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Pesquisa : L01.178.682.759.150 [Categoria DeCS]
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[PMID]:29202622
[Au] Autor:Laenkholm AV; Grabau D; Møller Talman ML; Balslev E; Bak Jylling AM; Tabor TP; Johansen M; Brügmann A; Lelkaitis G; Di Caterino T; Mygind H; Poulsen T; Mertz H; Søndergaard G; Bruun Rasmussen B
[Ad] Endereço:a Department of Surgical Pathology , Zealand University Hospital , Slagelse , Denmark.
[Ti] Título:An inter-observer Ki67 reproducibility study applying two different assessment methods: on behalf of the Danish Scientific Committee of Pathology, Danish breast cancer cooperative group (DBCG).
[So] Source:Acta Oncol;57(1):83-89, 2018 Jan.
[Is] ISSN:1651-226X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: In 2011, the St. Gallen Consensus Conference introduced the use of pathology to define the intrinsic breast cancer subtypes by application of immunohistochemical (IHC) surrogate markers ER, PR, HER2 and Ki67 with a specified Ki67 cutoff (>14%) for luminal B-like definition. Reports concerning impaired reproducibility of Ki67 estimation and threshold inconsistency led to the initiation of this quality assurance study (2013-2015). The aim of the study was to investigate inter-observer variation for Ki67 estimation in malignant breast tumors by two different quantification methods (assessment method and count method) including measure of agreement between methods. MATERIAL AND METHODS: Fourteen experienced breast pathologists from 12 pathology departments evaluated 118 slides from a consecutive series of malignant breast tumors. The staining interpretation was performed according to both the Danish and Swedish guidelines. Reproducibility was quantified by intra-class correlation coefficient (ICC) and Lights Kappa with dichotomization of observations at the larger than (>) 20% threshold. The agreement between observations by the two quantification methods was evaluated by Bland-Altman plot. RESULTS: For the fourteen raters the median ranged from 20% to 40% by the assessment method and from 22.5% to 36.5% by the count method. Light's Kappa was 0.664 for observation by the assessment method and 0.649 by the count method. The ICC was 0.82 (95% CI: 0.77-0.86) by the assessment method vs. 0.84 (95% CI: 0.80-0.87) by the count method. CONCLUSION: Although the study in general showed a moderate to good inter-observer agreement according to both ICC and Lights Kappa, still major discrepancies were identified in especially the mid-range of observations. Consequently, for now Ki67 estimation is not implemented in the DBCG treatment algorithm.
[Mh] Termos MeSH primário: Neoplasias da Mama/patologia
Imuno-Histoquímica/normas
Antígeno Ki-67/metabolismo
[Mh] Termos MeSH secundário: Biomarcadores/metabolismo
Conferências de Consenso como Assunto
Dinamarca
Feminino
Seres Humanos
Patologia Clínica/normas
Guias de Prática Clínica como Assunto
Reprodutibilidade dos Testes
Coloração e Rotulagem/métodos
Coloração e Rotulagem/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Ki-67 Antigen)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1080/0284186X.2017.1404127


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[PMID]:29362800
[Au] Autor:McInnes MDF; Moher D; Thombs BD; McGrath TA; Bossuyt PM; Clifford T; Cohen JF; Deeks JJ; Gatsonis C; Hooft L; Hunt HA; Hyde CJ; Korevaar DA; Leeflang MMG; Macaskill P; Reitsma JB; Rodin R; Rutjes AWS; Salameh JP; Stevens A; Takwoingi Y; Tonelli M; Weeks L; Whiting P; Willis BH; the PRISMA-DTA Group
[Ad] Endereço:Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada.
[Ti] Título:Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement.
[So] Source:JAMA;319(4):388-396, 2018 01 23.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Systematic reviews of diagnostic test accuracy synthesize data from primary diagnostic studies that have evaluated the accuracy of 1 or more index tests against a reference standard, provide estimates of test performance, allow comparisons of the accuracy of different tests, and facilitate the identification of sources of variability in test accuracy. Objective: To develop the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagnostic test accuracy guideline as a stand-alone extension of the PRISMA statement. Modifications to the PRISMA statement reflect the specific requirements for reporting of systematic reviews and meta-analyses of diagnostic test accuracy studies and the abstracts for these reviews. Design: Established standards from the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network were followed for the development of the guideline. The original PRISMA statement was used as a framework on which to modify and add items. A group of 24 multidisciplinary experts used a systematic review of articles on existing reporting guidelines and methods, a 3-round Delphi process, a consensus meeting, pilot testing, and iterative refinement to develop the PRISMA diagnostic test accuracy guideline. The final version of the PRISMA diagnostic test accuracy guideline checklist was approved by the group. Findings: The systematic review (produced 64 items) and the Delphi process (provided feedback on 7 proposed items; 1 item was later split into 2 items) identified 71 potentially relevant items for consideration. The Delphi process reduced these to 60 items that were discussed at the consensus meeting. Following the meeting, pilot testing and iterative feedback were used to generate the 27-item PRISMA diagnostic test accuracy checklist. To reflect specific or optimal contemporary systematic review methods for diagnostic test accuracy, 8 of the 27 original PRISMA items were left unchanged, 17 were modified, 2 were added, and 2 were omitted. Conclusions and Relevance: The 27-item PRISMA diagnostic test accuracy checklist provides specific guidance for reporting of systematic reviews. The PRISMA diagnostic test accuracy guideline can facilitate the transparent reporting of reviews, and may assist in the evaluation of validity and applicability, enhance replicability of reviews, and make the results from systematic reviews of diagnostic test accuracy studies more useful.
[Mh] Termos MeSH primário: Lista de Checagem
Técnicas e Procedimentos Diagnósticos/normas
Guias como Assunto
Metanálise como Assunto
Literatura de Revisão como Assunto
[Mh] Termos MeSH secundário: Conferências de Consenso como Assunto
Técnica Delfos
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19163


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[PMID]:29261244
[Au] Autor:Swanson T; Angel D
[Ti] Título:WOUND INFECTION IN CLINICAL PRACTICE UPDATE.
[So] Source:Aust Nurs Midwifery J;24(8):33, 2017 Mar.
[Is] ISSN:2202-7114
[Cp] País de publicação:Australia
[La] Idioma:eng
[Mh] Termos MeSH primário: Infecção dos Ferimentos/enfermagem
[Mh] Termos MeSH secundário: Conferências de Consenso como Assunto
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE


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[PMID]:28682533
[Au] Autor:Chappell PB; Stewart M; Alphs L; DiCesare F; DuBrava S; Harkavy-Friedman J; Lim P; Ratcliffe S; Silverman MM; Targum SD; Marder SR
[Ad] Endereço:Executive Director, Global Clinical Affairs, Pfizer Essential Health, 445 Eastern Point Rd, MS 8260-2534, Groton, CT 06340. phillip.b.chappell@pfizer.com.
[Ti] Título:Assessment of Suicidal Ideation and Behavior: Report of the International Society for CNS Clinical Trials and Methodology Consensus Meeting.
[So] Source:J Clin Psychiatry;78(6):e638-e647, 2017 Jun.
[Is] ISSN:1555-2101
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To develop consensus recommendations for assessment of suicidal ideation/suicidal behavior (SI/SB) in clinical trials. PARTICIPANTS: Stakeholders from academia, industry, regulatory agencies, National Institutes of Health, National Institute of Mental Health, and patient advocacy organizations participated in a consensus meeting that was sponsored by the International Society for CNS Clinical Trials and Methodology and held November 17-18, 2015. Prior to the meeting, teams of experts identified key areas of consensus and dissent related to SI/SB. The most critical issues were presented and discussed in the consensus meeting. EVIDENCE: Literature reviews and a pre-meeting survey were conducted. Findings were discussed in pre-meeting working group sessions and at the consensus meeting. CONSENSUS PROCESS: Five pre-meeting working groups reviewed (1) nomenclature and classification schemes for SI/SB, (2) detection and assessment of SI/SB, (3) analysis of SI/SB data, (4) design of clinical trials for new treatments of SI/SB, and (5) public health approaches to SI/SB. A modification of the RAND/UCLA Appropriateness Method was used to combine review of scientific evidence with the collective views of experts and stakeholders to reach the final consensus statements. After discussion, all attendees voted using an electronic interactive audience response system. Areas of agreement and areas of continuing dissent were recorded. CONCLUSIONS: All 5 working groups agreed that a major barrier to advancement of the field of SI/SB research and the development of new treatments for SI/SB remains the lack of a universally accepted standardized nomenclature and classification system. Achieving alignment on definitions and classification of suicide-related phenomena is critical to improving the detection and assessment of SI/SB, the design of clinical trials for new treatments, and effective public health interventions.
[Mh] Termos MeSH primário: Ensaios Clínicos como Assunto/normas
Conferências de Consenso como Assunto
Transtornos Mentais/diagnóstico
Guias de Prática Clínica como Assunto/normas
Suicídio
[Mh] Termos MeSH secundário: Seres Humanos
Ideação Suicida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE


  5 / 2226 MEDLINE  
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[PMID]:28682531
[Au] Autor:McIntyre RS; Suppes T; Tandon R; Ostacher M
[Ad] Endereço:University Health Network, 399 Bathurst St, Toronto, ON, Canada, M5T 2S8. roger.mcintyre@uhn.ca.
[Ti] Título:Florida Best Practice Psychotherapeutic Medication Guidelines for Adults With Major Depressive Disorder.
[So] Source:J Clin Psychiatry;78(6):703-713, 2017 Jun.
[Is] ISSN:1555-2101
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Herein we provide the 2015 update for the Florida Best Practice Psychotherapeutic Medication Guidelines (FPG) for major depressive disorder (MDD). The FPG represent evidence-based decision support for practitioners providing care to adults with MDD. PARTICIPANTS: The consensus meeting included representatives from the Florida Agency for Health Care Administration (FAHCA), advocacy members, academic experts in MDD, and multidisciplinary mental health clinicians, as well as health policy experts. The FAHCA provided funding support for the FPG. EVIDENCE: Evidence was limited to results from adequately powered, randomized, double-blind, placebo-controlled trials; in addition, pooled-, meta-, and network-analyses were included. Recommendations were based on consensus arrived at by the multistakeholder Florida Expert Panel. Articles selected were identified on the electronic search engine PubMed with the dates 2010 to present. The search terms were major depressive disorder, psychopharmacology, antidepressants, psychotherapy, neuromodulation, complementary alternative medicines, pooled-analysis, meta-analysis, and network-analysis. Bibliographies of the identified articles were manually searched for additional citations not identified in the original search. CONSENSUS PROCESS: A consensus meeting comprising all representatives took place on September 25-26, 2015, in Tampa, Florida. Guiding principles (eg, emphasis on the most rigorous evidence for efficacy, safety, and tolerability) were discussed, defined, and operationalized prior to review of extant data. As MDD often pursues a recurrent and chronic course, principles of practice, measurement-based care, and comprehensive assessment and management of overall physical and mental health were emphasized. Evidence supporting pretreatment major depressive episode specifiers (eg, mixed features, anxious distress) and the role of pharmacogenomics (and other biological-behavioral markers) in informing treatment selection were comprehensively discussed. Algorithmic priority was assigned to agents with relatively greater therapeutic index (ie, efficacy) and minimal propensity for safety and tolerability disadvantages. CONCLUSIONS: The updated 2015 FPG provide concise, pragmatic, evidence-based decision support for treatment selection and sequencing for adults with MDD. Principles of practice include measurement-based care, priority to both psychiatric and medical comorbidity, identification of DSM-5-defined specifiers (eg, mixed features), suicide risk assessment, and evaluation of cognitive symptoms. The FPG have purposefully aimed to minimize emphasis on "expert opinion" and instead differentially emphasized extant evidence for pharmacologic treatments.
[Mh] Termos MeSH primário: Antidepressivos/uso terapêutico
Conferências de Consenso como Assunto
Transtorno Depressivo Maior/terapia
Medicina Baseada em Evidências/normas
Guias de Prática Clínica como Assunto/normas
[Mh] Termos MeSH secundário: Adulto
Antidepressivos/efeitos adversos
Transtorno Depressivo Maior/classificação
Transtorno Depressivo Maior/diagnóstico
Florida
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antidepressive Agents)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE


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[PMID]:28596016
[Au] Autor:Randall LM; Pothuri B; Swisher EM; Diaz JP; Buchanan A; Witkop CT; Bethan Powell C; Smith EB; Robson ME; Boyd J; Coleman RL; Lu K
[Ad] Endereço:University of California Irvine, Irvine, CA, United States. Electronic address: lrandall@uci.edu.
[Ti] Título:Multi-disciplinary summit on genetics services for women with gynecologic cancers: A Society of Gynecologic Oncology White Paper.
[So] Source:Gynecol Oncol;146(2):217-224, 2017 Aug.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess current practice, advise minimum standards, and identify educational gaps relevant to genetic screening, counseling, and testing of women affected by gynecologic cancers. METHODS: The Society of Gynecologic Oncology (SGO) organized a multidisciplinary summit that included representatives from the American College of Obstetricians and Gynecologists (ACOG), the American Society Clinical Oncology (ASCO), the National Society of Genetic Counselors (NSGC), and patient advocacy groups, BrightPink and Facing our Risk of Cancer Empowered (FORCE). Three subject areas were discussed: care delivery models for genetic testing, barriers to genetic testing, and educational opportunities for providers of genetic testing. RESULTS: The group endorsed current SGO, National Comprehensive Cancer Network (NCCN), and NSGC genetic testing guidelines for women affected with ovarian, tubal, peritoneal cancers, or DNA mismatch repair deficient endometrial cancer. Three main areas of unmet need were identified: timely and universal genetic testing for women with ovarian, fallopian tube, and peritoneal cancers; education regarding minimum standards for genetic counseling and testing; and barriers to implementation of testing of both affected individuals as well as cascade testing of family members. Consensus building among all stakeholders resulted in an action plan to address gaps in education of gynecologic oncology providers and delivery of cancer genetics care.
[Mh] Termos MeSH primário: Serviços em Genética
Neoplasias dos Genitais Femininos/genética
Síndrome Hereditária de Câncer de Mama e Ovário/genética
Síndrome de Lynch II/genética
[Mh] Termos MeSH secundário: Congressos como Assunto
Conferências de Consenso como Assunto
Feminino
Aconselhamento Genético/métodos
Testes Genéticos/métodos
Ginecologia
Síndrome Hereditária de Câncer de Mama e Ovário/diagnóstico
Seres Humanos
Síndrome de Lynch II/diagnóstico
Seleção de Pacientes
Guias de Prática Clínica como Assunto
Sociedades Médicas
Oncologia Cirúrgica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170724
[Lr] Data última revisão:
170724
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170610
[St] Status:MEDLINE


  7 / 2226 MEDLINE  
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[PMID]:28510297
[Au] Autor:Wang J; Johnson T; Sahin L; Tassinari MS; Anderson PO; Baker TE; Bucci-Rechtweg C; Burckart GJ; Chambers CD; Hale TW; Johnson-Lyles D; Nelson RM; Nguyen C; Pica-Branco D; Ren Z; Sachs H; Sauberan J; Zajicek A; Ito S; Yao LP
[Ad] Endereço:Office of Drug Evaluation IV, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA.
[Ti] Título:Evaluation of the Safety of Drugs and Biological Products Used During Lactation: Workshop Summary.
[So] Source:Clin Pharmacol Ther;101(6):736-744, 2017 Jun.
[Is] ISSN:1532-6535
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This report serves as a summary of a 2-day public workshop sponsored by the US Food and Drug Administration (FDA) to discuss the safety of drugs and biological products used during lactation. The aim of the workshop was to provide a forum to discuss the collection of data to inform the potential risks to breastfed infants with maternal use of medications during lactation. Discussions included the review of current approaches to collect data on medications used during lactation, and the considerations for future approaches to design and guide clinical lactation studies. This workshop is part of continuing efforts to raise the awareness of the public for women who choose to breastfeed their infants.
[Mh] Termos MeSH primário: Produtos Biológicos/efeitos adversos
Aleitamento Materno/efeitos adversos
Conferências de Consenso como Assunto
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia
Lactação
Exposição Materna/efeitos adversos
[Mh] Termos MeSH secundário: Congressos como Assunto
Feminino
Seres Humanos
Lactente
Recém-Nascido
Modelos Biológicos
Gravidez
Medição de Risco
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biological Products)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170517
[St] Status:MEDLINE
[do] DOI:10.1002/cpt.676


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[PMID]:28475732
[Au] Autor:Hadley EC; Kuchel GA; Newman AB; Workshop Speakers and Participants
[Ad] Endereço:National Institute on Aging, Bethesda, Maryland.
[Ti] Título:Report: NIA Workshop on Measures of Physiologic Resiliencies in Human Aging.
[So] Source:J Gerontol A Biol Sci Med Sci;72(7):980-990, 2017 Jul 01.
[Is] ISSN:1758-535X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background/Objectives: Resilience, the ability to resist or recover from adverse effects of a stressor, is of widespread interest in social, psychologic, biologic, and medical research and particularly salient as the capacity to respond to stressors becomes diminished with aging. To date, research on human resilience responses to and factors influencing these responses has been limited. Methods: The National Institute on Aging convened a workshop in August 2015 on needs for research to improve measures to predict and assess resilience in human aging. Effects of aging-related factors in impairing homeostatic responses were developed from examples illustrating multiple determinants of clinical resilience outcomes. Research directions were identified by workshop participants. Results: Research needs identified included expanded uses of clinical data and specimens in predicting or assessing resilience, and contributions from epidemiological studies in identifying long-term predictors. Better measures, including simulation tests, are needed to assess resilience and its determinants. Mechanistic studies should include exploration of influences of biologic aging processes on human resiliencies. Important resource and infrastructure needs include consensus phenotype definitions of specific resiliencies, capacity to link epidemiological and clinical resilience data, sensor technology to capture responses to stressors, better laboratory animal models of human resiliencies, and new analytic methods to understand the effects of multiple determinants of stress responses. Conclusions: Extending the focus of care and research to improving the capacity to respond to stressors could benefit older adults in promoting a healthier life span.
[Mh] Termos MeSH primário: Envelhecimento/psicologia
Resiliência Psicológica
[Mh] Termos MeSH secundário: Adaptação Psicológica
Idoso
Pesquisa Comportamental/métodos
Conferências de Consenso como Assunto
Feminino
Avaliação Geriátrica/métodos
Seres Humanos
Masculino
Estresse Psicológico/diagnóstico
Estresse Psicológico/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170506
[St] Status:MEDLINE
[do] DOI:10.1093/gerona/glx015


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[PMID]:28432692
[Au] Autor:Chung MK; Zulkarnain A; Lee JB; Cho BC; Chung CY; Lee KM; Sung KH; Park MS
[Ad] Endereço:Department of Orthopaedic Surgery, Kangwon National University Hospital, Kangwon, Korea.
[Ti] Título:Functional status and amount of hip displacement independently affect acetabular dysplasia in cerebral palsy.
[So] Source:Dev Med Child Neurol;59(7):743-749, 2017 Jul.
[Is] ISSN:1469-8749
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: Acetabular dysplasia is the one of main causes of hip displacement in patients with cerebral palsy (CP). Although several studies have shown a relationship between hip displacement and acetabular dysplasia, relatively few have evaluated the association between quantitative acetabular dysplasia and related factors, such as Gross Motor Function Classification System (GMFCS) level. METHOD: We performed a morphometric analysis of the acetabulum in patients with CP using multiplanar reformation of computed tomography data. The three directional acetabular indices (anterosuperior, superolateral, and posterosuperior) were used to evaluate acetabular dysplasia. Consequently, linear mixed-effects models were used to adjust for related factors such as age, sex, GMFCS level, and migration percentage. RESULTS: A total of 176 patients (mean age 9y 5mo, range 2y 4mo-19y 6mo; 104 males, 72 females) with CP and 55 typically developing individuals (mean age 13y 6mo, range 2y 5mo-19y 10mo; 37 males, 18 females) in a comparison group were enrolled in this study. Statistical modelling showed that all three directional acetabular indices independently increased with GMFCS level (p<0.001) and migration percentage (p<0.001). INTERPRETATION: Acetabular dysplasia was independently affected by both the amount of hip displacement and the GMFCS level. Thus, physicians should consider not only the migration percentage but also three-dimensional evaluation in patients at high GMFCS levels.
[Mh] Termos MeSH primário: Acetábulo/anormalidades
Acetábulo/diagnóstico por imagem
Paralisia Cerebral/complicações
Paralisia Cerebral/diagnóstico por imagem
Luxação Congênita de Quadril/complicações
Luxação Congênita de Quadril/diagnóstico por imagem
[Mh] Termos MeSH secundário: Acetábulo/crescimento & desenvolvimento
Adolescente
Criança
Pré-Escolar
Conferências de Consenso como Assunto
Feminino
Luxação do Quadril/tratamento farmacológico
Luxação do Quadril/etiologia
Seres Humanos
Imagem Tridimensional
Modelos Lineares
Masculino
Reprodutibilidade dos Testes
Estudos Retrospectivos
Índice de Gravidade de Doença
Centros de Atenção Terciária
Tomografia Computadorizada por Raios X
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170619
[Lr] Data última revisão:
170619
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170423
[St] Status:MEDLINE
[do] DOI:10.1111/dmcn.13437


  10 / 2226 MEDLINE  
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[PMID]:28414115
[Au] Autor:Yu J; Elmore LC; Cyr AE; Aft RL; Gillanders WE; Margenthaler JA
[Ad] Endereço:Department of Surgery, Washington University School of Medicine, St Louis, MO.
[Ti] Título:Cost Analysis of a Surgical Consensus Guideline in Breast-Conserving Surgery.
[So] Source:J Am Coll Surg;225(2):294-301, 2017 Aug.
[Is] ISSN:1879-1190
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The Society of Surgical Oncology and American Society of Radiation Oncology consensus statement was the first professional guideline in breast oncology to declare "no ink on tumor" as a negative margin in patients with stages I/II breast cancer undergoing breast-conservation therapy. We sought to analyze the financial impact of this guideline at our institution using a historic cohort. STUDY DESIGN: We identified women undergoing re-excision after breast-conserving surgery for invasive breast cancer from 2010 through 2013 using a prospectively maintained institutional database. Clinical and billing data were extracted from the medical record and from administrative resources using CPT codes. Descriptive statistics were used in data analysis. RESULTS: Of 254 women in the study population, 238 (93.7%) had stage I/II disease and 182 (71.7%) had invasive disease with ductal carcinoma in situ. A subcohort of 83 patients (32.7%) who underwent breast-conservation therapy for stage I/II disease without neoadjuvant chemotherapy had negative margins after the index procedure, per the Society of Surgical Oncology and American Society of Radiation Oncology guideline. The majority had invasive ductal carcinoma (n = 70 [84.3%]) and had invasive disease (n = 45 [54.2%]), and/or ductal carcinoma in situ (n = 49 [59.0%]) within 1 mm of the specimen margin. Seventy-nine patients underwent 1 re-excision and 4 patients underwent 2 re-excisions, accounting for 81 hours of operative time. Considering facility fees and primary surgeon billing alone, the overall estimated cost reduction would have been $195,919, or $2,360 per affected patient, under the guideline recommendations. CONCLUSIONS: Implementation of the Society of Surgical Oncology and American Society of Radiation Oncology consensus guideline holds great potential to optimize resource use. Application of the guideline to a retrospective cohort at our institution would have decreased the overall re-excision rate by 5.6% and reduced costs by nearly $200,000. Additional analysis of patient outcomes and margin assessment methods is needed to define the long-term impact on surgical practice.
[Mh] Termos MeSH primário: Neoplasias da Mama/economia
Neoplasias da Mama/cirurgia
Custos e Análise de Custo
Mastectomia Segmentar/economia
Mastectomia Segmentar/normas
[Mh] Termos MeSH secundário: Estudos de Coortes
Conferências de Consenso como Assunto
Feminino
Seres Humanos
Meia-Idade
Guias de Prática Clínica como Assunto
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170418
[St] Status:MEDLINE



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