Lack Of Consistent Guidelines Research Articles

Chinese expert consensus on evaluation and treatment of advanced non-small cell lung cancer with negative driver genes after first-line immunotherapy resistance (2024 edition)

Immunotherapy has become the standard first-line treatment for advanced non-small cell lung cancer (NSCLC) with negative driver genes, which has significantly improved the prognosis of patients. However, there is still a lack of consistent guidelines or consensus on evaluation and treatment regimens after first-line immunotherapy resistance. The Committee of Non-Small Cell Lung Cancer of Chinese Society of Clinical Oncology organized multidisciplinary experts from medical oncology, respiratory medicine, thoracic surgery, radiotherapy, and imaging to conduct an in-depth discussion on the definition and classification of primary resistance and secondary resistance, evaluation criteria of immunotherapy, subsequent treatment strategies of oligo-progression or extensive progression after first-line immunotherapy, re-challenges of immunotherapy and clinical research of new drugs in advanced NSCLC patients with negative driver genes according to the existing evidence. After the consensus meeting, an expert consensus on evaluation and treatment strategy of advanced NSCLC with negative driver genes after first-line immunotherapy resistance was formed, aiming to provide standardized guidance for clinical practice of Chinese clinicians.

Axillary staging in micro invasive breast cancer. Is it needed?

Background: Micro-invasive ductal carcinoma (DCISM) is defined as DCIS with a focus of invasive carcinoma ≤ 1 mm, surgical staging of axilla in MIBC has always been debatable and there is lack of consistent guidelines. The aim of this review was to find evidence if axillary staging of the axilla in MIBC is needed?

Gaps in moderate plaque psoriasis management: A survey of Saudi dermatologists.

Background:There are many barriers that usually lead to under-treatment of moderate psoriasis patients, with subsequent unsatisfactory results and clinical outcomes.Objective:Given this lack of consistent guidelines on treating moderate plaque psoriasis patients, the aim of the current study is to define how Saudi dermatologists define and treat such cases in the real-world clinical setting.Methods:We conducted an online cross-sectional survey from May 2020 to October 2020, involving all eligible dermatologists working at different academic, governmental, and private sectors in Saudi Arabia.Results:Finally, a total of 260 dermatologists were included in the final analysis; out of them, 140 (53.8%) were males and 120 (46.2%) were females. Regarding the tools used by participating dermatologists for diagnosis of moderate psoriasis, most of the participants (86.5%) used Body Surface Area (BSA), 7.3% used Physician Global Assessment (PGA), and 6.2% used Dermatology Life Quality Index (DLQI). Cutoff scores for defining moderate psoriasis varied widely among surveyed dermatologists. The surveyed dermatologists reported that 46% of their patients with moderate plaque psoriasis were receiving biologics as their primary therapy, while 24.1% were receiving prescription topical treatment, 20.3% were receiving an oral systemic therapy, 4.9% were using over-the-counter topical treatment, and 4.7% were receiving phototherapy.Conclusion:There is a pervasive lack of consensus regarding the definition of moderate psoriasis, with reported wide ranges among the commonly used severity tools in psoriasis patients.

Recommendations and Outcomes for the Introduction of Complementary Foods for Children With Down Syndrome

Abstract Date Presented 04/13/21 The purpose is to begin to address the lack of consistent guidelines for when, and how, families should begin to introduce complementary foods for children with Down syndrome (DS). Semistructured interviews with 22 parents and 8 primary care providers were conducted and analyzed. Results indicated that no formal guidelines exist for this realm, and yet 17 of 22 children have experienced some level of feeding difficulty. Guidelines for feeding progression for this population are needed to improve feeding outcomes. Primary Author and Speaker: Erin Cochran Additional Authors and Speakers: Winifred Dunn

Indonesian antenatal nutrition education: A qualitative study of healthcare professional views.

Background:Early lifestyle intervention, including antenatal nutrition education, is required to reduce the triple burden of malnutrition. Understanding healthcare professionals’ views and experiences is essential for improving future nutrition education programmes for Indonesian pregnant women. This study aimed to investigate the views of Indonesian antenatal healthcare professionals regarding nutrition education for pregnant women and the improvements required to provide more effective antenatal nutrition education.Methods:A descriptive qualitative study involved semi-structured interviews was conducted with 24 healthcare professionals, including nutritionists (n = 10), midwives (n = 9) and obstetricians (n = 5) in Malang, Indonesia, between December 2018 and January 2019. Data were analysed using thematic analysis.Results:The study identified four main themes. First, healthcare professionals were aware of the importance of providing antenatal nutrition education, which included supporting its targeted delivery. Second, there were differing views on who should provide nutrition education. Most midwives and obstetricians viewed nutritionists as the prime nutrition education provider. Nutritionists were confident in their capability to provide nutrition education. However, some nutritionists reported that only a few women visited primary health centres and received nutrition counselling via this pathway. Third, healthcare professionals revealed some barriers in providing education for women. These barriers included a limited number of nutritionists, lack of consistent guidelines, lack of healthcare professionals’ nutrition knowledge and lack of time during antenatal care services. Fourth, participants expressed the need to strengthen some system elements, including reinforcing collaboration, developing guidelines, and enhancing capacity building to improve future antenatal nutrition education.Conclusions:Healthcare professionals play a central role in the provision of antenatal nutrition education. This study highlighted the importance of educational models that incorporate various antenatal nutrition education delivery strategies. These methods include maximizing referral systems and optimizing education through multiple delivery methods, from digital modes to traditional face-to-face nutrition education in pregnancy classes and community-based health services.

The Rise of Smart Courts in China

Information and communication technology has increasingly played an important role in judicial activities. In recent years, digitalization of courts has been explored actively in theory and practice in China. Generally, digitalization of courts refers to that litigation activities like case-filing, court trial, execution, service and preservation can be carried out online to a certain degree, with the help of modern technology like big data, cloud computing, artificial intelligence and high-tech equipment. Digitalization of courts is considered to help to improve judicial efficiency, contribute to judicial disclosures, provide convenience for people and to establish judicial big data. However, lack of consistent guidelines might undermine the application of digital means in the judiciary. The purpose of this paper is to investigate the progress made so far with regard to digitalization of courts in China, and to analyze the opportunities and challenges during the digitalized process of Chinese courts.

A Study Regarding the Recommendations and Outcomes for the Introduction of Complementary Foods for Children With Down Syndrome

Abstract Date Presented 03/26/20 The purpose is to begin to address the lack of consistent guidelines for when and how families should begin to introduce complementary foods for children with Down syndrome. Semistructured interviews with 22 parents and 8 primary-care physicians were conducted and analyzed. Results indicated no formal guidelines exist for this realm, and yet, 17 of 22 children with Down syndrome have experienced some level of feeding difficulty. Guidelines for feeding progression for this population are needed to improve feeding outcomes. Primary Author and Speaker: Erin Cochran Additional Authors and Speakers: Katherine Breithaupt Contributing Authors: Lauren Williams, Tess Sorensen

The Concept of City Carbon Maps: A Case Study of Melbourne, Australia

SummaryCities are thought to be associated with most of humanity's consumption of natural resources and impacts on the environment. Cities not only constitute major centers of economic activity, knowledge, innovation, and governance—they are also said to be linked to approximately 70% to 80% of global carbon dioxide emissions. This makes cities primary agents of change in a resource‐ and carbon‐constraint world. In order to set meaningful targets, design successful policies, and implement effective mitigation strategies, it is important that greenhouse gas (GHG) emissions accounting for cities is accurate, comparable, comprehensive, and complete. Despite recent developments in the standardization of city GHG accounting, there is still a lack of consistent guidelines regarding out‐of‐boundary emissions, thus hampering efforts to identify mitigation priorities and responsibilities. We introduce a new conceptual framework—based on environmental input‐output analysis—that allows for a consistent and complete reconciliation of direct and indirect GHG emissions from a city. The “city carbon map” shows local, regional, national, and global origins and destinations of flows of embodied emissions. We test the carbon map concept by applying it to the greater metropolitan area of Melbourne, Australia. We discuss the results and limitations of the approach in the light of possible mitigation strategies and policies by different urban stakeholders.

Clinical approach to the treatment of painful diabetic neuropathy

Painful neuropathy is a common and often progressive complication of diabetes. Patients frequently report symptoms of tingling, burning, lancinating pain, hyperesthesia and allodynia. The natural history of the disease may vary from intermittent mild symptoms to severe chronic daily pain; the latter is often associated with diminished quality of life. There are a variety of pharmaceutical agents from different medicinal categories available for the symptomatic treatment of painful diabetic neuropathy, however selecting an agent is often challenging given the breadth of choices and lack of consistent guidelines. As a result, many patients remain untreated or undertreated.This article presents a practical clinical approach to the treatment of pain in diabetic neuropathy. Recommendations for first, second and third line medications are based on specific evidence for the treatment of painful diabetic neuropathy as well as safety, tolerability, drug interactions and cost. Additional topics of discussion include breakthrough pain, opioid use and topical therapies. This review does not comprehensively discuss all possible treatments for painful neuropathy, but provides a systematic approach designed to guide clinicians in tailoring therapies to the individual patient.

Communicating About Alcohol Consumption to Nonharmful Drinkers with Hepatitis C: Patient and Provider Perspectives

Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C(HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not bea problem in the absence of their HCV diagnosis. This study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear. We conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (N=50) and healthcare providers (N=14) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program. We found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients.Patient respondents who reported hearing “stop completely”were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in“medical language” than were GI providers. To make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV.

Management of laryngopharyngeal reflux with proton pump inhibitors

There is a lack of consistent guidelines and consensus for the diagnosis of laryngopharyngeal reflux (LPR). A therapeutic trial with a proton pump inhibitor (PPI) has been suggested to identify patients with LPR. This review focuses on the current difficulties in diagnosing the disease and examines the evidence for the effectiveness of PPI therapy in suspected reflux-related laryngeal symptoms. Additionally, mode of action, safety, and tolerability of PPIs are described. A total of 7 placebo-controlled trials were identified and included in the review. All studies evaluated the effect of a PPI on symptoms and objective laryngoscopic findings in suspected LPR. Data from these trials show that PPI therapy is no more effective than placebo in producing symptom relief in patients suspected of LPR. Symptoms, laryngoscopic findings, or abnormal findings on pH monitoring will not predict response to PPI therapy. High placebo response levels suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Further studies are needed to characterize subgroups of patients with reflux-associated laryngeal symptoms that might benefit from treatment with PPI. Future studies should use validated patient reported outcome measures with endpoints that represent a predefined clinically meaningful change in symptom scores.

Communicating about Alcohol Consumption to Nonharmful Drinkers with Hepatitis C: Patient and Provider Perspectives

Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C (HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not be a problem in the absence of their HCV diagnosis. This study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear. We conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (N = 50) and healthcare providers (N = 14) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program. We found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients. Patient respondents who reported hearing "stop completely" were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in "medical language" than were GI providers. To make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV.

The physician and the disclosure of a handicap in a neonate: A review of the literature

After describing the different ways in which the disclosure of a handicap affects the parents, the child, and the physician, the author summarizes, what is now known about the experiences and wishes of the parents. He then extensively describes and analyses diagnostic interview situations and the problems facing the physician. The latter are analyzed in terms of three aspects. The first is medical, and shows that as the diagnostic, etiological, and especially prognostic uncertainties increase, due to a lack of scientific guidelines, the interview becomes all the more difficult to prepare, in terms of both form and content. The second, which is more individual, has to do with the moment the informing physician confronts the family, and shows that here too there is a lack of consistent guidelines. Emotions have to be brought under control, and physicians must not react as if they were the parents. The third concerns the child, and shows the danger of it disappearing beneath the adults' difficulties and its own handicap. The author points out that the major element is still the child and its reality, and he concludes with a description of three ways of overcoming the obstacles of disclosure: (i) using a multidisciplinary approach, (ii) giving information in repeated sessions, and liii), making the initial interview the starting point for parental guidance.