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1.
Medicine (Baltimore) ; 100(26): e26478, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190172

RESUMO

ABSTRACT: This study aims to evaluate the effect of dose titration for different oral antiepileptic medications among children with epilepsy in Riyadh, Saudi Arabia.A single-center prospective pilot, cohort study was undertaken at a tertiary hospital in Riyadh, Saudi Arabia. All medical records of pediatric patients below the age of 14 years of age who has been newly diagnosed with epilepsy by attending a medical specialist or on a new epileptic treatment plans were enrolled in the study.A total of 76 epileptic patients were screened for 3 months' period and 48 patients were included in this study. Out of the 48 patients, 31 patients followed the regular practice in the titration processes and 17 patients were in the British national formulary (BNF) guideline. Fifteen children who were on monotherapy of levetiracetam were in regular practice guideline experienced poor seizure control with a recorded number of seizure incidence (n = 10). The patient in regular practice guidelines using a combination therapy of phenytoin and levetiracetam were experiencing some behavioral disturbance and sedation effect. Seventeen patients followed in the BNF guideline who were on levetiracetam were experienced less adverse effect (n = 2) with no behavioral changes.The group who followed the regular practice found having a greater incidence of documented adverse effects compared to the patients following the BNF guideline. The titrating antiepileptic medication has a detrimental effect on the pediatric population as observed in this study.


Assuntos
Anticonvulsivantes , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Epilepsia , Conduta do Tratamento Medicamentoso , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/classificação , Criança , Saúde da Criança , Estudos de Coortes , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Epilepsia/fisiopatologia , Feminino , Humanos , Masculino , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Estudos Prospectivos , Arábia Saudita/epidemiologia
2.
Eur J Endocrinol ; 185(2): 265-278, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061767

RESUMO

Objective: Metabolic syndrome is a cluster of cardio-metabolic risk factors associated with an increased risk of cardiovascular disease and type 2 diabetes. In the last two decades, several definitions of metabolic syndrome have been proposed for the pediatric population; all of them agree on the defining components but differ in the suggested criteria for diagnosis. This review aims to analyze the current diagnostic criteria of metabolic syndrome in pediatrics with reference to their feasibility and reliability in clinical practice. Methods: The systematic research was conducted from January 2003 to June 2020 through MEDLINE via PubMed, Cochrane Library and EMBASE databases. Results: After the selection phase, a total of 15 studies (182 screened) met the inclusion criteria and are reported in the present review. Twelve studies were cross-sectional, two were longitudinal and one was a consensus report. The sample population consisted of multiethnic group or single ethnic group, including Turkish, European, Asian and Hispanic subjects. Conclusions: To date, there is not a univocal, internationally accepted pediatric definition of metabolic syndrome, which guarantees a high sensitivity and stability of the diagnosis. The definition proposed by IDF results the most straightforward and easy to use in clinical practice, having the unquestionable advantage of requiring measurements quickly accessible in clinical practice, without the adoption of multiple reference tables. Further research is needed to validate a new version of such definition which includes the diagnostic cut-off points recently suggested by published guidelines.


Assuntos
Técnicas de Diagnóstico Endócrino , Síndrome Metabólica/diagnóstico , Pediatria , Adolescente , Idade de Início , Criança , Pré-Escolar , Técnicas de Diagnóstico Endócrino/normas , Técnicas de Diagnóstico Endócrino/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pediatria/métodos , Pediatria/normas , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Reprodutibilidade dos Testes
3.
Artigo em Inglês | MEDLINE | ID: mdl-34169702

RESUMO

Almost 13 months have passed since the World Health Organization (WHO) declared the coronavirus disease 19 (COVID-19) pandemic, caused by the SARS-CoV-2, on March 11th, 2020. During this period, we have realized that the most effective weapon we have to prevent SARS-CoV-2 infection, or to make it less aggressive, is vaccines. Currently, according to the WHO document "Draft landscape of COVID-19 candidate vaccines," there are 275 vaccines in development against the virus, although at the moment there are four preparations in distribution in the United States and in Europe. The characteristics of these vaccines are quite different from each other and may even be unfamiliar in the medical field. In particular, among dermatologists, knowledge of vaccines is of fundamental importance, especially in atopic dermatitis. Atopic patients are aware of having a predisposition to develop allergies, and so they are asking dermatologists about the safety of the vaccines currently available against the SARS-CoV-2. This article provides an up-to-date overview of this topic by reviewing current literature and sharing our personal experience.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Dermatite Atópica/etiologia , Dermatologistas/normas , Padrões de Prática Médica/normas , Vacinas contra COVID-19/efeitos adversos , Competência Clínica , Dermatite Atópica/prevenção & controle , Europa (Continente) , Humanos
4.
Medicine (Baltimore) ; 100(18): e25810, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950984

RESUMO

ABSTRACT: Research that focuses on transfers to and from the intensive care unit (ICU) could highlight important patients' safety issues. This study aims to describe healthcare workers' (HCWs) practices involved in patient transfers to or from the ICU.This cross-sectional study was conducted among HCWs during the Saudi Critical Care Society's annual International Conference, April 2017. Responses were assessed using Likert scales and frequencies. Bivariate analysis was used to evaluate the significance of different indicators.Overall, 312 HCWs participated in this study. Regarding transfer to ICUs, the most frequently reported complications were deterioration in respiratory status (51.4%), followed by deterioration in hemodynamic status (46.5%), and missing clinical information (35.5%). Regarding transfers from ICUs to the general ward, the most commonly reported complications were changes in respiratory status (55.6%), followed by incomplete clinical information (37.9%), and change in hemodynamic conditions (29%). The most-used models for communicating transfers were written documents in electronic health records (69.3%) and verbal communication (62.8%). One-fourth of the respondents were not aware of the Situation, Background, Assessment, Recommendation (SBAR) method of patients' handover. Pearson's test of correlation showed that the HCW's perceived satisfaction with their hospital transfer guidelines showed significant negative correlation with their reported transfer-related complications (r = -0.27, P < .010).Hemodynamic and respiratory status deterioration is representing significant adverse events among patients transferred to or from the ICU. Factors controlling the perceived satisfaction of HCWs involved in patients, transfer to and from the ICU need to be addressed, focusing on their compliance to the hospital-wide transfer and handover policies. Quality improvement initiatives could improve patient safety to transfer patients to and from the ICU and minimize the associated adverse events.


Assuntos
Deterioração Clínica , Cuidados Críticos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cuidados Críticos/normas , Estado Terminal/terapia , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Transferência da Responsabilidade pelo Paciente/normas , Transferência da Responsabilidade pelo Paciente/estatística & dados numéricos , Transferência de Pacientes/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Arábia Saudita , Inquéritos e Questionários/estatística & dados numéricos
5.
Bull Cancer ; 108(7-8): 761-770, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33933290

RESUMO

Mucositis is defined as inflammatory and/or ulcerative lesions of the oral and/or gastrointestinal tract. It occurs in approximately 40% to 50% of adults patients receiving conventional chemotherapy and up to 75% of patients receiving high dose chemotherapy as conditioning for hematopoietic stem cell transplantation. It is a toxic side effect, which strongly impairs quality of life and leads to refractory pain, increasing risk of infection and even therapeutic modifications. Despite improvements made, the management of mucositis remains a challenge and is still not consensual. A multicentric survey of practices concerning the preventive and curative management of chemo-induced mucositis in pediatric oncology department in France was carried out using a standardized questionnaire. Results confirm heterogeneous practices and the small progress made during the last decade. This national survey and an analysis of the recent literature leads to propose guidelines for the prevention and treatment of oral mucositis in children receiving treatment for cancer.


Assuntos
Antineoplásicos/efeitos adversos , Mucosite/induzido quimicamente , Padrões de Prática Médica/normas , Institutos de Câncer/estatística & dados numéricos , Criança , França , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Transplante de Células-Tronco Hematopoéticas , Humanos , Terapia a Laser/métodos , Mucosite/complicações , Mucosite/microbiologia , Mucosite/prevenção & controle , Higiene Bucal , Manejo da Dor , Qualidade de Vida , Condicionamento Pré-Transplante/efeitos adversos
6.
Lancet Diabetes Endocrinol ; 9(6): 393-405, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34022157

RESUMO

China has one of the largest populations with obesity in the world, and obesity has become a major challenge for the country's health-care system. Current guidelines for obesity management are not adequately supported by evidence from clinical studies in Chinese populations. Effective lifestyle interventions suitable for Chinese populations are scarce, insufficient weight-loss medications have been approved by regulatory bodies, and there is low acceptance of non-lifestyle interventions (ie, medications and surgery) among both health-care providers and the general public. Large, well designed, and well implemented clinical trials are needed to strengthen the evidence base for the clinical management of obesity in China. Obesity management can be improved through use of a tiered system involving health management centres, integrated lifestyle interventions and medical treatments, strengthened obesity education and training, and use of advanced electronic health technologies. Resource mobilisation, support from major stakeholders for people with overweight or obesity, and education and changes to social norms among the wider public are also needed. National health policies should prioritise both obesity prevention and improvement of the treatment and management of obesity.


Assuntos
Obesidade/terapia , China/epidemiologia , Atenção à Saúde/normas , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Sobrepeso/terapia , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/normas , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Programas de Redução de Peso/métodos , Programas de Redução de Peso/estatística & dados numéricos , Programas de Redução de Peso/provisão & distribuição
7.
Diabetes Res Clin Pract ; 176: 108852, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33957143

RESUMO

Diabetes is a very important comorbidity in patients with heart failure. When both diseases coexist cardiovascular morbidity and mortality is greatly increased. Therefore, it is of clinical importance to treat both diseases as early as possible with an optimal therapy. Hitherto, heart failure therapy did not differ if a patient had concomitant diabetes. However, with SGLT-2 inhibitors having demonstrated to reduce hospitalization of heart failure independent of diabetes state and expected to be included into the ESC heart failure treatment guidelines in 2021 coexisting diabetes potentially will make a difference when to start therapy. In this article we provide an overview of current recommendations and also provide clinical considerations for the therapy of heart failure with concomitant diabetes.


Assuntos
Cardiologistas , Angiopatias Diabéticas/terapia , Insuficiência Cardíaca/terapia , Padrões de Prática Médica , Cardiologistas/normas , Cardiologistas/estatística & dados numéricos , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/epidemiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Prognóstico , Volume Sistólico
8.
Expert Rev Respir Med ; 15(6): 773-779, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33798401

RESUMO

Introduction: Bronchoscopy and related procedures have unambiguously been affected during the Corona Virus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS COV-2). Ordinary bronchoscopy practices and lung cancer services might have changed over this pandemic and for the years to come.Areas covered: This manuscript summarizes the utility of bronchoscopy in COVID-19 patients, and the impact of the pandemic in lung cancer diagnostic services, in view of possible viral spread during these We conducted a literature review of articles published in PubMed/Medline from inception to November 5th, 2020 using relevant terms.Expert opinion: Without doubt this pandemic has changed the way bronchoscopy and related procedures are being performed. Mandatory universal personal protective equipment, pre-bronchoscopy PCR tests, dedicated protective barriers and disposable bronchoscopes might be the safest and simpler way to perform even the most complicated procedures.


Assuntos
Broncoscopia , COVID-19/epidemiologia , COVID-19/terapia , Infecção Hospitalar/prevenção & controle , Padrões de Prática Médica , Broncoscópios/microbiologia , Broncoscópios/normas , Broncoscópios/virologia , Broncoscopia/instrumentação , Broncoscopia/métodos , Broncoscopia/normas , COVID-19/prevenção & controle , COVID-19/transmissão , Contaminação de Equipamentos/prevenção & controle , História do Século XXI , Humanos , Neoplasias Pulmonares/diagnóstico , Oncologia/instrumentação , Oncologia/métodos , Oncologia/normas , Pandemias , Equipamento de Proteção Individual/virologia , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , SARS-CoV-2/fisiologia
9.
Expert Rev Respir Med ; 15(6): 773-779, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1165209

RESUMO

Introduction: Bronchoscopy and related procedures have unambiguously been affected during the Corona Virus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS COV-2). Ordinary bronchoscopy practices and lung cancer services might have changed over this pandemic and for the years to come.Areas covered: This manuscript summarizes the utility of bronchoscopy in COVID-19 patients, and the impact of the pandemic in lung cancer diagnostic services, in view of possible viral spread during these We conducted a literature review of articles published in PubMed/Medline from inception to November 5th, 2020 using relevant terms.Expert opinion: Without doubt this pandemic has changed the way bronchoscopy and related procedures are being performed. Mandatory universal personal protective equipment, pre-bronchoscopy PCR tests, dedicated protective barriers and disposable bronchoscopes might be the safest and simpler way to perform even the most complicated procedures.


Assuntos
Broncoscopia , COVID-19/epidemiologia , COVID-19/terapia , Infecção Hospitalar/prevenção & controle , Padrões de Prática Médica , Broncoscópios/microbiologia , Broncoscópios/normas , Broncoscópios/virologia , Broncoscopia/instrumentação , Broncoscopia/métodos , Broncoscopia/normas , COVID-19/prevenção & controle , COVID-19/transmissão , Contaminação de Equipamentos/prevenção & controle , História do Século XXI , Humanos , Neoplasias Pulmonares/diagnóstico , Oncologia/instrumentação , Oncologia/métodos , Oncologia/normas , Pandemias , Equipamento de Proteção Individual/virologia , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , SARS-CoV-2/fisiologia
11.
Diabetes Res Clin Pract ; 176: 108828, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33894280

RESUMO

AIMS: To identify patient-specific factors associated with early metformin treatment modification among type 2 diabetes patients before and after implementation of the updated 2015 NICE (National Institute for Health and Care Excellence) guideline. METHODS: We conducted a population-based cohort study using data from the Clinical Practice Research Datalink GOLD database (2009-2016). Patients ≥ 18 years, newly treated with metformin only, during the period of valid data collection were included. The first prescription defined start of follow-up. Determinants of treatment modification in two cohorts (before and after implementation of the updated guideline) were studied by time-dependent Cox proportional hazards regression. RESULTS: After implementation of the updated guideline, patients were less likely to receive sulphonylureas (62.3% vs 41.3%) or thiazolidediones (4.7% vs 2.2%) and more likely to receive dipeptidyl peptidase-4 inhibitors (15.8% vs 27.1%) or sodium-glucose cotransporter-2 inhibitors (0.8% vs 9.9%). Some determinants influenced general practitioners' prescribing differently after implementation of the updated guideline compared to before, including a high body mass index and heart failure. CONCLUSIONS: Our results indicate that a first step towards tailored prescribing has been made. However, not all determinants that are important to consider when prescribing second-line glucose-lowering agents were of influence on general practitioners' prescribing.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Uso de Medicamentos/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Hipoglicemiantes , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Substituição de Medicamentos/normas , Substituição de Medicamentos/estatística & dados numéricos , Endocrinologia/história , Endocrinologia/métodos , Endocrinologia/normas , Feminino , História do Século XXI , Humanos , Hipoglicemiantes/classificação , Hipoglicemiantes/normas , Hipoglicemiantes/uso terapêutico , Ciência da Implementação , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Estudos Retrospectivos , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Compostos de Sulfonilureia/uso terapêutico , Adulto Jovem
12.
BMC Pregnancy Childbirth ; 21(1): 278, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827459

RESUMO

BACKGROUND: Computerized clinical decision support (CDSS) -digital information systems designed to improve clinical decision making by providers - is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes. METHODS: We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August -October 2017 (baseline) and the data collected between December 2019 - March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted. RESULTS: The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased. CONCLUSIONS: Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.


Assuntos
Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Assistência Perinatal/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Melhoria de Qualidade , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/prevenção & controle , Sistemas de Apoio a Decisões Clínicas/normas , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/normas , Implementação de Plano de Saúde , Humanos , Índia/epidemiologia , Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Assistência Perinatal/normas , Assistência Perinatal/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Gravidez , Avaliação de Programas e Projetos de Saúde , Natimorto/epidemiologia
13.
J Drugs Dermatol ; 20(3): 244-250, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33683089

RESUMO

BACKGROUND: The prevalence and clinical presentation of acne vulgaris in Latin America are comparable to that in Europe and the United States. This review aims at insight into the role of Over the Counter (OTC) products in acne treatment and maintenance in Latin America. METHODS: A panel of dermatologists from Latin America employed an online procedure to answer questions on this topic: What is used, by whom, when, how, and why? Before the meeting, a survey was completed by dermatologists from Latin America on OTC products for acne recommended by the panel in their clinical practice. The survey information and a literature review on Latin American acne guidelines and clinical studies were used to address this topic. RESULTS: The survey responders' choices on OTC products for monotherapy comprised alpha-hydroxy acid and beta-hydroxy acid-containing serum, ceramides-containing foaming cleanser, a soap-free exfoliating cleanser, adapalene, and benzoyl peroxide-containing products. The clinicians recommended OTC cleansing products mainly for younger patients at a starter level and for women with adult acne. The use of these OTC products is similar to practice described in therapeutic acne guidelines and algorithms for Latin American countries, Spain and Portugal, Europe, and the United States. CONCLUSIONS: Advisors agreed that OTC products and skincare recommendations, in addition to the use of prescription medications, are a crucial part of successful acne therapy. Participants noted that the use of quality OTC products could improve acne symptomatology and severity. J Drugs Dermatol. 2021;20(3):244-250. doi:10.36849/JDD.5779 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL fTEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.


Assuntos
Acne Vulgar/terapia , Fármacos Dermatológicos/uso terapêutico , Dermatologia/estatística & dados numéricos , Medicamentos sem Prescrição/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Acne Vulgar/epidemiologia , Administração Cutânea , Cosméticos/administração & dosagem , Dermatologia/normas , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Quimioterapia Combinada/estatística & dados numéricos , Humanos , América Latina/epidemiologia , Medicamentos sem Prescrição/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Medicamentos sob Prescrição/uso terapêutico , Prevalência , Higiene da Pele/métodos , Higiene da Pele/estatística & dados numéricos , Resultado do Tratamento
14.
J Surg Oncol ; 124(1): 143-151, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33751605

RESUMO

BACKGROUND: An opioid reduction education program to decrease discharge opioid prescriptions was initiated in our Department of Surgical Oncology. The study's aim was to measure the results and sustainability of these interventions 1 year later. METHODS: This prospective quality improvement project identified patients undergoing resection in five index tumor sites (peritoneal surface, sarcoma, stomach, pancreas, liver) at a high-volume cancer center. Patients were grouped into pre-education (PRE: July 2017-July 2018) and posteducation (POST: September 2018-July 2019) periods, before and after departmental education talks and videos in August 2018. Opioids were converted to oral morphine equivalents (OME) to compare the groups. RESULTS: Of 1168 evaluable patients (PRE 646, 55%; POST 522, 45%), the median last-24-h inpatient OME was 15 mg in PRE patients and 10 mg in POST patients (p < .001). Median discharge OME decreased from 200 mg in PRE to 100 mg in POST patients (p < .001). The frequency of patients with zero discharge opioids increased from 11% to 19% (p < .001). This discharge OME reduction amounted to 52,200 mg OME saved, or the equivalent of 6960 5-mg oxycodone pills not disseminated. CONCLUSIONS: A perioperative opioid reduction education program targeted to providers halved discharge OME, with sustained reductions 1 year later.


Assuntos
Analgésicos Opioides/administração & dosagem , Prescrições de Medicamentos/normas , Neoplasias/cirurgia , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica/normas , Cirurgiões/educação , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Dor Pós-Operatória/etiologia , Alta do Paciente , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos
15.
Cancer Med ; 10(8): 2877-2884, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33742559

RESUMO

BACKGROUND: Screening for lung cancer with low-dose computed tomography (LDCT) was shown to reduce lung cancer incidence and overall mortality, and it has been recently included in international guidelines. Despite the rising burden of lung cancer in low and middle-income countries (LMICs) such as Lebanon, little is known about what primary care physicians or pulmonologists know and think about LDCT as a screening procedure for lung cancer, and if they recommend it. OBJECTIVES: Evaluate the knowledge about LDCT and implementation of international guidelines for lung cancer screening among Lebanese primary care physicians (PCPs) and pulmonary specialists. METHODOLOGY: PCPs and PUs based in Lebanon were surveyed concerning knowledge and practices related to lung cancer screening by self-administered paper questionnaires. RESULTS: 73.8% of PCPs and 60.7% of pulmonary specialists recognized LDCT as an effective tool for lung cancer screening, with 63.6% of PCPs and 71% of pulmonary specialists having used it for screening. However, only 23.4% of PCPs and 14.5% of pulmonary specialists recognized the eligibility criteria for screening. Chest X-ray was recognized as ineffective by only 55.8% of PCPs and 40.7% of pulmonary specialists; indeed, 30.2% of PCPs and 46% of pulmonary specialists continue using it for screening. The majority have initiated a discussion about the risks and benefits of lung cancer screening. CONCLUSION: PCPs and pulmonary specialists are initiating discussions and ordering LDCT for lung cancer screening. However, a significant proportion of both specialties are still using a non-recommended screening tool (chest x-ray); only few PCPs and pulmonary specialists recognized the population at risk for which screening is recommended. Targeted provider education is needed to close the knowledge gap and promote proper implementation of guidelines for lung cancer screening.


Assuntos
Atitude do Pessoal de Saúde , Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Pulmonares/diagnóstico , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica/normas , Estudos Transversais , Humanos , Líbano/epidemiologia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/psicologia , Prognóstico , Inquéritos e Questionários
17.
Basic Clin Pharmacol Toxicol ; 128(5): 635-641, 2021 May.
Artigo em Inglês | MEDLINE | ID: covidwho-1132864

RESUMO

Opioids cover a broad class of natural, synthetic and semi-synthetic drugs that act on opioid receptors to produce powerful analgesic effects. Rates of opioid use and opioid agonist maintenance treatment have increased substantially in recent years, particularly among women. Trends and outcomes of opioids use on fertility, pregnancy and breastfeeding, and longer-term child developmental outcomes have not been well-described. Here, we review the existing literature on the health effects of opioid use on female fertility, pregnancy, breastmilk and the exposed infant. We find that the current literature is primarily concentrated on the impact of opioid use in pregnancy and neonatal outcomes, with little exploration of effects on fertility. Studies are limited in number, some with small sample sizes, and many are hampered by methodological challenges related to confounding and other potential biases. Opioid use is becoming more prevalent due to environmental pressures such as COVID-19. More research is needed to better elucidate its effects on reproductive health among younger women and support the development of evidence-based recommendations for safe prescription practices and public health messaging.


Assuntos
Aleitamento Materno , Fertilidade/efeitos dos fármacos , Transtornos Relacionados ao Uso de Opioides , Padrões de Prática Médica , Complicações na Gravidez , COVID-19/epidemiologia , Feminino , Humanos , Recém-Nascido , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Prevalência , SARS-CoV-2
19.
Am J Clin Oncol ; 44(6): 258-263, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33782334

RESUMO

BACKGROUND: A significant proportion of glioblastoma (GBM) patients are considered for repeat resection, but evidence regarding best management remains elusive. Our aim was to measure the degree of clinical uncertainty regarding reoperation for patients with recurrent GBM. METHODS: We first performed a systematic review of agreement studies examining the question of repeat resection for recurrent GBM. An electronic portfolio of 37 pathologically confirmed recurrent GBM patients including pertinent magnetic resonance images and clinical information was assembled. To measure clinical uncertainty, 26 neurosurgeons from various countries, training backgrounds, and years' experience were asked to select best management (repeat surgery, other nonsurgical management, or conservative), confidence in recommended management, and whether they would include the patient in a randomized trial comparing surgery with nonsurgical options. Agreement was evaluated using κ statistics. RESULTS: The literature review did not reveal previous agreement studies examining the question. In our study, agreement regarding best management of recurrent GBM was slight, even when management options were dichotomized (repeat surgery vs. other options; κ=0.198 [95% confidence interval: 0.133-0.276]). Country of practice, years' experience, and training background did not change results. Disagreement and clinical uncertainty were more pronounced within clinicians with (κ=0.167 [0.055-0.314]) than clinicians without neuro-oncology fellowship training (κ=0.601 [0.556-0.646]). A majority (51%) of responders were willing to include the patient in a randomized trial comparing repeat surgery with nonsurgical alternatives in 26/37 (69%) of cases. CONCLUSION: There is sufficient uncertainty and equipoise regarding the question of reoperation for patients with recurrent glioblastoma to support the need for a randomized controlled trial.


Assuntos
Tomada de Decisão Clínica , Glioblastoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Procedimentos Neurocirúrgicos/psicologia , Médicos/psicologia , Padrões de Prática Médica/normas , Reoperação/psicologia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/psicologia , Neoplasias Encefálicas/cirurgia , Gerenciamento Clínico , Feminino , Seguimentos , Glioblastoma/patologia , Glioblastoma/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/psicologia , Prognóstico , Revisões Sistemáticas como Assunto
20.
Best Pract Res Clin Endocrinol Metab ; 35(1): 101490, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33707082

RESUMO

Medical therapy is essential in the management of patients with Cushing's syndrome (CS) when curative surgery has failed, surgery is not feasible, when awaiting radiation effect, and in recurrent cases of CS. Steroidogenesis inhibitors have a rapid onset of action and are effective in reducing hypercortisolism, however, adverse effects, including adrenal insufficiency require very close patient monitoring. Osilodrostat is the only steroidogenesis inhibitor to have been assessed in prospective randomized controlled trials and approved for Cushing's disease (CD) by the US Food and Drug Administration and for CS by the European Medical Agency (EMA). Osilodrostat has been shown to be highly effective at maintaining normal urinary free cortisol in patients with CD. Drugs such as metyrapone, ketoconazole (both EMA approved), and etomidate lack prospective evaluation(s). There is, however, considerable clinical experience and retrospective data that show a very wide efficacy range in treating patients with CS. In the absence of head-to-head comparative clinical trials, therapy choice is determined by the specific clinical setting, risk of adverse events, cost, availability, and other factors. In this review practical points to help clinicians who are managing patients with CS being treated with steroidogenesis inhibitors are presented.


Assuntos
Síndrome de Cushing/tratamento farmacológico , Inibidores Enzimáticos/uso terapêutico , Imidazóis/uso terapêutico , Piridinas/uso terapêutico , Síndrome de Cushing/epidemiologia , Síndrome de Cushing/metabolismo , Citocromo P-450 CYP11B2/antagonistas & inibidores , Etomidato/uso terapêutico , Humanos , Hidrocortisona/uso terapêutico , Cetoconazol/uso terapêutico , Metirapona/uso terapêutico , Hipersecreção Hipofisária de ACTH/tratamento farmacológico , Hipersecreção Hipofisária de ACTH/epidemiologia , Hipersecreção Hipofisária de ACTH/metabolismo , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Esteroides/biossíntese
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