Joint Guidelines Research Articles

Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO and OH (CCO) Joint Guideline Update Summary.

Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO and OH (CCO) Joint Guideline Update Summary.

Blood Pressure-Lowering Therapy.

Extensive evidence demonstrates that lowering blood pressure can substantially reduce the risk of atherosclerotic cardiovascular disease and death.In light of the latest 2018 European Society of Cardiology/European Society of Hypertension Joint Guidelines, we summarize the current recommendations about lifestyle intervention strategies, pharmacotherapy, and device-based treatments for the management of arterial hypertension. Special attention is given to direct effects exerted by some antihypertensive drugs targeting vascular wall cell components that are involved in the pathogenesis of atherosclerosis.

Interobserver variability in high-resolution CT of the lungs

PurposeTo quantify the interobserver variability among the most frequently encountered parenchymal patterns in High Resolution CT (HRCT) and to compare the interobserver variability in the application of the 2011 and 2018 usual interstitial pneumonia (UIP) criteria according to the joint guidelines from international thoracic and respiratory societies. Material and methodsTwo observers independently evaluated 126 HRCT, with examples of most common parenchymal patterns, and noted the presence of each pattern. The readers also noted whether the findings met the 2011 criteria for UIP. In a second reading, the same readers noted whether the HRCT met the UIP criteria according to the 2018 UIP update. ResultsThe kappa values for interobserver variability for the different patterns ranged from 0.28 (intralobular lines) to 0.85 (tree-in-bud nodules). The kappa value for UIP pattern was similar for 2011 and 2018 criteria, 0.58 and 0.69, respectively. Compared to the 2011 UIP criteria, there was no statistically significant difference in the number of HRCT classified as UIP using the 2018 criteria. ConclusionsThere is a substantial variation in interobserver agreement between the different parenchymal patterns, which suggests that some patterns a more easily identified than others. There is also a considerable reader variation in the assessment of UIP applying the 2011 UIP criteria as well as applying the 2018 UIP update.

Is there a role for specialized geriatric centers in treating geriatric cancer patients?

As the population with colorectal cancer ages, the tailored approach required to manage older patients becomes all the more important for all providers and institutions treating colorectal cancer to adopt and improve the outcomes and well-being of this important and increasingly prevalent population. Joint guidelines from the American College of Surgeons and American Geriatric Association should be followed. Older cancer patients undergoing colorectal cancer surgery should be referred to centers with expertise in minimally invasive surgery. Likewise, older rectal cancer patients should be referred to centers with expertise in treating rectal cancer.

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Multiresistant Fusarium Pathogens on Plants and Humans: Solutions in (from) the Antifungal Pipeline?

The fungal genus Fusarium contains numerous plant pathogens causing considerable economic losses. In addition, Fusarium species are emerging as opportunistic human pathogens causing both superficial and systemic infections. Appropriate treatment of Fusarium infections in a clinical setting of neutropenia is currently not available. ESCMID and ECMM joint guidelines, following the majority of published studies, suggest early therapy with amphotericin B and voriconazole, in conjunction with surgical debridement and reversal of immunosuppression. In this review, we elaborate on the trans-kingdom pathogenicity of Fusarium. Intrinsic resistance to several antifungal drugs and the evolution of antifungal resistance over the years are highlighted. Recent studies present novel compounds that are effective against some pathogenic fungi including Fusarium. We discuss the robust and dynamic antifungal pipeline, including results from clinical trials as well as preclinical data that might appear beneficial for patients with invasive fusariosis.

PROCESS MODEL OF IMPLEMENTATION OF GOOD PHARMACY PRACTICE IN THE ACTIVITY OF PHARMACIES OF UKRAINE

Taking into account the recommendations of the FIP/WHO joint guidelines for GPP pharmacy practice: standards for quality of pharmacy services, the global experience of the pharmacy and legal regulation of pharmaceutical activities in Ukraine we offered the Guidance of Good Pharmacy Practice (GPP), which focused on content, functional and role-based approach to the development of national pharmacy practice standards, by the terms of cooperation of public professional, scientific and educational organizations. We consider the national standard of GPP as an interconnected groups of tasks aimed at ensuring the performance of individual roles and functions of pharmacy specialists. The proposed project structure of the national standard of GPP complies with the generally accepted normative document construction, requirements for stage properties (standard name, subject of regulation, date of adoption) and structure (introductory part, sections, annexes). The Guidance of GPP also establishes the procedure for development of standard operating procedure (SOP) for effective use in practice with the peculiarities of each pharmacy. As follows, based on the materials, the process model of GPP implementation in pharmacies of Ukraine was proposed and the expediency of developing its components, namely the Guidance of GPP, national standards of GPP and SOPs was provided.

Melanoma Nodal Management in Ontario the Year after the 2012 American Society of Clinical Oncology and Society of Surgical Oncology Guideline

In 2012 in the United States, the American Society of Clinical Oncology and the Society of Surgical Oncology (asco/sso) published a joint guideline about indications for sentinel lymph node biopsy (slnb) in cutaneous melanoma. The guideline supported completion lymph node dissection (clnd) for all patients with positive sentinel nodes. We examined the rates and predictors of slnb and clnd for melanoma patients in Ontario (population 13.6 million) after publication of that guideline. We used the Ontario Cancer Registry to identify patients diagnosed with cutaneous melanoma in 2013. Patient records were linked to prospectively maintained health administrative databases to obtain details for each patient, including surgical procedures. Of the 3298 patients with melanoma identified in Ontario in 2013, 1973 (59.8%) could be analyzed. Most of that group (n = 1227, 62.2%) underwent local excision alone; 746 (37.8%) had a slnb. The slnb was performed in 13.9%, 67.8%, 62.6%, and 47.2% of patients with T1, T2, T3, and T4 primary melanomas respectively. In multivariate analysis, receipt of slnb was positively associated with younger age (<80 years), higher T stage, and a non-head-and-neck primary. Of the patients who had a slnb, 136 (18.2%) were found to be node-positive. A clnd was performed in 82 of those patients (60.3%). In Ontario, only two thirds of patients with intermediate-thickness melanomas (T2, T3) underwent slnb as recommended by the asco/sso guideline. Use of slnb was less frequent for patients with a head-and-neck primary and higher for younger patients (<80 years). The rate of clnd after a positive slnb was also low relative to the guideline recommendation.

Summary of Guidelines for Preventing Occupational Exposure in Cancer Chemotherapy Drugs version 2019

Abstract In 2015, “JSCN/JSMO/JASPO Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs” was published. This guideline was made to inform all employees at medical institutions in Japan of lowering risk of occupational exposure of cancer chemotherapy drugs. Thereafter, these societies attempted to inform each members and publics of the current risk and its management of occupational exposure of cancer chemotherapy drugs. In addition, Industrial Safety and Health Act was amended in 2016. By this law, employers are obligated to identify harmfulness of any hazardous chemicals, and to estimate and lower their potent risk to health of employees. All institutions currently have to appropriately manage and control chemotherapeutic drugs. Furthermore, in 2016, USP General Chapter Hazardous Drugs- Handling in Healthcare Settings was announced in United States. This law will be enforced in December 2019, to put all employers and employees under an obligation to manage and lower risk of hazardous drugs including chemotherapeutic drugs. New cancer drugs including molecularly targeted drugs are keeping increasing, and new clinical questions are raising. Under such circumstances, “Guidelines for Preventing Occupational Exposure in Cancer Chemotherapy Drugs version 2019” was published in February 2019. We will summarize and introduce the content of new guidelines, mainly focusing on updated points.

Local surgical treatment of cutaneous squamous cell carcinoma: deficits and controversies in the literature.

The prognostic impact of primary excision in the treatment of cutaneous squamous cell carcinoma depends on certain tumor characteristics (risk factors), the surgical approach chosen and the subsequent histological examination. For the development of the AWMF (Association of Scientific Medical Societies in Germany) guidelines for squamous cell carcinoma, the most conclusive guidelines available were evaluated using the DELBI tool (German Instrument for the Methodological Appraisal of Guidelines). These were the Scottish and Canadian guidelines as well as the joint guidelines published by EDF, EADO and EORTC. The primary literature on the aforementioned topics that was used for these guidelines included 49 studies and 9 reviews. None of the studies had a prospective, randomized design; 19 studies contained prospective data; 30 studies provided retrospective data. Overall, the results were heterogeneous. Not only were there discrepancies in terms of the validity of the various risk factors for locoregional disease progression - such as dedifferentiation, desmoplasia and perineural invasion - but also with respect to tumor thickness and surgical consequences. Differences were also found regarding the histological processing method used. In general, there are two such methods: conventional histology (bread loaf technique) and complete histological assessment of excision margins. The latter was found to be associated both with low recurrence rates and low metastatic rates, possibly due to the fact that patients treated with the latter method had lower-risk tumors. Publications on bread loaf histology lacked precise information as to how the tissue was actually processed. Likewise, there was a lack of usable data in terms of the surgical margins used in the primary excision. Conclusion: The current literature is inconsistent and insufficient with regard to the various prognostic factors and the surgical approach to cutaneous squamous cell carcinoma.

Conservative versus operative treatment in supratentorial intracerebral hemorrhage - A survey among neurosurgeons and neurologists in Germany

ObjectivesDecision making for surgical therapy in patients with intracerebral hemorrhage is still controversial among neurologists and neurosurgeons. Whereas neurologists may favor conservative treatments, surgeons may opt for operations. This might lead to different therapy decisions. Patients and methodsBetween 2017 and 2018, we conducted a survey among the neurological and neurosurgical societies in Germany. An online questionnaire consisting of 10 fictive patients with spontaneous supratentorial intracerebral hemorrhage (including CT scans and brief case descriptions) was administered to the members of the societies. The participants were asked to decide whether conservative or surgical treatment would be preferred. Furthermore, the results from the neurosurgeons were compared to the results of our previous surveys in 1999 and 2009. ResultsA total of 157 answers were collected (response rate of 16.2%). Nineteen had to be excluded, leaving 138 for analysis (84 neurosurgeons and 54 neurologists). There were no significant differences in therapy decisions between neurologists and neurosurgeons in all ten cases. Comparing the answers from neurosurgeons with our previous results, there were no significant differences between the results from 1999, 2009 and 2017. ConclusionsAgainst common prejudices, the process of decision making for or against surgery in patients with spontaneous intracerebral hemorrhage is comparable among conservative physicians (neurologists) and neurosurgeons in Germany. This might be the result of joint efforts in spontaneous intracerebral hemorrhage (ICH) therapy, such as joint guidelines or a society of neurointensive care medicine.

A survey of the management of 16–18-year-olds presenting with diabetic ketoacidosis in the UK: a need for standardisation

Background: The standard of care of 16–18-year-olds presenting with diabetic ketoacidosis (DKA) is uncertain. It is unknown who looks after them or what guidelines are used to manage their DKA.Methods: We carried out a survey using a standardised questionnaire sent to diabetes and emergency care teams across the UK using mailing lists from the Association of British Clinical Diabetologists, The Diabetes Specialist Nurse Group (UK) and the British Society of Paediatric Endocrinology and Diabetes.Results: There was a relatively poor response rate; only 32 completed questionnaires were received between May and November 2018. The data suggest that the care was highly variable across the UK. There were no consistencies on how ‘16–18 years old’ was defined; who looked after them either during the acute phase once they had been triaged through the emergency department or during the later stages of their admission; or what guideline was used to treat their DKA. Several other aspects of care were also varied.Conclusions: The care of 16–18-year-olds presenting with DKA needs to be standardised across the UK. Furthermore, because a large number are looked after by adult non- specialist general medical teams, there is a clear need to ensure a consistent straightforward joint guideline that can be readily applied in all acute clinical settings regardless of whether care takes place in a paediatric or an adult clinical setting.

Melanoma nodal management in Ontario following ASCO/SSO guidelines.

e21054 Background:Methods:Results: Conclusions:The American Society of Clinical Oncology and Society of Surgical Oncology (ASCO/SSO) published a joint guideline in 2012 regarding indications for sentinel lymph node biopsy (SLNB) in cutaneous melanoma. The guideline supported completion lymph node dissection (CLND) for all patients with a positive SLNB. We examined the rates and predictors of SLNB and CLND for melanoma patients in Ontario (population 13.6 million) following guideline publication. Methods: We used the Ontario Cancer Registry (OCR) to identify cutaneous melanoma patients diagnosed in 2013. Patient records were linked to prospectively maintained health administrative databases to obtain details for each patient including surgical procedures. Results: We identified 3298 melanoma patients from Ontario in 2013 of which 1,973 (59.8%) could be analyzed. The majority, 1,227 (62.2%) had a local excision alone, while 746 (37.8%) had a SLNB. SLNB was performed on T1, T2, T3 and T4 primary melanomas in 13.9%, 67.8%, 62.6% and 47.2% of cases respectively. Receipt of a SLNB was positively associated with a younger age (&lt; 80), higher T stage, and non-head and neck primary in multivariate analysis. Of the patients who received a SLNB 136 (18.2%) were found to be node positive. A CLND was performed in 82 (60.3%) of these patients. Conclusions: In Ontario only two-thirds of intermediate thickness melanomas (T2, T3) received a SLNB as recommended by the ASCO/SSO guidelines. Utilization was lower for head and neck patients and higher for younger (&lt; 80 years) patients. Use of CLND for positive SLNB was also low relative to the guidelines.

Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines.

Severe Traumatic Brain Injury in Infants, Children, and Adolescents in 2019: Some Overdue Progress, Many Remaining Questions, and Exciting Ongoing Work in the Field of Traumatic Brain Injury ResearchIn this Supplement to Pediatric Critical Care Medicine, we are pleased to present the Third Edition o

Telemedicine and out-of-office blood pressure monitoring: up-to-date view of ESC/ESH

The 2018 Joint Guidelines of the European Society of Cardiology and the European Society of Hypertension Specialists present a successful attempt to revise the approach to one of the most prevalent health problems worldwide. For more than two years, a Task Force of experts from the two Societies have assessed and have investigated the most recent scientific advances in the field of hypertension (HTN) in order to provide doctors with the adequate diagnostic tools, evaluation of cardiovascular risk and the optimal drug treatment. Undoubtedly, among a number of crucial changes of target blood pressure (BP) range along with the new sections dedicated to HTN in different circumstances, one can notice equally valuable, albeit subtle remarks about out-of-office BP and closely related telehealth. Extensive use of ambulatory and self-BP monitoring forced to match it to office BP. Booming information and communication technologies applied successfully in various therapeutic areas and have taken place in the Guidelines. From now digital health becomes a piece of the follow-up and adherence control. This brief report highlights the current position of European experts on telemedicine and outpatient methods of monitoring blood pressure.

Joint Guideline of the OEGGG, AGO, AGK and ÖGZ on the Diagnosis and Treatment of Cervical Intraepithelial Neoplasia and Appropriate Procedures When Cytological Specimens Are Unsatisfactory.

Purpose On January 1st, 2018, the ÖGZ (Austrian Society of Cytology) revised its cytological nomenclature to make it more similar to the 2015 Bethesda system. Following these changes, the Austrian Society of Gynecology and Obstetrics felt it necessary to revise the approach currently used in Austria to diagnose and treat CIN and to review the procedures to be followed when the quality of cytological specimens is unsatisfactory. It was not possible to adopt the German S3 guideline “Prevention of Cervical Cancer” in its entirety, because the Munich III gynecological cytology nomenclature used in Germany is not used in Austria. This made it necessary to compile a separate scientific opinion for Austria. Methodology The OEGGG worked together with the ÖGZ (Austrian Society for Cytology), AGO Austria (Austrian Working Group for Gynecological Oncology), the AGK (Colposcopy Working Group), and physicians representing gynecologists in private practice. The different scientific associations nominated representatives, who attended the various meetings. After an in-depth analysis of the recent literature, three meetings and numerous votes by telephone, we were able to achieve a consensus about the contents of this guideline. Recommendations The guideline provides recommendations for the diagnosis and treatment of CIN which take account of the gynecological cytology nomenclature used in Austria.

Agreement Among Tools That Predict Perioperative Cardiovascular Risk

In 2014, the American College of Cardiology and the American Heart Association issued a joint guideline on perioperative cardiovascular evaluation for

IPF diagnosis: flexibility is a virtue

In 2011, the joint guidelines 1 Raghu G Collard HR Egan JJ et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011; 183: 788-824 Crossref PubMed Scopus (5323) Google Scholar of the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Thoracic Association of Latin America provided the first truly international evidence-based statement on the diagnosis of idiopathic pulmonary fibrosis (IPF). Although this statement undoubtedly underpinned international collaboration in science and interventional trials, the rigour of the 2011 diagnostic criteria effectively disenfranchised a large subgroup of patients with IPF, in whom a surgical lung biopsy (SLB) could not be done and no definite diagnosis could be made. The concept of probable IPF was not explored in the 2011 guidelines, and the document was misinterpreted by some as proscribing IPF-specific therapies unless formal diagnostic guideline criteria were met. CorrectionsWells A U. IPF: flexibility is a virtue. Lancet Respir Med 2018; published online Sept 14. http://dx.doi.org/10.1016/S2213-2600(18)30374-6—In this Comment, the title should be “IPF diagnosis: flexibility is a virtue”. This correction has been made to the online version as of Sept 26, 2018, and the printed version is correct. Full-Text PDF

Redefinición de hipertensión arterial y consideraciones en la gestación y en la preeclampsia. Introducción al simposio

En noviembre de 2017 apareció la Guía conjunta de diversas sociedades de los EE. UU., lideradas por el Colegio Americano de Cardiología y la Asociación Americana de Hipertensión, para la Prevención, Detección, Evaluación y Manejo de la Hipertensión Arterial en Adultos. La Guía determinaba nuevas categorías de presión arterial (PA) en los adultos: Normal &lt; 120/&lt; 80 mmHg, Presión arterial elevada 120-129/&lt; 80 mmHg, Hipertensión estadio 1: 130-139/80-89 mmHg, e Hipertensión estadio 2: &gt; 140/&gt; 90 mmHg. Interesados en conocer la opinión de expertos en la materia solicitamos manuscritos sobre su parecer de las repercusiones que pudieran tener la disminución de los valores de PA en la población general de adultos y en las mujeres gestantes y en aquellas con preeclampsia.

Comments on the new groin hernia guidelines: What has changed? What has remained unanswered?

Guidelines are meant to evaluate the options available in the current circumstances and suggest the proper solutions for particular problems. The duty of a guideline is to present a basis for decision-making. Surgical options for the treatment of groin hernias are numerous. Recently, a joint guideline called "International Guidelines for Groin Hernia Management" was developed by five continental hernia societies, the International Endo hernia Society, and the European Association for Endoscopic Surgery. This article aimed to review the methodology, statements, and recommendations of the new guidelines and emphasized the importance of the tailored surgery for groin hernias. Spreading the guidelines may provide surgeons with an up-to-date knowledge and be useful for better outcomes in groin hernia surgery.