The current international sepsis guidelines from 2021 are based on the work of a panel of 60 international experts from various fields. They include a total of 93 recommendations, some of which include new aspects compared to the 2016 version of the guidelines. This article provides a subjective compilation by two internal medicine intensivists who highlight some aspects, especially of changes within the guidelines compared to the previous version. The focus is on the fields of screening, sepsis bundles, fluid and vasopressor treatment and adjuvant treatment. In addition, for the first time these guidelines address the important issue of long-term sequelae for sepsis survivors and their environment.
UNASSIGNED: Die aktuelle internationale Sepsisleitlinie aus dem Jahr 2021 basiert auf der Arbeit eines Panels von 60 internationalen Experten aus verschiedenen Bereichen. Sie beinhaltet insgesamt 93 Empfehlungen, wobei einige Empfehlungen verglichen mit der Leitlinienversion von 2016 neue Aspekte beinhalten. Der vorliegende Beitrag bietet eine subjektive Zusammenstellung zweier internistischer Intensivmediziner, die einige Aspekte aufzeigen, insbesondere Veränderungen innerhalb der Leitlinie im Vergleich zur vorherigen Version. Der Fokus liegt auf den Bereichen Screening, Sepsis-Campaign-Bündel, Flüssigkeits- und Vasopressorentherapie und adjuvante Therapien. Zudem wird in dieser Leitlinie erstmalig das wichtige Thema der Langzeitfolgen für Sepsisüberlebende und deren Umfeld angesprochen.

BACKGROUND: The efficacy of art therapy as an adjuvant treatment for schizophrenia remains inconclusive, and variation in the effects of art therapy on schizophrenia by the type of schizophrenia, severity of schizophrenia, type of art therapy, follow-up duration, or different populations has never been systematically assessed. The objective of this study is to systematically evaluate the effects of art therapy on schizophrenia and to determine whether there are some potential influencing factors affecting the effects of art therapy.
METHODS: Seven online databases will be searched from their inception until June 30, 2022. All the relevant randomized clinical trials (RCTs) comparing art therapy plus standardized treatment versus standardized treatment alone for schizophrenia will be selected and assessed for inclusion. The Cochrane risk-of-bias tool will be used to evaluate the methodological quality of the included RCTs. Review Manager 5.4 will be used to analyze all the data obtained. Mental health symptoms are defined as the primary outcome, and the secondary outcomes include the Global Assessment of Functioning score, quality of life, functional remission, and the level of self-esteem. Subgroup analyses will be performed based on the type of schizophrenia, severity of schizophrenia, type of art therapy, follow-up duration, or different populations.
RESULTS: The results will be published in a peer-reviewed journal.
CONCLUSIONS: This updated systematic review and subgroup meta-analysis will evaluate the effects of art therapy as adjunctive treatment to standardized treatment in patients with schizophrenia and determine whether there are some potential confounding variables affecting the effects of art therapy on the outcomes of schizophrenia patients, thus strengthening the evidence base for the clinical application of this combination therapy for schizophrenia.

BACKGROUND: Compound Kushen injection (CKI) is a commonly used anti-tumor Chinese patent medicine, which is extracted from Kushen (Radix Sophorae Flavescentis) and Baituling (Rhizoma Smilacis Glabrae) and has been widely prescribed as an add-on therapy to platinum-based chemotherapy (PBC) for advanced non-small cell lung cancer (NSCLC). However, the efficacy and safety of this combination therapy remain controversial.
METHODS: A systematic review and meta-analysis will be performed following the PRISMA (Preferred Reported Items for Systematic Review and Meta-analysis) guidelines. All randomized controlled trials (RCTs) comparing CKI in combination with PBC versus PBC alone will be retrieved and assessed for inclusion. Analyses will be performed using Review Manager 5.3, Comprehensive Meta-Analysis 3.0 and Trial Sequential Analysis software. The disease control rate (DCR) will be defined as the primary outcome, and the objective response rate (ORR), quality of life (QOL), survival rate, and toxicities will be the secondary outcomes.
RESULTS: This study will systematically evaluate the efficacy and safety of Compound Kushen injection combined with platinum-based chemotherapy in the treatment of stage III/IV NSCLC. The results of this study will be published in a peer-reviewed journal.
CONCLUSIONS: This systematic review and meta-analysis of eligible randomized controlled trials will evaluate the effects of Compound Kushen injection as adjunctive therapy to platinum-based chemotherapy in patients with stage III/IV non-small cell lung cancer, thus providing evidence to the clinical use of this combination therapy for the specific subsets of patients.
UNASSIGNED: CRD42019134892.

Cancer pain is a frequent medical problem in our society. This syndrome affects from 80 to 90% of cancer patients and can be solved with relatively simple measures in 90% of the cases. Approximately 40% of cancer patients reported to be unsatisfied with the physician or nurse about their pain management. For these reasons, we gathered a task force in order to generate practice guidelines based on medical evidence and on the opinion of experts in this area. These guidelines were generated by a task force of 31 physicians who were leaders in this field and based on 599 papers selected by a previous literature search. This group evaluated the results of this search in three work sessions, during which a level of evidence was assigned to each recommendation.

OBJECTIVE: Our goal was to provide health-care providers, patients, and the general public with an assessment of currently available data regarding the use of adjuvant therapy for breast cancer.
METHODS: The participants included a non-Federal, non-advocate, 14-member panel representing the fields of oncology, radiology, surgery, pathology, statistics, public health, and health policy as well as patient representatives. In addition, 30 experts in medical oncology, radiation oncology, biostatistics, epidemiology, surgical oncology, and clinical trials presented data to the panel and to a conference audience of 1000.
METHODS: The literature was searched with the use of MEDLINE(TM) for January 1995 through July 2000, and an extensive bibliography of 2230 references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Evidence from randomized clinical trials and evidence from prospective studies were given precedence over clinical anecdotal experience.
METHODS: The panel, answering predefined questions, developed its conclusions based on the evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately after its release at the conference and was updated with the panel\'s final revisions. The statement is available at http://consensus.nih.gov.
CONCLUSIONS: The panel concludes that decisions regarding adjuvant hormonal therapy should be based on the presence of hormone receptor protein in tumor tissues. Adjuvant hormonal therapy should be offered only to women whose tumors express hormone receptor protein. Because adjuvant polychemotherapy improves survival, it should be recommended to the majority of women with localized breast cancer regardless of lymph node, menopausal, or hormone receptor status. The inclusion of anthracyclines in adjuvant chemotherapy regimens produces a small but statistically significant improvement in survival over non-anthracycline-containing regimens. Available data are currently inconclusive regarding the use of taxanes in adjuvant treatment of lymph node-positive breast cancer. The use of adjuvant dose-intensive chemotherapy regimens in high-risk breast cancer and of taxanes in lymph node-negative breast cancer should be restricted to randomized trials. Ongoing studies evaluating these treatment strategies should be supported to determine if such strategies have a role in adjuvant treatment. Studies to date have included few patients older than 70 years. There is a critical need for trials to evaluate the role of adjuvant chemotherapy in these women. There is evidence that women with a high risk of locoregional tumor recurrence after mastectomy benefit from postoperative radiotherapy. This high-risk group includes women with four or more positive lymph nodes or an advanced primary cancer. Currently, the role of postmastectomy radiotherapy for patients with one to three positive lymph nodes remains uncertain and should be tested in a randomized controlled trial. Individual patients differ in the importance they place on the risks and benefits of adjuvant treatments. Quality of life needs to be evaluated in selected randomized clinical trials to examine the impact of the major acute and long-term side effects of adjuvant treatments, particularly premature menopause, weight gain, mild memory loss, and fatigue. Methods to support shared decision-making between patients and their physicians have been successful in trials; they need to be tailored for diverse populations and should be tested for broader dissemination.

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