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1.
Biochem Med (Zagreb) ; 30(1): 010502, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839720

RESUMO

Extravascular body fluids (EBF) analysis can provide useful information in the differential diagnosis of conditions that caused their accumulation. Their unique nature and particular requirements accompanying EBF analysis need to be recognized in order to minimize possible negative implications on patient safety. This recommendation was prepared by the members of the Working group for extravascular body fluid samples (WG EBFS). It is designed to address the total testing process and clinical significance of tests used in EBF analysis. The recommendation begins with a chapter addressing validation of methods used in EBF analysis, and continues with specific recommendations for serous fluids analysis. It is organized in sections referring to the preanalytical, analytical and postanalytical phase with specific recommendations presented in boxes. Its main goal is to assist in the attainment of national harmonization of serous fluid analysis and ultimately improve patient safety and healthcare outcomes. This recommendation is intended to all laboratory professionals performing EBF analysis and healthcare professionals involved in EBF collection and processing. Cytological and microbiological evaluations of EBF are beyond the scope of this document.


Assuntos
Líquidos Corporais/química , Técnicas de Laboratório Clínico/normas , Líquidos Corporais/metabolismo , Exsudatos e Transudatos/química , Exsudatos e Transudatos/metabolismo , Guias como Assunto , Humanos , Segurança do Paciente , Derrame Pleural/diagnóstico , Garantia da Qualidade dos Cuidados de Saúde , Sociedades Médicas , Manejo de Espécimes/normas
2.
Anaesthesia ; 75(1): 21-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31236918

RESUMO

Previous studies on the safety of peri-operative transoesophageal echocardiography seem to suggest a low rate of associated morbidity and mortality. That said, there has been a paucity of prospective multicentre studies in this important area of clinical practice. We carried out a one-year prospective study in 2017, co-ordinated by the Association of Cardiothoracic Anaesthesia and Critical Care, to determine the rate and severity of complications associated with peri-operative transoesophageal echocardiography in anaesthetised cardiology and cardiac surgical patients. With the help of clinicians from 28 centres across the UK and Ireland, we recorded the total number of examinations conducted in anaesthetised patients during the study period. All major complications at each centre were prospectively reported and recorded. Of the 22,314 examinations, there were 17 patients diagnosed with a major complication which caused either palatal injury or gastro-oesophageal disruption. This corresponds to an incidence of 0.08% (95%CI 0.05-0.13%) or approximately 1:1300 examinations. There were seven deaths reported during the study period which were directly attributed to these complications, corresponding to an incidence of 0.03% (95%CI 0.01-0.07%) or approximately 1:3000. These figures are higher than previously reported and suggest a high probability of death following the development of a complication (~40%). Most complications occurred in patients without known risk factors for transoesophageal echocardiography associated gastro-oesophageal injury. We suggest clinicians and departments review their procedural guidelines, especially in relation to probe insertion techniques, together with the information communicated to patients when the risks and benefits of such examinations are discussed.


Assuntos
Anestesia em Procedimentos Cardíacos , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia Transesofagiana/efeitos adversos , Auditoria Médica/estatística & dados numéricos , Assistência Perioperatória/efeitos adversos , Idoso , Ecocardiografia Transesofagiana/estatística & dados numéricos , Feminino , Humanos , Irlanda , Masculino , Assistência Perioperatória/métodos , Assistência Perioperatória/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Sociedades Médicas , Reino Unido
3.
Zhonghua Zhong Liu Za Zhi ; 41(12): 881-890, 2019 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-31874543

RESUMO

Lung cancer is the most common cancer and the leading cause of cancer death in China, with 733 thousands estimated new lung cancer cases and 610 thousands deaths in 2015. In the pathological type of lung cancer, non-small cell lung cancer (NSCLC) accounts for 80%~85%, and 30% of NSCLC patients have already reached stage Ⅲ at diagnosis, who have lost the optimal opportunity for surgical treatment. Stage Ⅲ NSCLC is highly heterogeneous, the 5-year survival rates of stage ⅢA, ⅢB and ⅢC NSCLC are 36%, 26% and 13%, respectively. For the great complexity of making decisions in the clinical practice of stage Ⅲ NSCLC, the experts of this consensus group combine the latest clinical research results and cutting-edge multidisciplinary concepts, conduct in-depth and detailed discussions on the hot issues and controversies in the diagnosis, treatment and follow-up surveillance of stage Ⅲ NSCLC. Chinese Anti-Cancer Association and Committee of Lung Cancer Society jointly publish this consensus to provide guidance for Chinese clinicians.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , China/epidemiologia , Consenso , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Sociedades Médicas , Taxa de Sobrevida
4.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 654-662, dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184793

RESUMO

Las enfermedades endocrinas están experimentando un importante incremento de su prevalencia, debido a causas de diversa índole, entre ellas la epidemia de obesidad y de desnutrición, el envejecimiento de la población, pero también el efecto de los disruptores endocrinos, entre otros. Por otra parte, las nuevas tecnologías, tanto a nivel de analítica molecular y genética, de imagen y de nuevos dispositivos terapéuticos, obligan a que la comunidad profesional endocrina en España tenga que estar en constante formación. La conexión con los pacientes a través de sus asociaciones, cada vez más activas, y con la sociedad civil en general, el compromiso profesional y la demanda de diversos colectivos sociales de una atención moderna y equitativa, y a llevar a cabo investigación que facilite la consecución de avances para los pacientes, obligan al especialista en Endocrinología y Nutrición, y a la Sociedad Española de Endocrinología y Nutrición (SEEN), a posicionarse y dar respuesta a todos estos retos. En el presente documento, la SEEN expone sus propuestas y su estrategia hasta el 2022


Endocrine diseases are experiencing an important increase in their prevalence, due to causes of various kinds, including the epidemic of obesity and malnutrition, the aging of the population, but also the effect of endocrine disruptors, among others. On the other hand, new technologies, both in terms of molecular and genetic analysis, image and new therapeutic devices, require that the endocrine professional community in Spain must be in constant training. The connection with patients through their associations, increasingly active, and with the civil society in general, the professional commitment and demand of various social groups for a modern and equitable care, and to carry out research that facilitates the achievement of advances for patients, forces the specialist in endocrinology and nutrition and the Spanish Society of Endocrinology and Nutrition (SEEN) to position themselves and respond to all these challenges. In this document, the SEEN presents its proposals and its strategy until 2022


Assuntos
Endocrinologia/organização & administração , Sociedades Médicas/organização & administração , Sociedades Médicas/tendências , Estratégias , Endocrinologia/tendências , Sistemas Nacionais de Saúde , Medicina/organização & administração , Promoção da Saúde , Espanha
5.
Acta otorrinolaringol. esp ; 70(6): 364-372, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184882

RESUMO

En noviembre 2014 la Sociedad Española de Otorrinolaringología, la Sociedad Española de Sueño y la Sociedad Española de Cirugía Maxilofacial propusieron y avalaron la elaboración de una Guía de Práctica Clínica sobre la exploración física de la vía aérea superior en pacientes con apnea obstructiva del sueño. La Guía ha seguido de forma estricta en toda su elaboración las recomendaciones del manual de elaboración de guías de práctica clínica del Sistema Nacional de Salud 2007 y 2009 y el manual de la Scottish Intercollegiate Guidelines Network (SIGN) 2015. El documento final puede ser altamente útil para los fines que se propuso inicialmente: ser un referente para unificar las regiones que deben ser exploradas en los pacientes con síndrome de apnea-hipoapnea obstructiva del sueño, mediante qué tipo de exploración y cómo gradarla, y expresada para todos los ámbitos asistenciales a los que estos pacientes pueden acudir. Las conclusiones y recomendaciones están basadas en una revisión exhaustiva y actualizada de la bibliografía con alto nivel de evidencia, además de la experiencia y conocimientos demostrados de todos los integrantes del grupo de elaboración. Dicho grupo se constituyó pensando siempre en la transversalidad del proyecto, y, por tanto, han participado especialistas de todos los ámbitos implicados (cirugía maxilofacial, medicina de familia, neumología, neurofisiología clínica, odontología y otorrinolaringología). Con la misma idea se seleccionaron los revisores externos del texto final


In November 2014 the Spanish Society of Otolaryngology, the Spanish Sleep Society and the Spanish Society of Maxillofacial Surgery proposed and endorsed the development of a Clinical Practice Guideline on the physical examination of the upper airway in patients with obstructive sleep apnoea. The Guideline strictly followed the recommendations of the manual for the preparation of clinical practice guidelines of the National Health System 2007 and 2009 and the manual of the Scottish Intercollegiate Guidelines Network (SIGN) 2015. The final document could be highly useful for the purposes that were originally proposed: to act as a reference to unify the regions that should be explored in patients with obstructive sleep apnoea-hypopnoea syndrome, the type of examination and how to grade it, and specific to all the care areas to which these patients have access. The conclusions and recommendations are based on a thorough and up-to-date review of the literature with a high level of evidence, as well as the experience and knowledge demonstrated by all the members of the drafting group. This group was formed bearing in mind at all times the transversality of the project, and, therefore, specialists from all the involved areas participated (maxillofacial surgery, family medicine, pneumology, clinical neurophysiology, odontology and otolaryngology). The external reviewers of the final text were selected along the same lines


Assuntos
Humanos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Manuseio das Vias Aéreas/normas , Exame Físico/métodos , Sociedades Médicas/normas , Exame Físico/normas
6.
Orv Hetil ; 160(48): 1894-1903, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31760773

RESUMO

Introduction: According to the Hungarian law, placental examination is not mandatory, although it is known from the international practice that it can give valuable information in cases of stillbirth or in conditions, where the neonate has difficulty in the postnatal adaptation. Aim: It can be useful in the early detection of diseases, which otherwise would have gone undetected until late in life. This article is unique in Hungary, as no similar guideline exists in Hungarian language. Method: The recommendation of the Royal College of Pathologists (United Kingdom) determines those conditions where essential information can be obtained from the placental examination in not normal pregnancies. It serves as a useful guide in the medical practice. The journal titled "Placenta", first published in 1980 with impact factor above two, just underlines this statement. Results: In this article, the authors present the recent guideline of the RCPath and finish with the presentation of established clinicopathological association that might help clinicians to get the most valuable information from placental examination. Conclusion: The present article aims to summarise updated recommendations and present clinicopathological correlations. Orv Hetil. 2019; 160(48): 1894-1903.


Assuntos
Placenta/patologia , Guias de Prática Clínica como Assunto , Natimorto , Feminino , Humanos , Hungria , Recém-Nascido , Gravidez , Sociedades Médicas , Cordão Umbilical/patologia , Reino Unido
8.
Can Assoc Radiol J ; 70(4): 327-328, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31685097
9.
Pneumologie ; 73(10): 586-591, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31622997

RESUMO

Infectious Diseases are a cross-sectional area connected to various medical disciplines and offer interested physicians multiple working opportunities. The spectrum of infectious diseases covers both out- and inpatient care as well as basic, clinical and epidemiological research. The need for infectious diseases specialists is increasing, thus career prospects are promising. Working conditions in infectious diseases are comparatively family-friendly. With this article we intend to arouse interest for working in the fascinating fields of infectious diseases and provide information on career opportunities. Data from a recently conducted survey among members of the German Society of Infectious Diseases deliver insight, how infectious disease specialists work today.


Assuntos
Escolha da Profissão , Infectologia/educação , Infectologia/organização & administração , Médicos , Estudos Transversais , Alemanha , Humanos , Médicos/organização & administração , Médicos/estatística & dados numéricos , Sociedades Médicas , Inquéritos e Questionários
10.
Z Geburtshilfe Neonatol ; 223(5): 304-316, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31623006

RESUMO

AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS: Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS: Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.


Assuntos
Guias de Prática Clínica como Assunto , Nascimento Prematuro , Áustria , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Prevenção Primária , Sistema de Registros , Prevenção Secundária , Sociedades Médicas
11.
Isr Med Assoc J ; 21(10): 671-675, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599509

RESUMO

BACKGROUND: Recently, Israel established the first national-level adult cardiac surgery database, which was linked to the Society of Thoracic Surgeons (STS). OBJECTIVES: To validate and compare the STS predicted risk of mortality (PROM) to logistic EuroSCORE I (LESI) and EuroSCORE II (ESII) in Israeli patients undergoing cardiac surgery. METHODS: We retrospectively studied 1279 consecutive patients who underwent cardiac surgeries with a calculable PROM. Data were prospectively entered into our database and used to calculate PROM, LESI, and ESII. Scores were normalized and correlated using linear regression and Pearson's test. To examine model calibration, we plotted the total observed versus expected mortality for each score and across five risk-score subgroups. Model discrimination was assessed by measuring the area under the receiver operating curves. RESULTS: The observed 30-day operative mortality was 1.95%. The median (IQ1; IQ3) PROM, LESI, and the ESII scores were 1.45% (0.69; 3.22), 4.54% (2.28; 9.27), and 1.88% (1.18; 3.54), respectively, with observed over expected ratios of 0.63 (95% confidence interval [95%CI] 0.42-0.93), 0.59 (95%CI 0.40-0.87), and 0.24 (95%CI 0.17-0.36), respectively, (STS vs. ESII P = 0.36, STS vs. LESI P = 0.0001). There was good correlation among all scores. All models overestimated mortality. Model discrimination was high and similar for all three scores. Model calibration of the STS, PROM, and ESII were more accurate than the LESI, particularly in higher risk subgroups. CONCLUSIONS: All scores overestimated mortality. In Israeli patients, the STS, PROM, and ESII risk-scores were more reliable metrics than LESI, particularly in higher risk patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Gestão de Riscos/métodos , Gestão de Riscos/estatística & dados numéricos , Idoso , Bases de Dados Factuais , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Sociedades Médicas , Cirurgia Torácica
14.
Can Assoc Radiol J ; 70(4): 329-334, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31585825

RESUMO

This is a condensed summary of an international multisociety statement on ethics of artificial intelligence (AI) in radiology produced by the ACR, European Society of Radiology, RSNA, Society for Imaging Informatics in Medicine, European Society of Medical Imaging Informatics, Canadian Association of Radiologists, and American Association of Physicists in Medicine. AI has great potential to increase efficiency and accuracy throughout radiology, but it also carries inherent pitfalls and biases. Widespread use of AI-based intelligent and autonomous systems in radiology can increase the risk of systemic errors with high consequence and highlights complex ethical and societal issues. Currently, there is little experience using AI for patient care in diverse clinical settings. Extensive research is needed to understand how to best deploy AI in clinical practice. This statement highlights our consensus that ethical use of AI in radiology should promote well-being, minimize harm, and ensure that the benefits and harms are distributed among stakeholders in a just manner. We believe AI should respect human rights and freedoms, including dignity and privacy. It should be designed for maximum transparency and dependability. Ultimate responsibility and accountability for AI remains with its human designers and operators for the foreseeable future. The radiology community should start now to develop codes of ethics and practice for AI that promote any use that helps patients and the common good and should block use of radiology data and algorithms for financial gain without those two attributes.


Assuntos
Inteligência Artificial/ética , Radiologia/ética , Canadá , Consenso , Europa (Continente) , Humanos , Radiologistas/ética , Sociedades Médicas , Estados Unidos
15.
Rinsho Ketsueki ; 60(9): 1366-1371, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597865

RESUMO

A conflict of interest (COI) is a conflict between private interests and one's official responsibilities. COI is unavoidable and thus needs to be managed. Debates about COI in medical research area began in the United States in the 1980s. COI clause was added to the Helsinki Declaration in the year of 2000 after the Gelsinger affair. Discussions in Japan subsequently followed, and COI management guidelines have been sequentially presented by different organizations, particularly after the Diovan incident in 2013. Guidelines presented by the Japan Medical Association (JMA) in 2017 are currently regarded as standard. COI disclosure is required at research presentations and medical practice guideline announcements, among others, and should be carefully managed in the latter. In 2018, the Japanese Society of Hematology announced revision of the Japanese Society of Internal Medicine common guidance, presenting it in accordance with the JMA's guidelines. In the "Specific Clinical Research" section defined in the "Clinical Research Method Enforcement Rule", people who should not take a representative position or who should pay special attention when taking it are defined.


Assuntos
Conflito de Interesses , Hematologia/normas , Sociedades Médicas/normas , Revelação , Japão
16.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 566-570, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642237

RESUMO

OBJECTIVE: To explore the application value of American Urological Association symptom index (AUA-SI) score in female patients of type 2 diabetes mellitus with neurogenic bladder. METHODS: This study included 289 female patients with type 2 diabetes who were hospitalized in our hospital from July 2015 to July 2018. To each of them, residual urine volume (RUV) test, fundus test, and random urinary albumin creatinine ratio (UACR) test were performed, and a questionnaire survey was conducted using AUA-SI scale. Multivariate logistic regression was used to analyze the risk factors of diabetic neurogenic bladder (DNB) in women with type 2 diabetes.RUV≥100 mL was used as the diagnostic golden standard for DNB, and the patients were divided into DNB group and non-DNP group. The ROC curve was used to evaluate the diagnostic performance of AUA-SI. Linear regression was used to test the linear trend of AUA-SI score with diabetic retinopathy stage and diabetic nephropathy stage. RESULTS: The levels of the fasting plasma glucose, hemoglobin A1c (HbA1c) and AUA-SI score in DNP group were higher than those in non-DNP group (P < 0.001). Multivariate logistic regression analysis showed that AUA-SI score had the greatest predictive value for the occurrence of DNB 〔odds ratio (OR)=1.876, P < 0.001〕.The area under the curve (AUC) was 0.843, P=0.000, 95% confidence interval (CI) (0.799, 0.888). The optimal diagnostic threshold was 7.5, the corresponding sensitivity was 0.747, and the specificity was 0.822. There was a positive correlation between the severity of AUA-SI score and the stage of diabetic retinopathy and diabetic nephropathy (P < 0.01). CONCLUSION: AUA-SI score can be used to screen female patients with DNB, while it seems parallel to the severity of DNP, diabetic retinopathy and diabetic nephropathy.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Bexiga Urinaria Neurogênica/diagnóstico , Feminino , Humanos , Fatores de Risco , Sensibilidade e Especificidade , Sociedades Médicas , Inquéritos e Questionários , Estados Unidos , Bexiga Urinaria Neurogênica/etiologia
17.
Lakartidningen ; 1162019 Sep 27.
Artigo em Sueco | MEDLINE | ID: mdl-31573669

RESUMO

MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions.  MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny.  A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.


Assuntos
Mortalidade Materna , Adolescente , Adulto , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Morte Materna , Transtornos Mentais/mortalidade , Transtornos Mentais/prevenção & controle , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/prevenção & controle , Pré-Eclâmpsia/mortalidade , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Neoplásicas na Gravidez/mortalidade , Complicações Neoplásicas na Gravidez/prevenção & controle , Qualidade da Assistência à Saúde , Sociedades Médicas , Suicídio/prevenção & controle , Suécia/epidemiologia , Tromboembolia/mortalidade , Tromboembolia/prevenção & controle
20.
Urologe A ; 58(11): 1313-1323, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31659368

RESUMO

In this review article, the authors describe all relevant aspects of the new S2k guideline from the German Society of Urology (Deutschen Gesellschaft für Urologie, DGU) for the diagnosis and treatment of IC/PBS (interstitial cystitis/painful bladder syndrome). A list of necessary and optional examinations and the necessity of diagnosis of exclusion are summarized and evaluated. The treatment options listed (ranging from conservative, oral drug, and complementary medicine to interventional surgical procedures) also give the reader a good overview of the contents of the guideline and possible therapeutic approaches. Finally, the recommendations including consensus of the guideline group are also summarized in various information boxes.


Assuntos
Cistite Intersticial/diagnóstico , Cistite Intersticial/terapia , Guias de Prática Clínica como Assunto , Urologia/normas , Alemanha , Humanos , Dor , Exame Físico , Sociedades Médicas
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