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Pesquisa : M01.526.485.810.303 [Categoria DeCS]
Referências encontradas : 27 [refinar]
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  1 / 27 MEDLINE  
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[PMID]:28467179
[Au] Autor:Fonseca V; Grunberger G
[Ad] Endereço:Co-Chairs, AACE/ACE Consensus Conference Writing Committee.
[Ti] Título:LETTER TO THE EDITOR.
[So] Source:Endocr Pract;23(5):629-632, 2017 05.
[Is] ISSN:1530-891X
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Glicemia/análise
Equipamentos e Provisões/normas
Registros Médicos/normas
[Mh] Termos MeSH secundário: Automonitorização da Glicemia/métodos
Automonitorização da Glicemia/normas
Consenso
Endocrinologistas/organização & administração
Seres Humanos
Projetos de Pesquisa/normas
Sociedades Médicas
[Pt] Tipo de publicação:LETTER
[Nm] Nome de substância:
0 (Blood Glucose)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.4158/1934-2403-23.5.629


  2 / 27 MEDLINE  
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[PMID]:28534681
[Au] Autor:Papaleontiou M; Gauger PG; Haymart MR
[Ti] Título:REFERRAL OF OLDER THYROID CANCER PATIENTS TO A HIGH-VOLUME SURGEON: RESULTS OF A MULTIDISCIPLINARY PHYSICIAN SURVEY.
[So] Source:Endocr Pract;23(7):808-815, 2017 Jul.
[Is] ISSN:1530-891X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Surgical outcomes of thyroid cancer patients are improved with high-volume surgeons. However, age disparities in referral to specialist surgical centers still exist. The factors that influence decision making regarding referral of older thyroid cancer patients to high-volume surgeons remain unknown. METHODS: We surveyed members of the Endocrine Society, American College of Physicians, and American Academy of Family Practice. RESULTS: Overall, 270 physicians completed the survey. Patient preference (69%), transportation barriers (62%), and confidence in local surgeon (54%) were the most cited factors decreasing likelihood of referral to a high-volume surgeon. In clinical scenarios, referral rates to a high-volume surgeon were similar for patients aged 40 and 65 years with a 1-cm thyroid nodule diagnostic of thyroid cancer (n = 137 [54%]; n = 132 [52%], respectively) as for an 85-year-old with a 4-cm nodule (n = 148 [59%]). When comorbidities were introduced, more physicians (n = 186 [74%]) would refer a 65-year-old with a 4-cm thyroid nodule and comorbidities, compared to an 85-year-old with the same nodule size without comorbidi-ties. In multivariable analysis, treating >10 thyroid cancer patients/year (P<.001; P<.005) and endocrinology specialty (P = .003; P = .003) were associated with referral to a high-volume surgeon for a 65-year-old with comorbidities and an 85-year-old without comorbidities, respectively. CONCLUSION: Understanding surgical referral patterns of older thyroid cancer patients is vital in identifying obstacles in the referral process. We found that patient factors including comorbidities and physician factors including specialty and patient volume influence these patterns. This is the first step towards developing targeted interventions for these patients.
[Mh] Termos MeSH primário: Tomada de Decisão Clínica
Padrões de Prática Médica/estatística & dados numéricos
Encaminhamento e Consulta/estatística & dados numéricos
Cirurgiões
Neoplasias da Glândula Tireoide/cirurgia
Nódulo da Glândula Tireoide/cirurgia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Endocrinologistas
Feminino
Seres Humanos
Medicina Interna
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Médicos de Família
Inquéritos e Questionários
Tireoidectomia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171022
[Lr] Data última revisão:
171022
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE
[do] DOI:10.4158/EP171788.OR


  3 / 27 MEDLINE  
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[PMID]:28483503
[Au] Autor:Dokras A; Saini S; Gibson-Helm M; Schulkin J; Cooney L; Teede H
[Ad] Endereço:Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: adokras@ObGyn.upenn.edu.
[Ti] Título:Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome.
[So] Source:Fertil Steril;107(6):1380-1386.e1, 2017 Jun.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To identify gaps in polycystic ovary syndrome (PCOS) knowledge and practice patterns among physicians in North America in response to significant dissatisfaction identified among women with PCOS regarding their diagnosis and treatment experience. DESIGN: Online survey conducted via American College of Obstetrics and Gynecology of gynecologists (ObGyn) and American Society of Reproductive Medicine of reproductive endocrinologists (REI-ObGyn) in 2015-16. SETTING: Not applicable. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Diagnostic criteria used, key features of PCOS, management practices. RESULT(S): Of the 630 surveys completed, 70.2% were ObGyn and 64.4% were females. Overall 27.7% respondents did not know which PCOS diagnostic criteria they used. In a multivariable analysis including physician type, age, gender, and number of patients with PCOS seen annually, REI-ObGyn were less likely compared with ObGyn to report not knowing which criteria they used (adjusted odds ratio, 0.08; 95% confidence interval, 0.04, 0.16). REI-ObGyn were more likely to use the Rotterdam criteria (odds ratio, 2.26; 95% confidence interval, 1.33, 3.82). The majority of respondents recognized the clinical features associated with PCOS; however, over one-third associated "cysts on ovaries" with PCOS. The majority of responders (>85%) were aware of cardiometabolic comorbidities; however, fewer ObGyn were aware of associated depression, anxiety disorders, and reduced quality of life. More REI-ObGyn recommended lifestyle changes compared with ObGyn (56.4% vs. 41.6%). CONCLUSION(S): Our large-scale PCOS survey, conducted in response to patient concerns regarding diagnosis and treatment, highlights opportunities for physician education. Focus areas include targeting knowledge of internationally accepted Rotterdam criteria and ensuring consistent care informed by evidence-based guidelines across the reproductive, metabolic, and psychological features of PCOS.
[Mh] Termos MeSH primário: Endocrinologistas/estatística & dados numéricos
Ginecologia/estatística & dados numéricos
Alfabetização em Saúde/estatística & dados numéricos
Obstetrícia/estatística & dados numéricos
Síndrome do Ovário Policístico/diagnóstico por imagem
Síndrome do Ovário Policístico/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Competência Clínica/estatística & dados numéricos
Feminino
Conhecimentos, Atitudes e Prática em Saúde
Inquéritos Epidemiológicos
Seres Humanos
Masculino
Meia-Idade
América do Norte
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170818
[Lr] Data última revisão:
170818
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170510
[St] Status:MEDLINE


  4 / 27 MEDLINE  
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[PMID]:28230459
[Au] Autor:Hirsch JD; Bounthavong M; Arjmand A; Ha DR; Cadiz CL; Zimmerman A; Ourth H; Morreale AP; Edelman SV; Morello CM
[Ad] Endereço:1 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, and Veterans Affairs of San Diego Healthcare System, San Diego, California.
[Ti] Título:Estimated Cost-Effectiveness, Cost Benefit, and Risk Reduction Associated with an Endocrinologist-Pharmacist Diabetes Intense Medical Management "Tune-Up" Clinic.
[So] Source:J Manag Care Spec Pharm;23(3):318-326, 2017 Mar.
[Is] ISSN:2376-1032
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In 2012 U.S. diabetes costs were estimated to be $245 billion, with $176 billion related to direct diabetes treatment and associated complications. Although a few studies have reported positive glycemic and economic benefits for diabetes patients treated under primary care physician (PCP)-pharmacist collaborative practice models, no studies have evaluated the cost-effectiveness of an endocrinologist-pharmacist collaborative practice model treating complex diabetes patients versus usual PCP care for similar patients. OBJECTIVE: To estimate the cost-effectiveness and cost benefit of a collaborative endocrinologist-pharmacist Diabetes Intense Medical Management (DIMM) "Tune-Up" clinic for complex diabetes patients versus usual PCP care from 3 perspectives (clinic, health system, payer) and time frames. METHODS: Data from a retrospective cohort study of adult patients with type 2 diabetes mellitus (T2DM) and glycosylated hemoglobin A1c (A1c) ≥ 8% who were referred to the DIMM clinic at the Veterans Affairs San Diego Health System were used for cost analyses against a comparator group of PCP patients meeting the same criteria. The DIMM clinic took more time with patients, compared with usual PCP visits. It provided personalized care in three 60-minute visits over 6 months, combining medication therapy management with patient-specific diabetes education, to achieve A1c treatment goals before discharge back to the PCP. Data for DIMM versus PCP patients were used to evaluate cost-effectiveness and cost benefit. Analyses included incremental cost-effectiveness ratios (ICERs) at 6 months, 3-year estimated total medical costs avoided and return on investment (ROI), absolute risk reduction of complications, resultant medical costs, and quality-adjusted life-years (QALYs) over 10 years. RESULTS: Base case ICER results indicated that from the clinic perspective, the DIMM clinic costs $21 per additional percentage point of A1c improvement and $115-$164 per additional patient at target A1c goal level compared with the PCP group. From the health system perspective, medical cost avoidance due to improved A1c was $8,793 per DIMM patient versus $3,506 per PCP patient (P = 0.009), resulting in an ROI of $9.01 per dollar spent. From the payer perspective, DIMM patients had estimated lower total medical costs, a greater number of QALYs gained, and appreciable risk reductions for diabetes-related complications over 2-, 5- and 10-year time frames, indicating that the DIMM clinic was dominant. Sensitivity analyses indicated results were robust, and overall conclusions did not change appreciably when key parameters (including DIMM clinic effectiveness and cost) were varied within plausible ranges. CONCLUSIONS: The DIMM clinic endocrinologist-pharmacist collaborative practice model, in which the pharmacist spent more time providing personalized care, improved glycemic control at a minimal cost per additional A1c benefit gained and produced greater cost avoidance, appreciable ROI, reduction in long-term complication risk, and lower cost for a greater gain in QALYs. Overall, the DIMM clinic represents an advanced pharmacy practice model with proven clinical and economic benefits from multiple perspectives for patients with T2DM and high medication and comorbidity complexity. DISCLOSURES: No outside funding supported this study. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Preliminary versions of the study data were presented in abstract form at the American Pharmacists Association Annual Meeting & Exposition; March 27, 2015; San Diego, California, and the Academy of Managed Care Pharmacy Annual Meeting; April 21, 2016; San Francisco, California. Study concept and design were contributed by Hirsch, Bounthavong, and Edelman, along with Morello and Morreale. Arjmand, Ourth, Ha, Cadiz, and Zimmerman collected the data. Data interpretation was performed by Ha, Morreale, and Morello, along with Cadiz, Ourth, and Hirsch. The manuscript was written primarily by Hirsch and Zimmerman, along with Arjamand, Ourth, and Morello, and was revised by Hirsch and Cadiz, along with Bounthavong, Ha, Morreale, and Morello.
[Mh] Termos MeSH primário: Análise Custo-Benefício/economia
Diabetes Mellitus Tipo 2/tratamento farmacológico
Diabetes Mellitus Tipo 2/economia
Endocrinologistas/economia
Conduta do Tratamento Medicamentoso/economia
Assistência Farmacêutica/economia
Farmacêuticos/economia
[Mh] Termos MeSH secundário: Complicações do Diabetes/economia
Complicações do Diabetes/metabolismo
Diabetes Mellitus Tipo 2/metabolismo
Feminino
Hemoglobina A Glicada/metabolismo
Seres Humanos
Hipoglicemiantes/economia
Hipoglicemiantes/uso terapêutico
Masculino
Programas de Assistência Gerenciada/economia
Meia-Idade
Atenção Primária à Saúde/economia
Estudos Retrospectivos
Comportamento de Redução do Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Glycated Hemoglobin A); 0 (Hypoglycemic Agents)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170224
[St] Status:MEDLINE
[do] DOI:10.18553/jmcp.2017.23.3.318


  5 / 27 MEDLINE  
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[PMID]:28225987
[Au] Autor:Nones RB; Ivantes CP; Pedroso MLA
[Ad] Endereço:Serviço de Gastroenterologia, Hospital Nossa Senhora das Graças, Curitiba, PR, Brasil.
[Ti] Título:Can FIB4 and NAFLD fibrosis scores help endocrinologists refer patients with non-alcoholic fat liver disease to a hepatologist?
[So] Source:Arch Endocrinol Metab;61(3):276-281, 2017 May-Jun.
[Is] ISSN:2359-4292
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Objective: The objective of this study is to evaluate the performance of mathematical models used in non-invasive diagnosis of liver fibrosis in nonalcoholic fatty liver disease (NAFLD) patients to determine when the patient needs to be referred to a hepatologist. Subjects and methods: Patients referred by endocrinologists to the liver outpatient departments in two hospitals in Curitiba, Brazil, over a 72-month period were analyzed. The results calculated using the APRI, FIB 4, FORNS and NAFLD Fibrosis Score non-invasive liver fibrosis assessment models were analyzed and compared with histological staging of this population. Results: Sixty-seven patients with NAFLD were analyzed. Forty-two of them (62.68%) were female, mean age was 54.76 (±9.63) years, mean body mass index 31.42 (±5.64) and 59 (88.05%) of the 67 cases had glucose intolerance or diabetes. A diagnosis of steatohepatitis was made in 45 (76.27%) of the 59 biopsied patients, and advanced liver fibrosis (stages 3 and 4) was diagnosed in 18 (26.86%) of the 67 patients in the study population. The FIB 4 and NAFLD Fibrosis Score models had a high negative predictive value (93.48% and 93.61%, respectively) in patients with severe liver fibrosis (stages 3 and 4). Conclusion: In conclusion, use of the FIB 4 and NAFLD Fibrosis Score models in NAFLD patients allows a diagnosis of severe liver disease to be excluded.
[Mh] Termos MeSH primário: Endocrinologistas
Gastroenterologistas
Cirrose Hepática/patologia
Hepatopatia Gordurosa não Alcoólica/patologia
Encaminhamento e Consulta
[Mh] Termos MeSH secundário: Alanina Transaminase/sangue
Aspartato Aminotransferases/sangue
Biópsia
Progressão da Doença
Feminino
Seres Humanos
Fígado/patologia
Masculino
Meia-Idade
Modelos Teóricos
Padrões de Referência
Reprodutibilidade dos Testes
Sensibilidade e Especificidade
Índice de Gravidade de Doença
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
EC 2.6.1.1 (Aspartate Aminotransferases); EC 2.6.1.2 (Alanine Transaminase)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170223
[St] Status:MEDLINE


  6 / 27 MEDLINE  
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[PMID]:28156151
[Au] Autor:Jellinger PS; Handelsman Y; Rosenblit PD; Bloomgarden ZT; Fonseca VA; Garber AJ; Grunberger G; Guerin CK; Bell DSH; Mechanick JI; Pessah-Pollack R; Wyne K; Smith D; Brinton EA; Fazio S; Davidson M; Zangeneh F; Bush MA
[Ti] Título:AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF DYSLIPIDEMIA AND PREVENTION OF CARDIOVASCULAR DISEASE - EXECUTIVE SUMMARY .
[So] Source:Endocr Pract;23(4):479-497, 2017 Apr 02.
[Is] ISSN:1530-891X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). METHODS: Each Recommendation is based on a diligent review of the clinical evidence with transparent incorporation of subjective factors. RESULTS: The Executive Summary of this document contains 87 Recommendations of which 45 are Grade A (51.7%), 18 are Grade B (20.7%), 15 are Grade C (17.2%), and 9 (10.3%) are Grade D. These detailed, evidence-based recommendations allow for nuance-based clinical decision making that addresses multiple aspects of real-world medical care. The evidence base presented in the subsequent Appendix provides relevant supporting information for Executive Summary Recommendations. This update contains 695 citations of which 202 (29.1 %) are evidence level (EL) 1 (strong), 137 (19.7%) are EL 2 (intermediate), 119 (17.1%) are EL 3 (weak), and 237 (34.1%) are EL 4 (no clinical evidence). CONCLUSION: This CPG is a practical tool that endocrinologists, other healthcare professionals, regulatory bodies and health-related organizations can use to reduce the risks and consequences of dyslipidemia. It provides guidance on screening, risk assessment, and treatment recommendations for a range of patients with various lipid disorders. These recommendations emphasize the importance of treating low-density lipoprotein cholesterol (LDL-C) in some individuals to lower goals than previously recommended and support the measurement of coronary artery calcium scores and inflammatory markers to help stratify risk. Special consideration is given to patients with diabetes, familial hypercholesterolemia, women, and pediatric patients with dyslipidemia. Both clinical and cost-effectiveness data are provided to support treatment decisions. ABBREVIATIONS: A1C = hemoglobin A1C ACE = American College of Endocrinology ACS = acute coronary syndrome AHA = American Heart Association ASCVD = atherosclerotic cardiovascular disease ATP = Adult Treatment Panel apo = apolipoprotein BEL = best evidence level CKD = chronic kidney disease CPG = clinical practice guidelines CVA = cerebrovascular accident EL = evidence level FH = familial hypercholesterolemia HDL-C = high-density lipoprotein cholesterol HeFH = heterozygous familial hypercholesterolemia HIV = human immunodeficiency virus HoFH = homozygous familial hypercholesterolemia hsCRP = high-sensitivity C-reactive protein LDL-C = low-density lipoprotein cholesterol Lp-PLA = lipoprotein-associated phospholipase A MESA = Multi-Ethnic Study of Atherosclerosis MetS = metabolic syndrome MI = myocardial infarction NCEP = National Cholesterol Education Program PCOS = polycystic ovary syndrome PCSK9 = proprotein convertase subtilisin/kexin type 9 T1DM = type 1 diabetes mellitus T2DM = type 2 diabetes mellitus TG = triglycerides VLDL-C = very low-density lipoprotein cholesterol.
[Mh] Termos MeSH primário: Doenças Cardiovasculares/prevenção & controle
Dislipidemias/terapia
Endocrinologia/normas
Prevenção Primária/normas
[Mh] Termos MeSH secundário: Adulto
Doenças Cardiovasculares/economia
Criança
Análise Custo-Benefício
Técnicas de Diagnóstico Endócrino/economia
Técnicas de Diagnóstico Endócrino/normas
Dislipidemias/diagnóstico
Dislipidemias/economia
Endocrinologistas/organização & administração
Endocrinologistas/normas
Endocrinologia/organização & administração
Feminino
Seres Humanos
Programas de Rastreamento/economia
Programas de Rastreamento/métodos
Programas de Rastreamento/normas
Prevenção Primária/economia
Prevenção Primária/métodos
Sociedades Médicas/organização & administração
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170706
[Lr] Data última revisão:
170706
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170204
[St] Status:MEDLINE
[do] DOI:10.4158/EP171764.GL


  7 / 27 MEDLINE  
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[PMID]:28095040
[Au] Autor:Garber AJ; Abrahamson MJ; Barzilay JI; Blonde L; Bloomgarden ZT; Bush MA; Dagogo-Jack S; DeFronzo RA; Einhorn D; Fonseca VA; Garber JR; Garvey WT; Grunberger G; Handelsman Y; Hirsch IB; Jellinger PS; McGill JB; Mechanick JI; Rosenblit PD; Umpierrez GE
[Ti] Título:CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM - 2017 EXECUTIVE SUMMARY.
[So] Source:Endocr Pract;23(2):207-238, 2017 Feb.
[Is] ISSN:1530-891X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:ABBREVIATIONS: A1C = hemoglobin A1C AACE = American Association of Clinical Endocrinologists ACCORD = Action to Control Cardiovascular Risk in Diabetes ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure ACEI = angiotensin-converting enzyme inhibitor ADVANCE = Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation AGI = alpha-glucosidase inhibitor apo B = apolipoprotein B ASCVD = atherosclerotic cardiovascular disease BAS = bile acid sequestrant BMI = body mass index BP = blood pressure CHD = coronary heart disease CKD = chronic kidney disease CVD = cardiovascular disease DASH = Dietary Approaches to Stop Hypertension DPP-4 = dipeptidyl peptidase 4 eGFR = estimated glomerular filtration rate FDA = Food and Drug Administration GLP-1 = glucagon-like peptide 1 HDL-C = high-density lipoprotein cholesterol IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial LDL-C = low-density lipoprotein cholesterol LDL-P = low-density lipoprotein particle Look AHEAD = Look Action for Health in Diabetes NPH = neutral protamine Hagedorn OSA = obstructive sleep apnea SFU = sulfonylurea SGLT-2 = sodium glucose cotransporter-2 SMBG = self-monitoring of blood glucose T2D = type 2 diabetes TZD = thiazolidinedione VADT = Veterans Affairs Diabetes Trial.
[Mh] Termos MeSH primário: Algoritmos
Diabetes Mellitus Tipo 2/terapia
Endocrinologia/métodos
[Mh] Termos MeSH secundário: Consenso
Diabetes Mellitus Tipo 2/fisiopatologia
Diabetes Mellitus Tipo 2/prevenção & controle
Endocrinologistas
Seres Humanos
Estilo de Vida
Sociedades Médicas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170118
[St] Status:MEDLINE
[do] DOI:10.4158/EP161682.CS


  8 / 27 MEDLINE  
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[PMID]:27967229
[Au] Autor:Mechanick JI; Hurley DL; Garvey WT
[Ti] Título:ADIPOSITY-BASED CHRONIC DISEASE AS A NEW DIAGNOSTIC TERM: THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT.
[So] Source:Endocr Pract;23(3):372-378, 2017 Mar.
[Is] ISSN:1530-891X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) have created a chronic care model, advanced diagnostic framework, clinical practice guidelines, and clinical practice algorithm for the comprehensive management of obesity. This coordinated effort is not solely based on body mass index as in previous models, but emphasizes a complications-centric approach that primarily determines therapeutic decisions and desired outcomes. Adiposity-Based Chronic Disease (ABCD) is a new diagnostic term for obesity that explicitly identifies a chronic disease, alludes to a precise pathophysiologic basis, and avoids the stigmata and confusion related to the differential use and multiple meanings of the term "obesity." Key elements to further the care of patients using this new ABCD term are: (1) positioning lifestyle medicine in the promotion of overall health, not only as the first algorithmic step, but as the central, pervasive action; (2) standardizing protocols that comprehensively and durably address weight loss and management of adiposity-based complications; (3) approaching patient care through contextualization (e.g., primordial prevention to decrease obesogenic environmental risk factors and transculturalization to adapt evidence-based recommendations for different ethnicities, cultures, and socio-economics); and lastly, (4) developing evidence-based strategies for successful implementation, monitoring, and optimization of patient care over time. This AACE/ACE blueprint extends current work and aspires to meaningfully improve both individual and population health by presenting a new ABCD term for medical diagnostic purposes, use in a complications-centric management and staging strategy, and precise reference to the obesity chronic disease state, divested from counterproductive stigmata and ambiguities found in the general public sphere. ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists ABCD = Adiposity-Based Chronic Disease ACE = American College of Endocrinology BMI = body mass index CPG = clinical practice guidelines HCP = health care professionals.
[Mh] Termos MeSH primário: Adiposidade
Endocrinologistas
Endocrinologia
Terminologia como Assunto
[Mh] Termos MeSH secundário: Doença Crônica
Seres Humanos
Obesidade/epidemiologia
Guias de Prática Clínica como Assunto
Sociedades Médicas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161215
[St] Status:MEDLINE
[do] DOI:10.4158/EP161688.PS


  9 / 27 MEDLINE  
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[PMID]:27967219
[Au] Autor:Beshyah SA; Khalil AB; Sherif IH; Benbarka MM; Raza SA; Hussein W; Alzahrani AS; Chadli A
[Ti] Título:A SURVEY OF CLINICAL PRACTICE PATTERNS IN MANAGEMENT OF GRAVES DISEASE IN THE MIDDLE EAST AND NORTH AFRICA.
[So] Source:Endocr Pract;23(3):299-308, 2017 Mar.
[Is] ISSN:1530-891X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Graves disease (GD) is commonly seen in endocrine clinical practice. The objective of this study was to evaluate the current diagnosis and management of patients with GD in the Middle East and North Africa (MENA). METHODS: An electronic survey on GD management was performed using an online questionnaire of a large pool of practicing physicians. Responses from 352 eligible and willing physicians were included in this study. They were mostly endocrinologists (157) and internal medicine physicians (116). RESULTS: In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request serum antithyroid peroxidase antibody and TSH-receptor autoantibody (50% and 46%, respectively), whereas serum antithyroglobulin antibodies would be ordered by fewer respondents (36%). Thyroid ultra-sound would be requested by a high number of respondents (63.7%), while only a small percentage would order isotopic thyroid studies. Antithyroid drug (ATD) therapy was the preferred first-line treatment (52.7%), followed by radio-iodine (RAI) treatment (36.8%), ß-blockers alone (6.9%), thyroidectomy (3.2%), and no therapy (1.3%). When RAI treatment was selected in the presence of mild Graves orbitopathy and/or associated risk factors for its occurrence/exacerbation, steroid prophylaxis was frequently used. The preferred ATD in pregnancy was propylthiouracil in the first trimester and carbimazole in the second and third trimesters. On most issues, choices of the MENA physicians fell between European and American practices. CONCLUSION: Hybrid practices are seen in the MENA region, perhaps reflecting training and affiliations. Management approaches most suitable for patients in this region are needed. ABBREVIATIONS: ATD = antithyroid drug CBZ = carbimazole FT3 = free T3 FT4 = free T4 GD = Graves disease GO = Graves orbitopathy MENA = Middle East and North Africa MMI = methimazole RAI = radioactive iodine RAIU = RAI uptake T3 = tri-iodothyronine T4 = thyroxine TG Ab = antithyroglobulin antibodies TRAb = TSH-receptor autoantibody TSH = thyroid-stimulating hormone PTU = propylthiouracil TID = thrice daily UAE = United Arab Emirates US = ultrasound.
[Mh] Termos MeSH primário: Doença de Graves/terapia
Padrões de Prática Médica/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
África do Norte/epidemiologia
Idoso
Antitireóideos/uso terapêutico
Endocrinologistas
Feminino
Doença de Graves/tratamento farmacológico
Doença de Graves/epidemiologia
Pesquisas sobre Serviços de Saúde
Seres Humanos
Medicina Interna
Internet
Iodeto Peroxidase/sangue
Radioisótopos do Iodo/uso terapêutico
Masculino
Meia-Idade
Oriente Médio/epidemiologia
Médicos
Gravidez
Inquéritos e Questionários
Tireoglobulina/análise
Tireoidectomia
Tireotropina/sangue
Tiroxina/sangue
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antithyroid Agents); 0 (Iodine Radioisotopes); 9002-71-5 (Thyrotropin); 9010-34-8 (Thyroglobulin); EC 1.11.1.8 (Iodide Peroxidase); Q51BO43MG4 (Thyroxine)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161215
[St] Status:MEDLINE
[do] DOI:10.4158/EP161607.OR


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[PMID]:27842909
[Au] Autor:Wu S; Hwang SS; Haigh PI
[Ad] Endereço:Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
[Ti] Título:Influence of a negative sestamibi scan on the decision for parathyroid operation by the endocrinologist and surgeon.
[So] Source:Surgery;161(1):35-43, 2017 Jan.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: It has been observed that negative sestamibi scans may impact practice patterns in patients with primary hyperparathyroidism. However, there are no published data on the issue. The objective was to elucidate the influence of negative sestamibi scans on referrals by endocrinologists for parathyroidectomy and surgeon decision-making. METHODS: All patients with primary hyperparathyroidism were identified within a region-wide health care system over a 2-year period. Data, including age, calcium, parathyroid hormone, renal function, bone density, and sestamibi scan results, were collected from the electronic medical record of all patients. The electronic referral system was used to track consultations with endocrinologists and surgeons. Multivariable logistic regression analysis was done to model factors involved in endocrinologist recommendations (referral or no referral to operation) and surgeon recommendations (parathyroidectomy or no parathyroidectomy). RESULTS: A total of 539 patients with primary hyperparathyroidism were identified, and 452 were seen by endocrinologists. Of these, 260 patients had sestamibi scans done (120 negative and 140 positive), and 201 (77%) patients were referred to surgeons. Compared with positive sestamibi scans, negative sestamibi scans were independently associated with no referral to surgeons, after adjusting for presence of classic symptoms, age, fitness for operation, calcium, parathyroid hormone, glomerular filtration rate, and bone density (odds ratio = 0.36; 95% confidence interval 0.18-0.73). Surgeons saw an additional 54 patients referred from nonendocrinologists or primary care physicians and sestamibi scans were completed. Surgeons recommended parathyroidectomy in 236 of the 255 patients. Negative sestamibi scans were independently associated with no recommendation for operation (odds ratio = 0.32; 95% confidence interval 0.11-0.91). Surgeons initially scheduled and completed parathyroidectomies in 211/255 patients. Cure rate after operation was 98%, and this was not influenced by the sestamibi scan result. CONCLUSION: Negative sestamibi scans influence decision making in the management of patients with primary hyperparathyroidism. Endocrinologists commonly order sestamibi scans, and if negative, they are less likely to refer patients to surgeons. Surgeons are also influenced by sestamibi scans, and if negative, they are less likely to recommend parathyroidectomy. Cure rate in sestamibi-negative patients is excellent after operation.
[Mh] Termos MeSH primário: Tomada de Decisão Clínica
Hiperparatireoidismo Primário/diagnóstico por imagem
Hiperparatireoidismo Primário/cirurgia
Cintilografia/métodos
Tecnécio Tc 99m Sestamibi
[Mh] Termos MeSH secundário: Adulto
Idoso
Estudos de Coortes
Intervalos de Confiança
Bases de Dados Factuais
Endocrinologistas
Feminino
Seres Humanos
Masculino
Meia-Idade
Razão de Chances
Paratireoidectomia/métodos
Cuidados Pré-Operatórios/métodos
Encaminhamento e Consulta
Estudos Retrospectivos
Sensibilidade e Especificidade
Índice de Gravidade de Doença
Cirurgiões
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
971Z4W1S09 (Technetium Tc 99m Sestamibi)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161116
[St] Status:MEDLINE



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