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2.
Stud Health Technol Inform ; 264: 576-580, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437989

RESUMO

A fast and frugal generic tool can provide decision support to those making decisions about individual cases, particularly clinicians and clinical commissioners operating within the budget and time constraints of their practices. The multi-national Generic Rapid Evaluation Support Tool (GREST) is a standard preference-sensitive Multi-Criteria Decision Analysis-based tool, but innovatory insofar as an equity criterion is introduced as one of six. Equity impact reflects the number of population QALYs lost or gained in moving from Old (current intervention) to New (contemplated intervention). In the exemplar UK implementation Claxton's NHS Willingness to Pay per QALY is the numeraire. Any weight from 0 to 100% may be assigned to the equity criterion but its presence affirms that it is persons-as-citizens who experience any opportunity harms or benefits arising from actions within the health service commons. A fully-operational but demonstration-only version is available on open access, as proof of concept and method.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Anos de Vida Ajustados por Qualidade de Vida
3.
Stud Health Technol Inform ; 265: 163-168, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431593

RESUMO

Individuals have different preferences in how they wish to relate to healthcare professionals such as doctors. Given choice, they also have preferences in relation to the type and location of support they want for their health and healthcare decisions. We argue that preference-based clusters within this heterogeneity constitute different contexts and that evaluations of decision aids should be context-sensitive in this respect. We draw attention to two distinct preference-based clusters: individuals with a preference for 'intermediative' decision support as a patient, implemented in a largely qualitative deliberative model, on the one hand, and for 'apomediative' decision support as a person, implemented in a largely quantitative multi-criteria decision analytic model, on the other. For convenience, we refer to the latter as Person Decision Support Tools (PDSTs), leaving Patient Decision Aids (PDAs) for its former, conventional use. Seeking to establish proof of method, we present an online PDST that can help individuals establish which of these two types of decision support they would find optimal. It is based on nine key attributes on which PDAs and PDSTs can be contrasted. Within population heterogeneity, preference clusters should be identified, and acknowledged and respected as contexts relevant to the evaluation of decision support tools.


Assuntos
Técnicas de Apoio para a Decisão , Médicos , Tomada de Decisões , Sistemas Especialistas , Humanos , Preferência do Paciente , Software
4.
Rev Lat Am Enfermagem ; 27: e3169, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432922

RESUMO

OBJECTIVE: To develop a web software prototype to support retirement planning. METHOD: This is a methodological research, applied and based on the principles of prototyping model, which followed the steps of communication, planning, prototype creation, functional tests and consolidation of web software version 1. RESULTS: The functions of the web software prototype were defined from a flowchart and scope. In the creation stage, the screens that integrated the prototype, composed by interview, were projected from the filling of the Retirement Resources Inventory, screen of access to support planning materials, including lectures, scientific texts, and technical materials, retirement news screen, experiences screen, which allow users to post retirement expectations and comment on other users' posts. After performing tests, the prototype was made available at www.aposentarsecomsaude.com.br . CONCLUSION: the web software prototype consists of an interactive environment in which the user feels active in the reflection process about the retirement along the different screens. With clear language and expressions that are easily understood by the public, they are applicable to users of different professional profiles.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Aposentadoria , Desenho de Programas de Computador , Brasil , Instrução por Computador , Humanos , Acontecimentos que Mudam a Vida , Motivação , Sistemas On-Line , Reprodutibilidade dos Testes
5.
Stud Health Technol Inform ; 263: 109-121, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31411157

RESUMO

The accumulation of medical knowledge, technology and expertise has provided people with more and more options to improve their health and increase longevity. However, healthcare options typically come with benefits as well as harms and often involve important and complex, high-stakes trade-offs. The ideal of Shared Decision Making (SDM), where a healthcare provider and a patient exchange information, bring in their respective professional and existential expertise and consider the options in light of what matters most from the patient's perspective, is a paradigm that is increasingly viewed as a gold standard for high quality care nowadays. eHealth provides ample opportunities to foster personal health choices and SDM through digital information exchange and personal values clarification support. The boosting framework attempts to describe how to foster people's competences to make choices. Its vision is to equip individuals with competences, for instance improved risk literacy, to empower them to make well-informed choices when facing a difficult choice, such as decisions about health issues. Application of the boosting framework to personal health choices and the SDM process unveils new and promising horizons for future research and could inform the design and evaluation of health informatics interventions such as decision support systems.


Assuntos
Técnicas de Apoio para a Decisão , Informática Médica , Participação do Paciente , Tomada de Decisões , Pessoal de Saúde , Humanos
6.
Stud Health Technol Inform ; 263: 146-158, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31411160

RESUMO

The rising use of the Internet and information technology has made computerized interventions an attractive channel for providing advice and support for behaviour change. Health behaviour and behaviour change theories are a family of theories which aim to explain the mechanisms by which human behaviours change and use that knowledge to promote change. Among the best-known of these theories are the Social Learning and Social Cognitive theories, the Health Belief Model, the Theory of Reasoned Action and its successors the Theory of Planned Behaviour and the Reasoned Action Approach, and the Transtheoretical model. We discuss three examples of how behaviour change theories have been applied in computer-based interventions: a system to aid users to quit smoking, a decision aid for choice of breast cancer therapy, and an internet-based exercise program for reducing cardiovascular risk. We also discuss misapplication of theory, and reflect on how these theories can best be used. Behaviour change theory can be applied in health informatics interventions in several ways; for example, to select participants for a particular intervention, to shape the content of the intervention to effectively influence behaviour, or to tailor content to individual needs. Application of these theories to provide personalized advice ("decision support") is a young but promising area of research, and could inform other decision support interventions, including those that provide support for clinicians.


Assuntos
Exercício , Comportamentos Relacionados com a Saúde , Informática Médica , Técnicas de Apoio para a Decisão , Humanos
7.
Methodist Debakey Cardiovasc J ; 15(2): 111-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384374

RESUMO

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. The pathophysiology leading to sudden cardiac death, the specific risks associated with the different varieties of AAOCA, and the effects of different management strategies on the risk of sudden cardiac death are all unknown. This article describes the current knowledge of AAOCA, a proposed nomenclature for the different anatomic subtypes, the different modalities used to diagnose and characterize the disease, the available management strategies, and an algorithm used by the authors to diagnose and manage these patients.


Assuntos
Técnicas de Imagem Cardíaca , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Morte Súbita Cardíaca/prevenção & controle , Algoritmos , Tomada de Decisão Clínica , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Morte Súbita Cardíaca/etiologia , Técnicas de Apoio para a Decisão , Humanos , Seleção de Pacientes , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
8.
Rev. Hosp. El Cruce ; (24): 19-34, 18/07/2019.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1006630

RESUMO

OBJETIVO: Se describe la segunda parte de la revisión que comprende el pronóstico y el tratamiento actualizado de la embolia pulmonar en el servicio de emergencias. Se trata de describir, desarrollar el pronóstico y el tratamiento actual de la embolia de pulmón. MÉTODO: Revisión de evidencias científicas. CONCLUSIÓN: El enfoque diagnóstico de la embolia de pulmón en el Servicio de Emergencias representa un verdadero desafío, donde debemos tener un alto grado de sospecha dada la inespecificidad de los síntomas y que puede estar enmascarada por otras patologías.


OBJECTIVE: The second part of the review that includes the prognosis and the updated treatment of pulmonary embolism in the emergency service is described. It is about describing, developing the prognosis and the current treatment of lung embolism. METHODS: Review of scientific evidence. CONCLUSION: The diagnostic approach of pulmonary embolism in the Emergency Department represents a real challenge, where we must have a high degree of suspicion given the non-specificity of the symptoms and that may be masked by other pathologies.


Assuntos
Embolia Pulmonar , Epidemiologia , Técnicas de Apoio para a Decisão , Cuidados Críticos
9.
Ther Adv Cardiovasc Dis ; 13: 1753944719860676, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31319783

RESUMO

BACKGROUND: The role of cancer-specific factors for ischemic stroke and mortality in patients with cancer and atrial fibrillation (AF) is unknown. We evaluated the utility of a previously validated risk tool for venous thromboembolism (VTE) in cancer outpatients [Khorana score (KS)] in predicting stroke and mortality in cancer patients with AF. METHODS: We conducted a retrospective cohort study of patients with cancer and AF at the Cleveland Clinic from 2008 to 2014. Outcomes, CHADS2, CHA2DS2-VASc, and KS scores were calculated from date of cancer diagnosis. Prognostic factors were identified with Fine and Gray regression (for stroke) or Cox proportional hazards analysis (for mortality). RESULTS: The study population comprised 1181 patients. Genitourinary (19%), lung (18%), and gastrointestinal (13%) were the most frequent cancers. Overall, 67% had CHADS2 ⩾ 2, 57% had an intermediate KS (1-2), and 7% high KS (⩾3). Median follow up was 26.5 months (range 0.03-76). At a median of 8.2 months (range 0-61), 45 patients (3.8%) developed a stroke and 418 (35%) died. In multivariable analysis a high KS (HR 4.5, 95% CI 3.2-6.3, p < 0.001) was associated with a quadruple risk of death and every point increase in CHADS2 score had a 20% increased risk of death (HR 1.19, 95% CI 1.1-1.2, p < 0.001). The addition of KS did not improve risk stratification for ischemic stroke to CHADS2. CONCLUSION: In patients with cancer and AF, CHADS2 and CHA2DS2-VASc but not KS were predictive of ischemic stroke. A high KS represented a unique predictor of mortality beyond traditional risk scores.


Assuntos
Fibrilação Atrial/complicações , Isquemia Encefálica/etiologia , Técnicas de Apoio para a Decisão , Neoplasias/complicações , Acidente Vascular Cerebral/etiologia , Tromboembolia Venosa/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/mortalidade , Ohio , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade
11.
World J Emerg Surg ; 14: 33, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31338118

RESUMO

Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. It is a great mimicker that has unusual presentations. A high index of suspicion is essential for reaching its diagnosis. Clinical and radiological findings of abdominal tuberculosis are non-specific. Herein, we report the lessons we have learned over the last 30 years stemming from our own mistakes in diagnosing abdominal tuberculosis supported by illustrative challenging clinical cases. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis. This diagnostic algorithm will help in reaching the proper diagnosis by histopathology or microbiology. Our diagnostic workup depends on categorizing the clinical and radiological findings of abdominal tuberculosis into five different categories including (1) gastrointestinal, (2) solid organ lesions, (3) lymphadenopathy, (4) wet peritonitis, and (5) dry/fixed peritonitis. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound-guided aspiration followed by laparoscopy if needed. Diagnostic laparotomy should be kept as the last option for achieving a histological diagnosis. Capsule endoscopy and enteroscopy were not included in the diagnostic algorithm because of the limited data of using these modalities in abdominal tuberculosis. They need special expertise, and rarely used in low- and middle-income countries. Furthermore, capsule endoscopy may cause complete intestinal obstruction in small bowel strictures. A definite diagnosis can be reached in only 80% of the patients. Therapeutic diagnosis should be tried in the remaining 20%.


Assuntos
Tuberculose Gastrointestinal/diagnóstico , Adulto , Algoritmos , Antituberculosos/uso terapêutico , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Tuberculose Gastrointestinal/fisiopatologia , Ultrassonografia/métodos
12.
Medicine (Baltimore) ; 98(29): e16375, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335685

RESUMO

A human immunodeficiency virus (HIV) risk assessment tool was previously developed for predicting HIV infection among men who have sex with men (MSM), but was not externally validated. We evaluated the tool's validity for predicting HIV infection in an independent cohort.The tool was assessed using data from a retrospective cohort study of HIV-negative adult MSM who were recruited in Beijing, China between January 2009 and December 2016.High-risk behaviors occurring within 6 months before the survey were evaluated. Area under curve (AUC) of the receiver operating character curve (ROC) was used to quantify discrimination performance; calibration curve and Hosmer-Lemeshow statistic were used for calibration performance valuation; and decision curve analysis (DCA) was used to evaluate clinical usage.One thousand four hundred forty two participants from the cohort were included in the analysis; 246 (17.1%) sero-converted during follow-up. External validation of the tool showed good calibration, the Hosmer-Lemeshow test showed no statistical difference between observed probability and tool-based predictive probability of HIV infection (X = 4.55, P = .80). The tool had modest discrimination ability (AUC = 0.63, 95% confidence interval [CI]: 0.61-0.66). The decision curve analysis indicated that implementing treatment measures based on the tool's predicative risk thresholds ranging from 10% to 30% might increase the net benefit of treatment when compared with treating all or no MSM.The HIV risk assessment tool can predict the actual risk of HIV infection well amongst MSM in China, but it has a moderate ability to discriminate those at high risk of HIV infection.


Assuntos
Infecções por HIV , Medição de Risco/métodos , Adolescente , Adulto , Área Sob a Curva , Pequim/epidemiologia , Estudos de Coortes , Técnicas de Apoio para a Decisão , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Homossexualidade Masculina , Humanos , Masculino , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Minorias Sexuais e de Gênero/estatística & dados numéricos
13.
J Cancer Res Clin Oncol ; 145(8): 1949-1976, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31292714

RESUMO

PURPOSE: Efflux transporters of the adenosine triphosphate-binding cassette (ABC)-superfamily play an important role in the development of multidrug resistance (multidrug resistant; MDR) in cancer. The overexpression of these transporters can directly contribute to the failure of chemotherapeutic drugs. Several in vitro and in vivo models exist to screen for the efficacy of chemotherapeutic drugs against MDR cancer, specifically facilitated by efflux transporters. RESULTS: This article reviews a range of efflux transporter-based MDR models used to test the efficacy of compounds to overcome MDR in cancer. These models are classified as either in vitro or in vivo and are further categorised as the most basic, conventional models or more complex and advanced systems. Each model's origin, advantages and limitations, as well as specific efflux transporter-based MDR applications are discussed. Accordingly, future modifications to existing models or new research approaches are suggested to develop prototypes that closely resemble the true nature of multidrug resistant cancer in the human body. CONCLUSIONS: It is evident from this review that a combination of both in vitro and in vivo preclinical models can provide a better understanding of cancer itself, than using a single model only. However, there is still a clear lack of progression of these models from basic research to high-throughput clinical practice.


Assuntos
Transportadores de Cassetes de Ligação de ATP/fisiologia , Antineoplásicos/isolamento & purificação , Resistência a Múltiplos Medicamentos , Resistencia a Medicamentos Antineoplásicos , Ensaios de Seleção de Medicamentos Antitumorais/métodos , Modelos Biológicos , Transportadores de Cassetes de Ligação de ATP/antagonistas & inibidores , Transportadores de Cassetes de Ligação de ATP/genética , Antineoplásicos/farmacologia , Transporte Biológico/efeitos dos fármacos , Transporte Biológico/genética , Técnicas de Cultura/métodos , Técnicas de Apoio para a Decisão , Resistência a Múltiplos Medicamentos/efeitos dos fármacos , Resistência a Múltiplos Medicamentos/genética , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Resistencia a Medicamentos Antineoplásicos/genética , Humanos , Especificidade de Órgãos , Seleção de Pacientes
14.
J Stroke Cerebrovasc Dis ; 28(9): 2517-2524, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31296477

RESUMO

BACKGROUND: The purpose of this study was to validate and pilot the use of the four-variable screening tool (4V) and modified 4V tools to identify acute ischemic stroke and transient ischemic attack (TIA) patients at high risk of obstructive sleep apnea (OSA). METHODS: Two modified scales, 4V-1 (ie, using neck circumference instead body mass index, regardless of gender) and 4V-2 (ie, as above but scored differently according to gender) were designed. These tools were used in a consecutive cohort of 124 acute ischemic stroke/TIA patients, together with the 4V-1, 4V-2, 4V, as well as the STOP-BANG, the Berlin questionnaire, and the Epworth Sleepiness Scale (ESS). Objective level 2 or level 3 polysomnography was used to confirm OSA and its severity. Both questionnaires and polysomnography were completed within 1 week from symptom onset. RESULTS: Area under the curve (AUC) of 4V was 0.807 (P< .0001) while AUC of STOP-BANG, Berlin Questionnaire and ESS were .701 (P< .0001), .704 (P< .0001) and .576 (P = .1556), respectively. AUC of 4V was greater than of STOP-BANG (z = 2.200, P = .0220), Berlin (z = 2.024, P = .0430) and ESS (z = 3.363, P = .0003). AUC of modified 4V-1 and modified 4V-2 were .824 (P< .001) and .835 (P< .001), respectively. Performance of modified 4V-2 was higher versus modified 4V-1 (z = 2.111, P = .0348) and higher but not significantly so to regular 4V (z = 1.784, P = .0744). CONCLUSIONS: Neck circumference scored by gender is a useful substitution to body mass index in the 4V when screening OSA at early stages of ischemic stroke/TIA patients.


Assuntos
Isquemia Encefálica/diagnóstico , Técnicas de Apoio para a Decisão , Ataque Isquêmico Transitório/diagnóstico , Pescoço/patologia , Apneia Obstrutiva do Sono/etiologia , Acidente Vascular Cerebral/diagnóstico , Idoso , Pressão Sanguínea , Índice de Massa Corporal , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Feminino , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Polissonografia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Inquéritos e Questionários
15.
Health Qual Life Outcomes ; 17(1): 112, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262318

RESUMO

BACKGROUND: Health economists have shown a growing interest in deliberation and multi-criteria decision analysis (MCDA) as possible pathways to transparently integrate value judgments in cost-utility analyses. In line with these developments, this study piloted a consensus process to derive a German value set for the Short-Form Six-Dimension (SF-6D). In a conference setting, a group was tasked to deliberate on scores and weights for the SF-6D from the perspective of a self-determined and independent life. METHODS: The one-day consensus conference was based on a deliberative process in combination with the MCDA method MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique). According to MACBETH, participants were asked to qualitatively rate pairwise comparisons of SF-6D health states. The scoring within each dimension was conducted in parallel group sessions. Final agreement on the scores as well as weights for the SF-6D dimensions were derived in a subsequent plenary assembly. Results were analyzed using the software M-MACBETH and qualitative content analysis. RESULTS: A total of 34 participants were recruited. While each of the 6 small groups presented a consented score, the plenary assembly reached consensus on all dimensions apart from pain. Concerning dimension weights, some participants favored prioritizing pain and mental health. Others disputed that trade-offs between dimensions and thus assigning weights were not acceptable in a context where this may involve withholding care from someone. As a consequence, no consensus on a value set was reached. Participants identified the group size of the plenary session and the applied weighting procedure as main obstacles to the process. CONCLUSIONS: This pilot study presents a consensus-based approach for valuing health-related quality of life. However, further research is needed on deliberative processes that yield quantifiable results. Future conferences should explore smaller group sizes, longer durations of the deliberative process and alternatives to the additive value function applied in MACBETH.


Assuntos
Técnicas de Apoio para a Decisão , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Conferências de Consenso como Assunto , Análise Custo-Benefício , Feminino , Pesquisa sobre Serviços de Saúde , Nível de Saúde , Humanos , Masculino , Projetos Piloto , Adulto Jovem
16.
Expert Rev Pharmacoecon Outcomes Res ; 19(4): 409-420, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31210065

RESUMO

Introduction: Orphan diseases are low-prevalence conditions with chronically debilitating or life-threatening consequences. Their treatments are generally called orphan drugs (OD). Health-technology assessment processes have traditionally considered cost-effectiveness analysis (CEA), when making reimbursement and pricing decisions for health-care plans. Valuing OD with standard CEA raises important issues due to uncertain evidence, inability to meet cost-effectiveness thresholds for reimbursement and high budget impact, among others. Multi-criteria decision analysis (MCDA) allows to overcome these issues and improve the technical and ethical quality of decisions regarding prioritization, coverage, and reimbursement of OD. Areas covered: A scoping review was conducted in order to characterize MCDA frameworks for assessing OD and implementation experiences. We reviewed electronic databases (Medline, Embase, Cochrane Library, EBSCO, CINAHL, EconLit, Web of Science, LILACS, Google Scholar) key journals (Orphanet Journal of Rare Diseases and Value in Health) and organization repositories. Expert opinion: The theoretical framework for MCDA considers areas related to characteristics of orphan diseases and their technologies' clinical and economic impact. Participation processes are critical in incorporating societal values in weighting different dimensions and constructing decision rules. Local implementation pilots considering different stakeholders are necessary in order to pinpoint specific barriers and opportunities.


Assuntos
Técnicas de Apoio para a Decisão , Produção de Droga sem Interesse Comercial/métodos , Doenças Raras/tratamento farmacológico , Orçamentos , Análise Custo-Benefício , Tomada de Decisões , Humanos , Produção de Droga sem Interesse Comercial/economia , Doenças Raras/economia , Mecanismo de Reembolso , Avaliação da Tecnologia Biomédica/métodos
17.
Anticancer Res ; 39(6): 3033-3038, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177145

RESUMO

BACKGROUND/AIM: Treatment algorithms for primary and recurrent hepatocellular carcinoma (HCC) are described in the current Japanese Clinical Practice Guidelines; however, primary and recurrent tumors exhibit several differences in oncological characteristics such as clinicopathological features and prognostic factors. This study aimed to investigate the prognostic factors for recurrent HCC including time of recurrence after primary hepatectomy, to elucidate appropriate treatment strategies in these patients. PATIENTS AND METHODS: One hundred and nine patients who had undergone radical resection of primary HCC at our Hospital and had experienced intrahepatic recurrence were included in this study. Patients were categorized into the early-recurrence (ER, <1 year postoperatively) or the late-recurrence (LR, ≥1 year postoperatively) groups. Clinicopathological features were compared between the two groups for prognostic analyses. RESULTS: Comparison of clinicopathological features between the ER and LR groups revealed that, at the time of recurrence, the ER group had a significantly higher frequency of multiple recurrences compared to the LR group. In univariate prognostic analysis, the time of recurrence (ER or LR) and the number of recurrent tumors (≥3) were significant prognostic factors after recurrence. Multivariate analysis revealed that three or more recurrent tumors and ER were independent prognostic factors for poor survival after recurrence. CONCLUSION: HCC is likely to recur, and the characteristics of recurrent HCC are distinct from those of primary HCC. To improve post-recurrence poor prognosis, new and more feasible algorithms, such as aggressive surgical treatment for cases with less than three recurrent tumors, which were revealed in the current study, are needed.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/terapia , Idoso , Algoritmos , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
Angiol Sosud Khir ; 25(2): 11-15, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31149986

RESUMO

The purpose of the study was to comparatively assess efficacy of using agents belonging to the group of prostaglandin E1 in comprehensive conservative treatment of patients with unreconstructable critical limb ischaemia and trophic changes by the frequency of major amputation, amputation-free survival, and total mortality by combinations of the WIfI classification during a 6-month follow up period. Our retrospective multicentre study enrolled a total of 109 patients, including 60 men and 49 women, with a mean age of 70±7.3 years. The patients were subdivided into 2 groups. Group 1 patients (n=58) received standard conservative therapy without prostaglandin E1 and group 2 patients (n=51) received similar treatment with the use of prostaglandin E1. The statistical analysis (chi-squared test, Fisher criterion, log-rank test) was carried out with regard to stratification of the patients in the groups by the WIfI component combinations. No statistically significant differences between the groups in the frequency of amputation and total mortality were revealed (p=0.094 and p=0.925, respectively). The use of the WIfI classification system made it possible to single out a cohort of patients (with a WIfI combination of 130) for whom the results of administering prostaglandin E1 statistically significantly differed by the frequency of amputation (p=0.042) and by amputation-free survival (p=0.017). No significant differences by these outcomes were obtained for other combinations analysed. A conclusion was drawn that using prostaglandin E1 in comprehensive conservative treatment decreased the frequency of amputation and increased amputation-free survival in patients presenting with unreconstructable critical limb ischaemia and referred to the category with a combination of 130 according to the WIfI classification.


Assuntos
Tratamento Conservador , Isquemia , Salvamento de Membro , Infecção dos Ferimentos , Idoso , Amputação , Técnicas de Apoio para a Decisão , Feminino , Humanos , Isquemia/terapia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Cicatrização
20.
Nervenarzt ; 90(8): 796-803, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31243508

RESUMO

The German Academy for Rare Neurological Diseases (DASNE) founded in 2017 on the Wartburg in Eisenach, aims to pave the way for an optimized personalized management of patients in all age groups with rare neurological diseases. By bringing rare neurological disease experts together and through forming a dynamic national network the DASNE, initiated by the Centers for Rare Diseases in Lübeck and Tübingen, will continuously foster mutual exchange. Members of the DASNE are renowned experts covering the whole spectrum of rare neurological disorders including pediatric neurology. Through case presentations and multidisciplinary discussion both at yearly meetings and on an internet platform, the main aims of DASNE are to establish a German expertise and reference network for rare neurological disorders. Further main aims are to provide continuous medical education for younger academics in the field of rare neurological disorders and facilitate translation.


Assuntos
Técnicas de Apoio para a Decisão , Doenças do Sistema Nervoso , Neurologia , Academias e Institutos , Alemanha , Humanos , Doenças do Sistema Nervoso/terapia , Neurologia/métodos , Neurologia/tendências
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