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2.
Rev Prat ; 69(6): 647-648, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626426

RESUMO

When solicitated by his patient, the doctor must be vigilant regarding his establishment of a medical certificate. This document, often to be used in court, should not be considered as trivial. It is, indeed, not uncommon for the author of the medical certificate, to be disciplined for not having taken enough distance with the patient's grievances.


Assuntos
Padrões de Prática Médica , Redação , Avaliação da Deficiência , Humanos , Médicos
3.
Sante Publique ; Vol. 31(3): 395-404, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640327

RESUMO

OBJECTIVE: The aim of this research is, on the one hand, to describe the customs and attitudes of Swiss general practitioners (GP) considering cardiovascular risk, and on the other, to put into perspective with the national recommendation Eviprev (summary representations of the primary and secondary preventions recommendations for patients aged between 18 and 70 years old). METHODS: The study was based on an online survey sent to general practitioners belonging to the same research network and who were randomly selected. The sample was made of 200 Swiss GP. This article focuses on the frequency with which GP give advice related to consumption of tobacco and alcohol, exercising and nutrition during a regular meeting with their patient or a first visit. The results were analyzed according to age, sex, linguistic area and the extent to which they lived in a city or in the countryside. RESULTS: Results suggest that the majority (97.6%) of GP show concern about informing patients on cardiovascular risk factors. Nonetheless most of the advice given are usually related to the patient's case and not given in a systematic way. Tobacco addiction is the most systematically discussed theme during a first visit (33.9%), exercise comes second (25.6%), then nutrition (16.1%), and finally alcohol consumption (18.5%). Differences in numbers based on the different languages are little, except dealing with exercise. CONCLUSIONS: Recommendations on prevention are followed by a majority of GP. Improvements could be made considering the training given and the remuneration of these counseling activities.


Assuntos
Atitude do Pessoal de Saúde , Doenças Cardiovasculares/prevenção & controle , Clínicos Gerais/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Suíça , Adulto Jovem
4.
Sante Publique ; Vol. 31(3): 459-467, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640334

RESUMO

INTRODUCTION: Patient education is an important component in the management and monitoring of chronic diseases. It plays an important role in the decline of the disease severity, mortality and socioeconomic burden and the complications of these chronic diseases. In Côte d'Ivoire, there are few studies to evaluate the reality of this activity. OBJECTIVE: To explore the practice of patient education in Ivory Coast. METHOD: This qualitative study has been carried out by means of semi-structured interviews with 24 healthcare professionals including 14 health managers for individual interviews and 10 care providers for focus group discussion. RESULTS: There are various representations of therapeutic patient education among health professionals. There was no real distinction between patient education and the broader concept of health education. Absence of national patient education policy, the lack of training in TPE and lack of experience of educational practice lead health professionals to realize an unstructured educational activity. CONCLUSION: These results show the need for Côte d'Ivoire to have a national policy of patient education to educate patients in accordance with international recommendations.


Assuntos
Doença Crônica/terapia , Pessoal de Saúde/psicologia , Educação de Pacientes como Assunto/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Costa do Marfim , Humanos , Pesquisa Qualitativa
5.
Am Surg ; 85(9): 1040-1043, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638521

RESUMO

Although vascular surgery guidelines recommend immediate anticoagulation for acute occlusion of a peripheral artery, it is unclear whether trauma surgeons follow this practice. A survey regarding the use of perioperative anticoagulation was sent to surgeons who perform their own peripheral arterial repairs after traumatic injury to define contemporary practice patterns. This survey demonstrated minimal consensus opinion regarding the management of extremity vascular injuries, strongly suggesting the need for a consensus conference, meta-analysis, and prospective studies to guide further care.


Assuntos
Anticoagulantes/uso terapêutico , Assistência Perioperatória , Padrões de Prática Médica , Lesões do Sistema Vascular/cirurgia , Adulto , Idoso , Arteriopatias Oclusivas/cirurgia , Artéria Axilar/lesões , Artéria Axilar/cirurgia , Artéria Braquial/lesões , Artéria Braquial/cirurgia , Artéria Femoral/lesões , Artéria Femoral/cirurgia , Hemorragia/cirurgia , Humanos , Pessoa de Meia-Idade , Artéria Poplítea/lesões , Artéria Poplítea/cirurgia , Lesões dos Tecidos Moles/cirurgia , Cirurgiões
6.
Medicine (Baltimore) ; 98(38): e17265, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568003

RESUMO

BACKGROUND: Observational studies indicate that religious values of physicians influence clinical practice. The aim of this study was to test prior hypotheses of prevalence of this influence using a meta-analysis design. METHODS: Based on a systematic literature search we performed individual participant data meta-analysis (IPDMA) on data based on 2 preselected questionnaires. Ten samples from 7 countries remained after exclusion (n = 3342). IPDMA was performed using a random-effects model with 2 summary measures: the mean value of the scale "Religiosity of Health Professionals"; and a dichotomized value of the question "My religious beliefs influence my practice of medicine." Also, a sensitivity analysis was performed using a mixed-models design controlling for confounders. RESULTS: Mean score of religiosity (95% confidence interval [CI]) was significantly lower in the European subgroup (8.46 [6.96-9.96]) compared with the Asian samples India (10.46 [9.82-10.21]) and Indonesia (12.52 [12.19-12.84]), whereas Brazil (9.76 [9.54-9.99]) and USA (10.02 [9.82-10.21]) were placed in between. The proportion of the European physicians who agreed to the statement "My religious beliefs influence my practice of medicine" (95% CI) was 42% (26%-59%) compared with Brazil (36% [29%-43%]), USA (57% [54%-60%]), India (58% [52%-63%]), and Indonesia (91% [84%-95%]). CONCLUSIONS: Although large cross-cultural variations existed in the samples, 50% of physicians reported to be influenced by their religious beliefs. Religiosity and influence of religious beliefs were most pronounced in India, Indonesia, and a European faith-based hospital. Education regimes of current and future physicians should encompass this influence, and help physicians learn how their personal values influence their clinical practice.


Assuntos
Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Religião e Medicina , Adulto , Austrália , Brasil , Dinamarca , Feminino , Alemanha , Humanos , Índia , Indonésia , Masculino , Médicos/psicologia , Religião , Inquéritos e Questionários , Estados Unidos
7.
Medicine (Baltimore) ; 98(40): e17411, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577753

RESUMO

Evidence on the prescription patterns of antihypertensive drug use in children and adolescents in China is scarce. A descriptive analysis of the Beijing Medical Claim Data, which covered over 95% of the urban residents, was conducted to investigate antihypertensive prescribing patterns and trends in children and adolescents aged under 18 from 2009 to 2014 in Beijing, China. An additional meta-analysis of trends in hypertension prevalence was conducted to compare trends with antihypertensive medications.A total of 11,882 patients received at least 1 prescription for antihypertensive drugs from 2009 to 2014. The number of annual antihypertensive users increased from 2009 to 2012, then declined steadily until 2014, which was consistent with the trend of the hypertension prevalence estimated from the meta-analysis. ß-receptor blockers, thiazide diuretics, and angiotensin-converting enzyme inhibitors were the 3 most commonly prescribed antihypertensive drugs. More boys took the antihypertensive drugs than girls. For users aged under 3 years, thiazide diuretics, α-receptor blockers, and angiotensin-converting enzyme inhibitors were the most prescribed drugs, while ß-receptor blockers, thiazide diuretics were the most used drugs for users above 3 years.In conclusion, antihypertensive drug prescribing for children and adolescents increased from 2009 to 2014, with different characteristics in different subgroups.


Assuntos
Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adolescente , Fatores Etários , Pequim , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão/epidemiologia , Lactente , Masculino , Padrões de Prática Médica/estatística & dados numéricos , Fatores Sexuais , População Urbana/estatística & dados numéricos
8.
BMJ ; 367: l5205, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578187

RESUMO

OBJECTIVES: To determine how clinicians vary in their response to new guidance on existing or new interventions, by measuring the timing and magnitude of change at healthcare institutions. DESIGN: Automated change detection in longitudinal prescribing data. SETTING: Prescribing data in English primary care. PARTICIPANTS: English general practices. MAIN OUTCOME MEASURES: In each practice the following were measured: the timing of the largest changes, steepness of the change slope (change in proportion per month), and magnitude of the change for two example time series (expiry of the Cerazette patent in 2012, leading to cheaper generic desogestrel alternatives becoming available; and a change in antibiotic prescribing guidelines after 2014, favouring nitrofurantoin over trimethoprim for uncomplicated urinary tract infection (UTI)). RESULTS: Substantial heterogeneity was found between institutions in both timing and steepness of change. The range of time delay before a change was implemented was large (interquartile range 2-14 months (median 8) for Cerazette, and 5-29 months (18) for UTI). Substantial heterogeneity was also seen in slope following a detected change (interquartile range 2-28% absolute reduction per month (median 9%) for Cerazette, and 1-8% (2%) for UTI). When changes were implemented, the magnitude of change showed substantially less heterogeneity (interquartile range 44-85% (median 66%) for Cerazette and 28-47% (38%) for UTI). CONCLUSIONS: Substantial variation was observed in the speed with which individual NHS general practices responded to warranted changes in clinical practice. Changes in prescribing behaviour were detected automatically and robustly. Detection of structural breaks using indicator saturation methods opens up new opportunities to improve patient care through audit and feedback by moving away from cross sectional analyses, and automatically identifying institutions that respond rapidly, or slowly, to warranted changes in clinical practice.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Avaliação de Processos (Cuidados de Saúde)/métodos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Anti-Infecciosos/uso terapêutico , Conjuntos de Dados como Assunto , Substituição de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/uso terapêutico , Inglaterra , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Avaliação de Processos (Cuidados de Saúde)/estatística & dados numéricos , Medicina Estatal/normas , Fatores de Tempo , Infecções Urinárias/tratamento farmacológico
9.
J Opioid Manag ; 15(4): 307-322, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637683

RESUMO

BACKGROUND: Increasing opioid-related deaths have heightened focus on combating the opioid epidemic. The impact of surgical trainees on opioid-related deaths is unclear, and there is little data examining the association between trainee pain management education and opioid prescribing practices. METHODS: An anonymous, online survey was distributed to members of the Resident and Associate Society of the American College of Surgeons. The survey covered five themes: education and knowledge, prescribing practices, clinical case scenarios, policy, and beliefs and attitudes. Linear mixed models were used to evaluate the influence of respondent characteristics on reported morphine milligram equivalents (MME) prescribed for common general surgery clinical scenarios. RESULTS: Of 427 respondents, 54 percent indicated receiving training in postoperative pain management during medical school and 66 percent during residency. Only 35 percent agreed that they had received adequate training in prescribing opioids. There was a significant association between undergoing formal pain management training in medical school and prescribing fewer MME for common outpatient general surgery scenarios (94 ± 15.2 vs 108 ± 15.0; p = 0.003). Similarly, formal pain management training in residency was associated with prescribing fewer MME in the survey scenarios (92.6 ± 15.2 vs 109 ± 15.2; p = 0.002). CONCLUSION: In this survey, nearly two-thirds of surgical residents felt that they were inadequately trained in opioid pre-scribing. Our findings additionally suggest that improving education may result in increased resident comfort with man-aging surgical pain, potentially leading to more responsible opioid prescribing. Further work will facilitate residency pro-grams' development of educational curricula for opioid prescribing best practices.


Assuntos
Analgésicos Opioides , Prescrições de Medicamentos , Cuidados Pós-Operatórios/métodos , Padrões de Prática Médica , Analgésicos Opioides/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Inquéritos e Questionários
10.
J Opioid Manag ; 15(4): 333-341, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637685

RESUMO

BACKGROUND: The use of opioid analgesics in the United States has increased nearly fourfold since 1999 resulting in a similar increase in opioid-related overdose deaths. Although the Centers for Disease Control published guidelines for prescribing chronic opioids, there is a lack of guidance for prescribing postoperative opioids. OBJECTIVE: To offer an evidence-based approach to prescribing opioids for post-operative pain management in the orthopedic setting. METHODS: A narrative review was performed of studies evaluating and quantifying opioid use in orthopedic patients in the postoperative setting, as well as studies analyzing patient satisfaction and perception with regards to opioid use. RESULTS: Studies show that postoperative pain may not be the largest contributing factor to developing an opioid use disorder, but rather patient factors such as tobacco and substance use disorder, mental health disorders, anxiety, mood disorders, pre-existing chronic pain, and recent opioid use may play a role. The review also found that most patients do not utilize significant portions of prescribed opioids and most do not require a refill. This trend leaves patients with thousands of unused pills, which are either retained, shared, or diverted. Although there is no guideline for prescribing opioids postoperatively, data suggest that clinicians can prescribe smaller dosages and fewer quantities of opioids initially. There are also non-opioid strategies that can be employed to reduce opioid consumption. CONCLUSION: There is a need for more high quality research to be conducted to standardize postoperative opioid prescribing patterns and create best practice guidelines to guide clinicians. Orthopedic practices should consider creating institutional guidelines to reduce the amount of opioids prescribed.


Assuntos
Analgésicos Opioides , Prescrições de Medicamentos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides , Padrões de Prática Médica , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Humanos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Procedimentos Ortopédicos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Estados Unidos
13.
Schmerz ; 33(5): 466-470, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31478143

RESUMO

Since the adoption of the law of March 6, 2017, any German physician can prescribe medical cannabis flowers and cannabis-based magistral and finished medicinal products. No specific indications for prescriptions are provided in the law. The statutory health insurance companies bear the costs once an application for cost coverage has been approved by the Medical Service of the Health Funds. The German associations of psychiatry (child, adolescents, and adults), neurology, palliative care, addictology, and pain medicine are watching these developments in the media, politics, and medical world with concern due to: the option to prescribe cannabis flowers despite the lack of sound evidence and against the recommendations of the German Medical Association; the lack of distinction between medical cannabis flowers and cannabis-based magistral and finished medical products; the indiscriminately positive reports on the efficacy of cannabis-based medicines for chronic pain and mental disorders; the attempts by the cannabis industry to influence physicians; the increase in potential indications by leaders of medical opinion paid by manufacturers of cannabis-based medicines. The medical associations make the following appeal to journalists: To report on the medical benefits and risks of cannabis-based medicines in a balanced manner. To physicians: to prescribe cannabis-based medicines with caution; to prefer magistral and finished medicinal products over cannabis flowers. To politicians: to consider data according to the standards of evidence-based medicine when making decisions and provide financial support for medical research into cannabis-based medicines.


Assuntos
Cannabis , Dor Crônica , Seguro Saúde , Jornalismo , Maconha Medicinal , Política , Padrões de Prática Médica , Dor Crônica/tratamento farmacológico , Alemanha , Humanos , Seguro Saúde/ética , Seguro Saúde/normas , Maconha Medicinal/uso terapêutico , Médicos/ética , Médicos/normas , Padrões de Prática Médica/ética , Padrões de Prática Médica/normas
14.
Expert Opin Drug Saf ; 18(11): 1091-1098, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31524003

RESUMO

Objectives: Inappropriate prescription is a problem related to aging and deprescription could be a possible strategy. The aim of this study was to adapt the available evidence on deprescribing to the medication management of older people living in long-term care facilities. Methods: The authors carried out a bibliographic search based on the most prevalent drugs in our context to develop a specific deprescribing intervention. A committee of experts reviewed this intervention which was later validated through an interobserver variability study. Finally, the authors evaluated it in a sample of patients through a controlled before-after study. Results: The authors included 119 subjects living in a public elderly long-term care center and 122 controls living in a center with similar clinical characteristics. The authors evaluated 852 medications, identifying a total of 175 (20.5%) potentially inappropriate medications and 162 (92.5%) drugs were deprescribed (1.4 per patient). The application of the intervention meant an annual saving of 9.525.25 €. Conclusion: The implementation of a deprescribing intervention aimed at the most prevalent drugs prescribed in a particular setting improves the appropriateness of pharmacotherapy in the patients.


Assuntos
Desprescrições , Prescrição Inadequada/prevenção & controle , Conduta do Tratamento Medicamentoso/organização & administração , Lista de Medicamentos Potencialmente Inapropriados , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Custos de Medicamentos , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Prescrição Inadequada/economia , Assistência de Longa Duração/normas , Masculino , Casas de Saúde , Padrões de Prática Médica/normas
15.
Br J Anaesth ; 123(5): 627-636, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563269

RESUMO

BACKGROUND: Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia. METHODS: Eight bibliographic databases were searched for studies addressing opioid-free analgesia after a major surgery. We extracted the study characteristics, including design, country, year, surgical procedure(s), and interventions. Results were organised thematically according to surgical specialty and targeted phase of recovery: in hospital (early recovery, ≤24 h after operation; intermediate recovery, >24 h) and post-discharge (late recovery). Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for scoping reviews. RESULTS: We identified 424 studies addressing postoperative opioid-free analgesia. The number of studies conducted in countries where the opioid crisis is primarily focused was remarkably low (USA, n=11 [3%]; Canada, n=5 [1%]). Many RCTs compared opioid-free vs opioid analgesia during hospital stay (n=117), but few targeted analgesia post-discharge (n=8). Studies were predominantly focused on procedures in orthopaedic, general, and gynaecological/obstetric surgery. Limited attention has been directed towards non-pharmacological pain interventions. We did not identify knowledge synthesis studies (i.e. systematic reviews and meta-analyses) focused on the comparative effectiveness of opioid-free vs opioid analgesia. CONCLUSIONS: Opioids remain a mainstay analgesic for managing pain after surgery, but alternative analgesia strategies should not be overlooked. This scoping review indicates numerous opportunities for future research targeting opioid-free postoperative analgesia. REVIEW REGISTRATION: http://www.researchregistry.com; ID: reviewregistry576.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Humanos , Manejo da Dor/métodos , Cuidados Pós-Operatórios/métodos
16.
Z Gastroenterol ; 57(9): 1059-1066, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31525798

RESUMO

BACKGROUND: In Germany, colorectal cancer (CRC) screening includes a fecal blood test or colonoscopy, but not a sigmoidoscopy, which has been shown to reduce CRC incidences and mortality. Our aim was to compile physicians' experiences with sigmoidoscopy and their assessments of this procedure being an additional, possible screening method for early CRC detection. METHODS: At the end of 2015, gastroenterologists and internists in Lower Saxony and North Rhine-Westphalia who regularly perform screening colonoscopies in outpatient care were contacted per mail. Standardized telephone interviews consisting of 17 questions and lasting 10-15 minutes were conducted. RESULTS: Nearly two-thirds (56/87) of the respondents reject sigmoidoscopy as an acceptable early detection method. Compared to colonoscopy, key features of the sigmoidoscopy include more favorable patient-related aspects, while procedural aspects, except sedation, clearly rate in favor of the colonoscopy. In the instance that colonoscopy is rejected, 75 % of the physicians consider a sigmoidoscopy to be a possible alternative. CONCLUSIONS: The survey provides important practical insights into outpatient sigmoidoscopy. A majority of the physicians does not support evidence-based sigmoidoscopy for CRC screening. However, individuals who reject a colonoscopy are, in line with the current guideline, identified as a target group for a screening sigmoidoscopy. The benefit from an additionally offered sigmoidoscopy in CRC screening should be further analyzed with special consideration given to the preferences of insurees within the German healthcare system.


Assuntos
Atitude do Pessoal de Saúde , Neoplasias Colorretais/diagnóstico , Programas de Rastreamento/métodos , Médicos/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Sigmoidoscopia , Colonoscopia , Detecção Precoce de Câncer , Alemanha , Humanos , Sangue Oculto
18.
Zhonghua Fu Chan Ke Za Zhi ; 54(9): 608-614, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31550777

RESUMO

Objective: To investigate the similarities and differences between Chinese International Urogynecological Association (IUGA) members and international IUGA members on the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) with polypropylene (PP) mesh and sling. Methods: Questionnaires were sent to Chinese IUGA members by Email. The contents of the questionnaires included POP mesh, SUI slings, abdominal sacrocolpopexy (ASC), complications, patients' awareness of rights protection, litigation and database use.Chi-square test was used to compare the proportion of Chinese IUGA members and international IUGA members to the problem alternatives. Results: A total of 31 Chinese IUGA members (100%, 31/31) responded to the questionnaire. All Chinese IUGA members (100%, 31/31) recognized and used PP sling to treat SUI, 98% (917/936) of international IUGA members had used and continued to use PP sling. For ASC surgery, 81% (25/31) of Chinese IUGA members and 82% (768/936) of international IUGA members agreed with and implemented the operation (P=0.841), while 94% (29/31) of Chinese IUGA members and 72% (674/936) of international IUGA members had the same or increased surgical volume as before (P=0.019). For the treatment of POP by transvaginal implantation of PP mesh, Chinese IUGA members had significant differences with international IUGA members in terms of whether they had used (P=0.002), were using (P<0.001), reasons for not using mesh (P<0.001), and indications of mesh implantation (P<0.001). Totally 81% (25/31) of Chinese IUGA members used various databases for monitoring and follow-up, while only 62% (580/936) of international IUGA members used databases, but there was no statistical difference (P=0.092). Conclusion: There are great differences in the concept and clinical application of transvaginal PP mesh implantation for POP between Chinese IUGA members and international IUGA members.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Ginecologia/estatística & dados numéricos , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Polipropilenos , Telas Cirúrgicas , Incontinência Urinária por Estresse/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Masculino , Padrões de Prática Médica , Procedimentos Cirúrgicos Reconstrutivos , Inquéritos e Questionários , Incontinência Urinária por Estresse/fisiopatologia
19.
Gut ; 68(11): 1928-1941, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31375601

RESUMO

OBJECTIVE: Antireflux surgery can be proposed in patients with GORD, especially when proton pump inhibitor (PPI) use leads to incomplete symptom improvement. However, to date, international consensus guidelines on the clinical criteria and additional technical examinations used in patient selection for antireflux surgery are lacking. We aimed at generating key recommendations in the selection of patients for antireflux surgery. DESIGN: We included 35 international experts (gastroenterologists, surgeons and physiologists) in a Delphi process and developed 37 statements that were revised by the Consensus Group, to start the Delphi process. Three voting rounds followed where each statement was presented with the evidence summary. The panel indicated the degree of agreement for the statement. When 80% of the Consensus Group agreed (A+/A) with a statement, this was defined as consensus. All votes were mutually anonymous. RESULTS: Patients with heartburn with a satisfactory response to PPIs, patients with a hiatal hernia (HH), patients with oesophagitis Los Angeles (LA) grade B or higher and patients with Barrett's oesophagus are good candidates for antireflux surgery. An endoscopy prior to antireflux surgery is mandatory and a barium swallow should be performed in patients with suspicion of a HH or short oesophagus. Oesophageal manometry is mandatory to rule out major motility disorders. Finally, oesophageal pH (±impedance) monitoring of PPI is mandatory to select patients for antireflux surgery, if endoscopy is negative for unequivocal reflux oesophagitis. CONCLUSION: With the ICARUS guidelines, we generated key recommendations for selection of patients for antireflux surgery.


Assuntos
Refluxo Gastroesofágico/cirurgia , Seleção de Pacientes , Adulto , Atitude do Pessoal de Saúde , Consenso , Técnica Delfos , Endoscopia , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/patologia , Humanos , Manometria , Guias de Prática Clínica como Assunto , Padrões de Prática Médica
20.
Stud Health Technol Inform ; 264: 447-451, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437963

RESUMO

Process mining helps healthcare professionals understand processes within healthcare. While often used in secondary care, there is little work in process mining using primary care data. Serious adverse events that result from hazardous prescribing are common and costly. For example, non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelets can cause gastro-intestinal bleeds (GiBs). Prescribing typically occurs during primary care; therefore we used this setting to attempt process mining. We extracted events (drug started, drug stopped, GiB) for understanding three prescribing pathways, and applied process mining. We found NSAIDs are often short-term prescriptions whereas antiplatelets are often long-term. This perhaps explains our finding that co-prescription of gastro-protection is more prevalent for antiplatelets than NSAIDs. We identified reasons why primary care data is harder to process mine and proposed solutions. Process mining primary care data is possible and likely useful for improving patient safety and reducing costs.


Assuntos
Atenção Primária à Saúde , Anti-Inflamatórios não Esteroides , Prescrições de Medicamentos , Humanos , Segurança do Paciente , Padrões de Prática Médica
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