practical guidelines

  • 文章类型: Journal Article
    营养不良性大疱性表皮松解症(DEB),一种罕见的遗传性皮肤病,由编码VII型胶原(COL7)的基因COL7A1功能丧失突变引起,以皮肤起泡为特征,疤痕,和显著降低患者生活质量的皮外表现。Beremagenegeperpavec-svdt(\'B-VEC\')是一种采用非整合性,基于复制缺陷型单纯疱疹病毒1型(HSV-1)的载体,编码两个全长人COL7A1的拷贝,以在局部施用至DEB伤口后恢复COL7蛋白。B-VEC于2023年在美国被批准为第一个局部基因治疗和DEB的第一个批准治疗。然而,很少有提供者有使用这种基因疗法的经验。
    数据是通过文献综述和参与B-VEC临床研究或在B-VEC批准后开始治疗的提供者的经验获得的。
    这篇综述讨论了疾病负担,描述了B-VEC的临床试验结果,并提供医生和患者/护理人员的建议,作为实际使用B-VEC的实用指南,可以在办公室或在患者家中进行管理。
    通过继续优化B-VEC管理的实际方面,重点将继续转移到以患者为中心的考虑和改善患者预后.
    UNASSIGNED: Dystrophic epidermolysis bullosa (DEB), a rare genetic skin disease caused by loss-of-function mutations in COL7A1, the gene encoding type VII collagen (COL7), is characterized by skin blistering, scarring, and extracutaneous manifestations that markedly reduce patient quality-of-life. Beremagene geperpavec-svdt (\'B-VEC\') is a gene therapy employing a non-integrating, replication-defective herpes simplex virus type 1 (HSV-1)-based vector encoding two copies of full-length human COL7A1 to restore COL7 protein after topical administration to DEB wounds. B-VEC was approved in the United States in 2023 as the first topical gene therapy and the first approved treatment for DEB. However, few providers have experience with use of this gene therapy.
    UNASSIGNED: Data was obtained through literature review and the experience of providers who participated in the B-VEC clinical study or initiated treatment after B-VEC approval.
    UNASSIGNED: This review discusses the burden of disease, describes the clinical trial outcomes of B-VEC, and provides physician and patient/caregiver recommendations as a practical guide for the real-world use of B-VEC, which can be administered in-office or at the patient\'s home.
    UNASSIGNED: By continuing to optimize the practical aspects of B-VEC administration, the focus will continue to shift to patient-centric considerations and improved patient outcomes.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
    La Guía Española para el Manejo del Asma, mejor conocida por su acrónimo en español, GEMA, está a nuestra disposición desde hace más de veinte años. Veintiuna sociedades científicas o grupos relacionados, tanto de España como de otros países, han participado en la preparación y desarrollo de la edición actualizada de GEMA que, de hecho, se ha posicionado en la actualidad a nivel mundial como la guía de referencia sobre asma en lengua española.Su objetivo es prevenir y mejorar la situación clínica de las personas con asma, aumentando el conocimiento de los profesionales sanitarios involucrados en su cuidado. Su propósito es convertir la evidencia científica en recomendaciones prácticas sencillas y fáciles de seguir. Por lo tanto, no se trata de una monografía que reúna todo el conocimiento científico sobre la enfermedad, sino más bien de un documento conciso con lo esencial, diseñado para ser aplicado rápidamente en la práctica clínica de rutina. Las recomendaciones son necesariamente multidisciplinares, están desarrolladas para ser útiles y una herramienta indispensable para médicos de diferentes especialidades, así como para profesionales de enfermería y farmacia.Seguramente, los aspectos más destacados de la guía son las recomendaciones para: establecer el diagnóstico del asma utilizando un algoritmo secuencial basado en pruebas diagnósticas objetivas; el seguimiento de los pacientes, preferentemente basado en la estrategia de lograr y mantener el control de la enfermedad; el tratamiento según el nivel de gravedad del asma utilizando seis escalones, desde la menor hasta la mayor necesidad de medicamentos, y el algoritmo de tratamiento basado en fenotipos para la indicación de biológicos en pacientes con asma grave no controlada. A esto se suma ahora una novedad para su fácil uso y seguimiento a través de una aplicación informática basada en la inteligencia artificial conversacional de tipo chatbot (ia-GEMA).
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    本实践指南为在妇科临床实践中进行子宫内膜活检(EB)的妇科医生提供了最新的证据。国际妇科专家委员会根据AGREE报告指南制定了建议。进行EB时,必须进行足够的组织采样。对于怀疑子宫内膜恶性肿瘤的患者,不应首选盲法。宫腔镜检查是具有最高诊断准确性和成本效益的靶向活检方法。盲吸技术对子宫内膜息肉的诊断并不可靠。在低资源设置中,在没有能力进行宫腔镜检查的情况下,盲法技术可用于EB。宫腔镜穿刺活检只允许收集有限数量的子宫内膜组织。把握活检技术应被视为育龄女性的首选,对于子宫内膜肥厚或萎缩性,应首选双极电极芯片活检。EB是慢性子宫内膜炎的最终诊断所必需的。对于无症状的绝经后妇女,应使用哪种子宫内膜厚度切点来推荐EB,尚无共识。EB应提供给有异常子宫出血和子宫内膜癌危险因素的年轻女性。子宫内膜病理学应排除与EB在非肥胖女性没有反对的雌激素过高症。即使没有超声检查病理证据,宫腔镜检查也可用于异常出血的患者。EB对检测宫内病变具有高灵敏度。绝经后妇女子宫出血,建议使用EB。使用他莫昔芬超声检查子宫内膜厚度>4mm的女性应进行宫腔镜EB检查。
    This practice guideline provides updated evidence for the gynecologist who performs endometrial biopsy (EB) in gynecologic clinical practice. An international committee of gynecology experts developed the recommendations according to AGREE Reporting Guideline. An adequate tissue sampling is mandatory when performing an EB. Blind methods should not be first choice in patients with suspected endometrial malignancy. Hysteroscopy is the targeted-biopsy method with highest diagnostic accuracy and cost-effectiveness. Blind suction techniques are not reliable for the diagnosis of endometrial polyps. In low resources settings, and in absence of the capacity to perform office hysteroscopy, blind techniques could be used for EB. Hysteroscopic punch biopsy allows to collect only limited amount of endometrial tissue. grasp biopsy technique should be considered first choice in reproductive aged women, bipolar electrode chip biopsy should be preferred with hypotrophic or atrophic endometrium. EB is required for the final diagnosis of chronic endometritis. There is no consensus regarding which endometrial thickness cut-off should be used for recommending EB in asymptomatic postmenopausal women. EB should be offered to young women with abnormal uterine bleeding and risk factors for endometrial carcinoma. Endometrial pathology should be excluded with EB in nonobese women with unopposed hyperestrogenism. Hysteroscopy with EB is useful in patients with abnormal bleeding even without sonographic evidence of pathology. EB has high sensitivity for detecting intrauterine pathologies. In postmenopausal women with uterine bleeding, EB is recommended. Women with sonographic endometrial thickness > 4 mm using tamoxifen should undergo hysteroscopic EB.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: English Abstract
    The assessment of parent-child interactions and relationships (PCIR) plays an important role for many diagnostic purposes in child and adolescent psychology and psychological health care. While child and adolescent psychology has been intensively researched, the field still faces a lack of knowledge about health care practice. To offer knowledge about practical routine needs and derived needs in these domains, we aimed to obtain information from professionals who routinely assess PCIR.We aimed to gain a basic description of task-specific diagnostic fields, professional staff and their education, their clients, key diagnostic questions, observational settings, guidelines used in assessing PCIR and professionals\' personal understanding of PCIR. To gain information on how professionals assess PCIR, we used an online survey containing multiple choice questions and rating scales.We describe differences between task-specific diagnostic fields of inpatient and outpatient settings, consulting and officially appointed surveyors for court decision. Only responses from professionals performing PCIR are analyzed (N = 166). PCIR is regularly used for more than a half of children between 0-12 years of age and for more than a third of adolescents for answering a broad spectrum of diagnostical questions. We describe differences for nearly all facets of PCIR except for the content related domain. Based on these differences between task-specific fields, we give suggestions for standardized documentation of PCIR and how findings from this study can be used for scientific development.
    Zusammenfassung Die Diagnostik der Eltern-Kind-Interaktion und deren Beziehung (EKIB) stellt für viele psychologische Fragestellungen im Kindes- und Jugendalter einen wichtigen Baustein dar, der intensiv beforscht wird. Zur Praxis einer EKIB liegen bislang keine Informationen vor, um eine praxisbezogene und wissenschaftliche Diskussion anzuregen. Die Beschreibung soll einen Einblick in die diagnostische Praxis ermöglichen. Deskriptiv beschreibt die Studie Unterschiede zwischen den Tätigkeitsfelder in einer Klinik, in der Praxis, in der Beratung oder als Gutachter/in hinsichtlich der Durchführung, der Klientel, des/der Diagnostiker/in und dessen/ deren Ausbildung, der diagnostischen Fragestellungen, der Beobachtungssettings sowie die Bedeutung einer EKIB für die eigene Arbeit und die Umsetzung von Empfehlungen und Standards. Unterschiede zwischen den Tätigkeitsfeldern stationärer und ambulanter Therapie, Beratung und gerichtlicher Sachverständiger/innen werden deskriptiv beschrieben. Nur Teilnehmende, die selbst eine EKIB durchführen (N = 166), wurden ausgewertet. Eine EKIB wird von mehr als der Hälfte der Teilnehmenden bei Kindern zwischen 0 und 12 Jahren standardmäßig für ein breites Spektrum an Fragestellungen durchgeführt und von mehr als einem Drittel bei Jugendlichen bis zum 18. Lebensjahr eingesetzt. Es zeigten sich Unterschiede zwischen den Tätigkeitsfeldern in vielen Bereichen, jedoch nicht in den inhaltlichen Aspekten. Auf Basis der beschriebenen Variationen im diagnostischen Prozess wird eine standardisierte Dokumentation vorgeschlagen sowie Entwicklungsfelder für die Forschung diskutiert.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    目的:为面临手术的癌症患者实施应对技巧干预提供实用的指导。
    方法:回顾了有关应对和应对技巧以及评估对患者情绪状态的影响的文献。
    结论:在肿瘤患者围手术期准备的范围内,制定和提出简短的应对技能计划是可能的。这种应对技巧有助于培养自我效能感,个人控制,和韧性。患者对该计划做出了反应,并且似乎以令人满意的方式进行了家庭分配。
    结论:肿瘤科护士可以对患者实施部分或全部项目。应对技能属于各种医疗保健专业人员的职责范围,并且随时可以提供给患者。术前时期是让患者学习应对技能的合适时间。
    OBJECTIVE: To present a practical how-to guide on implementing a coping skills intervention for patients with cancer facing surgery.
    METHODS: A review of the literature on coping and coping skills and on assessing the impact on patients\' emotional status.
    CONCLUSIONS: Developing and presenting a brief coping skills program is possible within the confines of perioperative preparation for oncology patients. Such coping skills help develop a sense of self-efficacy, personal control, and resilience. Patients are responsive to the program and seem to practice their home assignments in a satisfactory manner.
    CONCLUSIONS: Oncology nurses can implement some of or all of the program with their patients. The coping skills fall under the mandate of a variety of health care professionals and are readily available to present to patients. The preoperative period is a suitable time to engage patients to learn coping skills.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    背景和目的:宫腔镜检查是一种可靠的技术,对于评估和治疗宫内病变非常有用。最近,不需要麻醉的办公室内手术的广泛性质一直要求验证实用方法以减少手术相关疼痛.在这方面,我们对有关办公室宫腔镜手术疼痛管理的文献进行了全面回顾.材料与方法:MEDLINE,EMBASE,Cochrane图书馆(Cochrane系统评价数据库,Cochrane中央控制试验登记册,Cochrane方法论登记册),全球卫生,卫生技术评估数据库和WebofScience,检索了其他研究登记册(例如临床试验数据库).我们搜索了所有关于宫腔镜手术期间疼痛缓解策略的原始文章,没有日期限制。根据研究和评估指南(AGREE)工具收集了结果并总结了建议。此外,每个建议的强度都是按照建议评估等级(GRADE)系统进行评分的,为了提供最好的证据。结果:疼痛管理的药理学和非药理学策略都是可行的,可以在宫腔镜手术的办公室环境中应用。应根据患者的特征和手术难度来调整策略的选择。结论:越来越多的证据支持使用药理学和其他无药理学策略来减轻办公室宫腔镜检查期间的疼痛。然而,未来的研究重点应根据患者的特点和手术难度确定推荐的方法(或组合方法).
    Background and Objectives: Hysteroscopy is a reliable technique which is highly useful for the evaluation and management of intrauterine pathology. Recently, the widespread nature of in-office procedures without the need for anesthesia has been requesting validation of practical approach in order to reduce procedure-related pain. In this regard, we performed a comprehensive review of literature regarding pain management in office hysteroscopic procedures. Materials and Methods: MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Global Health, Health Technology Assessment Database and Web of Science, other research registers (for example Clinical Trials database) were searched. We searched for all original articles regarding pain relief strategy during office hysteroscopy, without date restriction. Results have been collected and recommendations have been summarized according to the Appraisal of Guidelines for Research and Evaluation (AGREE) tool. Moreover, the strength of each recommendation was scored following the Grading of Recommendations Assessment (GRADE) system, in order to present the best available evidence. Results: Both pharmacological and non-pharmacological strategies for pain management are feasible and can be applied in office setting for hysteroscopic procedures. The selection of strategy should be modulated according to the characteristics of the patient and difficulty of the procedure. Conclusions: Accumulating evidence support the use of pharmacological and other pharmacological-free strategies for reducing pain during office hysteroscopy. Nevertheless, future research priorities should aim to identify the recommended approach (or combined approaches) according to the characteristics of the patient and difficulty of the procedure.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    对于参与介入程序的工人来说,估算有效剂量和眼睛晶状体的剂量是具有挑战性的。有问题的介入程序涉及高剂量,正因为如此,工人需要穿防护服。因此,已经开发了各种方法来评估眼睛晶状体的有效剂量和剂量。在本研究中,来自四个欧洲剂量测定服务的测量结果,在防护服之上和之下,已被收集和分析,以便根据介入工作场所工作人员对个人剂量的常规使用提供实用指南。讨论了使用一个或两个剂量测定器的优点和局限性。
    Estimation of effective dose and dose to the lens of the eye for workers involved in interventional procedures is challenging. The interventional procedures in question involve high doses and, due to this, workers need to wear protective garments. As a result, various methodologies have been developed to assess the effective dose and dose to the lens of the eye. In the present study, measurements from four European dosimetry services, over and under protective garments, have been collected and analysed in order to provide practical guidelines based on the routine use of personal dosemeters from staff in interventional workplaces. The advantages and limitations of using one or two dosemeters are discussed.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    OBJECTIVE: This specific review aims to expose clinicians, researchers and administrators in hospitals to the importance, procedures and safety of fMRI studies to promote the increased utilisation of such studies in different geographical places worldwide. The child\'s brain is developing rapidly, both structurally and functionally. These functional changes can only be detected using functional scans generated from an MRI machine and referred to as a functional MRI (fMRI). This method may be used clinically in complex medical and surgical conditions (e.g., epilepsy surgery), but these days are often used for research purposes. However, due to ethical and logistical considerations, fMRI in the paediatric population is not widely and equally used in different geographical places.
    CONCLUSIONS: The benefits of using this method to define the functional changes occurring in the developing brain are discussed in this review, along with desensitisation methods recommended when working with this vulnerable population in research and even in a clinical setting.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    There is currently a paucity of neuroscientific data recorded from more severely affected individuals with autism spectrum conditions (ASC). Enabling data collection to take place in a more familiar environment, that is, at home, may increase access to research participation in this group. Here, we present a new accessible method of studying brain activity of autistic individuals outside the laboratory in their home environment, using mobile electroencephalography (EEG) technology. The primary aim of the present study was to test the feasibility of acquiring good quality EEG data from autistic children at home, assessed via a set of objective data quality metrics, and to develop a list of practical guidelines on how to successfully conduct an EEG experiment in such a naturalistic setting based directly upon participants\' views. To demonstrate the utility of this method, we evaluated the EEG signal quality recorded from 69 children with ASC at home using a gel-based Eego Sports mobile EEG system. Five key indicators of data quality were assessed. Our results demonstrate that it is possible to record high quality EEG signal from children with ASC at home, generating data that could address a number of research questions. A user experience survey identified areas of good practice, which researchers should take into consideration when designing mobile EEG studies aiming to acquire data from children with ASC at a home environment.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    2019年冠状病毒病(COVID-19),随着全世界死亡人数的增加,造成了悲惨的全球卫生和经济紧急情况。疾病,由严重急性呼吸综合征冠状病毒2019(SARS-CoV-19)引起,是一种多系统炎症性疾病,许多COVID-19阳性患者因多器官功能衰竭而需要重症监护。生物标志物可靠地预测患者的病毒感染的临床原因,理想情况下,应用于护理点测试或通过常规诊断方法,是非常需要的。我们的目的是探讨常规评估的临床实验室值是否可以预测COVID-19病程的严重程度。因此,我们对来自4家医院的224例连续患者的入院实验室检查结果进行了回顾性分析,结果显示,全身免疫炎症指数(SII)是预测感染患者是否需要有创呼吸机支持和不良临床结局的有效指标.患者的生存和SARS-CoV-2感染的严重程度可以在入院时通过计算个体血液值的全身炎症指数来可靠地预测。我们提倡这种方法是一种可行且易于实施的检测方法,可能对改善高流入危机期间的患者管理特别有用。我们相信,通过这项工作,将有助于改善与COVID-19大流行障碍相关的基础设施可用性和病例管理。
    Coronavirus disease 2019 (COVID-19), with an increasing number of deaths worldwide, has created a tragic global health and economic emergency. The disease, caused by severe acute respiratory syndrome coronavirus 2019 (SARS-CoV-19), is a multi-system inflammatory disease with many of COVID-19-positive patients requiring intensive medical care due to multi-organ failures. Biomarkers to reliably predict the patient\'s clinical cause of the virus infection, ideally, to be applied in point of care testing or through routine diagnostic approaches, are highly needed. We aimed to probe if routinely assessed clinical lab values can predict the severity of the COVID-19 course. Therefore, we have retrospectively analyzed on admission laboratory findings in 224 consecutive patients from four hospitals and show that systemic immune inflammation index (SII) is a potent marker for predicting the requirement for invasive ventilator support and for worse clinical outcome of the infected patient. Patients\' survival and severity of SARS-CoV-2 infection could reliably be predicted at admission by calculating the systemic inflammatory index of individual blood values. We advocate this approach to be a feasible and easy-to-implement assay that may be particularly useful to improve patient management during high influx crisis. We believe with this work to contribute to improving infrastructure availability and case management associated with COVID-19 pandemic hurdles.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

       PDF(Pubmed)

公众号