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Pediatrics Feb 2017The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting... (Comparative Study)
Comparative Study Meta-Analysis Review
CONTEXT
The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting with supportive care is poorly understood.
OBJECTIVE
To compare sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with OSDB.
DATA SOURCES
Medline, Embase, and the Cochrane Library.
STUDY SELECTION
Two investigators independently screened studies against predetermined criteria.
DATA EXTRACTION
Two investigators independently extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. Investigators synthesized data qualitatively and meta-analyzed apnea-hypopnea index (AHI) scores.
RESULTS
We included 11 studies. Relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy. In 5 studies including children with polysomnography-confirmed OSDB, AHI scores improved more in children receiving tonsillectomy versus surgery. A meta-analysis of 3 studies showed a 4.8-point improvement in the AHI in children who underwent tonsillectomy compared with no surgery. Sleep-related quality of life and negative behaviors (eg, anxiety and emotional lability) also improved more among children who had a tonsillectomy. Changes in executive function were not significantly different. The length of follow-up in studies was generally <12 months.
LIMITATIONS
Few studies fully categorized populations in terms of severity of OSDB; outcome measures were heterogeneous; and the durability of outcomes beyond 12 months is not known.
CONCLUSIONS
Tonsillectomy can produce short-term improvement in sleep outcomes compared with no surgery in children with OSDB. Understanding of longer-term outcomes or effects in subpopulations is lacking.
Topics: Adenoidectomy; Child; Child Behavior; Humans; Polysomnography; Sleep Apnea, Obstructive; Tonsillectomy; Treatment Outcome; Watchful Waiting
PubMed: 28096514
DOI: 10.1542/peds.2016-3491 -
Cancer Biology & Medicine Aug 2020Active surveillance (AS) can be considered as a treatment strategy for low risk papillary thyroid microcarcinoma (PTMC), with the absence of clinically apparent lymph... (Review)
Review
Active surveillance (AS) can be considered as a treatment strategy for low risk papillary thyroid microcarcinoma (PTMC), with the absence of clinically apparent lymph nodes, extrathyroidal extensions, and distant metastasis. After reviewing the reports on AS of low risk PTMCs worldwide, we introduced AS, and discussed the selection criteria for active surveillance candidates based on different guidelines and the follow-up schedules. Moreover, the requirement of cytological diagnosis, progression evaluation methods, necessity of thyrotropin suppression, and medical costs were issues that both clinicians and patients considered. The usefulness of AS for low risk PTMC patients depended on accurate and confidential evaluation of patient risk. Clinicians may adopt measures like dynamic monitoring, risk stratification, and making personal follow-up schedules to minimize these potential risks. By appropriately selecting PTMC patients, AS can be an effective alternative treatment to immediate surgery.
Topics: Carcinoma, Papillary; Humans; Japan; Neoplasm Staging; Practice Guidelines as Topic; Risk; Thyroid Neoplasms; Treatment Outcome; Watchful Waiting
PubMed: 32944389
DOI: 10.20892/j.issn.2095-3941.2019.0470 -
Current Treatment Options in Oncology Nov 2023Since total neoadjuvant treatment achieves almost 30% pathologic complete response, organ preservation has been increasingly debated for good responders after... (Review)
Review
Since total neoadjuvant treatment achieves almost 30% pathologic complete response, organ preservation has been increasingly debated for good responders after neoadjuvant treatment for patients diagnosed with rectal cancer. Two organ preservation strategies are available: a watch and wait strategy and a local excision strategy including patients with a near clinical complete response. A major issue is the selection of patients according to the initial tumor staging or the response assessment. Despite modern imaging improvement, identifying complete response remains challenging. A better selection could be possible by radiomics analyses, exploiting numerous image features to feed data characterization algorithms. The subsequent step is to include baseline and/or pre-therapeutic MRI, PET-CT, and CT radiomics added to the patients' clinicopathological data, inside machine learning (ML) prediction models, with predictive or prognostic purposes. These models could be further improved by the addition of new biomarkers such as circulating tumor biomarkers, molecular profiling, or pathological immune biomarkers.
Topics: Humans; Treatment Outcome; Positron Emission Tomography Computed Tomography; Crying; Chemoradiotherapy; Rectal Neoplasms; Neoadjuvant Therapy; Watchful Waiting; Biomarkers; Retrospective Studies
PubMed: 37702885
DOI: 10.1007/s11864-023-01125-9 -
World Journal of Gastroenterology Jun 2019Technological advances and the widespread use of medical imaging have led to an increase in the identification of pancreatic cysts in patients who undergo... (Review)
Review
Technological advances and the widespread use of medical imaging have led to an increase in the identification of pancreatic cysts in patients who undergo cross-sectional imaging. Current methods for the diagnosis and risk-stratification of pancreatic cysts are suboptimal, resulting in both unnecessary surgical resection and overlooked cases of neoplasia. Accurate diagnosis is crucial for guiding how a pancreatic cyst is managed, whether with surveillance for low-risk lesions or surgical resection for high-risk lesions. This review aims to summarize the current literature on confocal endomicroscopy and cyst fluid molecular analysis for the evaluation of pancreatic cysts. These recent technologies are promising adjuncts to existing approaches with the potential to improve diagnostic accuracy and ultimately patient outcomes.
Topics: Biomarkers; Cyst Fluid; Diagnosis, Differential; Endoscopy; Humans; Intravital Microscopy; Microscopy, Confocal; Pancreas; Pancreatic Cyst; Pancreatic Neoplasms; Watchful Waiting
PubMed: 31235996
DOI: 10.3748/wjg.v25.i22.2734 -
Endocrinology and Metabolism (Seoul,... Feb 2024The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and... (Review)
Review
The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing lowrisk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.
Topics: Humans; Disease Progression; Lymphatic Metastasis; Prospective Studies; Quality of Life; Thyroid Neoplasms; Thyroidectomy; Watchful Waiting; Practice Guidelines as Topic
PubMed: 38356210
DOI: 10.3803/EnM.2024.1937 -
BMC Complementary and Alternative... May 2015Decision-making during pregnancy regarding different options of care can be difficult, particularly when risks of intervention versus no intervention for mother and baby... (Review)
Review
Watchful waiting or induction of labour--a matter of informed choice: identification, analysis and critical appraisal of decision aids and patient information regarding care options for women with uncomplicated singleton late and post term pregnancies: a review.
BACKGROUND
Decision-making during pregnancy regarding different options of care can be difficult, particularly when risks of intervention versus no intervention for mother and baby are unclear. Unbiased information and support for decision making may be beneficial in these situations. The management of normal pregnancies at and beyond term is an example of such a situation. In order to determine the need to develop an evidence-based decision aid this paper searches, analyses and appraises patient decision aids and patient information leaflets regarding care options in cases of late term and post-term pregnancies, including complementary and alternative medicine (CAM).
METHODS
A literature search was carried out in a variety of lay and medical databases.
INCLUSION CRITERIA
written information related to uncomplicated singleton pregnancies and targeted at lay people. Analysis and appraisal of included material by means of quality criteria was set up based on the International Patient Decision Aid Standards accounting for evidence-basing of CAM options.
RESULTS
Inclusion of two decision aids and eleven leaflets from four decision aids and sixteen leaflets. One decision aid met the quality criteria almost completely, the other one only insufficiently despite providing some helpful information. Only one leaflet is of good quality, but cannot substitute a decision aid.
CONCLUSIONS
There is an urgent need for the design of an evidence-based decision aid of good quality for late-term or post-term pregnancy, particularly in German language.
Topics: Decision Making; Decision Support Techniques; Female; Humans; Labor, Induced; Patient Education as Topic; Perinatal Care; Pregnancy; Watchful Waiting
PubMed: 25947100
DOI: 10.1186/s12906-015-0663-y -
Cancer Jul 2018The rate of advances in uveal melanoma has not kept pace with the rate of advances in cutaneous melanoma. Many patients lack access to or knowledge of specialty centers,... (Review)
Review
The rate of advances in uveal melanoma has not kept pace with the rate of advances in cutaneous melanoma. Many patients lack access to or knowledge of specialty centers, and integrated multidisciplinary care between ophthalmology, radiation oncology, and medical oncology is far from the norm. This treatment isolation leads to limited communication about novel clinical trial opportunities. Clinical trials themselves are not widely available, and a lack of robust funding limits rapid and complete investigations. This review outlines the obstacles to success in uveal melanoma management and highlights strategies for overcoming these challenges. Cancer 2018;124:2693-2703. © 2018 American Cancer Society.
Topics: Antineoplastic Agents; Chemotherapy, Adjuvant; Clinical Trials as Topic; Drug Resistance, Neoplasm; Humans; Liver Neoplasms; Mass Screening; Medical Oncology; Melanoma; Molecular Targeted Therapy; Ophthalmology; Patient Care Team; Practice Guidelines as Topic; Prognosis; Progression-Free Survival; Randomized Controlled Trials as Topic; Risk Assessment; Skin Neoplasms; Treatment Failure; Treatment Outcome; Uvea; Uveal Neoplasms; Watchful Waiting
PubMed: 29579316
DOI: 10.1002/cncr.31284 -
Nature Reviews. Urology Apr 2016Prostate cancer remains one of the most commonly diagnosed malignancies worldwide. Early diagnosis and curative treatment seem to improve survival in men with... (Review)
Review
Prostate cancer remains one of the most commonly diagnosed malignancies worldwide. Early diagnosis and curative treatment seem to improve survival in men with unfavourable-risk cancers, but significant concerns exist regarding the overdiagnosis and overtreatment of men with lower-risk cancers. To this end, active surveillance (AS) has emerged as a primary management strategy in men with favourable-risk disease, and contemporary data suggest that use of AS has increased worldwide. Although published surveillance cohorts differ by protocol, reported rates of metastatic disease and prostate-cancer-specific mortality are exceedingly low in the intermediate term (5-10 years). Such outcomes seem to be closely associated with programme-specific criteria for selection, monitoring, and intervention, suggesting that AS--like other management strategies--could be individualized based on the level of risk acceptable to patients in light of their personal preferences. Additional data are needed to better establish the risks associated with AS and to identify patient-specific characteristics that could modify prognosis.
Topics: Disease Management; Disease Progression; Humans; Male; Prostatectomy; Prostatic Neoplasms; Watchful Waiting
PubMed: 26954332
DOI: 10.1038/nrurol.2016.45 -
Hawai'i Journal of Medicine & Public... Feb 2012Methamphetamine abuse has become a significant problem in the United States with recent surveys reporting that nearly 10 million Americans have tried methamphetamine at...
Methamphetamine abuse has become a significant problem in the United States with recent surveys reporting that nearly 10 million Americans have tried methamphetamine at least once. Methamphetamine is a stimulant drug that causes the release of monoamine neurotransmitters. Among its most deleterious effects are its ability to produce tachycardia, hypertension, and ischemia. However, it also has the potential to cause clinically significant effects outside of the cardiovascular system although a case of paralytic ileus caused by methamphetamine use has not been described before in the literature. Described is a case in which a patient presented with chest and abdominal pain after methamphetamine use. The patient was ultimately diagnosed with a methamphetamine-induced paralytic ileus.
Topics: Central Nervous System Stimulants; Humans; Intestinal Pseudo-Obstruction; Male; Methamphetamine; Watchful Waiting; Young Adult
PubMed: 22454809
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Nov 2016
Topics: Adult; Aftercare; Female; Head and Neck Neoplasms; Humans; Neurofibroma, Plexiform; Tumor Burden; Watchful Waiting
PubMed: 27824540
DOI: 10.3949/ccjm.83a.16002