ResearchPad - guideline https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Analysis of an improved workflow of endoscope reprocessing for bedside endoscopic diagnosis and treatment on COVID-19 patients<sup>#</sup> ]]> https://www.researchpad.co/article/elastic_article_10696 Severe cases infected with the coronavirus disease 2019 (COVID-19), named by the World Health Organization (WHO) on Feb. 11, 2020, tend to present a hypercatabolic state because of severe systemic consumption, and are susceptible to stress ulcers and even life-threatening gastrointestinal bleeding. Endoscopic diagnosis and treatment constitute an irreplaceable part in the handling of severe COVID-19 cases. Endoscopes, as reusable precision instruments with complicated structures, require more techniques than other medical devices in cleaning, disinfection, sterilization, and other reprocessing procedures. From 2016 to 2019, health care-acquired infection caused by improper endoscope reprocessing has always been among the top 5 on the list of top 10 health technology hazards issued by the Emergency Care Research Institute. Considering the highly infective nature of COVID-19 and the potential aerosol contamination therefrom, it is of pivotal significance to ensure that endoscopes are strictly reprocessed between uses. In accordance with the national standard “Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS507-2016),” we improved the workflow of endoscope reprocessing including the selection of chemicals in an effort to ensure quality control throughout the clinical management towards COVID-19 patients. Based on the experience we attained from the 12 severe COVID-19 cases in our hospital who underwent endoscopy 23 times in total, the article provides an improved version of endoscopic reprocessing guidelines for bedside endoscopic diagnosis and treatment on COVID-19 patients for reference.

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<![CDATA[原发性肺癌外科手术临床路径(2013年版)]]> https://www.researchpad.co/article/5c052c87d5eed0c4848a83f4 <![CDATA[原发性肺癌诊疗规范(2011年版)]]> https://www.researchpad.co/article/5c052ad3d5eed0c4848a4d73 <![CDATA[影像引导射频消融治疗肺部肿瘤专家共识(2018年版)]]> https://www.researchpad.co/article/5c0528e9d5eed0c48489d6a9 <![CDATA[中国肺癌低剂量螺旋CT筛查指南(2018年版)]]> https://www.researchpad.co/article/5c0528e3d5eed0c48489d4c3 肺癌是导致中国癌症死亡的首要原因。已有的研究证明低剂量螺旋CT在肺癌高危人群进行肺癌筛查能降低20%的肺癌死亡。本研究的目的是建立适合中国国情的肺癌筛查指南。方法由国家卫计委任命的中国肺癌早诊早治专家组专家及部分非专家组专家,包括:4名胸外科专家、4名胸部影像学专家、2名肿瘤学专家、2名肺内科专家、2名病理学专家和2名流行病学专家,共同参与了本指南的制定工作。专家们在系统评价了美国NLST和中国农村肺癌LDCT筛查结果及经验,并达成共识的基础上,共同推荐了本肺癌筛查指南。结果本指南推荐的肺癌高危人群为:年龄50岁-74岁;吸烟20包/年,或者戒烟5年。参与肺癌LDCT筛查前,需要获得筛查者的知情同意。肺癌筛查需与健康教育结合,向患者宣传吸烟对健康的危害。因此,健康教育应该整合到肺癌筛查全过程,以便帮助患者戒烟。结论LDCT筛查能降低肺癌死亡率,本指南推荐中国肺癌高危人群进行LDCT筛查。但是,未来需要进行更多的研究,包括LDCT联合生物标志物用于肺癌筛查的研究,以优化肺癌LDCT筛查方法及技术。 ]]> <![CDATA[ISDE guidance statement: management of upper gastrointestinal endoscopy and surgery in COVID-19 outbreak]]> https://www.researchpad.co/article/N522a40f4-54f9-4b39-a513-2f16efb5bf63 This is an official guidance statement of The International Society of the Diseases of the Esophagus (ISDE) to address all the operators involved in management of patients affected by upper gastrointestinal diseases during COVID-19 pandemic. This guidance is based on the best available evidence to date and will be updated as new evidence becomes available.

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<![CDATA[Level 3 guideline on the treatment of patients with severe/multiple injuries]]> https://www.researchpad.co/article/N1330c27f-3a8b-4efa-81cb-0b1b43cb13e2 ]]> <![CDATA[The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America]]> https://www.researchpad.co/article/N7701febd-f84c-4067-83e4-3a3c7bfdc6e5

Abstract

[Related article:]

Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

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<![CDATA[Clinical diagnosis and treatment of immune checkpoint inhibitors‐related endocrine dysfunction]]> https://www.researchpad.co/article/N11841ab8-8264-46fc-9e07-8a5ac44b2257

As a new class of antitumor drugs, immune checkpoint inhibitors (ICIs) have shown remarkable efficacy toward the treatment of various malignant tumors. By virtue of their targets and mechanisms of action, ICIs can cause autoimmune and inflammatory effects, termed as immune‐related adverse events (irAEs) and unlike the adverse reactions of traditional therapies, irAEs are occult and not fixed, with some serious adverse reactions forcing patients to stop treatment which might even affect their survival. Therefore, with the wide clinical application of ICIs, clinicians need to fully understand the possible adverse reactions of these drugs and devise reasonable treatment strategies to improve the survival rate and therapeutic effects of patients receiving ICIs. In this article, we review the incidence, clinical manifestations, diagnosis and treatment of immune‐related endocrine events that may occur with the administration of ICIs.

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<![CDATA[A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiologya]]> https://www.researchpad.co/article/Na304a30d-8643-4941-85da-61a2658e27d9

Abstract

The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician/advanced practice provider and the microbiologists who provide enormous value to the healthcare team. This document, developed by experts in laboratory and adult and pediatric clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. This document presents a system-based approach rather than specimen-based approach, and includes bloodstream and cardiovascular system infections, central nervous system infections, ocular infections, soft tissue infections of the head and neck, upper and lower respiratory infections, infections of the gastrointestinal tract, intra-abdominal infections, bone and joint infections, urinary tract infections, genital infections, and other skin and soft tissue infections; or into etiologic agent groups, including arthropod-borne infections, viral syndromes, and blood and tissue parasite infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. In addition, the pediatric needs of specimen management are also emphasized. There is intentional redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a guidance for physicians in choosing tests that will aid them to quickly and accurately diagnose infectious diseases in their patients.

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<![CDATA[Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America]]> https://www.researchpad.co/article/Ndd0d6d02-9f67-4a97-8509-5bbaeb786a22

Abstract

The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.

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<![CDATA[Southern African HIV Clinicians Society guideline for the prevention, diagnosis and management of cryptococcal disease among HIV-infected persons: 2019 update]]> https://www.researchpad.co/article/N315e6d4a-ce51-4d48-9c6b-af0d5fc23ea8 ]]> <![CDATA[Spanish Guidelines for the use of targeted deep sequencing in myelodysplastic syndromes and chronic myelomonocytic leukaemia]]> https://www.researchpad.co/article/N11472a4c-3c33-4831-adb2-9f50a6b71faf

Summary

The landscape of medical sequencing has rapidly changed with the evolution of next generation sequencing (NGS). These technologies have contributed to the molecular characterization of the myelodysplastic syndromes (MDS) and chronic myelomonocytic leukaemia (CMML), through the identification of recurrent gene mutations, which are present in >80% of patients. These mutations contribute to a better classification and risk stratification of the patients. Currently, clinical laboratories include NGS genomic analyses in their routine clinical practice, in an effort to personalize the diagnosis, prognosis and treatment of MDS and CMML. NGS technologies have reduced the cost of large‐scale sequencing, but there are additional challenges involving the clinical validation of these technologies, as continuous advances are constantly being made. In this context, it is of major importance to standardize the generation, analysis, clinical interpretation and reporting of NGS data. To that end, the Spanish MDS Group (GESMD) has expanded the present set of guidelines, aiming to establish common quality standards for the adequate implementation of NGS and clinical interpretation of the results, hoping that this effort will ultimately contribute to the benefit of patients with myeloid malignancies.

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<![CDATA[Metformin Treatment for Patients with Diabetes and Chronic Kidney Disease: A Korean Diabetes Association and Korean Society of Nephrology Consensus Statement]]> https://www.researchpad.co/article/Nd64f7585-b7a8-45a7-88e0-219738ccba3f

The safety of metformin use for patients with type 2 diabetes mellitus (T2DM) and advanced kidney disease is controversial, and more recent guidelines have suggested that metformin be used cautiously in this group until more definitive evidence concerning its safety is available. The Korean Diabetes Association and the Korean Society of Nephrology have agreed on consensus statements concerning metformin use for patients with T2DM and renal dysfunction, particularly when these patients undergo imaging studies using iodinated contrast media (ICM). Metformin can be used safely when the estimated glomerular filtration rate (eGFR) is ≥45 mL/min/1.73 m2. If the eGFR is between 30 and 44 mL/min/1.73 m2, metformin treatment should not be started. If metformin is already in use, a daily dose of ≤1,000 mg is recommended. Metformin is contraindicated when the eGFR is <30 mL/min/1.73 m2. Renal function should be evaluated prior to any ICM-related procedures. During procedures involving intravenous administration of ICM, metformin should be discontinued starting the day of the procedures and up to 48 hours post-procedures if the eGFR is <60 mL/min/1.73 m2.

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<![CDATA[A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)]]> https://www.researchpad.co/article/N8f517ad0-79d6-4a8f-8ee6-23ca3ed3e888

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named “2019 novel coronavirus (2019-nCoV)” by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

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<![CDATA[Management of immune checkpoint inhibitor‐related dermatologic adverse events]]> https://www.researchpad.co/article/N26668f4c-eafe-4806-8a07-e16582b39151

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. The unique spectrum of immune‐related adverse events (IrAEs) may occur during treatment. Dermatologic toxicities appear to be one of the most prevalent immunotherapy‐related adverse events. The most common symptoms are maculopapular rash and pruritus. Serious dermatologic toxicities including Stevens‐Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reactions with eosinophilia and systemic symptoms are rare. In this review, we summarize guidelines of management of immunotherapy‐related toxicities, case reports, and proposed treatment recommendation.

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<![CDATA[Clinical manifestation and management of immune checkpoint inhibitor‐associated cardiotoxicity]]> https://www.researchpad.co/article/Nc4d22949-882b-4ee2-a4c9-600852871056

Abstract

Immune checkpoint inhibitors (ICIs) targeting programmed death‐1 (PD‐1), its ligand (PD‐L1), and cytotoxic T‐lymphocyte‐associated antigen 4 (CTLA4) have revolutionized cancer treatment by recovering the attack of T lymphocytes on the malignant cells. They have improved clinical outcomes dramatically in multiple types of advanced‐stage malignancies. Even though the tolerance and safety profiles are generally good, it has been widely reported that ICIs can cause severe or fatal immune‐related adverse events (irAEs), since the activated T lymphocytes are not specific for tumor cells. Cardiac irAEs appear to occur less frequently than irAEs in other organ systems but are notorious for high mortality. Here, we aim to identify and characterize the ICI‐associated cardiotoxicity and summarize the optional diagnosis and treatment strategies.

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<![CDATA[Clinical diagnosis and treatment recommendations for immune checkpoint inhibitor‐related adverse reactions in the nervous system]]> https://www.researchpad.co/article/N1f357579-2a9d-4a01-9592-67cc71f0dcec

Immune checkpoint inhibitors (ICIs) can cause adverse reactions in the nervous system. The incidence rate is 0.1%–12% and 80% of nervous system adverse reactions occur within the first four months of application. ICIs can cause diseases of various parts of the nervous system including central nervous system diseases such as aseptic meningitis, meningeal encephalitis, necrotizing encephalitis, brainstem encephalitis, transverse myelitis, etc., and peripheral neuropathy such as cranial nerve peripheral neuropathy, multifocal nerve root neuropathy, Guillain‐Barré syndrome, spinal nerve root neuropathy, myasthenia gravis, myopathy, etc. For these complications of the nervous system, diagnosis could be difficult. Physicians require a specific collection of nervous system symptoms and signs, combined with supplementary examinations including imaging, cerebrospinal fluid cytology, EEG or electromyography in order to exclude infection or malignant tumor before reaching a final diagnosis. With regard to treatment, ICIs should be discontinued in severe cases, and large doses of glucocorticoid or gamma globulin administered, and supportive treatment may be necessary. If severe adverse reactions of the nervous system occur, the prognosis could be poor.

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<![CDATA[Nordic Guidelines for Germline Predisposition to Myeloid Neoplasms in Adults: Recommendations for Genetic Diagnosis, Clinical Management and Follow-up]]> https://www.researchpad.co/article/Nebd245db-0001-4e17-a19d-7dadc12666c6

Abstract

Myeloid neoplasms (MNs) with germline predisposition have recently been recognized as novel entities in the latest World Health Organization (WHO) classification for MNs. Individuals with MNs due to germline predisposition exhibit increased risk for the development of MNs, mainly acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Setting the diagnosis of MN with germline predisposition is of crucial clinical significance since it may tailor therapy, dictate the selection of donor for allogeneic hematopoietic stem cell transplantation (allo-HSCT), determine the conditioning regimen, enable relevant prophylactic measures and early intervention or contribute to avoid unnecessary or even harmful medication. Finally, it allows for genetic counseling and follow-up of at-risk family members. Identification of these patients in the clinical setting is challenging, as there is no consensus due to lack of evidence regarding the criteria defining the patients who should be tested for these conditions. In addition, even in cases with a strong suspicion of a MN with germline predisposition, no standard diagnostic algorithm is available. We present the first version of the Nordic recommendations for diagnostics, surveillance and management including considerations for allo-HSCT for patients and carriers of a germline mutation predisposing to the development of MNs.

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<![CDATA[Palliative care guidelines for the management of HIV-infected people in South Africa]]> https://www.researchpad.co/article/N7baaacdb-0e05-4560-a565-4d3cdb7c7d78 ]]>