Societies, Medical

社会,医疗
  • 文章类型: Journal Article
    静脉血栓栓塞症(VTE)与高发病率和高死亡率相关。与VTE相关的风险评分已广泛用于临床实践。在发表的众多分数中,指南中包含的通常是典型的风险评分,这些评分已得到广泛验证和全球认可.这篇综述提供了与VTE相关的风险评分的最新概述,该评分由3个指南认可,这些指南在VTE领域得到了高度认可,包括欧洲心脏病学会。美国胸科医师学会,和美国血液学会,着眼于发展,修改,验证,以及这些分数的比较,为包括但不限于心脏病专家在内的医学读者提供与VTE相关的所有经典风险评分的全面和最新的理解,肺病学家,血液学家,密集主义者,医师,外科医生,和研究人员。尽管这些指南推荐的每个分数或多或少都得到了验证,仍有进一步改进的空间。可能仍然有必要寻求更简单的方法,更实用,以及未来更普遍适用的VTE相关风险评分。
    Venous thromboembolism (VTE) is associated with high morbidity and mortality. Risk scores associated with VTE have been widely used in clinical practice. Among numerous scores published, those included in guidelines are usually typical risk scores which have been extensively validated and globally recognized. This review provides an updated overview of the risk scores associated with VTE endorsed by 3 guidelines which are highly recognized in the field of VTE including the European Society of Cardiology, American College of Chest Physicians, and American Society of Hematology, focusing on the development, modification, validation, and comparison of these scores, to provide a comprehensive and updated understanding of all the classic risk scores associated with VTE to medical readers including but not limited to cardiologists, pulmonologists, hematologists, intensivists, physicians, surgeons, and researchers. Although each score recommended by these guidelines was more or less validated, there may still be room for further improvement. It may still be necessary to seek simpler, more practical, and more universally applicable VTE-related risk scores in the future.
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  • 文章类型: Journal Article
    目的提供欧洲心脏病学会(ESC)和美国心脏病学会/美国心脏协会(ACC/AHA)指南之间心脏MRI适应症的全面头对头比较和时间分析,以确定共识和分歧的领域。材料与方法进行系统评价和荟萃分析。直到2023年5月发布的ESC和ACC/AHA指南对与心脏MRI相关的建议进行了系统筛选。使用χ2或Fisher精确检验比较了两个指南之间以及每个指南的较新版本与较旧版本之间的心脏MRI建议的建议类别(COR)和证据水平(LOE)。结果ESC指南包括109条关于心脏MRI的建议,行政协调会/AHA准则包括90项建议。ACC/AHA指南中CORI和LOEB的比例高于ESC指南(60%[54/90]对46.8%[51/109];P=.06和53%[48/90]对35.8%[39/109],分别为;P=0.01)。随着时间的推移,ESC指南中心脏MRI推荐数量的增加显着增加(ESC从63到109,ACC/AHA从65到90;P=0.03)。达成共识的主要领域是心力衰竭和肥厚型心肌病,虽然主要的分歧是瓣膜性心脏病,心律失常,和主动脉疾病。结论ESC指南包括更多与心脏MRI使用相关的建议,而ACC/AHA建议的COR和LOE较高。在两个指南中,心脏MRI建议的数量随着时间的推移显著增加,表明心脏MRI评估和治疗心血管疾病的作用日益增强。关键词:心血管磁共振,Guideline,欧洲心脏病学会,ESC,美国心脏病学会/美国心脏协会,ACC/AHA补充材料可用于本文。©RSNA,2024.
    Purpose To provide a comprehensive head-to-head comparison and temporal analysis of cardiac MRI indications between the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines to identify areas of consensus and divergence. Materials and Methods A systematic review and meta-analysis was conducted. ESC and ACC/AHA guidelines published until May 2023 were systematically screened for recommendations related to cardiac MRI. The class of recommendation (COR) and level of evidence (LOE) for cardiac MRI recommendations were compared between the two guidelines and between newer versus older versions of each guideline using χ2 or Fisher exact tests. Results ESC guidelines included 109 recommendations regarding cardiac MRI, and ACC/AHA guidelines included 90 recommendations. The proportion of COR I and LOE B was higher in ACC/AHA versus ESC guidelines (60% [54 of 90] vs 46.8% [51 of 109]; P = .06 and 53% [48 of 90] vs 35.8% [39 of 109], respectively; P = .01). The increase in the number of cardiac MRI recommendations over time was significantly higher in ESC guidelines (from 63 to 109 for ESC vs from 65 to 90 for ACC/AHA; P = .03). The main areas of consensus were found in heart failure and hypertrophic cardiomyopathy, while the main divergences were in valvular heart disease, arrhythmias, and aortic disease. Conclusion ESC guidelines included more recommendations related to cardiac MRI use, whereas the ACC/AHA recommendations had higher COR and LOE. The number of cardiac MRI recommendations increased significantly over time in both guidelines, indicating the increasing role of cardiac MRI evaluation and management of cardiovascular disease. Keywords: Cardiovascular Magnetic Resonance, Guideline, European Society of Cardiology, ESC, American College of Cardiology/American Heart Association, ACC/AHA Supplemental material is available for this article. © RSNA, 2024.
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  • 文章类型: Journal Article
    十多年前,美国预防服务特别工作组(USPSTF)建议在所有男性中反对基于前列腺特异性抗原(PSA)的前列腺癌筛查,这在很大程度上影响了全球范围内的前列腺癌筛查政策。因此,世界上已经看到越来越多的晚期和前列腺癌死亡,后来导致USPSTF撤回了最初的声明。同时,欧盟制定了一项指令,以解决“欧洲抗癌计划”中实施前列腺癌筛查的问题。在瑞士,有关泌尿科医生成立了一个开放的瑞士前列腺癌筛查小组,以改善前列腺癌的早期发现。2023年9月20日,瑞士泌尿外科学会(SGU/SSU)在洛桑举行的年度大会期间,成员投票赞成逐步评估在瑞士实施有组织的前列腺癌筛查计划的可行性。以下文章将总结过去十年的事件和科学进展,在此期间出现了补充基于PSA的前列腺癌筛查的证据和有希望的其他方式。它还旨在概述当代战略及其潜在的危害和好处。
    Over a decade ago, the United States Preventive Services Taskforce (USPSTF) recommended against prostate-specific antigen (PSA)-based screening for prostate cancer in all men, which considerably influenced prostate cancer screening policies worldwide after that. Consequently, the world has seen increasing numbers of advanced stages and prostate cancer deaths, which later led the USPSTF to withdraw its initial statement. Meanwhile, the European Union has elaborated a directive to address the problem of implementing prostate cancer screening in \"Europe\'s Beating Cancer Plan\". In Switzerland, concerned urologists formed an open Swiss Prostate Cancer Screening Group to improve the early detection of prostate cancer. On the 20th of September 2023, during the annual general assembly of the Swiss Society of Urology (SGU/SSU) in Lausanne, members positively voted for a stepwise approach to evaluate the feasibility of implementing organised prostate cancer screening programs in Switzerland. The following article will summarise the events and scientific advances in the last decade during which evidence and promising additional modalities to complement PSA-based prostate cancer screening have emerged. It also aims to provide an overview of contemporary strategies and their potential harms and benefits.
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  • 文章类型: Journal Article
    背景:儿童完全或部分未代偿性前庭功能障碍的后果通常是平衡障碍,有跌倒和疲劳增加的风险,特别是在需要姿势控制的任务期间。这些建议的目的是为前庭损伤儿童建立前庭康复(VR)指南。
    方法:指南是在对国际文献进行系统回顾的基础上制定的,由讲法语的耳鼻喉科医生的多学科小组验证,科学家,和物理治疗师。它们被列为A级,B,C,或根据科学证据水平下降的专家意见。
    结果:PubMed搜索了1990年1月至2021年12月之间发表的研究,使用关键词“前庭,\"\"康复,\"和\"children\"。过滤和审阅文章后,共纳入10份出版物以确立建议。
    结论:建议在VR之前进行前庭评估,包括前庭眼反射的研究,耳石功能,和姿势控制。在前庭功能障碍的情况下,建议从早期开始进行物理治疗,以训练姿势控制的不同方面,包括预期和反应姿势调整。适用于儿科人群的VR被推荐用于前庭功能障碍导致患有头部创伤的人的功能性疾病或眩晕症状的儿童。建议使用注视稳定练习来适应和替代双侧前庭障碍的儿童。不建议对儿童和青少年进行光运动刺激和虚拟现实。
    BACKGROUND: The consequence of complete or partial uncompensated vestibular dysfunction in children is usually balance disorders, with the risk of falls and increased fatigue, particularly during tasks requiring postural control. The aim of these recommendations is to establish guidelines for vestibular rehabilitation (VR) in children with vestibular impairment.
    METHODS: The guidelines were developed based on a systematic review of the international literature, validated by a multidisciplinary group of French-speaking otorhinolaryngologists, scientists, and physiotherapists. They are classified as grade A, B, C, or expert opinion according to a decreasing level of scientific evidence.
    RESULTS: A PubMed search of studies published between January 1990 and December 2021 was carried out using the keywords \"vestibular,\" \"rehabilitation,\" and \"children\". After filtering and reviewing the articles, a total of 10 publications were included to establish the recommendations.
    CONCLUSIONS: It is recommended that a vestibular assessment be carried out before VR, including a study of vestibulo-ocular reflex, otolithic function, and postural control. In cases of vestibular dysfunction, physiotherapy treatment is recommended from an early age to train different aspects of postural control, including anticipatory and reactive postural adjustments. VR adapted to the pediatric population is recommended for children whose vestibular dysfunction leads to functional disorders or symptoms of vertigo for those who have suffered head trauma. It is recommended that children with bilateral vestibular impairment be treated using gaze stabilization exercises for adaptation and substitution. Optokinetic stimulation and virtual reality are not recommended for children and young adolescents.
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  • 文章类型: Journal Article
    背景:肥胖医学协会(OMA)和美国国家脂质协会(NLA)的联合专家审查为临床医生提供了有关肥胖的病理生理和临床考虑因素的概述,血脂异常,和心血管疾病(CVD)的风险。
    方法:这项联合专家审查是基于科学证据,作者的临床观点,以及OMA和NLA领导层的同行评审。
    结果:在肥胖个体中,脂肪组织可以储存超过50%的全身游离胆固醇。甘油三酯可以代表脂肪组织中高达99%的脂质种类。脂肪组织扩张的可能性是大多数个体体重差异最大的原因,身体脂肪百分比从不到5%到超过60%。虽然人群研究表明,过度肥胖会导致血液低密度脂蛋白胆固醇(LDL-C)水平适度增加,最常描述为肥胖增加的脂肪病性血脂异常模式包括甘油三酯升高,降低高密度脂蛋白胆固醇(HDL-C),增加非HDL-C,载脂蛋白B升高,LDL颗粒浓度增加,并且增加得很小,高密度低密度脂蛋白颗粒。
    结论:肥胖会增加心血管疾病的风险,至少部分是由于促进了一种脂肪病,致动脉粥样硬化的脂质分布。肥胖还会使其他心脏代谢危险因素恶化。在肥胖患者中,降低体重和改善CVD结局的干预措施通常与改善血脂水平相关.鉴于超重或肥胖患者的血液LDL-C随着体重的减少而适度改善,早期干预治疗过度肥胖和动脉粥样硬化胆固醇(LDL-C和/或非HDL-C)水平升高是降低CVD风险的优先事项.
    BACKGROUND: This joint expert review by the Obesity Medicine Association (OMA) and National Lipid Association (NLA) provides clinicians an overview of the pathophysiologic and clinical considerations regarding obesity, dyslipidemia, and cardiovascular disease (CVD) risk.
    METHODS: This joint expert review is based upon scientific evidence, clinical perspectives of the authors, and peer review by the OMA and NLA leadership.
    RESULTS: Among individuals with obesity, adipose tissue may store over 50% of the total body free cholesterol. Triglycerides may represent up to 99% of lipid species in adipose tissue. The potential for adipose tissue expansion accounts for the greatest weight variance among most individuals, with percent body fat ranging from less than 5% to over 60%. While population studies suggest a modest increase in blood low-density lipoprotein cholesterol (LDL-C) levels with excess adiposity, the adiposopathic dyslipidemia pattern most often described with an increase in adiposity includes elevated triglycerides, reduced high-density lipoprotein cholesterol (HDL-C), increased non-HDL-C, elevated apolipoprotein B, increased LDL particle concentration, and increased small, dense LDL particles.
    CONCLUSIONS: Obesity increases CVD risk, at least partially due to promotion of an adiposopathic, atherogenic lipid profile. Obesity also worsens other cardiometabolic risk factors. Among patients with obesity, interventions that reduce body weight and improve CVD outcomes are generally associated with improved lipid levels. Given the modest improvement in blood LDL-C with weight reduction in patients with overweight or obesity, early interventions to treat both excess adiposity and elevated atherogenic cholesterol (LDL-C and/or non-HDL-C) levels represent priorities in reducing the risk of CVD.
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  • 文章类型: Journal Article
    职业倦怠及其阴性后遗症是妇科肿瘤学中一个持续存在的问题,威胁到我们医生队伍的健康。个人层面的干预措施,如压力管理培训,身体活动,睡眠卫生只能部分解决这一普遍问题,系统性危机源于与妇科肿瘤学实践相关的延长工作时间和压力情况。迫切需要系统的,机构层面的变化,使妇科肿瘤学家能够继续护理妇科癌症患者的关键工作。我们提出了有关机构层面变更的建议,这些建议基于国家医学科学院《国家卫生工作人员福利计划》提出的框架。这些旨在促进妇科肿瘤学家的健康和减少倦怠。建议包括努力创造一个更加积极和包容的工作环境,减少行政壁垒,促进心理健康,优化电子病历使用,并支持多元化的劳动力。这些干预措施的实施和定期评估,特别关注高危人群,是重要的下一步。
    Burnout and its negative sequelae are a persistent problem in gynecologic oncology, threatening the health of our physician workforce. Individual-level interventions such as stress management training, physical activity, and sleep hygiene only partially address this widespread, systemic crisis rooted in the extended work hours and stressful situations associated with gynecologic oncology practice. There is an urgent need for systematic, institution-level changes to allow gynecologic oncologists to continue the crucial work of caring for people with gynecologic cancer. We present recommendations for institution-level changes which are grounded in the framework presented by the National Plan for Health Workforce Well-Being by the National Academy of Medicine. These are aimed at facilitating gynecologic oncologists\' well-being and reduction of burnout. Recommendations include efforts to create a more positive and inclusive work environment, decrease administrative barriers, promote mental health, optimize electronic medical record use, and support a diverse workforce. Implementation and regular evaluation of these interventions, with specific attention to at-risk groups, is an important next step.
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  • 文章类型: Journal Article
    目的:本研究的目的是系统回顾有关前隐静脉(ASV)反流治疗和治疗范围的保险障碍的文献。
    方法:使用PRISMA框架进行文献检索。此外,对ASV治疗保险单的横断面分析进行了评估.
    结果:讨论了文献中关于ASV治疗的公开证据和治疗考虑。在226份(68.6%)的保险中,有155份保险允许ASV消融的承保范围,而62/226份(27.4%)未指定承保范围,9/226份(4.0%)指定的ASV治疗未承保。在提供ASV覆盖的155个中,98(62.2%)提供了覆盖标准,例如需要对大隐静脉进行事先治疗。
    结论:静脉治疗专家应继续倡导保险公司更新其静脉曲张治疗政策,以反映大量临床证据,以便ASV反流患者可以得到适当治疗。
    OBJECTIVE: The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage.
    METHODS: A literature search was performed using a PRISMA framework. In addition, a cross-sectional analysis of insurance policies for ASV treatment was evaluated.
    RESULTS: Published evidence and treatment considerations in the literature for ASV treatment are discussed. In 155 of 226 (68.6%) insurance policies reviewed coverage of ASV ablation was allowed while 62/226 (27.4%) did not specify coverage and 9/226 (4.0%) specified ASV treatment was not covered. Of the 155 that provide ASV coverage, 98 (62.2%) provide coverage with criteria such as requiring prior treatment of the great saphenous vein.
    CONCLUSIONS: Vein treatment experts should continue to advocate to insurance carriers to update their varicose vein treatment policies to reflect the substantial clinical evidence so that patients with ASV reflux can be appropriately treated.
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  • 文章类型: Journal Article
    背景:促动力学是一类旨在改善胃肠(GI)运动的药理药物,无论是区域还是整个肠道。每种药物都有其优点和缺点,根据目前的证据,高质量的研究是有限的,我们没有一个类或其他明确的建议。然而,对于区域选择性和/或全球作用的促动力药物仍然存在大量未满足的需求,这些药物主要在腔内起作用并且是安全的并且没有全身副作用。
    目标:这里,我们描述了六类促动力药物的优缺点,包括它们的药代动力学特性,功效,安全性和耐受性以及潜在的适应症。
    BACKGROUND: Prokinetics are a class of pharmacological drugs designed to improve gastrointestinal (GI) motility, either regionally or across the whole gut. Each drug has its merits and drawbacks, and based on current evidence as high-quality studies are limited, we have no clear recommendation on one class or other. However, there remains a large unmet need for both regionally selective and/or globally acting prokinetic drugs that work primarily intraluminally and are safe and without systemic side effects.
    OBJECTIVE: Here, we describe the strengths and weaknesses of six classes of prokinetic drugs, including their pharmacokinetic properties, efficacy, safety and tolerability and potential indications.
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  • 文章类型: Systematic Review
    目的:头颈癌(HNC)幸存者的监测重点是早期发现复发或第二原发恶性肿瘤。在最初的重述确认无病状态后,对于无症状HNC患者使用监测影像学检查存在争议.我们的目标是全面回顾有关无症状HNSCC患者的影像学和生物标志物监测的文献。并召集多学科专家小组,为代表性临床情景中的监测提供适当的使用标准。
    方法:通过图书馆员对1990-2022年出版的文献进行的检索,收集了适当使用标准的证据基础,重点是使用MEDLINE(Ovid®)对非转移性HNSCC的监测成像和循环肿瘤特异性DNA,Embase,WebofScience核心合集,和Cochrane中央受控试验登记册。系统评价是根据PRISMA指南报告的。经由过程改良的Delphi,专家小组就适当的使用标准进行了投票,提供适当使用监测影像学和循环肿瘤人乳头瘤病毒DNA(HPVctDNA)的建议。
    结果:在5178项研究中,80人符合纳入标准(5项荟萃分析/系统综述,1项随机对照试验,1事后分析,25项前瞻性和48项回顾性队列研究[≥50例患者])报告了27,525例患者。大,随机化,在疾病特异性或生活质量结局方面,目前尚缺乏前瞻性试验来研究接受监测影像学检查或HPVctDNA监测的无症状患者是否从早期发现复发或第二原发肿瘤中获益.
    结论:在缺乏前瞻性数据的情况下,HNC幸存者的监测影像学检查应依赖于考虑初始疾病分期的个体化复发风险评估,HPV疾病状态,烟草使用历史。循环肿瘤生物标志物具有新兴的监测作用。
    Surveillance for survivors of head and neck cancer (HNC) is focused on early detection of recurrent or second primary malignancies. After initial restaging confirms disease-free status, the use of surveillance imaging for asymptomatic patients with HNC is controversial. Our objective was to comprehensively review literature pertaining to imaging and biomarker surveillance of asymptomatic patients treated for head and neck squamous cell carcinoma and to convene a multidisciplinary expert panel to provide appropriate use criteria for surveillance in representative clinical scenarios. The evidence base for the appropriate use criteria was gathered through a librarian-mediated search of literature published from 1990 to 2022 focused on surveillance imaging and circulating tumor-specific DNA for nonmetastatic head and neck squamous cell carcinoma using MEDLINE (Ovid), Embase, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials. The systematic review was reported according to PRISMA guidelines. Using the modified Delphi process, the expert panel voted on appropriate use criteria, providing recommendations for appropriate use of surveillance imaging and human papillomavirus (HPV) circulating tumor DNA. Of 5178 studies identified, 80 met inclusion criteria (5 meta-analyses/systematic reviews, 1 randomized control trial, 1 post hoc analysis, 25 prospective, and 48 retrospective cohort studies [with ≥50 patients]), reporting on 27,525 patients. No large, randomized, prospective trials examined whether asymptomatic patients who receive surveillance imaging or HPV circulating tumor DNA monitoring benefit from earlier detection of recurrence or second primary tumors in terms of disease-specific or quality-of-life outcomes. In the absence of prospective data, surveillance imaging for HNC survivors should rely on individualized recurrence-risk assessment accounting for initial disease staging, HPV disease status, and tobacco use history. There is an emerging surveillance role for circulating tumor biomarkers.
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  • 文章类型: Journal Article
    背景:居民研究已被所有专业的研究生医学教育认证委员会授权。东南密歇根医学教育中心(SEMCME)每年举办一次居民竞赛研究论坛,我们评估了获奖演讲的出版状况。
    方法:回顾了1978年至2018年SEMCME研究论坛的获奖演讲。作者的信息和摘要标题中的关键字用于搜索PubMed和GoogleScholar数据库中的出版物。描述性统计通常用于表征数据。
    结果:在147个获奖项目中,62%(78/126)是口头的,48%(10/21)是海报展示;88(60%)发表。妇产科的发表率最高(71%),其次是外科(61%)和医学专业(48%)。
    结论:尽管在SEMCME研究论坛上发表了60%的获奖演讲,需要做更多的工作来检查阻碍出版其余项目的障碍。
    BACKGROUND: Resident research has been mandated by the Accreditation Council of Graduate Medical Education across all specialties. Southeast Michigan Center for Medical Education (SEMCME) has an annual Research Forum for resident competition, and we assessed the publication status of award-winning presentations.
    METHODS: The SEMCME Research Forum\'s winning presentations from 1978 to 2018 were reviewed. The author\'s information and keywords from the abstract\'s title were used to search PubMed and Google Scholar databases for publications. Descriptive statistics were generally used to characterize the data.
    RESULTS: Of 147 winning projects, 62% (78/126) were oral and 48% (10/21) were poster presentations; 88 (60%) were published. Obstetrics and gynecology had the highest publication rate (71%), followed by surgical (61%) and medical specialties (48%).
    CONCLUSIONS: While 60% of the award-winning presentations at the SEMCME Research Forum were published, more work needs to be done to examine the barriers preventing the publication of the remaining projects.
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