RESUMO
CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCL CC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feed-back from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of Standards, Options and Recommendations for the dietetic consultation for cancer patient. METHODS: Data have been identified by literature search wing Medline and the expert groups personal reference lists. Once the guidelines were defined, the document was submitted for review to 74 independent reviewers, and to the medical committees of the 20 French Cancer Centres. RESULTS: The main recommendations for the referral of cancer patients for dietary advice are: I) in oncology, there are 3 types of dietetic consultation: diagnostic, preventive and therapeutic; 2) the following cancer patients must have a dietetic consultation: i) those with, or at risk of malnutrition, ii) those without malnutrition but in need of counseling and iii) those at risk of treatment-related nutritional side effects; 3) a nutritional assessment is standard at the time of the first dietetic consultation. Patients must be given individualized and written advice; 4) the dietetic opinion and advice should be brought to the attention of medical staff to facilitate a multidisciplinary approach to cancer treatment; 5) patient's relatives should be involved in the dietetic management; 6) the efficacy of dietetic advice can be assessed by monitoring weight, gastrointestinal signs and patient satisfaction.
Assuntos
Neoplasias/complicações , Avaliação Nutricional , Distúrbios Nutricionais/dietoterapia , Adulto , Humanos , Distúrbios Nutricionais/diagnóstico , Distúrbios Nutricionais/prevenção & controle , Educação de Pacientes como Assunto , Prática Profissional/normasRESUMO
CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, involves a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Regional Cancer Centres, some French public university and general hospitals and private Clinics and medical scientific societies. Its main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on a literature review followed by a critical appraisal by a multidisciplinary group of experts to produce the draft guidelines which are then validated by specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines for hospital catering for cancer patient using the methodology developed by the Standards, Options and Recommendations project. METHODS: Data were identified by a literature search of Medline and the reference lists of experts in the groups. After the guidelines were drafted, they were validated by independent reviewers. RESULTS: The main recommendations are: 1) While taking into consideration the specific needs of cancer patients, the dietician is responsible for the hygiene, the sanitary quality of alimentation, the equilibrium and nutritional quality of the hospital catering. 2) Ordering and distribution of meals, and clearing up afterwards contribute to the quality of hospital catering and the personnel who do this should have time and be willing to listen to the patients. 3) The ordering of meals should be adapted to individual patient's requirements and must take into account the patient's medication. 4) The method of transporting the food chosen by the institution (cold or warm method) should be respected. The personnel responsible should receive regular and specific training to use the method correctly. 5) The intake of patients with nutritional follow-up should be reliably and reproducibly evaluated by the personnel after every meal. 6) Patient satisfaction should be assessed once a year and the results of this assessment used to improve the quality of hospital catering. 7) The dietician is the interface between the accounts department, the medical wards, the hospital catering department and the patients.
Assuntos
Dietética , Serviço Hospitalar de Nutrição/normas , Neoplasias/complicações , Fenômenos Fisiológicos da Nutrição , Guias de Prática Clínica como Assunto , Adulto , Idoso , Humanos , Higiene , Pessoa de Meia-Idade , Satisfação do Paciente , Controle de QualidadeRESUMO
48 cases of embryonal sarcoma are reported. 41.6% of them are currently surviving, three for longer than five years, two longer than four, five longer than three, five longer than two, and five longer than twelve months. Treatment is based on surgery, chemotherapy and radiotherapy.
Assuntos
Rabdomiossarcoma , Fatores Etários , Criança , Pré-Escolar , Humanos , Lactente , Rabdomiossarcoma/epidemiologiaRESUMO
BACKGROUND: A new virus of the Flaviviridae family, the hepatitis G virus (HGV/HGBV-C), has been identified recently. The purpose of this study was to determine the prevalence of HGV infection in healthy children, in patients with liver disease, and in human immunodeficiency virus (HIV)-1-infected patients. The role of HGV in the clinical course of chronic HCV, the response to interferon-alpha2b, and the possible implications of intravenous gamma-globulin in the transmission of the virus were also evaluated. METHODS: Fifty healthy children, 66 patients with a variety of liver diseases, 19 patients with acquired immune deficiency syndrome (AIDS), and various batches of commercial intravenous immunoglobulins were investigated. Viral HGV RNA (5'NCR-NS5) and anti-HGV envelope protein E2 were assayed. RESULTS: The prevalence of HGV infection was 6% in the healthy children and 42% in the liver disease group. Viremia and anti-E2 were found in 11% and 79% of patients with AIDS. Four (27%) of 15 patients with chronic HCV, receiving treatment with interferon, were coinfected by HGV and became HGV-RNA negative during therapy. One year after the end of interferon therapy, three of them were again HGV RNA positive. CONCLUSIONS: The prevalence of HGV infection is high in healthy children higher in children affected with liver disease, but its potential pathologic implication is questionable, and further studies are warranted. Hepatitis G virus is sensitive to interferon therapy, although the infection often recurs after discontinuation of treatment.
Assuntos
Antivirais/farmacologia , Flaviviridae/efeitos dos fármacos , Flaviviridae/isolamento & purificação , Hepatite Viral Humana/epidemiologia , Interferon-alfa/farmacologia , Adolescente , Antivirais/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Flaviviridae/genética , Infecções por HIV/complicações , Infecções por HIV/virologia , HIV-1 , Hepatite C Crônica/complicações , Hepatite C Crônica/virologia , Hepatite Viral Humana/tratamento farmacológico , Hepatite Viral Humana/virologia , Humanos , Imunoglobulinas Intravenosas/química , Lactente , Interferon alfa-2 , Interferon-alfa/uso terapêutico , Hepatopatias/complicações , Hepatopatias/virologia , Masculino , Prevalência , RNA Viral/análise , Proteínas Recombinantes , Espanha/epidemiologiaRESUMO
Children with perinatally-acquired HIV-1 infection were studied to determine if major histocompatibility complex (MHC) genes are involved in progression to pediatric AIDS. Molecular genetic techniques were used to genotype loci in the class II region (DRB1, DQA1, DQB1, DPA1, DPB1, LMP2 and LMP7). HIV-infected children were classified by clinical manifestations and degree of immunosuppression using age-specific CD4 T-lymphocyte counts at enrollment. Alleles at the DPB1 and DQB1 loci showed independent and opposite associations; DPB1*0301 showed a trend toward protection while DQB1*0201 appeared to be a risk factor for developing severe immunosuppression and severe clinical outcomes. Presence of DQB1*0201 conferred a greater than 10-fold increased odds of having severe clinical manifestations and a 2.8-fold increased odds of severe immunosuppression. Presence of DPB1*0301 was associated with a greater than 8-fold decreased odds of severe immunosuppression and severe clinical manifestations. These results support host genetic influences on HIV-1 outcomes in children.