normas , Resultado do Tratamento
8.
Nutr Metab Cardiovasc Dis ; 30(11): 1882-1898, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-32998820

RESUMO

AIMS: Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects. DATA SYNTHESIS: Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior. CONCLUSIONS: There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use. This article is co-published in the journals Sport Sciences for Health and Nutrition, Metabolism and Cardiovascular Diseases.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/terapia , Medicina Baseada em Evidências/normas , Terapia por Exercício , Caminhada , Adulto , Idoso , Biomarcadores/sangue , Consenso , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Resultado do Tratamento , Perda de Peso
10.
Sports Health ; 12(6): 540-546, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936058

RESUMO

CONTEXT: With increased use of cannabis-based products by the public for both recreational and medical use, sports medicine clinicians should be informed of historical context, current legal considerations, and existing evidence with regard to efficacy, safety, and risks in the athletic community. EVIDENCE ACQUISITION: A review of ClinicalTrials.gov, MEDLINE, and CINAHL from 2015 to present was conducted with emphasis on the most recent literature using search terms, cannabis, nabiximols, cannabinoids, pain management, THC, CBD, and marijuana. Bibliographies based on original search were utilized to pursue further literature search. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: At present, limited high-quality studies exist for use of cannabinoids for acute pain, chronic pain, or concussion. None of the trials involving cannabinoids included the athletic population. Thus, results from this clinical review are extrapolated to conditions of the sports medicine population. For acute pain, 2 small-randomized double-blinded crossover trials concluded no immediate effect of cannabinoid therapy. More robust evidence exists for treatment of chronic pain conditions through meta-analysis and systemic reviews. Cannabinoid therapy exhibits moderate efficacy as a treatment for some chronic pain conditions. Investigations included a broad spectrum of chronic pain conditions, including neuropathic, musculoskeletal, inflammatory, and central pain conditions, and reveal reduction in pain and improvement of quality of life with limited adverse effects. For concussion, evidence is based on preclinical in vitro and animal models revealing possible neuroprotective effects as well as 2 clinical studies involving the presence of cannabinoids for concussion (some sports-related), but there are no high-quality trials evaluating efficacy for treatment with cannabinoids at this time. CONCLUSION: Although various biochemical explanations exist on the use of cannabinoid therapy through modulation of the endocannabinoid system for several medical issues affecting athletes, recommendations from clinicians must be extrapolated from a majority of research done in the nonathletic population. Lack of strong-quality clinical evidence, coupled with inconsistent federal and state law as well as purity issues with cannabis-based products, make it difficult for the sports medicine clinician to widely recommend cannabinoid therapeutics at present. Future larger, higher quality clinical research studies with standardized pure extracts will better guide appropriate medical use going forward. At present, evidence for a multitude of therapeutic applications is emerging for cannabinoid treatment approaches. With emphasis placed on patient-centered clinical decisions, cannabinoids hold promise of treatment for athletes with chronic pain conditions. Clinicians who treat the athletic community must consider legal and ethical issues when discussing and recommending the use of cannabinoids, with acknowledgment of inconsistencies in purity of various formulations and concerns of drug testing.


Assuntos
Traumatismos em Atletas/complicações , Canabinoides/uso terapêutico , Maconha Medicinal/uso terapêutico , Manejo da Dor/métodos , Dor Aguda/tratamento farmacológico , Traumatismos em Atletas/tratamento farmacológico , Concussão Encefálica/tratamento farmacológico , Canabinoides/efeitos adversos , Dor Crônica/tratamento farmacológico , Medicina Baseada em Evidências/normas , Humanos , Uso da Maconha/legislação & jurisprudência , Maconha Medicinal/efeitos adversos , Estados Unidos
11.
J Clin Neurophysiol ; 37(5): 399-405, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890061

RESUMO

Status epilepticus (SE), treatment-refractory status epilepticus (RSE), and super-treatment-refractory status epilepticus (SRSE) are associated with increased morbidity, mortality, and high socioeconomic burden and pose significant treatment challenges for intensivists and neurologists. To optimize and streamline emergency treatment, current practice guidelines recommend the use of continuously delivered intravenous anesthetic drugs such as midazolam, propofol, or barbiturates as the third-line therapy after first-line and second-line treatments have failed. Although the rationale for these third-line drugs seems intuitive at first glance, there is a clear paucity of evidence-based data on risks, benefits, and even on the choice of a third-line agent. Recent studies into safety and efficacy reveal disturbing results, such as a poor outcome and higher mortality associated with the use of intravenous anesthetic drugs, especially in patients with nonconvulsive SE without coma and in patients with out-of-hospital SE onset. Clinicians should deliberately weigh the advantages and disadvantages of intravenous anesthetic drug therapy in patients with different types of SE usually linked to a favorable outcome (i.e., simple partial, complex partial, or absence seizures). The lack of data to support evidence-based medicine prompts a careful balance of individual risks and benefits of intravenous anesthetic drug therapy in patients with SE, treatment-refractory SE, and super-RSE.


Assuntos
Anestésicos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Estado Epiléptico/tratamento farmacológico , Anestésicos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Encéfalo/efeitos dos fármacos , Bases de Dados Factuais/normas , Epilepsia Resistente a Medicamentos/diagnóstico , Medicina Baseada em Evidências/normas , Humanos , Neurologistas/normas , Estado Epiléptico/diagnóstico
12.
J Fam Pract ; 69(7): 336;338;340;343, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32936841

RESUMO

What are the limits of skin-prick testing? Is prevention possible? And do most children outgrow food allergies? This review provides the evidence to guide your care.


Assuntos
Anafilaxia/prevenção & controle , Medicina Baseada em Evidências/normas , Medicina de Família e Comunidade/normas , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/prevenção & controle , Guias de Prática Clínica como Assunto , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estados Unidos
13.
JCO Glob Oncol ; 6: 1455-1460, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32997540

RESUMO

The core pillars of multimodal care of patients with cancer are surgical, radiation, and medical oncology. The global pandemic of coronavirus disease 2019 (COVID-19) has suddenly resurrected a new pillar in oncology care: teleoncology. With oncologists reaching out to patients through telemedicine, it is possible to evaluate and fulfill patients' needs; triage patients for elective procedures; screen them for influenza-like illness; provide them with guidance for hospital visits, if needed; and bridge oral medications and treatments when a hospital visit is not desirable because of any high risk-benefit ratio. Teleoncology can bring great reassurance to patients at times when reaching an oncology center is challenging, and more so in resource-constrained countries. Evidence-based treatment protocols, dispensable by teleoncology, already exist for many sites of cancer and they can provide a bridge to treatment when patients are unable to reach cancer centers for their standard treatment. The young pillar of teleoncology is going to remain much longer than COVID-19.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Oncologia/organização & administração , Neoplasias/diagnóstico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Medicina Baseada em Evidências/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Oncologia/métodos , Oncologia/normas , Oncologia/tendências , Neoplasias/terapia , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Telemedicina/normas , Telemedicina/tendências , Triagem/métodos , Triagem/organização & administração , Triagem/normas
15.
Eur J Cancer ; 137: 235-239, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32805640

RESUMO

The outbreak of the Coronavirus disease (COVID-19) pandemic has deeply challenged healthcare systems and care of patients with cancer. Phase 1 studies are among the most complicated clinical trials and require thorough patient selection, as well as intensive patient monitoring. In this perspective, we discuss the key factors that should be considered for the conduct of phase 1 trials and management of COVID-19-positive patients with cancer enrolled in such trials. We notably present the risks and challenges raised by COVID-19-infected phase 1 patients, in terms of safety, toxicity causality assessment, drug efficacy evaluation and clinical research priorities. We finally propose some guidelines for the conduct of phase 1 trials and management of COVID-19-infected patients in a pandemic time.


Assuntos
Antineoplásicos/efeitos adversos , Ensaios Clínicos Fase I como Assunto/normas , Infecções por Coronavirus/terapia , Neoplasias/tratamento farmacológico , Seleção de Pacientes , Pneumonia Viral/terapia , Betacoronavirus/imunologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Medicina Baseada em Evidências/normas , Humanos , Controle de Infecções/normas , Oncologia/normas , Neoplasias/imunologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Resultado do Tratamento
17.
Stroke Vasc Neurol ; 5(3): 270-278, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32792457

RESUMO

AIM: Cerebrovascular disease is the leading cause of death and disability in China, causing a huge burden among patients and their families. Hence, stroke prevention is critical, especially in the high-risk population. Here, we present the evidence-based guideline suitable for the Chinese population. METHODS: Literature search of PubMed and Cochrane library (from January 1964 to June 2019) was done. After thorough discussion among the writing group members, recommendations were listed and summarised. This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association's Stroke. RESULTS: This evidence-based guideline was written in three parts: controlling the risk factors of stroke, utilisation of antiplatelet agents and assessing the risks of first-ever stroke. All recommendations were listed along with the recommending classes and levels of evidence. CONCLUSIONS: This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China. Controlling related risk factors, appropriately using antiplatelet agents, assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.


Assuntos
Transtornos Cerebrovasculares/prevenção & controle , Medicina Baseada em Evidências/normas , Neurologia/normas , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevenção Primária/normas , Comportamento de Redução do Risco , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , China/epidemiologia , Consenso , Avaliação da Deficiência , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Resultado do Tratamento
20.
Stroke Vasc Neurol ; 5(3): 260-269, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32641444

RESUMO

AIM: Stroke is characterised by high morbidity, mortality and disability, which seriously affects the health and safety of the people. Stroke has become a serious public health problem in China. Organisational stroke management can significantly reduce the mortality and disability rates of patients with stroke. We provide this evidence-based guideline to present current and comprehensive recommendations for organisational stroke management. METHODS: A formal literature search of MEDLINE (1 January 1997 through 30 September 2019) was performed. Data were synthesised with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The Chinese Stroke Association's Levels of Evidence grading algorithm was used to grade each recommendation. RESULTS: Evidence-based guidelines are presented for the organisational management of patients presenting with stroke. The focus of the guideline was subdivided into prehospital first aid system of stroke, rapid diagnosis and treatment of emergency in stroke centre, organisational management of stroke unit and stroke clinic, construction of regional collaborative network among stroke centres and evaluation and continuous improvement of stroke medical quality. CONCLUSIONS: The guidelines offer an organisational stroke management model for patients with stroke which might help dramatically.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Medicina Baseada em Evidências/normas , Neurologia/normas , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , China/epidemiologia , Consenso , Prestação Integrada de Cuidados de Saúde/organização & administração , Avaliação da Deficiência , Medicina Baseada em Evidências/organização & administração , Humanos , Modelos Organizacionais , Neurologia/organização & administração , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
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