Dialysis disequilibrium syndrome (DDS) in pediatric patients on dialysis: systematic review and clinical practice recommendations

PURPOSE To develop a clinical practice guideline for systemic antifungal prophylaxis in pediatric patients with cancer and hematopoietic stem-cell transplantation (HSCT) recipients. METHODS Recommendations were developed by an international multidisciplinary panel that included a patient advocate. We conducted a systematic review of systemic antifungal prophylaxis in children and adults with cancer and HSCT recipients. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to make strong or weak recommendations and to classify level of evidence as high, moderate, low, or very low. The panel considered directness of the data to pediatric patients. RESULTS There were 68 randomized trials included in the systematic review, of which 6 (9%) were conducted in a solely pediatric population. Strong recommendations were made to administer systemic antifungal prophylaxis to children and adolescents receiving treatment of acute myeloid leukemia, to those undergoing allogeneic HSCT pre-engraftment, and to those receiving systemic immunosuppression for graft-versus-host disease treatment. A strong recommendation was made to administer a mold-active agent with an echinocandin or a mold-active azole when systemic antifungal prophylaxis is warranted. For children younger than 13 years of age, an echinocandin, voriconazole, or itraconazole is suggested. Posaconazole may also be used in those age 13 years or older. A strong recommendation against routine administration of amphotericin as systemic antifungal prophylaxis was made. CONCLUSION We developed a clinical practice guideline for systemic antifungal prophylaxis administration in pediatric patients with cancer and HSCT recipients. Implementation and assessment of guideline-concordant rates and impacts are important future steps.

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Return to Golfing Activity After Joint Arthroplasty

The American Journal of Sports Medicine ◽

10.1177/0363546516641917 ◽

2016 ◽

Vol 45 (1) ◽

pp. 243-249 ◽

Cited By ~ 13

Author(s):

Dean N. Papaliodis ◽

Christos D. Photopoulos ◽

Nima Mehran ◽

Michael B. Banffy ◽

James E. Tibone

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Total Joint Arthroplasty ◽

Shoulder Arthroplasty ◽

Return To Sport ◽

Joint Arthroplasty ◽

Review Of The Literature ◽

Shoulder Replacement ◽

Web Based ◽

Practice Recommendations

Background: Many patients who are considering total joint arthroplasty, including hip, knee, and shoulder replacement, are concerned with their likelihood of returning to golf postoperatively as well as the effect that surgery will have on their game. Purpose: To review the existing literature on patients who have undergone major joint arthroplasty (hip, knee, and shoulder), to examine the effects of surgery on performance in golf, and to provide surgeon recommendations as related to participation in golf after surgery. A brief review of the history and biomechanics of the golf swing is also provided. Study Design: Systematic review. Methods: We performed a systematic review of the literature in the online Medline database, evaluating articles that contained the terms “golf” and “arthroplasty.” Additionally, a web-based search evaluating clinical practice recommendations after joint arthroplasty was performed. The research was reviewed, and objective and anecdotal guidelines were formulated. Results: Total joint arthroplasty provided an improvement in pain during golfing activity, and most patients were able to return to sport with variable improvements in sport-specific outcomes. Conclusion: In counseling patients regarding the return to golf after joint arthroplasty, it is our opinion, on the basis of our experience and those reported from others in the literature, that golfers undergoing total hip, knee, and shoulder arthroplasty can safely return to sport.

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