clinical evaluation

临床评价
  • 文章类型: Practice Guideline
    OBJECTIVE: The purpose of this literature review is to make recommendations regarding the first steps and care provided to the healthy newborn.
    METHODS: Consultation of the Medline database, and of national and international guidelines.
    RESULTS: The initial assessment of the newborn should quickly determine whether resuscitation is necessary or not. Any anomaly requires the help of the pediatrician (Consensus agreement). For a newborn with no cardiorespiratory adaptation, delayed cord clamping may be considered more as a physiological modality of delivery, which may help prevent iron deficiency in the first months of life, without deleterious effects for the child or his/her mother, apart from a slightly increased risk of neonatal jaundice (gradeC). In order to avoid separating a woman and her child, it is recommended to postpone routine postnatal procedures, to allow for skin-to-skin contact between the mother and the newborn, if she wishes, according to a defined/specified surveillance protocol (grade B). Breastfeeding should be encouraged, and supported, especially the first time (Consensus agreement). In the absence of suggestive clinical signs, aspiration of the upper airways and systematic verification of the permeability of posterior nasal apertures and of the esophagus are not recommended (Consensus agreement). The prevention of hemorrhagic disease of the newborn by the oral administration of vitamin K1 to all healthy term babies begins in the delivery room, preferably in the presence of the parents and after having obtained their consent (Consensus agreement).
    CONCLUSIONS: Regarding the birth of a healthy newborn, it is strongly advised to avoid unnecessary technical actions and to favor the mother-child relationship in a safe environment.
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  • 文章类型: Guideline
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  • 文章类型: Journal Article
    The Papanicolaou Society of Cytopathology has developed a set of guidelines for pulmonary cytology including indications for bronchial brushings, washings, and endobronchial ultrasound guided transbronchial fine-needle aspiration (EBUS-TBNA), technical recommendations for cytological sampling, recommended terminology and classification schemes, recommendations for ancillary testing and recommendations for post-cytological management and follow-up. All recommendations are based on the expertise of the authors, an extensive literature review and feedback from presentations at national and international conferences. This document selectively presents the results of these discussions. The present document summarizes recommendations regarding techniques used to obtain cytological and small histologic specimens from the lung and mediastinal lymph nodes including rapid on-site evaluation (ROSE), and the triage of specimens for immunocytochemical and molecular studies.
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  • 文章类型: Journal Article
    背景:本章建议中涉及的问题是:对生殖器脱垂的女性进行临床和临床评估,并已决定对其进行手术治疗。必须考虑哪些检查的临床要素作为手术后失败或复发的风险因素,为了预测和评估可能的手术困难,并朝着首选的手术技术迈进?
    方法:这项工作基于对文献的系统回顾(PubMed,Medline,科克伦图书馆,Cochrane系统评价数据库,EMBASE)用于元分析,随机试验,登记册,文献综述,对照研究和主要非对照研究,发表在主题上。它的实施遵循了HAS关于临床实践建议的方法,用科学的论证(用证据的水平,NP)和推荐等级(A,B,C,和专业协议[AP])。
    结果:首先要描述脱垂,通过临床检查,帮助,如果需要,如果临床检查数据不足或发现功能体征与临床异常之间存在差异,则通过图像的补充,或在相关病理学有疑问的情况下。适合查看复发危险因素(高度脱垂)和术后并发症危险因素(假体暴露的危险因素,手术方法困难,具有超敏反应的盆腔疼痛综合征)以告知患者并指导治疗选择。与脱垂(尿失禁,膀胱过度活动症,排尿困难,尿路感染,上尿路影响)将通过访谈和临床检查以及测量排尿后残留物的流量计进行搜索和评估,尿液分析,和肾脏膀胱超声检查.在存在排尿障碍的情况下,对其进行临床和尿动力学评估是合适的。在没有任何自发或隐藏的尿征的情况下,到目前为止,没有理由建议进行系统的尿动力学评估。与脱垂相关的肛门直肠症状(肠易激综合征,排便阻塞,大便失禁)应进行搜索和评估。脱垂手术前,重要的是不要忽视妇科病理。
    结论:在提出手术治疗女性生殖器脱垂之前,它适合于实现临床和临床旁评估来描述脱垂(涉及的解剖结构,grade),寻找复发,困难的方法和术后并发症的危险因素,并了解与脱垂相关的影响或症状(泌尿,肛门直肠,妇科,盆腔-会阴疼痛)以指导他们的评估和治疗。©2016由ElsevierMassonSAS发布。
    BACKGROUND: The issue addressed in this chapter of recommendations is: What is the clinical and para-clinical assessment to achieve in women with genital prolapse and for whom surgical treatment has been decided. What are the clinical elements of the examination that must be taken into account as a risk factor of failure or relapse after surgery, in order to anticipate and evaluate possible surgical difficulties, and to move towards a preferred surgical technique?
    METHODS: This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement [AP]).
    RESULTS: It suits first of all to describe prolapse, by clinical examination, helped, if needed, by a supplement of imagery if clinical examination data are insufficient or in case of discrepancy between the functional signs and clinical anomalies found, or in case of doubt in associated pathology. It suits to look relapse risk factors (high grade prolapse) and postoperative complications risk factors (risk factors for prothetic exposure, surgical approach difficulties, pelvic pain syndrome with hypersensitivity) to inform the patient and guide the therapeutic choice. Urinary functional disorders associated with prolapse (urinary incontinence, overactive bladder, dysuria, urinary tract infection, upper urinary tract impact) will be search and evaluated by interview and clinical examination and by a flowmeter with measurement of the post voiding residue, a urinalysis, and renal-bladder ultrasound. In the presence of voiding disorders, it is appropriate to do their clinical and urodynamic evaluation. In the absence of any spontaneous or hidden urinary sign, there is so far no reason to recommend systematically urodynamic assessment. Anorectal symptoms associated with prolapse (irritable bowel syndrome, obstruction of defecation, fecal incontinence) should be search and evaluated. Before prolapse surgery, it is essential not to ignore gynecologic pathology.
    CONCLUSIONS: Before proposing a surgical cure of genital prolapse of women, it suits to achieve a clinical and paraclinical assessment to describe prolapse (anatomical structures involved, grade), to look for recurrence, difficulties approach and postoperative complications risk factors, and to appreciate the impact or the symptoms associated with prolapse (urinary, anorectal, gynecological, pelvic-perineal pain) to guide their evaluation and their treatment. © 2016 Published by Elsevier Masson SAS.
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  • 文章类型: Journal Article
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    文章类型: Comparative Study
    Considerable disagreements and variations exist in diagnosis and treatment planning of periodontal disease. Achieving high interrater periodontal diagnosis can prove challenging. The objectives of this study were to measure variations in periodontal diagnosis and treatment planning among predoctoral periodontics faculty members after consensus training and to compare such variation with those identified in third- and fourth-year dental students. Nine electronically stored case vignettes and survey instruments were made available to eighteen faculty members and twenty dental students under standardized conditions. A chi-square test was used to compare responses between groups, and multirater kappa tests were used to evaluate interrater agreement/reliability. Of the nine cases, only one differed between groups significantly in terms of treatment. Also, third-year students differed from fourth-year students on the diagnosis of aggressive periodontitis versus chronic periodontitis. Most respondents were able to distinguish clearly among diagnoses of chronic periodontitis, aggressive periodontitis, and gingivitis. This study established a baseline assessment of the current status of consensus after training. We will reassess variations after addressing the specific challenges identified. Programs designed and implemented to help decrease the variation in periodontal diagnosis and treatment planning among faculty members may ultimately translate into better agreement and better standardization of dental instruction.
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