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[PMID]:28457798
[Au] Autor:Tabit CE; Coplan MJ; Spencer KT; Alcain CF; Spiegel T; Vohra AS; Adelman D; Liao JK; Sanghani RM
[Ad] Endereço:Section of Cardiology, Department of Medicine, The University of Chicago Medical Center, Ill.
[Ti] Título:Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure.
[So] Source:Am J Med;130(9):1112.e17-1112.e31, 2017 Sep.
[Is] ISSN:1555-7162
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. METHODS: There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded. RESULTS: Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery. CONCLUSION: Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure.
[Mh] Termos MeSH primário: Cardiologia/normas
Serviço Hospitalar de Emergência/utilização
Insuficiência Cardíaca/terapia
Educação de Pacientes como Assunto/organização & administração
Readmissão do Paciente/estatística & dados numéricos
[Mh] Termos MeSH secundário: Doença Aguda
Idoso
Cardiologia/economia
Cardiologia/métodos
Estudos de Casos e Controles
Chicago
Controle de Custos/métodos
Controle de Custos/normas
Serviço Hospitalar de Emergência/economia
Serviço Hospitalar de Emergência/organização & administração
Feminino
Insuficiência Cardíaca/economia
Seres Humanos
Masculino
Meia-Idade
Estudos de Casos Organizacionais
Alta do Paciente/economia
Alta do Paciente/normas
Alta do Paciente/estatística & dados numéricos
Educação de Pacientes como Assunto/economia
Educação de Pacientes como Assunto/métodos
Readmissão do Paciente/economia
Guias de Prática Clínica como Assunto
Pontuação de Propensão
Encaminhamento e Consulta/economia
Encaminhamento e Consulta/normas
Estudos Retrospectivos
Fatores Socioeconômicos
Centros de Atenção Terciária/economia
Centros de Atenção Terciária/organização & administração
Saúde da População Urbana/economia
Saúde da População Urbana/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:29437564
[Au] Autor:Chen Y; Wang C; Shang H; Yang K; Norris SL
[Ad] Endereço:Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China chenyaolong@lzu.edu.cn.
[Ti] Título:Clinical practice guidelines in China.
[So] Source:BMJ;360:j5158, 2018 02 05.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: China
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5158


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[PMID]:29385203
[Au] Autor:Cook DA; Pencille LJ; Dupras DM; Linderbaum JA; Pankratz VS; Wilkinson JM
[Ad] Endereço:Knowledge Delivery Center, Mayo Clinic, Rochester, Minnesota, United States of America.
[Ti] Título:Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants.
[So] Source:PLoS One;13(1):e0191943, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To understand clinicians' beliefs about practice variation and how variation might be reduced. METHODS: We surveyed board-certified physicians (N = 178), nurse practitioners (N = 60), and physician assistants (N = 12) at an academic medical center and two community clinics, representing family medicine, general internal medicine, and cardiology, from February-April 2016. The Internet-based questionnaire ascertained clinicians' beliefs regarding practice variation, clinical practice guidelines, and costs. RESULTS: Respondents agreed that practice variation should be reduced (mean [SD] 4.5 [1.1]; 1 = strongly disagree, 6 = strongly agree), but agreed less strongly (4.1 [1.0]) that it can realistically be reduced. They moderately agreed that variation is justified by situational differences (3.9 [1.2]). They strongly agreed (5.2 [0.8]) that clinicians should help reduce healthcare costs, but agreed less strongly (4.4 [1.1]) that reducing practice variation would reduce costs. Nearly all respondents (234/249 [94%]) currently depend on practice guidelines. Clinicians rated differences in clinician style and experience as most influencing practice variation, and inaccessibility of guidelines as least influential. Time to apply standards, and patient decision aids, were rated most likely to help standardize practice. Nurse practitioners and physicians assistants (vs physicians) and less experienced (vs senior) clinicians rated more favorably several factors that might help to standardize practice. Differences by specialty and academic vs community practice were small. CONCLUSIONS: Clinicians believe that practice variation should be reduced, but are less certain that this can be achieved. Accessibility of guidelines is not a significant barrier to practice standardization, whereas more time to apply standards is viewed as potentially helpful.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Pessoal de Saúde/psicologia
Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: Seres Humanos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191943


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[PMID]:28449646
[Au] Autor:Lubbe W; Ten Ham-Baloyi W
[Ad] Endereço:North-West University, School of Nursing Science, Private Bag X6001, Potchefstroom, 2520, South Africa. welma.lubbe@nwu.ac.za.
[Ti] Título:When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician's guide.
[So] Source:BMC Pregnancy Childbirth;17(1):130, 2017 04 27.
[Is] ISSN:1471-2393
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The use of pacifiers is an ancient practice, but often becomes a point of debate when parents and professionals aim to protect and promote breastfeeding as most appropriately for nurturing infants. We discuss the current literature available on pacifier use to enable critical decision-making regarding justifiable use of pacifiers, especially in the Baby-Friendly Hospital Initiative context, and we provide practical guidelines for clinicians. DISCUSSION: Suck-swallow-breathe coordination is an important skill that every newborn must acquire for feeding success. In most cases the development and maintenance of the sucking reflex is not a problem, but sometimes the skill may be compromised due to factors such as mother-infant separation or medical conditions. In such situations the use of pacifiers can be considered therapeutic and even provide medical benefits to infants, including reducing the risk of sudden infant death syndrome. The argument opposing pacifier use, however, is based on potential risks such as nipple confusion and early cessation of breastfeeding. The Ten Steps to Successful Breastfeeding as embedded in the Baby-Friendly Hospital Initiative initially prohibited the use of pacifiers in a breastfeeding friendly environment to prevent potential associated risks. This article provides a summary of the evidence on the benefits of non-nutritive sucking, risks associated with pacifier use, an identification of the implications regarded as 'justifiable' in the clinical use of pacifiers and a comprehensive discussion to support the recommendations for safe pacifier use in healthy, full-term, and ill and preterm infants. The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere with it. Justifiable conditions have been identified as: low-birth weight and premature infants; infants at risk for hypoglyceamia; infants in need of oral stimulation to develop, maintain and mature the sucking reflex in preterm infants; and the achievement of neurobehavioural organisation. Medical benefits associated with the use of pacifiers include providing comfort, contributing towards neurobehavioural organisation, and reducing the risk of sudden infant death syndrome. Guidelines are presented for assessing and guiding safe pacifier use, for specific design to ensure safety, and for cessation of use to ensure normal childhood development.
[Mh] Termos MeSH primário: Desenvolvimento Infantil/fisiologia
Hospitais/normas
Chupetas/normas
Comportamento de Sucção/fisiologia
[Mh] Termos MeSH secundário: Aleitamento Materno
Feminino
Seres Humanos
Recém-Nascido
Masculino
Guias de Prática Clínica como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1186/s12884-017-1306-8


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[PMID]:29269543
[Ti] Título:Clarity on use of formaldehyde in fish.
[So] Source:Vet Rec;181(25):670, 2017 12 23.
[Is] ISSN:2042-7670
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Aquicultura
Peixes
Formaldeído/uso terapêutico
Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: Animais
Seres Humanos
Sociedades
Reino Unido
Medicina Veterinária
[Pt] Tipo de publicação:NEWS
[Nm] Nome de substância:
1HG84L3525 (Formaldehyde)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE


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[PMID]:29203754
[Au] Autor:Pietras P; Lyp M; Nowicka K; Soliwoda M; Kruszynski M; Malczewski D
[Ad] Endereço:Klinika Kardiologii Oddzialu Fizjoterapii, Ii Wydzial Lekarski, Warszawski Uniwersytet Medyczny, Warszawa, Polska, Wyzsza Szkola Rehabilitacji W Warszawie, Warszawa, Polska.
[Ti] Título:[Scientific research results commercialization as an opportunity for the physiotherapy development].
[So] Source:Wiad Lek;70(5):988-991, 2017.
[Is] ISSN:0043-5147
[Cp] País de publicação:Poland
[La] Idioma:pol
[Ab] Resumo:Physiotherapy is under the very intensive development. The research carried out around the world result in implementing new forms of therapy. For several years higher education institutions are trying to support scientists in an attempt to commercialize the results of research, although the process is complex. The practice in the world shows that the cooperation of science and business is possible and results in the implementation of modern solutions as real applications. It is important to scientists and people planning a career in science knew the rules and limitations of the above process.
[Mh] Termos MeSH primário: Pesquisa Biomédica/organização & administração
Medicina Baseada em Evidências
Fisioterapia/organização & administração
[Mh] Termos MeSH secundário: Seres Humanos
Guias de Prática Clínica como Assunto
Indicadores de Qualidade em Assistência à Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE


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[PMID]:29157622
[Au] Autor:van Rhee F; Greenway A; Stone K
[Ad] Endereço:UAMS Myeloma Institute, University of Arkansas for Medical Sciences, 4301 West Markham, #816, Little Rock, AR 72205, USA. Electronic address: vanrheefrits@uams.edu.
[Ti] Título:Treatment of Idiopathic Castleman Disease.
[So] Source:Hematol Oncol Clin North Am;32(1):89-106, 2018 02.
[Is] ISSN:1558-1977
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Important progress has been made in the treatment of idiopathic multicentric Castleman disease (iMCD) with the introduction of interleukin-6 targeting monoclonal antibodies. This article describes the clinical results obtained with different treatment modalities and uses this evidence to provide treatment guidelines for the practicing clinician. Much is still to be learned about the pathophysiology of iMCD and further research is urgently needed to develop novel and curative treatment approaches for all patients.
[Mh] Termos MeSH primário: Antineoplásicos Imunológicos/uso terapêutico
Doença de Castleman/tratamento farmacológico
Interleucina-6/antagonistas & inibidores
[Mh] Termos MeSH secundário: Doença de Castleman/sangue
Doença de Castleman/patologia
Seres Humanos
Interleucina-6/sangue
Guias de Prática Clínica como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antineoplastic Agents, Immunological); 0 (IL6 protein, human); 0 (Interleukin-6)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171122
[St] Status:MEDLINE


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[PMID]:28742291
[Au] Autor:Sultan RS; Olfson M; Correll CU; Duncan EJ
[Ad] Endereço:New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Dr, New York, NY 10032. rs3511@cumc.columbia.edu.
[Ti] Título:Evaluating the Effect of the Changes in FDA Guidelines for Clozapine Monitoring.
[So] Source:J Clin Psychiatry;78(8):e933-e939, 2017 Sep/Oct.
[Is] ISSN:1555-2101
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Concerns exist that clozapine is underutilized in the management of treatment-resistant schizophrenia. Although a 2015 change in the US Food and Drug Administration (FDA) monitoring recommendations lowered the threshold of the absolute neutrophil count for treatment interruption from 1,500/µL to 1,000/µL and removed white blood cell count thresholds from the monitoring algorithm, the implications of this policy change on clozapine interruptions remain unknown. METHODS: We analyzed outpatient prescribing records for antipsychotic medications in the Veterans Integrated Service Network 7 (VISN 7) database between 1999 and 2012 to assess the potential impact of the recent changes in FDA neutropenia monitoring recommendations on clozapine treatment discontinuation. We evaluated results of complete blood count monitoring to compare percentages of patients who developed or would have developed ≥ 1 hematologic event under the previous and current FDA guidelines in the first year following initiation of clozapine. RESULTS: From a cohort of 14,620 patients with schizophrenia (ICD-9-295.x), 246 patients received clozapine treatment (1.7%). No agranulocytosis was observed during the study period. Under the former recommendations, 5 patients in the clozapine initiation cohort (n = 160, 3.1%; 95% CI, 0.43-5.83) qualified for treatment interruption during the first year of clozapine treatment, while only 1 patient (0.6%) qualified under the current recommendations. Under the former recommendations, hematologic events occurred at a similar rate for individuals taking and not taking clozapine. CONCLUSIONS: While clozapine remains an underused medication, the new FDA monitoring guidelines are likely to substantially reduce the percentage of patients who meet criteria for clozapine-associated hematologic events requiring treatment interruption. This decrease may reduce the clinical burden of managing patients on clozapine and therefore increase the number of individuals treated with this uniquely effective medication. However, prospective studies of individuals treated under the new guidelines are needed to fully assess safety of the FDA's change.
[Mh] Termos MeSH primário: Clozapina
Monitoramento de Medicamentos
Neutropenia
Esquizofrenia/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos
Antipsicóticos/administração & dosagem
Antipsicóticos/efeitos adversos
Clozapina/administração & dosagem
Clozapina/efeitos adversos
Monitoramento de Medicamentos/métodos
Monitoramento de Medicamentos/estatística & dados numéricos
Prescrições de Medicamentos/estatística & dados numéricos
Feminino
Seres Humanos
Contagem de Leucócitos
Masculino
Conduta do Tratamento Medicamentoso/organização & administração
Conduta do Tratamento Medicamentoso/normas
Meia-Idade
Neutropenia/induzido quimicamente
Neutropenia/diagnóstico
Neutropenia/epidemiologia
Neutropenia/prevenção & controle
Farmacovigilância
Guias de Prática Clínica como Assunto
Escalas de Graduação Psiquiátrica
Melhoria de Qualidade
Esquizofrenia/diagnóstico
Esquizofrenia/epidemiologia
Estados Unidos/epidemiologia
United States Food and Drug Administration
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antipsychotic Agents); J60AR2IKIC (Clozapine)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE


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[PMID]:28453700
[Au] Autor:Bleiberg H; Decoster G; de Gramont A; Rougier P; Sobrero A; Benson A; Chibaudel B; Douillard JY; Eng C; Fuchs C; Fujii M; Labianca R; Larsen AK; Mitchell E; Schmoll HJ; Sprumont D; Zalcberg J
[Ad] Endereço:Institut Jules Bordet, Brussels, Belgium.
[Ti] Título:A need to simplify informed consent documents in cancer clinical trials. A position paper of the ARCAD Group.
[So] Source:Ann Oncol;28(5):922-930, 2017 05 01.
[Is] ISSN:1569-8041
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background: In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants. The purpose of this work is to focus on the written information in the informed consent documentation for drug development clinical trials and suggests (i) to distinguish between necessary and not essential information, (ii) to define the optimal format allowing the best legibility of those documents. Methods: The Aide et Recherche en Cancérologie Digestive (ARCAD) Group, an international scientific committee involving oncologists from all over the world, addressed these issues and developed and uniformly accepted a simplified informed consent documentation for future clinical research. Results: A simplified form of informed consent with the leading part of 1200-1800 words containing all of the key information necessary to meet ethical and regulatory requirements and 'relevant supportive information appendix' of 2000-3000 words is provided. Conclusions: This position paper, on the basis of the ARCAD Group experts discussions, proposes our informed consent model and the rationale for its content.
[Mh] Termos MeSH primário: Termos de Consentimento
Neoplasias/tratamento farmacológico
[Mh] Termos MeSH secundário: Ensaios Clínicos como Assunto
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Consentimento Livre e Esclarecido
Participação do Paciente
Guias de Prática Clínica como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/annonc/mdx050


  10 / 100794 MEDLINE  
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[PMID]:29397592
[Au] Autor:National Clinical Research Center for Digestive Disease of China; Chinese Society of Digestive Endoscopy; Chinese Association of Endoscopologist, Gastroenterologist & Hepatologist
[Ti] Título:[Clinical guidelines for perioperative management of gastric endoscopic submucosal dissection].
[So] Source:Zhonghua Nei Ke Za Zhi;57(2):84-96, 2018 Feb 01.
[Is] ISSN:0578-1426
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:Gastric cancer has become one of the important public health issues endangering people's health in China. Currently, endoscopic submucosal dissection (ESD) has been used as the curative procedure of early gastric cancer without lymph node metastasis. Endoscopic resection has several advantages, including less invasiveness, permitting en bloc, histologically completed resection, accurate pathological diagnosis, lower recurrent rate and rapid recovery. The perioperative period of ESD is the time of a patient's endoscopic operative procedure; more specifically, it includes ward admission, indication, contraindication, preoperative preparation, endoscopic operation, postoperative complications, recovery and the disposal of specimen. The aim of this guideline is to assist endoscopists in providing standardized operation to patients, as well as managing perioperative complications.
[Mh] Termos MeSH primário: Ressecção Endoscópica de Mucosa
Mucosa Gástrica/cirurgia
Guias de Prática Clínica como Assunto
Neoplasias Gástricas/diagnóstico
Neoplasias Gástricas/cirurgia
[Mh] Termos MeSH secundário: China
Detecção Precoce de Câncer
Endoscopia
Seres Humanos
Metástase Linfática
Complicações Pós-Operatórias
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180206
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0578-1426.2018.02.002



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