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Craig White, Milton C Weinstein, Abbey L Fingeret, Gregory W Randolph, Akira Miyauchi, Yasuhiro Ito, Tiannan Zhan, Ayman Ali, G Scott Gazelle, Carrie C Lubitz
OBJECTIVE: To assess relative clinical and economic performance of the revised American Thyroid Association (ATA) thyroid cancer guidelines compared to current standard of care. BACKGROUND: Diagnosis of thyroid cancer in the United States has tripled whereas mortality has only marginally increased. Most patients present with small papillary carcinomas and have historically received at least a total thyroidectomy as a treatment. In 2015, the ATA released the revised guidelines recommending an option for active surveillance (AS) of small papillary thyroid carcinoma and thyroid lobectomy for larger unifocal tumors...
October 17, 2018: Annals of Surgery
Melanie Lloyd, Alexandra Mackintosh, Catherine Grant, Fiona McManus, Anne-Maree Kelly, Harin Karunajeewa, Clarice Y Tang
AIM: To determine whether patients presenting to the emergency department (ED) with possible benign paroxysmal positional vertigo (BPPV) are managed in accordance with best practice guidelines, and whether physiotherapists are involved in their care. DESIGN: Retrospective observational study. PARTICIPANTS: Ninety-six consecutive patients presenting to one of three EDs with vertigo, dizziness or imbalance symptoms documented at triage. Individuals with a clear non-vestibular cause of symptoms were excluded...
October 17, 2018: Physiotherapy Theory and Practice
Tariq F Al-Shaiji, Said M Yaiesh, Abdullatif E Al-Terki, Faisal M Alhajeri
INTRODUCTION: Erectile dysfunction affects over 50% of men 70 years and above, and penile prosthesis (PP) is its third-line treatment. Complications of PPs include infection, however, no formal guidelines exist for its management. METHODS: We performed a literature search and reviewed 53 recent published literatures of experiences with management of PP infections, prevention, and treatment. RESULTS: Acute infection can present early with pain and discharge and detection of early signs is of utmost importance...
October 15, 2018: Aging Male: the Official Journal of the International Society for the Study of the Aging Male
François-Régis Duss, Cathy Voide
Clostridia cause severe diseases. Tetanus is rare in Switzerland because of vaccine coverage and the application of guidelines for the management of contaminated wounds. Tetanus requires wound debridement and the administration of antibiotics and anti-tetanus immune. Besides gastroenteritis, infections due to C. perfringens most often require surgery, in addition to antibiotic treatment with penicillin and clindamycin. Botulism is a rare disease caused by a toxin produced by C. botulinum that causes flaccid paralysis...
October 10, 2018: Revue Médicale Suisse
Gary R Lichtenstein
No abstract text is available yet for this article.
August 2018: Gastroenterology & Hepatology
Tandra Harish Varma, Dangudubiyyam Sri Krishna Sahitya, Santosh Dusad, Ashish Agarwal, Devi Dayal
Hypercalcemia may occur in approximately 15% of children with the Williams-Beuren syndrome. The episodes of hypercalcemic crisis usually respond well to initial hyperhydration, loop diuretics and calcitonin, bisphosphonates, or subsequent dialysis. However, many patients suffer from recurrent or persistent hypercalcemia after the resolution of the hypercalcemic crisis. Although hypercalcemia in the Williams-Beuren syndrome is generally considered transient, it may last for several months, result in significant morbidity, and compromise physical growth...
2018: Pediatric Endocrinology, Diabetes, and Metabolism
Yuli Huang, Zhihui Deng, Zhen Se, Yujia Bai, Chuanjie Yan, Qiong Zhan, Qingchun Zeng, Ping Ouyang, Meng Dai, Dingli Xu
OBJECTIVES: This study aimed to develop a cumulative score composed of seven risk factors: age, resting heart rate, overweight or obesity, dyslipidemia, hyperuricemia, impaired glucose regulation, and impaired estimated glomerular filtration rate (eGFR), to evaluate the risk of new-onset hypertension. METHODS: We retrospectively conducted a cohort study in 23 665 participants free from hypertension at baseline, who attended at least two annual health examinations between 2011 and 2016...
October 8, 2018: Journal of Hypertension
Jerry C Middleton, Christopher Kalogeropoulos, Jason A Middleton, Martin Drapeau
RATIONALE, AIMS, AND OBJECTIVES: Clinical practice guidelines (CPGs) endeavour to incorporate the best available research evidence together with the clinically informed opinions of leading experts in order to guide clinical practice when dealing with a given condition. There has been increased interest in CPGs that are evidence based and that promote best practice, a central component of which is incorporating the best available research predicated on strong study designs. Despite this soaring interest, there remains heterogeneity in the methodological quality of many CPGs, which may have an effect on the quality of services that clinicians offer...
September 17, 2018: Journal of Evaluation in Clinical Practice
Tomoyasu Tsushima, Takafumi Miura, Takahiko Hachiya, Ichiro Nakamura, Toyoko Yamato, Takeshi Kishida, Yoshinori Tanaka, Shin Irie, Norio Meguro, Takashi Kawahara, Nobuhisa Nakajima
BACKGROUND: Urological symptoms such as gross hematuria, lower and upper urinary tract symptoms, and bladder pain are common in and distressing for patients with advanced cancer. Although palliation of urological symptoms is important to improve the quality of life of cancer patients and their families and caregivers, clinical guidelines for managing urological symptoms in patients with cancer have not been published. METHODS: Following the formal guideline development process, the Japanese Society for Palliative Medicine (JSPM) developed comprehensive clinical guidelines for the management of urological symptoms in patients with cancer...
October 5, 2018: Journal of Palliative Medicine
Susana Lopes, José Mesquita-Bastos, Alberto J Alves, Fernando Ribeiro
Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge for clinicians, as the available treatment options have reduced success. Physical activity and exercise training play an important role in the management of blood pressure. The importance of physical activity and exercise training as part of a comprehensive lifestyle intervention is acknowledged by several professional organizations in their recommendations/guidelines for the management of arterial hypertension...
2018: Integrated Blood Pressure Control
Aime Powell, Paul A Cohen, Katrina Spilsbury, Nerida Steel, Penny Blomfield
BACKGROUND: For Australian women with screen-detected adenocarcinoma-in-situ (AIS), an excisional biopsy is mandatory for further assessment, treatment, and to exclude the presence of cervical adenocarcinoma. The only exclusion to this rule is if the woman has a clinically evident invasive cervical malignancy. Excisional treatments should be tailored according to a patient's age and future obstetric needs. To date, practitioner compliance with this recommendation has not been investigated...
October 4, 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
George J Kahaly, Luigi Bartalena, Lazlo Hegedüs, Laurence Leenhardt, Kris Poppe, Simon H Pearce
Graves' disease (GD) is a systemic autoimmune disorder characterized by the infiltration of thyroid antigen-specific T cells into thyroid-stimulating hormone receptor (TSH-R)-expressing tissues. Stimulatory autoantibodies (Ab) in GD activate the TSH-R leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion. Diagnosis of GD is straightforward in a patient with biochemically confirmed thyrotoxicosis, positive TSH-R-Ab, a hypervascular and hypoechoic thyroid gland (ultrasound), and associated orbitopathy...
August 2018: European Thyroid Journal
Paula M McQuail, Ben S McCartney, Joseph F Baker, Mutaz Jaadan, John P McCabe
Background: The National Institute of Health and Clinical Excellence (NICE) provide a framework of evidence-based guidelines for the management of metastatic spinal cord compression (MSCC). We aimed to compare our center's provision of service to these best practice guidelines and discuss key shortcomings with their implications for the spinal surgeon. Methods: Patients with radiologic evidence of MSCC over a 30-month period were identified using the hospital electronic radiological database...
August 2018: International Journal of Spine Surgery
Caroline Diguisto, Laurence Foix L'Helias, Andrei S Morgan, Pierre-Yves Ancel, Gilles Kayem, Monique Kaminski, Franck Perrotin, Babak Khoshnood, Francois Goffinet
OBJECTIVE: To evaluate the association between active antenatal management and neonatal outcomes in extremely preterm newborns admitted to a neonatal intensive care unit (NICU). STUDY DESIGN: This population-based cohort study was conducted in 25 regions of France. Infants born in 2011 between 220/7 and 266/7 weeks of gestation and admitted to a NICU were included. Infants with lethal congenital malformations or death in the delivery room were excluded. A multilevel multivariable analysis was performed, accounting for clustering by mother (multiple pregnancies) and hospital plus individual characteristics, to estimate the association between the main exposure of no active antenatal management (not receiving antenatal corticosteroids, magnesium sulfate, or cesarean delivery for fetal indications) and a composite outcome of death or severe neonatal morbidity (including severe forms of brain or lung injury, retinopathy of prematurity, and necrotizing enterocolitis)...
September 27, 2018: Journal of Pediatrics
James Henderson
A multidisciplinary team representing 28 professional bodies has updated the guidelines for the management of complex regional pain syndrome (CRPS), published by the Royal College of Physicians (RCP) of England, 2018. The author represented the British Association of Plastic, Reconstructive and Aesthetic Surgeons in this process and is an author of the guidelines. This article summarises the updated guidelines and highlights aspects relevant to plastic and reconstructive surgery.
September 6, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Jeffrey R Andolina, Michael J Burke, Nobuko Hijiya, Sonali Chaudhury, Kirk R Schultz, Michael E Roth
Chronic myeloid leukemia (CML) is a rare disease in children where pediatric evidence-based guidelines are lacking. We designed an anonymous survey for practicing pediatric oncologists and bone marrow transplant (BMT) physicians to assess their willingness to recommend BMT for a patient with CML based on varied clinical scenarios. Two-hundred seventy-four (274) physicians responded to the survey (13.4% response rate). Nearly all pediatric oncologists and BMT physicians recommended against BMT at time of diagnosis of CML in chronic phase with only 8...
September 26, 2018: Biology of Blood and Marrow Transplantation
James Paul Pandarakalam
Guidelines for the management of treatment-resistant depression (TRD) do not meet the criteria of evidence-based medicine and better-quality research is required to inform clinical practice. Current treatments of resistant depression remains largely empirical. There are no bench-mark antidepressants. Clear and justifiable rationale should be followed while initiating new treatment strategies; systematic planning and careful monitoring of progress implemented while new treatment components are added. Biological psychiatrists should give due importance to the non-biological aspects of depression and psychotherapists should not overlook the biological correlates...
September 2018: Psychiatria Danubina
Kenneth Ng, Douglas B Mogul
Although liver tumors are rare in the pediatric population, they are common in the setting of children with specific risk factors requiring increased awareness and, in some instances, screening. The evaluation of a liver mass in children is largely driven by the age at diagnosis, the presence of any medical comorbidities, and initial testing with alpha fetoprotein and imaging. Specific guidelines for the management of different tumors have been implemented in recent years such that a multidisciplinary approach is ideal and care should be provided by centers with experience in their management...
November 2018: Clinics in Liver Disease
Jeroen Ml Hendriks, Hein Heidbüchel
The 2016 European Society of Cardiology guidelines for the management of atrial fibrillation recommends integrated care in the treatment of atrial fibrillation and follows a patient-centred, multidisciplinary team approach. Nurses and allied health professionals have a significant role to play in the management of chronic conditions such as atrial fibrillation, which is underlined by this guideline and the integrated care approach. In this article, members of the task force writing committee highlight significant evidence from this particular guideline as well as clinical implications for nurses and allied health professionals in their daily work with atrial fibrillation patients and their caregivers...
September 27, 2018: European Journal of Cardiovascular Nursing
Shelly-Anne Li, Paul E Alexander, Tea Reljic, Adam Cuker, Robby Nieuwlaat, Wojtek Wiercioch, Gordon Guyatt, Holger J Schünemann, Benjamin Djulbegovic
OBJECTIVE: It is unclear how guidelines panelists discuss and consider factors (criteria) that are formally and not formally included in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. To describe the use of decision criteria, we explored how panelists adhered to GRADE criteria, and sought to identify any emerging non-GRADE criteria when panelists used the Evidence to Decision (EtD) framework as part of GRADE application. STUDY DESIGN AND SETTING: We used conventional and summative qualitative analyses to identify themes emerging from face-to-face, panel meeting discussions...
September 22, 2018: Journal of Clinical Epidemiology
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