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Cleveland Clinic Journal of Medicine Nov 2020Aneurysms of the renal artery and splenic artery are uncommon but clinically important, as they pose a risk of rupture with a high fatality rate. Indications for... (Review)
Review
Aneurysms of the renal artery and splenic artery are uncommon but clinically important, as they pose a risk of rupture with a high fatality rate. Indications for surgical or endovascular repair are based on aneurysm location and risk factors for rupture, such as aneurysm size, growth, and associated conditions, while medical management is also important. Regular surveillance with imaging is critical before and after intervention to guide treatment.
Topics: Aneurysm; Angiography; Humans; Renal Artery; Risk Assessment; Splenic Artery; Vascular Surgical Procedures; Watchful Waiting
PubMed: 33229392
DOI: 10.3949/ccjm.87a.19140-2 -
BMC Urology Jun 2022Active surveillance (AS) is the preferred treatment for patients with very low-and low-risk prostate cancer (PCa), but it is underperformed worldwide. This study aimed...
BACKGROUND
Active surveillance (AS) is the preferred treatment for patients with very low-and low-risk prostate cancer (PCa), but it is underperformed worldwide. This study aimed to report knowledge, attitudes, and practices (KAP) of AS for PCa among urologists in Brazil.
METHODS
This cross-sectional study used a questionnaire with 50 questions divided into participant characteristics, knowledge regarding inclusion criteria for AS, follow-up, intervention triggers, acceptance, and practice for an index patient. Data analysis comprises absolute and relative frequencies of the variables. After that, a logistic regression was performed in order to verify possible patterns of answers provided by the respondents in the index patient questionnaire.
RESULTS
Questionnaires were sent through the SurveyMonkey® platform to 5,015 urologists using email addresses and through social media. A total of 600 (12%) questionnaires returned and 413 (8.2%) were completed and included in the analysis. Only 53% of urologists adopt AS for low- and very-low-risk PCa. Inclusion criteria were patients with age > 50 years (32.2%), prostate specific antigen (PSA) < 10 ng/mL (87.2%), T1 clinical stage (80.4%), Biopsy Gleason score ≤ 6, positive cores ≤ 2 (44.3%), positive core involvement < 50% (45.3%), and magnetic resonance imaging findings (38.7%). The PSA doubling time was still used by 60.3%. Confirmatory biopsy (55.9%), PSA level (36.6%), and digital rectal examination (34.4%) were considered by most urologists for follow-ups. Patient preference (85.7%), upgrade of Gleason score (73.4%), and increased number of positive cores (66.8%) were associated with conversion to definitive treatment. In an index patient, non-acceptance and active treatment request were the most cited reasons for not performing AS.
CONCLUSION
There is significant variability in the KAP of AS in Brazil, which indicates the need to reinforce AS, its inclusion and follow-up criteria, and the benefits for physicians and the general population.
TRIAL REGISTRATION
Not applicable.
Topics: Brazil; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Surveys and Questionnaires; Urologists; Watchful Waiting
PubMed: 35706024
DOI: 10.1186/s12894-022-01036-1 -
Trials Feb 2021Patients with acute low back pain frequently request diagnostic imaging, and clinicians feel pressure to acquiesce to such requests to sustain patient trust and...
BACKGROUND
Patients with acute low back pain frequently request diagnostic imaging, and clinicians feel pressure to acquiesce to such requests to sustain patient trust and satisfaction. Spinal imaging in patients with acute low back pain poses risks from diagnostic evaluation of false-positive findings, patient labeling and anxiety, and unnecessary treatment (including spinal surgery). Watchful waiting advice has been an effective strategy to reduce some low-value treatments, and some evidence suggests a watchful waiting approach would be acceptable to many patients requesting diagnostic tests.
METHODS
We will use key informant interviews of clinicians and focus groups with primary care patients to refine a theory-informed standardized patient-based intervention designed to teach clinicians how to advise watchful waiting when patients request low-value spinal imaging for low back pain. We will test the effectiveness of the intervention in a randomized clinical trial. We will recruit 8-10 primary care and urgent care clinics (~ 55 clinicians) in Sacramento, CA; clinicians will be randomized 1:1 to intervention and control groups. Over a 3- to 6-month period, clinicians in the intervention group will receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain; SPIs will instruct clinicians in a three-step model emphasizing establishing trust, empathic communication, and negotiation of a watchful waiting approach. Control physicians will receive no intervention. The primary outcome is the post-intervention rate of spinal imaging among actual patients with acute back pain seen by the clinicians adjusted for rate of imaging during a baseline period. Secondary outcomes are use of targeted communication techniques during a follow-up visit with an SP, clinician self-reported use of watchful waiting with actual low back pain patients, post-intervention rates of diagnostic imaging for other musculoskeletal pain syndromes (to test for generalization of intervention effects beyond back pain), and patient trust and satisfaction with physicians.
DISCUSSION
This trial will determine whether standardized patient instructors can help clinicians develop skill in negotiating a watchful waiting approach with patients with acute low back pain, thereby reducing rates of low-value spinal imaging. The trial will also examine the possibility that intervention effects generalize to other diagnostic tests.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04255199 . Registered on January 20, 2020.
Topics: Back Pain; Communication; Humans; Low Back Pain; Primary Health Care; Randomized Controlled Trials as Topic; Watchful Waiting
PubMed: 33639993
DOI: 10.1186/s13063-021-05106-x -
Indian Pediatrics Sep 2023
Topics: Humans; Watchful Waiting
PubMed: 37705273
DOI: No ID Found -
World Journal of Gastroenterology Mar 2020Accurate diagnosis of Pancreatic cysts (PC) is key in the management. The knowledge of indications for surgery, the role of endoscopic ultrasound-guided fine needle... (Review)
Review
Accurate diagnosis of Pancreatic cysts (PC) is key in the management. The knowledge of indications for surgery, the role of endoscopic ultrasound-guided fine needle aspiration, cyst fluid analysis, imaging, and surveillance of PC are all important in the diagnosis and management of PC. Currently, there are many guidelines for the management of PC. The optimal use of these guidelines with a patient-centered approach helps diagnose early cancer and prevent the spread of cancer.
Topics: Cyst Fluid; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Gastroenterology; Humans; Magnetic Resonance Imaging; Pancreas; Pancreatic Cyst; Patient-Centered Care; Practice Guidelines as Topic; Prevalence; Tomography, X-Ray Computed; Watchful Waiting
PubMed: 32231418
DOI: 10.3748/wjg.v26.i11.1128 -
The Canadian Journal of Urology Feb 2017There are numerous standard treatment options for men diagnosed with localized prostate cancer. Multidisciplinary consultation before decision-making is a consensus- and...
INTRODUCTION
There are numerous standard treatment options for men diagnosed with localized prostate cancer. Multidisciplinary consultation before decision-making is a consensus- and quality-based objective in Ontario. With the goals of working together more collaboratively and to provide higher quality information for patients at the time of decision-making, a prostate cancer community partnership consensus (PCPC) panel was formed among six partnering centers in the Greater Toronto Area.
MATERIALS AND METHODS
Five iterative meetings were held among 40 prostate cancer specialists (32 urologists and 8 radiation oncologists) who participate in multidisciplinary clinics. The meetings defined the goals of the partnership as well as the topics and questions the group would address together. Answers to these questions were developed by formal consensus: >= 75% of participants had to agree with wording based on secret ballots to achieve consensus.
RESULTS
All six groups wanted to participate to improve patient care/decision-making. Forty-one questions addressing 30 issues were derived from the literature and the group's collective experience. These issues were cross-tabbed against five management options: active surveillance, radical prostatectomy, low dose rate brachytherapy, high dose rate brachytherapy boost and external beam radiation. Answers common to all modalities were coalesced. Eighty-six issues were subjected to formal consensus. After three rounds of secret ballots, consensus was achieved for the answers to all issues.
CONCLUSIONS
A formal consensus-based partnership between urology and radiation oncology to support newly diagnosed prostate cancer patients was feasible and resulted in a patient information guide which may improve decision-making.
Topics: Brachytherapy; Decision Making; Humans; Interdisciplinary Communication; Male; Patient Education as Topic; Prostatic Neoplasms; Radiation Oncology; Urology; Watchful Waiting
PubMed: 28263130
DOI: No ID Found -
Pediatrics Feb 2017The effectiveness of tonsillectomy or adenotonsillectomy ("tonsillectomy") for recurrent throat infection compared with watchful waiting is uncertain. (Comparative Study)
Comparative Study Review
CONTEXT
The effectiveness of tonsillectomy or adenotonsillectomy ("tonsillectomy") for recurrent throat infection compared with watchful waiting is uncertain.
OBJECTIVE
To compare sleep, cognitive, behavioral, and health outcomes of tonsillectomy versus watchful waiting in children with recurrent throat infections.
DATA SOURCES
MEDLINE, Embase, and the Cochrane Library.
STUDY SELECTION
Two investigators independently screened studies against predetermined criteria.
DATA EXTRACTION
One investigator extracted data with review by a second. Investigators independently assessed risk of bias and strength of evidence (SOE) and confidence in the estimate of effects.
RESULTS
Seven studies including children with ≥3 infections in the previous 1 to 3 years addressed this question. In studies reporting baseline data, number of infections/sore throats decreased from baseline in both groups, with greater decreases in sore throat days, clinician contacts, diagnosed group A streptococcal infections, and school absences in tonsillectomized children in the short term (<12 months). Quality of life was not markedly different between groups at any time point.
LIMITATIONS
Few studies fully categorized infection/sore throat severity; attrition was high.
CONCLUSIONS
Throat infections, utilization, and school absences improved in the first postsurgical year in tonsillectomized children versus children not receiving surgery. Benefits did not persist over time; longer-term outcomes are limited. SOE is moderate for reduction in short-term throat infections and insufficient for longer-term reduction. SOE is low for no difference in longer-term streptococcal infection reduction. SOE is low for utilization and missed school reduction in the short term, low for no difference in longer-term missed school, and low for no differences in quality of life.
Topics: Absenteeism; Adenoidectomy; Child; Follow-Up Studies; Humans; Pharyngitis; Randomized Controlled Trials as Topic; Streptococcal Infections; Streptococcus pyogenes; Tonsillectomy; Tonsillitis; Watchful Waiting
PubMed: 28096515
DOI: 10.1542/peds.2016-3490 -
Cancer Medicine May 2022Watchful waiting (WW) is one of the standard approaches for newly diagnosed follicular lymphoma (FL) patients with low-tumor burden. However, the impact of WW in FL... (Review)
Review
Watchful waiting (WW) is one of the standard approaches for newly diagnosed follicular lymphoma (FL) patients with low-tumor burden. However, the impact of WW in FL patients at the first progression, remains unclear. We reviewed 206 FL patients who experienced the first progression after responding to the initial treatment at our institution between 1998 and 2017. Patients were classified into either the WW cohort (132 patients) or the immediate treatment cohort (74 patients). Overall, the median follow-up from the first progression was 79.8 months (range, 2.1-227.0 months). In the WW cohort, the estimated median time to next treatment (TNT) was 19.7 months (95% confidence interval [CI], 13.4-30.2), and 76.5% (95% CI, 68.0-84.1) of the patients subsequently underwent the second-line treatment at 5 years. There was a significant difference in the median time to treatment failure in the WW cohort (72.8 months; 95% CI, 64.6-94.0) compared to the immediate treatment cohort (23.3 months; 95% CI, 13.4-38.8) (HR, 2.13; 95% CI, 1.48-3.06), whereas overall survival and the cumulative incidence of histological transformation were not significantly different between two cohorts. In a multivariate analysis, rituximab refractory status, progression of disease within 24 months from the induction of first-line therapy, and a high Follicular Lymphoma International Prognostic Index score at diagnosis were significantly associated with shorter TNT. Interestingly, 15 patients (11%) of the WW cohort experienced spontaneous tumor regression during WW, and their TNT (median, 82.1 months, 95% CI, 11.7-NA) was longer than that of the remaining patients in the WW cohort (median, 16.5 months, 95% CI, 13.0-25.4), with a significant difference (p = 0.01). The results of the present study suggested that WW could be a safe and reasonable option even at the first progression for the selected FL patients, without a negative impact on clinical outcomes.
Topics: Antineoplastic Combined Chemotherapy Protocols; Cohort Studies; Humans; Incidence; Lymphoma, Follicular; Rituximab; Watchful Waiting
PubMed: 35129305
DOI: 10.1002/cam4.4588 -
Digestion 2022Rectal cancer remains a complex disease and a relevant global health issue, increasingly affecting also younger patients. This update review summarizes the current... (Review)
Review
BACKGROUND
Rectal cancer remains a complex disease and a relevant global health issue, increasingly affecting also younger patients. This update review summarizes the current standard of care and discusses the individualized treatment approaches taking into consideration individual tumor characteristics and patients preferences.
SUMMARY
Remaining "gray zones" of rectal cancer therapy warranting further prospective studies are identified including surgical approaches for rectal cancer, e.g., minimally invasive surgical techniques and lateral lymph node dissection for low rectal cancers. The emerging concept of a watch-and-wait strategy upon clinical complete response after chemoradiotherapy is discussed, also considering the still limited evidence and the clinical challenges arising from individualized patient management.
KEY MESSAGES
Finally, currently conducted clinical trials of the German Rectal Cancer Study Group are described, aiming to further individualize multimodal treatment according to risk profiles and strict MRI criteria.
Topics: Chemoradiotherapy; Humans; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Prospective Studies; Rectal Neoplasms; Treatment Outcome; Watchful Waiting
PubMed: 35350020
DOI: 10.1159/000522006 -
Microbiology Spectrum Dec 2023Our study's results provide promising evidence for the incorporation of a high-sensitivity carbapenem-resistant (CRAB) screening method in healthcare settings. Such an...
Our study's results provide promising evidence for the incorporation of a high-sensitivity carbapenem-resistant (CRAB) screening method in healthcare settings. Such an approach could prove beneficial in enhancing infection prevention and control measures, leading to improved patient outcomes and potentially alleviating the burden of CRAB in healthcare systems.
Topics: Humans; Acinetobacter baumannii; Carbapenems; Cross Infection; Watchful Waiting; Microbial Sensitivity Tests; Anti-Bacterial Agents
PubMed: 37943045
DOI: 10.1128/spectrum.03146-23