scholarly journals Anovulación y amenorrea secundaria: enfoque fácil y práctico

Revista Med ◽  
2021 ◽  
Vol 28 (2) ◽  
pp. 85-102
Author(s):  
Luis Ernesto Pérez Agudelo
Keyword(s):  
Clinical Guidelines ◽  
Cochrane Library

La anovulación ocurre en el 30 % de la infertilidad y la amenorrea secundaria en el 4 % de mujeres en edad reproductiva. Ambas alteraciones se pueden tornar crónicas conllevando riesgos de hiperestrogenismo e hipoestrogenismo crónicos. Tanto la anovulación como la amenorrea secundaria tienen las mismas causas endocrinas, excepto que la amenorrea tiene una adicional de causa uterina. No obstante existen muchas clasificaciones etiológicas, unas combinan la amenorrea secundaria con la primaria, otras se enfocan más a la anovulación y algunas agrupan las etiologías en compartimentos, sin lograr hacerlo en forma integral. El objetivo es revisar las clasificaciones etiológicas de anovulación y amenorrea secundaria, junto con la actualización de cada una de esas causas, a fin de seleccionar la clasificación que las agrupe integralmente para enfocar el manejo en forma fácil y práctica. Para ello, se revisó la literatura médica reciente en libros de texto, PubMed, Ovid, Clinical guidelines y Cochrane library, con palabras claves. Se concluye que la clasificación etiológica integral en cinco compartimentos es una guía fácil de seguir, para lograr el diagnóstico de cada una de esas causas, actualmente, cuando existen medicamentos y procedimientos quirúrgicos seguros para manejarlas como anovulación o como amenorrea secundaria.

scholarly journals Optimization of antenatal monitoring approaches of women with chronic inflammatory bowel diseases

2021 ◽  
pp. 84-92
Author(s):  
O.V. Bulavenko Bulavenko ◽  
D.G. Konkov ◽  
N.V. Kuzminova ◽  
T.V. Lobastova ◽  
I.V. Oleksienko
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Inflammatory Bowel Diseases ◽  
Clinical Guidelines ◽  
Cochrane Library ◽  
Chronic Inflammatory Bowel Diseases ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Chronic Inflammatory Bowel

Chronic inflammatory bowel diseases (CIBD) affect patients at their peak of reproductive age. Clinical presentation of CIBD in pregnancy is associated with an increased risk of adverse effects in mother and fetus, including prematurity, low birth weight, increased indications for caesarean section. Thus optimizing of the CIBD diagnosis and treatment before and during pregnancy is essential to improve maternal and fetal outcomes.Research aim: to analyze the effectiveness of the CIBD clinical management at the stage of preconception and during pregnancy.Materials and methods. It was searched the Cochrane Library, WHO platform, clinical guidelines, and research reference database Medline. All potential studies have evaluated the clinical practice guidelines in women with CIBD for conception, pregnancy and breastfeeding. Recommendations related to the necessary laboratory and instrumental examination methods, therapeutic strategy, the safety of drugs for mother and fetus, the features of multidisciplinary antenatal observation, the timing and method of delivery of pregnant women with CIBD. Results. Treatment in the planning phase and pregnancy should be multidisciplinary, involving a gastroenterologist, obstetrician-gynecologist, primary care physician, pediatrician and a colorectal surgeon if necessary, as well as stakeholders from the association of patients with CIBD. Communication between these professionals is critical to avoid ambivalent or even conflicting counseling, which is an additional source of anxiety for patients, and also potentially dangerous for suboptimal prevention of clinical CIBD manifestation. Obtained results of the analysis will prevent laboratory and therapeutic polypharmacy and significantly improve the pregnancy outcome.Conclusions. Most women with CIBD had a physiological pregnancy and healthy children. However, some studies have linked CIBD to an increased risk of preterm birth and low birth weight infants. The development of national clinical guidelines will optimize and improve the quality of perinatal care to women with CIBD in the Ukraine, and will lead to a decrease in obstetric, fetal and neonatal complications.

scholarly journals Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987385 ◽  
Author(s):  
Yujie Song ◽  
Hongyun Li ◽  
Chao Sun ◽  
Jian Zhang ◽  
Jianchao Gui ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Clinical Guidelines ◽  
Ankle Instability ◽  
Surgical Techniques ◽  
Cochrane Library ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Rehabilitation Strategies

Background: The surgical management of chronic lateral ankle instability (CLAI) has evolved since the 1930s, but for the past 50 years, the modified Broström technique of ligament repair has been the gold standard. However, with the development of arthroscopic techniques, significant variation remains regarding when and how CLAI is treated operatively, which graft is the optimal choice, and which other controversial factors should be considered. Purpose: To develop clinical guidelines on the surgical treatment of CLAI and provide standardized guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for patients with CLAI. Study Design: A consensus statement of the Chinese Society of Sports Medicine. Methods: A total of 14 physicians were queried for their input on guidelines for the surgical management of CLAI. After 9 clinical topics were proposed, a comprehensive systematic search of the literature published since 1980 was performed for each topic through use of China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, EMBASE, and the Cochrane Library. The recommendations and statements were drafted, discussed, and finalized by all authors. The recommendations were graded as grade 1 (strong) or 2 (weak) based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Based on the input from 28 external specialists independent from the authors, the clinical guidelines were modified and finalized. Results: A total of 9 topics were covered with regard to the following clinical areas: surgical indications, surgical techniques, whether to address intra-articular lesions, rehabilitation strategies, and assessments. Among the 9 topics, 6 recommendations were rated as strong and 3 recommendations were rated as weak. Each topic included a statement about how the recommendation was graded. Conclusion: This guideline provides recommendations for the surgical management of CLAI based on the evidence. We believe that this guideline will provide a useful tool for physicians in the decision-making process for the surgical treatment of patients with CLAI.

scholarly journals How well do international clinical guidelines on mental health and substance misuse address their coexistence? a systematic review of scope, quality and inclusivity

2021 ◽  
Author(s):  
Ray Alsuhaibani ◽  
Douglas Cary Smith ◽  
Richard Lowrie ◽  
Sumayah Aljhani ◽  
Vibhu Paudyal
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Clinical Guidelines ◽  
Substance Misuse ◽  
Data Extraction ◽  
Cochrane Library ◽  
Concurrent Disorders ◽  
Dual Diagnoses ◽  
Guideline Quality ◽  
Social Cause

Abstract Objective: It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review is to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance misuse in relation to diagnosis and treatment of such co-existing disorders and considerations for wider social and contextual factors in treatment recommendations.Method: A protocol (PROSPERO CRD42020187094) driven systematic review was conducted. A systematic search was undertaken using six databases including MEDLINE, Cochrane Library, EMBASE, PsychInfo from 2010 till June 2020; and webpages of guideline bodies and professional societies. Guideline quality was assessed based on ‘Appraisal of Guidelines for Research & Evaluation II’ (AGREE II) tool. Data was extracted using a pre-piloted structured data extraction form and synthesized narratively. Reporting was based on PRISMA guideline.Result: A total of 12,644 records were identified. Of these, 21 guidelines were included in this review. Three of the included guidelines were related to coexisting disorders, 11 related to SMI, and 7 guidelines were related to SUD. Seven (out of 18) single disorder guidelines did not adequately recommend the importance of diagnosis or treatment of concurrent disorders despite their high co-prevalence. The majority of the guidelines (n = 15) lacked recommendations for medicines optimisation in accordance with concurrent disorders (SMI or SUD) such as in the context of drug interactions. Social cause and consequence of dual diagnoses such as homelessness and safeguarding and associated referral pathways were sparsely mentioned.Conclusion: Despite very high co-prevalence, clinical guidelines for SUD or SMI tend to have limited considerations for coexisting disorders in diagnosis, treatment and management. There is a need to improve the scope, quality and inclusivity of guidelines to offer person-centred and integrated care.

scholarly journals Thyrotoxicosis. Clinical guidelines for diagnosis and treatment. Part ІІ

2020 ◽  
Vol 28 (3) ◽  
pp. 273-286
Author(s):  
N. S. Pidchenko ◽  
L. Ya. Vasylyev ◽  
G. V. Grushka ◽  
O. M. Astapieva ◽  
A. S. Savchenko
Keyword(s):  
Clinical Guidelines ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Cochrane Library ◽  
American Thyroid Association ◽  
Endocrine Society ◽  
Appropriate Treatment ◽  
Thyrotoxic Crisis ◽  
Medical Radiology ◽  
The Cochrane Library

Background. Recently they have reported an increased rate of thyrotoxicosis, which is characterized by polyetiology, a variety of clinical manifestations and potential treatment. Appropriate treatment requires an accurate diagnosis and depends on the comorbidities and preferences of the patient. Purpose. To highlight the key points of clinical guidelines for diagnosis and treatment of thyrotpxicosis provided by the American Thyroid Association and the American Association of Clinical Endocrinologists, US Endocrine Society dealing with diagnosis and treatment of thyroid diseases as well as the local clinical protocols of SO «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine». Materials and methods. Based on the search of contributions in the electronic databases over the last 5 years, which are included in the Cochrane Library, PUBMED and MEDLINE databases. Clinical guidelines are based on expert consensus and assessing the significance according to the international guidelines for thyrotoxicosis. Results and discussion. The paper deals with up-to-date guidelines on diagnosis, management and treatment of patients with different forms of thyrotoxicosis. It presents a detailed strategy for those patients depending on etiology of the disease. The therapeutic approaches to treating Graves’ disease, autoimmune ophthalmopathy, thyrotoxic crisis, gravidae as well as the peculiarities of treating patients with subclinical hyperthyroidism and iodine-induced thyrotoxicosis have been substantiated. Conclusions. The treatment of thyrotoxicosis remains a challenging issue of modern internal medicine. Despite the existing numerous clinically proven protocols for the treatment of this pathology, the comorbid background of patients complicates following them. The implementation of the provided protocol elements will make it possible to introduce the principles of a customized approach in thyrotoxicosis patients.

scholarly journals The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review

2016 ◽  
Vol 11 (3) ◽  
pp. 552-563 ◽  
Author(s):  
Omer A. Raheem ◽  
Jeannie J. Su ◽  
Joel R. Wilson ◽  
Tung-Chin Hsieh
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Erectile Dysfunction ◽  
Cardiovascular Risk ◽  
Clinical Guidelines ◽  
Strong Association ◽  
Consensus Conference ◽  
Assessment Tools ◽  
Cochrane Library ◽  
Consensus Statements

Despite strong association between erectile dysfunction (ED) and cardiovascular disease (CVD), there is a paucity of clear clinical guidelines detailing when and how to evaluate for ED in patients with known CVD, or vice versa. This systematic review discuss the role of cardiologists and urologists in the characterization of risk and management of CVD in the setting of ED, as well as contrasting the current evaluation of CVD and ED from the standpoint of published consensus statements. A comprehensive literature review utilizing MEDLINE®, the Cochrane Library® Central Search, and the Web of Science was performed to identify all published peer-reviewed articles in the English language describing ED and CVD across various disciplines. There is strong consensus that men with ED should be considered at high risk of CVD. Available risk assessment tools should be used to stratify the coronary risk score in each patient. The 2012 Princeton III Consensus Conference expanded on existing cardiovascular recommendations, proposing an approach to the evaluation and management of cardiovascular risk in men with ED and no known CVD. This systematic review highlights the similarities and differences of the existing clinical guidelines and recommendations regarding assessment and management of ED and CVD, as well as the pathophysiological linkage between ED and CVD, which may permit physicians, including urologists, to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors, particularly in young, nondiabetic men with ED.

scholarly journals Thyrotoxicosis. Clinical recommendations for diagnosis and treatment Part І

2020 ◽  
Vol 28 (2) ◽  
pp. 154-163
Author(s):  
N. S. Pidchenko
Keyword(s):  
Internal Medicine ◽  
Clinical Guidelines ◽  
American Association ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Cochrane Library ◽  
Clinical Protocols ◽  
Appropriate Treatment ◽  
Key Points ◽  
The Cochrane Library

Background. Currently submitted an increased rate of thyrotoxicosis, which is characterized by polyetiology, a variety of clinical manifestations and potential treatments. Appropriate treatment requires an accurate diag­nosis and depends on the comorbidities and preferences of the patient. The aim of the study was to consider the pathogenesis, clinical picture and di­agnosis of thyrotoxicosis. Purpose. To highlight the key points of clinical guidelines on thyrotoxi­cosis diagnosis and treatment provided by the American Thyroid Associa­tion and the American Association of Clinical Endocrinologists, US En­docrine Society dealing with diagnosis and treatment of thyroid diseases as well as the local clinical protocols of SO «Grigoriev Institute for Med­ical Radiology and Oncology of the National Academy of Medical Sci­ences of Ukraine». Materials and methods. Based on the research in the electronic databases of last 5 years publications, which are included in the Cochrane Library, PUBMED and MEDLINE databases. Clinical guidelines are based on expert consensus and assessing the significance according to the interna­tional guideline of thyrotoxicosis. Conclusions. Thyrotoxicosis treatment remains a challenging is­sue of modern internal medicine. Despite the existing numerous clini­cally proven protocols for the treatment of this pathology, the comorbid background of patients complicates following them. The implementa­tion of the provided protocol elements will make it possible to introduce the principles of a customized approach in thyrotoxicosis patients.

scholarly journals Strategies Used for Implementing and Promoting Adherence to Antibiotic Guidelines in Low- and Lower-Middle-Income Countries: A Systematic Review

2021 ◽  
Vol 6 (3) ◽  
pp. 166
Author(s):  
Nicola D. Foxlee ◽  
Nicola Townell ◽  
Claire Heney ◽  
Lachlan McIver ◽  
Colleen L. Lau
Keyword(s):  
Clinical Guidelines ◽  
Antibiotic Consumption ◽  
Audit And Feedback ◽  
World Health ◽  
Cochrane Library ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Middle Income ◽  
Positive Direction ◽  
Middle Income Countries

Containing antimicrobial resistance and reducing high levels of antibiotic consumption in low- and lower middle-income countries are a major challenge. Clinical guidelines targeting antibiotic prescribing can reduce consumption, however, the degrees to which clinical guidelines are adopted and adhered to are challenging for developers, policy makers and users. The aim of this study was to review the strategies used for implementing and promoting antibiotic guideline adherence in low- and lower middle-income countries. A review of published literature was conducted using PubMed, Cochrane Library, SCOPUS and the information systems of the World Health Organization and the Australian National University according to PRISMA guidelines and our PROSPERO protocol. The strategies were grouped into five broad categories based on the Cochrane Effective Practice and Organization of Care taxonomy. The 33 selected studies, representing 16 countries varied widely in design, setting, disease focus, methods, intervention components, outcomes and effects. The majority of interventions were multifaceted and resulted in a positive direction of effect. The nature of the interventions and study variability made it impossible to tease out which strategies had the greatest impact on improving CG compliance. Audit and feedback coupled with either workshops and/or focus group discussions were the most frequently used intervention components. All the reported strategies are established practices used in antimicrobial stewardship programs in high-income countries. We recommend interrupted time series studies be used as an alternative design to pre- and post-intervention studies, information about the clinical guidelines be made more transparent, and prescriber confidence be investigated.

scholarly journals Treatment of aseptic osteonecrosis of the talus. A draft of clinical guidelines

2021 ◽  
Vol 27 (2) ◽  
pp. 153-162
Author(s):  
A.N. Torgashin ◽  
◽  
A.K. Mursalov ◽  
S.S. Rodionova ◽  
N.V. Zagorodniy ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Treatment Options ◽  
Medical Professional ◽  
Diagnosis And Treatment ◽  
Disease Stage ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Non Profit ◽  
Clinical Recommendations ◽  
Aseptic Osteonecrosis

Clinical guidelines are an algorithm adapted for use in our country, based on the works systematized by the level of evidence, reflecting current approaches to the diagnosis and treatment of aseptic bone necrosis (osteonecrosis) of various localizations. Purpose of the study Creation of an algorithm for diagnosis and treatment of osteonecrosis based on the assessment of the evidence level of literature data. Material and methods The Guidelines are a systematized algorithm based on the level of evidence for the management of patients with osteonecrosis, reflecting current approaches to diagnosis, treatment and rehabilitation, which are based on literature data and the authors' own experience. Electronic databases of Medline, Embase, Web of Science, and Cochrane Library platforms were searched for related sources. Preference was given to the works with high levels of evidence. References to information sources are given in the order of their appearance in the text. The search depth was 50 years due to the availability of systematic literature reviews in the framework of previous international clinical guidelines. When specific medical procedures related to the diagnosis, conservative or surgical treatment of osteonecrosis were included in the clinical recommendations, their level of evidence was reliability, the appropriateness of their use, taking into account the unified scale for assessing the quality of evidence and the strength of the recommendations for application of medical technologies GRADE. Results The Guidelines reflect aspects of clinical, instrumental and laboratory examination of patients with osteonecrosis, treatment options depending on the location of the process and disease stage. Conclusion Clinical recommendations on the medical assistance to patients with aseptic osteonecrosis have been compiled according to the requirements imposed on clinical recommendations developed by medical professional non-profit institutions

scholarly journals Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ray Alsuhaibani ◽  
Douglas Cary Smith ◽  
Richard Lowrie ◽  
Sumayah Aljhani ◽  
Vibhu Paudyal
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Substance Abuse ◽  
Dual Diagnosis ◽  
Clinical Guidelines ◽  
Data Extraction ◽  
Cochrane Library ◽  
Concurrent Disorders ◽  
Community Outcomes ◽  
Social Cause

Abstract Objective It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review was to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance abuse in relation to diagnosis and treatment of co-existing disorders and considerations for wider social and contextual factors in treatment recommendations. Method A protocol (PROSPERO CRD42020187094) driven systematic review was conducted. A systematic search was undertaken using six databases including MEDLINE, Cochrane Library, EMBASE, PsychInfo from 2010 till June 2020; and webpages of guideline bodies and professional societies. Guideline quality was assessed based on ‘Appraisal of Guidelines for Research & Evaluation II’ (AGREE II) tool. Data was extracted using a pre-piloted structured data extraction form and synthesized narratively. Reporting was based on PRISMA guideline. Result A total of 12,644 records were identified. Of these, 21 guidelines were included in this review. Three of the included guidelines were related to coexisting disorders, 11 related to SMI, and 7 guidelines were related to SUD. Seven (out of 18) single disorder guidelines did not adequately recommend the importance of diagnosis or treatment of concurrent disorders despite their high co-prevalence. The majority of the guidelines (n = 15) lacked recommendations for medicines optimisation in accordance with concurrent disorders (SMI or SUD) such as in the context of drug interactions. Social cause and consequence of dual diagnosis such as homelessness and safeguarding and associated referral pathways were sparsely mentioned. Conclusion Despite very high co-prevalence, clinical guidelines for SUD or SMI tend to have limited considerations for coexisting disorders in diagnosis, treatment and management. There is a need to improve the scope, quality and inclusivity of guidelines to offer person-centred and integrated care.

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